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DeGraves BS, Titley H, Duan Y, Thorne TE, Banerjee S, Ginsburg L, Salma J, Hegadoren K, Angel C, Keefe J, Lanius R, Estabrooks CA. Workforce resilience supporting staff in managing stress: A coherent breathing intervention for the long-term care workforce. J Am Geriatr Soc 2024; 72:753-766. [PMID: 38156430 DOI: 10.1111/jgs.18727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/14/2023] [Accepted: 11/12/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Staff in long-term care (LTC) homes have long-standing stressors, such as short staffing and high workloads. These stressors increased during the COVID-19 pandemic; better resources are needed to help staff manage stress and well-being. The purpose of this study was to evaluate the effect of a simple stress management strategy (coherent breathing). METHODS We conducted a pre-post intervention study to evaluate a self-managed coherent breathing intervention from February to September 2022. The intervention included basic (breathing only) and comprehensive (breathing plus a biofeedback device) groups. Six hundred eighty-six participants were initially recruited (359 and 327 in the comprehensive and basic groups respectively) from 31 LTC homes in Alberta, Canada. Two hundred fifty-four participants completed pre-and post-intervention questionnaires (142 [55.9%] in comprehensive and 112 [44.1%] in basic). Participants were asked to use coherent breathing based on a schedule increasing from 2 to 10 min daily, 5-7 times a week over 8 weeks. Participants completed self-administered online questionnaires pre- and post-intervention to assess outcomes-stress, psychological distress, anxiety, depression, resilience, insomnia, compassion satisfaction, compassion fatigue, and burnout. We used a mixed-effects regression model to test the main effect of time (pre- and post-intervention) and group while testing the interaction between time and group and controlling for covariates. RESULTS We found statistically significant changes from pre- to post-intervention in stress (b = -2.5, p < 0.001, 95% CI = -3.1, -1.9), anxiety (b = -0.5, p < 0.001, 95% CI = -0.7, -0.3), depression (b = -0.4, p < 0.001, 95% CI = -0.6, -0.2), insomnia (b = -1.5, p < 0.001, 95% CI = -2.1, -0.9), and resilience (b = 0.2, p < 0.001, 95% CI = 0.1, 0.2). We observed no statistically significant differences between the two intervention groups on any outcome. CONCLUSIONS Our findings suggest that coherent breathing is a promising strategy for improving stress-related outcomes and resilience. This intervention warrants further, more rigorous testing.
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Affiliation(s)
| | - Heather Titley
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Yinfei Duan
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Trina E Thorne
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Sube Banerjee
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Liane Ginsburg
- School of Health Policy and Management, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Jordana Salma
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | - Cybele Angel
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Janice Keefe
- Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Ruth Lanius
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Ginsburg L, Hoben M, Berta W, Doupe M, Estabrooks CA, Norton PG, Reid C, Geerts A, Wagg A. Development and validation of the Overall Fidelity Enactment Scale for Complex Interventions (OFES-CI). BMJ Qual Saf 2024; 33:98-108. [PMID: 37648435 PMCID: PMC10850642 DOI: 10.1136/bmjqs-2023-016001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/05/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND In many quality improvement (QI) and other complex interventions, assessing the fidelity with which participants 'enact' intervention activities (ie, implement them as intended) is underexplored. Adapting the evaluative approach used in objective structured clinical examinations, we aimed to develop and validate a practical approach to assessing fidelity enactment-the Overall Fidelity Enactment Scale for Complex Interventions (OFES-CI). METHODS We developed the OFES-CI to evaluate enactment of the SCOPE QI intervention, which teaches nursing home teams to use plan-do-study-act (PDSA) cycles. The OFES-CI was piloted and revised early in SCOPE with good inter-rater reliability, so we proceeded with a single rater. An intraclass correlation coefficient (ICC) was used to assess inter-rater reliability. For 27 SCOPE teams, we used ICC to compare two methods for assessing fidelity enactment: (1) OFES-CI ratings provided by one of five trained experts who observed structured 6 min PDSA progress presentations made at the end of SCOPE, (2) average rating of two coders' deductive content analysis of qualitative process evaluation data collected during the final 3 months of SCOPE (our gold standard). RESULTS Using Cicchetti's classification, inter-rater reliability between two coders who derived the gold standard enactment score was 'excellent' (ICC=0.93, 95% CI=0.85 to 0.97). Inter-rater reliability between the OFES-CI and the gold standard was good (ICC=0.71, 95% CI=0.46 to 0.86), after removing one team where open-text comments were discrepant with the rating. Rater feedback suggests the OFES-CI has strong face validity and positive implementation qualities (acceptability, easy to use, low training requirements). CONCLUSIONS The OFES-CI provides a promising novel approach for assessing fidelity enactment in QI and other complex interventions. It demonstrates good reliability against our gold standard assessment approach and addresses the practicality problem in fidelity assessment by virtue of its suitable implementation qualities. Steps for adapting the OFES-CI to other complex interventions are offered.
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Affiliation(s)
- Liane Ginsburg
- School of Health Policy and Management, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Whitney Berta
- Institute of Health Policy Management and Evaluation, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Malcolm Doupe
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Centre for Care Research, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Peter G Norton
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Colin Reid
- School of Health and Exercise Science, The University of British Columbia, Kelowna, British Columbia, Canada
| | - Ariane Geerts
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Adrian Wagg
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Wagg A, Hoben M, Ginsburg L, Doupe M, Berta W, Song Y, Norton P, Knopp-Sihota J, Estabrooks C. Safer Care for Older Persons in (residential) Environments (SCOPE): a pragmatic controlled trial of a care aide-led quality improvement intervention. Implement Sci 2023; 18:9. [PMID: 36991434 PMCID: PMC10054219 DOI: 10.1186/s13012-022-01259-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/20/2022] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND The increased complexity of residents and increased needs for care in long-term care (LTC) have not been met with increased staffing. There remains a need to improve the quality of care for residents. Care aides, providers of the bulk of direct care, are well placed to contribute to quality improvement efforts but are often excluded from so doing. This study examined the effect of a facilitation intervention enabling care aides to lead quality improvement efforts and improve the use of evidence-informed best practices. The eventual goal was to improve both the quality of care for older residents in LTC homes and the engagement and empowerment of care aides in leading quality improvement efforts. METHODS Intervention teams participated in a year-long facilitative intervention which supported care aide-led teams to test changes in care provision to residents using a combination of networking and QI education meetings, and quality advisor and senior leader support. This was a controlled trial with random selection of intervention clinical care units matched 1:1 post hoc with control units. The primary outcome, between group change in conceptual research use (CRU), was supplemented by secondary staff- and resident-level outcome measures. A power calculation based upon pilot data effect sizes resulted in a sample size of 25 intervention sites. RESULTS The final sample included 32 intervention care units matched to 32 units in the control group. In an adjusted model, there was no statistically significant difference between intervention and control units for CRU or in secondary staff outcomes. Compared to baseline, resident-adjusted pain scores were statistically significantly reduced (less pain) in the intervention group (p=0.02). The level of resident dependency significantly decreased statistically for residents whose teams addressed mobility (p<0.0001) compared to baseline. CONCLUSIONS The Safer Care for Older Persons in (residential) Environments (SCOPE) intervention resulted in a smaller change in its primary outcome than initially expected resulting in a study underpowered to detect a difference. These findings should inform sample size calculations of future studies of this nature if using similar outcome measures. This study highlights the problem with measures drawn from current LTC databases to capture change in this population. Importantly, findings from the trial's concurrent process evaluation provide important insights into interpretation of main trial data, highlight the need for such evaluations of complex trials, and suggest the need to consider more broadly what constitutes "success" in complex interventions. TRIAL REGISTRATION ClinicalTrials.gov , NCT03426072, registered August 02, 2018, first participant site April, 05, 2018.
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Affiliation(s)
- Adrian Wagg
- Division of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Liane Ginsburg
- School of Health Policy & Management, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Malcolm Doupe
- Departments of Community Health Sciences, Emergency Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Whitney Berta
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, ON, Toronto, Canada
| | - Yuting Song
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Peter Norton
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer Knopp-Sihota
- Faculty of Health Disciplines, Athabasca University & Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Carole Estabrooks
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Estabrooks C, Saeidzadeh S, Bryan S, Norton P, Ginsburg L, Hoben M, McLeod D. SUPPORTING NURSING HOME MANAGERS TO ACT ON PERFORMANCE FEEDBACK DATA: A PROVINCEWIDE IMPLEMENTATION. Innov Aging 2022. [PMCID: PMC9766171 DOI: 10.1093/geroni/igac059.1520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INFORM (Improving Nursing home care through Feedback on perfoRMance data) is a tested research intervention targeting care managers that demonstrated positive two year follow up results and has subsequently been shaped into an operationally acceptable “implementation package”. This package or innovation is being scaled up in one Canadian province’s total Long-Term-Care (LTC) home population with in depth process evaluation during the first cohort of LTC homes. This evaluation will, among other things, assess sector needs for adaptation (vs fidelity). At its core INFORM is designed to address managers’ learning needs with respect to using data to make positive change in a continuous learning loop. We will discuss the transformation of a research intervention to a sector innovation and report on interim process evaluation results.
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Affiliation(s)
| | | | - Stirling Bryan
- Michael Smith Health Research, Vancouver, British Columbia, Canada
| | | | | | | | - Don McLeod
- Translating Research in Elder Care, Edmonton, Alberta, Canada
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Song Y, MacEachern L, Doupe MB, Ginsburg L, Chamberlain SA, Cranley L, Easterbrook A, Hoben M, Knopp-Sihota J, Reid RC, Wagg A, Estabrooks CA, Keefe JM, Rappon T, Berta WB. Influences of post-implementation factors on the sustainability, sustainment, and intra-organizational spread of complex interventions. BMC Health Serv Res 2022; 22:666. [PMID: 35581651 PMCID: PMC9116057 DOI: 10.1186/s12913-022-08026-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Complex interventions are increasingly applied to healthcare problems. Understanding of post-implementation sustainment, sustainability, and spread of interventions is limited. We examine these phenomena for a complex quality improvement initiative led by care aides in 7 care homes (long-term care homes) in Manitoba, Canada. We report on factors influencing these phenomena two years after implementation. Methods Data were collected in 2019 via small group interviews with unit- and care home-level managers (n = 11) from 6 of the 7 homes using the intervention. Interview participants discussed post-implementation factors that influenced continuing or abandoning core intervention elements (processes, behaviors) and key intervention benefits (outcomes, impact). Interviews were audio-recorded, transcribed verbatim, and analyzed with thematic analysis. Results Sustainment of core elements and sustainability of key benefits were observed in 5 of the 6 participating care homes. Intra-unit intervention spread occurred in 3 of 6 homes. Factors influencing sustainment, sustainability, and spread related to intervention teams, unit and care home, and the long-term care system. Conclusions Our findings contribute understanding on the importance of micro-, meso-, and macro-level factors to sustainability of key benefits and sustainment of some core processes. Inter-unit spread relates exclusively to meso-level factors of observability and practice change institutionalization. Interventions should be developed with post-implementation sustainability in mind and measures taken to protect against influences such as workforce instability and competing internal and external demands. Design should anticipate need to adapt interventions to strengthen post-implementation traction. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08026-x.
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Affiliation(s)
- Yuting Song
- School of Nursing, Qingdao University, 308 Ningxia Road, Qingdao, 266071, Shandong Province, China. .,Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 5-305, 11405 87 Ave, AB, T6G 1C9, Edmonton, Canada.
| | - Lauren MacEachern
- Management & Evaluation, Institute for Health Policy, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 1P8, Canada
| | - Malcolm B Doupe
- Max Rady College of Medicine, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada
| | - Liane Ginsburg
- School of Health Policy & Management, York University, Stong College 353, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Stephanie A Chamberlain
- Department of Family Medicine, University of Alberta, 6-50 University Terrace, Edmonton, AB, T6G 2T4, Canada
| | - Lisa Cranley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street Suite 130, Toronto, ON, M5T 1P8, Canada
| | - Adam Easterbrook
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 588 - 1081 Burrard Street, Vancouver, B.C., V6Z 1Y6, Canada
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 5-305, 11405 87 Ave, AB, T6G 1C9, Edmonton, Canada
| | - Jennifer Knopp-Sihota
- Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, AB, T9S 3A3, Canada
| | - R Colin Reid
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia - Okanagan campus, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada
| | - Adrian Wagg
- Department of Medicine, University of Alberta, 1-198 Clinical Sciences building, 11350 - 83Avenue, Edmonton, AB, T6G 2P4, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 5-305, 11405 87 Ave, AB, T6G 1C9, Edmonton, Canada
| | - Janice M Keefe
- Nova Scotia Centre On Aging, Mount Saint Vincent University, McCain 201F, 166 Bedford Hwy, Halifax, NS, B3M 2J6, Canada
| | - Tim Rappon
- Management & Evaluation, Institute for Health Policy, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 1P8, Canada
| | - Whitney B Berta
- Management & Evaluation, Institute for Health Policy, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 1P8, Canada
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Doupe M, Brunkert T, Wagg A, Ginsburg L, Norton P, Berta W, Knopp-Sihota J, Estabrooks C. Correction to: SCOPE: safer care for older persons (in residential) environments—a pilot study to enhance care aide-led quality improvement in nursing homes. Pilot Feasibility Stud 2022; 8:47. [PMID: 35232497 PMCID: PMC8886763 DOI: 10.1186/s40814-022-01004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Doupe M, Brunkert T, Wagg A, Ginsburg L, Norton P, Berta W, Knopp-Sihota J, Estabrooks C. SCOPE: safer care for older persons (in residential) environments-a pilot study to enhance care aide-led quality improvement in nursing homes. Pilot Feasibility Stud 2022; 8:26. [PMID: 35115053 PMCID: PMC8812152 DOI: 10.1186/s40814-022-00975-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 01/11/2022] [Indexed: 12/26/2022] Open
Abstract
Background Nursing home residents require daily support. While care aides provide most of this support they are rarely empowered to lead quality improvement (QI) initiatives. Researchers have shown that care aide-led teams can successfully participate in a QI intervention called Safer Care for Older Persons in Residential Care Environments (SCOPE). In preparation for a large-scale study, we conducted a 1-year pilot to evaluate how well coaching strategies helped teams to enact this intervention. Secondarily, we measured if improvements in team cohesion and communication, and resident quality of care, occurred. Methods This study was conducted using a prospective single-arm study design, on 7 nursing homes in Winnipeg Manitoba belonging to the Translating Research in Elder Care research program. One QI team was selected per site, led by care aides who partnered with other front-line staff. Each team received facilitated coaching to enact SCOPE during three learning sessions, and additional support from quality advisors between these sessions. Researchers developed a rubric to evaluate how well teams enacted their interventions (i.e., created actionable aim statements, implemented interventions using plan-do-study-act cycles, and used measurement to guide decision-making). Team cohesion and communication were measured using surveys, and changes in unit-level quality indicators were measured using Resident Assessment Instrument-Minimum Data Set data. Results Most teams successfully enacted their interventions. Five of 7 teams created adequate-to-excellent aim statements. While 6 of 7 teams successfully implemented plan-do-study-act cycles, only 2 reported spreading their change ideas to other residents and staff on their unit. Three of 7 teams explicitly stated how measurement was used to guide intervention decisions. Teams scored high in cohesion and communication at baseline, and hence improved minimally. Indicators of resident quality care improved in 4 nursing home units; teams at 3 of these sites were scored as ‘excellent’ in two or more enactment areas, versus 1 of the 3 remaining teams. Conclusions Our coaching strategies helped most care aide-led teams to enact SCOPE. Coaching modifications are needed to help teams more effectively use measurement. Refinements to our evaluation rubric are also recommended. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-00975-8.
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Affiliation(s)
- Malcolm Doupe
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Thekla Brunkert
- University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland.,Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Adrian Wagg
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Liane Ginsburg
- School of Health Policy & Management, York University, Toronto, Canada
| | - Peter Norton
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Whitney Berta
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada
| | | | - Carole Estabrooks
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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MacEachern L, Song Y, Ginsburg L, Wagg A, Hoben M, Doupe M, Estabrooks C, Berta W. A Pilot of a Sustainability-Extending Intervention in Canadian Nursing Homes. Innov Aging 2021. [PMCID: PMC8680551 DOI: 10.1093/geroni/igab046.2071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Understanding of intervention sustainability processes is limited. Failure to sustain evidence-based innovations means that intended improvements are short-lived, scale-up and spread are unlikely, and real losses are incurred on research investments. We explored the sustainability of a health care aide (HCA)-led quality improvement (QI) initiative, Safer Care for Older Persons (in residential) Environments (SCOPE), that was implemented in long-term care homes (LTCHs) in Manitoba, Canada. Based on our understanding of factors influencing post-implementation sustainability processes, we developed and piloted a “low-dose” and “high-dose” “Booster” intervention to extend the two-year post-implementation period over which SCOPE was naturally sustained. Both versions of the “Booster” involved the following components: a HCA-led team with management support, a workshop to review SCOPE QI approaches and tools, a binder of QI resources, and supports from an experienced Quality Advisor (QA). We collected data from various sources to depict the most accurate account of QI sustainability and conducted thematic analysis to understand each team’s experience with sustainability processes. We used a qualitative assessment rubric to evaluate the impact of the “Booster” conditions on the teams’ performance against core SCOPE components. Our results suggest that the “Booster” served to establish more relaxed expectations and generally renew interest in LTCH QI initiatives. The calibre of management support was associated with teams’ performance and management support varied with the level of QA support. These pilot results will inform the next study phase, which examines longer-term sustainability of QI initiatives in LTCHs beyond the initial 2-year post-implementation period.
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Affiliation(s)
| | - Yuting Song
- University of Alberta, Edmonton, Alberta, Canada
| | | | - Adrian Wagg
- University of Alberta, Edmonton, Alberta, Canada
| | - Matthias Hoben
- University of Alberta at Edmonton, Edmonton, Alberta, Canada
| | | | | | - Whitney Berta
- University of Toronto, University of Toronto, Ontario, Canada
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9
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MacEachern L, Song Y, Ginsburg L, Doupe M, Wagg A, Spiers J, Berta W. Factors Affecting the Sustainment, Sustainability, and Spread of Practice Changes in Canadian Long-Term Care Homes. Innov Aging 2021. [PMCID: PMC8679639 DOI: 10.1093/geroni/igab046.1593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Our understanding of the post-implementation sustainment, sustainability, and spread (SSS) of complex quality improvement interventions is limited. We explored factors that influenced the SSS of a care aide-led quality improvement initiative (Safer Care for Older Persons (in residential) Environments [SCOPE]) implemented in 6 Manitoba long-term care homes two years after the conclusion of SCOPE in 2017. We analyzed small group interview data collected from all unit- and facility-level managers who participated in SCOPE and were still working in these facilities. We asked about SCOPE implementation, post-SCOPE quality improvement activities, factors that influenced them, and about inter-unit spread of SCOPE following the project’s conclusion. The interviews were audio-recorded, transcribed verbatim, de-identified, and analyzed using thematic analysis. Five of the 6 facilities reported sustained SCOPE quality improvement activities, tools, and facilitative structures. In the same 5 facilities, SCOPE benefits (e.g., increases in care aide empowerment and self-efficacy, manager belief in care aide capacity) continued post-implementation. Spread beyond the original SCOPE units had occurred in 3 facilities. Factors that influenced the SSS of SCOPE were related to the team (e.g., care aides' quality improvement capacity), to the unit and facility (e.g., culture of innovation and change), and to the long-term care system (e.g., competing imperatives). Some factors influencing SSS differ from factors known to influence implementation. The identified factors affecting SSS highlight the influence of social dynamics (i.e., interactions, communication, relationships) among staff on SSS. Further research is warranted to explore interactions among these influencing factors and how they lead to SSS.
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Affiliation(s)
| | - Yuting Song
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Adrian Wagg
- University of Alberta, Edmonton, Alberta, Canada
| | - Jude Spiers
- University of Alberta, Edmonton, Alberta, Canada
| | - Whitney Berta
- University of Toronto, University of Toronto, Ontario, Canada
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Zaheer S, Ginsburg L, Wong HJ, Thomson K, Bain L, Wulffhart Z. Acute care nurses' perceptions of leadership, teamwork, turnover intention and patient safety - a mixed methods study. BMC Nurs 2021; 20:134. [PMID: 34330272 PMCID: PMC8323271 DOI: 10.1186/s12912-021-00652-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 07/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study contributes to a small but growing body of literature on how context influences perceptions of patient safety in healthcare settings. We examine the impact of senior leadership support for safety, supervisory leadership support for safety, teamwork, and turnover intention on overall patient safety grade. Interaction effects of predictors on perceptions of patient safety are also examined. METHODS In this mixed methods study, cross-sectional survey data (N = 185) were collected from nurses and non-physician healthcare professionals. Semi-structured interview data (N = 15) were collected from nurses. The study participants worked in intensive care, general medicine, mental health, or the emergency department of a large community hospital in Southern Ontario. RESULTS Hierarchical regression analyses showed that staff perceptions of senior leadership (p < 0.001), teamwork (p < 0.01), and turnover intention (p < 0.01) were significantly associated with overall patient safety grade. The interactive effect of teamwork and turnover intention on overall patient safety grade was also found to be significant (p < 0.05). The qualitative findings corroborated the survey results but also helped expand the characteristics of the study's key concepts (e.g., teamwork within and across professional boundaries) and why certain statistical relationships were found to be non-significant (e.g., nurse interviewees perceived the safety specific responsibilities of frontline supervisors much more broadly compared to the narrower conceptualization of the construct in the survey). CONCLUSIONS The results of the current study suggest that senior leadership, teamwork, and turnover intention significantly impact nursing staff perceptions of patient safety. Leadership is a modifiable contextual factor and resources should be dedicated to strengthen relational competencies of healthcare leaders. Healthcare organizations must also proactively foster inter and intra-professional collaboration by providing teamwork educational workshops or other on-site learning opportunities (e.g., simulation training). Healthcare organizations would benefit by considering the interactive effect of contextual factors as another lever for patient safety improvement, e.g., lowering staff turnover intentions would maximize the positive impact of teamwork improvement initiatives on patient safety.
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Affiliation(s)
- Shahram Zaheer
- School of Health Policy and Management, York University, Toronto, Canada. .,Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada. .,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
| | - Liane Ginsburg
- School of Health Policy and Management, York University, Toronto, Canada
| | - Hannah J Wong
- School of Health Policy and Management, York University, Toronto, Canada
| | - Kelly Thomson
- School of Administrative Studies, York University, Toronto, Canada
| | - Lorna Bain
- Interprofessional Collaboration and Education, Southlake Regional Health Centre, Newmarket, Canada.,University of Toronto, Toronto, Canada
| | - Zaev Wulffhart
- University of Toronto, Toronto, Canada.,Regional Cardiac Care Program, Southlake Regional Health Centre, Newmarket, Canada
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Berta WB, Wagg A, Cranley L, Doupe MB, Ginsburg L, Hoben M, MacEachern L, Chamberlain S, Clement F, Easterbrook A, Keefe JM, Knopp-Sihota J, Rappon T, Reid C, Song Y, Estabrooks CA. Sustainment, Sustainability, and Spread Study (SSaSSy): protocol for a study of factors that contribute to the sustainment, sustainability, and spread of practice changes introduced through an evidence-based quality-improvement intervention in Canadian nursing homes. Implement Sci 2019; 14:109. [PMID: 31856880 PMCID: PMC6923960 DOI: 10.1186/s13012-019-0959-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/02/2019] [Indexed: 11/16/2022] Open
Abstract
Background Implementation scientists and practitioners, alike, recognize the importance of sustaining practice change, however post-implementation studies of interventions are rare. This is a protocol for the Sustainment, Sustainability and Spread Study (SSaSSy). The purpose of this study is to contribute to knowledge on the sustainment (sustained use), sustainability (sustained benefits), and spread of evidence-based practice innovations in health care. Specifically, this is a post-implementation study of an evidence-informed, Care Aide-led, facilitation-based quality-improvement intervention called SCOPE (Safer Care for Older Persons (in long-term care) Environments). SCOPE has been implemented in nursing homes in the Canadian Provinces of Manitoba (MB), Alberta (AB) and British Columbia (BC). Our study has three aims: (i) to determine the role that adaptation/contextualization plays in sustainment, sustainability and spread of the SCOPE intervention; (ii) to study the relative effects on sustainment, sustainability and intra-organizational spread of high-intensity and low-intensity post-implementation “boosters”, and a “no booster” condition, and (iii) to compare the relative costs and impacts of each booster condition. Methods/design SSaSSy is a two-phase mixed methods study. The overarching design is convergent, with qualitative and quantitative data collected over a similar timeframe in each of the two phases, analyzed independently, then merged for analysis and interpretation. Phase 1 is a pilot involving up to 7 units in 7 MB nursing homes in which SCOPE was piloted in 2016 to 2017, in preparation for phase 2. Phase 2 will comprise a quasi-experiment with two treatment groups of low- and high-intensity post-implementation “boosters”, and an untreated control group (no booster), using pretests and post-tests of the dependent variables relating to sustained care and management practices, and resident outcomes. Phase 2 will involve 31 trial sites in BC (17 units) and AB (14 units) nursing homes, where the SCOPE trial concluded in May 2019. Discussion This project stands to advance understanding of the factors that influence the sustainment of practice changes introduced through evidence-informed practice change interventions, and their associated sustainability. Findings will inform our understanding of the nature of the relationship of fidelity and adaptation to sustainment and sustainability, and afford insights into factors that influence the intra-organizational spread of practice changes introduced through complex interventions.
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Affiliation(s)
- Whitney B Berta
- Institute of Health Policy, Management & Evaluation, University of Toronto, Dalla Lana School of Public Health, 155 College Street, Suite 425, Toronto, Ontario, M5T 3M6, Canada.
| | - Adrian Wagg
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, 1-198 Clinical Sciences Building, 11350 - 83 Avenue, Edmonton, Alberta, T6G 2P4, Canada
| | - Lisa Cranley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street - Suite 130, Toronto, Ontario, M5T 1P8, Canada
| | - Malcolm B Doupe
- Departments of Community Health Sciences and Emergency Medicine, Manitoba Centre for Health Policy, Manitoba Training Program for Health Services Research, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, Manitoba, R3E 3P5, Canada
| | - Liane Ginsburg
- School of Health Policy & Management, Faculty of Health, York University, HNES 413, Toronto, Ontario, Canada
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, 5-305 Edmonton Clinic Health Academy (ECHA), 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Lauren MacEachern
- Institute of Health Policy, Management & Evaluation, University of Toronto, Dalla Lana School of Public Health, 155 College Street, Suite 425, Toronto, Ontario, M5T 3M6, Canada
| | - Stephanie Chamberlain
- Department of Family Medicine, University of Alberta, Alzheimer Society of Canada Postdoctoral Fellow, 6-50 University Terrace, University of Alberta, Edmonton, Alberta, T6G 2T4, Canada
| | - Fiona Clement
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3rd Floor Training Research and Wellness Building, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Adam Easterbrook
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul's Hospital, 588-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - Janice M Keefe
- Nova Scotia Centre on Aging, Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, Nova Scotia, BEM 2J6, Canada
| | - Jennifer Knopp-Sihota
- Faculty of Health Disciplines, Athabasca University, 6th Floor, South Campus, 345 - 6 Avenue SE, Calgary, Alberta, T2G 4V1, Canada
| | - Tim Rappon
- Institute of Health Policy, Management & Evaluation, University of Toronto, Dalla Lana School of Public Health, 155 College Street, Suite 425, Toronto, Ontario, M5T 3M6, Canada
| | - Colin Reid
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia - Okanagan, 1147 Research Road, Kelowna, British Columbia, V1V 1V7, Canada
| | - Yuting Song
- Translating Research in Elder Care (TREC), Faculty of Nursing, University of Alberta, 5-007D Edmonton Clinic Health Academy (ECHA), 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, University of Alberta, 5-183, Edmonton Clinic Health Academy, 11405 87 Ave, Edmonton, Alberta, T6G 1C9, Canada
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12
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Zaheer S, Ginsburg L, Wong HJ, Thomson K, Bain L, Wulffhart Z. Turnover intention of hospital staff in Ontario, Canada: exploring the role of frontline supervisors, teamwork, and mindful organizing. Hum Resour Health 2019; 17:66. [PMID: 31412871 PMCID: PMC6693251 DOI: 10.1186/s12960-019-0404-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 08/01/2019] [Indexed: 05/16/2023]
Abstract
BACKGROUND This study contributes to a small but growing body of literature on how context influences employee turnover intention. We examine the impact of staff perceptions of supervisory leadership support for safety, teamwork, and mindful organizing on turnover intention. Interaction effects of safety-specific constructs on turnover intention are also examined. METHODS Cross-sectional survey data were collected from nurses, allied health professionals, and unit clerks working in intensive care, general medicine, mental health, or the emergency department of a large community hospital in Southern Ontario. RESULTS Hierarchical regression analyses showed that staff perceptions of teamwork were significantly associated with turnover intention (p < 0.001). Direct associations of supervisory leadership support for safety and mindful organizing with turnover intention were non-significant; however, when staff perceived lower levels of mindful organizing at the frontlines, the positive effect of supervisory leadership on turnover intention was significant (p < 0.01). CONCLUSIONS Our results suggest that, in addition to teamwork perceptions positively affecting turnover intentions, safety-conscious supportive supervisors can help alleviate the negative impact of poor mindful organizing on frontline staff turnover intention. Healthcare organizations should recruit and retain individuals in supervisory roles who prioritize safety and possess adequate relational competencies. They should further dedicate resources to build and strengthen the relational capacities of their supervisory leadership. Moreover, it is important to provide on-site workshops on topics (e.g., conflict management) that can improve the quality of teamwork and consequently reduce employees' intention to leave their unit/organization.
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Affiliation(s)
- Shahram Zaheer
- School of Health Policy and Management, York University, Toronto, Canada
| | - Liane Ginsburg
- School of Health Policy and Management, York University, Toronto, Canada
| | - Hannah J. Wong
- School of Health Policy and Management, York University, Toronto, Canada
| | - Kelly Thomson
- School of Administrative Studies, York University, Toronto, Canada
| | - Lorna Bain
- Interprofessional Collaboration and Education, Southlake Regional Health Centre, Newmarket, Canada
- University of Toronto, Toronto, Canada
| | - Zaev Wulffhart
- Interprofessional Collaboration and Education, Southlake Regional Health Centre, Newmarket, Canada
- University of Toronto, Toronto, Canada
- Regional Cardiac Care Program, Southlake Regional Health Centre, Newmarket, Canada
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13
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El Morr C, Ginsburg L, Nam S, Cheung W, Brien H, Maloul A, Cohen N, La Croix H, Woolard S. Insight into Health Care Outcomes for Persons Living with Heart Failure Using Health Data Analytics. Stud Health Technol Inform 2019; 257:98-102. [PMID: 30741180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The Integrated Funding Model (IFM) is designed to measure the impact of a bundled model of health care for patients with Congestive Heart Failure (CHF) for a period of 60 days post discharge. CHF is a primary reason for patient admissions. The goal of this study is to gain insight into the effectiveness of the IFM pathway intervention on health care outcomes for persons living with CHF, using Health data Analytics.
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Affiliation(s)
- Christo El Morr
- School of Health Policy and Management, York University, Toronto Ontario Canada
| | - Liane Ginsburg
- School of Health Policy and Management, York University, Toronto Ontario Canada
| | | | - Wendy Cheung
- North York General Hospital, Toronto, Ontario Canada
| | - Heather Brien
- North York General Hospital, Toronto, Ontario Canada
| | - Asmaa Maloul
- North York General Hospital, Toronto, Ontario Canada
| | - Nancy Cohen
- North York General Hospital, Toronto, Ontario Canada
| | | | - Susan Woolard
- North York General Hospital, Toronto, Ontario Canada
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14
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Ginsburg L, Easterbrook A, Berta W, Norton P, Doupe M, Knopp-Sihota J, Anderson RA, Wagg A. Implementing Frontline Worker-Led Quality Improvement in Nursing Homes: Getting to "How". Jt Comm J Qual Patient Saf 2018; 44:526-535. [PMID: 30166036 DOI: 10.1016/j.jcjq.2018.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 04/17/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite emerging frameworks for quality improvement (QI) implementation, little is known about how the implementation process works, particularly in nursing home settings. A study was conducted to describe "how"' a complex frontline worker-led QI program was implemented in nursing homes. METHODS Six focus groups were conducted in February 2017 with participants of a year-long, multicomponent, unit-level QI intervention in seven nursing homes in the Canadian province of Manitoba. Constant comparative analysis was used to examine perspectives of different groups of QI program participants-35 health care aides, health professionals, and managers. RESULTS Five themes important to the implementation process were identified: (1) "supportive elements of the QI program structure," (2) "navigating the workplace," (3) "negotiating relationships," (4) "developing individual skills," and (5) "observable program impact." Data on theme integration suggest that "supportive elements of the QI program structure" (Theme 1), "developing individual skills" (Theme 4), and "observable program impact" (on residents, health care aides, and leaders; Theme 5) operated as part of a reinforcing feedback loop that boosted team members' ability to navigate the workplace, negotiate relationships, and implement the QI program. CONCLUSION Health care aide-led QI teams are feasible. However, a leadership paradox exists whereby worker-led QI programs also must incorporate concrete mechanisms to promote strong leadership and sponsor support to teams. The findings also point to the underexplored impact of interpersonal relationships between health care aides and professional staff on QI implementation.
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15
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Berta W, Laporte A, Perreira T, Ginsburg L, Dass AR, Deber R, Baumann A, Cranley L, Bourgeault I, Lum J, Gamble B, Pilkington K, Haroun V, Neves P. Relationships between work outcomes, work attitudes and work environments of health support workers in Ontario long-term care and home and community care settings. Hum Resour Health 2018; 16:15. [PMID: 29566723 PMCID: PMC5863810 DOI: 10.1186/s12960-018-0277-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 02/23/2018] [Indexed: 05/04/2023]
Abstract
BACKGROUND Our overarching study objective is to further our understanding of the work psychology of Health Support Workers (HSWs) in long-term care and home and community care settings in Ontario, Canada. Specifically, we seek novel insights about the relationships among aspects of these workers' work environments, their work attitudes, and work outcomes in the interests of informing the development of human resource programs to enhance elder care. METHODS We conducted a path analysis of data collected via a survey administered to a convenience sample of Ontario HSWs engaged in the delivery of elder care over July-August 2015. RESULTS HSWs' work outcomes, including intent to stay, organizational citizenship behaviors, and performance, are directly and significantly related to their work attitudes, including job satisfaction, work engagement, and affective organizational commitment. These in turn are related to how HSWs perceive their work environments including their quality of work life (QWL), their perceptions of supervisor support, and their perceptions of workplace safety. CONCLUSIONS HSWs' work environments are within the power of managers to modify. Our analysis suggests that QWL, perceptions of supervisor support, and perceptions of workplace safety present particularly promising means by which to influence HSWs' work attitudes and work outcomes. Furthermore, even modest changes to some aspects of the work environment stand to precipitate a cascade of positive effects on work outcomes through work attitudes.
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Affiliation(s)
- Whitney Berta
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON M5T 3M6 Canada
| | - Audrey Laporte
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON M5T 3M6 Canada
- Canadian Centre for Health Economics, University of Toronto, 155 College Street, 4th Floor, Toronto, ON M5T 3M6 Canada
| | - Tyrone Perreira
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON M5T 3M6 Canada
| | - Liane Ginsburg
- School of Health Policy & Management, York University, 4700 Keele Street, Toronto, ON M3J 1P3 Canada
| | - Adrian Rohit Dass
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON M5T 3M6 Canada
- Canadian Centre for Health Economics, University of Toronto, 155 College Street, 4th Floor, Toronto, ON M5T 3M6 Canada
| | - Raisa Deber
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON M5T 3M6 Canada
| | - Andrea Baumann
- Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Lisa Cranley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON M5T 1P8 Canada
| | - Ivy Bourgeault
- Telfer School of Management, 55 Laurier Ave E., Ottawa, ON K1N 6N5 Canada
| | - Janet Lum
- Department of Politics and Public Administration, Faculty of Arts, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3 Canada
| | - Brenda Gamble
- Faculty of Health Sciences, University of Ontario Institute of Technology, 2000 Simcoe Street, North Science Building, Oshawa, ON L1H 7K4 Canada
| | - Kathryn Pilkington
- Ontario Association of Non-Profit Homes & Services for Seniors, 7050 Weston Rd, Woodbridge, ON L4L 8G7 Canada
| | - Vinita Haroun
- Ontario Long Term Care Association, 425 University Avenue, Suite 500, Toronto, ON M5G 1T6 Canada
| | - Paula Neves
- Regional Geriatric Program of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
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16
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Perreira TA, Berta W, Laporte A, Ginsburg L, Deber R, Elliott G, Lum J. Shining a Light: Examining Similarities and Differences in the Work Psychology of Health Support Workers Employed in Long-Term Care and Home and Community Care Settings. J Appl Gerontol 2017; 38:1595-1614. [PMID: 29164989 DOI: 10.1177/0733464817737622] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Health Support Workers (HSWs) provide up to 80% of care to residents and clients in the long-term care (LTC) and home and community care (HCC) sectors but have received little research attention compared with the regulated professions. The authors explore similarities and differences in the work psychology of HSWs employed in LTC and HCC settings. Data were collected via survey from 276 LTC and 184 HCC HSWs. Descriptive statistics and path analyses were conducted. HSWs in LTC and HCC settings have significant, positive associations between organizational citizenship behaviors directed toward the organization (OCB-Os) and psychological empowerment, as well as intention to stay (ITS) and job satisfaction. For LTC sector HSWs, there are significant relationships between OCB-Os and quality of work life (QWL), ITS and work engagement, and individual performance and both job satisfaction and QWL. For the HCC sector, OCB-Os and ITS are significantly and directly related to organizational commitment. This study has implications for organizations interested in developing targeted interventions to improve the retention of HSWs.
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Affiliation(s)
| | | | | | | | | | | | - Janet Lum
- Ryerson University, Toronto, ON, Canada
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17
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VanDenKerkhof E, Sears N, Edge DS, Tregunno D, Ginsburg L. Patient safety in practical nurses' education: A cross-sectional survey of newly registered practical nurses in Canada. Nurse Educ Today 2017; 51:48-56. [PMID: 28126688 DOI: 10.1016/j.nedt.2017.01.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 12/15/2016] [Accepted: 01/06/2017] [Indexed: 05/28/2023]
Abstract
BACKGROUND Practical nurses have experienced an increasing scope of practice, including an expectation to care for complex patients and function on interdisciplinary teams. Little is known about the degree to which patient safety principles are addressed in practical nursing education. PURPOSE To examine self-reported patient safety competencies of practical nurses. DESIGN A cross-sectional online survey (July 2014) and face-to-face interviews (June 2015). SETTING Ontario, Canada. PARTICIPANTS Survey participants were practical nurses newly registered with the College of Nurses of Ontario between January 2012 and December 2013. Interview participants were faculty and students in a practical nursing program in Ontario. METHODS Survey respondents completed the Health Professional Education in Patient Safety Survey online. Self-reported competencies in various patient safety domains were compared between classroom and clinical settings. Faculty members were interviewed about educational preparation of practical nurses and students were interviewed to provide insight into interpretation of survey questions. RESULTS The survey response rate was 28.4% (n=1104/3883). Mean domain scores indicated a high level of confidence in patient safety competence (<4.0/5.0). Confidence was highest in respondents registered with the College of Nurses of Ontario >2years and in those who obtained their education outside of Canada. Faculty believed their approach to teaching and learning instilled a deep understanding of the limits to practical nurse autonomous practice. CONCLUSIONS Practical nurses were confident in what they learned about patient safety in their educational programs. The high degree of patient safety competence may be a true reflection of practical nurses understanding of, and comfort with, the limits of their knowledge and, ultimately, the limits of their individual autonomous practice. Further exploration as to whether the questionnaire requires additional modification for use with practical nurse populations is warranted. However, this study provides the first examination of practical nurses' perspectives and perceptions about patient safety education.
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Affiliation(s)
- Elizabeth VanDenKerkhof
- School of Nursing and Dept of Anesthesiology & Perioperative Medicine, Queen's University, 92 Barrie St., Kingston, Ontario K7L 3N6, Canada.
| | - Nancy Sears
- School of Baccalaureate Nursing, St. Lawrence College, 100 Portsmouth Avenue, Kingston, ON K7L 5A6, Canada.
| | - Dana S Edge
- School of Nursing, Queen's University, 200-82, 82/84 Barrie St., Kingston, Ontario K7L 3N6, Canada.
| | - Deborah Tregunno
- School of Nursing, Queen's University, 92 Barrie St., Kingston, Ontario K7L 3N6, Canada.
| | - Liane Ginsburg
- School of Health Policy and Management, York University, 413 HNES, Keele Campus, Toronto, Ontario M3J 1P3, Canada.
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18
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El Morr C, Ginsburg L, Nam S, Woollard S. Assessing the Performance of a Modified LACE Index (LACE-rt) to Predict Unplanned Readmission After Discharge in a Community Teaching Hospital. Interact J Med Res 2017; 6:e2. [PMID: 28274908 PMCID: PMC5362694 DOI: 10.2196/ijmr.7183] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 01/31/2017] [Accepted: 02/14/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The LACE index was designed to predict early death or unplanned readmission after discharge from hospital to the community. However, implementing the LACE tool in real time in a teaching hospital required practical unavoidable modifications. OBJECTIVE The purpose of this study was to validate the implementation of a modified LACE index (LACE-rt) and test its ability to predict readmission risk using data in a hospital setting. METHODS Data from the Canadian Institute for Health Information's Discharge Abstract Database (DAD), the National Ambulatory Care Reporting System (NACRS), and the hospital electronic medical record for one large community hospital in Toronto, Canada, were used in this study. A total of 3855 admissions from September 2013 to July 2014 were analyzed (N=3855) using descriptive statistics, regression analysis, and receiver operating characteristic analysis. Prospectively collected data from DAD and NACRS were linked to inpatient data. RESULTS The LACE-rt index was a fair test to predict readmission risk (C statistic=.632). A LACE-rt score of 10 is a good threshold to differentiate between patients with low and high readmission risk; the high-risk patients are 2.648 times more likely to be readmitted than those at low risk. The introduction of LACE-rt had no significant impact on readmission reduction. CONCLUSIONS The LACE-rt is a fair tool for identifying those at risk of readmission. A collaborative cross-sectoral effort that includes those in charge of providing community-based care is needed to reduce readmission rates. An eHealth solution could play a major role in streamlining this collaboration.
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Affiliation(s)
- Christo El Morr
- Faculty of Health, School of Health Policy and Management, York University, Toronto, ON, Canada
| | - Liane Ginsburg
- Faculty of Health, School of Health Policy and Management, York University, Toronto, ON, Canada
| | - Seungree Nam
- Faculty of Health, School of Health Policy and Management, York University, Toronto, ON, Canada
| | - Susan Woollard
- North York General Hospital, Medicine, North York General Hospital, Toronto, ON, Canada
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Ginsburg L, Bain L. The evaluation of a multifaceted intervention to promote “speaking up” and strengthen interprofessional teamwork climate perceptions. J Interprof Care 2017; 31:207-217. [DOI: 10.1080/13561820.2016.1249280] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Liane Ginsburg
- School of Health Policy & Management, York University, Toronto, Ontario, Canada
| | - Lorna Bain
- Coordinator Interprofessional Collaboration and Education,Southlake Regional Health Centre, Newmarket, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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20
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Ahmad F, Lou W, Shakya Y, Ginsburg L, Ng PT, Rashid M, Dinca-Panaitescu S, Ledwos C, McKenzie K. Preconsult interactive computer-assisted client assessment survey for common mental disorders in a community health centre: a randomized controlled trial. CMAJ Open 2017; 5:E190-E197. [PMID: 28401134 PMCID: PMC5378520 DOI: 10.9778/cmajo.20160118] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Access disparities for mental health care exist for vulnerable ethnocultural and immigrant groups. Community health centres that serve these groups could be supported further by interactive, computer-based, self-assessments. METHODS An interactive computer-assisted client assessment survey (iCCAS) tool was developed for preconsult assessment of common mental disorders (using the Patient Health Questionnaire [PHQ-9], Generalized Anxiety Disorder 7-item [GAD-7] scale, Primary Care Post-traumatic Stress Disorder [PTSD-PC] screen and CAGE [concern/cut-down, anger, guilt and eye-opener] questionnaire), with point-of-care reports. The pilot randomized controlled trial recruited adult patients, fluent in English or Spanish, who were seeing a physician or nurse practitioner at the partnering community health centre in Toronto. Randomization into iCCAS or usual care was computer generated, and allocation was concealed in sequentially numbered, opaque envelopes that were opened after consent. The objectives were to examine the interventions' efficacy in improving mental health discussion (primary) and symptom detection (secondary). Data were collected by exit survey and chart review. RESULTS Of the 1248 patients assessed, 190 were eligible for participation. Of these, 148 were randomly assigned (response rate 78%). The iCCAS (n = 75) and usual care (n = 72) groups were similar in sociodemographics; 98% were immigrants, and 68% were women. Mental health discussion occurred for 58.7% of patients in the iCCAS group and 40.3% in the usual care group (p ≤ 0.05). The effect remained significant while controlling for potential covariates (language, sex, education, employment) in generalized linear mixed model (GLMM; adjusted odds ratio [OR] 2.2; 95% confidence interval [CI] 1.1-4.5). Mental health symptom detection occurred for 38.7% of patients in the iCCAS group and 27.8% in the usual care group (p > 0.05). The effect was not significant beyond potential covariates in GLMM (adjusted OR 1.9; 95% CI 0.9-4.1). INTERPRETATION The studied intervention holds potential for community health centres to improve mental health discussion. Further research with larger samples should examine the impact on detection and enhance generalizability. Trial registration: ClinicalTrials.gov, no: NCT02023957, registered on Dec. 12, 2013.
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Affiliation(s)
- Farah Ahmad
- School of Health Policy and Management (Ahmad, Ginsburg, Dinca-Panaitescu), York University; Biostatistics Division (Lou), Dalla Lana School of Public Health, University of Toronto; Access Alliance Multicultural Health and Community Services (Shakya, Ledwos); School of Administrative Studies (Ng), York University; Women's College Hospital (Rashid); Department of Family and Community Medicine (Rashid), University of Toronto; Centre for Addiction and Mental Health (McKenzie); The Wellesley Institute (McKenzie), Toronto, Ont
| | - Wendy Lou
- School of Health Policy and Management (Ahmad, Ginsburg, Dinca-Panaitescu), York University; Biostatistics Division (Lou), Dalla Lana School of Public Health, University of Toronto; Access Alliance Multicultural Health and Community Services (Shakya, Ledwos); School of Administrative Studies (Ng), York University; Women's College Hospital (Rashid); Department of Family and Community Medicine (Rashid), University of Toronto; Centre for Addiction and Mental Health (McKenzie); The Wellesley Institute (McKenzie), Toronto, Ont
| | - Yogendra Shakya
- School of Health Policy and Management (Ahmad, Ginsburg, Dinca-Panaitescu), York University; Biostatistics Division (Lou), Dalla Lana School of Public Health, University of Toronto; Access Alliance Multicultural Health and Community Services (Shakya, Ledwos); School of Administrative Studies (Ng), York University; Women's College Hospital (Rashid); Department of Family and Community Medicine (Rashid), University of Toronto; Centre for Addiction and Mental Health (McKenzie); The Wellesley Institute (McKenzie), Toronto, Ont
| | - Liane Ginsburg
- School of Health Policy and Management (Ahmad, Ginsburg, Dinca-Panaitescu), York University; Biostatistics Division (Lou), Dalla Lana School of Public Health, University of Toronto; Access Alliance Multicultural Health and Community Services (Shakya, Ledwos); School of Administrative Studies (Ng), York University; Women's College Hospital (Rashid); Department of Family and Community Medicine (Rashid), University of Toronto; Centre for Addiction and Mental Health (McKenzie); The Wellesley Institute (McKenzie), Toronto, Ont
| | - Peggy T Ng
- School of Health Policy and Management (Ahmad, Ginsburg, Dinca-Panaitescu), York University; Biostatistics Division (Lou), Dalla Lana School of Public Health, University of Toronto; Access Alliance Multicultural Health and Community Services (Shakya, Ledwos); School of Administrative Studies (Ng), York University; Women's College Hospital (Rashid); Department of Family and Community Medicine (Rashid), University of Toronto; Centre for Addiction and Mental Health (McKenzie); The Wellesley Institute (McKenzie), Toronto, Ont
| | - Meb Rashid
- School of Health Policy and Management (Ahmad, Ginsburg, Dinca-Panaitescu), York University; Biostatistics Division (Lou), Dalla Lana School of Public Health, University of Toronto; Access Alliance Multicultural Health and Community Services (Shakya, Ledwos); School of Administrative Studies (Ng), York University; Women's College Hospital (Rashid); Department of Family and Community Medicine (Rashid), University of Toronto; Centre for Addiction and Mental Health (McKenzie); The Wellesley Institute (McKenzie), Toronto, Ont
| | - Serban Dinca-Panaitescu
- School of Health Policy and Management (Ahmad, Ginsburg, Dinca-Panaitescu), York University; Biostatistics Division (Lou), Dalla Lana School of Public Health, University of Toronto; Access Alliance Multicultural Health and Community Services (Shakya, Ledwos); School of Administrative Studies (Ng), York University; Women's College Hospital (Rashid); Department of Family and Community Medicine (Rashid), University of Toronto; Centre for Addiction and Mental Health (McKenzie); The Wellesley Institute (McKenzie), Toronto, Ont
| | - Cliff Ledwos
- School of Health Policy and Management (Ahmad, Ginsburg, Dinca-Panaitescu), York University; Biostatistics Division (Lou), Dalla Lana School of Public Health, University of Toronto; Access Alliance Multicultural Health and Community Services (Shakya, Ledwos); School of Administrative Studies (Ng), York University; Women's College Hospital (Rashid); Department of Family and Community Medicine (Rashid), University of Toronto; Centre for Addiction and Mental Health (McKenzie); The Wellesley Institute (McKenzie), Toronto, Ont
| | - Kwame McKenzie
- School of Health Policy and Management (Ahmad, Ginsburg, Dinca-Panaitescu), York University; Biostatistics Division (Lou), Dalla Lana School of Public Health, University of Toronto; Access Alliance Multicultural Health and Community Services (Shakya, Ledwos); School of Administrative Studies (Ng), York University; Women's College Hospital (Rashid); Department of Family and Community Medicine (Rashid), University of Toronto; Centre for Addiction and Mental Health (McKenzie); The Wellesley Institute (McKenzie), Toronto, Ont
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Ahmad F, Shakya Y, Ginsburg L, Lou W, Ng PT, Rashid M, Ferrari M, Ledwos C, McKenzie K. Burden of common mental disorders in a community health centre sample. Can Fam Physician 2016; 62:e758-e766. [PMID: 27965352 PMCID: PMC5154667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To examine the rates of common mental disorders (CMDs) such as depression, anxiety, posttraumatic stress disorder (PTSD), and alcohol use in an urban community health care centre (CHC) serving vulnerable immigrant and ethnoracial communities in order to improve knowledge on the rates of CMDs specific to these groups accessing primary care settings. DESIGN English or Spanish, self-administered, tablet-based survey known as the Interactive Computer-Assisted Client Assessment Survey (iCCAS). SETTING Access Alliance Multicultural Health and Community Services CHC in Toronto, Ont. PARTICIPANTS Adult patients waiting to see a clinician. MAIN OUTCOME MEASURES The iCCAS screened for depression (using the PHQ-9 [Patient Health Questionnaire]), anxiety (using the GAD-7 [Generalized Anxiety Disorder 7-item scale]), PTSD (using the PC-PTSD [Primary Care PTSD Screen]), and alcohol dependency (using the CAGE questionnaire); those with an existing diagnosis and active treatment for one of these conditions were not asked to complete that condition-specific screening scale. An exit survey measured demographic characteristics and relevant indicators. RESULTS A response rate of 78.6% was achieved. The iCCAS survey was completed by 75 patients (26 men and 49 women) with a mean age of 36.5 years. Almost all were first-generation immigrants: 32.0% originated from Latin America, 28.0% from South Asia, and 17.3% from Africa or the Middle East. Major depression was found among 44.0% of participants (11 with diagnosis and treatment, 22 with a score of 10 or greater on the PHQ-9). Generalized anxiety disorder was present in 26.7% of participants (7 with diagnosis and treatment, 13 with a score of 10 or greater on the GAD-7 scale). Posttraumatic stress disorder was detected in 37.3% of participants (7 with diagnosis and treatment, 21 with a score of 3 or greater on the PC-PTSD tool). Alcohol dependency was found among 10.7% of participants (1 with diagnosis and treatment, 7 with a score of 2 or greater on the CAGE questionnaire). CONCLUSION The high rates of probable depression, generalized anxiety, and PTSD that were found in the studied population suggest a need for systematic assessment of CMDs in CHCs, as well as training and resources to increase readiness to handle identified cases.
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Affiliation(s)
- Farah Ahmad
- Associate Professor in the School of Health Policy and Management at York University in Toronto, Ont, and Research Scientist at the North York General Hospital.
| | - Yogendra Shakya
- Senior Research Scientist at Access Alliance Multicultural Health and Community Services and Assistant Professor in the Dalla Lana School of Public Health at the University of Toronto
| | - Liane Ginsburg
- Associate Professor in the School of Health Policy and Management at York University
| | - Wendy Lou
- Professor and Head of the Biostatistics Division of the Dalla Lana School of Public Health at the University of Toronto
| | - Peggy T Ng
- Professor in the School of Administrative Studies at York University
| | - Meb Rashid
- Director of Cross Roads Clinic at Women's College Hospital and Assistant Professor at the Department of Family and Community Medicine at the University of Toronto
| | - Manuela Ferrari
- Postdoctoral fellow in the School of Health Policy and Management at York University
| | - Cliff Ledwos
- Director of Primary Health Care and Special Initiatives at Access Alliance Multicultural Health and Community Services
| | - Kwame McKenzie
- Psychiatrist and Medical Director of Underserved Populations at the Centre for Addiction and Mental Health in Toronto, Ont, and Chief Executive Officer of The Wellesley Institute
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Cummings GG, Doupe M, Ginsburg L, McGregor MJ, Norton PG, Estabrooks CA. Development and Validation of A Scheduled Shifts Staffing (ASSiST) Measure of Unit-Level Staffing in Nursing Homes. GERONT 2016; 57:509-516. [DOI: 10.1093/geront/gnv682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 09/30/2015] [Indexed: 11/14/2022] Open
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Ginsburg L, Berta W, Baumbusch J, Rohit Dass A, Laporte A, Reid RC, Squires J, Taylor D. Measuring Work Engagement, Psychological Empowerment, and Organizational Citizenship Behavior Among Health Care Aides. GERONT 2016; 56:e1-11. [DOI: 10.1093/geront/gnv129] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 07/20/2015] [Indexed: 11/14/2022] Open
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24
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El Morr C, Ginsburg L, Nam VS, Woollard S, Hansen B. Analyzing Readmissions Patterns: Assessment of the LACE Tool Impact. Stud Health Technol Inform 2016; 223:25-30. [PMID: 27139381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This paper will discuss the assessment of the use of the LACE tool at North York General Hospital (NYGH). The LACE tool estimates the readmission risk of patients. This paper describes the tool and a modified LACE score implementation and use at NYGH. We also describe our statistical analysis for the LACE effectiveness in order to inform future decisions in resource allocations. We will look at suggestions for adjustments in the way the LACE tool is used as well as implications for service delivery and patients' quality of life. Our study shows that the modified LACE is a predictive tool for readmission risk in day-to-day hospital activity, but that implementation of LACE alone cannot reduce readmission rates unless coupled with efforts of those in charge of providing community-based care.
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Estabrooks CA, Squires JE, Hayduk L, Morgan D, Cummings GG, Ginsburg L, Norton PG. Does organizational context influence the use of best practices by healthcare aides in residential long term care? Implement Sci 2015. [PMCID: PMC4551727 DOI: 10.1186/1748-5908-10-s1-a64] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
Background When patient safety climate (PSC) surveys are used in healthcare, reporting typically focuses on PSC level (mean or per cent positive scores). This paper explores how an additional focus on PSC strength can enhance the utility of PSC survey data. Setting and participants 442 care providers from 24 emergency departments (EDs) across Canada. Methods We use anonymised data from the Can-PSCS PSC instrument collected in 2011 as part of the Qmentum accreditation programme. We examine differences in climate strength across EDs using the Rwg(j) and intraclass correlation coefficients measures of inter-rater agreement. Results Across the six survey dimensions, median Rwg(j) was sufficiently high to support shared climate perceptions (0.64–0.83), but varied widely across the 24 ED units. We provide an illustrative example showing vastly different climate strength (Rwg(j) range=0.17–0.86) for units with an equivalent level of PSC (eg, climate mean score=3). Conclusions Most PSC survey results focus solely on climate level. To facilitate improvement in PSC, we advocate a simple, holistic safety climate profile including three metrics: climate level (using mean or per cent positive climate scores), climate strength (using the Rwg(j), or SD as a proxy) and the shape of the distribution (using histograms to see the distribution of scores within units). In PSC research, we advocate paying attention to climate strength as an important variable in its own right. Focusing on PSC level and strength can further understanding of the extent to which PSC is a key variable in the domain of patient safety.
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Affiliation(s)
- Liane Ginsburg
- School of Health Policy & Management, York University, Toronto, Ontario, Canada
| | - Debra Gilin Oore
- Department of Psychology, Saint Mary's University, Halifax, Nova Scotia, Canada
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Lukewich J, Edge DS, Tranmer J, Raymond J, Miron J, Ginsburg L, VanDenKerkhof E. Undergraduate baccalaureate nursing students’ self-reported confidence in learning about patient safety in the classroom and clinical settings: An annual cross-sectional study (2010–2013). Int J Nurs Stud 2015; 52:930-8. [DOI: 10.1016/j.ijnurstu.2015.01.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 01/16/2015] [Accepted: 01/20/2015] [Indexed: 10/24/2022]
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Estabrooks CA, Squires JE, Hayduk L, Morgan D, Cummings GG, Ginsburg L, Stewart N, McGilton K, Kang SH, Norton PG. The influence of organizational context on best practice use by care aides in residential long-term care settings. J Am Med Dir Assoc 2015; 16:537.e1-10. [PMID: 25899110 DOI: 10.1016/j.jamda.2015.03.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 02/10/2015] [Accepted: 03/10/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study assessed individual and organizational context (work environment) factors that influence use of best practices by care aides (nursing assistants) in nursing homes. Little scientific attention has been focused on understanding best practice use in nursing homes and almost none on care aides. SETTING AND PARTICIPANTS A total of 1262 care aides in 25 nursing homes in the 3 Canadian prairie provinces. Care aides are unregulated workers who provide 80% of direct care to residents in Canadian nursing homes. METHOD We used hierarchical linear modeling to (1) assess the amount of variance in use of best practices, as reported by care aides, that could be attributed to individual or organizational factors, and (2) identify predictors of best practices use by care aides. RESULTS At the individual level, statistically significant predictors of instrumental use of best practices included sex, age, shift worked, job efficacy, and belief suspension. At the unit level, significant predictors were social capital, organizational slack (staffing and time), number of informal interactions, and unit type. At the facility level, ownership model and province were significant. Significant predictors of conceptual use of best practices at the individual level included English as a first language, job efficacy, belief suspension, intent to use research, adequate knowledge, and number of information sources used. At the unit level, significant predictors were evaluation (feedback mechanisms), structural resources, and organizational slack (time). At the facility level, province was significant. The R(2) was 18.3% for instrumental use of best practices and 43.4% for conceptual use. Unit level factors added a substantial amount of explained variance whereas facility level factors added relatively little explained variance. CONCLUSIONS Our study suggests that context plays an important role in care aides' use of best practices in nursing homes. Individual characteristics played a more prominent role than contextual factors in predicting conceptual use of best practices.
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Affiliation(s)
| | - Janet E Squires
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Leslie Hayduk
- Department of Sociology, University of Alberta, Edmonton, Alberta, Canada
| | - Debra Morgan
- Canadian Center for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Greta G Cummings
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Liane Ginsburg
- School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Norma Stewart
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Katherine McGilton
- Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Sung Hyun Kang
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Peter G Norton
- Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
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Doyle P, VanDenKerkhof EG, Edge DS, Ginsburg L, Goldstein DH. Self-reported patient safety competence among Canadian medical students and postgraduate trainees: a cross-sectional survey. BMJ Qual Saf 2015; 24:135-41. [PMID: 25605953 PMCID: PMC4316835 DOI: 10.1136/bmjqs-2014-003142] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 11/03/2014] [Accepted: 11/09/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Quality and patient safety (PS) are critical components of medical education. This study reports on the self-reported PS competence of medical students and postgraduate trainees. METHODS The Health Professional Education in Patient Safety Survey was administered to medical students and postgraduate trainees in January 2012. PS dimension scores were compared across learning settings (classroom and clinical) and year in programme. RESULTS Sixty-three percent (255/406) of medical students and 32% (141/436) of postgraduate trainees responded. In general, both groups were most confident in their learning of clinical safety skills (eg, hand hygiene) and least confident in learning about sociocultural aspects of safety (eg, understanding human factors). Medical students' confidence in most aspects of safety improved with years of training. For some of the more intangible dimensions (teamwork and culture), medical students in their final year had lower scores than students in earlier years. Thirty-eight percent of medical students felt they could approach someone engaging in unsafe practice, and the majority of medical students (85%) and postgraduate trainees (78%) agreed it was difficult to question authority. CONCLUSIONS Our results suggest the need to improve the overall content, structure and integration of PS concepts in both classroom and clinical learning environments. Decreased confidence in sociocultural aspects of PS among medical students in the final year of training may indicate that culture in clinical settings negatively affects students' perceived PS competence. Alternatively, as medical students spend more time in the clinical setting, they may develop a clearer sense of what they do not know.
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Affiliation(s)
- Patricia Doyle
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Elizabeth G VanDenKerkhof
- School of Nursing and Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Dana S Edge
- School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Liane Ginsburg
- School of Health Policy & Management, York University, Toronto, Ontario, Canada
| | - David H Goldstein
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
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Tregunno D, Ginsburg L, Clarke B, Norton P. Integrating patient safety into health professionals' curricula: a qualitative study of medical, nursing and pharmacy faculty perspectives. BMJ Qual Saf 2014; 23:257-64. [PMID: 24299734 PMCID: PMC3932978 DOI: 10.1136/bmjqs-2013-001900] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 09/25/2013] [Accepted: 10/09/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND As efforts to integrate patient safety into health professional curricula increase, there is growing recognition that the rate of curricular change is very slow, and there is a shortage of research that addresses critical perspectives of faculty who are on the 'front-lines' of curricular innovation. This study reports on medical, nursing and pharmacy teaching faculty perspectives about factors that influence curricular integration and the preparation of safe practitioners. METHODS Qualitative methods were used to collect data from 20 faculty members (n=6 medical from three universities; n=6 pharmacy from two universities; n=8 nursing from four universities) engaged in medical, nursing and pharmacy education. Thematic analysis generated a comprehensive account of faculty perspectives. RESULTS Faculty perspectives on key challenges to safe practice vary across the three disciplines, and these different perspectives lead to different priorities for curricular innovation. Additionally, accreditation and regulatory requirements are driving curricular change in medicine and pharmacy. Key challenges exist for health professional students in clinical teaching environments where the culture of patient safety may thwart the preparation of safe practitioners. CONCLUSIONS Patient safety curricular innovation depends on the interests of individual faculty members and the leveraging of accreditation and regulatory requirements. Building on existing curricular frameworks, opportunities now need to be created for faculty members to act as champions of curricular change, and patient safety educational opportunities need to be harmonises across all health professional training programmes. Faculty champions and practice setting leaders can collaborate to improve the culture of patient safety in clinical teaching and learning settings.
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Affiliation(s)
- Deborah Tregunno
- School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Liane Ginsburg
- School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Beth Clarke
- Bridgepoint Health, Toronto, Ontario, Canada
| | - Peter Norton
- Department of Family Medicine (Emeritus), University of Calgary, Calgary, Canada
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Andermann A, Ginsburg L, Norton P, Arora N, Bates D, Wu A, Larizgoitia I. Core competencies for patient safety research: a cornerstone for global capacity strengthening. BMJ Qual Saf 2012; 20:96-101. [PMID: 21228081 PMCID: PMC3022363 DOI: 10.1136/bmjqs.2010.041814] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Tens of millions of patients worldwide suffer disabling injuries or death every year due to unsafe medical care. Nonetheless, there is a scarcity of research evidence on how to tackle this global health priority. The shortage of trained researchers is a major limitation, particularly in developing and transitional countries. Objectives As a first step to strengthen capacity in this area, the authors developed a set of internationally agreed core competencies for patient safety research worldwide. Methods A multistage process involved developing an initial framework, reviewing the existing literature relating to competencies in patient safety research, conducting a series of consultations with potential end users and international experts in the field from over 35 countries and finally convening a global consensus conference. Results An initial draft list of competencies was grouped into three themes: patient safety, research methods and knowledge translation. The competencies were considered by the WHO Patient Safety task force, by potential end users in developing and transitional countries and by international experts in the field to be relevant, comprehensive, clear, easily adaptable to local contexts and useful for training patient safety researchers internationally. Conclusions Reducing patient harm worldwide will require long-term sustained efforts to build capacity to enable practical research that addresses local problems and improves patient safety. The first edition of Competencies for Patient Safety Researchers is proposed by WHO Patient Safety as a foundation for strengthening research capacity by guiding the development of training programmes for researchers in the area of patient safety, particularly in developing and transitional countries, where such research is urgently needed.
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Affiliation(s)
- Anne Andermann
- Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, New Jersey, USA
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Duhn L, Karp S, Oni O, Edge D, Ginsburg L, VanDenKerkhof E. Perspectives on patient safety among undergraduate nursing students. J Nurs Educ 2012; 51:526-31. [PMID: 22766076 DOI: 10.3928/01484834-20120706-04] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 04/18/2012] [Indexed: 11/20/2022]
Abstract
Incorporating patient safety principles in academic and clinical education for health science professionals is necessary to support widespread adoption of safety practices. It is vital to understand nursing students' perspectives on patient safety and the extent to which patient safety is addressed in the classroom and clinical settings. In this cross-sectional study, students in all 4 years of an undergraduate program were asked to complete the Health Professional Education in Patient Safety Survey. Eighty-one percent (238 of 293) of students completed the questionnaire. Responses were favorable, with students reporting confidence in learning about a variety of patient safety competencies. Of note, there were decreasing levels of confidence in the third-year and fourth-year students and low-to-moderate correlation between classroom and clinical responses. These results support the importance of consistently engaging students in safety principles early in and throughout their health care programs.
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Affiliation(s)
- Lenora Duhn
- School of Nursing and Department of Anesthesiology & Perioperative Medicine, Queen's University, Kingston, ON, Canada
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Gravely S, Ginsburg L, Stewart DE, Mak S, Grace SL. Referral and use of heart failure clinics: what factors are related to use? Can J Cardiol 2012; 28:483-9. [PMID: 22366509 PMCID: PMC4494832 DOI: 10.1016/j.cjca.2011.11.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 11/29/2011] [Accepted: 11/29/2011] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Heart failure (HF) clinics have been shown to reduce hospital readmissions and generally have favourable effects on quality of life, survival, and care costs. This study investigated the rates of referral and use of HF clinics and examined factors related to program use. METHODS This study represents a secondary analysis of a larger prospective cohort study conducted in Ontario. In hospital, 474 HF inpatients from 11 hospitals across Ontario completed a survey that examined predisposing, enabling, and need factors affecting HF clinic use. Then 1 year later, 271 HF patients completed a mailed survey that assessed referral to and use of HF clinics. RESULTS Forty-one patients (15.2%) self-reported referral, and 35 (13%) self-reported attending an HF clinic. Generalized estimating equations showed that factors related to greater program use were having an HF clinic at the site of hospital recruitment (odds ratio [OR] = 8.40; P = 0.04), referral to other disease management programs (OR = 4.87; P = 0.04), higher education (OR = 4.61; P = 0.02), lower stress (OR = 0.93; P = 0.03), and lower functional status (OR = 0.97; P = 0.03). CONCLUSION Similar to previous research, only one-seventh of HF patients were referred to and used an HF clinic. Both patient-level and health-system factors were related to HF clinic use. Given the benefits of HF clinics, more research examining how equitable access can be increased is needed. Also, the appropriateness and cost repercussions of use of multiple disease management programs should be investigated.
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Affiliation(s)
- Shannon Gravely
- York University, Faculty of Health, Toronto, Ontario, Canada
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Ginsburg L, Castel E, Tregunno D, Norton PG. The H-PEPSS: an instrument to measure health professionals' perceptions of patient safety competence at entry into practice. BMJ Qual Saf 2012; 21:676-84. [PMID: 22562876 PMCID: PMC3402748 DOI: 10.1136/bmjqs-2011-000601] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Enhancing competency in patient safety at entry to practice requires introduction and integration of patient safety into health professional education. As efforts to include patient safety in health professional education increase, it is important to capture new health professionals' perspectives of their own patient safety competence at entry to practice. Existing instruments to measure patient safety knowledge, skills and attitudes have been developed largely to examine the impact of specific patient safety curricular initiatives and the psychometric analyses of the instruments used thus far have been exploratory in nature. METHODS Confirmatory factor analytic approaches are used to extensively test the Health Professional Education in Patient Safety Survey (H-PEPSS), a newly designed survey rooted in a patient safety competency framework and designed to measure health professionals' self-reported patient safety competence around the time of entry to practice. The H-PEPSS focuses primarily on the socio-cultural aspects of patient safety including culture, teamwork, communication, managing risk and understanding human factors. RESULTS Results support a parsimonious six-factor measurement model of health professionals' perceptions of patient safety competency. These results support the validity of a reduced version of the H-PEPSS and suggest it can be appropriately used at or near training completion with a variety of health professional groups. CONCLUSIONS Given increased demands for patient safety competency among health professionals at entry to practice and slow, but emerging changes in health professional education, ongoing research to understand the extent of patient safety competency among health professionals around the time of entry to practice will be important.
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Affiliation(s)
- Liane Ginsburg
- School of Health Policy & Management, York University, Toronto, Canada.
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Abstract
OBJECTIVE To examine the psychometric and unit of analysis/strength of culture issues in patient safety culture (PSC) measurement. DATA SOURCE Two cross-sectional surveys of health care staff in 10 Canadian health care organizations totaling 11,586 respondents. STUDY DESIGN A cross-validation study of a measure of PSC using survey data gathered using the Modified Stanford PSC survey (MSI-2005 and MSI-2006); a within-group agreement analysis of MSI-2006 data. Extraction Methods. Exploratory factor analyses (EFA) of the MSI-05 survey data and confirmatory factor analysis (CFA) of the MSI-06 survey data; Rwg coefficients of homogeneity were calculated for 37 units and six organizations in the MSI-06 data set to examine within-group agreement. PRINCIPAL FINDINGS The CFA did not yield acceptable levels of fit. EFA and reliability analysis of MSI-06 data suggest two reliable dimensions of PSC: Organization leadership for safety (alpha=0.88) and Unit leadership for safety (alpha=0.81). Within-group agreement analysis shows stronger within-unit agreement than within-organization agreement on assessed PSC dimensions. CONCLUSIONS The field of PSC measurement has not been able to meet strict requirements for sound measurement using conventional approaches of CFA. Additional work is needed to identify and soundly measure key dimensions of PSC. The field would also benefit from further attention to strength of culture/unit of analysis issues.
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Affiliation(s)
- Liane Ginsburg
- School of Health Policy and Management, Faculty of Health, York University, HNES Building 413, 4700 Keele Street, Toronto, ON, Canada M3J 1P3.
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Ginsburg L, Tregunno D. New approaches to interprofessional education and collaborative practice: lessons from the organizational change literature. J Interprof Care 2005; 19 Suppl 1:177-87. [PMID: 16096154 DOI: 10.1080/13561820500083105] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This paper highlights a variety of issues from the organizational change literature that are especially relevant to the implementation of initiatives in interprofessional education (IPE) for collaborative practice (CP). At the level of the individual, these include the existence of strong professional cultures and the need to motivate change. At the level of the organization, context and leadership for IPE and CP are relevant. At the system level, a discussion of incremental versus radical forces for change is particularly germane. Drawing on relevant theoretical and empirical literature, we address each of these three domains and highlight lessons learned from the study of organizational change to the implementation and adoption of IPE and CP. The paper concludes with a set of key recommendations suggested for reducing the incidence of implementation failure.
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Affiliation(s)
- Liane Ginsburg
- School of Health Policy & Management, York University, Ontario, Canada
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Abstract
OBJECTIVE To design a training intervention and then test its effect on nurse leaders' perceptions of patient safety culture. STUDY SETTING Three hundred and fifty-six nurses in clinical leadership roles (nurse managers and educators/CNSs) in two Canadian multi-site teaching hospitals (study and control). STUDY DESIGN A prospective evaluation of a patient safety training intervention using a quasi-experimental untreated control group design with pretest and posttest. Nurses in clinical leadership roles in the study group were invited to participate in two patient safety workshops over a 6-month period. Individuals in the study and control groups completed surveys measuring patient safety culture and leadership for improvement prior to training and 4 months following the second workshop. EXTRACTION METHODS Individual nurse clinical leaders were the unit of analysis. Exploratory factor analysis of the safety culture items was conducted; repeated-measures analysis of variance and paired t-tests were used to evaluate the effect of the training intervention on perceived safety culture (three factors). Hierarchical regression analyses looked at the influence of demographics, leadership for improvement, and the training intervention on nurse leaders' perceptions of safety culture. PRINCIPAL FINDINGS A statistically significant improvement in one of three safety culture measures was shown for the study group (p<.001) and a significant decline was seen on one of the safety culture measures for the control group (p<.05). Leadership support for improvement was found to explain significant amounts of variance in all three patient safety culture measures; workshop attendance explained significant amounts of variance in one of the three safety culture measures. The total R(2) for the three full hierarchical regression models ranged from 0.338 and 0.554. CONCLUSIONS Sensitively delivered training initiatives for nurse leaders can help to foster a safety culture. Organizational leadership support for improvement is, however, also critical for fostering a culture of safety. Together, training interventions and leadership support may have the most significant impact on patient safety culture.
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Affiliation(s)
- Liane Ginsburg
- School of Health Policy and Management, York University, Toronto, ON, Canada
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Ginsburg L, Hamilton P, Madora P, Robichaud L, White J. Geriatric psychiatry outreach practices in the province of Ontario: the role of the psychiatrist. Can J Psychiatry 1998; 43:386-90. [PMID: 9598276 DOI: 10.1177/070674379804300407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the mode of practice of multidiscliplinary and interdisciplinary teams in the field of geriatric psychiatry in the province of Ontario with specific reference to the role of the psychiatrist on the teams. METHOD Teams were identified, and a simple questionnaire was developed and submitted to every team at an annual conference. RESULTS Responses were obtained from 38 out of 47 teams. The composition of the teams is variable as regards size and represented discliplines. Nine teams do not have psychiatrists directly affiliated with them. Eighteen teams, 4 of which are based in teaching hospitals, have fewer than 1 full-time equivalent (FTE) psychiatrist. Among these teams, 4 have fewer than 0.1 FTE psychiatrist and 10 have fewer than 0.5 FTE psychiatrist. Eleven teams include between 1 and 1.5 FTE psychiatrists on their staff. Four teams (10.5%) require that the initial assessment of all patients be undertaken by a psychiatrist. In 18 (47%) of the teams, assessment by a psychiatrist can be infrequent or nonexistent. Discussion of the referral with a psychiatrist occurs in the majority of teams, but in a significant minority (10 [27%]), this occurs quite infrequently or not at all. CONCLUSION Geriatric psychiatry outreach practices in Ontario involve many different disciplines in the assessment and follow-up of geriatric psychiatry patients, often without the ready availability of psychiatric input. We applaud the expanding roles of different disciplines in this practice. We are concerned, however, at the paucity of psychiatrists working in this field.
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Quirt CF, Mackillop WJ, Ginsburg AD, Sheldon L, Brundage M, Dixon P, Ginsburg L. Do doctors know when their patients don't? A survey of doctor-patient communication in lung cancer. Lung Cancer 1997; 18:1-20. [PMID: 9268944 DOI: 10.1016/s0169-5002(97)00048-2] [Citation(s) in RCA: 132] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES a) To determine how much patients with recently diagnosed lung cancer know about their illness and its treatment, and b) to find out if doctors know what their patients know and what they don't. PATIENTS AND METHODS One hundred patients with recently diagnosed lung cancer, who were undergoing radiotherapy or chemotherapy, were interviewed to determine their view of their diagnosis, the extent of the cancer, the intent of treatment, and the risks and benefits of treatment. Their attending physicians' view were elicited contemporaneously, using a self-administered questionnaire. The principle outcome measure of the study was the level of agreement between the views of the patients and the doctors about the disease, the treatment, and the prognosis. Concordance between doctors' and patients' views was expressed in terms of percentage agreement, and Kappa (kappa). RESULTS Ninety-nine percent of the patients knew that they had lung cancer. Sixty-four percent (64%) agreed with their doctor about the extent of the disease (kappa = 0.48). Most of those who disagreed underestimated the extent of their cancer. Seventy-two percent (72%) agreed with their doctor about the intent of treatment (kappa = 0.49). Thirty-six percent (36%) agreed with their doctors about their probability of cure, (kappa = 0.17): most of those who disagreed systematically overestimated it. Sixty-eight patients were receiving palliative treatment. Of these, 56% agreed with their doctor about the probability of symptomatic benefit (kappa = 0.42), but only 14% agreed with their doctor about the probability that the treatment would prolong life (kappa = 0.06). Doctors frequently failed to recognize their patients' misconceptions about the intent of treatment and the prognosis. CONCLUSION Many patients did not understand their situation well enough to make a truly autonomous treatment decision, and their doctors often failed to recognize this.
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Affiliation(s)
- C F Quirt
- Department of Oncology, Queen's University, Kingston Regional Cancer Centre, Ontario, Canada
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Lightman D, Colucciello M, Ginsburg L, Tuller R. "Surgeon glove finger" gas delivery system. Ophthalmic Surg 1995; 26:188. [PMID: 7651680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Wu G, Weiter JJ, Santos S, Ginsburg L, Villalobos R. The macular photostress test in diabetic retinopathy and age-related macular degeneration. Arch Ophthalmol 1990; 108:1556-8. [PMID: 2244839 DOI: 10.1001/archopht.1990.01070130058030] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We propose the macular photostress test for the evaluation of macular function in the office setting. Eighty eyes were tested and divided into four diagnostic categories: background diabetic retinopathy, diabetic macular edema, age-related macular degeneration, and normal. The recovery times for the eyes with age-related macular degeneration were longer than for eyes with macular edema (P = .03). Age-matched patients with age-related macular degeneration had longer recovery times than did those without age-related macular degeneration (P = .0001). A possible explanation is that the prolonged recovery time in the eyes with age-related macular degeneration reflects that the anatomic lesion is located in the retinal pigment epithelium-photoreceptor complex. In comparison, the eyes with macular edema, whose lesion is in the inner retina and not the retinal pigment epithelium, show a less-prolonged recovery time than the eyes with age-related macular degeneration.
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Affiliation(s)
- G Wu
- Beetham Eye Institute, Joslin Diabetes Center, Harvard Medical School, Boston, MA 02215
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The development of part-time training in the United States and Canada is described. The flexibility required for young women physicians who attempted to combine childbearing and career development, together with the increasing number of women entering medicine, underlines the importance of part-time training schedules. A variety of flexible training options have been defined and a set of guidelines has been produced by the Canadian Royal College of Physicians and Surgeons. The experiences of part-time psychiatry residents at Queen's University, Kingston is presented. Thus far this has involved a total of six residents over a four year period, including the authors of this paper. The advantages and disadvantages, viewed from both the resident and system viewpoint, are discussed.
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Abstract
Abstract
One of the richest occurrences of fossil Mammalia in Europe was discovered in 1834 in the Helvetian (middle Miocene) deposits of Sansan in southwestern France. Nearly all groups are represented, from Chiroptera to proboscidians. The extraordinary richness of the deposit makes statistical treatment possible. Although many changes occurred in the marshy to lacustrine environment during the time of deposition, as reflected in clays, marls, limestones, and molasse, the amplitude of the changes never was large enough to destroy the balance that prevailed through the Helvetian in the area. Restudy of the fossil materials collected over a long period of time resulted in some nomenclatural changes.
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