Implementing action research in hospital settings: a systematic review

Real-Time Triage, Position, and Documentation (TriPoD) During Medical Response to Major Incidents: Protocol for an Action Research Study

BACKGROUND

There is a need to address the implementation of technological innovation into emergency medical services to facilitate and improve information exchange between prehospital emergency care providers, command centers, and hospitals during major incidents to enable better allocation of resources and minimize loss of life. At present, there is a lack of technology supporting real-time information sharing in managing major incidents to optimize the use of resources available.

OBJECTIVE

The aim of this protocol is to develop, design, and evaluate information technology innovations for use in medical response to major incidents.

METHODS

This study has a qualitative action research design. This research approach is suitable for developing and changing practice in health care settings since it is cyclical in nature and involves development, evaluation, redevelopment, and replanning. The qualitative data collection will include workshops, structured meetings, semistructured interviews, questionnaires, observations, and focus group interviews. This study assesses the use of a digital solution for real-time information sharing by involving 3 groups of indented users: prehospital emergency care personnel, hospital personnel, and designated duty officers with experience and specific knowledge in managing major incidents. This study will explore end users' experiences and needs, and a digital solution for prehospital and hospital settings will be developed in collaboration with technology producers.

RESULTS

The trial implementation and evaluation phase for this study is from April 2024 to May 2026. Interviews and questionnaires with end users were conducted during the planning phase. We have performed observations in connection with 2 major exercises in April 2024 and November 2024. The outcome of this analysis will form the basis for the design and development of a new information technology system. We aim to complete the observations in training sessions and exercises (phase 3) by September 2025, followed by modification of the technology solutions tested (phase 4) before dissemination in a scientific journal.

CONCLUSIONS

This protocol includes several methods for data collection that will form the basis for the design and development process of a digital solution for real-time information sharing to support efficient management in major incidents based on the experiences and requirements of end users. The findings from this study will contribute to the limited research on users' perspectives and the development of digital solutions for real-time information during major incidents.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/57819.

Using co-design to understand consumer's health information-seeking behaviours and design preferences for a new digital clinical dashboard in aged care

BACKGROUND

Little is known about the information needs of older people and their family caregivers, particularly around medication management. This is largely because this population are infrequently consulted in research. Health technologies such as digital dashboards can present comprehensive and timely data summaries to improve knowledge and guide decision-making.

OBJECTIVES

The aim of this study was to understand current information seeking-behaviours of aged care service users and their families, and their preferences for the presentation of these types of information to support the co-design of a digital aged care dashboard.

METHODS

Aged care clients (community and residential aged care) and their family members were invited to participate in semi-structured, one-on-one interviews conducted over the telephone. The interviews explored how participants sought health information, how this information supported their clinical decision-making, and how they would want this information to be presented via a digital dashboard. Interviews were audio-recorded, transcribed verbatim and independently analysed using an inductive content approach by three reviewers to identify prominent categories.

RESULTS

Aged care clients and family members sought health information from healthcare providers, aged care facilities and the Internet. Information regarding medications, medical conditions and an overview for family members were of particular importance to participants. Participants saw the usefulness of a digital dashboard displaying relevant information, and provided suggestions regarding presentation of this information. This included the use of large text, representative colours, symbols and graphs. Participants recommended being able to tailor the dashboard to individual end-users.

CONCLUSIONS

By engaging aged care clients and their families in research, it was found that they had positive views about a digital dashboard that presented clinical information and was readily accessible. Such a dashboard could complement their current practices of information-seeking. However, for the dashboard to be effective for this population, several suggestions for its design were raised. Understanding the information-seeking behaviours of aged care clients and their families, together with knowledge of the information that is important to them, and then subsequent incorporation of this information into a digital dashboard that reflects their design preferences, could lead to more informed decision-making in this population.

Effectiveness of an intervention program to develop e-cigarette control leaders at the University in Lampang Province, Thailand

INTRODUCTION

The use of e-cigarettes is increasing worldwide, especially among young adults. Due to the health risks, this study aimed to assess undergraduate students' e-cigarette use and attitudes toward them, and evaluate the effectiveness of an intervention program to develop e-cigarette control leaders at the University in Lampang province, Thailand.

METHODS

Participatory action research (PAR) was conducted among 46 undergraduate students. To assess the situations of undergraduate students' e-cigarette use and attitudes toward them, in-depth interviews were conducted with 18 of those students - nine users and nine non-users. The remaining 28 were student leaders who were given questionnaires and took part in focus groups to evaluate the effectiveness of the intervention program in developing e-cigarette control leaders. Descriptive statistics and the Wilcoxon signed rank test were used to analyze quantitative data. The qualitative data were analyzed using a thematic analysis of the content. This study took place at the University in Lampang province, Thailand, in 2023.

RESULTS

Regarding the use of e-cigarettes on the part of undergraduate students and their attitudes about their use, the majority of users stated that e-cigarettes were accessible, appealing, and more socially acceptable than conventional cigarettes. However, most non-users cited vapor smell and health impacts as their main reason for not using e-cigarettes. The intervention program to develop leaders in e-cigarette control could significantly enhance the leaders' knowledge (p<0.001) and attitude regarding e-cigarettes (p=0.001). After their anti-e-cigarette campaign, the soft skills and managerial abilities of the leaders in e-cigarette control improved, and the knowledge and attitude regarding e-cigarettes of undergraduate students who attended the campaign also increased.

CONCLUSIONS

The intervention program to develop leaders in e-cigarette control resulted in positive outcomes. This program could enhance the leaders' knowledge and attitude regarding e-cigarettes. Their soft skills and managerial abilities in e-cigarette control also improved.

Developing a capacity-building intervention for healthcare workers to improve communication skills and awareness of hard of hearing and D/deaf patients: results from a participatory action research study

BACKGROUND

Healthcare workers (HCWs) are commonly not prepared to properly communicate with D/deaf and hard of hearing (HoH) patients. The resulting communication challenges reinforce the existing barriers to accessing and benefiting from quality of care in these populations. In response, this study aimed to develop and evaluate a capacity-building intervention for HCWs to raise their awareness of D/deaf and HoH individuals' experiences in healthcare and improve their capacity to communicate with these populations.

METHODS

This study featured a participatory action research design using qualitative and quantitative methods. The intervention was developed and tested through 4 iterative phases. Reactions (i.e., satisfaction and perception of the intervention content, quality, appropriateness and usefulness) were assessed quantitatively and qualitatively after the intervention, whereas perceived knowledge and self-efficacy in communicating with D/deaf and HoH patients and organizational payoffs (use frequency of basic rules and tools improving communication) were quantitatively assessed before, after and 6-month post-intervention.

RESULTS

Main qualitative and quantitative findings showed that the final version of the intervention reached high levels of satisfaction among participants. Next, perceived knowledge and self-efficacy scores obtained after receiving the intervention and 6 months later were significantly higher than those yielded in the initial assessment, although both scores significantly decreased at 6 months (compared to the scores obtained just after the intervention). Finally, findings showed no significant changes in organizational payoffs after receiving the intervention. Echoing these results, main qualitative findings documented that after receiving the intervention, participants felt more confident yet not more equipped to communicate with D/deaf and HoH patients.

CONCLUSIONS

Findings suggest that the capacity-building intervention is a promising means to sustainably increase HCWs' perceived knowledge and self-efficacy on how communicating with D/deaf and HoH patients, although complementary approaches and follow-up intervention reminders may be necessary to enable practice changes in the working environment.

[Advanced nursing practice model for head and neck cancer: A practice development project]

Advanced nursing practice model for head and neck cancer: A practice development project Abstract. Background: Head and neck cancer confronts patients and their families with big challenges due to complex treatments as well as changes in vital functions and appearance. They require multifaceted support and benefit from coordinated, interprofessional collaboration and advanced nursing practice. Problem/aim: In a tertiary head and neck cancer center, a coordinating contact person was missing for patients, families and the care team. Therefore, a project was launched to develop an advanced nursing practice program. Methods: Methods included an advanced nursing practice concept, approaches for practice development, and action research. The project consisted of four phases: Stakeholder analysis and literature review were followed by the definition of the advanced nursing practice program, which was then tested during a pilot phase, and evaluated using structural/process data and stakeholder interviews. Results: Evidence-based, continuous, person-centered care was improved across the care continuum for patients/families. The nurses' expertise was supported and the collaboration with internal/external clinicians was facilitated. Patients/families valued the continuity offered by the advanced practice nurse. Discussion: The methodological approaches supported a goal-oriented approach; especially participatory practice development helped to address employees' concerns. Limitations/transfer: To date, a sustainable program cannot yet be warranted. For similar projects, an approach with stakeholder analysis, multidisciplinary focus, and early evaluation planning is recommended.

Nursing staff facilitate patient participation by championing the patient's perspective: An action research study in spinal cord injury rehabilitation

INTRODUCTION

Persons with spinal cord injury have experienced a life-changing event, and they need to engage in the rehabilitation process to adjust to their current situation and future living conditions. Due to the highly contextual and varying psychological and physical ability to participate from patient to patient during rehabilitation, this is difficult for the injured person and for health professionals to support. Therefore, the aim of the study was to develop and facilitate patient participation by engaging nursing staff and from this engagement in the process, disclose methods to support participation.

METHODS

The processes conducted were based on an action research approach, from problem identification to the development, test and evaluation of four new nursing initiatives. The initiatives were developed by eight nursing staff members who participated actively as co-researchers in a 2-year study conducted at a Spinal Cord Injury Centre in Denmark from 2016 to 2018. Data evolved from workshops, transcriptions of meetings and written evaluations and was further analysed using Ricoeur's phenomenological-hermeneutic approach.

RESULTS

Action research processes facilitated the development of four communicative initiatives and a shift in the nursing staff's support of the patient. In a collaborative process, the nursing staff acted as participants in the patient's rehabilitation. Awareness of the patient's perspective facilitated a caring, attentive and engaged approach from the nursing staff, which promoted rehabilitation tailored to the individual.

CONCLUSION

Patient participation was enhanced when nursing staff actively participated in the development of initiatives and a culture supporting a person-to-person approach involving the patient and themselves as equal participants in the collaborative rehabilitation process.

PATIENT OR PUBLIC CONTRIBUTION

Eight nursing staff members from the rehabilitation centre participated throughout the study as co-researchers. Patients participated in observations and as informants in interviews during the first phase to identify challenges to patient participation. Patients also participated in testing the nursing initiatives during the action phase (Phase 3). Furthermore, a former patient was a member of the advisory board.

Reducing Changeover Time Between Surgeries Through Lean Thinking: An Action Research Project

Background

Maximizing the utilization of the operating room suite by safely and efficiently changing over patients is an opportunity to deliver more value to patients and be more efficient in the operating suite. Lean Thinking is a concept that focuses on the waste inadvertently generated during organization and development of an activity, which should maximize customer value while minimizing waste. It has been widely applied to increase process efficiency and foster continuous improvement in healthcare and in the operating room environment. The objective of this paper is to provide insight on how healthcare professionals can be engaged in continuous improvement by embracing Lean Thinking and ultimately reducing changeover time between surgeries.

Methods

Using an action research approach, Lean methodology such as Gemba walks, Process Mapping, Root-Cause-Analysis, and the Single Minute Exchange of Dies (SMED) system was applied to understand the causes of variability and wastes concerning changeovers and improve processes in the context of gynecological- and general surgery. Data were collected and analyzed through observations and video recordings. Problem and issue have been raised to management team attention and included in the annual balanced scorecard of the hospital. This initiative has been also made relevant to the team working in the operating suite and related processes before and after the entry of the patient in the operating suite.

Results

Improved patient flow and inter-professional collaboration through standardized and safer work enabled effective parallel processing and allowed the hospital to reduce changeover time between operations by 25% on average, without changes in terms of infrastructure, technology or resources.

Conclusion

Lean thinking allowed the team to re-evaluate how the whole operating suite performs as a system, by starting from a sub-process as changeover. It is fundamental in order to improve further and obtain sustainable results over time, to act on a system level by defining a common goal between all stakeholders supported by a management and leading system such as visual/weekly management, optimizing planning, implementing standard-works to be followed by every associate and guaranteeing the role of the surgeon as process driver who pull performances.

Integrating a New Dietetic Care Process in a Health Information System: A System and Process Analysis and Assessment

Managing routinely collected data in health care and public health is important for evaluation of interventions and answering research questions using “real life” and ”big data”. In addition to the technical requirements of information systems, both standardized terminology and standardized processes are needed. The aim of this project was to analyse and assess the integration of standardized terminology and document templates for a dietetic care process (DCP) into the health information system (HIS) in a hospital in Austria. Using an action research approach, the DCP was analysed through four expert interviews and the integration into the HIS through two expert interviews with observations. Key strengths and weaknesses for the main criteria (“integration of the ICF catalogue”, “adaption of the document templates”, “adaption of the DCP”, and the “adaption of the user authorizations”) were presented and proposals for improvement given. The system and process integration of the DCP is possible, and the document templates can be adapted with the software currently in use. Although an increase in resources and finances required is to be expected initially, the integration of a standardized dietetic terminology in combination with a standardized process is likely to improve the quality of care and support outcomes management and research.

Long-term effectiveness evaluation of an action-research intervention to improve hand hygiene in an intensive care unit

OBJECTIVES

To evaluate the long-term effectiveness of an action research intervention aimed at improving hand hygiene in an intensive care unit of a public hospital in Italy.

METHODS

An observational, prospective before-after study was carried out.Compliance with hand hygiene was estimated by measuring the utilization of hand hygiene products before the intervention and four years after the end of the project. Products used were the following: detergent liquid soap, antiseptic liquid soap and alcohol-based hand gel. Endpoints were quantity consumed (in grams) for each product category. Quantitative consumptions per workshift were compared.

RESULTS

In 2017 the median consumption of antiseptic liquid soap and alcohol-based hand gel per workshift was significantly higher than in 2012 (111.5 g vs 72.5 g, p = 0.014, and 18.0 g vs 5.0 g, p < 0.001). Odds in favour of a higher value in 2017 were 1.99:1 (CI95%: 1.19:1 to 3.73:1) for antiseptic solution, and 5.39:1 (CI95%: 3.09:1 to 13.61:1) for antiseptic gel. Covariates were not associated with consumption of products, and this made it possible to compare the measurements in the two data collections.

CONCLUSIONS

Results of this study support the long-term effectiveness of the action research intervention to improve practices of hand hygiene in an intensive care setting.

Developing and Evaluating a Capacity-Building Intervention for Healthcare Providers to Improve Communication Skills and Awareness of Hard of Hearing and D/deaf Populations: Protocol for a Participative Action Research-Based Study

Background: D/deaf and hard of hearing populations are at higher risk for experiencing physical and mental health problems compared to hearing populations. In addition, they commonly encounter barriers to accessing and benefiting from health services, which largely stem from challenges they face in communicating with healthcare providers. Healthcare providers commonly lack tailored communication skills in caring for D/deaf and hard of hearing populations, which lead to difficulties and dissatisfaction for both staff and D/deaf and hard of hearing communities. This research project aims to develop and evaluate a capacity-building intervention for healthcare providers with the goal of increasing their awareness of D/deaf and hard of hearing individuals' experiences with the healthcare system, their distinct needs, and improving their capacity to communicate effectively with this patient population. Methods: This research project features a participative action research design using qualitative and quantitative methods. Consistent with participative action research, the study will actively involve the target populations, key stakeholders and representative associations. The intervention will be developed and tested through iterative phases. The Integrated Model of Training Evaluation and Effectiveness will guide prospective evaluation of the intervention. The latter will involve qualitative and quantitative assessments in participants before and after the intervention and at 6-months follow-up. Discussion: Results will contribute to research aimed at decreasing barriers to accessing and benefiting from healthcare services for D/deaf and hard of hearing individuals. Findings will be presented to representative associations and political authorities, as well as disseminated at research conferences and in peer-reviewed journals.

Developing a framework for youth empowerment to prevent smoking behavior in a rural setting: study protocol for a participatory action research

Purpose

There is limited research examining community-based youth empowerment that addresses smoking prevention in the rural Indonesian context. This paper describes participatory action research (PAR) applied to develop a framework for empowering youth aged 17–25 years toward smoking prevention. This research conducted in the Indonesian rural community setting was divided into four stages: diagnosing, planning action, taking action and evaluating action.

Design/methodology/approach

PAR was chosen as the approach to developing a framework for youth empowerment in smoking prevention programs. In this study, the PAR cycle started with a prestep stage through interviews with village heads, community leaders, youth organization organizers, observations of target resources and observations of participation in youth activities as well as forming teamwork with target participants. The diagnosis stage consists of three activities, that is, focus group discussions with youth groups of male and female, youth assessment of empowerment domains through the Participatory Rural Appraisal (PRA) with the Empowerment Assessment Rating Scale (EARS) and measuring individual and group involvement levels related to the smoking behavior prevention program by questionnaire. The EARS assessment results were presented in the action planning stage, followed by a discussion on youth empowerment plans and strategies. In the action stage, activities and programs are planned according to the planning discussion, that is: training in healthy life skills (outbound and training) and initiating youth health programs without smoking called “Remaja Berdaya Sehat Tanpa Rokok” (Empowered Youth Healthy Without Smoking) or the JayaStar Program. After these community participation activities, the evaluating action stage will assess the empowerment domain in the youth groups, conduct focus group discussions with parents, evaluate the impact of empowerment on individual and group changes with a questionnaire and facilitate self-reflection by the youth community called Madiska.

Findings

This protocol describes a doctoral research project on developing a youth empowerment framework in smoking prevention programs through PAR. The intended study will provide valuable information on the planning, implementation and evaluation of youth empowerment in the prevention of smoking behavior.

Originality/value

This research project is expected to contribute to the literature relating to PAR for rural settings and the use of empowerment strategies to prevent youth smoking behavior. The results can be replicated in the same settings, but the process of empowerment must still be adapted to the characteristics and local wisdom of the community.

Intervening on Burnout in Complex Organizations - The Incomplete Process of an Action Research in the Hospital

Health professionals are at high risk for developing burnout symptoms. Directed at reducing the organizational variables affecting professionals’ burnout, an action research was developed in a specific sector of a large hospital, with 59 doctors, 66 nurses, and 42 ancilliary professionals. Researchers conducted 11 interviews, one focus group, and 20 h of in loco observation. Professionals report demotivation and the need to address the emotional part of their job. Nonetheless, the hierarchy blocked the proposed intervention possibilities. Organizational factors are unequivocally relevant, particularly in complex settings with emotionally charged interactions, and the direct hierarchy is pivotal for facilitating organizational change.

Action research as a catalyst for change: Empowered nurses facilitating patient participation in rehabilitation

Based on action research as a practitioner-involving approach, this article communicates the findings of a two-year study on implementing patient participation as an empowering learning process for both patients and rehabilitation nurses. At a rehabilitation facility for patients who have sustained spinal cord injuries, eight nurses were engaged throughout the process aiming at improving patient participation. The current practice was explored to understand possibilities and obstacles to patient participation. Observations, interviews and logbooks, creative workshops and reflective meetings led to the development and testing of four new rehabilitation initiatives aimed at enhancing patient participation. This study suggests that skills of critical reflection from action research toolbox shed light on both the notion of patient participation and caring in nursing rehabilitation. By actively involving nurses in research, the knowledge development stems from practice and the solutions therefore became practice-oriented. In addition, the personal and professional development experienced by the involved nurses points to a secondary gain in the form of an analytical and reflective approach to complex issues in relation to patient participation, rehabilitation in general and the individual nurses' sense of professional pride.

Ten years of the Helsinki Declaration on patient safety in anaesthesiology: An expert opinion on peri-operative safety aspects

: Patient safety is an activity to mitigate preventable patient harm that may occur during the delivery of medical care. The European Board of Anaesthesiology (EBA)/European Union of Medical Specialists had previously published safety recommendations on minimal monitoring and postanaesthesia care, but with the growing public and professional interest it was decided to produce a much more encompassing document. The EBA and the European Society of Anaesthesiology (ESA) published a consensus on what needs to be done/achieved for improvement of peri-operative patient safety. During the Euroanaesthesia meeting in Helsinki/Finland in 2010, this vision was presented to anaesthesiologists, patients, industry and others involved in health care as the 'Helsinki Declaration on Patient Safety in Anaesthesiology'. In May/June 2020, ESA and EBA are celebrating the 10th anniversary of the Helsinki Declaration on Patient Safety in Anaesthesiology; a good opportunity to look back and forward evaluating what was achieved in the recent 10 years, and what needs to be done in the upcoming years. The Patient Safety and Quality Committee (PSQC) of ESA invited experts in their fields to contribute, and these experts addressed their topic in different ways; there are classical, narrative reviews, more systematic reviews, political statements, personal opinions and also original data presentation. With this publication we hope to further stimulate implementation of the Helsinki Declaration on Patient Safety in Anaesthesiology, as well as initiating relevant research in the future.

Translation and psychometric evaluation of the German version of the Organisational Readiness for Implementing Change measure (ORIC): a cross-sectional study

OBJECTIVES

To translate the Organisational Readiness for Implementing Change measure into German and assess its psychometric properties.

DESIGN

Cross-sectional psychometric study based on secondary analysis of baseline data from a shared decision-making implementation study.

SETTING

Three departments within one academic cancer centre in Hamburg, Germany.

PARTICIPANTS

For comprehensibility assessment of the translated ORIC version, we conducted cognitive interviews with healthcare professionals (HCPs, n=11). Afterwards, HCPs (n=230) filled out the measure.

PRIMARY AND SECONDARY OUTCOME MEASURES

The original English version of the ORIC was translated into German using a team translation protocol. Based on comprehensibility assessment via cognitive interviews with HCPs, the translated version was revised. We analysed acceptance (completion rate), factorial structure (exploratory factor analysis (EFA), confirmatory factor analysis (CFA), model fit), item characteristics (item difficulties, corrected item-total correlations, inter-item correlations) and internal consistency (Cronbach's α).

RESULTS

Translation and cognitive testing of the German ORIC was successful except for item 10, which showed low comprehensibility as part of content validity in cognitive interviews. Completion rate was >97%. EFA and CFA provided a one-factorial structure. Item difficulties ranged between 55.98 and 65.32, corrected item-total-correlation ranged between 0.665 and 0.774, inter-item correlations ranged between 0.434 and 0.723 and Cronbach's α was 0.93.

CONCLUSIONS

The German ORIC is a reliable measure with high completion rates and satisfying psychometric properties. A one-factorial structure of the German ORIC was confirmed. Item 10 showed limited comprehensibility and therefore reduces content validity of the measure. The German ORIC can be used to analyse organisational readiness for change as a precursor for implementation success of various interventions.

Reducing medication errors using lean six sigma methodology in a Thai hospital: an action research study

Purpose

The purpose of this paper is to illustrate the use of Lean Six Sigma (LSS) and its associated tools to reduce dispensing errors in an inpatient pharmacy of a teaching hospital in Thailand.

Design/methodology/approach

The action research methodology was used to illustrate the implementation of Lean Six Sigma through the collaboration between the researcher and participants. The project team followed the Lean Six Sigma Define, Measure, Analyze, Improve, Control (DMAIC) methodology and applied its tools in various phases of the methodology.

Findings

The number of dispensing errors decreased from 6 to 2 incidents per 20,000 inpatient days per month between April 2018 and August 2019 representing a 66.66% reduction. The project has improved the dispensing process performance resulting in dispensing error reduction and improved patient safety. The communication channels between the hospital pharmacy and the pharmacy technicians have also been improved.

Research limitations/implications

This study was conducted in an inpatient pharmacy of a teaching hospital in Thailand. Therefore, the findings from this study cannot be generalized beyond the specific setting. However, the findings are applicable in the case of similar contexts and/or situations.

Originality/value

This is the first study that employs a continuous improvement methodology for the purpose of improving the dispensing process and the quality of care in a hospital. This study contributes to an understanding of how the application of action research can save patients' lives, improve patient safety and increase work satisfaction in the pharmacy service.

Using patient experience data to develop a patient experience toolkit to improve hospital care: a mixed-methods study

Background

Patients are increasingly being asked to provide feedback about their experience of health-care services. Within the NHS, a significant level of resource is now allocated to the collection of this feedback. However, it is not well understood whether or not, or how, health-care staff are able to use these data to make improvements to future care delivery.

Objective

To understand and enhance how hospital staff learn from and act on patient experience (PE) feedback in order to co-design, test, refine and evaluate a Patient Experience Toolkit (PET).

Design

A predominantly qualitative study with four interlinking work packages.

Setting

Three NHS trusts in the north of England, focusing on six ward-based clinical teams (two at each trust).

Methods

A scoping review and qualitative exploratory study were conducted between November 2015 and August 2016. The findings of this work fed into a participatory co-design process with ward staff and patient representatives, which led to the production of the PET. This was primarily based on activities undertaken in three workshops (over the winter of 2016/17). Then, the facilitated use of the PET took place across the six wards over a 12-month period (February 2017 to February 2018). This involved testing and refinement through an action research (AR) methodology. A large, mixed-methods, independent process evaluation was conducted over the same 12-month period.

Findings

The testing and refinement of the PET during the AR phase, with the mixed-methods evaluation running alongside it, produced noteworthy findings. The idea that current PE data can be effectively triangulated for the purpose of improvement is largely a fallacy. Rather, additional but more relational feedback had to be collected by patient representatives, an unanticipated element of the study, to provide health-care staff with data that they could work with more easily. Multidisciplinary involvement in PE initiatives is difficult to establish unless teams already work in this way. Regardless, there is merit in involving different levels of the nursing hierarchy. Consideration of patient feedback by health-care staff can be an emotive process that may be difficult initially and that needs dedicated time and sensitive management. The six ward teams engaged variably with the AR process over a 12-month period. Some teams implemented far-reaching plans, whereas other teams focused on time-minimising ‘quick wins’. The evaluation found that facilitation of the toolkit was central to its implementation. The most important factors here were the development of relationships between people and the facilitator’s ability to navigate organisational complexity.

Limitations

The settings in which the PET was tested were extremely diverse, so the influence of variable context limits hard conclusions about its success.

Conclusions

The current manner in which PE feedback is collected and used is generally not fit for the purpose of enabling health-care staff to make meaningful local improvements. The PET was co-designed with health-care staff and patient representatives but it requires skilled facilitation to achieve successful outcomes.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

The co-design of timely and meaningful information needed to enhance social participation in community aged care services: Think tank proceedings

OBJECTIVE

To determine what information from community aged care social participation and quality of life assessments needs to be captured, and meaningfully utilised as part of an integrated information and communication technology system.

METHODS

Two think tank sessions comprised of community aged care staff and researchers (n = 9) were conducted over 5 weeks. The sessions were guided by the Continuous Quality Improvement framework. Thematic analysis was used to categorise the think tank data.

RESULTS

To monitor progress over time, participants needed more contextual information captured in the assessment forms, such as client goals and outcomes of assessments. The aged care provider agreed to embed outcome measure score and action following assessment into its information and communication technology system.

CONCLUSION

Collaboration between aged care staff and researchers resulted in adjustments to the aged care provider's information and communication technology system to better target the monitoring and planning of its clients' psychosocial needs.

Health psychology at the age of Anthropocene

This commentary argues that health psychology, as a scientific discipline, needs to address the negative consequences of Anthropocene by helping individuals, communities and health systems to produce proactive efforts and prepare effective responses strategies for climate change consequences. The commentary addresses the following questions: How to demarcate health psychology at Anthropocene age? What are the best mitigation and adaptation behaviors for health and environment? How to help the environmental migrants and future climate refugees? How to develop a more resilient and adapted health care systems? Should we be in and out of health psychology? In conclusion, health psychologists and academics have to move forward helping individuals, communities and health systems to radically develop lower-carbon lifestyles in a sustainable society.

New ways to get policy into practice

PURPOSE

Health service effectiveness continues to be limited by misaligned objectives between policy makers and frontline clinicians. While capturing the discretion workers inevitably exercise, the concept of "street-level bureaucracy" has tended to artificially separate policy makers and workers. The purpose of this paper is to understand the role of social-organizational context in aligning policy with practice.

DESIGN/METHODOLOGY/APPROACH

This mixed-method participatory study focuses on a locally developed tool to implement an Australia-wide strategy to engage and respond to mental health services for parents with mental illness. Researchers: completed 69 client file audits; administered 64 staff surveys; conducted 24 interviews and focus groups (64 participants) with staff and a consumer representative; and observed eight staff meetings, in an acute and sub-acute mental health unit. Data were analyzed using content analysis, thematic analysis and descriptive statistics.

FINDINGS

Based on successes and shortcomings of the implementation (assessment completed for only 30 percent of clients), a model of integration is presented, distinguishing "assimilist" from "externalist" positions. These depend on the degree to which, and how, the work environment affords clinicians the setting to coordinate efforts to take account of clients' personal and social needs. This was particularly so for allied health clinicians and nurses undertaking sub-acute rehabilitative-transitional work.

ORIGINALITY/VALUE

A new conceptualization of street-level bureaucracy is offered. Rather than as disconnected, it is a process of mutual influence among interdependent actors. This positioning can serve as a framework to evaluate how and under what circumstances discretion is appropriate, and to be supported by managers and policy makers to optimize client-defined needs.

Development and Validation of a Cross-Country Hospital Patient Quality of Care Assessment Tool in Europe

BACKGROUND

Patient perceptions of quality of care (QoC) are directly linked with patient safety and clinical effectiveness. We need patient-designed QoC instruments that work across languages and countries to optimise studies across systems in this area. Few QoC measurement tools exist that assess all aspects of QoC from the patient perspective. This paper describes the development and validation of a comprehensive measure to assess patient perceptions of QoC that incorporates technical and interpersonal aspects of care and is grounded in the established Institute of Medicine (IOM) QoC framework.

DESIGN

We conducted a multi-country cross-sectional study.

METHODS

Following a literature review and patient focus groups, an expert panel generated questionnaire items. Following a pilot study, item numbers were reduced. The final questionnaire consisted of three sections: demographics, perceived QoC and one open-ended question. Data was collected from patients (n = 531) discharged from hospitals across seven countries in South East Europe (languages: Turkish, Greek, Portuguese, Romanian, Croatian, Macedonian and Bulgarian). Reliability and validity of the measure were assessed.

RESULTS

Confirmatory factor analysis was used to compare various factor models of patient-perceived QoC. Good model fit was demonstrated for a two-factor model: communication and interpersonal care, and hospital facilities.

CONCLUSIONS

The ORCAB (Improving quality and safety in the hospital: The link between organisational culture, burnout and quality of care) Patient QoC questionnaire has been collaboratively and exhaustively developed between healthcare professionals and patients. It enables patient QoC data to be assessed in the context of the IOM pillars of quality, considering both technical and interpersonal dimensions of care. It represents an important first step in including the patient perspective.