1
|
Janssen C, Kover I, Kyratsis Y, Kop M, Boland M, Boersma FK, Cremers AL. The corona pandemic and participatory governance: Responding to the vulnerabilities of secondary school students in Europe. Int J Disaster Risk Reduct 2023; 88:103608. [PMID: 36945362 PMCID: PMC10002677 DOI: 10.1016/j.ijdrr.2023.103608] [Citation(s) in RCA: 1] [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] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 02/07/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
Adolescents in secondary schools have limited susceptibility to the SARS-COV-2 virus, but paradoxically are considered to be carrying the highest psychosocial burden during this pandemic. The aim of our European multi-country qualitative research was to investigate the COVID-19 crisis response in secondary schools and the role of national, regional, and local stakeholders in contributing to a participatory governance approach. We carried out 11 months of qualitative fieldwork, which included 90 respondents from the Netherlands, Ireland, and Finland for in-depth interviews and/or group discussions. Participant observation was conducted in four secondary schools to explore the interplay of day-to-day formal and informal practices of crisis governance. Our findings contribute to a better understanding of what efforts were made to facilitate participatory governance and where a bottom-up approach would have served useful in successfully implementing the COVID-19 mitigation strategies. Moreover, we show how these mitigation strategies have led to unintended consequences, such as students' difficulties with isolation and associated mental health problems, and the struggles of socialization when returning to a physical school environment. Our findings highlight the importance of the school environment in the socio-emotional developments of adolescents. We introduce the TAPIC-R model to analyze good governance, advancing the existing TAPIC model with an emphasis on the role of resilience in shaping participatory governance. We argue this is urgently needed during crises to strengthen engagement of the community, including vulnerable groups and achieve positive outcomes within and across policy structures and action domains.
Collapse
Affiliation(s)
- C Janssen
- Faculty of Social Science, Department of Organization Sciences, VU University, Amsterdam, the Netherlands
| | - I Kover
- Faculty of Social Science, Department of Organization Sciences, VU University, Amsterdam, the Netherlands
| | - Y Kyratsis
- Faculty of Social Science, Department of Organization Sciences, VU University, Amsterdam, the Netherlands
| | - M Kop
- Faculty of Social Science, Department of Organization Sciences, VU University, Amsterdam, the Netherlands
| | - M Boland
- National Health Protection Service, Dublin, Ireland
| | - F K Boersma
- Faculty of Social Science, Department of Organization Sciences, VU University, Amsterdam, the Netherlands
| | - A L Cremers
- Faculty of Social Science, Department of Organization Sciences, VU University, Amsterdam, the Netherlands
| |
Collapse
|
2
|
Bistaraki A, McKeown E, Kyratsis Y. Leading interagency planning and collaboration in mass gatherings: public health and safety in the 2012 London Olympics. Public Health 2018; 166:19-24. [PMID: 30439552 DOI: 10.1016/j.puhe.2018.09.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 06/24/2018] [Revised: 08/02/2018] [Accepted: 09/30/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Planning and implementing public health initiatives in mass gatherings such as the Olympic Games pose unique challenges for interorganizational collaboration, which involves interaction among multiple and diverse agencies. Nonetheless, there is limited empirical evidence to support interagency collaboration and public health planning decisions in mass gatherings and how leadership can shape such interactions. We empirically explored these topics in the 2012 London Olympics to identify lessons to inform planning for future mass gatherings. STUDY DESIGN This is a qualitative case study. METHODS Data comprised 39 semistructured interviews with key informants conducted before, during, and after the games; in addition, direct observations of field exercises and documentary analysis were also used. Open coding and thematic analysis was used to analyze the data. RESULTS We identified two main leadership challenges that influenced interagency collaboration: organizational public health leadership and coordinating collaborative decision-making. Two facilitative conditions helped overcome the previous challenges: nurturing interorganizational linkages and creating shared understanding by activating codified frameworks at the organizational level. CONCLUSIONS Our study highlights leadership issues in interagency collaboration in mass gatherings. Practical implications arising from this study may inform the ways the organizers of mass gatherings, public health and safety agencies, and professionals can engage in effective partnerships and joint working.
Collapse
Affiliation(s)
| | - E McKeown
- School of Health Sciences, City, University of London, London, UK
| | - Y Kyratsis
- School of Health Sciences, City, University of London, London, UK
| |
Collapse
|
3
|
Kyratsis Y, Ahmad R, Iwami M, Castro Sanchez E, Atun R, Holmes A. A multi-level analysis of infection control in English hospitals: coerced safety culture change. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - R Ahmad
- Imperial College London, London, UK
| | - M Iwami
- Imperial College London, London, UK
| | | | - R Atun
- Harvard University, Boston, USA
| | - A Holmes
- Imperial College London, London, UK
| |
Collapse
|
4
|
Mizuno S, Iwami M, Kunisawa S, Naylor N, Yamashita K, Kyratsis Y, Meads G, Otter JA, Holmes AH, Imanaka Y, Ahmad R. Comparison of national strategies to reduce meticillin-resistant Staphylococcus aureus infections in Japan and England. J Hosp Infect 2018; 100:280-298. [PMID: 30369423 DOI: 10.1016/j.jhin.2018.06.026] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 06/28/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND National responses to healthcare-associated infections vary between high-income countries, but, when analysed for contextual comparability, interventions can be assessed for transferability. AIM To identify learning from country-level approaches to addressing meticillin-resistant Staphylococcus aureus (MRSA) in Japan and England. METHODS A longitudinal analysis (2000-2017), comparing epidemiological trends and policy interventions. Data from 441 textual sources concerning infection prevention and control (IPC), surveillance, and antimicrobial stewardship interventions were systematically coded for: (a) type: mandatory requirements, recommendations, or national campaigns; (b) method: restrictive, persuasive, structural in nature; (c) level of implementation: macro (national), meso (organizational), micro (individual) levels. Healthcare organizational structures and role of media were also assessed. FINDINGS In England significant reduction has been achieved in number of reported MRSA bloodstream infections. In Japan, in spite of reductions, MRSA remains a predominant infection. Both countries face new threats in the emergence of drug-resistant Escherichia coli. England has focused on national mandatory and structural interventions, supported by a combination of outcomes-based incentives and punitive mechanisms, and multi-disciplinary IPC hospital teams. Japan has focused on (non-mandatory) recommendations and primarily persuasive interventions, supported by process-based incentives, with voluntary surveillance. Areas for development in Japan include resourcing of dedicated data management support and implementation of national campaigns for healthcare professionals and the public. CONCLUSION Policy interventions need to be relevant to local epidemiological trends, while acceptable within the health system, culture, and public expectations. Cross-national learning can help inform the right mix of interventions to create sustainable and resilient systems for future infection and economic challenges.
Collapse
Affiliation(s)
- S Mizuno
- Department of Healthcare Economics and Quality Management, Kyoto University, Japan
| | - M Iwami
- Division of Infectious Diseases, Imperial College London, London, UK
| | - S Kunisawa
- Department of Healthcare Economics and Quality Management, Kyoto University, Japan
| | - N Naylor
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK
| | - K Yamashita
- Department of Healthcare Economics and Quality Management, Kyoto University, Japan
| | - Y Kyratsis
- Health Services Research & Management Division, School of Health Sciences, City University of London, London, UK
| | - G Meads
- Health and Wellbeing Research Group, University of Winchester, Winchester, UK
| | - J A Otter
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK; Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - A H Holmes
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK; Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Y Imanaka
- Department of Healthcare Economics and Quality Management, Kyoto University, Japan
| | - R Ahmad
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK; Health Group, Management Department, Imperial College Business School, London, UK.
| |
Collapse
|
5
|
Hansen S, Zingg W, Ahmad R, Kyratsis Y, Behnke M, Schwab F, Pittet D, Gastmeier P. Organization of infection control in European hospitals. J Hosp Infect 2015; 91:338-45. [PMID: 26542950 DOI: 10.1016/j.jhin.2015.07.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [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: 04/29/2015] [Accepted: 07/22/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Prevention of Hospital Infections by Intervention and Training (PROHIBIT) survey was initiated to investigate the status of healthcare-associated infection (HCAI) prevention across Europe. AIM This paper presents the methodology of the quantitative PROHIBIT survey and outlines the findings on infection control (IC) structure and organization including management's support at the hospital level. METHODS Hospitals in 34 countries were invited to participate between September 2011 and March 2012. Respondents included IC personnel and hospital management. FINDINGS Data from 309 hospitals in 24 countries were analysed. Hospitals had a median (interquartile range) of four IC nurses (2-6) and one IC doctor (0-2) per 1000 beds. Almost all hospitals (96%) had defined IC objectives, which mainly addressed hand hygiene (87%), healthcare-associated infection reduction (84%), and antibiotic stewardship (66%). Senior management provided leadership walk rounds in about half of hospitals, most often in Eastern and Northern Europe, 65% and 64%, respectively. In the majority of hospitals (71%), sanctions were not employed for repeated violations of IC practices. Use of sanctions varied significantly by region (P < 0.001), but not by countries' healthcare expenditure. CONCLUSION There is great variance in IC staffing and policies across Europe. Some areas of practice, such as hand hygiene, seem to receive considerably more attention than others that are equally important, such as antibiotic stewardship. Programmes in IC suffer from deficiencies in human resources and local policies, ubiquitous factors that negatively impact on IC effectiveness. Strengthening of IC policies in European hospitals should be a public health priority.
Collapse
Affiliation(s)
- S Hansen
- Charité - University Medicine Berlin, Institute for Hygiene, Germany.
| | - W Zingg
- University of Geneva Hospitals, Infection Control Programme, Switzerland
| | - R Ahmad
- Imperial College Healthcare NHS Trust, London, UK
| | - Y Kyratsis
- School of Health Sciences, City University London, UK
| | - M Behnke
- Charité - University Medicine Berlin, Institute for Hygiene, Germany
| | - F Schwab
- Charité - University Medicine Berlin, Institute for Hygiene, Germany
| | - D Pittet
- University of Geneva Hospitals, Infection Control Programme, Switzerland
| | - P Gastmeier
- Charité - University Medicine Berlin, Institute for Hygiene, Germany
| | | |
Collapse
|
6
|
Charani E, Castro-Sanchez E, Sevdalis N, Kyratsis Y, Drumright L, Shah N, Holmes A. Understanding the determinants of antimicrobial prescribing within hospitals: the role of "prescribing etiquette". Clin Infect Dis 2013; 57:188-96. [PMID: 23572483 PMCID: PMC3689346 DOI: 10.1093/cid/cit212] [Citation(s) in RCA: 302] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Prescribing etiquette is an important determinant of antimicrobial prescribing behaviors. Prescribing etiquette recognizes clinical decision-making autonomy and the role of hierarchy in influencing practice. Existing clinical groups and clinical leadership should be utilized to influence antimicrobial prescribing behaviors. Background. There is limited knowledge of the key determinants of antimicrobial prescribing behavior (APB) in hospitals. An understanding of these determinants is required for the successful design, adoption, and implementation of quality improvement interventions in antimicrobial stewardship programs. Methods. Qualitative semistructured interviews were conducted with doctors (n = 10), pharmacists (n = 10), and nurses and midwives (n = 19) in 4 hospitals in London. Interviews were conducted until thematic saturation was reached. Thematic analysis was applied to the data to identify the key determinants of antimicrobial prescribing behaviors. Results. The APB of healthcare professionals is governed by a set of cultural rules. Antimicrobial prescribing is performed in an environment where the behavior of clinical leaders or seniors influences practice of junior doctors. Senior doctors consider themselves exempt from following policy and practice within a culture of perceived autonomous decision making that relies more on personal knowledge and experience than formal policy. Prescribers identify with the clinical groups in which they work and adjust their APB according to the prevailing practice within these groups. A culture of “noninterference” in the antimicrobial prescribing practice of peers prevents intervention into prescribing of colleagues. These sets of cultural rules demonstrate the existence of a “prescribing etiquette,” which dominates the APB of healthcare professionals. Prescribing etiquette creates an environment in which professional hierarchy and clinical groups act as key determinants of APB. Conclusions. To influence the antimicrobial prescribing of individual healthcare professionals, interventions need to address prescribing etiquette and use clinical leadership within existing clinical groups to influence practice.
Collapse
Affiliation(s)
- E Charani
- The National Centre for Infection Prevention and Management, Imperial College London, 2nd Floor, Hammersmith House, Du Cane Road, London W12 OHS, UK.
| | | | | | | | | | | | | |
Collapse
|
7
|
Charani E, Kyratsis Y, Lawson W, Wickens H, Brannigan ET, Moore LSP, Holmes AH. An analysis of the development and implementation of a smartphone application for the delivery of antimicrobial prescribing policy: lessons learnt. J Antimicrob Chemother 2012; 68:960-7. [PMID: 23258314 PMCID: PMC3594497 DOI: 10.1093/jac/dks492] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [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: 11/16/2022] Open
Abstract
Objectives Smartphone usage amongst clinicians is widespread. Yet smartphones are not widely used for the dissemination of policy or as clinical decision support systems. We report here on the development, adoption and implementation process of the Imperial Antimicrobial Prescribing Application across five teaching hospitals in London. Methods Doctors and clinical pharmacists were recruited to this study, which employed a mixed methods in-depth case-study design with focus groups, structured pre- and post-intervention survey questionnaires and live data on application uptake. The primary outcome measure was uptake of the application by doctors and its acceptability. The development and implementation processes were also mapped. Results The application was downloaded by 40% (376) of junior doctors with smartphones (primary target user group) within the first month and by 100% within 12 months. There was an average of 1900 individual access sessions per month, compared with 221 hits on the Intranet version of the policy. Clinicians (71%) reported that using the application improved their antibiotic knowledge. Conclusions Clinicians rapidly adopted the mobile application for antimicrobial prescribing at the point of care, enabling the policy to reach a much wider audience in comparison with paper- and desktop-based versions of the policy. Organizations seeking to optimize antimicrobial prescribing should consider utilizing mobile technology to deliver point-of-care decision support. The process revealed a series of barriers, which will need to be addressed at individual and organizational levels to ensure safe and high-quality delivery of local policy at the point of care.
Collapse
Affiliation(s)
- E Charani
- National Centre for Infection Prevention and Management, Imperial College London, London, UK.
| | | | | | | | | | | | | |
Collapse
|
8
|
Ahmad R, Kyratsis Y, Holmes A. When the user is not the chooser: learning from stakeholder involvement in technology adoption decisions in infection control. J Hosp Infect 2012; 81:163-8. [PMID: 22633278 DOI: 10.1016/j.jhin.2012.04.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 04/01/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Health systems need efficient and effective innovation decisions to provide maximum benefit to patients, particularly in a climate of financial constraints. Although evidence-based innovations exist for helping to address healthcare-associated infections, the uptake and implementation of these is highly variable and in some cases very slow. AIM To investigate innovation adoption decisions and implementation processes from an organizational perspective, focusing on the implications of stakeholder involvement during the innovation process. METHODS Thirty-eight technology adoption decisions and implementation processes were examined through 121 qualitative interviews in 12 National Health Service healthcare organizations across England. FINDINGS Stakeholder involvement varied across organizations with decisions highly exclusive to the infection prevention and control (IPC) team, to highly inclusive of wider organizational members. The context, including organizational culture, previous experience, and logistical factors influenced the level of stakeholder engagement. The timing of stakeholder involvement in the process impacted on: (i) the range of innovations considered; (ii) the technologies selected, and (iii) the success of technology implementation. Cases of non-adoption, discontinued adoption, and of successful implementation are presented to share learning. The potential benefits of stakeholder involvement for 'successful' innovation adoption are presented including a goal-oriented framework for involvement. CONCLUSIONS Key stakeholder involvement can lead to innovation adoption and implementation compatible with structural and cultural contexts, particularly when involvement crosses the phases of initiation, decision-making and implementation. Involving members of the wider healthcare organization can raise the profile of IPC and reinforce efforts to make IPC everybody's business.
Collapse
Affiliation(s)
- R Ahmad
- National Centre for Infection Prevention and Management, Faculty of Medicine, Imperial College London, UK.
| | | | | |
Collapse
|
9
|
Ahmad R, Kyratsis Y, Holmes A. When the user is not the chooser: stakeholder involvement in innovation adoption and implementation for addressing HCAIS. BMC Proc 2011. [PMCID: PMC3239448 DOI: 10.1186/1753-6561-5-s6-o36] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
10
|
Kyratsis Y, Ahmad R, Holmes A. The sources and types of innovation knowledge in technology adoption decisions in infection prevention and control – comparative case studies of 12 NHS trusts in England. BMC Proc 2011. [PMCID: PMC3239460 DOI: 10.1186/1753-6561-5-s6-o47] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|