1
|
Levett-Jones T, Brogan E, Debono D, Goodhew M, Govind N, Pich J, River J, Smith J, Sheppard-Law S, Cant R. Use and effectiveness of the arts for enhancing healthcare students' empathy skills: A mixed methods systematic review. Nurse Educ Today 2024; 138:106185. [PMID: 38555825 DOI: 10.1016/j.nedt.2024.106185] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 03/10/2024] [Accepted: 03/21/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE To identify, critically appraise and synthesise evidence of the use and effectiveness of the arts for enhancing pre-registration/prelicensure healthcare students' empathy skills. DESIGN A systematic review of mixed methods literature. DATA SOURCES A search of six electronic databases was conducted. REVIEW METHODS Articles describing English language, peer-reviewed, primary research studies reporting empathy as an outcome of an arts-based intervention with pre-registration/prelicensure healthcare students (years 1-7) and published between 2000 and 2024 were eligible for inclusion. The JBI Manual for Evidence Synthesis guided the review and a convergent segregated methodology was used to synthesise the results. Methodological rigour of included studies was examined using the Mixed Methods Appraisal Tool. RESULTS Twenty studies from 12 countries described the use of the arts to develop empathy, with visual arts being the most common approach (n = 8). Other modalities included film, drama, digital stories, literature, creative writing, music, poetry, photography and dance. Studies included nursing, medicine and dental, pharmacy and/or health sciences students. Ten studies used quantitative methods, three qualitative, and seven used mixed methods designs. Of the studies that presented pre-post outcome measures, nine reported significant gains in empathy scores at post-test and two reported non-significant gains in empathy. In eight studies, empathy scores demonstrated a significant intervention effect with effect sizes ranging from moderate (d = 0.52) to large (d = 1.19). Findings from qualitative studies revealed that arts pedagogies support students to better understand the perspectives of people with a lived experience of suffering but that these approaches are sometimes perceived negatively by students. CONCLUSIONS Arts interventions generally have a positive effect on healthcare students' empathy levels and enable a nuanced conceptual understanding of empathy. Arts modalities used as a stimulus for active learning and supported with facilitated group-based discussion and/or reflection, tend to be most effective.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Jo River
- University of Technology Sydney and Northern Sydney Local Health District, Australia.
| | | | | | - Robyn Cant
- Federation University Australia, Australia.
| |
Collapse
|
2
|
Hetland LH, Maguire J, Debono D, Wright H. Scholarly literature on nurses and pharmacogenomics: A scoping review. Nurse Educ Today 2024; 137:106153. [PMID: 38484442 DOI: 10.1016/j.nedt.2024.106153] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/18/2024] [Accepted: 03/05/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Pharmacogenomics is the bioscience investigating how genes affect medication responses. Nurses are instrumental in medication safety. Pharmacogenomics is slowly being integrated into healthcare, and knowledge and understanding of it is now pertinent to nursing practice. PURPOSE This paper aims to map the scholarly literature on pharmacogenomics in relation to nurses. METHODS A scoping review was conducted in four databases: CINAHL, Embase (Ovid), ProQuest Health and Medicine and PubMed using the search terms pharmacogenomic*, pharmacogenetic*, PGx*, and nurs*, resulting in 263 articles of which 77 articles met the inclusion criteria. FINDINGS Most articles (85 %, n = 65) were non-empirical and 12 presented empirical data (15 %, n = 12). The articles were USA-centric (81 %, n = 62) and represented a broad range of nursing specialties. CONCLUSION The majority of scholarly literature on nurses and pharmacogenomics is narrative reviews. Further empirical research is warranted to investigate nurses' current knowledge levels and potential involvement with pharmacogenomics in clinical practice.
Collapse
Affiliation(s)
- Linn Helen Hetland
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, NSW, Australia; Nursing and Midwifery, College of Healthcare Sciences, James Cook University, QLD, Australia; School of Public Health, Faculty of Health, University of Technology Sydney, NSW, Australia.
| | - Jane Maguire
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, NSW, Australia; Nursing and Midwifery, College of Healthcare Sciences, James Cook University, QLD, Australia; School of Public Health, Faculty of Health, University of Technology Sydney, NSW, Australia
| | - Deborah Debono
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, NSW, Australia; Nursing and Midwifery, College of Healthcare Sciences, James Cook University, QLD, Australia; School of Public Health, Faculty of Health, University of Technology Sydney, NSW, Australia
| | - Helen Wright
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, NSW, Australia; Nursing and Midwifery, College of Healthcare Sciences, James Cook University, QLD, Australia; School of Public Health, Faculty of Health, University of Technology Sydney, NSW, Australia
| |
Collapse
|
3
|
Shan LL, Telianidis S, Westcott MJ, Debono D, Davies AH, Choong PF. Patient perspectives of quality of life in chronic limb-threatening ischemia: a qualitative study. ANZ J Surg 2024; 94:429-437. [PMID: 38012083 DOI: 10.1111/ans.18791] [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: 09/03/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Quality of life (QOL) is an outcome that matters to patients with chronic limb-threatening ischemia (CLTI). However, we identified the lack of and need for a CLTI-specific QOL instrument. Our group is developing this instrument which requires a deep understanding of patient perspectives of QOL in CLTI. METHODS Qualitative inquiry with patient and public involvement was performed in accordance with the Standards for Reporting Qualitative Research. Reflexive thematic analysis of semi-structured interviews was conducted within a constructivist-interpretivist research paradigm. Data were organized and managed in NVivo. Techniques to enhance trustworthiness included maintaining an audit trail, member checking, mentoring, and peer-debriefing. Patient and the public were consulted for feedback on codes, themes, and thematic maps. RESULTS Thirteen participants (median age: 74 years, range: 43-90 years) with a variety of patient demographics were interviewed. Four themes were developed on QOL in CLTI: (i) 'independence as key to life satisfaction', (ii) 'change in identity when continuity is needed', (iii) 'coping with intractable disease', and (iv) 'not wanting to be alone'. Member checking with patient and public involvement confirmed the relevance and centrality of these themes to the lived experiences of patients with CLTI. CONCLUSIONS The thematic outputs contribute important insights into what QOL truly means to patients with CLTI and what matters for their QOL. The content validity of the new CLTI-specific QOL instrument is improved by giving patients voice. This study highlights the value of qualitative inquiry and patient and public involvement in vascular surgical research.
Collapse
Affiliation(s)
- Leonard L Shan
- Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stacey Telianidis
- Department of Vascular Surgery, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Mark J Westcott
- Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Deborah Debono
- Centre for Health Services Management, School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Alun H Davies
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Peter F Choong
- Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
4
|
Meulenbroeks I, Mercado C, Gates P, Nguyen A, Seaman K, Wabe N, Silva SM, Zheng WY, Debono D, Westbrook J. Effectiveness of fall prevention interventions in residential aged care and community settings: an umbrella review. BMC Geriatr 2024; 24:75. [PMID: 38243175 PMCID: PMC10799511 DOI: 10.1186/s12877-023-04624-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/18/2023] [Indexed: 01/21/2024] Open
Abstract
INTRODUCTION Preventing falls is a priority for aged care providers. Research to date has focused on fall prevention strategies in single settings (e.g., residential aged care (RAC) or community settings). However, some aged care providers deliver care, including fall prevention interventions, across RAC and community settings. We conducted an umbrella review to identify what type of fall prevention interventions had the greatest impact on falls outcomes in RAC and community settings. METHODS Five databases were searched for systematic reviews of falls prevention randomised control trials in older adults living in the community or RAC. Data extracted included systematic review methods, population characteristics, intervention characteristics, setting details (RAC or community), and fall-related outcomes (falls, people who have had a fall, fall-related hospitalisations, and fall-related fractures). Review quality was appraised using the Assessment of Multiple Systematic Reviews-2 tool. RESULTS One-hundred and six systematic reviews were included; 63 and 19 of these stratified results by community and RAC settings respectively, the remainder looked at both settings. The most common intervention types discussed in reviews included 'exercise' (61%, n = 65), 'multifactorial' (two or more intervention types delivered together) (26%, n = 28), and 'vitamin D' (18%, n = 19). In RAC and community settings, 'exercise' interventions demonstrated the most consistent reduction in falls and people who have had a fall compared to other intervention types. 'Multifactorial' interventions were also beneficial in both settings however demonstrated more consistent reduction in falls and people who fall in RAC settings compared to community settings. 'Vitamin D' interventions may be beneficial in community-dwelling populations but not in RAC settings. It was not possible to stratify fall-related hospitalisation and fall-related fracture outcomes by setting due to limited number of RAC-specific reviews (n = 3 and 0 respectively). CONCLUSION 'Exercise' interventions may be the most appropriate falls prevention intervention for older adults in RAC and community settings as it is beneficial for multiple fall-related outcomes (falls, fall-related fractures, and people who have had a fall). Augmenting 'exercise' interventions to become 'multifactorial' interventions may also improve the incidence of falls in both settings.
Collapse
Affiliation(s)
- Isabelle Meulenbroeks
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia.
| | - Crisostomo Mercado
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
| | - Peter Gates
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Amy Nguyen
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
- St Vincent's Clinical School, UNSW Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Karla Seaman
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
| | - Nasir Wabe
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
| | - Sandun M Silva
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
| | - Wu Yi Zheng
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Deborah Debono
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
| |
Collapse
|
5
|
Hemsley B, Almond B, Given F, Darcy S, L'Espoir Decosta P, Dann S, Carnemolla P, Freeman-Sanderson A, Debono D, Balandin S. Craving inclusion: a systematic review on the experiences and needs of people with disability eating out. Disabil Rehabil 2023:1-16. [PMID: 38146693 DOI: 10.1080/09638288.2023.2295006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 12/09/2023] [Indexed: 12/27/2023]
Abstract
Purpose: To systematically review the research relating to views and experiences of people with disability eating out in cafés, restaurants, and other settings; and identify factors that impede or enhance accessibility of eating out experiences, inform future inclusive research, and guide policy development.Materials and Methods: This study involved systematic search and review procedures with qualitative metasynthesis of the barriers to and facilitators for participation and inclusion in eating/dining-out activities. In total, 36 studies were included.Results: Most studies reviewed related to people with physical or sensory disability eating out, with few studies examining the dining experiences of adults with intellectual or developmental disability, swallowing disability, or communication disability. People with disability encountered negative attitudes and problems with physical and communicative access to the venue. Staff lacked knowledge of disability. Improvements in the design of dining spaces, consultation with the disability community, and staff training are needed.Conclusion: People with disability may need support for inclusion in eating out activities, as they encounter a range of barriers to eating out. Further research within and across both a wide range of populations with disability and eating out settings could guide policy and practice and help develop training for hospitality staff.
Collapse
Affiliation(s)
- Bronwyn Hemsley
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Barbara Almond
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Fiona Given
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Simon Darcy
- The Business School, University of Technology Sydney, Sydney, Australia
| | | | - Stephen Dann
- Research School of Management, Australian National University, Canberra, Australia
| | | | | | - Deborah Debono
- School of Public Health, University of Technology Sydney, Sydney, Australia
| | - Susan Balandin
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
- Deakin University, Geelong, Australia
| |
Collapse
|
6
|
Chen L, Hemsley B, Debono D. The Impact of Food-Shaping Techniques on Nutrition, Mealtime Experiences, and Quality of Life for Older Adults in Aged Care Settings: A Systematic Review. Curr Nutr Rep 2023; 12:744-766. [PMID: 37665541 PMCID: PMC10766673 DOI: 10.1007/s13668-023-00493-w] [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] [Accepted: 08/08/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE Food-shaping methods, particularly for texture-modified foods, present numerous opportunities to improve the visual appeal of food and potentially the nutrition of older people with dysphagia (swallowing difficulty). This review appraises and synthesizes the evidence on the use of food-shaping methods to enhance nutrition in older adults with swallowing difficulties. METHODS In August 2022, five electronic databases (PubMed, CINAHL, Scopus, Cochrane Library, and Web of Science) were searched for original research related to the intersection of nutrition, food shaping, and older adults with swallowing difficulties. Characteristics of included studies were described and data from results and findings extracted for analysis across studies. RESULTS Eighteen studies met the inclusion criteria and encompassed a variety of settings, including aged care settings (n = 15) and food science laboratories (n = 3). Qualitative and quantitative findings demonstrated a variety of impacts of food shaping for the older adult with swallowing difficulty, including enhanced nutrition and wellbeing. The content themes identified across studies were: links between food shaping and nutrition, shaping food for individual choice, food shaping for enjoyment, a combination of supporting factors, collaborative inter-disciplinary teams and roles, and implementation aligns with local contexts. CONCLUSION With recent growth in research on food shaping, the body of studies reviewed identified an influence of food-shaping methods on the nutritional status of older adults with swallowing difficulties. Given the identified potential benefit of food shaping and attention to the visual appeal of food for older people, further research examining links between food shaping and nutrition are warranted.
Collapse
Affiliation(s)
- Lily Chen
- University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Sydney, Australia.
| | - Bronwyn Hemsley
- University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Sydney, Australia
| | - Deborah Debono
- University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Sydney, Australia
| |
Collapse
|
7
|
Jain S, Dempsey K, Wilcox S, Bradd P, Travaglia J, Debono D, Justin L, Hor SY. Practice development amidst a pandemic: a pilot programme to develop leadership in infection prevention and control professionals. Leadersh Health Serv (Bradf Engl) 2023; ahead-of-print. [PMID: 37753816 DOI: 10.1108/lhs-06-2023-0037] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
PURPOSE This paper aims to describe the design and evaluation of a pilot leadership development programme for infection prevention and control (IPAC) professionals during the COVID-19 pandemic. The programme's aim was to improve IPAC knowledge and capacity in the health-care system by developing the leadership skills and capacities of novice and advanced Infection Control Professionals (ICPs), to respond flexibly, and competently, in their expanding and ever-changing roles. DESIGN/METHODOLOGY/APPROACH The leadership programme was piloted with seven nurses, who were part of a clinical nursing team in New South Wales, Australia, over a 12-month period between 2021 and 2022. The programme was designed using a leadership development framework underpinned by transformational leadership theory, practice development approaches and collaborative and experiential learning. These principles were applied during programme design, with components adapted to learners' interests and regular opportunities provided for collaboration in active learning and critical reflection on workplace experiences. FINDINGS The authors' evaluation suggests that the programme was feasible, acceptable and considered to be effective by this cohort. Moreover, participants valued the opportunities to engage in active and experience-based learning with peers, and with the support of senior and experienced ICPs. The action learning sets were well-received and allowed participants to critically reflect on and learn from one another's experiences. The mentoring programme allowed them to apply their developing leadership skills to real workplace challenges that they face. RESEARCH LIMITATIONS/IMPLICATIONS Despite a small sample size, the authors' results provide empirical evidence about the effectiveness of using a practice development approach for strengthening ICP leadership capacity. The success of this pilot study has paved the way for a bigger second cohort of participants in the programme, for which further evaluation will be conducted. PRACTICAL IMPLICATIONS The success of this leadership programme reflects both the need for leadership development in the IPAC professions and the applicability of this approach, with appropriate facilitation, for other professions and organizations. ORIGINALITY/VALUE ICP leadership programmes have not been previously reported in the literature. This pilot study builds on the growing interest in IPAC leadership to foster health system responsiveness and change.
Collapse
Affiliation(s)
- Susan Jain
- Infection Prevention and Control/Healthcare Associated Programme, Clinical Excellence Commission, Sydney, Australia
| | - Kathy Dempsey
- Infection Prevention and Control/Healthcare Associated Programme, Clinical Excellence Commission, Sydney, Australia
| | - Stephanie Wilcox
- Infection Prevention and Control/Healthcare Associated Programme, Clinical Excellence Commission, Sydney, Australia
| | - Patricia Bradd
- Patient Safety, Clinical Excellence Commission, Sydney, Australia
| | - Joanne Travaglia
- School of Public Health/Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Deborah Debono
- School of Public Health/Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Linda Justin
- School of Public Health/Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Su-Yin Hor
- School of Public Health/Faculty of Health, University of Technology Sydney, Sydney, Australia
| |
Collapse
|
8
|
Miao M, Morrow R, Salomon A, Mcculloch B, Evain JC, Wright MR, Murphy MT, Welsh M, Williams L, Power E, Rietdijk R, Debono D, Brunner M, Togher L. Digital Health Implementation Strategies Coproduced With Adults With Acquired Brain Injury, Their Close Others, and Clinicians: Mixed Methods Study With Collaborative Autoethnography and Network Analysis. J Med Internet Res 2023; 25:e46396. [PMID: 37725413 PMCID: PMC10548320 DOI: 10.2196/46396] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/10/2023] [Accepted: 08/03/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Acquired brain injuries (ABIs), such as stroke and traumatic brain injury, commonly cause cognitive-communication disorders, in which underlying cognitive difficulties also impair communication. As communication is an exchange with others, close others such as family and friends also experience the impact of cognitive-communication impairment. It is therefore an internationally recommended best practice for speech-language pathologists to provide communication support to both people with ABI and the people who communicate with them. Current research also identifies a need for neurorehabilitation professionals to support digital communication, such as social media use, after ABI. However, with >135 million people worldwide affected by ABI, alternate and supplementary service delivery models are needed to meet these communication needs. The "Social Brain Toolkit" is a novel suite of 3 interventions to deliver communication rehabilitation via the internet. However, digital health implementation is complex, and minimal guidance exists for ABI. OBJECTIVE This study aimed to support the implementation of the Social Brain Toolkit by coproducing implementation knowledge with people with ABI, people who communicate with people with ABI, clinicians, and leaders in digital health implementation. METHODS A maximum variation sample (N=35) of individuals with living experience of ABI, close others, clinicians, and digital health implementation leaders participated in an explanatory sequential mixed methods design. Stakeholders quantitatively prioritized 4 of the 7 theoretical domains of the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework as being the most important for Social Brain Toolkit implementation. Qualitative interview and focus group data collection focused on these 4 domains. Data were deductively analyzed against the NASSS framework with stakeholder coauthors to determine implementation considerations and strategies. A collaborative autoethnography of the research was conducted. Interrelationships between considerations and strategies were identified through a post hoc network analysis. RESULTS Across the 4 prioritized domains of "condition," "technology," "value proposition," and "adopters," 48 digital health implementation considerations and 52 tailored developer and clinician implementation strategies were generated. Benefits and challenges of coproduction were identified. The post hoc network analysis revealed 172 unique relationships between the identified implementation considerations and strategies, with user and persona testing and responsive design identified as the potentially most impactful strategies. CONCLUSIONS People with ABI, close others, clinicians, and digital health leaders coproduced new knowledge of digital health implementation considerations for adults with ABI and the people who communicate with them, as well as tailored implementation strategies. Complexity-informed network analyses offered a data-driven method to identify the 2 most potentially impactful strategies. Although the study was limited by a focus on 4 NASSS domains and the underrepresentation of certain demographics, the wealth of actionable implementation knowledge produced supports future coproduction of implementation research with mutually beneficial outcomes for stakeholders and researchers. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/35080.
Collapse
Affiliation(s)
- Melissa Miao
- Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Rosemary Morrow
- Stakeholder with living experience of acquired brain injury, Sydney, Australia
| | - Alexander Salomon
- Stakeholder with living experience of acquired brain injury, Sydney, Australia
| | - Ben Mcculloch
- Stakeholder with living experience of acquired brain injury, Sydney, Australia
| | - Jean-Christophe Evain
- Acquired Brain Injury Rehabilitation Ward, Caulfield Hospital, Alfred Health Network, Melbourne, Australia
- Stakeholder with living experience of acquired brain injury, Melbourne, Australia
| | - Meg Rebecca Wright
- Stakeholder with living experience of acquired brain injury, Blenheim, Australia
| | - Marie Therese Murphy
- Stakeholder with living experience as a communication partner of a person with acquired brain injury, Sydney, Australia
- Faculty of Education, Western Sydney University, Sydney, Australia
- Faculty of Education and Social Work, The University of Sydney, Sydney, Australia
| | - Monica Welsh
- Brain Injury Rehabilitation Unit, South Australian Brain Injury Rehabilitation Service, Adelaide, Australia
| | - Liz Williams
- Brain Injury Rehabilitation Community and Home (BIRCH), South Australian Brain Injury Rehabilitation Service, Adelaide, Australia
| | - Emma Power
- Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Rachael Rietdijk
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Deborah Debono
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Melissa Brunner
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Leanne Togher
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| |
Collapse
|
9
|
Morrow A, Steinberg J, Chan P, Tiernan G, Kennedy E, Egoroff N, Hilton D, Sankey L, Venchiarutti R, Hayward A, Pearn A, McKay S, Debono D, Hogden E, Taylor N. In person and virtual process mapping experiences to capture and explore variability in clinical practice: application to genetic referral pathways across seven Australian hospital networks. Transl Behav Med 2023; 13:561-570. [PMID: 37036763 PMCID: PMC10415733 DOI: 10.1093/tbm/ibad009] [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] [Indexed: 04/11/2023] Open
Abstract
Genetic referral for Lynch syndrome (LS) exemplifies complex clinical pathways. Identifying target behaviours (TBs) for change and associated barriers requires structured group consultation activities with busy clinicians - consolidating implementation activities whilst retaining rigour is crucial. This study aimed to: i) use process mapping to gain in-depth understandings of site-specific LS testing and referral practices in Australian hospitals and support identification of TBs for change, ii) explore if barriers to identified TBs could be identified through process mapping focus-group data, and iii) demonstrate pandemic-induced transition from in-person to virtual group interactive process mapping methods. LS clinical stakeholders attended interactive in-person or virtual focus groups to develop site-specific "process maps" visually representing referral pathways. Content analysis of transcriptions informed site-specific process maps, then clinical audit data was compared to highlight TBs for change. TBs were reviewed in follow-up focus groups. Secondary thematic analysis explored barriers to identified TBs, coded against the Theoretical Domains Framework (TDF). The transition from in-person to pandemic-induced virtual group interactive process mapping methods was documented. Process mapping highlighted six key areas of clinical practice variation across sites and site-specific TBs for change were identified. Key barriers to identified TBs emerged, categorised to seven TDF domains. Process mapping revealed variations in clinical practices surrounding LS referral between sites. Incorporating qualitative perspectives enhances process mapping by facilitating identification of TBs for change and barriers, providing a pathway to developing targeted interventions. Virtual process mapping activities produced detailed data and enabled comprehensive map development.
Collapse
Affiliation(s)
- April Morrow
- Implementation to Impact Hub, School of Population Health, Faculty of Medicine, UNSW, Sydney, NSW, Australia
| | - Julia Steinberg
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
| | - Priscilla Chan
- Implementation to Impact Hub, School of Population Health, Faculty of Medicine, UNSW, Sydney, NSW, Australia
| | - Gabriella Tiernan
- Implementation to Impact Hub, School of Population Health, Faculty of Medicine, UNSW, Sydney, NSW, Australia
| | - Elizabeth Kennedy
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
| | - Natasha Egoroff
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Desiree Hilton
- Familial Cancer Service, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, NSW, Australia
| | | | - Rebecca Venchiarutti
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Anne Hayward
- The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Amy Pearn
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
| | - Skye McKay
- Implementation to Impact Hub, School of Population Health, Faculty of Medicine, UNSW, Sydney, NSW, Australia
| | - Deborah Debono
- Centre for Health Services Management, School of Public Health, University of Technology Sydney, New South Wales, Australia
| | - Emily Hogden
- Implementation to Impact Hub, School of Population Health, Faculty of Medicine, UNSW, Sydney, NSW, Australia
| | - Natalie Taylor
- Implementation to Impact Hub, School of Population Health, Faculty of Medicine, UNSW, Sydney, NSW, Australia
| |
Collapse
|
10
|
Miao M, Debono D, Power E, Rietdijk R, Brunner M, Togher L. Digital Health Interventions for Adults with Acquired Brain Injury and Their Close Others: Implementation, Scalability, and Sustainability in the COVID-19 Context. Stud Health Technol Inform 2023; 304:96-100. [PMID: 37347578 DOI: 10.3233/shti230379] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
The Social Brain Toolkit is a novel suite of web-based interventions to support people with acquired brain injury and their close others with communication difficulties post-injury. The aim of this study was to investigate potential impacts of the Toolkit's wider political, economic, regulatory, professional, and sociocultural context on its implementation, scalability, and sustainability. Nine people with academic, healthcare or industry experience implementing digital health interventions prior to and during COVID-19 were individually interviewed. Data were deductively analysed according to the Non-adoption, Abandonment, Scaleup, Spread and Sustainability framework, with a focus on the domain of the 'Wider system'. Results indicated that COVID-19 facilitated a pivot to virtual care models which was timely for the implementation of the Social Brain Toolkit; political and economic changes were entwined; and risk management, data compliance and governance were key considerations for healthcare professionals and organisations.
Collapse
Affiliation(s)
- Melissa Miao
- University of Technology Sydney, Sydney, Australia
| | | | - Emma Power
- University of Technology Sydney, Sydney, Australia
| | | | | | | |
Collapse
|
11
|
Roberts HI, Kinlay M, Debono D, Burke R, Jones A, Baysari MT. Nurses' Medication Administration Workarounds when Using Electronic Systems: An Analysis of Safety Incident Reports. Stud Health Technol Inform 2023; 304:57-61. [PMID: 37347569 DOI: 10.3233/shti230369] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Electronic medication management systems (EMMS) have been implemented in most acute care settings in Australia to reduce medication error rates. One of the key challenges related to the introduction of EMMS in hospitals is the uptake of informal "workarounds" by clinicians, including nurses. In this study, we aimed to examine one workaround in depth, nurses not documenting medication administration in the EMMS at the time of administration. We conducted a review of incident reports to identify the factors that contribute to this workaround occurring and the consequences or potential consequences of this workaround on patients. We identified a range of contributing factors, with factors relating to the user (e.g. nurses being time poor) occurring most frequently in incident reports. The most frequently seen consequence of this workaround was the patient receiving an additional dose. This research revealed that strategies to reduce the uptake of this workaround should consider user and organisational factors rather than just EMMS design alone.
Collapse
|
12
|
Harrison R, Ní Shé É, Debono D, Chauhan A, Newman B. Creating space for theory when codesigning healthcare interventions. J Eval Clin Pract 2023; 29:572-575. [PMID: 35700040 PMCID: PMC10947053 DOI: 10.1111/jep.13720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/16/2022] [Accepted: 05/24/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Reema Harrison
- Centre for Health Systems and Safety, Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
| | - Éidín Ní Shé
- Graduate School of Healthcare ManagementRCSI University of Medicine and Health SciencesDublinIreland
| | - Deborah Debono
- Centre for Health Services ResearchUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Ashfaq Chauhan
- Centre for Health Systems and Safety, Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
| | - Bronwyn Newman
- Centre for Health Systems and Safety, Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
| |
Collapse
|
13
|
Chen L, Debono D, Hemsley B. A bite closer: Using 3D food printing to achieve Sustainable Development Goals 2, 3, 9 and 17. Int J Speech Lang Pathol 2023; 25:58-61. [PMID: 36573398 DOI: 10.1080/17549507.2022.2132290] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE This commentary paper focuses on four Sustainable Development Goals (SDGs): zero hunger (SDG 2), good health and well-being (SDG 3), industry, innovation and infrastructure (SDG 9), and partnerships for the goals (SDG 17). Each bite of food has the potential to impact on nutrition and well-being, particularly for the older adult aged over 65 years with swallowing disability. Better attention to the shape of the foods presented for consumption may help improve access to food and nutrition through food shaping methods such as 3D food printing. Target objectives across these four SDGs should help to improve the physical and emotional health of older people with swallowing disability who need texture-modified foods. RESULT We discuss the potential for methods to improve food shaping and influence better health outcomes for older people, particularly those with swallowing disability. Texture-modified food should be both nourishing and enjoyable while being safe to swallow without coughing or choking; to improve nutrition, health, and quality of life. CONCLUSION Along with temperature and taste, the shape of texture-modified foods influences the appeal of the food as important elements of food design. The link between the enjoyment of food and nutrition sets the foundation for a good quality of life for older people. 3D food printing, among other food shaping methods, helps establish this link through the creation of nutritious and appealing foods. Applying the targets for SDGs relating to food shaping techniques will involve innovation and collaboration with older people and multiple disciplines.
Collapse
Affiliation(s)
- Lily Chen
- University of Technology Sydney, Australia
| | | | | |
Collapse
|
14
|
Maddison K, Perry L, Debono D. Psychological sequelae of hand injuries: an integrative review. J Hand Surg Eur Vol 2023; 48:33-40. [PMID: 36039570 DOI: 10.1177/17531934221117429] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This integrative review investigated reports of psychological impact and sequelae of traumatic hand injuries. A systematic search using Medline, PsychINFO, PubMed, EMBASE, CINAHL and hand-searching methods was conducted from 2008 to 2020. Nine included articles with a total of 503 participants were reported in prospective cross-sectional or longitudinal cohort studies. Depression and anxiety were common, affecting between 7% and 71% and between 23% and 71% of patients, respectively. Post-traumatic stress disorder affected between 3% and 95% of patients. Factors reported predicting psychological sequelae of hand injuries included injury severity, pain, limb dysfunction, negative perceptions of injured limbs, suboptimal coping mechanisms and limited social support. Symptoms persisted for protracted periods of follow-up but broadly attenuated after 3 months. We conclude that the high prevalence and enduring nature of psychological symptoms demonstrate an urgent need for further research to optimize treatment.Level of evidence: III.
Collapse
Affiliation(s)
- Kay Maddison
- University of Technology Sydney, Sydney, NSW, Australia.,Hand Unit, Sydney Hospital and Sydney Eye Hospital, Sydney, NSW, Australia
| | - Lin Perry
- University of Technology Sydney, Sydney, NSW, Australia.,Prince of Wales Hospital, Sydney, NSW, Australia
| | | |
Collapse
|
15
|
Stockton DA, Fowler C, Debono D, Travaglia J. Adapting community child and family health service models for rural and other diverse settings: A modified Delphi study to identify key elements. Health Soc Care Community 2022; 30:e6145-e6162. [PMID: 36195997 PMCID: PMC10092049 DOI: 10.1111/hsc.14052] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 06/29/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Inequity in health outcomes is pervasive, with poorer health outcomes identified in rural, regional and remote communities. An international call to action emphasises the need for service models adapted for less well-resourced settings. The aim of this study was to identify key elements of a framework for the adaptation of specialist community-based child and family health (CFH) service models for rural and other under-resourced settings. A modified Delphi study was undertaken with a 12-person expert panel in CFH including Australian and international professionals and parents from rural and remote communities. The study was informed by the WHO Framework for Strengthening Health Service Systems building blocks, the outcomes of an integrative review of literature and a Participatory Action Research study. Experts assessed 107 potential elements for service model development and rated them for importance when adapting service models for different contexts. Round 1 of the Delphi generated considerable consensus with 80 of the 107 potential elements identified as necessary for the service model adaptation framework. A further 17 elements for CFH service models were added in round 2. While multiple varied elements are important for adapting CFH service models for diverse settings, some elements had common themes. Experts highlighted the importance of community engagement and participation; utilising both data and local knowledge to develop a robust understanding of the community context; and the need for a flexible approach to funding and modes of service delivery to address barriers to implementation and access.
Collapse
Affiliation(s)
- Deborah A. Stockton
- Centre for Health Services Management, Faculty of HealthUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Cathrine Fowler
- School of Nursing and MidwiferyUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Deborah Debono
- Centre for Health Services Management, Faculty of HealthUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Joanne Travaglia
- Centre for Health Services Management, Faculty of HealthUniversity of Technology SydneyUltimoNew South WalesAustralia
| |
Collapse
|
16
|
Stockton DA, Fowler C, Debono D, Travaglia J. Development of a framework for the collaborative adaptation of service models for child and family health in diverse settings (CASCADES). J Child Health Care 2022:13674935221129003. [PMID: 36165065 DOI: 10.1177/13674935221129003] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The impact of health service access disparities has significant implications for society. The importance of addressing health and social inequities is never more critical than in the early years of a child's life. Despite advances in healthcare implementation, there is a lack of an evidence-based framework to specifically guide the adaptation of child and family health (CFH) service models for different community contexts. This paper describes the development of a framework for the adaptation of community-based CFH service models. Drawing on the findings of an integrative review and Delphi study, Participatory Action Research was used to test the framework, resulting in the Framework for Collaborative Adaptation of Service Models for Child and Family Health in Diverse Settings (CASCADES). The Framework uses the analogy of a waterfall to represent the iterative process of collecting information to inform each step. The framework supports a collaborative co-design approach to build a comprehensive understanding of the target community to inform the adaptation and evaluation of evidence-based interventions appropriate to the local context. The ultimate aim is to enable the delivery of services that are contextually relevant for local communities and provide greater access to effective, accessible services to support children and their families.
Collapse
Affiliation(s)
- Deborah A Stockton
- Centre for Health Services Management, Faculty of Health, 110561University of Technology Sydney, Ultimo, NSW, Australia
| | - Cathrine Fowler
- School of Nursing and Midwifery, University of Technology Sydney, Sydney, NSW, Australia
| | - Deborah Debono
- Centre for Health Services Management, Faculty of Health, 110561University of Technology Sydney, Ultimo, NSW, Australia
| | - Joanne Travaglia
- Centre for Health Services Management, Faculty of Health, 110561University of Technology Sydney, Ultimo, NSW, Australia
| |
Collapse
|
17
|
Abstract
PURPOSE This paper explores the role of hospital cleaners and their contribution to healthcare safety. Few studies have examined the activities and input of hospital cleaners, rendering them largely invisible in healthcare research. Yet, as coronavirus disease 2019 (COVID-19) has demonstrated, this sizeable workforce carries out tasks critical to healthcare facilities and wider health system functioning. DESIGN/METHODOLOGY/APPROACH Drawing on the work of Habermas, the authors examine the literature surrounding cleaners and quality and safety in healthcare. The authors theorise cleaners' work as both instrumental and communicative and examine the perceptions of healthcare professionals and managers, as well as cleaners themselves, of healthcare professionals and managers' role and contribution to quality and safety. FINDINGS Cleaners are generally perceived by the literature as performing repetitive - albeit important - tasks in isolation from patients. Cleaners are not considered part of the "healthcare team" and are excluded from decision-making and interprofessional communication. Yet, cleaners can contribute to patient care; ubiquity and proximity of cleaners to patients offer insights and untapped potential for involvement in hospital safety. ORIGINALITY/VALUE This paper brings an overdue focus to this labour force by examining the nature and potential of their work. This paper offers a new application of Habermas' work to this domain, rendering visible how the framing of cleaners' role works to exclude this important workforce from participation in the patient safety agenda.
Collapse
Affiliation(s)
- Charles E Hacker
- Faculty of Law, University of Technology Sydney, Sydney, Australia
| | - Deborah Debono
- Centre for Health Services Management, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Joanne Travaglia
- Centre for Health Services Management, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - David J Carter
- Faculty of Law, University of Technology Sydney, Sydney, Australia
| |
Collapse
|
18
|
Miao M, Rietdijk R, Brunner M, Debono D, Togher L, Power E. Implementation of Web-Based Psychosocial Interventions for Adults With Acquired Brain Injury and Their Caregivers: Systematic Review. J Med Internet Res 2022; 24:e38100. [PMID: 35881432 PMCID: PMC9328122 DOI: 10.2196/38100] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/16/2022] [Accepted: 06/15/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND More than 135 million people worldwide live with acquired brain injury (ABI) and its many psychosocial sequelae. This growing global burden necessitates scalable rehabilitation services. Despite demonstrated potential to increase the accessibility and scalability of psychosocial supports, digital health interventions are challenging to implement and sustain. The Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework can offer developers and researchers a comprehensive overview of considerations to implement, scale, and sustain digital health interventions. OBJECTIVE This systematic review identified published, peer-reviewed primary evidence of implementation outcomes, strategies, and factors for web-based psychosocial interventions targeting either adults with ABI or their formal or informal caregivers; evaluated and summarized this evidence; synthesized qualitative and quantitative implementation data according to the NASSS framework; and provided recommendations for future implementation. Results were compared with 3 hypotheses which state that complexity (dynamic, unpredictable, and poorly characterized factors) in most or all NASSS domains increases likelihood of implementation failure; success is achievable, but difficult with many complicated domains (containing multiple interacting factors); and simplicity (straightforward, predictable, and few factors) in most or all domains increases the likelihood of success. METHODS From a comprehensive search of MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, speechBITE, and neuroBITE, we reviewed primary implementation evidence from January 2008 to June 2020. For web-based psychosocial interventions delivered via standard desktop computer, mobile phone, tablet, television, and virtual reality devices to adults with ABI or their formal or informal caregivers, we extracted intervention characteristics, stakeholder involvement, implementation scope and outcomes, study design and quality, and implementation data. Implementation data were both narratively synthesized and descriptively quantified across all 7 domains (condition, technology, value proposition, adopters, organization, wider system, and their interaction over time) and all subdomains of the NASSS framework. Study quality and risk of bias were assessed using the 2018 Mixed Methods Appraisal Tool. RESULTS We identified 60 peer-reviewed studies from 12 countries, including 5723 adults with ABI, 1920 carers, and 50 health care staff. The findings aligned with all 3 hypotheses. CONCLUSIONS Although studies were of low methodological quality and insufficient number to statistically test relationships, the results appeared consistent with recommendations to reduce complexity as much as possible to facilitate implementation. Although studies excluded individuals with a range of comorbidities and sociocultural challenges, such simplification of NASSS domain 1 may have been necessary to advance intervention value propositions (domain 3). However, to create equitable digital health solutions that can be successfully implemented in real-world settings, it is recommended that developers involve people with ABI, their close others, and health care staff in addressing complexities in domains 2 to 7 from the earliest intervention design stages. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42020186387; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020186387. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1177/20552076211035988.
Collapse
Affiliation(s)
- Melissa Miao
- University of Technology Sydney, Sydney, Australia
| | | | | | | | | | - Emma Power
- University of Technology Sydney, Sydney, Australia
| |
Collapse
|
19
|
Reddacliff C, Hemsley B, Smith R, Dalton S, Jones S, Fitzpatrick A, Given F, Kelly J, Lawson X, Darcy S, Debono D, Benfer K, Balandin S. Examining the Content and Outcomes of Training in Dysphagia and Mealtime Management: A Systematic Review Informing Co-Design of New Training. Am J Speech Lang Pathol 2022; 31:1535-1552. [PMID: 35377733 DOI: 10.1044/2022_ajslp-21-00231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Dysphagia (swallowing difficulty) impacts physical health, quality of life, and mealtime enjoyment. Staff who provide mealtime assistance to people with dysphagia require adequate training to help ensure that the mealtimes are safe and enjoyable. This systematic review examined literature relating to training in dysphagia (e.g., recognizing signs and symptoms) and mealtime assistance, its components, and benefits for people with dysphagia. METHOD In July 2020, five scientific databases were searched for papers meeting the inclusion criteria relating to mealtime assistance training. The quality of the studies was evaluated using the Quality Assessment Tool for Studies of Diverse Design, with scores ranging from 38.1% to 83.3%. We completed a qualitative synthesis using the data extracted from the included studies. RESULTS Twenty-four studies met the inclusion criteria. Participants in these studies benefited from both group training and one-on-one training. Training programs had many formats including computer-based, face-to-face, individual training, and group training. Each included study demonstrated some level of positive impact to the learners, such as improved knowledge and skills in mealtime management for people with dysphagia. No studies reported negative outcomes. Training duration ranged from 30 min to 5 days. CONCLUSIONS The benefits of different components of mealtime training (e.g., group training, or face-to-face training) for mealtime assistance for people with dysphagia were reviewed. Further research is needed to compare the effectiveness of different training formats, involving not only the assistant but also people with dysphagia as both trainers and trainees, and determine the health outcomes of training programs for people with dysphagia.
Collapse
Affiliation(s)
- Courtney Reddacliff
- Graduate School of Health, University of Technology, Sydney, New South Wales, Australia
| | - Bronwyn Hemsley
- Graduate School of Health, University of Technology, Sydney, New South Wales, Australia
| | - Rebecca Smith
- Graduate School of Health, University of Technology, Sydney, New South Wales, Australia
| | - Sayne Dalton
- Dietitians Australia, Canberra, Australian Capital Territory
| | - Sarah Jones
- Occupational Therapy Australia, Melbourne, Victoria
| | | | - Fiona Given
- Graduate School of Health, University of Technology, Sydney, New South Wales, Australia
| | - Jack Kelly
- Graduate School of Health, University of Technology, Sydney, New South Wales, Australia
| | - Xanthe Lawson
- Studio 3 Learning, Sydney, New South Wales, Australia
| | - Simon Darcy
- UTS Business School, Management Discipline Group, University of Technology, Sydney, New South Wales, Australia
| | - Deborah Debono
- Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - Kath Benfer
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Susan Balandin
- Graduate School of Health, University of Technology, Sydney, New South Wales, Australia
- Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| |
Collapse
|
20
|
Wise S, Coleshill MJ, Taylor N, Le M, Debono D, Day RO, Melocco T, Baysari MT, Laba T, Carland JE. Australian hospital outpatient pharmacies: service adaptations during the 2020 national coronavirus disease 2019 lockdown. Pharmacy Practice and Res 2022; 52:326-328. [PMID: 35942385 PMCID: PMC9348013 DOI: 10.1002/jppr.1810] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/22/2022] [Accepted: 03/31/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Sarah Wise
- Centre for Health Economics Research and Evaluation University of Technology Sydney Sydney Australia
- St Vincent’s Clinical Campus University of NSW Kensington Australia
| | - Matthew J. Coleshill
- St Vincent’s Clinical Campus University of NSW Kensington Australia
- Department of Clinical Pharmacology and Toxicology St Vincent’s Hospital Darlinghurst Australia
- Black Dog Institute Randwick Australia
| | - Natalie Taylor
- School of Population Health University of NSW Kensington Australia
| | - Michelle Le
- Department of Pharmacy St Vincent’s Hospital Sydney Australia
| | - Deborah Debono
- Faculty of Health University of Technology Sydney Sydney Australia
| | - Richard O. Day
- St Vincent’s Clinical Campus University of NSW Kensington Australia
- Department of Clinical Pharmacology and Toxicology St Vincent’s Hospital Darlinghurst Australia
| | - Terry Melocco
- Department of Pharmacy St Vincent’s Hospital Sydney Australia
| | - Melissa T. Baysari
- Biomedical Informatics and Digital Health School of Medical Sciences Faculty of Medicine and Health The University of Sydney Sydney Australia
| | - Tracey‐Lea Laba
- Centre for Health Economics Research and Evaluation University of Technology Sydney Sydney Australia
- Pharmacy Program, Clinical and Health Services Unit University of South Australia Adelaide Australia
| | - Jane E. Carland
- St Vincent’s Clinical Campus University of NSW Kensington Australia
- Department of Clinical Pharmacology and Toxicology St Vincent’s Hospital Darlinghurst Australia
| |
Collapse
|
21
|
Affiliation(s)
- Reema Harrison
- Macquarie University, Sydney, New South Wales 2109, Australia
| | | | - Deborah Debono
- University of Technology, Sydney, New South Wales, Australia
| |
Collapse
|
22
|
Miao M, Power E, Rietdijk R, Debono D, Brunner M, Salomon A, Mcculloch B, Wright MR, Welsh M, Tremblay B, Rixon C, Williams L, Morrow R, Evain JC, Togher L. Coproducing Knowledge of the Implementation of Complex Digital Health Interventions for Adults with Acquired Brain Injury and their Communication Partners: Protocol for a Mixed Methods Study. JMIR Res Protoc 2022; 11:e35080. [PMID: 35006082 PMCID: PMC8787662 DOI: 10.2196/35080] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 11/24/2021] [Indexed: 02/06/2023] Open
Abstract
Background The Social Brain Toolkit, conceived and developed in partnership with stakeholders, is a novel suite of web-based communication interventions for people with brain injury and their communication partners. To support effective implementation, the developers of the Social Brain Toolkit have collaborated with people with brain injury, communication partners, clinicians, and individuals with digital health implementation experience to coproduce new implementation knowledge. In recognition of the equal value of experiential and academic knowledge, both types of knowledge are included in this study protocol, with input from stakeholder coauthors. Objective This study aims to collaborate with stakeholders to prioritize theoretically based implementation targets for the Social Brain Toolkit, understand the nature of these priorities, and develop targeted implementation strategies to address these priorities, in order to support the Social Brain Toolkit’s implementation. Methods Theoretically underpinned by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework of digital health implementation, a maximum variation sample (N=35) of stakeholders coproduced knowledge of the implementation of the Social Brain Toolkit. People with brain injury (n=10), communication partners (n=11), and clinicians (n=5) participated in an initial web-based prioritization survey based on the NASSS framework. Survey completion was facilitated by plain English explanations and accessible captioned videos developed through 3 rounds of piloting. A speech-language pathologist also assisted stakeholders with brain injury to participate in the survey via video teleconference. Participants subsequently elaborated on their identified priorities via 7 web-based focus groups, in which researchers and stakeholders exchanged stakeholder perspectives and research evidence from a concurrent systematic review. Stakeholders were supported to engage in focus groups through the use of visual supports and plain English explanations. Additionally, individuals with experience in digital health implementation (n=9) responded to the prioritization survey questions via individual interview. The results will be deductively analyzed in relation to the NASSS framework in a coauthorship process with people with brain injury, communication partners, and clinicians. Results Ethical approval was received from the University of Technology Sydney Health and Medical Research Ethics Committee (ETH20-5466) on December 15, 2020. Data were collected from April 13 to November 18, 2021. Data analysis is currently underway, with results expected for publication in mid-2022. Conclusions In this study, researchers supported individuals with living experience of acquired brain injury, of communicating with or clinically supporting someone post injury, and of digital health implementation, to directly access and leverage the latest implementation research evidence and theory. With this support, stakeholders were able to prioritize implementation research targets, develop targeted implementation solutions, and coauthor and publish new implementation findings. The results will be used to optimize the implementation of 3 real-world, evidence-based interventions and thus improve the outcomes of people with brain injury and their communication partners. International Registered Report Identifier (IRRID) DERR1-10.2196/35080
Collapse
Affiliation(s)
- Melissa Miao
- University of Technology Sydney, Sydney, Australia
| | - Emma Power
- University of Technology Sydney, Sydney, Australia
| | | | | | | | | | | | | | - Monica Welsh
- See Authors' Contributions, Australia.,Brain Injury Rehabilitation Unit, South Australian Brain Injury Rehabilitation Service, Hampstead Rehabilitation Centre, Adelaide, Australia
| | | | - Caleb Rixon
- See Authors' Contributions, Australia.,Genyus Network, Melbourne, Australia
| | - Liz Williams
- See Authors' Contributions, Australia.,Brain Injury Rehabilitation Community and Home, South Australian Brain Injury Rehabilitation Service, Hampstead Rehabilitation Centre, Adelaide, Australia
| | | | - Jean-Christophe Evain
- See Authors' Contributions, Australia.,Acquired Brain Injury Rehabilitation Centre, Caulfield Hospital, Alfred Health Network, Melbourne, Australia
| | | |
Collapse
|
23
|
Miao M, Power E, Rietdijk R, Brunner M, Debono D, Togher L. A Web-Based Service Delivery Model for Communication Training After Brain Injury: Protocol for a Mixed Methods, Prospective, Hybrid Type 2 Implementation-Effectiveness Study. JMIR Res Protoc 2021; 10:e31995. [PMID: 34889770 PMCID: PMC8704121 DOI: 10.2196/31995] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/13/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Acquired brain injuries (ABIs) commonly cause cognitive-communication disorders, which can have a pervasive psychosocial impact on a person's life. More than 135 million people worldwide currently live with ABI, and this large and growing burden is increasingly surpassing global rehabilitation service capacity. A web-based service delivery model may offer a scalable solution. The Social Brain Toolkit is an evidence-based suite of 3 web-based communication training interventions for people with ABI and their communication partners. Successful real-world delivery of web-based interventions such as the Social Brain Toolkit requires investigation of intervention implementation in addition to efficacy and effectiveness. OBJECTIVE The aim of this study is to investigate the implementation and effectiveness of the Social Brain Toolkit as a web-based service delivery model. METHODS This is a mixed methods, prospective, hybrid type 2 implementation-effectiveness study, theoretically underpinned by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework of digital health implementation. We will document implementation strategies preemptively deployed to support the launch of the Social Brain Toolkit interventions, as well as implementation strategies identified by end users through formative evaluation of the Social Brain Toolkit. We will prospectively observe implementation outcomes, selected on the basis of the NASSS framework, through quantitative web analytics of intervention use, qualitative and quantitative pre- and postintervention survey data from all users within a specified sample frame, and qualitative interviews with a subset of users of each intervention. Qualitative implementation data will be deductively analyzed against the NASSS framework. Quantitative implementation data will be analyzed descriptively. We will obtain effectiveness outcomes through web-based knowledge tests, custom user questionnaires, and formal clinical tools. Quantitative effectiveness outcomes will be analyzed through descriptive statistics and the Reliable Change Index, with repeated analysis of variance (pretraining, posttraining, and follow-up), to determine whether there is any significant improvement within this participant sample. RESULTS Data collection commenced on July 2, 2021, and is expected to conclude on June 1, 2022, after a 6-month sample frame of analytics for each Social Brain Toolkit intervention. Data analysis will occur concurrently with data collection until mid-2022, with results expected for publication late 2022 and early 2023. CONCLUSIONS End-user evaluation of the Social Brain Toolkit's implementation can guide intervention development and implementation to reach and meet community needs in a feasible, scalable, sustainable, and acceptable manner. End user feedback will be directly incorporated and addressed wherever possible in the next version of the Social Brain Toolkit. Learnings from these findings will benefit the implementation of this and future web-based psychosocial interventions for people with ABI and other populations. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Registry ACTRN12621001170819; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621001170819, Australia and New Zealand Clinical Trials Registry ACTRN12621001177842; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621001177842, Australia and New Zealand Clinical Trials Registry ACTRN12621001180808; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621001180808. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/31995.
Collapse
Affiliation(s)
- Melissa Miao
- University of Technology Sydney, Sydney, Australia
| | - Emma Power
- University of Technology Sydney, Sydney, Australia
| | | | | | | | | |
Collapse
|
24
|
Hemsley B, Debono D. Recognising complexity: Foregrounding vulnerable and diverse populations for inclusive health information management research. HEALTH INF MANAG J 2021; 51:113-117. [PMID: 34822259 DOI: 10.1177/18333583211052708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Deborah Debono
- Faculty of Health, 1994University of Technology Sydney, Ultimo, NSW, Australia
| |
Collapse
|
25
|
Ludlow K, Westbrook J, Jorgensen M, Lind KE, Baysari MT, Gray LC, Day RO, Ratcliffe J, Lord SR, Georgiou A, Braithwaite J, Raban MZ, Close J, Beattie E, Zheng WY, Debono D, Nguyen A, Siette J, Seaman K, Miao M, Root J, Roffe D, O'Toole L, Carrasco M, Thompson A, Shaikh J, Wong J, Stanton C, Haddock R. Co-designing a dashboard of predictive analytics and decision support to drive care quality and client outcomes in aged care: a mixed-method study protocol. BMJ Open 2021; 11:e048657. [PMID: 34433599 PMCID: PMC8388274 DOI: 10.1136/bmjopen-2021-048657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION There is a clear need for improved care quality and quality monitoring in aged care. Aged care providers collect an abundance of data, yet rarely are these data integrated and transformed in real-time into actionable information to support evidence-based care, nor are they shared with older people and informal caregivers. This protocol describes the co-design and testing of a dashboard in residential aged care facilities (nursing or care homes) and community-based aged care settings (formal care provided at home or in the community). The dashboard will comprise integrated data to provide an 'at-a-glance' overview of aged care clients, indicators to identify clients at risk of fall-related hospitalisations and poor quality of life, and evidence-based decision support to minimise these risks. Longer term plans for dashboard implementation and evaluation are also outlined. METHODS This mixed-method study will involve (1) co-designing dashboard features with aged care staff, clients, informal caregivers and general practitioners (GPs), (2) integrating aged care data silos and developing risk models, and (3) testing dashboard prototypes with users. The dashboard features will be informed by direct observations of routine work, interviews, focus groups and co-design groups with users, and a community forum. Multivariable discrete time survival models will be used to develop risk indicators, using predictors from linked historical aged care and hospital data. Dashboard prototype testing will comprise interviews, focus groups and walk-through scenarios using a think-aloud approach with staff members, clients and informal caregivers, and a GP workshop. ETHICS AND DISSEMINATION This study has received ethical approval from the New South Wales (NSW) Population & Health Services Research Ethics Committee and Macquarie University's Human Research Ethics Committee. The research findings will be presented to the aged care provider who will share results with staff members, clients, residents and informal caregivers. Findings will be disseminated as peer-reviewed journal articles, policy briefs and conference presentations.
Collapse
Affiliation(s)
- Kristiana Ludlow
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Mikaela Jorgensen
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kimberly E Lind
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Arizona, USA
| | - Melissa T Baysari
- Discipline of Biomedical Informatics and Digital Health, Charles Perkins Centre, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Leonard C Gray
- Centre for Research in Geriatric Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Richard O Day
- St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Julie Ratcliffe
- College of Nursing and Health Sciences, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- The International Society for Quality in Health Care (ISQua), Dublin, Ireland
| | - Magdalena Z Raban
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jacqueline Close
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Elizabeth Beattie
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Wu Yi Zheng
- Black Dog Institute, Sydney, New South Wales, Australia
| | - Deborah Debono
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Amy Nguyen
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Joyce Siette
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Karla Seaman
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Melissa Miao
- Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jo Root
- Consumers Health Forum of Australia, Deakin, Victoria, Australia
| | - David Roffe
- IT Consultant, Sydney, New South Wales, Australia
| | - Libby O'Toole
- Aged Care Quality and Safety Commission, Sydney, New South Wales, Australia
| | | | - Alex Thompson
- Anglicare Sydney, Sydney, New South Wales, Australia
| | - Javed Shaikh
- Anglicare Sydney, Sydney, New South Wales, Australia
| | - Jeffrey Wong
- Anglicare Sydney, Sydney, New South Wales, Australia
| | - Cynthia Stanton
- Sydney North Health Network, Sydney, New South Wales, Australia
| | - Rebecca Haddock
- Deeble Institute for Health Policy Research, Australian Healthcare and Hospitals Association, Canberra, Australian Capital Territory, Australia
| |
Collapse
|
26
|
Morrow A, Chan P, Tiernan G, Steinberg J, Debono D, Wolfenden L, Tucker KM, Hogden E, Taylor N. Building capacity from within: qualitative evaluation of a training program aimed at upskilling healthcare workers in delivering an evidence-based implementation approach. Transl Behav Med 2021; 12:6320108. [PMID: 34255088 PMCID: PMC8765000 DOI: 10.1093/tbm/ibab094] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Translating evidence into complex health systems is an ongoing challenge. Building the capacity of healthcare workers in behavioral and implementation science methods may facilitate the use of evidence-based implementation approaches, leading to sustainable and effective translation. The aim was to describe the development, contents and evaluation of a training workshop aimed at upskilling hospital-embedded staff to deliver an evidence-based implementation approach. The Hide and Seek Project (HaSP) is a cluster randomized controlled trial testing two implementation approaches for improving hereditary cancer referral at eight Australian hospitals. Healthcare workers were recruited as “Implementation Leads” and trained via a one-day workshop—TRAining in evideNce-baSed ImpLementATion for hEalth (TRANSLATE). The purpose of TRANSLATE was to upskill Implementation Leads in the delivery of HaSP, as well as implementation science methods more broadly. Implementation Leads participated in semi-structured evaluation interviews, which were analyzed using inductive thematic analysis. Nine Implementation Leads from various professional backgrounds completed the training. Four key themes were identified: (i) training day reactions, (ii) learning, (iii) implementation barriers and facilitators, and (iv) building health system capacity for implementation. Participants reported high levels of satisfaction, and anticipated that the knowledge and skills may be useful in the future. We describe a novel training program focused on the delivery of evidence-based implementation within health systems. Guided by insights from this study, methods to deliver the training on a larger scale and across different contexts are being explored. The prolonged impact of TRANSLATE will be further evaluated at trial completion. Trial registration: ANZCTR, ACTRN12618001072202. Registered on June 27, 2018
Collapse
Affiliation(s)
- April Morrow
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Camperdown New South Wales, Australia
| | - Priscilla Chan
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
| | - Gabriella Tiernan
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
| | - Julia Steinberg
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Camperdown New South Wales, Australia
| | - Deborah Debono
- Centre for Health Services Management, School of Public Health, University of Technology Sydney, New South Wales, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | - Katherine M Tucker
- Hereditary Cancer Centre, Prince of Wales Hospital, New South Wales, Australia.,Prince of Wales Clinical School, UNSW Sydney, New South Wales, Australia
| | - Emily Hogden
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
| | - Natalie Taylor
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Camperdown New South Wales, Australia
| |
Collapse
|
27
|
Stockton DA, Fowler C, Debono D, Travaglia J. World Health Organization building blocks in rural community health services: An integrative review. Health Sci Rep 2021; 4:e254. [PMID: 33732894 PMCID: PMC7942400 DOI: 10.1002/hsr2.254] [Citation(s) in RCA: 3] [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: 09/08/2020] [Revised: 01/15/2021] [Accepted: 02/04/2021] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Developing and adapting health service models to effectively meet the needs of rural and remote communities is an international priority given inequities in health outcomes compared with metropolitan counterparts. This integrative review aims to inform rural and remote health service delivery systems by drawing on the WHO Framework building blocks to identify lessons learned from the literature describing experiences of rural and remote community health service planning and implementation; and inform recommendations to strengthen often disadvantaged rural and remote health systems for policy makers, health service managers, and those implementing international healthcare initiatives within these contexts. METHODS The integrative review examined the literature reporting rural and remote community health service delivery published from 2007 to 2017 (the decade following the release of the WHO Framework). Using an analytic frame, a structured template was developed to extract data and categorized against the WHO building blocks, followed by a synthesis of the key findings. RESULTS This integrative review identified that WHO Framework building blocks such as "Service Delivery" and "Health Workforce" are commonly reflected in rural and remote community health service delivery literature in the decade since the Framework's release. However, others such as "Sustainable Funding and Social Protection" are less commonly reported in the literature despite these elements being identified by the WHO as being integral to successful, sustainable health service delivery systems. CONCLUSIONS We found that collaboration across the health system governance continuum from local to policy level is an essential enabler for rural and remote health service delivery. Community-based participatory action research provides an opportunity to learn from one another, build capacity, optimize service model suitability, and promotes cultural safety by demonstrating respect and inclusivity in decision-making. Policy makers and funders need to acknowledge the time and resources required to build trust and community coalitions to inform effective planning and implementation.
Collapse
Affiliation(s)
- Deborah A. Stockton
- Centre for Health Services Management, Faculty of HealthUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Cathrine Fowler
- School of Nursing and MidwiferyUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Deborah Debono
- Centre for Health Services Management, Faculty of HealthUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Joanne Travaglia
- Centre for Health Services Management, Faculty of HealthUniversity of Technology SydneyUltimoNew South WalesAustralia
| |
Collapse
|
28
|
Abstract
INTRODUCTION Hospitals commonly examine patient safety culture and other quality indicators to evaluate and improve performance in relation to quality and safety. A growing body of research has separately examined relationships between patient safety culture and patient experience on clinical outcomes and other quality indicators. However, there is a knowledge gap regarding the relationship between these two important domains. This article describes the protocol for a scoping review of published literature examining the relationship between patient safety culture and patient experience in hospital settings. The scoping review will provide an overview of research into the relationship between patient safety culture and patient experience in hospital contexts, map key concepts underpinning these domains and identify research gaps for further study. METHODS AND ANALYSIS The scoping review will be conducted using the five stages of Arksey and O'Malley's framework: identify the research question; identify relevant studies; study selection; chart data; and collate, summarise and report the results. The inclusion criteria will be applied using the Population, Concept and Context Framework. Searches will be conducted in the CINAHL, Cochrane Library, ProQuest, MEDLINE, PsycINFO, Scopus and SciELO databases, without applying date range limits. Hand-searching of grey literature will also be performed to find relevant, non-indexed literature. Data will be extracted using a standardised data extraction form developed by the Joanna Briggs Institute. Both descriptive and thematic analyses will be undertaken to scope key concepts within the body of reviewed literature. ETHICS AND DISSEMINATION This type of study does not require an ethics review. The results will be submitted for publication in a peer-reviewed journal and presented at conferences.
Collapse
Affiliation(s)
- Adel Alabdaly
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia
| | - Deborah Debono
- Centre for Health Services Management, School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Reece Hinchcliff
- Centre for Health Services Management, School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Su-Yin Hor
- Centre for Health Services Management, School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
29
|
Sheppard-Law S, Cruickshank M, Debono D. Mapping diversity and demographic-based changes to a pediatric population attending a specialist tertiary hospital: a retrospective review. J Clin Nurs 2020; 30:466-474. [PMID: 33174268 DOI: 10.1111/jocn.15559] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 09/04/2020] [Accepted: 10/31/2020] [Indexed: 11/28/2022]
Abstract
AIMS This study aimed to describe the demographic characteristics and to measure annual changes in composition of the paediatric population attending a specialist tertiary hospital in Sydney, Australia, between 2015 and 2017. BACKGROUND Australia has experienced steady growth in the number of people born overseas in the last fifty years thereby building a culturally and linguistically rich country. Such dynamic population changes pose a challenge to the nursing workforce, in particular how the needs of migrant families from non-English-speaking countries are accommodated. DESIGN Retrospective review of medical records. METHODS De-identified paediatric inpatient data were imported from a hospital database into Statistical Package for the Social Sciences (version 21) database for cleaning and analysis. Strengthening the reporting of observational studies in epidemiology checklist was completed. RESULTS Paediatric inpatients born in a country other than Australia (8762, 5.7%) emigrated from 155 countries or were "born at Sea" (n = 13, 0.1%) and spoke an array of primary languages (n = 139), other than English. Whilst inpatient health service rates remained constant during the study period, an increased rate of service utilisation was reported for children born in Asia (IRR 1.3, p ≤ 0.001, 95% CI: 1.2-1.4) and in the Middle East (IRR 1.4, p ≤ 0.001, 95% CI: 1.2-1.6). Families who reported that they preferred to speak Chinese Languages, Middle Eastern languages (not Arabic) and languages of India reported increased rates. CONCLUSION Significant annual changes in composition of the paediatric population were reported. Regular analysis of local inpatient data will inform health care that is responsive to change and addresses the unique needs of diverse families. RELEVANCE TO CLINICAL PRACTICE Diversity poses a potential challenge to the nursing workforce on a daily basis and more broadly. To meet the changing needs of diverse inpatient populations, nurses will need to plan, implement and evaluate cultural competency, linguistic access, workforce diversity and the quality of care to diverse populations.
Collapse
Affiliation(s)
- Suzanne Sheppard-Law
- Nursing Research Unit, Sydney Children's Hospital Network, Sydney, NSW, Australia.,School of Nursing & Midwifery, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Marilyn Cruickshank
- Nursing Research Unit, Sydney Children's Hospital Network, Sydney, NSW, Australia.,School of Nursing & Midwifery, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Deborah Debono
- Centre for Health Services Management, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| |
Collapse
|
30
|
Hinchcliff R, Debono D, Carter D, Glennie M, Robertson H, Travaglia J. Options to enhance the veracity of Australian health service accreditation assessments. HEALTH INF MANAG J 2020; 51:59-62. [DOI: 10.1177/1833358320910890] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Assessment processes applied within some health service accreditation programs have been criticised at times for being inaccurate, inconsistent or inefficient. Such criticism has inspired the development of innovative assessment methods. Objective: The Australian Commission on Safety and Quality in Health Care considered the use of three such methods: short-notice or unannounced methods; patient journey or tracer methods; and attestation by governing bodies. Method: A systematic search and synthesis of published peer-reviewed and grey literature associated with these methods. Results and Conclusion: The published literature demonstrates that the likely benefits of these three assessment methods warrant further evaluation, real-world trials and stakeholder consultation to determine the most appropriate models to introduce into national accreditation programs. Implications: The subsequent introduction of models of short-notice assessments and attestation by governing bodies into the Australian Health Service Safety and Quality Accreditation Scheme in January 2019 demonstrates how the findings presented in this article influenced the national change in assessment practice, providing an example of evidence-informed accreditation development.
Collapse
Affiliation(s)
- Reece Hinchcliff
- Queensland University of Technology, Australia
- University of Technology Sydney, Australia
| | | | | | | | | | | |
Collapse
|
31
|
Debono D, Robertson H, Travaglia J. Organisational communication as trespass: a patient safety perspective. J Health Organ Manag 2019. [DOI: 10.1108/jhom-10-2018-0310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Significant, sustained improvement in patient safety has proved an intractable goal. Attempts to address persistent problems have largely focused on technical solutions to issues conceptualised as clinical, cultural or system based. While communication is at the core of many remediation strategies, the focus has remained largely on communication between clinicians or between clinicians and patients, and on creating centralised guidelines as communicative mechanisms to transmit approved practice. Yet, current attempts at improvement have had limited impact. The purpose of this paper is to highlight vital new ways of conceptualising and exploring the relations and actions that are meant to constitute safety within organisations.
Design/methodology/approach
Utilising theory from social sciences, the authors reconceptualise trespass and transgression, traditionally positioned as infringements, as acts of resistance: mechanisms for intrusion which intentionally or unintentionally disrupt the territorial claims of professions and organisations to enhance patient safety.
Findings
Drawing on the literature, research and professional experience, two forms of trespass are discussed: the intrusion of largely invisible and understudied ancillary staff into the world of clinicians; and the use of workarounds by clinicians themselves. In both cases, transgressors intend to increase rather than decrease patient safety and may, upon further examination, prove to do so.
Originality/value
Trespasses and transgressions considered in this light offer the opportunity to make visible people, relationships and actions which have previously remained hidden in our understanding of, and therefore proposed solutions to, patient safety.
Collapse
|
32
|
Duffield C, Roche MA, Wise S, Debono D. Harnessing ward‐level administrative data and expert knowledge to improve staffing decisions: A multi‐method case study. J Adv Nurs 2019; 76:287-296. [DOI: 10.1111/jan.14207] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/11/2019] [Accepted: 09/12/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Christine Duffield
- Centre for Health Services Management Faculty of Health, University of Technology Sydney Ultimo Australia
- School of Nursing and Midwifery Edith Cowan University Joondalup Australia
| | - Michael A. Roche
- Centre for Health Services Management Faculty of Health, University of Technology Sydney Ultimo Australia
| | - Sarah Wise
- Centre for Health Economic Research and Evaluation UTS Business School University of Technology Sydney Ultimo Australia
| | - Deborah Debono
- Centre for Health Services Management Faculty of Health, University of Technology Sydney Ultimo Australia
| |
Collapse
|
33
|
Son J, Debono D, Leitner R, Lenroot R, Johnson J. Pass the parcel: Service provider views on bridging gaps for youth with dual diagnosis of intellectual disability and mental health disorders in regional areas. J Paediatr Child Health 2019; 55:666-672. [PMID: 30311314 DOI: 10.1111/jpc.14266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 08/24/2018] [Accepted: 09/16/2018] [Indexed: 11/29/2022]
Abstract
AIM Youth with both intellectual disability (ID) and mental health (MH) disorders (dual diagnosis) have complex physical and MH needs that can make providing integrated care for this complex group challenging. We conducted a mixed methods needs assessment to identify gaps and challenges in care delivery, identify bridges for these and identify what works well in existing services. METHODS Our research team recruited service providers (n = 126) caring for youth aged 14-24 years with a dual diagnosis in the Illawarra Shoalhaven region of New South Wales, Australia, to participate in focus group interviews. Data were transcribed and analysed thematically. RESULTS We identified six themes related to caring for youth with dual diagnosis in regional areas: access to services and information about services, communication between service providers and with clients and carers, the divide between MH and ID, early intervention and health promotion, capacity building of service providers and capacity building of clients and carers. Across these themes, service providers highlighted the transition from child to adult services as a particularly challenging time for clients, families and carers. CONCLUSIONS Our data suggest several approaches to break down silos and to facilitate collaboration between current services for youth with a dual diagnosis, including increasing specialised ID/MH services and building the capacity of current disability and MH service providers. Our results provide important information to provide quality and integrated care for youth with complex health needs.
Collapse
Affiliation(s)
- Jane Son
- Kogarah Developmental Assessment Service, Sydney, New South Wales, Australia.,School of Women's and Childen's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Deborah Debono
- Centre for Health Services Management, University of Technology, Sydney, New South Wales, Australia
| | - Robert Leitner
- Kogarah Developmental Assessment Service, Sydney, New South Wales, Australia
| | - Rhoshel Lenroot
- School of Psychiatry and Neuroscience Research, University of New South Wales, Sydney, New South Wales, Australia.,Department of Psychiatry and Behavioural Sciences, University of New Mexico, Albuquerque, New Mexico, United States
| | - Julie Johnson
- Center for Healthcare Studies, Feinberg Schools of Medicine, Northwestern University, Chicago, Illinois, United States
| |
Collapse
|
34
|
Long JC, Winata T, Debono D, Phan-Thien KC, Zhu C, Taylor N. Process evaluation of a behaviour change approach to improving clinical practice for detecting hereditary cancer. BMC Health Serv Res 2019; 19:180. [PMID: 30894169 PMCID: PMC6425681 DOI: 10.1186/s12913-019-3985-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 11/13/2018] [Accepted: 03/01/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND This retrospective process evaluation reports on the application of a 1-year implementation program to increase identification and management of patients at high risk of a hereditary cancer syndrome. The project used the Theoretical Domains Framework Implementation (TDFI) approach, a promising implementation methodology, used successfully in the United Kingdom to address patient safety issues. This Australian project run at two large public hospitals aimed to increase referrals of patients flagged as being at risk of Lynch syndrome on the basis of a screening test to genetic services. At the end of the project, the pathologists' processes had changed, but the referral rate remained inconsistent and low. METHODS Semi-structured interviews explored participants' perceptions of the TDFI approach and Health services researchers wrote structured reflections. Interview transcripts and reflections were coded initially against implementation outcomes for the various TDFI approach activities: acceptability, appropriateness, feasibility, value for time cost, and adoption. On a second pass, themes were coded around challenges to the approach. RESULTS Interviews were held with nine key project participants including pathologists, oncologists, surgeons, genetic counsellors and an administrative officer. Two health services researchers wrote structured reflections. The first of two major themes was 'Theory-related challenges', with subthemes of accessibility of theory underpinning the TDFI, commitment to that theory-based approach, and the problem of complexity. The second theme was 'Practical challenges' with subthemes of stakeholder management, navigating the system, and perceptions of the problem. Health services researchers reflected on the benefits of bridging professional divides and facilitating collective learning and problem solving, but noted frustrations around clinicians' time constraints that led to sparse interactions with the team, and lack of authority to effect change themselves. CONCLUSIONS Mixed success of adoption as an outcome was attributed to the complexity and highly nuanced nature of the setting. This made identifying the target behaviour, a key step in the TDFI approach, challenging. Introduced changes in the screening process led to new, unexpected issues yet to be addressed. Strategies to address challenges are presented, including using an internal facilitator with a focus on applying a theory-based implementation approach.
Collapse
Affiliation(s)
- Janet C Long
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, 2109, Australia
| | - Teresa Winata
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, 2109, Australia
| | - Deborah Debono
- Centre for Health Services Management, Faculty of Health, University of Technology, Sydney, NSW, 2007, Australia
| | - Kim-Chi Phan-Thien
- St George and Sutherland Clinical School, University of New South Wales, Kensington, Sydney, NSW, 2052, Australia
| | - Christine Zhu
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, 2109, Australia
| | - Natalie Taylor
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, 2109, Australia. .,Cancer Research Division, Cancer Council NSW, 153 Dowling St, Woolloomooloo, NSW, 2011, Australia. .,Faculty of Health Sciences, University of Sydney, Camperdown, Sydney, NSW, 2006, Australia.
| |
Collapse
|
35
|
Long JC, Debono D, Williams R, Salisbury E, O'Neill S, Eykman E, Butler J, Rawson R, Phan-Thien KC, Thompson SR, Braithwaite J, Chin M, Taylor N. Using behaviour change and implementation science to address low referral rates in oncology. BMC Health Serv Res 2018; 18:904. [PMID: 30486812 PMCID: PMC6263048 DOI: 10.1186/s12913-018-3653-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 02/20/2018] [Accepted: 10/26/2018] [Indexed: 12/12/2022] Open
Abstract
Background Patients undergoing surgery for bowel cancer now have a routine screening test to assess their genetic predisposition to this and other cancers (Lynch syndrome). A result indicating a high risk should trigger referral to a genetic clinic for diagnostic testing, information, and management. Appropriate management of Lynch syndrome lowers morbidity and mortality from cancer for patients and their family, but referral rates are low. The aim of this project was to increase referral rates for patients at high risk of Lynch syndrome at two Australian hospitals, using the Theoretical Domains Framework (TDF) Implementation approach. Methods Multidisciplinary teams at each hospital mapped the referral process and discussed barriers to referral. A 12-month retrospective audit measured baseline referral rates. The validated Influences on Patient Safety Behaviours Questionnaire was administered to evaluate barriers using the TDF. Results were discussed in focus groups and interviews, and interventions co-designed, guided by theory. Continuous monitoring audits assessed change in referral rates. Results Teams (n = 8, 11) at each hospital mapped referral processes. Baseline referral rates were 80% (4/5) from 71 screened patients and 8% (1/14) from 113 patients respectively. The questionnaire response rate was 51% (36/71). Most significant barrier domains were: ‘environmental context;’ ‘memory and decision making;’ ‘skills;’ and ‘beliefs about capabilities.’ Focus groups and interviews with 19 healthcare professionals confirmed these domains as significant. Fifteen interventions were proposed considering both emerging and theory-based results. Interventions included: clarification of pathology reports, education, introduction of e-referrals, and inclusion of genetic status in documentation. Audits continued to December 2016 showing a change in pathology processes which increased the accuracy of screening. The referral rate remained low: 46% at Hospital A and 9% Hospital B. Results suggest patients who have their referral deferred for some reason are not referred later. Conclusion Lynch syndrome is typical of low incidence problems likely to overwhelm the system as genomic testing becomes mainstream. It is crucial for health researchers to test methods and define generalizable solutions to address this problem. Whilst our approach did not improve referrals, we have deepened our understanding of barriers to referral and approaches to low frequency conditions. Electronic supplementary material The online version of this article (10.1186/s12913-018-3653-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Janet C Long
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health, Macquarie University, Sydney, NSW, Australia.
| | - Deborah Debono
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health, Macquarie University, Sydney, NSW, Australia.,Faculty of Health, University of Technology, Sydney, Australia
| | - Rachel Williams
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia.,Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | - Sharron O'Neill
- School of Business, University of NSW, Campbell, ACT, Australia
| | - Elizabeth Eykman
- NSW Pathology (SEALS), St George Hospital, Kogarah, NSW, Australia
| | - Jordan Butler
- NSW Pathology (SEALS), Prince of Wales Hospital, Randwick, NSW, Australia
| | - Robert Rawson
- Anatomical Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Kim-Chi Phan-Thien
- St George and Sutherland Clinical School, University of New South Wales, Randwick, NSW, Australia
| | - Stephen R Thompson
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia.,Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health, Macquarie University, Sydney, NSW, Australia
| | - Melvin Chin
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Natalie Taylor
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health, Macquarie University, Sydney, NSW, Australia.,Cancer Council NSW, Woolloomooloo, NSW, Australia
| |
Collapse
|
36
|
Hinchcliff R, Debono D, Carter D, Banks M. ISQUA18-2585Systematic Reviews of the Evidence Supporting Three Methods of External Accreditation Assessment. Int J Qual Health Care 2018. [DOI: 10.1093/intqhc/mzy167.14] [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: 11/13/2022] Open
Affiliation(s)
| | - D Debono
- Centre for Health Services Management
| | - D Carter
- Faculty of Law, University of Technology Sydney
| | - M Banks
- Australian Commission on Safety and Quality in Health Care, Sydney, Australia
| |
Collapse
|
37
|
Debono D, Azzopardi T, Scicluna R. Audit of waiting times and referrals to fresh trauma clinic in a european mediterranean hospital. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
38
|
Debono D, Greenfield D, Testa L, Mumford V, Hogden A, Pawsey M, Westbrook J, Braithwaite J. Understanding stakeholders’ perspectives and experiences of general practice accreditation. Health Policy 2017; 121:816-822. [DOI: 10.1016/j.healthpol.2017.05.006] [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: 06/25/2016] [Revised: 04/29/2017] [Accepted: 05/12/2017] [Indexed: 01/19/2023]
|
39
|
Hogden A, Greenfield D, Brandon M, Debono D, Mumford V, Westbrook J, Braithwaite J. How does accreditation influence staff perceptions of quality in residential aged care? QAOA 2017. [DOI: 10.1108/qaoa-07-2016-0028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Quality of care in the residential aged sector has changed over the past decade. The purpose of this paper is to examine these changes from the perspectives of staff to identify factors influencing quality of residential aged care, and the role and influence of an aged care accreditation programme.
Design/methodology/approach
Focus groups were held with 66 aged care staff from 11 Australian aged care facilities. Data from semi-structured interviews were analysed to capture categories representing participant views.
Findings
Participants reported two factors stimulating change: developments in the aged care regulatory and policy framework, and rising consumer expectations. Four corresponding effects on service quality were identified: increasing complexity of resident care, renewed built environments of aged care facilities, growing focus on resident-centred care and the influence of accreditation on resident quality of life. The accreditation programme was viewed as maintaining minimum standards of quality throughout regulatory and social change, yet was considered to lack capacity of itself to explicitly promote or improve resident quality of life.
Research limitations/implications
For an increasingly complex aged care population, regulatory and societal change has led to a shift in service provision from institutional care models to one that is becoming more responsive to consumer expectations. The capacity of long-established and relatively static accreditation standards to better accommodate changing consumer needs comes into question.
Originality/value
This is the first study to examine the relationship between accreditation and residential aged care service quality from the perspectives of staff, and offers a nuanced view of “quality” in this setting.
Collapse
|
40
|
Greenfield D, Debono D, Hogden A, Hinchcliff R, Mumford V, Pawsey M, Westbrook J, Braithwaite J. Examining challenges to reliability of health service accreditation during a period of healthcare reform in Australia. J Health Organ Manag 2017; 29:912-24. [PMID: 26556158 DOI: 10.1108/jhom-02-2015-0034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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]
Abstract
PURPOSE Health systems are changing at variable rates. Periods of significant change can create new challenges or amplify existing barriers to accreditation program credibility and reliability. The purpose of this paper is to examine, during the transition to a new Australian accreditation scheme and standards, challenges to health service accreditation survey reliability, the salience of the issues and strategies to manage threats to survey reliability. DESIGN/METHODOLOGY/APPROACH Across 2013-2014, a two-phase, multi-method study was conducted, involving five research activities (two questionnaire surveys and three group discussions). This paper reports data from the transcribed group discussions involving 100 participants, which was subject to content and thematic analysis. Participants were accreditation survey coordinators employed by the Australian Council on Healthcare Standards. FINDINGS Six significant issues influencing survey reliability were reported: accreditation program governance and philosophy; accrediting agency management of the accreditation process, including the program's framework; survey coordinators; survey team dynamics; individual surveyors; and healthcare organizations' approach to accreditation. A change in governance arrangements promoted reliability with an independent authority and a new set of standards, endorsed by Federal and State governments. However, potential reliability threats were introduced by having multiple accrediting agencies approved to survey against the new national standards. Challenges that existed prior to the reformed system remain. ORIGINALITY/VALUE Capturing lessons and challenges from healthcare reforms is necessary if improvements are to be realized. The study provides practical and theoretical strategies to promote reliability in accreditation programs.
Collapse
Affiliation(s)
- David Greenfield
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Greenfield D, Hogden A, Hinchcliff R, Mumford V, Pawsey M, Debono D, Westbrook JI, Braithwaite J. The impact of national accreditation reform on survey reliability: a 2-year investigation of survey coordinators' perspectives. J Eval Clin Pract 2016; 22:662-7. [PMID: 26804610 DOI: 10.1111/jep.12512] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/23/2015] [Indexed: 11/26/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVE Accrediting health care organizations against standards is a recognized safety and quality intervention. The credibility of an accreditation programme relies on surveying reliability. We investigated accreditation survey coordinators' perceptions of reliability issues and their continued relevancy, during a period of national accreditation reform. METHOD In 2013 and 2014, questionnaire surveys were developed using survey coordinators' feedback of their experiences and concerns regarding the accreditation process. Each year, a purpose-designed questionnaire survey was administered during the accrediting agency survey coordinator training days. RESULTS Participants reported that survey reliability was informed by five categories of issues: the management of the accreditation process, including standards and health care organizational issues; surveyor workforce management; survey coordinator role; survey team; and individual surveyors. A new accreditation system and programme did not alter the factors reported to shape survey reliability. However, across the reform period, there was a noted change within each category of the specific issues that were of concern. Furthermore, consensus between coordinators that existed in 2013 appears to have diminished in 2014. Across all categories, in 2014 there was greater diversity of opinion than in 2013. CONCLUSIONS The known challenges to the reliability of an accreditation programme retained their potency and relevancy during a period of reform. The diversity of opinion identified across the coordinator workforce could potentially place the credibility and reliability of the new scheme at risk. The study highlights that reliability of an accreditation scheme is an ongoing achievement, not a one-off attainment.
Collapse
Affiliation(s)
- David Greenfield
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
| | - Anne Hogden
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Reece Hinchcliff
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, New South Wales
| | - Virginia Mumford
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Marjorie Pawsey
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Deborah Debono
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| |
Collapse
|
42
|
Debono D, Greenfield D, Mumford V, Braithwaite J. ISQUA16-3062IMPROVEMENTS IDENTIFIED, BUT FUTURE SUSTAINABILITY IS NOT ASSURED: STAKEHOLDERS’ VIEWS ON ACCREDITATION IN AUSTRALIAN GENERAL PRACTICES. Int J Qual Health Care 2016. [DOI: 10.1093/intqhc/mzw104.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
43
|
Taylor N, Long JC, Debono D, Williams R, Salisbury E, O’Neill S, Eykman E, Braithwaite J, Chin M. Achieving behaviour change for detection of Lynch syndrome using the Theoretical Domains Framework Implementation (TDFI) approach: a study protocol. BMC Health Serv Res 2016; 16:89. [PMID: 26969429 PMCID: PMC4788820 DOI: 10.1186/s12913-016-1331-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 02/23/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Lynch syndrome is an inherited disorder associated with a range of cancers, and found in 2-5 % of colorectal cancers. Lynch syndrome is diagnosed through a combination of significant family and clinical history and pathology. The definitive diagnostic germline test requires formal patient consent after genetic counselling. If diagnosed early, carriers of Lynch syndrome can undergo increased surveillance for cancers, which in turn can prevent late stage cancers, optimise treatment and decrease mortality for themselves and their relatives. However, over the past decade, international studies have reported that only a small proportion of individuals with suspected Lynch syndrome were referred for genetic consultation and possible genetic testing. The aim of this project is to use behaviour change theory and implementation science approaches to increase the number and speed of healthcare professional referrals of colorectal cancer patients with a high-likelihood risk of Lynch syndrome to appropriate genetic counselling services. METHODS The six-step Theoretical Domains Framework Implementation (TDFI) approach will be used at two large, metropolitan hospitals treating colorectal cancer patients. Steps are: 1) form local multidisciplinary teams to map current referral processes; 2) identify target behaviours that may lead to increased referrals using discussion supported by a retrospective audit; 3) identify barriers to those behaviours using the validated Influences on Patient Safety Behaviours Questionnaire and TDFI guided focus groups; 4) co-design interventions to address barriers using focus groups; 5) co-implement interventions; and 6) evaluate intervention impact. Chi square analysis will be used to test the difference in the proportion of high-likelihood risk Lynch syndrome patients being referred for genetic testing before and after intervention implementation. A paired t-test will be used to assess the mean time from the pathology test results to referral for high-likelihood Lynch syndrome patients pre-post intervention. Run charts will be used to continuously monitor change in referrals over time, based on scheduled monthly audits. DISCUSSION This project is based on a tested and refined implementation strategy (TDFI approach). Enhancing the process of identifying and referring people at high-likelihood risk of Lynch syndrome for genetic counselling will improve outcomes for patients and their relatives, and potentially save public money.
Collapse
Affiliation(s)
- Natalie Taylor
- />Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health, Macquarie University, Sydney, NSW 2109 Australia
| | - Janet C. Long
- />Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health, Macquarie University, Sydney, NSW 2109 Australia
| | - Deborah Debono
- />Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health, Macquarie University, Sydney, NSW 2109 Australia
| | - Rachel Williams
- />Prince of Wales Hospital, Sydney, NSW Australia
- />Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | | | - Sharron O’Neill
- />International Governance and Research Centre, Faculty of Business and Economics, Macquarie University, Sydney, Australia
| | - Elizabeth Eykman
- />NSW Pathology (SEALS), St George Hospital, Sydney, NSW Australia
| | - Jeffrey Braithwaite
- />Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health, Macquarie University, Sydney, NSW 2109 Australia
| | - Melvin Chin
- />Prince of Wales Hospital, Sydney, NSW Australia
| |
Collapse
|
44
|
Debono D, Travaglia JF, Dunn AG, Thoms D, Hinchcliff R, Plumb J, Milne J, Erez-Rein N, Wiley J, Braithwaite J. Strengthening the capacity of nursing leaders through multifaceted professional development initiatives: A mixed method evaluation of the ‘Take The Lead’ program. Collegian 2016; 23:19-28. [DOI: 10.1016/j.colegn.2014.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
45
|
Mumford V, Greenfield D, Hogden A, Debono D, Forde K, Westbrook J, Braithwaite J. Development and application of an indicator assessment tool for measuring health services accreditation programs. BMC Res Notes 2015; 8:363. [PMID: 26289324 PMCID: PMC4541736 DOI: 10.1186/s13104-015-1330-6] [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] [Received: 02/11/2014] [Accepted: 08/12/2015] [Indexed: 11/27/2022] Open
Abstract
Background Hospital accreditation programs are internationally widespread and consume increasingly scarce health resources. However, we lack tools to consistently identify suitable indicators to assess and monitor accreditation outcomes. We describe the development and validation of such a tool. Results Using Australian accreditation standards as our reference point we: reviewed the research evidence for potential indicators; looked for links with existing external indicators; and assessed relevant state and federal policies. We allocated provisional scores, on a five point Likert scale, to the five accountability criteria in the tool: research; accuracy; proximity; no adverse effects; and specificity. An expert panel validated the use of the purpose designed indicator assessment tool. The panel identified hand hygiene compliance rates as a suitable process indicator, and hospital acquired Staphylococcus aureus infection (SAB) rates as an outcome indicator, with the hypothesis that improved hand hygiene compliance rates and lower SAB rates would correlate with accreditation performance. Conclusions This new tool can be used to identify, analyse, and compare accreditation indicators. Using infection control indicators such as hand hygiene compliance and SAB rates to measure accreditation effectiveness has merit, and their efficacy can be determined by comparing accreditation scores with indicator outcomes. To verify the tool as a robust instrument, testing is needed in other health service domains, both in Australia and internationally. This tool provides health policy makers with an important means for assessing the accreditation programs which form a critical part of the national patient safety and quality framework.
Collapse
Affiliation(s)
- Virginia Mumford
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, UNSW, Sydney, Australia.
| | - David Greenfield
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, UNSW, Sydney, Australia.
| | - Anne Hogden
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, UNSW, Sydney, Australia.
| | - Deborah Debono
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, UNSW, Sydney, Australia.
| | - Kevin Forde
- School of Public Health and Community Medicine, UNSW, Sydney, Australia.
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, UNSW, Sydney, Australia.
| | - Jeffrey Braithwaite
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, UNSW, Sydney, Australia.
| |
Collapse
|
46
|
Greenfield D, Hinchcliff R, Hogden A, Mumford V, Debono D, Pawsey M, Westbrook J, Braithwaite J. A hybrid health service accreditation program model incorporating mandated standards and continuous improvement: interview study of multiple stakeholders in Australian health care. Int J Health Plann Manage 2015; 31:e116-30. [PMID: 26044988 DOI: 10.1002/hpm.2301] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The study aim was to investigate the understandings and concerns of stakeholders regarding the evolution of health service accreditation programs in Australia. Stakeholder representatives from programs in the primary, acute and aged care sectors participated in semi-structured interviews. Across 2011-12 there were 47 group and individual interviews involving 258 participants. Interviews lasted, on average, 1 h, and were digitally recorded and transcribed. Transcriptions were analysed using textual referencing software. Four significant issues were considered to have directed the evolution of accreditation programs: altering underlying program philosophies; shifting of program content focus and details; different surveying expectations and experiences and the influence of external contextual factors upon accreditation programs. Three accreditation program models were noted by participants: regulatory compliance; continuous quality improvement and a hybrid model, incorporating elements of these two. Respondents noted the compatibility or incommensurability of the first two models. Participation in a program was reportedly experienced as ranging on a survey continuum from "malicious compliance" to "performance audits" to "quality improvement journeys". Wider contextual factors, in particular, political and community expectations, and associated media reporting, were considered significant influences on the operation and evolution of programs. A hybrid accreditation model was noted to have evolved. The hybrid model promotes minimum standards and continuous quality improvement, through examining the structure and processes of organisations and the outcomes of care. The hybrid model appears to be directing organisational and professional attention to enhance their safety cultures. Copyright © 2015 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- David Greenfield
- University of New South Wales, Centre for Clinical Governance Research, Faculty of Medicine, Sydney, NSW, Australia
| | - Reece Hinchcliff
- University of New South Wales, Centre for Clinical Governance Research, Faculty of Medicine, Sydney, NSW, Australia
| | - Anne Hogden
- University of New South Wales, Centre for Clinical Governance Research, Faculty of Medicine, Sydney, NSW, Australia
| | - Virginia Mumford
- University of New South Wales, Centre for Clinical Governance Research, Faculty of Medicine, Sydney, NSW, Australia
| | - Deborah Debono
- University of New South Wales, Centre for Clinical Governance Research, Faculty of Medicine, Sydney, NSW, Australia
| | - Marjorie Pawsey
- University of New South Wales, Centre for Clinical Governance Research, Faculty of Medicine, Sydney, NSW, Australia
| | - Johanna Westbrook
- University of New South Wales, Australian Institute of Health Innovation, Centre for Health Systems and Safety Research, Sydney, NSW, Australia
| | - Jeffrey Braithwaite
- University of New South Wales, Centre for Clinical Governance Research, Faculty of Medicine, Sydney, NSW, Australia
| |
Collapse
|
47
|
Greenfield D, Hinchcliff R, Banks M, Mumford V, Hogden A, Debono D, Pawsey M, Westbrook J, Braithwaite J. Analysing 'big picture' policy reform mechanisms: the Australian health service safety and quality accreditation scheme. Health Expect 2014; 18:3110-22. [PMID: 25367049 DOI: 10.1111/hex.12300] [Citation(s) in RCA: 17] [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] [Accepted: 10/09/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Agencies promoting national health-care accreditation reform to improve the quality of care and safety of patients are largely working without specific blueprints that can increase the likelihood of success. OBJECTIVE This study investigated the development and implementation of the Australian Health Service Safety and Quality Accreditation Scheme and National Safety and Quality Health Service Standards (the Scheme), their expected benefits, and challenges and facilitators to implementation. METHODS A multimethod study was conducted using document analysis, observation and interviews. Data sources were eight government reports, 25 h of observation and 34 interviews with 197 diverse stakeholders. RESULTS Development of the Scheme was achieved through extensive consultation conducted over a prolonged period, that is, from 2000 onwards. Participants, prior to implementation, believed the Scheme would produce benefits at multiple levels of the health system. The Scheme offered a national framework to promote patient-centred care, allowing organizations to engage and coordinate professionals' quality improvement activities. Significant challenges are apparent, including developing and maintaining stakeholder understanding of the Scheme's requirements. Risks must also be addressed. The standardized application of, and reliable assessment against, the standards must be achieved to maintain credibility with the Scheme. Government employment of effective stakeholder engagement strategies, such as structured consultation processes, was viewed as necessary for successful, sustainable implementation. CONCLUSION The Australian experience demonstrates that national accreditation reform can engender widespread stakeholder support, but implementation challenges must be overcome. In particular, the fundamental role of continued stakeholder engagement increases the likelihood that such reforms are taken up and spread across health systems.
Collapse
Affiliation(s)
- David Greenfield
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW, Australia
| | - Reece Hinchcliff
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW, Australia
| | - Margaret Banks
- Australian Commission on Safety and Quality in Health Care, Sydney, NSW, Australia
| | - Virginia Mumford
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW, Australia
| | - Anne Hogden
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW, Australia
| | - Deborah Debono
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW, Australia
| | - Marjorie Pawsey
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW, Australia
| | - Jeffrey Braithwaite
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
48
|
Mumford V, Greenfield D, Hogden A, Debono D, Gospodarevskaya E, Forde K, Westbrook J, Braithwaite J. Disentangling quality and safety indicator data: a longitudinal, comparative study of hand hygiene compliance and accreditation outcomes in 96 Australian hospitals. BMJ Open 2014; 4:e005284. [PMID: 25248496 PMCID: PMC4173108 DOI: 10.1136/bmjopen-2014-005284] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The study aims are twofold. First, to investigate the suitability of hand hygiene as an indicator of accreditation outcomes and, second, to test the hypothesis that hospitals with better accreditation outcomes achieve higher hand hygiene compliance rates. DESIGN A retrospective, longitudinal, multisite comparative survey. SETTING Acute public hospitals in New South Wales, Australia. PARTICIPANTS 96 acute hospitals with accreditation survey results from two surveys during 2009-2012 and submitted data for more than four hand hygiene audits between 2010 and 2013. OUTCOMES Our primary outcome comprised observational hand hygiene compliance data from eight audits during 2010-2013. The explanatory variables in our multilevel regression model included: accreditation outcomes and scores for the infection control standard; timing of the surveys; and hospital size and activity. RESULTS Average hand hygiene compliance rates increased from 67.7% to 80.3% during the study period (2010-2013), with 46.7% of hospitals achieving target compliance rates of 70% in audit 1, versus 92.3% in audit 8. Average hand hygiene rates at small hospitals were 7.8 percentage points (pp) higher than those at the largest hospitals (p<0.05). The association between hand hygiene rates, accreditation outcomes and infection control scores is less clear. CONCLUSIONS Our results indicate that accreditation outcomes and hand hygiene audit data are measuring different parts of the quality and safety spectrum. Understanding what is being measured when selecting indicators to assess the impact of accreditation is critical as focusing on accreditation results would discount successful hand hygiene implementation by smaller hospitals. Conversely, relying on hand hygiene results would discount the infection control related research and leadership investment by larger hospitals. Our hypothesis appears to be confounded by an accreditation programme that makes it more difficult for smaller hospitals to achieve high infection control scores.
Collapse
Affiliation(s)
- Virginia Mumford
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, UNSW, Sydney, New South Wales, Australia
| | - David Greenfield
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, UNSW, Sydney, New South Wales, Australia
| | - Anne Hogden
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, UNSW, Sydney, New South Wales, Australia
| | - Deborah Debono
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, UNSW, Sydney, New South Wales, Australia
| | - Elena Gospodarevskaya
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, UNSW, Sydney, New South Wales, Australia
| | - Kevin Forde
- School of Public Health and Community Medicine, UNSW, Sydney, New South Wales, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, UNSW, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, UNSW, Sydney, New South Wales, Australia
| |
Collapse
|
49
|
Sarrami-Foroushani P, Travaglia J, Debono D, Braithwaite J. Implementing strategies in consumer and community engagement in health care: results of a large-scale, scoping meta-review. BMC Health Serv Res 2014; 14:402. [PMID: 25230846 PMCID: PMC4177168 DOI: 10.1186/1472-6963-14-402] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 09/11/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There is growing recognition of the importance of the active involvement of consumers and community members in health care. Despite the long history of consumer and community engagement (CCE) research and practice, there is no consensus on the best strategies for CCE. In this paper, we identify various dimensions of CCE-related strategies and offer a practical model to assist policy-makers, practitioners and researchers. METHODS We undertook a large-scale, scoping meta-review and searched six databases using a list of nine medical subject headings (MeSH) and a comprehensive list of 47 phrases. We identified and examined a total of 90 relevant systematic reviews. RESULTS Identified reviews show that although there is a significant body of research on CCE, the development of the field is hindered by a lack of evidence relating to specific elements of CCE. They also indicate a diverse and growing enterprise, drawing on a wide range of disciplinary, political and philosophical perspectives and a mix of definitions, targets, approaches, strategies and mechanisms. CCE interventions and strategies aim to involve consumers, community members and the public in general, as well as specific sub-groups, including children and people from culturally and linguistically diverse backgrounds. Strategies for CCE vary in terms of their aim and type of proposed activity, as do the methods and tools which have been developed to support them. Methods and tools include shared decision making, use of decision aids, consumer representation, application of electronic and internet-based facilities, and peer support. The success of CCE is dependent on both the approach taken and contextual factors, including structural facilitators such as governmental support, as well as barriers such as costs, organisational culture and population-specific limitations. CONCLUSIONS The diversity of the field indicates the need to measure each component of CCE. This meta-review provides the basis for development of a new eight stage model of consumer and community engagement. This model emphasises the importance of clarity and focus, as well as an extensive evaluation of contextual factors within specific settings, before the implementation of CCE strategies, enabling those involved in CCE to determine potential facilitators and barriers to the process.
Collapse
Affiliation(s)
- Pooria Sarrami-Foroushani
- />Australian Institute for Health Innovation (AIHI), University of New South Wales (UNSW), Sydney, NSW 2052 Australia
| | - Joanne Travaglia
- />Australian Institute for Health Innovation (AIHI), University of New South Wales (UNSW), Sydney, NSW 2052 Australia
- />School of Public Health and Community Medicine (SPHCM), University of New South Wales (UNSW), Sydney, NSW 2052 Australia
| | - Deborah Debono
- />Australian Institute for Health Innovation (AIHI), University of New South Wales (UNSW), Sydney, NSW 2052 Australia
| | - Jeffrey Braithwaite
- />Australian Institute for Health Innovation (AIHI), University of New South Wales (UNSW), Sydney, NSW 2052 Australia
| |
Collapse
|
50
|
Abstract
For researchers, policymakers, and practitioners facing a new field, undertaking a systematic review can typically present a challenge due to the enormous number of relevant papers. A scoping review is a method suggested for addressing this dilemma; however, scoping reviews present their own challenges. This paper introduces the "scoping meta-review" (SMR) for expanding current methodologies and is based on our experiences in mapping the field of consumer engagement in healthcare. During this process, we developed the novel SMR method. An SMR combines aspects of a scoping review and a meta-review to establish an evidence-based map of a field. Similar to a scoping review, an SMR offers a practical and flexible methodology. However, unlike in a traditional scoping review, only systematic reviews are included. Stages of the SMR include: undertaking a preliminary nonsystematic review; building a search strategy; interrogating academic literature databases; classifying and excluding studies based on titles and abstracts; saving the refined database of references; revising the search strategy; selecting and reviewing the full text papers; and thematically analyzing the selected texts and writing the report. The main benefit of an SMR is to map a new field based on high-level evidence provided by systematic reviews.
Collapse
Affiliation(s)
- Pooria Sarrami-Foroushani
- Centre for Clinical Governance Research, Australian Institute of Health Innovation (AIHI), University of New South Wales (UNSW), Sydney, Australia
| | | | | | | | | |
Collapse
|