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Stoffels M, Broeksma LA, Barry M, van der Burgt SME, Daelmans HEM, Peerdeman SM, Kusurkar RA. Bridging School and Practice? Barriers to the Integration of 'Boundary Objects' for Learning and Assessment in Clinical Nursing Education. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:392-405. [PMID: 39006554 PMCID: PMC11243767 DOI: 10.5334/pme.1103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 06/21/2024] [Indexed: 07/16/2024]
Abstract
Introduction In clinical health professions education, portfolios, assignments and assessment standards are used to enhance learning. When these tools fulfill a bridging function between school and practice, they can be considered 'boundary objects'. In the clinical setting, these tools may be experienced as time-consuming and lacking value. This study aimed to investigate the barriers to the integration of boundary objects for learning and assessment from a Cultural-Historical Activity Theory (CHAT) perspective in clinical nursing education. Methods Nineteen interviews and five observations were conducted with team leads, clinical educators, supervisors, students, and teachers to obtain insight into intentions and use of boundary objects for learning and assessment. Boundary objects (assessment standards, assignments, feedback/reflection/patient care/development plan templates) were collected. The data collection and thematic analysis were guided by CHAT. Results Barriers to the integration of boundary objects included: a) conflicting requirements in clinical competency monitoring and assessment, b) different application of analytical skills, and c) incomplete integration of boundary objects for self-regulated learning into supervision practice. These barriers were amplified by the simultaneous use of boundary objects for learning and assessment. Underlying contradictions included different objectives between school and practice, and tensions between the distribution of labor in the clinical setting and school's rules. Discussion School and practice have both convergent and divergent priorities around students' clinical learning. Boundary objects can promote continuity in learning and increase students' understanding of clinical practice. However, effective integration requires for flexible rules that allow for collaborative learning around patient care.
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Affiliation(s)
- Malou Stoffels
- Amsterdam UMC, Vrije Universiteit Amsterdam, Faculty of Medicine, Research in Education, Amsterdam, The Netherlands
- Amsterdam UMC, VUmc Amstel Academy, Institute for Education and Training, The Netherlands
- LEARN! research institute for learning and education, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands
| | - Louti A Broeksma
- Amsterdam UMC, Vrije Universiteit Amsterdam, Faculty of Medicine, Research in Education, Amsterdam, The Netherlands
| | - Margot Barry
- RadboudUmc Health Academy, Nijmegen, The Netherlands
| | - Stephanie M E van der Burgt
- Amsterdam UMC location University of Amsterdam, Teaching and Learning Center (TLC), Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| | - Hester E M Daelmans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Faculty of Medicine, Research in Education, Amsterdam, The Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Faculty of Medicine, Department of skills training, The Netherlands
| | - Saskia M Peerdeman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Faculty of Medicine, Research in Education, Amsterdam, The Netherlands
- Research institute: Amsterdam Public Health (APH), program Quality of Care, Amsterdam, The Netherlands
| | - Rashmi A Kusurkar
- Amsterdam UMC, Vrije Universiteit Amsterdam, Faculty of Medicine, Research in Education, Amsterdam, The Netherlands
- LEARN! research institute for learning and education, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
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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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Maassen S, van Oostveen C, Weggelaar AM, Rafferty AM, Zegers M, Vermeulen H. Measuring the work environment among healthcare professionals: Validation of the Dutch version of the Culture of Care Barometer. PLoS One 2024; 19:e0298391. [PMID: 38421985 PMCID: PMC10903908 DOI: 10.1371/journal.pone.0298391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 01/23/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVES A positive work environment (WE) is paramount for healthcare employees to provide good quality care. To stimulate a positive work environment, employees' perceptions of the work environment need to be assessed. This study aimed to assess the reliability and validity of the Dutch version of the Culture of Care Barometer (CoCB-NL) survey in hospitals. METHODS This longitudinal validation study explored content validity, structural validity, internal consistency, hypothesis testing for construct validity, and responsiveness. The study was conducted at seven departments in two Dutch university hospitals. The departments were included based on their managers' motivation to better understand their employees' perception of their WE. All employees of participating departments were invited to complete the survey (n = 1,730). RESULTS The response rate was 63.2%. The content of the CoCB-NL was considered relevant and accessible by the respondents. Two factor models were found. First, confirmative factor analysis of the original four-factor structure showed an acceptable fit (X2 2006.49; df 399; p = <0.001; comparative fit index [CFI] 0.82; Tucker-Lewis index [TLI] 0.80; root mean square error of approximation [RMSEA] 0.09). Second, explanatory factor analysis revealed a five-factor model including 'organizational support', 'leadership', 'collegiality and teamwork', 'relationship with manager', and 'employee influence and development'. This model was confirmed and showed a better fit (X2 1552.93; df 395; p = < 0.00; CFI 0.87; TLI 0.86; RMSEA 0.07). Twelve out of eighteen hypotheses were confirmed. Responsiveness was assumed between the measurements. CONCLUSIONS The CoCB-NL is a valid and reliable instrument for identifying areas needing improvement in the WE. Furthermore, the CoCB-NL appears to be responsive and therefore useful for longitudinal evaluations of healthcare employees' work environments.
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Affiliation(s)
- Susanne Maassen
- Department of Quality and Patientcare, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- TRANZO, Tilburg University, Tilburg, The Netherlands
| | - Catharina van Oostveen
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
- Spaarne Gasthuis Academy, Spaarne Gasthuis Hospital, Hoofddorp, Haarlem, The Netherlands
| | | | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing and Midwifery & Palliative Care, King’s College London, London, United Kingdom
| | - Marieke Zegers
- Department of Intensive Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hester Vermeulen
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
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Clay-Williams R, Hibbert P, Loy G, Braithwaite J. Innovative Models of Care for Hospitals of the Future. Int J Health Policy Manag 2024; 13:7861. [PMID: 38618834 PMCID: PMC11016280 DOI: 10.34172/ijhpm.2024.7861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/23/2024] [Indexed: 04/16/2024] Open
Abstract
New ways of providing acute care outside of traditional hospital building complexes, such as virtual care or hospital in the home, are becoming more common. Despite this, many hospitals are still conceived as "bricks and mortar" centralised constructions, and few health service infrastructure organisations meet intensively with consumers or clinicians prior to conceptualising hospital design. Our study sought to understand the needs and expectation of community members and healthcare providers, and co-design innovative models of acute care to inform development of a new metropolitan hospital in Australia. Our study used a three-step approach, consisting of academic and grey literature reviews; a demographic analysis of the hospital catchment population; and a series of 20 workshops and 6 supplementary interviews with community members and local healthcare providers. We found that care should be tailored to the healthcare needs and expectations of each consumer, with consumers cared for in the community where possible and safe. We propose an innovative model of care for hospitals of the future, consisting of fully integrated acute care underpinned by appropriate digital architecture to deliver care that is community focussed. It is vital that new hospitals build in sufficient adaptability to leverage future innovation and meet the needs of growing and changing communities.
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Affiliation(s)
- Robyn Clay-Williams
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Peter Hibbert
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Graeme Loy
- Western Sydney Local Health District, Sydney, NSW, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
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Sharma KM, Jones PB, Cumming J, Middleton L. Key elements and contextual factors that influence successful implementation of large-system transformation initiatives in the New Zealand health system: a realist evaluation. BMC Health Serv Res 2024; 24:54. [PMID: 38200522 PMCID: PMC10782523 DOI: 10.1186/s12913-023-10497-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Despite three decades of policy initiatives to improve integration of health care, delivery of health care in New Zealand remains fragmented, and health inequities persist for Māori and other high priority populations. An evidence base is needed to increase the chances of success with implementation of large-system transformation (LST) initiatives in a complex adaptive system. METHODS This research aimed to identify key elements that support implementation of LST initiatives, and to investigate contextual factors that influence these initiatives. The realist logic of enquiry, nested within the macro framing of complex adaptive systems, formed the overall methodology for this research and involved five phases: theory gleaning from a local LST initiative, literature review, interviews, workshop, and online survey. NVivo software programme was used for thematic analysis of the interview, workshop, and the survey data. We identified key elements and explained variations in success (outcomes) by identifying mechanisms triggered by various contexts in which LST initiatives are implemented. RESULTS The research found that a set of 10 key elements need to be present in the New Zealand health system to increase chances of success with implementation of LST initiatives. These are: (i) an alliancing way of working; (ii) a commitment to te Tiriti o Waitangi; (iii) an understanding of equity; (iv) clinical leadership and involvement; (v) involved people, whānau, and community; (vi) intelligent commissioning; (vii) continuous improvement; (viii) integrated health information; (ix) analytic capability; and (x) dedicated resources and time. The research identified five contextual factors that influenced implementation of LST initiatives: a history of working together, distributed leadership from funders, the maturity of Alliances, capacity and capability for improvement, and a continuous improvement culture. The research found that the key mechanism of trust is built and nurtured over time through sharing of power by senior health leaders by practising distributed leadership, which then creates a positive history of working together and increases the maturity of Alliances. DISCUSSION Two authors (KMS and PBJ) led the development and implementation of the local LST initiative. This prior knowledge and experience provided a unique perspective to the research but also created a conflict of interest and introduced potential bias, these were managed through a wide range of data collection methods and informed consent from participants. The evidence-base for successful implementation of LST initiatives produced in this research contains knowledge and experience of senior system leaders who are often in charge of leading these initiatives. This evidence base enables decision makers to make sense of complex processes involved in the successful implementation of LST initiatives. CONCLUSIONS Use of informal trust-based networks provided a critical platform for successful implementation of LST initiatives in the New Zealand health system. Maturity of these networks relies on building and sustaining high-trust relationships among the network members. The role of local and central agencies and the government is to provide the policy settings and conditions in which trust-based networks can flourish. OTHER This study was approved by the Victoria University of Wellington Human Ethics Committee (Ethics Approval Number 27,356). The research was supported by the Victoria University of Wellington research grant (222,809) and from the University of Auckland Department of Medicine research fund (H10779).
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Affiliation(s)
- Kanchan M Sharma
- Te Tai Ōhanga- The Treasury, 1 The Terrace, 6011, Wellington, New Zealand.
| | - Peter B Jones
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 34 Princes Street, Auckland CBD, 1010, Auckland, New Zealand
| | - Jacqueline Cumming
- Health Services Research Centre, Faculty of Health, Victoria University of Wellington, Kelburn Parade, 6012, Kelburn, Wellington, New Zealand
| | - Lesley Middleton
- Faculty of Health, Victoria University of Wellington, Kelburn Parade, 6012, Kelburn, Wellington, New Zealand
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Varga AI, Spehar I, Skirbekk H. Trustworthy management in hospital settings: a systematic review. BMC Health Serv Res 2023; 23:662. [PMID: 37340412 DOI: 10.1186/s12913-023-09610-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 05/26/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Trustful relationships play a vital role in successful organisations and well-functioning hospitals. While the trust relationship between patients and providers has been widely studied, trust relations between healthcare professionals and their supervisors have not been emphasised. A systematic literature review was conducted to map and provide an overview of the characteristics of trustworthy management in a hospital setting. METHODS We searched Web of Science, Embase, MEDLINE, APA PsycInfo, CINAHL, Scopus, EconLit, Taylor & Francis Online, SAGE Journals and Springer Link from database inception up until Aug 9, 2021. Empirical studies written in English undertaken in a hospital or similar setting and addressed trust relationships between healthcare professionals and their supervisors were included, without date restrictions. Records were independently screened for eligibility by two researchers. One researcher extracted the data and another one checked the correctness. A narrative approach, which involves textual and tabular summaries of findings, was undertaken in synthesising and analysing the data. Risk of bias was assessed independently by two researchers using two critical appraisal tools. Most of the included studies were assessed as acceptable, with some associated risk of bias. RESULTS Of 7414 records identified, 18 were included. 12 were quantitative papers and 6 were qualitative. The findings were conceptualised in two categories that were associated with trust in management, namely leadership behaviours and organisational factors. Most studies (n = 15) explored the former, while the rest (n = 3) additionally explored the latter. Leadership behaviours most commonly associated with employee's trust in their supervisors include (a) different facets of ethical leadership, such as integrity, moral leadership and fairness; (b) caring for employee's well-being conceptualised as benevolence, supportiveness and showing concern and (c) the manager's availability measured as being accessible and approachable. Additionally, four studies found that leaders' competence were related to perceptions of trust. Empowering work environments were most commonly associated with trust in management. CONCLUSIONS Ethical leadership, caring for employees' well-being, manager's availability, competence and an empowering work environment are characteristics associated with trustworthy management. Future research could explore the interplay between leadership behaviours and organisational factors in eliciting trust in management.
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Affiliation(s)
- Andreea Isabela Varga
- Department of Health Management and Health Economics, Institute of Health and Society, Medical Faculty, University of Oslo (UiO), P.O. Box 1089, Oslo, NO-0317, Norway
| | - Ivan Spehar
- Department of Health Management and Health Economics, Institute of Health and Society, Medical Faculty, University of Oslo (UiO), P.O. Box 1089, Oslo, NO-0317, Norway
- Institute of Psychology, Oslo New University College, Oslo, Norway
| | - Helge Skirbekk
- Department of Health Management and Health Economics, Institute of Health and Society, Medical Faculty, University of Oslo (UiO), P.O. Box 1089, Oslo, NO-0317, Norway.
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
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Sanlorenzo LA, Hatch LD. Developing a Respiratory Quality Improvement Program to Prevent and Treat Bronchopulmonary Dysplasia in the Neonatal Intensive Care Unit. Clin Perinatol 2023; 50:363-380. [PMID: 37201986 DOI: 10.1016/j.clp.2023.01.003] [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: 05/20/2023]
Abstract
Improvements in respiratory care have resulted in improved outcomes for preterm infants over the past three decades. To target the multifactorial nature of neonatal lung diseases, neonatal intensive care units (NICUs) should consider developing comprehensive respiratory quality improvement programs that address all drivers of neonatal respiratory disease. This article presents a potential framework for developing a quality improvement program to prevent bronchopulmonary dysplasia in the NICU. Drawing on available research and quality improvement reports, the authors discuss key components, measures, drivers, and interventions that should be considered when building a respiratory quality improvement program devoted to preventing and treating bronchopulmonary dysplasia.
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Affiliation(s)
- Lauren A Sanlorenzo
- Department of Pediatrics, Division of Neonatology, Columbia University Medical Center, 3959 Broadway Avenue, New York, NY 10032, USA
| | - Leon Dupree Hatch
- Department of Pediatrics, Division of Neonatology, Vanderbilt University Medical Center, 4413 VCH, 2200 Children's Way, Nashville, TN 37232, USA; Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA; Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, TN, USA.
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O'Connor RC, Worthman CM, Abanga M, Athanassopoulou N, Boyce N, Chan LF, Christensen H, Das-Munshi J, Downs J, Koenen KC, Moutier CY, Templeton P, Batterham P, Brakspear K, Frank RG, Gilbody S, Gureje O, Henderson D, John A, Kabagambe W, Khan M, Kessler D, Kirtley OJ, Kline S, Kohrt B, Lincoln AK, Lund C, Mendenhall E, Miranda R, Mondelli V, Niederkrotenthaler T, Osborn D, Pirkis J, Pisani AR, Prawira B, Rachidi H, Seedat S, Siskind D, Vijayakumar L, Yip PSF. Gone Too Soon: priorities for action to prevent premature mortality associated with mental illness and mental distress. Lancet Psychiatry 2023; 10:452-464. [PMID: 37182526 DOI: 10.1016/s2215-0366(23)00058-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/17/2023] [Accepted: 02/28/2023] [Indexed: 05/16/2023]
Abstract
Globally, too many people die prematurely from suicide and the physical comorbidities associated with mental illness and mental distress. The purpose of this Review is to mobilise the translation of evidence into prioritised actions that reduce this inequity. The mental health research charity, MQ Mental Health Research, convened an international panel that used roadmapping methods and review evidence to identify key factors, mechanisms, and solutions for premature mortality across the social-ecological system. We identified 12 key overarching risk factors and mechanisms, with more commonalities than differences across the suicide and physical comorbidities domains. We also identified 18 actionable solutions across three organising principles: the integration of mental and physical health care; the prioritisation of prevention while strengthening treatment; and the optimisation of intervention synergies across social-ecological levels and the intervention cycle. These solutions included accessible, integrated high-quality primary care; early life, workplace, and community-based interventions co-designed by the people they should serve; decriminalisation of suicide and restriction of access to lethal means; stigma reduction; reduction of income, gender, and racial inequality; and increased investment. The time to act is now, to rebuild health-care systems, leverage changes in funding landscapes, and address the effects of stigma, discrimination, marginalisation, gender violence, and victimisation.
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Affiliation(s)
- Rory C O'Connor
- Suicidal Behaviour Research Laboratory, School of Health & Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
| | | | - Marie Abanga
- Hope for the Abused and Battered, Douala, Cameroon
| | | | | | - Lai Fong Chan
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Helen Christensen
- Faculty of Medicine & Health, University of New South Wales, Sydney and the Black Dog Institute, Sydney, NSW, Australia
| | - Jayati Das-Munshi
- Department of Psychological Medicine, King's College London, London, UK; Institute of Psychiatry, Psychology, and Neuroscience, and Centre for Society and Mental Health, King's College London, London, UK; South London and Maudsley NHS Trust, London, UK
| | - James Downs
- Royal College of Psychiatrists, UK and Faculty of Wellbeing, Education, and Language Studies, Open University, Milton Keynes, UK
| | | | | | - Peter Templeton
- The William Templeton Foundation for Young People's Mental Health, Cambridge, UK
| | - Philip Batterham
- Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | | | | | - Simon Gilbody
- York Mental Health and Addictions Research Group, University of York, York, UK
| | - Oye Gureje
- WHO Collaborating Centre for Research and Training in Mental Health, Neuroscience, Drug and Alcohol Abuse, University of Ibadan, Ibadan, Nigeria
| | - David Henderson
- Department of Psychiatry, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Ann John
- Swansea University Medical School, Swansea University, Swansea, UK
| | | | - Murad Khan
- Brain & Mind Institute, Aga Khan University, Karachi, Pakistan
| | - David Kessler
- Bristol Population Health Science Institute, Centre for Academic Mental Health, Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Olivia J Kirtley
- Center for Contextual Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | - Brandon Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Alisa K Lincoln
- Institute for Health Equity and Social Justice Research, Northeastern University, Boston, MA, USA
| | - Crick Lund
- Health Services and Population Research Department, King's College London, London, UK; Centre for Global Mental Health, King's College London, London, UK
| | - Emily Mendenhall
- Edmund A Walsh School of Foreign Service, Georgetown University, Washington, DC, USA
| | - Regina Miranda
- Hunter College, Department of Psychology, The Graduate Center, City University of New York, New York, NY, USA
| | - Valeria Mondelli
- Department of Psychological Medicine, King's College London, London, UK
| | - Thomas Niederkrotenthaler
- Department of Social and Preventive Medicine, Suicide Research & Mental Health Promotion Unit, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - David Osborn
- Division of Psychiatry, University College London and Camden and Islington NHS Foundation Trust, London, UK
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Anthony R Pisani
- University of Rochester Center for the Study and Prevention of Suicide, SafeSide Prevention, Rochester, NY, USA
| | | | | | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, SAMRC Genomics of Brain Disorders Unit, Stellenbosch University, Cape Town, South Africa
| | - Dan Siskind
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
| | | | - Paul S F Yip
- Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong Special Administrative Region, China
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Lewis TP, McConnell M, Aryal A, Irimu G, Mehata S, Mrisho M, Kruk ME. Health service quality in 2929 facilities in six low-income and middle-income countries: a positive deviance analysis. Lancet Glob Health 2023; 11:e862-e870. [PMID: 37202022 DOI: 10.1016/s2214-109x(23)00163-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/08/2023] [Accepted: 03/16/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Primary care is of insufficient quality in many low-income and middle-income countries. Some health facilities perform better than others despite operating in similar contexts, although the factors that characterise best performance are not well known. Existing best-performance analyses are concentrated in high-income countries and focus on hospitals. We used the positive deviance approach to identify the factors that differentiate best from worst primary care performance among health facilities across six low-resource health systems. METHODS This positive deviance analysis used nationally representative samples of public and private health facilities from Service Provision Assessments of the Democratic Republic of the Congo, Haiti, Malawi, Nepal, Senegal, and Tanzania. Data were collected starting June 11, 2013, in Malawi and ending Feb 28, 2020, in Senegal. We assessed facility performance through completion of the Good Medical Practice Index (GMPI) of essential clinical actions (eg, taking a thorough history, conducting an adequate physical examination) according to clinical guidelines and measured with direct observations of care. We identified hospitals and clinics in the top decile of performance (defined as best performers) and conducted a quantitative, cross-national positive deviance analysis to compare them with facilities performing below the median (defined as worst performers) and identify facility-level factors that explain the gap between best and worst performance. FINDINGS We identified 132 best-performing and 664 worst-performing hospitals, and 355 best-performing and 1778 worst-performing clinics based on clinical performance across countries. The mean GMPI score was 0·81 (SD 0·07) for the best-performing hospitals and 0·44 (0·09) for the worst-performing hospitals. Among clinics, mean GMPI scores were 0·75 (0·07) for the best performers and 0·34 (0·10) for the worst performers. High-quality governance, management, and community engagement were associated with best performance compared with worst performance. Private facilities out-performed government-owned hospitals and clinics. INTERPRETATION Our findings suggest that best-performing health facilities are characterised by good management and leaders who can engage staff and community members. Governments should look to best performers to identify scalable practices and conditions for success that can improve primary care quality overall and decrease quality gaps between health facilities. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Todd P Lewis
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA.
| | - Margaret McConnell
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Amit Aryal
- Swiss TPH, University of Basel, Basel, Switzerland
| | - Grace Irimu
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Suresh Mehata
- Policy, Planning and Public Health Division, Ministry of Health, Biratnagar, Nepal
| | - Mwifadhi Mrisho
- Department of Health Systems, Impact Evaluation, and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
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Belasen A, Belasen A, Feng Z. The physician CEO advantage and hospital performance during the COVID-19 pandemic: capacity utilization and patient satisfaction. J Health Organ Manag 2023; ahead-of-print. [PMID: 36859352 DOI: 10.1108/jhom-04-2022-0126] [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: 03/03/2023]
Abstract
PURPOSE Prior studies have shown that physician-led hospitals have several advantages over non-physician-led hospitals. This study seeks to test whether these advantages also extend to periods of extreme disruptions such as the COVID-19 pandemic, which affect bed availability and hospital utilization. DESIGN/METHODOLOGY/APPROACH The authors utilize a bounded Tobit estimation to identify differences in patient satisfaction rates and in-hospital utilization rates of top-rated hospitals in the United States. FINDINGS Among top-rated US hospitals, those that are physician-led achieve higher patient satisfaction ratings and are more likely to have higher utilization rates. RESEARCH LIMITATIONS/IMPLICATIONS While the COVID-19 pandemic generated greater demand for inpatient beds, physician-led hospitals improved their hospitals' capacity utilization as compared with those led by non-physician leaders. A longitudinal study to show the change over the years and whether physician Chief Executive Officers (CEOs) are more likely to improve their hospitals' ratings than non-physician CEOs is highly recommended. PRACTICAL IMPLICATIONS Recruiting and retaining physicians to lead hospitals, especially during disruptions, improve hospital's operating efficiency and enhance patient satisfaction. ORIGINALITY/VALUE The paper reviews prior research on physician leadership and adds further insights into the crisis leadership literature. The authors provide evidence based on quantitative data analysis that during the COVID-19 pandemic, physician-led top-rated US hospitals experienced an improvement in operating efficiency.
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Affiliation(s)
- Alan Belasen
- MBA Program, SUNY Empire State College, Saratoga Springs, New York, USA
| | - Ariel Belasen
- Department of Economics and Finance, Southern Illinois University Edwardsville, Edwardsville, Illinois, USA
| | - Zhilan Feng
- David D. Reh School of Business, Clarkson University, Potsdam, New York, USA
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Nduka IR, Ali N, Kabasinguzi I, Abdy D. The psycho-social impact of obstetric fistula and available support for women residing in Nigeria: a systematic review. BMC Womens Health 2023; 23:87. [PMID: 36841757 PMCID: PMC9960620 DOI: 10.1186/s12905-023-02220-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 02/09/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Obstetric fistula continues to affect the social and mental wellbeing of women living in Nigeria giving rise to poor maternal health outcome. While the World Health Organisation (WHO) has recommended the introduction of psycho-social interventions in the management of obstetric fistula women, psycho-social support for women living with obstetric fistula in Nigeria, are limited. This systematic review aimed to synthesise the psycho-social impact of obstetric fistula on women living in Nigeria as well as the available psycho-social support for these affected women. METHODS Following a keyword strategy, Medline, CINAHL, Google scholar, ScienceDirect, Cochrane library, PsychINFO, AMED, British Nursing database, Pubmed central, TRIP database, UK Pubmed central, socINDEX, Annual reviews, ISI Web of Science, Academic search complete, Credo reference, Sage premier and Scopus databases were searched alongside hand searching of articles. The inclusion criteria were set as articles published between 2000 and 2020, on the psychosocial consequences of obstetric fistula in Nigeria. The Critical Appraisal Skills Program (CASP) tool was used to appraise the quality of the included studies. The data was extracted and then analysed using narrative synthesis. RESULTS 620 relevant citations were identified, and 8 studies were included. Women with obstetric fistula, living in Nigeria were found to be ostracised, abandoned by families and friends, stigmatised and discriminated against, which led to depression, loneliness, loss of self-esteem, self-worth and identity. Psycho-social interventions for women who experienced obstetric fistula are not widely available. CONCLUSION There is a need for the introduction of more rehabilitation and reintegration programs across the country. The psychosocial effect of obstetric fistula is significant and should be considered when developing interventions. Further, more research is needed to evaluate the sustainability of psychosocial interventions in Nigeria.
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Affiliation(s)
| | - Nasreen Ali
- grid.15034.330000 0000 9882 7057Institute of Health Research, University of Bedfordshire, Luton, LU1 3JU UK
| | - Isabella Kabasinguzi
- grid.15034.330000 0000 9882 7057Institute of Health Research, University of Bedfordshire, Luton, LU1 3JU UK
| | - David Abdy
- grid.15034.330000 0000 9882 7057Institute of Health Research, University of Bedfordshire, Luton, LU1 3JU UK
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Segura-García MT, Castro Vida MÁ, García-Martin M, Álvarez-Ossorio-García de Soria R, Cortés-Rodríguez AE, López-Rodríguez MM. Patient Safety Culture in a Tertiary Hospital: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2329. [PMID: 36767694 PMCID: PMC9916148 DOI: 10.3390/ijerph20032329] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
Patient safety (PS) culture is the set of values and norms common to the individuals of an organization. Assessing the culture is a priority to improve the quality and PS of hospital services. This study was carried out in a tertiary hospital to analyze PS culture among the professionals and to determine the strengths and weaknesses that influence this perception. A cross-sectional descriptive study was carried out. The AHRQ Questionnaire on the Safety of Patients in Hospitals (SOPS) was used. A high perception of PS was found among the participants. In the strengths found, efficient teamwork, mutual help between colleagues and the support of the manager and head of the unit stood out. Among the weaknesses, floating professional templates, a perception of pressure and accelerated pace of work, and loss of relevant information on patient transfer between units and shift changes were observed. Among the areas for improvement detected were favoring feedback to front-line professionals, abandoning punitive measures and developing standardized tools that minimize the loss of information.
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Affiliation(s)
- María Teresa Segura-García
- Subdirectorate of Nursing, Hospital Universitario Poniente, Servicio Andaluz de Salud, 04700 El Ejido, Almería, Spain
| | - María Ángeles Castro Vida
- Pharmacy Service, Hospital Universitario Poniente, Servicio Andaluz de Salud, 04700 El Ejido, Almería, Spain
| | - Manuel García-Martin
- Intensive Care Unit, Hospital Universitario Poniente, Servicio Andaluz de Salud, 04700 El Ejido, Almería, Spain
| | | | | | - María Mar López-Rodríguez
- Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 La Cañada, Almería, Spain
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Dennis D, Vernon van Heerden P, Knott C, Khanna R. The nature and sources of the emotional distress felt by intensivists and the burdens that are carried: A qualitative study. Aust Crit Care 2023; 36:52-58. [PMID: 34972619 DOI: 10.1016/j.aucc.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/05/2021] [Accepted: 11/14/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Work in intensive care units is often traumatic and emotionally distressing, sometimes leading to growth but at other times to negative outcomes such as worker burnout and mental illness. The type and origin of distresses to intensivists has been poorly characterised in the literature. This evidence gap makes it difficult to develop tailored educational process or cultural interventions for all who work within the specialty. OBJECTIVES The aim of this study was to elicit the nature and sources of workplace emotional distress in an international sample of intensivists. METHOD Interviews were undertaken with experienced intensivists in Australia and Israel related to the basis of workplace distress. These were transcribed and qualitatively thematically analysed. RESULTS In 2018, 19 intensivists participated in the study. Several key themes emerged from data analysis, some relating to clinical work, such as catastrophic patient outcomes, and some relating to interpersonal and systems-level challenges. Navigating complex interpersonal dynamics with carers and staff, both within and outside the intensive care unit team, caused substantial emotional burden. CONCLUSIONS Many factors contribute to workplace stress for doctors in the intensive care setting. In elucidating common reactions to these stressors, we have attempted to normalise responses. We further note that the skill sets relevant to the many challenges identified are generally missing in medical training curricula. It may be prudent to consider their inclusion in the future.
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Affiliation(s)
- Diane Dennis
- Department of Intensive Care and Physiotherapy Department, Sir Charles Gairdner Hospital, Perth, Western Australia 6009, Australia; Faculty of Health Sciences, Curtin University, Perth, Western Australia 6102, Australia.
| | - Peter Vernon van Heerden
- Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, 91120001, Israel.
| | - Cameron Knott
- Department of Intensive Care, Bendigo Health, Bendigo, Victoria 3550, Australia; Monash Rural Health Bendigo, Monash University, Victoria 3552, Australia; Rural Clinical School, University of Melbourne, Victoria 3010, Australia; Department of Intensive Care, Austin Health, Heidelberg, Victoria 3084, Australia.
| | - Rahul Khanna
- Department of Psychiatry, Phoenix Australia, University of Melbourne, Melbourne, Victoria 3010, Australia; Division of Mental Health, Austin Health, Heidelberg, Victoria 3084, Australia.
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Rapport F, Smith J, Hutchinson K, Clay-Williams R, Churruca K, Bierbaum M, Braithwaite J. Too much theory and not enough practice? The challenge of implementation science application in healthcare practice. J Eval Clin Pract 2022; 28:991-1002. [PMID: 34268832 DOI: 10.1111/jep.13600] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Implementation science (IS) should contribute to maintaining high standards of care across healthcare systems and enhancing care practices. However, despite the evident need for greater and more rapid uptake and integration of evidence in practice, IS design and methodology fall short of the needs of effective translation. AIM In this paper we examine what it is about IS that makes it so appealing for effective uptake of interventions in routine practice, and yet so difficult to achieve. We propose a number of ways that implementation scientists could build mutual relationships with healthcare practitioners and other stakeholders including public members to ensure greater shared care practices, and highlight the value of IS training, collaborative educational events, and co-designed research. DISCUSSION More consideration should be given to IS applications in healthcare contexts. Implementation scientists can make a valuable contribution by mobilizing theory and improving practice. However, goals for an evidence-based system may be more appropriately achieved through greater outreach and collaboration, with methods that are flexible to support rapid implementation in complex adaptive systems. Collective learning and mutual trust can be cultivated by embedding researchers into healthcare services while offering greater opportunities for practitioners to learn about, and engage in, implementation research. CONCLUSION To bridge the worlds of healthcare practice and IS, researchers could be more consistent in the relationships they build with professionals and the public, communicating through a shared language and co-joining practical approaches to effective implementation. This will build capacity for improved collaboration and foster respectful, interdisciplinary relationships.
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Affiliation(s)
- Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - James Smith
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Karen Hutchinson
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Morris M, Seguin M, Landon S, McKee M, Nolte E. Exploring the Role of Leadership in Facilitating Change to Improve Cancer Survival: An Analysis of Experiences in Seven High Income Countries in the International Cancer Benchmarking Partnership (ICBP). Int J Health Policy Manag 2022; 11:1756-1766. [PMID: 34380203 PMCID: PMC9808244 DOI: 10.34172/ijhpm.2021.84] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 07/12/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The differences in cancer survival across countries and over time are well recognised, with progress varying even among high-income countries with comparable health systems. Previous research has examined several possible explanations, but the role of leadership in systems providing cancer care has attracted little attention. As part of the International Cancer Benchmarking Partnership (ICBP), this study looked at diverse aspects of leadership to identify drivers of change and opportunities for improvement across seven high-income countries. METHODS Key informants in 13 jurisdictions were interviewed: Australia (2 states), Canada (3 provinces), Denmark, Ireland, New Zealand, Norway and United Kingdom (4 countries). Participants represented a range of stakeholders at different tiers of the system. They were recruited through a combination of purposive and 'snowball' strategies and participated in semi-structured telephone interviews. Interview transcripts were analysed thematically drawing on the World Health Organization (WHO) health systems framework and previous work analysing national cancer control programmes (NCCPs). RESULTS Several facets of leadership were perceived as important for improving outcomes. These included political leadership to initiate and maintain progress, intellectual leadership to support those engaged in local implementation of national policies and drive change, and a coherent vision from leaders at different levels of the system. Clinical leadership was also viewed as vital for translating policy into action. CONCLUSION Certain aspects of cancer care leadership emerged as underpinning and sustaining improvements, such as appointing a central agency, involving clinicians at every stage, ensuring strong leadership of cancer care with a consistent political mandate. Improving cancer outcomes is challenging and complex, but it is unlikely to be achieved without effective leadership, both political and clinical.
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Affiliation(s)
- Melanie Morris
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
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Thusini S, Milenova M, Nahabedian N, Grey B, Soukup T, Henderson C. Identifying and understanding benefits associated with return-on-investment from large-scale healthcare Quality Improvement programmes: an integrative systematic literature review. BMC Health Serv Res 2022; 22:1083. [PMID: 36002852 PMCID: PMC9404657 DOI: 10.1186/s12913-022-08171-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/08/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND We previously developed a Quality Improvement (QI) Return-on-Investment (ROI) conceptual framework for large-scale healthcare QI programmes. We defined ROI as any monetary or non-monetary value or benefit derived from QI. We called the framework the QI-ROI conceptual framework. The current study describes the different categories of benefits covered by this framework and explores the relationships between these benefits. METHODS We searched Medline, Embase, Global health, PsycInfo, EconLit, NHS EED, Web of Science, Google Scholar, organisational journals, and citations, using ROI or returns-on-investment concepts (e.g., cost-benefit, cost-effectiveness, value) combined with healthcare and QI. Our analysis was informed by Complexity Theory in view of the complexity of large QI programmes. We used Framework analysis to analyse the data using a preliminary ROI conceptual framework that was based on organisational obligations towards its stakeholders. Included articles discussed at least three organisational benefits towards these obligations, with at least one financial or patient benefit. We synthesized the different QI benefits discussed. RESULTS We retrieved 10 428 articles. One hundred and two (102) articles were selected for full text screening. Of these 34 were excluded and 68 included. Included articles were QI economic, effectiveness, process, and impact evaluations as well as conceptual literature. Based on these literatures, we reviewed and updated our QI-ROI conceptual framework from our first study. Our QI-ROI conceptual framework consists of four categories: 1) organisational performance, 2) organisational development, 3) external outcomes, and 4) unintended outcomes (positive and negative). We found that QI benefits are interlinked, and that ROI in large-scale QI is not merely an end-outcome; there are earlier benefits that matter to organisations that contribute to overall ROI. Organisations also found positive aspects of negative unintended consequences, such as learning from failed QI. DISCUSSION AND CONCLUSION Our analysis indicated that the QI-ROI conceptual framework is made-up of multi-faceted and interconnected benefits from large-scale QI programmes. One or more of these may be desirable depending on each organisation's goals and objectives, as well as stage of development. As such, it is possible for organisations to deduce incremental benefits or returns-on-investments throughout a programme lifecycle that are relevant and legitimate.
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Affiliation(s)
| | | | | | - Barbara Grey
- South London and Maudsley NHS Foundation Trust, London, UK
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17
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Lewis TP, Aryal A, Mehata S, Thapa A, Yousafzai AK, Kruk ME. Best and worst performing health facilities: A positive deviance analysis of perceived drivers of primary care performance in Nepal. Soc Sci Med 2022; 309:115251. [PMID: 35961216 PMCID: PMC9458868 DOI: 10.1016/j.socscimed.2022.115251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 07/19/2022] [Accepted: 07/27/2022] [Indexed: 11/30/2022]
Abstract
Primary care services are on average of low quality in Nepal. However, there is marked variation in performance of basic clinical and managerial functions between primary health care centers. The determinants of variation in primary care performance in low- and middle-income countries have been understudied relative to the prominence of primary care in national health plans. We used the positive deviance approach to identify best and worst performing primary health care centers in Nepal and investigated perceived drivers of best performance. We selected eight primary health care centers in Province 1, Nepal, using an index of basic clinical and operational activities to identify four best and four worst performing primary health care centers. We conducted semi-structured, in-depth interviews with managers and clinical staff from each of the eight primary health care centers for a total of 32 interviews. We identified the following factors that distinguished best from worst performers: 1) Managing the facility effectively, 2) engaging local leadership, 3) building active community accountability, 4) assessing and responding to facility performance, 5) developing sources of funding, 6) compensating staff fairly, 7) managing clinical staff performance, and 8) promoting uninterrupted availability of supplies and equipment. These findings can be used to inform quality improvement efforts and health system reforms in Nepal and other similarly under-resourced health systems. Local leaders and health workers felt good management was key to best performance. Best performers reported strong leadership at both the facility and local levels. Community accountability was also seen as a critical enabler of top performance. Leaders of worst performers were less responsive to facility and community needs.
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Lucas J, Leggat SG, Taylor NF. Association between use of clinical governance systems at the frontline and patient safety: a pre-post study. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2022. [DOI: 10.1108/ijhg-02-2022-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeTo investigate the association between implementation of clinical governance and patient safety.Design/methodology/approachA pre-post study was conducted in an Australian health service following the implementation of clinical governance systems (CGS) in the inpatient wards in 2016. Health service audit data from 2017 on CGS implementation and the rate of adverse patient safety events (PSE) for 2015 (pre-implementation) and 2017 (post-implementation), across 45 wards in six hospitals were collected. CGS examined compliance with 108 variables, based on the Australian National Safety and Quality Health Service standards. Patient safety was measured as PSE per 100 bed days. Data were analysed using odds ratios to explore the association between patient safety and CGS percentage compliance score.FindingsThere was no change in PSE between 2015 and 2017 (MD 0.04 events/100 bed days, 95% CI -0.11 to 0.21). There were higher odds that wards with a CGS score >90% reported reduced PSE, compared to wards with lower compliance. The domains of leadership and culture, risk management and clinical practice had the strongest association with the reduction in PSE.Practical implicationsGiven that wards with a CGS score >90% showed increased odds of reduced PSE health service boards need to put in place strategies that engage frontline managers and staff to facilitate full implementation of clinical governance systems for patient safety.Originality/valueThe findings provide evidence that implementation of all facets of CGS in a large public health service is associated with improved patient safety.
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Pesch L, Stafford T, Hunter J, Stewart G, Miltner R. Utilization of Improvement Methodologies by Healthcare Quality Professionals During the COVID-19 Pandemic. J Healthc Qual 2022; 44:123-130. [PMID: 35439210 DOI: 10.1097/jhq.0000000000000344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION This study describes the work of healthcare quality professionals during the COVID-19 pandemic, highlighting the successes and challenges they faced when applying their expertise in performance and process improvement (PPI) to help manage the crisis. METHODS The researchers performed a descriptive analysis of anonymous survey data collected from members of the National Association for Healthcare Quality professional community who were asked about their improvement work during the pandemic response. RESULTS Most survey respondents used improvement methods to a great or moderate extent to measure what was happening (83%), rapidly review processes and practice (81%), and decide where to focus effort (81%). Fewer respondents used PPI methods to engage with patients and families (58% to a great or moderate extent). Looking to the future, respondents indicated that embedding systematic approaches to improvement within healthcare organizations (59%) and working in a more integrated way across teams (48%) should be prioritized in the post-pandemic recovery. CONCLUSIONS The results from this study demonstrate why healthcare leaders should recognize the value that performance improvement approaches provide to everyday operations. They must empower PPI experts to lead this critical work and continue building workforce capacity in PPI methods to strengthen staff engagement and achieve better outcomes.
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Vranas KC, Golden SE, Mathews KS, Schutz A, Valley TS, Duggal A, Seitz KP, Chang SY, Nugent S, Slatore CG, Sullivan DR, Hough CL. The Influence of the COVID-19 Pandemic on ICU Organization, Care Processes, and Frontline Clinician Experiences: A Qualitative Study. Chest 2021; 160:1714-1728. [PMID: 34062115 PMCID: PMC8164514 DOI: 10.1016/j.chest.2021.05.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic resulted in unprecedented adjustments to ICU organization and care processes globally. RESEARCH QUESTIONS Did hospital emergency responses to the COVID-19 pandemic differ depending on hospital setting? Which strategies worked well to mitigate strain as perceived by intensivists? STUDY DESIGN AND METHODS Between August and November 2020, we carried out semistructured interviews of intensivists from tertiary and community hospitals across six regions in the United States that experienced early or large surges of COVID-19 patients, or both. We identified themes of hospital emergency responses using the four S framework of acute surge planning: space, staff, stuff, system. RESULTS Thirty-three intensivists from seven tertiary and six community hospitals participated. Clinicians across both settings believed that canceling elective surgeries was helpful to increase ICU capabilities and that hospitals should establish clearly defined thresholds at which surgeries are limited during future surge events. ICU staff was the most limited resource; staff shortages were improved by the use of tiered staffing models, just-in-time training for non-ICU clinicians, designated treatment teams, and deployment of trainees. Personal protective equipment (PPE) shortages and reuse were widespread, causing substantial distress among clinicians; hands-on PPE training was helpful to reduce clinicians' anxiety. Transparency and involvement of frontline clinicians as stakeholders were important components of effective emergency responses and helped to maintain trust among staff. INTERPRETATION We identified several strategies potentially to mitigate strain as perceived by intensivists working in both tertiary and community hospital settings. Our study also demonstrated the importance of trust and transparency between frontline staff and hospital leadership as key components of effective emergency responses during public health crises.
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Affiliation(s)
- Kelly C Vranas
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR; Division of Pulmonary and Critical Care, Oregon Health & Science University, Portland, OR; Palliative and Advanced Illness Research (PAIR) Center, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Sara E Golden
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR
| | - Kusum S Mathews
- Division of Pulmonary, Critical Care, & Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amanda Schutz
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Thomas S Valley
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI
| | - Abhijit Duggal
- Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Kevin P Seitz
- Division of Pulmonary, Allergy, and Critical Care Medicine, Vanderbilt University, Nashville, TN
| | - Steven Y Chang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, Los Angeles, CA
| | - Shannon Nugent
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR; Department of Psychiatry, Oregon Health & Science University, Portland, OR
| | - Christopher G Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR; Division of Pulmonary and Critical Care, Oregon Health & Science University, Portland, OR
| | - Donald R Sullivan
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR; Division of Pulmonary and Critical Care, Oregon Health & Science University, Portland, OR; Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Catherine L Hough
- Division of Pulmonary and Critical Care, Oregon Health & Science University, Portland, OR
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21
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Lamming L, Montague J, Crosswaite K, Faisal M, McDonach E, Mohammed MA, Cracknell A, Lovatt A, Slater B. Fidelity and the impact of patient safety huddles on teamwork and safety culture: an evaluation of the Huddle Up for Safer Healthcare (HUSH) project. BMC Health Serv Res 2021; 21:1038. [PMID: 34598704 PMCID: PMC8487146 DOI: 10.1186/s12913-021-07080-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/10/2021] [Indexed: 11/24/2022] Open
Abstract
Background The Patient Safety Huddle (PSH) is a brief multidisciplinary daily meeting held to discuss threats to patient safety and actions to mitigate risk. Despite growing interest and application of huddles as a mechanism for improving safety, evidence of their impact remains limited. There is also variation in how huddles are conceived and implemented with insufficient focus on their fidelity (the extent to which delivered as planned) and potential ways in which they might influence outcomes. The Huddle Up for Safer Healthcare (HUSH) project attempted to scale up the implementation of patient safety huddles (PSHs) in five hospitals – 92 wards - across three UK NHS Trusts. This paper aims to assess their fidelity, time to embed, and impact on teamwork and safety culture. Methods A multi-method Developmental Evaluation was conducted. The Stages of Implementation Checklist (SIC) was used to determine time taken to embed PSHs. Observations were used to check embedded status and fidelity of PSH. A Teamwork and Safety Climate survey (TSC) was administered at two time-points: pre- and post-embedding. Changes in TSC scores were calculated for Trusts, job role and clinical speciality. Results Observations confirmed PSHs were embedded in 64 wards. Mean fidelity score was 4.9/9. PSHs frequently demonstrated a ‘fear free’ space while Statistical Process Control charts and historical harms were routinely omitted. Analysis showed a positive change for the majority (26/27) of TSC questions and the overall safety grade of the ward. Conclusions PSHs are feasible and effective for improving teamwork and safety culture, especially for nurses. PSH fidelity criteria may need adjusting to include factors deemed most useful by frontline staff. Future work should examine inter-disciplinary and role-based differences in TSC outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07080-1.
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Affiliation(s)
- Laura Lamming
- Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Jane Montague
- Faculty of Health Studies, University of Bradford, Bradford, UK.
| | - Kate Crosswaite
- Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Muhammad Faisal
- Faculty of Health Studies, University of Bradford, Bradford, UK
| | | | | | - Alison Cracknell
- St James's University Hospital, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Alison Lovatt
- The Improvement Academy, Bradford Institute for Health Research, Bradford, UK
| | - Beverley Slater
- The Improvement Academy, Bradford Institute for Health Research, Bradford, UK
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22
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Edge R, Meyers J, Tiernan G, Li Z, Schiavuzzi A, Chan P, Vassallo A, Morrow A, Mazariego C, Wakefield CE, Canfell K, Taylor N. Cancer care disruption and reorganisation during the COVID-19 pandemic in Australia: A patient, carer and healthcare worker perspective. PLoS One 2021; 16:e0257420. [PMID: 34534231 PMCID: PMC8448370 DOI: 10.1371/journal.pone.0257420] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/18/2021] [Indexed: 11/19/2022] Open
Abstract
The COVID-19 pandemic has dramatically impacted cancer care worldwide. Disruptions have been seen across all facets of care. While the long-term impact of COVID-19 remains unclear, the immediate impacts on patients, their carers and the healthcare workforce are increasingly evident. This study describes disruptions and reorganisation of cancer services in Australia since the onset of COVID-19, from the perspectives of people affected by cancer and healthcare workers. Two separate online cross-sectional surveys were completed by: a) cancer patients, survivors, carers, family members or friends (n = 852) and b) healthcare workers (n = 150). Descriptive analyses of quantitative survey data were conducted, followed by inductive thematic content analyses of qualitative survey responses relating to cancer care disruption and perceptions of telehealth. Overall, 42% of cancer patients and survivors reported experiencing some level of care disruption. A further 43% of healthcare workers reported atypical delays in delivering cancer care, and 50% agreed that patient access to research and clinical trials had been reduced. Almost three quarters (73%) of patients and carers reported using telehealth following the onset of COVID-19, with high overall satisfaction. However, gaps were identified in provision of psychological support and 20% of participants reported that they were unlikely to use telehealth again. The reorganisation of cancer care increased the psychological and practical burden on carers, with hospital visitation restrictions and appointment changes reducing their ability to provide essential support. COVID-19 has exacerbated a stressful and uncertain time for people affected by cancer and healthcare workers. Service reconfiguration and the adoption of telehealth have been essential adaptations for the pandemic response, offering long-term value. However, our findings highlight the need to better integrate psychosocial support and the important role of carers into evolving pandemic response measures. Learnings from this study could inform service improvements that would benefit patients and carers longer-term.
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Affiliation(s)
- Rhiannon Edge
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Sydney, NSW, Australia
| | - Josh Meyers
- Cancer Council NSW, Sydney, NSW, Australia
- * E-mail:
| | - Gabriella Tiernan
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Sydney, NSW, Australia
| | - Zhicheng Li
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Sydney, NSW, Australia
| | - Alexandra Schiavuzzi
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Sydney, NSW, Australia
| | - Priscilla Chan
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Sydney, NSW, Australia
| | - Amy Vassallo
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - April Morrow
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Sydney, NSW, Australia
| | - Carolyn Mazariego
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Sydney, NSW, Australia
- The University of Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Claire E. Wakefield
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW, Australia
- School of Women’s and Children’s Health, UNSW Sydney, Sydney, Australia
| | - Karen Canfell
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Sydney, NSW, Australia
- The University of Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Natalie Taylor
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Sydney, NSW, Australia
- The University of Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Austin EE, Do V, Nullwala R, Fajardo Pulido D, Hibbert PD, Braithwaite J, Arnolda G, Wiles LK, Theodorou T, Tran Y, Lystad RP, Hatem S, Long JC, Rapport F, Pantle A, Clay-Williams R. Systematic review of the factors and the key indicators that identify doctors at risk of complaints, malpractice claims or impaired performance. BMJ Open 2021; 11:e050377. [PMID: 34429317 PMCID: PMC8386219 DOI: 10.1136/bmjopen-2021-050377] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/05/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify the risk factors associated with complaints, malpractice claims and impaired performance in medical practitioners. DESIGN Systematic review. DATA SOURCES Ovid-Medline, Ovid Embase, Scopus and Cochrane Central Register of Controlled Trials were searched from 2011 until March 2020. Reference lists and Google were also handsearched. RESULTS Sixty-seven peer-reviewed papers and three grey literature publications from 2011 to March 2020 were reviewed by pairs of independent reviewers. Twenty-three key factors identified, which were categorised as demographic or workplace related. Gender, age, years spent in practice and greater number of patient lists were associated with higher risk of malpractice claim or complaint. Risk factors associated with physician impaired performance included substance abuse and burn-out. CONCLUSIONS It is likely that risk factors are interdependent with no single factor as a strong predictor of a doctor's risk to the public. Risk factors for malpractice claim or complaint are likely to be country specific due to differences in governance structures, processes and funding. Risk factors for impaired performance are likely to be specialty specific due to differences in work culture and access to substances. New ways of supporting doctors might be developed, using risk factor data to reduce adverse events and patient harm. PROSPERO REGISTRATION NUMBER PROSPERO registration number: CRD42020182045.
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Affiliation(s)
- Elizabeth E Austin
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Vu Do
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Ruqaiya Nullwala
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Diana Fajardo Pulido
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Peter D Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Louise K Wiles
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
| | - Tahlia Theodorou
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Yvonne Tran
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Reidar P Lystad
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Sarah Hatem
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Annette Pantle
- Medical Council of New South Wales, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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24
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Grailey KE, Murray E, Reader T, Brett SJ. The presence and potential impact of psychological safety in the healthcare setting: an evidence synthesis. BMC Health Serv Res 2021; 21:773. [PMID: 34353319 PMCID: PMC8344175 DOI: 10.1186/s12913-021-06740-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Psychological safety is the shared belief that the team is safe for interpersonal risk taking. Its presence improves innovation and error prevention. This evidence synthesis had 3 objectives: explore the current literature regarding psychological safety, identify methods used in its assessment and investigate for evidence of consequences of a psychologically safe environment. METHODS We searched multiple trial registries through December 2018. All studies addressing psychological safety within healthcare workers were included and reviewed for methodological limitations. A thematic analysis approach explored the presence of psychological safety. Content analysis was utilised to evaluate potential consequences. RESULTS We included 62 papers from 19 countries. The thematic analysis demonstrated high and low levels of psychological safety both at the individual level in study participants and across the studies themselves. There was heterogeneity in responses across all studies, limiting generalisable conclusions about the overall presence of psychological safety. A wide range of methods were used. Twenty-five used qualitative methodology, predominantly semi-structured interviews. Thirty quantitative or mixed method studies used surveys. Ten studies inferred that low psychological safety negatively impacted patient safety. Nine demonstrated a significant relationship between psychological safety and team outcomes. The thematic analysis allowed the development of concepts beyond the content of the original studies. This analytical process provided a wealth of information regarding facilitators and barriers to psychological safety and the development of a model demonstrating the influence of situational context. DISCUSSION This evidence synthesis highlights that whilst there is a positive and demonstrable presence of psychological safety within healthcare workers worldwide, there is room for improvement. The variability in methods used demonstrates scope to harmonise this. We draw attention to potential consequences of both high and low psychological safety. We provide novel information about the influence of situational context on an individual's psychological safety and offer more detail about the facilitators and barriers to psychological safety than seen in previous reviews. There is a risk of participation bias - centres involved in safety research may be more aligned to these ideals. The data in this synthesis are useful for institutions looking to improve psychological safety by providing a framework from which modifiable factors can be identified.
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Affiliation(s)
- K. E. Grailey
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - E. Murray
- Said Business School, University of Oxford, Oxford, UK
| | - T. Reader
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, UK
| | - S. J. Brett
- Department of Surgery and Cancer, Imperial College London, London, UK
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25
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Edgar D, Middleton R, Kalchbauer S, Wilson V, Hinder C. Safety attitudes build safety culture: Nurse/midwife leaders improving health care using quantitative data. J Nurs Manag 2021; 29:2433-2443. [PMID: 34350644 DOI: 10.1111/jonm.13444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 08/02/2021] [Indexed: 11/28/2022]
Abstract
AIM We aim to determine safety attitudes of nurses and midwives across a Local Health District in Australia and compare results 1 year later following facilitated feedback of results. BACKGROUND Positive safety cultures are imperative for positive patient and staff outcomes. Staff member's attitude contribute to an organisations safety culture but can differ between health professional groups and across different subcultures. METHOD The Safety Attitudes Questionnaire (SAQ-Short version) was administered to all nurses and midwives within a Local Health District in NSW, Australia in 2019 and 2020. Results were facilitated back to nursing/midwifery leadership teams with an expectation of developing and enacting an action plan, based on results. RESULTS Of the six domains in the SAQ-Short version, five domains scores increased significantly (p < .001) over the time period. CONCLUSIONS Measures over time are important to establish differences in perceptions and feedback on impact of actions. Facilitated feedback of results shows meaning when nursing/midwifery leadership staff have data explained and an opportunity to discuss and plan. IMPLICATIONS FOR NURSING MANAGEMENT This study shows that facilitated feedback of quantitative survey results brings improved results when a survey is replicated. Nurse managers should enact a contextualized action plan with teams based on survey results to influence improvement in safety attitudes of staff.
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Affiliation(s)
- Denise Edgar
- Nursing and Midwifery Research Unit, Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Rebekkah Middleton
- Nursing and Midwifery Research Unit, Illawarra Shoalhaven Local Health District, Wollongong, Australia.,School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia.,IHMRI, University of Wollongong, Wollongong, New South Wales, Australia
| | - Sarah Kalchbauer
- Nursing and Midwifery Research Unit, Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Val Wilson
- Nursing and Midwifery Research Unit, Illawarra Shoalhaven Local Health District, Wollongong, Australia.,School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
| | - Christopher Hinder
- Nursing and Midwifery Research Unit, Illawarra Shoalhaven Local Health District, Wollongong, Australia
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26
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Maassen SM, Weggelaar Jansen AMJW, Brekelmans G, Vermeulen H, van Oostveen CJ. Psychometric evaluation of instruments measuring the work environment of healthcare professionals in hospitals: a systematic literature review. Int J Qual Health Care 2021; 32:545-557. [PMID: 32648902 PMCID: PMC7654380 DOI: 10.1093/intqhc/mzaa072] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/23/2020] [Accepted: 07/02/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose Research shows that the professional healthcare working environment influences the quality of care, safety climate, productivity, and motivation, happiness, and health of staff. The purpose of this systematic literature review was to assess instruments that provide valid, reliable and succinct measures of health care professionals’ work environment (WE) in hospitals. Data sources Embase, Medline Ovid, Web of Science, Cochrane CENTRAL, CINAHL EBSCOhost and Google Scholar were systematically searched from inception through December 2018. Study selection Pre-defined eligibility criteria (written in English, original work-environment instrument for healthcare professionals and not a translation, describing psychometric properties as construct validity and reliability) were used to detect studies describing instruments developed to measure the working environment. Data extraction After screening 6397 titles and abstracts, we included 37 papers. Two reviewers independently assessed the 37 instruments on content and psychometric quality following the COSMIN guideline. Results of data synthesis Our paper analysis revealed a diversity of items measured. The items were mapped into 48 elements on aspects of the healthcare professional’s WE. Quality assessment also revealed a wide range of methodological flaws in all studies. Conclusions We found a large variety of instruments that measure the professional healthcare environment. Analysis uncovered content diversity and diverse methodological flaws in available instruments. Two succinct, interprofessional instruments scored best on psychometrical quality and are promising for the measurement of the working environment in hospitals. However, further psychometric validation and an evaluation of their content is recommended.
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Affiliation(s)
- Susanne M Maassen
- Department of Quality & Patient Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Anne Marie J W Weggelaar Jansen
- Department of Health Services Management & Organization, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50 (Bayle Building) Postbus 1738, 3000 DR Rotterdam, The Netherlands
| | - Gerard Brekelmans
- Department of Quality & Patient Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Hester Vermeulen
- Departement of IQ Healthcare, Radboud Institute of Health Sciences, Scientific Center for Quality of Healthcare, Geert Grooteplein 21 (route 114) Postbus 9101, 6500 HB, NIjmegen, The Netherlands.,Departement of Faculty of Health and Social studies, Hogeschool of Arnhem and Nijmegen (HAN) University of Applied Sciences, Kapittelweg 33, Postbus 6960, 6503 GL Nijmegen, The Netherlands
| | - Catharina J van Oostveen
- Department of Health Services Management & Organization, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50 (Bayle Building) Postbus 1738, 3000 DR Rotterdam, The Netherlands.,Department of Wetenschapsbureau, Spaarnegasthuis Academie, Spaarne Gasthuis, Spaarnepoort 1, Postbus 770, 2130 AT Hoofddorp, The Netherlands
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27
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Amon CC, Paley AR, Forbes JA, Guzman LV, Rajwani AA, Trzcinka A, Comenzo RL, Drzymalski DM. Implementing structured handoffs to verify operating room blood delivery using a quality academy training program: an interrupted time-series analysis. Int J Qual Health Care 2021; 33:6213818. [PMID: 33825860 DOI: 10.1093/intqhc/mzab061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/02/2021] [Accepted: 04/06/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Blood transfusion is a complex process at risk for error. OBJECTIVE To implement a structured handoff during the blood transfusion process to improve delivery verification. METHODS A multidisciplinary team participated in the quality academy training program at an academic medical center and implemented a structured handoff of blood delivery to the operating room (OR) using Plan-Do-Study-Act cycles between 28 October 2019 and 1 December 2019. An interrupted time-series analysis was performed to investigate the proportions of verified deliveries (primary outcome) and of verified deliveries among those without a handoff (secondary outcome). Delivery duration was also assessed. RESULTS A total of 2606 deliveries occurred from 1 July 2019 to 19 April 2020. The baseline trend for verified deliveries was unchanging [parameter coefficient -0.0004; 95% confidence interval (CI) -0.002 to 0.001; P = 0.623]. Following intervention, there was an immediate level change (parameter coefficient 0.115; 95% CI 0.053 to 0.176; P = 0.001) without slope change (parameter coefficient 0.002; 95% CI -0.004 to 0.007; P = 0.559). For the secondary outcome, there was no immediate level change (parameter coefficient -0.039; 95% CI -0.159 to 0.081; P = 0.503) or slope change (parameter coefficient 0.002; 95% CI -0.022 to 0.025; P = 0.866). The mean (SD) delivery duration during the intervention was 12.4 (2.8) min and during the post-intervention period was 9.6 (1.6) min (mean difference 2.8; 95% CI 0.9 to 4.8; P = 0.008). CONCLUSION Using the quality academy framework supported the implementation of a structured handoff during blood delivery to the OR, resulting in a significant increase in verified deliveries.
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Affiliation(s)
- Carly C Amon
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, USA
| | - Adina R Paley
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, USA
| | - Judith A Forbes
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, 800 Washington St, Boston, MA 02111, USA
| | - Leidy V Guzman
- Department of Quality and Patient Safety, Tufts Medical Center, 800 Washington St, Boston, MA 02111, USA
| | - Aliysa A Rajwani
- Department of Quality and Patient Safety, Tufts Medical Center, 800 Washington St, Boston, MA 02111, USA
| | - Agnieszka Trzcinka
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, USA.,Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, 800 Washington St #298 Ziskind Building, 6th Floor, Boston, MA 02111, USA
| | - Raymond L Comenzo
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, USA.,Department of Pathology and Laboratory Medicine, Tufts Medical Center, 800 Washington St, Boston, MA 02111, USA
| | - Dan M Drzymalski
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, USA.,Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, 800 Washington St #298 Ziskind Building, 6th Floor, Boston, MA 02111, USA
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28
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Hibbert PD, Basedow M, Braithwaite J, Wiles LK, Clay-Williams R, Padbury R. How to sustainably build capacity in quality improvement within a healthcare organisation: a deep-dive, focused qualitative analysis. BMC Health Serv Res 2021; 21:588. [PMID: 34144717 PMCID: PMC8212075 DOI: 10.1186/s12913-021-06598-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 06/02/2021] [Indexed: 01/03/2023] Open
Abstract
Background A key characteristic of healthcare systems that deliver high quality and cost performance in a sustainable way is a systematic approach to capacity and capability building for quality improvement. The aim of this research was to explore the factors that lead to successful implementation of a program of quality improvement projects and a capacity and capability building program that facilitates or support these. Methods Between July 2018 and February 2020, the Southern Adelaide Local Health Network (SALHN), a network of health services in Adelaide, South Australia, conducted three capability-oriented capacity building programs that incorporated 82 longstanding individual quality improvement projects. Qualitative analysis of data collected from interviews of 19 project participants and four SALHN Improvement Faculty members and ethnographic observations of seven project team meetings were conducted. Results We found four interacting components that lead to successful implementation of quality improvement projects and the overall program that facilitates or support these: an agreed and robust quality improvement methodology, a skilled faculty to assist improvement teams, active involvement of leadership and management, and a deep understanding that teams matter. A strong safety culture is not necessarily a pre-requisite for quality improvement gains to be made; indeed, undertaking quality improvement activities can contribute to an improved safety culture. For most project participants in the program, the time commitment for projects was significant and, at times, maintaining momentum was a challenge. Conclusions Healthcare systems that wish to deliver high quality and cost performance in a sustainable way should consider embedding the four identified components into their quality improvement capacity and capability building strategy. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06598-8.
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Affiliation(s)
- Peter D Hibbert
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, New South Wales, Australia. .,IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.
| | - Martin Basedow
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, New South Wales, Australia
| | - Louise K Wiles
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, New South Wales, Australia.,IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, New South Wales, Australia
| | - Robert Padbury
- Department of Surgery and Perioperative Medicine, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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29
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Dye ME, Pugh C, Sala C, Scott TA, Wallace T, Grubb PH, Hatch LD. Developing a Unit-Based Quality Improvement Program in a Large Neonatal ICU. Jt Comm J Qual Patient Saf 2021; 47:654-662. [PMID: 34284954 DOI: 10.1016/j.jcjq.2021.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Quality improvement (QI) methods have been widely adopted in health care. Although theoretical frameworks and models for organizing successful QI programs have been described, few reports have provided practical examples to link existing QI theory to building a unit-based QI program. The purpose of this report is to describe the authors' experience in building QI infrastructure in a large neonatal ICU (NICU). METHODS A unit-based QI program was developed with the goal of fostering the growth of high-functioning QI teams. This program was based on six pillars: shared vision for QI, QI team capacity, QI team capability, actionable data for improvement, culture of improvement, and QI team integration with external collaboratives. Multiple interventions were developed, including a QI dashboard to align NICU metrics with unit and hospital quality goals, formal training for QI leaders, QI coaches imbedded in project teams, a day-long QI educational workshop to introduce QI methodology to unit staff, and a secure, Web-based QI data infrastructure. RESULTS Over a five-year period, this QI infrastructure brought organization and support for individual QI project teams and improved patient outcomes in the unit. Two case studies are presented, describing teams that used support from the QI infrastructure. The Infection Prevention team reduced central line-associated bloodstream infections from 0.89 to 0.36 infections per 1,000 central line-days. The Nutrition team decreased the percentage of very low birth weight infants discharged with weights less than the 10th percentile from 51% to 40%. CONCLUSION The clinicians provide a pragmatic example of incorporating QI organizational and contextual theory into practice to support the development of high-functioning QI teams and build a unit-based QI program.
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Sebastian AT, Rajkumar E, Tejaswini P, Lakshmi R, Romate J. Applying social cognitive theory to predict physical activity and dietary behavior among patients with type-2 diabetes. Health Psychol Res 2021; 9:24510. [PMID: 35106392 PMCID: PMC8801595 DOI: 10.52965/001c.24510] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/10/2020] [Indexed: 11/17/2023] Open
Abstract
INTRODUCTION Non-communicable diseases, arising out of changing lifestyle habits of people, are the foremost causes of mortality and morbidity worldwide. Most of these diseases occur in low and middle-income countries. Chronic diseases can be managed with the help of health behaviors such as proper diet, physical exercise, adherence to medication, and avoidance of health risk behaviors such as smoking, alcohol consumption, sedentary lifestyle, etc. The social cognitive theory addresses the role of personal and environmental factors in an individual's health behavior. The current study aims to understand the role of social cognitive theory on physical activity and dietary behavior amongst individuals diagnosed with type-2 diabetes. METHODS A correlational study was conducted among 225 participants with type-2 diabetes, who are under medication. The data was collected using social cognitive questionnaire for physical activity & dietary behavior and Health-Promoting Lifestyle Profile II. Descriptive statistics, Pearson's correlation coefficient and multiple linear regression analysis were used to analyze the data. RESULTS It was found from the study results that, all the domains of social cognitive theory were significantly correlated with physical activity (p<0.001) and the SCT domains- self-regulation (p<0.001), social support (p<0.001), and outcome expectancy (p<0.05) were significantly correlated with dietary behavior. The results of multiple linear regressions indicated that the domains self- regulation and self- efficacy were the significant predictor for physical activity behavior (R2=.21, p ≤ 0.001) while the domains social support and self-regulation were the significant predictor of dietary behavior (R2=.09, p ≤ 0.001). CONCLUSION The study results show that there is an influence of social cognitive domains on physical activity and dietary behaviour. Further, this study suggests that social cognitive theory based intervention can be used to promote healthy behaviour.
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Affiliation(s)
| | | | - P Tejaswini
- Department of Psychology, Jyothinivas College
| | - R Lakshmi
- Department of Psychology, Central University of Karnataka
| | - J Romate
- Department of Psychology, Central University of Karnataka
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Abstract
Talent Management (T.M.) constitutes a modern and emerging research area in Human Resources Management (HRM). Using a systematic literature approach, we searched in Talent Management literature in the healthcare sector context. We conclude that the number of related studies is minimal. The benefits of implementing Talent Management strategies in healthcare organizations are essential for the organization’s sustainable development and the talented staff and healthcare services patients. Our goal is to undertake a systematic literature review to identify these factors related to talent management practices suitable for healthcare organizations and professionals. We have conducted, according to PRISMA guidelines, a systematic literature review (2010–2020) in the electronic databases PubMed, CINAHL, Cochrane Database of Systematic Reviews, Health Source/Nursing Academic Edition. Search terms related to T.M. were (“Talent Management” AND “Talent Healthcare”). Strict inclusion and exclusion criteria were set for observational studies, while grey and unpublished literature, uncontrolled studies, protocols, commentaries, and conference proceedings were excluded. All included items were assessed for their quality according to set criteria. Six hundred and eighty-four studies were identified, of which 24 met the requirements. The resulting Talent Management Factors were grouped into nine categories: Programming, Attraction, Development, Preservation, Performance Assessment, Work Climate, Culture, Succession Planning, and Leadership. Based on these factors, we provide a holistic picture of the referred domain’s leading developments. The paper determines the Talent Management factors and explains what happens in practice. In this way, we contribute to building a theoretical framework for T.M. in terms of the organizational context.
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Alsowaida YS, Kovacevic MP, Belisle C, Cotugno MC, Cooley T, Matta L, Fanikos J, Dell’Orfano H. Implementation of Pharmacy Executive Quality and Safety Walkrounds at a Tertiary Academic Medical Center. Hosp Pharm 2021; 57:211-216. [PMID: 35601721 PMCID: PMC9117781 DOI: 10.1177/00185787211010155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Executive Quality and Safety WalkRounds (EWRs) is a tool that engages department leadership in discussion with the front-line employees to solicit feedback to improve quality and safety. The purpose of this study was to evaluate the impact of the implementation of pharmacy department specific EWRs on quality and safety at a tertiary academic medical center. Method: This was a single-center, retrospective analysis conducted at Brigham and Women’s Hospital between November 2016 and November 2019. This study aimed to analyze the implementation of EWRs conducted every other month throughout various service areas and satellites of the pharmacy department. Data evaluated included the number of EWRs conducted, the specific areas visited, the total number of action items recommended by the staff, along with the total number of action items that were completed or remained in process. Results: During the study period, 17 visits were completed in 12 different BWH pharmacy sub-departments. A total of 98 operational, technological, and environmental action items were recommended by staff to improve quality and safety. Of the 98 action items documented, 95 (96.9%) were completed by time of our analysis. Conclusion: Pharmacy department EWRs are an important and systematic process of communication between the pharmacy leadership and frontline staff. Pharmacy department EWRs have resulted in safety and quality improvements at different levels in the pharmacy department. The EWRs program at the pharmacy department was effective in identifying and completing safety initiatives to improve the safety culture of the department.
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Affiliation(s)
- Yazed Saleh Alsowaida
- Brigham and Women’s Hospital, Boston, MA, USA
- College of Pharmacy, Department of Clinical Pharmacy, Hail University, Hail, Saudi Arabia
| | | | | | | | - Tom Cooley
- Brigham and Women’s Hospital, Boston, MA, USA
| | - Lina Matta
- Brigham and Women’s Hospital, Boston, MA, USA
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Antonacci G, Lennox L, Barlow J, Evans L, Reed J. Process mapping in healthcare: a systematic review. BMC Health Serv Res 2021; 21:342. [PMID: 33853610 PMCID: PMC8048073 DOI: 10.1186/s12913-021-06254-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 03/08/2021] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Process mapping (PM) supports better understanding of complex systems and adaptation of improvement interventions to their local context. However, there is little research on its use in healthcare. This study (i) proposes a conceptual framework outlining quality criteria to guide the effective implementation, evaluation and reporting of PM in healthcare; (ii) reviews published PM cases to identify context and quality of PM application, and the reported benefits of using PM in healthcare. METHODS We developed the conceptual framework by reviewing methodological guidance on PM and empirical literature on its use in healthcare improvement interventions. We conducted a systematic review of empirical literature using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. Inclusion criteria were: full text empirical study; describing the process through which PM has been applied in a healthcare setting; published in English. Databases searched are: Medline, Embase, HMIC-Health Management Information Consortium, CINAHL-Cumulative Index to Nursing and Allied Health Literature, Scopus. Two independent reviewers extracted and analysed data. Each manuscript underwent line by line coding. The conceptual framework was used to evaluate adherence of empirical studies to the identified PM quality criteria. Context in which PM is used and benefits of using PM were coded using an inductive thematic analysis approach. RESULTS The framework outlines quality criteria for each PM phase: (i) preparation, planning and process identification, (ii) data and information gathering, (iii) process map generation, (iv) analysis, (v) taking it forward. PM is used in a variety of settings and approaches to improvement. None of the reviewed studies (N = 105) met all ten quality criteria; 7% were compliant with 8/10 or 9/10 criteria. 45% of studies reported that PM was generated through multi-professional meetings and 15% reported patient involvement. Studies highlighted the value of PM in navigating the complexity characterising healthcare improvement interventions. CONCLUSION The full potential of PM is inhibited by variance in reporting and poor adherence to underpinning principles. Greater rigour in the application of the method is required. We encourage the use and further development of the proposed framework to support training, application and reporting of PM. TRIAL REGISTRATION Prospero ID: CRD42017082140.
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Affiliation(s)
- Grazia Antonacci
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, London, UK
- Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, London, UK
| | - Laura Lennox
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, London, UK
| | - James Barlow
- Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, London, UK
| | - Liz Evans
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Northwest London, London, UK
| | - Julie Reed
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Northwest London, London, UK
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Esdar M, Hübner U, Thye J, Babitsch B, Liebe JD. The Effect of Innovation Capabilities of Health Care Organizations on the Quality of Health Information Technology: Model Development With Cross-sectional Data. JMIR Med Inform 2021; 9:e23306. [PMID: 33720029 PMCID: PMC8077601 DOI: 10.2196/23306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/13/2020] [Accepted: 02/07/2021] [Indexed: 01/12/2023] Open
Abstract
Background Large health organizations often struggle to build complex health information technology (HIT) solutions and are faced with ever-growing pressure to continuously innovate their information systems. Limited research has been conducted that explores the relationship between organizations’ innovative capabilities and HIT quality in the sense of achieving high-quality support for patient care processes. Objective The aim of this study is to explain how core constructs of organizational innovation capabilities are linked to HIT quality based on a conceptual sociotechnical model on innovation and quality of HIT, called the IQHIT model, to help determine how better information provision in health organizations can be achieved. Methods We designed a survey to assess various domains of HIT quality, innovation capabilities of health organizations, and context variables and administered it to hospital chief information officers across Austria, Germany, and Switzerland. Data from 232 hospitals were used to empirically fit the model using partial least squares structural equation modeling to reveal associations and mediating and moderating effects. Results The resulting empirical IQHIT model reveals several associations between the analyzed constructs, which can be summarized in 2 main insights. First, it illustrates the linkage between the constructs measuring HIT quality by showing that the professionalism of information management explains the degree of HIT workflow support (R²=0.56), which in turn explains the perceived HIT quality (R²=0.53). Second, the model shows that HIT quality was positively influenced by innovation capabilities related to the top management team, the information technology department, and the organization at large. The assessment of the model’s statistical quality criteria indicated valid model specifications, including sufficient convergent and discriminant validity for measuring the latent constructs that underlie the measures of HIT quality and innovation capabilities. Conclusions The proposed sociotechnical IQHIT model points to the key role of professional information management for HIT workflow support in patient care and perceived HIT quality from the viewpoint of hospital chief information officers. Furthermore, it highlights that organizational innovation capabilities, particularly with respect to the top management team, facilitate HIT quality and suggests that health organizations establish this link by applying professional information management practices. The model may serve to stimulate further scientific work in the field of HIT adoption and diffusion and to provide practical guidance to managers, policy makers, and educators on how to achieve better patient care using HIT.
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Affiliation(s)
- Moritz Esdar
- Health Informatics Research Group, Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrueck, Osnabrueck, Germany
| | - Ursula Hübner
- Health Informatics Research Group, Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrueck, Osnabrueck, Germany
| | - Johannes Thye
- Health Informatics Research Group, Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrueck, Osnabrueck, Germany
| | - Birgit Babitsch
- Institute of Health and Education, New Public Health, Osnabrück University, Osnabrueck, Germany
| | - Jan-David Liebe
- Health Informatics Research Group, Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrueck, Osnabrueck, Germany.,Institute of Medical Informatics, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
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Race to the Top of the Hospital Value-Based Purchasing Program. J Healthc Manag 2021; 66:95-108. [PMID: 33692313 DOI: 10.1097/jhm-d-20-00087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
EXECUTIVE SUMMARY Medicare's Hospital Valued-Based Purchasing (HVBP) program measures hospitals' total performance score (TPS); its measurement strategies have changed regularly since its rollout in 2013. Because the program influences care delivery, it is important to examine how the policy has changed hospitals' behavior and how it may inform future policies. The purpose of this study was to assess the relationship between hospitals' performance on TPS annually from 2013 to 2018 and organizational characteristics. Using the HVBP TPS from 2013 to 2018 and associated hospital characteristics-hospital size, teaching hospital status, system membership, ownership type, urban/rural location, average percentages of patients from Medicare and Medicaid, operating margins, percentages of inpatient revenue as a proportion of total revenue, and case mix index-we conducted a retrospective cohort study of all U.S. hospitals participating in the HVBP program. Regression and panel analyses found that organizations that were expected to have robust and rigid resources were unable to score in the superior category consistently. In addition, organizations were unable to consistently perform positively over time because of changes in the HVBP program measurement and the required organizational responses. Policymakers should consider the ability of organizations to respond to changes to the HVBP program. Likewise, healthcare managers, particularly those in larger organizations, should seek to remove bureaucracy or allow for greater resource slack to meet these changes.
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Maassen SM, van Oostveen C, Vermeulen H, Weggelaar AM. Defining a positive work environment for hospital healthcare professionals: A Delphi study. PLoS One 2021; 16:e0247530. [PMID: 33630923 PMCID: PMC7906333 DOI: 10.1371/journal.pone.0247530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 02/09/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The work environment of healthcare professionals is important for good patient care and is receiving increasing attention in scientific research. A clear and unambiguous understanding of a positive work environment, as perceived by healthcare professionals, is crucial for gaining systematic objective insights into the work environment. The aim of this study was to gain consensus on the concept of a positive work environment in the hospital. METHODS This was a three-round Delphi study to establish consensus on what defines a positive work environment. A literature review and 17 semi-structured interviews with experts (transcribed and analyzed by open and thematic coding) were used to generate items for the Delphi study. RESULTS The literature review revealed 228 aspects that were clustered into 48 work environment elements, 38 of which were mentioned in the interviews also. After three Delphi rounds, 36 elements were regarded as belonging to a positive work environment in the hospital. DISCUSSION The work environment is a broad concept with several perspectives. Although all 36 elements are considered important for a positive work environment, they have different perspectives. Mapping the included elements revealed that no one work environment measurement tool includes all the elements. CONCLUSION We identified 36 elements that are important for a positive work environment. This knowledge can be used to select the right measurement tool or to develop interventions for improving the work environment. However, the different perspectives of the work environment should be considered.
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Affiliation(s)
- Susanne M. Maassen
- Department of Quality and Patient Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- * E-mail:
| | - Catharina van Oostveen
- Spaarne Gasthuis Hospital, Haarlem, The Netherlands
- Erasmus School of Health, Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - Hester Vermeulen
- Department IQ Healthcare, Radboudumc University Medical Center, Nijmegen, The Netherlands
- Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Anne Marie Weggelaar
- Erasmus School of Health, Policy and Management, Erasmus University, Rotterdam, The Netherlands
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Pfaff H, Hammer A, Ballester M, Schubin K, Swora M, Sunol R. Social determinants of the impact of hospital management boards on quality management: a study of 109 European hospitals using a parsonian approach. BMC Health Serv Res 2021; 21:70. [PMID: 33468129 PMCID: PMC7814745 DOI: 10.1186/s12913-020-06053-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 12/29/2020] [Indexed: 12/02/2022] Open
Abstract
Background The consolidated framework for implementation research states that personal leadership matters in quality management implementation. However, it remains to be answered which characteristics of plural leadership in hospital management boards make them impactful. The present study focuses on social determinants of implementation power of hospital boards using Talcott Parsons’ sociological concept of adaptation, goal attainment, integration, and latency (AGIL), focusing on the G (goal attainment) and I (integration) factors of this concept. The study aims to test the hypothesis that hospitals with management boards that are oriented toward the quality goal (G) and socially integrated (I) (GI boards) are better at implementing quality management than hospitals with boards lacking these characteristics (non-GI boards). Methods A cross-sectional mixed-method design was used for data collection in 109 randomly selected hospitals in seven European countries. Data is based on the study “Deepening our understanding of quality improvement in Europe” (DUQUE). We used responses from (a) hospitals’ chief executive officers to measure the variable social integration and the variable quality orientation of the board and (b) responses from quality managers to measure the degree of implementation of the quality management system. We developed the GI index measuring the combination of goal-orientation and integration. A multiple linear regression analysis was performed. Results Hospitals with management boards that are quality oriented and socially integrated (GI boards) had significantly higher scores on the quality management system index than hospitals with boards scoring low on these features, when controlled for several context factors. Conclusions Our findings suggest that the implementation power of hospital management boards is higher if there is a sense of unity and purpose within the boards. Thus, to improve quality management, it could be worthwhile to increase boards’ social capital and to increase time designated for quality management in board meetings.
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Affiliation(s)
- Holger Pfaff
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Science, Faculty of Medicine, University of Cologne, Eupener Strasse 129, 50933, Cologne, Germany.
| | - Antje Hammer
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Science, Faculty of Medicine, University of Cologne, Eupener Strasse 129, 50933, Cologne, Germany
| | - Marta Ballester
- Avedis Donabedian Research Institute (FAD), Universitat Autònoma de Barcelona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barcelona, Spain
| | - Kristina Schubin
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Science, Faculty of Medicine, University of Cologne, Eupener Strasse 129, 50933, Cologne, Germany
| | - Michael Swora
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Science, Faculty of Medicine, University of Cologne, Eupener Strasse 129, 50933, Cologne, Germany
| | - Rosa Sunol
- Avedis Donabedian Research Institute (FAD), Universitat Autònoma de Barcelona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barcelona, Spain
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Walker RM, Boorman RJ, Vaux A, Cooke M, Aitken LM, Marshall AP. Identifying barriers and facilitators to recognition and response to patient clinical deterioration by clinicians using a behaviour change approach: A qualitative study. J Clin Nurs 2021; 30:803-818. [PMID: 33351998 DOI: 10.1111/jocn.15620] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/03/2020] [Accepted: 12/10/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Failure of clinicians to recognise and respond to patient clinical deterioration is associated with increased hospital mortality. Emergency response teams are implemented throughout hospitals to support direct-care clinicians in managing patient deterioration, but patient clinical deterioration is often not identified or acted upon by clinicians in ward settings. To date, no studies have used an integrative theoretical framework in multiple sites to examine why clinicians' delay identification and action on patients' clinical deterioration. AIM To identify barriers and facilitators that influence clinicians' absent or delayed response to patient clinical deterioration using the Theoretical Domains Framework. METHODS The Theoretical Domains Framework guided: (a) semi-structured interviews with clinicians, health consumers and family members undertaken at two sites; (b) deductive analyses of inductive themes to identify barriers and facilitators to optimal care. This study complied with the COREQ research guidelines. FINDINGS Seven themes identified: (a) information transfer; (b) ownership of patient care; (c) confidence to respond; (d) knowledge and skills; (e) culture; (f) emotion; and (g) environmental context and resources. DISCUSSION The Theoretical Domains Framework identified traditional social and professional hierarchies and limitations due to environmental contexts and resources as contributors to diminished interprofessional recognition and impediments to the development of effective relationships between professional groups. Communication processes were impacted by these restraints and further confounded by inadequate policy development and limited access to regular effective team-based training. As a result, patient safety was compromised, and clinicians frustrated. CONCLUSIONS These results inform the development, implementation and evaluation of a behaviour change intervention and increase knowledge about barriers and facilitators to timely response to patient clinical deterioration. RELEVANCE TO CLINICAL PRACTICE Results contribute to understanding of why clinicians delay responding to patient clinical deterioration and suggest key recommendations to identify and challenge traditional hierarchies and practices that prevent interdisciplinary collaboration and decision-making.
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Affiliation(s)
- Rachel M Walker
- School of Nursing and Midwifery, Griffith University, Brisbane, Qld, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, Qld, Australia.,Division of Surgery, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Rhonda J Boorman
- School of Nursing and Midwifery, Griffith University, Brisbane, Qld, Australia
| | - Amanda Vaux
- Metro South Patient Flow Program, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Marie Cooke
- School of Nursing and Midwifery, Griffith University, Brisbane, Qld, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, Qld, Australia
| | - Leanne M Aitken
- School of Nursing and Midwifery, Griffith University, Brisbane, Qld, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, Qld, Australia.,School of Health Sciences, City University of London, London, UK
| | - Andrea P Marshall
- School of Nursing and Midwifery, Griffith University, Brisbane, Qld, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, Qld, Australia.,Gold Coast Health, Gold Coast, Qld, Australia
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Goldman J, Kuper A, Baker GR, Bulmer B, Coffey M, Jeffs L, Shea C, Whitehead C, Shojania KG, Wong B. Experiential Learning in Project-Based Quality Improvement Education: Questioning Assumptions and Identifying Future Directions. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1745-1754. [PMID: 32079957 DOI: 10.1097/acm.0000000000003203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Project-based experiential learning is a defining element of quality improvement (QI) education despite ongoing challenges and uncertainties. The authors examined stakeholders' perceptions and experiences of QI project-based learning to increase understanding of factors that influence learning and project experiences. METHOD The authors used a case study approach to examine QI project-based learning in 3 advanced longitudinal QI programs, 2 at the University of Toronto and 1 at an academic tertiary-care hospital. From March 2016 to June 2017, they undertook 135 hours of education program observation and 58 interviews with learners, program directors, project coaches, and institutional leaders and reviewed relevant documents. They analyzed data using a conventional and directed data analysis approach. RESULTS The findings provide insight into 5 key factors that influenced participants' project-based learning experiences and outcomes: (1) variable emphasis on learning versus project objectives and resulting benefits, tensions, and consequences; (2) challenges integrating the QI project into the curriculum timeline; (3) project coaching factors (e.g., ability, capacity, role clarity); (4) participants' differing access to resources and ability to direct a QI project given their professional roles; and (5) workplace environment influence on project success. CONCLUSIONS The findings contribute to an empirical basis toward more effective experiential learning in QI by identifying factors to target and optimize. Expanding conceptualizations of project-based learning for QI education beyond learner-initiated, time-bound projects, which are at the core of many QI educational initiatives, may be necessary to improve learning and project outcomes.
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Affiliation(s)
- Joanne Goldman
- J. Goldman is assistant professor, Department of Medicine, scientist, Centre for Quality Improvement and Patient Safety, and cross-appointed researcher, Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0003-1589-4070
| | - Ayelet Kuper
- A. Kuper is associate professor, Department of Medicine, scientist and associate director, Wilson Centre for Research in Education, University Health Network, University of Toronto, and staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - G Ross Baker
- G.R. Baker is professor and program lead, Quality Improvement and Patient Safety, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Beverly Bulmer
- B. Bulmer is vice president, Education, St. Michael's Hospital, Unity Health Toronto, and lecturer, Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Maitreya Coffey
- M. Coffey is associate professor, Department of Paediatrics, University of Toronto, medical officer for patient safety, Hospital for Sick Children, Toronto, Ontario, Canada, and associate clinical director, Children's Hospitals Solutions for Patient Safety, Cincinnati, Ohio
| | - Lianne Jeffs
- L. Jeffs is research and innovation lead scholar in residence and senior clinician scientist, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, associate professor, Lawrence S. Bloomberg Faculty of Nursing, Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, and affiliate scientist, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Christine Shea
- C. Shea is program director and lecturer, Quality Improvement and Patient Safety, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia Whitehead
- C. Whitehead is professor, Department of Family and Community Medicine, director and scientist, Wilson Centre for Research in Education, University Health Network, University of Toronto, and vice president of education, Women's College Hospital, Toronto, Ontario, Canada
| | - Kaveh G Shojania
- K.G. Shojania is professor and vice chair, Department of Medicine, Faculty of Medicine, University of Toronto, and staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0002-9942-0130
| | - Brian Wong
- B. Wong is associate professor, Department of Medicine, University of Toronto, director, Centre for Quality Improvement and Patient Safety, Faculty of Medicine, University of Toronto, and staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Sarkies M, Long JC, Pomare C, Wu W, Clay-Williams R, Nguyen HM, Francis-Auton E, Westbrook J, Levesque JF, Watson DE, Braithwaite J. Avoiding unnecessary hospitalisation for patients with chronic conditions: a systematic review of implementation determinants for hospital avoidance programmes. Implement Sci 2020; 15:91. [PMID: 33087147 PMCID: PMC7579904 DOI: 10.1186/s13012-020-01049-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/01/2020] [Indexed: 12/31/2022] Open
Abstract
Background Studies of clinical effectiveness have demonstrated the many benefits of programmes that avoid unnecessary hospitalisations. Therefore, it is imperative to examine the factors influencing implementation of these programmes to ensure these benefits are realised across different healthcare contexts and settings. Numerous factors may act as determinants of implementation success or failure (facilitators and barriers), by either obstructing or enabling changes in healthcare delivery. Understanding the relationships between these determinants is needed to design and tailor strategies that integrate effective programmes into routine practice. Our aims were to describe the implementation determinants for hospital avoidance programmes for people with chronic conditions and the relationships between these determinants. Methods An electronic search of four databases was conducted from inception to October 2019, supplemented by snowballing for additional articles. Data were extracted using a structured data extraction tool and risk of bias assessed using the Hawker Tool. Thematic synthesis was undertaken to identify determinants of implementation success or failure for hospital avoidance programmes for people with chronic conditions, which were categorised according to the Consolidated Framework for Implementation Research (CFIR). The relationships between these determinants were also mapped. Results The initial search returned 3537 articles after duplicates were removed. After title and abstract screening, 123 articles underwent full-text review. Thirteen articles (14 studies) met the inclusion criteria. Thematic synthesis yielded 23 determinants of implementation across the five CFIR domains. ‘Availability of resources’, ‘compatibility and fit’, and ‘engagement of interprofessional team’ emerged as the most prominent determinants across the included studies. The most interconnected implementation determinants were the ‘compatibility and fit’ of interventions and ‘leadership influence’ factors. Conclusions Evidence is emerging for how chronic condition hospital avoidance programmes can be successfully implemented and scaled across different settings and contexts. This review provides a summary of key implementation determinants and their relationships. We propose a hypothesised causal loop diagram to represent the relationship between determinants within a complex adaptive system. Trial registration PROSPERO 162812
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Affiliation(s)
- Mitchell Sarkies
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia.
| | - Janet C Long
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Chiara Pomare
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Wendy Wu
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Robyn Clay-Williams
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Hoa Mi Nguyen
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Emilie Francis-Auton
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Jean-Frédéric Levesque
- Agency for Clinical Innovation, New South Wales, Australia.,Centre for Primary Health Care and Equity, University of New South Wales, New South Wales, Australia
| | - Diane E Watson
- Bureau of Health Information, New South Wales, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
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Clay-Williams R, Taylor N, Ting HP, Arnolda G, Winata T, Braithwaite J. Do quality management systems influence clinical safety culture and leadership? A study in 32 Australian hospitals. Int J Qual Health Care 2020; 32:60-66. [PMID: 32026935 DOI: 10.1093/intqhc/mzz107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/21/2019] [Accepted: 09/12/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE This study aimed to explore the associations between the organization-level quality arrangements, improvement and implementation and department-level safety culture and leadership measures across 32 large Australian hospitals. DESIGN Quantitative observational study, using linear and multi-level modelling to identify relationships between quality management systems and clinician safety culture and leadership. SETTING Thirty-two large Australian public hospitals. PARTICIPANTS Quality audit at organization level, senior quality manager at each participating hospital, 1382 clinicians (doctors, nurses and allied health professionals). MAIN OUTCOME MEASURES Associations between organization-level quality measures and department-level clinician measures of teamwork climate, safety climate and leadership for acute myocardial infarction (AMI), hip fracture and stroke treatment conditions. RESULTS We received 1332 valid responses from participants. The quality management systems index (QMSI, a questionnaire-based measure of the hospitals' quality management structures) was 'positively' associated with all three department-level scales in the stroke department, with safety culture and leadership in the emergency department, but with none of the three scales in the AMI and hip fracture departments. The quality management compliance index (QMCI, an external audit-based measure of the quality improvement activities) was 'negatively' associated with teamwork climate and safety climate in AMI departments, after controlling for QMSI, but not in other departments. There was no association between QMCI and leadership in any department, after controlling for QMSI, and there was no association between the clinical quality implementation index (CQII, an external audit-based measure of the level of implementation of quality activities) and any of the three department-level scales in any of the four departments, after controlling for both QMSI and QMCI. CONCLUSIONS The influence of organization-level quality management systems on clinician safety culture and leadership varied depending on the hospital department, suggesting that whilst there was some consistency on patient safety attitudes and behaviours throughout the organizations, there were also other factors at play.
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Affiliation(s)
- Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, Australia
| | - Natalie Taylor
- Cancer Research Division, Cancer Council NSW, 153 Dowling St, Woolloomooloo, NSW 2011, Australia.,Faculty of Health Sciences, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Hsuen P Ting
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, Australia
| | - Teresa Winata
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, Australia
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Braithwaite J, Clay-Williams R, Taylor N, Ting HP, Winata T, Hogden E, Li Z, Selwood A, Warwick M, Hibbert P, Arnolda G. Deepening our Understanding of Quality in Australia (DUQuA): An overview of a nation-wide, multi-level analysis of relationships between quality management systems and patient factors in 32 hospitals. Int J Qual Health Care 2020; 32:8-21. [PMID: 31725882 DOI: 10.1093/intqhc/mzz103] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/19/2019] [Accepted: 09/12/2019] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE The Deepening our Understanding of Quality in Australia (DUQuA) project is a multisite, multi-level, cross-sectional study of 32 of the largest hospitals in Australia. This overview examines relationships between (i) organization-level quality management systems and department-level quality management strategies and (ii) patient-level measures (clinical treatment processes, patient-reported perceptions of care and clinical outcomes) within Australian hospitals. DESIGN We examined hospital quality improvement structures, processes and outcomes, collecting data at organization, department and patient levels for acute myocardial infarction (AMI), hip fracture and stroke. Data sources included surveys of quality managers, clinicians and patients, hospital visits, medical record reviews and national databases. Outcomes data and patient admissions data were analysed. Relationships between measures were evaluated using multi-level models. We based the methods on the Deepening our Understanding of Quality Improvement in Europe (DUQuE) framework, extending that work in parts and customizing the design to Australian circumstances. SETTING, PARTICIPANTS AND OUTCOME MEASURES The 32 hospitals, containing 119 participating departments, provided wide representation across metropolitan, inner and outer regional Australia. We obtained 31 quality management, 1334 clinician and 857 patient questionnaires, and conducted 2401 medical record reviews and 151 external assessments. External data via a secondary source comprised 14 460 index patient admissions across 14 031 individual patients. Associations between hospital, Emergency Department (ED) and department-level systems and strategies and five patient-level outcomes were assessed: 19 of 165 associations (11.5%) were statistically significant, 12 of 79 positive associations (15.2%) and 7 of 85 negative associations (8.2%). RESULTS We did not find clear relationships between hospital-level quality management systems, ED or department quality strategies and patient-level outcomes. ED-level clinical reviews were related to adherence to clinical practice guidelines for AMI, hip fracture and stroke, but in different directions. The results, when considered alongside the DUQuE results, are suggestive that front line interventions may be more influential than department-level interventions when shaping quality of care and that multi-pronged strategies are needed. Benchmark reports were sent to each participating hospital, stimulating targeted quality improvement activities. CONCLUSIONS We found no compelling relationships between the way care is organized and the quality of care across three targeted patient-level outcome conditions. The study was cross-sectional, and thus we recommend that the relationships studied should be assessed for changes across time. Tracking care longitudinally so that quality improvement activities are monitored and fed back to participants is an important initiative that should be given priority as health systems strive to develop their capacity for quality improvement over time.
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Affiliation(s)
- Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Natalie Taylor
- Cancer Research Division, Cancer Council NSW, 153 Dowling Street, Woolloomooloo, NSW 2011, Australia.,Faculty of Health Sciences, University of Sydney, Camperdown, Sydney, NSW 2006, Australia
| | - Hsuen P Ting
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Teresa Winata
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Emily Hogden
- Cancer Research Division, Cancer Council NSW, 153 Dowling Street, Woolloomooloo, NSW 2011, Australia
| | - Zhicheng Li
- Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, NSW 2006, Australia
| | - Amanda Selwood
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Meagan Warwick
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Peter Hibbert
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia.,Australian Centre for Precision Health, Cancer Research Institute (UniSA CRI), School of Health Sciences, University of South Australia, 101 Currie Street, Adelaide, SA 5000, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
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Clay-Williams R, Taylor N, Ting HP, Winata T, Arnolda G, Braithwaite J. The clinician safety culture and leadership questionnaire: refinement and validation in Australian public hospitals. Int J Qual Health Care 2020; 32:52-59. [PMID: 31725871 DOI: 10.1093/intqhc/mzz106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/13/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study aimed to refine and validate a tool to measure safety culture and leadership in Australian hospitals. DESIGN The clinician safety culture and leadership questionnaire was constructed by combining and refining the following two previously validated scales: Safety Attitudes Questionnaire and the Leadership Effectiveness Survey. Statistical processes were used to explore the factor structure, reliability, validity and descriptive statistics of the new instrument. SETTING Thirty-two large Australian public hospitals. PARTICIPANTS 1382 clinicians (doctors, nurses and allied health professionals). MAIN OUTCOME MEASURE(S) Descriptive statistics, structure and validity of clinician safety culture and leadership scale. RESULTS We received 1334 valid responses from participants. The distribution of ratings was left-skewed, with a small ceiling effect, meaning that scores were clustered toward the high end of the scale. Using confirmatory factor analysis, we confirmed the structure of the three scales as a combined measure of safety culture and leadership. The data were divided into equal calibration and validation datasets. For the calibration dataset, the Chi-square: df ratio was 4.4, the root mean square error of approximation RMSEA (a measure of spread of the data) was 0.071, the standardized root mean square residual SRMR (an absolute measure of the fit of the data) was 0.058 and the Confirmatory Fit Index (CFI) (another test confirming the fit of the data) was 0.82; while none of the indices suggested good fit, all but CFI fell within acceptable thresholds. All factors demonstrated adequate internal consistency and construct reliability, as desired. All three domains achieved discriminant validity through cross-loadings, meaning that the three domains were determined to be independent constructs. Results for the validation dataset were effectively identical to those found in the calibration dataset. CONCLUSIONS While the model may benefit from additional refinement, we have validated the tool for measuring clinician safety culture and leadership in our Australian sample. The DUQuA safety culture and leadership scale can be used by Australian hospitals to assess clinician safety culture and leadership, and is readily modifiable for other health systems depending on their needs.
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Affiliation(s)
- Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie University, NSW 2109, Australia
| | - Natalie Taylor
- Cancer Research Division, Cancer Council NSW, 153 Dowling St, Woolloomooloo, NSW 2011, Australia.,Faculty of Health Sciences, University of Sydney, Camperdown, Sydney, NSW 2006, Australia
| | - Hsuen P Ting
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie University, NSW 2109, Australia
| | - Teresa Winata
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie University, NSW 2109, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie University, NSW 2109, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie University, NSW 2109, Australia
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Braithwaite J, Tran Y, Ellis LA, Westbrook J. Inside the black box of comparative national healthcare performance in 35 OECD countries: Issues of culture, systems performance and sustainability. PLoS One 2020; 15:e0239776. [PMID: 32986783 PMCID: PMC7521685 DOI: 10.1371/journal.pone.0239776] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/14/2020] [Indexed: 11/18/2022] Open
Abstract
Background Is national healthcare performance associated with country-level characteristics, and if so what are the implications for international health policy? Methods and findings We compared Hofstede’s six cultural dimensions against relative health systems performance of 35 countries. Hierarchical cluster analysis identified best-matched groupings of countries. Performance was measured by the Organisation for Economic Co-operation and Development’s (OECD’s) Health at a Glance indicators data framework (five dimensions with 57 indicators) and the United Nations’ (UNs’) Sustainability Development Goals (SDG) data set (15 indicators). Three country clusters emerged: Collective-Pyramidal (n = 9: comprising Slovak Republic, Mexico, Poland, Greece, Spain, Turkey, Portugal, Chile, and Slovenia); Collaborative-Networked (n = 12: UK, Canada, Australia, USA, Ireland, New Zealand, Netherlands, Finland, Iceland, Norway, Denmark, and Sweden); and Orderly-Future Orientated (n = 14: Korea, Estonia, Latvia, Austria, Israel, Japan, Czech Republic, Hungary, Italy, Belgium, France, Germany, Luxembourg and Switzerland). The Collaborative-Networked cluster had significantly better performing health systems measured by both the Health at a Glance and SDG performance data, followed by the Orderly-Future Orientated cluster, followed by the Collective-Pyramidal cluster. The Collaborative-Networked Cluster was characterized by low power distance (e.g., greater levels of equity), low uncertainty avoidance (e.g., toleration of others’ opinions), individualism (e.g., self-reliance) and indulgence (e.g., drives and norms to enjoy life and have fun). Conclusions National cultures are associated with healthcare performance on two key international measures. In national and international efforts to improve health system performance, cultural characteristics play an important role. This information may be of value to regulators, policymakers, researchers and clinicians examining the practical impact of culture on healthcare performance.
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Affiliation(s)
- Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- * E-mail:
| | - Yvonne Tran
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Louise A. Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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Lloyd S, Cliff C, FitzGerald G, Collie J. Can publicly reported data be used to understand performance in an Australian rural hospital? Health Inf Manag 2020; 50:35-46. [PMID: 32935590 DOI: 10.1177/1833358320948559] [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: 11/16/2022]
Abstract
BACKGROUND Despite agreement among policymakers, funders, consumers and researchers about the value of public reporting of health information, limited attention has been paid to how it can be used to understand the performance of rural hospitals. OBJECTIVE To determine whether publicly available information can be used to measure health service performance in a rural hospital. METHOD The study used performance data routinely reported for public consumption in Australia. Data across four domains, multiple measures and time periods were collected to examine access and equity; efficiency and sustainability; quality, safety and patient orientation; and employee engagement. Performance of the rural hospital was examined using a visualisation tool. RESULTS Visualisation of multiple measures of performance over time was achievable but required a high degree of health information management skills. CONCLUSION AND IMPLICATIONS Publicly reported data can be used to represent performance for a rural hospital. Timeliness, level of detail available and peer groupings of data limits optimal utility. Consumers, clinicians and health service managers wanting to understand the performance of rural hospitals will need to use significant health information management skills to gain a picture of performance. Further research in the applied use of publicly available performance data and relevant dashboards for rural hospitals is suggested.
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Linnander E, McNatt Z, Boehmer K, Cherlin E, Bradley E, Curry L. Changing hospital organisational culture for improved patient outcomes: developing and implementing the leadership saves lives intervention. BMJ Qual Saf 2020; 30:475-483. [PMID: 32675328 PMCID: PMC8142460 DOI: 10.1136/bmjqs-2019-010734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 11/17/2022]
Abstract
Background Leadership Saves Lives (LSL) was a prospective, mixed methods intervention to promote positive change in organisational culture across 10 diverse hospitals in the USA and reduce mortality for patients with acute myocardial infarction (AMI). Despite the potential impact of complex interventions such as LSL, descriptions in the peer-reviewed literature often lack the detail required to allow adoption and adaptation of interventions or synthesis of evidence across studies. Accordingly, here we present the underlying design principles, overall approach to intervention design and core content of the intervention. Methods of intervention development Hospitals were selected for participation from the membership of the Mayo Clinic Care Network using random sampling with a purposeful component. The intervention was designed based on the Assess, Innovate, Develop, Engage, Devolve model for diffusion of innovation, with attention to pressure testing of the intervention with user groups, creation of a think tank to develop a comprehensive assessment of the landscape, and early and continued engagement with strategically identified stakeholders in multiple arenas. Results We provide in-depth descriptions of the design and delivery of the three intervention components (three annual meetings of all hospitals, four rounds of in-hospital workshops and an online community), designed to equip a guiding coalition within each site to identify and address root causes of AMI mortality and improve organisational culture. Conclusions This detailed practical description of the intervention may be useful for healthcare practitioners seeking to promote organisational culture change in their own contexts, researchers seeking to compare the results of the intervention with other leadership development and organisational culture change efforts, and healthcare professionals committed to understanding complex interventions across healthcare settings.
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Affiliation(s)
- Erika Linnander
- Global Health Leadership Initiative, Yale University School of Public Health, New Haven, Connecticut, USA
| | | | - Kasey Boehmer
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Emily Cherlin
- Global Health Leadership Initiative, Yale University School of Public Health, New Haven, Connecticut, USA
| | | | - Leslie Curry
- Global Health Leadership Initiative, Yale University School of Public Health, New Haven, Connecticut, USA
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Yoo SGK, Davies D, Mohanan PP, Baldridge AS, Charles PM, Schumacher M, Bhalla S, Devarajan R, Hirschhorn LR, Prabhakaran D, Huffman MD. Hospital-Level Cardiovascular Management Practices in Kerala, India. Circ Cardiovasc Qual Outcomes 2020; 12:e005251. [PMID: 31092020 DOI: 10.1161/circoutcomes.118.005251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background Hospital management practices are associated with cardiovascular process of care measures and patient outcomes. However, management practices related to acute cardiac care in India has not been studied. Methods and Results We measured management practices through semistructured, in-person interviews with hospital administrators, physician managers, and nurse managers in Kerala, India between October and November 2017 using the adapted World Management Survey. Trained interviewers independently scored management interview responses (range: 1-5) to capture management practices ranging from performance data tracking to setting targets. We performed univariate regression analyses to assess the relationship between hospital-level factors and management practices. Using Pearson correlation coefficients and mixed-effect logistic regression models, we explored the relationship between management practices and 30-day major adverse cardiovascular events defined as all-cause mortality, reinfarction, stroke, or major bleeding. Ninety managers from 37 hospitals participated. We found suboptimal management practices across 3 management levels (mean [SD]: 2.1 [0.5], 2.0 [0.3], and 1.9 [0.3] for hospital administrators, physician managers, and nurse managers, respectively [ P=0.08]) with lowest scores related to setting organizational targets. Hospitals with existing healthcare quality accreditation, more cardiologists, and private ownership were associated with higher management scores. In our exploratory analysis, higher physician management practice scores related to operation, performance, and target management were correlated with lower 30-day major adverse cardiovascular event. Conclusions Management practices related to acute cardiac care in participating Kerala hospitals were suboptimal but were correlated with clinical outcomes. We identified opportunities to strengthen nonclinical practices to improve patient care.
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Affiliation(s)
- Sang Gune K Yoo
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.G.K.Y., A.S.B., M.D.H.)
| | - Divin Davies
- WestFort Hi-Tech Hospital Ltd, Thrissur, India (D.D., P.P.M.)
| | | | - Abigail S Baldridge
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.G.K.Y., A.S.B., M.D.H.)
| | | | - Mark Schumacher
- Northwestern Memorial Healthcare, Chicago, IL (P.M.C., M.S.)
| | - Sandeep Bhalla
- Public Health Foundation of India, Gurgaon, India (S.B., D.P.)
| | - Raji Devarajan
- Centre for Chronic Disease Control, New Delhi, India (R.D., D.P.)
| | - Lisa R Hirschhorn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL (L.R.H.)
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, Gurgaon, India (S.B., D.P.).,Centre for Chronic Disease Control, New Delhi, India (R.D., D.P.).,London School of Hygiene and Tropical Medicine, London, United Kingdom (D.P.)
| | - Mark D Huffman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.G.K.Y., A.S.B., M.D.H.)
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Innis J, Barnsley J, Berta W, Daniel I. Do hospital size, location, and teaching status matter? Role of context in the use of evidence-based discharge practices. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2020. [DOI: 10.1080/20479700.2020.1725716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Jan Barnsley
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Whitney Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Imtiaz Daniel
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Ontario Hospital Association, Toronto, Canada
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Arnolda G, Winata T, Ting HP, Clay-Williams R, Taylor N, Tran Y, Braithwaite J. Implementation and data-related challenges in the Deepening our Understanding of Quality in Australia (DUQuA) study: implications for large-scale cross-sectional research. Int J Qual Health Care 2020; 32:75-83. [PMID: 32026937 DOI: 10.1093/intqhc/mzz108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/07/2019] [Accepted: 09/12/2019] [Indexed: 12/31/2022] Open
Abstract
Healthcare organisations vary in the degree to which they implement quality and safety systems and strategies. Large-scale cross-sectional studies have been implemented to explore whether this variation is associated with outcomes relevant at the patient level. The Deepening our Understanding of Quality in Australia (DUQuA) study draws from earlier research of this type, to examine these issues in 32 Australian hospitals. This paper outlines the key implementation and analysis challenges faced by DUQuA. Many of the logistical difficulties of implementing DUQuA derived from compliance with the administratively complex and time-consuming Australian ethics and governance system designed principally to protect patients involved in clinical trials, rather than for low-risk health services research. The complexity of these processes is compounded by a lack of organizational capacity for multi-site health services research; research is expected to be undertaken in addition to usual work, not as part of it. These issues likely contributed to a relatively low recruitment rate for hospitals (41% of eligible hospitals). Both sets of issues need to be addressed by health services researchers, policymakers and healthcare administrators, if health services research is to flourish. Large-scale research also inevitably involves multiple measurements. The timing for applying these measures needs to be coherent, to maximise the likelihood of finding real relationships between quality and safety systems and strategies, and patient outcomes; this timing was less than ideal in DUQuA, in part due to administrative delays. Other issues that affected our study include low response rates for measures requiring recruitment of clinicians and patients, missing data and a design that necessarily included multiple statistical comparisons. We discuss how these were addressed. Successful completion of these projects relies on mutual and ongoing commitment, and two-way communication between the research team and hospital staff at all levels. This will help to ensure that enthusiasm and engagement are established and maintained.
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Affiliation(s)
- Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, North Ryde, Australia
| | - Teresa Winata
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, North Ryde, Australia
| | - Hsuen P Ting
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, North Ryde, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, North Ryde, Australia
| | - Natalie Taylor
- Cancer Research Division, Cancer Council NSW, 153 Dowling St, Woolloomooloo, NSW 2011, Woolloomooloo, Australia.,Faculty of Health Sciences, University of Sydney, Camperdown, Sydney, NSW 2006, Sydney, Australia
| | - Yvonne Tran
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, North Ryde, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, North Ryde, Australia
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Braithwaite J, Clay-Williams R, Taylor N, Ting HP, Winata T, Arnolda G, Sunol R, Græne O, Wagner C, Klazinga NS, Donaldson L, Dowton SB. Bending the quality curve. Int J Qual Health Care 2020; 32:1-7. [PMID: 31821447 DOI: 10.1093/intqhc/mzz102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/19/2019] [Accepted: 09/12/2019] [Indexed: 12/24/2022] Open
Abstract
With this paper, we initiate the Supplement on Deepening our Understanding of Quality in Australia (DUQuA). DUQuA is an at-scale, cross-sectional research programme examining the quality activities in 32 large hospitals across Australia. It is based on, with suitable modifications and extensions, the Deepening our Understanding of Quality improvement in Europe (DUQuE) research programme, also published as a Supplement in this Journal, in 2014. First, we briefly discuss key data about Australia, the health of its population and its health system. Then, to provide context for the work, we discuss previous activities on the quality of care and improvement leading up to the DUQuA studies. Next, we present a selection of key interventional studies and policy and institutional initiatives to date. Finally, we conclude by outlining, in brief, the aims and scope of the articles that follow in the Supplement. This first article acts as a framing vehicle for the DUQuA studies as a whole. Aggregated, the series of papers collectively attempts an answer to the questions: what is the relationship between quality strategies, both hospital-wide and at department level? and what are the relationships between the way care is organised, and the actual quality of care as delivered? Papers in the Supplement deal with a multiplicity of issues including: how the DUQuA investigators made progress over time, what the results mean in context, the scales designed or modified along the way for measuring the quality of care, methodological considerations and provision of lessons learnt for the benefit of future researchers.
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Affiliation(s)
- Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie University, NSW, Sydney, 2109, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie University, NSW, Sydney, 2109, Australia
| | - Natalie Taylor
- Cancer Research Division, Cancer Council NSW, 153 Dowling St, Woolloomooloo, NSW 2011, Australia.,Faculty of Health Sciences, University of Sydney, Camperdown, Sydney, NSW, 2006, Australia
| | - Hsuen P Ting
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie University, NSW, Sydney, 2109, Australia
| | - Teresa Winata
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie University, NSW, Sydney, 2109, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie University, NSW, Sydney, 2109, Australia
| | - Rosa Sunol
- Avedis Donabedian Research Institute (FAD), Universitat Autonoma de Barcelona, Bellaterra, Barcelona, 08193, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barcelona, Spain
| | - Oliver Græne
- OptiMedis AG, Burchardstraße 17, Hamburg, 20095, Germany.,London School of Hygiene and Tropical Medicine, University of London, Keppel St, Bloomsbury, London, WC1E 7HT, United Kingdom
| | - Cordula Wagner
- Netherlands Institute of Health Services Research (NIVEL), Otterstraat 118, CR Utrecht, 3513, The Netherlands.,Amsterdam UMC, VU University Medical Centers, De Boelelaan, 1117, Amsterdam
| | - Niek S Klazinga
- Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, The Netherlands
| | - Liam Donaldson
- London School of Hygiene and Tropical Medicine, University of London, Keppel St, Bloomsbury, London, WC1E 7HT, United Kingdom
| | - S Bruce Dowton
- Office of the Vice Chancellor, Macquarie University, NSW, Sydney, 2109, Australia
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