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O'Malley R, O'Connor P, Lydon S. Strategies that facilitate the delivery of exceptionally good patient care in general practice: a qualitative study with patients and primary care professionals. BMC PRIMARY CARE 2024; 25:141. [PMID: 38678200 PMCID: PMC11055247 DOI: 10.1186/s12875-024-02352-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/27/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND In recent years, proactive strengths-based approaches to improving quality of care have been advocated. The positive deviance approach seeks to identify and learn from those who perform exceptionally well. Central to this approach is the identification of the specific strategies, behaviours, tools and contextual strategies used by those positive deviants to perform exceptionally well. This study aimed to: identify and collate the specific strategies, behaviours, processes and tools used to support the delivery of exceptionally good care in general practice; and to abstract the identified strategies into an existing framework pertaining to excellence in general practice; the Identifying and Disseminating the Exceptional to Achieve Learning (IDEAL) framework. METHODS This study comprised a secondary analysis of data collected during semi-structured interviews with 33 purposively sampled patients, general practitioners, practice nurses, and practice managers. Discussions explored the key factors and strategies that support the delivery of exceptional care across five levels of the primary care system; the patient, provider, team, practice, and external environment. For analysis, a summative content analysis approach was undertaken whereby data were inductively analysed and summated to identify the key strategies used to achieve the delivery of exceptionally good general practice care, which were subsequently abstracted as a new level of the IDEAL framework. RESULTS In total, 222 individual factors contributing to exceptional care delivery were collated and abstracted into the framework. These included specific behaviours (e.g., patients providing useful feedback and personal history to the provider), structures (e.g., using technology effectively to support care delivery (e.g., electronic referrals & prescriptions)), processes (e.g., being proactive in managing patient flow and investigating consistently delayed wait times), and contextual factors (e.g., valuing and respecting contributions of every team member). CONCLUSION The addition of concrete and contextual strategies to the IDEAL framework has enhanced its practicality and usefulness for supporting improvement in general practices. Now, a multi-level systems approach is needed to embed these strategies and create an environment where excellence is supported. The refined framework should be developed into a learning tool to support teams in general practice to measure, reflect and improve care within their practice.
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Affiliation(s)
- Roisin O'Malley
- Discipline of General Practice, University of Galway, Newcastle, 1 Distillery Road, Galway, H91TK33, Ireland.
| | - Paul O'Connor
- Discipline of General Practice, University of Galway, Newcastle, 1 Distillery Road, Galway, H91TK33, Ireland
| | - Sinéad Lydon
- Discipline of General Practice, University of Galway, Newcastle, 1 Distillery Road, Galway, H91TK33, Ireland
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Tang D, Jin Y, Zhang K, Wang D. Internet Use, Social Networks, and Loneliness Among the Older Population in China. Front Psychol 2022; 13:895141. [PMID: 35645921 PMCID: PMC9133735 DOI: 10.3389/fpsyg.2022.895141] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/15/2022] [Indexed: 01/07/2023] Open
Abstract
While the rate of Internet use among the older population in China is rapidly increasing, the outcomes associated with Internet use remain largely unexplored. Currently, there are contradictory findings indicating that Internet use is sometimes positively and sometimes negatively associated with older adults' subjective well-being. Therefore, we examined the associations between different types of Internet use, social networks, and loneliness among Chinese older adults using data from the Chinese Longitudinal Ageing Society Survey (N = 1863). Internet use was classified as interpersonal communication and information acquisition, and social networks were divided into family and friendship ties. The results showed that both interpersonal communication and information acquisition were associated with lower loneliness. Interpersonal communication can increase social networks, and family ties have a mediating effect on the association between Internet use for interpersonal communication and loneliness. Although information acquisition can directly decrease loneliness in older adults, it can also damage existing social networks and further increase loneliness. Family ties act as a suppressor in the association between Internet use for information acquisition and loneliness. Our study further discusses important implications for improving the subjective well-being of older adults in the digital era, based on the empirical findings.
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Affiliation(s)
- Dan Tang
- Center for Population and Development Studies, Renmin University of China, Beijing, China
- Institute of Gerontology, Renmin University of China, Beijing, China
| | - Yongai Jin
- Center for Population and Development Studies, Renmin University of China, Beijing, China
| | - Kun Zhang
- National Institute of Education Sciences, Beijing, China
| | - Dahua Wang
- Faculty of Psychology, Beijing Normal University, Beijing, China
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Abstract
Objectives Primary care networks (PCNs) were introduced in the National Health Service (NHS) in England in 2019 to improve integrated care for patients and help address financial and workforce sustainability issues in general practice. The purpose of this study was to collect early evidence on their implementation and development, including motivations to participate and what enables or inhibits progress. This paper considers the core characteristics of PCNs, and how this informs their management. Design A qualitative mixed-methods rapid evaluation was conducted across four case study sites in England, informed by a literature review and stakeholder workshop. Data collection comprised interviews, non-participant observation of meetings, an online survey and documentary review. Results General practitioners (GPs) are motivated to participate in PCNs for their potential to improve patient care, enable better coordinated services and enhance financial and workforce sustainability within primary care. However, PCNs also have an almost mandatory feel, based on the national policy context and significant financial incentives associated with joining them. PCNs offer potential to bring GPs together to work towards common goals, deliver national priorities and respond rapidly to local needs. Conclusions PCNs face similar challenges to other meso-level primary care organisations internationally, as they respond to local and national priorities and operate in a context of multiple goals and interests. In managing these organisations, it is important to find a balance between local and national autonomy, decision making and control.
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Li J, Wu H, Deng Z, Lu N, Evans R, Xia C. How professional capital and team heterogeneity affect the demands of online team-based medical service. BMC Med Inform Decis Mak 2019; 19:119. [PMID: 31262282 PMCID: PMC6604171 DOI: 10.1186/s12911-019-0831-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The provision of medical services by Medical Teams (MT) on Online Healthcare Communities (OHCs) is a novel method employed by geographically-dispersed healthcare professionals to serve one patient simultaneously, allowing patients to receive more specific, targeted and comprehensive advice. As a relatively new method of service delivery, little attention has been paid to identifying the determinants of Team-based Service Demands (TSD). Based on Upper Echelons Theory and Social Exchange Theory, this study examines the impact of both professional capital (status capital and decisional capital) and team heterogeneity (team size and dispersion) on TSD. METHODS This study uses data collected from 890 MTs, employing 3994 team members, operating on haodf.com , a Chinese OHC, to examine effects of both leader and team characteristics on TSD. RESULTS Our findings suggest that a MT's characteristics have a significant impact on TSD. Firstly, the decisional capital of both leaders and teams were positively related with TSD, while only the status capital of leaders saw a positive impact. Secondly, team heterogeneity influenced TSD in two ways: (1) provided a direct negative impact and (2) positively moderated the relationship between professional capital and TSD. CONCLUSION This paper comprehensively studies the impact of TSD from the perspectives of professional capital and team heterogeneity, expanding current theoretical understanding of team heterogeneity and social capital in OHCs. Further, it provides practical suggestions for platform development and team leaders managing MTs in online environments.
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Affiliation(s)
- Jiaying Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Qiaokou District, Wuhan, China
| | - Hong Wu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Qiaokou District, Wuhan, China
| | - Zhaohua Deng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Qiaokou District, Wuhan, China.
| | - Naiji Lu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Qiaokou District, Wuhan, China
| | - Richard Evans
- College of Engineering, Design and Physical Sciences, Brunel University London, London, UK
| | - Chenxi Xia
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Qiaokou District, Wuhan, China
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Thomas L, Parker S, Song H, Gunatillaka N, Russell G, Harris M. Health service brokerage to improve primary care access for populations experiencing vulnerability or disadvantage: a systematic review and realist synthesis. BMC Health Serv Res 2019; 19:269. [PMID: 31035997 PMCID: PMC6489346 DOI: 10.1186/s12913-019-4088-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 04/09/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Individuals experiencing disadvantage or marginalisation often face difficulty accessing primary health care. Overcoming access barriers is important for improving the health of these populations. Brokers can empower and enable people to access resources; however, their role in increasing access to health services has not been well-defined or researched in the literature. This review aims to identify whether a health service broker working with health and social service providers in the community can (a) identify individuals experiencing vulnerability who may benefit from improved access to quality primary care, and (b) link these individuals with an appropriate primary care provider for enduring, appropriate primary care. METHODS Six databases were searched for studies published between January 2008 and August 2015 that evaluated a health service broker intervention linking adults experiencing vulnerability to primary care. Relevant websites were also searched. Included studies were analysed using candidacy theory and a realist matrix was developed to identify mechanisms that may have contributed to changes in response to the interventions in different contexts. RESULTS Eleven studies were included in the review. Of the eight studies judged to provide detailed description of the programs, the interventions predominately addressed two domains of candidacy (identification of candidacy and navigation), with limited applicability to the third and fourth dimensions (permeability of services and appearances at health services). Six of the eight studies were judged to have successfully linked their target group to primary care. The majority of the interventions focused on assisting patients to reach services and did not look at ways that providers or health services could alter the way they deliver care to improve access. CONCLUSIONS While specific mechanisms behind the interventions could not be identified, it is suggested that individual advocacy may be a key element in the success of these types of interventions. The interventions were found to address some dimensions of candidacy, with health service brokers able to help people to identify their need for care and to access, navigate and interact with services. More consideration should be given to the influence of providers on patient candidacy, rather than placing the onus on patients.
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Affiliation(s)
- Louise Thomas
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2052 Australia
| | - Sharon Parker
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2052 Australia
| | - Hyun Song
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2052 Australia
| | - Nilakshi Gunatillaka
- The Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Notting Hill, Victoria 3168 Australia
| | - Grant Russell
- The Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Notting Hill, Victoria 3168 Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2052 Australia
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Leal DL, Martins RC, Carneiro NCR, de Abreu MHNG, Werneck MAF, Borges-Oliveira AC. Analysis of the oral health care network development in Minas Gerais state, Brazil. J Public Health Dent 2019; 79:154-159. [PMID: 30716163 DOI: 10.1111/jphd.12308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 12/11/2018] [Accepted: 01/11/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study aimed to analyze the development stage of the oral health care network of the Brazilian Unified Health System in the state of Minas Gerais, Brazil. METHODS A cross-sectional descriptive and analytical study was conducted with 205 municipal oral health coordinators from the state. Data collection was carried out through a validated questionnaire to analyze the state of development of the oral health care network. Descriptive and cluster analysis were performed, and two clusters were generated. RESULTS The total median score of the questionnaires classified Minas Gerais as a state with incipient oral health care networks and a minimal capacity to operate such networks, reflected in the predominance of cluster 1 in the sample. There was no statistical association between age, time since graduation, and time spent working as a coordinator and the clusters (Mann-Whitney test). The coordinators' gender and educational level were also not statistically associated with the clusters (Pearson's chi-square and Fisher's exact, respectively). CONCLUSION There is a great need to improve the organization of services of the oral health care network in Minas Gerais. This can be done through improvements in its operational structure, as well as investment in management training.
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Affiliation(s)
- Daniele Lopes Leal
- Faculty of Dentistry, Department of Social and Preventive Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Renata Castro Martins
- Faculty of Dentistry, Department of Social and Preventive Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Natália Cristina Ruy Carneiro
- Faculty of Dentistry, Department of Pediatric Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | - Marcos Azeredo Furquim Werneck
- Faculty of Dentistry, Department of Social and Preventive Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Ana Cristina Borges-Oliveira
- Faculty of Dentistry, Department of Social and Preventive Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
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Crabtree BF, Miller WL, Gunn JM, Hogg WE, Scott CM, Levesque JF, Harris MF, Chase SM, Advocat JR, Halma LM, Russell GM. Uncovering the wisdom hidden between the lines: the Collaborative Reflexive Deliberative Approach. Fam Pract 2018; 35:266-275. [PMID: 29069335 PMCID: PMC5965090 DOI: 10.1093/fampra/cmx091] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Meta-analysis and meta-synthesis have been developed to synthesize results across published studies; however, they are still largely grounded in what is already published, missing the tacit 'between the lines' knowledge generated during many research projects that are not intrinsic to the main objectives of studies. OBJECTIVE To develop a novel approach to expand and deepen meta-syntheses using researchers' experience, tacit knowledge and relevant unpublished materials. METHODS We established new collaborations among primary health care researchers from different contexts based on common interests in reforming primary care service delivery and a diversity of perspectives. Over 2 years, the team met face-to-face and via tele- and video-conferences to employ the Collaborative Reflexive Deliberative Approach (CRDA) to discuss and reflect on published and unpublished results from participants' studies to identify new patterns and insights. RESULTS CRDA focuses on uncovering critical insights, interpretations hidden within multiple research contexts. For the process to work, careful attention must be paid to ensure sufficient diversity among participants while also having people who are able to collaborate effectively. Ensuring there are enough studies for contextual variation also matters. It is necessary to balance rigorous facilitation techniques with the creation of safe space for diverse contributions. CONCLUSIONS The CRDA requires large commitments of investigator time, the expense of convening facilitated retreats, considerable coordination, and strong leadership. The process creates an environment where interactions among diverse participants can illuminate hidden information within the contexts of studies, effectively enhancing theory development and generating new research questions and strategies.
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Affiliation(s)
- Benjamin F Crabtree
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - William L Miller
- Department of Family Medicine; Lehigh Valley Health Network, Allentown, USA
| | - Jane M Gunn
- Department of General Practice and Primary Health Care, University of Melbourne, Melbourne, Australia
| | - William E Hogg
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - Cathie M Scott
- Alberta Centre for Child, Family and Community Research, Edmonton, Canada
| | - Jean-Frederic Levesque
- Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, Australia.,Bureau of Health Information, Chatswood, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, Australia
| | - Sabrina M Chase
- Rutgers Biomedical and Health Sciences (RBHS), Rutgers School of Nursing, Rutgers University, New Brunswick, USA
| | - Jenny R Advocat
- Southern Academic Primary Care Research Unit, School of Primary and Allied Health Care, Monash University, Clayton, Australia
| | - Lisa M Halma
- Zone Analytics and Reporting Services, Alberta Health Services, Edmonton, Canada
| | - Grant M Russell
- Southern Academic Primary Care Research Unity, School of Primary and Allied Health Care, Monash University, Clayton, Australia
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McPherson C, Ploeg J, Edwards N, Ciliska D, Sword W. A catalyst for system change: a case study of child health network formation, evolution and sustainability in Canada. BMC Health Serv Res 2017; 17:100. [PMID: 28143621 PMCID: PMC5286844 DOI: 10.1186/s12913-017-2018-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 01/16/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The purpose of this study was to examine key processes and supportive and inhibiting factors involved in the development, evolution, and sustainability of a child health network in rural Canada. This study contributes to a relatively new research agenda aimed at understanding inter-organizational and cross-sectoral health networks. These networks encourage collaboration focusing on complex issues impacting health - issues that individual agencies cannot effectively address alone. This paper presents an overview of the study findings. METHODS An explanatory qualitative case study approach examined the Network's 13-year lifespan. Data sources were documents and Network members, including regional and 71 provincial senior managers from 11 child and youth service sectors. Data were collected through 34 individual interviews and a review of 127 documents. Interview data were analyzed using framework analysis methods; Prior's approach guided document analysis. RESULTS Three themes related to network development, evolution and sustainability were identified: (a) Network relationships as system triggers, (b) Network-mediated system responsiveness, and (c) Network practice as political. CONCLUSIONS Study findings have important implications for network organizational development, collaborative practice, interprofessional education, public policy, and public system responsiveness research. Findings suggest it is important to explicitly focus on relationships and multi-level socio-political contexts, such as supportive policy environments, in understanding health networks. The dynamic interplay among the Network members; central supportive and inhibiting factors; and micro-, meso-, and macro-organizational contexts was identified.
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Affiliation(s)
- Charmaine McPherson
- School of Nursing, Faculty of Science, St. Francis Xavier University, Box 5000, Antigonish, Nova Scotia B2G 2W5 Canada
| | - Jenny Ploeg
- School of Nursing, Faculty of Health Sciences, McMaster University, 1200 Main Street West, Hamilton, Ontario L8N 3Z5 Canada
| | - Nancy Edwards
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, Ontario KlH 8M5 Canada
| | - Donna Ciliska
- School of Nursing, Faculty of Health Sciences, McMaster University, 1200 Main Street West, Hamilton, Ontario L8N 3Z5 Canada
| | - Wendy Sword
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, Ontario KlH 8M5 Canada
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Leroy L, Rittner JL, Johnson KE, Gerteis J, Miller T. Facilitative Components of Collaborative Learning: A Review of Nine Health Research Networks. Healthc Policy 2017; 12:19-33. [PMID: 28277202 PMCID: PMC5344361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVE Collaborative research networks are increasingly used as an effective mechanism for accelerating knowledge transfer into policy and practice. This paper explored the characteristics and collaborative learning approaches of nine health research networks. DATA SOURCES/STUDY SETTING Semi-structured interviews with representatives from eight diverse US health services research networks conducted between November 2012 and January 2013 and program evaluation data from a ninth. STUDY DESIGN The qualitative analysis assessed each network's purpose, duration, funding sources, governance structure, methods used to foster collaboration, and barriers and facilitators to collaborative learning. DATA COLLECTION The authors reviewed detailed notes from the interviews to distill salient themes. PRINCIPAL FINDINGS Face-to-face meetings, intentional facilitation and communication, shared vision, trust among members and willingness to work together were key facilitators of collaborative learning. Competing priorities for members, limited funding and lack of long-term support and geographic dispersion were the main barriers to coordination and collaboration across research network members. CONCLUSION The findings illustrate the importance of collaborative learning in research networks and the challenges to evaluating the success of research network functionality. Conducting readiness assessments and developing process and outcome evaluation metrics will advance the design and show the impact of collaborative research networks.
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Affiliation(s)
- Lisa Leroy
- US Health Division, Abt Associates, Cambridge, MA
| | | | - Karin E. Johnson
- MacColl Center for Health Care Innovation, Group Health Research Institute, Seattle, WA
| | | | - Therese Miller
- Center for Evidence & Practice Improvement, Agency for Healthcare Research and Quality, Rockville, MD
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Shehzad S. Extending the scope of interprofessional education: Integrating insights from policy, management and economics for improved health outcomes. J Taibah Univ Med Sci 2016. [DOI: 10.1016/j.jtumed.2016.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Hunt CM, Spence M, McBride A. The role of boundary spanners in delivering collaborative care: a process evaluation. BMC FAMILY PRACTICE 2016; 17:96. [PMID: 27473529 PMCID: PMC4966858 DOI: 10.1186/s12875-016-0501-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 07/21/2016] [Indexed: 12/02/2022]
Abstract
Background On average, people with schizophrenia and psychosis die 13–30 years sooner than the general population (World Psychiatry 10 (1):52–77, 2011). Mental and physical health care is often provided by different organisations, different practitioners and in different settings which makes collaborative care difficult. Research is needed to understand and map the impact of new collaborative ways of working at the primary/secondary care interface (PloS One 7 (5); e36468). The evaluation presented in this paper was designed to explore the potential of a Community and Physical Health Co-ordinator role (CPHC) (CPHCs were previously Care Co-ordinators within the Community Mental Health Team, Community in the title CPHC refers to Community Mental Health) and Multi-Disciplinary Team (MDT) meetings across primary and community care, with the aim of improving collaboration of mental and physical health care for service users with Severe Mental Illness (SMI). Methods Data collection took place across five general practices (GPs) and a Community Mental Health Team (CMHT) in the Northwest of England, as part of a process evaluation. Semi-structured interviews were conducted with a purposive sample of GP staff (n= 18) and CMHT staff (n=4), a focus group with CMHT staff (n=8) and a survey completed by 13 CMHT staff, alongside cardiovascular risk data and MDT actions. Framework analysis was used to manage and interpret data. Results The results from the evaluation demonstrate that a CPHC role and MDT meetings are effective mechanisms for improving the collaboration and co-ordination of physical health care for SMI service users. The findings highlight the importance of embedding and supporting the CPHC role, with an emphasis on protected time and continuing professional roles and integrating multiple perspectives through MDT meetings. Considering the importance of physical health care for SMI service users and the complex environment, these are important findings for practitioners, researchers and policy makers in the field of primary care and mental health. Conclusion There is an increasing focus on integration and collaborative working to ensure the delivery of quality care across the whole patient pathway, with a growing need for professionals to work together across service and professional boundaries. The introduction of a two pronged approach to collaboration has shown some important improvements in the management of physical health care for service users with SMI.
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Affiliation(s)
- Carianne M Hunt
- NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC), Greater Manchester, Salford Royal NHS Foundation Trust, 3rd Floor Mayo Building, Stott Lane, Salford, M6 8HD, Greater Manchester, UK.
| | - Michael Spence
- NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC), Greater Manchester, Salford Royal NHS Foundation Trust, 3rd Floor Mayo Building, Stott Lane, Salford, M6 8HD, Greater Manchester, UK
| | - Anne McBride
- Manchester Business School, University of Manchester, Room E26, Booth Street East, Manchester, M15 6PB, UK
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Bainbridge D, Brazil K, Ploeg J, Krueger P, Taniguchi A. Measuring healthcare integration: Operationalization of a framework for a systems evaluation of palliative care structures, processes, and outcomes. Palliat Med 2016; 30:567-79. [PMID: 26934948 DOI: 10.1177/0269216315619862] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Healthcare integration is a priority in many countries, yet there remains little direction on how to systematically evaluate this construct to inform further development. The examination of community-based palliative care networks provides an ideal opportunity for the advancement of integration measures, in consideration of how fundamental provider cohesion is to effective care at end of life. AIM This article presents a variable-oriented analysis from a theory-based case study of a palliative care network to help bridge the knowledge gap in integration measurement. DESIGN Data from a mixed-methods case study were mapped to a conceptual framework for evaluating integrated palliative care and a visual array depicting the extent of key factors in the represented palliative care network was formulated. SETTING/PARTICIPANTS The study included data from 21 palliative care network administrators, 86 healthcare professionals, and 111 family caregivers, all from an established palliative care network in Ontario, Canada. RESULTS The framework used to guide this research proved useful in assessing qualities of integration and functioning in the palliative care network. The resulting visual array of elements illustrates that while this network performed relatively well at the multiple levels considered, room for improvement exists, particularly in terms of interventions that could facilitate the sharing of information. CONCLUSION This study, along with the other evaluative examples mentioned, represents important initial attempts at empirically and comprehensively examining network-integrated palliative care and healthcare integration in general.
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Affiliation(s)
- Daryl Bainbridge
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, ON, Canada Department of Health, Aging & Society, McMaster University, Hamilton, ON, Canada
| | - Paul Krueger
- Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Alan Taniguchi
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, ON, Canada
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Abstract
Introduction: Meeting the complex health needs of people often
requires interaction among numerous different sectors. No one service can
adequately respond to the diverse care needs of consumers. Providers working
more effectively together is frequently touted as the solution. Cross-sector
service provision is defined as independent, yet interconnected sectors working
together to better meet the needs of consumers and improve the quality and
effectiveness of service provision. Cross-sector service provision is expected,
yet much remains unknown about how it is conceptualised or its impact on health
status. This umbrella review aims to clarify the critical attributes that shape
cross-sector service provision by presenting the current state of the literature
and building on the findings of the 2004 review by Sloper. Methods: Literature related to cross-sector service provision is
immense, which poses a challenge for decision makers wishing to make
evidence-informed decisions. An umbrella review was conducted to articulate the
overall state of cross-sector service provision literature and examine the
evidence to allow for the discovery of consistencies and discrepancies across
the published knowledge base. Findings: Sixteen reviews met the inclusion criteria. Seven themes
emerged: Focusing on the consumer, developing a shared vision of care,
leadership involvement, service provision across the boundaries, adequately
resourcing the arrangement, developing novel arrangements or aligning with
existing relationships, and strengthening connections between sectors. Future
research from a cross-organisational, rather than individual provider,
perspective is needed to better understand what shapes cross-sector service
provision at the boundaries. Conclusion: Findings aligned closely with the work done by Sloper
and raise red flags related to reinventing what is already known. Future
researchers should look to explore novel areas rather than looking into areas
that have been explored at length. Evaluations of out-comes related to
cross-sector service provision are still needed before any claims about
effectiveness can be made.
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Harris MF, Advocat J, Crabtree BF, Levesque JF, Miller WL, Gunn JM, Hogg W, Scott CM, Chase SM, Halma L, Russell GM. Interprofessional teamwork innovations for primary health care practices and practitioners: evidence from a comparison of reform in three countries. J Multidiscip Healthc 2016; 9:35-46. [PMID: 26889085 PMCID: PMC4743635 DOI: 10.2147/jmdh.s97371] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Context A key aim of reforms to primary health care (PHC) in many countries has been to enhance interprofessional teamwork. However, the impact of these changes on practitioners has not been well understood. Objective To assess the impact of reform policies and interventions that have aimed to create or enhance teamwork on professional communication relationships, roles, and work satisfaction in PHC practices. Design Collaborative synthesis of 12 mixed methods studies. Setting Primary care practices undergoing transformational change in three countries: Australia, Canada, and the USA, including three Canadian provinces (Alberta, Ontario, and Quebec). Methods We conducted a synthesis and secondary analysis of 12 qualitative and quantitative studies conducted by the authors in order to understand the impacts and how they were influenced by local context. Results There was a diverse range of complex reforms seeking to foster interprofessional teamwork in the care of patients with chronic disease. The impact on communication and relationships between different professional groups, the roles of nursing and allied health services, and the expressed satisfaction of PHC providers with their work varied more within than between jurisdictions. These variations were associated with local contextual factors such as the size, power dynamics, leadership, and physical environment of the practice. Unintended consequences included deterioration of the work satisfaction of some team members and conflict between medical and nonmedical professional groups. Conclusion The variation in impacts can be understood to have arisen from the complexity of interprofessional dynamics at the practice level. The same characteristic could have both positive and negative influence on different aspects (eg, larger practice may have less capacity for adoption but more capacity to support interprofessional practice). Thus, the impacts are not entirely predictable and need to be monitored, and so that interventions can be adapted at the local level.
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Affiliation(s)
- Mark F Harris
- Center for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia
| | - Jenny Advocat
- Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Notting Hill, VIC, Australia
| | - Benjamin F Crabtree
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Jean-Frederic Levesque
- Center for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia; Bureau of Health Information, NSW Government, Sydney, NSW, Australia
| | - William L Miller
- Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - Jane M Gunn
- Department of General Practice, The University of Melbourne, Melbourne, VIC, Australia
| | - William Hogg
- The CT Lamont Primary Care Research Center, The University of Ottawa, Ottawa, ON, Canada
| | - Cathie M Scott
- Alberta Centre for Child, Family, and Community Research, University of Calgary, AB, Canada
| | - Sabrina M Chase
- Rutgers University, Rutgers School of Nursing, Rutgers, NJ, USA
| | - Lisa Halma
- Alberta Health Services, Lethbridge, AB, Canada
| | - Grant M Russell
- School of Primary Health Care, Monash University, Notting Hill, VIC, Australia
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Giles M, Parker V, Mitchell R. Examining Nurse Consultant connectivity: An Australian mixed method study. Nurs Health Sci 2015; 18:154-62. [PMID: 26305104 DOI: 10.1111/nhs.12235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 06/03/2015] [Indexed: 11/27/2022]
Abstract
The nurse consultant (NC) role in Australia is a senior classification of advanced practice nurse has been described as enhancing health care outcomes largely through extensive collaboration with consumers, nurses, and other health professionals. However, little is known about the actual nature, amount, and quality of NC interactions. This study examines the connectivity of the NC role across metropolitan and rural contexts, using a mixed method sequential design with an online survey and focus groups with NCs and other stakeholders. Results demonstrated that NCs most commonly have high density connectivity patterns with other nursing colleagues, medical staff, patients/clients, and administrative staff. Position grade (1, 2 or 3) influences density of connectivity, as does location, with those based in metropolitan roles engaging significantly less with other clinicians. Findings demonstrate that many NCs are highly collaborative and predominantly embedded into interprofessional practice models. This study provides valuable insight into the diverse and often complex NC role and the way in which NC expertise and influence is deployed and integrated across a large local health district.
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Affiliation(s)
- Michelle Giles
- Clinical Nurse Consultant Research, Hunter New England Local Health District, James Fletcher Campus, Newcastle, NSW, Australia.,School of Health, University of New England, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Vicki Parker
- Clinical Nurse Consultant Research, Hunter New England Local Health District, James Fletcher Campus, Newcastle, NSW, Australia.,School of Health, University of New England, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Rebecca Mitchell
- School of Business and Law, University of Newcastle, Newcastle, NSW, Australia
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Santos JS, Valle DA, Palmier AC, Amaral JHLD, Abreu MHNGD. Utilização dos serviços de atendimento odontológico hospitalar sob sedação e/ou anestesia geral por pessoas com necessidades especiais no SUS-MG, Brasil. CIENCIA & SAUDE COLETIVA 2015; 20:515-24. [DOI: 10.1590/1413-81232015202.06732014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 07/21/2014] [Indexed: 11/22/2022] Open
Abstract
O presente estudo identificou as características demográficas dos indivíduos e assistenciais do tratamento odontológico sob sedação e/ou anestesia geral em ambiente hospitalar no SUS-MG. Foram avaliadas todas as Autorizações de Internações Hospitalares (AIH) para o procedimento Tratamento Odontológico para Pacientes com Necessidades Especiais, de julho de 2011 a junho de 2012. Foram mensuradas variáveis demográficas e assistenciais dos atendimentos. Foram calculadas as taxas de internações por 10.000 habitantes e a cobertura assistencial realizada no estado de Minas Gerais e em cada uma das Regiões Ampliadas de Saúde. A análise descritiva das variáveis foi feita por meio de cálculo da frequência e medidas de tendência central e variabilidade. Foram avaliadas todas as 1.063 AIH pagas no período estudado, que representaram uma taxa de 0,54 internações por 10.000 habitantes. A maioria dos indivíduos era adulta, do sexo masculino, com diagnóstico de transtornos mentais ou comportamentais e residente em 27,7% dos municípios de Minas Gerais. Os procedimentos foram realizados em 39 municípios e a cobertura assistencial foi igual a 1,58%. O estudo revelou um perfil clássico do paciente atendido. Dificuldades em se estabelecer uma rede de atenção à saúde bucal foram identificadas.
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Bainbridge D, Brazil K, Krueger P, Ploeg J, Taniguchi A, Darnay J. Measuring horizontal integration among health care providers in the community: an examination of a collaborative process within a palliative care network. J Interprof Care 2014; 29:245-52. [PMID: 25418319 DOI: 10.3109/13561820.2014.984019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In many countries formal or informal palliative care networks (PCNs) have evolved to better integrate community-based services for individuals with a life-limiting illness. We conducted a cross-sectional survey using a customized tool to determine the perceptions of the processes of palliative care delivery reflective of horizontal integration from the perspective of nurses, physicians and allied health professionals working in a PCN, as well as to assess the utility of this tool. The process elements examined were part of a conceptual framework for evaluating integration of a system of care and centred on interprofessional collaboration. We used the Index of Interdisciplinary Collaboration (IIC) as a basis of measurement. The 86 respondents (85% response rate) placed high value on working collaboratively and most reported being part of an interprofessional team. The survey tool showed utility in identifying strengths and gaps in integration across the network and in detecting variability in some factors according to respondent agency affiliation and profession. Specifically, support for interprofessional communication and evaluative activities were viewed as insufficient. Impediments to these aspects of horizontal integration may be reflective of workload constraints, differences in agency operations or an absence of key structural features.
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Affiliation(s)
- Daryl Bainbridge
- Department of Oncology, Juravinski Cancer Centre, McMaster University , Hamilton, Ontario , Canada
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19
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Barman-Adhikari A, Rice E. Social networks as the context for understanding employment services utilization among homeless youth. EVALUATION AND PROGRAM PLANNING 2014; 45:90-101. [PMID: 24780279 PMCID: PMC4069330 DOI: 10.1016/j.evalprogplan.2014.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 03/05/2014] [Accepted: 03/09/2014] [Indexed: 05/27/2023]
Abstract
Little is known about the factors associated with use of employment services among homeless youth. Social network characteristics have been known to be influential in motivating people's decision to seek services. Traditional theoretical frameworks applied to studies of service use emphasize individual factors over social contexts and interactions. Using key social network, social capital, and social influence theories, this paper developed an integrated theoretical framework that capture the social network processes that act as barriers or facilitators of use of employment services by homeless youth, and understand empirically, the salience of each of these constructs in influencing the use of employment services among homeless youth. We used the "Event based-approach" strategy to recruit a sample of 136 homeless youth at one drop-in agency serving homeless youth in Los Angeles, California in 2008. The participants were queried regarding their individual and network characteristics. Data were entered into NetDraw 2.090 and the spring embedder routine was used to generate the network visualizations. Logistic regression was used to assess the influence of the network characteristics on use of employment services. The study findings suggest that social capital is more significant in understanding why homeless youth use employment services, relative to network structure and network influence. In particular, bonding and bridging social capital were found to have differential effects on use of employment services among this population. The results from this study provide specific directions for interventions aimed to increase use of employment services among homeless youth.
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Affiliation(s)
- Anamika Barman-Adhikari
- School of Social Work, California State University, Fresno, CA, United States; School of Social Work, University of Southern California, Los Angeles, CA, United States.
| | - Eric Rice
- School of Social Work, University of Southern California, Los Angeles, CA, United States
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20
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Keygnaert I, Vettenburg N, Roelens K, Temmerman M. Sexual health is dead in my body: participatory assessment of sexual health determinants by refugees, asylum seekers and undocumented migrants in Belgium and The Netherlands. BMC Public Health 2014; 14:416. [PMID: 24886093 PMCID: PMC4012172 DOI: 10.1186/1471-2458-14-416] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 04/25/2014] [Indexed: 11/28/2022] Open
Abstract
Background Although migrants constitute an important proportion of the European population, little is known about migrant sexual health. Existing research mainly focuses on migrants’ sexual health risks and accessibility issues while recommendations on adequate sexual health promotion are rarely provided. Hence, this paper explores how refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands define sexual health, search for sexual health information and perceive sexual health determinants. Methods Applying Community-based Participatory Research as the overarching research approach, we conducted 223 in-depth interviews with refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands. The Framework Analysis Technique was used to analyse qualitative data. We checked the extensiveness of the qualitative data and analysed the quantitative socio-demographic data with SPSS. Results Our results indicate that gender and age do not appear to be decisive determinants. However, incorporated cultural norms and education attainment are important to consider in desirable sexual health promotion in refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands. Furthermore, our results demonstrate that these migrants have a predominant internal health locus of control. Yet, most of them feel that this personal attitude is hugely challenged by the Belgian and Dutch asylum system and migration laws which force them into a structural dependent situation inducing sexual ill-health. Conclusion Refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands are at risk of sexual ill-health. Incorporated cultural norms and attained education are important determinants to address in desirable sexual health promotion. Yet, as their legal status demonstrates to be the key determinant, the prime concern is to alter organizational and societal factors linked to the Belgian and Dutch asylum system. Refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands should be granted the same opportunity as Belgian and Dutch citizens have, to become equally in control of their sexual health and sexuality.
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Affiliation(s)
- Ines Keygnaert
- International Centre for Reproductive Health, Faculty of Medicine & Health Sciences, Ghent University, De Pintelaan 185 UZP114, 9000 Ghent, Belgium.
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21
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Luckett T, Phillips J, Agar M, Virdun C, Green A, Davidson PM. Elements of effective palliative care models: a rapid review. BMC Health Serv Res 2014; 14:136. [PMID: 24670065 PMCID: PMC3986907 DOI: 10.1186/1472-6963-14-136] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 03/10/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Population ageing, changes to the profiles of life-limiting illnesses and evolving societal attitudes prompt a critical evaluation of models of palliative care. We set out to identify evidence-based models of palliative care to inform policy reform in Australia. METHOD A rapid review of electronic databases and the grey literature was undertaken over an eight week period in April-June 2012. We included policy documents and comparative studies from countries within the Organisation for Economic Co-operation and Development (OECD) published in English since 2001. Meta-analysis was planned where >1 study met criteria; otherwise, synthesis was narrative using methods described by Popay et al. (2006). RESULTS Of 1,959 peer-reviewed articles, 23 reported systematic reviews, 9 additional RCTs and 34 non-randomised comparative studies. Variation in the content of models, contexts in which these were implemented and lack of detailed reporting meant that elements of models constituted a more meaningful unit of analysis than models themselves. Case management was the element most consistently reported in models for which comparative studies provided evidence for effectiveness. Essential attributes of population-based palliative care models identified by policy and addressed by more than one element were communication and coordination between providers (including primary care), skill enhancement, and capacity to respond rapidly to individuals' changing needs and preferences over time. CONCLUSION Models of palliative care should integrate specialist expertise with primary and community care services and enable transitions across settings, including residential aged care. The increasing complexity of care needs, services, interventions and contextual drivers warrants future research aimed at elucidating the interactions between different components and the roles played by patient, provider and health system factors. The findings of this review are limited by its rapid methodology and focus on model elements relevant to Australia's health system.
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Affiliation(s)
- Tim Luckett
- Improving Palliative Care through Clinical Trials (ImPaCCT), Sydney, NSW, Australia
- University of Technology Sydney (UTS), Faculty of Health, Building 10, Level 7, 235-253 Jones St, Ultimo, NSW 2007, Australia
- South Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Jane Phillips
- University of Technology Sydney (UTS), Faculty of Health, Building 10, Level 7, 235-253 Jones St, Ultimo, NSW 2007, Australia
- The Cunningham Centre for Palliative Care Sydney, Sacred Heart Hospice, Sydney, NSW, Australia
- School of Nursing, The University of Notre Dame Australia, Sydney, NSW, Australia
| | - Meera Agar
- South Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia
- HammondCare, Sydney, NSW, Australia
- The Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Claudia Virdun
- University of Technology Sydney (UTS), Faculty of Health, Building 10, Level 7, 235-253 Jones St, Ultimo, NSW 2007, Australia
| | - Anna Green
- University of Technology Sydney (UTS), Faculty of Health, Building 10, Level 7, 235-253 Jones St, Ultimo, NSW 2007, Australia
| | - Patricia M Davidson
- University of Technology Sydney (UTS), Faculty of Health, Building 10, Level 7, 235-253 Jones St, Ultimo, NSW 2007, Australia
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
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22
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Rodríguez C, Bélanger E. Stories and metaphors in the sensemaking of multiple primary health care organizational identities. BMC FAMILY PRACTICE 2014; 15:41. [PMID: 24588933 PMCID: PMC4015182 DOI: 10.1186/1471-2296-15-41] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 02/24/2014] [Indexed: 11/24/2022]
Abstract
Background The Quebec primary health care delivery system has experienced numerous reforms over the last 15 years. In this study, we sought to examine how managers and primary care providers made sense of the creation of successive new primary care organizational forms. Methods We conducted a longitudinal qualitative case study in a primary care practice group located in Montreal, Quebec, for over 6 years (2002 to 2008). The data sources for the study include 31 semi-structured interviews with key informants, in-situ observations of group meetings, as well as documents and field notes. Textual material was submitted to narrative and metaphor analysis. Results The core metaphor of the journey came from a set of stories in which the members of this primary care group depicted the processes undertaken towards developing a multidisciplinary cooperative practice, which include an uneasy departure, uncertainty about the destination, conflict among members who jump ship or stay on board, negotiations about the itinerary, and, finally, enduring challenges in leading the way and being pioneers of change in the organization of primary care in their institutional context. Identification with the initial family medicine unit identity was persistent over time, but successive reforms further enriched its meaning as it became a multidisciplinary primary care practice pioneering organizational change. Conclusions In order to support primary care reforms in complex institutional fields, this study proposes that decision-makers undertake a journey in which they recognize both the need to capitalize on existing meaningful and legitimated organizational identities, as well as the necessity for collective leadership in the management of multiple organizational identities over time.
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Affiliation(s)
- Charo Rodríguez
- Department of Family Medicine, Faculty of Medicine, McGill University, 5858 Côte-des-Neiges Boulevard, Montreal, Quebec H3S 1Z1, Canada.
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23
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Manoochehri H, Lolaty HA, Hassani P, Arbon P, Shorofi SA. Iranian senior nursing managers' experiences and understanding of social capital in the nursing profession. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2014; 19:464-72. [PMID: 25400673 PMCID: PMC4223962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 11/25/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND This study aimed to explore the role of social capital within the context of the nursing profession in Iran, based on the experience and perspectives of senior nursing managers. MATERIALS AND METHODS The study was conducted using the Graneheim and Lundman content analysis method. Using purposive sampling, 26 senior nursing managers from the Ministry of Health and Medical Education, the College of Nursing and Midwifery, the Iranian Nursing Organization, nursing associations and hospitals were selected, who participated in semi-structured in-depth interviews. RESULTS Content analysis revealed three main themes (social capital deficit, applying multiple strategies, and cultivating social capital) as well as eight categories which included professional remoteness, deficiency in professional potency, deficiency in professional exchanges, accumulation of personal social capital, accumulation of professional social capital, socio-political strategies, psychological-cognitive strategies, and ethical/spiritual strategies. The results show the perceived level of social capital in nursing in Iran, the application of some key strategies, and the principal rewards accrued from active participation in improving the social capital in nursing environment and profession. CONCLUSIONS Efforts should be made to strengthen the social capital and apply key strategies with the aim of achieving personal and professional benefits for nurses, their patients, and co-workers, and for the delivery of healthcare in general. In this respect, the role of senior managers is vital in stimulating collective action within the profession, planning for the development of a culture of participation in healthcare services, helping to develop all fields of the profession, and developing and strengthening intra- and inter-professional exchanges and networking.
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Affiliation(s)
- Houman Manoochehri
- Department of Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamideh Azimi Lolaty
- Department of Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Address for correspondence: Dr. Hamideh Azimi Lolaty, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Vali-Asr Street, Next to Niyayesh Highway, Tehran, Iran. E-mail:
| | - Parkhideh Hassani
- Department of Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Paul Arbon
- World Association for Disaster and Emergency Medicine (President), School of Nursing and Midwifery, Flinders University, Adelaide, Australia
| | - Seyed Afshin Shorofi
- Department of Nursing, School of Nursing and Midwifery, Mazandaran University of Medical Sciences Sari, Iran
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Zawisza K, Galas A, Tobiasz-Adamczyk B, Chatterji S, Haro JM, Miret M, Koskinen S, Power M, Leonardi M. The Validity of the Instrument to Evaluate Social Network in the Ageing Population: The Collaborative Research on Ageing in Europe Social Network Index. Clin Psychol Psychother 2013; 21:227-41. [DOI: 10.1002/cpp.1860] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Katarzyna Zawisza
- Department of Medical Sociology, Chair of Epidemiology and Preventive Medicine; Jagiellonian University Medical College; Krakow Poland
| | - Aleksander Galas
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine; Jagiellonian University Medical College; Krakow Poland
| | - Beata Tobiasz-Adamczyk
- Department of Medical Sociology, Chair of Epidemiology and Preventive Medicine; Jagiellonian University Medical College; Krakow Poland
| | - Somnath Chatterji
- Department of Health Statistics and Information Systems; World Health Organization; Geneva Switzerland
| | - Josep Maria Haro
- Instituto de Salud Carlos III, Centro de Investigación en Red de Salud Mental; CIBERSAM; Madrid Spain
- Parc Sanitari Sant Joan de Déu; Universitat de Barcelona, Sant Boi de Llobregat; Barcelona Spain
| | - Marta Miret
- Instituto de Salud Carlos III, Centro de Investigación en Red de Salud Mental; CIBERSAM; Madrid Spain
- Department of Psychiatry; Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP); Madrid Spain
- Department of Psychiatry; Universidad Autónoma de Madrid; Madrid Spain
| | - Seppo Koskinen
- National Institute for Health and Welfare; Helsinki Finland
| | - Mick Power
- Section of Clinical and Health Psychology; University of Edinburgh; Edinburgh UK
| | - Matilde Leonardi
- Fondazione IRCCS; Neurological Institute Carlo Besta; Milano Italy
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25
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Hofmeyer AT. How can a social capital framework guide managers to develop positive nurse relationships and patient outcomes? J Nurs Manag 2013; 21:782-9. [DOI: 10.1111/jonm.12128] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Anne T. Hofmeyer
- Senior Lecturer School of Nursing and Midwifery; University of South Australia; Adelaide South Australia Australia
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Abstract
Health systems around the world are implementing integrated care strategies to improve quality, reduce or maintain costs, and improve the patient experience. Yet few practical tools exist to aid leaders and managers in building the prerequisites to integrated care, namely a shared vision, clear roles and responsibilities, and a common understanding of how the vision will be realized. Outcome mapping may facilitate stakeholder alignment on the vision, roles, and processes of integrated care delivery via participative and focused dialogue among diverse stakeholders on desired outcomes and enabling actions. In this paper, we describe an outcome-mapping exercise we conducted at a Local Health Integration Network in Ontario, Canada, using consensus development conferences. Our preliminary findings suggest that outcome mapping may help stakeholders make sense of a complex system and foster collaborative capital, a resource that can support information sharing, trust, and coordinated change toward integration across organizational and professional boundaries. Drawing from the theoretical perspectives of complex adaptive systems and collaborative capital, we also outline recommendations for future outcome-mapping exercises. In particular, we emphasize the potential for outcome mapping to be used as a tool not only for identifying and linking strategic outcomes and actions, but also for studying the boundaries, gaps, and ties that characterize social networks across the continuum of care.
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Affiliation(s)
- Peter Tsasis
- School of Health Policy and Management, Faculty of Health, York University, Toronto, Canada
| | - Jenna M Evans
- Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Canada
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Sword W, Niccols A, Yousefi-Nooraie R, Dobbins M, Lipman E, Smith P. Partnerships Among Canadian Agencies Serving Women with Substance Abuse Issues and Their Children. Int J Ment Health Addict 2013; 11:344-357. [PMID: 23710160 PMCID: PMC3663195 DOI: 10.1007/s11469-012-9418-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Women with substance use issues and their children have unique needs that are best met through collaborative and coordinated service delivery offered by a variety of agencies. However, in Canada and elsewhere, services tend to be fragmented and fail to address children's needs. This study aimed to describe the partnership patterns, activities, and qualities among Canadian agencies serving women with addictions and to determine predictors of partnerships. We found that a number of partnerships exist, and that the extent and characteristics of these partnerships vary. Agency responsiveness to clients was predictive of sending referrals whereas friendliness predicted joint programming and consultation. Four central agencies played key linkage roles. Efforts should be made to build on the social capital inherent in these agencies to strengthen existing networks, further develop linkages to improve service delivery, and promote evidence-informed practice in a field where there is an identified research-practice gap.
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Affiliation(s)
- Wendy Sword
- School of Nursing and Department of Clinical Epidemiology and Biostatistics, McMaster University, HSC 3H48B, 1280 Main Street West, Hamilton, Canada L8S 4K1
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Keygnaert I, Vettenburg N, Temmerman M. Hidden violence is silent rape: sexual and gender-based violence in refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands. CULTURE, HEALTH & SEXUALITY 2012; 14:505-20. [PMID: 22468763 PMCID: PMC3379780 DOI: 10.1080/13691058.2012.671961] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 02/28/2012] [Indexed: 05/17/2023]
Abstract
Although women, young people and refugees are vulnerable to sexual and gender-based violence (SGBV) worldwide, little evidence exists concerning SGBV against refugees in Europe. Using community-based participatory research, 223 in-depth interviews were conducted with refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands. Responses were analysed using framework analysis. The majority of the respondents were either personally victimised or knew of a close peer being victimised since their arrival in the European Union. A total of 332 experiences of SGBV were reported, mostly afflicted on them by (ex-)partners or asylum professionals. More than half of the reported violent experiences comprised sexual violence, including rape and sexual exploitation. Results suggest that refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands are extremely vulnerable to violence and, specifically, to sexual violence. Future SGBV preventive measures should consist of rights-based, desirable and participatory interventions, focusing on several socio-ecological levels concurrently.
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Affiliation(s)
- Ines Keygnaert
- International Centre for Reproductive Health - Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium.
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29
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What promotes and inhibits cooperation in mental health care across disciplines, services and service sectors? A qualitative study. Epidemiol Psychiatr Sci 2012; 21:63-72. [PMID: 22670414 DOI: 10.1017/s2045796011000539] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIMS To explore the practice of cooperation in mental health care across services and identify conditions that promote and inhibit cooperation. METHODS Focus groups with relevant service providers were conducted in four exemplary regions in Germany (rural/ urban and East/West). The discussions were content analysed. RESULTS Seven central categories were deduced: (1) involved service providers, (2) comprehension, (3) reasons, (4) instruments for cooperation, (5) promoting and inhibiting conditions, (6) interdisciplinarity, and (7) regional and personal networks. Cooperation is practiced in networks, rather than defined relations. Who is involved in cooperation depends on patients/clients needs and may vary from case to case. Service providers do not have theoretical concepts of cooperation. Cooperation relies not only on personal contacts and knowledge between services but also on time, financial reimbursement and the social capital of the environment. In particular, cooperation with physicians was considered to be difficult by non-medical professionals. Physician's role models do not seem to include cooperation with other disciplines as a core task. CONCLUSIONS To improve cooperation, regional and sustainable mental health networks have to be systematically implemented by providing leadership, time and reimbursement for network meetings. Interdisciplinary cooperation practice should be part of the curricula of medical students and residents in psychiatry.
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Ramanadhan S, Kebede S, Mantopoulos J, Bradley EH. Network-based social capital and capacity-building programs: an example from Ethiopia. HUMAN RESOURCES FOR HEALTH 2010; 8:17. [PMID: 20594321 PMCID: PMC2906407 DOI: 10.1186/1478-4491-8-17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 07/01/2010] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Capacity-building programs are vital for healthcare workforce development in low- and middle-income countries. In addition to increasing human capital, participation in such programs may lead to new professional networks and access to social capital. Although network development and social capital generation were not explicit program goals, we took advantage of a natural experiment and studied the social networks that developed in the first year of an executive-education Master of Hospital and Healthcare Administration (MHA) program in Jimma, Ethiopia. CASE DESCRIPTION We conducted a sociometric network analysis, which included all program participants and supporters (formally affiliated educators and mentors). We studied two networks: the Trainee Network (all 25 trainees) and the Trainee-Supporter Network (25 trainees and 38 supporters). The independent variable of interest was out-degree, the number of program-related connections reported by each respondent. We assessed social capital exchange in terms of resource exchange, both informational and functional. Contingency table analysis for relational data was used to evaluate the relationship between out-degree and informational and functional exchange. DISCUSSION AND EVALUATION Both networks demonstrated growth and inclusion of most or all network members. In the Trainee Network, those with the highest level of out-degree had the highest reports of informational exchange, chi2 (1, N = 23) = 123.61, p < 0.01. We did not find a statistically significant relationship between out-degree and functional exchange in this network, chi2(1, N = 23) = 26.11, p > 0.05. In the Trainee-Supporter Network, trainees with the highest level of out-degree had the highest reports of informational exchange, chi2 (1, N = 23) = 74.93, p < 0.05. The same pattern held for functional exchange, chi2 (1, N = 23) = 81.31, p < 0.01. CONCLUSIONS We found substantial and productive development of social networks in the first year of a healthcare management capacity-building program. Environmental constraints, such as limited access to information and communication technologies, or challenges with transportation and logistics, may limit the ability of some participants to engage in the networks fully. This work suggests that intentional social network development may be an important opportunity for capacity-building programs as healthcare systems improve their ability to manage resources and tackle emerging problems.
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Affiliation(s)
- Shoba Ramanadhan
- Center for Community-Based Research, Dana-Farber Cancer Institute, 44 Binney St., LW 703, Boston, MA 02115 USA
| | - Sosena Kebede
- Division of Health Policy and Administration, Yale School of Public Health, 60 College St. P.O. Box 208034, New Haven, CT 06520 USA
| | - Jeannie Mantopoulos
- Division of Health Policy and Administration, Yale School of Public Health, 60 College St. P.O. Box 208034, New Haven, CT 06520 USA
| | - Elizabeth H Bradley
- Division of Health Policy and Administration, Yale School of Public Health, 60 College St. P.O. Box 208034, New Haven, CT 06520 USA
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Casebeer A, Popp J, Scott C. Positively deviant networks: what are they and why do we need them? J Health Organ Manag 2009; 23:610-26. [PMID: 20020595 DOI: 10.1108/14777260911001635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This paper aims to report "positively deviant" experiences of three public sector networks seeking to enhance organizational and system level capacities. It is the authors' thesis that the knowledge base concerning the true benefits and pitfalls of networks can be captured and interpreted only through intense, ongoing learning effort embedded in practice on the ground, combined with sustained in-depth observation and collaborative research. DESIGN/METHODOLOGY/APPROACH The paper describes through case examples why and how different kinds of networks within different jurisdictional contexts and different organizational cultures are being used to enhance the climate for change towards better health care and improved health. The authors describe the contexts, structures, processes and impacts of three "positively deviant" networks. FINDINGS The network form can provide opportunity for nurturing changes and innovations within large organizational and complex system environments. This opportunity to create additional and different pathways for improved decision making and service provision comes with challenges that should be recognized. PRACTICAL IMPLICATIONS The authors' experiences indicate that, for networks, a key component of success relates to pulling and pushing at the edges of multiple connections and boundaries in "positively deviant" ways. This pushing and pulling is intrinsically evidence of organizational and intraorganizational learning--in the examples presented--for the improvement of health care and health. ORIGINALITY/VALUE Other networks can learn from the reported experiences and add their own cases to the empirical understanding of how networks can make a difference; this in turn can help the conceptual and theoretical understanding of them.
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Affiliation(s)
- Ann Casebeer
- Department of Community Health Sciences, University of Calgary, Calgary, Canada.
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Mitton C, Adair CE, McKenzie E, Patten S, Waye-Perry B, Smith N. Designing a knowledge transfer and exchange strategy for the Alberta Depression Initiative: contributions of qualitative research with key stakeholders. Int J Ment Health Syst 2009; 3:11. [PMID: 19523226 PMCID: PMC2701921 DOI: 10.1186/1752-4458-3-11] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Accepted: 06/12/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depressive disorders are highly prevalent and of significant societal burden. In fall 2004, the 'Alberta Depression Initiative' (ADI) research program was formed with a mission to enhance the mental health of the Alberta population. A key expectation of the ADI is that research findings will be effectively translated to appropriate research users. To help ensure this, one of the initiatives funded through the ADI focused specifically on knowledge transfer and exchange (KTE). The objectives of this project were first to examine the state of the KTE literature, and then based on this review and a set of key informant interviews, design a KTE strategy for the ADI. METHODS Face to face interviews were conducted with 15 key informants familiar with KTE and/or mental health policy and programs in Alberta. Interviews were transcribed and analyzed using the constant comparison method. RESULTS This paper reports on findings from the qualitative interviews. Respondents were familiar with the barriers to and facilitators of KTE as identified in the existing literature. Four key themes related to the nature of effective KTE were identified in the data analysis: personal relationships, cultivating champions, supporting communities of practice, and building receptor capacity. These recommendations informed the design of a contextually appropriate KTE strategy for the ADI. The three-phased strategy involves preliminary research, public workshops, on-going networking and linkage activities and rigorous evaluation against pre-defined and mutually agreed outcome measures. CONCLUSION Interest in KTE on the part of ADI has led to the development of a strategy for engaging decision makers, researchers, and other mental health stakeholders in an on-going network related to depression programs and policy. A similarly engaged process might benefit other policy areas.
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Affiliation(s)
- Craig Mitton
- University of British Columbia Okanagan, Kelowna BC, Canada.
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Yousefi-Nooraie R, Akbari-Kamrani M, Hanneman RA, Etemadi A. Association between co-authorship network and scientific productivity and impact indicators in academic medical research centers: a case study in Iran. Health Res Policy Syst 2008; 6:9. [PMID: 18796149 PMCID: PMC2553770 DOI: 10.1186/1478-4505-6-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Accepted: 09/16/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to examine the co-authorship networks in three successful Iranian academic research centers, in order to find the association between the scientific productivity and impact indicators with network features in a case study. METHODS We searched for English articles of the three research centers. We drew co-authorship maps of each center and calculated social network measures. RESULTS The collaboration networks in centers shared many structural features, including a "star-like" pattern of relations. Centers with more successful scientific profile showed denser and more cooperative networks. Key figures in each center were interviewed for their understandings of the reasons for the emergence of these patterns. CONCLUSION Star shape network structure and dependency on a single big member is a common feature observed in our case study. Scientific output measures correlate with the network structure of research centers. Network analysis seems a useful method to explore the subtle scientific contexts in research organizations.
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Affiliation(s)
- Reza Yousefi-Nooraie
- Center for Academic and Health Policy, Tehran University of Medical Sciences, Tehran, Iran.
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