Utility of the AHRQ Learning Collaboratives Taxonomy for Analyzing Innovations from an Australian Collaborative

BACKGROUND

Despite the proliferation of learning collaborations such as innovation platforms, the factors contributing to their success or failure are rarely documented. The Agency for Healthcare Research and Quality learning collaboratives taxonomy provides a framework for understanding how such collaborations work in different settings according to four primary elements: innovation, communication, time, and social systems. This study applied the taxonomy to assess an innovation platform and the utility of applying the taxonomy.

METHODS

The study focus was a five-year national research collaboration operating as an innovation platform to strengthen primary health care quality improvement efforts for Indigenous Australians. The study team analyzed project records, reports and publications, and interviews that were conducted with 35 stakeholders. Data were mapped retrospectively against the taxonomy domains and thematically analyzed.

RESULTS

The taxonomy proved useful in understanding how and why the innovation platform generated innovations. It revealed that time was particularly important, both to see innovations through and to establish a social system that enabled interconnectivity between members. However, the taxonomy did not provide useful guidance on identifying the types of innovations from the collaboration or the importance of a culture of continuous adaptation and learning. The study also found that the primary and secondary elements of the taxonomy were not discrete, which meant that it was difficult to align themes with only one element.

CONCLUSION

To improve the utility of the taxonomy, several elaborations are proposed, including reconfiguring it to a more dynamic form that recognizes the interconnections and links between the elements.

Collaboration and knowledge generation in an 18-year quality improvement research programme in Australian Indigenous primary healthcare: a coauthorship network analysis

OBJECTIVES

Though multidisciplinary research networks support the practice and effectiveness of continuous quality improvement (CQI) programmes, their characteristics and development are poorly understood. In this study, we examine publication outputs from a research network in Australian Indigenous primary healthcare (PHC) to assess to what extent the research network changed over time.

SETTING

Australian CQI research network in Indigenous PHC from 2002 to 2019.

PARTICIPANTS

Authors from peer-reviewed journal articles and books published by the network.

DESIGN

Coauthor networks across four phases of the network (2002-2004; 2005-2009; 2010-2014; 2015-2019) were constructed based on author affiliations and examined using social network analysis methods. Descriptive characteristics included organisation types, Indigenous representation, gender, student authorship and thematic research trends.

RESULTS

We identified 128 publications written by 308 individual authors from 79 different organisations. Publications increased in number and diversity over each funding phase. During the final phase, publication outputs accelerated for organisations, students, project officers, Indigenous and female authors. Over time there was also a shift in research themes to encompass new clinical areas and social, environmental or behavioural determinants of health. Average degree (8.1), clustering (0.81) and diameter (3) indicated a well-connected network, with a core-periphery structure in each phase (p≤0.03) rather than a single central organisation (degree centralisation=0.55-0.65). Academic organisations dominated the core structure in all funding phases.

CONCLUSION

Collaboration in publications increased with network consolidation and expansion. Increased productivity was associated with increased authorship diversity and a decentralised network, suggesting these may be important factors in enhancing research impact and advancing the knowledge and practice of CQI in PHC. Publication diversity and growth occurred mainly in the fourth phase, suggesting long-term relationship building among diverse partners is required to facilitate participatory research in CQI. Despite improvements, further work is needed to address inequities in female authorship and Indigenous authorship.

Principles guiding ethical research in a collaboration to strengthen Indigenous primary healthcare in Australia: learning from experience

INTRODUCTION

Indigenous communities worldwide are leading calls for all research involving Indigenous people to be underpinned by values and principles articulated by them. Many researchers are explicitly adopting these principles to guide what, where, how and when research is undertaken with Indigenous people. With critical reflection to support the implementation of such principles largely absent from published literature, this paper explores both the implementation of, and the outcomes from a set of guiding principles used in a large-scale Australian research collaboration to improve Indigenous health.

METHODS

In this inductive qualitative study, we adopted a principles-focused evaluation approach. Based on interviews with 35 actors in the collaboration and a review of project documents, we generated themes that were then iteratively discussed, refined and categorised into (1) 'strategies'-activities by which implementation of our guiding principles were recognised; (2) 'outcomes'-results seen from implementing the principles and (3) 'conditions'-aspects of the context that facilitated and constrained implementation of the principles.

RESULTS

Respondents found it difficult to articulate how the guiding principles were actually implemented, and frequently referred to them as part of the fabric of the collaboration. They viewed the set of principles as mutually reinforcing, and as providing a rudder for navigating complexity and conflict. Implementation of the principles occurred through five strategies-honouring the principles; being dynamic and adaptable; sharing and dispersing leadership; collaborating purposefully and adopting a culture of mutual learning. Outcomes included increased Indigenous leadership and participation; the ability to attract principled and values-driven researchers and stakeholders, and the development of trusting and respectful relationships. The conditions that facilitated the implementation of the principles were collaborating over time; an increasing number of Indigenous researchers and taking an 'innovation platform' approach.

CONCLUSION

Our findings show that principles guiding collaborations are valuable in providing a focus, direction and a way of working together when they are collaboratively developed, hold genuine meaning for all members and are implemented within a culture of continuous critical reflection, learning and adaptation, with ongoing reinterpretation of the principles over time.

Using developmental evaluation to enhance continuous reflection, learning and adaptation of an innovation platform in Australian Indigenous primary healthcare

Effective efforts to strengthen health systems need diverse, multi-stakeholder networks working together on complex or 'wicked' problems such as prevention and control of chronic diseases, solutions to which go beyond the role and capability of one organisation. The contextual complexities inherent in 'wicked' problems mean that solutions warrant a systems approach that encompasses innovation and new ways of thinking about, facilitating and implementing collective decision-making processes and change practices.Innovation platforms are a mechanism for facilitating communication and collaboration among diverse stakeholders, promoting joint action and stimulating innovation. Developmental evaluation is an approach that is increasingly being used to evaluate innovative and emergent programmes and projects, as it enables evaluators to provide real-time feedback so that evaluation findings can be used to guide development and adaptations. Developmental evaluation emphasises learning and adaptation, and aligns well with the implementation of innovation platforms that have continuous reflection, learning and adaptation as a specific design principle.Here, we outline our rationale for applying a developmental evaluation to enhance the formation, functioning and outcomes of an innovation platform aimed at accelerating and strengthening large-scale quality improvement efforts in Australian Aboriginal and Torres Strait Islander primary healthcare. We provide examples to explain how the developmental evaluation findings were used for adaptation of the innovation platform and assess to what extent our application of developmental evaluation was consistent with, and reflective of, its essential principles.Our evaluation aligned strongly with the principles of developmental evaluation, and the approach we took was well suited to situations with a developmental purpose, innovation niche and complexity such as innovation platforms. As a result, along with the increasing interest in multi-stakeholder platforms (e.g. innovation platforms) and the inherent challenges with evaluating these complex networks, we anticipate our use of this approach being of interest globally.

Rationale and methods for a cross-sectional study of mental health and wellbeing following river flooding in rural Australia, using a community-academic partnership approach

BACKGROUND

Climate change is associated with greater frequency, duration, intensity and unpredictability of certain weather-related events, including floods. Floods harm mental health. There is limited understanding of the mental health and well-being effects from river flooding, particularly over the longer term and in rural contexts. This paper describes the rationale, aims, objectives, study design and socio-demographic characteristics of the sample for a study measuring associations between flood experience and mental health and wellbeing of residents (particularly those most likely to be negatively impacted and hard to reach) in rural NSW Australia 6 months following a devastating flood in 2017. To our knowledge, the study is the first of its kind within Australia in a rural community and is an important initiative given the likelihood of an increasing frequency of severe flooding in Australia given climate change.

METHODS

A conceptual framework (The Flood Impact Framework) drawing on social ecological approaches was developed by the research team. It was based on the literature and feedback from the community. The Framework describes putative relationships between flood exposure and mental health and wellbeing outcomes. Within a community-academic partnership approach, a cross-sectional survey was then undertaken to quantify and further explore these relationships.

RESULTS

The cross-sectional survey was conducted online (including on mobile phone) and on paper between September and November 2017 and recruited 2530 respondents. Of those, 2180 provided complete demographic data, among whom 69% were women, 91% were aged 25-74, 4% identified as Aboriginal and/or Torres Strait Islander, 9% were farmers and 33% were business owners.

CONCLUSIONS

The study recruited a wide range of respondents and the partnership facilitated the community's engagement with the design and implementation of the study. The study will provide a basis for a follow-up study, that will aim to improve the understanding of mental health and wellbeing effects over the longer term. It will provide an important and original contribution to understanding river flooding and mental health in rural Australia, a topic that will grow in importance in the context of human-induced climate change, and identify critical opportunities to strengthen services, emergency planning and resilience to future flooding.

Ventilatory standards for clinically well aboriginal adults

OBJECTIVE

To obtain reference standards for ventilatory function of clinically well Australian Aboriginal adults.

DESIGN

A cross-sectional assessment of the population of a North Queensland Aboriginal community.

SETTING

A specialist clinical and public health service. The measurements were made with the cooperation of the local primary health care centre.

PARTICIPANTS

The 288 study subjects included over 70% of Aboriginal adults residing in an isolated Cape York community. Those with known respiratory disease, abnormal chest x-ray findings, positive loose cough sign, abnormal lung signs or inability to perform the ventilatory tests satisfactorily were excluded; 229 persons (80%) remained for analysis. Smoking was prevalent in both men (85%) and women (76%). As in most other studies producing reference values for lung function, smokers were not excluded.

MAIN OUTCOME MEASURES

Age, standing height in bare feet and sitting height were recorded. Ventilatory measurements included forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and maximum mid-expiratory flow (MMEF) which is also known as the forced expiratory flow (FEF 25%-75%).

RESULTS

Standing height, age and sex were the major determinants of ventilatory function. Sitting height was not a good predictor. Ventilatory values differed significantly from those expected for Europeans: Aboriginal lung volumes were much smaller (by about 25%) and fell much faster with age. The age-related decrease in lung function was less in smokers.

CONCLUSION

The smoking effect may reflect the operation of differential survival or other selective factors and has been noted in some other ethnic groups. Although previous studies have yielded some ventilatory function data on Aborigines, we report the first population-based reference values expected for clinically well adults. The information will be useful to clinicians and public health workers.