Engaging Healthcare Staff and Stakeholders in Healthcare Simulation Modeling to Better Translate Research Into Health Impact: A Systematic Review

Codesign Use in Palliative Care Intervention Development: A Systematic Review

CONTEXT

Codesign is a methodology that includes active collaboration between stakeholders in designing solutions and has been used in the development and implementation of palliative care (PC) interventions.

OBJECTIVES

To synthesize the state of evidence for codesign in the development of PC interventions.

METHODS

We searched PubMed, EMBASE, and CINAHL for peer-reviewed studies published after 1995 that reported evidence of codesigned interventions and outcomes in patients receiving palliative, hospice, or end-of-life care. We screened studies through independent and blinded dual review within Covidence and assessed study quality with the 2018 Mixed Methods Appraisal Tool. We narratively synthesized codesign duration, engagement approach, stakeholders involved, intervention designs, follow-ups, and outcomes, comparing among codesigns reporting meaningful improvement in outcomes. We created a best practice checklist which we used to evaluate codesign use in each study.

RESULTS

About 1,036 abstracts and 54 full text articles were screened. Twenty-eight studies met inclusion criteria and were abstracted. Feedback collection modalities ranged from iterative drafting, pilot testing, advisory panels, workshops, focus groups, and interviews. Thirteen studies applied pretesting/prototyping through pretest post-test, focus groups, prototypes, alpha and beta testing, and mock-ups. Eleven studies reported improved outcomes, eight of which utilized iterative codesign. All the studies reporting improved outcomes mentioned meeting with stakeholders at least twice. Two studies met all criteria in our codesign best practice checklist.

CONCLUSION

Codesigned PC interventions demonstrate high variance in the modality of acquiring feedback and application of codesign. Successful codesign leading to improvement in outcomes is achieved by involving patients, caregivers, and providers in iterating intervention design.

A context-driven approach through stakeholder engagement to introduce a digital emergency obstetric and newborn care register into routine obstetric health care services in Bangladesh

Background

Emergency obstetric and newborn care (EmONC) in Bangladesh focusses on maternal health, whereby it addresses childbirth and postpartum complications to ensure women's health and well-being. It was transitioned to a digital platform to overcome challenges with the paper-based EmONC register and we conducted implementation research to assess the outcome. Here we outline the stakeholder engagement process integral to the implementation research process.

Methods

We adopted a four-step stakeholder engagement model based on the identification, sensitisation, involvement, and engagement of stakeholders. The approach was informed by previous experience, desk reviews, and expert consultations to ensure comprehensive engagement with stakeholders at multiple levels. Led by the Maternal Health Programme of the Government of Bangladesh, we involved high-power and high-interest stakeholders in developing a joint action plan for digitisation of the paper-based EmONC register. Finally, we demonstrated this digital EmONC register in real-life settings to stakeholders at different levels.

Results

The successful demonstration process fostered government ownership and collaboration with multiple stakeholders, while laying the foundation for scalability and sustainability. Nevertheless, our experience highlighted that the stakeholder engagement process is context-driven, time-consuming, resource-intensive, iterative, and dynamic, and it requires involving stakeholders with varied expertise. Effective strategic planning, facilitation, and the allocation of sufficient time and resources are essential components for successful stakeholder engagement.

Conclusions

Our experience demonstrates the potential of adopting the 'identification, sensitisation, involvement, and engagement' stakeholder engagement model. Success in implementing this model in diverse settings depends on leveraging knowledge gained during implementation, maintaining robust communication with stakeholders, and harnessing the patience and determination of the facilitating organisation.

Fit for Purpose-Re-Designing Australia's Mental Health Information System

BACKGROUND

Monitoring and reporting mental health is complex. Australia's first National Mental Health Strategy in 1992 included a new national commitment to accountability and data collection in mental health. This article provides a narrative review of thirty years of experience.

MATERIALS AND METHODS

This review considers key documents, policies, plans and strategies in relation to the evolution of mental health data and reporting. Documents produced by the Federal and the eight state and territory governments are considered, as well as publications produced by key information agencies, statutory authorities and others. A review of this literature demonstrates both its abundance and limitations.

RESULTS

Australia's approach to mental health reporting is characterised by duplication and a lack of clarity. The data available fail to do justice to the mental health services provided in Australia. Mental health data collection and reporting processes are centrally driven, top-down and activity-focused, largely eschewing actual health outcomes, the social determinants of mental health. There is little, if any, link to clearly identifiable service user or carer priorities. Consequently, it is difficult to link this process longitudinally to clinical or systemic quality improvement. Initial links between the focus of national reform efforts and mental health data collection were evident, but these links have weakened over time. Changes to governance and reporting, including under COVID, have made the task of delivering accountability for mental health more difficult.

CONCLUSION

Australia's current approach is not fit for purpose. It is at a pivotal point in mental health reform, with new capacity to use modelled data to simulate prospective mental health reform options. By drawing on these new techniques and learning the lessons of the past, Australia (and other nations) can design and implement more effective systems of planning, reporting and accountability for mental health.