1
|
Carroll Á, McKenzie J, Collins C. Medical consultants' experience of collective leadership in complexity: a qualitative interview study. J Health Organ Manag 2024; 38:297-312. [PMID: 39308090 PMCID: PMC11346208 DOI: 10.1108/jhom-04-2023-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 12/15/2023] [Accepted: 01/26/2024] [Indexed: 09/26/2024]
Abstract
PURPOSE The aim of this study was to explore and understand the leadership experiences of medical consultants prior to a major hospital move. Health and care is becoming increasingly complex and there is no greater challenge than the move to a new hospital. Effective leadership has been identified as being essential for successful transition. However, there is very little evidence of how medical consultants experience effective leadership. DESIGN/METHODOLOGY/APPROACH A qualitative methodology was utilized with one-to-one semi-structured interviews conducted with ten medical consultants. These were transcribed verbatim and analyzed using inductive thematic analysis. The research complied with the consolidated criteria for reporting qualitative research (COREQ). FINDINGS Four themes were found to influence medical consultants' experience of leadership: collaboration, patient centredness, governance and knowledge mobilization. Various factors were identified that negatively influenced their leadership effectiveness. The findings suggest that there are a number of factors that influence complexity leadership effectiveness. Addressing these areas may enhance leadership effectiveness and the experience of leadership in medical consultants. RESEARCH LIMITATIONS/IMPLICATIONS This study provides a rich exploration of medical consultants' experience of collective leadership prior to a transition to a new hospital and provides new understandings of the way collective leadership is experienced in the lead up to a major transition and makes recommendations for future leadership research and practice. PRACTICAL IMPLICATIONS The findings suggest that there are a number of factors that influence complexity leadership effectiveness. Addressing these areas may enhance leadership effectiveness and the experience of leadership in medical consultants. SOCIAL IMPLICATIONS Clinical leadership is associated with better outcomes for patients therefore any interventions that enhance leadership capability will improve outcomes for patients and therefore benefit society. ORIGINALITY/VALUE This is the first research to explore medical consultants' experience of collective leadership prior to a transition to a new hospital.
Collapse
Affiliation(s)
- Áine Carroll
- School of Medicine,
University College Dublin, Dublin, Ireland
- National Rehabilitation Hospital, Dublin,
Ireland
- Henley Business School,
University of Reading, Reading, UK
| | - Jane McKenzie
- Henley Business School,
University of Reading, Reading, UK
| | - Claire Collins
- Henley Business School,
University of Reading, Reading, UK
| |
Collapse
|
2
|
van Engen V, Buljac-Samardzic M, Baatenburg de Jong R, Braithwaite J, Ahaus K, Den Hollander-Ardon M, Peters I, Bonfrer I. A decade of change towards Value-Based Health Care at a Dutch University Hospital: a complexity-informed process study. Health Res Policy Syst 2024; 22:94. [PMID: 39103922 DOI: 10.1186/s12961-024-01181-z] [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: 03/23/2024] [Accepted: 07/13/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND While healthcare organizations in several countries are embracing Value-Based Health Care (VBHC), there are limited insights into how to achieve this paradigm shift. This study examines the decade-long (2012-2023) change towards VBHC in a pioneering Dutch university hospital. METHOD Through retrospective, complexity-informed process research, we study how a Dutch university hospital's strategy to implement VBHC evolved, how implementation outcomes unfolded, and the underlying logic behind these developments. Data include the hospital's internal documents (n = 10,536), implementation outcome indicators (n = 4), a survey among clinicians (n = 47), and interviews with individuals contributing to VBHC at the hospital level (n = 20). RESULTS The change towards VBHC is characterized by three sequential strategies. Initially, the focus was on deep change through local, tailored implementation of multiple VBHC elements. The strategy then transitioned to a hospital-wide program aimed at evolutionary change on a large scale, emphasizing the integration of VBHC into mainstream IT and policies. Recognizing the advantages and limitations of both strategies, the hospital currently adopts a "hybrid" strategy. This strategy delicately combines deep and broad change efforts. The strategy evolved based on accumulated insights, contextual developments and shifts in decision-makers. The complexity of change was downplayed in plans and stakeholder communication. By the end of 2023, 68 (sub)departments engaged in VBHC, enabled to discuss patients' responses to Patient Reported Outcomes Measures (PROMs) during outpatient care. However, clinicians' use of PROMs data showed limitations. While pioneers delved deeper into VBHC, laggards have yet to initiate it. CONCLUSIONS VBHC does not lend itself to linear planning and is not easily scalable. While there appears to be no golden standard for implementation, blending local and larger-scale actions appears advantageous. Local, deep yet harmonized and system-integrated changes culminate in large scale transformation. Embracing complexity and focusing on the ultimate aims of (re)institutionalization and (re)professionalization are crucial.
Collapse
Affiliation(s)
- Veerle van Engen
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Martina Buljac-Samardzic
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Rob Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Kees Ahaus
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Ingrid Peters
- Department of Quality and Patient Care, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Igna Bonfrer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
3
|
Thille P, Tobin A, Evans JM, Katz A, Russell GM. Evolving through multiple, co-existing pressures to change: a case study of self-organization in primary care during the COVID-19 pandemic in Canada. BMC PRIMARY CARE 2024; 25:285. [PMID: 39103760 DOI: 10.1186/s12875-024-02520-3] [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: 11/23/2023] [Accepted: 07/10/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Primary care is often described as slow to change. But conceptualized through complexity theory, primary care is continually changing in unpredictable, non-linear ways through self-organization processes. Self-organization has proven hard to study directly. We aimed to develop a methodology to study self-organization and describe how a primary care clinic self-organizes over time. METHODOLOGY We completed a virtual case study of an urban primary care clinic from May-Nov 2021, applying methodological insights from actor-network theory to examine the complexity theory concept of self-organization. We chose to focus our attention on self-organization activities that alter organizational routines. Data included fieldnotes of observed team meetings, document collection, interviews with clinic members, and notes from brief weekly discussions to detect actions to change clinical and administrative routines. Adapting schema analysis, we described changes to different organizational routines chronologically, then explored intersecting changes. We sought feedback on results from the participating clinic. FINDINGS Re-establishing equilibrium remained challenging well into the COVID-19 pandemic. The primary care clinic continued to self-organize in response to changing health policies, unintended consequences of earlier adaptations, staff changes, and clinical care initiatives. Physical space, technologies, external and internal policies, guidelines, and clinic members all influenced self-organization. Changing one created ripple effects, sometimes generating new, unanticipated problems. Member checking confirmed we captured most of the changes to organizational routines during the case study period. CONCLUSIONS Through insights from actor-network theory, applied to studying actions taken that alter organizational routines, it is possible to operationalize the theoretical construct of self-organization. Our methodology illuminates the primary care clinic as a continually changing entity with co-existing and intersecting processes of self-organization in response to varied change pressures.
Collapse
Affiliation(s)
- Patricia Thille
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, R106-771 McDermot Ave, Winnipeg, MB, R3E 0T6, Canada.
| | - Anastasia Tobin
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, R106-771 McDermot Ave, Winnipeg, MB, R3E 0T6, Canada
| | - Jenna M Evans
- DeGroote School of Business, McMaster University, 1280 Main Street West, L8S 4L8, Hamilton, ON, Canada
| | - Alan Katz
- Manitoba Centre for Health Policy & Departments of Community Health Sciences and Family Medicine, University of Manitoba, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada
| | - Grant M Russell
- Department of General Practice, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| |
Collapse
|
4
|
Benjamin E. The work of patient flow management: A grounded theory study of emergency nurses. Int Emerg Nurs 2024; 74:101457. [PMID: 38744106 DOI: 10.1016/j.ienj.2024.101457] [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: 10/30/2023] [Revised: 04/02/2024] [Accepted: 04/26/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION The current crisis of emergency department overcrowding demands novel approaches. Despite a growing body of patient flow literature, there is little understanding of the work of emergency nurses. This study explored how emergency nurses perform patient flow management. METHODS Constructivist grounded theory and situational analysis methodologies were used to examine the work of emergency nurses. Twenty-nine focus groups and interviews of 27 participants and 64 hours of participant observation across four emergency departments were conducted between August 2022 and February 2023. Data were analyzed using coding, constant comparative analysis, and memo-writing to identify emergent themes and develop a substantive theory. FINDINGS Patient flow management is the work of balancing department resources and patient care to promote collective patient safety. Patient safety arises when care is ethical, efficient, and appropriately weighs care timeliness and comprehensiveness. Emergency nurses use numerous patient flow management strategies that can be organized into five tasks: information gathering, continuous triage, resource management, throughput management, and care oversight. CONCLUSION Patient flow management is complex, cognitively demanding work. The central contribution of this paper is a theoretical model that reflects emergency nurses'conceptualizations, discourse, and priorities. This model lays the foundation for knowledge sharing, training, and practice improvement.
Collapse
Affiliation(s)
- Ellen Benjamin
- Elaine Marieb College of Nursing, University of Massachusetts, Amherst, MA, United States; Present address: Manning College of Nursing and Health Sciences, University of Massachusetts, Boston, MA, United States.
| |
Collapse
|
5
|
Gans EA, de Ruijter UW, van der Heide A, van der Meijden SA, van den Bos F, van Munster BC, de Groot JF. A Grounded Theory of Interdisciplinary Communication and Collaboration in the Outpatient Setting of the Hospital for Patients with Multiple Long-Term Conditions. J Pers Med 2024; 14:533. [PMID: 38793115 PMCID: PMC11122402 DOI: 10.3390/jpm14050533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Interdisciplinary communication and collaboration are crucial in the care of people with multiple long-term conditions (MLTCs) yet are often experienced as insufficient. Through the lens of complexity science, this study aims to explain how healthcare professionals (HCPs) adapt to emerging situations in the care of patients with MLTC by examining interdisciplinary communication and collaboration in the outpatient hospital setting. We used the constant comparative method to analyze transcribed data from seven focus groups with twenty-one HCPs to generate a constructivist grounded theory of 'interdisciplinary communication and collaboration in the outpatient setting of the hospital for patients with multiple long-term conditions'. Our theory elucidates the various pathways of communication and collaboration. Why, when, and how team members choose to collaborate influences if and to what degree tailored care is achieved. There is great variability and unpredictability to this process due to internalized rules, such as beliefs on the appropriateness to deviate from guidelines, and the presence of an interprofessional identity. We identified organizational structures that influence the dynamics of the care team such as the availability of time and financial compensation for collaboration. As we strive for tailored care for patients with MLTC, our theory provides promising avenues for future endeavors.
Collapse
Affiliation(s)
- Emma A. Gans
- University Center of Geriatric Medicine, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (S.A.v.d.M.); (B.C.v.M.)
- Knowledge Institute of the Dutch Association of Medical Specialists, 3502 GH Utrecht, The Netherlands;
| | - Ursula W. de Ruijter
- Department of Public Health, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; (U.W.d.R.); (A.v.d.H.)
- Department of Internal Medicine, Northwest Clinics, 1817 MS Alkmaar, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; (U.W.d.R.); (A.v.d.H.)
| | - Suzanne A. van der Meijden
- University Center of Geriatric Medicine, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (S.A.v.d.M.); (B.C.v.M.)
| | - Frederiek van den Bos
- Department of Gerontology and Geriatrics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Barbara C. van Munster
- University Center of Geriatric Medicine, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (S.A.v.d.M.); (B.C.v.M.)
| | - Janke F. de Groot
- Knowledge Institute of the Dutch Association of Medical Specialists, 3502 GH Utrecht, The Netherlands;
| |
Collapse
|
6
|
Gear C, Ting C, Manuel C, Eppel E, Koziol-McLain J. Integrated System Responses for Families Impacted by Violence: A Scoping Review. Int J Integr Care 2024; 24:17. [PMID: 38798719 PMCID: PMC11122700 DOI: 10.5334/ijic.7542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/07/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Violence within families is a complex problem which significantly impacts health and wellbeing. Despite the ubiquitous call for integrated family violence service delivery, integrated approaches vary significantly and challenges to implementation remain. This scoping review explored how integrated approaches to family violence service delivery are conceptualised within international and Aotearoa New Zealand literature. Methods Following a documented scoping review process identified from literature, dynamic interplay between system agents within integrated family violence service delivery were mapped with the assistance of a complexity theory lens. We analysed characteristics of included studies, agents involved, how they interacted and the methods and mechanisms of integration among them. Results Seventy-two published reports were included. The most common interactions occurred between statutory agencies such as police and child protection. While health care service providers were included within 55 studies, their engagement was often peripheral. Qualitative analysis elucidated three broad pathways to service delivery impact underpinned by systems-centred, person-centred, or Indigenous-centred worldviews. Discussion and Conclusion Integrated approaches to family violence service delivery are highly variable. Despite a strong assumption that integration leads to improved safety, health, and wellbeing for care-seekers, most studies did not include evidence of such impact. Consideration of how worldviews characterise service provision provides insight into why integration has proven challenging over time.
Collapse
Affiliation(s)
- Claire Gear
- Centre for Interdisciplinary Trauma Research, School of Clinical Sciences, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Chien Ting
- Centre for Interdisciplinary Trauma Research, School of Clinical Sciences, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Carey Manuel
- Āio Consulting Limited, Tauranga Moana, New Zealand
| | - Elizabeth Eppel
- School of Government, Victoria University of Wellington, Wellington, New Zealand
| | - Jane Koziol-McLain
- Centre for Interdisciplinary Trauma Research, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| |
Collapse
|
7
|
Nordin HMA, Mathisen GE, Rørtveit K, Joa I, Johannessen JO, Ruud T, Hartveit M. Implementing Clinical Guidelines for the Treatment of Psychosis: The Frontline Leaders' Point of View. A Qualitative Study. J Healthc Leadersh 2024; 16:93-104. [PMID: 38440078 PMCID: PMC10910968 DOI: 10.2147/jhl.s430285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/24/2024] [Indexed: 03/06/2024] Open
Abstract
Background Despite the large amount of leadership and implementation theories and recommendations, healthcare services continue to struggle with efficiently incorporating new knowledge. The questioning of conventional leadership approaches in healthcare organizations prompted us to investigate how frontline leaders comprehend their own implementation intentions and actions, and how these intentions and actions may impact the implementation of clinical guidelines in mental healthcare in Norway. Methods Employing a theory-driven qualitative design, we conducted nine semi-structured interviews with frontline leaders who had recently led implementation of clinical guidelines for the treatment of psychosis in mental health. We employed Systematic Text Condensation, informed by Normalization Process Theory, to structure and analyze the data and used fidelity scales to measure the degree of implementation and distinguish between leaders' levels of success in implementation. Results Frontline leaders in units that achieved high success in implementation described their intentions and actions differently, from those with less success. The former group's actions aligned more closely with the constructs of the Normalization Process Theory compared to the latter group when describing their actions. Frontline leaders leading units with a high degree of implementation success describe relation-orientation, trust, and providing adaptive space for staff members to take initiative. In contrast, those leading units with less implementation success describe more control and guidance of co-operators and place more emphasize on information and knowledge. Conclusion Differences in how frontline leaders describe their actions and intentions to achieve clinical guideline implementation suggest that the leadership approach of these frontline leaders is an important factor to consider when planning and conducting implementation. To better understand the implementation process, it is important to pay attention to how frontline leaders customize their leadership approaches to the dynamics of complex organizations, and how they interact with their team and superiors.
Collapse
Affiliation(s)
- Håkan M A Nordin
- Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway
- Department of Caring and Ethics, University of Stavanger, Stavanger, Norway
| | - Gro Ellen Mathisen
- Norwegian School of Hotel Management, University of Stavanger, Stavanger, Norway
| | - Kristine Rørtveit
- Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway
- Department of Caring and Ethics, University of Stavanger, Stavanger, Norway
| | - Inge Joa
- Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway
- Department of Public Health, University of Stavanger, Stavanger, Norway
| | - Jan O Johannessen
- Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway
- Department of Public Health, University of Stavanger, Stavanger, Norway
| | - Torleif Ruud
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Miriam Hartveit
- Department for Research and Innovation, Helse Fonna Health Trust, Valen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| |
Collapse
|
8
|
Miles K, O'Neill B, Li S. The 'Kidney' model for optimising feedback in undergraduate clinical communication: A meta-ethnographic systematic review. PATIENT EDUCATION AND COUNSELING 2024; 119:108050. [PMID: 37948906 DOI: 10.1016/j.pec.2023.108050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/13/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES Feedback frameworks/models focus on certain aspects of the feedback process, but a coherent and systematic model is lacking. A meta-ethnography was conducted to identify and synthesise guidance for optimising feedback interactions in undergraduate clinical communication simulations. METHODS A systematic search of 4 electronic databases and grey literature was conducted. Following Noblit and Hare's seven phases for conducting meta-ethnography, key themes and concepts were synthesised to provide new interpretations of components in effective feedback interactions. RESULTS 373 publications were identified and 14 included for the final synthesis, which informed the development of a new Feedback Kidney Model. The Model illustrates the interconnections of various components that allow for effective feedback interactions. The main processes include preparation, proactivity, analysis and feedback information, reception and response, and influencing factors. CONCLUSIONS This meta-ethnography moves beyond providing an up-to-date synthesis of feedback guidance to proposing the brand-new Feedback Kidney Model, which can guide medical education and future research into how feedback is co-constructed and utilised to promote learning. PRACTICE IMPLICATIONS Clinical communication should incorporate meta-cognitive training and using this Model will help students better utilise on-site face-to-face feedback to enhance their learning and improve future communication with patients.
Collapse
Affiliation(s)
- Katherine Miles
- Department of Pharmacology, Public Health and Clinical Skills, Faculty of Medicine, Hashemite University, Zarqa, Jordan; GKT School of Medical Education, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Bernadette O'Neill
- GKT School of Medical Education, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Shuangyu Li
- GKT School of Medical Education, Faculty of Life Sciences and Medicine, King's College London, London, UK; King's Cultural Competency Unit, Faculty of Arts and Humanities, King's College London, UK.
| |
Collapse
|
9
|
Rimal R, Shepherd RM, Curley LE, Sundram F. Perspectives from gambling expert stakeholders in relation to electronic gaming machines in New Zealand. Health Policy 2023; 136:104897. [PMID: 37651971 DOI: 10.1016/j.healthpol.2023.104897] [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: 05/10/2023] [Revised: 07/23/2023] [Accepted: 08/19/2023] [Indexed: 09/02/2023]
Abstract
Electronic gaming machines (EGMs) are one of the most addictive and harmful forms of gambling. Gaming machine characteristics, easy accessibility of EGMs and normalisation of gambling behaviour have exacerbated these effects. We conducted a pilot study investigating the perspectives of gambling expert stakeholders on gambling harm and effective harm-minimisation policies regarding EGMs. In-depth individual interviews were undertaken with 14 health professionals working in the addiction sector, academics in the field of gambling and individuals from a range of government and non-government organisations who have an impact on gambling policy making in New Zealand. Five major themes were identified: the need to shift focus from problematic people to the problematic product, the need for a holistic approach to gambling intervention, focus on creating an empowered population, and improving protective factors and refining public health initiatives to gambling harm. The results suggest the need to challenge current narratives of EGM-related gambling harm and have wide-ranging implications for EGM harm minimisation and health promotion policies.
Collapse
Affiliation(s)
- Retina Rimal
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Robin-Marie Shepherd
- Community Health Centre in Waiheke Island, Piritahi Hau Ora, Auckland, New Zealand
| | - Louise Elizabeth Curley
- Centre for Addiction Research, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand; School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand; Centre for Brain Research, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Frederick Sundram
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand; Centre for Addiction Research, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand; Centre for Brain Research, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
| |
Collapse
|
10
|
Devine C, Ghosal R, Weller M, Doren T, Yu CH, Marsillo R, Kenton N. Longitudinal Policy and Systems Change as a Component of Community Power. FAMILY & COMMUNITY HEALTH 2023; 46:S41-S51. [PMID: 37696015 DOI: 10.1097/fch.0000000000000371] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Community power represents the ability of communities to develop, sustain, and grow the capacity to participate in and advance systems change that addresses health inequities but is difficult to assess because of its multifaceted, longitudinal nature. Using California's school-based Local Control Funding Formula (LCFF) as an example, this article examines the interconnectedness of longitudinal policy and systems changes as one approach to understanding and visualizing evolving community power. Data on policy and systems changes were collected during the 10-year, place-based Building Healthy Communities initiative and coded using thematic analysis. Related changes within sites and between community and state levels were linked to show how changes built and overlapped over time. Around 45% of changes were interconnected and cascaded to build momentum within sites; in addition, a substantial proportion of statewide changes (68%) overlapped with community ones. The state-level LCFF policy led to multiple community-based changes over time, involving ongoing engagement from various community groups across communities. Local implementation of the LCFF policy change was used to illustrate the usefulness of connecting community-driven policy and systems changes over time to explore the dynamics of community power and address some of the limitations of that approach.
Collapse
Affiliation(s)
- Claire Devine
- Center for Outcomes Research & Education, Providence St Joseph Health, Portland, Oregon
| | | | | | | | | | | | | |
Collapse
|
11
|
Miao M, Morrow R, Salomon A, Mcculloch B, Evain JC, Wright MR, Murphy MT, Welsh M, Williams L, Power E, Rietdijk R, Debono D, Brunner M, Togher L. Digital Health Implementation Strategies Coproduced With Adults With Acquired Brain Injury, Their Close Others, and Clinicians: Mixed Methods Study With Collaborative Autoethnography and Network Analysis. J Med Internet Res 2023; 25:e46396. [PMID: 37725413 PMCID: PMC10548320 DOI: 10.2196/46396] [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: 02/10/2023] [Revised: 05/10/2023] [Accepted: 08/03/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Acquired brain injuries (ABIs), such as stroke and traumatic brain injury, commonly cause cognitive-communication disorders, in which underlying cognitive difficulties also impair communication. As communication is an exchange with others, close others such as family and friends also experience the impact of cognitive-communication impairment. It is therefore an internationally recommended best practice for speech-language pathologists to provide communication support to both people with ABI and the people who communicate with them. Current research also identifies a need for neurorehabilitation professionals to support digital communication, such as social media use, after ABI. However, with >135 million people worldwide affected by ABI, alternate and supplementary service delivery models are needed to meet these communication needs. The "Social Brain Toolkit" is a novel suite of 3 interventions to deliver communication rehabilitation via the internet. However, digital health implementation is complex, and minimal guidance exists for ABI. OBJECTIVE This study aimed to support the implementation of the Social Brain Toolkit by coproducing implementation knowledge with people with ABI, people who communicate with people with ABI, clinicians, and leaders in digital health implementation. METHODS A maximum variation sample (N=35) of individuals with living experience of ABI, close others, clinicians, and digital health implementation leaders participated in an explanatory sequential mixed methods design. Stakeholders quantitatively prioritized 4 of the 7 theoretical domains of the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework as being the most important for Social Brain Toolkit implementation. Qualitative interview and focus group data collection focused on these 4 domains. Data were deductively analyzed against the NASSS framework with stakeholder coauthors to determine implementation considerations and strategies. A collaborative autoethnography of the research was conducted. Interrelationships between considerations and strategies were identified through a post hoc network analysis. RESULTS Across the 4 prioritized domains of "condition," "technology," "value proposition," and "adopters," 48 digital health implementation considerations and 52 tailored developer and clinician implementation strategies were generated. Benefits and challenges of coproduction were identified. The post hoc network analysis revealed 172 unique relationships between the identified implementation considerations and strategies, with user and persona testing and responsive design identified as the potentially most impactful strategies. CONCLUSIONS People with ABI, close others, clinicians, and digital health leaders coproduced new knowledge of digital health implementation considerations for adults with ABI and the people who communicate with them, as well as tailored implementation strategies. Complexity-informed network analyses offered a data-driven method to identify the 2 most potentially impactful strategies. Although the study was limited by a focus on 4 NASSS domains and the underrepresentation of certain demographics, the wealth of actionable implementation knowledge produced supports future coproduction of implementation research with mutually beneficial outcomes for stakeholders and researchers. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/35080.
Collapse
Affiliation(s)
- Melissa Miao
- Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Rosemary Morrow
- Stakeholder with living experience of acquired brain injury, Sydney, Australia
| | - Alexander Salomon
- Stakeholder with living experience of acquired brain injury, Sydney, Australia
| | - Ben Mcculloch
- Stakeholder with living experience of acquired brain injury, Sydney, Australia
| | - Jean-Christophe Evain
- Acquired Brain Injury Rehabilitation Ward, Caulfield Hospital, Alfred Health Network, Melbourne, Australia
- Stakeholder with living experience of acquired brain injury, Melbourne, Australia
| | - Meg Rebecca Wright
- Stakeholder with living experience of acquired brain injury, Blenheim, Australia
| | - Marie Therese Murphy
- Stakeholder with living experience as a communication partner of a person with acquired brain injury, Sydney, Australia
- Faculty of Education, Western Sydney University, Sydney, Australia
- Faculty of Education and Social Work, The University of Sydney, Sydney, Australia
| | - Monica Welsh
- Brain Injury Rehabilitation Unit, South Australian Brain Injury Rehabilitation Service, Adelaide, Australia
| | - Liz Williams
- Brain Injury Rehabilitation Community and Home (BIRCH), South Australian Brain Injury Rehabilitation Service, Adelaide, Australia
| | - Emma Power
- Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Rachael Rietdijk
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Deborah Debono
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Melissa Brunner
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Leanne Togher
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| |
Collapse
|
12
|
Brooks C, Mirzoev T, Chowdhury D, Deuri SP, Madill A. Using evidence in mental health policy agenda-setting in low- and middle-income countries: a conceptual meta-framework from a scoping umbrella review. Health Policy Plan 2023; 38:876-893. [PMID: 37329301 PMCID: PMC10394497 DOI: 10.1093/heapol/czad038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/15/2023] [Accepted: 07/12/2023] [Indexed: 06/19/2023] Open
Abstract
The purpose of this article is to close the gap in frameworks for the use of evidence in the mental health policy agenda-setting in low- and middle-income countries (LMICs). Agenda-setting is important because mental health remains a culturally sensitive and neglected issue in LMICs. Moreover, effective evidence-informed agenda-setting can help achieve, and sustain, the status of mental health as a policy priority in these low-resource contexts. A scoping 'review of reviews' of evidence-to-policy frameworks was conducted, which followed preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Nineteen reviews met the inclusion criteria. A meta-framework was developed from analysis and narrative synthesis of these 19 reviews, which integrates the key elements identified across studies. It comprises the concepts of evidence, actors, process, context and approach, which are linked via the cross-cutting dimensions of beliefs, values and interests; capacity; power and politics; and trust and relationships. Five accompanying questions act as a guide for applying the meta-framework with relevance to mental health agenda-setting in LMICs. This is a novel and integrative meta-framework for mental health policy agenda-setting in LMICs and, as such, an important contribution to this under-researched area. Two major recommendations are identified from the development of the framework to enhance its implementation. First, given the paucity of formal evidence on mental health in LMICs, informal evidence based on stakeholder experience could be better utilized in these contexts. Second, the use of evidence in mental health agenda-setting in LMICs would be enhanced by involving a broader range of stakeholders in generating, communicating and promoting relevant information.
Collapse
Affiliation(s)
- Chloe Brooks
- School of Psychology, University of Leeds, Lifton Terrace, Leeds LS2 9JT, UK
| | - Tolib Mirzoev
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Diptarup Chowdhury
- Department of Clinical Psychology, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam 784001, India
| | - Sonia Pereira Deuri
- Department of Psychiatric Social Work, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam 784001, India
| | - Anna Madill
- School of Psychology, University of Leeds, Lifton Terrace, Leeds LS2 9JT, UK
| |
Collapse
|
13
|
Moon SEJ, Hogden A, Eljiz K, Siddiqui N. Looking Back, Looking Forward: A Study Protocol for a Mixed-Methods Multiple-Case Study to Examine Improvement Sustainability of Large-Scale Initiatives in Tertiary Hospitals. Healthcare (Basel) 2023; 11:2175. [PMID: 37570415 PMCID: PMC10418688 DOI: 10.3390/healthcare11152175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Background Hospitals invest extensive resources in large-scale initiatives to improve patient safety and quality at an organizational level. However, initial success, if any, does not guarantee longer-term improvement. Empirical and theoretical knowledge that informs hospitals on how to attain sustained improvement from large-scale change is lacking. Aim The proposed study aims to examine improvement sustainability of two large-scale initiatives in an Australian tertiary hospital and translate the lessons into strategies for achieving sustained improvement from large-scale change in hospital settings. Design and Methods The study employs a single-site, multiple-case study design to evaluate the initiatives separately and comparatively using mixed methods. Semi-structured staff interviews will be conducted in stratified cohorts across the organizational hierarchy to capture different perspectives from various staff roles involved in the initiatives. The output and impact of the initiatives will be examined through organizational documents and relevant routinely collected organizational indicators. The obtained data will be analyzed thematically and statistically before being integrated for a synergic interpretation. Implications Capturing a comprehensive organizational view of large-scale change, the findings will have the potential to guide the practice and contribute to the theoretical understandings for achieving meaningful and longer-term organizational improvement in patient safety and quality.
Collapse
Affiliation(s)
- Sarah E. J. Moon
- Australian Institute of Health Service Management, College of Business and Economics, University of Tasmania, Sydney 2040, Australia
- Statewide Quality and Patient Safety Service, Department of Health Tasmania, Launceston 7250, Australia
| | - Anne Hogden
- Australian Institute of Health Service Management, College of Business and Economics, University of Tasmania, Sydney 2040, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney 2052, Australia
| | - Kathy Eljiz
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney 2052, Australia
| | - Nazlee Siddiqui
- Australian Institute of Health Service Management, College of Business and Economics, University of Tasmania, Sydney 2040, Australia
| |
Collapse
|
14
|
Saragosa M, Singh H, Steele Gray C, Tang T, Orchanian-Cheff A, Nelson MLA. Use of eco-mapping in health services research: a scoping review protocol. BMJ Open 2023; 13:e072588. [PMID: 37236661 DOI: 10.1136/bmjopen-2023-072588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION People with complex health and social needs often require care from different providers and services. Identifying their existing sources of support could assist with addressing potential gaps and opportunities for enhanced service delivery. Eco-mapping is an approach used to visually capture people's social relationships and their linkages to the larger social systems. As it is an emerging and promising approach in the health services field, a scoping review on eco-mapping is warranted. This scoping review aims to synthesise the empirical literature that has focused on the application of eco-mapping by describing characteristics, populations, methodological approaches and other features of eco-mapping in health services research. METHODS AND ANALYSIS This scoping review will follow the Joanna Briggs Institute methodology. From the date of database construction to 16 January 2023, the following databases in English will be searched: Ovid Medline, Ovid Embase, CINAHL Ultimate (EBSCOhost), Emcare (Ovid), Cochrane Central Register of Controlled Trials (Ovid) and Cochrane Database of Systematic Reviews (Ovid) Study/Source of Evidence selection. The inclusion criteria consist of empirical literature that uses eco-mapping or a related tool in the context of health services research. Two researchers will independently screen references against inclusion and exclusion criteria using Covidence software. Once screened, the data will be extracted and organised according to the following research questions: (1) What research questions and phenomena of interest do researchers address when using eco-mapping? (2) What are the characteristics of studies that use eco-mapping in health services research? (3) What are the methodological considerations for eco-mapping in health services research? ETHICS AND DISSEMINATION This scoping review does not require ethical approval. The findings will be disseminated through publications, conference presentations and stakeholder meetings. TRIAL REGISTRATION NUMBER https://doi.org/10.17605/OSF.IO/GAWYN.
Collapse
Affiliation(s)
- Marianne Saragosa
- Science of Care Institute, Lunenfeld-Tanenbaum Research Institute, Science Health System, Toronto, Ontario, Canada
| | - Hardeep Singh
- Occupational Science and Occupational Therapy Department, University of Toronto, Toronto, Ontario, Canada
| | - Carolyn Steele Gray
- Science of Care Institute, Lunenfeld-Tanenbaum Research Institute, Science Health System, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Terence Tang
- Institute for Better Health and General Internal Medicine, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Ani Orchanian-Cheff
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Michelle L A Nelson
- Science of Care Institute, Lunenfeld-Tanenbaum Research Institute, Science Health System, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
15
|
Carroll Á, Collins C, McKenzie J, Stokes D, Darley A. Application of complexity theory in health and social care research: a scoping review. BMJ Open 2023; 13:e069180. [PMID: 36921939 PMCID: PMC10030763 DOI: 10.1136/bmjopen-2022-069180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Complexity theory has been chosen by many authors as a suitable lens through which to examine health and social care. Despite its potential value, many empirical investigations apply the theory in a tokenistic manner without engaging with its underlying concepts and underpinnings. OBJECTIVES The aim of this scoping review is to synthesise the literature on empirical studies that have centred on the application of complexity theory to understand health and social care provision. METHODS This scoping review considered primary research using complexity theory-informed approaches, published in English between 2012 and 2021. Cochrane Database of Systematic Reviews, MEDLINE, CINAHL, EMBASE, Web of Science, PSYCHINFO, the NHS Economic Evaluation Database, and the Health Economic Evaluations Database were searched. In addition, a manual search of the reference lists of relevant articles was conducted. Data extraction was conducted using Covidence software and a data extraction form was created to produce a descriptive summary of the results, addressing the objectives and research question. The review used the revised Arksey and O'Malley framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR). RESULTS 2021 studies were initially identified with a total of 61 articles included for extraction. Complexity theory in health and social care research is poorly defined and described and was most commonly applied as a theoretical and analytical framework. The full breadth of the health and social care continuum was not represented in the identified articles, with the majority being healthcare focused. DISCUSSION Complexity theory is being increasingly embraced in health and care research. The heterogeneity of the literature regarding the application of complexity theory made synthesis challenging. However, this scoping review has synthesised the most recent evidence and contributes to translational systems research by providing guidance for future studies. CONCLUSION The study of complex health and care systems necessitates methods of interpreting dynamic prcesses which requires qualitative and longitudinal studies with abductive reasoning. The authors provide guidance on conducting complexity-informed primary research that seeks to promote rigor and transparency in the area. REGISTRATION The scoping review protocol was registered at Open Science Framework, and the review protocol was published at BMJ Open (https://bit.ly/3Ex1Inu).
Collapse
Affiliation(s)
- Áine Carroll
- School of Medicine, University College Dublin, Dublin, Ireland
- Academic Department, National Rehabilitation University Hospital, Dublin, Ireland
| | - Claire Collins
- Henley Business School, University of Reading, Reading, UK
| | - Jane McKenzie
- Henley Business School, University of Reading, Reading, UK
| | - Diarmuid Stokes
- College of Health Sciences, University College Dublin, Dublin, Ireland
| | - Andrew Darley
- School of Medicine, University College Dublin, Dublin, Ireland
| |
Collapse
|
16
|
Grant R, McMurtry A, Archibald D. Mapping Health Professions Education: Using Complexity Science to Make Sense of Learning Through Electronic Consultations. MEDICAL SCIENCE EDUCATOR 2023; 33:233-242. [PMID: 37008438 PMCID: PMC10060472 DOI: 10.1007/s40670-023-01730-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 06/19/2023]
Abstract
Phenomena studied within health professions education are often complex and multifaceted. This article describes a complexity science-informed theoretical framework that was developed for exploring how electronic consultations support learning among primary care providers, as well as within the larger organizations or systems in which they practice. This framework enables researchers to investigate learning occurring simultaneously at multiple levels (including individuals and social groups), without simplistically conflating levels or theories. The various levels of learning and associated theories are illustrated using examples from electronic consultations. This complexity science-inspired framework can be used for studying learning in complex, multilayered systems.
Collapse
Affiliation(s)
- Rachel Grant
- Faculty of Education, University of Ottawa, Ottawa, ON Canada
| | - Angus McMurtry
- Faculty of Education, University of Ottawa, Ottawa, ON Canada
| | - Douglas Archibald
- Faculty of Education, University of Ottawa, Ottawa, ON Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
- Bruyère Research Institute, Ottawa, ON Canada
| |
Collapse
|
17
|
Pittalis C, Brugha R, Bijlmakers L, Cunningham F, Mwapasa G, Clarke M, Broekhuizen H, Ifeanyichi M, Borgstein E, Gajewski J. Using Network and Complexity Theories to Understand the Functionality of Referral Systems for Surgical Patients in Resource-Limited Settings, the Case of Malawi. Int J Health Policy Manag 2022; 11:2502-2513. [PMID: 35065544 PMCID: PMC9818113 DOI: 10.34172/ijhpm.2021.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 12/20/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND A functionally effective referral system that links district level hospitals (DLHs) with referral hospitals (RHs) facilitates surgical patients getting timely access to specialist surgical expertise not available locally. Most published studies from low- and middle-income countries (LMICs) have examined only selected aspects of such referral systems, which are often fragmented. Inadequate understanding of their functionality leads to missed opportunities for improvements. This research aimed to investigate the functionality of the referral system for surgical patients in Malawi, a low-income country. METHODS This study, conducted in 2017-2019, integrated principles from two theories. We used network theory to explore interprofessional relationships between DLHs and RHs at referral network, member (hospital) and community levels; and used principles from complex adaptive systems (CAS) theory to unpack the mechanisms of network dynamics. The study employed mixed-methods, specifically surveys (n=22 DLHs), interviews with clinicians (n=20), and a database of incoming referrals at two sentinel RHs over a six-month period. RESULTS Obstacles to referral system functionality in Malawi included weaknesses in formal coordination structures, notably: unclear scope of practice of district surgical teams; lack of referral protocols; lack of referral communication standards; and misaligned organisational practices. Deficiencies in informal relationships included mistrust and uncollaborative operating environments, undermining coordination between DLHs and RHs. Poor system functionality adversely impacted the quality, efficiency and safety of patient referral-related care. Respondents identified aspects of the district-RH relationships, which could be leveraged to build more collaborative and productive inter-professional relationships in the future. CONCLUSION Multi-level interventions are needed to address failures at both ends of the referral pathway. This study captured new insights into longstanding problems in referral systems in resource-limited settings, contributing to a better understanding of how to build more functional systems to optimise the continuum and quality of surgical care for rural populations in similar settings.
Collapse
Affiliation(s)
- Chiara Pittalis
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ruairí Brugha
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Leon Bijlmakers
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Frances Cunningham
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Brisbane, QLD, Australia
| | - Gerald Mwapasa
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Morgane Clarke
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Henk Broekhuizen
- Department of Health and Society, Wageningen University and Research, Wageningen, The Netherlands
| | - Martilord Ifeanyichi
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Eric Borgstein
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Jakub Gajewski
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
18
|
Nickitas DM, Emmons KR, Ackerman-Barger K. A policy pathway: Nursing's role in advancing diversity and health equity. Nurs Outlook 2022; 70:S38-S47. [PMID: 36446539 DOI: 10.1016/j.outlook.2022.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/15/2022] [Accepted: 03/25/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this manuscript is to embolden nurses to engage in policy that promotes diversity, equity, inclusion, and belonging to advance health equity. BACKGROUND It uses the Future of Nursing Report 2020-2030 to acknowledge the impact of structural racism and the need for a more equitable, just, and fair society. DISCUSSION It also recognizes that nurses must harness their power and political will, to change and strengthen policies, so all nurses can practice to the full extent of their education and license. CONCLUSION A case study of the response to COVID-19 in one underserved community is included to illustrate policy in action.
Collapse
|
19
|
Gurung G, Jaye C, Gauld R, Stokes T. Lessons learnt from the implementation of new models of care delivery through alliance governance in the Southern health region of New Zealand: a qualitative study. BMJ Open 2022; 12:e065635. [PMID: 36316079 PMCID: PMC9628683 DOI: 10.1136/bmjopen-2022-065635] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/18/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To explore the process of implementation of the primary and community care strategy (new models of care delivery) through alliance governance in the Southern health region of New Zealand (NZ). DESIGN Qualitative semistructured interviews were undertaken. A framework-guided rapid analysis was conducted, informed by implementation science theory-the Consolidated Framework for Implementation Research. SETTING Southern health region of NZ (Otago and Southland). PARTICIPANTS Eleven key informants (Alliance Leadership Team members and senior health professionals) who were involved in the development and/or implementation of the strategy. RESULTS The large number of strategy action plans and interdependencies of activities made implementation of the strategy complex. In the inner setting, communication and relationships between individuals and organisations were identified as an important factor for joint and integrated working. Key elements of a positive implementation climate were not adequately addressed to better align the interests of health providers, and there were multiple competing priorities for the project leaders. A perceived low level of commitment from the leadership of both organisations to joint working and resourcing indicated poor organisational readiness. Gaps in the implementation process included no detailed implementation plan (reflected in poor execution), ambitious targets, the lack of a clear performance measurement framework and an inadequate feedback mechanism. CONCLUSIONS This study identified factors for the successful implementation of the PCSS using an alliancing approach in Southern NZ. A key enabler is the presence of a stable and committed senior leadership team working through high trust relationships and open communication across all partner organisations. With alliances, partnerships and networks increasingly held up as models for integration, this evaluation identifies important lessons for policy makers, managers and services providers both in NZ and internationally.
Collapse
Affiliation(s)
- Gagan Gurung
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Centre for Health Systems and Technology (CHeST), University of Otago, Dunedin, New Zealand
| | - Chrystal Jaye
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- CARE Research Theme, University of Otago, Dunedin, New Zealand
| | - Robin Gauld
- Centre for Health Systems and Technology (CHeST), University of Otago, Dunedin, New Zealand
- Otago Business School, University of Otago, Dunedin, New Zealand
| | - Tim Stokes
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Centre for Health Systems and Technology (CHeST), University of Otago, Dunedin, New Zealand
| |
Collapse
|
20
|
Alves S, Betrabet Gulwadi G, Nilsson P. An Exploration of How Biophilic Attributes on Campuses Might Support Student Connectedness to Nature, Others, and Self. Front Psychol 2022; 12:793175. [PMID: 35498153 PMCID: PMC9043241 DOI: 10.3389/fpsyg.2021.793175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
University Campuses remain important settings for nurturing and supporting student health and quality of life (QoL). Research shows the health benefits of nature experiences may be facilitated by campus spaces and activities that afford connectedness. Connectedness to nature, others, and self may allow students to cope with mental fatigue, stress, and a constant need for restoration. Despite recent encouraging trends, we still lack an integrative conceptual framework to describe the mechanisms involved in achieving connectedness for making recommendations for campus design. In this conceptual review, we examine students' connectedness in campus settings in relation to biophilic elements and attributes. We aim to understand how both direct and indirect pursuits in nature and also place-based experiences on campus foster connectedness and consequently impact students' health and QoL. Our analysis shows that connectedness seen through the lens of Kellert's biophilic design principles and aided by Alexander's pattern language provides a relational and long-term perspective on recommending strategies for connecting students to nature, to others, and to themselves in campus settings.
Collapse
Affiliation(s)
- Susana Alves
- Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy
| | - Gowri Betrabet Gulwadi
- School of Applied Human Sciences, University of Northern Iowa, Cedar Falls, IA, United States
| | | |
Collapse
|
21
|
Cane TC, Newton P, Foster J. Understanding women’s help-seeking for problematic and unhealthy alcohol use through the lens of complexity theory. ADVANCES IN DUAL DIAGNOSIS 2022. [DOI: 10.1108/add-12-2021-0019] [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
Purpose
It is well established that women face multiple barriers accessing treatment for problematic and unhealthy alcohol use, but less is known about how their interconnected problems affect how they seek help from, and access, alcohol-treatment services. This study aims to explore the dynamic nature of women’s help-seeking for problematic and unhealthy alcohol use and how this can be compounded by unsuitable treatment services, especially when women present with complex needs.
Design/methodology/approach
Thirteen semi-structured interviews with women who had accessed alcohol-support services were conducted, audio-recorded, transcribed and analysed thematically using the complexity theory.
Findings
For women with complex needs, the process of seeking help may trigger unpredictable behaviours, health or social problems and intermittent serial access to treatment. Current services do not always address women’s holistic needs. Unless services focus on addressing interconnected problems – including historic trauma – they may compound the complexity of women’s problems. Complexity theory offers novel insights into this process, a concept not applied to problematic and unhealthy alcohol use treatment previously.
Research limitations/implications
Services should adopt the complexity-focused perspective featured in this study. While the authors acknowledge the increase in gender-responsive provision, the limitations of this study include a small sample size, the self-selecting nature of the sample and retrospective reporting. Participants were recruited and selected by service staff resulting in gatekeeping and possible sampling bias.
Practical implications
Services should adopt non-linear approaches to treatment. Implementing complexity approaches to treating women’s problematic and unhealthy alcohol use should capture the dynamics, complexity and non-linear nature of women’s help-seeking journeys as well as their internal and external responses that may result in relapse. The authors recommend complexity-focused, multiple-component and integrated collaborative strategies to address not only addiction but also all components of women’s needs, including past trauma.
Originality/value
Applying complexity-thinking to help-seeking experiences for alcohol treatment and recovery services is novel and proved useful in understanding the variety of women’s experiences and how these interact with their help-seeking behaviours, including treatment environments.
Collapse
|
22
|
Healthcare Management: A Bibliometric Analysis Based on the Citations of Research Articles Published between 1967 and 2020. Healthcare (Basel) 2022; 10:healthcare10030555. [PMID: 35327034 PMCID: PMC8954756 DOI: 10.3390/healthcare10030555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/21/2022] [Accepted: 03/14/2022] [Indexed: 02/05/2023] Open
Abstract
The purpose of this study is to analyse the trends manifested in research literature from the field of healthcare management, with emphasis on bibliometric features and different influencing factors. For this, a search was conducted of nine academic databases between January and May 2021. Article features were registered in our database after first applying the validation criteria used for their inclusion. Then, data regarding the publication of the included articles were collected. The analysis focused on trends over time, topic, and journals in which they were published. Moreover, the effect of some factors on the citation of articles was analysed. Our results showed that the 250 analysed articles were published in 139 journals, and many of were by researchers affiliated with universities in the United States. Over time, the publication of analysed articles and their number of citations registered a continuous increase. The most common topics of focus were healthcare management systems and their challenges. In our study, we identified factors that significantly affect citation number, such as number of years since publication, the number of words in the title, and the number of authors of an article. In addition, major gaps were identified, as were new unresolved challenges that can trigger new research ideas.
Collapse
|
23
|
Bourne E, Short K, Kenny B, McAllister L. Clinical educators can supervise students without increased stress: a study of interacting factors using insights from complexity theory. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:125-145. [PMID: 34591229 DOI: 10.1007/s10459-021-10075-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 09/19/2021] [Indexed: 06/13/2023]
Abstract
Supervising students in healthcare settings is complex and can be stressful for clinical educators. However, it is unclear how to design student placements without clinical educator stress. Using complexity theory as a lens, fuzzy set Qualitative Comparative Analysis (fsQCA) was used to explore factors associated with no increased stress for clinical educators during speech pathology (SP) placements. Factor selection was informed by the Demand- Control- Support model and existing literature. No single factor was necessary for clinical educators to experience no increased stress. Varied combinations of all factors were found in 10 paths to no increased stress. These combinations often had passing student(s); however, multiple paths included other factors that could be adjusted by clinical educators prior to placement. For example, having more than one workday per week without students was a factor in four paths to no increased stress despite other potential challenges such as a higher caseload throughput. More experienced educators, who had other supporting factors (e.g. lower caseload throughput or workplace engagement such as support from colleagues and managers), also perceived no increased stress in four paths. Student placements without increased stress for clinical educators require consideration of multiple interacting factors. Principles of complexity theory provide insight into how clinical educators uniquely respond to their individual circumstances, resulting in different experiences of student placement impact even within similar workplaces. FsQCA has highlighted practical ways clinical educators supervise students without increased stress. However, any changes for an individual clinical educator need to be considered in combination with other factors given the complexity of clinical education and healthcare settings.
Collapse
Affiliation(s)
- Elizabeth Bourne
- Work Integrated Learning, Sydney School of Health Sciences, University of Sydney, Susan Wakil Health Building D18, Western Avenue, Camperdown, NSW, 2600, Australia.
| | - Kate Short
- Liverpool Hospital and Ingham Institute of Applied Medical Research, Liverpool, Australia
| | - Belinda Kenny
- School of Health Sciences, Western Sydney University, Campbelltown, Australia
| | - Lindy McAllister
- University of Sydney, Sydney School of Health Sciences, Sydney, Australia
| |
Collapse
|
24
|
Jabin MSR, Nilsson E, Nilsson AL, Bergman P, Jokela P. Digital Health Testbeds in Sweden: An exploratory study. Digit Health 2022; 8:20552076221075194. [PMID: 35186314 PMCID: PMC8848084 DOI: 10.1177/20552076221075194] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/12/2021] [Accepted: 01/05/2022] [Indexed: 11/30/2022] Open
Abstract
Objective This study explored the Swedish digital health testbeds through the lens of complexity science. Methods The purposive sampling was used to identify 38 digital health testbed organizations to conduct interviews in written or audio-conferencing. The interview responses were aggregated and analyzed using thematic analysis. The themes were mainly generated through complexity theory and the principles of complex adaptive systems. Results Fifteen testbed organizations responded, comprising 13 written responses and two audio-conferencing. Five main theoretical themes were generated: agents and diversity, connections and communication, adaptation and learning, perturbations, and path dependence. Agents and diversity depicted different types of testbeds, stakeholders and innovation, and the primary function and purpose of the testbeds. Various factors enhancing connections and communications among multiple stakeholders were identified, such as the quality of e-health solutions and the 2030 Agenda for Sustainable Development. Some adaptation and learning factors, such as internal reorganization, sharing and creating learning opportunities, and additional funding, guaranteed the sustainability of testbeds. Perturbations were characterized by two factors: non-linear interactions – lack of commitment and transparency in stakeholders' engagement, and uncertainty about testbed definitions and concepts. Path dependence highlighted the importance of history, such as previous positive and negative experiences. Conclusion This study provided insights into testbeds' organization, their functions, how various aspects were challenged, and how they adapted to overcome and improve the system issues. Identifying the stakeholders and relevant factors, commissioning an evaluation, backing up with a contingency plan, securing adequate funding, and disseminating the findings can improve the testbeds' design and implementation.
Collapse
Affiliation(s)
| | - Evalill Nilsson
- Department of Medicine and Optometry, eHealth Institute, Linnaeus University, Kalmar, Sweden
| | - Anna-Lena Nilsson
- Department of Medicine and Optometry, eHealth Institute, Linnaeus University, Kalmar, Sweden
| | - Patrick Bergman
- Department of Medicine and Optometry, eHealth Institute, Linnaeus University, Kalmar, Sweden
| | - Päivi Jokela
- Faculty of Technology, Department of Informatics, Linnaeus University, Kalmar, Sweden
| |
Collapse
|
25
|
Watermeyer J, Hume VJ, Seabi T, Nattrass R. Complexities in interdisciplinary community engagement projects: some reflections and lessons from an applied drama and theatre project in diabetes care. MEDICAL HUMANITIES 2021; 47:485-495. [PMID: 33990417 DOI: 10.1136/medhum-2019-011822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/31/2020] [Indexed: 06/12/2023]
Abstract
There is a growing interest in using drama techniques and theatrical performance to disseminate health information to lay audiences as part of community engagement projects. This process can be challenging for a number of reasons, however. In this paper, we describe the process and pitfalls of an interdisciplinary project involving the development and performance of a play about diabetes mellitus. The play formed part of a long-term, three-way community engagement project between social science, applied drama and a diabetes clinic in South Africa. Building on a framework derived from a number of applied drama methods, we elicited narratives from key 'storytellers' that were developed and embodied by actors in a new performance called Blood Sugars Creating this play provided insight into working in an interdisciplinary space and highlighted the importance of establishing shared goals and joint ownership of the project right from the outset. This was without doubt a challenging project and the complexities of finding common ground across three disciplines are not to be underestimated. In this paper, we explore the collaboration and its challenges, drawing on the framework of complexity theory. In particular, we examine the layers of complexity that emerged as a result of the interdisciplinary nature of the project and the demands of balancing the authenticity of the stories with the perceived requirements of health messaging. We consider the methodological, conceptual and ethical challenges of this type of research, and discuss some recommendations for teams taking on similar complex multidisciplinary research and intervention projects.
Collapse
Affiliation(s)
- Jennifer Watermeyer
- Health Communication Research Unit, School of Human and Community Development, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Victoria Jane Hume
- Health Communication Research Unit, School of Human and Community Development, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
- WiSER, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Tshegofatso Seabi
- Health Communication Research Unit, School of Human and Community Development, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
- MRC/Wits Population Health and Health Transition Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Rhona Nattrass
- Health Communication Research Unit, School of Human and Community Development, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| |
Collapse
|
26
|
Gear C, Ting CJ, Eraki M, Eppel E, Koziol-McLain J. Integrated system responses for families impacted by violence: a scoping review protocol. BMJ Open 2021; 11:e051363. [PMID: 34785553 PMCID: PMC8596046 DOI: 10.1136/bmjopen-2021-051363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The impacts of violence have a significant effect on health and well-being, particularly for women and children. Violence within families is widely recognised as a complex problem constituted by constantly interacting and evolving social, economic, health and cultural elements. Calls for integrated services have arisen from growing understanding about the implications of this complexity, which suggest family violence and solutions to it are generated endogenously from the reflexive nonlinear interactions of system agents. Despite these calls for integration, services designed to support families impacted by violence and the systems that design and fund them are often responsive only to one part of the problem and might not pay attention to agent interactions and their adaptive reflexivity. This paper outlines a scoping protocol to explore how integrated approaches to family violence are conceptualised in current literature, with innovative use of a complexity theory lens. METHOD Our scoping review protocol follows the framework outlined by Arksey and O'Malley and refined by Levac. It searches 6 databases, 3 journals and 10 websites using keywords to capture the notion of integration and a complex adaptive system, namely the participant (system agents), concept (system agent interaction) and the context (family violence). Selection criteria require the articles to be written in English, have full-text article available, and were published after 2010. Items selected also need to be evidence based showing interaction between system agents. Applying complexity theory, sensitises us to the reflexive patterns of interaction between system elements and routine ways of interacting. ETHICS AND DISSEMINATION The nature of this review means that ethics approval is not required. Findings will be disseminated via academic publications, conferences and discussions with policy decision-makers. The findings will be used to develop a plan for stakeholder consultation to share and validate learnings and inform future research.
Collapse
Affiliation(s)
- Claire Gear
- Centre for Interdisciplinary Trauma Research, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Chien-Ju Ting
- Centre for Interdisciplinary Trauma Research, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Manarah Eraki
- Centre for Interdisciplinary Trauma Research, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Elizabeth Eppel
- School of Government, Victoria University of Wellington, Wellington, New Zealand
| | - Jane Koziol-McLain
- Centre for Interdisciplinary Trauma Research, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| |
Collapse
|
27
|
Morgan-Trimmer S, Kudlicka A, Warmoth K, Leroi I, Oyebode JR, Pool J, Woods R, Clare L. Implementation processes in a cognitive rehabilitation intervention for people with dementia: a complexity-informed qualitative analysis. BMJ Open 2021; 11:e051255. [PMID: 34702730 PMCID: PMC8549661 DOI: 10.1136/bmjopen-2021-051255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Healthcare is often delivered through complex interventions. Understanding how to implement these successfully is important for optimising services. This article demonstrates how the complexity theory concept of 'self-organisation' can inform implementation, drawing on a process evaluation within a randomised controlled trial of the GREAT (Goal-oriented cognitive Rehabilitation in Early-stage Alzheimer's and related dementias: a multi-centre single-blind randomised controlled Trial) intervention which compared a cognitive rehabilitation intervention for people with dementia with usual treatment. DESIGN A process evaluation examined experiences of GREAT therapists and participants receiving the intervention, through thematic analysis of a focus group with therapists and interviews with participants and their carers. Therapy records of participants receiving the intervention were also analysed using adapted framework analysis. Analysis adopted a critical realist perspective and a deductive-inductive approach to identify patterns in how the intervention operated. SETTING The GREAT intervention was delivered through home visits by therapists, in eight regions in the UK. PARTICIPANTS Six therapists took part in a focus group, interviews were conducted with 25 participants and 26 carers, and therapy logs for 50 participants were analysed. INTERVENTION A 16-week cognitive rehabilitation programme for people with mild-to-moderate dementia. RESULTS 'Self-organisation' of the intervention occurred through adaptations made by therapists. Adaptations included simplifying the intervention for people with greater cognitive impairment, and extending it to meet additional needs. Relational work by therapists produced an emergent outcome of 'social support'. Self-organised aspects of the intervention were less visible than formal components, but were important aspects of how it operated during the trial. This understanding can help to inform future implementation. CONCLUSIONS Researchers are increasingly adopting complexity theory to understand interventions. This study extends the application of complexity theory by demonstrating how 'self-organisation' was a useful concept for understanding aspects of the intervention that would have been missed by focusing on formal intervention components. Analysis of self-organisation could enhance future process evaluations and implementation studies. TRIAL REGISTRATION NUMBER ISRCTN21027481.
Collapse
Affiliation(s)
| | | | - Krystal Warmoth
- School of Health and Social Work & NIHR Applied Research Collaboration East of England, University of Hertfordshire, Hatfield, UK
| | - Iracema Leroi
- School of Medicine and Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Jan R Oyebode
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Jackie Pool
- Dementia Pal Ltd, QCS Quality Compliance Systems, Guildford, UK
| | - Robert Woods
- Dementia Services Development Centre Wales, School of Health Sciences, Bangor University, Bangor, UK
| | - Linda Clare
- College of Medicine and Health & NIHR Applied Research Collaboration South-West Peninsula, University of Exeter, Exeter, UK
| |
Collapse
|
28
|
Hussey AJ, Sibbald SL, Ferrone M, Hergott A, McKelvie R, Faulds C, Roberts Z, Scarffe AD, Meyer MJ, Vollbrecht S, Licskai C. Confronting complexity and supporting transformation through health systems mapping: a case study. BMC Health Serv Res 2021; 21:1146. [PMID: 34688279 PMCID: PMC8540206 DOI: 10.1186/s12913-021-07168-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/11/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Health systems are a complex web of interacting and interconnected parts; introducing an intervention, or the allocation of resources, in one sector can have effects across other sectors and impact the entire system. A prerequisite for effective health system reorganisation or transformation is a broad and common understanding of the current system amongst stakeholders and innovators. Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are common chronic diseases with high health care costs that require an integrated health system to effectively treat. STUDY DESCRIPTION This case study documents the first phase of system transformation at a regional level in Ontario, Canada. In this first phase, visual representations of the health system in its current state were developed using a collaborative co-creation approach, and a focus on COPD and HF. Multiple methods were used including focus groups, open-ended questionnaires, and document review, to develop a series of graphical and visual representations; a health care ecosystem map. RESULTS The ecosystem map identified key sectoral components, inter-component interactions, and care requirements for patients with COPD and HF and inventoried current programs and services available to deliver this care. Main findings identified that independent system-wide navigation for this vulnerable patient group is limited, primary care is central to the accessibility of nearly half of the identified care elements, and resources are not equitably distributed. The health care ecosystem mapping helped to identify care gaps and illustrates the need to resource the primary care provider and the patient with system navigation resources and interdisciplinary team care. CONCLUSION The co-created health care ecosystem map brought a collective understanding of the health care system as it applies to COPD and HF. The map provides a blueprint that can be adapted to other disease states and health systems. Future transformation will build on this foundational work, continuing the robust interdisciplinary co-creation strategies, exploring predictive health system modelling and identifying areas for integration.
Collapse
Affiliation(s)
- Anna J Hussey
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
| | - Shannon L Sibbald
- Faculty of Health Sciences, Western University, London, ON, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Madonna Ferrone
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
- Hotel-Dieu Grace Healthcare, Windsor, ON, Canada
| | - Alyson Hergott
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
| | - Robert McKelvie
- St. Joseph's Health Care, London, ON, Canada
- Cardiology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Cathy Faulds
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- St. Joseph's Health Care, London, ON, Canada
| | - Zofe Roberts
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
| | - Andrew D Scarffe
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
| | - Matthew J Meyer
- London Health Sciences Centre, London, ON, Canada
- Department of Epidemiology and Biostatistics and Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Ivey Business School, London, ON, Canada
| | | | - Christopher Licskai
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada.
- London Health Sciences Centre, London, ON, Canada.
- Lawson Health Research Institute, London, ON, Canada.
- Respirology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
| |
Collapse
|
29
|
Batt AM, Williams B, Brydges M, Leyenaar M, Tavares W. New ways of seeing: supplementing existing competency framework development guidelines with systems thinking. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:1355-1371. [PMID: 34003391 DOI: 10.1007/s10459-021-10054-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 05/05/2021] [Indexed: 06/12/2023]
Abstract
Competency frameworks provide a link between professional practice, education, training, and assessment. They support and inform downstream processes such as curriculum design, assessment, accreditation and professional accountability. However, existing guidelines are limited in accounting for the complexities of professional practice potentially undermining utility of such guidelines and validity of outcomes. This necessitates additional ways of "seeing" situated and context-specific practice. We highlight what a conceptual framework informed by systems thinking can offer when developing competency frameworks. Mirroring shifts towards systems thinking in program evaluation and quality improvement, we suggest that similar approaches that identify and make use of the role and influence of system features and contexts can provide ways of augmenting existing guidelines when developing competency frameworks. We framed a systems thinking approach in two ways. First using an adaptation of Ecological Systems Theory which offers a realist perspective of the person and environment, and the evolving interaction between the two. Second, by employing complexity thinking, which obligates attention to the relationships and influences of features within the system, we can explore the multiple complex, unique, and context-embedded problems that exist within and have stake in real-world practice settings. The ability to represent clinical practice when developing competency frameworks can be improved when features that may be relevant, including their potential interactions, are identified and understood. A conceptual framework informed by systems thinking makes visible features of a practice in context that may otherwise be overlooked when developing competency frameworks using existing guidelines.
Collapse
Affiliation(s)
- Alan M Batt
- Department of Paramedicine, Monash University, Frankston, VIC, Australia.
- McNally Project for Paramedicine Research, Toronto, ON, Canada.
- Fanshawe College, London, ON, Canada.
| | - Brett Williams
- Department of Paramedicine, Monash University, Frankston, VIC, Australia
| | - Madison Brydges
- McNally Project for Paramedicine Research, Toronto, ON, Canada
- Department of Health, Ageing and Society, McMaster University, Hamilton, ON, Canada
| | - Matthew Leyenaar
- McNally Project for Paramedicine Research, Toronto, ON, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Walter Tavares
- McNally Project for Paramedicine Research, Toronto, ON, Canada
- The Wilson Centre, Department of Medicine, University of Toronto/University Health Network, Toronto, ON, Canada
- Post‑MD Education (Post‑Graduate Medical Education/Continued Professional Development), University of Toronto, Toronto, ON, Canada
| |
Collapse
|
30
|
Tuti T, Aluvaala J, Akech S, Agweyu A, Irimu G, English M. Pulse oximetry adoption and oxygen orders at paediatric admission over 7 years in Kenya: a multihospital retrospective cohort study. BMJ Open 2021; 11:e050995. [PMID: 34493522 PMCID: PMC8424839 DOI: 10.1136/bmjopen-2021-050995] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/13/2021] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES To characterise adoption and explore specific clinical and patient factors that might influence pulse oximetry and oxygen use in low-income and middle-income countries (LMICs) over time; to highlight useful considerations for entities working on programmes to improve access to pulse oximetry and oxygen. DESIGN A multihospital retrospective cohort study. SETTINGS All admissions (n=132 737) to paediatric wards of 18 purposely selected public hospitals in Kenya that joined a Clinical Information Network (CIN) between March 2014 and December 2020. OUTCOMES Pulse oximetry use and oxygen prescription on admission; we performed growth-curve modelling to investigate the association of patient factors with study outcomes over time while adjusting for hospital factors. RESULTS Overall, pulse oximetry was used in 48.8% (64 722/132 737) of all admission cases. Use rose on average with each month of participation in the CIN (OR: 1.11, 95% CI 1.05 to 1.18) but patterns of adoption were highly variable across hospitals suggesting important factors at hospital level influence use of pulse oximetry. Of those with pulse oximetry measurement, 7% (4510/64 722) had hypoxaemia (SpO2 <90%). Across the same period, 8.6% (11 428/132 737) had oxygen prescribed but in 87%, pulse oximetry was either not done or the hypoxaemia threshold (SpO2 <90%) was not met. Lower chest-wall indrawing and other respiratory symptoms were associated with pulse oximetry use at admission and were also associated with oxygen prescription in the absence of pulse oximetry or hypoxaemia. CONCLUSION The adoption of pulse oximetry recommended in international guidelines for assessing children with severe illness has been slow and erratic, reflecting system and organisational weaknesses. Most oxygen orders at admission seem driven by clinical and situational factors other than the presence of hypoxaemia. Programmes aiming to implement pulse oximetry and oxygen systems will likely need a long-term vision to promote adoption, guideline development and adherence and continuously examine impact.
Collapse
Affiliation(s)
- Timothy Tuti
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Jalemba Aluvaala
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Samuel Akech
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Ambrose Agweyu
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Grace Irimu
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Mike English
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine and Department of Paediatrics, University of Oxford, Oxford, UK
| |
Collapse
|
31
|
Carroll A, Stokes D, Darley A. Use of complexity theory in health and social care: a scoping review protocol. BMJ Open 2021; 11:e047633. [PMID: 34321301 PMCID: PMC8319978 DOI: 10.1136/bmjopen-2020-047633] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 06/29/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Despite the use of a wide variety of improvement tools and approaches, healthcare organisations continue to struggle in several key areas. Complexity-informed approaches have the potential to offer health and social care a new paradigm for understanding, designing, implementing and evaluating solutions, yet so far has failed to gain the traction anticipated some years ago. There is a growing need for high quality syntheses of the existing knowledge base in this area and given the diversity of theory and approaches, a scoping review is the best approach to curate this knowledge. METHODS A scoping review of relevant literature from January 2000 to present, using the refined Arksey and O'Malley six-stage framework will be conducted. This protocol will follow the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols Extension for Scoping Reviews. A three-step search strategy will be used. An initial search of databases will be undertaken to identify key search terms followed by an analysis of retrieved papers title and abstract text words, and of index terms used to describe the articles. A second search using all identified keywords and index terms will then be undertaken across all included databases. Third, the reference lists of identified reports and articles will be searched. Authors of primary articles will be contacted and a search for grey material performed. Finally, a complete search strategy of one major database will be included. ETHICS AND DISSEMINATION As this is a scoping review, ethical approval is not required. The results of the scoping review will be published in a peer-reviewed journal and presented at national and international conferences and will guide a large research project investigating teamwork. All data will be stored in accordance with best General Data Protection Regulation practice. REGISTRATION This scoping review protocol has been registered with Open Science Framework.
Collapse
Affiliation(s)
- Aine Carroll
- School of Medicine, University College Dublin, Dublin, Ireland
- Medical Department, National Rehabilitation Hospital, Dublin, Ireland
| | | | - Andrew Darley
- School of Medicine, University College Dublin, Dublin, Ireland
| |
Collapse
|
32
|
Yu CH, McCann M, Sale J. "In my age, we didn't have the computers": Using a complexity lens to understand uptake of diabetes eHealth innovations into primary care-A qualitative study. PLoS One 2021; 16:e0254157. [PMID: 34234368 PMCID: PMC8263251 DOI: 10.1371/journal.pone.0254157] [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: 08/21/2020] [Accepted: 06/21/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Shared decision-making is a central component of person-centred care and can be facilitated with the use of patient decision aids (PtDA). Barriers and facilitators to shared decision-making and PtDA use have been identified, yet integration of PtDAs into clinical care is limited. We sought to understand why, using the concepts of complexity science. METHODS We conducted 60-minute in-depth interviews with patients with diabetes, primary care physicians, nurses and dietitians who had participated in a randomized controlled trial examining the impact of MyDiabetesPlan (an online goal-setting PtDA). Relying on a qualitative description approach, we used a semi-structured interview guide to explore participants' experiences with using MyDiabetesPlan and how it was integrated into the clinical encounter and clinical care. Audiotapes were transcribed verbatim, then coded independently by two analysts. FINDINGS 17 interviews were conducted (5 physicians, 3 nurses, 2 dietitians, 7 patients). Two themes were developed: (1) MyDiabetesPlan appeared to empower patients by providing tailored patient-important information which engaged them in decision-making and self-care. Patients' use of MyDiabetesPlan was however impacted by their competing medical conditions, other life priorities and socioeconomic context. (2) MyDiabetesPlan emphasized to clinicians a patient-centred approach that helped patients assume greater ownership for their care. Clinicians' use of MyDiabetesPlan was impacted by pre-existing clinical tools/workplans, workflow, technical issues, clinic administrative logistics and support, and time. How clinicians adapted to these barriers influenced the degree to which MyDiabetesPlan was integrated into care. CONCLUSIONS A complexity lens (that considers relationships between multiple components of a complex system) may yield additional insights to optimize integration of PtDA into clinical care. A complexity lens recognizes that shared decision-making does not occur in the vacuum of a clinical dyad (patient and clinician), and will enable us to develop a family of interventions that address the whole process, rather than individual components. TRIAL REGISTRATION ClinicalTrials.gov NCT02379078.
Collapse
Affiliation(s)
- Catherine H. Yu
- Division of Endocrinology & Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Maggie McCann
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Joanna Sale
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
33
|
Churruca K, Ludlow K, Wu W, Gibbons K, Nguyen HM, Ellis LA, Braithwaite J. A scoping review of Q-methodology in healthcare research. BMC Med Res Methodol 2021; 21:125. [PMID: 34154566 PMCID: PMC8215808 DOI: 10.1186/s12874-021-01309-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/30/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Q-methodology is an approach to studying complex issues of human 'subjectivity'. Although this approach was developed in the early twentieth century, the value of Q-methodology in healthcare was not recognised until relatively recently. The aim of this review was to scope the empirical healthcare literature to examine the extent to which Q-methodology has been utilised in healthcare over time, including how it has been used and for what purposes. METHODS A search of three electronic databases (Scopus, EBSCO-CINAHL Complete, Medline) was conducted. No date restriction was applied. A title and abstract review, followed by a full-text review, was conducted by a team of five reviewers. Included articles were English-language, peer-reviewed journal articles that used Q-methodology (both Q-sorting and inverted factor analysis) in healthcare settings. The following data items were extracted into a purpose-designed Excel spreadsheet: study details (e.g., setting, country, year), reasons for using Q-methodology, healthcare topic area, participants (type and number), materials (e.g., ranking anchors and Q-set), methods (e.g., development of the Q-set, analysis), study results, and study implications. Data synthesis was descriptive in nature and involved frequency counting, open coding and the organisation by data items. RESULTS Of the 2,302 articles identified by the search, 289 studies were included in this review. We found evidence of increased use of Q-methodology in healthcare, particularly over the last 5 years. However, this research remains diffuse, spread across a large number of journals and topic areas. In a number of studies, we identified limitations in the reporting of methods, such as insufficient information on how authors derived their Q-set, what types of analyses they performed, and the amount of variance explained. CONCLUSIONS Although Q-methodology is increasingly being adopted in healthcare research, it still appears to be relatively novel. This review highlight commonalities in how the method has been used, areas of application, and the potential value of the approach. To facilitate reporting of Q-methodological studies, we present a checklist of details that should be included for publication.
Collapse
Affiliation(s)
- Kate Churruca
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia.
| | - Kristiana Ludlow
- School of Psychology, University of Queensland, Brisbane, QLD, 4072, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, 2109, Australia
| | - Wendy Wu
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia
| | - Kate Gibbons
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia
| | - Hoa Mi Nguyen
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia
| | - Louise A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia
| |
Collapse
|
34
|
Conroy T, Pinero de Plaza MA, Mudd A, Mitchell M, Kitson A. Measuring fundamental care using complexity science: A descriptive case study of a methodological innovation. J Clin Nurs 2021; 32:2903-2912. [PMID: 34137100 DOI: 10.1111/jocn.15905] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES This paper presents an exploratory account of an innovative methodology to record and evaluate fundamental care. Fundamental care is defined as the care required by everyone for survival, health and welfare. BACKGROUND Fundamental care has been informed by the development and testing of the Fundamentals of Care Framework, which describes how fundamental care is complex and multidimensional, and consists of three interrelated dimensions and 38 elements. This accords with a broader re-examination of care provision as part of a complex adaptive system in which existing linear models of cause and effect are inadequate to describe the totality of activity. DESIGN Informed by graph theory and complexity science, this paper presents a novel methodological innovation. It uses the Fundamentals of Care Framework to create a Matrix to quantify the relationships between different elements within the Framework. METHODS We use a Matrix methodology to process care recipient narratives to generate three outputs: a heat map, a summary table and a network analysis. CONCLUSIONS The three outputs serve to quantify and evaluate fundamental care in a multidimensional manner. They capture different perspectives (care recipients and their families, direct care providers and care managers) to improve care outcomes. The future aim is to advance this exploration into digitalising and operationalising the Matrix in a user-friendly manner for it to become a real-time mechanism to evaluate and potentially predict patterns of fundamental care.
Collapse
Affiliation(s)
- Tiffany Conroy
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Caring Futures institute, Adelaide, SA, Australia
| | | | - Alexandra Mudd
- Flinders University College of Nursing and Health Sciences, Adelaide, SA, Australia
| | - Merle Mitchell
- Aged Care Consumer Advocate and Community Activist, Victoria, Australia
| | - Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Caring Futures institute, Adelaide, SA, Australia
| |
Collapse
|
35
|
Bouchard Cordier S. L’appropriation par certaines théoriciennes de la discipline infirmière du savoir sur les systèmes complexes : un enjeu disciplinaire méconnu. Rech Soins Infirm 2021; 144:22-33. [DOI: 10.3917/rsi.144.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
36
|
Kleib M, Jackman D, Duarte-Wisnesky U. Interprofessional simulation to promote teamwork and communication between nursing and respiratory therapy students: A mixed-method research study. NURSE EDUCATION TODAY 2021; 99:104816. [PMID: 33662866 DOI: 10.1016/j.nedt.2021.104816] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 11/30/2020] [Accepted: 02/03/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Collaboration and teamwork are vitally important for safe patient care. Experiential learning through interprofessional simulation helps prepare students for the expansive requirements of today's complex healthcare environment. PURPOSE To develop and evaluate an interprofessional simulation educational activity to promote teamwork and communication between respiratory therapy and nursing students. DESIGN A mixed method design employing surveys, observation, and focus groups with educators and students was used. Thirty-six students from two institutions in Western Canada participated in this study. Data was analyzed using descriptive statistics and content analysis. RESULTS Baseline assessment revealed students were most familiar and comfortable with team functioning and communication interprofessional competencies, familiar but uncomfortable with collaborative leadership, conflict resolution, patient-centered care, and role clarification competencies. Correlation between communication and teamwork and collaborative leadership suggests these competencies play an important role in students' ability to enact more complex skills, such as conflict resolution competency. Overall, participants were highly satisfied and shared invaluable insights for improving this simulation experience in the future. CONCLUSION This evaluation study demonstrated feasibility of interprofessional simulation and its potential to enhance acquisition of interprofessional competencies. A future study will incorporate additional disciplines, such as medicine and pharmacy, applying a controlled evaluation design.
Collapse
Affiliation(s)
- Manal Kleib
- Office 5-112, University of Alberta, Faculty of Nursing, Edmonton Clinic Health Academy, 11405 87 Ave, Edmonton, Alberta T6T 1C9, Canada.
| | - Deirdre Jackman
- Office 4-254, University of Alberta, Faculty of Nursing, Edmonton Clinic Health Academy, 11405 87 Ave, Edmonton, Alberta T6T 1C9, Canada.
| | - Uirá Duarte-Wisnesky
- University of Alberta, Faculty of Nursing, Edmonton Clinic Health Academy, 11405 87 Ave, Edmonton, Alberta T6T 1C9, Canada.
| |
Collapse
|
37
|
Perspectives of Australian hospital leaders on the provision of safe care: implications for safety I and safety II. J Health Organ Manag 2021. [DOI: 10.1108/jhom-10-2020-0398] [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
PurposeThere is evidence that patient safety has not improved commensurate with the global attention and resources dedicated to achieving it. The authors explored the perspectives of hospital leaders on the challenges of leading safe care.Design/methodology/approachThis paper reports the findings of a three-year longitudinal study of eight Australian hospitals. A representative sample of hospital leaders, comprising board members, senior and middle managers and clinical leaders, participated in focus groups twice a year from 2015 to 2017.FindingsAlthough the participating hospitals had safety I systems, the leaders consistently reported that they relied predominantly on their competent well-meaning staff to ensure patient safety, more of a safety II perspective. This trust was based on perceptions of the patient safety actions of staff, rather than actual knowledge about staff abilities or behaviours. The findings of this study suggest this hegemonic relational trust was a defence mechanism for leaders in complex adaptive systems (CASs) unable to influence care delivery at the front line and explores potential contributing factors to these perceptions.Practical implicationsIn CASs, leaders have limited control over the bedside care processes and so have little alternative but to trust in “good staff providing good care” as a strategy for safe care. However, trust, coupled with a predominantly safety 1 approach is not achieving harm reduction. The findings of the study suggest that the beliefs the leaders held about the role their staff play in assuring safe care contribute to the lack of progress in patient safety. The authors recommend three evidence-based leadership activities to transition to the proactive safety II approach to pursuing safe care.Originality/valueThis is the first longitudinal study to provide the perspectives of leaders on the provision of quality and safety in their hospitals. A large sample of board members, managers and clinical leaders provides extensive data on their perspectives on quality and safety.
Collapse
|
38
|
Azar AJ, Khamis AH, Naidoo N, Lindsbro M, Boukhaled JH, Gonuguntla S, Davis D, Banerjee Y. Design, Implementation and Evaluation of a Distance Learning Framework to Expedite Medical Education during COVID-19 pandemic: A Proof-of-Concept Study. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2021; 8:23821205211000349. [PMID: 35392266 PMCID: PMC8981515 DOI: 10.1177/23821205211000349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/16/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The COVID-19 pandemic has forced medical schools to suspend on-campus live-sessions and shift to distance-learning (DL). This precipitous shift presented medical educators with a challenge, 'to create a "simulacrum" of the learning environment that students experience in classroom, in DL'. This requires the design of an adaptable and versatile DL-framework bearing in mind the theoretical underpinnings associated with DL. Additionally, effectiveness of such a DL-framework in content-delivery followed by its evaluation at the user-level, and in cognitive development needs to be pursued such that medical educators can be convinced to effectively adopt the framework in a competency-based medical programme. MAIN In this study, we define a DL-framework that provides a 'simulacrum' of classroom experience. The framework's blueprint was designed amalgamating principles of: Garrison's community inquiry, Siemens' connectivism and Harasim's online-collaborative-learning; and improved using Anderson's DL-model. Effectiveness of the DL-framework in course delivery was demonstrated using the exemplar of fundamentals in epidemiology and biostatistics (FEB) course during COVID-19 lockdown. Virtual live-sessions integrated in the framework employed a blended-approach informed by instructional-design strategies of Gagne and Peyton. The efficiency of the framework was evaluated using first 2 levels of Kirkpatrick's framework. Of 60 students, 51 (85%) responded to the survey assessing perception towards DL (Kirkpatrick's Level 1). The survey-items, validated using exploratory factor analysis, were classified into 4-categories: computer expertise; DL-flexibility; DL-usefulness; and DL-satisfaction. The overall perception for the 4 categories, highlighted respondents' overall satisfaction with the framework. Scores for specific survey-items attested that the framework promoted collaborative-learning and student-autonomy. For, Kirkpatrick's Level 2 that is, cognitive-development, performance in FEB's summative-assessment of students experiencing DL was compared with students taught using traditional methods. Similar, mean-scores for both groups indicated that shift to DL didn't have an adverse effect on students' learning. CONCLUSION In conclusion, we present here the design, implementation and evaluation of a DL-framework, which is an efficient pedagogical approach, pertinent for medical schools to adopt (elaborated using Bourdieu's Theory of Practice) to address students' learning trajectories during unprecedented times such as that during the COVID-19 pandemia.
Collapse
Affiliation(s)
- Aida J Azar
- College of Medicine and Health
Sciences, Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU),
Dubai Health Care City, Dubai, AE
| | - Amar Hassan Khamis
- College of Medicine and Health
Sciences, Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU),
Dubai Health Care City, Dubai, AE
| | - Nerissa Naidoo
- College of Medicine and Health
Sciences, Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU),
Dubai Health Care City, Dubai, AE
| | - Marjam Lindsbro
- College of Medicine and Health
Sciences, Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU),
Dubai Health Care City, Dubai, AE
| | - Juliana Helena Boukhaled
- Faculty of Health, Medicine and Life
Sciences, Maastricht University, Maastricht, The Netherlands
| | - Suneetha Gonuguntla
- College of Medicine and Health
Sciences, Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU),
Dubai Health Care City, Dubai, AE
| | - David Davis
- Department of Family and Community
Medicine, University of Toronto, Toronto, Canada
| | - Yajnavalka Banerjee
- College of Medicine and Health
Sciences, Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU),
Dubai Health Care City, Dubai, AE
- Centre for Medical Education,
University of Dundee, Nethergate, Dundee, UK
| |
Collapse
|
39
|
Barrera LA, Quiceno B. A Scoping Review of Complexity Science in Dentistry. DENTAL HYPOTHESES 2021. [DOI: 10.4103/denthyp.denthyp_166_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
40
|
Papoutsi C, Shaw J, Paparini S, Shaw S. We Need to Talk About Complexity in Health Research: Findings From a Focused Ethnography. QUALITATIVE HEALTH RESEARCH 2021; 31:338-348. [PMID: 33155510 PMCID: PMC7750672 DOI: 10.1177/1049732320968779] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
There is increasing focus on complexity-informed approaches across health disciplines. This attention takes several forms, but commonly involves framing research topics as "complex" to justify use of particular methods (e.g., qualitative). Little emphasis is placed on how divergent and convergent ways of knowing complexity become negotiated within academic communities. Drawing on findings from a focused ethnography of an international workshop, we illustrate how health researchers employ "boundary-ordering devices" to navigate different meanings ascribed to complexity while they attempt to sustain interdisciplinary communication and collaboration. These include (a) surfacing (but not resolving) tensions between philosophical grounding of knowledge claims and need for practical purchase, (b) employing techniques of representation and abstraction, and (c) drawing on the fluid, ongoing accomplishment of complexity for different audiences and purposes. Our findings have implications for progressing complexity-informed health research, particularly with respect to qualitative approaches.
Collapse
Affiliation(s)
| | - James Shaw
- Women’s College Hospital, Toronto,
Ontario, Canada
- University of Toronto, Toronto,
Ontario, Canada
| | | | - Sara Shaw
- University of Oxford, Oxford,
United Kingdom
| |
Collapse
|
41
|
Chishtie JA, Marchand JS, Turcotte LA, Bielska IA, Babineau J, Cepoiu-Martin M, Irvine M, Munce S, Abudiab S, Bjelica M, Hossain S, Imran M, Jeji T, Jaglal S. Visual Analytic Tools and Techniques in Population Health and Health Services Research: Scoping Review. J Med Internet Res 2020; 22:e17892. [PMID: 33270029 PMCID: PMC7716797 DOI: 10.2196/17892] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 07/01/2020] [Accepted: 09/24/2020] [Indexed: 01/27/2023] Open
Abstract
Background Visual analytics (VA) promotes the understanding of data with visual, interactive techniques, using analytic and visual engines. The analytic engine includes automated techniques, whereas common visual outputs include flow maps and spatiotemporal hot spots. Objective This scoping review aims to address a gap in the literature, with the specific objective to synthesize literature on the use of VA tools, techniques, and frameworks in interrelated health care areas of population health and health services research (HSR). Methods Using the 2018 PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, the review focuses on peer-reviewed journal articles and full conference papers from 2005 to March 2019. Two researchers were involved at each step, and another researcher arbitrated disagreements. A comprehensive abstraction platform captured data from diverse bodies of the literature, primarily from the computer and health sciences. Results After screening 11,310 articles, findings from 55 articles were synthesized under the major headings of visual and analytic engines, visual presentation characteristics, tools used and their capabilities, application to health care areas, data types and sources, VA frameworks, frameworks used for VA applications, availability and innovation, and co-design initiatives. We found extensive application of VA methods used in areas of epidemiology, surveillance and modeling, health services access, use, and cost analyses. All articles included a distinct analytic and visualization engine, with varying levels of detail provided. Most tools were prototypes, with 5 in use at the time of publication. Seven articles presented methodological frameworks. Toward consistent reporting, we present a checklist, with an expanded definition for VA applications in health care, to assist researchers in sharing research for greater replicability. We summarized the results in a Tableau dashboard. Conclusions With the increasing availability and generation of big health care data, VA is a fast-growing method applied to complex health care data. What makes VA innovative is its capability to process multiple, varied data sources to demonstrate trends and patterns for exploratory analysis, leading to knowledge generation and decision support. This is the first review to bridge a critical gap in the literature on VA methods applied to the areas of population health and HSR, which further indicates possible avenues for the adoption of these methods in the future. This review is especially important in the wake of COVID-19 surveillance and response initiatives, where many VA products have taken center stage. International Registered Report Identifier (IRRID) RR2-10.2196/14019
Collapse
Affiliation(s)
- Jawad Ahmed Chishtie
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Advanced Analytics, Canadian Institute for Health Information, Toronto, ON, Canada.,Ontario Neurotrauma Foundation, Toronto, ON, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | | | - Luke A Turcotte
- Advanced Analytics, Canadian Institute for Health Information, Toronto, ON, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Iwona Anna Bielska
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Jessica Babineau
- Library & Information Services, University Health Network, Toronto, ON, Canada
| | - Monica Cepoiu-Martin
- Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael Irvine
- Department of Mathematics, University of British Columbia, Vancouver, BC, Canada.,British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Sarah Munce
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sally Abudiab
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Marko Bjelica
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Saima Hossain
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Muhammad Imran
- Department of Epidemiology and Public Health, Health Services Academy, Islamabad, Pakistan
| | - Tara Jeji
- Ontario Neurotrauma Foundation, Toronto, ON, Canada
| | - Susan Jaglal
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
42
|
Jesus TS, Kamalakannan S, Bhattacharjya S, Bogdanova Y, Arango-Lasprilla JC, Bentley J, Gibson BE, Papadimitriou C. People with Disabilities and Other Forms of Vulnerability to the COVID-19 Pandemic: Study Protocol for a Scoping Review and Thematic Analysis. Arch Rehabil Res Clin Transl 2020; 2:100079. [PMID: 32839757 PMCID: PMC7438226 DOI: 10.1016/j.arrct.2020.100079] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To develop a protocol for a scoping review mapping as well as thematically analyzing the literature on the effect of, and responses to, the coronavirus disease 2019 (COVID-19) pandemic, focused on people with disabilities with other layers of individual vulnerability or social disadvantage. METHODS We will search scientific databases (Medline/PubMed, Web of Science, Scopus, AgeLine, PsycINFO, CINAHL, ERIC) and preprint servers (MedRxiv, SocArXiv, PsyArXiv). Google searches, snowballing, and key-informant strategies were also used, including a focus on the gray literature (eg, official reports). Peer-reviewed and preprint publications will be covered in 6 languages, and the gray literature in English. Publications will be included if they address individuals with disabilities; the COVID-19 pandemic or subsequent socioeconomic or occupational effects; and individual or social vulnerabilities, including any form of discrimination, marginalization, or social disadvantage. Two independent reviewers will perform eligibility decisions and key data extractions. Beyond mapping the literature, the results will thematically analyze any disproportionate risks people with disabilities and other forms of vulnerability experience in terms of being infected by COVID-19, having severe health consequences, and facing negative socioeconomic effects. Actions taken or recommended to reduce identified inequalities will also be synthesized. Our entire research team, with diverse backgrounds, will be involved in the synthesis. CONCLUSIONS This review, which we plan to expedite, aims to inform policy makers, health authorities, disability advocates, and other stakeholders regarding the needs and ways to promote equity and disability-inclusive responses to the COVID-19 pandemic and the resultant socioeconomic shockwaves.
Collapse
Affiliation(s)
- Tiago S. Jesus
- Global Health and Tropical Medicine and WHO Collaborating Centre for Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Lisbon, Portugal
- Department of Occupational Therapy, College of Health & Rehabilitation Sciences, Sargent College, Boston University, Boston, MA
| | - Sureshkumar Kamalakannan
- Public Health Foundation of India, South Asia Centre for Disability Inclusive Development and Research, Indian Institute of Public Health–Hyderabad, Hyderabad, India
| | - Sutanuka Bhattacharjya
- Department of Occupational Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA
| | - Yelena Bogdanova
- Physical Medicine & Rehabilitation Service, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - Juan Carlos Arango-Lasprilla
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Department of Cell Biology and Histology, University of the Basque Country UPV/EHU, Leioa, Spain
| | - Jacob Bentley
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA
- Department of Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD
| | - Barbara E. Gibson
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Christina Papadimitriou
- School of Health Sciences, Departments of Interdisciplinary Health Sciences, and Sociology, Oakland University, Rochester, MI
| | - Refugee Empowerment Task Force, International Networking Group of the American Congress of Rehabilitation Medicine
- Global Health and Tropical Medicine and WHO Collaborating Centre for Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Lisbon, Portugal
- Department of Occupational Therapy, College of Health & Rehabilitation Sciences, Sargent College, Boston University, Boston, MA
- Public Health Foundation of India, South Asia Centre for Disability Inclusive Development and Research, Indian Institute of Public Health–Hyderabad, Hyderabad, India
- Department of Occupational Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA
- Physical Medicine & Rehabilitation Service, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Department of Cell Biology and Histology, University of the Basque Country UPV/EHU, Leioa, Spain
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA
- Department of Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- School of Health Sciences, Departments of Interdisciplinary Health Sciences, and Sociology, Oakland University, Rochester, MI
| |
Collapse
|
43
|
Sund Levander M, Tingström P. Complicated versus complexity: when an old woman and her daughter meet the health care system. BMC WOMENS HEALTH 2020; 20:230. [PMID: 33046068 PMCID: PMC7552441 DOI: 10.1186/s12905-020-01092-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/28/2020] [Indexed: 11/16/2022]
Abstract
Background Detecting infection in frail elderly is a challenge due to lack of specific signs and symptoms. We highlight the complex situation when an elderly woman with urinary tract infection (UTI) and her daughter meet the highly qualified health care system. The aim was to describe and analyze the process when an elderly individual with an acute infection encounters the healthcare system. Methods A descriptive, retrospective Single Case Study design with a qualitative approach was used. Data from interviews with the old women and her daughter, medical record data and different regulatory documents were gathered and analysed with a qualitative content analysis. In a second step, the results were interpreted with concepts from the complexity theory. Complexity theory has been used as a conceptual framework for analysis or a framework for interpretation. In this study we are using the theory for interpretation by comparing the results with the complexity theory, which is explored in the discussion. Results The latent content analysis of the daughter’s story is interpreted as though she perceives the situation as causing a life crisis and a threat to her mother’s entire existence. The old women herself does not take part in what is happening, though after returning to home she is trying to understand her behaviour and what has happened. The health care tries different diagnoses and treatment according to standardized care plans without success. When urinary tract infection is finally diagnosed and treated successfully, the old women recovers quickly. Conclusion The healthcare system should embrace the complexity in the encounter with an elderly individual. However, we found that the immediate reaction from the healthcare system is to handle the patients’ problem as complicated by complexity reduction. Shortcomings are that elderly patients with multiple disorders are difficult to evaluate and triage “correctly” for later placement in the appropriate continuum of care, although the findings of this case study also imply that with time the system instead took on an approach of absorption of complexity.
Collapse
Affiliation(s)
- Märta Sund Levander
- Department of Nursing, Medical faculty, Linköping University, Linköping, Sweden.
| | - Pia Tingström
- Department of Nursing, Medical faculty, Linköping University, Linköping, Sweden
| |
Collapse
|
44
|
Makleff S, Billowitz M, Garduño J, Cruz M, Silva Márquez VI, Marston C. Applying a complex adaptive systems approach to the evaluation of a school-based intervention for intimate partner violence prevention in Mexico. Health Policy Plan 2020; 35:993-1002. [PMID: 32761146 PMCID: PMC7553757 DOI: 10.1093/heapol/czaa067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2020] [Indexed: 11/13/2022] Open
Abstract
Despite calls for evaluation practice to take a complex systems approach, there are few examples of how to incorporate complexity into real-life evaluations. This article presents the case for using a complex systems approach to evaluate a school-based intimate partner violence-prevention intervention. We conducted a post hoc analysis of qualitative evaluation data to examine the intervention as a potential system disruptor. We analysed data in relation to complexity concepts particularly relevant to schools: 'diverse and dynamic agents', 'interaction', 'unpredictability', 'emergence' and 'context dependency'. The data-two focus groups with facilitators and 33 repeat interviews with 14-17-year-old students-came from an evaluation of a comprehensive sexuality education intervention in Mexico City, which serves as a case study for this analysis. The findings demonstrate an application of complex adaptive systems concepts to qualitative evaluation data. We provide examples of how this approach can shed light on the ways in which interpersonal interactions, group dynamics, the core messages of the course and context influenced the implementation and outcomes of this intervention. This gender-transformative intervention appeared to disrupt pervasive gender norms and reshape beliefs about how to engage in relationships. An intervention comprises multiple dynamic and interacting elements, all of which are unlikely to be consistent across implementation settings. Applying complexity concepts to our analysis added value by helping reframe implementation-related data to focus on how the 'social' aspects of complexity influenced the intervention. Without examining both individual and group processes, evaluations may miss key insights about how the intervention generates change, for whom, and how it interacts with its context. A social complex adaptive systems approach is well-suited to the evaluation of gender-transformative interventions and can help identify how such interventions disrupt the complex social systems in which they are implemented to address intractable societal problems.
Collapse
Affiliation(s)
- Shelly Makleff
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Marissa Billowitz
- Independent, Juárez 208, Col. Tlalpan Centro, 14000 Mexico City, Mexico
| | - Jovita Garduño
- Fundación Mexicana para la Planeación Familiar, A.C. (Mexfam), Juárez 208, Col. Tlalpan Centro, 14000 Mexico City, Mexico
| | - Mariana Cruz
- IPPF/WHR Mexico, Juárez 208, Col. Tlalpan Centro, 14000 Mexico City, Mexico
| | - Vanessa Ivon Silva Márquez
- Fundación Mexicana para la Planeación Familiar, A.C. (Mexfam), Juárez 208, Col. Tlalpan Centro, 14000 Mexico City, Mexico
| | - Cicely Marston
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| |
Collapse
|
45
|
Abstract
Health care organizations that deliver health care to a population are a major constituent of health care systems in many countries. Although some of the components of a health care organization may function as a simple or complicated system where interventions would yield the expected results, many parts of it function as complex systems within the organization. As such, is not always possible to predict changes or the effects of interventions on these systems due to their complex nature. Appreciation of the complex nature of health care systems and characteristics of these complex systems and their networks are necessary to manage health care organizations and changes in health care. This article described different types of systems and discusses why health care organizations are considered complex adaptive systems.
Collapse
|
46
|
“It's about how we do it, not if we do it”. Nurses’ experiences with implicit rationing of nursing care in acute care hospitals: A descriptive qualitative study. Int J Nurs Stud 2020; 109:103688. [DOI: 10.1016/j.ijnurstu.2020.103688] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/10/2020] [Accepted: 06/10/2020] [Indexed: 01/10/2023]
|
47
|
Kho J, Gillespie N, Martin-Khan M. A systematic scoping review of change management practices used for telemedicine service implementations. BMC Health Serv Res 2020; 20:815. [PMID: 32873295 PMCID: PMC7461334 DOI: 10.1186/s12913-020-05657-w] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 08/13/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Telemedicine improves access to health care services enabling remote care diagnosis and treatment of patients at a distance. However, the implementation of telemedicine services often pose challenges stemming from the lack of attention to change management (CM). Health care practitioners and researchers agree that successful telemedicine services require significant organizational and practice change. Despite recognizing the importance of the "people-side" of implementation, research on what constitutes best practice CM strategies for telemedicine implementations remains fragmented, offering little cohesive insight into the specific practices involved in the change process. We conducted a systematic scoping review of the literature to examine what and how CM practices have been applied to telemedicine service implementation, spanning a variety of health care areas and countries. METHODS Three bibliographic databases (CINAHL, PubMed, and ISI Web of Science) and four specialist telehealth journals were searched. To keep the review manageable and relevant to contemporary telemedicine technologies and contexts, the search was limited to articles published from 2008 to 2019. Forty-eight articles were selected for inclusion. RESULTS From the 48 articles, 16 CM practices were identified relating to either strategic or operational aspects of telemedicine implementations. We identify the key CM practices that are recognized in the broader CM literature as essential for successful and sustained change but are not commonly reported in telemedicine implementation studies. We draw on the CM literature to provide a comprehensive process-based, researched-informed, organizing framework to guide future telemedicine service implementations and research. CONCLUSIONS Our findings suggest that the slow rate of adoption of telemedicine may be due to a piecemeal approach to the change process, and a lack of understanding of how to plan, manage and reinforce change when implementing telemedicine services.
Collapse
Affiliation(s)
- Joanna Kho
- UQ Business School, The University of Queensland, Colin Clark Building 39 Blair Drive, St Lucia, Brisbane, QLD, 4072, Australia.
| | - Nicole Gillespie
- UQ Business School, The University of Queensland, Colin Clark Building 39 Blair Drive, St Lucia, Brisbane, QLD, 4072, Australia
| | - Melinda Martin-Khan
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| |
Collapse
|
48
|
Robinson L, Poole M, McLellan E, Lee R, Amador S, Bhattarai N, Bryant A, Coe D, Corbett A, Exley C, Goodman C, Gotts Z, Harrison-Dening K, Hill S, Howel D, Hrisos S, Hughes J, Kernohan A, Macdonald A, Mason H, Massey C, Neves S, Paes P, Rennie K, Rice S, Robinson T, Sampson E, Tucker S, Tzelis D, Vale L, Bamford C. Supporting good quality, community-based end-of-life care for people living with dementia: the SEED research programme including feasibility RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2020. [DOI: 10.3310/pgfar08080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
In the UK, most people with dementia die in the community and they often receive poorer end-of-life care than people with cancer.
Objective
The overall aim of this programme was to support professionals to deliver good-quality, community-based care towards, and at, the end of life for people living with dementia and their families.
Design
The Supporting Excellence in End-of-life care in Dementia (SEED) programme comprised six interlinked workstreams. Workstream 1 examined existing guidance and outcome measures using systematic reviews, identified good practice through a national e-survey and explored outcomes of end-of-life care valued by people with dementia and family carers (n = 57) using a Q-sort study. Workstream 2 explored good-quality end-of-life care in dementia from the perspectives of a range of stakeholders using qualitative methods (119 interviews, 12 focus groups and 256 observation hours). Using data from workstreams 1 and 2, workstream 3 used co-design methods with key stakeholders to develop the SEED intervention. Worksteam 4 was a pilot study of the SEED intervention with an embedded process evaluation. Using a cluster design, we assessed the feasibility and acceptability of recruitment and retention, outcome measures and our intervention. Four general practices were recruited in North East England: two were allocated to the intervention and two provided usual care. Patient recruitment was via general practitioner dementia registers. Outcome data were collected at baseline, 4, 8 and 12 months. Workstream 5 involved economic modelling studies that assessed the potential value of the SEED intervention using a contingent valuation survey of the general public (n = 1002). These data informed an economic decision model to explore how the SEED intervention might influence care. Results of the model were presented in terms of the costs and consequences (e.g. hospitalisations) and, using the contingent valuation data, a cost–benefit analysis. Workstream 6 examined commissioning of end-of-life care in dementia through a narrative review of policy and practice literature, combined with indepth interviews with a national sample of service commissioners (n = 20).
Setting
The workstream 1 survey and workstream 2 included services throughout England. The workstream 1 Q-sort study and workstream 4 pilot trial took place in North East England. For workstream 4, four general practices were recruited; two received the intervention and two provided usual care.
Results
Currently, dementia care and end-of-life care are commissioned separately, with commissioners receiving little formal guidance and training. Examples of good practice rely on non-recurrent funding and leadership from an interested clinician. Seven key components are required for good end-of-life care in dementia: timely planning discussions, recognising end of life and providing supportive care, co-ordinating care, effective working with primary care, managing hospitalisation, continuing care after death, and valuing staff and ongoing learning. Using co-design methods and the theory of change, the seven components were operationalised as a primary care-based, dementia nurse specialist intervention, with a care resource kit to help the dementia nurse specialist improve the knowledge of family and professional carers. The SEED intervention proved feasible and acceptable to all stakeholders, and being located in the general practice was considered beneficial. None of the outcome measures was suitable as the primary outcome for a future trial. The contingent valuation showed that the SEED intervention was valued, with a wider package of care valued more than selected features in isolation. The SEED intervention is unlikely to reduce costs, but this may be offset by the value placed on the SEED intervention by the general public.
Limitations
The biggest challenge to the successful delivery and completion of this research programme was translating the ‘theoretical’ complex intervention into practice in an ever-changing policy and service landscape at national and local levels. A major limitation for a future trial is the lack of a valid and relevant primary outcome measure to evaluate the effectiveness of a complex intervention that influences outcomes for both individuals and systems.
Conclusions
Although the dementia nurse specialist intervention was acceptable, feasible and integrated well with existing care, it is unlikely to reduce costs of care; however, it was highly valued by all stakeholders (professionals, people with dementia and their families) and has the potential to influence outcomes at both an individual and a systems level.
Future work
There is no plan to progress to a full randomised controlled trial of the SEED intervention in its current form. In view of new National Institute for Health and Care Excellence dementia guidance, which now recommends a care co-ordinator for all people with dementia, the feasibility of providing the SEED intervention throughout the illness trajectory should be explored. Appropriate outcome measures to evaluate the effectiveness of such a complex intervention are needed urgently.
Trial registration
Current Controlled Trials ISRCTN21390601.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research, Vol. 8, No. 8. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Marie Poole
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Emma McLellan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Lee
- Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Sarah Amador
- Division of Psychiatry, University College London, London, UK
| | - Nawaraj Bhattarai
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Bryant
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dorothy Coe
- North East and North Cumbria Local Clinical Research Network, Newcastle upon Tyne, UK
| | - Anne Corbett
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Catherine Exley
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Goodman
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - Zoe Gotts
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Sarah Hill
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Denise Howel
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Susan Hrisos
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Christopher Massey
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Paul Paes
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Katherine Rennie
- Faculty of Medical Sciences, Professional Services, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Rice
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tomos Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Elizabeth Sampson
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | | | - Dimitrios Tzelis
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Bamford
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
49
|
Franklin PD, Montgomery KL, Dorr P, Trandel D. Building Maryland's health care leadership capacity: The Nurse Leadership Institute at the University of Maryland School of Nursing. Nurs Outlook 2020; 68:657-670. [PMID: 32854936 DOI: 10.1016/j.outlook.2020.06.001] [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: 02/21/2020] [Revised: 06/02/2020] [Accepted: 06/07/2020] [Indexed: 10/23/2022]
Abstract
Nurse leadership was identified as essential to the advancement of health care in the State of Maryland. The State's Health Services Cost Review Commission's (HSCRC) committed to building the next generation of nurse leaders as part of its vision for advancing healthcare in Maryland. In 2015, HSCRC approved a $2.5 million, multiyear grant that supported development of the Nurse Leadership Institute (NLI) at the University of Maryland School of Nursing. The NLI designed a leadership development program that prepared nurse faculty and clinicians with critical competencies needed for assuming leadership positions unique to complex adaptive systems, facilitating collaborative partnerships between academia and practice, and ultimately improving health outcomes for Maryland's residents. This article is the first in a series reporting on outcomes of this initiative, which describes the design and implementation of the Nurse Leadership Institute, its Leadership Development Program, and preliminary findings for the first 4 years.
Collapse
Affiliation(s)
| | - Kathryn L Montgomery
- Adjunct Associate Professor, University of Maryland School of Nursing, Baltimore, MD
| | - Peggy Dorr
- University of Maryland Medical Center, Baltimore, MD
| | | |
Collapse
|
50
|
Van Schalkwyk SC, Couper ID, Blitz J, De Villiers MR. A framework for distributed health professions training: using participatory action research to build consensus. BMC MEDICAL EDUCATION 2020; 20:154. [PMID: 32410654 PMCID: PMC7227246 DOI: 10.1186/s12909-020-02046-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/20/2020] [Indexed: 05/24/2023]
Abstract
BACKGROUND There is a global trend towards providing training for health professions students outside of tertiary academic complexes. In many countries, this shift places pressure on available sites and the resources at their disposal, specifically within the public health sector. Introducing an educational remit into a complex health system is challenging, requiring commitment from a range of stakeholders, including national authorities. To facilitate the effective implementation of distributed training, we developed a guiding framework through an extensive, national consultative process with a view to informing both practice and policy. METHODS We adopted a participatory action research approach over a four year period across three phases, which included seven local, provincial and national consultative workshops, reflective work sessions by the research team, and expert reviews. Approximately 240 people participated in these activities. Engagement with the national department of health and health professions council further informed the development of the Framework. RESULTS Each successive 'feedback loop' contributed to the development of the Framework which comprised a set of guiding principles, as well as the components essential to the effective implementation of distributed training. Analysis further pointed to the centrality of relationships, while emphasising the importance of involving all sectors relevant to the training of health professionals. A tool to facilitate the implementation of the Framework was also developed, incorporating a set of 'Simple Rules for Effective distributed health professions training'. A national consensus statement was adopted. CONCLUSIONS In this project, we drew on the thinking and practices of key stakeholders to enable a synthesis between their embodied and inscribed knowledge, and the prevailing literature, this with a view to further enaction as the knowledge generators become knowledge users. The Framework and its subsequent implementation has not only assisted us to apply the evidence to our educational practice, but also to begin to influence policy at a national level.
Collapse
Affiliation(s)
- Susan C. Van Schalkwyk
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Ian D. Couper
- Ukwanda Centre for Rural Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Julia Blitz
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Marietjie R. De Villiers
- Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| |
Collapse
|