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Chien LJ, Slade D, Goncharov L, Taylor J, Dahm MR, Brady B, McMahon J, Raine SE, Thornton A. Implementing a ward-level intervention to improve nursing handover communication with a focus on bedside handover-A qualitative study. J Clin Nurs 2024. [PMID: 38528438 DOI: 10.1111/jocn.17107] [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: 09/12/2023] [Revised: 12/08/2023] [Accepted: 01/19/2024] [Indexed: 03/27/2024]
Abstract
AIM To improve the effectiveness of nursing clinical handover through a qualitative, tailored communication intervention. DESIGN A multisite before and after intervention using qualitative ethnography combined with discourse analysis of nursing handover interactions. METHODS We implemented a tailored ward-based intervention to redesign nursing handover practice with co-constructed recommendations for organisational and cultural change on seven wards across three affiliated metropolitan hospitals between February 2020 and November 2022. The intervention was informed by pre-implementation interviews and focus groups with nursing, medical and allied health staff and patients (n = 151) and observed and/or audio-recorded handover events (n = 233). Post-intervention we conducted interviews and focus groups (n = 79) and observed and/or audio-recorded handover events (n = 129) to qualitatively evaluate impact. RESULTS Our translational approach resulted in substantial changes post-intervention. Nurses conducted more shift-to-shift handovers at the bedside, with greater patient interaction and better structured and more comprehensive information transfer, supported by revised handover documentation. Redesigned group handovers were focused and efficient, communicating critical patient information. CONCLUSION Contextualised training combined with changes to ward-level systemic factors impeding communication results in improved nursing handovers. Practice change requires strong executive leadership and project governance, combined with effective ward-level leadership, collaboration and mentoring. The speed and degree of change post-intervention demonstrates the power of interdisciplinary collaborative research between hospital executive, ward leadership and communication specialists. RELEVANCE TO CLINICAL PRACTICE Nurses are more likely to conduct efficient group handovers and informative, patient-centred bedside handovers in line with policy when they understand the value of handover and have practical strategies to support communication. Communication training should be combined with broader ward-level changes to handover practice tailored to the ward context. A multilevel approach results in more effective practice change. REPORTING METHOD We adhered to the COREQ guidelines. PATIENT OR PUBLIC CONTRIBUTION We interviewed patients on study wards pre and post intervention.
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Affiliation(s)
- Laura J Chien
- Institute for Communication in Health Care, College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Diana Slade
- Institute for Communication in Health Care, College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Liza Goncharov
- Institute for Communication in Health Care, College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Joanne Taylor
- St Vincent's Health Network Sydney, Sydney, Australia
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Sydney, Australia
| | - Maria R Dahm
- Institute for Communication in Health Care, College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Bernadette Brady
- Institute for Communication in Health Care, College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Jake McMahon
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Sydney, Australia
- St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Suzanne Eggins Raine
- Institute for Communication in Health Care, College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Anna Thornton
- St Vincent's Health Network Sydney, Sydney, Australia
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Haddy E, Proops L, Burden F, Raw Z, Kaminski J, Brown J. "We forgot about the donkeys!" An institutional analysis of the shift in animal welfare from direct implementation towards advocacy-based programming. Anim Welf 2024; 33:e9. [PMID: 38510421 PMCID: PMC10951660 DOI: 10.1017/awf.2024.11] [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: 10/24/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 03/22/2024]
Abstract
Shifts from direct implementation to advocacy-based programming have been documented across many non-governmental organisation (NGO) sectors, including animal welfare. Semi-structured interviews with 32 staff from different positions within animal welfare NGOs explored recent programming changes. Maintaining a balance between direct implementation and advocacy-based activities emerged as a strong theme. The findings suggest that risks are associated with both the direct implementation status quo and transitioning to an advocacy-based focus. Risks of the former include treating symptoms rather than root causes of welfare problems. Organisational change can be disruptive and necessitates realignment of core competences, in turn influencing NGO mission. Identified risks of transition include loss of individuals whose values fail to align with new programming directions, increased upwards accountability requirements for accessing institutional donors and difficulties when phasing out direct implementation approaches. Whilst having to be dynamic, NGOs need to evaluate the risks associated with programming decisions, considering their vision, mission and staff identity in order to ensure that welfare programming is as effective as possible.
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Affiliation(s)
- Emily Haddy
- University of Portsmouth, Faculty of Humanities and Social Sciences, Portsmouth, Hampshire, UK
| | - Leanne Proops
- University of Portsmouth, Department of Psychology, Portsmouth, Hampshire, UK
| | - Faith Burden
- The Donkey Sanctuary, Equine Operations, Sidmouth, Devon, UK
| | - Zoe Raw
- The Donkey Sanctuary, Equine Operations, Sidmouth, Devon, UK
| | - Juliane Kaminski
- University of Portsmouth, Department of Psychology, Portsmouth, Hampshire, UK
| | - Julia Brown
- University of Portsmouth, School of the Environment, Geography and Geosciences, Portsmouth, UK
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3
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McLeod KE, Buxton JA, Martin RE. "A different sense of what we do here, who we are and what we deliver": Provider perspectives on the effects of a change in governance of healthcare services in correctional facilities in British Columbia. Health Serv Manage Res 2023:9514848231218626. [PMID: 38018489 DOI: 10.1177/09514848231218626] [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: 11/30/2023]
Abstract
In 2017, British Columbia (BC) transferred responsibility for healthcare services in provincial correctional facilities from the Ministry of Public Safety and Solicitor General to the Ministry of Health. This study explored how healthcare leadership perceived the impact of the transfer on services, work-life, and job satisfaction. We conducted one-on-one interviews (n = 8) with healthcare managers and medical and administrative leadership within Correctional Health Services. Using the Two-Factor theory of job satisfaction as a framework, we applied Interpretive Description methodology to analyse interview data. Participants identified changes to four areas of the working environment: (1) staffing, equipment, and resources (2) systems of supervision and support (3) standards, policies, and quality improvement and (4) culture and orientation. These changes predominantly affected motivational factors of job satisfaction and were described as enriching the roles of managers and staff. Participants described improved autonomy and recognition of providers, increased quality of services delivered, and a shift toward patient-centred care. The perspectives of healthcare leaders provide new insight into the potential impact of transferring healthcare services in custody to a public healthcare system. Discussion of changes and their affects also provide practical learning for jurisdictions seeking to improve healthcare under a variety of governance and service-delivery models.
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Affiliation(s)
- Katherine E McLeod
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - Jane A Buxton
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Ruth Elwood Martin
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
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Björne P, McGill P, Deveau R, Hofvander B. Organisational impact on the use of restrictive measures: The perspective of Swedish front-line managers. J Appl Res Intellect Disabil 2023; 36:1025-1033. [PMID: 37151147 DOI: 10.1111/jar.13112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 04/17/2023] [Accepted: 04/23/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Restrictive measures (RM) are prevalent in services for people with intellectual disabilities. This study investigates managerial awareness of RM and the nature of organisational supports required to reduce their use. METHOD A survey asked front-line managers and staff what (RM) were used, their purpose, impact and importance (10-item Likert scales) and what organisational changes were required (free text). Responses were analysed using descriptive methods and content analysis. RESULTS Managers reported a lower use of RM, compared with staff. According to managers, RM were mainly used to keep service users from harm, their use having a significant impact. Opportunities to change practices were limited by a lack of resources and organisational support. CONCLUSION Front-line managers seem to lack the capacity to address the use of RM due to organisational drift; limited manager time and opportunity to allocate resources; inadequate environments; and lack of skilled staff, knowledge and relevant professional input.
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Affiliation(s)
- Petra Björne
- Department for Disability Support, City of Malmö, Malmö, Sweden
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Peter McGill
- Tizard Centre, University of Kent, Canterbury, UK
| | - Roy Deveau
- Tizard Centre, University of Kent, Canterbury, UK
| | - Björn Hofvander
- Lund Clinical Research on Externalizing and Developmental Psychopathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Forensic Psychiatry, Region Skåne, Sweden
- Centre of Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden
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Neumann W, Purdy N. The better work, better care framework: 7 strategies for sustainable healthcare system process improvement. Health Syst (Basingstoke) 2023; 12:429-445. [PMID: 38235296 PMCID: PMC10791105 DOI: 10.1080/20476965.2023.2198580] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/23/2023] [Indexed: 01/19/2024] Open
Abstract
Healthcare systems are under pressure to control costs and improve performance. Efforts to apply improvement trends such as "Lean" and other industrial engineering approaches have led to degradation of the working environment for healthcare professionals. Research is increasingly demonstrating how poor working environments contribute to declines in care quality and has led to calls for a "quadruple aim" with a focus on the working environment alongside quality, cost, and patient experience factors. This paper contributes to the debate by using a "systems" perspective to propose seven strategies by which healthcare systems might be improved without compromising the working environment. This article presents a rationale for these strategies based on current organisational psychology and human factors research and how these strategies might be deployed in practice. The authors argue that better working conditions leads to better care for patients and presents a viable approach for both practitioners and researchers to pursue the "Better Work, Better Care" agenda.
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Affiliation(s)
- W.P. Neumann
- Department of Mechanical and Industrial Engineering, Toronto Metropolitan University, Toronto, ON, Canada
| | - N. Purdy
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada
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Strong S, Letts L, Gillespie A, Martin ML, McNeely HE. Organisational change to integrate self-management into specialised mental health services: Creating collaborative spaces. J Eval Clin Pract 2023; 29:13-21. [PMID: 35791053 DOI: 10.1111/jep.13723] [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] [Received: 05/24/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Self-management support for schizophrenia has become expected practice leaving organisations to find ways for feasible implementation. Self-management support involves a foundational cultural shift for traditional disease-based services, new ways of clients-providers working together, coupled with delivering a portfolio of tools and techniques. A new model of self-management support embedded into traditional case management services, called SET for Health (Self-management Engaging Together for Health), was designed and tailored to make such services meaningfully accessible to clients of a tertiary care centre. This paper describes the proof of concept demonstration efforts, the successes/challenges, and initial organisational changes. METHOD An integrated knowledge translation approach was selected as a means to foster organisational change grounded in users' daily realities. Piloting the model in two community case management programmes, we asked two questions: Can a model of self-management support be embedded in existing case management and delivered within routine specialised mental health services? What organisational changes support implementation? RESULTS Fifty-one clients were enroled. Indicators of feasible delivery included 72.5% completion of self-management plans in a diverse sample, exceeding the 44% set minimum; and an attrition rate of 21.6%, less than 51% set maximum. Through an iterative evaluation process, the innovation evolved to a targeted hybrid approach revolving around client goals and a core set of co-created reference tools, supplemental tools and resources. Operationalisation by use of tools was implemented to create spaces for client-provider collaborations. Monitoring of organisational changes identified realignment of practices. Changes were made to procedures and operations to further spread and sustain the model. CONCLUSION This study demonstrated how self-management support can be implemented, within existing resources, for routine delivery of specialised services for individuals living with schizophrenia. The model holds promise as a hybrid option for supporting clients to manage their own health and wellness.
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Affiliation(s)
- Susan Strong
- Schizophrenia and Community Integration Service, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Lori Letts
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Alycia Gillespie
- Schizophrenia and Community Integration Service, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Mary-Lou Martin
- Forensic Service, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Heather E McNeely
- Schizophrenia and Community Integration Service, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Nienaber AM, Woodcook A, Soares AE, Searle R, Tietmeyer J. The role of women as change agents in a male-dominated context: Empirical findings from the transport and mobility industry. Work 2023; 76:853-865. [PMID: 37355919 DOI: 10.3233/wor-210996] [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: 06/26/2023] Open
Abstract
BACKGROUND A variety of scholars deal with change agents' role within change processes and highlight their relevance as role models in an organisation, but there are shortcomings. First, research on the impact of change processes has traditionally focused on the impact on employees' (change recipients') wellbeing but only limited attention has been paid to the impact on change agents' own well-being, resilience, and health. Second, studies that reflect on female CAs' well-being are missed. OBJECTIVE This study aims to enhance our knowledge on the role of women as change agents in analysing their perceived self-efficacy during change and their job satisfaction as job-related dimension of wellbeing. METHODS We applied a mixed-method design, conducting two studies based on data from 71 specialists - change agents - working in the transport or mobility departments of seven local authorities participating in the H2020 CIVITAS SUITS project, from six different countries, Greece, Spain, Italy, Romania, United Kingdom, and Lithuania. RESULTS The first quantitative survey shows that female change agents may have to perceive higher levels of self-efficacy during organisational change to perceive similar levels of job satisfaction as men. The second qualitative study (focus groups) provides more in-depth explanations of these results. This allows us to derive managerial implications to prevent decreases in women's well-being and strengthen their resilience and health during change. CONCLUSION This mixed-method study highlights the role of women as change agents, driving organisational change within male-dominated transport departments of local authorities. Our results show that female change agents need extra support in managing change processes within male-dominated contexts as the transport and mobility field to avoid a decrease in their perceived job satisfaction, their well-being and herewith, their physical and mental health.
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Affiliation(s)
- Ann-Marie Nienaber
- Centre for Trust, Peace and Social Relations, Coventry University, Coventry, UK
- Management Centre, University of Muenster, Muenster, Germany
| | - Andree Woodcook
- Research Centre for Arts, Memory and Communities, Coventry University, Coventry, UK
| | | | | | - Jan Tietmeyer
- FOM - University of Applied Sciences, Essen, Germany
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8
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Helme ZE, Morris JL, Nichols J, Chalkley AE, Bingham DD, McLoughlin GM, Bartholomew JB, Daly-Smith A. Assessing the Impacts of Creating Active Schools on Organisational Culture for Physical Activity. Int J Environ Res Public Health 2022; 19:16950. [PMID: 36554831 PMCID: PMC9778943 DOI: 10.3390/ijerph192416950] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND National and international guidance recommends whole-school approaches to physical activity, but there are few studies assessing their effectiveness, especially at an organisational level. This study assesses the impact of the Creating Active School's (CAS) programme on organisational changes to physical activity provision. METHODS In-school CAS leads completed a 77-item questionnaire assessing school-level organisational change. The questionnaire comprised 19 domains aligned with the CAS framework and COM-B model of behaviour change. Wilcoxon Signed Rank Tests assessed the pre-to-nine-month change. RESULTS >70% of schools (n = 53) pre-CAS had inadequate whole-school physical activity provision. After nine months (n = 32), CAS had a significant positive effect on organisational physical activity. The positive change was observed for: whole-school culture and ethos, teachers and wider school staff, academic lessons, physical education (PE) lessons, commute to/from school and stakeholder behaviour. CONCLUSIONS This study provides preliminary evidence that CAS is a viable model to facilitate system-level change for physical activity in schools located within deprived areas of a multi-ethnic city. To confirm the results, future studies are required which adopt controlled designs combined with a holistic understanding of implementation determinants and underlying mechanisms.
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Affiliation(s)
- Zoe E. Helme
- Faculties of Life Sciences and Health Studies, University of Bradford, Richmond Road, Bradford BD7 IDP, UK
- Centre for Applied Education Research, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford BD9 6TP, UK
| | - Jade L. Morris
- Faculties of Life Sciences and Health Studies, University of Bradford, Richmond Road, Bradford BD7 IDP, UK
- Centre for Applied Education Research, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford BD9 6TP, UK
| | - Joanna Nichols
- Faculties of Life Sciences and Health Studies, University of Bradford, Richmond Road, Bradford BD7 IDP, UK
- Centre for Applied Education Research, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford BD9 6TP, UK
| | - Anna E. Chalkley
- Centre for Applied Education Research, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford BD9 6TP, UK
- Centre for Physically Active Learning, Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, 5063 Bergen, Norway
| | - Daniel D. Bingham
- Faculties of Life Sciences and Health Studies, University of Bradford, Richmond Road, Bradford BD7 IDP, UK
- Centre for Applied Education Research, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford BD9 6TP, UK
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals Foundation Trust, Bradford BD9 6RJ, UK
| | - Gabriella M. McLoughlin
- College of Public Health, Temple University, Philadelphia, PA 19140, USA
- Implementation Science Center for Cancer Control and Prevention Research Center, Brown School, Washington University, St. Louis, MO 63130, USA
| | - John B. Bartholomew
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX 78712, USA
| | - Andrew Daly-Smith
- Faculties of Life Sciences and Health Studies, University of Bradford, Richmond Road, Bradford BD7 IDP, UK
- Centre for Applied Education Research, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford BD9 6TP, UK
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Berglund M, Harlin U, Elg M, Wallo A. Scaling up and scaling down: Improvisational handling of critical work practices during the COVID-19 pandemic. Manag Learn 2022. [PMCID: PMC9742729 DOI: 10.1177/13505076221137980] [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] [Indexed: 12/13/2022]
Abstract
The aim of this article is to explore improvisational handling of critical work practices during the COVID-19 pandemic and interpret these practices from a learning perspective. Based on an interview study with representatives of private, public and intermediary organisations, the study identified three different types of improvisational handling as responses to the pandemic crisis involving ‘scaling up’ and ‘scaling down’ critical work practices. By ‘scaling up’ and ‘scaling down’, we refer to practices for which, due to the pandemic, it has been imperative to urgently scale up an existing operational process or develop a new process, and alternatively extensively scale down or cease an existing process. The types of improvisational handling differed depending on the discretion of involved actors in terms of the extent to which the tasks, methods and/or results were given beforehand. These types of improvisational handling resulted in temporary solutions that may become permanent after the pandemic. The framework and model proposed in the article can be used as a tool to analyse and learn from the changes in work practices that have been set in motion during the pandemic. Such learning may improve the ability to cope with future extensive crises and other rapid change situations.
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Affiliation(s)
| | - Ulrika Harlin
- Ulrika Harlin, RISE Research Institutes of Sweden, Box 104, SE-431 22, Mölndal, Sweden.
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de la Perrelle L, Klinge N, Windsor T, Low LF, Laver K, Cations M. Characterising trauma-informed aged care: An appreciative inquiry approach. Int J Geriatr Psychiatry 2022; 37. [PMID: 36017588 DOI: 10.1002/gps.5802] [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] [Received: 04/19/2022] [Accepted: 08/12/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE While Trauma-informed care (TIC) has the potential to improve the quality of aged and dementia care, the challenge remains in translating the principles of TIC into practice. This study aimed to characterise what trauma-informed aged care looks like in practice, by learning from an aged care service acknowledged as delivering trauma-informed aged care effectively. METHOD We conducted an appreciative inquiry study within a residential aged care service catering for veterans and others with trauma histories. Observation of care behaviours, interviews with staff and residents, and organisational policy mapping were used to identify elements that maximised care safety and accessibility for trauma survivors. Data were analysed and triangulated using a framework analysis approach. RESULTS The aged care provider embedded the principles of TIC into its staff training (i) to promote understanding of how trauma may affect experiences in care, and (ii) to adapt care when appropriate to promote safety. The service promoted a calm atmosphere where residents could make choices and felt safe. Uniforms and signage provided consistency, clarity, and transparency for residents. Staff behaviours demonstrated respect, fostered trust, and anticipated needs without unnecessarily imposing care. Staff consistently offered choices, used residents' names, sought permission before providing care, and offered reassurance. Staff reported high morale with a commitment to delivering high quality care, and feedback to management. Effective communication promoted information sharing and trust among staff. CONCLUSION Trauma-informed practice was facilitated through organisational policy, a dignified environment, and thoughtful staff behaviour creating safety, choice, and control for residents.
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Affiliation(s)
- Lenore de la Perrelle
- College of Education, Psychology and Social Work, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Nathan Klinge
- RSL Care SA, Myrtle Bank, South Australia, Australia
| | - Tim Windsor
- College of Education, Psychology and Social Work, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Lee-Fay Low
- Sydney School of Health Sciences, Faculty of Medicine and Health, Sydney University, Sydney, New South Wales, Australia
| | - Kate Laver
- Department of Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
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Norton MJ. Co-Production within Child and Adolescent Mental Health: A Systematic Review. Int J Environ Res Public Health 2021; 18:ijerph182211897. [PMID: 34831653 PMCID: PMC8623106 DOI: 10.3390/ijerph182211897] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/20/2021] [Accepted: 11/03/2021] [Indexed: 12/11/2022]
Abstract
Background: Mental health services are currently experiencing much systemic and organisational change. Many countries have adopted a recovery approach to service provision through the development of national policies and frameworks. Within an Irish context, co-production has been identified as one of the four pillars required for services to become recovery orientated. However, there is a paucity of literature relating to the concept within child and adolescent mental health services. This paper aims to synthesise the peer-reviewed evidence on co-production within such services. Methods: A PRISMA compliant systematic review was undertaken. This includes how the reviewer retrieved, shortlisted, and selected studies for inclusion in the review. It outlines the inclusion/exclusion criteria and how these were further developed through the PICO framework. Finally, the methods also outline how the reviewer assessed bias and quality, as well as the process of data synthesis. Results: Two studies were included in this review, both focusing on co-production, but in different contexts within child and adolescent mental health. Two themes were identified: ‘road less travelled’ and ‘co-producing equality’. These themes and the associated sub-themes describe how co-production works in these services. Discussion: These results highlight the paucity of quality literature in co-production within child and adolescent mental health. Both studies scored poorly in terms of quality. Resulting from this review, a number of actions relating to the therapeutic environment need to be taken into account for co-production to be further implemented. Other: The reviewer has not received any funding for this paper. A protocol was not created or registered for this review.
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Affiliation(s)
- Michael John Norton
- Mental Health Engagement & Recovery, St. Loman’s Hospital, D20 HK69 Dublin, Ireland;
- Adult Continuing Education, The Laurels, University College Cork, College Road, T12 YN60 Cork, Ireland
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12
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Barnes S. Radical Knowledge Management: Using Lessons Learned From Artists to Create Sustainable Workplaces. Front Artif Intell 2021; 4:598807. [PMID: 34327327 PMCID: PMC8314007 DOI: 10.3389/frai.2021.598807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
This study weaves together research that has been published over the last 20 years and creates a narrative about how we can change our organisations so that they are fit-for-purpose in the 21st century. Using knowledge management as the starting point, the question "How do we move forward in a sustainable, holistic way to create organisations that are healthy and balanced among social, environmental, and financial performance (triple bottom line)?" needs to be answered. This brand new form of knowledge management is called radical knowledge management (radical KM).
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Choi S. Nurse managers' perception of governance among Korean nurses. J Nurs Manag 2021; 29:2065-2073. [PMID: 34053130 DOI: 10.1111/jonm.13389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/09/2021] [Accepted: 05/25/2021] [Indexed: 11/30/2022]
Abstract
AIM This study aims to ascertain nurse managers' perception of nurses' governance and explore their perception of facilitating and hindering factors of shared governance. BACKGROUND Shared governance has been introduced in nursing as a plan to improve nursing service quality. There is limited understanding about how governance is implemented. METHODS A mixed-methods design was used to elicit Korean nurse managers' views. RESULTS Quantitative data revealed the level of nurses' governance perceived by nurse managers as shared governance. However, among the subdomains, 'control over personnel' and 'participation in committee structures' indicate traditional governance. Analysis of qualitative data identified the factors that facilitate or hinder the subdomains: 'stifled atmosphere', 'nurse manager's encouragement', 'lack of opportunity and perception of the given authority' and 'flexible organisational structure'. CONCLUSION Findings from the study can be used to inform shared governance programmes for hospitals. IMPLICATIONS FOR NURSING MANAGEMENT Health care organisations, nurse managers and nurses must take action at each level to improve the current nurse governance situation. A flexible organisational culture with opinion windows for participation by nurses is important for shared governance. Supportive leadership of nurse managers and nurse-directed implementation could advance shared governance.
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Affiliation(s)
- Sujin Choi
- College of Nursing, Woosuk University, Wanju, South Korea
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Abstract
Behavioral health influences patient health outcomes and healthcare utilization rates. Hospitals are promising settings for appropriate identification, treatment, and referral of behavioral health issues and may affect hospital admission rates and healthcare costs. Implementation frameworks are designed to aid successful adoption and scaling of health innovations. One type - process models - present staged frameworks for rolling out an innovation into routine practice. Process models are appealing for their pragmatism but are criticized for oversimplifying the complexity of implementation. This review investigates the empirical evidence for process models' utility in hospitals, chosen for their uniquely complex structures, by determining whether their use impacts implementation outcomes. Using systematic search and selection criteria across six databases, ten peer-reviewed studies were identified. Each applied a process model for implementing behavioral health innovations within hospital systems. Studies were coded by type of stage framework and reported implementation outcomes. Studies reported mostly favorable or mixed outcomes. No one framework prevailed in use nor evidence. Due to the paucity of published literature and reported data, there is limited evidence that process model application propels implementation outcomes in hospital settings. Furthering the science requires creating and utilizing systematic guidelines to employ process models, measure and report implementation stage transition, and measure and report implementation outcomes. Management and practitioners can include such data collection in standard process evaluations of hospital implementation and scale-up activities, or adopt complexity-informed approaches that lack the simplicity of process models but may be more realistic for complex settings.
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Affiliation(s)
- Ariel M Domlyn
- Department of Psychology 2629University of South Carolina, Columbia, SC, USA
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Abstract
INTRODUCTION This paper examines one of the NHS England Pioneers programmes of Integrated Care, which was implemented in three localities in East London, covering the area served by one of the largest hospital groups in the UK and bringing together commissioners, providers and local authorities. The partners agreed to build a model of integrated care that focused on the whole person. This qualitative and participatory evaluation looked at how an ambitious vision translated into the delivery of integrated care on the ground. The study explored the micro-mechanisms of integrated care relationships based on the experience of health and social care professionals working in acute and community care settings. METHODS We employed a participatory approach, the Researcher in Residence model, whereby the researcher was embedded in the organisations she evaluated and worked alongside managers and clinicians to build collaboration across the full range of stakeholders, develop shared learning, and find common ground through competing interests, while trying to address power imbalances. A number of complementary qualitative methods of data generation were used, including documentary analysis, participant observations, semi-structured interviews, and coproduction workshops with frontline health and social care professionals to interpret the data and develop recommendations. RESULTS Our fieldwork exposed persistent organisational fragmentation, despite the dominant rhetoric of integration and efforts to build a shared vision at senior governance levels. The evaluation identified several important themes, including: a growing barrier between acute and community services; a persisting difficulty experienced by health and social care staff in working together because of professional and cultural differences, as well as conflicting organisational priorities and guidelines; and a lack of capacity and support to deliver a genuine multidisciplinary approach in practice, despite the ethos of multiagency being embraced widely. DISCUSSION By focusing on professionals' working routines, we detailed how and why action taken by organisational leaders failed to have tangible impact. The inability to align organisational priorities and guidelines on the ground, as well as a failure to acknowledge the impact of structural incentives for organisations to compete at the expense of cooperation, in a context of limited financial and human resources, acted as barriers to more coordinated working. Within an environment of continuous reconfigurations, staff were often confused about the functions of new services and did not feel they had influence on change processes. Investing in a genuine bottom-up approach could ensure that the range of activities needed to generate system-wide cultural transformation reflect the capacity of the organisations and systems and address genuine local needs. LIMITATIONS The authors acknowledge several limitations of this study, including the focus on one geographical area, East London, and the timing of the evaluation, with several new interventions and programmes introduced more or less simultaneously. Some of the intermediate care services under evaluation were still at pilot stage and some teams were undergoing new reconfigurations, reflecting the fast-pace of change of the past decade. This created confusion at times, for instance when discussing specific roles and activities with participants. We tried to address some of these challenges by organising several workshops with different teams to co-interpret and discuss the findings.
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Domm E, Urban AM. Public health nurse perceptions of evolving work and how work is managed: A qualitative study. J Nurs Manag 2020; 28:2017-2024. [PMID: 32476181 DOI: 10.1111/jonm.13058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/02/2019] [Revised: 05/10/2020] [Accepted: 05/22/2020] [Indexed: 11/30/2022]
Abstract
AIM To explore public health nurse (PHN) perspectives of their evolving work and how public health nurse work is managed in a Canadian health region. BACKGROUND Professional and public health organisations describe public health nurse practice roles as population-focused work. Health care management directs public health nurse work to achieve specific goals. METHODS In this qualitative study, data were collected during focus groups with 42 public health nurse participants in one health region. Focus group data were analysed for meanings and themes. RESULTS Public health nurses perceived increasing immunizations and limited resources for public health nurse work meant that population-focused care for the public was rationed or missing. Participants perceived the health care organisation directed, managed and assigned public health nurse specialist work; however, public health nurses managed their client-focused practice with knowledge, reasoning and support from colleagues. CONCLUSIONS Evolving visible public health nurse work was managed by health organisational management directives to increase immunizations and disease control. Public health nurses managed their evolving visible and invisible work supported by their knowledge, practice values and public health nurse colleagues. IMPLICATIONS FOR NURSING MANAGEMENT Nursing management must lead and communicate the vision supporting better health, better population-focused care and health outcomes to public health nurse and stakeholders, while reviewing resources needed to optimize public health nursing and improve population health.
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Affiliation(s)
- Elizabeth Domm
- Faculty of Nursing, University of Regina, Regina, SK, Canada
| | - Ann Marie Urban
- Faculty of Nursing, University of Regina, Regina, SK, Canada
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Bridgman H, Ashby M, Sargent C, Marsh P, Barnett T. Implementing an outreach headspace mental health service to increase access for disadvantaged and rural youth in Southern Tasmania. Aust J Rural Health 2019; 27:444-447. [PMID: 31663208 DOI: 10.1111/ajr.12550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/10/2019] [Accepted: 05/21/2019] [Indexed: 11/29/2022] Open
Abstract
PROBLEM Barriers, including distance and lack of transport, make it difficult for young people to access mental health services such as headspace. DESIGN A collaborative mental health outreach service initiative with outcome measures assessed at baseline and after 2 years. SETTING The service was designed and implemented by headspace Hobart and Pulse Youth Health Service based in Glenorchy, Tasmania, Australia. KEY MEASURES FOR IMPROVEMENT Number of rural and socio-economically disadvantaged young people accessing the outreach service. Wait time to see a mental health clinician. STRATEGIES FOR CHANGE Organisational leadership and adoption of co-design principles. Staff and youth from both services were engaged in planning and implementation. Regular service reviews were undertaken by representatives from both organisations. EFFECTS OF CHANGE Numbers of young people from rural and socio-economically disadvantaged areas accessing the service increased. Wait times to see a mental health clinician were reduced by a minimum 10 working days. LESSONS LEARNT Staff engagement was vital in supporting and promoting the new outreach service. The risk of diluting the headspace model fidelity was ameliorated by collaborating with an existing, complimentary youth health service. The success of the service has resulted in four more outreach sites. Although administration resources are stretched, the outreach model offers an opportunity to increase access to youth-friendly mental health services for young people from disadvantaged and rural areas of Southern Tasmania.
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Affiliation(s)
- Heather Bridgman
- Centre for Rural Health, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Celina Sargent
- Pulse Youth Health South, Tasmanian Health Service, Hobart, Tasmania, Australia
| | - Pauline Marsh
- Centre for Rural Health, University of Tasmania, Hobart, Tasmania, Australia
| | - Tony Barnett
- Centre for Rural Health, University of Tasmania, Hobart, Tasmania, Australia
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Ong BN. The ethnographer as health service leader: An insider's view of organisational change. Int J Health Plann Manage 2018; 34:e934-e946. [PMID: 30408236 DOI: 10.1002/hpm.2708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/17/2018] [Accepted: 10/19/2018] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The conceptual presentation of a detailed case study of structural reorganisation in the English NHS illustrates what factors lead to productive or unproductive organisational change. FINDINGS This autoethnography of a NHS Trust chair provides an account of two reorganisations over an 8-year period. The paper is based on diaries that allow for the presentation of examples that highlight different processes and outcomes. The various actors in the two reorganisations gave complex and multilayered meanings to structural changes and their impact. Two theoretical frameworks helped to analyse the dynamics of productive and unproductive changes. CONCLUSION It is argued that structural change rarely delivers and that working through people and paying due attention to their motivations and moral imperatives will more likely produce benefits to organisations, staff, and patients.
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Affiliation(s)
- Bie Nio Ong
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
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Abstract
There is increasing interest and belief in applying quality improvement (QI) to help solve our most complex challenges in healthcare, yet little published literature to help leaders develop a business case and evaluate return on investment from QI. This is even more pronounced in fields such as mental health and community health services. This paper presents a framework to help identify, understand and evaluate return on investment from large-scale application of QI in healthcare providers. The framework has been developed at East London NHS Foundation Trust (ELFT), a provider of predominantly mental health and community health services to a population of 1.5 million people, which has been undertaking QI at scale since 2014. This paper presents case studies and examples from ELFT to illustrate return on investment from QI at multiple levels: improving outcomes for patients and service users, improving the experience of staff, improving productivity and efficiency, avoiding costs, reducing costs and increasing revenue.
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Affiliation(s)
- Amar Shah
- East London NHS Foundation Trust, London, UK
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20
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Leone L, Pesce C. From Delivery to Adoption of Physical Activity Guidelines: Realist Synthesis. Int J Environ Res Public Health 2017; 14:E1193. [PMID: 28991184 PMCID: PMC5664694 DOI: 10.3390/ijerph14101193] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/04/2017] [Accepted: 10/05/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Evidence-based guidelines published by health authorities for the promotion of health-enhancing physical activity (PA), continue to be implemented unsuccessfully and demonstrate a gap between evidence and policies. This review synthesizes evidence on factors influencing delivery, adoption and implementation of PA promotion guidelines within different policy sectors (e.g., health, transport, urban planning, sport, education). METHODS Published literature was initially searched using PubMed, EBSCO, Google Scholar and continued through an iterative snowball technique. The literature review spanned the period 2002-2017. The realist synthesis approach was adopted to review the content of 39 included studies. An initial programme theory with a four-step chain from evidence emersion to implementation of guidelines was tested. RESULTS The synthesis furthers our understanding of the link between PA guidelines delivery and the actions of professionals responsible for implementation within health services, school departments and municipalities. The main mechanisms identified for guidance implementation were scientific legitimation, enforcement, feasibility, familiarity with concepts and PA habits. Threats emerged to the successful implementation of PA guidelines at national/local jurisdictional levels. CONCLUSIONS The way PA guidelines are developed may influence their adoption by policy-makers and professionals. Useful lessons emerged that may inform synergies between policymaking and professional practices, promoting win-win multisectoral strategies.
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Affiliation(s)
- Liliana Leone
- CEVAS Center for Research and Evaluation, 00175 Rome, Italy.
| | - Caterina Pesce
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", 00135 Rome, Italy.
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21
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Abstract
Progress in health care integration is largely linked to changes in processes and ways of doing. These changes have knowledge management and learning implications. For this reason, the use of the concept of organisational learning is explored in the field of integrated care. There are very limited contributions that have connected the fields of organisational learning and care integration in a systematic way, both at the theoretical and empirical level. For this reason, hybridization of both perspectives still provides opportunities for understanding care integration initiatives from a research perspective as well as potential applications in health care management and planning.
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Stewart D, Mair A, Wilson M, Kardas P, Lewek P, Alonso A, McIntosh J, MacLure K. Guidance to manage inappropriate polypharmacy in older people: systematic review and future developments. Expert Opin Drug Saf 2016; 16:203-213. [PMID: 27885844 DOI: 10.1080/14740338.2017.1265503] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Single disease state led evidence-based guidelines do not provide sufficient coverage of issues of multimorbidities, with the cumulative impact of recommendations often resulting in overwhelming medicines burden. Inappropriate polypharmacy increases the likelihood of adverse drug events, drug interactions and non-adherence. Areas covered: A detailed description of a pan-European initiative, 'Stimulating Innovation Management of Polypharmacy and Adherence in the Elderly, SIMPATHY', which is a project funded by the European Commission to support innovation across the European Union. This includes a systematic review of the literature aiming to summarize and review critically current policies and guidelines on polypharmacy management in older people. The policy driven, evidence-based approach to managing inappropriate polypharmacy in Scotland is described, with consideration of a change management strategy based on Kotter's eight step process for leading sustainable change. Expert opinion: The challenges around promoting appropriate polypharmacy are on many levels, primarily clinical, organisational and political, all of which any workable solution will need to address. To be effective, safe and efficient, any programme that attempts to deal with the complexities of prescribing in this population must be patient-centred, clinically robust, multidisciplinary and designed to fit into the healthcare system in which it is delivered.
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Affiliation(s)
- Derek Stewart
- a School of Pharmacy and Life Sciences , Robert Gordon University, Aberdeen , Aberdeen AB10 7GJ , United Kingdom of Great Britain and Northern Ireland
| | - Alpana Mair
- b Healthcare Quality and Strategy Directorate , The Scottish Government , Edinburgh , United Kingdom of Great Britain and Northern Ireland
| | - Martin Wilson
- b Healthcare Quality and Strategy Directorate , The Scottish Government , Edinburgh , United Kingdom of Great Britain and Northern Ireland
| | - Przemyslaw Kardas
- c Department of Family Medicine , Medical University of Lodz , Lodz , Poland
| | - Pawel Lewek
- c Department of Family Medicine , Medical University of Lodz , Lodz , Poland
| | - Albert Alonso
- d Innovation Directorate , Fundacio Clinic per a la Recerca Biomedica , Barcelona , Spain
| | - Jennifer McIntosh
- d Innovation Directorate , Fundacio Clinic per a la Recerca Biomedica , Barcelona , Spain
| | - Katie MacLure
- a School of Pharmacy and Life Sciences , Robert Gordon University, Aberdeen , Aberdeen AB10 7GJ , United Kingdom of Great Britain and Northern Ireland
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Campbell FM, Balabanova D, Howard N. The role of global public health strategy in non-profit organisational change at country level: lessons from the joining of Save the Children and Merlin in Myanmar. Int J Health Plann Manage 2016; 33:88-101. [PMID: 27678108 DOI: 10.1002/hpm.2386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 08/22/2016] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION The paper presents a case study that critically assesses the role of global strategy 'Public Health on the Frontline 2014-2015' ('the Strategy') in supporting Merlin and Save the Children's organisational change and future programme of the combined organisation in Myanmar. MATERIALS AND METHODS Research was undertaken in 2014 in Myanmar. Twenty-six individual and three group interviews were conducted with stakeholders, and 10 meetings relevant to the country organisational transition process were observed. A conceptual framework was developed to assess the role of the global strategy in supporting the country change process. RESULTS Several positive aspects of the global strategy were found, as well as critical shortcomings in its support to the organisational change process at country level. The strategy was useful in signalling Save the Children's intention to scale up humanitarian health provision. However, it had only limited influence on the early change process and outcomes in Myanmar. CONCLUSIONS Results highlight several aspects that would enhance the role of a global strategy at country level. Lessons can be applied by organisations undertaking a similar process. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Fiona M Campbell
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, London, United Kingdom
| | - Dina Balabanova
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, London, United Kingdom
| | - Natasha Howard
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, London, United Kingdom
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Burau V, Bro F. The making of local hospital discharge arrangements: specifying the role of professional groups. BMC Health Serv Res 2015; 15:305. [PMID: 26238863 PMCID: PMC4524021 DOI: 10.1186/s12913-015-0963-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 07/16/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Timely discharge is a key component of contemporary hospital governance and raises questions about how to move to more explicit discharge arrangements. Although associated organisational changes closely intersect with professional interests, there are relatively few studies in the literature on hospital discharge that explicitly examine the role of professional groups. Recent contributions to the literature on organisational studies of the professions help to specify how professional groups in hospitals contribute to the introduction and routinisation of discharge arrangements. This study builds on a view of organisational and professional projects as closely intertwined, where professionals take up organising roles and where organisations shape professionalism. METHODS The analysis is based on a case study of the introduction and routinisation of explicit discharge arrangements for patients with prostate cancer in two hospitals in Denmark. This represents a typical case that involves changes in professional practice without being first and foremost a professional project. The multiple case design also makes the findings more robust. The analysis draws from 12 focus groups with doctors, nurses and secretaries conducted at two different stages in the process of the making of the local discharge arrangements. RESULTS From the analysis, two distinct local models of discharge arrangements that connect more or less directly to existing professional practice emerge: an 'add-on' model, which relies on extra resources, special activities and enforced change; and an 'embedded model', which builds on existing ways of working, current resources, and perspectives of professional groups. The two models reveal differences in the roles of professional groups in terms of their stakes and involvement in the process of organisational change: whereas in the 'add on' model the professional groups remain at a distance, in the 'embedded model' they are closely engaged. CONCLUSIONS In terms of understanding the making of hospital discharge arrangements, the study contributes two sets of insights into the specific roles of professional groups. First, professional interests are an important driver for health professionals to engage in adapting discharge arrangements; and second, professional practice offers a powerful lever for turning new discharge arrangements into organisational routines.
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Affiliation(s)
- Viola Burau
- CFK - Public Health and Quality Improvement, Olof Palmes Allé 15, 8200, Aarhus N, Denmark.
- Department of Political Science, Aarhus University, Aarhus N, Denmark.
| | - Flemming Bro
- Department of Public Health, Research Unit for General Practice, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
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Ferlie E. Public management 'reform' narratives and the changing organisation of primary care. London J Prim Care (Abingdon) 2015; 3:76-80. [PMID: 25949627 DOI: 10.1080/17571472.2010.11493306] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 06/11/2010] [Accepted: 06/14/2010] [Indexed: 10/23/2022]
Abstract
This paper explores how different models of public management affect the changing organisation of primary care. It examines important non-clinical drivers of major organisational change. It uses the concept of a 'reform narrative' to connect public management reform ideas, political doctrines and their effects on primary care organisations. It outlines a set of possible models of public management and their application with primary care settings. It explores what might be the dominant reform ideas of the next decade.
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Affiliation(s)
- Ewan Ferlie
- Department of Management, Kings College London, UK
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26
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Bernstrøm VH, Kjekshus LE. Effect of organisational change type and frequency on long-term sickness absence in hospitals. J Nurs Manag 2014; 23:813-22. [PMID: 24612363 DOI: 10.1111/jonm.12218] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 12/30/2013] [Indexed: 11/30/2022]
Abstract
AIM The present study was conducted to investigate how the frequency of structural change and patient care-related change is related to employees' long-term sickness absence. BACKGROUND Although a growing body of research is investigating the potentially harmful effects of organisational change on employee health, most studies have focused on single episodes of organisational change and do not differentiate among the types and frequencies of change. METHOD National registry data were collected from 2005 and 2007. A total of 34 712 health professionals from 56 hospitals were included (76% nurses, 18% physicians and 6% other health professionals) and the data were analysed using multilevel logistic regression. RESULT The research findings reveal a significantly higher probability of long-term sickness absence among employees who experienced more frequent structural changes (OR = 1.03; CI: 1.00-1.06; P < 0.05), but not among employees who experienced more frequent patient care-related changes. CONCLUSIONS A higher frequency of organisational change may lead to more sickness-related absence among employees, with the effect depending on the type of change. IMPLICATIONS FOR NURSING MANAGEMENT These findings highlight the need for managers who are contemplating or are in the process of implementing organisational change to become more aware of the potentially harmful effects of frequent organisational change on employee health.
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Affiliation(s)
- Vilde H Bernstrøm
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Blindern, Oslo, Norway
| | - Lars Erik Kjekshus
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Blindern, Oslo, Norway
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Booth BJ, Zwar N, Harris MF. Healthcare improvement as planned system change or complex responsive processes? a longitudinal case study in general practice. BMC Fam Pract 2013; 14:51. [PMID: 23617833 PMCID: PMC3644498 DOI: 10.1186/1471-2296-14-51] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 04/12/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Interest in how to implement evidence-based practices into routine health care has never been greater. Primary care faces challenges in managing the increasing burden of chronic disease in an ageing population. Reliable prescriptions for translating knowledge into practice, however, remain elusive, despite intense research and publication activity. This study seeks to explore this dilemma in general practice by challenging the current way of thinking about healthcare improvement and asking what can be learned by looking at change through a complexity lens. METHODS This paper reports the local level of an embedded case study of organisational change for better chronic illness care over more than a decade. We used interviews, document review and direct observation to explore how improved chronic illness care developed in one practice. This formed a critical case to compare, using pattern matching logic, to the common prescription for local implementation of best evidence and a rival explanation drawn from complexity sciences interpreted through modern sociology and psychology. RESULTS The practice changed continuously over more than a decade to deliver better chronic illness care in line with research findings and policy initiatives--re-designing care processes, developing community linkages, supporting patient self-management, using guidelines and clinical information systems, and integrating nurses into the practice team. None of these improvements was designed and implemented according to an explicit plan in response to a documented gap in chronic disease care. The process that led to high quality chronic illness care exhibited clear complexity elements of co-evolution, non-linearity, self-organisation, emergence and edge of chaos dynamics in a network of agents and relationships where a stable yet evolving way of organizing emerged from local level communicative interaction, power relating and values based choices. CONCLUSIONS The current discourse of implementation science as planned system change did not match organisational reality in this critical case of improvement in general practice. Complexity concepts translated in human terms as complex responsive processes of relating fit the pattern of change more accurately. They do not provide just another fashionable blueprint for change but inform how researchers, policymakers and providers participate in improving healthcare.
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Affiliation(s)
- Barbara J Booth
- Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Nicholas Zwar
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
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Fulop N, Boaden R, Hunter R, McKevitt C, Morris S, Pursani N, Ramsay AIG, Rudd AG, Tyrrell PJ, DA Wolfe C. Innovations in major system reconfiguration in England: a study of the effectiveness, acceptability and processes of implementation of two models of stroke care. Implement Sci 2013; 8:5. [PMID: 23289439 PMCID: PMC3545851 DOI: 10.1186/1748-5908-8-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 12/19/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Significant changes in provision of clinical care within the English National Health Service (NHS) have been discussed in recent years, with proposals to concentrate specialist services in fewer centres. Stroke is a major public health issue, accounting for over 10% of deaths in England and Wales, and much disability among survivors. Variations have been highlighted in stroke care, with many patients not receiving evidence-based care. To address these concerns, stroke services in London and Greater Manchester were reorganised, although different models were implemented. This study will analyse processes involved in making significant changes to stroke care services over a short time period, and the factors influencing these processes. We will examine whether the changes have delivered improvements in quality of care and patient outcomes; and, in light of this, whether the significant extra financial investment represented good value for money. METHODS/DESIGN This study brings together quantitative data on 'what works and at what cost?' with qualitative data on 'understanding implementation and sustainability' to understand major system change in two large conurbations in England. Data on processes of care and their outcomes (e.g. morbidity, mortality, and cost) will be analysed to evidence services' performance before and after reconfiguration. The evaluation draws on theories related to the dissemination and sustainability of innovations and the 'social matrix' underlying processes of innovation. We will conduct a series of case studies based on stakeholder interviews and documentary analysis. These will identify drivers for change, how the reconfigurations were governed, developed, and implemented, and how they influenced service quality. DISCUSSION The research faces challenges due to: the different timings of the reconfigurations; the retrospective nature of the evaluation; and the current organisational turbulence in the English NHS. However, these issues reflect the realities of major systems change and its evaluation. The methods applied in the study have been selected to account for and learn from these complexities, and will provide useful lessons for future reconfigurations, both in stroke care and other specialties.
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Affiliation(s)
- Naomi Fulop
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom
| | - Ruth Boaden
- Manchester Business School, University of Manchester, Booth Street West, Manchester, M15 6PB, United Kingdom
| | - Rachael Hunter
- Research Department of Primary Care & Population Health, University College London, Royal Free Campus, London, NW3 2PF, United Kingdom
| | - Christopher McKevitt
- Division of Health & Social Care Research, School of Medicine, King's College London, Capital House 7th Floor, 42 Weston Street, London, SE1 3QD, United Kingdom
| | - Steve Morris
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom
| | - Nanik Pursani
- King’s College London Stroke Research Patients and Family Group, Division of Health & Social Care Research, School of Medicine, King's College London, Capital House 7th Floor, 42 Weston Street, London, SE1 3QD, United Kingdom
| | - Angus IG Ramsay
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom
| | - Anthony G Rudd
- Guy’s and St Thomas’ NHS Foundation Trust, St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Pippa J Tyrrell
- The University of Manchester Stroke & Vascular Centre, Manchester Academic Health Science Centre, Salford Royal Hospitals NHS Foundation Trust, Eccles Old Road, Stott Lane, Salford, M6 8HD, United Kingdom
| | - Charles DA Wolfe
- Division of Health & Social Care Research, School of Medicine, King's College London, Capital House 7th Floor, 42 Weston Street, London, SE1 3QD, United Kingdom
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Hendy J, Chrysanthaki T, Barlow J, Knapp M, Rogers A, Sanders C, Bower P, Bowen R, Fitzpatrick R, Bardsley M, Newman S. An organisational analysis of the implementation of telecare and telehealth: the whole systems demonstrator. BMC Health Serv Res 2012; 12:403. [PMID: 23153014 PMCID: PMC3532839 DOI: 10.1186/1472-6963-12-403] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 11/13/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To investigate organisational factors influencing the implementation challenges of redesigning services for people with long term conditions in three locations in England, using remote care (telehealth and telecare). METHODS Case-studies of three sites forming the UK Department of Health's Whole Systems Demonstrator (WSD) Programme. Qualitative research techniques were used to obtain data from various sources, including semi-structured interviews, observation of meetings over the course programme and prior to its launch, and document review. Participants were managers and practitioners involved in the implementation of remote care services. RESULTS The implementation of remote care was nested within a large pragmatic cluster randomised controlled trial (RCT), which formed a core element of the WSD programme. To produce robust benefits evidence, many aspect of the trial design could not be easily adapted to local circumstances. While remote care was successfully rolled-out, wider implementation lessons and levels of organisational learning across the sites were hindered by the requirements of the RCT. CONCLUSIONS The implementation of a complex innovation such as remote care requires it to organically evolve, be responsive and adaptable to the local health and social care system, driven by support from front-line staff and management. This need for evolution was not always aligned with the imperative to gather robust benefits evidence. This tension needs to be resolved if government ambitions for the evidence-based scaling-up of remote care are to be realised.
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Affiliation(s)
- Jane Hendy
- University of Surrey, Department of Health Care Management and Policy, University of Surrey, Guildford, UK
| | | | | | - Martin Knapp
- PSSRU, London School of Economics and Political Science, London, UK
| | - Anne Rogers
- University of SouthamptonHealth Sciences, Southampton, UK
| | - Caroline Sanders
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Peter Bower
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Robert Bowen
- Institute of Population Health, University of Manchester, Manchester, UK
| | | | | | - Stanton Newman
- City University London, Health Services Research; UCL, Cardiovascular Sciences, London, UK
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