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Hawarna S, Ahmed S, Alqasmi I, Ashrafi DM, Rahman MK, Paraman P. The Intricate Relationship of Employee Engagement and Lean Approach toward Quality Improvement of the Public Hospitals. Hosp Top 2025; 103:72-86. [PMID: 36951405 DOI: 10.1080/00185868.2023.2192995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
The lean approach is a value-added system that reduces cost and waste to continuously improve the quality performance of the healthcare organization. The present study investigates the relationships of the lean approach with top management team and employee engagement toward quality improvement of the public hospitals in Malaysia. This study used stratified random sampling to collect data from the public hospitals' staff who were directly involved with patient services. In this study, PLS-SEM 3.3.4 was applied to measure the research constructs and hypotheses. The research findings indicate that the lean approach has a significant relationship with the top management team and employee engagement to positively impact the quality improvement of the public hospital. However, research findings also indicate that the top management team has no significant influence on quality improvement in public hospitals, but it has an indirect effect through the lean approach and employee engagement. The findings of the study will provide guidelines on how the lean approach contributes to the body of knowledge and practical implications to continuously improve the quality performance of public healthcare system.
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Affiliation(s)
- Shatha Hawarna
- School of Business and Quality Management, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
| | - Selim Ahmed
- World School of Business, World University of Bangladesh, Dhaka, Bangladesh
| | - Ibrahim Alqasmi
- Public Health School of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia
| | - Dewan Mehrab Ashrafi
- ULAB School of Business, University of Liberal Arts Bangladesh, Dhaka, Bangladesh
| | | | - Pradeep Paraman
- Faculty of Business and Accounting, Segi University, Petaling Jaya, Malaysia
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Brooke J, Allsop F, Richards L, Ojo O. The Development, Delivery, Content, and Impact of Nutrition Education in Prisons: A Systematic Review. JOURNAL OF CORRECTIONAL HEALTH CARE 2025; 31:17-28. [PMID: 39761131 DOI: 10.1089/jchc.24.08.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2025]
Abstract
People in prison are at an increased risk of long-term conditions that have been associated with poor nutrition intake, low levels of physical activity, and obesity. We aim to identify the necessary components of nutrition education to impact the health and health behaviors of people in prison. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines informed the structure of this article. Our protocol was registered in PROSPERO (CRD42022353925). Electronic databases were searched for relevant studies published in the English language from January 1, 2000, to December 31, 2023. Data were extracted and narrative synthesis completed. The search identified 394 studies, of which 10 studies included nutrition education delivered to and with people in prison. In most cases, nutrition was one element of a complex intervention, with the inclusion of physical activity and/or a focus on health. The outcomes measured varied considerably across studies; therefore, our narrative synthesis explored the (1) development and delivery, (2) content, and (3) impact of nutrition education delivered for people in prison. There remains a need for nutrition education for people in prison, developed through coproduction, that encompasses their individual needs, with quantifiable outcome measures through validated tools and/or physiological measures.
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Affiliation(s)
- Joanne Brooke
- Birmingham City University, Birmingham, United Kingdom
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Weglarz P, Skop-Lewandowska A, Prill R, Peričić TP, Vrbová T, Klugarová J, Leśniak W, Bala MM. Nutrition as therapy - the role of dietitian counseling: a best practice implementation project. JBI Evid Implement 2024:02205615-990000000-00146. [PMID: 39530227 DOI: 10.1097/xeb.0000000000000479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Abstract
OBJECTIVES The objective of this best practice implementation project was to improve dieticians' professional practice and dietary care through the use of counseling strategies. INTRODUCTION Improving the design and implementation of evidence-based practice depends on successful behavior change interventions. This requires an appropriate method for designing the interventions and then analyzing the targeted behavior. Behavior change techniques (BCTs) have been demonstrated to improve the patient-dietitian relationship and patient treatment outcomes. METHODS This evidence-based quality improvement project used the JBI Evidence Implementation Framework to identify gaps in clinical practice and barriers to changing practice. We recruited 20 dietitians and conducted a baseline audit to determine their level of knowledge of BCTs, the extent to which they applied BCTs in their practice, and barriers to using BCTs. To address the identified barriers, a 5-hour training session was conducted by a dietitian with psychological training. A follow-up audit was then conducted to measure improvements in compliance with best practice. RESULTS The baseline audit revealed that 80% of participants used some of the targeted counseling strategies. The most common barriers were lack of guidance on the use of BCTs or insufficient knowledge of BCTs. The follow-up audit revealed that 93% of participants used some counseling strategies, representing a 13% improvement from baseline. CONCLUSIONS Applying BCTs is a challenge in dietary practice. The results indicate that education about these techniques is needed. As the next step, we suggest disseminating the relevant recommendations among dietitians in Poland and providing education about the use of these methods. SPANISH ABSTRACT http://links.lww.com/IJEBH/A289.
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Affiliation(s)
- Paulina Weglarz
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kraków, Poland
| | - Agata Skop-Lewandowska
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kraków, Poland
| | - Robert Prill
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Tina Poklepović Peričić
- Department of Prosthodontics, Study of Dental Medicine, University of Split School of Medicine, Split, Croatia
| | - Tereza Vrbová
- Center of Evidence-based Education & Arts Therapies: A JBI Affiliated Group, Faculty of Education, Palacký University Olomouc, Czech Republic
- Cochrane Czech Republic, Czech Republic: A JBI Centre of Excellence, Czech GRADE Network, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Jitka Klugarová
- Cochrane Czech Republic, Czech Republic: A JBI Centre of Excellence, Czech GRADE Network, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
- Institute of Special Education Studies, Palacký University Olomouc, Olomouc, Czech Republic
| | | | - Małgorzata M Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kraków, Poland
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Clark PW, Williams LT, Brickley B, Ball L. Minimum reporting standards for process and outcomes assessments for private practice dietitians working in Australian primary care: The Thought Leader Consensus study. Nutr Diet 2023; 80:284-296. [PMID: 36217703 PMCID: PMC10952596 DOI: 10.1111/1747-0080.12776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/18/2022] [Accepted: 08/09/2022] [Indexed: 11/30/2022]
Abstract
AIM To identify minimum reporting standards for assessing the processes and outcomes of Australian primary care dietetics practice. METHODS A sequential, mixed-method, exploratory process with peer-nominated Australian 'thought leaders'. A literature review was undertaken to identify possible standards, followed by semi-structured qualitative interviews with thought leaders. Content analysis was used to identify a comprehensive group of items that could inform evidence-based reporting standards. Two rounds of a modified Delphi survey were conducted with the same thought leaders to seek consensus on the most relevant items. Individual items were analysed for content validity, and those with a rating of excellent item-content validity (index >0.78) were included as evidenced-based standards for primary care practice. RESULTS Twenty-six thought leaders (response rate: 87%) from all mainland Australian states completed a qualitative interview and two rounds of modified-Delphi consensus surveys. Items were identified and categorised into three domains: business, clinical, and implementation. Content analysis identified 216 items published or used in practice by the thought leaders. After two rounds of consensus review, 97 items (45 business, 33 clinical, and 19 implementation) achieved excellent consensus ratings. Combining these items into a standardised tool, the scale-content validity index average was >0.90, which is considered excellent content validity. CONCLUSIONS This study has identified minimum reporting standards for evidence-based process and outcome assessments in primary care dietetics practice in Australia. Incorporating such standards into a standardised tool could enable benchmarking across the dietetics workforce and contribute to a broader understanding of the dietetic impact on public health.
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Affiliation(s)
- Peter W. Clark
- Griffith University School of Allied Health Sciences, Parklands DriveSouthport, Gold CoastQueenslandAustralia
- Healthier You Pty. LtdPort MacquarieNew South WalesAustralia
| | - Lauren T. Williams
- Griffith University School of Allied Health Sciences, Parklands DriveSouthport, Gold CoastQueenslandAustralia
| | - Bryce Brickley
- Griffith University School of Allied Health Sciences, Parklands DriveSouthport, Gold CoastQueenslandAustralia
| | - Lauren Ball
- Griffith University School of Allied Health Sciences, Parklands DriveSouthport, Gold CoastQueenslandAustralia
- Griffith University, Menzies Health Institute QueenslandNathanQueenslandAustralia
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Kirkegaard A, Mitchell L, Ball L, Williams LT. Developing the EQUIPED approach to quality management using multi-grounded theory. Nutr Diet 2023; 80:273-283. [PMID: 36278267 PMCID: PMC10953428 DOI: 10.1111/1747-0080.12780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/05/2022] [Accepted: 09/16/2022] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to develop a theoretical approach to quality management for dietetics services operating in primary care settings in Australia. METHODS Multi-grounded theory was used to develop a theoretical approach to quality management across three phases. A preliminary approach was developed in the first phase using empirical data outlining quality management activities employed by primary care dietetics services. In the second phase, the preliminary approach was matched to theoretical data captured from the Australian National Safety and Quality in Primary and Community Healthcare Standards, the Quality in Nutrition Care Model for Dietitians, and complex adaptive systems theory. Central concepts were defined and described in the final phase. RESULTS Seventeen small (n = 7) and medium-large (n = 10) dietetics services from all Australian states and territories, except Tasmania, participated. The theoretical approach to quality management comprised 107 rules organised into six attractors (culture, integrated care, evidence-based care, safe environment and care, client partnerships and personalised care) and 10 governance elements. Rules had one or more foci that aimed to: improve quality within the service (internally focused), improve care by influencing other healthcare professionals (externally focused), improve the client relationship (client-focused), or monitor and respond to external systems (system-focused). CONCLUSIONS The theoretical approach developed in this study produced a set of rules that primary care dietetics services can use to inform quality management activities. The use of multi-grounded theory should be investigated in other healthcare disciplines and settings to address quality.
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Affiliation(s)
- Amy Kirkegaard
- Menzies Health Institute of Queensland, Griffith HealthGriffith UniversitySouthportQueenslandAustralia
- School of Health Sciences and Social Work, Griffith HealthGriffith University, Gold Coast CampusSouthportQueenslandAustralia
| | - Lana Mitchell
- Menzies Health Institute of Queensland, Griffith HealthGriffith UniversitySouthportQueenslandAustralia
- School of Health Sciences and Social Work, Griffith HealthGriffith University, Gold Coast CampusSouthportQueenslandAustralia
| | - Lauren Ball
- Menzies Health Institute of Queensland, Griffith HealthGriffith UniversitySouthportQueenslandAustralia
- School of Health Sciences and Social Work, Griffith HealthGriffith University, Gold Coast CampusSouthportQueenslandAustralia
| | - Lauren T. Williams
- Menzies Health Institute of Queensland, Griffith HealthGriffith UniversitySouthportQueenslandAustralia
- School of Health Sciences and Social Work, Griffith HealthGriffith University, Gold Coast CampusSouthportQueenslandAustralia
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Kirkegaard A, Mitchell L, Ball L, Williams LT. Developing the Quality in Nutrition Care Model for Dietitians (QUINCE-MOD) in primary care: A mixed-method survey of healthcare consumers and professionals. J Hum Nutr Diet 2023; 36:311-322. [PMID: 35822586 PMCID: PMC10087511 DOI: 10.1111/jhn.13065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/16/2022] [Accepted: 06/24/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Evidence-based models are effective tools for informing quality improvement activities in health care. The Quality in Nutrition Care (QUINCE) model is an evidence-based model that describes quality nutrition care in the primary care setting but has not been applied to primary care dietetics. The present study comprised two phases. In the first phase, the study aimed to evaluate and compare healthcare consumers and professional perspectives on the importance of the 10 statements to understand their relevance for dietetics care. In the second phase, the study aimed to test and enhance the QUINCE model using healthcare consumer and professional responses to statements that were identified as relevant to primary care dietetics in the first phase. METHODS Quantitative and qualitative data were collected using an online survey comprising statements describing quality dietetic care adapted from the complexity literature. Quantitative data were analysed using descriptive statistical analysis to investigate statement importance as rated by participants using a six-point Likert scale. Qualitative content analysis was performed on the qualitative data using a deductive-inductive approach to identify patterns in the data. The QUINCE model was compared with identified patterns and modified as appropriate. RESULTS One hundred and fourteen consumers and 107 primary care professionals agreed on the importance of seven statements but expressed divergent views on the remaining three statements that addressed: (1) access to medical records; (2) access to performance and safety information; and (3) variation in care between dietitians. The QUINCE model was modified to produce the Quality in Nutrition Care Model for Dietitians (QUINCE-MOD) describing quality dietetic care in the primary care setting. CONCLUSIONS Consumers and professionals share views on some aspects of quality dietetic care but diverge on other aspects. The QUINCE-MOD is an evidence-based, complexity-informed model that describes components of quality relevant to primary care dietetics. The model should be applied at the practice level to reflect the unique perspective of quality at that level.
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Affiliation(s)
- Amy Kirkegaard
- Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
| | - Lana Mitchell
- Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
| | - Lauren Ball
- Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
| | - Lauren T Williams
- Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
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Kirkegaard A, Ball L, Mitchell L, Williams LT. A novel perspective of Australian primary care dietetics: Insights from an exploratory study using complex adaptive systems theory. Nutr Diet 2022; 79:469-480. [PMID: 35692187 PMCID: PMC9545103 DOI: 10.1111/1747-0080.12742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/29/2022] [Accepted: 04/12/2022] [Indexed: 11/28/2022]
Abstract
Aims Effective quality improvement strategies are essential to enhancing outcomes of dietetic care. Interventions informed by complex adaptive systems theory have demonstrated effectiveness in other healthcare settings. This study aimed to explore primary care dietetics practice using complex adaptive systems theory and to identify factors that individuals across the healthcare system can examine and address to improve the quality of dietetic care. Methods Qualitative analysis of semi‐structured interviews of healthcare consumers and professionals involved in the provision of dietetic care. Data collection and analysis was guided by a complexity‐informed conceptual framework. The Framework Method was used to code transcripts and identify themes describing primary care dietetics. Results Twenty‐three consumers and 26 primary care professionals participated. Participants described dietetic care as being delivered by individuals organised into formal and informal systems that were influenced by the wider environment, including legal, economic, and socio‐cultural systems. Dietitians described interactions with consumers as a learning opportunity and sought education, mentoring, or supervision to address knowledge and skill gaps. Relationships underpinned transfer of information between individuals. Conclusion Complex adaptive systems theory proved to be a useful conceptual framework for primary care dietetics. Factors identified at the macro (e.g., funding), meso (e.g., professional networks), and micro (e.g., consumer education) levels should be examined and addressed to improve the quality of dietetic care.
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Affiliation(s)
- Amy Kirkegaard
- Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Southport, QLD, Australia
| | - Lauren Ball
- Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Southport, QLD, Australia
| | - Lana Mitchell
- Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Southport, QLD, Australia
| | - Lauren T Williams
- Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Southport, QLD, Australia
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