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Najaffard N, Mohammadi A, Mojtahedzadeh R, Zarei A. E-portfolio as an effective tool for improvement of practitioner nurses' clinical competence. BMC MEDICAL EDUCATION 2024; 24:114. [PMID: 38317105 PMCID: PMC10845774 DOI: 10.1186/s12909-024-05092-z] [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: 04/03/2023] [Accepted: 01/24/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Clinical competence is essential for providing effective patient care. Clinical Governance (CG) is a framework for learning and assessing clinical competence. A portfolio is a work-placed-based tool for monitoring and reflecting on clinical practice. This study aimed to investigate the effect of using an e-portfolio on the practitioner nurses' competence improvement through the CG framework. METHODS This was a quasi-experimental study with 30 nurses in each intervention and control group. After taking the pretests of knowledge and performance, the participants attended the in-person classes and received the educational materials around CG standards for four weeks. In addition, nurses in the intervention group received the links to their e-portfolios individually and filled them out. They reflected on their clinical practice and received feedback. Finally, nurses in both groups were taken the post-tests. RESULTS Comparing the pre-and post-test scores in each group indicated a significant increase in knowledge and performance scores. The post-test scores for knowledge and performance were significantly higher in the intervention group than in the control one, except for the initial patient assessment. CONCLUSION This study showed that the e-portfolio is an effective tool for the improvement of the nurses' awareness and performance in CG standards. Since the CG standards are closely related to clinical competencies, it is concluded that using portfolios effectively improves clinical competence in practitioner nurses.
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Affiliation(s)
- Nastaran Najaffard
- Department of E-learning in Medical Education, School of Medicine, Tehran University of Medical Sciences; and Clinical Nurse at Imam Sajjad Hospital, Tehran, Iran
| | - Aeen Mohammadi
- Department of E-Learning in Medical Education, Center of Excellence for E-learning in Medical Education, School of Medicine, Tehran University of Medical Sciences, No. 2, Dolatshahi Alley, Naderi St., Keshavarz BLVD, Tehran, Iran
| | - Rita Mojtahedzadeh
- Department of E-Learning in Medical Education, Center of Excellence for E-learning in Medical Education, School of Medicine, Tehran University of Medical Sciences, No. 2, Dolatshahi Alley, Naderi St., Keshavarz BLVD, Tehran, Iran.
| | - Afagh Zarei
- Education Development Center, Birjand University of Medical Sciences, Birjand, Iran
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Overgaard Jensen ML, Bro F, Mygind A. Implementation of healthcare accreditation in Danish general practice: a questionnaire study exploring general practitioners' perspectives on external support. Scand J Prim Health Care 2021; 39:85-91. [PMID: 33646089 PMCID: PMC7971222 DOI: 10.1080/02813432.2021.1882084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To describe the use and perceived usefulness of implementation support provided to general practice during an accreditation process and to explore potential variations across clinic characteristics. DESIGN Cross-sectional questionnaire study. SETTING AND SUBJECTS All Danish general practice clinics undergoing an accreditation survey from 27 September 2016 to 15 December 2017 (n = 608). MAIN OUTCOME MEASURES Use and perceived usefulness of seven types of implementation support as reported by general practitioners (GPs). Clinic characteristics included practice type, number of GP partners and staff and employment of GP trainees. RESULTS The total response rate was 74% (n = 447). Most clinics (99.5%) used some type of implementation support (average: 4.8 different types). The most used types of support were peer support (80-92%) and various accreditation documents (85-92%). Support tailored to the individual clinic was most often considered useful (91-97%). However, this type of support was used relatively infrequently (16-40%). In most cases, clinic characteristics were neither significantly associated with the use of support nor with the perceived usefulness of the available support. CONCLUSION During the accreditation processes, each clinic used a broad variety of implementation support. Support tailored to the individual clinic was highly appreciated and should be promoted in future quality interventions in general practice. Discussions with peers were widely used, and it should be investigated further how peer discussions are best facilitated. The study calls for a multifactorial approach to future quality interventions in general practice to target the needs and capacities of the individual clinics.
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Affiliation(s)
- Maria Luisa Overgaard Jensen
- Department of Public Health, Aarhus University, Aarhus C, Denmark
- Research Unit for General Practice, Aarhus C, Denmark
- CONTACT Maria Luisa Overgaard Jensen Research Unit for General Practice, Bartholins Allé 2, Aarhus, 8000, Denmark
| | - Flemming Bro
- Department of Public Health, Aarhus University, Aarhus C, Denmark
- Research Unit for General Practice, Aarhus C, Denmark
| | - Anna Mygind
- Research Unit for General Practice, Aarhus C, Denmark
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Dowling S, Last J, Finnegan H, Daly P, Bourke J, Hanrahan C, Harrold P, McCombe G, Cullen W. Impact of participation in continuing medical education small group learning (CME-SGL) on the stress, morale, and professional isolation of rurally-based GPs: a qualitative study in Ireland. BJGP Open 2019; 3:bjgpopen19X101673. [PMID: 31662316 PMCID: PMC6995863 DOI: 10.3399/bjgpopen19x101673] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 09/12/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The pressures of general practice contribute to high levels of stress, low morale, and burnout in some GPs. In addition, rurally-based doctors may experience significant professional isolation. Participation in continuing medical education (CME) appears to reduce stress, and may improve the retention of rural GPs. AIM As part of a larger study devised to examine the effectiveness of regular participation in CME small group learning (SGL) on rurally-based Irish GPs, this study explored whether CME-SGL had any impact on GP stress, morale, and professional isolation. DESIGN & SETTING This was a qualitative study involving four CME-SGL groups based in rural Ireland. METHOD Semi-structured focus group interviews were conducted in established CME-SGL groups in four different rural geographical locations. Interviews were audiorecorded, transcribed verbatim, and analysed thematically. RESULTS All members of these CME-SGL groups (n = 43) consented to interview. These GPs reported that regular meetings with an established group of trusted colleagues who are 'in the same boat' provided a 'safe space' for discussion of, and reflection on, both clinical concerns and personal worries. This interaction in a supportive, non-threatening atmosphere helped to relieve stress, lift morale, and boost self-confidence. The social aspect of CME-SGL sustained these rural GPs, and served to alleviate their sense of professional isolation. CONCLUSION Delivery of CME through locally-based SGL provides as an important means of supporting GPs working in rural areas. The non-educational benefits of CME-SGL, as described by these Irish GPs, are of relevance for rural doctors in other countries.
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Affiliation(s)
- Stephanie Dowling
- ICGP Assistant National Academic Director of CME, Irish College of General Practitioners, Dublin, Ireland
- Research Student, Health Sciences Centre, University College Dublin School of Medicine, Dublin, Ireland
| | - Jason Last
- Associate Dean, Director of Education Development and Academic Affairs, University College Dublin School of Medicine, Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Henry Finnegan
- Former National Director of ICGP CME (retired), Irish College of General Practitioners, Dublin, Ireland
| | - Pat Daly
- ICGP CME Tutor, Irish College of General Practitioners, Dublin, Ireland
| | - John Bourke
- ICGP CME Tutor, Irish College of General Practitioners, Dublin, Ireland
| | - Conor Hanrahan
- ICGP CME Tutor, Irish College of General Practitioners, Dublin, Ireland
| | - Pat Harrold
- ICGP CME Tutor, Irish College of General Practitioners, Dublin, Ireland
| | - Geoff McCombe
- Post-doctoral Research Fellow, University College Dublin School of Medicine, Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Walter Cullen
- Professor of Urban General Practice and Head of Subject, General Practice, University College Dublin School of Medicine, Health Sciences Centre, University College Dublin, Dublin, Ireland
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Kousgaard MB, Thorsen T, Due TD. Experiences of accreditation impact in general practice - a qualitative study among general practitioners and their staff. BMC FAMILY PRACTICE 2019; 20:146. [PMID: 31660860 PMCID: PMC6819337 DOI: 10.1186/s12875-019-1034-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/10/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Accreditation is a widespread tool for quality management in health care. However, there is lack of research on the impact of accreditation, particularly in general practice. This study explores how general practitioners and their staff experienced the impact of a mandatory accreditation program in Denmark. METHODS Qualitative interviews with general practitioners and staff from 11 clinics. The respondents were interviewed twice: during preparation and after the survey visit. The interviews were analyzed using thematic analysis, and all specific changes and other types of impact were extracted from the transcribed interview data from each clinic. RESULTS The impact of accreditation varied markedly among the clinics as did the participants' overall assessments of accreditation. Concerning specific changes in behavior and physical infrastructure, some clinics had only implemented a few minor changes in response to accreditation, some had made a relatively moderate number of changes, and a few clinics had made relatively many changes including a few pronounced ones. Further, some participants experienced that accreditation had enhanced knowledge sharing or upgraded competencies, and increased job satisfaction. However, the workload related to accreditation was emphasized as a problem by a majority of the professionals and for a few, accreditation had influenced job satisfaction negatively. CONCLUSION Accreditation may affect general practice clinics in very different ways. In spite of several examples of positive impact, the results suggest that it is difficult to design a mandatory accreditation program for general practice in which most professionals experience that the benefits of accreditation equal the resources used in the process.
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Affiliation(s)
- Marius Brostrøm Kousgaard
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.
| | - Thorkil Thorsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
| | - Tina Drud Due
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
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Due TD, Thorsen T, Kousgaard MB. Understanding accreditation standards in general practice - a qualitative study. BMC FAMILY PRACTICE 2019; 20:23. [PMID: 30704399 PMCID: PMC6354356 DOI: 10.1186/s12875-019-0910-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 01/16/2019] [Indexed: 11/26/2022]
Abstract
Background Accreditation is a widely adopted tool for quality control and quality improvement in health care, which has increasingly been employed for general practice. However, there is lack of knowledge of how accreditation is received and experienced by health professionals in general practice. This study explores how general practitioners (GPs) and their staff experienced the comprehensibility of accreditation standards and how they worked to increase their understanding of the standards. The study was conducted in Denmark where accreditation was mandatory in general practice from 2016 to 2018. Methods The study consists of qualitative interviews with general practitioners and staff from 11 general practices that were strategically sampled among practices set to receive their survey visit in 2017. Participants were interviewed twice; once during the preparation phase and once after the survey visit. GPs and staff were interviewed separately. The interviews were analysed inductively using thematic analysis. Results Understanding the requirements of the accreditation standards was a major challenge for the professionals when preparing for the accreditation survey visit. The participants attempted to increase their understanding of the standards in several ways including the use of regional support options and seeking out experts and colleagues. However, participants had mixed experiences with the various support options and many found the sense making work frustrating and time consuming. Conclusion The results point to the importance of considering the level of specificity in accreditation standards and how to ensure an organisational set-up that can offer appropriate support to primary care clinics in terms of understanding what is required to meet the standards. Electronic supplementary material The online version of this article (10.1186/s12875-019-0910-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tina Drud Due
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Thorkil Thorsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Marius Brostrøm Kousgaard
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Alyahya M, Hijazi H, Harvey H. Explaining the accreditation process from the institutional isomorphism perspective: a case study of Jordanian primary healthcare centers. Int J Health Plann Manage 2016; 33:102-120. [PMID: 27761956 DOI: 10.1002/hpm.2397] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/30/2016] [Accepted: 08/31/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While the main focus of accreditation initiatives has been on hospitals, the implementation of these programs is a relatively new notion among other types of healthcare facilities. Correspondingly, this study aims to understand how accreditation is perceived among primary public healthcare centers using an isomorphic institutional theory. DESIGN/METHODOLOGY Semi-structured, in-depth interviews were conducted with 56 healthcare professionals and administrative staff from seven non-profit healthcare centers in Jordan using an explanatory case-study approach. RESULTS The informants' narratives revealed that all three components of institutional theory: coercive, mimetic, and normative pressure, were drivers for institutional change in seeking accreditation. There was an overlapping and blending between the three various types of pressure. While participants perceived that healthcare centers faced formal and informal pressures to achieve accreditation, health centers were reluctant about the time, amount of effort, and their ability to achieve the accreditation. Ambiguity and fear of failure forced them to model successful ones. Moreover, the findings revealed that normative values of health professionals enhanced institutional isomorphism and influenced the accreditation process. CONCLUSION Identifying these isomorphic changes may help key stakeholders to develop plans, policies, and procedures that could improve the quality of healthcare and enhance accreditation as an organizational strategic plan. Moreover, the study provided explanations of why and how organizations move to adopt new interventions and grow over time. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Mohammad Alyahya
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Jordan
| | - Heba Hijazi
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Jordan
| | - Heather Harvey
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Jordan
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Frigola-Capell E, Pareja-Rossell C, Gens-Barber M, Oliva-Oliva G, Alava-Cano F, Wensing M, Davins-Miralles J. Quality indicators for patient safety in primary care. A review and Delphi-survey by the LINNEAUS collaboration on patient safety in primary care. Eur J Gen Pract 2016; 21 Suppl:31-4. [PMID: 26339833 PMCID: PMC4828619 DOI: 10.3109/13814788.2015.1043730] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Quality indicators are measured aspects of healthcare, reflecting the performance of a healthcare provider or healthcare system. They have a crucial role in programmes to assess and improve healthcare. Many performance measures for primary care have been developed. Only the Catalan model for patient safety in primary care identifies key domains of patient safety in primary care. Objective: To present an international framework for patient safety indicators in primary care. Methods: Literature review and online Delphi-survey, starting from the Catalan model. Results: A set of 30 topics is presented, identified by an international panel and organized according to the Catalan model for patient safety in primary care. Most topic areas referred to specific clinical processes; additional topics were leadership, people management, partnership and resources. Conclusion: The framework can be used to organize indicator development and guide further work in the field.
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Affiliation(s)
- Eva Frigola-Capell
- a Ministry of Health of the Government of Catalonia, Subdirectorate-General for Health Services , Barcelona , Spain
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Nouwens E, van Lieshout J, Bouma M, Braspenning J, Wensing M. Effectiveness of improvement plans in primary care practice accreditation: a clustered randomized trial. PLoS One 2014; 9:e114045. [PMID: 25463149 PMCID: PMC4252098 DOI: 10.1371/journal.pone.0114045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 08/11/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Accreditation of healthcare organizations is a widely used method to assess and improve quality of healthcare. Our aim was to determine the effectiveness of improvement plans in practice accreditation of primary care practices, focusing on cardiovascular risk management (CVRM). METHOD A two-arm cluster randomized controlled trial with a block design was conducted with measurements at baseline and follow-up. Primary care practices allocated to the intervention group (n = 22) were instructed to focus improvement plans during the intervention period on CVRM, while practices in the control group (n = 23) could focus on any domain except on CVRM and diabetes mellitus. Primary outcomes were systolic blood pressure <140 mmHg, LDL cholesterol <2.5 mmol/l and prescription of antiplatelet drugs. Secondary outcomes were 17 indicators of CVRM and physician's perceived goal attainment for the chosen improvement project. RESULTS No effect was found on the primary outcomes. Blood pressure targets were reached in 39.8% of patients in the intervention and 38.7% of patients in the control group; cholesterol target levels were reached in 44.5% and 49.0% respectively; antiplatelet drugs were prescribed in 82.7% in both groups. Six secondary outcomes improved: smoking status, exercise control, diet control, registration of alcohol intake, measurement of waist circumference, and fasting glucose. Participants' perceived goal attainment was high in both arms: mean scores of 7.9 and 8.2 on the 10-point scale. CONCLUSIONS The focus of improvement plans on CVRM in the practice accreditation program led to some improvements of CVRM, but not on the primary outcomes. ClinicalTrials.gov NCT00791362.
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Affiliation(s)
- Elvira Nouwens
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands
- * E-mail:
| | - Jan van Lieshout
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Margriet Bouma
- Dutch College of General Practitioners, Utrecht, The Netherlands
| | - Jozé Braspenning
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Michel Wensing
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands
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Goetz K, Campbell SM, Broge B, Brodowski M, Wensing M, Szecsenyi J. Effectiveness of a quality management program in dental care practices. BMC Oral Health 2014; 14:41. [PMID: 24773764 PMCID: PMC4012092 DOI: 10.1186/1472-6831-14-41] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 04/23/2014] [Indexed: 11/10/2022] Open
Abstract
Background Structured quality management is an important aspect for improving patient dental care outcomes, but reliable evidence to validate effects is lacking. We aimed to examine the effectiveness of a quality management program in primary dental care settings in Germany. Methods This was an exploratory study with a before-after-design. 45 dental care practices that had completed the European Practice Assessment (EPA) accreditation scheme twice (intervention group) were selected for the study. The mean interval between the before and after assessment was 36 months. The comparison group comprised of 56 dental practices that had undergone their first assessment simultaneously with follow-up assessment in the intervention group. Aggregated scores for five EPA domains: ‘infrastructure’, ‘information’, ‘finance’, ‘quality and safety’ and ‘people’ were calculated. Results In the intervention group, small non-significant improvements were found in the EPA domains. At follow-up, the intervention group had higher scores on EPA domains as compared with the comparison group (range of differences was 4.2 to 10.8 across domains). These differences were all significant in regression analyses, which controlled for relevant dental practice characteristics. Conclusions Dental care practices that implemented a quality management program had better organizational quality in contrast to a comparison group. This may reflect both improvements in the intervention group and a selection effect of dental practices volunteering for the first round of EPA practice assessment.
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Affiliation(s)
- Katja Goetz
- Department of General Practice and Health Services Research, University of Heidelberg, Vosstr, 2, Building 37, Heidelberg D-69115, Germany.
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Wensing M, Kersnik J. Improving the quality of care for patients with chronic diseases: what research and education in family medicine can contribute. Eur J Gen Pract 2013. [PMID: 23205967 DOI: 10.3109/13814788.2012.742059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The theme of the EGPRN conference in Ljubljana 2012 was 'Quality improvement in the care of chronic disease in family practice: the contribution of education and research.' OBJECTIVE In this contribution, we summarize our key note lectures and provide reflections on the theme. RESULTS Many countries have established programmes for training of primary care professionals and quality improvement in family medicine. Research and development has focused on new educational methods, practice accreditation, patient safety in primary care, models of structured chronic care, and tailored improvement. CONCLUSION An international academic network of physicians, teachers and researchers in primary care should be nurtured to address the challenges of chronic illness care.
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Affiliation(s)
- Michel Wensing
- Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Healthcare, Nijmegen, the Netherlands.
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Quality assuring GPs and their practices. Br J Gen Pract 2012; 62:228-9. [DOI: 10.3399/bjgp12x636281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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