1
|
Keil M, Frehse L, Hagemeister M, Knieß M, Lange O, Kronenberg T, Rogowski W. Carbon footprint of healthcare systems: a systematic review of evidence and methods. BMJ Open 2024; 14:e078464. [PMID: 38688670 PMCID: PMC11086491 DOI: 10.1136/bmjopen-2023-078464] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 04/15/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE Given the demand for net-zero healthcare, the carbon footprint (CF) of healthcare systems has attracted increasing interest in research in recent years. This systematic review investigates the results and methodological transparency of CF calculations of healthcare systems. The methodological emphasis lies specifically on input-output based calculations. DESIGN Systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. DATA SOURCES PubMed, Web of Science, EconBiz, Scopus and Google Scholar were initially searched on 25 November 2019. Search updates in PubMed and Web of Science were considered until December 2023. The search was complemented by reference tracking within all the included studies. ELIGIBILITY CRITERIA We included original studies that calculated and reported the CF of one or more healthcare systems. Studies were excluded if the specific systems were not named or no information on the calculation method was provided. DATA EXTRACTION AND SYNTHESIS Within the initial search, two independent reviewers searched, screened and extracted information from the included studies. A checklist was developed to extract information on results and methodology and assess the included studies' transparency. RESULTS 15 studies were included. The mean ratio of healthcare system emissions to total national emissions was 4.9% (minimum 1.5%; maximum 9.8%), and CFs were growing in most countries. Hospital care led to the largest relative share of the total CF. At least 71% of the methodological items were reported by each study. CONCLUSIONS The results of this review show that healthcare systems contribute substantially to national carbon emissions, and hospitals are one of the main contributors in this regard. They also show that mitigation measures can help reduce emissions over time. The checklist developed here can serve as a reference point to help make methodological decisions in future research reports as well as report homogeneous results.
Collapse
Affiliation(s)
- Mattis Keil
- Department of Health Care Management, Institute of Public Health and Nursing Research, Health Sciences, University of Bremen, Bremen, Germany
- Joint research cluster "Healthy City Bremen" of the University of Bremen, Bremen University of Applied Sciences and Apollon University of Applied Sciences Bremen, Bremen, Germany
| | - Leonie Frehse
- Professional Public Decision Making, Faculty of Cultural Studies, University of Bremen, Bremen, Germany
| | - Marco Hagemeister
- Professional Public Decision Making, Faculty of Cultural Studies, University of Bremen, Bremen, Germany
| | - Mona Knieß
- Professional Public Decision Making, Faculty of Cultural Studies, University of Bremen, Bremen, Germany
| | - Oliver Lange
- Department of Health Care Management, Institute of Public Health and Nursing Research, Health Sciences, University of Bremen, Bremen, Germany
- Leibniz ScienceCampus Digital Public Health, Bremen, Germany
| | - Tobias Kronenberg
- Department of Economics, Bochum University of Applied Sciences, Bochum, Germany
| | - Wolf Rogowski
- Department of Health Care Management, Institute of Public Health and Nursing Research, Health Sciences, University of Bremen, Bremen, Germany
| |
Collapse
|
2
|
Fish L, Heathers R, Litherland M, Jung M, Yu K. Implementation of a multi-modal intervention adopting new technologies, clinical services, and feedback improves catheter-associated urinary tract infections. Hosp Pract (1995) 2024:1-5. [PMID: 38526501 DOI: 10.1080/21548331.2024.2335099] [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: 02/08/2024] [Accepted: 03/22/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVES Catheter-associated urinary tract infections (CAUTI) are a significant cause of morbidity and financial burden to healthcare systems. The aim of this study was to develop and implement a program designed to reduce Foley catheter use days and associated CAUTI rates. METHODS A retrospective evaluation of a multi-modal program aimed toward reducing Foley catheter use days and associated CAUTI rates across the Indiana University Health (IUH) system was conducted. IUH is comprised of 16 hospitals and 2,703 available beds. The program included the adoption of new technologies with evidence-based clinical training materials based on change management and feedback from clinicians. National Healthcare Safety Network Standardized Infection Ratio (SIR), Standardized Utilization Ratio (SUR), and Incidence Density Ratio (IDR) rates were assessed. RESULTS Implementation of the multi-modal program resulted in a significant reduction in SIR, SUR, and IDR in the post-implementation compared to the baseline periods. CONCLUSIONS Through CAUTI bundle workflow assessments, education, and interventions designed to standardize practice variation, the program was successfully implemented and resulted in a significant decrease in Foley Catheter use days, and associated CAUTI rates.
Collapse
Affiliation(s)
- Lauren Fish
- Department of Infection Prevention, Indiana University Health, Indianapolis, IN, USA
| | - Rachael Heathers
- Department of Infection Prevention, Indiana University Health, Indianapolis, IN, USA
| | - Micah Litherland
- Department of Infection Prevention, Indiana University Health, Indianapolis, IN, USA
| | - Molly Jung
- Medical Affairs, Becton Dickinson, Franklin Lakes, NJ, USA
| | - Kalvin Yu
- Medical Affairs, Becton Dickinson, Franklin Lakes, NJ, USA
| |
Collapse
|
3
|
Crilly E, Harrison C, Maahs J, Beijlevelt M, Ramsay B, Githinji C, Sisdelli M, Dsouza A. Riding the wave of change: Providing solid ground to support nursing with patient transitions to novel haemophilia therapies. Haemophilia 2024; 30 Suppl 3:135-139. [PMID: 38549492 DOI: 10.1111/hae.15003] [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: 01/16/2024] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Haemophilia nursing practice has experienced a shift in the past decade, as the historic chief focus on factor infusions shifted to extended half-life products, bispecific antibody therapies and other non-replacement therapies. This evolution has driven a need for changes in nursing practice in many haemophilia treatment centres. AIM This article intends to provide insights to the haemophilia nurse to champion practice changes at their haemophilia treatment centres. METHODS Two popular change theories, Lewin's three-step change model and Kotter's eight-step change model are discussed as a framework for haemophilia nurses to think, structure and be leaders in change. CONCLUSION Examples of these models in practice could give guidance and examples to reflect on for haemophilia nurses needing to make changes in their practice settings. These models of change, alongside existing haemophilia nurse competencies and tools such as the shared decision-making tool from the World Federation of Hemophilia, can assist the nurse to be a capable change agent to usher in these new innovations.
Collapse
Affiliation(s)
- Erica Crilly
- Division of Paediatric Hematology/Oncology/BMT, Vancouver, British Columbia, Canada
| | - Cathy Harrison
- Sheffield Haemophilia & Thrombosis Centre, Royal Hallamshire Hospital, Sheffield, UK
| | - Jennifer Maahs
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana, USA
| | - Marlene Beijlevelt
- Hemophilia Treatment Centre, Amsterdam University Medical Centre, Amsterdam, Amsterdam, Netherlands
| | - Brian Ramsay
- Wellington Blood and Cancer Centre, Wellington Regional Hospital, Wellington, New Zealand
| | - Cyrus Githinji
- Moi Teaching & Referral Hospital, AMPATH Programs, Eldoret, Kenya
| | - Marcela Sisdelli
- Fundação Hemocentro de Ribeirão Preto, Ribeirão Preto-SP, Brazil
| | - Anjalin Dsouza
- Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India
| |
Collapse
|
4
|
Sturmberg JP, Gainsford L. Complex adaptive organisations: How three-dimensional visualisations can help to understand their structures and behaviours. J Eval Clin Pract 2024; 30:497-502. [PMID: 38164046 DOI: 10.1111/jep.13958] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/26/2023] [Indexed: 01/03/2024]
Abstract
Many organisations struggle to achieve their true potential. In part it is a problem of organisational design, which is an outcome of a particularly common-command and control-leadership philosophy. The traditional linear hierarchical structure of organisations suggests that all knowledge and power concentrates at the top organisational layer, and that people in the lower layers need to be told what to do and when. These arrangements disempower people at the lower level, preventing them from providing the necessary feedback to pre-emptively address emerging concerns. Systems and complexity thinking provide different ways of understanding organisations and their complex adaptive behaviours. In this paper, we first describe the key characteristics of complex adaptive organisations-their structure and dynamic behaviours-and then propose a three-dimensional visualisation of a complex adaptive organisation that allows its members to clearly see and appreciate its interdependencies.
Collapse
Affiliation(s)
- Joachim P Sturmberg
- Department of General Practice, School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- International Society for Systems and Complexity Sciences for Health, Callaghan, Australia
| | - Len Gainsford
- Business School, Centre for Enterprise Performance, Swinburne University of Technology, Hawthorn, Australia
| |
Collapse
|
5
|
Mashaw A, Byelyakova H, Desrochers D. Implementing Systemwide Physician Change Management in an Integrated Health Care Setting: Improving Physician Participation in an Advanced Care at Home Model. Perm J 2024; 28:22-32. [PMID: 38088744 PMCID: PMC10940246 DOI: 10.7812/tpp/23.080] [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: 03/16/2024]
Abstract
INTRODUCTION Advanced Care at Home is a clinical model that delivers hospital-level care in a patient's home. This model of care has been studied for decades, but there have been difficulties scaling the model to a higher census because of poor physician participation. Kaiser Permanente at Home, an Advanced Care at Home model created by Kaiser Permanente Northwest, was able to quickly increase its patient census by using several different change management interventions. The aim of this study was to describe the specific physician change management interventions used and to determine their relative impacts on physician participation with Kaiser Permanente at Home. METHODS This study used a retrospective qualitative approach. Hospitalist and emergency department (ED) physicians completed an online survey in December 2021. This was followed by focused, one-on-one interviews that were held in February 2022. Content analysis was performed using a general inductive approach to identify core themes. RESULTS Of 78 ED and 79 hospitalist physicians recruited, 35% submitted responses. Of these respondents, 16 (29%) were ED physicians, and 39 (61%) were hospitalist physicians. Of these respondents, 90% rated Kaiser Permanente at Home favorably over the course of a year. More than 90% of respondents rated a combination of multiple approaches as impactful, but respondents overwhelmingly noted that physician-to-physician engagement was the most important (51%). CONCLUSION In the development of the Kaiser Permanente at Home, physicians highlighted that a multifactorial change management approach centered on peer-to-peer engagement had the most substantial effect on their participation, a process that could extend up to a year.
Collapse
Affiliation(s)
- Arsheeya Mashaw
- Northwest Permanente, Professional Corporation, Portland, OR, USA
| | - Helen Byelyakova
- Kaiser Permanente Health Plan of the Northwest, Beaverton, OR, USA
| | | |
Collapse
|
6
|
Reineholm C, Lundqvist D, Wallo A. Change competence: An integrative literature review. Work 2024:WOR230633. [PMID: 38489211 DOI: 10.3233/wor-230633] [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: 03/17/2024] Open
Abstract
BACKGROUND Organizations are in a state of continual evolution, driven by the relentless shifts in their external environments. Numerous theories have been proposed to understand the essential skills and capabilities for successful organizational change. Yet, there remains a gap in capturing a holistic view necessary to fully comprehend the dynamics of competence in today's rapidly changing landscape. OBJECTIVE This research aims to explore and consolidate the concept of 'competence' in the context of organizational change processes. METHODS Employing an integrative literature review approach, a total of 3,230 studies were screened. Out of these, 32 studies were selected based on strict relevance and quality criteria, providing a robust foundation for the analysis. RESULTS The findings reveal a multi-layered nature of organizational change, highlighting that the nature and prerequisites of change vary significantly across different organizational levels. By applying a competence lens, we discern how required competence during change are not uniform but rather vary depending on whether they are applied in an operational or strategic context. This demonstrates a nuanced, level-dependent variability in change competence across the organizational hierarchy. CONCLUSION We conceptualize 'change competence' as a dual-faceted construct. It encompasses both the capacity to leverage existing organizational competence and the adeptness to develop new competence, thereby meeting the evolving demands imposed by both internal and external drivers of change. This comprehensive understanding paves the way for more effective strategies in managing organizational change.
Collapse
Affiliation(s)
- Cathrine Reineholm
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Daniel Lundqvist
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Andreas Wallo
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| |
Collapse
|
7
|
Herrmann S, Giesel-Gerstmeier J, Demuth A, Fenske D. We Ask and Listen: A Group-Wide Retrospective Survey on Satisfaction with Digital Medication Software. J Multidiscip Healthc 2024; 17:923-936. [PMID: 38449841 PMCID: PMC10916516 DOI: 10.2147/jmdh.s446896] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/09/2024] [Indexed: 03/08/2024] Open
Abstract
Purpose Computerized physician order entry (CPOE) and clinical decision support systems (CDSS) are used internationally since the 1980s. These systems reduce costs, enhance drug therapy safety, and improve quality of care. A few years ago, there was a growing effort to digitize the healthcare sector in Germany. Implementing such systems like CPOE-CDSS requires training for effective adoption and, more important, acceptance by the users. Potential improvements for the software and implementation process can be derived from the users' perspective. The implementation process is globally relevant and applicable across professions due to the constant advancement of digitalization. The study assessed the implementation of medication software and overall satisfaction. Methods In an anonymous voluntary online survey, physicians and nursing staff were asked about their satisfaction with the new CPOE-CDSS. The survey comprised single-choice queries on a Likert scale, categorizing into general information, digital medication administration, drug safety, and software introduction. In addition multiple-choice questions are mentioned. Data analysis was performed using Microsoft Office Excel 2016 and GraphPad PRISM 9.5.0. Results Nurses and physicians' satisfaction with the new software increased with usage hours. The software's performance and loading times have clearly had a negative impact, which leads to a low satisfaction of only 20% among physicians and 17% among nurses. 53% of nurses find the program's training period unsuitable for their daily use, while 57% of physicians approve the training's scope for their professional group. Both professions agree that drug-related problems are easier to detect using CPOE-CDSS, with 76% of nurses and 75% of physicians agreeing. The study provides unbiased feedback on software implementation. Conclusion In conclusion, digitizing healthcare requires managing change, effective training, and addressing software functionality concerns to ensure improved medication safety and streamlined processes. Interfaces, performance optimization, and training remain crucial for software acceptance and effectiveness.
Collapse
Affiliation(s)
- Saskia Herrmann
- Hospital Pharmacy, Helios Kliniken Gmbh, Berlin, Berlin, Germany
- Department of Pharmaceutical/Medicinal Chemistry, Institute of Pharmacy, Friedrich Schiller University Jena, Jena, Thuringia, Germany
| | | | - Annika Demuth
- Hospital Pharmacy, Helios Kliniken Gmbh, Berlin, Berlin, Germany
| | - Dominic Fenske
- Hospital Pharmacy, Helios Kliniken Gmbh, Berlin, Berlin, Germany
| |
Collapse
|
8
|
Tower M, Hyun A, Denton M, Cottle-Quinn A. Implementation of a nurse practitioner service in a rural setting: a qualitative analysis of healthcare practitioners' experiences. Contemp Nurse 2024:1-11. [PMID: 38377070 DOI: 10.1080/10376178.2024.2316597] [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: 03/09/2023] [Accepted: 02/04/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Nurse Practitioners work independently and collaboratively within multidisciplinary teams to fill unmet service delivery needs. Despite strong evidence of the benefits of the nurse practitioner service model, organisational support for nurse practitioners varies in terms of resources and support from leadership and other healthcare professionals. AIMS The study aimed to explore healthcare practitioners' experiences of implementation of a NP service in a rural setting. METHODS Semi-structured interviews were conducted with ten healthcare practitioners to investigate their perspectives of a recently implemented NP service. Data were analysed inductively using thematic analysis. FINDINGS Themes emerged related to facilitating collaborative practice, person-centred continuity of care and positive health outcomes for the community. Challenges and limitations related to operational role clarity, scopes of practice and leadership. CONCLUSION Healthcare practitioners were mostly satisfied with the service however challenges caused tension. Change management principles provide a framework to strengthen the effective clinical alignment of the service.
Collapse
Affiliation(s)
- Marion Tower
- School of Nursing, Midwifery & Social Work, The University of Queensland, Brisbane, Australia
| | - Areum Hyun
- School of Nursing, Midwifery & Social Work, The University of Queensland, Brisbane, Australia
| | - Michelle Denton
- School of Nursing, Midwifery & Social Work, The University of Queensland, Brisbane, Australia
| | - Amanda Cottle-Quinn
- School of Nursing, Midwifery & Social Work, The University of Queensland, Brisbane, Australia
| |
Collapse
|
9
|
Reynolds Kueny C, Price A, Canfield C. Measure Twice, Change Once: Using Simulation to Support Change Management in Rural Healthcare Delivery. Adv Health Care Manag 2024; 22:29-53. [PMID: 38262009 DOI: 10.1108/s1474-823120240000022002] [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: 01/25/2024]
Abstract
Barriers to adequate healthcare in rural areas remain a grand challenge for local healthcare systems. In addition to patients' travel burdens, lack of health insurance, and lower health literacy, rural healthcare systems also experience significant resource shortages, as well as issues with recruitment and retention of healthcare providers, particularly specialists. These factors combined result in complex change management-focused challenges for rural healthcare systems. Change management initiatives are often resource intensive, and in rural health organizations already strapped for resources, it may be particularly risky to embark on change initiatives. One way to address these change management concerns is by leveraging socio-technical simulation models to estimate techno-economic feasibility (e.g., is it technologically feasible, and is it economical?) as well as socio-utility feasibility (e.g., how will the changes be utilized?). We present a framework for how healthcare systems can integrate modeling and simulation techniques from systems engineering into a change management process. Modeling and simulation are particularly useful for investigating the amount of uncertainty about potential outcomes, guiding decision-making that considers different scenarios, and validating theories to determine if they accurately reflect real-life processes. The results of these simulations can be integrated into critical change management recommendations related to developing readiness for change and addressing resistance to change. As part of our integration, we present a case study showcasing how simulation modeling has been used to determine feasibility and potential resistance to change considerations for implementing a mobile radiation oncology unit. Recommendations and implications are discussed.
Collapse
|
10
|
Trigueiro G, Oliveira C, Rodrigues A, Seabra S, Pinto R, Bala Y, Gutiérrez Granado M, Vallejo S, Gonzalez V, Cardoso C. Conversion of a classical microbiology laboratory to a total automation laboratory enhanced by the application of lean principles. Microbiol Spectr 2024; 12:e0215323. [PMID: 38230933 PMCID: PMC10846136 DOI: 10.1128/spectrum.02153-23] [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: 06/29/2023] [Accepted: 11/03/2023] [Indexed: 01/18/2024] Open
Abstract
Laboratory automation in microbiology improves productivity and reduces sample turnaround times (TATs). However, its full potential can be unlocked through the optimization of workflows by adopting lean principles. This study aimed to explore the relative impact of laboratory automation and continuous improvement events (CIEs) on productivity and TATs. Laboratory automation took place in November 2020 and consisted of the introduction of WASPLab and VITEK MS systems. CIEs were run in May and September 2021. Before the conversion, the laboratory processed about ~492 samples on weekdays and had 10 full-time equivalent (FTE) staff for a productivity of 49 samples/FTE/day. In March 2021, after laboratory automation, the caseload went up to ~621 while the FTEs decreased to 8.5, accounting for productivity improvement to 73 samples/FTE/day. The hypothetical productivity went up to 110 samples/FTE/day following CIEs, meaning that the laboratory could at that point deal with a caseload increase to ~935 with unchanged FTEs. Laboratory conversion also led to an improvement in TATs for all sample types. For vaginal swabs and urine samples, median TATs decreased from 70.3 h [interquartile range (IQR): 63.5-93.1] and 73.7 h (IQR: 35.6-50.7) to 48.2 h (IQR: 44.8-67.7) and 40.0 h (IQR: 35.6-50.7), respectively. Automation alone was responsible for 37.2% and 75.8% of TAT reduction, respectively, while the remaining reduction of 62.8% and 24.2%, respectively, was achieved due to CIEs. The laboratory reached productivity and TAT goals predefined by the management after CIEs. In conclusion, automation substantially improved productivity and TATs, while the subsequent implementation of lean management further unlocked the potential of laboratory automation.IMPORTANCEIn this study, we combined total laboratory automation with lean management to show that appropriate laboratory work organization enhanced the benefit of the automation and substantially contributed to productivity improvements. Globally, the rapid availability of accurate results in the setting of a clinical microbiology laboratory is part of patient-centered approaches to treat infections and helps the implementation of antibiotic stewardship programs backed by the World Health Organization. Locally, from the point of view of laboratory management, it is important to find ways of maximizing the benefits of the use of technology, as total laboratory automation is an expensive investment.
Collapse
Affiliation(s)
- Graça Trigueiro
- Department of Microbiology, Dr. Joaquim Chaves Clinical Analysis Laboratory, Lisbon, Portugal
| | - Carlos Oliveira
- Department of Microbiology, Dr. Joaquim Chaves Clinical Analysis Laboratory, Lisbon, Portugal
| | - Alexandra Rodrigues
- Department of Microbiology, Dr. Joaquim Chaves Clinical Analysis Laboratory, Lisbon, Portugal
| | - Sofia Seabra
- Department of Microbiology, Dr. Joaquim Chaves Clinical Analysis Laboratory, Lisbon, Portugal
| | - Rui Pinto
- Department of Microbiology, Dr. Joaquim Chaves Clinical Analysis Laboratory, Lisbon, Portugal
| | - Yohann Bala
- Global Medical Affairs, bioMérieux, Marcy L’Etoile, France
| | | | - Sandra Vallejo
- Lab Consultancy, bioMérieux, bioMérieux SA, Lisbon, Portugal
| | | | - Carlos Cardoso
- Department of Microbiology, Dr. Joaquim Chaves Clinical Analysis Laboratory, Lisbon, Portugal
| |
Collapse
|
11
|
Sibbald M, Zwaan L, Yilmaz Y, Lal S. Incorporating artificial intelligence in medical diagnosis: A case for an invisible and (un)disruptive approach. J Eval Clin Pract 2024; 30:3-8. [PMID: 35761764 DOI: 10.1111/jep.13730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 12/30/2022]
Abstract
As big data becomes more publicly accessible, artificial intelligence (AI) is increasingly available and applicable to problems around clinical decision-making. Yet the adoption of AI technology in healthcare lags well behind other industries. The gap between what technology could do, and what technology is actually being used for is rapidly widening. While many solutions are proposed to address this gap, clinician resistance to the adoption of AI remains high. To aid with change, we propose facilitating clinician decisions through technology by seamlessly weaving what we call 'invisible AI' into existing clinician workflows, rather than sequencing new steps into clinical processes. We explore evidence from the change management and human factors literature to conceptualize a new approach to AI implementation in health organizations. We discuss challenges and provide recommendations for organizations to employ this strategy.
Collapse
Affiliation(s)
- Matt Sibbald
- Department of Medicine, McMaster Education Research Innovation and Theory (MERIT) Program, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Laura Zwaan
- Erasmus Medical Center, Institute of Medical Education Research Rotterdam (iMERR), Rotterdam, The Netherlands
| | - Yusuf Yilmaz
- McMaster Education Research Innovation and Theory (MERIT) Program, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Continuing Professional Development Office, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Medical Education, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Sarrah Lal
- Department of Medicine, Division of Innovation and Education, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
12
|
Hall KC, Lauria M. Processes and the Electronic Health Record: Challenges and Difficulties Faced when Creating an OB Quality Dashboard. Stud Health Technol Inform 2024; 310:1408-1409. [PMID: 38269670 DOI: 10.3233/shti231218] [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: 01/26/2024]
Abstract
Healthcare quality as defined by the National Academy of Medicine is "the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes [1]". While building QI dashboard data quality to improve the maternal health of our patient population issues were discovered that hindered that the progress of the project. This paper will discuss the challenges and difficulties faced while creating an OB quality dashboard at a regional perinatal.
Collapse
Affiliation(s)
- Kendria C Hall
- Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, SUNY
| | - Michele Lauria
- Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, SUNY
| |
Collapse
|
13
|
Anttilainen J, Pehkonen I, Savinainen M, Haukka E. Social and health care top managers' perceptions and aims of strategic work ability management in the midst of change. Work 2024; 77:533-545. [PMID: 37742684 PMCID: PMC10894579 DOI: 10.3233/wor-230034] [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: 01/19/2023] [Accepted: 07/13/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Existing research has mostly focused on themes related to returning to or staying at work and studied organizations' operational rather than strategic level actions to support work ability. Top managers' understanding of work ability management (WAM) may influence how work ability support processes are implemented in organizations. OBJECTIVE To find out how top managers define WAM, what the aims of WAM were and whether the aims were on a strategic level. METHODS Altogether 28 semi-structured interviews among Finnish social and health care top managers were conducted during the years 2019-2021 and analyzed inductively using qualitative thematic analysis. RESULTS Top managers' definition of WAM was mainly multidimensional. Two main aims were identified, i.e., to support work ability 1) at the individual and 2) at the organizational level. The aims of the former were to anticipate the decrease of health and functional capacity, to support workers already decrease in these, to develop competence, and to manage the effects of changes on work ability. The aims at the organizational level were to improve labor availability and personnel retention, to ensure the flow of work, and to increase trust and create shared values. Top managers described the aims as being at a strategic level, but this was not yet realized in their organizations because the actions were reactive rather than proactive. CONCLUSION Top managers' multidimensional perception of WAM, emphasizing proactive actions, and strategic level aims are crucial and require the commitment of the top managers for strategic WAM, especially during constant changes.
Collapse
Affiliation(s)
| | | | | | - Eija Haukka
- Finnish Institute of Occupational Health, Helsinki, Finland
| |
Collapse
|
14
|
Kothari M, Andreadis J, Glynn MK, Lie-Tjauw S, Isbell SDD. Readiness for Public Health Emergency Response: The Foundational Role of a Data Ecosystem. Public Health Rep 2024; 139:5-10. [PMID: 37119176 PMCID: PMC10905764 DOI: 10.1177/00333549231166450] [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] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Affiliation(s)
- Mimi Kothari
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joanne Andreadis
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - M. Kathleen Glynn
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | |
Collapse
|
15
|
Greaves R, Kricka L, Gruson D, Ferrari M, Martin H, Loh TP, Bernardini S. Toolkit for emerging technologies in laboratory medicine. Clin Chem Lab Med 2023; 61:2102-2114. [PMID: 37314970 DOI: 10.1515/cclm-2023-0571] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 05/31/2023] [Accepted: 06/04/2023] [Indexed: 06/16/2023]
Abstract
An emerging technology (ET) for laboratory medicine can be defined as an analytical method (including biomarkers) or device (software, applications, and algorithms) that by its stage of development, translation into broad routine clinical practice, or geographical adoption and implementation has the potential to add value to clinical diagnostics. Considering the laboratory medicine-specific definition, this document examines eight key tools, encompassing clinical, analytical, operational, and financial aspects, used throughout the life cycle of ET implementation. The tools provide a systematic approach starting with identifying the unmet need or identifying opportunities for improvement (Tool 1), forecasting (Tool 2), technology readiness assessment (Tool 3), health technology assessment (Tool 4), organizational impact map (Tool 5), change management (Tool 6), total pathway to method evaluation checklist (Tool 7), and green procurement (Tool 8). Whilst there are differences in clinical priorities between different settings, the use of this set of tools will help support the overall quality and sustainability of the emerging technology implementation.
Collapse
Affiliation(s)
- Ronda Greaves
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Larry Kricka
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, PA, USA
| | - Damien Gruson
- Cliniques Universitaires Saint Luc, Département des Laboratoires Cliniques, Biochimie Médicale, Brussels, Belgium
| | | | | | - Tze Ping Loh
- National University Hospital, Singapore, Singapore
| | - Sergio Bernardini
- Department of Experimental Medicine, University Tor Vergata, Rome, Italy
| |
Collapse
|
16
|
Schwen LO, Kiehl TR, Carvalho R, Zerbe N, Homeyer A. Digitization of Pathology Labs: A Review of Lessons Learned. J Transl Med 2023; 103:100244. [PMID: 37657651 DOI: 10.1016/j.labinv.2023.100244] [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: 06/07/2023] [Revised: 07/18/2023] [Accepted: 08/23/2023] [Indexed: 09/03/2023] Open
Abstract
Pathology laboratories are increasingly using digital workflows. This has the potential of increasing laboratory efficiency, but the digitization process also involves major challenges. Several reports have been published describing the individual experiences of specific laboratories with the digitization process. However, a comprehensive overview of the lessons learned is still lacking. We provide an overview of the lessons learned for different aspects of the digitization process, including digital case management, digital slide reading, and computer-aided slide reading. We also cover metrics used for monitoring performance and pitfalls and corresponding values observed in practice. The overview is intended to help pathologists, information technology decision makers, and administrators to benefit from the experiences of others and to implement the digitization process in an optimal way to make their own laboratory future-proof.
Collapse
Affiliation(s)
- Lars Ole Schwen
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany.
| | - Tim-Rasmus Kiehl
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Pathology, Berlin, Germany
| | - Rita Carvalho
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Pathology, Berlin, Germany
| | - Norman Zerbe
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Pathology, Berlin, Germany
| | - André Homeyer
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| |
Collapse
|
17
|
Taipale M, Herttalampi M, Muotka J, Mauno S, Feldt T. Stress of conscience in healthcare in turbulent times: A longitudinal study. Nurs Ethics 2023:9697330231204949. [PMID: 37888885 DOI: 10.1177/09697330231204949] [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: 10/28/2023]
Abstract
BACKGROUND Healthcare workers frequently face ethically demanding situations in their work, potentially leading to stress of conscience. Long-term work intensification (more and more effort demanded year after year), organizational change and COVID-19 may be risk factors concerning stress of conscience. AIMS The main aim was to investigate the relationship between long-term work intensification and stress of conscience among the personnel in a healthcare organization. Organizational change management was considered a mediator and COVID-19-related work stress a moderator in the association between work intensification and stress of conscience. RESEARCH DESIGN, PARTICIPANTS AND CONTEXT A total of 211 healthcare district employees participated in a longitudinal survey using questionnaires collected in 2019 (major organizational change in the planning stage) and 2021 (organizational change completed). ETHICAL CONSIDERATIONS The study was implemented according to the guidelines of the Finnish National Board on Research Integrity. The Finnish instructions were that no review by an ethics committee was necessary because participation was voluntary, informed consent was requested, participants were assured that they were free to withdraw from the longitudinal study at any time and no health data were collected. FINDINGS Long-term work intensification was associated with more severe stress of conscience. Long-term work intensification was partially mediated through change management to stress of conscience. High COVID-19 stress strengthened the association between long-term work intensification and stress of conscience. CONCLUSIONS Long-term work intensification must be addressed to reduce stress of conscience in healthcare, otherwise the healthcare system will be vulnerable to changes and crisis. Extra resources for personnel and management should be allocated because of work intensification during organizational change and health crises like the COVID-19 pandemic to alleviate stress of conscience.
Collapse
Affiliation(s)
| | | | | | - Saija Mauno
- University of Jyväskylä, Finland
- Tampere University, Finland
| | | |
Collapse
|
18
|
Yi H, Shi F, Wang Z, Kuai L, Xu D, Xie Y, Xing H. Impacts of adjustment of National Reimbursement Drug List on orphan drugs volume and spending in China: an interrupted time series analysis. BMJ Open 2023; 13:e064811. [PMID: 37852769 PMCID: PMC10603398 DOI: 10.1136/bmjopen-2022-064811] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/11/2023] [Indexed: 10/20/2023] Open
Abstract
OBJECTIVE To evaluate the impacts of the 2017 adjustment of National Reimbursement Drug List (NRDL) on orphan drugs hospital procurement volumes and spending in China. DESIGN We used an interrupted time series design covering the period from 2016 to 2018 to analyse changes in hospital procurement volumes and spending of orphan drugs for which were included in the 2017 NRDL. SETTING AND DATA The study was conducted in China. Orphan drug procurement data of 789 public hospitals (594 tertiary hospitals and 195 secondary hospitals) were derived from the Chinese Medical Economic Information (CMEI). OUTCOME MEASURES Monthly orphan drugs hospital procurement volumes and spending. RESULTS Nine orphan drugs were included in the 2017 NRDL (seven were directly included, and two were included after price negotiation). Comparing to orphan drugs not included in the NRDL, hospital procurement volumes ([Formula: see text] =43 312, p<0.001) and spending ([Formula: see text] =6 48 927, p<0.001) of the nine included drugs showed significant upward trends after implementation of the 2017 NRDL adjustment. CONCLUSIONS Our results suggest that the 2017 adjustment of NRDL significantly changed the usage and spending on certain orphan drugs. The increase in orphan drug hospital procurement volumes should improve rare disease patients' access to these orphan drugs.
Collapse
Affiliation(s)
- Hongbin Yi
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, China
| | - Fenghao Shi
- International Research Center for Medical Administration, Peking University, Beijing, China
| | - Zihao Wang
- College of Computer Science and Technology, Civil Aviation University of China, Tianjin, China
| | - Liping Kuai
- Science and Technology Development Center, Chinese Pharmaceutical Association, Beijing, China
| | - Dongyan Xu
- Science and Technology Development Center, Chinese Pharmaceutical Association, Beijing, China
| | - Yu Xie
- Science and Technology Development Center, Chinese Pharmaceutical Association, Beijing, China
| | - Hua Xing
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, China
| |
Collapse
|
19
|
López Seguí F, Cos Codina J, Ricou Ríos L, Martínez Segura MI, Miró Mezquita L, Escrich Navarro R, Davins Riu M, Estrada Cuxart O, Anashkin Kachalin G, Moreno-Martínez D. Readiness for Change in the Implementation of a 3D Printing Initiative in a Catalan Tertiary Hospital Using the Normalization Process Theory: Survey Study. JMIR Hum Factors 2023; 10:e47390. [PMID: 37801353 PMCID: PMC10589830 DOI: 10.2196/47390] [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: 03/18/2023] [Revised: 07/13/2023] [Accepted: 08/12/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The high failure rate of innovation projects motivates us to understand the perceptions about resistances and barriers of the main stakeholders to improving success rates. OBJECTIVE This study aims to analyze the readiness for change in the implementation of a 3D printing project in a Catalan tertiary hospital prior to its implementation. METHODS We used a web-based, voluntary, and anonymous survey using the Normalization Measurement Development questionnaire (NoMAD) to gather views and perceptions from a selected group of health care professionals at Germans Trias i Pujol University Hospital. RESULTS In this study, 58 professionals, including heads of service (n=30, 51%), doctors (n=18, 31%), nurses (n=7, 12%), and support staff (n=3, 5%), responded to the questionnaire. All groups saw the value of the project and were willing to enroll and support it. Respondents reported the highest scores (out of 5) in cognitive participation (mean 4.45, SD 0.04), coherence (mean 3.72, SD 0.13), and reflective monitoring (mean 3.80, SD 0.25). The weakest score was in collective action (mean 3.52, SD 0.12). There were no statistically significant differences in scores among professions in the survey. CONCLUSIONS The 3D printing project implementation should pay attention to preparing, defining, sharing, and supporting the operational work involved in its use and implementation. It should also understand, assess, and communicate the ways in which the new set of practices can affect the users and others around them. We suggest that health officers and politicians consider this experience as a solid ground toward the development of a more efficient health innovation system and as a catalyst for transformation.
Collapse
Affiliation(s)
- Francesc López Seguí
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
- Hospital Germans Trias i Pujol, Institut Català de la Salut, Badalona, Spain
- Chair in ICT and Health, Centre for Health and Social Care Research, University of Vic - Central University of Catalonia, Vic, Spain
| | - Joan Cos Codina
- Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Laura Ricou Ríos
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
- Hospital Germans Trias i Pujol, Institut Català de la Salut, Badalona, Spain
| | - María Isabel Martínez Segura
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
- Hospital Germans Trias i Pujol, Institut Català de la Salut, Badalona, Spain
| | - Laura Miró Mezquita
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
- Hospital Germans Trias i Pujol, Institut Català de la Salut, Badalona, Spain
| | - Raquel Escrich Navarro
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
- Hospital Germans Trias i Pujol, Institut Català de la Salut, Badalona, Spain
| | - Meritxell Davins Riu
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
- Hospital Germans Trias i Pujol, Institut Català de la Salut, Badalona, Spain
| | - Oriol Estrada Cuxart
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
- Hospital Germans Trias i Pujol, Institut Català de la Salut, Badalona, Spain
| | - German Anashkin Kachalin
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
| | - Daniel Moreno-Martínez
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
- Hospital Germans Trias i Pujol, Institut Català de la Salut, Badalona, Spain
| |
Collapse
|
20
|
Bakari M, Shayo EH, Barongo V, Kiwale Z, Fabbri C, Turner E, Eldred E, Mubyazi GM, Rodrigues K, Devries K. Qualitative process evaluation of the EmpaTeach intervention to reduce teacher violence in schools in Nyarugusu Refugee Camp, Tanzania. BMJ Open 2023; 13:e069993. [PMID: 37734883 PMCID: PMC10514605 DOI: 10.1136/bmjopen-2022-069993] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 07/07/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE We explored the experiences and perceptions of school staff and students with the EmpaTeach intervention to prevent teachers' violence against school students. DESIGN This qualitative study involved in-depth interviews with 58 and 39 participants at midline and endline, respectively, with Burundian and Congolese intervention schools in Nyarugusu refugee camp. They comprised three education coordinators of primary and secondary schools, 29 EmpaTeach intervention coordinators, 14 stakeholders including headteachers and discipline teachers, 25 classroom teachers and 26 students. Thematic analysis was used to develop codes by examining the content of quotes to capture key themes in line with the key elements of the programme theory. RESULTS Coordinators and teachers widely reported positive experiences with the EmpaTeach programme. The intervention sessions enabled teachers to reflect on their own values and experiences of corporal punishment and equipped them with useful and acceptable classroom management and alternative discipline strategies. Teachers adopted the use of counselling, praise and reward, and joint discussions with students and parents. On the other hand, several teachers reported persistent use of corporal punishment which they attributed to children's (mis)behaviours and strong beliefs that beating was a positive approach to disciplining students. CONCLUSION The majority of coordinators and teachers widely accepted the EmpaTeach intervention as it offered useful and relevant knowledge and skills on alternative disciplinary methods. Students noticed some positive changes on the way they were being disciplined by teachers, where non-violent methods were used. Further research is needed to understand how violence prevention interventions can successfully lead to reductions in violence in fragile settings. TRIAL REGISTRATION NUMBER NCT03745573.
Collapse
Affiliation(s)
- Mtumwa Bakari
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Elizabeth H Shayo
- Health Systems, Policy and Translational Research Section, National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Vivien Barongo
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Zenais Kiwale
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Camilla Fabbri
- Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Ellen Turner
- Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Emily Eldred
- Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Katherine Rodrigues
- Research and Innovation Department, International Rescue Committee, New York, New York, USA
| | - Karen Devries
- Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
21
|
Higginbotham EJ, Hertz K, Fahl C, Duckett DB, Mahoney K, Jameson JL. Addressing Structural Racism Using a Whole-Scale Planning Process in a Single Academic Center. Health Equity 2023; 7:487-496. [PMID: 37731779 PMCID: PMC10507939 DOI: 10.1089/heq.2023.0093] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 09/22/2023] Open
Abstract
Purpose The murder of George Floyd in 2020 prompted a national demand for cultural transformation to confront the systemic racism prevalent in the country. Academic medical centers were not exempt from this urgent call. This article evaluates the efficacy of a strategic process in fostering cultural transformation within an academic medical system. Methods A whole-scale strategic planning process was implemented over 13 months, involving multiple working groups representing key stakeholders from each entity across the system, an anonymous survey, a communication plan, and a balanced scorecard to monitor progress. More than 5500 voices, 160 recommendations, 122 data gathering sessions, and town hall meetings contributed to the creation and implementation of vital action items and a strategic framework. The Diversity Engagement Survey (DES) was administered 18 months following the process launch. Results Of the 45,554 employees, students, faculty, and trainees, 96.5% completed unconscious bias education within the fiscal year and 76% of action items, termed "Just Do Its," were completed. Mission, vision, values, and strategic priorities were crafted to serve as a framework for intermediate and long-term actions. The DES revealed improvement in the "respect" attribute of an inclusive culture, and 64% of respondents confirmed that action for cultural transformation is addressing racism both within and outside of the institution. Conclusion Implementing a shared purpose, engaging multiple working groups representing key stakeholders, and empowerment of stakeholders to implement changes, in conjunction with the development of a strategic framework addressing structural racism, resulted in the completion of vital action items to initiate cultural change.
Collapse
Affiliation(s)
- Eve J. Higginbotham
- Perelman School of Medicine, Office of the Dean, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kya Hertz
- Perelman School of Medicine, Office of the Dean, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Corrinne Fahl
- Perelman School of Medicine, Office of the Dean, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dwaine B. Duckett
- Perelman School of Medicine, Office of the Dean, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kevin Mahoney
- Perelman School of Medicine, Office of the Dean, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - J. Larry Jameson
- Perelman School of Medicine, Office of the Dean, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
22
|
Weyman A, O'Hara R, Nolan P, Glendinning R, Roy D, Coster J. Determining the relative salience of recognised push variables on health professional decisions to leave the UK National Health Service (NHS) using the method of paired comparisons. BMJ Open 2023; 13:e070016. [PMID: 37699606 PMCID: PMC10514647 DOI: 10.1136/bmjopen-2022-070016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 07/10/2023] [Indexed: 09/14/2023] Open
Abstract
OBJECTIVE The primary and secondary impacts from the COVID-19 pandemic are claimed to have had a detrimental impact on health professional retention within the UK National Health Service (NHS). This study set out to identify priorities for intervention by scaling the relative importance of widely cited push (leave) influences. DESIGN During Summer/Autumn 2021, a UK-wide opportunity sample (n=1958) of NHS health professionals completed an online paired-comparisons exercise to determine the relative salience of work-related stress, workload intensity, time pressure, staffing levels, working hours, work-homelife balance, recognition of effort and pay as reasons why health professionals leave NHS employment. SETTING The study is believed to be the first large-scale systematic assessment of factors driving staff exits from the NHS since the COVID-19 pandemic. RESULTS All professions gave primacy to work-related stress, workload intensity and staffing levels. Pay was typically located around the midpoint of the respective scales; recognition of effort and working hours were ranked lowest. However, differences were apparent in the rank order and relative weighting of push variables between health professions and care delivery functions. Ambulance paramedics present as an outlier, notably with respect to staffing level (F-stat 4.47, p=0.004) and the primacy of work-homelife balance. Relative to staffing level, other push variables exert a stronger influence on paramedics than nurses or doctors (f 4.29, p=0.006). CONCLUSION Findings are relevant to future NHS health professional retention intervention strategy. Excepting paramedics/ambulance services, rankings of leave variables across the different health professional families and organisation types exhibit strong alignment at the ordinal level. However, demographic differences in the weightings and rankings, ascribed to push factors by professional family and organisation type, suggests that, in addition to signposting universal (all-staff) priorities for intervention, bespoke solutions for different professions and functions may be needed.
Collapse
Affiliation(s)
- Andrew Weyman
- Department of Psychology, University of Bath, Bath, UK
| | - Rachel O'Hara
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Peter Nolan
- School of Management, University of Leicester, Leicester, UK
| | | | - Deborah Roy
- Department of Psychology, University of Bath, Bath, UK
| | - Joanne Coster
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| |
Collapse
|
23
|
Vlassi A, Tzikos G, Dardavesis T, Zioga O, Papadimitriou K, Papavramidis T. The Impact of Change Management in the Greek National Health System: A Quantitative Study. Cureus 2023; 15:e45574. [PMID: 37868399 PMCID: PMC10586886 DOI: 10.7759/cureus.45574] [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] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
INTRODUCTION Serious changes took place in Greece due to the economic crisis of 2008, which led to significant changes in Greece's health sector. The reforms and changes that were made to the National Health System (NHS) aimed to improve it, provide quality services to its users, and adapt it to Greece's new external environment. The aim of this study was to assess the management of these changes by the leadership of the NHS and to examine their effectiveness. MATERIAL AND METHODS The survey was based on quantitative research methods, using a questionnaire as a research tool. The sample population comprised employees of a tertiary-care public hospital in northern Greece. RESULTS We recruited a sample size of 100 participants for the survey. The questionnaire's Cronbach's alpha was equal to 0.724. The overall change management was moderate, and Greece's NHS did not follow a specific change-management model that provided principles facilitating the success of the effort. The most serious problems identified by using the questionnaire were the following: the changes were not structured and clear, the management set unrealistic goals and objectives, the changes to the NHS were made without the appropriate financial support, and there is uncertainty about the future of health care in Greece. CONCLUSION The present study showed that changes cannot be made randomly; rather, they require careful planning and organization. Further changes, continuous feedback, and development are required to improve the status of Greece's healthcare system.
Collapse
Affiliation(s)
- Alexandra Vlassi
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Georgios Tzikos
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Thessaloniki, GRC
| | - Theodoros Dardavesis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Olga Zioga
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Konstantinos Papadimitriou
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Theodosios Papavramidis
- Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| |
Collapse
|
24
|
Boudabbous M, Charfi N, Gdoura H, Chtourou L, Moalla M, Mnif L, Amouri A, Maalej M, Tahri N. A survey to explore the psychological and professional impact of change imposed by COVID-19. Future Sci OA 2023; 9:FSO879. [PMID: 37621849 PMCID: PMC10445553 DOI: 10.2144/fsoa-2023-0057] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 06/02/2023] [Indexed: 08/26/2023] Open
Abstract
Aim Staff of a department underwent a change following the COVID-19 pandemic. The objective of this study was to assess the psychological and professional impact of this change. Materials & methods This is cross-sectional study, including all department staff conducted from 15 July 2021 to 15 August 2021. Results All the staff concerned (n = 36) participated. Only 9.37% declared that they understood the change. The main problem encountered by participants was poor communication (86.2%). More than 75% among participants had a demotivation and 54.5% had resisted. The main cause of resistance was quality of organization (42.4%). Conclusion Our study illustrates the difficulties encountered by actors involved in organizational change and the high risk of their resistance.
Collapse
Affiliation(s)
- Mona Boudabbous
- Gastroenterology Departement, Hédi Chaker Hospital, Sfax, Tunisia
- Medecin B Departement, Medecin Sfax University, Sfax University, Sfax, Tunisia
| | - Nada Charfi
- Psychiatry C Departement, Hédi Chaker Hospital, Sfax, Tunisia
- Medecin B Departement, Medecin Sfax University, Sfax University, Sfax, Tunisia
| | - Héla Gdoura
- Gastroenterology Departement, Hédi Chaker Hospital, Sfax, Tunisia
- Medecin B Departement, Medecin Sfax University, Sfax University, Sfax, Tunisia
| | - Lassad Chtourou
- Gastroenterology Departement, Hédi Chaker Hospital, Sfax, Tunisia
- Medecin B Departement, Medecin Sfax University, Sfax University, Sfax, Tunisia
| | - Manel Moalla
- Gastroenterology Departement, Hédi Chaker Hospital, Sfax, Tunisia
- Medecin B Departement, Medecin Sfax University, Sfax University, Sfax, Tunisia
| | - Leila Mnif
- Gastroenterology Departement, Hédi Chaker Hospital, Sfax, Tunisia
- Medecin B Departement, Medecin Sfax University, Sfax University, Sfax, Tunisia
| | - Ali Amouri
- Gastroenterology Departement, Hédi Chaker Hospital, Sfax, Tunisia
- Medecin B Departement, Medecin Sfax University, Sfax University, Sfax, Tunisia
| | - Mohamed Maalej
- Psychiatry C Departement, Hédi Chaker Hospital, Sfax, Tunisia
- Medecin B Departement, Medecin Sfax University, Sfax University, Sfax, Tunisia
| | - Nabil Tahri
- Gastroenterology Departement, Hédi Chaker Hospital, Sfax, Tunisia
- Medecin B Departement, Medecin Sfax University, Sfax University, Sfax, Tunisia
| |
Collapse
|
25
|
Quinonez RB, Zomorodi M, Broome A, Mason M, Duqum I. Using a change management model to develop and implement dental curricula: A case study. J Dent Educ 2023; 87:1279-1283. [PMID: 37401448 DOI: 10.1002/jdd.13289] [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: 02/16/2023] [Revised: 04/17/2023] [Accepted: 05/10/2023] [Indexed: 07/05/2023]
Abstract
Curriculum transformation is a guiding principle and driving force to continued institutional growth and innovation in oral health education. The transformation process starts from the need and desire for change to achieve the strategic goals of curriculum invocation. The design and implementation process must follow a systematic approach to ensure the oral health curricula are meeting the demands of preparing learners for their future careers and are in line with the institutional strategic goals and processes. The process of curriculum transformation needs to be carefully crafted and implemented to include all constituents and have clear and measurable outcomes to define its path and results. The University of North Carolina at Chapel Hill Adams School of Dentistry is undergoing the journey of oral health curriculum innovation and transformation. The goal of this paper is to describe the change management process using Kotter's organizational model that may apply to other schools aiming to innovate dental curricula.
Collapse
Affiliation(s)
- Rocio B Quinonez
- Division of Pediatric Dentistry and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Meg Zomorodi
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Angela Broome
- Division of Diagnostic Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Matt Mason
- Division of Comprehensive Oral Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ibrahim Duqum
- Division of Comprehensive Oral Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
26
|
Xie C, Li L, Zhou L, Sun C, Zhang Y, Li Y. Mediating role of learned helplessness' components in the association between health literacy/social support and self-management among maintenance haemodialysis patients in Changsha, China: a cross-sectional study. BMJ Open 2023; 13:e068601. [PMID: 37640465 PMCID: PMC10462950 DOI: 10.1136/bmjopen-2022-068601] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 07/27/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES To explore the multiple mediating roles of the learned helplessness's core system in the relationship between health literacy/social support and self-management. DESIGN Cross-sectional survey design. SETTING Changsha, China. PARTICIPANTS 239 Chinese maintenance haemodialysis (MHD) patients. METHODS Two multiple mediator models were constructed based on the COM-B (Capacity, Opportunity, Motivation - Behaviour) model. A total of 239 Chinese MHD patients participated in a cross-sectional study, which included surveys on the Learned Helplessness Scale for MHD patients, Dialysis Knowledge Questionnaire, Social Support Scale and Self-Management Scale for Haemodialysis. The PROCESS macro in SPSS was used for mediated effects analysis. RESULTS Helplessness and internality partially mediated the relationship between health literacy/social support and self-management ((β=-0.212, p<0.01; β=0.240, p<0.01)/(β=-0.331, p<0.001; β=0.376, p<0.001)). The mediation effect size was 0.780 (95% CI (0.373 to 1.218)) in the health literacy model, accounting for 45.29% of the total effect, and 0.286 (95% CI (0.207 to 0.377)) in the social support model, accounting for 57.88% of the total effect. The differences in effect sizes for helplessness and internality in the two models were -0.080 (95% CI (-0.374 to 0.216)) and -0.041 (95% CI (-0.127 to 0.043)), respectively. CONCLUSION Health literacy/social support directly affects MHD patients' self-management and indirectly affects it by changing learned helplessness, such as increasing internality while reducing helplessness.
Collapse
Affiliation(s)
- Chunyan Xie
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
- Xiangya Nursing School, Central South University, Changsha, China
| | - Li Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
- Department of Urology, Xinjiang Medical University Affiliated First Hospital, Urumqi, China
| | - Lin Zhou
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
- Blood Purification Center, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Cuifang Sun
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
- Blood Purification Center, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yini Zhang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
- Blood Purification Center, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yamin Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
| |
Collapse
|
27
|
Haapatalo E, Reponen E, Torkki P. Sustainability of performance improvements after 26 Kaizen events in a large academic hospital system: a mixed methods study. BMJ Open 2023; 13:e071743. [PMID: 37640468 PMCID: PMC10462939 DOI: 10.1136/bmjopen-2023-071743] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Implementing Kaizen can improve productivity in healthcare but maintaining long-term results has proven challenging. This study aimed to assess improved performance achieved and sustained by Kaizen events and find explanatory factors for the persistence or decline of long-term results. METHODS Kaizen events were conducted in 26 specialised healthcare units in a large academic hospital system in southern Finland. Primary data for mixed methods analysis was collected from each unit with 21 semi-structured interviews, Kaizen report files and performance metrics. RESULTS Fifteen explanatory factors were found in this study. Work culture and motivation for continuous improvement stood out as the most important explanatory factor for the persistence of long-term results-lack of time for improvement activities and high workload for the decline. Success in preparation and follow-up was associated with sustained long-term results. Thirteen units achieved long-term results, three units could not sustain the performance improvements and five units struggled to make any improvements. CONCLUSIONS This study explains the long-term sustainability of performance improvements, bringing new insights to Kaizen research. Our findings can guide organising successful Kaizen events. The events can be worth organising even though long-term performance improvements are not guaranteed. Units with supportive working culture and motivation for the Kaizen event will likely succeed. A unit should aim to create a supportive foundation for Kaizen before organising a Kaizen event. Units that lack the foundation can be identified, trained and guided to increase their chances of success. Pitfalls like high workload and insufficient follow-up should be proactively identified and appropriately managed by allocating the required time and resources for the development work.
Collapse
Affiliation(s)
- Erik Haapatalo
- Faculty of Medicine, Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Elina Reponen
- HUS Shared Group Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Paulus Torkki
- Faculty of Medicine, Department of Public Health, University of Helsinki, Helsinki, Finland
- Department of Industrial Engineering and Management, Aalto University, Espoo, Finland
| |
Collapse
|
28
|
Shashar S, Ellen M, Codish S, Davidson E, Novack V. Unravelling the determinants of medical practice variation in referrals among primary care physicians: insights from a retrospective cohort study in Southern Israel. BMJ Open 2023; 13:e072837. [PMID: 37586857 PMCID: PMC10432653 DOI: 10.1136/bmjopen-2023-072837] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/04/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVES Reducing medical practice variation (MPV) is a central theme of system improvement because it is associated with poor health outcomes, increased costs and disparities in care. This study aimed to estimate the extent to which each determinant (patient, physician, clinic) explains MPV among primary care physicians and to identify the characteristics of health services with a greater explained variance. METHODS A retrospective cohort study of primary care physicians practising in non-private clinics of Clalit Health Services in Southern Israel, for longer than a year between 2011 and 2017 and with more than 100 adult patients per practice. We assessed the variation in referral rates among 17 health services and the proportion explained by each domain (patient, physician and clinic). We used generalised linear negative binomial mixed models and the Nakagawa's R2, computing the marginal r2. RESULTS The study included 243 physicians working in 295 practices and 139 clinics. The mean-explained variance was 28.5%±10.0%, where physician characteristics explained 4.5% of the variation. The intrapractice variation (within a single physician between the years) was explained better than the interphysician (between physicians). Health services with high explained variation were blood tests characterised by both low intrapractice variation (Rs=-0.65, p value=0.005) and high referral rates (Rs=0.46, p value=0.06). CONCLUSION Over 70% of MPV is not explained by the patient, clinic and physician demographic and professional characteristics. Future research should focus on the fraction of MPV that is explained by the physicians' psychological characteristics, and thus potentially identify psychological targets for behavioural modifications aimed at reducing MPV.
Collapse
Affiliation(s)
- Sagi Shashar
- Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Moriah Ellen
- Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Shlomi Codish
- Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ehud Davidson
- General Management, Clalit Health Services, Tel Aviv, Israel
| | - Victor Novack
- Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| |
Collapse
|
29
|
Teo KW, Hu Y, Chew KT, Pek WY, Chua HC, Matchar DB, Ng YF. Health System Transformation Playbook and Unified Care Model: an integrated design, systems & complexity thinking approach to health system transformation. Front Health Serv 2023; 3:1157038. [PMID: 37600927 PMCID: PMC10433688 DOI: 10.3389/frhs.2023.1157038] [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] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/27/2023] [Indexed: 08/22/2023]
Abstract
Health system transformation is a complex journey that often results in unintended consequences. Existing methods to drive health system transformation have intrinsic limitations which impede successful implementation in local contexts. The Health System Transformation Playbook is a design-, systems-, and complexity-thinking enabled methodology to systematically design, prioritize and test health system and services transformation actions, anchored on iterative story telling, model building and pathfinding processes that tackles the scale of socially and technologically complex adaptive systems through time. The Unified Care Model and its associated cascade of models are examples of ongoing application of Health System Transformation Playbook in a regional population health system in Singapore. Use of Health System Transformation Playbook enables stewards of health systems to gain a more systematic and coherent understanding of health systems and services planning and organization development, to accelerate transformation towards people-centered, integrated and value-driven health systems.
Collapse
Affiliation(s)
- Ken Wah Teo
- Corporate Development, Khoo Teck Puat Hospital, Yishun Health, National Healthcare Group, Singapore, Singapore
| | - Yun Hu
- Corporate Development, Khoo Teck Puat Hospital, Yishun Health, National Healthcare Group, Singapore, Singapore
| | - Kwee Tiang Chew
- Hospital Administration, Khoo Teck Puat Hospital, Yishun Health, National Healthcare Group, Singapore, Singapore
| | - Wee Yang Pek
- Hospital Administration, Khoo Teck Puat Hospital, Yishun Health, National Healthcare Group, Singapore, Singapore
| | - Hong Choon Chua
- CEO’s Office, Khoo Teck Puat Hospital, Yishun Health, National Healthcare Group, Singapore, Singapore
| | - David Bruce Matchar
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Yeuk Fan Ng
- Corporate Development, Khoo Teck Puat Hospital, Yishun Health, National Healthcare Group, Singapore, Singapore
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| |
Collapse
|
30
|
Moon SEJ, Hogden A, Eljiz K, Siddiqui N. Looking Back, Looking Forward: A Study Protocol for a Mixed-Methods Multiple-Case Study to Examine Improvement Sustainability of Large-Scale Initiatives in Tertiary Hospitals. Healthcare (Basel) 2023; 11:2175. [PMID: 37570415 PMCID: PMC10418688 DOI: 10.3390/healthcare11152175] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Background Hospitals invest extensive resources in large-scale initiatives to improve patient safety and quality at an organizational level. However, initial success, if any, does not guarantee longer-term improvement. Empirical and theoretical knowledge that informs hospitals on how to attain sustained improvement from large-scale change is lacking. Aim The proposed study aims to examine improvement sustainability of two large-scale initiatives in an Australian tertiary hospital and translate the lessons into strategies for achieving sustained improvement from large-scale change in hospital settings. Design and Methods The study employs a single-site, multiple-case study design to evaluate the initiatives separately and comparatively using mixed methods. Semi-structured staff interviews will be conducted in stratified cohorts across the organizational hierarchy to capture different perspectives from various staff roles involved in the initiatives. The output and impact of the initiatives will be examined through organizational documents and relevant routinely collected organizational indicators. The obtained data will be analyzed thematically and statistically before being integrated for a synergic interpretation. Implications Capturing a comprehensive organizational view of large-scale change, the findings will have the potential to guide the practice and contribute to the theoretical understandings for achieving meaningful and longer-term organizational improvement in patient safety and quality.
Collapse
Affiliation(s)
- Sarah E. J. Moon
- Australian Institute of Health Service Management, College of Business and Economics, University of Tasmania, Sydney 2040, Australia
- Statewide Quality and Patient Safety Service, Department of Health Tasmania, Launceston 7250, Australia
| | - Anne Hogden
- Australian Institute of Health Service Management, College of Business and Economics, University of Tasmania, Sydney 2040, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney 2052, Australia
| | - Kathy Eljiz
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney 2052, Australia
| | - Nazlee Siddiqui
- Australian Institute of Health Service Management, College of Business and Economics, University of Tasmania, Sydney 2040, Australia
| |
Collapse
|
31
|
Colquhoun H, Ellen M, Brehaut J, Weinreich NK, Morvinski C, Zarshenas S, Nguyen T, Presseau J, McCleary N, Proctor E. Potential social marketing applications for knowledge translation in healthcare: a scoping review protocol. BMJ Open 2023; 13:e071901. [PMID: 37399439 DOI: 10.1136/bmjopen-2023-071901] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Abstract
INTRODUCTION Knowledge translation has emerged as a practice and a science to bridge the gap between evidence and practice in healthcare. While the field has appropriately borrowed from other related fields to advance its science, there remain fields less mined. One such field with potential relevance to knowledge translation, but limited application to date, is social marketing. This review aims to determine elements of social marketing interventions that could be applied to knowledge translation science. Our objectives are to: (1) summarise the types of studies that have tested social marketing interventions in controlled intervention study designs; (2) describe the social marketing interventions and their effects; and (3) propose strategies for the integration of social marketing interventions into knowledge translation science. METHODS AND ANALYSIS This scoping review will be conducted using the Joanna Briggs Institute Methodological Guidance. For the first and second objectives, all English-language studies published from 1971 onwards will be included if they (1) used a randomised or non-randomised controlled intervention design, and (2) tested a social marketing intervention as defined by five essential social marketing criteria. The research team will address the third objective through discussion and consensus. All screening and extraction will be performed independently by two reviewers. Variables extracted will include intervention details using essential and desirable social marketing criteria and the context, mechanism and outcomes of the interventions. ETHICS AND DISSEMINATION This project is a secondary analysis of published papers and does not require ethics approval. We will disseminate our review outputs in knowledge translation journals and present at relevant conferences across the spectrum of the field. We will produce a short and long version of a plain language summary that will be tailored to various groups including implementation scientists and quality improvement researchers. REGISTRATION DETAILS Open Science Framework Registration link: osf.io/6q834.
Collapse
Affiliation(s)
- Heather Colquhoun
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Moriah Ellen
- Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jamie Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Coby Morvinski
- Department of Management; Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sareh Zarshenas
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Tram Nguyen
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicola McCleary
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Enola Proctor
- Brown School, Washington University in St Louis, St Louis, Missouri, USA
| |
Collapse
|
32
|
Pakulska T, Religioni U. Implementation of technology in healthcare entities - barriers and success factors. J Med Econ 2023:1-5. [PMID: 37334704 DOI: 10.1080/13696998.2023.2226537] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Affiliation(s)
- Teresa Pakulska
- Department of Competition Strategy, Collegium of Business Administration, Warsaw School of Economics, Warsaw, Poland
| | - Urszula Religioni
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, Poland
| |
Collapse
|
33
|
Long JC, Sarkies MN, Francis-Auton E, Roberts N, Hardwick R, Nguyen HM, Levesque JF, Watson DE, Westbrook J, Hibbert PD, Rapport F, Braithwaite J. Guiding principles for effective collaborative implementation strategies for multisite hospital improvement initiatives: a mixed-method realist evaluation of collaborative strategies used in four multisite initiatives at public hospitals in New South Wales, Australia. BMJ Open 2023; 13:e070799. [PMID: 37286318 DOI: 10.1136/bmjopen-2022-070799] [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: 06/09/2023] Open
Abstract
OBJECTIVE Large-scale, multisite hospital improvement initiatives can advance high-quality care for patients. Implementation support is key to adoption of change in this context. Strategies that foster collaboration within local teams, across sites and between initiative developers and users are important. However not all implementation strategies are successful in all settings, sometimes realising poor or unintended outcomes. Our objective here is to develop guiding principles for effective collaborative implementation strategies for multi-site hospital initiatives. DESIGN Mixed-method realist evaluation. Realist studies aim to examine the underlying theories that explain differing outcomes, identifying mechanisms and contextual factors that may trigger them. SETTING We report on collaborative strategies used in four multi-site initiatives conducted in all public hospitals in New South Wales, Australia (n>100). PARTICIPANTS Using an iterative process, information was gathered on collaborative implementation strategies used, then initial programme theories hypothesised to underlie the strategies' outcomes were surfaced using a realist dialogic approach. A realist interview schedule was developed to elicit evidence for the posited initial programme theories. Fourteen participants from 20 key informants invited participated. Interviews were conducted via Zoom, transcribed and analysed. From these data, guiding principles of fostering collaboration were developed. RESULTS Six guiding principles were distilled: (1) structure opportunities for collaboration across sites; (2) facilitate meetings to foster learning and problem-solving across sites; (3) broker useful long-term relationships; (4) enable support agencies to assist implementers by giving legitimacy to their efforts in the eyes of senior management; (5) consider investment in collaboration as effective well beyond the current projects; (6) promote a shared vision and build momentum for change by ensuring inclusive networks where everyone has a voice. CONCLUSION Structuring and supporting collaboration in large-scale initiatives is a powerful implementation strategy if contexts described in the guiding principles are present.
Collapse
Affiliation(s)
- Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Mitchell N Sarkies
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Emilie Francis-Auton
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Natalie Roberts
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | | | - Hoa Mi Nguyen
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jean-Frederic Levesque
- NSW Agency for Clinical Innovation, St Leonards, New South Wales, Australia
- Centre for Primary Health Care and Equity, University of New South Wales, Kensington, New South Wales, Australia
| | - Diane E Watson
- Bureau of Health Information, St Leonards, New South Wales, Australia
| | - Johanna Westbrook
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Peter D Hibbert
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| |
Collapse
|
34
|
Turja T. Uncertainties about accepting care robots. Front Digit Health 2023; 5:1092974. [PMID: 37274766 PMCID: PMC10233153 DOI: 10.3389/fdgth.2023.1092974] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 05/08/2023] [Indexed: 06/06/2023] Open
Abstract
In the midst of the anticipation of care robots renewing elderly care, care workers are expected to orient themselves in this future, however uncertain. To examine how uncertainty over the appropriateness of care-robot use associates with robot acceptance, different scenarios of robot assistance were presented to a sample of care professionals in two waves 2016-2020. The views of usefulness of robot assistance yielded underlying structures of plausible and implausible care-robot use. The perceived appropriateness of utilizing robots in care was stronger in the plausible robot scenarios. The uncertainty about robots having an appropriate role in care work correlated negatively with the perceived usefulness of robot assistance, but was even highlighted among the scenarios of implausible tasks. Findings further show how uncertainties about care-robot use have been reduced across four years between data collections. In robotizing care work processes, it may be more beneficial to attempt to convince the care workers who are undecided about robot acceptance than to push care-robot orientation to those who strongly oppose care-robot use.
Collapse
|
35
|
van Dijk MD, van Beeck EF, Huis A, van der Gun BT, Polinder S, van Eijsden RA, Burdorf A, Vos MC, Erasmus V. Effects of a management team training intervention on the compliance with a surgical site infection bundle: a before-after study in operating theatres in the Netherlands. BMJ Open 2023; 13:e073137. [PMID: 37085301 PMCID: PMC10124304 DOI: 10.1136/bmjopen-2023-073137] [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: 04/23/2023] Open
Abstract
OBJECTIVES To assess the effects of a quality improvement (QI) team training intervention, by measuring the intervention fidelity and the compliance with a surgical site infection (SSI) bundle in the operating theatre (OT). DESIGN Multicentre before-after study. SETTING This study was performed in four Dutch hospitals. INTERVENTION The QI team training intervention consisted of four sessions per hospital and stimulated participants to set culture norms and targets, identify barriers, and formulate management activities to improve compliance with four standard operating procedures (SOPs) of a SSI bundle in the OT. Participants were executive board members, top-level managers, leading clinicians and support staff. The four SOPs were: (1) reducing door movements; (2) preoperative antibiotic prophylaxis prescribing; (3) preoperative shaving; and (4) postoperative normothermia. Poisson and logistic regression analyses were performed to analyse the effect of the intervention on compliance with the individual SOPs (primary outcome measure) and on the influence of medical specialty, time of day the procedure took place and time in the OT (secondary outcome measures). RESULTS Not all management layers were successfully involved during all sessions in the hospitals. Top-level managers were best represented in all hospitals, leading clinicians the least. The number of implemented improvement activities was low, ranging between 2 and 14. The team training intervention we developed was not associated with improvements in the compliance with the four SOP of the SSI bundle. Medical specialty, time of day, and time in OT were associated with median number of door movements, and preoperative antibiotic prophylaxis administration. CONCLUSION This study showed that after the QI team training intervention the overall compliance with the four SOPs did not improve. Minimal involvement of leading clinicians and a low number of self-initiated activities after the team training were important barriers for compliance.
Collapse
Affiliation(s)
- Manon D van Dijk
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ed F van Beeck
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Anita Huis
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Bernardina Tf van der Gun
- Department of Medical Microbiology and Infection Prevention, University Medical Centre Groningen, Groningen, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Rianne Am van Eijsden
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Alex Burdorf
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Vicki Erasmus
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
36
|
Rider EA, Chou C, Abraham C, Weissmann P, Litzelman DK, Hatem D, Branch W. Longitudinal faculty development to improve interprofessional collaboration and practice: a multisite qualitative study at five US academic health centres. BMJ Open 2023; 13:e069466. [PMID: 37076167 PMCID: PMC10124268 DOI: 10.1136/bmjopen-2022-069466] [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: 04/21/2023] Open
Abstract
OBJECTIVES Interprofessional (IP) collaboration and effective teamwork remain variable in healthcare organisations. IP bias, assumptions and conflicts limit the capacity of healthcare teams to leverage the expertise of their members to meet growing complexities of patient needs and optimise healthcare outcomes. We aimed to understand how a longitudinal faculty development programme, designed to optimise IP learning, influenced its participants in their IP roles. DESIGN In this qualitative study, using a constructivist grounded theory approach, we analysed participants' anonymous narrative responses to open-ended questions about specific knowledge, insights and skills acquired during our IP longitudinal faculty development programme and applications of this learning to teaching and practice. SETTING Five university-based academic health centres across the USA. PARTICIPANTS IP faculty/clinician leaders from at least three different professions completed small group-based faculty development programmes over 9 months (18 sessions). Site leaders selected participants from applicants forecast as future leaders of IP collaboration and education. INTERVENTIONS Completion of a longitudinal IP faculty development programme designed to enhance leadership, teamwork, self-knowledge and communication. RESULTS A total of 26 programme participants provided 52 narratives for analysis. Relationships and relational learning were the overarching themes. From the underlying themes, we developed a summary of relational competencies identified at each of three learning levels: (1) Intrapersonal (within oneself): reflective capacity/self-awareness, becoming aware of biases, empathy for self and mindfulness. (2) Interpersonal (interacting with others): listening, understanding others' perspectives, appreciation and respect for colleagues and empathy for others. (3) Systems level (interacting within organisation): resilience, conflict engagement, team dynamics and utilisation of colleagues as resources. CONCLUSIONS Our faculty development programme for IP faculty leaders at five US academic health centres achieved relational learning with attitudinal changes that can enhance collaboration with others. We observed meaningful changes in participants with decreased biases, increased self-reflection, empathy and understanding of others' perspectives and enhanced IP teamwork.
Collapse
Affiliation(s)
- Elizabeth A Rider
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Calvin Chou
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Corrine Abraham
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Peter Weissmann
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Debra K Litzelman
- Department of Medicine, Regenstrief Institute, Indianapolis, Indiana, USA
- Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - David Hatem
- Department of Medicine, University of Massachusetts T H Chan School of Medicine, Worcester, Massachusetts, USA
| | - William Branch
- Medicine, Emory University, Atlanta, Georgia, USA
- Medicine, Emory Clinic, Atlanta, Georgia, USA
| |
Collapse
|
37
|
Robbins T, Shennan A, Sandall J, Eshetu Guangul T, Demissew R, Abdella A, Mayston R, Hanlon C. Understanding challenges as they impact on hospital-level care for pre-eclampsia in rural Ethiopia: a qualitative study. BMJ Open 2023; 13:e061500. [PMID: 37068897 PMCID: PMC10111927 DOI: 10.1136/bmjopen-2022-061500] [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: 04/19/2023] Open
Abstract
OBJECTIVE To explore hospital-level care for pre-eclampsia in Ethiopia, considering the perspectives of those affected and healthcare providers, in order to understand barriers and facilitators to early detection, care escalation and appropriate management. SETTING A primary and a general hospital in southern Ethiopia. PARTICIPANTS Women with lived experience of pre-eclampsia care in the hospital, families of women deceased due to pre-eclampsia, midwives, doctors, integrated emergency surgical officers and healthcare managers. RESULTS This study identified numerous systemic barriers to provision of quality, person-centred care for pre-eclampsia in hospitals. Individual staff efforts to respond to maternal emergencies were undermined by a lack of consistency in availability of resources and support. The ways in which policies were applied exacerbated inequities in care. Staff improvised as a means of managing with limited material or human resources and knowledge. Social hierarchies and punitive cultures challenged adequacy of communication with women, documentation of care given and supportive environments for quality improvement. CONCLUSIONS Quality care for pre-eclampsia requires organisational change to create a safe space for learning and improvement, alongside efforts to offer patient-centred care and ensure providers are equipped with knowledge, resources and support to adhere to evidence-based practice.
Collapse
Affiliation(s)
- Tanya Robbins
- Department of Women and Children's Health, King's College London, London, UK
| | - Andrew Shennan
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Jane Sandall
- Department of Women and Children's Health, King's College London, London, UK
| | - Tigist Eshetu Guangul
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Rahel Demissew
- Department of Obstetrics and Gynaecology, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Ahmed Abdella
- Department of Obstetrics and Gynaecology, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Rosie Mayston
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Charlotte Hanlon
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
- Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, King's College London, London, UK
| |
Collapse
|
38
|
Jomy J, Jani P, Sheikh F, Charide R, Mah J, Couban RJ, Kligler B, Darzi AJ, White BK, Hoppe T, Busse JW, Zeraatkar D. Health measurement instruments and their applicability to military veterans: a systematic review. BMJ Mil Health 2023:military-2022-002219. [PMID: 37028907 DOI: 10.1136/military-2022-002219] [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: 08/02/2022] [Accepted: 03/11/2023] [Indexed: 04/09/2023]
Abstract
INTRODUCTION Accurate measurement of health status is essential to assess veterans' needs and the effects of interventions directed at improving veterans' well-being. We conducted a systematic review to identify instruments that measure subjective health status, considering four components (ie, physical, mental, social or spiritual well-being). METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we searched CINAHL, MEDLINE, Embase, PsycINFO, Web of Science, JSTOR, ERIC, Social Sciences Abstracts and ProQuest in June 2021 for studies reporting on the development or evaluation of instruments measuring subjective health among outpatient populations. We assessed risk of bias with the Consensus-based Standards for the Selection of Health Measurement Instruments tool and engaged three veteran partners to independently assess the clarity and applicability of identified instruments. RESULTS Of 5863 abstracts screened, we identified 45 eligible articles that reported health-related instruments in the following categories: general health (n=19), mental health (n=7), physical health (n=8), social health (n=3) and spiritual health (n=8). We found evidence for adequate internal consistency for 39 instruments (87%) and good test-retest reliability for 24 (53%) instruments. Of these, our veteran partners identified five instruments for the measurement of subjective health (Military to Civilian Questionnaire (M2C-Q), Veterans RAND 36-Item Health Survey (VR-36), Short Form 36, Abbreviated World Health Organization Quality of Life questionnaire (WHOQOL-BREF) and Sleep Health Scale) as clear and very applicable to veterans. Of the two instruments developed and validated among veterans, the 16-item M2C-Q considered most components of health (mental, social and spiritual). Of the three instruments not validated among veterans, only the 26-item WHOQOL-BREF considered all four components of health. CONCLUSION We identified 45 health measurement instruments of which, among those reporting adequate psychometric properties and endorsed by our veteran partners, 2 instruments showed the most promise for measurement of subjective health. The M2C-Q, which requires augmentation to capture physical health (eg, the physical component score of the VR-36), and the WHOQOL-BREF, which requires validation among veterans.
Collapse
Affiliation(s)
- Jane Jomy
- Faculty of Medicine, University of Toronto Temerty, Toronto, Ontario, Canada
| | - P Jani
- School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - F Sheikh
- Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - R Charide
- Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - J Mah
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - R J Couban
- Michael G DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada
| | - B Kligler
- Office of Patient Centered Care and Cultural Transformation, Veterans Health Administration, Washington, District of Columbia, USA
| | - A J Darzi
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - B K White
- The Canadian Veterans Chronic Pain Centre of Excellence, Hamilton, Ontario, Canada
| | - T Hoppe
- The Canadian Veterans Chronic Pain Centre of Excellence, Hamilton, Ontario, Canada
| | - J W Busse
- Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - D Zeraatkar
- Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
39
|
Gungoren MS. Crossing the chasm: strategies for digital transformation in clinical laboratories. Clin Chem Lab Med 2023; 61:570-575. [PMID: 36753305 DOI: 10.1515/cclm-2022-1229] [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: 11/30/2022] [Accepted: 01/16/2023] [Indexed: 02/09/2023]
Abstract
Total testing process in a clinical laboratory is designed to produce useful information for patients and clinicians. The changing landscape of healthcare industry forces clinical laboratory leaders to meet the needs of their stakeholders, maximize operational efficiency and improve overall quality of patient care at the same time. The increasing number of data produced force healthcare services industry to digital transformation. Digital transformation is a process of change which includes finding solutions to novel and unmet requirements of an industry by integrating information, computing, communication and connectivity technologies to minimize the number of low-value tasks and focus on high-value tasks. As the process of digital transformation includes not only the modernization of IT infrastructure but also a paradigm shift in perception of value creation and delivery to improve the quality and cost-effectiveness of laboratory operations in the long run, financial, managerial, and educational issues have been blocking the widespread implementation. Clinical laboratories are at the crossroads on the road to the future. Laboratories that fail to align themselves with data-driven practices will risk losing a competitive advantage. In this review, strategies for a successful digital transformation will be overviewed in the context of clinical laboratory settings.
Collapse
|
40
|
Cobianchi L, Dal Mas F, Denicolai S, Previtali P, Venturi A. Editorial: New frontiers in pancreatic cancer care: Multidisciplinary approaches, the role of Pancreas Units, and their organizational impacts. Front Surg 2023; 10:1182206. [PMID: 37035562 PMCID: PMC10076855 DOI: 10.3389/fsurg.2023.1182206] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 04/11/2023] Open
Affiliation(s)
- Lorenzo Cobianchi
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Department of General Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
- ITIR – Institute for Transformative Innovation Research, University of Pavia, Pavia, Italy
| | | | - Stefano Denicolai
- ITIR – Institute for Transformative Innovation Research, University of Pavia, Pavia, Italy
- Department of Economics and Management, University of Pavia, Pavia, Italy
| | - Pietro Previtali
- ITIR – Institute for Transformative Innovation Research, University of Pavia, Pavia, Italy
- Department of Economics and Management, University of Pavia, Pavia, Italy
| | - Alessandro Venturi
- ITIR – Institute for Transformative Innovation Research, University of Pavia, Pavia, Italy
- Department of Political and Social Sciences, University of Pavia, Pavia, Italy
- Bureau of the Presidency, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| |
Collapse
|
41
|
Chmielewska M, Lotek-Waćkowska R, Brzozowski S, Tytko Z, Dziok-Dmowska K, Hermanowski T. The capacity to implement Lean Management in the healthcare system in Poland - results of a public consultation. Med Pr 2023; 74:1-8. [PMID: 36661115 DOI: 10.13075/mp.5893.01303] [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: 01/21/2023] Open
Abstract
BACKGROUND Lean healthcare management is an innovative approach to process management in healthcare organizations. Despite that the Lean principles have been increasingly recognized worldwide as a tool to boost organizational performance, improve the quality of care and curb waste, the Lean methodology can be difficult to implement in some countries. This study seeks to identify the facilitators of and barriers to the implementation of Lean in the healthcare system in Poland. MATERIAL AND METHODS A public consultation was held among 318 representatives of stakeholder groups in the healthcare system in Poland. Data was collected using validated self-administered questionnaires. Statistical analysis was performed using the IBM SPSS Statistics 25 software. RESULTS The study revealed that a large share of respondents believed that the awareness of the existing organizational deficiencies in work practices among stakeholders can greatly facilitate the implementation of Lean in the healthcare system in Poland (50.9%, p < 0.05). The main barriers to the deployment of Lean include lack of awareness of the Lean methodology and its benefits (76.1%, p < 0.001); insufficient institutional support (43.7%), and lack of funding for Lean solutions (32.4%). CONCLUSIONS Gaps in the medical curricula and education programs for healthcare professionals concerning the latest process management solutions in healthcare should be addressed in order to raise awareness of the benefits of cooperation with and the active involvement of Lean experts in applying "lean" ideas to improve the organizational performance in healthcare. It is also necessary for policy makers to be aware of the benefits of contemporary process management in healthcare and to support its implementation. Med Pr. 2023;74(1):1-8.
Collapse
Affiliation(s)
- Małgorzata Chmielewska
- The John Paul II Catholic University of Lublin, Lublin, Poland (Institute of Health Sciences, Faculty of Medicine)
| | | | | | | | - Kinga Dziok-Dmowska
- Medical University of Warsaw, Warsaw, Poland (Department of Applied Pharmacy, Faculty of Pharmacy)
| | - Tomasz Hermanowski
- Medical University of Warsaw, Warsaw, Poland (Department of Applied Pharmacy, Faculty of Pharmacy)
| |
Collapse
|
42
|
Kapanadze G, Berg J, Sun Y, Gerdin Wärnberg M. Facilitators and barriers impacting in-hospital Trauma Quality Improvement Program (TQIP) implementation across country income levels: a scoping review. BMJ Open 2023; 13:e068219. [PMID: 36806064 PMCID: PMC9944272 DOI: 10.1136/bmjopen-2022-068219] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
OBJECTIVE Trauma is a leading cause of mortality and morbidity globally, disproportionately affecting low/middle-income countries (LMICs). Understanding the factors determining implementation success for in-hospital Trauma Quality Improvement Programs (TQIPs) is critical to reducing the global trauma burden. We synthesised topical literature to identify key facilitators and barriers to in-hospital TQIP implementation across country income levels. DESIGN Scoping review. DATA SOURCES PubMed, Web of Science and Global Index Medicus databases were searched from June 2009 to January 2022. ELIGIBILITY CRITERIA Published literature involving any study design, written in English and evaluating any implemented in-hospital quality improvement programme in trauma populations worldwide. Literature that was non-English, unpublished and involved non-hospital TQIPs was excluded. DATA EXTRACTION AND SYNTHESIS Two reviewers completed a three-stage screening process using Covidence, with any discrepancies resolved through a third reviewer. Content analysis using the Consolidated Framework for Implementation Research identified facilitator and barrier themes for in-hospital TQIP implementation. RESULTS Twenty-eight studies met the eligibility criteria from 3923 studies identified. The most discussed in-hospital TQIPs in included literature were trauma registries. Facilitators and barriers were similar across all country income levels. The main facilitator themes identified were the prioritisation of staff education and training, strengthening stakeholder dialogue and providing standardised best-practice guidelines. The key barrier theme identified in LMICs was poor data quality, while high-income countries (HICs) had reduced communication across professional hierarchies. CONCLUSIONS Stakeholder prioritisation of in-hospital TQIPs, along with increased knowledge and consensus of trauma care best practices, are essential efforts to reduce the global trauma burden. The primary focus of future studies on in-hospital TQIPs in LMICs should target improving registry data quality, while interventions in HICs should target strengthening communication channels between healthcare professionals.
Collapse
Affiliation(s)
- George Kapanadze
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Johanna Berg
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Emergency and Internal Medicine, Skånes universitetssjukhus Malmö, Malmo, Sweden
| | - Yue Sun
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Martin Gerdin Wärnberg
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
43
|
Ellis LA, Tran Y, Pomare C, Long JC, Churruca K, Saba M, Braithwaite J. Hospital organizational change: The importance of teamwork culture, communication, and change readiness. Front Public Health 2023; 11:1089252. [PMID: 36844850 PMCID: PMC9947780 DOI: 10.3389/fpubh.2023.1089252] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/19/2023] [Indexed: 02/11/2023] Open
Abstract
Background Hospital organizational change can be a challenging time, especially when staff do not feel informed and ready for the change to come. A supportive workplace culture can mitigate the negative effects allowing for a smooth transition during hospital organizational change. In this paper, we test an exploratory path model by which teamwork culture influences staff attitudes in feeling informed and ready for change, and which are ultimately related to reduced staff burnout. We also examined different types of change communication, identifying the channels that were perceived as most useful for communicating organizational change. Methods In 2019, a cross-sectional online and paper-based survey of all staff (clinical and non-clinical) was conducted at a hospital undergoing major organizational change in Sydney, Australia. The survey included items regarding teamwork culture, communication (feeling informed, communication channels), change readiness (appropriateness, change efficacy), and burnout. With a sample size of 153 (62% clinical staff), regression and path analyses were used to examine relationships between variables. Results The total effects between teamwork culture and burnout was significant [β (Total) = -0.37, p < 0.001) and explained through a serial mediation. This relationship was found to be mediated by three factors (feeling informed, appropriateness of change and change efficacy) in a full mediation. Further, change readiness (appropriateness of change and change efficacy) mediated the relationship between feeling informed and burnout. The most useful channels of change communication included face-to-face informal communication, emails, and a newsletter specifically about the change. Conclusion Overall, the results supported the predicted hypotheses and were consistent with past research. In the context of large hospital change, staff with a positive teamwork culture who feel informed are more likely to feel change-ready, heightening the chances of successful organizational change and potentially reducing staff burnout. Understanding the pathways on how culture and communication related to burnout during organizational change provides an explanatory pathway that can be used to heighten the chances of a smooth change transition with minimal disruption to staff and patient care.
Collapse
Affiliation(s)
| | - Yvonne Tran
- Faculty of Medicine, Health, and Human Sciences, Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Macquarie, NSW, Australia
| | - Chiara Pomare
- Faculty of Medicine, Health, and Human Sciences, Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Macquarie, NSW, Australia
| | - Janet C. Long
- Faculty of Medicine, Health, and Human Sciences, Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Macquarie, NSW, Australia
| | - Kate Churruca
- Faculty of Medicine, Health, and Human Sciences, Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Macquarie, NSW, Australia
| | - Maree Saba
- Faculty of Medicine, Health, and Human Sciences, Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Macquarie, NSW, Australia
| | - Jeffrey Braithwaite
- Faculty of Medicine, Health, and Human Sciences, Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Macquarie, NSW, Australia
| |
Collapse
|
44
|
Abril-Jiménez P, Merino-Barbancho B, Fico G, Martín Guirado JC, Vera-Muñoz C, Mallo I, Lombroni I, Cabrera Umpierrez MF, Arredondo Waldmeyer MT. Evaluating IoT-Based Services to Support Patient Empowerment in Digital Home Hospitalization Services. Sensors (Basel) 2023; 23:s23031744. [PMID: 36772784 PMCID: PMC9919249 DOI: 10.3390/s23031744] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 06/12/2023]
Abstract
Hospitals need to optimize patient care, as, among other factors, life expectancy has increased due to improvements in sanitation, nutrition, and medicines. Hospitalization-at-home (HaH) could increase admission efficiency, moderate costs, and reduce the demand for beds. This study aimed to provide data on the feasibility, acceptability, and effectiveness of the integration of IoT-based technology to support the remote monitoring and follow-up of patients admitted to HaH units, as well as the acceptability of IoT-based solutions in healthcare processes. The need for a reduction in the number of admission days, the percentage of admissions after discharge, and the actions of the emergency services during admission were the most relevant findings of this study. Furthermore, in terms of patient safety and trust perception, 98% of patients preferred this type of digitally-supported hospitalization model and up to 95% were very satisfied. On the professional side, the results showed a reduction in work overload and an increase in trust when the system was adopted.
Collapse
|
45
|
Tobiano G, Roberts S, Muir R, Jerofke-Owen T, Ting C, Thorning S, Heyland DK, Marshall AP. Patient-mediated interventions in hospital: A systematic review. J Adv Nurs 2023; 79:418-441. [PMID: 36408930 DOI: 10.1111/jan.15500] [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: 07/21/2022] [Revised: 10/13/2022] [Accepted: 11/06/2022] [Indexed: 11/22/2022]
Abstract
AIMS To describe the characteristics of hospital-based, patient-mediated interventions and their impact on patient, clinician and organization outcomes. DESIGN Systematic review. DATA SOURCES Health literature databases (MEDLINE, CINAHL and EMBASE) were searched in August 2021. Backward and forward citation searching was conducted. REVIEW METHODS Studies investigating patient-mediated interventions, targeted at adult hospitalized patients were eligible. Data were extracted related to study and intervention characteristics. Narrative synthesis was used to understand intervention impact on patient, clinician and organization outcomes (as per a framework). Methodological quality was assessed using the Mixed Methods Assessment Tool. RESULTS Thirty-three studies, reporting 18 interventions, were included. Twelve interventions prompted patients to report health information about their own health/needs/concerns and six interventions encouraged patients to provide feedback about clinical practice. Across all interventions, there was evidence that patients used patient-mediated interventions and that they may improve patient communication. Healthcare professional outcomes were mixed for actual/intended use, acceptability and usefulness of interventions; yet there was some evidence of healthcare professional behaviour change. Interventions that encouraged patients to report health information about their own health/needs/concerns appeared more successful than other types of interventions. CONCLUSIONS There is some evidence that hospital-based patient-mediated interventions may influence patient communication and healthcare professional behaviour. Patient-mediated interventions that encourage patients to report patient data before a clinical encounter may be more impactful than interventions that encourage patient feedback during or post-encounter. IMPACT To date, most patient-mediated intervention research has been conducted in primary care settings; we uncovered the types of patient-mediated interventions that have been trialled in hospitals. We found that patient communication and healthcare professional behaviour may be influenced by these patient-mediated interventions. Future researchers could explore the suitability and effectiveness of a wider range of hospital-based patient-mediated interventions. NO PATIENT OR PUBLIC CONTRIBUTION There was no funding to remunerate a patient/member of the public for this review.
Collapse
Affiliation(s)
- Georgia Tobiano
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia.,NHMRC CRE in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Shelley Roberts
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Rachel Muir
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | | | - Christine Ting
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Sarah Thorning
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Daren K Heyland
- Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada.,Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada
| | - Andrea P Marshall
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| |
Collapse
|
46
|
Jammer I, Brandsborg B. How to improve perioperative pathways for the patient and society. Acta Anaesthesiol Scand 2023; 67:126-127. [PMID: 36583646 DOI: 10.1111/aas.14192] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Ib Jammer
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | |
Collapse
|
47
|
Cruchinho P, Teixeira G, Lucas P, Gaspar F. Influencing Factors of Nurses' Practice during the Bedside Handover: A Qualitative Evidence Synthesis Protocol. J Pers Med 2023; 13. [PMID: 36836500 DOI: 10.3390/jpm13020267] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/20/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023] Open
Abstract
Nursing Bedside Handover (NBH) is acknowledged as a nursing practice implemented at the patient's bedside to improve communication safety during the shift change, but it is vulnerable due to inconsistent application among nurses. This synthesis of qualitative evidence aims to review and synthesize the perceptions and experiences of nurses regarding the factors that, in their perspective, influence NBH practice. We will follow the thematic synthesis methodology of Thomas and Harden and the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) Statement guidelines. A search will be conducted through the databases of MEDLINE, CINAHL, Web of Science, and Scopus, and we will follow the three-step search process to identify primary studies with qualitative or mixed-method research designs and projects of quality improvement. The screening and selection of the studies will be carried out by two independent reviewers. We will use the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) to report the screening, search, and selection of studies. To assess its methodological quality, two reviewers will independently use the CASM Tool. The extracted data will be reviewed, categorized, and summarized in tabular and narrative formats. The findings obtained will allow us to inform future research and change management led by nurse managers.
Collapse
|
48
|
Davis SD, Bayes S, Geraghty S. Development of a tool to identify barriers and enablers to practice innovation in midwifery: A participatory action research study. Eur J Midwifery 2023; 7:1. [PMID: 36761447 PMCID: PMC9885374 DOI: 10.18332/ejm/157459] [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: 07/29/2022] [Revised: 03/18/2022] [Accepted: 12/14/2022] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Transferring research evidence into midwifery practice is fraught with challenges and obstacles. Implementation tools can streamline the process and are most effective when they are discipline-specific; however, there are currently no midwifery specific implementation tools. The aim of this study was to develop a midwifery specific tool to identify barriers and enablers to evidence-informed practice change within the clinical setting. METHODS Participatory action research methodology was employed to ensure potential end-users contributed to content and format of the tool. Purposeful sampling ensured participants were selected from a range of midwifery practice settings in Western Australia and the United Kingdom. Data were collected through stakeholder advisory groups (SAGs) and online surveys. RESULTS Ten midwives participated in this project. Consultation occurred through face-to-face SAG meetings and online surveys until consensus was reached among participants about the content, format, and functionality of the end product which we called the 'Midwifery Tool for Change' (MT4C). CONCLUSIONS To our knowledge, the MT4C is the first readiness for change context assessment tool specific to midwifery practice settings. Evaluation of the MT4C in real-world practice change implementation initiatives will enable further refinement of the tool.
Collapse
Affiliation(s)
- Sara D. Davis
- School of Nursing and Midwifery, Edith Cowan University, Perth, Australia
| | - Sara Bayes
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Australia
| | - Sadie Geraghty
- School of Nursing, Midwifery, Health Sciences and Physiotherapy, University of Notre Dame Australia, Fremantle, Australia
| |
Collapse
|
49
|
Le Boutillier C, Saratzis A, Saha P, Benson R, Bridgwood B, Watson E, Lawrence V. Factors that influence the feasibility and implementation of a complex intervention to improve the treatment of peripheral arterial disease in primary and secondary care: a qualitative exploration of patient and provider perspectives. BMJ Open 2023; 13:e066883. [PMID: 36690397 PMCID: PMC9872459 DOI: 10.1136/bmjopen-2022-066883] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/02/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES Our aim was to examine the feasibility and implementation of a complex intervention to improve the care of patients with peripheral arterial disease (the LEGS intervention) from the perspective of patients, general practitioners and secondary care clinicians. DESIGN A qualitative study involving semistructured individual interviews with patients and providers to gain an understanding of the feasibility of the LEGS intervention as well the barriers and facilitators to implementation in secondary and primary care. SETTING Primary and secondary care settings across two National Health Service Trusts. PARTICIPANTS Twenty-five semistructured telephone interviews were conducted with (1) patients who had received the intervention (n=11), (2) secondary care clinicians responsible for delivering the intervention (n=8) and (3) general practitioners (n=6). ANALYSIS Data were initially analysed using inductive descriptive thematic analysis. The consolidated framework for implementation research was then used as a matrix to explore patterns in the data and to map connections between the three participant groups. Lastly, interpretive analysis allowed for refining, and a final coding frame was developed. RESULTS Four overarching themes were identified: (1) the potential to make a difference, (2) a solution to address the gap in no man's land, (3), prioritising and making it happen and (4) personalised information and supportive conversations for taking on the advice. The impetus for prioritising and delivering the intervention was further driven by its flexibility and adaptability to be tailored to the individual and to the environment. CONCLUSIONS The LEGS intervention can be tailored for use at early and late stages of peripheral arterial disease, provides an opportunity to meet patient needs and can be used to promote shared working across the primary-secondary care interface.
Collapse
Affiliation(s)
- Clair Le Boutillier
- Department of Health Services & Population Research, King's College London, London, UK
- Division of Methodologies, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | | | - Prakash Saha
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | | | - Emma Watson
- University of Leicester, Leicester, UK
- NIHR Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Vanessa Lawrence
- Department of Health Services & Population Research, King's College London, London, UK
| |
Collapse
|
50
|
Curtis K, Fry M, Kourouche S, Kennedy B, Considine J, Alkhouri H, Lam M, McPhail SM, Aggar C, Hughes J, Murphy M, Dinh M, Shaban R. Implementation evaluation of an evidence-based emergency nursing framework (HIRAID): study protocol for a step-wedge randomised control trial. BMJ Open 2023; 13:e067022. [PMID: 36653054 PMCID: PMC9853264 DOI: 10.1136/bmjopen-2022-067022] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Poor patient assessment results in undetected clinical deterioration. Yet, there is no standardised assessment framework for >29 000 Australian emergency nurses. To reduce clinical variation and increase safety and quality of initial emergency nursing care, the evidence-based emergency nursing framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, communication and reassessment) was developed and piloted. This paper presents the rationale and protocol for a multicentre clinical trial of HIRAID. METHODS AND ANALYSIS Using an effectiveness-implementation hybrid design, the study incorporates a stepped-wedge cluster randomised controlled trial of HIRAID at 31 emergency departments (EDs) in New South Wales, Victoria and Queensland. The primary outcomes are incidence of inpatient deterioration related to ED care, time to analgesia, patient satisfaction and medical satisfaction with nursing clinical handover (effectiveness). Strategies that optimise HIRAID uptake (implementation) and implementation fidelity will be determined to assess if HIRAID was implemented as intended at all sites. ETHICS AND DISSEMINATION Ethics has been approved for NSW sites through Greater Western Human Research Ethics Committee (2020/ETH02164), and for Victoria and Queensland sites through Royal Brisbane & Woman's Hospital Human Research Ethics Committee (2021/QRBW/80026). The final phase of the study will integrate the findings in a toolkit for national rollout. A dissemination, communications (variety of platforms) and upscaling strategy will be designed and actioned with the organisations that influence state and national level health policy and emergency nurse education, including the Australian Commission for Quality and Safety in Health Care. Scaling up of findings could be achieved by embedding HIRAID into national transition to nursing programmes, 'business as usual' ED training schedules and university curricula. TRIAL REGISTRATION NUMBER ACTRN12621001456842.
Collapse
Affiliation(s)
- Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Margaret Fry
- Faculty of Health, University of Technology Sydney, Broadway, New South Wales, Australia
- Emergency and Critical Care, Northern Sydney Local Health District, Saint Leonards, New South Wales, Australia
| | - Sarah Kourouche
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Belinda Kennedy
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Julie Considine
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, & Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
- Eastern Health Foundation, Box Hill, Victoria, Australia
| | - Hatem Alkhouri
- Emergency Care Institute, NSW Agency for Clinical Innovation, North Ryde, New South Wales, Australia
| | - Mary Lam
- Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Steven M McPhail
- Australian Centre for Health Service Innovation and School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Christina Aggar
- Northern New South Wales Local Health Network, Lismore, New South Wales, Australia
| | - James Hughes
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - M Murphy
- Western Sydney Local Health District, Wentworthville, New South Wales, Australia
| | - Michael Dinh
- Department of Emergency, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Ramon Shaban
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Marie Bashir Institute for Infectious Diseases & Biosecurity, University of Sydney, Sydney, New South Wales, Australia
- Department of Infection Control, Western Sydney Local Health District, Westmead, New South Wales, Australia
| |
Collapse
|