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Lessios AS, Vilendrer S, Peterson A, Brown-Johnson C, Kling SM, Veruttipong D, Arteaga M, Gessner D, Gostic WJ. Mixed methods evaluation of a specialty-specific system to promote physician engagement in safety and quality reporting in a large academic health system. BMJ Open Qual 2024; 13:e002806. [PMID: 39089742 PMCID: PMC11293395 DOI: 10.1136/bmjoq-2024-002806] [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: 02/20/2024] [Accepted: 07/09/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Incident reporting systems (IRS) can improve care quality and patient safety, yet their impact is limited by clinician engagement. Our objective was to assess barriers to reporting in a hospital-wide IRS and use data to inform ongoing improvement of a specialty-specific IRS embedded in the electronic health record targeting anaesthesiologists. METHODS This quality improvement (QI) evaluation used mixed methods, including qualitative interviews, faculty surveys and user data from the specialty-specific IRS. We conducted 24 semi-structured interviews from January to May 2023 in a large academic health system in Northern California. Participants included adult and paediatric anaesthesiologists, operating room nurses, surgeons and QI operators, recruited through convenience and snowball sampling. We identified key themes and factors influencing engagement, which were classified using the Systems Engineering Initiative for Patient Safety framework. We surveyed hospital anaesthesiologists in January and May 2023, and characterised the quantity and type of reports submitted to the new system. RESULTS Participants shared organisation and technology-related barriers to engagement in traditional system-wide IRSs, many of which the specialty-specific IRS addressed-specifically those related to technological access to the system. Barriers related to building psychological safety for those who report remain. Survey results showed that most barriers to reporting improved following the specialty-specific IRS launch, but limited time remained an ongoing barrier (25 respondents out of 44, 56.8%). A total of 964 reports with quality/safety concerns were submitted over the first 8 months of implementation; 47-76 unique anaesthesiologists engaged per month. The top safety quality categories of concern were equipment and technology (25.9%), clinical complications (25.3%) and communication and scheduling (19.9%). CONCLUSIONS These findings suggest that a specialty-specific IRS can facilitate increased physician engagement in quality and safety reporting and complement existing system-wide IRSs.
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Affiliation(s)
- Anna Sophia Lessios
- Medicine, Primary Care and Population Health Division, Evaluation Sciences Unit, Stanford University School of Medicine, Stanford, California, USA
| | - Stacie Vilendrer
- Medicine, Primary Care and Population Health Division, Evaluation Sciences Unit, Stanford University School of Medicine, Stanford, California, USA
| | - Ashley Peterson
- Department of Anesthesia, Perioperative and Pain Medicine, Stanford Health Care, Stanford, California, USA
| | - Cati Brown-Johnson
- Medicine, Primary Care and Population Health Division, Evaluation Sciences Unit, Stanford University School of Medicine, Stanford, California, USA
| | | | - Darlene Veruttipong
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Michelle Arteaga
- Department of Anesthesiology, Perioperative & Pain Medicine, Stanford Health Care, Stanford, California, USA
| | - Daniel Gessner
- Internal Medicine, Stanford University Medical Center, Stanford, California, USA
| | - William John Gostic
- Department of Anesthesiology, Perioperative & Pain Medicine, Stanford Health Care, Stanford, California, USA
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McCulloch P. Fixing patient safety: Are we nearly there yet? BMJ Qual Saf 2024; 33:539-542. [PMID: 38816196 DOI: 10.1136/bmjqs-2023-016589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/04/2023] [Indexed: 06/01/2024]
Affiliation(s)
- Peter McCulloch
- Nuffield Department of Surgical Science, Oxford University, Oxford, UK
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Rixon A, Judkins S, Wilson S. Power and politics of leading change in emergency departments: A qualitative study of Australasian emergency physicians. Emerg Med Australas 2024; 36:389-400. [PMID: 38114889 DOI: 10.1111/1742-6723.14363] [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: 10/19/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE The ability to lead change is well recognised as a core leadership competency for clinicians, including emergency physicians. However, little is known about how emergency physicians' think about change leadership. The present study explores Australasian emergency physicians' beliefs about the factors that help and hinder efforts to lead change in Australasian EDs. METHODS An online modified Delphi study was conducted with 19 Fellows of the Australasian College for Emergency Medicine. To structure the process, participants were sorted into four panels. Using a three-phase Delphi process, participants were guided through a process of brainstorming, narrowing down and ranking the factors that help and hinder attempts to lead change. Reflexive thematic analysis was used to code and interpret the qualitative data set emerging from participants' responses through the final ranking phase. RESULTS A wide array of self-, ED- and hospital-related enablers and barriers of leading change were identified, the relative importance of which varied as a function of panel. Five core themes characterised emergency physicians' conceptions of change leadership in hospitals: challenging environments of competing interests and tribalism; need for trust and psychological safety to sustain collaboration; challenges of navigating complex hierarchies; need to garner executive leadership support and; need to maintain a growth mindset and motivation to practice change leadership. CONCLUSION The findings of our study provide new insight into emergency physicians' conceptions of the nature, barriers to and enablers of change and point to new directions in leadership development to support emergency physicians' aspirations in the context of quality, organisation and health systems improvement.
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Affiliation(s)
- Andrew Rixon
- Griffith Business School, Griffith University, Gold Coast, Queensland, Australia
| | - Simon Judkins
- Emergency Department, Austin Hospital, Melbourne, Victoria, Australia
| | - Samuel Wilson
- Management and Marketing, Swinburne University of Technology, Hawthorn, Victoria, Australia
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Grove BE, de Thurah A, Ivarsen P, Kvisgaard AK, Hjollund NH, Grytnes R, Schougaard LMV. Remote Symptom Monitoring Using Patient-Reported Outcomes in Patients With Chronic Kidney Disease: Process Evaluation of a Randomized Controlled Trial. JMIR Form Res 2024; 8:e48173. [PMID: 38656781 PMCID: PMC11079764 DOI: 10.2196/48173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 02/02/2024] [Accepted: 03/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND In Denmark, outpatient follow-up for patients with chronic kidney disease (CKD) is changing from in-hospital visits toward more remote health care delivery. The nonuse of remote patient-reported outcomes (PROs) is a well-known challenge, and it can be difficult to explain which mechanisms of interventions influence the outcome. Process evaluation may, therefore, be used to answer important questions on how and why interventions work, aiming to enhance the implications for clinical practice. OBJECTIVE This study aimed to provide insight into the intervention process by evaluating (1) the representativity of the study population, (2) patient and physician use patterns, (3) patient adherence to the intervention, and (4) clinical engagement. METHODS A process evaluation determining the reach, dose, fidelity, and clinical engagement was carried out, alongside a multicenter randomized controlled trial (RCT). We developed and implemented an intervention using PRO measures to monitor outpatients remotely. Data were collected for the PRO intervention arms in the RCT from 4 sources: (1) PRO data from the participants to determine personal factors, (2) the web-based PRO system to identify key usage intervention patterns, (3) medical records to identify clinical factors relating to the use of the intervention, and (4) semistructured interviews conducted with involved physicians. RESULTS Of the 320 patients invited, 152 (47.5%) accepted to participate. The study population reflected the target population. The mean adherence rate to the PRO intervention arms was 82% (95% CI 76-87). The questionnaire response rate was 539/544 (99.1%). A minority of 13 (12.9%) of 101 patients needed assistance to complete study procedures. Physicians assessed 477/539 (88.5%) of the questionnaires. Contact was established in 417/539 (77.4%) of the cases, and 122/539 (22.6%) of the patients did not have contact. Physicians initiated 288/417 (69.1%) and patients requested 129/417 (30.9%) of all the contacts. The primary causes of contact were clinical data (242/417, 58%), PRO data (92/417, 22.1%), and medication concerns and precautionary reasons (83/417, 19.9%). Physicians found the use of PRO measures in remote follow-up beneficial for assessing the patient's health. The inclusion of self-reported clinical data in the questionnaire motivated physicians to assess patient responses. However, some barriers were emphasized, such as loss of a personal relationship with the patient and the risk of missing important symptoms in the absence of a face-to-face assessment. CONCLUSIONS This study demonstrates the importance and practical use of remote monitoring among patients with CKD. Overall, the intervention was implemented as intended. We observed high patient adherence rates, and the physicians managed most questionnaires. Some physicians worried that distance from the patients made it unfeasible to use their "clinical glance," posing a potential risk of overlooking crucial patients' symptoms. These findings underscore key considerations for the implementation of remote follow-up. Introducing a hybrid approach combining remote and face-to-face consultations may address these concerns. TRIAL REGISTRATION ClinicalTrials.gov NCT03847766; https://clinicaltrials.gov/study/NCT03847766.
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Affiliation(s)
- Birgith Engelst Grove
- AmbuFlex, Centre for Patient-Reported Outcomes, Gødstrup Hospital, Herning, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Annette de Thurah
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Per Ivarsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Niels Henrik Hjollund
- AmbuFlex, Centre for Patient-Reported Outcomes, Gødstrup Hospital, Herning, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Regine Grytnes
- AmbuFlex, Centre for Patient-Reported Outcomes, Gødstrup Hospital, Herning, Denmark
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Gagnon J, Breton M, Gaboury I. Decision-maker roles in healthcare quality improvement projects: a scoping review. BMJ Open Qual 2024; 13:e002522. [PMID: 38176953 PMCID: PMC10773379 DOI: 10.1136/bmjoq-2023-002522] [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: 07/28/2023] [Accepted: 12/17/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVES Evidence suggests that healthcare quality improvement (QI) projects are more successful when decision-makers are involved in the process. However, guidance regarding the engagement of decision-makers in QI projects is lacking. We conducted a scoping review to identify QI projects involving decision-makers published in the literature and to describe the roles decision-makers played. METHODS Following the Joanna Briggs Institute framework for scoping reviews, we systematically searched for all types of studies in English or French between 2002 and 2023 in: EMBASE, MEDLINE via PubMed, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature. Criteria for inclusion consisted of literature describing health sector QI projects that involved local, regional or system-level decision-makers. Descriptive analysis was performed. Drawing on QI and participatory research literature, the research team developed an inductive data extraction grid to provide a portrait of QI project characteristics, decision-makers' contributions, and advantages and challenges associated with their involvement. RESULTS After screening and review, we retained 29 references. 18 references described multi-site projects and 11 were conducted in single sites. Local decision-makers' contributions were documented in 27 of the 29 references and regional decision-makers' contributions were documented in 12. Local decision-makers were more often active participants in QI processes, contributing toward planning, implementation, change management and capacity building. Regional decision-makers more often served as initiators and supporters of QI projects, contributing toward strategic planning, recruitment, delegation, coordination of local teams, as well as assessment and capacity building. Advantages of decision-maker involvement described in the retained references include mutual learning, frontline staff buy-in, accountability, resource allocation, effective leadership and improved implementation feasibility. Considerations regarding their involvement included time constraints, variable supervisory expertise, issues concerning centralised leadership, relationship strengthening among stakeholders, and strategic alignment of frontline staff and managerial priorities CONCLUSIONS: This scoping review provides important insights into the various roles played by decision-makers, the benefits and challenges associated with their involvement, and identifies opportunities for strengthening their engagement. The results of this review highlight the need for practical collaboration and communication strategies that foster partnership between frontline staff and decision-makers at all levels.
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Affiliation(s)
- Justin Gagnon
- Department of Community Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mylaine Breton
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Isabelle Gaboury
- Department of Community Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Prenestini A, Palumbo R, Grilli R, Lega F. Exploring physician engagement in health care organizations: a scoping review. BMC Health Serv Res 2023; 23:1029. [PMID: 37749568 PMCID: PMC10521513 DOI: 10.1186/s12913-023-09935-1] [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: 10/27/2022] [Accepted: 08/18/2023] [Indexed: 09/27/2023] Open
Abstract
RATIONALE Enhancing health system effectiveness, efficiency, and appropriateness is a management priority in most world countries. Scholars and practitioners have focused on physician engagement to facilitate such outcomes. OBJECTIVES Our research was intended to: 1) unravel the definition of physician engagement; 2) understand the factors that promote or impede it; 3) shed light on the implications of physician engagement on organizational performance, quality, and safety; and 4) discuss the tools to measure physician engagement. METHOD A scoping review was undertaken. Items were collected through electronic databases search and snowball technique. The PRISMA extension for Scoping Reviews (PRISMA-ScR) statement and checklist was followed to enhance the study replicability. RESULTS The search yielded 16,062 records. After an initial screening, 300 were selected for potential inclusion in this literature review. After removing duplicates and records not meeting the inclusion criteria, full-text analysis of 261 records was performed, yielding a total of 174 records. DISCUSSION Agreement on the conceptualization of physician engagement is thin; furthermore, scholars disagree on the techniques and approaches used to assess its implementation and implications. Proposals have been made to overcome the barriers to its adoption, but empirical evidence about implementing physician engagement is still scarce. CONCLUSIONS Our scoping review highlights the limitations of the extant literature about physician engagement. Physician engagement is a relatively ill-defined concept: developing an evidence base for its actual implementation is necessitated to provide reliable guidance on how the governance of health care organizations could be improved. Although we did not assess the quality or the robustness of current empirical research, our findings call for further research to: 1) identify potential drivers of physician engagement, 2) develop dependable assessment tools providing health care organizations with guidance on how to foster physician engagement, and 3) evaluate engagement's actual impact on health care organizations' performance.
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Affiliation(s)
- Anna Prenestini
- Department of Economics, Management and Quantitative Methods (DEMM) and Center of Research and Advanced Education in Health Administration (CRC HEAD), Università Degli Studi Di Milano, Milan, Italy.
| | - Rocco Palumbo
- Department of Management & Law, Università Degli Studi Di Roma Tor Vergata, Rome, Italy
| | - Roberto Grilli
- Health Services Research, Evaluation and Policy Unit, Local Health Authority of Romagna, Ravenna, Italy
| | - Federico Lega
- Department of Biomedical Sciences for Health (SCIBIS) and Center of Research and Advanced Education in Health Administration (CRC HEAD), Università Degli Studi Di Milano, Milan, Italy
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Wang Y, Wong ELY, Nilsen P, Chung VCH, Tian Y, Yeoh EK. A scoping review of implementation science theories, models, and frameworks - an appraisal of purpose, characteristics, usability, applicability, and testability. Implement Sci 2023; 18:43. [PMID: 37726779 PMCID: PMC10507824 DOI: 10.1186/s13012-023-01296-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 08/26/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND A proliferation of theories, models, and frameworks (TMFs) have been developed in the implementation science field to facilitate the implementation process. The basic features of these TMFs have been identified by several reviews. However, systematic appraisals on the quality of these TMFs are inadequate. To fill this gap, this study aimed to assess the usability, applicability, and testability of the current TMFs in a structured way. METHODS A scoping review method was employed. Electronic databases were searched to locate English and Chinese articles published between January 2000 and April 2022. Search terms were specific to implementation science. Additionally, hand searches were administered to identify articles from related reviews. Purpose and characteristics such as the type of TMF, analytical level, and observation unit were extracted. Structured appraisal criteria were adapted from Birken et al.'s Theory Comparison and Selection Tool (T-CaST) to conduct an in-depth analysis of the TMFs' usability, applicability, and testability. RESULTS A total of 143 TMFs were included in this analysis. Among them, the most common purpose was to identify barriers and facilitators. Most TMFs applied the descriptive method to summarize the included constructs or the prescriptive method to propose courses of implementation actions. TMFs were mainly mid-range theories built on existing conceptual frameworks or demonstrated grand theories. The usability of the TMFs needs to be improved in terms of the provision of conceptually matched strategies to barriers and facilitators and instructions on the TMFs usage. Regarding the applicability, little attention was paid to the constructs of macro-level context, stages of scale-up and sustainability, and implementation outcomes like feasibility, cost, and penetration. Also, fewer TMFs could propose recommended research and measurement methods to apply the TMFs. Lastly, explicit hypotheses or propositions were lacking in most of the TMFs, and empirical evidence was lacking to support the claimed mechanisms between framework elements in testability. CONCLUSIONS Common limitations were found in the usability, application, and testability of the current TMFs. The findings of this review could provide insights for developers of TMFs for future theoretical advancements.
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Affiliation(s)
- Yingxuan Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Eliza Lai-Yi Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Per Nilsen
- Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, 581 83, Linköping, Sweden
| | - Vincent Chi-Ho Chung
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Yue Tian
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Eng-Kiong Yeoh
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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Breton M, Gaboury I, Martin E, Green ME, Kiran T, Laberge M, Kaczorowski J, Ivers N, Deville-Stoetzel N, Bordeleau F, Beaulieu C, Descoteaux S. Impact of externally facilitated continuous quality improvement cohorts on Advanced Access to support primary healthcare teams: protocol for a quasi-randomized cluster trial. BMC PRIMARY CARE 2023; 24:97. [PMID: 37038126 PMCID: PMC10088119 DOI: 10.1186/s12875-023-02048-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/29/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Improving access to primary health care is among top priorities for many countries. Advanced Access (AA) is one of the most recommended models to improve timely access to care. Over the past 15 years, the AA model has been implemented in Canada, but the implementation of AA varies substantially among providers and clinics. Continuous quality improvement (CQI) approaches can be used to promote organizational change like AA implementation. While CQI fosters the adoption of evidence-based practices, knowledge gaps remain, about the mechanisms by which QI happens and the sustainability of the results. The general aim of the study is to analyse the implementation and effects of CQI cohorts on AA for primary care clinics. Specific objectives are: 1) Analyse the process of implementing CQI cohorts to support PHC clinics in their improvement of AA. 2) Document and compare structural organisational changes and processes of care with respect to AA within study groups (intervention and control). 3) Assess the effectiveness of CQI cohorts on AA outcomes. 4) Appreciate the sustainability of the intervention for AA processes, organisational changes and outcomes. METHODS Cluster-controlled trial allowing for a comprehensive and rigorous evaluation of the proposed intervention 48 multidisciplinary primary care clinics will be recruited to participate. 24 Clinics from the intervention regions will receive the CQI intervention for 18 months including three activities carried out iteratively until the clinic's improvement objectives are achieved: 1) reflective sessions and problem priorisation; 2) plan-do-study-act cycles; and 3) group mentoring. Clinics located in the control regions will receive an audit-feedback report on access. Complementary qualitative and quantitative data reflecting the quintuple aim will be collected over a period of 36 months. RESULTS This research will contribute to filling the gap in the generalizability of CQI interventions and accelerate the spread of effective AA improvement strategies while strengthening local QI culture within clinics. This research will have a direct impact on patients' experiences of care. CONCLUSION This mixed-method approach offers a unique opportunity to contribute to the scientific literature on large-scale CQI cohorts to improve AA in primary care teams and to better understand the processes of CQI. TRIAL REGISTRATION Clinical Trials: NCT05715151.
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Affiliation(s)
- Mylaine Breton
- Université de Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada.
| | - Isabelle Gaboury
- Université de Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada
| | - Elisabeth Martin
- Université de Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada
| | | | - Tara Kiran
- University of Toronto, Toronto, ON, Canada
| | | | | | - Noah Ivers
- University of Toronto, Toronto, ON, Canada
| | - Nadia Deville-Stoetzel
- Université de Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada
| | - Francois Bordeleau
- Université de Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada
| | - Christine Beaulieu
- Université de Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada
| | - Sarah Descoteaux
- Université de Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada
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Ostojic K, Paget S, Martin T, Dee-Price BJ, McIntyre S, Smithers Sheedy H, Mimmo L, Burnett H, Scott T, Berg A, Masi A, Scarcella M, Calderan J, Azmatullah S, Mohamed M, Woodbury M, Wilkinson A, Zwi K, Dale R, Eapen V, Lingam R, Strnadová I, Woolfenden S. Codesigning a social prescribing pathway to address the social determinant of health concerns of children with cerebral palsy and their families in Australia: a protocol for a mixed-methods formative research study. BMJ Open 2023; 13:e066346. [PMID: 37024248 PMCID: PMC10083805 DOI: 10.1136/bmjopen-2022-066346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
INTRODUCTION Social determinants of health (SDH) are contributors to health inequities experienced by some children with cerebral palsy and pose barriers to families engaging with complex and fragmented healthcare systems. There is emerging evidence to support 'social prescribing' interventions that systematically identify SDH concerns and refer patients to non-medical social care support and services to address their needs. To date, social prescribing has not been trialled specifically for children with neurodevelopmental disabilities, including cerebral palsy, in Australia. This study aims to codesign a social prescribing programme to address SDH concerns of children with cerebral palsy and their families who attend one of the three tertiary paediatric rehabilitation services in New South Wales, Australia. METHODS AND ANALYSIS This is a qualitative multi-site study conducted at the three NSW paediatric hospitals' rehabilitation departments using a codesign approach. Children aged 12-18 years with cerebral palsy, parents/caregivers of children (aged 0-18 years) with cerebral palsy, and clinicians will be involved in all stages to codesign the social prescribing programme. The study will consist of three components: (1) 'what we need', (2) 'creating the pathways' and (3) 'finalising and sign off'. This project is overseen by two advisory groups: one group of young adults with cerebral palsy and one group of parents of young people with cerebral palsy. The study will be guided by the biopsychosocial ecological framework, and analysis will follow Braun and Clark's thematic approach. ETHICS AND DISSEMINATION The study protocol was approved by the human research ethics committee of the Sydney Children's Hospitals Network. This codesign study will inform a future pilot study of feasibility and acceptability, then if indicated, a pilot clinical trial of efficacy. We will collaborate with all project stakeholders to disseminate findings and undertake further research to build sustainable and scalable models of care. TRIAL REGISTRATION NUMBER ACTRN12622001459718.
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Affiliation(s)
- Katarina Ostojic
- Population Child Health Research Group, University of New South Wales, Sydney, New South Wales, Australia
| | - Simon Paget
- Kids Rehab, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Tanya Martin
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
| | - Betty-Jean Dee-Price
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Sarah McIntyre
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Hayley Smithers Sheedy
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Laurel Mimmo
- Population Child Health Research Group, University of New South Wales, Sydney, New South Wales, Australia
- Nursing Research Unit, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Heather Burnett
- John Hunter Children's Hospital, Hunter Region Mail Centre, New South Wales, Australia
| | - Timothy Scott
- Rehab2Kids, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Alison Berg
- Kids Rehab, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Anne Masi
- School of Psychiatry, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Michele Scarcella
- Aboriginal Health, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Jack Calderan
- EPIC-CP Research Group, University of New South Wales, Sydney, New South Wales, Australia
| | - Sheikh Azmatullah
- EPIC-CP Research Group, University of New South Wales, Sydney, New South Wales, Australia
| | - Masyitah Mohamed
- EPIC-CP Research Group, University of New South Wales, Sydney, New South Wales, Australia
| | - Mackenzie Woodbury
- EPIC-CP Research Group, University of New South Wales, Sydney, New South Wales, Australia
| | - Alunya Wilkinson
- EPIC-CP Research Group, University of New South Wales, Sydney, New South Wales, Australia
| | - Karen Zwi
- Population Child Health Research Group, University of New South Wales, Sydney, New South Wales, Australia
- Community Child Health, Sydney Children's Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia
| | - Russell Dale
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Kids Neuroscience Centre, Kids Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Valsamma Eapen
- School of Psychiatry, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Raghu Lingam
- Population Child Health Research Group, University of New South Wales, Sydney, New South Wales, Australia
| | - Iva Strnadová
- School of Education, University of New South Wales, Sydney, New South Wales, Australia
- Disability Innovation Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Susan Woolfenden
- Population Child Health Research Group, University of New South Wales, Sydney, New South Wales, Australia
- Community Paediatrics Research Group, Institute for Women, Children and Families, Sydney Local Health District, Camperdown, New South Wales, Australia
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Olmos-Ochoa TT, Luger TM, Oishi A, Dyer KE, Sumberg A, Canelo I, Gideonse TK, Cheney A, Yano EM, Hamilton AB. Challenges to Engaging Women Veterans in Quality Improvement From Patient Care to Policy: Women's Health Managers' Perspectives. Womens Health Issues 2023; 33:199-207. [PMID: 36153165 DOI: 10.1016/j.whi.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Patients are uniquely positioned to identify issues and to provide innovative solutions to problems impacting their care. Yet, patient engagement in quality improvement (QI) and health care governance remains limited and underexplored. In the Veterans Health Administration, the work of women's health managers (WHMs) includes engaging women veterans, a numerical minority with unique health care needs, in QI. We aimed to understand the extent to which WHMs engage women veterans along a continuum, highlight challenges to engagement, and identify potential strategies to facilitate multilevel patient engagement. METHODS Data were generated from a multisite evaluation to improve delivery of comprehensive women's health care in Veterans Health Administration primary care sites. We conducted 39 semistructured interviews with WHMs across 21 sites. Guided by Carman et al.'s patient engagement framework, we analyzed the interviews using rapid-qualitative and content analysis methods. RESULTS When effectively engaged, women veterans were important champions and partners in QI activities to improve the structure and delivery of care. However, most WHMs engaged women veterans in mainly informal or passive ways-that is, solicited feedback through comment cards, surveys, focus groups, and townhall meetings-and did not report pursuing more in-depth or long-term forms of engagement. WHMs also identified a variety of facilitators and challenges to engaging women veterans in QI. CONCLUSIONS There may be unanticipated benefits to health care policy from engaging patients in QI, especially for patients with unique health care needs who represent a minority within the health care system. However, managers require training and workflow integration of patient engagement tasks to increase their efficiency and allow for meaningful patient engagement.
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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, California.
| | - Tana M Luger
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California; Covenant Health Network, Phoenix, Arizona
| | - Anneka Oishi
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California
| | - Karen E Dyer
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California
| | - Annie Sumberg
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California
| | - Ismelda Canelo
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California
| | - Theodore K Gideonse
- Department of Health, Science, and Behavior, Program in Public Health, University of California, Irvine, Irvine, California
| | - Ann Cheney
- Department of Social Medicine, Population, and Public Health, University of California Riverside School of Medicine, Riverside, California
| | - Elizabeth M Yano
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California; Department of Health Policy & Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California; Department of Medicine, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Alison B Hamilton
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California; Department of Psychiatry & Biobehavioral Sciences, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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11
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Russ SJ, Green J, de Winter L, Herrington E, Hughes-Hallett A, Taylor JM, Sevdalis N. An introduction to quality improvement. JOURNAL OF CLINICAL UROLOGY 2023. [DOI: 10.1177/20514158221075405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
The concept of quality has moved to the top of the international healthcare agenda in the past 30 years. This has been driven by a growing awareness of the scale of variation in patient outcomes, influenced by both the paucity of and consistency in implementation of evidence-based actions or interventions performed during the delivery of patient care. Concurrently there has been growing interest on the part of healthcare professionals to use a wider range of knowledge and available techniques, from outside of medicine, to continuously improve standards of safe and effective patient care. This is the first in a series of three articles introducing Quality Improvement (QI) methodology and supporting concepts to multidisciplinary teams working in Urology departments in the United Kingdom. We start, in this article, by providing an overview of key QI principles and their industrial roots; we position QI in the context of other approaches to improvement, such as audit, and we outline the key organisations and infrastructure supporting QI work on the ground.
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Affiliation(s)
- Stephanie J Russ
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | | | | | | | | | - Julia M Taylor
- Salford Royal NHS Foundation Trust, UK
- British Association of Urology Nurses, UK
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
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12
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Singleton G, Dowrick A, Manby L, Fillmore H, Syverson A, Lewis-Jackson S, Uddin I, Sumray K, Bautista-González E, Johnson G, Vindrola-Padros C. UK Healthcare Workers' Experiences of Major System Change in Elective Surgery During the COVID-19 Pandemic: Reflections on Rapid Service Adaptation. Int J Health Policy Manag 2022; 11:2072-2082. [PMID: 34523860 PMCID: PMC9808275 DOI: 10.34172/ijhpm.2021.101] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/07/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic disrupted the delivery of elective surgery in the United Kingdom. The majority of planned surgery was cancelled or postponed in March 2020 for the duration of the first wave of the pandemic. We investigated the experiences of staff responsible for delivering rapid changes to surgical services during the first wave of the pandemic in the United Kingdom, with the aim of developing lessons for future major systems change (MSC). METHODS Using a rapid qualitative study design, we conducted 25 interviews with frontline surgical staff during the first wave of the pandemic. Framework analysis was used to organise and interpret findings. RESULTS Staff discussed positive and negative experiences of rapid service organisation. Clinician-led decision-making, the flexibility of individual staff and teams, and the opportunity to innovate service design were all seen as positive contributors to success in service adaptation. The negative aspects of rapid change were inconsistent guidance from national government and medical bodies, top-down decisions about when to cancel and restart surgery, the challenges of delivering emergency surgical care safely and the complexity of prioritising surgical cases when services re-started. CONCLUSION Success in the rapid reorganisation of elective surgical services can be attributed to the flexibility and adaptability of staff. However, there was an absence of involvement of staff in wider system-level pandemic decision-making and competing guidance from national bodies. Involving staff in decisions about the organisation and delivery of MSC is essential for the sustainability of change processes.
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Affiliation(s)
- Georgina Singleton
- Department of Targeted Intervention, University College London, London, UK
- Rapid Research Evaluation and Appraisal Lab (RREAL), University College London, London, UK
| | - Anna Dowrick
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Louisa Manby
- Institute of Epidemiology and Healthcare, University College London, London, UK
| | | | - Aron Syverson
- Institute of Epidemiology and Healthcare, University College London, London, UK
| | - Sasha Lewis-Jackson
- Department of Targeted Intervention, University College London, London, UK
- Rapid Research Evaluation and Appraisal Lab (RREAL), University College London, London, UK
| | - Inayah Uddin
- Department of Targeted Intervention, University College London, London, UK
- Rapid Research Evaluation and Appraisal Lab (RREAL), University College London, London, UK
| | - Kirsi Sumray
- Institute of Epidemiology and Healthcare, University College London, London, UK
| | - Elysse Bautista-González
- Rapid Research Evaluation and Appraisal Lab (RREAL), University College London, London, UK
- Institute of Epidemiology and Healthcare, University College London, London, UK
| | - Ginger Johnson
- Department of Targeted Intervention, University College London, London, UK
- Rapid Research Evaluation and Appraisal Lab (RREAL), University College London, London, UK
| | - Cecilia Vindrola-Padros
- Department of Targeted Intervention, University College London, London, UK
- Rapid Research Evaluation and Appraisal Lab (RREAL), University College London, London, UK
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13
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Brösterhaus M, Hammer A, Gruber R, Kalina S, Grau S, Roeth AA, Ashmawy H, Groß T, Binnebösel M, Knoefel WT, Manser T. Using the Global Trigger Tool in surgical and neurosurgical patients: A feasibility study. PLoS One 2022; 17:e0272853. [PMID: 35972977 PMCID: PMC9380916 DOI: 10.1371/journal.pone.0272853] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/28/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The Global Trigger Tool (GTT) has become a worldwide used method for estimating adverse events through a retrospective patient record review. However, little is known about the facilitators and the challenges in the GTT-implementation process. Thus, this study followed two aims: First, to apply a comprehensive set of feasibility criteria to qualitatively and systematically assess the GTT-implementation process in three departments of German university hospitals. Second, to identify the facilitators and the obstacles met in the GTT-implementation process and to derive recommendations for supporting other hospitals in implementing the GTT in clinical practice. METHODS The study used a qualitative documentary method based on process documentation, with written and verbal feedback from the reviewer, as well as evaluating the study sites during the implementation process. The study was conducted in three departments, each in a different German university hospital. The authors applied a comprehensive set of 22 feasibility criteria assessing the level of challenge in GTT implementation. The results were synthesized and they focused on the facilitators and the challenges. RESULTS Of these 22 feasibility criteria, nine were assessed as a low-level challenge, eleven regarded as a moderate-level challenge, and two with a problematic level of challenge. In particular, the lack of time and staff resources, the quality of the information in the patient records, organizational procedures, and local issues, posed major challenges in the implementation process. By contrast, the use of local coordinators and an external expert made important contributions to the GTT implementation. CONCLUSIONS Considering the facilitators and the obstacles beforehand may help with the implementation of the GTT in routine practice. In particular, early and effective planning can reduce or prevent critical challenges in terms of time, staff resources, and organizational aspects.
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Affiliation(s)
| | - Antje Hammer
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
| | - Rosalie Gruber
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
| | - Steffen Kalina
- Central Division Medical Synergies, University Hospital of Cologne, Cologne, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Stefan Grau
- Center of Neurosurgery, University Hospital of Cologne, Cologne, Germany
| | - Anjali A. Roeth
- Department of General, Visceral, and Transplantation Surgery, University Hospital Aachen, Aachen, Germany
| | - Hany Ashmawy
- Heinrich-Heine-Universität und Universitätsklinikum Düsseldorf, Duesseldorf, Germany
| | - Thomas Groß
- Central Division Medical Synergies, University Hospital of Cologne, Cologne, Germany
| | - Marcel Binnebösel
- Department of General, Visceral, and Transplantation Surgery, University Hospital Aachen, Aachen, Germany
| | - Wolfram Trudo Knoefel
- Heinrich-Heine-Universität und Universitätsklinikum Düsseldorf, Duesseldorf, Germany
| | - Tanja Manser
- FHNW School of Applied Psychology, University of Applied Sciences and Arts, Northwestern Switzerland, Olten, Switzerland
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Nally DM, Lonergan PE, O’Connell EP, McNamara DA, Elwahab SA, Bass G, Burke E, Cagney D, Canas A, Cronin C, Cullinane C, Devane L, Fearon N, Fowler A, Fullard A, Hechtl D, Kelly M, Lenihan J, Murphy E, Neary C, O'Connell R, O'Neill M, Ramkaran C, Troy A, Tully R, White C, Yadav H. Increasing the use of perioperative risk scoring in emergency laparotomy: nationwide quality improvement programme. BJS Open 2022; 6:6649489. [PMID: 35876188 PMCID: PMC9309802 DOI: 10.1093/bjsopen/zrac092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 06/07/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022] Open
Abstract
Background Emergency laparotomy is associated with high morbidity and mortality. The early identification of high-risk patients allows for timely perioperative care and appropriate resource allocation. The aim of this study was to develop a nationwide surgical trainee-led quality improvement (QI) programme to increase the use of perioperative risk scoring in emergency laparotomy. Methods The programme was structured using the active implementation framework in 15 state-funded Irish hospitals to guide the staged implementation of perioperative risk scoring. The primary outcome was a recorded preoperative risk score for patients undergoing an emergency laparotomy at each site. Results The rate of patients undergoing emergency laparotomy receiving a perioperative risk score increased from 0–11 per cent during the exploratory phase to 35–100 per cent during the full implementation phase. Crucial factors for implementing changes included an experienced central team providing implementation support, collaborator engagement, and effective communication and social relationships. Conclusions A trainee-led QI programme increased the use of perioperative risk assessment in patients undergoing emergency laparotomy, with the potential to improve patient outcomes and care delivery.
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Affiliation(s)
- Deirdre M Nally
- Department of Surgical Affairs, Royal College of Surgeons in Ireland , Dublin , Ireland
- Department of Surgery, Mater Misericordiae University Hospital , Dublin , Ireland
| | - Peter E Lonergan
- National Clinical Programme in Surgery, Royal College of Surgeons in Ireland , Dublin , Ireland
- Department of Urology, St. James’s Hospital , Dublin , Ireland
- Department of Surgery, Trinity College , Dublin , Ireland
| | | | - Deborah A McNamara
- National Clinical Programme in Surgery, Royal College of Surgeons in Ireland , Dublin , Ireland
- Department of Surgery, Beaumont Hospital , Dublin , Ireland
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15
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Zhou S, Jin Y, Ma J, Dong X, Li N, Shi H, Zhang Y, Guan X, LaBresh KA, Smith SC, Huo Y, Zheng ZJ. Factors Associated With Medical Staff's Engagement and Perception of a Quality Improvement Program for Acute Coronary Syndromes in Hospitals: A Nationally Representative Mixed-Methods Study in China. J Am Heart Assoc 2022; 11:e024845. [PMID: 35352565 PMCID: PMC9075455 DOI: 10.1161/jaha.121.024845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Medical staff represent critical stakeholders in the process of implementing a quality improvement (QI) program. Few studies, however, have examined factors that influence medical staff engagement and perception regarding QI programs. Methods and Results We conducted a nationally representative survey of a QI program in 6 cities in China. Quantitative data were analyzed using multilevel mixed-effects linear regression models, and qualitative data were analyzed using the framework method. The engagement of medical staff was significantly related to knowledge scores regarding the specific content of chest pain center accreditation (β=0.42; 95% CI, 0.27-0.57). Higher scores for inner motivation (odds ratio [OR], 1.79; 95% CI, 1.18-2.72) and resource support (OR, 1.52; 95% CI, 1.02-2.24) and lower scores for implementation barriers (OR, 0.81; 95% CI, 0.67-0.98) were associated with improved treatment behaviors among medical staff. Resource support (OR, 4.52; 95% CI, 2.99-6.84) and lower complexity (OR, 0.81; 95% CI, 0.65-1.00) had positive effects on medical staff satisfaction, and respondents with improved treatment behaviors were more satisfied with the QI program. Similar findings were found for factors that influenced medical staff's assessment of QI program sustainability. The qualitative analysis further confirmed and supplemented the findings of quantitative analysis. Conclusions Clarifying and addressing factors associated with medical staff's engagement and perception of QI programs will allow further improvements in quality of care for patients with acute coronary syndrome. These findings may also be applicable to other QI programs in China and other low- and middle-income countries. Registration URL: https://www.chictr.org.cn/; Unique identifier: Chi-CTR2100043319.
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Affiliation(s)
- Shuduo Zhou
- Department of Global Health Peking University School of Public Health Beijing China.,Institute for Global Health and Development Peking University Beijing China
| | - Yinzi Jin
- Department of Global Health Peking University School of Public Health Beijing China.,Institute for Global Health and Development Peking University Beijing China
| | - Junxiong Ma
- Department of Global Health Peking University School of Public Health Beijing China.,Institute for Global Health and Development Peking University Beijing China
| | - Xuejie Dong
- Department of Global Health Peking University School of Public Health Beijing China.,Institute for Global Health and Development Peking University Beijing China
| | - Na Li
- Department of Global Health Peking University School of Public Health Beijing China.,Institute for Global Health and Development Peking University Beijing China
| | - Hong Shi
- China Cardiovascular Association and China Chest Pain Centers Suzhou China
| | - Yan Zhang
- Division of Cardiology Peking University First Hospital Beijing China
| | - Xiaoyu Guan
- China Cardiovascular Association and China Chest Pain Centers Suzhou China
| | | | - Sidney C Smith
- Division of Cardiovascular Medicine School of Medicine University of North Carolina at Chapel Hill NC
| | - Yong Huo
- Division of Cardiology Peking University First Hospital Beijing China
| | - Zhi-Jie Zheng
- Department of Global Health Peking University School of Public Health Beijing China.,Institute for Global Health and Development Peking University Beijing China
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16
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Grant AM, Wright FA, O'Brien TA. Rationalised premedication practice for blood product transfusions: A single-centre quality initiative. J Paediatr Child Health 2022; 58:267-273. [PMID: 34397131 DOI: 10.1111/jpc.15698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/30/2021] [Indexed: 11/29/2022]
Abstract
AIM Blood and platelets are scarce resources that are an essential part of the supportive care for paediatric cancer patients. There are many inherent risks involved with transfusions including acute transfusion reactions (ATRs). Following an initial ATR, prophylactic medications are commonly given prior to subsequent transfusions. However, there are risks with medication administration as well as negative implications for the health system. Our aim was to prevent the automatic prescribing of premedications prior to blood and platelet transfusions for ATRs. We hypothesised this would not increase the risk of harm. METHODS Our intervention was to eliminate automatic prescribing of intravenous corticosteroids and intravenous promethazine prior to a transfusion. This was approached through a behaviour change model and the implementation of recommended prescribing guidelines. Three Plan Do Study Act (PDSA) cycles refined the guidelines to align with clinicians' needs and build support through co-design. Data gathered on individual patients receiving transfusions and reaction rates during the trial were compared to international data. RESULTS A total of 100 patients received a transfusion during the trial. Eleven patients either had a previous reaction or experienced their first reaction during this time. All patients followed the guidelines and had either no premedication or an oral antihistamine premedication. There were no breakthrough reactions using oral antihistamines. The overall reaction rate was 1.33%, which aligns with the reported data on ATRs internationally. CONCLUSION A restricted prescribing approach to pharmaceutical cover prior to blood and platelet transfusions can be implemented effectively in a paediatric cancer population, without an increase in the risk of harm to the patients.
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Affiliation(s)
- Andrew M Grant
- Kids Cancer Centre, Sydney Children's Hospital Randwick, Sydney Children's Hospital's Network, Sydney, New South Wales, Australia
| | - Felicity A Wright
- Kids Cancer Centre, Sydney Children's Hospital Randwick, Sydney Children's Hospital's Network, Sydney, New South Wales, Australia.,Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Tracey A O'Brien
- Kids Cancer Centre, Sydney Children's Hospital Randwick, Sydney Children's Hospital's Network, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
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17
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Flores BE, Fernandez AA, Wang CP, Bobadilla R, Hernandez L, Jain MK, Turner BJ. Educating Primary Care Providers and Associate Care Providers About Hepatitis C Screening of Baby Boomers: a Multi-practice Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:217-223. [PMID: 32588350 DOI: 10.1007/s13187-020-01805-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Chronic hepatitis C virus (HCV) increases the risk for hepatocellular carcinoma. Despite higher prevalence of HCV in persons born 1945-1965 (baby boomer), screening has not been widely adopted. Both primary care providers (PCPs) and associate care providers (ACPs) need to be educated about the rationale and methods to screen for HCV. In five Federally Qualified Health Centers serving low-income Hispanic communities, PCPs and ACPs attended a 50-min training lecture about HCV epidemiology, screening methods, and evaluation. Using a 12-item questionnaire, knowledge and attitudes were compared for PCPs and ACPs at baseline (pre-test) and following training (post-test). A higher proportion of PCPs correctly answered 3 of 6 knowledge questions on both pre-test and post-test but ACPs' showed more improvement in knowledge (all P < 0.05). ACPs had more favorable attitudes about linking patients to care on pre- and post-tests than PCPs, and ACPs' attitudes improved on all 6 items versus 4 for PCPs. Both PCPs and ACPs improved knowledge and attitudes after training about HCV screening but ACPs had more favorable attitudes than PCPs. Engaging the entire primary care practice team in learning about HCV screening promotes knowledge and attitudes necessary for successful implementation.
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Affiliation(s)
- Bertha E Flores
- School of Nursing, UT Health San Antonio, San Antonio, TX, 78229-3900, USA
| | - Andrea A Fernandez
- School of Nursing, UT Health San Antonio, San Antonio, TX, 78229-3900, USA
| | - Chen-Pin Wang
- Population Health, UT Health San Antonio, San Antonio, TX, USA
- Center for Research to Advance Community Health (ReACH), UT Health San Antonio, San Antonio, TX, USA
| | - Raudel Bobadilla
- Center for Research to Advance Community Health (ReACH), UT Health San Antonio, San Antonio, TX, USA
| | - Ludivina Hernandez
- Center for Research to Advance Community Health (ReACH), UT Health San Antonio, San Antonio, TX, USA
| | | | - Barbara J Turner
- Gehr Center for Health Systems Science and Innovation, Keck School of Medicine, University of Southern California, 2020 Zonal Dr IRD 322, Los Angeles, CA, 91202, USA.
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18
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Teixeira CC, Bezerra ALQ, Paranaguá TTDB, Afonso TC. Professionals’ beliefs in patient involvement for hospital safety. Rev Bras Enferm 2022; 75:e20210359. [DOI: 10.1590/0034-7167-2021-0359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/22/2021] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objectives: to analyze the beliefs of health care professionals about the benefits of patient involvement in care during hospitalization. Methods: a descriptive, exploratory, qualitative study was conducted with 87 health professionals from a teaching hospital. Semi-structured interviews were conducted between December 2019 and January 2020 - data was submitted to content analysis and interpreted in light of Rosenstock’s Model of Beliefs in Health. Results: participants included nursing technicians, nurses, doctors, and other professionals. The categories “Professionals’ beliefs about patient involvement in care”, “Practices of patient involvement in care” and “Factors favoring patient involvement in hospital care” emerged. The perception of professionals revealed the influence of patient involvement in care outcomes and benefits for the safety of care. Final Considerations: involving the patient in care is associated with the healthcare professional’s belief in the benefits of this practice for reducing incidents.
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19
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Alexander CC, Tschannen D, Hays D, Clouse M, Zellefrow C, Amer KS, Lambert-Davis J, Watson TH, Tovar EG, Milner KA. An Integrative Review of the Barriers and Facilitators to Nurse Engagement in Quality Improvement in the Clinical Practice Setting. J Nurs Care Qual 2022; 37:94-100. [PMID: 33734188 DOI: 10.1097/ncq.0000000000000562] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nurse engagement in quality improvement (QI) improves health care quality and outcomes but is typically low in clinical settings. PURPOSE An integrative review was conducted to identify facilitators and barriers of nurse engagement in QI. METHODS This integrative review was conducted using an electronic search of databases with search terms specific to nursing engagement in QI. The Johns Hopkins Nursing Evidence-Based Practice Evidence Level and Quality Guide was used to rate quality and level of evidence. RESULTS Nine articles met the criteria for review. Top barriers were leadership, education and training, resource constraints, data, culture, and time. Top facilitators were leadership, education and training, culture, mentors, and champions. CONCLUSION High-quality literature exploring barriers and facilitators of nurse engagement in QI is lacking. Research is needed to examine the degree to which these barriers and facilitators impact engagement and how they can be addressed to increase it.
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Affiliation(s)
- Catherine C Alexander
- San Francisco VA Health Care System, San Francisco, California (Dr Alexander); University of Michigan, School of Nursing, Ann Arbor (Dr Tschannen); Oakland University School of Nursing, Rochester, Michigan (Dr Hays); Tennessee Valley Healthcare System, GRECC, Nashville (Dr Clouse); National Institute for Evidence Based Practice in Nursing and Healthcare, The Ohio State University College of Nursing, Columbus (Dr Zellefrow); School of Nursing, DePaul University, Chicago, Illinois (Dr Amer); Southeast HEALTH College of Nursing and Health Sciences, Cape Girardeau County, Missouri (Dr Watson); University of Kentucky College of Nursing, Lexington (Dr Tovar); and Davis & Henley College of Nursing Sacred Heart University, Fairfield, Connecticut (Dr Milner). Dr Lambert-Davis is a certified peer reviewer and an independent scholar, Montgomery, Alabama
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20
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Kendrick M, Kendrick KB, Taylor NF, Leggat SG. A qualitative study of hospital clinical staff perceptions of their interactions with healthcare middle managers. J Health Organ Manag 2021; ahead-of-print. [PMID: 34921600 DOI: 10.1108/jhom-06-2021-0216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The authors explored clinical staff perceptions of their interactions with middle management and their experiences of the uncongeniality of their working environment. DESIGN/METHODOLOGY/APPROACH Semi-structured interviews of clinical staff from an Australian public health service's Emergency, Surgery and Psychiatry departments. Volunteer interview transcripts were inductively coded using a reflexive thematic content analysis. FINDINGS Of 73 interviews, 66 participants discussed their interactions with management. Most clinicians considered their interactions with middle management to be negative based on a violation of their expectations of support in the workplace. Collectively, these interactions formed the basis of clinical staff perceptions of management's lack of capacity and fit for the needs of staff to perform their roles. PRACTICAL IMPLICATIONS Strategies to improve management's fit with clinicians' needs may be beneficial for reducing uncongenial workplaces for healthcare staff and enhanced patient care. ORIGINALITY/VALUE This article is among the few papers that discuss interactions with management from the perspective of clinical staff in healthcare. How these perspectives inform the perception of workplace uncongeniality for clinicians contributes greater understanding of the factors contributing to adversarial relationships between clinicians and managers.
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Affiliation(s)
- Madeleine Kendrick
- Public Health, La Trobe University - Bundoora Campus, Melbourne, Australia
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21
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McGill A, Smith D, McCloskey R, Morris P, Goudreau A, Veitch B. The Functional Resonance Analysis Method as a health care research methodology: a scoping review. JBI Evid Synth 2021; 20:1074-1097. [PMID: 34845171 DOI: 10.11124/jbies-21-00099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review was to examine and map the literature on the use of the Functional Resonance Analysis Method (FRAM) in health care research. INTRODUCTION The FRAM is a resilient health care tool that offers an approach to deconstruct complex systems by mapping health care processes to identify essential activities, how they are interrelated, and the variability that emerges, which can strengthen or compromise outcomes. Insight into how the FRAM has been operationalized in health care can help researchers and policy-makers understand how this method can be used to strengthen health care systems. INCLUSION CRITERIA This scoping review included research and narrative reports on the application of the FRAM in any health care setting. The focus was to identify the key concepts and definitions used to describe the FRAM, the research questions, aims, and objectives used to study the FRAM, the methods used to operationalize the FRAM, the health care processes examined, and the key findings. METHODS A three-step search strategy was used to find published and unpublished research and narrative reports conducted in any country. Only papers published in English were considered. No limits were placed on the year of publication. CINAHL, MEDLINE, Embase, PsycINFO, Inspec Engineering Village, ProQuest Nursing & Allied Health were searched originally in June 2020 and again in March 2021. A search of the gray literature was also completed in March 2021. Data were extracted from papers by two independent reviewers using a data extraction tool developed by the reviewers. Search results are summarized in a flow diagram, and the extracted data are presented in tabular format. RESULTS Thirty-one papers were included in the final review, and most (n = 25; 80.6%) provided a description or definition of the FRAM. Only two (n = 2; 6.5%) identified a specific research question. The remaining papers each identified an overall aim or objective in applying the FRAM, the most common being to understand a health care process (n = 20; 64.5%). Eleven different methods of data collection were identified, with interviews being the most common (n = 21; 67.7%). Ten different health care processes were explored, with safety and risk identification (n = 8; 25.8%) being the most examined process. Key findings identified the FRAM as a mapping tool that can identify essential activities or functions of a process (n = 20; 64.5%), how functions are interdependent or coupled (n = 18 58.1%), the variability that can emerge within a process (n = 20; 64.5%), discrepancies between work as done and work as imagined (n = 20; 64.5%), the resiliency that exists within a process (n = 12; 38.7%), and the points of risk within a process (n = 10, 32.3%). Most papers (n = 27; 87.1%) developed models representing the complexity of a process. CONCLUSIONS The FRAM aims to use a systems approach to examine complex processes and as evidenced by this review, is suited for use within the health care domain. Interest in the FRAM is growing, with most of the included literature being published since 2017 (n = 24; 77.4%). The FRAM has the potential to provide comprehensive insight into how health care work is done and how that work can become more efficient, safer, and better supported.
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Affiliation(s)
- Alexis McGill
- Horizon Health Network, Saint John, NB, Canada Graduate Student, Memorial University, St. John's, NL, Canada Faculty of Engineering & Applied Science, Memorial University, NL, Canada Department of Nursing & Health Sciences, University of New Brunswick, Saint John, NB, Canada The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: A JBI Centre of Excellence, The University of New Brunswick, Saint John, NB, Canada Graduate Student, University of New Brunswick, Saint John, NB, Canada University of New Brunswick Libraries, University of New Brunswick, Saint John, NB, Canada
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Khurshid Z, McAuliffe E, De Brún A. Exploring healthcare staff narratives to understand the role of quality improvement methods in innovative practices during COVID-19. BMC Health Serv Res 2021; 21:1271. [PMID: 34823517 PMCID: PMC8613456 DOI: 10.1186/s12913-021-07297-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/15/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND COVID-19 has impacted the context in which healthcare staff and teams operate and this has implications for quality improvement (QI) work. Contrary to the usual ambivalent relationship staff have with QI work, there have been examples of unprecedented staff engagement in implementing rapid changes during the pandemic indicating a change in important underlying factors that impact staff involvement in QI. The purpose of this study is to explore staff perspectives about how experience and skills of QI methods supported them in implementing innovative practices during COVID-19. METHODS This is a qualitative narrative study based on narrative interviews to collect healthcare staff stories of implementing rapid change. The stories were identified through social media (Twitter) and a national health magazine issued by the Irish health service. Twenty staff members participated in the interviews. Interviews were audio recorded, transcribed, and anonymised. A four-step thematic analysis was conducted. RESULTS The analysis revealed the transformational journey of healthcare staff from the initial shock and anxiety caused by COVID-19 to making sense of the situation, implementing rapid changes, and acknowledging COVID as a learning experience. Six themes were evident from the analysis: COVID anxiety and fear, emotional supports and coping mechanisms, person-centric changes, COVID as a 'forcing function' for change, a collective way of working and looking back and thinking ahead. CONCLUSIONS While most rapid changes during COVID-19 did not represent a systematic and explicit QI application, QI principles were evident throughout the stories and actions taken, including making small changes, testing changes, learning, reflecting as a team, and improving. Many staff members were able to retrospectively identify the relevance of QI principles. COVID-19 eliminated some traditional barriers to change leading to efficient solutions, thus highlighting a need to sustain these positive changes into routine practice to develop an adaptive healthcare system receptive to QI.
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Affiliation(s)
- Zuneera Khurshid
- School of Nursing, Midwifery and Health Systems, UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin, Dublin, Ireland.
| | - Eilish McAuliffe
- School of Nursing, Midwifery and Health Systems, UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin, Dublin, Ireland
| | - Aoife De Brún
- School of Nursing, Midwifery and Health Systems, UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin, Dublin, Ireland
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Malinowska-Lipień I, Wadas T, Gabryś T, Kózka M, Gniadek A, Brzostek T, Squires A. Evaluating Polish nurses' working conditions and patient safety during the COVID-19 pandemic. Int Nurs Rev 2021; 69:239-248. [PMID: 34716590 PMCID: PMC8653238 DOI: 10.1111/inr.12724] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 09/16/2021] [Indexed: 01/02/2023]
Abstract
Aim To study the relationship between Polish nurses' working conditions and their attitudes towards patient safety during the COVID‐19 pandemic. Background Facing the COVID‐19 pandemic, caused by the SARS‐CoV‐2 virus, healthcare worldwide has been reorganised. How these changes affected patient safety for hospitalised persons is not well understood. Introduction Difficult working conditions related to the outbreak of the COVID‐19 pandemic may affect the provision of safe and effective care by healthcare staff. Methods This observational research was performed on the group of 577 nurses working during the COVID‐19 pandemic in isolation infection wards (n = 201) and non‐infectious diseases wards (n = 376) in Polish hospitals. The evaluation of working conditions was performed with an author's questionnaire, while the evaluation of factors influencing attitudes towards safety of the hospitalised patients was performed using Safety Attitudes Questionnaire. The STROBE checklist was used to report this study. Results The procedures developed by management in advance for COVID‐19 patient treatment had a statistically significant influence on nurses' ‘evaluation of teamwork climate, safety climate, job satisfaction, perception of management and work conditions’. Providing management with the ability to perform a swab polymerase chain reaction SARS‐CoV‐2 test for hospital staff in the workplace, and psychological support from professionals and employers were statistically significant for higher ratings of ‘teamwork climate, safety climate, job satisfaction, stress recognition, perception of management and work conditions’ by the Polish nurses. Hospital workload during the COVID‐19 pandemic was significantly correlated with lower evaluation of work conditions. Discussion Our study reinforces the existing literature on many fronts and demonstrates how even when operating under the COVID‐19 pandemic conditions, some factors remain critical for fostering a culture of patient safety. Reinforcing patient safety practices is a imperative under these conditions. Conclusions and implications for nursing Working conditions influence nurses' attitudes towards safety of the hospitalised patients. These are largely modifiable factors related to the workplace and include prior preparation of procedures, restrictions to extending daily work hours and psychological counselling for the staff.
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Affiliation(s)
- Iwona Malinowska-Lipień
- Faculty of Health Sciences, Institute of Nursing and Midwifery, Jagiellonian University Medical College, Krakow, Poland.,Małopolska District Chamber of Nurses and Midwives in Krakow, Kraków, Poland
| | - Tadeusz Wadas
- Małopolska District Chamber of Nurses and Midwives in Krakow, Kraków, Poland
| | - Teresa Gabryś
- Faculty of Health Sciences, Institute of Nursing and Midwifery, Jagiellonian University Medical College, Krakow, Poland
| | - Maria Kózka
- Faculty of Health Sciences, Institute of Nursing and Midwifery, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Gniadek
- Faculty of Health Sciences, Institute of Nursing and Midwifery, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Brzostek
- Faculty of Health Sciences, Institute of Nursing and Midwifery, Jagiellonian University Medical College, Krakow, Poland
| | - Allison Squires
- Rory Meyers College of Nursing, New York University, New York, USA
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Sbai M, Martin F, Partridge J, Dhesi J. Comprehensive geriatric assessment (CGA) in the perioperative setting: the current state of play. J R Coll Physicians Edinb 2021; 50:356-358. [PMID: 33469607 DOI: 10.4997/jrcpe.2020.401] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Magda Sbai
- Older Person Assessment Unit (OPAU), Guy's Hospital, Westminster Bridge Road, London SE1 7EH, UK,
| | - Fionna Martin
- Perioperative medicine for Older People undergoing Surgery (POPS), Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London
| | - Judith Partridge
- Perioperative medicine for Older People undergoing Surgery (POPS), Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London
| | - Jugdeep Dhesi
- Division of Primary Care and Public Health Sciences, Faculty of Life Sciences and Medicine, King's College London
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Ojanperä H, Korhonen A, Meriläinen M, Syrjälä H, Kanste O. The role of managers in promoting good hand hygiene in a Finnish tertiary care hospital. Am J Infect Control 2021; 49:753-758. [PMID: 33285225 DOI: 10.1016/j.ajic.2020.11.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hospital managers play an essential role in implementing strategies to promote good hand hygiene (HH) among health care workers. We investigated the managers' views on their roles, challenges and developmental ideas in promoting good HH practice. METHODS A descriptive cross-sectional study with an online survey of both medical and nursing managers was conducted within a single tertiary care hospital in Finland. Three open-ended questions were analyzed using inductive content analysis. RESULTS A total of 78 managers out of 168 responded to the survey (response rate 46%). Managers helped promote HH practices by enabling the proper environment for adherence to good HH, visible commitment, and using various means to instruct staff about HH. Challenges included the acute hospital setting and practical problems related to the managers' numerous responsibilities. Developmental ideas included information communication technology applications for monitoring HH as an indicator of the quality of care, versatile responses to HH audits, and clarifying the roles of different management levels. CONCLUSIONS Managers are committed to and use various methods to promote HH. Managers would benefit from information communication technology applications to provide easy and targeted information regarding compliance with HH.
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Affiliation(s)
- Helena Ojanperä
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland; Department of Infection Control, Oulu University Hospital, Medical Research Center Oulu, Oulu, Finland.
| | | | - Merja Meriläinen
- Department of Administration, Oulu University Hospital, Medical Research Center Oulu, Oulu, Finland
| | - Hannu Syrjälä
- Department of Infection Control, Oulu University Hospital, Medical Research Center Oulu, Oulu, Finland
| | - Outi Kanste
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
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Improving Care for Childhood Obesity: A Quality Improvement Initiative. Pediatr Qual Saf 2021; 6:e412. [PMID: 34046541 PMCID: PMC8143745 DOI: 10.1097/pq9.0000000000000412] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 12/04/2020] [Indexed: 11/29/2022] Open
Abstract
Obesity affected 13.7 million children in the United States in 2015. The American Academy of Pediatrics (AAP) offers an evidence-based approach to obesity management, but adherence to recommendations is suboptimal. Our objective was to improve provider adherence to the AAP recommendations for care of patients with obesity by making systematic changes in our practice for patients of ages > 2 and younger than 19 years with a BMI > 95th percentile.
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Haile AB, Haile MB, Dagnaw AM, Asefa EY, Tizazu MA. The Engagement Level of Board Members and Associated Health Care Quality in Public Health Centers of Addis Ababa, Ethiopia, 2018. Risk Manag Healthc Policy 2021; 14:2201-2209. [PMID: 34079407 PMCID: PMC8166354 DOI: 10.2147/rmhp.s310878] [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: 03/12/2021] [Accepted: 05/09/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A board member was an important bridge to accelerate a day-to-day health care quality in a routine clinical activity at health institutions. They are significant in planning and examine integrated governance systems that encourage quality of care and accountability. So, the current research was planned to identify the level of engagement of the board members in health care quality and factors associated. METHODS A facility-based cross-sectional study was implemented among 250 board members and data were collected by self-administered questionnaire at selected governing health centers in Addis Ababa, Ethiopia from May 1 to 30, 2018. A simple random sampling technique was used to reach the study participants. Data were entered using EpiData 3.1 software and analysis was done using SPSS 23. Adjusted odds ratio with 95% confidence interval and p-value < 0.05 was used to declare statistical significance. The level of board members' engagement was found to be low which implies that the board members do not give appropriate attention to the quality of care. RESULTS Good level of engagement of board members was (50.9%) [AOR=7.11, 95% CI (3.07-16.47)]. Most of the governing board members did not engage in the quality of health care activities. Uses quality data as a basis for recognition [AOR=7.11, 95% CI (3.07-16.47)], review a quality scorecard or dashboard [AOR=10.83, 95% CI (3.75-31.29)], establishing goals relating to staff satisfaction [AOR=15.42, 95% CI (6.14-38.75)] and receiving formal training [AOR=3.42, 95% CI (1.35 -8.62)], having a strategy relating to communication with clients [AOR= 4.95, 95% CI (2.02-12.15)] and spending more than 20% [AOR=11.96, 95% CI (3.27-43.83)], received training on healthcare disparities [AOR=3.81, 95% CI (1.40-10.36)], and having a plan on quality [AOR=16.38 95% CI (5.39-49.72)] were found to be significant predictors of level of board member engagement. CONCLUSION Collectively, most of the governing board members did not engage in the quality of health care activities. Stakeholders should work on capacity building for board members using training and further follow-up. Encouraging them to put quality health services at the forefront of their agenda during their involvement at their respective facilities.
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Affiliation(s)
- Assalif Beyene Haile
- Midwifery Department, Health Science College, University of Debre Berhan, Debre Berhan, Ethiopia
| | | | - Abebe Mihretie Dagnaw
- Midwifery Department, Health Science College, University of Debre Berhan, Debre Berhan, Ethiopia
| | - Eyosiyas Yeshialem Asefa
- Midwifery Department, Health Science College, University of Debre Berhan, Debre Berhan, Ethiopia
| | - Michael Amera Tizazu
- Midwifery Department, Health Science College, University of Debre Berhan, Debre Berhan, Ethiopia
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Tschannen D, Alexander C, Taylor S, Tovar EG, Ghosh B, Zellefrow C, Milner KA. Quality improvement engagement and competence: A comparison between frontline nurses and nurse leaders. Nurs Outlook 2021; 69:836-847. [PMID: 33993986 DOI: 10.1016/j.outlook.2021.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 01/27/2021] [Accepted: 02/22/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nurses play a pivotal role in improving patient care. To maximize nurses' impact on quality, nurses must have quality improvement (QI) competence and engage fully in QI initiatives. PURPOSE To describe QI competence (knowledge, skills, and attitudes) among frontline nurses and leaders; and compare variations in competence among nursing roles, experience, and specialty areas. METHODS A total of 681 nurses at one heath system fully completed the Nursing Quality Improvement Practice tool electronically. FINDINGS Half of the respondents reported QI engagement (53.6%). Mean knowledge scores were 5.08 (SD 1.16, 7 items). Skill proficiency was low (M = 2.82, SD = 1.03; range 1-6) although QI attitudes were favorable (M = 3.76, SD = 0.63; range 1-5). Significant differences in skills and attitudes were identified by role. QI competence among nurses employed in various specialty areas were similar. DISCUSSION Strategies for increasing QI competence and engagement of nurses must be created and deployed in order to improve quality and safety.
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Affiliation(s)
- Dana Tschannen
- University of Michigan, School of Nursing, Ann Arbor, MI.
| | | | - Sarah Taylor
- University of Michigan Health System, Trauma Burn ICU, Ann Arbor MI
| | - Elizabeth G Tovar
- DNP Primary Care Track Coordinator University of Kentucky, Lexington, KY
| | | | - Cindy Zellefrow
- Academic Core at The Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare, The Ohio State University College of Nursing, Columbus, OH
| | - Kerry A Milner
- Sacred Heart University, Davis & Henley College of Nursing, Fairfield, CT
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Schmidt J, Gambashidze N, Manser T, Güß T, Klatthaar M, Neugebauer F, Hammer A. Does interprofessional team-training affect nurses' and physicians' perceptions of safety culture and communication practices? Results of a pre-post survey study. BMC Health Serv Res 2021; 21:341. [PMID: 33853593 PMCID: PMC8048288 DOI: 10.1186/s12913-021-06137-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 02/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many hospitals seek to increase patient safety through interprofessional team-trainings. Accordingly, these trainings aim to strengthen important key aspects such as safety culture and communication. This study was designed to investigate if an interprofessional team-training, administered to a relatively small group of nurses and physicians would promote a change in healthcare professionals' perceptions on safety culture and communication practices throughout the hospital. We further sought to understand which safety culture aspects foster the transfer of trained communication practices into clinical practice. METHODS We conducted a pre-post survey study using six scales to measure participants' perceptions of safety culture and communication practices. Mean values were compared according to profession and participation in training. Using multiple regression models, the relationship between safety culture and communication practices was determined. RESULTS Before and after the training, we found high mean values for all scales. A significant, positive effect was found for the communication practices of the physicians. Participation in the training sessions played a variably relevant role in the communication practices. In addition, the multiple regression analyses showed that specific safety culture aspects have a cross-professional influence on communication practices in the hospital. CONCLUSIONS This study suggest that interprofessional team-trainings of a small group of professionals can successfully be transferred into clinical practice and indicates the importance of safety culture aspects for such transfer processes. Thus, we recommend the consideration of safety culture aspects before starting a training intervention.
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Affiliation(s)
- Jan Schmidt
- Institute for Patient Safety, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Nikoloz Gambashidze
- Institute for Patient Safety, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Tanja Manser
- FHNW School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Riggenbachstrasse 16, 4600, Olten, Switzerland
| | - Tim Güß
- UKM Trainingszentrum, University Hospital of Muenster, Malmedyweg 17, 48149, Muenster, Germany
| | - Michael Klatthaar
- UKM Trainingszentrum, University Hospital of Muenster, Malmedyweg 17, 48149, Muenster, Germany
| | - Frank Neugebauer
- QM and clinical risk management, University Hospital of Muenster, Domagkstrasse 20, 48149, Muenster, Germany
| | - Antje Hammer
- Institute for Patient Safety, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Alghamdi S, Berrou I, Bajnaid E, Aslanpour Z, Haseeb A, Hammad MA, Shebl N. Antimicrobial Stewardship Program Implementation in a Saudi Medical City: An Exploratory Case Study. Antibiotics (Basel) 2021; 10:280. [PMID: 33803325 PMCID: PMC8000012 DOI: 10.3390/antibiotics10030280] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/04/2021] [Accepted: 03/08/2021] [Indexed: 12/13/2022] Open
Abstract
Antimicrobial stewardship programs (ASPs) in hospitals have long been shown to improve antimicrobials' use and reduce the rates of antimicrobial resistance. However, their implementation in hospitals, especially in developing countries such as Saudi Arabia, remains low. One of the main barriers to implementation is the lack of knowledge of how to implement them. This study aims to explore how an antimicrobial stewardship programme was implemented in a Saudi hospital, the challenges faced and how they were overcome, and the program outcomes. A key stakeholder case study design was used, involving in-depth semi-structured interviews with the core members of the ASP team and analysis of 35 ASP hospital documents. ASP implementation followed a top-down approach and involved an initial preparatory phase and an implementation phase, requiring substantial infectious diseases and clinical pharmacy input throughout. Top management support was key to the successful implementation. ASP implementation reduced rates of multi-drug resistance and prescription of broad-spectrum antimicrobials. The implementation of ASPs in hospital is administrator rather than clinician driven. Outsourcing expertise and resources may help hospitals address the initial implementation challenges.
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Affiliation(s)
- Saleh Alghamdi
- Department of Clinical Pharmacy, Faculty of Clinical Pharmacy, Albaha University, Albaha 65779-77388, Saudi Arabia; (S.A.); (M.A.H.)
| | - Ilhem Berrou
- Faculty of Health & Applied Sciences, University of the West of England, Staple Hill, Bristol BS16 1DD, UK
| | - Eshtyag Bajnaid
- Department of Clinical Pharmacy, Pharmaceutical Services Administration, King Abdullah Medical City, Makkah 11176, Saudi Arabia;
| | - Zoe Aslanpour
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK; (Z.A.); (N.S.)
| | - Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al Qura University, Makkah 77207, Saudi Arabia;
| | - Mohamed Anwar Hammad
- Department of Clinical Pharmacy, Faculty of Clinical Pharmacy, Albaha University, Albaha 65779-77388, Saudi Arabia; (S.A.); (M.A.H.)
| | - Nada Shebl
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK; (Z.A.); (N.S.)
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Radwan TF, Agyako Y, Ettefaghian A, Kamran T, Din O, Tahir MA, Schofield P, L'Esperance V. Improving the management of type 2 diabetes through large-scale general practice: the role of a data-driven and technology-enabled education programme. BMJ Open Qual 2021; 10:bmjoq-2020-001087. [PMID: 33547158 PMCID: PMC7871240 DOI: 10.1136/bmjoq-2020-001087] [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: 06/30/2020] [Revised: 11/28/2020] [Accepted: 01/13/2021] [Indexed: 11/26/2022] Open
Abstract
A quality improvement (QI) scheme was launched in 2017, covering a large group of 25 general practices working with a deprived registered population. The aim was to improve the measurable quality of care in a population where type
2 diabetes (T2D) care had previously proved challenging. A complex set of QI interventions were co-designed by a team of primary care clinicians and educationalists and managers. These interventions included organisation-wide goal setting, using a data-driven approach, ensuring staff engagement, implementing an educational programme for pharmacists, facilitating web-based QI learning at-scale and using methods which ensured sustainability. This programme was used to optimise the management of T2D through improving the eight care processes and three treatment targets which form part of the annual national diabetes audit for patients with T2D. With the implemented improvement interventions, there was significant improvement in all care processes and all treatment targets for patients with diabetes. Achievement of all the eight care processes improved by 46.0% (p<0.001) while achievement of all three treatment targets improved by 13.5% (p<0.001). The QI programme provides an example of a data-driven large-scale multicomponent intervention delivered in primary care in ethnically diverse and socially deprived areas.
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Affiliation(s)
| | | | | | | | - Omar Din
- AT Medics Ltd, London, London, UK
| | | | - Peter Schofield
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Veline L'Esperance
- AT Medics Ltd, London, London, UK .,School of Population Health and Environmental Sciences, King's College London, London, UK
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Depla AL, Crombag NM, Franx A, Bekker MN. Implementation of a standard outcome set in perinatal care: a qualitative analysis of barriers and facilitators from all stakeholder perspectives. BMC Health Serv Res 2021; 21:113. [PMID: 33530989 PMCID: PMC7852077 DOI: 10.1186/s12913-021-06121-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To improve their quality, healthcare systems are increasingly focused on value delivered to patients. For perinatal care, the International Consortium for Health Outcomes Measurement (ICHOM) proposed a patient-centred outcome set with both clinical and patient-reported measures for pregnancy and childbirth (PCB set). This study aimed to identify factors that affect the implementation of the PCB set at the pre-implementation stage, using the consolidated framework for implementation research (CFIR). METHODS In this qualitative study, we conducted semi-structured interviews amongst a purposive sample of key stakeholders within an obstetric care network (OCN): 1) patients, 2) perinatal care professionals involved in the full cycle of perinatal care, and 3) policy makers, including hospital managers, administrative staff and health care insurers. While the CFIR guided data capture and structuring, thematic analysis revealed overarching themes that best reflected the barriers and facilitators from different stakeholder perspectives. Within these overarching themes, the CFIR constructs were maintained. RESULTS Interviews were conducted with 6 patients, 16 professionals and 5 policy makers. Thematic analysis supported by the CFIR framework identified four main themes: the instrument and its implementation process, use in individual patient care, use in quality improvement, and the context of the OCN. Important barriers included professional workload, data reliability, and interprofessional and interorganizational collaboration. Potential facilitators were the PCB set's direct value in individual care, interprofessional feedback and education, and aligning with existing systems. Prominent variations between stakeholder groups included the expected patient burden, the level of use, transparency of outcomes and the degree of integrated care. CONCLUSIONS This study clarified critical factors that affect successful implementation of the PCB set in perinatal care. Practice recommendations, suggested at multiple levels, can enable structural patient-centred care improvement and may unite stakeholders towards integrated birth care.
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Affiliation(s)
- Anne L. Depla
- Department of Obstetrics and Gynaecology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, KE.04.123.1, Lundlaan 6, 3584 EA Utrecht, The Netherlands
| | - Neeltje M. Crombag
- Department of Development and Regeneration, KU Leuven University, Leuven, Belgium
| | - Arie Franx
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Mireille N. Bekker
- Department of Obstetrics and Gynaecology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, KE.04.123.1, Lundlaan 6, 3584 EA Utrecht, The Netherlands
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Lamprell K, Tran Y, Arnolda G, Braithwaite J. Nudging clinicians: A systematic scoping review of the literature. J Eval Clin Pract 2021; 27:175-192. [PMID: 32342613 DOI: 10.1111/jep.13401] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/19/2020] [Accepted: 03/23/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND While the quality of medical care delivered by physicians can be very good, it can also be inconsistent and feature behaviours that are entrenched despite updated information and evidence. The "nudge" paradigm for behaviour change is being used to bring clinical practice in line with desired standards. The premise is that behaviour can be voluntarily shifted by making particular choices instinctively appealing. We reviewed studies that are explicit about their use of nudge theory in influencing clinician behaviour. METHODS Databases were searched from April 2008 (the publication date of the book that introduced nudge theory to a wider audience) to November 2018, inclusive. The search strategy and narrative review of results addressed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. RESULTS 22 studies were identified. Randomized trials or pre-post comparisons were generally used in community-based settings; single-site pre-post studies were favoured in hospitals. The studies employed eight intervention types: active choice; patient chart redesign; default and default alerts; partitioning of prescription menus; audit and feedback; commitment messages; peer comparisons; and redirection of workflow. Three core cognitive factors underpinned the eight interventions: bias towards prominent choices (salience); predisposition to social norms; and bias towards time or cost savings. CONCLUSIONS Published studies that are explicit about their use of nudge theory are few in number and diverse in their settings, targets, and results. Default and chart re-design interventions reported the most substantial improvements in adherence to evidence and guideline-based practice. Studies that are explicit in their use of nudge theory address the widespread failure of clinical practice studies to identify theoretical frameworks for interventions. However, few studies identified in our review engaged in research to understand the contextual and site-specific barriers to a desired behaviour before designing a nudge intervention.
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Affiliation(s)
- Klay Lamprell
- Macquarie University, Australian Institute of Health Innovation, Sydney, New South Wales, Australia
| | - Yvonne Tran
- Macquarie University, Australian Institute of Health Innovation, Sydney, New South Wales, Australia
| | - Gaston Arnolda
- Macquarie University, Australian Institute of Health Innovation, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Macquarie University, Australian Institute of Health Innovation, Sydney, New South Wales, Australia
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Burn AM, Vainre M, Humphrey A, Howarth E. Evaluating the CYP-IAPT transformation of child and adolescent mental health services in Cambridgeshire, UK: a qualitative implementation study. Implement Sci Commun 2020; 1:89. [PMID: 33073242 PMCID: PMC7556968 DOI: 10.1186/s43058-020-00078-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background The Children and Young People's Improving Access to Psychological Therapies (CYP-IAPT) programme was introduced to transform Child and Adolescent Mental Health Services (CAMHS) across England. The programme comprised a set of principles that local CAMHS partnerships were expected to operationalise and embed with the aim of increasing access to services and improving the quality of care. This study explored how the implementation of the CYP-IAPT programme was executed and experienced by CAMHS professionals in the county of Cambridgeshire (UK), and the extent to which the CYP-IAPT principles were perceived to be successfully embedded into everyday practice. Methods We analysed 275 documents relating to the CYP-IAPT programme issued between 2011 and 2015. We also conducted a thematic analysis of 20 qualitative interviews, undertaken at two time points, with professionals from three CAMHS teams in Cambridgeshire. Analysis was informed by implementation science frameworks. Results Document analysis suggested that the CYP-IAPT programme was initially not clearly defined and lacked guidance on how to operationalise key programme principles and apply them in everyday practice. There was also a degree of programme evolution over time, which made it difficult for local stakeholders to understand the scope and aims of CYP-IAPT. Interviews with staff showed low coherent understanding of the programme, variable levels of investment among stakeholders and difficulties in collaborative working. Barriers and facilitators to programme implementation were identified at individual, service and strategic levels. These in turn impacted the local implementation efforts and sustainability of the programme in Cambridgeshire. Conclusions We identified factors relating to programme design and national and local implementation planning, as well as features of inner and outer context, which impacted on the delivery and sustainability of the programme. These findings can be drawn upon to inform the development and delivery of other local and national quality improvement (QI) initiatives relating to children and young people's mental health.
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Affiliation(s)
- Anne-Marie Burn
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Maris Vainre
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Ayla Humphrey
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Emma Howarth
- School of Psychology, University of East London, London, UK
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Shaikh U, Lachman P, Padovani AJ, McCarthy SE. The care and keeping of clinicians in quality improvement. Int J Qual Health Care 2020; 32:480-485. [PMID: 32613236 DOI: 10.1093/intqhc/mzaa071] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Although frontline clinicians are crucial in implementing and spreading innovations, their engagement in quality improvement remains suboptimal. Our goal was to identify facilitators and barriers to the development and engagement of clinicians in quality improvement. DESIGN A 25-item questionnaire informed by theoretical frameworks was developed, tested and disseminated by email. SETTINGS Members and fellows of the International Society for Quality in Healthcare. PARTICIPANTS 1010 eligible participants (380 fellows and 647 members). INTERVENTIONS None. MAIN OUTCOME MEASURES Self-efficacy and effectiveness in conducting and leading quality improvement activities. RESULTS We received 212 responses from 50 countries, a response rate of 21%. Dedicated time for quality improvement, mentorship and coaching and a professional quality improvement network were significantly related to higher self-efficacy. Factors enhancing effectiveness were dedicated time for quality improvement, multidisciplinary improvement teams, professional development in quality improvement, ability to select areas for improvement and organizational values and culture. Inadequate time, mentorship, organizational support and access to professional development resources were key barriers. Personal strengths contributing to effectiveness were the ability to identify problems that need to be fixed, reflecting on and learning from experiences and facilitating sharing of ideas. Key quality improvement implementation challenges were adopting new payment models, demonstrating the business case for quality and safety and building a culture of accountability and transparency. CONCLUSIONS Our findings highlight areas that organizations and professional development programs should focus on to promote clinician development and engagement in quality improvement. Barriers related to training, time, mentorship, organizational support and implementation must be concurrently addressed to augment the effectiveness of other approaches.
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Affiliation(s)
- Ulfat Shaikh
- General Pediatrics, University of California Davis Health, 2516 Stockton Blvd, 3rd Floor, Sacramento, CA 95817, USA
| | - Peter Lachman
- International Society for Quality in Healthcare (ISQua), 4th Floor, Huguenot House, 35-38 St Stephens Green, Dublin 2, Ireland
| | - Andrew J Padovani
- Center for Healthcare Policy and Research, University of California at Davis, 2103 Stockton Blvd, Sacramento, CA 95817, USA
| | - SiobhÁn E McCarthy
- Institute of Leadership, Royal College of Surgeons in Ireland, Reservoir House, Ballymoss Road, Sandyford, Dublin 18, Ireland
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Petit Dit Dariel O, Cristofalo P. Improving patient safety in two French hospitals: why teamwork training is not enough. J Health Organ Manag 2020; ahead-of-print. [PMID: 32737962 DOI: 10.1108/jhom-02-2020-0045] [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 The persistent challenges that healthcare organizations face as they strive to keep patients safe attests to a need for continued attention. To contribute to better understanding the issues currently defying patient safety initiatives, this paper reports on a study examining the aftermath of implementing a national team training program in two hospital units in France. DESIGN/METHODOLOGY/APPROACH Data were drawn from a longitudinal qualitative study analyzing the implementation of a French patient safety program aimed at improving teamwork in hospitals. Data collection took place over a four-year period (2015-2019) in two urban hospitals in France and included multiple interviews with 31 participants and 150 h of observations. FINDINGS Despite explicit efforts to improve inter-professional teamwork, three main obstacles interfered with healthcare professionals' attempts at safeguarding patients: perspectival variations in what constituted "patient safety", a paradoxical injunction to do more with less and conflicting organizational priorities. ORIGINALITY/VALUE This paper exposes patient safety as misleadingly consensual and identifies a lack of alignment between stakeholders in the complex system that is a hospital. This ultimately interferes with patient safety objectives and highlights that even well-equipped, frontline actors cannot achieve long-term results without more systemic organizational changes.
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Evaluation of initial progress to implement Common Metrics across the NIH Clinical and Translational Science Awards (CTSA) Consortium. J Clin Transl Sci 2020; 5:e25. [PMID: 33948248 PMCID: PMC8057371 DOI: 10.1017/cts.2020.517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Introduction The Clinical and Translational Science Awards (CTSA) Consortium, about 60 National Institutes of Health (NIH)-supported CTSA hubs at academic health care institutions nationwide, is charged with improving the clinical and translational research enterprise. Together with the NIH National Center for Advancing Translational Sciences (NCATS), the Consortium implemented Common Metrics and a shared performance improvement framework. Methods Initial implementation across hubs was assessed using quantitative and qualitative methods over a 19-month period. The primary outcome was implementation of three Common Metrics and the performance improvement framework. Challenges and facilitators were elicited. Results Among 59 hubs with data, all began implementing Common Metrics, but about one-third had completed all activities for three metrics within the study period. The vast majority of hubs computed metric results and undertook activities to understand performance. Differences in completion appeared in developing and carrying out performance improvement plans. Seven key factors affected progress: hub size and resources, hub prior experience with performance management, alignment of local context with needs of the Common Metrics implementation, hub authority in the local institutional structure, hub engagement (including CTSA Principal Investigator involvement), stakeholder engagement, and attending training and coaching. Conclusions Implementing Common Metrics and performance improvement in a large network of research-focused organizations proved feasible but required substantial time and resources. Considerable heterogeneity across hubs in data systems, existing processes and personnel, organizational structures, and local priorities of home institutions created disparate experiences across hubs. Future metric-based performance management initiatives across heterogeneous local contexts should anticipate and account for these types of differences.
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Salindera S, Brennan M. Development of the 'People-Processes-Paradigm' critical analysis tool for mortality and morbidity reviews: improving understanding of systems factors. ANZ J Surg 2020; 90:984-990. [PMID: 32418366 DOI: 10.1111/ans.15919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 03/10/2020] [Accepted: 04/02/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The impact of systems problems and human factors on delivering safe, high-quality patient care is well recognized. In the surgical setting, mortality and morbidity reviews (MMRs) are the key forum for reviewing and analysing adverse events in patient care yet there is a paucity of simple tools for undertaking such analyses. The aim of this study was to develop and pilot a new tool for analysing mortality and morbidity cases incorporating human factors and systems analysis. METHODS The published literature, professional standards, guidelines and existing audit tools for MMRs were reviewed. The 'People-Processes-Paradigm' tool was developed and pilot testing was undertaken and stakeholder feedback was obtained. RESULTS Models found for undertaking systems-based analysis of adverse surgical events included the 3D model, SEIPS and the Queensland Health human error and patient safety (HEAPS) Incident Management Tool. Guidelines for standards in MMRs are provided by the Royal Australasian College of Surgeons, New South Wales Clinical Excellence Commission and Australia and New Zealand audit of surgical mortality (ANZASM). The People-Processes-Paradigm model incorporates these standards and evidence-based systems analysis tools into a single effective tool. The pilot study evaluating the use of this tool demonstrated it to be practical and easily applicable to regular use by clinicians, with the ability to be tailored to individual health service use. Improvements such as electronic format and clarification of case selection processes were recommended by users. CONCLUSION The People-Processes-Paradigm tool has been developed for surgeons by surgeons incorporating current professional, legal and regulatory requirements in Australasia, easily transferrable to electronic platforms. This model requires further testing for validation.
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Affiliation(s)
- Shehnarz Salindera
- The University of Oxford, Oxford, UK.,Coffs Harbour Hospital, Coffs Harbour, New South Wales, Australia
| | - Meagan Brennan
- Westmead Breast Cancer Institute, The University of Sydney, Sydney, New South Wales, Australia
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Fonseca J, Violette R, Houle SK, Dolovich L, McCarthy LM, Waite NM. Helping Unlock Better Care (HUB|C) using quality improvement science in community pharmacies - An implementation method. Res Social Adm Pharm 2020; 17:572-577. [PMID: 32487368 DOI: 10.1016/j.sapharm.2020.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Community pharmacists' optimal scope of practice extends far beyond traditional dispensing or compounding, and health promotion or chronic disease management services based in the pharmacy can generate significant social and economic value. But, with many competing demands and performance expectations from patients, payers, and policymakers, many pharmacies face challenges when introducing, maintaining, optimizing, or integrating their service offerings. Quality Improvement (QI) science may provide a practical change management framework for pharmacy professionals to lead their teams in embracing optimal scope and in making pharmacy-based services more feasible and attractive for all parties. PROJECT AIMS To build community pharmacies' capacity for continuous QI (CQI) and to understand how the implementation of CQI is best achieved in this setting. METHODS Community pharmacies will undertake a process of change within one or more existing pharmacy services. Participatory action research principles will empower these sites to identify their own opportunities for improvement, generate change ideas, and trial and study those ideas in practice, using a QI system built on the Model for Improvement and Plan-Do-Study-Act (PDSA) cycles. An external Quality Facilitator will consult and train an internal Change Champion and other pharmacy staff to use QI tools and strategy. Mixed methods will be used to explore changes in pharmacy service quality, and to understand the experience of the pharmacy professionals taking part in the QI process. INTENDED OUTCOMES To assess the capacity and willingness of community pharmacies to undertake self-directed QI initiatives, with the support of an external Quality Facilitator and an established QI approach. Understandings surrounding the transferability of this process, including further scale-up, and the production of additional change management tools are additional potential outcomes of this work.
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Affiliation(s)
- Joseph Fonseca
- University of Waterloo School of Pharmacy, 10A Victoria St S, Kitchener, ON, N2G 1C5, Canada; OPEN, Ontario Pharmacy Evidence Network, Canada
| | - Richard Violette
- University of Waterloo School of Pharmacy, 10A Victoria St S, Kitchener, ON, N2G 1C5, Canada; OPEN, Ontario Pharmacy Evidence Network, Canada; School of Human Services and Social Work, Griffith University, 68 University Dr, Meadowbrook, Queensland, 4131, Australia
| | - Sherilyn Kd Houle
- University of Waterloo School of Pharmacy, 10A Victoria St S, Kitchener, ON, N2G 1C5, Canada; OPEN, Ontario Pharmacy Evidence Network, Canada
| | - Lisa Dolovich
- OPEN, Ontario Pharmacy Evidence Network, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON, M5S 3M2, Canada; Department of Family Medicine, McMaster University, 100 Main St W, Hamilton, ON, L8P 1H6, Canada
| | - Lisa M McCarthy
- OPEN, Ontario Pharmacy Evidence Network, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON, M5S 3M2, Canada; Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada; Women's College Research Institute, 76 Grenville St, Toronto, ON, N5G 1N8, Canada
| | - Nancy M Waite
- University of Waterloo School of Pharmacy, 10A Victoria St S, Kitchener, ON, N2G 1C5, Canada; OPEN, Ontario Pharmacy Evidence Network, Canada.
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Abstract
OBJECTIVES Care transitions between hospitals and skilled nursing facilities (SNFs) are associated with disruptions in patient care and high risk for adverse events. Communication between hospital-based and SNF-based clinicians is often suboptimal; there have been calls to foster direct, real-time communication between sending and receiving clinicians to enhance patient safety. This article described the implementation of a warm handoff between hospital and SNF physicians and advanced practice providers at the time of hospital discharge. METHODS Before patient transfer, hospital clinicians called SNF clinicians to provide information relevant to the continuation of safe patient care and offer SNF clinicians the opportunity to ask clarifying questions. The calls were documented in the hospital discharge summary. RESULTS A total of 2417 patient discharges were eligible for inclusion. Warm handoffs were documented at an increasing rate throughout implementation of the intervention, beginning with 15.78% (n = 3) in stage 1, then 20.27% (n = 75) in stage 2, and finally 46.89% (n = 951) in stage 3. The overall average rate of documentation was 42.57%. Participant feedback indicated that clinicians were most concerned about understanding the purpose of the warm handoff, managing their workload, and improving the efficiency of the process. CONCLUSIONS Use of a warm handoff showed promise in improving communication during hospital-SNF patient transfers. However, the implementation also highlighted specific barriers to the handoff related to organizational structures and clinician workload. Addressing these underlying issues will be critical in ensuring continued participation and support for efforts that foster direct communication among clinicians from different healthcare institutions.
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Kuchinad K, Sharma R, Isenberg SR, Hamayel NAA, Weaver SJ, Zhu J, Hannum SM, Kamal AH, Walling AM, Lorenz KA, Ailon J, Dy SM. Perceptions of Facilitators and Barriers to Measuring and Improving Quality in Palliative Care Programs. Am J Hosp Palliat Care 2020; 37:1022-1028. [PMID: 32336104 DOI: 10.1177/1049909120916702] [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: 11/15/2022] Open
Abstract
OBJECTIVE To examine perceptions of facilitators and barriers to quality measurement and improvement in palliative care programs and differences by professional and leadership roles. METHODS We surveyed team members in diverse US and Canadian palliative care programs using a validated survey addressing teamwork and communication and constructs for educational support and training, leadership, infrastructure, and prioritization for quality measurement and improvement. We defined key facilitators as constructs rated ≥4 (agree) and key barriers as those ≤3 (disagree) on 1 to 5 scales. We conducted multivariable linear regressions for associations between key facilitators and barriers and (1) professional and (2) leadership roles, controlling for key program and respondent factors and clustering by program. RESULTS We surveyed 103 respondents in 11 programs; 45.6% were physicians and 50% had leadership roles. Key facilitators across sites included teamwork, communication, the implementation climate (or environment), and program focus on quality improvement. Key barriers included educational support and incentives, particularly for quality measurement, and quality improvement infrastructure such as strategies, systems, and skilled staff. In multivariable analyses, perceptions did not differ by leadership role, but physicians and nurse practitioners/nurses/physician assistants rated most constructs statistically significantly more negatively than other team members, especially for quality improvement (6 of the 7 key constructs). CONCLUSIONS Although participants rated quality improvement focus and environment highly, key barriers included lack of infrastructure, especially for quality measurement. Building on these facilitators and measuring and addressing these barriers might help programs enhance palliative care quality initiatives' acceptability, particularly for physicians and nurses.
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Affiliation(s)
| | - Ritu Sharma
- Department of Health Policy and Management, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sarina R Isenberg
- Department of Health Policy and Management, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Temmy Latner Centre for Palliative Care, 518775Sinai Health System, Toronto, Ontario, Canada.,Division of Palliative Care, Department of Family and Community Medicine, 7938University of Toronto, Ontario, Canada.,Institute for Health Policy, Management and Evaluation, 7938University of Toronto, Ontario, Canada
| | - Nebras Abu Al Hamayel
- Department of Health Policy and Management, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Junya Zhu
- 1466Yale University, New Haven, CT, USA
| | - Susan M Hannum
- Department of Health, Behavior and Society, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Arif H Kamal
- Duke Cancer Institute and Duke Fuqua School of Business, 3065Duke University, Durham, NC, USA
| | - Anne M Walling
- 19975VA Greater Los Angeles Health System, Los Angeles, CA, USA.,19975University of California, Los Angeles, CA, USA
| | | | - Jonathan Ailon
- Division of Palliative Care, Department of Medicine, 7938University of Toronto, Ontario, Canada
| | - Sydney M Dy
- 1466Johns Hopkins School of Medicine, Baltimore, MD, USA.,Department of Health Policy and Management, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Smith MA, Nordby PA, Yu M, Jaffery J. A practical model for research with learning health systems: Building and implementing effective complex case management. APPLIED ERGONOMICS 2020; 84:103023. [PMID: 31983393 DOI: 10.1016/j.apergo.2019.103023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 09/27/2019] [Accepted: 11/29/2019] [Indexed: 06/10/2023]
Abstract
For researchers to contribute meaningfully to the creation of learning health systems, practical tools are required to operationalize existing conceptual frameworks. We describe a model currently in use by the University of Wisconsin Health Innovation Program (HIP). The HIP model consolidates and enhances existing learning health system frameworks by defining specific steps needed to create sustainable change based on research conducted within the health system. As an example of the model's application, we describe its use to improve patient identification for the University of Wisconsin health system's case management program. Our case study shows the importance of culture, infrastructure, and strong leadership support in realizing a learning health systems research project and creating sustainable change within the health system. By articulating the foundational elements and steps to conduct research with learning health systems, our model supports researchers in achieving the challenge of moving learning health systems from concept to action.
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Affiliation(s)
- Maureen A Smith
- Department of Population Health Sciences, University of Wisconsin - Madison School of Medicine and Public Health, Madison, WI, USA; Department of Family Medicine and Community Health, University of Wisconsin - Madison School of Medicine and Public Health, Madison, WI, USA; Health Innovation Program, University of Wisconsin - Madison School of Medicine and Public Health, Madison, WI, USA.
| | - Peter A Nordby
- Health Innovation Program, University of Wisconsin - Madison School of Medicine and Public Health, Madison, WI, USA
| | - Menggang Yu
- Department of Biostatistics and Medical Informatics, University of Wisconsin - Madison School of Medicine and Public Health, Madison, WI, USA
| | - Jonathan Jaffery
- Office of Population Health, UW Health, Madison, WI, USA; Department of Medicine, University of Wisconsin - Madison School of Medicine and Public Health, Madison, WI, USA
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Abstract
Annually, an estimated 234 million major surgical operations occur worldwide, with concomitant seven million complications and one million deaths. It is now well established that technical competence is necessary, but not sufficient for modern surgical practice and outcomes. Breakdown in non-technical skills has been attributed as a key root cause for near misses and patient harm in the operating room. This article discusses the multi-faceted skills-set that is necessary for the modern surgeon to succeed and for optimal patient outcomes. This includes technical skills, non-technical skills, with a focus on key CanMEDS framework domains, including leadership, communication, evidence-based surgery and mentorship.
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Affiliation(s)
- Ankur Khajuria
- Department of Surgery and Cancer, Imperial College London, UK.,Kellogg College, University of Oxford, UK
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Scott IA, Kallie J, Gavrilidis A. Achieving greater clinician engagement and impact in health care improvement: a neglected imperative. Med J Aust 2019; 212:5-7.e1. [DOI: 10.5694/mja2.50438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ian A Scott
- Princess Alexandra Hospital Brisbane QLD
- University of Queensland Brisbane QLD
| | - Jennifer Kallie
- Brisbane Diamantina Health PartnersTranslational Research Institute Brisbane QLD
| | - Areti Gavrilidis
- Brisbane Diamantina Health PartnersTranslational Research Institute Brisbane QLD
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Shaw G, Smith N, Khowaja A, Mitton C, Denis JL, Lovato C. Strategies to increase physician engagement in acute care settings: a scoping review. J Health Organ Manag 2019. [DOI: 10.1108/jhom-08-2019-0237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Despite growing attention to physician engagement there is a lack of literature to guide the development of physician-led interventions. A scoping review was conducted to describe physician-led strategies that have been implemented to promote increased physician engagement in acute care settings. Strategies are viewed through the theoretical lens of institutional work to advance the understanding about how the theory can be applied. The paper aims to discuss this issue.
Design/methodology/approach
Searches were conducted in English-language publications (2012–2017). Of 35 retained articles, 15 were from the gray literature; and 20 were peer reviewed. The review was guided by Arskey and O’Malley’s (2005) five-stage process.
Findings
Five themes reflecting different foci of physician-led activity were examined from the perspective of institutional work: systematically analyze context using participatory methods; work collaboratively toward locally defined, shared targets and build in processes to monitor progress; expand physicians’ role and capacity to include leadership toward shared organizational goals; promote appropriate rewards and incentives for work that builds engagement; and invest in opportunities for formal and informal communication and interaction.
Practical implications
Physicians considering action to increase their engagement in system improvement may benefit from analysis of local opportunities and barriers in selecting context-relevant activities that will motivate participation and build engagement through a balance of institutional work.
Originality/value
The paper considers the potential for physicians to initiate and support activity that will increase their engagement. It provides pragmatic strategies for designing intervention and research using the theoretical lens of institutional work.
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Jones KJ, Skinner A, Venema D, Crowe J, High R, Kennel V, Allen J, Reiter‐Palmon R. Evaluating the use of multiteam systems to manage the complexity of inpatient falls in rural hospitals. Health Serv Res 2019; 54:994-1006. [PMID: 31215029 PMCID: PMC6736913 DOI: 10.1111/1475-6773.13186] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To evaluate the implementation and outcomes of evidence-based fall-risk-reduction processes when those processes are implemented using a multiteam system (MTS) structure. DATA SOURCES/STUDY SETTING Fall-risk-reduction process and outcome measures from 16 small rural hospitals participating in a research demonstration and dissemination study from August 2012 to July 2014. Previously, these hospitals lacked a fall-event reporting system to drive improvement. STUDY DESIGN A one-group pretest-posttest embedded in a participatory research framework. We required hospitals to implement MTSs, which we supported by conducting education, developing an online toolkit, and establishing a fall-event reporting system. DATA COLLECTION Hospitals used gap analyses to assess the presence of fall-risk-reduction processes at study beginning and their frequency and effectiveness at study end; they reported fall-event data throughout the study. PRINCIPAL FINDINGS The extent to which hospitals implemented 21 processes to coordinate the fall-risk-reduction program and trained staff specifically about the program predicted unassisted and injurious fall rates during the end-of-study period (January 2014-July 2014). Bedside fall-risk-reduction processes were not significant predictors of these outcomes. CONCLUSIONS Multiteam systems that effectively coordinate fall-risk-reduction processes may improve the capacity of hospitals to manage the complex patient, environmental, and system factors that result in falls.
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Affiliation(s)
- Katherine J. Jones
- College of Allied Health ProfessionsUniversity of Nebraska Medical CenterOmahaNebraska
| | - Anne Skinner
- College of Allied Health ProfessionsUniversity of Nebraska Medical CenterOmahaNebraska
| | - Dawn Venema
- College of Allied Health ProfessionsUniversity of Nebraska Medical CenterOmahaNebraska
| | - John Crowe
- Department of PsychologyUniversity of Nebraska at OmahaOmahaNebraska
| | - Robin High
- College of Public HealthUniversity of Nebraska Medical CenterOmahaNebraska
| | - Victoria Kennel
- College of Allied Health ProfessionsUniversity of Nebraska Medical CenterOmahaNebraska
| | - Joseph Allen
- Department of PsychologyUniversity of Nebraska at OmahaOmahaNebraska
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Struthers A, Metge C, Charette C, Harlos K, Bapuji SB, Beaudin P, Botting I, Katz A, Kreindler S. Primary care renewal strategies in Manitoba: Family physicians' perceptions. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2019; 65:e397-e404. [PMID: 31515327 PMCID: PMC6741804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To understand family physicians' perceptions of Manitoba's strategies for primary care renewal or reform (PCR). DESIGN Qualitative substudy of an explanatory case study. SETTING Rural and urban Manitoba. PARTICIPANTS A total of 60 family physicians (31 fee-for-service physicians, 26 alternate-funded physicians, and 3 physicians representing provincial physician organizations). METHODS Semistructured interviews and focus groups. MAIN FINDINGS Many physicians were hesitant to participate in PCR initiatives, perceiving clear risks but uncertain benefits to patients and providers. Additional barriers to participation included concerns about the adequacy and import of communication about PCR, the meaningfulness of opportunities for physician "voice," and the trustworthiness of decision makers. There was an appetite for tailored, clinic-level support in addressing concrete, physician-identified problems; however, the initiatives on offer were not widely viewed as providing such support. CONCLUSION Although some of the observed barriers might fade over time, concentrating PCR efforts on the everyday realities of family physician practice might be the best way to build a primary care system that works for patients and providers.
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Affiliation(s)
- Ashley Struthers
- Research associate with the Evaluation Platform of the George and Fay Yee Centre for Healthcare Innovation at the University of Manitoba in Winnipeg.
| | - Colleen Metge
- Associate Professor in the Department of Community Health Sciences at the University of Manitoba
| | - Catherine Charette
- Researcher with the Evaluation Platform of the George and Fay Yee Centre for Healthcare Innovation and Assistant Professor (part-time member) with the Department of Community Health Sciences at the University of Manitoba
| | - Karen Harlos
- Professor in the Department of Business and Administration at the University of Winnipeg
| | - Sunita Bayyavarapu Bapuji
- Former research associate for the Evaluation Platform of the George and Fay Yee Centre for Healthcare Innovation and is currently Research Officer with the Australian Health Practitioner Regulation Agency in Melbourne, Australia
| | - Paul Beaudin
- Researcher with the Evaluation Platform of the George and Fay Yee Centre for Healthcare Innovation
| | - Ingrid Botting
- Assistant Professor in the Department of Community Health Sciences at the University of Manitoba, Corporate Secretary with the Winnipeg Regional Health Authority, and former Director of Health Services Integration for the Winnipeg Regional Health Authority Family Medicine-Primary Care program
| | - Alan Katz
- Professor in the Department of Family Medicine and the Department of Community Health Sciences and Manitoba Health Research Council Chair in Primary Prevention Research at the University of Manitoba
| | - Sara Kreindler
- Researcher with the Health System Performance Platform of the George and Fay Yee Centre for Healthcare Innovation, Assistant Professor in the Department of Community Health Sciences, and Manitoba Research Chair in Health System Innovation at the University of Manitoba
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Mummery TA, John M, Stokes SM. A quality improvement project to assess the use of preventative measures against acute alveolar osteitis. BDJ Open 2019; 5:10. [PMID: 31258931 PMCID: PMC6594952 DOI: 10.1038/s41405-019-0019-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/23/2019] [Accepted: 04/28/2019] [Indexed: 11/09/2022] Open
Abstract
Aims A quality improvement project was conducted in a General Dental Practice environment. The aim was to reduce the rate of Acute Alveolar Osteitis, which was locally found to be at 19.4%. Methods A range of quality improvement tools were utilised to determine and measure potential interventions, and the results from the initial Plan-Do-Study-Act cycle utilising perioperative 0.2% Chlorhexidine as a preventative method are presented. Results The use of perioperative 0.2% Chlorhexidine mouthwash showed an absolute risk reduction of 6.2%. Discussion Generalisation from the results is highly dependent on local factors, although the favourable reduction in acute alveolar osteitis and cost savings found supported the project. Conclusions This project highlights the strengths of Quality Improvement methodologies in implementing and assessing changes to improve service provision and patient outcomes.
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Affiliation(s)
| | - Miriam John
- LINCymru Clinical Lead, Quality Improvement Skills Training Section, Health Education and Improvement Wales, Cardiff, UK
| | - Susan Mary Stokes
- Dental Educator Quality Improvement, Dental Postgraduate Section Health Education Improvement Wales, Cardiff, UK
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Giannitrapani KF, Rodriguez H, Huynh AK, Hamilton AB, Kim L, Stockdale SE, Needleman J, Yano EM, Rubenstein LV. How middle managers facilitate interdisciplinary primary care team functioning. Healthcare (Basel) 2019; 7:10-15. [DOI: 10.1016/j.hjdsi.2018.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/28/2018] [Accepted: 11/12/2018] [Indexed: 12/01/2022] Open
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Leggat SG, Balding C. Effective quality systems: implementation in Australian public hospitals. Int J Health Care Qual Assur 2019; 31:1044-1057. [PMID: 30415611 DOI: 10.1108/ijhcqa-02-2017-0037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to review the implementation of seven components of quality systems (QSs) linked with quality improvement in a sample of Australian hospitals. DESIGN/METHODOLOGY/APPROACH The authors completed a systematic review to identify QS components associated with measureable quality improvement. Using mixed methods, the authors then reviewed the current state of these QS components in a sample of eight Australian hospitals. FINDINGS The literature review identified seven essential QS components. Both the self-evaluation and focus group data suggested that none of the hospitals had all of these seven components in place, and that there were some implementation issues with those components that were in use. Although board and senior executives could point to a large number of quality and safety documents that they felt were supporting a vision and framework for safe, high-quality care, middle managers and clinical staff described the QSs as compliance driven and largely irrelevant to their daily pursuit of safe, high-quality care. The authors also found little specific training in quality improvement for staff, lack of useful data for clinicians on the quality of care they provide and confusion about how organisational QSs work. PRACTICAL IMPLICATIONS This study provides a clearer picture of why QSs are not yet achieving the results that boards and executives want to achieve, and that patients require. ORIGINALITY/VALUE This is the first study to explore the implementation of QSs in hospitals in-depth from the perspective of hospital staff, linking the findings to the implementation of QS component identified in the literature.
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