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Ross D, Roerig M, Allin S, Marchildon G, Christenson J, Abu-Laban RB. A Global Survey of Emergency Care Clinical Networks: Discussion and Implications for Canadian Learning Health Systems. Healthc Policy 2023; 19:28-35. [PMID: 38105665 PMCID: PMC10751757 DOI: 10.12927/hcpol.2023.27235] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Clinical networks (CNs) can promote innovation and collaboration across providers and stakeholders. However, little is known about the structure and operations of CNs, particularly in emergency care. As Canada advances learning health systems (LHSs), foundational research is essential to enable future comparisons across CNs to identify those that contribute to positive system change. Drawing from the results of our international survey, we provide a description of 32 emergency care CNs worldwide, including their structure, operations and sustainability. Future research should consider the context of such networks, how they may contribute to an LHS and how they impact patient outcomes.
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Affiliation(s)
- Duncan Ross
- Learning Health Systems Data Analyst, BC Support Unit Michael Smith Health Research BC, Adjunct Professor, Department of Emergency Medicine Faculty of Medicine, University of British Columbia, Vancouver, BC
| | - Monika Roerig
- Research Coordinator, North American Observatory on Health Systems and Policies, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Sara Allin
- Associate Professor, North American Observatory on Health Systems and Policies, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Greg Marchildon
- Professor Emeritus, North American Observatory on Health Systems and Policies, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Jim Christenson
- Professor, Department of Emergency Medicine Faculty of Medicine, University of British Columbia, Senior Medical Advisor Emergency Care BC, Vancouver, BC
| | - Riyad B. Abu-Laban
- Professor, Department of Emergency Medicine Faculty of Medicine, University of British Columbia, Interim Scientific Director, Emergency Care BC, Vancouver, BC
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Adhikari DR, Shrestha P. Knowledge management initiatives for achieving sustainable development goal 4.7: higher education institutions’ stakeholder perspectives. JOURNAL OF KNOWLEDGE MANAGEMENT 2023. [DOI: 10.1108/jkm-03-2022-0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
Purpose
The purpose of this study is to explore knowledge management (KM) initiatives for achieving sustainable development goal (SDG) 4.7 and to investigate enablers and barriers to insert KM to prepare higher education institutions (HEIs) ready to contribute to SDGs’ performance. At the end, this paper provides a practical perspective of KM initiatives for higher education for sustainable development (HESD).
Design/methodology/approach
This is an exploratory study. It applies a descriptive-interpretative-qualitative approach. The analysis is based on the opinions collected from 170 HEIs’ stakeholders. Discussions among participants have been organized through zoom meetings, telephone interviews and focus group discussions in three phases. In the first phase, a total of 113 informants took part in the discussion on various dates. In the second phase, 10 interviews were conducted with university officials using three open-ended questions; and in the third phase, three focus group discussions were organized to interact about the effectiveness of the Masters in Business Administration in Global Leadership and Management programme and curriculum with teachers, students and the programme initiators.
Findings
From the analysis of stakeholders’ views, it appears that Nepalese HEIs have yet to move forward with integrating KM activities into their aims, structure and functions to address the government’s policy guidelines applicable to maximizing SDG’ performance. A KM cultural framework that values intellectual capital is urgently needed to fill the knowledge-doing gap for the benefit of society. HEIs appear to require multidisciplinary teaching, learning and research methods to play a civic role in society. They have to improve their rules and regulation, develop a boundary-spanning structure from a conventional structure and apply KM initiatives to support achieving SDGs’ performance. Understanding and inculcating these initiatives in the academic programmes could provide a value-adding higher education in the country.
Research limitations/implications
This paper is entirely based on the perspectives of stakeholders in higher education. So, understanding their points of view and perspectives may have resulted in vague explanations. Furthermore, because the setting of Nepal’s HEIs differs from that of developed countries, the results should only be interpreted in Nepalese contexts.
Practical implications
This paper acknowledges the gaps and complexities in Nepalese HEIs from the standpoints of HEIs’ leaders, teachers and students for the application of KM initiatives to reform HEIs, with HESD in consideration, and enhance SDGs’ performance.
Originality/value
To the best of the authors’ knowledge, the paper is the first of its kind in the context of Nepal, exploring KM initiatives for SDGs. It provides a new perspective on KM and comprehends KM initiatives in the case of Nepalese HEIs transformation into HESD for achieving SDG 4.7.
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Wind A, Oberst S, Westerhuis W, Blaauwgeers H, Sæter G, de Paoli P, Nagy P, Burrion JB, Jolly E, Lovey J, van Harten W. Evaluating comprehensive cancer networks; a review of standards and evaluation methods for care networks to inform a comparison with the OECI comprehensive cancer network standards. Acta Oncol 2023; 62:15-24. [PMID: 36786345 DOI: 10.1080/0284186x.2023.2170275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
INTRODUCTION To ensure that all citizens have equal access to high-quality cancer diagnosis and care, the EU4Health Programme, Europe's Beating Cancer Plan, and Horizon Europe's Cancer Mission propose Comprehensive Cancer Infrastructures in every European Union Member State. It is therefore important to establish the basic principles for high-performing cancer networks and a methodology for evaluating their quality and effectiveness. This article describes methods and standards/indicators for network evaluation found in literature, gives a comparative overview of the new OECI European Cancer Network Quality standards, and proposes principles for evaluating the performance of Comprehensive Cancer Networks as a basis for continuous improvement. MATERIALS AND METHODS We performed a scoping literature review on methods and standards/indicators for care-network evaluation. We then compared the OECI set with literature findings, categorised standards that were similar, reflected on standards that were different, and deduced principles for quality standards for cancer networks. RESULTS Of 1002 articles identified, 17 reported on evaluation methods and/or (mostly) qualitative indicators. Sixteen studies described indicators/standards for evaluating care networks, critical success factors or desirable outcomes. Of the 54 present OECI standards, 32 had a literature equivalent. No literature equivalent was found for 22 standards, especially on those related to the combination of care and research. The proposed OECI evaluation methods (survey, document review, and interviews) were all reported in the literature. From the conformity of these results, we deduced 8 principles for standards evaluating the effectiveness of Comprehensive Cancer Networks. CONCLUSIONS Research on the evaluation of the effectiveness of care networks is scarce. Evaluation methods vary and are often single time-point assessments. The OECI set contributes to establishing clear principles and standards to evaluate the effectiveness of Comprehensive Cancer Networks.
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Affiliation(s)
- Anke Wind
- Rijnstate Hospital, Arnhem, The Netherlands
| | - Simon Oberst
- Accreditation and Designation, Organisation of European Cancer Institutes, Brussels, Belgium
| | - Willien Westerhuis
- Accreditation and Designation, Organisation of European Cancer Institutes, Brussels, Belgium.,The Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Harriet Blaauwgeers
- Accreditation and Designation, Organisation of European Cancer Institutes, Brussels, Belgium.,The Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Gunnar Sæter
- Accreditation and Designation, Organisation of European Cancer Institutes, Brussels, Belgium.,Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Paolo de Paoli
- Accreditation and Designation, Organisation of European Cancer Institutes, Brussels, Belgium.,Alliance Against Cancer, Rome, Italy
| | - Péter Nagy
- Accreditation and Designation, Organisation of European Cancer Institutes, Brussels, Belgium.,National Institute of Oncology, Budapest, Hungary
| | - Jean-Benoit Burrion
- Accreditation and Designation, Organisation of European Cancer Institutes, Brussels, Belgium.,Institut Jules Bordet, Brussels, Belgium
| | - Eva Jolly
- Accreditation and Designation, Organisation of European Cancer Institutes, Brussels, Belgium.,Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - József Lovey
- Accreditation and Designation, Organisation of European Cancer Institutes, Brussels, Belgium.,National Institute of Oncology, Budapest, Hungary
| | - Wim van Harten
- Rijnstate Hospital, Arnhem, The Netherlands.,Accreditation and Designation, Organisation of European Cancer Institutes, Brussels, Belgium.,Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
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Marmo R, Pascale F, Diana L, Sicignano E, Polverino F. Lessons learnt for enhancing hospital resilience to pandemics: A qualitative analysis from Italy. INTERNATIONAL JOURNAL OF DISASTER RISK REDUCTION : IJDRR 2022; 81:103265. [PMID: 36061241 PMCID: PMC9419438 DOI: 10.1016/j.ijdrr.2022.103265] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
The COVID-19 pandemic has outlined the need to strengthen the resilience of healthcare systems. It has cost millions of human lives and has had indirect health impacts too. Hospital buildings have undergone extensive modifications and adaptations to ensure infection control and prevention measures, and, as it is happened following past epidemics, the COVID-19 experience might change the design of hospital buildings in the future. This paper aims to capitalise on the knowledge developed by the stakeholders directly involved with the hospital response during the pandemic to generate new evidence that will enhance resilience of hospital buildings to pandemics. The research adopted qualitative research methods, namely literature review and interviews with Italian experts including doctors and facility managers to collect data which were analysed through a thematic analysis. The findings include the identification of new needs for hospital buildings and the related actions to be taken or already performed at hospital building and service level which are viable for long term implementation and are aimed at improving hospital resilience to pandemics. The results specify how to improve resilience by means of structural modifications (e.g. placing filter zones among different wards, ensuring the presence of airborne infection isolation rooms at least in the emergency departments), technological changes (e.g. oversizing capacity such as medical gases, information technology improvement for delivering healthcare services remotely), and operational measures (e.g. assessing the risk of infection before admission, dividing acute-care from low-care assets). The needs discussed in this paper substantiate the urge to renovate the Italian healthcare infrastructures and they can be considered useful elements of knowledge for enhancing hospital resilience to pandemics in the extended and in the post-COVID-19 era.
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Affiliation(s)
- Rossella Marmo
- Department of Civil Engineering, University of Salerno, 84084, Fisciano, Italy
| | - Federica Pascale
- Faculty of Science and Engineering, Anglia Ruskin University, CM1 1SQ, Chelmsford, UK
| | - Lorenzo Diana
- Department of Civil, Building and Environmental Engineering, University of Naples "Federico II", 80138, Naples, Italy
| | - Enrico Sicignano
- Department of Civil Engineering, University of Salerno, 84084, Fisciano, Italy
| | - Francesco Polverino
- Department of Civil, Building and Environmental Engineering, University of Naples "Federico II", 80138, Naples, Italy
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Kierkegaard P, Owen-Smith J. Determinants of physician networks: an ethnographic study examining the processes that inform patterns of collaboration and referral decision-making among physicians. BMJ Open 2021; 11:e042334. [PMID: 33402408 PMCID: PMC7786804 DOI: 10.1136/bmjopen-2020-042334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 12/04/2020] [Accepted: 12/10/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Most scholarly attention to studying collaborative ties in physician networks has been devoted to quantitatively analysing large, complex datasets. While valuable, such studies can reduce the dynamic and contextual complexities of physician collaborations to numerical values. Qualitative research strategies can contribute to our understanding by addressing the gaps left by more quantitative approaches. This study seeks to contribute to the literature that applies network science approaches to the context of healthcare delivery. We use qualitative, observational and interview, methods to pursue an in-depth, micro-level approach to the deeply social and discursive processes that influence patterns of collaboration and referral decision-making in physician networks. DESIGN Qualitative methodologies that paired ethnographic field observations, semistructured interviews and document analysis were used. An inductive thematic analysis approach was used to analyse, identify and describe patterns in those data. SETTING This study took place in a high-volume cardiovascular department at a major academic medical centre (AMC) located in the Midwest region of the USA. PARTICIPANTS Purposive and snowballing sampling were used to recruit study participants for both the observational and face-to-face in-depth interview portions of the study. In total, 25 clinicians and 43 patients participated in this study. RESULTS Two primary thematic categories were identified: (1) circumstances for external engagement; and (2) clinical conditions for engagement. Thematic subcategories included community engagement, scientific engagement, reputational value, experiential information, professional identity, self-awareness of competence, multidisciplinary programmes and situational factors. CONCLUSION This study adds new contextual knowledge about the mechanisms that characterise referral decision-making processes and how these impact the meaning of physician relationships, organisation of healthcare delivery and the knowledge and beliefs that physicians have about their colleagues. This study highlights the nuances that influence how new collaborative networks are formed and maintained by detailing how relationships among physicians develop and evolve over time.
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Affiliation(s)
- Patrick Kierkegaard
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, London, UK
- CRUK Convergence Science Centre, Institute of Cancer Research & Imperial College London, London, UK
| | - Jason Owen-Smith
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
- Department of Sociology, University of Michigan, Ann Arbor, Michigan, USA
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Romiti A, Del Vecchio M, Sartor G. Network governance forms in healthcare: empirical evidence from two Italian cancer networks. BMC Health Serv Res 2020; 20:1018. [PMID: 33167969 PMCID: PMC7650201 DOI: 10.1186/s12913-020-05867-2] [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: 09/25/2019] [Accepted: 10/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background This study focuses on the application of Provan and Kenis’ modes of network governance to the specific field of public healthcare networks, extending the framework to an analysis of systems in which networks are involved. Thus, the aim of this study is to analyze and compare the governance of two cancer networks in two Italian regions that underwent system reconfiguration processes due to reforms in the healthcare system. Methods A qualitative study of two clinical networks in the Italian healthcare system was conducted. The sample for interviews included representatives of the regional administration (n = 4), network coordinators (n = 6), and general and clinical directors of health organizations involved in the two networks (n = 25). Data were collected using semi-structured interviews. Results Our study shows that healthcare system reforms have a limited impact on network governance structures. In fact, strong inertial tendencies characterize networks, especially network administrative organization models (NAO). Networks tend to find their own balance with respect to the trade-offs analyzed using a mix of formal and informal ties. Our study confirms the general validity of Provan and Kenis’ framework and shows how other specific factors and contingencies may affect the possibility that cancer networks find positive equilibria between competing needs of inclusivity and efficiency, internal and external legitimacy, and stability and flexibility. It also shows how networks react to external changes. Conclusions Our study shows the importance of considering three factors and contingencies that may affect network effectiveness: a) the importance of looking at network governance modes not in isolation, but in relationship to the governance of regional systems; b) the influence of a specific network’s governance structure on the network’s ability to respond to tensions and to achieve its goals; and c) the need to take into account the role of professionals in network governance.
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Affiliation(s)
- Anna Romiti
- Department of Experimental and Clinical Medicine, Health Services Research Unit, University of Florence, Florence, Italy.
| | - Mario Del Vecchio
- Department of Experimental and Clinical Medicine, Health Services Research Unit, University of Florence, Florence, Italy.,SDA Bocconi, Bocconi University, Milan, Italy
| | - Gino Sartor
- School of Specialization in Hygiene and Preventive Medicine, University of Florence, Florence, Italy
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Shaw G. National clinical programmes in the Republic of Ireland: a qualitative study of acute hospitals. J Res Nurs 2020; 25:421-440. [PMID: 34394656 DOI: 10.1177/1744987119893014] [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] [Indexed: 11/16/2022] Open
Abstract
Background The national clinical programmes (NCPs) were established in 2010 to achieve three objectives, namely: improve quality, access and cost effectiveness. Limited research exists on their implementation in the Republic of Ireland (ROI). This qualitative study identified key stakeholders' perceptions on (a) implementation thus far, and (b) conditions perceived necessary for implementation in acute hospitals. Aims The overall aim of this research was to undertake an in-depth study to explore from the perspectives of key stakeholders, their perceptions on implementation of the national clinical programmes, thus far, in relation to three overarching objectives (to improve quality, access, cost effectiveness) and what are the conditions necessary for their implementation in the Republic of Ireland's acute hospitals. Methods Twenty participants were interviewed using face-to-face audio-recorded semi-structured interviews. Transcribed data were coded and analysed, and a number of themes emerged from the dataset relating to the study aims. Results Implementation was perceived as being inconsistent. Outcomes were identified as: best practice guidelines, models of care, protocols, pathways; education & training; new services; improved discharges; improved patient outcomes; reduced length of stay; timely access; reduced waiting lists; cost effectiveness and other intangible outcomes. Sixteen conditions, under four themes, were perceived necessary for implementation, namely: Governance - structure, audit & monitoring, senior management support, accountability, and clear objectives and expectations; Communication - visible face-to-face engagement, internal awareness, and external awareness; Leadership - programme level, national level, hospital level, and professional level; Resources - budget, staff, information technology, training, skills, and competency. Conclusions This study adds to the existing limited body of knowledge on implementation of the NCPs in the acute hospitals in the ROI while contributing to the wider international literature in this area. The study provides hitherto unreported knowledge on the conditions that are perceived necessary for implementation. Novel in the ROI context is the perceived necessity to condense the number of NCPs, placing greater emphasis on (a) the need to structurally integrate the NCPs across the continuum of care, and (b) the importance of communication through visible face-to-face engagement. This study concludes that significant progress has been made by the NCPs towards meeting the objectives, albeit to varying degrees. There is a strong perception that the NCPs should remain, and that addressing the conditions perceived necessary for implementation in the areas of governance, communications, leadership and resources by both top-down senior health officials and bottom-up front-line hospital staff would significantly enhance the ability of the NCPs to meet objectives and implementation. It provides the ROI health services with valuable information to inform future reform, strategic planning and NCP implementation.
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Affiliation(s)
- Geraldine Shaw
- Nursing & Midwifery Services Director, Office of the Nursing and Midwifery Services Director (ONMSD), Assistant National Director, HSE, Adjunct Associate Professor University College Dublin School of Nursing, Ireland
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Sibbald S, Schouten K, Sedig K, Maskell R, Licskai C. Key characteristics and critical junctures for successful Interprofessional networks in healthcare - a case study. BMC Health Serv Res 2020; 20:700. [PMID: 32727464 PMCID: PMC7391486 DOI: 10.1186/s12913-020-05565-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 07/21/2020] [Indexed: 12/02/2022] Open
Abstract
Background The use of networks in healthcare has been steadily increasing over the past decade. Healthcare networks reduce fragmented care, support coordination amongst providers and patients, improve health system efficiencies, support better patient care and improve overall satisfaction of both patients and healthcare professionals. There has been little research to date on the implementation, development and use of small localized networks. This paper describes lessons learned from a successful small localized primary care network in Southwestern Ontario that developed and implemented a regional respiratory care program (The ARGI Respiratory Health Program - ARGI is a not-for-profit corporation leading the implementation and evaluation of a respiratory health program. Respiratory therapists (who have a certified respiratory educators designation), care for patients from all seven of the network’s FHTs. Patients rostered within the network of FHTs that have been diagnosed with a chronic respiratory disease are referred by their family physicians to the program. The RTs are integrated into the FHTs, and work in a triad along with patients and providers to educate and empower patients in self-management techniques, create exacerbation action plans, and act as a liaison between the patient’s care providers. ARGI uses an eTool designed specifically for use by the network to assist care delivery, choosing education topics, and outcome tracking. RTs are hired by ARGI and are contracted to the participating FHTs in the network.). Methods This study used an exploratory case study approach. Data from four participant groups was collected using focus groups, observations, interviews and document analysis to develop a rich understanding of the multiple perspectives associated with the network. Results This network’s success can be described by four characteristics (growth mindset and quality improvement focus; clear team roles that are strengths-based; shared leadership, shared success; and transparent communication); and five critical junctures (acknowledge a shared need; create a common vision that is flexible and adaptable depending on the context; facilitate empowerment; receive external validation; and demonstrate the impacts and success of their work). Conclusions Networks are used in healthcare to act as integrative, interdisciplinary tools to connect individuals with the aim of improving processes and outcomes. We have identified four general lessons to be learned from a successful small and localized network: importance of clear, flexible, and strengths-based roles; need for shared goals and vision; value of team support and empowerment; and commitment to feedback and evaluations. Insight from this study can be used to support the development and successful implementation of other similar locally developed networks.
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Affiliation(s)
- Shannon Sibbald
- Faculty of Health Sciences, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada. .,Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada. .,Western Center for Public Health and Family Medicine, 1465 Richmond Street, London, Ontario, N6G 2M1, Canada.
| | - Karen Schouten
- Faculty of Health Sciences, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada
| | - Kimia Sedig
- Faculty of Health Sciences, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada
| | - Rachelle Maskell
- Faculty of Health Sciences, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada
| | - Christopher Licskai
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada
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Abu-Laban RB, Drebit S, Svendson B, Chan N, Ho K, Khazei A, Lindstrom RR, Lund A, Marsden J, Christenson J. Process and findings informing the development of a provincial emergency medicine network. Healthc Manage Forum 2019; 32:253-258. [PMID: 31180243 DOI: 10.1177/0840470419844276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe the process undertaken to inform the development of the recently launched British Columbia (BC) Emergency Medicine Network (EM Network). Five methods were undertaken: (1) a scoping literature review, (2) a survey of BC emergency practitioners and EM residents, (3) key informant interviews, (4) focus groups in sites across BC, and (5) establishment of a brand identity. There were 208 survey respondents: 84% reported consulting Internet resources once or more per emergency department shift; however, 26% reported feeling neutral, somewhat unsatisfied, or very unsatisfied with searching for information on the Internet to support their practice. Enthusiasm was expressed for envisioned EM Network resources, and the key informant interviews and focus group results helped identify and refine key desired components of the EM Network. In describing this, we provide guidance and lessons learned for health leaders and others who aspire to establish similar clinical networks, whether in EM or other medical disciplines.
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Affiliation(s)
- Riyad B Abu-Laban
- 1 Department of Emergency Medicine, University of British Columbia, BC Emergency Medicine Network, Vancouver, British Columbia, Canada
| | - Sharla Drebit
- 1 Department of Emergency Medicine, University of British Columbia, BC Emergency Medicine Network, Vancouver, British Columbia, Canada
| | - Brandy Svendson
- 2 Be the Change Group Inc., Vancouver, British Columbia, Canada
| | - Natalie Chan
- 2 Be the Change Group Inc., Vancouver, British Columbia, Canada
| | - Kendall Ho
- 1 Department of Emergency Medicine, University of British Columbia, BC Emergency Medicine Network, Vancouver, British Columbia, Canada
| | - Afshin Khazei
- 1 Department of Emergency Medicine, University of British Columbia, BC Emergency Medicine Network, Vancouver, British Columbia, Canada
| | - Ronald R Lindstrom
- 1 Department of Emergency Medicine, University of British Columbia, BC Emergency Medicine Network, Vancouver, British Columbia, Canada
| | - Adam Lund
- 1 Department of Emergency Medicine, University of British Columbia, BC Emergency Medicine Network, Vancouver, British Columbia, Canada
| | - Julian Marsden
- 1 Department of Emergency Medicine, University of British Columbia, BC Emergency Medicine Network, Vancouver, British Columbia, Canada
| | - Jim Christenson
- 1 Department of Emergency Medicine, University of British Columbia, BC Emergency Medicine Network, Vancouver, British Columbia, Canada
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Lukeman S, Davies B, McPherson C, Etowa J. Understanding evidence-informed decision-making: a rural interorganizational breastfeeding network. BMC Health Serv Res 2019; 19:337. [PMID: 31133038 PMCID: PMC6537355 DOI: 10.1186/s12913-019-4138-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 05/01/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Networks are a vehicle for mobilizing knowledge, but there is little research about evidence-informed decision-making in community settings. Breastfeeding is a powerful intervention for population health; combined system and community interventions can increase exclusive breastfeeding rates by 2.5 times. This study examined evidence-informed decision-making within an interorganizational network, including the facilitators and barriers to achieving network goals. METHODS A mixed method case study design was used. The primary sources of data were focus group discussion and questionnaire administration. Data were analyzed concurrently using framework analysis and social network analysis. RESULTS Key findings were at the interorganizational and external levels: 1) Relationships and trust are connected to knowledge exchange 2) Need for multiple levels of leadership. CONCLUSIONS The findings of this study have potential implications for enhancing the use of evidence-informed decision-making as other networks work toward Baby Friendly Initiative (BFI) designation and also highlights the potential for network maps to be used as a knowledge mobilization tool.
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Affiliation(s)
- Sionnach Lukeman
- St. Francis Xavier University, PO BOX 5000, Antigonish, Nova Scotia B2G 2W5 Canada
| | - Barbara Davies
- Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1N 6N5 Canada
| | | | - Josephine Etowa
- Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1N 6N5 Canada
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De Pourcq K, De Regge M, Van den Heede K, Van de Voorde C, Paul G, Eeckloo K. The role of governance in different types of interhospital collaborations: A systematic review. Health Policy 2019; 123:472-479. [PMID: 30878172 DOI: 10.1016/j.healthpol.2019.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 01/13/2019] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
CONTEXT Financial challenges and the need for high-quality care have vastly increased the number of hospital collaborations in recent decades. The governance of these collaborations remains a challenge. The goal of this study is twofold: (1) to investigate the governance characteristics in an interhospital collaboration and (2) explore the impact on the performance of the interhospital collaboration. METHODS A systematic review was conducted to provide a comprehensive overview of the evidence on governance in interhospital collaborations. Database searches yielded 9304 candidate articles, of which 26 studies fulfilled the inclusion criteria. FINDINGS Governance in collaborations differs in collaboration structure, governance characteristics and contextual factors. Although outcome factors are influenced by contextual determinants and the collaboration structure itself, governance characteristics are of great importance. CONCLUSIONS A critical challenge for managers is to successfully adapt collaborations structures and governance characteristics to rapidly changing conditions. Policy makers should ensure that new legislation and guidelines for internal governance can be adapted to different contextual factors. Research in the future should investigate the impact of governance as a dynamic process. More longitudinal case study research is needed to provide an in-depth view of the relationship between this process and the performance of a collaboration.
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Affiliation(s)
- Kaat De Pourcq
- Department of Marketing, Innovation and Organisation, Ghent University, Tweekerkenstraat 2 9000 Ghent, Belgium.
| | - Melissa De Regge
- Department of Marketing, Innovation and Organisation, Ghent University, Tweekerkenstraat 2 9000 Ghent, Belgium; Strategic Policy Cell, Ghent University Hospital, De Pintelaan 185 9000 Ghent, Belgium.
| | - Koen Van den Heede
- Belgian Health Care Knowledge Centre, Kruidtuinlaan 55 1000 Brussels, Belgium.
| | | | - Gemmel Paul
- Department of Marketing, Innovation and Organisation, Ghent University, Tweekerkenstraat 2 9000 Ghent, Belgium.
| | - Kristof Eeckloo
- Strategic Policy Cell, Ghent University Hospital, De Pintelaan 185 9000 Ghent, Belgium; Department of Public Health, Faculty of Medicine and Health Science, Ghent University, De Pintelaan 185 9000 Ghent, Belgium.
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Achieving quadruple aim goals through clinical networks: A systematic review. J Healthc Qual Res 2019; 34:29-39. [PMID: 30713135 DOI: 10.1016/j.jhqr.2018.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/09/2018] [Accepted: 10/22/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Clinical Networks are complex interventions that enable healthcare professionals from various disciplines to work in a coordinated manner in the context of multiple care settings, to provide a high quality response to a specific disease. The aim of this study was to evaluate if clinical networks are able to improve effectiveness, efficiency, patients' satisfaction and professionals' behavior in the health care settings, namely the "quadruple aim" quality goals. MATERIALS AND METHODS A systematic review of documents published until February 28, 2018, in Medline, Embase and CINAHL was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach. A specific research strategy was created to identify studies evaluating effectiveness, efficiency, patient satisfaction and professionals well-being obtained through clinical networks implementation. RESULTS 14249 studies were identified; 12 of these were eligible to the evaluation of "Quadruple Aim" outcomes. 9 studies focused on patients' outcomes improvement and 4 on network efficiency. Professionals' and patients' experience were not considered in any study. CONCLUSIONS There are some evidences that clinical network can improve patients' outcomes and health funds allocation in a small number of moderate-low quality studies. Further rigorous studies are needed to confirm these findings and to evaluate patients' and professionals' experience, taking into account also networks' structural features that could influence outcomes achievement.
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Abu-Laban RB, Drebit S, Lindstrom RR, Archibald C, Eggers K, Ho K, Khazei A, Lund A, MacKinnon C, Markham R, Marsden J, Martin E, Christenson J. The British Columbia Emergency Medicine Network: A Paradigm Shift in a Provincial System of Emergency Care. Cureus 2018. [PMID: 29531875 PMCID: PMC5837260 DOI: 10.7759/cureus.2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
As generalists, emergency practitioners face challenges in providing state-of-the-art care owing to the broad spectrum of practice and the rapid rate of new knowledge generation. Networks have become increasingly prevalent in health care, and it was in this backdrop, and the resulting opportunity to advance evidence-informed emergency care in the Canadian province of British Columbia (BC), that a new “Emergency Medicine Network” (EM Network) was launched in 2017. The EM Network consists of four programs, each led by a physician with expertise and a track record in the domain: (1) Clinical Resources; (2) Innovation; (3) Continuing Professional Development; and (4) Real-time Support. This paper provides an overview of the EM Network, including its background, purpose, programs, anticipated evolution, and impact on the BC health care system.
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Affiliation(s)
| | - Sharla Drebit
- Department of Emergency Medicine, University of British Columbia
| | | | | | | | - Kendall Ho
- Department of Emergency Medicine, University of British Columbia
| | - Afshin Khazei
- Department of Emergency Medicine, University of British Columbia
| | - Adam Lund
- Deparment of Emergency Medicine, University of British Columbia
| | | | - Ray Markham
- Department of Family Practice, University of British Columbia
| | - Julian Marsden
- Department of Emergency Medicine, University of British Columbia
| | | | - Jim Christenson
- Department of Emergency Medicine, University of British Columbia
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Norris JM, Hecker KG, Rabatach L, Noseworthy TW, White DE. Development and psychometric testing of the clinical networks engagement tool. PLoS One 2017; 12:e0174056. [PMID: 28350834 PMCID: PMC5369681 DOI: 10.1371/journal.pone.0174056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 03/02/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Clinical networks are being used widely to facilitate large system transformation in healthcare, by engagement of stakeholders throughout the health system. However, there are no available instruments that measure engagement in these networks. METHODS The study purpose was to develop and assess the measurement properties of a multiprofessional tool to measure engagement in clinical network initiatives. Based on components of the International Association of Public Participation Spectrum and expert panel review, we developed 40 items for testing. The draft instrument was distributed to 1,668 network stakeholders across different governance levels (leaders, members, support, frontline stakeholders) in 9 strategic clinical networks in Alberta (January to July 2014). With data from 424 completed surveys (25.4% response rate), descriptive statistics, exploratory and confirmatory factor analysis, Pearson correlations, linear regression, multivariate analysis, and Cronbach alpha were conducted to assess reliability and validity of the scores. RESULTS Sixteen items were retained in the instrument. Exploratory factor analysis indicated a four-factor solution and accounted for 85.7% of the total variance in engagement with clinical network initiatives: global engagement, inform (provided with information), involve (worked together to address concerns), and empower (given final decision-making authority). All subscales demonstrated acceptable reliability (Cronbach alpha 0.87 to 0.99). Both the confirmatory factor analysis and regression analysis confirmed that inform, involve, and empower were all significant predictors of global engagement, with involve as the strongest predictor. Leaders had higher mean scores than frontline stakeholders, while members and support staff did not differ in mean scores. CONCLUSIONS This study provided foundational evidence for the use of this tool for assessing engagement in clinical networks. Further work is necessary to evaluate engagement in broader network functions and activities; to assess barriers and facilitators of engagement; and, to elucidate how the maturity of networks and other factors influence engagement.
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Affiliation(s)
- Jill M. Norris
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Kent G. Hecker
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Leora Rabatach
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tom W. Noseworthy
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Deborah E. White
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
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Brown BB, Haines M, Middleton S, Paul C, D'Este C, Klineberg E, Elliott E. Development and validation of a survey to measure features of clinical networks. BMC Health Serv Res 2016; 16:531. [PMID: 27716364 PMCID: PMC5045605 DOI: 10.1186/s12913-016-1800-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 09/27/2016] [Indexed: 11/19/2022] Open
Abstract
Background Networks of clinical experts are increasingly being implemented as a strategy to improve health care processes and outcomes and achieve change in the health system. Few are ever formally evaluated and, when this is done, not all networks are equally successful in their efforts. There is a need to formatively assess the strategic and operational management and leadership of networks to identify where functioning could be improved to maximise impact. This paper outlines the development and psychometric evaluation of an Internet survey to measure features of clinical networks and provides descriptive results from a sample of members of 19 diverse clinical networks responsible for evidence-based quality improvement across a large geographical region. Methods Instrument development was based on: a review of published and grey literature; a qualitative study of clinical network members; a program logic framework; and consultation with stakeholders. The resulting domain structure was validated for a sample of 592 clinical network members using confirmatory factor analysis. Scale reliability was assessed using Cronbach’s alpha. A summary score was calculated for each domain and aggregate level means and ranges are reported. Results The instrument was shown to have good construct validity across seven domains as demonstrated by a high level of internal consistency, and all Cronbach’s α coefficients were equal to or above 0.75. In the survey sample of network members there was strong reported commitment and belief in network-led quality improvement initiatives, which were perceived to have improved quality of care (72.8 %) and patient outcomes (63.2 %). Network managers were perceived to be effective leaders and clinical co-chairs were perceived as champions for change. Perceived external support had the lowest summary score across the seven domains. Conclusions This survey, which has good construct validity and internal reliability, provides a valid instrument to use in future research related to clinical networks. The survey will be of use to health service managers to identify strengths and areas where networks can be improved to increase effectiveness and impact on quality of care and patient outcomes. Equally, the survey could be adapted for use in the assessment of other types of networks. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1800-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Mary Haines
- Sax Institute, PO Box K617, Haymarket, NSW, 1240, Australia.,School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Sandy Middleton
- Nursing Research Institute, St. Vincent's Health Australia (Sydney) and Australian Catholic University, Executive Suite, Level 5, St Vincent's Hospital, deLacy Building, Victoria Street, Darlinghurst, NSW, 2010, Australia.
| | - Christine Paul
- School of Medicine and Public Health, Priority Research Centre for Health Behaviour & Hunter Medical Research Institute, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Catherine D'Este
- National Centre for Epidemiology & Population Health, Research School of Population Health, ANU College of Medicine, Biology & Environment, Australian National University, Building 62, Cnr of Eggleston and Mills Roads, Canberra, ACT, 2601, Australia
| | - Emily Klineberg
- New South Wales Health, 73 Miller Street, North Sydney, NSW, 2060, Australia
| | - Elizabeth Elliott
- School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia
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Brown BB, Patel C, McInnes E, Mays N, Young J, Haines M. The effectiveness of clinical networks in improving quality of care and patient outcomes: a systematic review of quantitative and qualitative studies. BMC Health Serv Res 2016; 16:360. [PMID: 27613378 PMCID: PMC5018194 DOI: 10.1186/s12913-016-1615-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 07/31/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reorganisation of healthcare services into networks of clinical experts is increasing as a strategy to promote the uptake of evidence based practice and to improve patient care. This is reflected in significant financial investment in clinical networks. However, there is still some question as to whether clinical networks are effective vehicles for quality improvement. The aim of this systematic review was to ascertain the effectiveness of clinical networks and identify how successful networks improve quality of care and patient outcomes. METHODS A systematic search was undertaken in accordance with the PRISMA approach in Medline, Embase, CINAHL and PubMed for relevant papers between 1 January 1996 and 30 September 2014. Established protocols were used separately to examine and assess the evidence from quantitative and qualitative primary studies and then integrate findings. RESULTS A total of 22 eligible studies (9 quantitative; 13 qualitative) were included. Of the quantitative studies, seven focused on improving quality of care and two focused on improving patient outcomes. Quantitative studies were limited by a lack of rigorous experimental design. The evidence indicates that clinical networks can be effective vehicles for quality improvement in service delivery and patient outcomes across a range of clinical disciplines. However, there was variability in the networks' ability to make meaningful network- or system-wide change in more complex processes such as those requiring intensive professional education or more comprehensive redesign of care pathways. Findings from qualitative studies indicated networks that had a positive impact on quality of care and patients outcomes were those that had adequate resources, credible leadership and efficient management coupled with effective communication strategies and collaborative trusting relationships. CONCLUSIONS There is evidence that clinical networks can improve the delivery of healthcare though there are few high quality quantitative studies of their effectiveness. Our findings can provide policymakers with some insight into how to successfully plan and implement clinical networks by ensuring strong clinical leadership, an inclusive organisational culture, adequate resourcing and localised decision-making authority.
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Affiliation(s)
- Bernadette Bea Brown
- Sax Institute, PO Box K617, Haymarket, NSW, 1240, Australia.,School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Cyra Patel
- Nursing Research Institute, St Vincent's Health Australia (Sydney) & Australian Catholic University, School of Nursing, Midwifery and Paramedicine, Darlinghurst, NSW, 2010, Australia
| | - Elizabeth McInnes
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Nicholas Mays
- School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Jane Young
- School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Mary Haines
- Nursing Research Institute, St Vincent's Health Australia (Sydney) & Australian Catholic University, School of Nursing, Midwifery and Paramedicine, Darlinghurst, NSW, 2010, Australia.,School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia
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18
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Aranda S, Paul CL. Rethinking system change in cancer. Asia Pac J Clin Oncol 2016; 12:10-2. [DOI: 10.1111/ajco.12479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sanchia Aranda
- Cancer Council Australia and The University of Melbourne; Melbourne Victoria Australia
| | - Christine L Paul
- School of Medicine and Pubic Health; University of Newcastle; Newcastle, New South Wales Australia
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Long JC, Hibbert P, Braithwaite J. Structuring successful collaboration: a longitudinal social network analysis of a translational research network. Implement Sci 2016; 11:19. [PMID: 26864452 PMCID: PMC4750242 DOI: 10.1186/s13012-016-0381-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 02/04/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In 2012 and 2013, we conducted a social network survey of a new translational research network (TRN) designed to deliver better care to cancer patients. Results of these two surveys showed that silos of researchers and clinicians existed before the TRN was established but that the network had mediated collaborative relationships. This paper reports on a third social network survey of the TRN and focusses on the structure of the collaborative arrangements among members. METHODS Members of the TRN were invited to complete an on-line, whole network survey in May 2015. The survey asked respondents to identify personal impacts, outputs and wider outcomes attributable to their TRN membership. The final question asked respondents to select the name of TRN members with whom they had collaborated either formally or informally. For each member nominated, they were asked to say whether they had known this person before joining the TRN. RESULTS Response rate was 70 %. Over 4 years, the TRN has grown in size from 68 to 244 members. Relationships within and across the TRN have become more collaborative and interactive, with 1658 collaborative ties between members and over 40 % of ties with people unknown to participants before they joined the TRN. This points to a well-functioning network which has retained its focus on the original goals of the TRN and has fostered collaboration between researchers, clinicians, managers, consumers and TRN operational staff. This survey shows that the TRN's impact goes beyond outcomes from formal TRN-funded projects. About one third of respondents could list projects not directly funded by the TRN but which are attributed to TRN membership. Examples of practice change brought about through the TRN were given by 77 % of respondents. A substantial risk factor for the future is the high levels of dependency on key or central TRN participants. CONCLUSIONS The structure of the TRN with its active central actors and brokers has been able to foster collaboration on implementation initiatives that result in practice change. The role of a social professional network in driving this collaboration is shown.
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Affiliation(s)
- Janet C Long
- Australian Institute of Health Innovation, Level 6, 75 Talavera Road, North Ryde, 2109, NSW, Australia.
| | - Peter Hibbert
- Australian Institute of Health Innovation, Level 6, 75 Talavera Road, North Ryde, 2109, NSW, Australia.
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Level 6, 75 Talavera Road, North Ryde, 2109, NSW, Australia.
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McInnes E, Haines M, Dominello A, Kalucy D, Jammali-Blasi A, Middleton S, Klineberg E. What are the reasons for clinical network success? A qualitative study. BMC Health Serv Res 2015; 15:497. [PMID: 26541410 PMCID: PMC4635586 DOI: 10.1186/s12913-015-1096-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 09/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical networks have been established to improve patient outcomes and processes of care by implementing a range of innovations and undertaking projects based on the needs of local health services. Given the significant investment in clinical networks internationally, it is important to assess their effectiveness and sustainability. This qualitative study investigated the views of stakeholders on the factors they thought were influential in terms of overall network success. METHOD Ten participants were interviewed using face-to-face, audio-recorded semi-structured interviews about critical factors for networks' successes over the study period 2006-2008. Respondents were purposively selected from two stakeholder groups: i) chairs of networks during the study period of 2006-2008 from high- moderate- and low-impact networks (as previously determined by an independent review panel) and ii) experts in the clinical field of the network who had a connection to the network but who were not network members. Participants were blind to the performance of the network they were interviewed about. Transcribed data were coded and analysed to generate themes relating to the study aims. RESULTS Themes relating to influential factors critical to network success were: network model principles; leadership; formal organisational structures and processes; nature of network projects; external relationships; profile and credibility of the network. CONCLUSIONS This study provides clinical networks with guidance on essential factors for maximising optimal network outcomes and that may assist networks to move from being a 'low-impact' to 'high-impact' network. Important ingredients for successful clinical networks were visionary and strategic leadership with strong links to external stakeholders; and having formal infrastructure and processes to enable the development and management of work plans aligned with health priorities.
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Affiliation(s)
- Elizabeth McInnes
- Nursing Research Institute - St Vincents Health Australia (Sydney) and Australian Catholic University, DeLacy Building, 379 Victoria Road, Darlinghurst, NSW, 2010, Australia. .,School of Nursing, Midwifery & Paramedicine (NSW & ACT), Australian Catholic University, North Sydney, 2060, NSW, Australia.
| | - Mary Haines
- Sax Institute, Level 13, Building 10, 235 Jones Street, Ultimo, NSW, 2007, Australia. .,School of Public Health, The University of Sydney, Sydney, 2006, NSW, Australia.
| | - Amanda Dominello
- Sax Institute, Level 13, Building 10, 235 Jones Street, Ultimo, NSW, 2007, Australia.
| | - Deanna Kalucy
- Sax Institute, Level 13, Building 10, 235 Jones Street, Ultimo, NSW, 2007, Australia.
| | - Asmara Jammali-Blasi
- Nursing Research Institute - St Vincents Health Australia (Sydney) and Australian Catholic University, DeLacy Building, 379 Victoria Road, Darlinghurst, NSW, 2010, Australia. .,School of Nursing, Midwifery & Paramedicine (NSW & ACT), Australian Catholic University, North Sydney, 2060, NSW, Australia.
| | - Sandy Middleton
- Nursing Research Institute - St Vincents Health Australia (Sydney) and Australian Catholic University, DeLacy Building, 379 Victoria Road, Darlinghurst, NSW, 2010, Australia. .,School of Nursing, Midwifery & Paramedicine (NSW & ACT), Australian Catholic University, North Sydney, 2060, NSW, Australia.
| | - Emily Klineberg
- NSW Kids and Families, 73 Miller Street, North Sydney, NSW, 2060, Australia. .,Sydney Medical School, The University of Sydney, Sydney, 2006, NSW, Australia.
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21
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Bodolica V, Spraggon M, Tofan G. A structuration framework for bridging the macro-micro divide in health-care governance. Health Expect 2015; 19:790-804. [PMID: 26072929 DOI: 10.1111/hex.12375] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Extant studies demonstrate that macro (hierarchical) and micro (relational) governance initiatives in health-care settings continue to be developed in isolation rather than interactively. Government-driven hierarchical governance endeavours that guide health-care reforms and medical practice are disconnected from micro-level physician-patient interactions being unable to account for patient preferences in the macro-level policymaking. METHOD/OBJECTIVE We undertake a review of the recent literature to couch our argument for a unified governance framework for bridging the macro-micro divide in medical contexts. Adopting an interdisciplinary approach to health-care delivery, we maintain that the (strong) structuration theory provides a fruitful opportunity for narrowing the gap between hierarchical and relational governance. DISCUSSION Emphasizing the coexistence of institutional structures and human agency, the (strong) structuration theory elucidates how macro and micro governance devices shape each other's structure via mutually reinforcing cycles of influence. Micro-level encounters between patients and physicians give rise to social structures that constitute the constraining and enabling forces through which macro-level health-care infrastructures are altered and reproduced over time. Permitting to illustrate how patients' agency can effectively emerge from complex networks of clinical trajectories, the advanced structuration framework for macro-micro governance integration avoids the extremes of paternalism and autonomy through a balanced consideration of professional judgement and patient preferences. CONCLUSION/IMPLICATIONS The macro-micro integration of governance efforts is a critical issue in both high-income states, where medical institutions attempt to deploy substantial realignment efforts, and developing nations, which are lagging behind due to leadership weaknesses and lower levels of governmental investment. A key priority for regulators is the identification of relevant systems to support this holistic governance by providing clinicians with needed resources for focusing on patient advocacy and installing enabling mechanisms for incorporating patients' inputs in health-care reforms and policymaking.
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Affiliation(s)
- Virginia Bodolica
- School of Business Administration, American University of Sharjah, P.O. Box 26666, Sharjah, United Arab Emirates
| | - Martin Spraggon
- School of Business Administration, American University of Sharjah, P.O. Box 26666, Sharjah, United Arab Emirates
| | - Gabriela Tofan
- National Health Insurance Company, MD 2005 Chisinau, Republic of Moldova
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Mazel O, Ewen S. Innovation in Indigenous Health and Medical Education: The Leaders in Indigenous Medical Education (LIME) Network as a Community of Practice. TEACHING AND LEARNING IN MEDICINE 2015; 27:314-328. [PMID: 26158334 DOI: 10.1080/10401334.2015.1044655] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PROBLEM The Leaders in Indigenous Medical Education (LIME) Network aims to improve the quality and effectiveness of Indigenous health in medical education as well as best practice in the recruitment, retention, and graduation of Indigenous medical students. INTERVENTION In this article we explore the utility of Etienne Wenger's "communities of practice" (CoP) concept in providing a theoretical framework to better understand the LIME Network as a form of social infrastructure to further knowledge and innovation in this important area of health care education reform. CONTEXT The Network operates across all medical schools in Australia and New Zealand. OUTCOME Utilizing a model of evaluation of communities of practice developed by Fung-Kee-Fung et al., we seek to analyze the outcomes of the LIME Network as a CoP and assess its approach and contribution to improving the implementation of Indigenous health in the medical curriculum and the graduation of Indigenous medical students. LESSONS LEARNED By reflecting on the Network through a community of practice lens, this article highlights the synthesis between the LIME Network and Wenger's theory and provides a framework with which to measure Network outputs. It also posits an opportunity to better capture the impact of Network activities into the future to ensure that it remains a relevant and sustainable entity.
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Affiliation(s)
- Odette Mazel
- a Leaders in Indigenous Medical Education (LIME) Network and Melbourne Poche Centre for Indigenous Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne , Parkville , Victoria , Australia
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Finley EP. EMPOWERING VETERANS WITH PTSD IN THE RECOVERY ERA: ADVANCING DIALOGUE AND INTEGRATING SERVICES. ANNALS OF ANTHROPOLOGICAL PRACTICE 2014. [DOI: 10.1111/napa.12028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Long JC, Cunningham FC, Carswell P, Braithwaite J. Patterns of collaboration in complex networks: the example of a translational research network. BMC Health Serv Res 2014; 14:225. [PMID: 24885971 PMCID: PMC4033678 DOI: 10.1186/1472-6963-14-225] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 05/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper examines collaboration in a complex translational cancer research network (TRN) made up of a range of hospital-based clinicians and university-based researchers. We examine the phenomenon of close-knit and often introspective clusters of people (silos) and test the extent that factors associated with this clustering (geography, profession and past experience) influence patterns of current and future collaboration on TRN projects. Understanding more of these patterns, especially the gaps or barriers between members, will help network leaders to manage subgroups and promote connectivity crucial to efficient network function. METHODS An on-line, whole network survey was used to collect attribute and relationship data from all members of the new TRN based in New South Wales, Australia in early 2012. The 68 members were drawn from six separate hospital and university campuses. Social network analysis with UCInet tested the effects of geographic proximity, profession, past research experience, strength of ties and previous collaborations on past, present and future intended partnering. RESULTS Geographic proximity and past working relationships both had significant effects on the choice of current collaboration partners. Future intended collaborations included a significant number of weak ties and ties based on other members' reputations implying that the TRN has provided new opportunities for partnership. Professional grouping, a significant barrier discussed in the translational research literature, influenced past collaborations but not current or future collaborations, possibly through the mediation of network brokers. CONCLUSIONS Since geographic proximity is important in the choice of collaborators a dispersed network such as this could consider enhancing cross site interactions by improving virtual communication technology and use, increasing social interactions apart from project related work, and maximising opportunities to meet members from other sites. Key network players have an important brokerage role facilitating linkages between groups.
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Affiliation(s)
- Janet C Long
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, Faculty of Medicine, University of New South Wales, Kensington 2052, Australia.
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Carswell P, Manning B, Long J, Braithwaite J. Building clinical networks: a developmental evaluation framework. BMJ Qual Saf 2014; 23:422-7. [PMID: 24481646 DOI: 10.1136/bmjqs-2013-002405] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Peter Carswell
- School of Population Health, University of Auckland, , Auckland, New Zealand
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Long JC, Cunningham FC, Wiley J, Carswell P, Braithwaite J. Leadership in complex networks: the importance of network position and strategic action in a translational cancer research network. Implement Sci 2013; 8:122. [PMID: 24120075 PMCID: PMC3854121 DOI: 10.1186/1748-5908-8-122] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 10/03/2013] [Indexed: 12/03/2022] Open
Abstract
Background Leadership behaviour in complex networks is under-researched, and little has been written concerning leadership of translational research networks (TRNs) that take discoveries made ‘at the bench’ and translate them into practices used ‘at the bedside.’ Understanding leaders’ opportunities and behaviours within TRNs working to solve this key problem in implementing evidence into clinical practice is therefore important. This study explored the network position of governing body members and perceptions of their role in a new TRN in Sydney, Australia. The paper asks three questions: Firstly, do the formal, mandated leaders of this TRN hold key positions of centrality or brokerage in the informal social network of collaborative ties? Secondly, if so, do they recognise the leadership opportunities that their network positions afford them? Thirdly, what activities associated with these key roles do they believe will maximise the TRN’s success? Methods Semi-structured interviews of all 14 governing body members conducted in early 2012 explored perceptions of their roles and sought comments on a list of activities drawn from review of successful transdisciplinary collaboratives combined with central and brokerage roles. An on-line, whole network survey of all 68 TRN members sought to understand and map existing collaborative connections. Leaders’ positions in the network were assessed using UCInet, and graphs were generated in NetDraw. Results Social network analysis identified that governing body members had high centrality and high brokerage potential in the informal network of work-related ties. Interviews showed perceived challenges including ‘silos’ and the mismatch between academic and clinical goals of research. Governing body members recognised their central positions, which would facilitate the leadership roles of leading, making decisions, and providing expert advice necessary for the co-ordination of effort and relevant input across domains. Brokerage potential was recognised in their clearly understood role of representing a specialty, campus or research group on the governing body to provide strategic linkages. Facilitation, mentoring and resolving conflicts within more localised project teams were spoken of as something ‘we do all the time anyway,’ as well as something they would do if called upon. These leadership roles are all linked with successful collaborative endeavours in other fields. Conclusions This paper links the empirical findings of the social network analysis with the qualitative findings of the interviews to show that the leaders’ perceptions of their roles accord with both the potential inherent in their network positions as well as actual activities known to increase the success of transdisciplinary teams. Understanding this is key to successful TRNs.
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Affiliation(s)
- Janet C Long
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, Level 1, AGSM Building, Kensington, Australia.
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Willis CD, Riley BL, Herbert CP, Best A. Networks to strengthen health systems for chronic disease prevention. Am J Public Health 2013; 103:e39-48. [PMID: 24028225 DOI: 10.2105/ajph.2013.301249] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Interorganizational networks that harness the priorities, capacities, and skills of various agencies and individuals have emerged as useful approaches for strengthening preventive services in public health systems. We use examples from the Canadian Heart Health Initiative and Alberta's Primary Care Networks to illustrate characteristics of networks, describe the limitations of existing frameworks for assessing the performance of prevention-oriented networks, and propose a research agenda for guiding future efforts to improve the performance of these initiatives. Prevention-specific assessment strategies that capture relevant aspects of network performance need to be identified, and feedback mechanisms are needed that make better use of these data to drive change in network activities.
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Affiliation(s)
- Cameron D Willis
- Cameron D. Willis and Allan Best are with the Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, and the School of Population and Public Health, University of British Columbia, Vancouver. Cameron D. Willis is also with the University of Adelaide, Adelaide, Australia. Barbara L. Riley is with the Propel Centre for Population Health Impact and the School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Ontario. Carol P. Herbert is with the Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London Ontario
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Long JC, Cunningham FC, Carswell P, Braithwaite J. Who are the key players in a new translational research network? BMC Health Serv Res 2013; 13:338. [PMID: 23987790 PMCID: PMC3844428 DOI: 10.1186/1472-6963-13-338] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 08/27/2013] [Indexed: 11/12/2022] Open
Abstract
Background Professional networks are used increasingly in health care to bring together members from different sites and professions to work collaboratively. Key players within these networks are known to affect network function through their central or brokerage position and are therefore of interest to those who seek to optimise network efficiency. However, their identity may not be apparent. This study using social network analysis to ask: (1) Who are the key players of a new translational research network (TRN)? (2) Do they have characteristics in common? (3) Are they recognisable as powerful, influential or well connected individuals? Methods TRN members were asked to complete an on-line, whole network survey which collected demographic information expected to be associated with key player roles, and social network questions about collaboration in current TRN projects. Three questions asked who they perceived as powerful, influential and well connected. Indegree and betweenness centrality values were used to determine key player status in the actual and perceived networks and tested for association with demographic and descriptive variables using chi square analyses. Results Response rate for the online survey was 76.4% (52/68). The TRN director and manager were identified as key players along with six other members. Only two of nine variables were associated with actual key player status; none with perceived. The main finding was the mismatch between actual and perceived brokers. Members correctly identified two of the three central actors (the two mandated key roles director and manager) but there were only three correctly identified actual brokers among the 19 perceived brokers. Possible reasons for the mismatch include overlapping structures and weak knowledge of members. Conclusions The importance of correctly identifying these key players is discussed in terms of network interventions to improve efficiency.
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Affiliation(s)
- Janet C Long
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, Kensington 2052, Australia.
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Development of a regional nursing research partnership for academic and practice collaborations. Nurs Res Pract 2013; 2013:473864. [PMID: 23984059 PMCID: PMC3745952 DOI: 10.1155/2013/473864] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 07/10/2013] [Indexed: 11/18/2022] Open
Abstract
Background. Collaborative nursing research across academic and practice settings is imperative to generate knowledge to improve patient care. Models of academic/practice partnerships for nursing research are lacking. This paper reports data collected before and during a one-day retreat for nurse researchers and administrators from local universities and health care organizations designed to establish a regional nursing research partnership. Methods. Quantitative and qualitative methods were used to address the study aims: (1) to assess research involvement and institutional research resources; (2) to assess interest in and concerns regarding cross-institutional collaborations; and (3) to describe perceptions of the purpose of a partnership and resources needed to ensure success. Results. Participants (n = 49) had differing perceptions of accessibility to resources; participants in practice settings reported less accessibility to resources, notably grant development, informatics, and research assistant support. Participants were interested in collaboration although concerns about conflict of interest were expressed. Four themes related to partnering were identified: harnessing our nursing voice and identity; developing as researchers; staying connected; and positioning for a collaborative project. Conclusion. Academic-practice research collaborations will become increasingly important with health care system changes. Strategies to develop and sustain productive partnerships should be supported.
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Willem A, Gemmel P. Do governance choices matter in health care networks?: an exploratory configuration study of health care networks. BMC Health Serv Res 2013; 13:229. [PMID: 23800334 PMCID: PMC3727985 DOI: 10.1186/1472-6963-13-229] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 06/19/2013] [Indexed: 12/05/2022] Open
Abstract
Background Health care networks are widely used and accepted as an organizational form that enables integrated care as well as dealing with complex matters in health care. However, research on the governance of health care networks lags behind. The research aim of our study is to explore the type and importance of governance structure and governance mechanisms for network effectiveness. Methods The study has a multiple case study design and covers 22 health care networks. Using a configuration view, combinations of network governance and other network characteristics were studied on the level of the network. Based on interview and questionnaire data, network characteristics were identified and patterns in the data looked for. Results Neither a dominant (or optimal) governance structure or mechanism nor a perfect fit among governance and other characteristics were revealed, but a number of characteristics that need further study might be related to effective networks such as the role of governmental agencies, legitimacy, and relational, hierarchical, and contractual governance mechanisms as complementary factors. Conclusions Although the results emphasize the situational character of network governance and effectiveness, they give practitioners in the health care sector indications of which factors might be more or less crucial for network effectiveness.
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Affiliation(s)
- Annick Willem
- Faculty of Medicine and Health Sciences, Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, Ghent 9000, Belgium.
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Haines M, Brown B, Craig J, D'Este C, Elliott E, Klineberg E, McInnes E, Middleton S, Paul C, Redman S, Yano EM. Determinants of successful clinical networks: the conceptual framework and study protocol. Implement Sci 2012; 7:16. [PMID: 22414246 PMCID: PMC3328243 DOI: 10.1186/1748-5908-7-16] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Accepted: 03/13/2012] [Indexed: 12/14/2022] Open
Abstract
Background Clinical networks are increasingly being viewed as an important strategy for increasing evidence-based practice and improving models of care, but success is variable and characteristics of networks with high impact are uncertain. This study takes advantage of the variability in the functioning and outcomes of networks supported by the Australian New South Wales (NSW) Agency for Clinical Innovation's non-mandatory model of clinical networks to investigate the factors that contribute to the success of clinical networks. Methods/Design The objective of this retrospective study is to examine the association between external support, organisational and program factors, and indicators of success among 19 clinical networks over a three-year period (2006-2008). The outcomes (health impact, system impact, programs implemented, engagement, user perception, and financial leverage) and explanatory factors will be collected using a web-based survey, interviews, and record review. An independent expert panel will provide judgements about the impact or extent of each network's initiatives on health and system impacts. The ratings of the expert panel will be the outcome used in multivariable analyses. Following the rating of network success, a qualitative study will be conducted to provide a more in-depth examination of the most successful networks. Discussion This is the first study to combine quantitative and qualitative methods to examine the factors that contribute to the success of clinical networks and, more generally, is the largest study of clinical networks undertaken. The adaptation of expert panel methods to rate the impacts of networks is the methodological innovation of this study. The proposed project will identify the conditions that should be established or encouraged by agencies developing clinical networks and will be of immediate use in forming strategies and programs to maximise the effectiveness of such networks.
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