Reema Harrison

The Application of e-Mental Health in Response to COVID-19: Scoping Review and Bibliometric Analysis

Publisher: JMIR Publications Inc.

Date: 06-12-2021

DOI: 10.2196/32948

Abstract: The COVID-19 pandemic and its mitigation measures and impacts, such as shelter-in-place orders, social isolation, restrictions on freedoms, unemployment, financial insecurity, and disrupted routines, have led to declines in mental health worldwide and concomitant escalating demands for mental health services. Under the circumstances, electronic mental health (e-mental health) programs and services have rapidly become the “new normal.” The aim of this study was to assess key characteristics and evidence gaps in the e-mental health literature published in relation to the COVID-19 pandemic via a scoping review and bibliometric analysis. We conducted a search of four academic databases (ie, MEDLINE, Embase, PsycInfo, and CINAHL) for documents published from December 31, 2019, to March 31, 2021, using keywords for e-mental health and COVID-19. Article information was extracted that was relevant to the review objective, including journal, type of article, keywords, focus, and corresponding author. Information was synthesized by coding these attributes and was then summarized through descriptive statistics and narrative techniques. Article influence was examined from Altmetric and CiteScore data, and a network analysis was conducted on article keywords. A total of 356 publications were included in the review. Articles on e-mental health quickly thrived early in the pandemic, with most articles being nonempirical, chiefly commentaries or opinions (n=225, 63.2%). Empirical publications emerged later and became more frequent as the pandemic progressed. The United States contributed the most articles (n=160, 44.9%), though a notable number came from middle-income countries (n=59, 16.6%). Articles were spread across 165 journals and had above-average influence (ie, almost half of the articles were in the top 25% of output scores by Altmetric, and the average CiteScore across articles was 4.22). The network analysis of author-supplied keywords identified key topic areas, including specific mental disorders, eHealth modalities, issues and challenges, and populations of interest. These were further explored via full-text analysis. Applications of e-mental health during the pandemic overcame, or were influenced by, system, service, technology, provider, and patient factors. COVID-19 has accelerated applications of e-mental health. Further research is needed to support the implementation of e-mental health across system and service infrastructures, alongside evidence of the relative effectiveness of e-mental health in comparison to traditional modes of care.

Resilience to emotional distress in response to failure, error or mistakes: A systematic review

Publisher: Elsevier BV

Date: 03-2017

DOI: 10.1016/J.CPR.2016.11.007

Abstract: Perceptions of failure have been implicated in a range of psychological disorders, and even a single experience of failure can heighten anxiety and depression. However, not all in iduals experience significant emotional distress following failure, indicating the presence of resilience. The current systematic review synthesised studies investigating resilience factors to emotional distress resulting from the experience of failure. For the definition of resilience we used the Bi-Dimensional Framework for resilience research (BDF) which suggests that resilience factors are those which buffer the impact of risk factors, and outlines criteria a variable should meet in order to be considered as conferring resilience. Studies were identified through electronic searches of PsycINFO, MEDLINE, EMBASE and Web of Knowledge. Forty-six relevant studies reported in 38 papers met the inclusion criteria. These provided evidence of the presence of factors which confer resilience to emotional distress in response to failure. The strongest support was found for the factors of higher self-esteem, more positive attributional style, and lower socially-prescribed perfectionism. Weaker evidence was found for the factors of lower trait reappraisal, lower self-oriented perfectionism and higher emotional intelligence. The majority of studies used experimental or longitudinal designs. These results identify specific factors which should be targeted by resilience-building interventions. Resilience failure stress self-esteem attributional style perfectionism.

Patients' experiences in Australian hospitals: A systematic review of evidence

Publisher: CSIRO Publishing

Date: 2017

DOI: 10.1071/AH16053

Abstract: Objective Patients are uniquely positioned to provide insightful comments about their care. Currently, a lack of comparable patient experience data prevents the emergence of a detailed picture of patients’ experiences in Australian hospitals. The present study addresses this gap by identifying factors reported in primary research as relating to positive and negative experiences of patients in Australian hospitals. Methods Evidence from Australian qualitative studies of patients of all ages reporting their experiences in any hospital or day procedure centre was synthesised. A range of text words, synonyms and subject headings was developed and used to undertake a systematic search of seven electronic databases from January 1995 to July 2015 and the grey literature. Two reviewers independently screened the titles, abstracts or executive summaries and applied the inclusion criteria. Data were synthesised in a meta-narrative. Results Thirty-nine publications were included: 33 articles from database searches and six from the grey literature. Quality improvement researchers produced the dominant narrative and the nursing perspective was strong. Six themes emerged: ‘Reciprocal communication and information sharing’, ‘Interpersonal skills and professionalism’, ‘The care environment’, ‘Emotional support’, ‘Discharge planning and process’ and ‘Correct treatment and physical outcomes’. Conclusion Tangible opportunities to enhance the patient experience are apparent. Small changes to the way that the health system operates and is resourced and the way that health professionals engage with patients could substantially improve care. Ex les include inviting patients and carers to contribute to decision making and discussions about their treatment options and care preferences. What is known about the topic? Patient experience is identified as a key component of an optimal health system, along with improving the health of populations and reducing the per capita costs of care. The use of patient experience data has been associated with improved clinical effectiveness and patient safety. What does this paper add? Patient experience data are currently not routinely captured and difficulties exist as to where this information is available. These data are gathered using a variety of different methods that prohibit the development of a national picture. As a step towards overcoming this barrier, the present study identifies the common elements of healthcare experience reported by patients in Australia as being positive or negative. What are the implications for practitioners? Ensuring that patients and carers are active partners in their care is at the centre of a positive patient experience. Health professionals should provide patients with opportunities to make decisions about their care and ask questions, and to provide clear information before, during and after hospitalisation to enhance patients’ experiences in Australian hospitals.

Inequities in quality and safety outcomes for hospitalized children with intellectual disability

Publisher: Wiley

Date: 25-09-2022

DOI: 10.1111/DMCN.15066

Abstract: To investigate if there are inequities in quality and safety outcomes for children with intellectual disability admitted to two tertiary paediatric hospitals. A cross‐sectional study of 1367 admissions for 1018 randomly selected patients admitted for more than 23 hours to one of two tertiary children’s hospitals in Sydney, Australia (1st January–31st December 2017). Electronic medical records were manually interrogated to identify children with intellectual disability (including developmental delay). Data extracted included patient demographics, length of stay, number of admissions, and reported clinical incidents. In total, 12.3% ( n =125) of children admitted during the study period had intellectual disability, which represented 13.9% ( n =190) of admissions. Sex and age at admission in children with and without intellectual disability were similar: 83 (43.7%) vs 507 (43.1%) females and 107 (56.3%) vs 670 (56.9%) males, p =0.875 median age 3 years (0–18y) vs 4 years (0–18y), p =0.122. Children with intellectual disability had significantly greater median length of stay (100.5h vs 79h, p .001) and cost of admission (A$11 596.38 vs A$8497.96) than their peers ( p =0.001). Children with intellectual disability had more admissions with at least one incident compared to children without intellectual disability (14.7% vs 9.7%) this was not statistically significant ( p =0.06). Children with intellectual disability experience inequitable quality and safety outcomes in hospital. Engaging children and families in clinical incident reporting may enhance understanding of safety risks for children with intellectual disability in hospital.

A Survey of the Impact of Patient Adverse Events and near Misses on Anaesthetists in Australia and New Zealand

Publisher: SAGE Publications

Date: 09-2019

DOI: 10.1177/0310057X1804600513

Abstract: We conducted a cross-sectional online survey of members of the Australian and New Zealand College of Anaesthetists to investigate their experiences of adverse patient safety events and near misses, including their use of incident reporting systems and the organisational support available. There were 247 respondents. Of the 243 anaesthetists whose patients had an adverse event or near miss, 199 reported this had affected them personally or professionally 177 reported stress, 153 anxiety, 109 sleep disturbance, and 127 lower professional confidence. Of 188 who had reported an adverse event using their local incident reporting systems, 68 were satisfied with this process, 136 received useful feedback, 114 saw local improvements, and 104 saw system changes. Two hundred and thirty-four reported feeling determined to improve, and 228 were anxious about the potential for future errors. Seventy-five anaesthetists admitted not reporting a safety incident that they knew they should have. Reasons for not reporting included an impression that nothing would improve from incident reporting, that reporting was onerous, or fears of punitive action. These findings should spur anaesthetists, anaesthetic departments and professional organisations across Australia and New Zealand to examine their support mechanisms in relation to adverse events and errors and their incident reporting mechanisms, and to attempt to improve these services where necessary.

Seldom heard voices: a meta-narrative systematic review of Aboriginal and Torres Strait Islander peoples healthcare experiences

Publisher: Springer Science and Business Media LLC

Date: 12-2020

DOI: 10.1186/S12939-020-01334-W

Abstract: It is well established that Aboriginal and Torres Strait Islander populations face considerable health inequities, exacerbated by poorer healthcare quality. Patient experience is recognised as a major contributing factor to healthcare quality and outcomes, therefore, enriched knowledge of the patient experiences of Aboriginal and Torres Strait Islander populations is critical to redress health inequities. This review synthesises evidence of the healthcare experiences amongst Aboriginal and Torres Strait Islander patients through a metanarrative synthesis of qualitative literature. A systematic search strategy was developed and applied to six electronic databases between January 2000 and July 2019. Titles and abstracts were screened before applying the inclusion criteria to full text articles. A meta-narrative synthesis was undertaken. Fifty-four publications were identified from four research traditions each with a unique conceptualisation of patient experience. Three themes emerged that demonstrate Aboriginal and Torres Strait Islander patient experiences are informed by 1) beliefs about wellbeing and healthcare provision, 2) their level of trust in the healthcare system, and 3) in idual and community health system interactions. The findings highlight a range of aspects of patient experience that were important to participating Aboriginal and Torres Strait Islanders in the included studies but not captured currently in health system surveys. This review highlights the influence of beliefs about health and wellbeing on the patient experience amongst Aboriginal and Torres Strait Islander populations in the Australian health system. Patient experiences were informed by past experience and their trust in the health system. The different factors influencing patient experience and the gravity of their influence must be considered in current approaches to capturing patient experience data collection methods. PROSPERO (ID: CRD42019134765 ).

Is Physician Mentorship Associated With the Occurrence of Adverse Patient Safety Events?

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 14-03-2019

DOI: 10.1097/PTS.0000000000000592

Clinicians’ Experience of Providing Care: A Rapid Review

Publisher: Research Square Platform LLC

Date: 12-05-2020

DOI: 10.21203/RS.3.RS-26639/V1

Abstract: Background Health care services internationally are refocussing care delivery towards patient centred, integrated care that utilises effective, efficient and innovative models of care to optimise patient outcomes and system sustainability. Whilst significant efforts have been made to examine and enhance patient experience, to date little has progressed in relation to provider experience. This review aims to explore this knowledge gap by capturing evidence of clinician experience, and how this experience is defined and measured in the context of health system change and innovation. Methods: A rapid review of published and grey literature review was conducted utilising a rapid evidence assessment methodology. 79 studies retrieved from the literature were included in the review. 14 articles were identified from the grey literature search and one article obtained via hand searching. In total, 94 articles were included in the review. This study was commissioned by and co-designed with the New South Wales, Ministry of Health. Results: Clinician experience of delivering health care is inconsistently defined in the literature, with identified articles lacking clarity regarding distinctions between experience, engagement and work-related outcomes such as job satisfaction. Clinician experience was commonly explored using qualitative research that focused on experiences of discrete health care activities or events in which a change was occurring. Such research enabled exploration of complex experiences. In these contexts, clinician experience was captured in terms of self-reported information that clinicians provided about the health care activity or event, their perceptions of its value, the lived impacts they experienced, and the specific behaviours they displayed in relation to the activity or event. Moreover, clinician’s experience has been identified to have a paucity of measurement tools. Conclusion: Literature to date has not examined clinician experience in a holistic sense. In order to achieve the goals identified in relation to value-based care, further work is needed to conceptualise clinician experience and understand the nature of measurement tools required to assess this. In health system application, a broader ‘clinician pulse’ style assessment may be valuable to understand the experience of clinical work on a continuum rather than in the context of episodes of change/care.

Collective leadership to improve professional practice, healthcare outcomes, and staff well-being

Publisher: Wiley

Date: 19-01-2021

DOI: 10.1002/14651858.CD013850

Investigating the system effect of reporting multidisciplinary care measures for cancer services in New South Wales, Australia

Publisher: Springer Science and Business Media LLC

Date: 02-10-2021

DOI: 10.1186/S12913-021-07050-7

Abstract: Multidisciplinary cancer care to facilitate the provision of patient centred and evidence-based care is considered best practice internationally. In 2016 multidisciplinary care measures were developed for all local health districts across NSW. The aim of this study was to identify system-level changes and quality improvement activities across the NSW cancer system linked to reporting on these measures. Focus group discussions were used to generate a synergy of ideas from key stakeholders. An exploratory descriptive approach was used within the ontological position of Framework Analysis, the analysis method chosen for this research study, sitting most closely within pragmatism. The use of Framework Analysis in the analytic strategy is because it is well-suited to addressing policy issues and maintaining specific focus within a wider dataset. Two focus groups were held with a total of 18 purposively selected participants. Four primary themes emerged: value of electronic documentation role clarity relationships and future development of measures. Key findings included that the reporting of performance measures has expedited the development of electronic documentation and data extraction from the multidisciplinary team meeting (MDT), identified barriers and facilitators to MDT data collection and supported MDT improvement activities across NSW. The findings of this study have highlighted that MDTs and their meetings across NSW are harnessing technological advancements to support and further develop their MDTs, as well as the challenges of implementing new processes within the MDTM. This study adds a unique contribution to knowledge of how the reporting of measures can assist in understanding variation in the development and implementation of multidisciplinary teams, as well as highlighting future programs of work to decrease variation in multidisciplinary team meetings and quality improvement activities.

Do patient engagement interventions work for all patients? A systematic review and realist synthesis of interventions to enhance patient safety

Publisher: Wiley

Date: 25-08-2021

DOI: 10.1111/HEX.13343

Abstract: Patients are increasingly being asked for feedback about their healthcare and treatment, including safety, despite little evidence to support this trend. This review identifies the strategies used to engage patients in safety during direct care, explores who is engaged and determines the mechanisms that impact effectiveness. A systematic review was performed of seven databases (CINAHL, Cochrane, Cochrane‐Central, Embase, ISI Web of Science, Medline, PsycINFO) that included research published between 2010 and 2020 focused on patient engagement interventions to increase safety during direct care and reported using PRISMA. All research designs were eligible two reviewers applied criteria independently to determine eligibility and quality. A narrative review and realist synthesis were conducted. Twenty‐six papers reporting on twenty‐seven patient engagement strategies were included and classified as consultation (9), involvement (7) and partnership (11). The definitions of ‘patient engagement’ varied, and we found limited details about participant characteristics or interactions between people utilizing strategies. Collaborative strategy development, a user‐friendly design, proactive messaging and agency sponsorship were identified as mechanisms to improve engagement about safety at the point of direct care. Agency sponsorship of collaboration between staff and patients is essential in the development and implementation of strategies to keep patients safe during direct care. Insufficient details about participant characteristics and patient–provider interactions limit recommendations for practice change. More needs to be learned about how patients are engaged in discussions about safety, particularly minority groups unable to engage with standard information. Review progress was reported to the CanEngage team, including the consumer steering group, to inform project priorities (PROSPERO CRD42020196453).

The ultimate question? Evaluating the use of Net Promoter Score in healthcare: A systematic review

Publisher: Wiley

Date: 19-08-2022

DOI: 10.1111/HEX.13577

Abstract: Patient experience is a complex phenomenon that presents challenges for appropriate and effective measurement. With the lack of a standardized measurement approach, efforts have been made to simplify the evaluation and reporting of patient experience by using single‐item measures, such as the Net Promoter Score (NPS). Although NPS is widely used in many countries, there has been little research to validate its effectiveness and value in the healthcare setting. The aim of this study was to systematically evaluate the evidence that is available about the application of NPS in healthcare settings. Studies were identified using words and synonyms that relate to NPS, which was applied to five electronic databases: Medline, CINAHL, Proquest, Business Journal Premium, and Scopus. Titles and abstracts between January 2005 and September 2020 were screened for relevance, with the inclusion of quantitative and qualitative studies in the healthcare setting that evaluated the use of NPS to measure patient experience. Twelve studies met the inclusion criteria. Four studies identified benefits associated with using NPS, such as ease of use, high completion rates and being well‐understood by a range of patients. Three studies questioned the usefulness of the NPS recommendation question in healthcare settings, particularly when respondents are unable to select their service provider. The free‐text comments section, which provides additional detail and contextual cues, was viewed positively by patients and staff in 4 of 12 studies. According to these studies, NPS can be influenced by a wide range of variables, such as age, condition/disease, intervention and cultural variation therefore, caution should be taken when using NPS for comparisons. Four studies concluded that NPS adds minimal value to healthcare improvement. The literature suggests that many of the proposed benefits of using NPS are not supported by research. NPS may not be sufficient as a stand‐alone metric and may be better used in conjunction with a larger survey. NPS may be more suited for use in certain healthcare settings, for ex le, where patients have a choice of provider. Staff attitudes towards the use of NPS for patient surveying are mixed. More research is needed to validate the use of NPS as a primary metric of patient experience. Consumer representatives were provided with the research findings and their feedback was sought about the study. Consumers commented that they found the results to be useful and felt that this study highlighted important considerations when NPS data is used to evaluate patient experience.

Assessing the environment for engagement in health services: The Audit for Consumer Engagement (ACE) tool

Publisher: Wiley

Date: 28-10-2022

DOI: 10.1111/HEX.13610

Abstract: Although it is widely accepted that the physical environment can impact health quality and care outcomes, its impact on consumer engagement with health services has not been examined. Currently, no tools exist that assess the opportunities for consumer engagement offered within the physical environment. We aimed to develop and validate an environmental audit tool to assist health services and researchers to assess the extent to which the physical environment in health services creates and supports opportunities for consumer engagement. An iterative, team‐based approach in partnership with erse stakeholders was used to develop the Audit for Consumer Engagement (ACE) tool. A four‐stage process consisting of desktop review, concept clarification, identification of domains and validation was implemented. The tool was validated in one cancer service via face and content validation and inter‐rater reliability was also assessed. The ACE tool was demonstrated to comprise four main domains (access and signage information resources for consumers resources to support ersity and consumer engagement events or activities) measured with 17 items. Face and content validity was achieved, and preliminary reliability analysis indicated substantial agreement between the two researchers for all four domains with an average of 86% agreement. The ACE is a novel tool that is practical, relevant and reliable, and developed in partnership with consumers and health service providers. The tool can be used by health service providers, researchers and consumer agency groups to assess opportunities for consumer engagement offered within the physical environment of cancer services. The ACE tool has the potential to be used as a guide for enhancing consumer engagement opportunities and for research purposes. Further evidence about the validity of the tool is required, including criterion‐related validity and utility in other health settings. This project is part of a wider ‘CanEngage’ project that includes a consumer investigator and is supported by a consumer advisory group. This study was completed in active partnership with members of a consumer advisory group from erse backgrounds. Feedback was sought from the members throughout the development process of the tool with findings discussed with the CanEngage group members in scheduled meetings.

The missing evidence: a systematic review of patients' experiences of adverse events in health care

Publisher: Oxford University Press (OUP)

Date: 29-09-2015

DOI: 10.1093/INTQHC/MZV075

Abstract: Preventable patient harm due to adverse events (AEs) is a significant health problem today facing contemporary health care. Knowledge of patients' experiences of AEs is critical to improving health care safety and quality. A systematic review of studies of patients' experiences of AEs was conducted to report their experiences, knowledge gaps and any challenges encountered when capturing patient experience data. Key words, synonyms and subject headings were used to search eight electronic databases from January 2000 to February 2015, in addition to hand-searching of reference lists and relevant journals. Titles and abstracts of publications were screened by two reviewers and checked by a third. Full-text articles were screened against the eligibility criteria. Data on design, methods and key findings were extracted and collated. Thirty-three publications demonstrated patients identifying a range of problems in their care most commonly identified were medication errors, communication and coordination of care problems. Patients' income, education, health burden and marital status influence likelihood of reporting. Patients report distress after an AE, often exacerbated by receiving inadequate information about the cause. Investigating patients' experiences is h ered by the lack of large representative patient s les, data over sufficient time periods and varying definitions of an AE. Despite the emergence of policy initiatives to enhance patient engagement, few studies report patients' experiences of AEs. This information must be routinely captured and utilized to develop effective, patient-centred and system-wide policies to minimize and manage AEs.

Improving Medication Safety in Cancer Services for Ethnic Minority Consumers: Protocol for a Pilot Feasibility and Acceptability Study of a Co-Designed Consumer Engagement Intervention (Preprint)

Publisher: JMIR Publications Inc.

Date: 13-06-2023

DOI: 10.2196/PREPRINTS.49902

Abstract: eople from ethnic minority backgrounds are more at risk of poor care and outcomes in health services, this inequity is widely recognised. We used an adapted, experience-based co-design (EBCD) process to facilitate collaboration between staff and ethnic minority patients to identify key safety issues and devise a tailored solution at a cancer service in New South Wales, Australia. Identifying health service contact points relevant to medication concerns between appointments or hospital admissions was a key issue identified in the workshop. The co-design process resulted in the creation of a communication tool: Making it Meaningful (MiM). This protocol presents a pilot study testing whether MiM is feasible and acceptable for use with ethnic minority consumers in cancer services in Australia. This protocol is particularly significant as co-designed interventions are increasingly valued, but rarely documented in trials. o test whether MiM is feasible and acceptable for use with ethnic minority consumers in cancer services in Australia. single-site, controlled before and after pilot study to determine the feasibility and acceptability of ‘MiM’. Forty patients from Chinese and Russian cultural backgrounds will be recruited 20 treatment and 20 control. These cohorts were selected as the co-design participants identified these communities are at particular risk of medication safety concerns. The intervention group will use the MiM tool during usual appointments ,while the control group will receive routine care. Telephone surveys will be conducted with patients at three time points to assess patient knowledge and self-efficacy in medication management, and the perceived usability and acceptability of the MiM. Qualitative interviews with staff will be conducted at pilot conclusion to explore practitioner perceptions of MiM feasibility and acceptability. sing Evidence Based Codesign (EBCD) we identified communication about medication, particularly between appointments, as a key issue. Increasing consumer engagement in medication management was identified as a strategy to reduce medication safety problems in cancer care the MiM was developed to address this issue. his study involves implementation and evaluation of the feasibility and acceptability of the MiM, together with preliminary data on patient knowledge about prescribed medications and confidence in medication management, with a view to expanding the study to test whether the intervention is effective in improving patient outcomes. his protocol is registered with Australian New Zealand Clinical Trials Registry RN: ACTRN12622001260718p

Optimising co-design with ethnic minority consumers

Publisher: Springer Science and Business Media LLC

Date: 04-11-2021

DOI: 10.1186/S12939-021-01579-Z

Abstract: Co-design as a participatory method aims to improve health service design and implementation. It is being used more frequently by researchers and practitioners in various health and social care settings. Co-design has the potential for achieving positive outcomes for the end users involved in the process however, involvement of erse ethnic minority population in the process remains limited. While the need to engage with erse voices is identified, there is less information available on how to achieve meaningful engagement with these groups. Ethnic minorities are super- erse population and the ersity between and within these groups need consideration for optimising their participation in co-design. Based on our experience of working with erse ethnic minority groups towards the co-design of consumer engagement strategies to improve patient safety in cancer services as part of the two nationally-funded research projects in Australia, we outline reflections and practical techniques to optimise co-design with people from erse ethnic backgrounds. We identify three key aspects of the co-design process pertinent to the involvement of this population 1) starting at the pre-commencement stage to ensure erse, seldom heard consumers are invited to and included in co-design work, 2) considering logistics and adequate resources to provide appropriate support to address needs before, during and beyond the co-design process, and 3) supporting and enabling a ersity of contributions via the co-design process.

Burnout in medical students: A systematic review of experiences in Chinese medical schools

Publisher: Springer Science and Business Media LLC

Date: 16-11-2017

DOI: 10.1186/S12909-017-1064-3

Mentorship for Newly Appointed Physicians

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 09-2014

DOI: 10.1097/PTS.0B013E31829E4B7E

Interprofessional collaboration to improve professional practice and healthcare outcomes

Publisher: Wiley

Date: 22-06-2017

DOI: 10.1002/14651858.CD000072.PUB3

Erratum

Publisher: Wiley

Date: 03-04-2015

DOI: 10.1111/BJHP.12140

What does co-design mean for Australia’s diverse clinical workforce?

Publisher: CSIRO Publishing

Date: 30-08-2021

DOI: 10.1071/AH21116

Abstract: Co-design is increasingly employed as a user-centric method to create healthcare change. In healthcare co-design, small groups of consumers and healthcare workers come together to identify processes, policies or service elements that require improvement and to design solutions. Multiple frameworks have emerged to guide the health work force and health researchers how to conduct co-design and support consumer members to engage in the process effectively. Frameworks have sought to address the propensity for co-design to exacerbate inequities for consumers with complex care needs or in under-served populations. Advice regarding the need to consider and ensure co-design is accessible to an increasingly erse health workforce is, however, lacking. Drawing on our experience co-designing with erse consumer and healthcare-worker populations, we discuss the implications of co-design for the healthcare workforce.

Supporting efficiency improvement in public health systems: a rapid evidence synthesis

Publisher: Springer Science and Business Media LLC

Date: 03-03-2022

DOI: 10.1186/S12913-022-07694-Z

Abstract: Public health systems internationally are under pressure to meet increasing demand for healthcare in the context of increasing financial resource constraint. There is therefore a need to maximise health outcomes achieved with public healthcare expenditure. This paper aims to establish and synthesize the contemporary evidence base for approaches taken at a system management level to improve efficiency. Rapid Evidence Assessment (REA) methodology was employed. A search strategy was developed and applied (PUBMED, MEDLINE) returning 5,377 unique titles. 172 full-text articles were screened to determine relevance with 82 publications included in the final review. Data regarding country, study design, key findings and approaches to efficiency improvement were extracted and a narrative synthesis produced. Publications covering health systems from developed countries were included. Identified study designs included policy reviews, qualitative reviews, mixed methods reviews, systematic reviews, literature reviews, retrospective analyses, scoping reviews, narrative papers, regression analyses and opinion papers. While findings revealed no comprehensive frameworks for system-wide efficiency improvement, a range of specific centrally led improvement approaches were identified. Elements associated with success in current approaches included dedicated central functions to drive system-wide efficiency improvement, managing efficiency in tandem with quality and value, and inclusive stakeholder engagement. The requirement for public health systems to improve efficiency is likely to continue to increase. Reactive cost-cutting measures and short-term initiatives aimed only at reducing expenditure are unlikely to deliver sustainable efficiency improvement. By providing dedicated central system-wide efficiency improvement support, public health system management entities can deliver improved financial, health service and stakeholder outcomes.

Can we prepare healthcare professionals and students for involvement in stressful healthcare events? A mixed-methods evaluation of a resilience training intervention

Publisher: Springer Science and Business Media LLC

Date: 27-11-2020

DOI: 10.1186/S12913-020-05948-2

Abstract: Healthcare professionals are experiencing unprecedented levels of occupational stress and burnout. Higher stress and burnout in health professionals is linked with the delivery of poorer quality, less safe patient care across healthcare settings. In order to understand how we can better support healthcare professionals in the workplace, this study evaluated a tailored resilience coaching intervention comprising a workshop and one-to-one coaching session addressing the intrinsic challenges of healthcare work in health professionals and students. The evaluation used an uncontrolled before-and-after design with four data-collection time points: baseline (T1) after the workshop (T2) after the coaching session (T3) and four-to-six weeks post-baseline (T4). Quantitative outcome measures were Confidence in Coping with Adverse Events (‘Confidence’), a Knowledge assessment (‘Knowledge’) and Resilience. At T4, qualitative interviews were also conducted with a subset of participants exploring participant experiences and perceptions of the intervention. We recruited 66 participants, retaining 62 (93.9%) at T2, 47 (71.2%) at T3, and 33 (50%) at T4. Compared with baseline, Confidence was significantly higher post-intervention: T2 (unadj. β = 2.43, 95% CI 2.08–2.79, d = 1.55, p .001), T3 (unadj. β = 2.81, 95% CI 2.42–3.21, d = 1.71, p .001) and T4 (unadj. β = 2.75, 95% CI 2.31–3.19, d = 1.52, p .001). Knowledge increased significantly post-intervention (T2 unadj. β = 1.14, 95% CI 0.82–1.46, d = 0.86, p .001). Compared with baseline, resilience was also higher post-intervention (T3 unadj. β = 2.77, 95% CI 1.82–3.73, d = 0.90, p .001 and T4 unadj. β = 2.54, 95% CI 1.45–3.62, d = 0.65, p .001). The qualitative findings identified four themes. The first addressed the ‘tension between mandatory and voluntary delivery’, suggesting that resilience is a mandatory skillset but it may not be effective to make the training a mandatory requirement. The second, the ‘importance of experience and reference points for learning’, suggested the intervention was more appropriate for qualified staff than students. The third suggested participants valued the ‘peer learning and engagement’ they gained in the interactive group workshop. The fourth, ‘opportunities to tailor learning’, suggested the coaching session was an opportunity to personalise the workshop material. We found preliminary evidence that the intervention was well received and effective, but further research using a randomised controlled design will be necessary to confirm this.

Integrative omics identifies conserved and pathogen-specific responses of sepsis-causing bacteria

Publisher: Springer Science and Business Media LLC

Date: 18-03-2023

DOI: 10.1038/S41467-023-37200-W

Abstract: Even in the setting of optimal resuscitation in high-income countries severe sepsis and septic shock have a mortality of 20–40%, with antibiotic resistance dramatically increasing this mortality risk. To develop a reference dataset enabling the identification of common bacterial targets for therapeutic intervention, we applied a standardized genomic, transcriptomic, proteomic and metabolomic technological framework to multiple clinical isolates of four sepsis-causing pathogens: Escherichia coli , Klebsiella pneumoniae species complex, Staphylococcus aureus and Streptococcus pyogenes . Exposure to human serum generated a sepsis molecular signature containing global increases in fatty acid and lipid biosynthesis and metabolism, consistent with cell envelope remodelling and nutrient adaptation for osmoprotection. In addition, acquisition of cholesterol was identified across the bacterial species. This detailed reference dataset has been established as an open resource to support discovery and translational research.

Quality assessment with diverse studies (QuADS): an appraisal tool for methodological and reporting quality in systematic reviews of mixed- or multi-method studies

Publisher: Springer Science and Business Media LLC

Date: 15-02-2021

DOI: 10.1186/S12913-021-06122-Y

Abstract: In the context of the volume of mixed- and multi-methods studies in health services research, the present study sought to develop an appraisal tool to determine the methodological and reporting quality of such studies when included in systematic reviews. Evaluative evidence regarding the design and use of our existing Quality Assessment Tool for Studies with Diverse Designs (QATSDD) was synthesised to enhance and refine it for application across health services research. Secondary data were collected through a literature review of all articles identified using Google Scholar that had cited the QATSDD tool from its inception in 2012 to December 2019. First authors of all papers that had cited the QATSDD ( n =197) were also invited to provide further evaluative data via a qualitative online survey. Evaluative findings from the survey and literature review were synthesised narratively and these data used to identify areas requiring refinement. The refined tool was subject to inter-rater reliability, face and content validity analyses. Key limitations of the QATSDD tool identified related to a lack of clarity regarding scope of use of the tool and in the ease of application of criteria beyond experimental psychological research. The Quality Appraisal for Diverse Studies (QuADS) tool emerged as a revised tool to address the limitations of the QATSDD. The QuADS tool demonstrated substantial inter-rater reliability (k=0.66), face and content validity for application in systematic reviews with mixed, or multi-methods health services research. Our findings highlight the perceived value of appraisal tools to determine the methodological and reporting quality of studies in reviews that include heterogeneous studies. The QuADS tool demonstrates strong reliability and ease of use for application to multi or mixed-methods health services research.

Evaluating clinician experience in value-based health care

Publisher: Springer Science and Business Media LLC

Date: 06-12-2022

DOI: 10.1186/S12913-022-08900-8

Abstract: Clinicians’ experiences of providing care constitute an important outcome for evaluating care from a value-based healthcare perspective. Yet no currently available instruments have been designed and validated for assessing clinicians’ experiences. This research sought to address this important gap by developing and validating a novel instrument in a public health system in Australia. A multi-method project was conducted using co-design with 12 clinician leaders from a range of NSW Health Local Health Districts to develop the Clinician Experience Measure (CEM). Validity and reliability analyses were conducted in two stages, first assessing face and content validity with a pool of 25 clinicians and then using psychometric analysis with data from 433 clinicians, including nurses, doctors and allied health and representing all districts within one jurisdiction in Australia. Data gathered from 25 clinicians via the face and content validity process indicated that the initial 31-items were relevant to the range of staff employed in the NSW state health system, with minor edits made to the survey layout and wording within two items. Psychometric analysis led to a rationalised 18-item final instrument, comprising four domains: psychological safety (4-items) quality of care (5-items) clinician engagement (4-items) and interprofessional collaboration (5-items). The 18-item four-factor model produced a good fit to the data and high levels of reliability, with factor loadings ranging from .62 to .94, with Cronbach’s alpha (range: .83 to .96) and composite reliability (range: .85 to .97). The CEM is an instrument to capture clinicians’ experiences of providing care across a health system. The CEM provides a useful tool for healthcare leaders and policy makers to benchmark and assess the impact of value-based care initiatives and direct change efforts.

Toward Constructive Change After Making a Medical Error: Recovery From Situations of Error Theory as a Psychosocial Model for Clinician Recovery

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 27-05-2022

DOI: 10.1097/PTS.0000000000001038

Preparing for partnerships in cancer care: an explorative analysis of the role of family-based caregivers

Publisher: Springer Science and Business Media LLC

Date: 29-06-2021

DOI: 10.1186/S12913-021-06611-0

Abstract: Family-based ‘informal’ caregivers are critical to enable sustainable cancer care that produces optimal health outcomes but also gives rise to psychological burdens on caregivers. Evidence of psychosocial support for caregivers does not currently address the impacts of their role in providing clinical and health-related care for their loved ones. The present study sought to address this gap including with those from priority populations. Qualitative data was collected using focus group and interview methods. We purposively s led caregivers identified as having a high burden of responsibility for providing clinical care including those from ethnic minority backgrounds, parental caregivers and those living rurally. Transcripts were subject to thematic analysis utilising a team-based approach. Family-based caregivers included spouses (11), parents (7), children (1), siblings (1). Ten participants were from ethnic minority backgrounds and five participants were from regional or rural locations. Four resulting inter-related themes were 1) Dual burden of providing clinical care and managing personal emotional distress 2) Navigating healthcare partnership dynamics 3) Developing a caregiving skillset, and 4) Unique supportive needs and barriers to access. These data provide evidence of the unique challenge of providing clinical care as part of family-based caregiving for a loved one with cancer, and the absence of support for caregivers to take up this role. Our findings highlight the substantial contribution of family-based caregivers to the provision of cancer care in contemporary health systems. Inadequate support for caregivers is apparent with regard to their role in providing clinical aspects of care such as medication administration and management. Support programs to prepare caregivers to provide clinical care while building capacity to manage their stressors and emotions through this challenging period may be valuable towards sustainable, person-centred care.

Physical activity and adolescents: An exploratory randomized controlled trial investigating the influence of affective and instrumental text messages

Publisher: Wiley

Date: 11-2010

DOI: 10.1348/135910710X486889

<p>Open disclosure of adverse events: exploring the implications of service and policy structures on practice</p>

Publisher: Informa UK Limited

Date: 2019

DOI: 10.2147/RMHP.S180359

‘Making it Meaningful’: Co-designing an intervention to improve medication safety for people from culturally and linguistically diverse backgrounds accessing cancer services.

Publisher: The Beryl Institute

Date: 02-08-2023

DOI: 10.35680/2372-0247.1732

Creating equitable healthcare quality and safety for children with intellectual disability in hospital

Publisher: Wiley

Date: 05-06-2020

DOI: 10.1111/CCH.12787

Doctors’ experiences of adverse events in secondary care: the professional and personal impact

Publisher: Royal College of Physicians

Date: 12-2014

DOI: 10.7861/CLINMEDICINE.14-6-585

Mentorship for newly appointed consultants: what makes it work?

Publisher: Oxford University Press (OUP)

Date: 20-06-2014

DOI: 10.1136/POSTGRADMEDJ-2013-132333

Abstract: Mentorship has been identified as a beneficial practice for doctors and may be particularly valuable for newly appointed consultants. It is associated with a number of potential clinical and non-clinical gains, such as enhanced job satisfaction and well-being. Despite strong support, many formalised schemes fail to launch or gain momentum. Research to date has largely focused on the gains associated with mentorship but has lacked study of the factors that facilitate uptake and maintenance of mentoring relationships by physicians. To explore perceptions of mentorship, the extent to which UK doctors appear to value mentorship and factors that may contribute to its successful use. Qualitative, descriptive, multi-centre study. 30 doctors including registrars, those newly appointed to consultant grade, senior doctors and medical leaders from nine hospitals in the north of England. Semistructured in idual interviews were undertaken between August and December 2013. Findings revealed a demand for mentorship for new consultants, with widely recognised benefits associated with its use. Several factors were identified as critical to successful mentorship relationships, including consistent understanding and expectations of mentorship between mentee and mentor, positive prior experiences, a suitable match between mentee and mentor, making time for people to act as mentors and the ensuring that mentors can meet a erse and changing set of needs. Mentorship for newly appointed consultants is valued, but current models of mentorship may suffer from rigid structures, mismatched expectations of participants and the absence of a culture of mentorship from training into practice. A social network approach, in which doctors have the opportunity to engage with a range of mentors through informal and naturally occurring relationships, may be one way to encourage successful and sustained mentoring relationships among doctors. An organisational culture in which mentorship is permitted and is the norm may enable such approaches to be widely adopted.

Review: Home health nurses coping with practice care errors

Publisher: SAGE Publications

Date: 16-09-2011

DOI: 10.1177/1744987111411432

Is there an association between out-of-pocket hospital costs, quality and care outcomes?

Publisher: Springer Science and Business Media LLC

Date: 13-09-2023

DOI: 10.1186/S12913-023-09941-3

Value‐based public health: Moving beyond value‐based health care to support a wellbeing economy

Publisher: Wiley

Date: 18-05-2023

DOI: 10.1002/HPJA.736

Abstract: While value‐based health care (VBHC) is transforming Australia's health system, with its focus on patient‐centred care and outcomes, it cannot transform Australia's health without policy action to address the social determinants of health. Australia is moving towards a wellbeing economy, but governments have not been explicit in the methods by which the health system will contribute to the development of a wellbeing economy at a macro level. It is also unclear how governments will ensure that approaches to valuing wellbeing will complement current health care innovations in defining and evaluating value in relation to health outcomes. To address this gap, we present a value‐based public health (VBPH) framework to conceptualise a health‐informed model to expand current thinking about defining, delivering and evaluating the value of population health and wellbeing. The framework provides a critical and innovative approach beyond VBHC for improving population health and wellbeing outcomes, in alignment with principles and measures being put forth in early ex les of governments using wellbeing economy policies. In VBPH, the focus is on ensuring value in interventions to improve population outcomes. VBPH offers an approach for joined‐up policy across government, using Health in All Policies for multi‐sector public health interventions in response to population needs, across full cycles of policy development, implementation and evaluation. It promotes social return on investment methods to measure outcomes that matter to erse stakeholders within and across communities. VBPH also requires cost estimation from a whole of government perspective, across complete cycles and stages of policy.

Collective leadership to improve professional practice, healthcare outcomes and staff well-being

Publisher: Wiley

Date: 10-10-2022

DOI: 10.1002/14651858.CD013850.PUB2

Enhancing ovarian cancer care: a systematic review of guideline adherence and clinical variation

Publisher: Springer Science and Business Media LLC

Date: 12-03-2019

DOI: 10.1186/S12889-019-6633-4

A realist process evaluation of an intervention to promote competencies in interprofessional collaboration among interdisciplinary integrated care teams for older people: Study protocol.

Publisher: F1000 Research Ltd

Date: 13-09-2023

DOI: 10.12688/HRBOPENRES.13729.1

Patients' reports of adverse events: a data linkage study of Australian adults aged 45 years and over

Publisher: BMJ

Date: 29-03-2017

DOI: 10.1136/BMJQS-2016-006339

Abstract: Understanding a patient's hospital experience is fundamental to improving health services and policy, yet, little is known about their experiences of adverse events (AEs). This study redresses this deficit by investigating the experiences of patients in New South Wales hospitals who suffered an AE. Data linkage was used to identify a random s le of 20 000 participants in the 45 and Up Cohort Study, out of 267 153 adults aged 45 years and over, who had been hospitalised in the prior 6 months. A cross-sectional survey was administered to these patients to capture their experiences, including whether they had an AE and received honest communication about it. Of the 18 993 eligible participants, 7661 completed surveys were received (40% response rate) and 474 (7%) reported having an AE. Most AEs related to clinical processes and procedures (33%), or medications and intravenous fluids (21%). Country of birth and admission through emergency were significant predictors of the occurrence of an event. An earlier admission in the prior 6 months or a transfer to another healthcare facility was also associated with more AEs. Of those who suffered an AE, 58% reported serious or moderate effects. Given the exclusions in our s le population (under 45 years), the AE rate reported by patients of 7% is similar to the approximately 10% rate reported in the general population by retrospective medical record reviews. AE data that include patient experience may provide contextual information currently missing. Capturing and using patient experience data more effectively is critical there may be opportunities for applying co-design methodology to improve the management of AEs and be more responsive to patients' concerns.

How do health services engage culturally and linguistically diverse consumers? An analysis of consumer engagement frameworks in Australia

Publisher: Wiley

Date: 15-07-2021

DOI: 10.1111/HEX.13315

Abstract: Engagement frameworks provide the conceptual structure for consumer engagement in healthcare decision making, but the level to which these frameworks support culturally and linguistically erse (CALD) consumer engagement is not known. This study aimed to investigate how consumer engagement is conceptualised and operationalized and to determine the implications of current consumer engagement frameworks for engagement with CALD consumers. Altheide's document analysis approach was used to guide a systematic search, selection and analytic process. Australian Government health department websites were searched for eligible publicly available engagement frameworks. A narrative synthesis was conducted. Eleven engagement frameworks published between 2007 and 2019 were identified and analysed. Only four frameworks discussed engagement with CALD consumers distinctly. Organisational prerequisites to enhance engagement opportunities and approaches to enable activities of engagement were highlighted to improve CALD consumers' active participation in decision making however, these largely focused on language, with limited exploration of culturally sensitive services. There is limited discussion of what culturally sensitive services look like and what resources are needed to enhance CALD consumer engagement in high‐level decision making. Health services and policy makers can enhance opportunities for engagement with CALD consumers by being flexible in their approach, implementing policies for reimbursement for participation and evaluating and adapting the activities of engagement in collaboration with CALD consumers. This study is part of a wider ‘CanEngage’ project, which includes a consumer investigator, and is supported by a consumer advisory group. The study was conceived with inputs from the consumer advisory group, which continued to meet regularly with the project team to discuss the methodology and emerging findings.

The contribution of nurses to incident disclosure: A narrative review

Publisher: Elsevier BV

Date: 02-2014

DOI: 10.1016/J.IJNURSTU.2013.07.001

Abstract: To explore (a) how nurses feel about disclosing patient safety incidents to patients, (b) the current contribution that nurses make to the process of disclosing patient safety incidents to patients and (c) the barriers that nurses report as inhibiting their involvement in disclosure. A systematic search process was used to identify and select all relevant material. Heterogeneity in study design of the included articles prohibited a meta-analysis and findings were therefore synthesised in a narrative review. A range of text words, synonyms and subject headings were developed in conjunction with the York Centre for Reviews and Dissemination and used to undertake a systematic search of electronic databases (MEDLINE EMBASE CENTRAL PsycINFO Health Management and Information Consortium CINAHL ASSIA Science Citation Index Social Science Citation Index Cochrane Database of Systematic Reviews Database of Abstracts of Reviews of Effects Health Technology Assessment Database Health Systems Evidence PASCAL LILACS). Retrieval of studies was restricted to those published after 1980. Further data sources were: websites, grey literature, research in progress databases, hand-searching of relevant journals and author contact. The title and abstract of each citation was independently screened by two reviewers and disagreements resolved by consensus or consultation with a third person. Full text articles retrieved were further screened against the inclusion and exclusion criteria then checked by a second reviewer (YB). Relevant data were extracted and findings were synthesised in a narrative empirical synthesis. The systematic search and selection process identified 15 publications which included 11 unique studies that emerged from a range of locations. Findings suggest that nurses currently support both physicians and patients through incident disclosure, but may be ill-prepared to disclose incidents independently. Barriers to nurse involvement included a lack of opportunities for education and training, and the multiple and sometimes conflicting roles within nursing. Numerous potential benefits were identified that may result from nurses having a greater contribution to the disclosure process, but the provision of support and training is essential to overcome the reported barriers faced by nurses internationally.

Clinicians’ and public acceptability of universal risk-of-death screening for older people in routine clinical practice in Australia: cross-sectional surveys

Publisher: Springer Science and Business Media LLC

Date: 26-05-2020

DOI: 10.1007/S40520-020-01598-W

Beyond translation: Engaging with culturally and linguistically diverse consumers

Publisher: Wiley

Date: 18-10-2020

DOI: 10.1111/HEX.12984

Workplace training for senior trainees: A systematic review and narrative synthesis of current approaches to promote patient safety

Publisher: Oxford University Press (OUP)

Date: 12-08-2015

DOI: 10.1136/POSTGRADMEDJ-2014-133130

Abstract: Preventable harm is one of the top six health problems in the developed world. Developing patient safety skills and knowledge among advanced trainee doctors is critical. Clinical supervision is the main form of training for advanced trainees. The use of supervision to develop patient safety competence has not been established. To establish the use of clinical supervision and other workplace training to develop non-technical patient safety competency in advanced trainee doctors. Keywords, synonyms and subject headings were used to search eight electronic databases in addition to hand-searching of relevant journals up to 1 March 2014. Titles and abstracts of retrieved publications were screened by two reviewers and checked by a third. Full-text articles were screened against the eligibility criteria. Data on design, methods and key findings were extracted. Clinical supervision documents were assessed against components common to established patient safety frameworks. Findings from the reviewed articles and document analysis were collated in a narrative synthesis. Clinical supervision is not identified as an avenue for embedding patient safety skills in the workplace and is consequently not evaluated as a method to teach trainees these skills. Workplace training in non-technical patient safety skills is limited, but one-off training courses are sometimes used. Clinical supervision is the primary avenue for learning in postgraduate medical education but the most overlooked in the context of patient safety learning. The widespread implementation of short courses is not matched by evidence of rigorous evaluation. Supporting supervisors to identify teaching moments during supervision and to give weight to non-technical skills and technical skills equally is critical.

Enacting open disclosure in the UK National Health Service: A qualitative exploration

Publisher: Wiley

Date: 21-02-2017

DOI: 10.1111/JEP.12702

Abstract: Open and honest discussion between healthcare providers and patients and families affected by error is considered to be a central feature of high quality and safer patient care, evidenced by the implementation of open disclosure policies and guidance internationally. This paper discusses the perceived enablers that UK doctors and nurses report as facilitating the enactment of open disclosure. Semistructured interviews with 13 doctors and 22 nurses from a range of levels and specialities from 5 national health service hospitals and primary care trusts in the UK were conducted and analysed using a framework approach. Five themes were identified which appear to capture the factors that are critical in supporting open disclosure: open disclosure as a moral and professional duty, positive past experiences, perceptions of reduced litigation, role models and guidance, and clarity. Greater openness in relation to adverse events requires health professionals to recognise candour as a professional and moral duty, exemplified in the behaviour of senior clinicians and that seems more likely to occur in a nonpunitive, learning environment. Recognising incident disclosure as part of ongoing respectful and open communication with patients throughout their care is critical.

The role of emotion in patient safety: Are we brave enough to scratch beneath the surface?

Publisher: SAGE Publications

Date: 18-12-2015

DOI: 10.1177/0141076815620614

Abstract: Healthcare professionals work in emotionally charged settings yet, little is known about the role of emotion in ensuring safe patient care. This article presents current knowledge in this field, drawing upon psychological approaches and evidence from clinical settings. We explore the emotions that health professionals experience in relation to making a medical error and describe the impact on healthcare professionals and on their professional and patient relationships. We also explore how positive and negative emotions can contribute to clinical decision making and affect responses to clinical situations. Evidence to date suggests that emotion plays an integral role in patient safety. Implications for training, practice and research are discussed in addition to strategies to facilitate health services to understand and respond to the influence of emotion in clinical practice.

Factors influencing interprofessional collaboration between community pharmacists and general practitioners—A systematic review

Publisher: Hindawi Limited

Date: 20-12-2018

DOI: 10.1111/HSC.12705

Abstract: Effective interprofessional collaboration is critical for sustaining high quality care in the context of the increasing burden on primary healthcare services. Despite this, there is limited understanding of the factors contributing to effective collaboration between general practitioners and community pharmacists. The aim of this systematic review was to identify the factors that impact on interprofessional collaboration between general practitioners (GPs) and community pharmacists (CPs). Keywords and synonyms were combined and applied to four databases (EMBASE, CINAHL, SCOPUS, and MEDLINE) to identify articles published between January 2000 to April 2017. Relevant journals and reference lists were also hand-searched. A total of 37 articles met the eligibility criteria. Factors that posed a challenge to effective interprofessional collaboration were the perceived imbalance in hierarchy and power between the professions and a lack of understanding of each other's skills and knowledge. Experience of collaboration with the other party led to greater understanding of each other's capabilities and potential role in co-delivering patient care. The physical environment was also identified as important, with co-location and other resources to facilitate clear and regular communication identified as important facilitators of interprofessional collaboration. The review findings highlight a range of approaches that may positively influence interprofessional collaboration between GPs and CPS such as co-location, co-education to understand the professional capabilities of each group, and utilising compatible technologies to facilitate communication between the two professions.

Patient safety vulnerabilities for children with intellectual disability in hospital: a systematic review and narrative synthesis.

Publisher: BMJ

Date: 2018

DOI: 10.1136/BMJPO-2017-000201

Using patients’ experiences of adverse events to improve health service delivery and practice: protocol of a data linkage study of Australian adults age 45 and above

Publisher: BMJ

Date: 10-2014

DOI: 10.1136/BMJOPEN-2014-006599

Abstract: Evidence of patients’ experiences is fundamental to creating effective health policy and service responses, yet is missing from our knowledge of adverse events. This protocol describes explorative research redressing this significant deficit investigating the experiences of a large cohort of recently hospitalised patients aged 45 years and above in hospitals in New South Wales (NSW), Australia. The 45 and Up Study is a cohort of 265 000 adults aged 45 years and above in NSW. Patients who were hospitalised between 1 January and 30 June 2014 will be identified from this cohort using data linkage and a random s le of 20 000 invited to participate. A cross-sectional survey (including qualitative and quantitative components) will capture patients’ experiences in hospital and specifically of adverse events. Approximately 25% of respondents are likely to report experiencing an adverse event. Quantitative components will capture the nature and type of events as well as common features of patients’ experiences. Qualitative data provide contextual knowledge of their condition and care and the impact of the event on in iduals. Respondents who do not report an adverse event will report their experience in hospital and be the control group. Statistical and thematic analysis will be used to present a patient perspective of their experiences in hospital the characteristics of patients experiencing an adverse event experiences of information sharing after an event (open disclosure) and the other avenues of redress pursued. Interviews with key policymakers and a document analysis will be used to create a map of the current practice. Dissemination via a one-day workshop, peer-reviewed publications and conference presentations will enable effective clinical responses and service provision and policy responses to adverse events to be developed.

Is Gaining Affective Commitment the Missing Strategy for Successful Change Management in Healthcare?

Publisher: Informa UK Limited

Date: 2022

DOI: 10.2147/JHL.S347987

Adoption of out-of-pocket cost caps: an Australian perspective

Publisher: CSIRO Publishing

Date: 2023

DOI: 10.1071/AH23197

Population-level quality indicators of end-of-life-care in an aged care setting

Publisher: Elsevier BV

Date: 2024

DOI: 10.1016/J.ARCHGER.2023.105130

Health Impact Assessments of Health Sector Proposals: An Audit and Narrative Synthesis

Publisher: MDPI AG

Date: 31-10-2021

DOI: 10.3390/IJERPH182111466

Abstract: Background: Health impact assessment (HIA) is a tool used to assess the potential health impacts of proposed projects, programs, and policies. The extent of the use of HIAs conducted on health sector proposals, and what they focus on, is currently largely undocumented. This paper reviews HIAs conducted on health sector proposals, their characteristics and describes the settings in which they were conducted. Methods: A systematic review was conducted, including peer-reviewed journals and grey literature utilizing keywords, synonyms, and subject headings relevant to HIA and the health sector. Eligibility criteria were independently applied to the identified works and data appraisal conducted using the Critical Appraisal Skills Programme qualitative checklist tool. Results: 19 HIAs were identified and included in the review, including 13 rapid, three intermediate, and two comprehensive HIAs. The HIAs use was evident across a range of health service contexts, though all but one had been conducted in developed countries. Conclusion: The use of HIAs in the health sector is limited. There were various benefits attributed to the HIAs analysed including and not limited to the allocation of resources, reducing inequalities, and identification of possible negative consequences of a project. There is an opportunity to improve the use and reporting of HIAs across health settings internationally to enhance the consideration of broader determinants of health, influence decision making, and use of evidence in health sector planning for the future.

Critical care nursing workforce in crisis: A discussion paper examining contributing factors, the impact of the COVID‐19 pandemic and potential solutions

Publisher: Wiley

Date: 23-02-2023

DOI: 10.1111/JOCN.16642

Abstract: The critical care nursing workforce is in crisis, with one‐third of critical care nurses worldwide intending to leave their roles. This paper aimed to examine the problem from a wellbeing perspective, offering implications for research, and potential solutions for organisations. Discursive/Position paper. The discussion is based on the nursing and wellbeing literature. It is guided by the authors' collaborative expertise as both clinicians and researchers. Data were drawn from nursing and wellbeing peer‐reviewed literature, such as reviews and empirical studies, national surveys and government and thinktank publications/reports. Critical care nurses have been disproportionately affected by the COVID‐19 pandemic with studies consistently showing critical care nurses to have the worst psychological outcomes on wellbeing measures, including depression, burnout and post‐traumatic stress disorder (PTSD). These findings are not only concerning for the mental wellbeing of critical care nurses, they also raise significant issues for healthcare systems/organisations: poor wellbeing, increased burnout and PTSD are directly linked with critical care nurses intending to leave the profession. Thus, the wellbeing of critical care nurses must urgently be supported. Resilience has been identified as a protective mechanism against the development of PTSD and burnout, thus offering evidence‐based interventions that address resilience and turnover have much to offer in tackling the workforce crisis. However, turnover data must be collected by studies evaluating resilience interventions, to further support their evidence base. Organisations cannot solely rely on the efficacy of these interventions to address their workforce crisis but must concomitantly engage in organisational change. We conclude that critical care nurses are in urgent need of preventative, evidence‐based wellbeing interventions, and make suggestions for research and practice.

Managing Complex Healthcare Change: A Qualitative Exploration of Current Practice in New South Wales, Australia

Publisher: Informa UK Limited

Date: 12-2020

DOI: 10.2147/JHL.S274958

Development of an evidence-based framework of factors contributing to patient safety incidents in hospital settings: a systematic review

Publisher: BMJ

Date: 15-03-2012

DOI: 10.1136/BMJQS-2011-000443

Integrating virtual models of care through infrastructure innovation in healthcare facility design

Publisher: CSIRO Publishing

Date: 03-03-2022

DOI: 10.1071/AH21335

Abstract: The coronavirus disease 2019 (COVID-19) pandemic has highlighted the potential value of virtual models of care to support more efficient and accessible healthcare delivery at reduced cost. In order to achieve this, the healthcare services and facilities must be designed to integrate virtual care. To date, incremental approaches have been used to accommodate virtual care innovations within existing systems and services. Infrastructure innovation is now critical to fully realise the benefits of virtual and hybrid models of care for population health and health system efficiency. With record capital expenditure on healthcare infrastructure across Australian jurisdictions, we are in a critical period for making transformative changes to the design of healthcare facilities to ensure the relevance of future facilities and redevelopments. We examine the value proposition posed by our current healthcare infrastructure approach and how system-wide planning for the integration of virtual models of care may optimise the ability of the Australian health system to meet emerging and future health needs.

Medical error in the hospice setting: exploring the perspectives of management staff

Publisher: Mark Allen Group

Date: 08-2010

DOI: 10.12968/IJPN.2010.16.8.377

Abstract: This study explores the experiences of health professionals in managerial roles at various levels in child and adult hospice care in northern England, studying perspectives around managing medical error, the issues that arise, and the challenges faced. A multicentred, descriptive, exploratory design was adopted. The s le comprised 10 hospice managers (five deputy and five senior managers) from four hospices (two adult and two children's) in the north of England. Participants took part in in idual semi-structured interviews, which lasted between 45–60 minutes each. Interviews were transcribed and analysed by a team of three researchers, including two health psychologists and one nurse using a qualitative analytic framework. Emerging themes appeared to be inter-related and were ultimately linked to two meta-concepts underpinning and fundamental to the data, these issues were intrinsically tied to all emerging themes. Primary themes were defined by their explanatory power and regularity. Primary themes highlighted the impact of managing error on management teams at a professional and personal level, the challenges for error management in hospice settings, the use of error management tools, and the conceptualization of blame in these settings. The strong influence of the health-care setting in which an error takes place on the outcomes of an error event for the health professional, managers, health-care organizations, and ultimately patients was evident.

End‐of‐life priorities of older adults with terminal illness and caregivers: A qualitative consultation

Publisher: Wiley

Date: 06-01-2019

DOI: 10.1111/HEX.12860

Child and parent perceptions of acceptability and therapeutic value of a socially assistive robot used during pediatric rehabilitation

Publisher: Informa UK Limited

Date: 23-05-2019

DOI: 10.1080/09638288.2019.1617357

Coping with medical error: a systematic review of papers to assess the effects of involvement in medical errors on healthcare professionals' psychological well-being

Publisher: BMJ

Date: 31-05-2010

DOI: 10.1136/QSHC.2009.035253

Abstract: Previous research has established health professionals as secondary victims of medical error, with the identification of a range of emotional and psychological repercussions that may occur as a result of involvement in error.2 3 Due to the vast range of emotional and psychological outcomes, research to date has been inconsistent in the variables measured and tools used. Therefore, differing conclusions have been drawn as to the nature of the impact of error on professionals and the subsequent repercussions for their team, patients and healthcare institution. A systematic review was conducted. Data sources were identified using database searches, with additional reference and hand searching. Eligibility criteria were applied to all studies identified, resulting in a total of 24 included studies. Quality assessment was conducted with the included studies using a tool that was developed as part of this research, but due to the limited number and erse nature of studies, no exclusions were made on this basis. Review findings suggest that there is consistent evidence for the widespread impact of medical error on health professionals. Psychological repercussions may include negative states such as shame, self-doubt, anxiety and guilt. Despite much attention devoted to the assessment of negative outcomes, the potential for positive outcomes resulting from error also became apparent, with increased assertiveness, confidence and improved colleague relationships reported. It is evident that involvement in a medical error can elicit a significant psychological response from the health professional involved. However, a lack of literature around coping and support, coupled with inconsistencies and weaknesses in methodology, may need be addressed in future work.

What qualities are required for globally-relevant health service managers? An exploratory analysis of health systems internationally

Publisher: Springer Science and Business Media LLC

Date: 06-02-2019

DOI: 10.1186/S12992-019-0452-3

From Detractors to Promoters: A comparative analysis of patient experience drivers across Net Promoter Score subcategories

Publisher: Wiley

Date: 30-08-2023

DOI: 10.1111/IJN.13197

Abstract: The utilization of patient experience surveying by health care institutions has become increasingly prevalent, yet its effectiveness in promoting quality improvement remains uncertain. To enhance the utility of patient feedback, the examination of free‐text comments may provide valuable insights to guide patient experience strategy. This study aims to explore the utility of free‐text comments and identify key differences for patient experience drivers between Net Promoter Score (NPS) subcategories of Detractors, Passives, and Promoters. Evaluation and classification of comments was conducted using the eight Picker Principles of Person Centred Care, with descriptive analysis of patient comments performed on the NPS data. Analysis of patient NPS comments can be classified into three key drivers: “feeling well‐treated” (for Detractors), “feeling comfortable” (for Passives), and “feeling valued” (for Promoters). Specifically, Detractor comments provided the most comprehensive and detailed feedback to guide patient experience improvement activities. This study highlights differences between NPS subcategories, particularly regarding aspects of safety, comfort, and feeling valued. Comments from Detractor respondents may be especially useful for guiding quality improvements due to increased specificity and insights. These results also emphasize the essential nature of empathy and compassionate interactions between patients and clinicians to achieve the highest level of patient satisfaction and experience.

Evaluating and enhancing quality in higher education teaching practice: a meta- review

Publisher: Informa UK Limited

Date: 03-2022

DOI: 10.1080/03075079.2020.1730315

Responding to adverse patient safety events in Viet Nam

Publisher: Springer Science and Business Media LLC

Date: 18-09-2019

DOI: 10.1186/S12913-019-4518-Y

Abstract: The psychological and professional impact of adverse events on doctors and nurses is well-established, but limited data has emerged from low- and middle-income. This article reports the experiences of being involved in a patient safety event, incident reporting and organisational support available to assist health professionals in Viet Nam to learn and recover. Doctors and nurses (1000) from all departments of a 1500-bed surgical and trauma hospital in Viet Nam were invited to take part in a cross-sectional survey. The survey explored respondents’ involvement in adverse events and/or near miss, their emotional, behavioural and coping responses, experiences of organisational incident reporting, and the learning and/or other consequences of the event. Survey items also assessed the availability of organisational support including peer support and mentorship. Of the 497 respondents, 295 (59%) experienced an adverse event in which a patient was harmed, of which 86 (17%) resulted in serious patient harm. 397 (80%) of respondents experienced a near miss, with 140 of these (28%) having potential for serious harm. 386 (77%) reporting they had been affected professionally or personally in some way, with impacts to psychological health (416 84%), physical health (388 78%), job satisfaction (378 76%) and confidence in their ability (276 56%) commonly reported. Many respondents were unable to identify local improvements (373 75%) or organisation-wide improvements following safety events (359 72%) and 171 (34%) admitted that they had not reported an event to their organisation or manager that they should have. Health professionals in Viet Nam report impacts to psychological and physical health as a result of involvement in safety events that reflect those of health professionals internationally. Reports of limited organisational learning and improvement following safety events suggest that patient safety culture is underdeveloped in Viet Nam currently. In order to progress work on patient safety cultures and incident reporting in Viet Nam, health professionals will need to be convinced not only that they will not be exposed to punitive action, but that learning and positive changes will occur as a result of reporting safety events.

What Are the Psycho-Social and Information Needs of Adolescents and Young Adults Cancer Care Consumers with Intellectual Disability? A Systematic Review of Evidence with Recommendations for Future Research and Practice.

Publisher: MDPI AG

Date: 02-12-2021

DOI: 10.3390/CHILDREN8121118

Abstract: People with intellectual disability have unmet health needs and experience health inequalities. There is limited literature regarding cancer care for children, adolescents, and young adults (AYA) with intellectual disability despite rising cancer incidence rates in this population. This systematic review aimed to identify the psycho-social and information support needs of AYA cancer care consumers with intellectual disability to generate recommendations for future research and cancer care service delivery enhancement. We searched eight databases yielding 798 articles. Following abstract and full-text review, we identified 12 articles meeting our inclusion criteria. Our three themes related to communication and accessible information supports and system navigation, cancer service provider training, and reasonable adjustments. There was a lack of user-friendly, accessible information about cancer and screening programs available. Both paid and family carers are critical in accessing cancer supports, services, and screening programs for AYA with intellectual disability. Ongoing training should be provided to healthcare professionals regarding the importance of care screening for AYAs with intellectual disability. This review recommends that AYA with intellectual disability and their family carers be involved in developing tailored cancer services. This should focus on enabling inclusive screening programs, accessible consent, and challenging the enduring paternalism of support services via training and appropriate communication tools.

Health policy evaluation in rural and remote Australia: a qualitative exploration and lessons from the Northern Territory

Publisher: CSIRO Publishing

Date: 28-02-2023

DOI: 10.1071/AH22255

Abstract: Objective This study explored approaches of government policymakers to health policy evaluation (HPE) in Australian rural and remote settings. Methods Semi-structured interviews captured experiences and insights of 25 policymakers in the Northern Territory Department of Health. Data were thematically analysed using an inductive approach to coding and theme development. Results We identified five main themes about HPE in rural and remote settings: (1) centring the rural and remote context (2) balancing ideology, power and evidence (3) working with community (4) strengthening policy workforce capabilities in monitoring and evaluation and (5) valuing evaluation through leadership. Conclusion HPE is complex in any setting, however, policymakers navigate unique complexities in rural and remote health contexts. HPE can be enabled by developing policymaker and leadership capabilities in rural and remote settings and supporting co-design with communities.

Provision of cervical cancer prevention services in Northern Uganda: a survey of health workers from rural health centres

Publisher: Springer Science and Business Media LLC

Date: 11-08-2021

DOI: 10.1186/S12913-021-06795-5

Abstract: Cervical cancer is the leading cancer among Ugandan women, contributing to 40 % of all cancer cases recorded in the cancer registry. Having identified the substantial impact of cervical cancer among Ugandan women, the Ministry of Health in 2010 launched a Strategic Plan for Cervical Cancer prevention and control. This study was conducted to determine if health workers working in rural health centres (HCs) III and IV in Northern Uganda provide cervical cancer screening services as recommended in the Strategic Plan. A cross-sectional survey using a structured questionnaire was conducted among nurses, midwives and clinical officers working in rural HC III and IV in Northern Uganda. Data were entered in Epidata 3.1 and analysed using Stata 16 statistical software. Univariate, bivariate, and multivariate analyses were performed. Any factor with p -value ≤ 0.05 was considered a significant predictor of outcome. We surveyed 286 health workers. Fifty-one (18 %) health workers were screening women for cervical cancer. Fifty-eight (21 %) health workers have guideline for cervical cancer screening in their HCs, 93 (33 %) participants were trained to screen women for cervical cancer. Two hundred sixty-two (92 %) participants provided HPV vaccination. Two hundred forty-six (87 %) participants were conducting health education about cervical cancer in their HCs. Factors associated with screening women for cervical cancer include: being a staff member from HCs III (AOR = 0.30, 95 % CI 0.13–0.68, p = 0.00), being staff of HCs that have organization to support cervical cancer screening services (AOR = 4.38, 95 % CI 1.99–9.63, p -=0.00), being a health worker who had been trained to screen for cervical cancer (AOR = 2.21, 95 % CI 1.00–4.90, p = 0.05) and staff from HCs that has guideline for cervical cancer screening (AOR = 2.89, 95 % CI 1.22–6.86, p = 0.02). This study shows an overall structural problem related to the delivery of cervical cancer screening services in HC III and IV in Northern Uganda which the Strategic Plan has not addressed. These structural problems need urgent attention if the Uganda government and other sub-Saharan African (SSA) countries are to achieve the World Health Organization (WHO) 90–70–90 targets by 2030 to be on track for cervical cancer elimination.

Being open about unanticipated problems in health care: the challenges of uncertainties

Publisher: SAGE Publications

Date: 02-12-2014

DOI: 10.1177/1355819614558100

Abstract: Discussion of unanticipated problems in care with patients and their families (‘open disclosure’) is now widely advocated. Despite international efforts and the introduction of a range of policies and guidance to promote such discussions, the expectations of policy makers and patients are often not matched in practice. We consider some reasons for the persistence of shortfalls in the occurrence and quality of open disclosure. We draw on research conducted to investigate the implementation of a ‘ Being open’ policy in England, reflecting particularly on insights derived from interviews with health care professionals. Health care professionals were broadly supportive of the idea of open disclosure. Some expressed well-recognized concern about punishment and being blamed, but this did not appear to be the main driver of their communication practices. Their accounts of what happened around particular problems in health care indicated that they brought a complex range of considerations to bear on questions of whether and how these were discussed with patients and relatives. Guidance about open disclosure based on assessments of levels of harm to patients can complicate and perhaps distort health care professionals’ approaches, particularly when the extent and/or cause of harm was uncertain. Health care professionals who engage in open disclosure must be able to negotiate appropriate ways through complex and sensitive discussions. The responses of patients and relatives are not always predictable and even the best open disclosure practice may not resolve problems and concerns. Guidance, training and support for staff need to reflect these challenges.

Implementing and evaluating co-designed change in health

Publisher: SAGE Publications

Date: 20-01-2022

DOI: 10.1177/01410768211070206

Vital signs monitoring and nurse–patient interaction: A qualitative observational study of hospital practice

Publisher: Elsevier BV

Date: 04-2016

DOI: 10.1016/J.IJNURSTU.2015.12.007

Abstract: High profile safety failures have demonstrated that recognising early warning signs of clinical and physiological deterioration can prevent or reduce harm resulting from serious adverse events. Early warning scoring systems are now routinely used in many places to detect and escalate deteriorating patients. Timely and accurate vital signs monitoring are critical for ensuring patient safety through providing data for early warning scoring systems, but little is known about current monitoring practices. To establish a profile of nurses' vital signs monitoring practices, related dialogue, and adherence to health service protocol in New South Wales, Australia. Direct observations of nurses' working practices were conducted in two wards. The observations focused on times of the day when vital signs were generally measured. Patient interactions were recorded if occurring any time during the observation periods. Participants (n=42) included nursing staff on one chronic disease medical and one acute surgical ward in a large urban teaching hospital in New South Wales. We observed 441 patient interactions. Measurement of vital signs occurred in 52% of interactions. The minimum five vital signs measures required by New South Wales Health policy were taken in only 6-21% of instances of vital signs monitoring. Vital signs were documented immediately on 93% of vitals-taking occasions and documented according to the policy in the patient's chart on 89% of these occasions. Nurse-patient interactions were initiated for the purpose of taking vital signs in 49% of interactions, with nurse-patient discourse observed during 88% of all interactions. Nurse-patient dialogue led to additional care being provided to patients in 12% of interactions. The selection of appropriate vital signs measured and responses to these appears to rely on nurses' clinical judgement or time availability rather than on policy-mandated frequency. The prevalence of incomplete sets of vital signs may limit identification of deteriorating patients. The findings from this study present an important baseline profile against which to evaluate the impact of introducing continuous monitoring approaches on current hospital practice.

Reviewing studies with diverse designs: the development and evaluation of a new tool

Publisher: Wiley

Date: 16-03-2011

DOI: 10.1111/J.1365-2753.2011.01662.X

Abstract: RATIONALE, AIMS & OBJECTIVE: Tools for the assessment of the quality of research studies tend to be specific to a particular research design (e.g. randomized controlled trials, or qualitative interviews). This makes it difficult to assess the quality of a body of research that addresses the same or a similar research question but using different approaches. The aim of this paper is to describe the development and preliminary evaluation of a quality assessment tool that can be applied to a methodologically erse set of research articles. The 16-item quality assessment tool (QATSDD) was assessed to determine its reliability and validity when used by health services researchers in the disciplines of psychology, sociology and nursing. Qualitative feedback was also gathered from mixed-methods health researchers regarding the comprehension, content, perceived value and usability of the tool. Reference to existing widely used quality assessment tools and experts in systematic review confirmed that the components of the tool represented the construct of 'good research technique' being assessed. Face validity was subsequently established through feedback from a s le of nine health researchers. Inter-rater reliability was established through substantial agreement between three reviewers when applying the tool to a set of three research papers (κ = 71.5%), and good to substantial agreement between their scores at time 1 and after a 6-week interval at time 2 confirmed test-retest reliability. The QATSDD shows good reliability and validity for use in the quality assessment of a ersity of studies, and may be an extremely useful tool for reviewers to standardize and increase the rigour of their assessments in reviews of the published papers which include qualitative and quantitative work.

Perceptions of key informants on the provision of cervical cancer prevention and control programme in Uganda: implication for cervical cancer policy

Publisher: Springer Science and Business Media LLC

Date: 14-09-2020

DOI: 10.1186/S12889-020-09482-Y

Abstract: Uganda has one of the highest burdens of cervical cancer globally. In 2010 the Ugandan Ministry of Health launched the Strategic Plan for Cervical Cancer Prevention and Control with the hope of developing cervical cancer policy in Uganda. This study explored the beliefs of senior key informants in Uganda about cervical cancer prevention, the control programme, and the relevance of cervical cancer policy. We conducted 15 key informant interviews with participants from six organisations across Northern and Central Uganda. Participants were drawn from district local government health departments, St. Mary’s Hospital Lacor, Uganda Nurses and Midwifery Council, non-governmental organisations (NGOs) and Ministry of Health in K ala, Uganda. The interview recordings were transcribed and analysed using thematic analysis. Seven themes emerged relating to the cervical cancer prevention and control programmes in Uganda: (1) policy frameworks for cervical cancer, (2) operationalising cervical cancer prevention and control, (3) financial allocation and alignment, (4) human resources and capability, (5) essential supplies and vaccines, (6) administrative data and resource distribution, and (7) cervical cancer services. The key informants perceive that the lack of a cervical cancer policy in Uganda is hindering cervical cancer prevention and control programmes. Therefore, the Ministry of Health and stakeholders need to work together in coming up with an effective policy framework that will accelerate efforts towards cervical cancer prevention and control in Uganda.

Enabling the space and conditions for co-leadership in co-design: an evaluation of co-facilitator training for culturally and linguistically diverse consumers

Publisher: The Sax Institute

Date: 2022

DOI: 10.17061/PHRP3222214

Experience-based codesign approach to improve care in Australian emergency departments for complex consumer cohorts: the MyED project protocol, Stages 1.1–1.3

Publisher: BMJ

Date: 07-2023

DOI: 10.1136/BMJOPEN-2023-072908

Abstract: Emergency department (ED) care must adapt to meet current and future demands. In Australia, ED quality measures (eg, prolonged length of stay, re-presentations or patient experience) are worse for older adults with multiple comorbidities, people who have a disability, those who present with a mental health condition, Indigenous Australians, and those with a culturally and linguistically erse (CALD) background. Strengthened ED performance relies on understanding the social and systemic barriers and preferences for care of these different cohorts, and identifying viable solutions that may result in sustained improvement by service providers. A collaborative 5-year project (MyED) aims to codesign, with ED users and providers, new or adapted models of care that improve ED performance, improve patient outcomes and improve patient experience for these five cohorts. Experience-based codesign using mixed methods, set in three hospitals in one health district in Australia. This protocol introduces the staged and incremental approach to the whole project, and details the first research elements: ethnographic observations at the ED care interface, interviews with providers and interviews with two patient cohorts—older adults and adults with a CALD background. We aim to s le a erse range of participants, carefully tailoring recruitment and support. Ethics approval has been obtained from the Western Sydney Local Health District Human Research Ethics Committee (2022/PID02749-2022/ETH02447). Prior informed written consent will be obtained from all research participants. Findings from each stage of the project will be submitted for peer-reviewed publication. Project outputs will be disseminated for implementation more widely across New South Wales, Australia.

Patient complaints about hospital services: Applying a complaint taxonomy to analyse and respond to complaints

Publisher: Oxford University Press (OUP)

Date: 29-01-2016

DOI: 10.1093/INTQHC/MZW003

Abstract: To explore the applicability of a patient complaint taxonomy to data on serious complaint cases. Qualitative descriptive study. Complaints made to the New South Wales (NSW) Health Care Complaints Commission, Australia between 2005 and 2010. All 138 cases of serious complaints by patients about public hospitals and other health facilities investigated in the 5-year period. A thematic analysis of the complaints was conducted to identify particular complaint issues and the Reader et al. (Patient complaints in healthcare systems: a systematic review and coding taxonomy. BMJ Qual Saf 2014 :678-89.) patient complaint taxonomy was then used to classify these issues into categories and sub-categories. The 138 investigated cases revealed 223 complaint issues. Complaint issues were distributed into the three domains of the patient complaint taxonomy: clinical, management and relationships. Complaint issue most commonly related to delayed diagnosis, misdiagnosis, medication errors, inadequate examinations, inadequate/nil treatment and quality of care including nursing care. The types of complaints from patients about their healthcare investigated by the NSW Commission were similar to those received by other patient complaint entities in Australia and worldwide. The application of a standard taxonomy to large numbers of complaints cases from different sources would enable the creation of aggregated data. Such data would have better statistical capacity to identify common safety and quality healthcare problems and so point to important areas for improvement. Some conceptual challenges in devising and using a taxonomy must be addressed, such as inherent problems in ensuring coding consistency, and giving greater weight to patient concerns about their treatment.

Hospitalization from the patient perspective: a data linkage study of adults in Australia

Publisher: Oxford University Press (OUP)

Date: 03-2018

DOI: 10.1093/INTQHC/MZY024

Abstract: Evidence of the patient experience of hospitalization is an essential component of health policy and service improvement but studies often lack a representative population s le or do not examine the influence of patient and hospital characteristics on experiences. We address these gaps by investigating the experiences of a large cohort of recently hospitalized patients aged 45 years and over in New South Wales (NSW), Australia who were identified using data linkage. Cross-sectional survey. Hospitals in NSW, Australia. The Picker Patient Experience Survey (PPE-15) was administered to a random s le of 20 000 patients hospitalized between January and June 2014. Multivariable negative binomial regression was used to investigate factors associated with a higher PPE-15 score. There was a 40% response rate (7661 completed surveys received). Respondents often reported a positive experience of being treated with dignity and respect, yet almost 40% wanted to be more involved in decisions about their care. Some respondents identified other problematic aspects of care such as receiving conflicting information from different care providers (18%) and feeling that doctors spoke in front of them as if they were not there (14%). Having an unplanned admission or having an adverse event were both very strongly associated with a poorer patient experience (P < 0.001). No other factors were found to be associated. Patient involvement in decision-making about care was highlighted as an important area for improvement. Further work is needed to address the challenges experienced by patients, carers and health professionals in achieving a genuine partnership model.

Partnerships for safe care: A meta‐narrative of the experience for the parent of a child with Intellectual Disability in hospital

Publisher: Wiley

Date: 27-09-2019

DOI: 10.1111/HEX.12968

Knowledge, attitudes, and practice of cervical cancer prevention among health workers in rural health centres of Northern Uganda

Publisher: Springer Science and Business Media LLC

Date: 03-02-2021

DOI: 10.1186/S12885-021-07847-Z

Abstract: Cervical cancer is a leading cancer and cause of premature death among women in Uganda aged 15 to 44 years. To address the increasing burden of cervical cancer in Uganda, the Ministry of Health has adopted several strategies which include public education and advocacy. This study aims to assess knowledge, attitudes, and practice of cervical cancer prevention among health workers employed in rural health centres (HCs) III and IV in the Acholi sub-region of Northern Uganda. We conducted a cross-sectional survey of nurses, midwives, and clinical officers between February and April 2019 using self-administered questionnaire. We s led fifty-four HCs III and eight HCs IV. In Uganda, HCs are structured from HC I to HC IV and the health care package provided increases with increasing level of the HC. We used Epidata version 3.1 to create database and analysis was performed using Stata 16. Descriptive and logistic regression analyses were performed. Factors with p -values ≤ 0.05 were considered as predictors of outcome. There were 286 participants who completed the questionnaire: Majority (188, 66%) were females. Nurses were 153 (54%). 141 (75%) female participants self-reported to have been screened for cervical cancer. 171 (60%) participants had adequate knowledge of cervical cancer. 187 (66%) participants had positive attitudes. Participants who indicated not to have ever received training on cervical cancer screening were less likely to have adequate knowledge (AOR = 0.39, 95% CI 0.21–0.71). Participants who indicated not to have ever been trained on cervical cancer screening were less likely to have positive attitudes (AOR = 0.52, 95% CI 0.28–0.97). Health workers from rural HCs in Uganda play crucial role in cervical cancer prevention as they can reach a wider community. Their significance in the prevention of cervical cancer points to the need for Uganda and other sub-Sahara Africa (SSA) countries to establish training to improve their knowledge, attitudes, and practical skills on cervical cancer screening. Furthermore, Uganda government should develop and disseminate guidelines for cervical cancer prevention to rural health workers to promote standardised cervical cancer prevention activities.

Improving Medication Safety in Cancer Services for Ethnic Minority Consumers: Protocol for a Pilot Feasibility and Acceptability Study of a Co-Designed Consumer Engagement Intervention

Publisher: JMIR Publications Inc.

Date: 18-09-2023

DOI: 10.2196/49902

Can feedback approaches reduce unwarranted clinical variation? A systematic rapid evidence synthesis

Publisher: Springer Science and Business Media LLC

Date: 16-01-2020

DOI: 10.1186/S12913-019-4860-0

Abstract: Assessment of clinical variation has attracted increasing interest in health systems internationally due to growing awareness about better value and appropriate health care as a mechanism for enhancing efficient, effective and timely care. Feedback using administrative databases to provide benchmarking data has been utilised in several countries to explore clinical care variation and to enhance guideline adherent care. Whilst methods for detecting variation are well-established, methods for determining variation that is unwarranted and addressing this are strongly debated. This study aimed to synthesize published evidence of the use of feedback approaches to address unwarranted clinical variation (UCV). A rapid review and narrative evidence synthesis was undertaken as a policy-focused review to understand how feedback approaches have been applied to address UCV specifically. Key words, synonyms and subject headings were used to search the major electronic databases Medline and PubMed between 2000 and 2018. Titles and abstracts of publications were screened by two reviewers and independently checked by a third reviewer. Full text articles were screened against the eligibility criteria. Key findings were extracted and integrated in a narrative synthesis. Feedback approaches that occurred over a duration of 1 month to 9 years to address clinical variation emerged from 27 publications with quantitative (20), theoretical/conceptual/descriptive work (4) and mixed or multi-method studies (3). Approaches ranged from presenting evidence to in iduals, teams and organisations, to providing facilitated tailored feedback supported by a process of ongoing dialogue to enable change. Feedback approaches identified primarily focused on changing clinician decision-making and behaviour. Providing feedback to clinicians was identified, in a range of a settings, as associated with changes in variation such as reducing overuse of tests and treatments, reducing variations in optimal patient clinical outcomes and increasing guideline or protocol adherence. The review findings suggest value in the use of feedback approaches to respond to clinical variation and understand when action is warranted. Evaluation of the effectiveness of particular feedback approaches is now required to determine if there is an optimal approach to create change where needed.

Variation in ovarian cancer care in Australia: An analysis of patterns of care in diagnosis and initial treatment in New South Wales.

Publisher: Hindawi Limited

Date: 03-07-2022

DOI: 10.1111/ECC.13649

Abstract: Ovarian cancer has the highest mortality of all gynaecological cancers. This study aimed to identify the extent to which women across New South Wales experienced variation in their care in diagnosis and initial treatment for ovarian cancer against the national optimal care pathway for ovarian cancer. Clinical audit methodology was utilised to explore variations for women with primary ovarian cancer 171 eligible cases were identified through by the NSW Cancer Registry for the period of 1 March 2017 to 28 February 2018. Limited variation was detected with 86% of women being reviewed by a specialist gynaecological oncology multidisciplinary team 54% of women received their first treatment within 28 days of their first specialist appointment, 66% of women having their first surgery completed by a gynaecological oncologist and 45% of women received their first treatment in a specialist gynaecological oncology hospital. Deviation from effective ovarian cancer care is apparent particularly in the location and timeliness of first treatment, with implications for the quality of care received and care outcomes. Understanding factors that contribute to variation is critical to ensure optimal and appropriate ovarian cancer care and to tackle systemic barriers to the provision of effective care.

Addressing unwarranted clinical variation: A rapid review of current evidence

Publisher: Wiley

Date: 15-05-2019

DOI: 10.1111/JEP.12930

Abstract: Unwarranted clinical variation (UCV) can be described as variation that can only be explained by differences in health system performance. There is a lack of clarity regarding how to define and identify UCV and, once identified, to determine whether it is sufficiently problematic to warrant action. As such, the implementation of systemic approaches to reducing UCV is challenging. A review of approaches to understand, identify, and address UCV was undertaken to determine how conceptual and theoretical frameworks currently attempt to define UCV, the approaches used to identify UCV, and the evidence of their effectiveness. Rapid evidence assessment (REA) methodology was used. A range of text words, synonyms, and subject headings were developed for the major concepts of unwarranted clinical variation, standards (and deviation from these standards), and health care environment. Two electronic databases (Medline and Pubmed) were searched from January 2006 to April 2017, in addition to hand searching of relevant journals, reference lists, and grey literature. Results were merged using reference-management software (Endnote) and duplicates removed. Inclusion criteria were independently applied to potentially relevant articles by 3 reviewers. Findings were presented in a narrative synthesis to highlight key concepts addressed in the published literature. A total of 48 relevant publications were included in the review 21 articles were identified as eligible from the database search, 4 from hand searching published work and 23 from the grey literature. The search process highlighted the voluminous literature reporting clinical variation internationally yet, there is a dearth of evidence regarding systematic approaches to identifying or addressing UCV. Wennberg's classification framework is commonly cited in relation to classifying variation, but no single approach is agreed upon to systematically explore and address UCV. The instances of UCV that warrant investigation and action are largely determined at a systems level currently, and stakeholder engagement in this process is limited. Lack of consensus on an evidence-based definition for UCV remains a substantial barrier to progress in this field.

Codesigning patient experience measures for and with children and young people with intellectual disability: a study protocol

Publisher: BMJ

Date: 12-2021

DOI: 10.1136/BMJOPEN-2021-050973

Abstract: Children and young people with intellectual disability represent one of the most vulnerable groups in healthcare, yet they remain under-represented in projects to design, develop and/or improve healthcare service delivery. Increasingly, healthcare services are using various codesign and coproduction methodologies to engage children and young people in service delivery improvements. This study employs an inclusive approach to the study design and execution, including two co-researchers who are young people with intellectual disability on the project team. We will follow an adapted experience-based co-design methodology to enable children and young people with intellectual disability to participate fully in the co-design of a prototype tool for eliciting patient experience data from children and young people with intellectual disability in hospital. This study was granted ethical approval on 1 February 2021 by the Sydney Children’s Hospitals Network Human Research Ethics Committee, reference number 2020/ETH02898. Dissemination plan includes publications, doctoral thesis chapter, educational videos. A summary of findings will be shared with all participants and presented at the organisation quality and safety committee.

What Drives Patients’ Complaints About Adverse Events in Their Hospital Care? A Data Linkage Study of Australian Adults 45 Years and Older

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 12-2021

DOI: 10.1097/PTS.0000000000000813

Achieving change readiness for health service innovations

Publisher: Hindawi Limited

Date: 19-02-2022

DOI: 10.1111/NUF.12713

Abstract: Continual innovation to address emerging population needs necessitates health service ongoing redesign and transformation worldwide. Recent ex les include service transformations in response to Covid-19, many of which were led and managed by nurses. Ensuring change readiness is central to delivering these transformative changes yet has been identified as a central challenge impacting nurse leaders and managers. Recent evidence indicates that affective commitment to change among healthcare staff may be an important contributor to gaining support for change implementation but understudied in healthcare. A cross-sectional survey study was used to examine the association between affective commitment to change and change readiness among 30 healthcare staff across four projects in one state-wide health system in Australia. Our findings indicate that affective commitment to change healthcare worker's emotional and personal perception of the value of the proposed change is independently associated with in idual and collective change readiness. Given that achieving change readiness is a central goal of change management strategies, this pilot work provides valuable insight to inform the change management practices of nurse leaders and managers.

Efficiency Improvement Strategies for Public Health Systems: Developing and Evaluating a Taxonomy in the Australian Healthcare System

Publisher: MDPI AG

Date: 31-07-2023

DOI: 10.3390/HEALTHCARE11152177

Abstract: Introduction: As demand for healthcare continues to grow, public health systems are increasingly required to drive efficiency improvement (EI) to address public service funding challenges. Despite this requirement, evidence of EI strategies that have been successful applied at the whole-of-system level is limited. This study reports the development, implementation and evaluation of a novel taxonomy of EI strategies used in public health systems to inform systemwide EI models. Materials and methods: The public health system in New South Wales, Australia, operates a centralised EI model statewide and was the setting for this study. An audit of EI strategies implemented in the NSW Health system between July 2016 and June 2019 was used to identify all available EI strategies within the study timeframe. A content management approach was applied to audit the strategies, with each strategy coded to an EI focus area. Codes were clustered according to similarity, and category names were assigned to each cluster to form a preliminary taxonomy. Each category was defined and ex les were provided. The resulting taxonomy was distributed and evaluated by user feedback survey and pre–post study to assess the impact on EI strategy distribution. Results: A total of 1127 EI strategies were identified and coded into 263 unique strategies, which were clustered into nine categories to form the taxonomy of EI strategies. Categories included the following: non-clinical contracts and supplies avoided and preventable activity clinical service delivery and patient outcomes finance and operations recruitment, vacancies and FTE staffing models leave management staff engagement and development premium staffing and clinical contracts and supplies. Evaluative findings revealed a perceived reduction in the duplication of EI work, improved access to EI knowledge and improved engagement with EI processes when using the taxonomy. The taxonomy was also associated with wider use of EI strategies. Conclusions: Whole-of-system EI is an increasing requirement. Using a taxonomy to guide systemwide practice appears to be advanta-geous in reducing duplication and guiding practice, with implications for use in health systems internationally.

The HUSH Project: Using codesign to reduce sleep disruptions for patients in hospital

Publisher: Wiley

Date: 23-09-2023

DOI: 10.1111/HEX.13881

The Impact of Adverse Events on Clinicians: What's in a Name?

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 07-11-2017

DOI: 10.1097/PTS.0000000000000256

Improving primary health care quality for refugees and asylum seekers: A systematic review of interventional approaches

Publisher: Wiley

Date: 15-10-2021

DOI: 10.1111/HEX.13365

Abstract: It has been widely acknowledged that refugees are at risk of poorer health outcomes, spanning mental health and general well‐being. A common point of access to health care for the migrant population is via the primary health care network in the country of resettlement. This review aims to synthesize the evidence of primary health care interventions to improve the quality of health care provided to refugees and asylum seekers. A systematic review was undertaken, and 55 articles were included in the final review. The Preferred Reporting Items for Systematic Reviews was used to guide the reporting of the review, and articles were managed using a reference‐management software (Covidence). The findings were analysed using a narrative empirical synthesis. A quality assessment was conducted for all the studies included. The interventions within the broad primary care setting could be organized into four categories, that is, those that focused on developing the skills of in idual refugees/asylum seekers and their families skills of primary health care workers system and/or service integration models and structures and lastly, interventions enhancing communication services. Promoting effective health care delivery for refugees, asylum seekers and their families is a complex challenge faced by primary care professionals, the patients themselves and the communication between them. This review highlights the innovative interventions in primary care promoting refugee health. Primary care interventions mostly focused on upskilling doctors, with a paucity of research exploring the involvement of other health care members. Further research can explore the involvement of interprofessional team members in providing effective refugee/migrant health. Patient and public involvement was explored in terms of interventions designed to improve health care delivery for the humanitarian migrant population, that is, specifically refugees and asylum seekers.

The safety of health care for ethnic minority patients: A systematic review

Publisher: Springer Science and Business Media LLC

Date: 08-07-2020

DOI: 10.1186/S12939-020-01223-2

Abstract: Evidence to date indicates that patients from ethnic minority backgrounds may experience disparity in the quality and safety of health care they receive due to a range of socio-cultural factors. Although heightened risk of patient safety events is of key concern, there is a dearth of evidence regarding the nature and rate of patient safety events occurring amongst ethnic minority consumers, which is critical for the development of relevant intervention approaches to enhance the safety of their care. To establish how ethnic minority populations are conceptualised in the international literature, and the implications of this in shaping of our findings the evidence of patient safety events arising among ethnic minority healthcare consumers internationally and the in idual, service and system factors that contribute to unsafe care. A systematic review of five databases (MEDLINE, PUBMED, PsycINFO, EMBASE and CINAHL) were undertaken using subject headings (MeSH) and keywords to identify studies relevant to our objectives. Inclusion criteria were applied independently by two researchers. A narrative synthesis was undertaken due to heterogeneity of the study designs of included studies followed by a study appraisal process. Forty-five studies were included in this review. Findings indicate that: (1) those from ethnic minority backgrounds were conceptualised variably (2) people from ethnic minority backgrounds had higher rates of hospital acquired infections, complications, adverse drug events and dosing errors when compared to the wider population and (3) factors including language proficiency, beliefs about illness and treatment, formal and informal interpreter use, consumer engagement, and interactions with health professionals contributed to increased risk of safety events amongst these populations. Ethnic minority consumers may experience inequity in the safety of care and be at higher risk of patient safety events. Health services and systems must consider the in idual, inter- and intra-ethnic variations in the nature of safety events to understand the where and how to invest resource to enhance equity in the safety of care. This systematic review is registered with Research Registry: reviewregistry761.

Multiple meanings of resilience: Health professionals' experiences of a dual element training intervention designed to help them prepare for coping with error.

Publisher: Wiley

Date: 04-03-2022

DOI: 10.1111/JEP.13555

Abstract: Consistent data demonstrates negative psychological effects of caregiving on front-line health professionals. Evidence that psychological resilience factors can help minimize distress and the potential for low-cost interventions have created interest in resilience-based development programmes yet evidence of perceived value amongst health professionals is lacking. This study explored health professionals' experiences and perceptions of a novel, resilience-based intervention designed to pro-actively prepare staff for coping with error to investigate their perceptions of what resilience meant to them, the relevance of the intervention, and impact of participation on ability to cope with error. Semi-structured interviews 4-6 weeks post intervention with 23 randomly selected participants from seven cohorts (midwives, paediatricians, obstetricians/gynaecologists, paramedics) and trainees (physician associates, mammographers, sonographers). Thematic analysis of interview data. Participants reported various interpretations of, and a shift in perception regarding what the concept of psychological resilience meant to them and their practice. These included for ex le, resilience as a positive or negative concept and their awareness and response to a range of personal, organizational and system factors influencing personal resilience. They valued the prophylactic, clinically relevant, interactive and applied nature of the intervention having developed and applied valuable skills beyond the context of involvement in error, noting that in iduals needed to be willing to explore their own coping mechanisms and human fallibility to gain maximum benefit. There was also consensus that whilst proactively developing in idual level psychological resilience is important, so too is addressing the organizational and system factors that affect staff resilience which are outside in idual staff control. Enhancing resilience appears to be considered useful in supporting staff to prepare for coping with error and the wider emotional burden of clinical work, but such interventions require integration into wider system approaches to reduce the burden of clinical work for health professionals.

Employing cofacilitation to balance power and priorities during health service codesign

Publisher: Wiley

Date: 19-09-2023

DOI: 10.1111/HEX.13875

Codesigning consumer engagement strategies with ethnic minority consumers in Australian cancer services: the CanEngage Project protocol

Publisher: BMJ

Date: 08-2021

DOI: 10.1136/BMJOPEN-2020-048389

Abstract: Consumer engagement is central to high-quality cancer service delivery and is a recognised strategy to minimise healthcare-associated harm. Strategies developed to enhance consumer engagement specifically in relation to preventing healthcare harm include questioning health professionals, raising concerns about possible mistakes or risks in care and encouraging patients and caregivers to report suspected errors. Patients from ethnic minority backgrounds are particularly vulnerable to unsafe care, but current engagement strategies have not been developed specifically for (and with) this population. Using an adapted approach to experience-based codesign (EBCD) to support the target population, the aim of the project is to codesign consumer engagement interventions to increase consumer engagement and safety in New South Wales and Victorian cancer inpatient, outpatient and day procedure services. A mixed-method project will be undertaken at six study sites. Our EBCD approach includes a preparatory phase in which we will provide training and support to the codesign participants, in addition to recruiting and training consumer cofacilitators for the codesign workshops. The project will follow the EBCD process of gathering and synthesising observational data from each cancer service, with interview data from consumers and staff. With the resulting in-depth understanding of the safety threats commonly experienced by ethnic minority consumers in each site, we will work through feedback events and codesign groups with consumers and staff to determine how they can be more involved with their care to minimise the potential for patient harm. Consumer engagement interventions will be coproduced in each of the six participating services that are tailored to the ethnic minority populations served. Ethics approval has been obtained from the Western Sydney Local Health District Human Research Ethics Committee. The project will provide strategies for ethnic minority consumers to engage with cancer services to minimise healthcare-associated harm that may be applied to erse healthcare settings.

What is the role of cultural competence in ethnic minority consumer engagement? An analysis in community healthcare

Publisher: Springer Science and Business Media LLC

Date: 12-2019

DOI: 10.1186/S12939-019-1104-1

Abstract: Effective patient engagement has been associated with high quality health care. There is a dearth of evidence around effective engagement with consumers from ethnic minority backgrounds specifically in relation to the role of cultural competence amongst healthcare professionals in effective engagement with consumers from ethnic minority backgrounds. To address this knowledge gap, we analysed the role of cultural competence in the consumer engagement approaches taken by community healthcare professionals working with consumers from ethnic minority backgrounds. Semi-structured in idual interviews were conducted with 21 healthcare professionals employed across four community healthcare and affiliated services in four local government areas in Australia. Adopting patient-centric approaches (that seek to understand and be responsive to the patient as an in idual) featured as an underpinning theme that transcended other emerging themes. Recognition of ersity within communities and in iduals in those communities, all with their own story, was described as pivotal to effective engagement. This was encapsulated in the theme of Cultural standpoints and personal context that contained four further themes of: (1) Build foundations of trust and respect (2) Diversify communication channels (3) Generate system, service and community partnerships (4) Take the time . Our findings indicate that cultural competence and effective consumer engagement are closely linked in ethnic minority populations. Embedding cultural competence as a health system, service and professional capability is therefore critical to ensure equitable healthcare quality for consumers from all ethnic backgrounds.

Virtual care post-pandemic: Why user engagement is critical to create and optimise future models of care

Publisher: SAGE Publications

Date: 2022

DOI: 10.1177/20552076221131455

Abstract: Health systems are shifting from the use of virtual models of care reactively in response to the conditions of the pandemic, to deliberate planning for the integration of virtual models to enhance and extend current service provision. Use of virtual care in recent years has highlighted the critical role of clinician and consumer behaviour and mindsets in realising the opportunities of virtual care for improved health care and outcomes. Yet, the rapid and changing circumstances of the pandemic period provided limited opportunities for effective involvement of both clinicians and consumers in health system decision-making about when, how and which virtual services and associated technologies should be deployed. We explore the opportunity for enhanced engagement with these primary stakeholder groups to create quality healthcare as we emerge from the pandemic and enter a new phase of integrated virtual services.

Engaging with ethnic minority consumers to improve safety in cancer services: A national stakeholder analysis

Publisher: Elsevier BV

Date: 08-2022

DOI: 10.1016/J.PEC.2022.04.014

Abstract: Ethnic minority populations are often exposed to healthcare-associated harm. There is little evidence about whether current patient engagement interventions are relevant. We conducted a national analysis of existing approaches amongst stakeholders in cancer care. Five online focus groups were conducted with 24 participants from consumer and health organisations across the Australian cancer system. Case studies depicting common methods of healthcare engagement to improve patient safety were developed and used to explore the suitability of current methods. Data were analysed thematically using the framework method. Three themes were identified: 1) sociocultural foundations of consumer engagement 2) principles for adaptation and 3) integration and implementation into cancer services. Sociocultural beliefs about cancer were considered to influence suitability. Adaptation may include multichannel methods, visual modalities and culturally specific content. Health system capacity, cultural competence of health service providers and consumer-led co-development were identified as critical to successful implementation. Existing engagement strategies are not completely suitable for ethnic minority populations nor feasible for implementation within cancer services. Healthcare services must work with ethnic minority populations to understand if and how underpinning beliefs influence engagement with cancer services. A range of tangible techniques may enhance the suitability of existing interventions.

Emotion and Coping in the Aftermath of Medical Error

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 03-2015

DOI: 10.1097/PTS.0B013E3182979B6F

Meta-Analysis of the Reasoned Action Approach (RAA) to Understanding Health Behaviors

Publisher: Oxford University Press (OUP)

Date: 11-05-2016

DOI: 10.1007/S12160-016-9798-4

Driving Efficiency Improvement (EI): Exploratory Analysis of a Centralised Model in New South Wales

Publisher: Informa UK Limited

Date: 10-2022

DOI: 10.2147/RMHP.S383107

Learning how to deliver bad and challenging news: Exploring the experience of trainee sonographers – A qualitative study

Publisher: SAGE Publications

Date: 24-09-2019

DOI: 10.1177/1742271X19876087

Abstract: Previous studies suggest there is a need to improve the delivery of bad and challenging news in obstetric ultrasound settings. However, no research has explored the experiences of trainee sonographers when learning how to deliver challenging news. Understanding this could identify gaps in current provision and inform future training interventions. To explore the experiences of trainee sonographers when learning how to deliver challenging news. Semi-structured interviews were conducted with trainee sonographers ( n = 7) from four training centres to explore their experiences and preferences for news delivery training. Learning how to deliver difficult news was a journey where trainees developed their confidence over time. Most learning occurred in clinical settings, but classroom teaching complemented this. Trainees appreciated the opportunity to observe clinical practice and to hear from patient representatives. However, quality of teaching varied between centres and trainees reported uncertainty regarding the specific language and behaviours they should use. They described building their own personal protocol for news delivery through the course of their training. An ultrasound-specific news delivery protocol which details the words and behaviours sonographers can employ could help reduce uncertainty in trainees. Trainees may also benefit from receiving structured feedback on their news delivery performance.

Integrating the sciences of improvement, implementation and managing change in nursing practice

Publisher: Wiley

Date: 18-12-2022

DOI: 10.1111/JOCN.16605

Improving hospital death certification in Vietnam: results of a pilot study of injury-related fatalities

Publisher: BMJ

Date: 08-2017

DOI: 10.1136/INJURYPREV-2017-042341

Abstract: Vietnam has prioritised the establishment of a civil registration system for deaths but as yet is unable to report accurate national statistics for the population of 93.5 million people due to inadequate mortality data. Verbal autopsy data suggest that injury is a third leading cause of death (by International Statistical Classification of Diseases and Related Health Problems 10th Revision chapters) in Vietnam, with road traffic injuries in particular a significant and increasing challenge. The study aims to present a more accurate profile of the number and probable causes of these deaths based on data collected hospitals using a version of the WHO death certificate modified for the Vietnamese context. Death data collected from Viet Duc Surgical and Trauma Hospital in Vietnam between 1 March 2013 to 31 March 2015 was analysed to explore the number and probable causes of deaths for deaths resulting from an injury. A total of 1616 deaths were recorded for Viet Duc Hospital, of which 73% (1181/1616) were associated with an injury. Most (83% n=871/1049) injury-related deaths for which immediate cause of death was documented were as a result of head/brain injuries. Injury-related deaths were most commonly caused by from traffic accidents (72%, 853/1181). The majority of patients suffering injury-related deaths were discharged home to die (93%, 1097/1181). The study confirms some findings from previous studies about deaths from injuries, while disagreeing with others, highlighting the challenge for Vietnam in collecting these data. Gathering detailed death data provides essential evidence on which to base decisions about allocation of government funding and policy for injury prevention and treatment.

Characterising consumer engagement in virtual models of care: A systematic review and narrative synthesis

Publisher: Elsevier BV

Date: 10-2023

DOI: 10.1016/J.PEC.2023.107922

‘Smiles and laughter and all those really great things’: Nurses' perceptions of good experiences of care for inpatient children and young people with intellectual disability

Publisher: Wiley

Date: 22-04-2022

DOI: 10.1111/JAN.15256

Abstract: To understand what constitutes a good experience of care for inpatient children and young people with intellectual disability as perceived by nursing staff. Interpretive qualitative study. Focus groups with clinical nursing staff from speciality neurological/neurosurgical and adolescent medicine wards across two specialist tertiary children's hospitals in Australia were conducted between March and May 2021. Data analysis followed interpretative analysis methods to develop themes and codes which were mapped to a conceptual model of safe care. Six focus groups with 29 nurses of varying experience levels were conducted over 3 months. Themes and codes were mapped to the six themes of the conceptual model: use rapport, know the child, negotiate roles, shared learning, build trust and relationships, and past experiences. The analysis revealed two new themes that extended the conceptual model to include the unique role of a paediatric nurse, and joy and job satisfaction, with a third contextual theme, impacts of COVID‐19 pandemic restrictions. With the perspectives of paediatric nurses incorporated into the model we have enhanced our model of safe care specifically for inpatient paediatric nursing care of children and young people with intellectual disability. Including perceptions of paediatric nurses confirmed the position of the child with intellectual disability being at the centre of safe care, where care is delivered as a partnership between nursing staff, child or young person and their parents/family and the hospital systems and processes. The enhanced model offers a specialized framework for clinical staff and health managers to optimize the delivery of safe care for children and young people with intellectual disability in hospital.

Disclosure of adverse events: a data linkage study reporting patient experiences among Australian adults aged ≥45 years

Publisher: CSIRO Publishing

Date: 2019

DOI: 10.1071/AH17179

Abstract: Objective Since Australia initiated national open disclosure standards in 2002, open disclosure policies have been adopted in all Australian states and territories. Yet, research evidence regarding their adoption is limited. The aim of the present study was to determine the frequency with which patients who report an adverse event had information disclosed to them about the incident, including whether they participated in a formal open disclosure process, their experiences of the process and the extent to which these align with the current New South Wales (NSW) policy. Methods A cross-sectional survey about patient experiences of disclosure associated with an adverse event was administered to a random s le of 20000 participants in the 45 and Up Study who were hospitalised in NSW, Australia, between January and June 2014. Results Of the 18993 eligible potential participants, completed surveys were obtained from 7661 (40% response rate), with 474 (7%) patients reporting an adverse event. Of those who reported an adverse event, a significant majority reported an informal or bedside disclosure (91% 430/474). Only 79 patients (17%) participated in a formal open disclosure meeting. Most informal disclosures were provided by nurses, with only 25% provided by medical practitioners. Conclusions Experiences of open disclosure may be enhanced by informing patients of their right to full disclosure in advance of or upon admission to hospital, and recognition of and support for informal or bedside disclosure for appropriate types of incidents. A review of the open disclosure guidelines in relation to the types of adverse events that require formal open disclosure and those more suitable to informal bedside disclosure is indicated. Guidelines for bedside disclosure should be drafted to assist medical practitioners and other health professionals facilitate and improve their communications about adverse events. Alignment of formal disclosure with policy requirements may also be enhanced by training multidisciplinary teams in the process. What is known about the topic? While open disclosure is required in all cases of serious adverse events, patients’ experiences are variable, and lack of, or poor quality disclosures are all too common. What does this paper add? This paper presents experiences reported by patients across New South Wales in a large cross-sectional survey. Unlike previous studies of open disclosure, recently hospitalised patients were identified and invited using data linkage with medical records. Findings suggest that most patients receive informal disclosures rather than a process that aligns with the current policy guidance. What are the implications for practitioners? Experiences of open disclosure may be enhanced by informing patients of their right to full disclosure in advance of or upon admission to hospital, and recognition of and support for informal or bedside disclosure for appropriate types of incidents.

How safe is virtual healthcare?

Publisher: Oxford University Press (OUP)

Date: 31-03-2022

DOI: 10.1093/INTQHC/MZAC021

Patient safety and quality of care in developing countries in Southeast Asia: a systematic literature review

Publisher: Oxford University Press (OUP)

Date: 12-06-2015

DOI: 10.1093/INTQHC/MZV041

Abstract: To establish current knowledge of patient safety and quality of care in developing countries in Southeast Asia, current interventions and the knowledge gaps. Systematic review and narrative synthesis. Key words, synonyms and subject headings were used to search seven electronic databases in addition to manual searching of relevant journals. Titles and abstracts of publications between 1990 and 2014 were screened by two reviewers and checked by a third. Full text articles were screened against the eligibility criteria. Data on design, methods and key findings were extracted and synthesized. Four inter-related safety and quality concerns were evident from 33 publications: (i) the risk of patient infection in healthcare delivery, (ii) medications errors/use, (iii) the quality and provision of maternal and perinatal care and (iv) the quality of healthcare provision overall. Large-scale prevalence studies are needed to identify the full range of safety and quality problems in developing countries in Southeast Asia. Sharing lessons learnt from extensive quality and safety work conducted in industrialized nations may contribute to significant improvements. Yet the applicability of interventions utilized in developed countries to the political and social context in this region must be considered. Strategies to facilitate the collection of robust safety and quality data in the context of limited resources and the local context in each country are needed.

Safety subcultures in health-care organizations and managing medical error

Publisher: SAGE Publications

Date: 02-2012

DOI: 10.1258/HSMR.2011.011018

Abstract: Leadership has been proposed as a key latent factor influencing the safety culture of an organization, the likelihood of errors occurring and the way in which these are managed. Therefore, when an error occurs, managers have an integral role to ensure that the most desirable outcomes are achieved for patients, health-care staff and their organization. Semistructured interviews were conducted in a large UK teaching hospital to explore the perspectives of staff who are tasked in some way with managing patient safety. Data from 26 transcripts were analysed using an adapted version of Spencer's (2003) qualitative framework, which revealed five primary themes. This paper reports findings from two overarching primary themes, described as being management and safety subcultures. These themes describe experiences of managing medical errors and the subgroup variations between professions, ranks and specialties in attitudes and behaviours towards error, and its management in a large National Health Service Trust. We discuss implications for health-care managers and health professionals in developing a stronger and more unified safety culture in their organizations, along with considerations for academic researchers when undertaking health services research.

Where Do Models for Change Management, Improvement and Implementation Meet? A Systematic Review of the Applications of Change Management Models in Healthcare

Publisher: Informa UK Limited

Date: 03-2021

DOI: 10.2147/JHL.S289176

Most doctors have negative experiences of reporting incidents

Publisher: BMJ

Date: 12-11-2013

DOI: 10.1136/BMJ.F6714

Correction: Using patients' experiences of adverse events to improve health service delivery and practice: Protocol of a data linkage study of Australian adults age 45 and above (BMJ Open (2014) 4 (e006599))

Publisher: BMJ

Date: 21-01-2015

DOI: 10.1136/BMJOPEN-2014-006599CORR1

Supporting second victims is a system-wide responsibility

Publisher: BMJ

Date: 06-05-2015

DOI: 10.1136/BMJ.H2341

The Application of e-Mental Health in Response to COVID-19: Scoping Review and Bibliometric Analysis (Preprint)

Publisher: JMIR Publications Inc.

Date: 16-08-2021

DOI: 10.2196/PREPRINTS.32948

Abstract: he COVID-19 pandemic and its mitigation measures and impacts, such as shelter-in-place orders, social isolation, restrictions on freedoms, unemployment, financial insecurity, and disrupted routines, have led to declines in mental health worldwide and concomitant escalating demands for mental health services. Under the circumstances, electronic mental health (e-mental health) programs and services have rapidly become the “new normal.” he aim of this study was to assess key characteristics and evidence gaps in the e-mental health literature published in relation to the COVID-19 pandemic via a scoping review and bibliometric analysis. e conducted a search of four academic databases (ie, MEDLINE, Embase, PsycInfo, and CINAHL) for documents published from December 31, 2019, to March 31, 2021, using keywords for e-mental health and COVID-19. Article information was extracted that was relevant to the review objective, including journal, type of article, keywords, focus, and corresponding author. Information was synthesized by coding these attributes and was then summarized through descriptive statistics and narrative techniques. Article influence was examined from Altmetric and CiteScore data, and a network analysis was conducted on article keywords. total of 356 publications were included in the review. Articles on e-mental health quickly thrived early in the pandemic, with most articles being nonempirical, chiefly commentaries or opinions (n=225, 63.2%). Empirical publications emerged later and became more frequent as the pandemic progressed. The United States contributed the most articles (n=160, 44.9%), though a notable number came from middle-income countries (n=59, 16.6%). Articles were spread across 165 journals and had above-average influence (ie, almost half of the articles were in the top 25% of output scores by Altmetric, and the average CiteScore across articles was 4.22). The network analysis of author-supplied keywords identified key topic areas, including specific mental disorders, eHealth modalities, issues and challenges, and populations of interest. These were further explored via full-text analysis. Applications of e-mental health during the pandemic overcame, or were influenced by, system, service, technology, provider, and patient factors. OVID-19 has accelerated applications of e-mental health. Further research is needed to support the implementation of e-mental health across system and service infrastructures, alongside evidence of the relative effectiveness of e-mental health in comparison to traditional modes of care.

Creating space for theory when codesigning healthcare interventions

Publisher: Wiley

Date: 14-06-2022

DOI: 10.1111/JEP.13720

Using consumer engagement strategies to improve healthcare safety for young people: An exploration of the relevance and suitability of current approaches

Publisher: Wiley

Date: 28-10-2022

DOI: 10.1111/HEX.13629

Abstract: Consumer engagement in health care is recognized as a critical strategy to minimize healthcare‐associated harms, however, little research has focussed on strategies to engage young people in healthcare safety. This study explores the suitability of commonly used engagement strategies, such as brochures, interactive bedside charts or apps, for young people (14–25 years) to improve their healthcare safety, with a focus on cancer care. Four qualitative online workshops were conducted ( N = 19). Two workshops included young people who had experienced cancer ( n = 6) and two workshops included staff who support young people who had experienced a diagnosis of cancer ( n = 12). Evidence from a systematic review was used to develop case studies of existing strategies as a topic guide for the online workshops. Data were analysed using a framework method and template analysis approach. Thematic analysis against the analytic framework led to the development of four principles for engagement with young people: empowerment, transparency, participatory culture and flexibility. The transition from being ‘looked after’ to young people being responsible for their own care was an integrative theme which intersected all elements of the framework. For service providers to engage with young people about safety issues in cancer services, the strategies employed need to be tailored to consider the transitional nature of being an adolescent or young adult. A systemic approach that incorporates flexible, tailored engagement strategies, education and empowerment of young people and healthcare providers is required to engage effectively with young people about safety in healthcare. These findings may have implications beyond cancer care. Workshop content was developed with and by the CanEngage team, including the Consumer Advisory Group, who reviewed content and inform wider project priorities.

Improving hospital death certification in Viet Nam: results of a pilot study implementing an adapted WHO hospital death report form in two national hospitals

Publisher: BMJ

Date: 04-2016

DOI: 10.1136/BMJGH-2015-000014

Macquarie University

Location: Australia

View Organisation

Linkage Projects - Grant ID: LP190100552

Start Date: 10-2020

End Date: 10-2024

Amount: $469,627.00

Funder: Australian Research Council

Discovery Projects - Grant ID: DP220100884

Start Date: 10-2022

End Date: 10-2025

Amount: $435,000.00

Funder: Australian Research Council