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Ingel S, Drazdowski T, Rudes D, McCart M, Chapman J, Taxman F, Sheidow A. Juvenile Probation Officers’ Perceptions of Sanctions and Incentives as Compliance Strategies. JOURNAL OF APPLIED JUVENILE JUSTICE SERVICES 2022; 2022:27-41. [PMID: 37007431 PMCID: PMC10061776 DOI: 10.52935/22.9147.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In juvenile probation, noncompliance with probation conditions is a common occurrence. To deal with this, juvenile probation officers (JPOs) may use different strategies, such as sanctions and incentives. This study uses survey and focus group data from 19 JPOs to evaluate their perceptions of the effectiveness of sanctions and incentives in reducing youth noncompliance, specifically in the form of substance use. Results show that there are two distinct groups of JPOs: those who believe sanctions are an effective deterrent strategy and those who do not. Perceptually and demographically these two groups contain significant differences. Notably, both groups have similar views of social incentives, but JPOs who believe sanctions are ineffective are significantly more likely to have positive views of tangible incentives. This study has implications for how the field of juvenile probation can target JPO perceptions to move toward incentive-based strategies rather than sanction-based strategies for reducing youth substance use.
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Hill JE, Stephani AM, Sapple P, Clegg AJ. The effectiveness of continuous quality improvement for developing professional practice and improving health care outcomes: a systematic review. Implement Sci 2020; 15:23. [PMID: 32306984 PMCID: PMC7168964 DOI: 10.1186/s13012-020-0975-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 02/19/2020] [Indexed: 02/08/2023] Open
Abstract
Background Efforts to improve the quality, safety, and efficiency of health care provision have often focused on changing approaches to the way services are organized and delivered. Continuous quality improvement (CQI), an approach used extensively in industrial and manufacturing sectors, has been used in the health sector. Despite the attention given to CQI, uncertainties remain as to its effectiveness given the complex and diverse nature of health systems. This review assesses the effectiveness of CQI across different health care settings, investigating the importance of different components of the approach. Methods We searched 11 electronic databases: MEDLINE, CINAHL, EMBASE, AMED, Academic Search Complete, HMIC, Web of Science, PsycINFO, Cochrane Central Register of Controlled Trials, LISTA, and NHS EED to February 2019. Also, we searched reference lists of included studies and systematic reviews, as well as checking published protocols for linked papers. We selected randomized controlled trials (RCTs) within health care settings involving teams of health professionals, evaluating the effectiveness of CQI. Comparators included current usual practice or different strategies to manage organizational change. Outcomes were health care professional performance or patient outcomes. Studies were published in English. Results Twenty-eight RCTs assessed the effectiveness of different approaches to CQI with a non-CQI comparator in various settings, with interventions differing in terms of the approaches used, their duration, meetings held, people involved, and training provided. All RCTs were considered at risk of bias, undermining their results. Findings suggested that the benefits of CQI compared to a non-CQI comparator on clinical process, patient, and other outcomes were limited, with less than half of RCTs showing any effect. Where benefits were evident, it was usually on clinical process measures, with the model used (i.e., Plan-Do-Study-Act, Model of Improvement), the meeting type (i.e., involving leaders discussing implementation) and their frequency (i.e., weekly) having an effect. None considered socio-economic health inequalities. Conclusions Current evidence suggests the benefits of CQI in improving health care are uncertain, reflecting both the poor quality of evaluations and the complexities of health services themselves. Further mixed-methods evaluations are needed to understand how the health service can use this proven approach. Trial registration Protocol registered on PROSPERO (CRD42018088309).
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Affiliation(s)
- James E Hill
- Faculty of Health and Wellbeing, University of Central Lancashire (UCLan), Preston, Lancashire, PR1 2HE, UK
| | - Anne-Marie Stephani
- Faculty of Health and Wellbeing, University of Central Lancashire (UCLan), Preston, Lancashire, PR1 2HE, UK
| | | | - Andrew J Clegg
- Faculty of Health and Wellbeing, University of Central Lancashire (UCLan), Preston, Lancashire, PR1 2HE, UK.
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Price J, Man SL, Bartlett S, Taylor K, Dinwoodie M, Bowie P. Repeat prescribing of medications: A system-centred risk management model for primary care organisations. J Eval Clin Pract 2017; 23:779-796. [PMID: 28370904 PMCID: PMC5763272 DOI: 10.1111/jep.12718] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 01/10/2017] [Accepted: 01/11/2017] [Indexed: 12/01/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Reducing preventable harm from repeat medication prescriptions is a patient safety priority worldwide. In the United Kingdom, repeat prescriptions items issued has doubled in the last 20 years from 5.8 to 13.3 items per patient per annum. This has significant resource implications and consequences for avoidable patient harms. Consequently, we aimed to test a risk management model to identify, measure, and reduce repeat prescribing system risks in primary care. METHODS All 48 general medical practices in National Health Service (NHS) Lambeth Clinical Commissioning Group (an inner city area of south London in England) were recruited. Multiple interventions were implemented, including educational workshops, a web-based risk monitoring system, and external reviews of repeat prescribing system risks by clinicians. Data were collected via documentation reviews and interviews and subject to basic thematic and descriptive statistical analyses. RESULTS Across the 48 participating general practices, 62 unique repeat prescribing risks were identified on 505 occasions (eg, practices frequently experiencing difficulty interpreting medication changes on hospital discharge summaries), equating to a mean of 8.1 risks per practice (range: 1-33; SD = 7.13). Seven hundred sixty-seven system improvement actions were recommended across 96 categories (eg, alerting hospitals to illegible writing and delays with discharge summaries) with a mean of 15.6 actions per practice (range: 0-34; SD = 8.0). CONCLUSIONS The risk management model tested uncovered important safety concerns and facilitated the development and communication of related improvement recommendations. System-wide information on hazardous repeat prescribing and how this could be mitigated is very limited. The approach reported may have potential to close this gap and improve the reliability of general practice systems and patient safety, which should be of high interest to primary care organisations internationally.
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Affiliation(s)
| | - Shu Ling Man
- NHS Lambeth Clinical Commissioning Group, London, UK
| | | | | | | | - Paul Bowie
- Institute of Health and Wellbeing, University of Glasgow, UK
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Moshabela M, Sene M, Nanne I, Tankoano Y, Schaefer J, Niang O, Sachs SE. Early detection of maternal deaths in Senegal through household-based death notification integrating verbal and social autopsy: a community-level case study. BMC Health Serv Res 2015; 15:16. [PMID: 25609079 PMCID: PMC4323233 DOI: 10.1186/s12913-014-0664-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 12/16/2014] [Indexed: 11/10/2022] Open
Abstract
Background Reliable detection of maternal deaths is an essential prerequisite for successful diagnosis of barriers to care and formulation of relevant targeted interventions. In a community-level case study, the use of household-level surveillance in Senegal unveiled an apparent increase in maternal deaths, which triggered a rapid-cycle collaborative response to implement a multipronged set of quick-win and sustained interventions intended to improve quality care. Methods Part of a multi-country effort, the Millennium Villages Project is implementing a routine community-level information system in Senegal, able to detect maternal deaths in real-time and uncover clinical and social factors contributing to mortality. Within this geographically demarcated area of approximately 32 000 inhabitants, with a well-structured health system with patient referral services, deaths were registered and notified by community health workers, followed by timely verbal and social autopsies. Using the Pathway to Survival conceptual framework, case analysis and mortality reviews were conducted for evaluation and quality improvement purposes. Results The estimated maternal mortality rates rose from 67/100000 births in 2009 (1 death), to 202/100000 births in 2010 (3 deaths) and 392/100000 births (5 deaths) in 2011. Although absolute numbers of maternal deaths remained too small for robust statistical analysis, following verbal autopsy analyses in 2011, it became evident that an unexpectedly high proportion of maternal deaths were occurring at the referral hospital, mostly post-Caesarian section. Inadequate case management of post-partum haemorrhage at the referral hospital was the most frequently identified probable cause of death. A joint task team systematically identified several layers of inefficiencies, with a potential negative impact on a larger catchment area than the study community. Conclusions In this study, routine community-based surveillance identified inefficiencies at a tertiary level of care. Community-level surveillance systems that include pregnancy, birth and death tracking through household visits by community health workers , combined with verbal and social autopsy can identify barriers within the continuum of maternal care. Use of mHealth data collection tools sensitive enough to detect small changes in community-level mortality trends in real-time, can facilitate rapid-cycle quality improvement interventions, particularly when associated with social accountability structures of mortality reviews.
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Affiliation(s)
- Mosa Moshabela
- Department of Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Science Drive, Howard College, Fourth Floor, George Campbell Building, Durban, 4001, South Africa.
| | - Massamba Sene
- Millennium Promise, Columbia University, Dakar, Senegal.
| | - Ingrid Nanne
- Millennium Development Goal Centre, Columbia University, Dakar, Senegal.
| | - Yombo Tankoano
- Earth Institute, Columbia University, New York City, USA.
| | - Jennifer Schaefer
- School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Australia.
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Baskerville NB, Liddy C, Hogg W. Systematic review and meta-analysis of practice facilitation within primary care settings. Ann Fam Med 2012; 10:63-74. [PMID: 22230833 PMCID: PMC3262473 DOI: 10.1370/afm.1312] [Citation(s) in RCA: 344] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE This study was a systematic review with a quantitative synthesis of the literature examining the overall effect size of practice facilitation and possible moderating factors. The primary outcome was the change in evidence-based practice behavior calculated as a standardized mean difference. METHODS In this systematic review, we searched 4 electronic databases and the reference lists of published literature reviews to find practice facilitation studies that identified evidence-based guideline implementation within primary care practices as the outcome. We included randomized and nonrandomized controlled trials and prospective cohort studies published from 1966 to December 2010 in English language only peer-reviewed journals. Reviews of each study were conducted and assessed for quality; data were abstracted, and standardized mean difference estimates and 95% confidence intervals (CIs) were calculated using a random-effects model. Publication bias, influence, subgroup, and meta-regression analyses were also conducted. RESULTS Twenty-three studies contributed to the analysis for a total of 1,398 participating practices: 697 practice facilitation intervention and 701 control group practices. The degree of variability between studies was consistent with what would be expected to occur by chance alone (I2 = 20%). An overall effect size of 0.56 (95% CI, 0.43-0.68) favored practice facilitation (z = 8.76; P <.001), and publication bias was evident. Primary care practices are 2.76 (95% CI, 2.18-3.43) times more likely to adopt evidence-based guidelines through practice facilitation. Meta-regression analysis indicated that tailoring (P = .05), the intensity of the intervention (P = .03), and the number of intervention practices per facilitator (P = .004) modified evidence-based guideline adoption. CONCLUSION Practice facilitation has a moderately robust effect on evidence-based guideline adoption within primary care. Implementation fidelity factors, such as tailoring, the number of practices per facilitator, and the intensity of the intervention, have important resource implications.
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Affiliation(s)
- N Bruce Baskerville
- Propel Centre for Population Health Impact, University of Waterloo, Ontario, Canada.
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Swinglehurst D, Greenhalgh T, Russell J, Myall M. Receptionist input to quality and safety in repeat prescribing in UK general practice: ethnographic case study. BMJ 2011; 343:d6788. [PMID: 22053317 PMCID: PMC3208023 DOI: 10.1136/bmj.d6788] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2011] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To describe, explore, and compare organisational routines for repeat prescribing in general practice to identify contributors and barriers to safety and quality. DESIGN Ethnographic case study. SETTING Four urban UK general practices with diverse organisational characteristics using electronic patient records that supported semi-automation of repeat prescribing. PARTICIPANTS 395 hours of ethnographic observation of staff (25 doctors, 16 nurses, 4 healthcare assistants, 6 managers, and 56 reception or administrative staff), and 28 documents and other artefacts relating to repeat prescribing locally and nationally. MAIN OUTCOME MEASURES Potential threats to patient safety and characteristics of good practice. METHODS Observation of how doctors, receptionists, and other administrative staff contributed to, and collaborated on, the repeat prescribing routine. Analysis included mapping prescribing routines, building a rich description of organisational practices, and drawing these together through narrative synthesis. This was informed by a sociological model of how organisational routines shape and are shaped by information and communications technologies. Results Repeat prescribing was a complex, technology-supported social practice requiring collaboration between clinical and administrative staff, with important implications for patient safety. More than half of requests for repeat prescriptions were classed as "exceptions" by receptionists (most commonly because the drug, dose, or timing differed from what was on the electronic repeat list). They managed these exceptions by making situated judgments that enabled them (sometimes but not always) to bridge the gap between the idealised assumptions about tasks, roles, and interactions that were built into the electronic patient record and formal protocols, and the actual repeat prescribing routine as it played out in practice. This work was creative and demanded both explicit and tacit knowledge. Clinicians were often unaware of this input and it did not feature in policy documents or previous research. Yet it was sometimes critical to getting the job done and contributed in subtle ways to safeguarding patients. Conclusion Receptionists and administrative staff make important "hidden" contributions to quality and safety in repeat prescribing in general practice, regarding themselves accountable to patients for these contributions. Studying technology-supported work routines that seem mundane, standardised, and automated, but which in reality require a high degree of local tailoring and judgment from frontline staff, opens up a new agenda for the study of patient safety.
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Affiliation(s)
- Deborah Swinglehurst
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, London E1 2AT, UK.
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Addington D, Kyle T, Desai S, Wang J. Facilitators and barriers to implementing quality measurement in primary mental health care: Systematic review. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2010; 56:1322-1331. [PMID: 21375065 PMCID: PMC3001932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To identify facilitators and barriers to implementing quality measurement in primary mental healthcare as part of a large Canadian study (Continuous Enhancement of Quality Measurement) to identify and select key performances measures for quality improvement in primary mental health care.DATA SOURCES CINAHL, EMBASE, MEDLINE, and PsycINFO were searched, using various terms that represented the main concepts, for articles published in English between 1996 and 2005.STUDY SELECTION In consultation with a health sciences research librarian, the initial list of identified references was reduced to 702 abstracts, which were assessed for relevance by 2 coders using predetermined selection criteria. Following a consensus process, 34 articles were selected for inclusion in the analysis. An additional 106 citations were identified in the references of these articles, 14 of which were deemed relevant to this study, for a total of 57 empirical articles identified for review. Most articles described implementation of health care innovations and clinical practice guidelines, 5 focused on quality indicators, and 1 examined mental health indicators.SYNTHESIS Content analysis of the 57 articles identified 7 common categories of facilitators and barriers for implementing innovations, guidelines, and quality indicators: indicator characteristics, promotional strategies,implementation strategies, resources, individual-level factors, organizational-level factors, and external factors.Implementation studies in which these factors were addressed were more likely to achieve successful outcomes.CONCLUSION The overlap in facilitators and barriers across implementation of mental health indicators, healthcare innovations, and practice guidelines is not surprising, as they are often related. The overlap strengthens the findings of the limited number of studies of quality indicators. The Continuous Enhancement of Quality Measurement process for identification and selection of indicators has attended to some of these issues by using a rigorous scientific approach and by engaging a range of stakeholders in selecting and prioritizing the indicators.
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Affiliation(s)
- Donald Addington
- University of Calgary, Psychiatry, Foothills Hospital,1403 29th St NW, Calgary AB T2N 2T9; Canada.
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Exploring the fit between organizational culture and quality improvement in a home-care environment. Health Care Manage Rev 2010; 35:147-60. [DOI: 10.1097/hmr.0b013e3181cd1780] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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A systematic approach to practice assessment and quality improvement intervention tailoring. Qual Manag Health Care 2010; 18:268-77. [PMID: 19851234 DOI: 10.1097/qmh.0b013e3181bee268] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The ways in which tailored interventions foster sustained improvement in the quality of health care delivery across different practice settings are not well understood. Using the empirically developed Practice Change Model (PCM), we identify and describe assessment and tailoring activities with potential to enhance the fit between proposed interventions and practice settings. METHODS We obtained quantitative and qualitative data from 2 quality improvement trials conducted in diverse primary care practices in northeast Ohio. A multidisciplinary team used a PCM-based template to identify features of practice assessment and tailoring associated with practices' willingness and ability to change. RESULTS Our results suggest that intervention tailoring requires assessment of key stakeholders' motivations, external influences, resources and opportunities for change, and the interactions between these factors. Using this information, intervention tailoring then includes seeking and working with key stakeholders, building assets, providing options, keeping change processes flexible, offering feedback, providing exposure to scientific evidence, facilitating group processes, involving new partners, brainstorming, using stories/play acting/humor, assuming a consultant role, reframing, moving meetings off-site, and stepping back or pausing. CONCLUSIONS A model-driven approach guiding practice assessment enables tailored responses to the unique and emerging conditions that distinguish health care practices and influence implementation of quality management interventions.
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Abstract
'Creating a Patient-Led NHS' (Department of Health, 2005b) advises us to develop services with the patient at the centre of all that we do. In today's current agenda for reform and improvement, with the additional pressure on organizations to achieve Government performance targets where there is increasing demand and limited resources, it is sometimes difficult to provide the optimum patient experience. This article describes how a district general hospital used continuous quality improvement methodology to improve quality of care when developing a one-stop diagnostic clinic for patients urgently referred with suspected gynaecological cancer. As well as increasing clinic capacity and meeting access targets, redesigning the patient care pathway to improve services also provides the opportunity to build in patient choice and convenience. The article also discusses how clinical teams can involve patients when planning and evaluating services, and explores user involvement as a core component of continuous quality improvement methodology.
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Kelly DR, Lough M, Rushmer R, Wilkinson JE, Greig G, Davies HTO. Delivering feedback on learning organization characteristics--using a Learning Practice Inventory. J Eval Clin Pract 2007; 13:734-40. [PMID: 17824866 DOI: 10.1111/j.1365-2753.2006.00746.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Learning is recognized to be at the heart of the quality improvement process in the National Health Service (NHS). However, the challenge will be how to ensure that learning becomes embedded within the NHS culture. The aim of this study is to identify a robust feedback process and format in which practices could receive data on their responses to a Learning Practice Inventory (a diagnostic instrument designed to identify a practice's capacity for collective learning and change). METHOD Five practices volunteered to test the instrument, and it was distributed to all members of the primary care team. A process was worked through to identify different formats for presenting scores within and between practices. The preferred method of data presentation was sought, and an evaluation gathered information on the preferred form of feedback, the usefulness of the data, the clarity of the questions and the level of interest in receiving further information. RESULTS Eighty-five staff from five practices completed the questionnaire, and 61 individuals completed the evaluation forms. In most cases, there was a spread of scores by staff within practices and across the scale of 1-10. Medians were clustered at the learning practice end for all five practices. However, despite this skew, there were sometimes quite large differences between practices in their median scores. CONCLUSION Our study suggests that a robust feedback process on collective capacity for learning and change can be identified that is useful and feasible. A key implication is that some form of educational support is required, and this work will take place as part of an ongoing programme of research by the authors.
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Affiliation(s)
- Diane R Kelly
- NHS Education for Scotland, West of Scotland Region, Glasgow, UK.
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Wall RJ, Ely EW, Elasy TA, Dittus RS, Foss J, Wilkerson KS, Speroff T. Using real time process measurements to reduce catheter related bloodstream infections in the intensive care unit. Qual Saf Health Care 2006; 14:295-302. [PMID: 16076796 PMCID: PMC1744064 DOI: 10.1136/qshc.2004.013516] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PROBLEM Measuring a process of care in real time is essential for continuous quality improvement (CQI). Our inability to measure the process of central venous catheter (CVC) care in real time prevented CQI efforts aimed at reducing catheter related bloodstream infections (CR-BSIs) from these devices. DESIGN A system was developed for measuring the process of CVC care in real time. We used these new process measurements to continuously monitor the system, guide CQI activities, and deliver performance feedback to providers. SETTING Adult medical intensive care unit (MICU). KEY MEASURES FOR IMPROVEMENT Measured process of CVC care in real time; CR-BSI rate and time between CR-BSI events; and performance feedback to staff. STRATEGIES FOR CHANGE An interdisciplinary team developed a standardized, user friendly nursing checklist for CVC insertion. Infection control practitioners scanned the completed checklists into a computerized database, thereby generating real time measurements for the process of CVC insertion. Armed with these new process measurements, the team optimized the impact of a multifaceted intervention aimed at reducing CR-BSIs. EFFECTS OF CHANGE The new checklist immediately provided real time measurements for the process of CVC insertion. These process measures allowed the team to directly monitor adherence to evidence-based guidelines. Through continuous process measurement, the team successfully overcame barriers to change, reduced the CR-BSI rate, and improved patient safety. Two years after the introduction of the checklist the CR-BSI rate remained at a historic low. LESSONS LEARNT Measuring the process of CVC care in real time is feasible in the ICU. When trying to improve care, real time process measurements are an excellent tool for overcoming barriers to change and enhancing the sustainability of efforts. To continually improve patient safety, healthcare organizations should continually measure their key clinical processes in real time.
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Affiliation(s)
- R J Wall
- Veterans Affairs National Quality Scholars Program, Tennessee Valley Healthcare System, Nashville, TN, USA.
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Glen S, Reeves S. Developing interprofessional education in the pre-registration curricula: mission impossible? Nurse Educ Pract 2004; 4:45-52. [DOI: 10.1016/s1471-5953(03)00019-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2003] [Indexed: 11/28/2022]
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Harvey G, Wensing M. Methods for evaluation of small scale quality improvement projects. Qual Saf Health Care 2003; 12:210-4. [PMID: 12792012 PMCID: PMC1743722 DOI: 10.1136/qhc.12.3.210] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Evaluation is an integral component of quality improvement and there is much to be learned from the evaluation of small scale quality improvement initiatives at a local level. This type of evaluation is useful for a number of different reasons including monitoring the impact of local projects, identifying and dealing with issues as they arise within a project, comparing local projects to draw lessons, and collecting more detailed information as part of a bigger evaluation project. Focused audits and developmental studies can be used for evaluation within projects, while methods such as multiple case studies and process evaluations can be used to draw generalised lessons from local experiences and to provide examples of successful projects. Evaluations of small scale quality improvement projects help those involved in improvement initiatives to optimise their choice of interventions and use of resources. Important information to add to the knowledge base of quality improvement in health care can be derived by undertaking formal evaluation of local projects, particularly in relation to building theory around the processes of implementation and increasing understanding of the complex change processes involved.
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Affiliation(s)
- G Harvey
- Royal College of Nursing Institute, Radcliffe Infirmary, Oxford OX2 6HE, UK
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Wilcock PM, Brown GCS, Bateson J, Carver J, Machin S. Using patient stories to inspire quality improvement within the NHS Modernization Agency collaborative programmes. J Clin Nurs 2003; 12:422-30. [PMID: 12709117 DOI: 10.1046/j.1365-2702.2003.00780.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The importance of obtaining the opinions of service users has long been recognized and, traditionally, most contact has focused on measuring their satisfaction with the services they receive. However, there is little evidence that this has had much impact on improving care. The Discovery Interview Process, a technique for listening to patients and carers and using their narratives to improve care, is discussed in this article. This approach has been used in the pilot phases of the UK Coronary Heart Disease Collaborative and Critical Care Collaborative. These narratives develop understanding grounded in experience. Those delivering care can interpret the narratives using their own clinical and professional knowledge and experience to create better or new ways of meeting patients' and carers' needs. Using their own expert knowledge they can identify needs within the narratives, including those that patients and carers did not know they had. The principal techniques for gathering these narratives are outlined, and ways of using such data to inform patient-focused service improvements are discussed. Various locally sensitive methods for presenting the narratives to expert interprofessional teams are also described along with emerging experience of this feedback. We consider the Discovery Interview technique for gathering patient and carer narratives to be a potentially powerful method for informing quality improvements, discovering what really matters to patients and their carers. This pragmatic approach could prove manageable within local quality improvement projects.
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Affiliation(s)
- Peter Michael Wilcock
- Bournemouth University, Institute of Health & Community Studies, Royal London House, Bournemouth BH1 3LT, UK
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Wilcock PM, Campion-Smith C, Head M. The Dorset Seedcorn Project: interprofessional learning and continuous quality improvement in primary care. Br J Gen Pract 2002; 52 Suppl:S39-44. [PMID: 12389771 PMCID: PMC1316142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
There is a need to develop models of practice-based learning that are effective in bringing about improvement in the quality of care that patients receive. This paper describes a facilitated practice-based project where five general practices in Dorset formed interprofessional teams that worked over a six-month period using a continuous quality improvement (CQI) approach to make a change in areas of importance to them. All the teams completed the project and planned and implemented demonstrable changes. Qualitative enquiry showed changes in relationships and teamworking that extended beyond the specific topic of the project with teams reporting an enhanced sense of competence and achievement. The project facilitators were able to develop a model of learning that acknowledges and utilises the depth of experience and understanding within interprofessional practice teams. Protected time and an environment and processes that encourage full partcipation of a wide range of team members is essential.
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Affiliation(s)
- Peter M Wilcock
- Institute of Health and Community Studies, Bournemouth University, Dorset
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Fraser S, Wilson T, Burch K, Osborne M, Knightley M. Using collaborative improvement in a single organisation: improving anti‐coagulant care. Int J Health Care Qual Assur 2002. [DOI: 10.1108/09526860210431814] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Smith R. Quality improvement reports: a new kind of article. They should allow authors to describe improvement projects so others can learn. BMJ (CLINICAL RESEARCH ED.) 2000; 321:1428. [PMID: 11110723 PMCID: PMC1119157 DOI: 10.1136/bmj.321.7274.1428] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Geboers H. Implementing continuous quality improvement in general practice: the whole package or a series of projects? Qual Health Care 1999; 8:77. [PMID: 10557681 PMCID: PMC2483643 DOI: 10.1136/qshc.8.2.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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