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Löfqvist N. Enhancing capability for continuous organisational improvement and learning in healthcare organisations: a systematic review of the literature 2013-2022. BMJ Open Qual 2024; 13:e002566. [PMID: 38569667 PMCID: PMC10989174 DOI: 10.1136/bmjoq-2023-002566] [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: 08/18/2023] [Accepted: 03/24/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Healthcare organisations strive to meet their current and future challenges and need to increase their capacity for continuous organisational improvement and learning (COIL). A key aspect of this capacity is the development of COIL capability among employees. OBJECTIVE This systematic review aims to explore common attributes of interventions that contribute to the development of COIL capability in healthcare organisations and to explore possible facilitating and hindering factors. METHODS A comprehensive search was conducted in Scopus, MEDLINE and Business Source Complete for primary research studies in English or Swedish, in peer-reviewed journals, focusing on organisational improvements and learning in healthcare organisations. Studies were included if they were published between 2013 and 23 November 2022, reported outcomes on COIL capability, included organisations or groups, and were conducted in high-income countries. The included articles were analysed to identify themes related to successful interventions and factors influencing COIL capability. RESULTS Thirty-six articles were included, with two studies reporting unsuccessful attempts at increasing COIL capability. The studies were conducted in nine different countries, encompassing diverse units, with the timeframes varying from 15 weeks to 8 years, and they employed quantitative (n=10), qualitative (n=11) and mixed methods (n=15). Analysis of the included articles identified four themes for both attributes of interventions and the factors that facilitated or hindered successful interventions: (1) engaged managers with a strategic approach, (2) external training and guidance to develop internal knowledge, skills and confidence, (3) process and structure to achieve improvements and learning and (4) individuals and teams with autonomy, accountability, and safety. CONCLUSION This review provides insights into the intervention attributes that are associated with increasing COIL capability in healthcare organisations as well as factors that can have hindering or facilitating effects. Strategic management, external support, structured processes and empowered teams emerged as key elements for enhancing COIL capability.
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Affiliation(s)
- Ninni Löfqvist
- Department of Communication, Quality Management, and Information Systems, Mid Sweden University, Östersund, Sweden
- Department of Pediatrics, Region Västernorrland, Härnösand, Sweden
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Wiese A, Galvin E, Korotchikova I, Bennett D. Doctors' attitudes to maintenance of professional competence: A scoping review. MEDICAL EDUCATION 2022; 56:374-386. [PMID: 34652830 DOI: 10.1111/medu.14678] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 10/05/2021] [Accepted: 10/08/2021] [Indexed: 06/13/2023]
Abstract
CONTEXT Recent decades have seen the international implementation of programmes aimed at assuring the continuing competence of doctors. Maintenance of Professional Competence (MPC) programmes aim to encourage doctors' lifelong learning and ensure high-quality, safe patient care; however, programme requirements can be perceived as bureaucratic and irrelevant to practice, leading to disengagement. Doctors' attitudes and beliefs about MPC are critical to translating regulatory requirements into committed and effective lifelong learning. We aimed to summarise knowledge about doctors' attitudes to MPC to inform the development of MPC programmes and identify under-researched areas. METHODS We undertook a scoping review following Arksey and O'Malley, including sources of evidence about doctors' attitudes to MPC in the United States, the United Kingdom, Canada, Australia, New Zealand and Ireland, and using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) as a guide. RESULTS One hundred and twenty-five sources of evidence were included in the review. One hundred and two were peer-reviewed publications, and 23 were reports. Most were from the United Kingdom or the United States and used quantitative or mixed methods. There was agreement across jurisdictions that MPC is a good idea in theory but doubt that it achieves its objectives in practice. Attitudes to the processes of MPC, and their impact on learning and practice were mixed. The lack of connection between MPC and practice was a recurrent theme. Barriers to participation were lack of time and resources, complexity of the requirements and a lack of flexibility in addressing doctors' personal and professional circumstances. CONCLUSIONS Overall, the picture that emerged is that doctors are supportive of the concept of MPC but have mixed views on its processes. We highlight implications for research and practice arising from these findings.
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Affiliation(s)
- Anél Wiese
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | - Emer Galvin
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | - Irina Korotchikova
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | - Deirdre Bennett
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
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Rohrbasser A, Harris J, Mickan S, Tal K, Wong G. Quality circles for quality improvement in primary health care: Their origins, spread, effectiveness and lacunae- A scoping review. PLoS One 2018; 13:e0202616. [PMID: 30557329 PMCID: PMC6296539 DOI: 10.1371/journal.pone.0202616] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/04/2018] [Indexed: 01/02/2023] Open
Abstract
Quality circles or peer review groups, and similar structured small groups of 6–12 health care professionals meet regularly across Europe to reflect on and improve their standard practice. There is debate over their effectiveness in primary health care, especially over their potential to change practitioners’ behaviour. Despite their popularity, we could not identify broad surveys of the literature on quality circles in a primary care context. Our scoping review was intended to identify possible definitions of quality circles, their origins, and reported effectiveness in primary health care, and to identify gaps in our knowledge. We searched appropriate databases and included any relevant paper on quality circles published until December 2017. We then compared information we found in the articles to that we found in books and on websites. Our search returned 7824 citations, from which we identified 82 background papers and 58 papers about quality circles. We found that they originated in manufacturing industry and that many countries adopted them for primary health care to continuously improve medical education, professional development, and quality of care. Quality circles are not standardized and their techniques are complex. We identified 19 papers that described individual studies, one paper that summarized 3 studies, and 1 systematic review that suggested that quality circles can effectively change behaviour, though effect sizes varied, depending on topic and context. Studies also suggested participation may affirm self-esteem and increase professional confidence. Because reports of the effect of quality circles on behaviour are variable, we recommend theory-driven research approaches to analyse and improve the effectiveness of this complex intervention.
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Affiliation(s)
- Adrian Rohrbasser
- Department of Continuing Education University of Oxford, Oxford, United Kingdom
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- * E-mail:
| | - Janet Harris
- University of Sheffield School of Health & Related Research, Sheffield, United Kingdom
| | - Sharon Mickan
- The Gold Coast Health, Griffith University, Southport, Australia
| | - Kali Tal
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Ford JH, Oliver KA, Giles M, Cates-Wessel K, Krahn D, Levin FR. Maintenance of certification: How performance in practice changes improve tobacco cessation in addiction psychiatrists’ practice. Am J Addict 2017; 26:34-41. [DOI: 10.1111/ajad.12480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 11/08/2016] [Accepted: 12/05/2016] [Indexed: 02/01/2023] Open
Affiliation(s)
| | - Karen A. Oliver
- American Academy of Addiction Psychiatry; Providence Rhode Island
| | - Miriam Giles
- American Academy of Addiction Psychiatry; Providence Rhode Island
| | | | - Dean Krahn
- University of Wisconsin School of Medicine and Public Health; Madison Wisconsin
- Department of Veteran Affairs; VAMC - Madison; Madison Wisconsin
| | - Frances R. Levin
- Columbia University; New York New York
- New York State Psychiatric Institute; New York New York
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Rose S, Shah BJ, Onken J, DeCross AJ, Davis MH, Jain R, Kim LS, Persley K, Pfeil SA, Marks LN. Introducing the Gastroenterologist-Accountable Professionalism in Practice (G-APP) pathway: bridging the G-APP-replacing MOC with a model for lifelong learning and accountability. Gastroenterology 2015; 149:1609-26. [PMID: 26824093 DOI: 10.1053/j.gastro.2015.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Suzanne Rose
- University of Connecticut School of Medicine, Academic Affairs and Education and Department of Medicine, Division of Gastroenterology and Hepatology, Farmington, Connecticut.
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Rose S, Shah BJ, Onken J, DeCross AJ, Davis MH, Jain R, Kim LS, Persley K, Pfeil SA, Marks LN. Bridging the G-APP: Continuous Professional Development for Gastroenterologists: Replacing MOC with a Model for Lifelong Learning and Accountability. Clin Gastroenterol Hepatol 2015; 13:S1542-3565(15)01121-0. [PMID: 26297857 DOI: 10.1016/j.cgh.2015.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | | | - Jane Onken
- Duke University School of Medicine, Durham, NC
| | | | | | - Rajeev Jain
- Partner, Texas Digestive Disease Consultants, Dallas, TX
| | - Lawrence S Kim
- Partner, South Denver Gastroenterology, P.C., Lone Tree, CO
| | - Kim Persley
- Partner, Texas Digestive Disease Consultants, Dallas, TX
| | | | - Lori N Marks
- Vice President of Education and Training, AGA Staff, Bethesda, MD
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Billimek J, Malik S, Sorkin DH, Schmalbach P, Ngo-Metzger Q, Greenfield S, Kaplan SH. Understanding disparities in lipid management among patients with type 2 diabetes: gender differences in medication nonadherence after treatment intensification. Womens Health Issues 2015; 25:6-12. [PMID: 25442365 PMCID: PMC4275363 DOI: 10.1016/j.whi.2014.09.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 09/07/2014] [Accepted: 09/10/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Gender differences in dyslipidemia are widely documented, but the contributors to these differences are not well understood. This study examines whether differences in quality of care, intensity of lipid-lowering medication regimen, and medication adherence can explain this disparity. METHODS Secondary analysis of medical records data and questionnaires collected from adult patients with type 2 diabetes (n = 1,369) from seven outpatient clinics affiliated with an academic medical center as part of the Reducing Racial Disparities in Diabetes: Coached Care (R2D2C2) study. Primary outcome was low-density lipoprotein (LDL) cholesterol. FINDINGS Women had higher LDL cholesterol levels than men (mean [SD], 101.2 [35.2] vs. 92.3 [33.0] mg/dL; p < .001), but were no less likely to receive recommended processes of diabetes care, to attain targets for glycemic control and blood pressure, or to be on intensive medication regimens. More women than men reported medication nonadherence related to cost (32.7% vs. 24.2%; p = .040) and related to side effects (47.2% vs. 36.8%; p = .024). For all patients, regimen intensity (p < .05) and nonadherence related to side effects (p < .01) were each associated with higher LDL cholesterol levels. The addition of a new lipid-lowering agent was associated with subsequent nonadherence related to side effects for women (p < .001), but not for men (p = .45; test for interaction p = .048). CONCLUSIONS Despite comparable quality of diabetes care and regimen intensity for lipid management, women with diabetes experienced poorer lipid control than men. Medication nonadherence seemed to be a major contributor to dyslipidemia, particularly for women because of side effects associated with intensifying the lipid-lowering regimen.
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Affiliation(s)
- John Billimek
- Health Policy Research Institute, School of Medicine, University of California, Irvine, California; Department of Medicine, School of Medicine, University of California, Irvine, California.
| | - Shaista Malik
- Division of Cardiology, Department of Medicine, School of Medicine, University of California, Irvine, California
| | - Dara H Sorkin
- Health Policy Research Institute, School of Medicine, University of California, Irvine, California; Department of Medicine, School of Medicine, University of California, Irvine, California
| | - Priel Schmalbach
- School of Social Ecology, University of California, Irvine, California; School of Medicine, University of California, Irvine, California
| | - Quyen Ngo-Metzger
- Health Policy Research Institute, School of Medicine, University of California, Irvine, California; Department of Medicine, School of Medicine, University of California, Irvine, California
| | - Sheldon Greenfield
- Health Policy Research Institute, School of Medicine, University of California, Irvine, California; Department of Medicine, School of Medicine, University of California, Irvine, California
| | - Sherrie H Kaplan
- Health Policy Research Institute, School of Medicine, University of California, Irvine, California; Department of Medicine, School of Medicine, University of California, Irvine, California
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Norcini JJ, Lipner RS, Grosso LJ. Assessment in the context of licensure and certification. TEACHING AND LEARNING IN MEDICINE 2013; 25 Suppl 1:S62-S67. [PMID: 24246109 DOI: 10.1080/10401334.2013.842909] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Over the past 25 years, three major forces have had a significant influence on licensure and certification: the shift in focus from educational process to educational outcomes, the increasing recognition of the need for learning and assessment throughout a physician's career, and the changes in technology and psychometrics that have opened new vistas for assessment. These forces have led to significant changes in assessment for licensure and certification. To respond to these forces, licensure and certification programs have improved the ways in which their examinations are constructed, scored, and delivered. In particular, we note the introduction of adaptive testing; automated item creation, scoring, and test assembly; assessment engineering; and data forensics. Licensure and certification programs have also expanded their repertoire of assessments with the rapid development and adoption of simulation and workplace-based assessment. Finally, they have invested in research intended to validate their programs in four ways: (a) the acceptability of the program to stakeholders, (b) the extent to which stakeholders are encouraged to learn and improve, (c) the extent to which there is a relationship between performance in the programs and external measures, and (d) the extent to which there is a relationship between performance as measured by the assessment and performance in practice. Over the past 25 years, changes in licensure and certification have been driven by the educational outcomes movement, the need for lifelong learning, and advances in technology and psychometrics. Over the next 25 years, we expect these forces to continue to exert pressure for change which will lead to additional improvement and expansion in examination processes, methods of assessment, and validation research.
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Affiliation(s)
- John J Norcini
- a Foundation for Advancement of International Medical Education and Research , Philadelphia , Pennsylvania , USA
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