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Simons M, Harvey G, McMillan L, Ryan EG, De Young AG, McPhail SM, Kularatna S, Senanayake S, Kimble R, Tyack Z. Implementation outcomes of a digital, trauma-informed care, educational intervention targeting health professionals in a paediatric burns setting: A mixed methods process evaluation. Burns 2024; 50:1690-1703. [PMID: 38664169 DOI: 10.1016/j.burns.2024.03.032] [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: 08/29/2023] [Revised: 03/05/2024] [Accepted: 03/31/2024] [Indexed: 06/14/2024]
Abstract
Trauma-informed care practices are associated with a culture of safety following traumatic experiences, including medical trauma. An interactive, web-based training package ('Responsive CARE') was developed for voluntary uptake by paediatric burns health professionals to increase staff knowledge about trauma-informed practice. This paper reports on a mixed methods process evaluation conducted alongside a preliminary effectiveness study of 'Responsive CARE'. The process evaluation was conducted using The Consolidated Framework for Implementation Research (CFIR) and a logic model, to examine feasibility of both the intervention and implementation strategy. Health practitioners (including senior managers) delivering care to children and caregivers attending an outpatient burns service were eligible to enrol in 'Responsive CARE'. Qualitative interview data and quantitative metadata were used to evaluate the implementation outcomes (adoption, acceptability, fidelity, feasibility and preliminary effectiveness). Children and caregivers attending an outpatient service for change of burn wound dressing or burn scar management during the 3-month control or 3-month intervention period were eligible to enrol in the effectiveness study. The impact on child pain and distress, as well as cost, was investigated using a pretest-posttest design. Thirteen (from anticipated 50 enrolled) health professionals (all female) with mean 10 years (SD=11) of experience with paediatric burns hospital-based outpatient care completed an average of 65% (range 36% to 88%) of available content. Twenty-five semi-structured interviews were completed with health practitioners (21 female) and with 14 caregivers (11 female). Four themes were identified as influencing feasibility and acceptability of the intervention: 1) Keeping a trauma-informed lens; 2) Ways of incorporating trauma-informed care; 3) Working within system constraints; and 4) Being trauma-informed. Preliminary effectiveness data included 177 participants (median age 2 years, and median total body surface area burn 1%). Causal assumptions within the logic model were unable to be fully tested, secondary to lower-than-expected adoption and fidelity. We found no significant difference for pain, distress and per-patient hospital care costs between groups (pre- and post-intervention). Future implementation strategies should include organizational support to keep a trauma-informed lens and to incorporate trauma-informed principles within a medical model of care. Despite efforts to co-design a staff education intervention and implementation approach focused on stakeholder engagement, adaptations are indicated to both the intervention and implementation strategies to promote uptake highlighting the complexity of changing clinician behaviours.
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Affiliation(s)
- Megan Simons
- Occupational Therapy Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Queensland, Australia; Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Queensland, Australia.
| | - Gillian Harvey
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Queensland, Australia; Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Lucinda McMillan
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Queensland, Australia
| | - Elizabeth G Ryan
- QCIF Faculty for Advanced Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Queensland, Australia; Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Queensland, Australia
| | - Alexandra G De Young
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Queensland, Australia; School of Psychology, The University of Queensland, Queensland, Australia; Queensland Centre for Perinatal and Infant Mental Health, Children's Health Queensland Hospital and Health Service, Queensland, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Queensland, Australia; Digital Health and Informatics Directorate, Metro South Health, Queensland, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Queensland, Australia
| | - Sameera Senanayake
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Queensland, Australia
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Queensland, Australia
| | - Zephanie Tyack
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Queensland, Australia; Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Queensland, Australia
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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.
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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;
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3
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Chan WS, Funk L, Thompson G. A Social Capital Perspective on Social-Medical Collaboration in Community End-of-Life Care in Hong Kong. OMEGA-JOURNAL OF DEATH AND DYING 2024; 89:57-72. [PMID: 34991381 PMCID: PMC11017689 DOI: 10.1177/00302228211066678] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Recent developments in Hong Kong end-of-life (EOL) care have shifted some caring work for dying people and their families to cross-disciplinary collaboration in community settings. Social-medical collaboration becomes especially important. This study aims to use social capital as an analytical lens to examine the processes and mechanisms of social-medical collaboration in EOL care and elucidate practice implications for engaging in the care of dying people and their families. Qualitative data were collected using in-depth interviews. Three major conceptual categories were generated through grounded theory methodology. They are (a) establishing trust through keeping clear and simple boundaries, (b) cultivating mutuality in the multi-disciplinary meeting, and (c) fostering social-medical collaboration in EOL care. Each new stage is based on the social capital accumulated in the previous one through the social interactions between professionals. Such theorization also provides insights into how to achieve effective social-medical collaboration in this context.
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Affiliation(s)
- Wing-sun Chan
- Department of Sociology and Criminology, University of Manitoba, Winnipeg, MB, Canada
| | - Laura Funk
- Department of Sociology and Criminology, University of Manitoba, Winnipeg, MB, Canada
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Ventres WB, Stone LA, Gibson-Oliver LE, Meehan EK, Ricker MA, Loxterkamp D, Ogbeide SA, deGruy FV, Mahoney MR, Lin S, MacRae C, Mercer SW. Storylines of family medicine VIII: clinical approaches. Fam Med Community Health 2024; 12:e002795. [PMID: 38609085 PMCID: PMC11029325 DOI: 10.1136/fmch-2024-002795] [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] [Indexed: 04/14/2024] Open
Abstract
Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'VIII: clinical approaches', authors address the following themes: 'Evaluation, diagnosis and management I-toward a working diagnosis', 'Evaluation, diagnosis and management II-process steps', 'Interweaving integrative medicine and family medicine', 'Halfway-the art of clinical judgment', 'Seamless integration in family medicine-team-based care', 'Technology-uncovering stories from noise' and 'Caring for patients with multiple long-term conditions'. May readers recognise in these essays the uniqueness of a family medicine approach to care.
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Affiliation(s)
- William B Ventres
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | - Leslie A Stone
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | - Lauren E Gibson-Oliver
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | - Elizabeth Kyle Meehan
- Family and Community Medicine, The University of Arizona College of Medicine - Tucson, Tucson, Arizona, USA
| | - Mari A Ricker
- Family and Community Medicine, The University of Arizona College of Medicine - Tucson, Tucson, Arizona, USA
| | | | - Stacy A Ogbeide
- Family and Community Medicine, UT Health San Antonio Long School of Medicine, San Antonio, Texas, USA
| | - Frank V deGruy
- Eugene S. Farley, Jr. Health Policy Center, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - Megan R Mahoney
- Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Steven Lin
- Division of Primary Care and Population Health, Stanford Medicine, Palo Alto, California, USA
| | - Clare MacRae
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Stewart W Mercer
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
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Wang J, Anderson R, Perez JS, Estabrooks CA, Berta W, Lanham HJ, Duan Y, Iaconi A, Beeber A. Understanding Adaptive Leadership in the Context of Nursing Homes. J Appl Gerontol 2024:7334648241243312. [PMID: 38566520 DOI: 10.1177/07334648241243312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Rapidly growing populations of older adults rely heavily on formal long-term care services such as those provided in nursing homes. Nursing home staff are confronted with complex challenges. We explored how staff (N = 88), particularly care aides, interpreted challenges and responded to them by taking adaptive leadership roles, and engaging in technical and adaptive work in nursing homes. We conducted analysis of the ethnographic case studies. In long-term care settings, staff face complex challenges in improving resident care due to contextual barriers. These include demanding work conditions and inadequate resources. Additionally, top-down communications, despite being well-intentioned, often lead to misinterpretation and a lack of staff motivation. Nonetheless, we found that certain staff managed to overcome these contextual barriers and effectively execute change initiatives by assuming adaptive leadership roles. Formal leaders have a vital role in empowering staff, including care aides, and facilitating their adaptive leadership behaviors.
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Affiliation(s)
- Jing Wang
- College of Health and Human Services, University of New Hampshire, Durham, NH, USA
| | - Ruth Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Janelle Santos Perez
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Whitney Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Holly J Lanham
- Joe R. & Teresa Lozano Long School of Medicine, University of Texas Health, San Antonio, TX, USA
| | - Yinfei Duan
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Alba Iaconi
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Anna Beeber
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
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Etherington C, Boet S, Chen I, Duffy M, Mamas MA, Bader Eddeen A, Bateman BT, Sun LY. Association Between Surgeon/Anesthesiologist Sex Discordance and 1-year Mortality Among Adults Undergoing Noncardiac Surgery: A Population-based Retrospective Cohort Study. Ann Surg 2024; 279:563-568. [PMID: 37791498 DOI: 10.1097/sla.0000000000006111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVE To investigate the association between surgeon-anesthesiologist sex discordance and patient mortality after noncardiac surgery. BACKGROUND Evidence suggests different practice patterns exist among female and male physicians. However, the influence of physician sex on team-based practices in the operating room and subsequent patient outcomes remains unclear in the context of noncardiac surgery. METHODS We conducted a population-based, retrospective cohort study of adult Ontario residents who underwent index, inpatient noncardiac surgery between January 2007 and December 2017. The primary exposure was physician sex discordance (ie, the surgeon and anesthesiologist were of the opposite sex). The primary outcome was 1-year mortality. The association between physician sex discordance and patient outcomes was modeled using multivariable Cox proportional hazard regression with adjustment for relevant physician, patient, and hospital characteristics. RESULTS Of 541,209 patients, 158,084 (29.2%) were treated by sex-discordant physician teams. Physician sex discordance was associated with a lower rate of mortality at 1 year [5.2% vs. 5.7%; adjusted HR: 0.95 (0.91-0.99)]. Patients treated by teams composed of female surgeons and male anesthesiologists were more likely to be alive at 1 year than those treated by all-male physician teams [adjusted HR: 0.90 (0.81-0.99)]. CONCLUSIONS Noncardiac surgery patients had a lower likelihood of 1-year mortality when treated by sex-discordant surgeon-anesthesiologist teams. The likelihood of mortality was further reduced if the surgeon was female. Further research is needed to explore the underlying mechanisms of these observations and design strategies to diversify operating room teams to optimize performance and patient outcomes.
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Affiliation(s)
- Cole Etherington
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sylvain Boet
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Innie Chen
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Melissa Duffy
- Department of Educational Studies, University of South Carolina, Columbia, SC
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, Staffordshire, UK
| | | | - Brian T Bateman
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Louise Y Sun
- Institute for Clinical Evaluative Sciences, ON, Canada
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
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van Klaveren LM, Geukers V, de Vos R. Care complexity, perceptions of complexity and preferences for interprofessional collaboration: an analysis of relationships and social networks in paediatrics. BMC MEDICAL EDUCATION 2024; 24:334. [PMID: 38528513 DOI: 10.1186/s12909-024-05304-6] [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: 11/30/2023] [Accepted: 03/13/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND In the context of increasingly intricate healthcare systems, professionals are compelled to collaborate within dynamically changing interprofessional teams. Moreover, they must adapt these collaborative processes to effectively and efficiently manage the evolving complexity of care needs. It remains unclear how professionals determine care complexity and relate this complexity to their preferences for interprofessional collaboration (IPC). This study investigated the relationships between care complexity, professionals' perceived complexity and IPC preferences, and examined the variation in individual and team characteristics of IPC-practices across different levels of complexity in paediatric care. METHODS In an online questionnaire, 123 healthcare professionals working at an academic tertiary children's hospital scored their perceptions of complexity and preferences for IPC. They also selected family and various professions as members of the interprofessional (IP-) team based on thirteen patient cases. We employed conjoint analysis to systematically model the complexity of case descriptions across the five domains of the International Classification of Functioning, Disability and Health (ICF). Additionally, we applied social network analysis to identify important professions, crucial connectors and influential professions in the IP-team, and to describe the cohesiveness of IP-teams. RESULTS Modelled case complexity, professionals' perceived complexity and IPC preferences were positively associated. We found large inter-individual variations in the degree of these associations. Social network analysis revealed that the importance and influence of professions was more equally distributed when case complexity increased. Depending on the context and complexity of the case, different professions (e.g. medical doctors, social professionals, extramural professionals) were considered to be more crucial connectors within the IP-team. Furthermore, team cohesion was positively associated with modelled and perceived care complexity. CONCLUSIONS In conclusion, our study contributes to the existing knowledge by integrating task-specific insights and broadening the use of conjoint and social network analysis in the context of IPC. The findings substantiate the contingency theory that relates characteristics of IPC to care complexity, offering quantified insights into how IP-teams adapt to situational needs. This understanding of relationships and variations within IPC holds crucial implications for designing targeted interventions in both clinical and health profession education contexts. Consequently, it contributes to advancements in healthcare systems.
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Affiliation(s)
- Lisa-Maria van Klaveren
- Institute for Education and Training, Amsterdam Universities Medical Centres location University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands.
| | - Vincent Geukers
- Emma Children's Hospital, Amsterdam Universities Medical Centres location University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands
| | - Rien de Vos
- Institute for Education and Training, Amsterdam Universities Medical Centres location University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands
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Olive MV, Gastaldi L, Corso M. Digitally-mediated coordination in healthcare: the effects of teleconsultation on doctor-to-doctor relational coordination. BMC Health Serv Res 2024; 24:258. [PMID: 38419009 PMCID: PMC10900703 DOI: 10.1186/s12913-024-10726-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/15/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Digitalization transforms the way in which interdependent work is coordinated, especially in healthcare settings. This work deepens the effect of teleconsultation use on health professionals' coordination. For this aim, we rely on Relational Coordination Theory (RCT), which explores coordination as an interactive process among group participants within the context of task interdependency. METHODS We collected data through an online survey administered to Italian specialist doctors between March and April 2023. 489 complete answers were gathered. Hypotheses have been tested through Structural Equation Modelling. RESULTS We found that teleconsultation frequency of use has a positive and significant effect on both components of relational coordination, confirming our hypotheses. CONCLUSIONS Theoretically, this research contributes to our understanding of the effect of digitally mediated coordination mechanisms on relational coordination. In practice, we shed light on the organizational implications of telemedicine under a novel perspective, focusing on the role of professional interactions in digitally mediated work and providing useful elements for the organizational design of telemedicine.
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Affiliation(s)
- Mattia Vincenzo Olive
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy.
| | - Luca Gastaldi
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | - Mariano Corso
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
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Keshavarz Mohammadi N, Rezaei Z, Burggraf L, Pype P. Exploring settings as social complex adaptive systems in setting-based health research: a scoping review. Health Promot Int 2024; 39:daae001. [PMID: 38365190 DOI: 10.1093/heapro/daae001] [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] [Indexed: 02/18/2024] Open
Abstract
Since launching health health-promoting settings approach to health by WHO, valuable progress has happened in implementing its holistic concepts in settings such as cities, schools, workplaces, hospitals and healthcare services. However, significant knowledge-intention-success gaps still exist in creating sustainable health-promoting changes in settings. The complexity of the task of bridging this gap has contributed to the call for a complexity-informed paradigm shift to health as well as settings, followed by increasing consultation of relevant complexity theories, frameworks and tools in health research. This paper provides a critical scoping review of the application of complex adaptive system (CAS) theory in settings-based health promotion research. We included 14 papers, mostly qualitative studies, reporting on planning or implementation of change initiatives, less on its evaluation. CAS theory application was often incomplete thereby reducing the potential benefit of using this lens to understand change management. We suggest some recommendations how to comprehensively apply the CAS theory in setting-based health research and to report on all CAS characteristics to enhance the understanding of settings as adaptive health-promoting settings.
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Affiliation(s)
- Nastaran Keshavarz Mohammadi
- Department of Public Health, Shahid Beheshti University of Medical Sciences, Daneshjoo Blvd, 1985717443 Tehran, Iran
| | - Zahed Rezaei
- Deprtment of Public health, Asadabad School of Medical Sciences, Imam Khomeini Square, 6541843189 Asadabad, Iran
| | - Larissa Burggraf
- Department for Sociology, University of Education, Oberbettringer Street 200, 73525 Schwäbisch Gmünd, Germany
| | - Peter Pype
- Department of Public Health and Primary Care, University Hospital, Ghent University, Gent, Belgium
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de Graaf E, Grant M, van der Baan F, Ausems M, Leget C, Teunissen S. The Impact of Hospice Care Structures on Care Processes: A Retrospective Cohort Study. Am J Hosp Palliat Care 2024:10499091241228254. [PMID: 38234063 DOI: 10.1177/10499091241228254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Background: Palliative care is subject to substantial variations in care, which may be shaped through adapting the organisational structures through which care is provided. Whilst the goal of these structures is to improve patient care, there is a lack of evidence regarding their effect on care processes and patient outcomes. Aims: This study aims to describe the relationship between care structures and the quantity and domains of care processes in hospice care. Design: Retrospective cohort study. Settings/Participants: Data were collected from Dutch hospice patient's clinical records and hospice surveys, detailing hospice structures, patient clinical characteristics and care processes. Results: 662 patients were included from 42 hospices, mean age 76.1 years. Hospices were categorised according to their care structures - structured clinical documentation and multidisciplinary meetings. Patients receiving care in hospices with structured multidisciplinary meetings had an increased quantity of documented care processes per patient on admission through identification (median 4 vs 3, P < .001), medication (2 vs 1, P = .004) and non-medication (1 vs 0, P < .001) interventions, monitoring (2 vs 1, P < .001) and evaluation (0 vs 0, P = .014), and prior to death. Similar increases were identified for patients who received care in hospices with structured documentation upon admission, but these changes were not consistent prior to death. Conclusions: This study details that the care structures of documentation and multidisciplinary meetings are associated with increased quantity and breadth of documentation of care processes in hospice care. Employing these existing structures may result in improvements in the documentation of patient care processes, and thus better communication around patient care.
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Affiliation(s)
- Everlien de Graaf
- Centre of Expertise in Palliative Care Utrecht, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Matthew Grant
- Centre of Expertise in Palliative Care Utrecht, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Frederieke van der Baan
- Centre of Expertise in Palliative Care Utrecht, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Marieke Ausems
- Palliative Care Physician, The Dutch College of General Practitioners, the Netherlands
| | - Carlo Leget
- University of Humanistic Studies, Utrecht, the Netherlands
| | - Saskia Teunissen
- Centre of Expertise in Palliative Care Utrecht, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
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Wang B, Manskow US. Health professionals' experience and perceived obstacles with managing patients' medication information in Norway: cross-sectional survey. BMC Health Serv Res 2024; 24:68. [PMID: 38218841 PMCID: PMC10790274 DOI: 10.1186/s12913-023-10485-9] [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: 08/28/2023] [Accepted: 12/15/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Access to correct and up to date medication information is crucial for effective patient treatment. However, persistent discrepancies exist. This study examines the experiences and challenges health professionals encounter while utilizing current digital solutions in the Norwegian healthcare system to manage patients' medication information. METHODS A cross-sectional descriptive analysis using quantitative survey data was conducted to investigate how health professionals managed patients' medication information. Content analysis was used to analyze free-text responses concerning challenges they encountered when transferring medication information and to identify factors deemed necessary for implementing the Shared Medication List in Norway. RESULTS A total of 262 doctors and 244 nurses responded to the survey. A higher percentage of doctors (72.2%) expressed concerns regarding obtaining accurate and updated medication lists than nurses (42.9%), particularly for patients with polypharmacy (35.3%) or transitioning between primary and specialist care services (27.6%). The patient's verbal information was the main source for hospital doctors (17%) to obtain an overview of the patient's medication usage, while general practitioners (19%) and nurses (working in both primary and specialist care services, 28% and 27% respectively) predominantly relied on electronic prescriptions. Doctors, in particular general practitioners, reported carrying excessive responsibilities in coordinating with other health actors (84.8%) and managing patients' medication information. The vast majority of both doctors (84.4%) and nurses (82.0%) were in favor of a Shared Medication List. However, about a third of doctors (36.3%) and nurses (29.8%) expressed the need for a more balanced responsibility in updating and managing patients' medication information, while ensuring compatibility with existing digital systems. CONCLUSIONS Fragmented resources for medication information and unclear responsibilities were prevalent concerns among both professional groups. Doctors voiced more concern than nurses about the accuracy of patients' medication list. While both groups are positive about a shared medication list, successful implementation requires proactive training initiatives and clearer role clarification.
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Affiliation(s)
- Bo Wang
- Norwegian Centre for E-Health Research, University Hospital of North Norway, Sykehusvegen 23, Forskningsparken, Tromsø, Norway.
| | - Unn Sollid Manskow
- Norwegian Centre for E-Health Research, University Hospital of North Norway, Sykehusvegen 23, Forskningsparken, Tromsø, Norway
- Department of Health and Care Sciences, Centre for Care Research, UiT- The Arctic University of Norway, Tromsø, Norway
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Kappler CB, Coffman CJ, Stechuchak KM, Choate A, Meyer C, Zullig LL, Hughes JM, Drake C, Sperber NR, Kaufman BG, Van Houtven CH, Allen KD, Hastings SN. Evaluation of strategies to support implementation of a hospital walking program: protocol for a type III effectiveness-implementation hybrid trial. Implement Sci Commun 2024; 5:8. [PMID: 38216967 PMCID: PMC10790254 DOI: 10.1186/s43058-024-00544-5] [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: 10/05/2023] [Accepted: 12/29/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND STRIDE is a supervised walking program designed to address the negative consequences of immobility during hospitalization for older adults. In an 8-hospital stepped wedge randomized controlled trial, STRIDE was associated with reduced odds of hospital discharge to skilled nursing facility. STRIDE has the potential to become a system-wide approach to address hospital-associated disability in Veteran's Affairs; however, critical questions remain about how best to scale and sustain the program. The overall study goal is to compare the impact of two strategies on STRIDE program penetration (primary), fidelity, and adoption implementation outcomes. METHODS Replicating Effective Programs will be used as a framework underlying all implementation support activities. In a parallel, cluster randomized trial, we will use stratified blocked randomization to assign hospitals (n = 32) to either foundational support, comprised of standard, low-touch activities, or enhanced support, which includes the addition of tailored, high-touch activities if hospitals do not meet STRIDE program benchmarks at 6 and 8 months following start date. All hospitals begin with foundational support for 6 months until randomization occurs. The primary outcome is implementation penetration defined as the proportion of eligible hospitalizations with ≥ 1 STRIDE walks at 10 months. Secondary outcomes are fidelity and adoption with all implementation outcomes additionally examined at 13 and 16 months. Fidelity will be assessed for STRIDE hospitalizations as the percentage of eligible hospital days with "full dose" of the program, defined as two or more documented walks or one walk for more than 5 min. Program adoption is a binary outcome defined as ≥ 5 patients with a STRIDE walk or not. Analyses will also include patient-level effectiveness outcomes (e.g., discharge to nursing home, length of stay) and staffing and labor costs. We will employ a convergent mixed-methods approach to explore and understand pre-implementation contextual factors related to differences in hospital-level adoption. DISCUSSION Our study results will dually inform best practices for promoting successful implementation of an evidence-based hospital-based walking program. This information may support other programs by advancing our understanding of how to apply and scale-up national implementation strategies. TRIAL REGISTRATION This study was registered on June 1, 2021, at ClinicalTrials.gov (identifier NCT04868656 ).
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Affiliation(s)
- Caitlin B Kappler
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA.
| | - Cynthia J Coffman
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Karen M Stechuchak
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
| | - Ashley Choate
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
| | - Cassie Meyer
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
| | - Leah L Zullig
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jaime M Hughes
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Section On Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Connor Drake
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Nina R Sperber
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Brystana G Kaufman
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Courtney H Van Houtven
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Kelli D Allen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Medicine & Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Susan N Hastings
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
- Geriatrics Research, Education, and Clinical Center, Durham VA Health Care System, Durham, NC, USA
- Department of Medicine, Division of Geriatrics, Duke University School of Medicine, Durham, NC, USA
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Amorøe TN, Rystedt H, Oxelmark L, Dieckmann P, Andréll P. How theories of complexity and resilience affect interprofessional simulation-based education: a qualitative analysis of facilitators' perspectives. BMC MEDICAL EDUCATION 2023; 23:717. [PMID: 37784048 PMCID: PMC10546720 DOI: 10.1186/s12909-023-04690-7] [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: 05/04/2023] [Accepted: 09/15/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Quality of care and patient safety rely on the ability of interprofessional teams to collaborate effectively. This can be trained through interprofessional simulation-based education (IPSE). Patient safety also relies on the ability to adapt to the complexity of such situations, an ability termed resilience. Since these needs are not explicitly addressed in IPSE, the aim of this study was to explore how central concepts from complexity-theory and resilience affect IPSE, from facilitators' perspective, when applied in debriefings. METHODS A set of central concepts in complexity-theory and resilience were introduced to facilitators on an IPSE course for nursing and medical students. In five iterations of focus groups interviews the facilitators discussed their application of these concepts by reviewing video recordings of their own debriefings. Video recordings of the interviews were subjected to coding and thematic analysis. RESULTS Three themes were identified. The first, Concepts of complexity and resilience are relevant for IPSE, points to the applicability of these concepts and to the fact that students often need to deviate from prescribed guidelines/algorithms in order to solve cases. The second theme, Exploring complexity, shows how uncertainty could be used as a cue to explore complexity. Further, that individual performance needs to account for the context of actions and how this may lead to certain outcomes. Moreover, it was suggested that several ways to approach a challenge can contribute to important insight in the conditions for teamwork. The third theme, Unpacking how solutions are achieved, turns to needs for handling the aforementioned complexity. It illustrates the importance of addressing self-criticism by highlighting how students were often able to overcome challenges and find solutions. Finally, this theme highlights how pre-defined guidelines and algorithms still work as important resources to help students in transforming perceived messiness into clarity. CONCLUSIONS This study suggests that IPSE provides the possibility to explore complexity and highlight resilience so that such capability can be trained and improved. Further studies are needed to develop more concrete ways of using IPSE to account for complexity and developing resilience capacity and to evaluate to what extent IPSE can provide such an effect.
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Affiliation(s)
- Torben Nordahl Amorøe
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Hans Rystedt
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Research, Education and Development, Simulation Centre West, Diagnosvägen 10, Gothenburg, SE-416 85, Sweden
| | - Lena Oxelmark
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Dieckmann
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources, Capital Region of Denmark, Herlev Hospital, Herlev, Denmark
- Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Paulin Andréll
- Region Västra Götaland, Sahlgrenska University Hospital Östra, Department of Anaesthesiology and Intensive Care Medicine/Paincenter, Gothenburg, Sweden
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Usman F, Farouk ZL, Tsiga-Ahmed FI, Abdussalam M, Jalo RI, Mohammad SS, Aliyu MH. Improvised bubble continuous positive airway pressure ventilation use in neonates in resource-limited settings: a systematic review and meta-analysis. J Perinat Med 2023; 51:840-849. [PMID: 35263514 DOI: 10.1515/jpm-2022-0009] [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] [Received: 01/07/2022] [Accepted: 02/14/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES In the face of limited fiscal and technical resources, improvised methods have been used to provide effective and sustainable ventilatory support in low-resource settings to reduce neonatal mortality associated with respiratory complications. This study assessed the use of improvised bubble continuous positive airway pressure (ibCPAP) ventilation among neonates with respiratory complications and determined its effect on neonatal outcomes in low- and middle-income countries (LMICs). CONTENT Hospital-based studies conducted between 2010 and 2020 in LMICs were reviewed. Rayyan® software for systematic review was used for screening and article selection. We used Stata® Statacorp Texas USA software to estimate pooled prevalence, proportion estimates, weighted mean differences and 95% Confidence Interval (CI), using the random effects model. SUMMARY A total of 193 articles were generated and 125 were reviewed. Thirteen articles with 806 neonates on ibCPAP ventilation were included. The pooled prevalence of ibCPAP use was 7.0% (95% CI: 3.0%-13.0%). There was a significant difference in mean oxygen saturation before and after ibCPAP use (-1.34% [95% CI: -1.65% to -1.02%, p<0.01). The duration of oxygen requirement among neonates on ibCPAP was 6.5 hours less than controls (0.27 days [95%CI: -0.49 to -0.05, p<0.01). OUTLOOK IbCPAP had no effect on the respiratory rate, duration of admission, mortality and survival. IbCPAP use in LMIC hospitals is low and its use improved oxygen saturation and duration on oxygen among the neonates, but had no impact on length of stay, respiratory rate, mortality or survival.
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Affiliation(s)
- Fatima Usman
- Department of Pediatrics, Bayero University, Kano & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Zubaida L Farouk
- Department of Pediatrics, Bayero University, Kano & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Fatimah I Tsiga-Ahmed
- Department of Community Medicine, Bayero University, Kano & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Muhammed Abdussalam
- Department of Pediatrics, Bayero University, Kano & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Rabiu I Jalo
- Department of Community Medicine, Bayero University, Kano & Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, USA
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Jiao S, Bungay V, Jenkins E, Gagnon M. How an emergency department is organized to provide opioid-specific harm reduction and facilitators and barriers to harm reduction implementation: a systems perspective. Harm Reduct J 2023; 20:139. [PMID: 37735432 PMCID: PMC10515241 DOI: 10.1186/s12954-023-00871-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND The intersection of dual public health emergencies-the COVID-19 pandemic and the drug toxicity crisis-has led to an urgent need for acute care based harm reduction for unregulated opioid use. Emergency Departments (EDs) as Complex Adaptive Systems (CASs) with multiple, interdependent, and interacting elements are suited to deliver such interventions. This paper examines how the ED is organized to provide harm reduction and identifies facilitators and barriers to implementation in light of interactions between system elements. METHODS Using a case study design, we conducted interviews with Emergency Physicians (n = 5), Emergency Nurses (n = 10), and clinical leaders (n = 5). Nine organizational policy documents were also collected. Interview data were analysed using a Reflexive Thematic Analysis approach. Policy documents were analysed using a predetermined coding structure pertaining to staffing roles and responsibilities and the interrelationships therein for the delivery of opioid-specific harm reduction in the ED. The theory of CAS informed data analysis. RESULTS An array of system agents, including substance use specialist providers and non-specialist providers, interacted in ways that enable the provision of harm reduction interventions in the ED, including opioid agonist treatment, supervised consumption, and withdrawal management. However, limited access to specialist providers, when coupled with specialist control, non-specialist reliance, and concerns related to safety, created tensions in the system that hinder harm reduction provision with resulting implications for the delivery of care. CONCLUSIONS To advance harm reduction implementation, there is a need for substance use specialist services that are congruent with the 24 h a day service delivery model of the ED, and for organizational policies that are attentive to discourses of specialized practice, hierarchical relations of power, and the dynamic regulatory landscape. Implementation efforts that take into consideration these perspectives have the potential to reduce harms experienced by people who use unregulated opioids, not only through overdose prevention and improving access to safer opioid alternatives, but also through supporting people to complete their unique care journeys.
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Affiliation(s)
- Sunny Jiao
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Vicky Bungay
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - Emily Jenkins
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Marilou Gagnon
- School of Nursing, University of Victoria, 3800 Finnerty Road, HSD Building A402a, Victoria, BC, V8P 5C2, Canada
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16
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Milani C, Naldini G, Baggiani L, Nerattini M, Bonaccorsi G. How to promote changes in primary care? The Florentine experience of the House of Community. Front Public Health 2023; 11:1216814. [PMID: 37732087 PMCID: PMC10508287 DOI: 10.3389/fpubh.2023.1216814] [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: 05/12/2023] [Accepted: 08/09/2023] [Indexed: 09/22/2023] Open
Abstract
Primary care (PC) has a central role in promoting health and preventing diseases, even during health emergencies. The COVID-19 pandemic has shown how strengthening comprehensive primary healthcare (c-PHC) services is key to ensuring community health. The Italian government decided to support PHC by investing resources from the Next Generation EU (NextGenEu) plan in the development of local health districts (LHDs) and local PC centers called "Houses of Community (HoC)". The Florence LHD (Tuscany)-in direct collaboration with the University of Florence-has represented the experimental context in which a c-PHC-inspired organizational model has been proposed and included the HoC as the nearest access point to PC services. Through multiprofessional collaboration practices, HoCs provide continuity of care as well as health and social integration. Different levels of action must coexist to initiate, implement, and sustain this new PC model: the organizational and managerial level, the experimentation of a new model of care, and the research level, which includes universities and LHD through participatory research and action approaches. This process benefits from health professionals' (HPs) participation and continuous assessment, the care for working relationships between HPs and services, an appropriate research methodology together with a "permeable" multidisciplinary research group, and educational programs. In this context, the HoC assumes the role of a permanent laboratory of experimentation in PC, supporting the effectiveness of care and answering what the Next Gen EU plan has been foreseeing for the rethinking of Italian territorial services.
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Affiliation(s)
- Chiara Milani
- Department of Health Science, University of Florence, Florence, Italy
| | - Giulia Naldini
- Department of District Healthcare Network, Azienda USL Toscana Centro, Florence, Italy
| | - Lorenzo Baggiani
- Department of District Healthcare Network, Azienda USL Toscana Centro, Florence, Italy
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Hedqvist AT, Praetorius G, Ekstedt M. Exploring interdependencies, vulnerabilities, gaps and bridges in care transitions of patients with complex care needs using the Functional Resonance Analysis Method. BMC Health Serv Res 2023; 23:851. [PMID: 37568114 PMCID: PMC10422836 DOI: 10.1186/s12913-023-09832-7] [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: 10/28/2022] [Accepted: 07/18/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Hospital discharge is a complex process encompassing multiple interactions and requiring coordination. To identify potential improvement measures in care transitions for people with complex care needs, intra- and inter-organisational everyday work needs to be properly understood, including its interdependencies, vulnerabilities and gaps. The aims of this study were to 1) map coordination and team collaboration across healthcare and social care organisations, 2) describe interdependencies and system variability in the discharge process for older people with complex care needs, and 3) evaluate the alignment between discharge planning and the needs in the home. METHODS Data were collected through participant observations, interviews, and document review in a region of southern Sweden. The Functional Resonance Analysis Method (FRAM) was used to model the discharge process and visualise and analyse coordination of care across healthcare and social care organisations. RESULTS Hospital discharge is a time-sensitive process with numerous couplings and interdependencies where healthcare professionals' performance is constrained by system design and organisational boundaries. The greatest vulnerability can be found when the patient arrives at home, as maladaptation earlier in the care chain can lead to an accumulation of issues for the municipal personnel in health and social care working closest to the patient. The possibilities for the personnel to adapt are limited, especially at certain times of day, pushing them to make trade-offs to ensure patient safety. Flexibility and appropriate resources enable for handling variability and responding to uncertainties in care after discharge. CONCLUSIONS Mapping hospital discharge using the FRAM reveals couplings and interdependencies between various individuals, teams, and organisations and the most vulnerable point, when the patient arrives at home. Resilient performance in responding to unexpected events and variations during the first days after the return home requires a system allowing flexibility and facilitating successful adaptation of discharge planning.
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Affiliation(s)
- Ann-Therese Hedqvist
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.
- Ambulance Service, Region Kalmar County, Västervik, Sweden.
| | - Gesa Praetorius
- Swedish National Road and Transport Research Institute, Linköping, Sweden
- Department of Maritime Operations, University of South-Eastern Norway, Borre, Norway
| | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
- Department of Learning, Informatics, Management and Ethics, LIME, Karolinska Institutet, Stockholm, Sweden
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Iyahen EO, Omoruyi OO, Rowa-Dewar N, Dobbie F. Exploring the barriers and facilitators to the uptake of smoking cessation services for people in treatment or recovery from problematic drug or alcohol use: A qualitative systematic review. PLoS One 2023; 18:e0288409. [PMID: 37440505 DOI: 10.1371/journal.pone.0288409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Smoking prevalence and the associated poor health and mortality is significantly higher among people with/recovering from problematic drug or alcohol (PDA) use in comparison with the general population. Evidence from existing systematic reviews shows smoking cessation enhances rather than compromises long-term abstinence from alcohol or drug use. However, these systematic reviews lack important contextual detail around the reasons why uptake of, and successful engagement with existing stop smoking services remains low for people in treatment or recovery from PDA use. This systematic review explores qualitative data on the barriers and facilitators to the uptake of smoking cessation services for people in treatment or recovery from PDA use. This key objective addresses the limited inclusion of qualitative studies in previous systematic reviews on this issue. METHODS A qualitative systematic review was conducted with searches across four electronic databases (PubMed, Embase, PsycINFO and Cumulative Index to Nursing and Allied Health Literature [CINAHL]). All studies that had a qualitative component about free smoking cessation/reduction programmes for people in treatment or recovery from PDA use were included. Studies that examined electronic smoking or services that required a fee were excluded. Study quality was assessed using National Institute for Health and Care Excellence checklist. Qualitative synthesis involved inductive thematic analysis. (PROSPERO Registration number: CRD42022298521). RESULTS 8809 potentially eligible articles were identified, 72 full texts were screened and ten articles were included for full review. Barriers to uptake and engagement with existing stop smoking services centered on three key themes: perception of public health importance, programme structure, and intervention elements. Facilitators included supportive treatment environment and optimization of support/staff resources for smoking cessation service delivery. CONCLUSION Recommendations included influencing a change in the way people perceive the importance of smoking cessation activities during PDA use treatment or recovery. There was also some emphasis on the need to create the right environment for sustained adherence to treatment or recovery plans, and deliver the interventions within the health system as comprehensive care. The limited qualitative evidence on community-based and outpatient services highlights a research gap.
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Affiliation(s)
| | | | - Neneh Rowa-Dewar
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Fiona Dobbie
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
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White NM, Carter HE, Kularatna S, Borg DN, Brain DC, Tariq A, Abell B, Blythe R, McPhail SM. Evaluating the costs and consequences of computerized clinical decision support systems in hospitals: a scoping review and recommendations for future practice. J Am Med Inform Assoc 2023; 30:1205-1218. [PMID: 36972263 PMCID: PMC10198542 DOI: 10.1093/jamia/ocad040] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/23/2023] [Accepted: 03/03/2023] [Indexed: 11/14/2023] Open
Abstract
OBJECTIVE Sustainable investment in computerized decision support systems (CDSS) requires robust evaluation of their economic impacts compared with current clinical workflows. We reviewed current approaches used to evaluate the costs and consequences of CDSS in hospital settings and presented recommendations to improve the generalizability of future evaluations. MATERIALS AND METHODS A scoping review of peer-reviewed research articles published since 2010. Searches were completed in the PubMed, Ovid Medline, Embase, and Scopus databases (last searched February 14, 2023). All studies reported the costs and consequences of a CDSS-based intervention compared with current hospital workflows. Findings were summarized using narrative synthesis. Individual studies were further appraised against the Consolidated Health Economic Evaluation and Reporting (CHEERS) 2022 checklist. RESULTS Twenty-nine studies published since 2010 were included. Studies evaluated CDSS for adverse event surveillance (5 studies), antimicrobial stewardship (4 studies), blood product management (8 studies), laboratory testing (7 studies), and medication safety (5 studies). All studies evaluated costs from a hospital perspective but varied based on the valuation of resources affected by CDSS implementation, and the measurement of consequences. We recommend future studies follow guidance from the CHEERS checklist; use study designs that adjust for confounders; consider both the costs of CDSS implementation and adherence; evaluate consequences that are directly or indirectly affected by CDSS-initiated behavior change; examine the impacts of uncertainty and differences in outcomes across patient subgroups. DISCUSSION AND CONCLUSION Improving consistency in the conduct and reporting of evaluations will enable detailed comparisons between promising initiatives, and their subsequent uptake by decision-makers.
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Affiliation(s)
- Nicole M White
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Hannah E Carter
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David N Borg
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David C Brain
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Amina Tariq
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bridget Abell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Robin Blythe
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Digital Health and Informatics Directorate, Metro South Health, Brisbane, Queensland, Australia
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20
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Jeffries M, Salema NE, Laing L, Shamsuddin A, Sheikh A, Avery T, Chuter A, Waring J, Keers RN. Using sociotechnical theory to understand medication safety work in primary care and prescribers' use of clinical decision support: a qualitative study. BMJ Open 2023; 13:e068798. [PMID: 37105697 PMCID: PMC10151989 DOI: 10.1136/bmjopen-2022-068798] [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: 04/29/2023] Open
Abstract
OBJECTIVES The concept of safety work draws attention to the intentional work of ensuring safety within care systems. Clinical decision support (CDS) has been designed to enhance medication safety in primary care by providing decision-making support to prescribers. Sociotechnical theory understands that healthcare settings are complex and dynamically connected systems of fluid networks, human agents, changing relationships and social processes. This study aimed to understand the relationship between safety work and the use of CDS. DESIGN AND SETTING This qualitative study took place across nine different general practices in England. Stakeholders included general practitioners (GPs) and general practice-based pharmacists and nurse prescribers. Semi-structured interviews were conducted to illicit how the system was used by the participants in the context of medication safety work. Data analysis conducted alongside data collection was thematic and drew on socio-technical theory. PARTICIPANTS Twenty-three interviews were conducted with 14 GPs, three nurse prescribers and three practice pharmacists between February 2018 and June 2020. RESULTS Safety work was contextually situated in a complex network of relationships. Three interconnected themes were interpreted from the data: (1) the use of CDS within organisational and social practices and workflows; (2) safety work and the use of CDS within the interplay between prescribers, patients and populations; and (3) the affordances embedded in CDS systems. CONCLUSION The use of sociotechnical theory here extends current thinking in patient safety particularly in the ways that safety work was co-constituted with the use of CDS alerts. This has implications for implementation and use to ensure that the contexts into which such CDS systems are implemented are taken into account. Understanding how alerts can adapt safety culture will help improve the efficacy of CDS systems, enhance prescribing safety and help to further understand how safety work is achieved in primary care.
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Affiliation(s)
- Mark Jeffries
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Nde-Eshimuni Salema
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Libby Laing
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Aziz Sheikh
- Division of Community Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Tony Avery
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Antony Chuter
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Justin Waring
- School of Social Policy, Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Richard Neil Keers
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Manchester, UK
- Suicide, Risk and Safety Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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21
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Ma L, Wang X, Zou S, Lin M, Qiu S, Li W. A structural equation modelling analysis: interprofessional team collaboration, organizational career management, and post competency of community nurses. BMC Health Serv Res 2023; 23:327. [PMID: 37005581 PMCID: PMC10067220 DOI: 10.1186/s12913-023-09303-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 03/17/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND With the advent of an ageing society and an increase in the prevalence of chronic diseases, the role of primary health care has become increasingly important and reliant on multidisciplinary collaboration. As members of this interprofessional cooperative team, community nurses play a dominant role. Thus, the post competencies of community nurses study deserve our attention. In addition, organizational career management can affect nurses in some ways. This study aims to examine the current situation and relationship among interprofessional team collaboration, organizational career management and post-competency of community nurses. METHODS A survey was conducted among 530 nurses in 28 community medical institutions from November 2021 to April 2022 in Chengdu, Sichuan Province, China. Descriptive analysis was used for analysis, and a structural equation model was used to hypothesize and verify the model. A total of 88.2% of respondents met the inclusion criteria and did not meet the exclusion criteria. The main reason nurses gave for not participating was that they were too busy. RESULTS Among the competencies on the questionnaire, ensuring quality and helping roles scored the lowest. The teaching-coaching and diagnostic functions played a mediating role. Nurses with greater seniority and those who were transferred to administrative departments had lower scores, and the difference was statistically significant (p < 0.05). In the structural equation model, CFI = 0.992 and RMSEA = 0.049, which shows that the model fit well, suggesting that organizational career management had no statistically significant effect on post competency (β = -0.006, p = 0.932) but that interprofessional team collaboration had a statistically significant effect on post competency (β = 1.146, p < 0.001) and organizational career management had a statistically significant effect on interprofessional team collaboration (β = 0.684, p < 0.001). CONCLUSIONS Attention should be given to the improvement of community nurses' post competency in ensuring quality and performing helping, teaching-coaching, and diagnostic roles. Moreover, researchers should focus on the decline in community nurses' abilities, particularly for those with greater seniority or in administrative roles. The structural equation model shows that interprofessional team collaboration is a complete intermediary between organizational career management and post competency.
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Affiliation(s)
- Li Ma
- Institute of Hospital Management, Outpatient Department, West China School of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xinwei Wang
- School of Business, Sichuan University, Chengdu, Sichuan, China
| | - Shiyue Zou
- The First People's Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Min Lin
- The First People's Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Shi Qiu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, Institute of Respiratory Health, Frontiers Science Center for Disease-Related Molecular Network/Precision Medicine Research Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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22
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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).
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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
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23
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Abraham J, Duffy C, Kandasamy M, France D, Greilich P. An evidence synthesis on perioperative Handoffs: A call for balanced sociotechnical solutions. Int J Med Inform 2023; 174:105038. [PMID: 36948060 DOI: 10.1016/j.ijmedinf.2023.105038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/18/2023] [Accepted: 02/27/2023] [Indexed: 03/09/2023]
Abstract
SIGNIFICANCE Perioperative handoffs interconnect the preoperative, intraoperative, and postoperative phases underlying surgical care to maintain care continuity -yet are prone to coordination and communication failures. OBJECTIVE To synthesize evidence on factors affecting the safety and quality of perioperative handoff conduct and process. MATERIALS AND METHODS A search of PubMed, EMBASE, and CINAHL was conducted to include observational, descriptive studies of preoperative, intraoperative, and postoperative handoffs published in English language, peer-reviewed journals. Data analysis was informed by the Systems Engineering Initiative for Patient Safety (SEIPS) framework describing the relationship between the work-system, work processes, and outcomes. Study quality was assessed using the Quality Scoring System. RESULTS Twenty-three studies were included. Eighteen studies focused on postoperative handoffs, with one on preoperative, three on intraoperative and only one that looked at preoperative/postoperative handoffs combined. The SEIPS framework elucidated the complex inter-related factors (enablers and barriers) related to perioperative handoff safety. While some studies found that the use of standardized handoff tools and protocols and interdisciplinary teamwork were frequently-reported enablers, other studies identified the lack of structured handoff tools and protocols, poor teamwork and communication, and improper use of documentation tools were top-cited barriers affecting handoff quality. Suggestions to ensure handoff safety and quality included implementing structured handoff checklists and protocols and building interprofessional teamwork competencies for effective communication. DISCUSSION AND CONCLUSION Our review highlights an urgency to develop more holistic sociotechnical solutions that can create and sustain a balance between technical innovations in tools and technologies and the non-technical interventions/training needed to improve interpersonal relations and teamwork competencies - taken together, can improve the quality and safety of perioperative handoff practice.
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Affiliation(s)
- Joanna Abraham
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA; Institute for Informatics, Washington University School of Medicine, St. Louis, MO, USA.
| | - Caoimhe Duffy
- Department of Anesthesiology & Critical Care, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA
| | - Madhumitha Kandasamy
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Dan France
- Department of Anesthesiology, Nursing, Medicine, & Biomedical Engineering, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Philip Greilich
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX, USA
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24
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Van Aerde J, Gomes MM, Giuliani M, Thoma B, Lieff S. Complex adaptive systems in CanMEDS 2025. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:50-53. [PMID: 36998500 PMCID: PMC10042785 DOI: 10.36834/cmej.75538] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- John Van Aerde
- University of Alberta, Alberta, Canada
- Canadian Society of Physician Leaders, Ontario, Canada
| | - Marcio M Gomes
- University of Ottawa, Ontario, Canada
- Royal College of Physicians and Surgeons of Canada, Canada
| | | | - Brent Thoma
- University of Saskatchewan, Saskatchewan, Canada
- Royal College of Physicians and Surgeons of Canada, Canada
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25
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Thelen J, Sant Fruchtman C, Bilal M, Gabaake K, Iqbal S, Keakabetse T, Kwamie A, Mokalake E, Mupara LM, Seitio-Kgokgwe O, Zafar S, Cobos Muñoz D. Development of the Systems Thinking for Health Actions framework: a literature review and a case study. BMJ Glob Health 2023; 8:bmjgh-2022-010191. [PMID: 36931663 PMCID: PMC10030275 DOI: 10.1136/bmjgh-2022-010191] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/19/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Systems thinking is an approach that views systems with a holistic lens, focusing on how components of systems are interconnected. Specifically, the application of systems thinking has proven to be beneficial when applied to health systems. Although there is plenty of theory surrounding systems thinking, there is a gap between the theoretical use of systems thinking and its actual application to tackle health challenges. This study aimed to create a framework to expose systems thinking characteristics in the design and implementation of actions to improve health. METHODS A systematised literature review was conducted and a Taxonomy of Systems Thinking Objectives was adapted to develop the new 'Systems Thinking for Health Actions' (STHA) framework. The applicability of the framework was tested using the COVID-19 response in Pakistan as a case study. RESULTS The framework identifies six key characteristics of systems thinking: (1) recognising and understanding interconnections and system structure, (2) identifying and understanding feedback, (3) identifying leverage points, (4) understanding dynamic behaviour, (5) using mental models to suggest possible solutions to a problem and (6) creating simulation models to test policies. The STHA framework proved beneficial in identifying systems thinking characteristics in the COVID-19 national health response in Pakistan. CONCLUSION The proposed framework can provide support for those aiming to applying systems thinking while developing and implementing health actions. We also envision this framework as a retrospective tool that can help assess if systems thinking was applied in health actions.
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Affiliation(s)
- Jenna Thelen
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Carmen Sant Fruchtman
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Muhammad Bilal
- Public Health, Child Advocacy International, Islamabad, Pakistan
| | - Kebabonye Gabaake
- Public Health, Institute of Development Management, Gaborone, Botswana
| | - Shahid Iqbal
- Public Health, Child Advocacy International, Islamabad, Pakistan
| | | | - Aku Kwamie
- Alliance for Health Policy and Systems Research, World Health Organization, Geneve, Switzerland
| | - Ellen Mokalake
- Public Health, Institute of Development Management, Gaborone, Botswana
| | | | - Onalenna Seitio-Kgokgwe
- Monitoring Evaluation and Quality Assurance, Ministry of Health Botswana, Gaborone, Botswana
| | - Shamsa Zafar
- Department of Obstetrics and Gynecology, Fazaia Medical College, Islamabad, Pakistan
| | - Daniel Cobos Muñoz
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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26
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Opsomer S, Joossens S, Lauwerier E, De Lepeleire J, Pype P. Resilience in advanced cancer caregiving promoted by an intimate partner's support network: insights through the lens of complexity science. A framework analysis. BMC Palliat Care 2023; 22:12. [PMID: 36803396 PMCID: PMC9936125 DOI: 10.1186/s12904-023-01134-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 02/06/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND The tremendous physical and mental burden that comes with caregiving puts the intimate partners of patients diagnosed with advanced cancer at risk for mental disorders. However, most partners seem to be protected by resilience. Such a resilience process is promoted by certain individual characteristics (e.g., flexibility, positive attitude, internal strength, capacity to balance incoming and outgoing information, and ability to ask for and accept support and advice) and by the availability of a support network, consisting of family, friends, and healthcare professionals. Such a heterogeneous group striving towards the same goals can be considered a complex adaptive system (CAS), a concept stemming from complexity science. AIMS To study the behavior of the support network through the lens of complexity science and to provide insights to the means by which an available network may promote resilience. METHODS Nineteen interviews with members from the support networks of eight intimate partners were analyzed deductively using the CAS principles as a coding framework. Subsequently, the quotes under each principle were coded inductively to concretize patterns in the behavior of the support networks. Eventually, the codes were charted into a matrix to identify intra- and inter-CAS similarities, differences, and patterns. FINDINGS The network's behavior adapts dynamically to the changing circumstances as the patient's prognosis worsens. Furthermore, the behavior is based on internalized basic rules (such as reassuring availability and maintaining communication without being intrusive), attractors (e.g., feeling meaningful, appreciated, or connected), and the history of the support network. However, the interactions are non-linear and often unpredictable due to the context member's own concerns, needs, or emotions. CONCLUSIONS Applying the lens of complexity science to the behavior of an intimate partner's support network gives us insight into the network's behavioral patterns. Indeed, a support network is a dynamic system that behaves according to the principles of a CAS and adapts resiliently to the changing circumstances as the patient's prognosis worsens. Moreover, the behavior of the support network appears to promote the intimate partner's resilience process throughout the patient's care period.
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Affiliation(s)
- Sophie Opsomer
- Academic Centre for General Practice, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33, box 7001, 3000, Leuven, Belgium. .,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Sofie Joossens
- grid.451396.cProgram of Health, University Colleges Leuven - Limburg, Leuven, Belgium
| | - Emelien Lauwerier
- grid.5342.00000 0001 2069 7798Department of Public Health and Primary Care, Ghent University, Ghent, Belgium ,grid.5342.00000 0001 2069 7798Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Jan De Lepeleire
- grid.5596.f0000 0001 0668 7884Academic Centre for General Practice, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33, box 7001, 3000 Leuven, Belgium
| | - Peter Pype
- grid.5342.00000 0001 2069 7798Department of Public Health and Primary Care, Ghent University, Ghent, Belgium ,grid.5342.00000 0001 2069 7798End-of-Life Care Research Group, Ghent University Campus, Ghent, Belgium
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27
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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.
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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
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28
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Kejžar A, Dimovski V, Colnar S. The impact of knowledge management on the quality of services in nursing homes. Front Psychol 2023; 13:1106014. [PMID: 36743605 PMCID: PMC9893278 DOI: 10.3389/fpsyg.2022.1106014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/29/2022] [Indexed: 01/21/2023] Open
Abstract
Introduction Current management strategies in nursing homes (NH) aim to ensure effective knowledge management (KM) in order to provide both best possible services to residents, and care for staff in NH. Teamwork in NH is essential for effective delivery of the highest quality of services. As a result, NH are increasingly adopting KM activities to enable knowledge creation, storage, transfer, and implementation in an environment facing many challenges such as lack of staff, increasing demands, and expectations of residents. Methods In our quantitative study, we examined how two Slovenian state NH that adopted the E-Qalin quality management model (European quality-improving learning model) adapted their KM, and what impact their quality management system and KM activities actually have on the quality of services. Furthermore, we examined how two Slovenian private NH that have not adopted a certified quality management program (like ISO or E-Qalin) tackle the issue of quality of services from the KM perspective. The sample consisted of 80 nursing professionals. In every NH that is part of this study, teamwork is essential and every individual that was involved in our survey is part of a team. In our study, we analyzed relationships between individual variables using linear regression. Results We found a significant and positive relationship between knowledge creation, transfer, and implementation in NH with and without the E-Qalin certificate. We found a significant and positive relationship between knowledge storage and the quality of services only in NH without a E-Qualin certificate. It seems that when connecting multidisciplinary fields such as NH and KM, there is still a lack of awareness and knowledge on the topic of KM, which might be one of the reasons for some bias in the answers provided by respondents. We also found different teamwork approaches in NH with and without a E-Qalin certificate. Our research results therefore emphasize the need to gain additional insight into quality management and KM in the environment of NH. Conclusion Teamwork based on knowledge storage, transfer, the implementation of existing knowledge, and creation of new knowledge are essential for well-trained professionals and, as a result, contribute to continuous improvement in service quality. Implementation of KM is well received by NH, and enables them to better meet the needs and expectations of residents. More importantly, nursing staff also share and pass on tacit knowledge through teamwork. Finally, all of the NH in our study that implemented quality and KM activities noted an improvement in the quality of services that are offered to residents in practice. Our results indicate that the topic of KM in NH is interesting, and it has a positive impact on the quality of services in practice. However, the problem of awareness and knowledge on the topic of KM in the environment of NH still exists, highlighting the need for further research, additional insight, and dissemination of knowledge to every interested stakeholder functioning in the field of NH. The results of the study make an important contribution to the research of KM in NH, focusing on the transfer of tacit knowledge.
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Affiliation(s)
- Anamarija Kejžar
- Faculty of Social Work, University of Ljubljana, Ljubljana, Slovenia,*Correspondence: Anamarija Kejžar, ✉
| | - Vlado Dimovski
- School of Economics and Business, University of Ljubljana, Ljubljana, Slovenia
| | - Simon Colnar
- School of Economics and Business, University of Ljubljana, Ljubljana, Slovenia
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29
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de Graaf E, Grant M, van de Baan F, Ausems M, Verboeket-Crul C, Leget C, Teunissen S. Variations in Clinical Practice: Assessing Clinical Care Processes According to Clinical Guidelines in a National Cohort of Hospice Patients. Am J Hosp Palliat Care 2023; 40:87-95. [PMID: 35531900 DOI: 10.1177/10499091221100804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: National clinical guidelines have been developed internationally to reduce variations in clinical practices and promote the quality of palliative care. In The Netherlands, there is considerable variability in the organisation and care processes of inpatient palliative care, with three types of hospices - Volunteer-Driven Hospices (VDH), Stand-Alone Hospices (SAH), and nursing home Hospice Units (HU). Aim: This study aims to examine clinical practices in palliative care through different hospice types and identify variations in care. Methods: Retrospective cohort study utilising clinical documentation review, including patients who received inpatient palliative care at 51 different hospices and died in 2017 or 2018. Care provision for each patient for the management of pain, delirium and palliative sedation were analysed according to the Dutch national guidelines. Results: 412 patients were included: 112 patients who received treatment for pain, 53 for delirium, and 116 patients underwent palliative sedation therapy. Care was provided in accordance with guidelines for pain in 32%, 61% and 47% (P = .047), delirium in 29%, 78% and 79% (P = .0016), and palliative sedation in 35%, 63% and 42% (P = .067) of patients who received care in VDHs, SAHs and HUs respectively. When all clinical practices were considered, patient care was conducted according to the guidelines for 33% of patients in VDHs, 65% in SAHs, and 50% in HUs (P < .001). Conclusions: The data demonstrate that care practices are not standardised throughout Dutch hospices and exhibit significant variations between type of hospice.
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Affiliation(s)
- Everlien de Graaf
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, 8124University Medical Center Utrecht, Utrecht, The Netherlands
| | - Matthew Grant
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, 8124University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frederieke van de Baan
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, 8124University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marijke Ausems
- 8106The Dutch College of General Practitioners, Palliative Care Physician, Utrecht, The Netherlands
| | | | - Carlo Leget
- University of Humanistic Studies, Utrecht, The Netherlands
| | - Saskia Teunissen
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, 8124University Medical Center Utrecht, Utrecht, The Netherlands
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30
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Cai J, Wu R, Zhang J, Sun X. The effect of subliminal priming on team trust: The mediating role of perceived trustworthiness. Front Psychol 2023; 14:1099267. [PMID: 36910825 PMCID: PMC9998700 DOI: 10.3389/fpsyg.2023.1099267] [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: 11/15/2022] [Accepted: 01/30/2023] [Indexed: 02/26/2023] Open
Abstract
The present study aimed to explore the effect of subliminal priming on team trust and the mechanism through the mediating role of perceived trustworthiness. A total of 144 participants were asked to complete a lexical decision task that was embedded with the "trust" or "suspicion" Chinese words as the subliminal stimuli. Then, they played a public good game and evaluated the perceived trustworthiness of the team. The results of the study showed that subliminal stimuli had a significant effect on team trust [β = -0.99, 95% CI = (-1.64, -0.33)]. Perceived trustworthiness was found to have a significant mediating effect between the priming condition and team trust [β = -0.35, 95% CI = (-0.72, -0.02)]. The current study revealed the underlying mechanism through which subliminal priming techniques influence team trust and informed efforts by altering perceived trustworthiness.
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Affiliation(s)
- Jie Cai
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.,Department of Psychology, Zhejiang Sci-Tech University, Hangzhou, China
| | - Rongxiu Wu
- Science Education Department, Harvard-Smithsonian Center for Astrophysics, Harvard University, Cambridge, MA, United States
| | - Jingyu Zhang
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xianghong Sun
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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31
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Bruening RA, Sperber N, Wang V, Mahanna E, Choate A, Tucker M, Zullig LL, Van Houtven CH, Allen KD, Hastings SN. Self-Organization of Interprofessional Staff to Improve Mobility of Hospitalized Patients with STRIDE: a Complexity Science-Informed Qualitative Study. J Gen Intern Med 2022; 37:4216-4222. [PMID: 35319083 PMCID: PMC9708971 DOI: 10.1007/s11606-022-07482-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/03/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Inpatient mobility programs can help older adults maintain function during hospitalization. Changing hospital practice can be complex and require engagement of various staff levels and disciplines; however, we know little about how interprofessional teams organize around implementing such interventions. Complexity science can inform approaches to understanding and improving multidisciplinary collaboration to implement clinical programs. OBJECTIVE To examine, through a complexity science lens, how clinical staff's understanding about roles in promoting inpatient mobility evolved during implementation of the STRIDE (assiSTed eaRly mobIlity for hospitalizeD older vEterans) hospital mobility program. DESIGN Qualitative study using semi-structured interviews. PARTICIPANTS Ninety-two clinical staff at eight Veterans Affairs hospitals. INTERVENTIONS STRIDE is a supervised walking program for hospitalized older adults designed to maintain patients' mobility and function. APPROACH We interviewed key staff involved in inpatient mobility efforts at each STRIDE site in pre- and post-implementation periods. Interviews elicited staff's perception of complexity-science aspects of inpatient mobility teams (e.g., roles over time, team composition). We analyzed data using complexity science-informed qualitative content analysis. KEY RESULTS We identified three key themes related to patterns of self-organization: (1) individuals outside of the "core" STRIDE team voluntarily assumed roles as STRIDE advocates, (2) leader-champions adapted their engagement level to match local implementation team needs during implementation, and (3) continued leadership support and physical therapy involvement were key factors for sustainment. CONCLUSIONS Staff self-organized around implementation of a new clinical program in ways that were responsive to changing program and contextual needs. These findings demonstrate the importance of effective self-organization for clinical program implementation. Researchers and practitioners implementing clinical programs should allow for, and encourage, flexibility in staff roles in planning for implementation of a new clinical program, encourage the development of advocates, and engage leaders in program planning and sustainment efforts.
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Affiliation(s)
- Rebecca A Bruening
- ADAPT Center of Innovation, Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
| | - Nina Sperber
- ADAPT Center of Innovation, Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA.
- Department of Population Health Sciences, Duke University School of Medicine, Durham, USA.
| | - Virginia Wang
- ADAPT Center of Innovation, Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, USA
- Department of Medicine, Duke University School of Medicine, Durham, USA
| | - Elizabeth Mahanna
- ADAPT Center of Innovation, Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
| | - Ashley Choate
- ADAPT Center of Innovation, Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
| | - Matthew Tucker
- ADAPT Center of Innovation, Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
| | - Leah L Zullig
- ADAPT Center of Innovation, Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, USA
| | - Courtney Harold Van Houtven
- ADAPT Center of Innovation, Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, USA
| | - Kelli D Allen
- ADAPT Center of Innovation, Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Department of Medicine and Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Susan N Hastings
- ADAPT Center of Innovation, Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, USA
- Department of Medicine, Duke University School of Medicine, Durham, USA
- Center for the Study of Aging and Human Development, Duke University, Durham, USA
- Geriatrics Research, Education, and Clinical Center, Durham VA Health Care System, Durham, USA
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Slaghmuylder Y, Pype P, Van Hecke A, Lauwerier E. Exploring healthcare providers’ perceptions regarding the prevention and treatment of chronic pain in breast cancer survivors: A qualitative analysis among different disciplines. PLoS One 2022; 17:e0273576. [PMID: 36006950 PMCID: PMC9409579 DOI: 10.1371/journal.pone.0273576] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/10/2022] [Indexed: 12/02/2022] Open
Abstract
Background The prevention and treatment of chronic pain problems in breast cancer follow-up care require an adequate response from healthcare providers. Generally, this involves the uptake of evidence-based principles regarding pain management in everyday practice. However, despite the extensive literature on effective pain interventions, systematic and coordinated follow-up care is lacking for breast cancer survivors with pain problems in Flanders, Belgium. Objective This study aimed to gather insight into healthcare providers’ perceptions of pain prevention and treatment in breast cancer follow-up care, particularly with attention to the multilevel influences on pain follow-up. Methods We conducted four online focus groups with twenty-two healthcare providers from different disciplines such as oncologists, pharmacists, nurses, physiotherapists, and psychologists. Data analysis was guided by the Qualitative Analysis Guide of Leuven. This guide is inspired by the constant comparison method, based on Grounded Theory. Results The identified influencing factors were thematically grouped into four levels: at the level of the individual healthcare provider, in interaction with the patient, in interaction with colleagues, and at the context level. At each level, we distinguished factors related to healthcare providers’ perceptions such as awareness, knowledge, attitudes, beliefs, experiences, and intentions. For example, because of a lack of knowledge and certain beliefs among healthcare providers, referral to other disciplines often does not happen in the context of pain. Conclusion This study points out the need to explore the prevention and treatment of chronic pain after breast cancer from a multidimensional point of view. This involves not only the characteristics of individual healthcare providers but is also inherently interactional and system-like in nature. This analysis provides opportunities for the development of interventions that target the influencing factors of prevention and treatment of chronic pain in breast cancer survivors.
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Affiliation(s)
- Yaël Slaghmuylder
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, InterProfessional Collaboration in Education, Research and Practice (IPC-ERP), Ghent University, Ghent, Flanders, Belgium
- * E-mail:
| | - Peter Pype
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, InterProfessional Collaboration in Education, Research and Practice (IPC-ERP), Ghent University, Ghent, Flanders, Belgium
| | - Ann Van Hecke
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, InterProfessional Collaboration in Education, Research and Practice (IPC-ERP), Ghent University, Ghent, Flanders, Belgium
- Nursing Department, Ghent University Hospital, Ghent, Flanders, Belgium
| | - Emelien Lauwerier
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, InterProfessional Collaboration in Education, Research and Practice (IPC-ERP), Ghent University, Ghent, Flanders, Belgium
- Faculty of Psychology and Educational Sciences, Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Flanders, Belgium
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Ndateba I, Wong ST, Beaumier J, Burge F, Martin-Misener R, Hogg W, Wodchis W, McGrail K, Johnston S. Primary care practice characteristics associated with team functioning in primary care settings in Canada: A practice-based cross-sectional survey. J Interprof Care 2022; 37:352-361. [PMID: 35880781 DOI: 10.1080/13561820.2022.2099359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Team-based care is recognized as a foundational building block of high-performing primary care. The purpose of this study was to identify primary care practice characteristics associated with team functioning and examine whether there is relationship between team composition or size and team functioning. We sought to answer the following research questions: (1) are primary care practice characteristics associated with team functioning; and (2) does team composition or size influence team functioning. This cross-sectional correlational study was conducted in Fraser East, British Columbia, Eastern Ontario Health Unit, Ontario and Central Zone, Nova Scotia in Canada. Data were collected from primary care practices using an organization survey and the Team Climate Inventory (TCI) as a measure team functioning. The independent variables of interest were: physicians' payment model, internal clinic meetings to discuss clinical issues, care coordination through informal and ad hoc exchange, care coordination through electronic medical records and sharing clinic mission, values and objectives among health professionals. Potentially confounding variables were as follows: team size, composition, and practice panel size. A total of 63 practices were included in these analyses. The overall mean score of team climate was 73 (SD: 10.75) out of 100. Regression analyses showed that care coordination through human interaction and sharing the practice's mission, values, and objectives among health professionals were positively associated with higher functioning teams. Care coordination through electronic medical records and larger team size were negatively associated with team climate. This study provides baseline data on what practice characteristics are associated with highly functioning teams in Canada.
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Affiliation(s)
- Innocent Ndateba
- School of Nursing, University of British Columbia, Vancouver, Canada.,Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada
| | - Sabrina T Wong
- School of Nursing, University of British Columbia, Vancouver, Canada.,Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada
| | - Jonathan Beaumier
- School of Nursing, University of British Columbia, Vancouver, Canada.,Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada
| | | | | | - William Hogg
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Walter Wodchis
- University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto, Canada
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Sharon Johnston
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
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Turato G, Whiteoak J, Oprescu F. Allied health front-line manager perceptions of factors impacting workplace morale and burnout risk. J Health Organ Manag 2022; ahead-of-print. [PMID: 35731943 DOI: 10.1108/jhom-09-2021-0355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This exploratory case study investigated the factors impacting employee morale and burnout risk among allied health professionals operating within a large Australian public hospital. The study aimed to understand what factors may positively influence group morale and reduce burnout risk. DESIGN/METHODOLOGY/APPROACH Qualitative data was collected using semi-structured interviews and focus groups with 30 Allied Health Managers. A manual thematic analysis and confirmatory content analysis (viz., Leximancer) identified several prominent themes impacting morale and potential burnout risk. FINDINGS Key factors impacting allied health morale and contributing to burnout risk were captured in three main themes. The first included processes and relationships between people that were contributing to the culture negatively. The second identified the general lack of management training and limited capability of supervisors and leaders in human resource skills. The third theme identified change, high workloads and ineffective systems that were not supporting managers to be effective in their roles. This was also considered to be stifling internal innovation. RESEARCH LIMITATIONS/IMPLICATIONS This case study took a top-down approach which may have provided a biased viewpoint from the managers perspective, rather than the perspective of all levels. The findings are within one context, hence there is a potential lack of generalisability. A final limitation is that this project collected and interpreted data through processes of social interaction and relied on the individual perception, skill and knowledge of the researchers, which may cause some uncertainty in the findings. PRACTICAL IMPLICATIONS These findings support prioritising the evidence-based development of leadership and management competencies that have a focus on human resource management in hospitals. The study findings support the adoption of the theoretical framework of a systems approach to leadership that encourages the concept of being a learning organisation that creates pod-synergy within teams to enhance healthy personal, organisational and clinical outcomes. Adopting an empathetic leadership style that seeks to understand and support staff could improve staff morale within public health organisations and prevent burnout risk. Training managers with the skills and abilities to support autonomy amongst employees will support employee motivation and satisfaction in the workplace. SOCIAL IMPLICATIONS The findings were discussed using a socio technical system thinking perspective. This involves understanding the people (both leaders and front-line workers) and the systems and how they interact to support positive workplace morale. ORIGINALITY/VALUE Limited research has empirically explored from a socio-technical systems perspective how the systems and structures in healthcare organisations support allied health managers and employees in their role. Furthermore, the results provide new insights that encourage a more empathetic systems approach to leadership, one that supports social relationships and encourages pod-synergy amongst employees. Together these findings delivered strategies that can buffer against low morale and burnout risk among allied health care workers. This is an area that arguably has not yet been adequately addressed in allied health.
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Affiliation(s)
- Gemma Turato
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sunshine Coast, Australia.,Allied Health Service, Sunshine Coast Hospital and Health Service, Birtinya, Australia
| | - John Whiteoak
- School of Business and Creative Industries, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Florin Oprescu
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sunshine Coast, Australia
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Persson MH, Søndergaard J, Mogensen CB, Skjøt-Arkil H, Andersen PT. Healthcare professionals' experiences and attitudes to care coordination across health sectors: an interview study. BMC Geriatr 2022; 22:509. [PMID: 35729544 PMCID: PMC9210644 DOI: 10.1186/s12877-022-03200-6] [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: 03/10/2022] [Accepted: 06/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background The number of older people is increasing, resulting in more people endure chronic diseases, multimorbidities and complex care needs. Insufficient care coordination across healthcare sectors has negative consequences for health outcomes, costs and patient evaluation. Despite introducing initiatives to solve coordination challenges within healthcare, the need remains for more consistent solutions. In particular, improved care coordination would benefit older adults characterised by complex care needs, high use of healthcare resources and multiple care providers. Aims and objectives To identify and analyse healthcare professionals’ perspectives and approaches to care coordination across sectors when older people are acutely hospitalised. Design Qualitative interview study. Methods Semi-structured, individual interviews with 13 healthcare professionals across health sectors and professions were conducted. The strategy for the qualitative analysis was inspired by Kirsti Malterud and labelled ‘systematic text condensation’. This strategy is a descriptive and explorative method for thematic cross-case analysis of qualitative data. Results Four themes/categories emerged from the analysis; “Organisational factors”, “Approaches to care”, “Communication and knowledge”, and “Relations”. Conclusion Different organisational cultures can discourage intersectoral care coordination. Approaches to care vary at all levels across health sectors and professions. Organisational, leadership and professional identity affect the working cultures and must be considered in the future recruitment and socialisation of healthcare staff. Our research suggests that combinations of healthcare standardisations and flexible, adaptive solutions are required to improve intersectoral care coordination. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03200-6.
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Affiliation(s)
- Maiken Hjuler Persson
- Department of Public Health, University of Southern Denmark, Degnevej 14, 6705, Esbjerg, Denmark.
| | - Jens Søndergaard
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J. B. Winsløws Vej 9A, 5000, Odense, Denmark
| | - Christian Backer Mogensen
- Emergency Department, Hospital Sønderjylland, Kresten Philipsens vej 15, 6200, Aabenraa, Denmark.,Department of Regional Health Research, University of Southern, Winsløwparken 19,3, 5000, Odense, Denmark
| | - Helene Skjøt-Arkil
- Emergency Department, Hospital Sønderjylland, Kresten Philipsens vej 15, 6200, Aabenraa, Denmark.,Department of Regional Health Research, University of Southern, Winsløwparken 19,3, 5000, Odense, Denmark
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Huber C, Montreuil C, Christie D, Forbes A. Integrating Self-Management Education and Support in Routine Care of People With Type 2 Diabetes Mellitus: A Conceptional Model Based on Critical Interpretive Synthesis and A Consensus-Building Participatory Consultation. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:845547. [PMID: 36992783 PMCID: PMC10012123 DOI: 10.3389/fcdhc.2022.845547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/23/2022] [Indexed: 11/13/2022]
Abstract
The integration of self-management education and support into the routine diabetes care is essential in preventing complications. Currently, however, there is no consensus on how to conceptualise integration in relation to self-management education and support. Therefore, this synthesis presents a framework conceptualising integration and self-management.MethodsSeven electronic databases (Medline, HMIC, PsycINFO, CINAHL, ERIC, Scopus and Web of Science) were searched. Twenty-one articles met the inclusion criteria. Data were synthesised using principles of critical interpretive synthesis to build the conceptual framework. The framework was presented to 49 diabetes specialist nurses working at different levels of care during a multilingual workshop.ResultsA conceptual framework is proposed in which integration is influenced by five interacting components: the programme ethos of the diabetes self-management education and support intervention (content and delivery), care system organisation (the framework in which such interventions are delivered), adapting to context (the aspects of the people receiving and delivering the interventions), interpersonal relationship (the interactions between the deliverer and receiver of the intervention), and shared learning (what deliverer and receiver gain from the interactions). The critical inputs from the workshop participants related to the different priorities given to the components according to their sociolinguistic and educational experiences, Overall, they agreed with the conceptualisation of the components and their content specific to diabetes self-management education and support.DiscussionIntegration was conceptualised in terms of the relational, ethical, learning, contextual adapting, and systemic organisational aspects of the intervention. It remains uncertain which prioritised interactions of components and to what extent these may moderate the integration of self-management education and support into routine care; in turn, the level of integration observed in each of the components may moderate the impact of these interventions, which may also apply to the impact of the professional training.ConclusionThis synthesis provides a theoretical framework that conceptualises integration in the context of diabetes self-management education and support in routine care. More research is required to evaluate how the components identified in the framework can be addressed in clinical practice to assess whether improvements in self-management education and support can be effectively realised in this population.
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Affiliation(s)
- Claudia Huber
- HES-SO University of Applied Sciences and Arts Western Switzerland, School of Health Science Fribourg, Fribourg, Switzerland
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, James Clerk Maxwell Building, London, United Kingdom
- *Correspondence: Claudia Huber,
| | - Chantal Montreuil
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | - Derek Christie
- HES-SO University of Applied Sciences and Arts Western Switzerland, School of Health Science Fribourg, Fribourg, Switzerland
| | - Angus Forbes
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, James Clerk Maxwell Building, London, United Kingdom
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Devery K, Winsall M, Rawlings D. Teams and continuity of end-of-life care in hospitals: managing differences of opinion. BMJ Open Qual 2022; 11:bmjoq-2021-001724. [PMID: 35443999 PMCID: PMC9021766 DOI: 10.1136/bmjoq-2021-001724] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/31/2022] [Indexed: 11/21/2022] Open
Abstract
Background Recognised as an essential element in end-of-life care by the Australian Commission on Safety and Quality in Health Care, effective teamwork can enhance the quality and safety of end-of-life care for patients in hospitals. End-of-Life Essentials (EOLE) is a Commonwealth funded project that delivers peer-reviewed, evidence-based, online education and practice change resources for doctors, nurses and allied health professionals working in hospitals. ‘Teams and Continuity for the Patient’ features in the suite of EOLE modules and includes education around effective teamwork in end-of-life care. The aim of this study was to explore the views of module learners on managing differences of opinion among staff regarding patient care management. Methods Participants were learners (health professionals) who registered to the EOLE website and engaged with the Teams module. Learner responses to a question posed at the end of the module ‘How do you manage differences of opinion among staff regarding patient care management?’ were extracted for a 12-month period. Qualitative data were analysed thematically in NVivo V.12, with pragmatism as an overarching theoretical framework. Data were coded using an inductive, open approach, and axial coding was used to organise the codes into themes and subthemes. Findings A total of 293 learner statements were analysed, with subthemes organised into three overarching themes: prioritising the patient, team collaboration and communication skills and emotional awareness. Conclusion In complex, fast-paced, hospital environments, the potential for conflict among teams is high. Quality care relies on team members who work in unison, who can also recognise conflict emerging and respond in respectful and appropriate ways. In this study, the management actions reported by health professionals as proving helpful when differences of opinion among team members arise, are valuable to organisations who are considering how to prepare for quality and safety accreditation.
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Affiliation(s)
- Kim Devery
- Palliative and Supportive Services, Flinders University, Bedford Park, South Australia, Australia
| | - Megan Winsall
- Palliative and Supportive Services, Flinders University, Bedford Park, South Australia, Australia
| | - Deb Rawlings
- Palliative and Supportive Services, Flinders University, Bedford Park, South Australia, Australia
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Borghmans F. The radical and requisite openness of viable systems: Implications for healthcare strategy and practice. J Eval Clin Pract 2022; 28:324-331. [PMID: 33977559 DOI: 10.1111/jep.13576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/18/2021] [Indexed: 11/29/2022]
Abstract
This paper addresses an ontological question about the nature of health and challenges some underpinning assumptions in western healthcare. In its analysis, health in its various statuses, is framed as a naturally occurring complex adaptive system made up of dynamically interacting subsystems that include the physiological, psychological, and social realms. Furthermore, openness in complex systems such as health, is necessary for the exchange of energy, information, and resources. Yet, within healthcare much effort is invested in constraining systems' behaviours, whether they be systems of knowledge, health, healthcare, and more. This paper draws on the complexity sciences and Levinasian philosophy to explicate the essential role of system openness in individual, population, and systemic viability. It highlights holism to be "not whole-ism", and system openness to be, not just a reality, but a critical feature of viability. Hence requisite openness is advocated as essential to efficacious and ethical healthcare practice and strategy, and vital for health.
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Affiliation(s)
- Felice Borghmans
- Faculty of Education, Monash University, Wellington Road, Clayton, Victoria, 3800, Australia
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Zimmerman S, Resnick B, Ouslander J, Levy C, Gaugler JE, Sloane PD, Mor V. Pragmatic Trials and Improving Long-Term Care: Recommendations From a National Institutes of Health Conference. J Am Med Dir Assoc 2022; 23:323-327. [DOI: 10.1016/j.jamda.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/06/2022] [Indexed: 12/27/2022]
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40
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Zimmerman S, Resnick B, Ouslander J, Levy C, Gaugler JE, Sloane PD, Mor V. Pragmatic Trials and Improving Long-Term Care: Recommendations From a National Institutes of Health Conference. J Am Geriatr Soc 2022; 70:688-694. [PMID: 35195278 PMCID: PMC8915540 DOI: 10.1111/jgs.17697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research and Schools of Social Work and Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Address correspondence to Sheryl Zimmerman, PhD, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr Blvd, Campus Box 7590, Chapel Hill, NC 27599-7590, USA. (S. Zimmerman)
| | - Barbara Resnick
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Joseph Ouslander
- Department of Integrated Medical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Cari Levy
- Department of Veterans Affairs, Rocky Mountain Regional VA Medical Center, and University of Colorado, Aurora, CO, USA
| | - Joseph E. Gaugler
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Philip D. Sloane
- Cecil G. Sheps Center for Health Services Research and Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Vincent Mor
- Center of Innovation in Long-term Services and Supports, Providence VA Medical Center; Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
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Derksen C, Kötting L, Keller FM, Schmiedhofer M, Lippke S. Psychological Intervention to Improve Communication and Patient Safety in Obstetrics: Examination of the Health Action Process Approach. Front Psychol 2022; 13:771626. [PMID: 35250715 PMCID: PMC8894763 DOI: 10.3389/fpsyg.2022.771626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/19/2022] [Indexed: 01/23/2023] Open
Abstract
Background Human failure and a lack of effective communication are the main reasons for preventable adverse events, compromising patient safety in obstetrics. In order to improve safety, team and communication interventions have been implemented but lack feasibility in obstetric care. Psychological models such as the health action process approach might help to improve interventions. Methods In a cross-sectional online survey with N = 129 healthcare workers (Study 1) and a paper-pencil survey with N = 137 obstetric healthcare workers at two obstetric university hospitals (Study 2), associations of social-cognitive variables were tested in a path analysis and a multiple regression. Preliminary results informed a communication training for all obstetric healthcare workers. A repeated-measures MANOVA was used to compare pre- and post-intervention data. Results Social-cognitive variables were associated according to model suggestions (β = –0.26 to 0.45, p < 0.05) except for planning in the first study. Triggers of adverse events were associated (β = –0.41 to 0.24, p < 0.05) with communication behavior (Study 2), action self-efficacy and planning (Study 1), as well as barriers to effective communication (both studies). The intervention was rated positively (M = 3.3/4). Afterward, fewer triggers were reported and coping self-efficacy increased. There were group differences regarding hospital, experience, and time. Discussion The health action process approach was examined in the context of safe communication in obstetrics and can be used to inform interventions. A theory-based, short training was feasible and acceptable. Perceived patient safety improved but communication behavior did not. Future research should aim to test a more comprehensive psychological communication intervention in a thorough RCT design.
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Affiliation(s)
- Christina Derksen
- Health Psychology and Behavioral Medicine, Psychology and Methods, Jacobs University Bremen, Bremen, Germany
- *Correspondence: Christina Derksen,
| | - Lukas Kötting
- Health Psychology and Behavioral Medicine, Psychology and Methods, Jacobs University Bremen, Bremen, Germany
| | - Franziska Maria Keller
- Health Psychology and Behavioral Medicine, Psychology and Methods, Jacobs University Bremen, Bremen, Germany
| | - Martina Schmiedhofer
- Health Psychology and Behavioral Medicine, Psychology and Methods, Jacobs University Bremen, Bremen, Germany
- Coalition for Patient Safety e.V., Berlin, Germany
| | - Sonia Lippke
- Health Psychology and Behavioral Medicine, Psychology and Methods, Jacobs University Bremen, Bremen, Germany
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Grant MP, Philip JAM, Deliens L, Komesaroff PA. Understanding Complexity in Care: Opportunities for Ethnographic Research in Palliative Care. J Palliat Care 2022:8258597221078375. [PMID: 35167402 DOI: 10.1177/08258597221078375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Ethnography has been used to address a broad range of research questions in health care. With ethnographic research methods it is possible to gain access to the complex realities of health care practice as it occurs, through interpreting the nuances of individual and team behaviours, the roles and dynamics of care provision, and the social impacts and influences of illness. The provision of clinical palliative care is complex, involving multidisciplinary collaboration across different health systems, and is subject to a multitude of personal, cultural and environmental influences. This complexity demands creative methodological approaches to research in palliative care, of which ethnography plays an important, if infrequently utilised, role. Aim: This article aims to explore potential opportunities of ethnographic methods for palliative care research. Findings: Ethnographic methods focuses on behaviour in the 'natural' setting of participants, to create theoretical descriptions of events, cultures, interactions and experiences. In palliative care these methods may provide nuanced understandings of illness, relationships and teams, communication, medical education, complex care provision, and novel or changing health practices. Of particular importance is the potential of these methods to understand complex practices and processes, and engage with under-represented population groups who may be excluded from interview research. Conclusion: Ethnography offers important opportunities for future research in palliative care and should be considered as part of the 'research toolbox' to improve understanding of the complex nature of care provision and the experiences of illness and loss.
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Affiliation(s)
- Matthew P Grant
- Palliative Nexus Research Group, Department of Medicine, University of Melbourne, Parkville Victoria, Australia
- St Vincent's Hospital Melbourne
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
- Monash University
| | - Jennifer A M Philip
- Palliative Nexus Research Group, Department of Medicine, University of Melbourne, Parkville Victoria, Australia
- St Vincent's Hospital Melbourne
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
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Marshall AD, Rance J, Grebely J, Treloar C. 'Not just one box that you tick off' - Deconstructing the hepatitis C care cascade in the interferon-free direct acting antiviral era from the client perspective. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 102:103610. [PMID: 35151085 DOI: 10.1016/j.drugpo.2022.103610] [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: 10/28/2021] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND To achieve hepatitis C viral (HCV) elimination targets set by the World Health Organisation, pillars of the HCV care cascade are often referenced to track progress. The aim of this qualitative study was to explore the limitations of the care cascade framework through the real-world accounts of 'HCV journeys' among people who inject drugs (PWID), with particular attention to the intersection of PWID agency and structural determinants in the healthcare system. METHODS An in-depth analysis was conducted on five case studies to better understand participant experiences 'behind the cascade pillars'. The five case studies were drawn from the ETHOS Engage cohort as exemplars of the real-world complexities of people's HCV cascade journeys. Inclusion criteria for the qualitative study were participant has voluntarily signed the informed consent form, aged ≥18 years, HCV antibody positive by self-report, clients of selected sites participating in the ETHOS Engage cohort, and sufficiently proficient in English to participate in an interview. Thirty-four semi-structured interviews were conducted with participants who had received or had not received HCV treatment to identify barriers and facilitators to HCV care. RESULTS Participants 'housed' at the 'HCV RNA diagnosed pillar' (n = 2; Will; Julie) reported withholding their HCV serostatus in certain healthcare settings for fear that disclosure would lead to discriminatory decision-making from their treating physician. among participants who had completed treatment (n = 3; Corey; John; Nora) two reported still being unsure of their HCV status >6 months post-treatment. Ongoing feelings of frustration and shame were expressed in this 'post-cure care pillar' due to a perceived lack of quality care from clinic services and continued uneasiness when discussing drug use and reinfection while receiving opioid agonist treatment (OAT). Both case 'categories' described often tenuous therapeutic relationships with their physicians and recommended task-shifting to nurses and trusted case workers for ongoing care. CONCLUSION The care cascade provides a linear, two dimensional snapshot of clinical targets. Our findings illuminate structural barriers not visible behind its 'static' pillars, presenting insights into experiences among PWID otherwise dismissed as 'disengaged' or 'lost to follow-up'.
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Affiliation(s)
- A D Marshall
- The Kirby Institute, UNSW Sydney, Australia; Centre for Social Research in Health, UNSW Sydney, Australia.
| | - J Rance
- Centre for Social Research in Health, UNSW Sydney, Australia
| | - J Grebely
- The Kirby Institute, UNSW Sydney, Australia
| | - C Treloar
- Centre for Social Research in Health, UNSW Sydney, Australia
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Zimmerman S, Resnick B, Ouslander J, Levy C, Gaugler JE, Sloane PD, Mor V. Pragmatic trials and improving long-term care: Recommendations from a national institutes of health conference. Geriatr Nurs 2022; 44:288-292. [DOI: 10.1016/j.gerinurse.2022.02.008] [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]
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Wei H. The development of an evidence-informed Convergent Care Theory: Working together to achieve optimal health outcomes. Int J Nurs Sci 2022; 9:11-25. [PMID: 35079601 PMCID: PMC8766786 DOI: 10.1016/j.ijnss.2021.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/17/2021] [Accepted: 12/17/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Healthcare is a complex and divergent system with uncertainty, unpredictability, and multi-layered stakeholders. The relationships among the stakeholders are multifaceted and dynamic, requiring continual interpersonal connections, networks, and co-evolution. It is pivotal to have an evidence-informed theory to explain the phenomenon, uniting the multifaceted stakeholders' efforts. PURPOSE To describe the development of an evidence-informed theory, the Convergent Care Theory, assembling healthcare stakeholders to work together and achieve optimal health outcomes. METHODS The Convergent Care Theory was developed using a theory synthesis approach based on empirical research and literature reviews published by the theory-proposing author. The empirical evidence was categorized into: patients and families, healthcare providers, healthcare organizations, and patients' and healthcare providers' self-care. RESULTS The Convergent Care Theory includes four concepts: all-inclusive organizational care , healthcare professional collaborative care, person-centered precision care, and patients ' and healthcare providers' self-care. Achieving convergent care is a process requiring all stakeholders to work together. Six major facilitators emerged from the research evidence: competence, compassion, accountability, trusting, sharing, and engaging. CONCLUSION This article introduced the development process of the evidence-informed Convergent Care Theory. Healthcare systems are complex, with multiple stakeholders' needs to meet. The Convergent Care Theory strives to unite healthcare stakeholders, bond resources, and join forces to achieve optimal healthcare outcomes. The underpinning of the theory is a caring culture, which is an underlying code for organizational and team behaviors and the foundation of optimal health outcomes.
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Affiliation(s)
- Holly Wei
- University of Louisville School of Nursing, Louisville, KY, USA
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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.
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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
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Opsomer S, Lauwerier E, De Lepeleire J, Pype P. Resilience in advanced cancer caregiving. A systematic review and meta-synthesis. Palliat Med 2022; 36:44-58. [PMID: 34986698 PMCID: PMC8796166 DOI: 10.1177/02692163211057749] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Close relatives provide much of the care to people with cancer. As resilience can shield family caregivers from mental health problems, there has been a burgeoning interest in resilience-promoting interventions. However, the evidence necessary for the development of these interventions is scant and unsynthesized. AIM To create an overall picture of evidence on resilience in cancer caregiving by a theory-driven meta-synthesis. DESIGN In this systematically constructed review a thematic synthesis approach has been applied. The original findings were coded and structured deductively according to the theoretical framework. Consequently, the codes were organized inductively into themes and subthemes. DATA SOURCES Through September 2019, five electronic databases were searched for qualitative studies on resilience in cancer caregiving. The search was extended by a supplementary hand search. Seventeen studies met the eligibility criteria. RESULTS The elements of resilience, as described in the pre-defined theoretical framework of Bonanno, are reflected in the lived experiences of family caregivers. The resilience process starts with the diagnosis of advanced cancer and may result in mental wellbeing, benefit finding, and personal growth. The process is influenced by context elements such as individual history, sociocultural background, caregiver characteristics, and the behavior of the supportive network. A repertoire of coping strategies that caregivers use throughout the caregiving process moderates the resilience process. CONCLUSION This review and theoretical synthesis reveal key elements of resilience in the process of cancer caregiving, including influencing factors and outcomes. Implications and avenues for further research are discussed.
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Affiliation(s)
- Sophie Opsomer
- Academic Centre for General Practice, Catholic University of Leuven, Leuven, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Emelien Lauwerier
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Jan De Lepeleire
- Academic Centre for General Practice, Catholic University of Leuven, Leuven, Belgium
| | - Peter Pype
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,End-of-Life Care Research Group, Ghent University, Ghent, Belgium
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Shetty A. Medical students' perspective on working in a health-care team - Revealed by thematic analysis. ARCHIVES OF MEDICINE AND HEALTH SCIENCES 2022. [DOI: 10.4103/amhs.amhs_223_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Organisational networks, organisational learning, organisational adaptability and role clarity among humanitarian organisations during relief delivery. JOURNAL OF HUMANITARIAN LOGISTICS AND SUPPLY CHAIN MANAGEMENT 2021. [DOI: 10.1108/jhlscm-04-2021-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Organisations involved in relief delivery tend to have cross-boundary mandates, which cause ambiguity of roles during delivery of relief services to the targeted victims. Having no clear role, specialisation affects service timeliness and increases resource duplication among the relief organisations. The objective of this study is to understand how organisational networks and organisational learning as complex adaptive system metaphors improve both organisational adaptability and role clarity in humanitarian logistics.
Design/methodology/approach
Using ordinary partial least squares regression through SmartPLS version 3.3.3, the authors tested the study hypotheses basing on survey data collected from 315 respondents who were selected randomly to complete a self-administered questionnaire from 101 humanitarian organisations. Common method bias (CMB) associated with surveys was minimised by implementing both procedural and post statistics methods.
Findings
The results indicate that organisational networks and organisational learning have a significant influence on organisational adaptability and role clarity. The results also show that organisational adaptability partially mediates in the relationship between organisational networks, organisational learning and role clarity.
Research limitations/implications
The major limitation of the study is that the authors have used cross-sectional data to test this research hypotheses. However, this was minimised following Guide and Ketokivi's (2015) recommendation on how to address the limitations of cross-sectional data or the use of longitudinal data that can address CMB and endogeneity problems.
Practical implications
Managers in humanitarian organisations can use the authors’ framework to understand, first, how complex adaptive system competence can be used to create organisational adaptability and, second, how organisational adaptability can help organisational networks and organisational learning in improving role clarity among humanitarian organisations by collaboratively working together.
Originality/value
This research contributes to the existing body of knowledge in humanitarian logistics and supply chain management by empirically testing the anecdotal and conceptual evidence. The findings may be useful to managers who are contemplating the use of organisational networks, organisational learning and organisational adaptability to improve role clarity in disaster relief-related activities.
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Lopes A, Roque F, Morgado S, Dinis C, Herdeiro MT, Morgado M. Behavioral Sciences in the Optimization of Pharmacological and Non-Pharmacological Therapy for Type 2 Diabetes. Behav Sci (Basel) 2021; 11:bs11110153. [PMID: 34821614 PMCID: PMC8614941 DOI: 10.3390/bs11110153] [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: 08/02/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 11/21/2022] Open
Abstract
Type 2 diabetes mellitus is one of the main chronic diseases worldwide, with a significant impact on public health. Behavioral changes are an important step in disease prevention and management, so the way in which individuals adapt their lifestyle to new circumstances will undoubtedly be a predictor of the success of the treatments instituted, contributing to a reduction in the morbidity and mortality that may be associated with them. It is essential to prepare and educate all diabetic patients on the importance of changing behavioral patterns in relation to the disease, with health professionals assuming an extremely important role in this area, both from a pharmacological and non-pharmacological point of view, and also ensuring the monitoring of the progress of these measures. Diabetes is a chronic disease that requires a high self-management capacity on the part of patients in order to achieve success in treating the disease, and non-adherence to therapy or non-compliance with the previously defined plan, together with an erratic lifestyle, will contribute to failure in controlling the disease. The lower adherence to pharmacological and non-pharmacological treatment in diabetes is mainly correlated to socio-economic aspects, lower health literacy, the side effects associated with the use of antidiabetic therapy or even the concomitant use of several drugs. This article consists of a narrative review that aims to synthesize the findings published in the literature, retrieved by searching databases, manuals, previously published scientific articles and official texts, following the methodology of the Scale for Assessment of Narrative Review Articles (SANRA). We aim to address the importance of behavioral sciences in the treatment of diabetes, in order to assess behavior factors and barriers for behavior changes that have an impact on the therapeutic and non-therapeutic optimization in patients with type 2 diabetes mellitus control.
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Affiliation(s)
- António Lopes
- Pharmaceutical Services of Unity Local of Health of Guarda (ULS da Guarda), 6300-035 Guarda, Portugal; (A.L.); (C.D.)
- Health Sciences Faculty, University of Beira Interior (FCS-UBI), 6200-506 Covilhã, Portugal;
| | - Fátima Roque
- Research Unit for Inland Development, Polytechnic Institute of Guarda (UDI-IPG), 6300-559 Guarda, Portugal
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal
- Correspondence:
| | - Sandra Morgado
- Pharmaceutical Services of University Hospital Center of Cova da Beira, 6200-251 Covilhã, Portugal;
| | - Cristina Dinis
- Pharmaceutical Services of Unity Local of Health of Guarda (ULS da Guarda), 6300-035 Guarda, Portugal; (A.L.); (C.D.)
| | - Maria Teresa Herdeiro
- Institute of Biomedicine, Department of Medical Sciences (iBiMED-UA), University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Manuel Morgado
- Health Sciences Faculty, University of Beira Interior (FCS-UBI), 6200-506 Covilhã, Portugal;
- Research Unit for Inland Development, Polytechnic Institute of Guarda (UDI-IPG), 6300-559 Guarda, Portugal
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal
- Pharmaceutical Services of University Hospital Center of Cova da Beira, 6200-251 Covilhã, Portugal;
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