ORCID Profile
0000-0002-6107-7445
Current Organisation
Macquarie University
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In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Applied Ethics | Law and Society | Bioethics (human and animal) | Professional Ethics (incl. police and research ethics)
Public Health (excl. Specific Population Health) not elsewhere classified | Law, Politics and Community Services not elsewhere classified | Bioethics |
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-07-2021
Publisher: SAGE Publications
Date: 16-02-2022
DOI: 10.1177/19375867221077469
Abstract: The aim of this study was to develop built environment (BE) design knowledge to support resilient healthcare by systematically reviewing the evidence-based design (EBD) literature. Although the EBD literature is vast, it has not made explicit its contribution to resilient healthcare, which is a key component of the highly complex health service. This review followed the steps recommended by the Preferred Reporting Items for Systematic reviews and Meta-Analyses method. After applying the inclusion and exclusion criteria, 43 journal papers were selected. The papers were analyzed in light of five guidelines for coping with complexity, allowing for the development of BE design knowledge that supports resilient healthcare. The design knowledge compiled by the review was structured according to four levels of abstraction: five design-meta principles, corresponding to the five complexity guidelines, seven design principles, 21 design prescriptions, and 58 practical ex les. The design knowledge emphasizes the interactions between the BE as physical infrastructure and the functions that it supports. The design knowledge is expected to be useful not only to architects but also to those involved in the functional design of health services as they interact with the BE. Furthermore, our proposal provides a knowledge template that can be continuously updated based on the experience of practitioners and academic research.
Publisher: BMJ
Date: 03-2022
DOI: 10.1136/BMJOPEN-2021-058406
Abstract: Awareness of the benefits of cochlear implants is low, and barriers such as fear of surgery and ongoing rehabilitation have been noted. Perceived stigma associated with hearing loss also plays a key role, with many adults not wanting to appear old or be identified as a person with a disability. In effect, a cochlear implant makes deafness visible. New technologies have led to a smaller external profile for some types of cochlear implants, but qualitative assessments of benefit have not been explored. This study will examine cochlear implant aesthetics and cosmetics, and its impact on perceived stigma, social interactions, communication and quality of life. A particular focus will be the examination of totally implantable device concepts. A secondary aim is to understand what research techniques are best suited and most appealing for cochlear implant recipients, to assist in future study design and data collection methods. This study utilises a mixed-methods design. Three datasets will be collected from each participant with an expected s le size of 10–15 participants to allow for data saturation of themes elicited. Each participant will complete a demographic questionnaire, a quickfire survey (a short concise questionnaire on a topic of research familiarity and preference) and a semi-structured interview. Questionnaire and quickfire survey data will be analysed using descriptive statistics. Interviews will be transcribed and analysed thematically. All participants will be adults with more than 1 year of experience using cochlear implants. This study has been granted ethical approval from Macquarie University (HREC: 520211056232432) and meets the requirements set out in the National Statement on Ethical Conduct in Human Research. Study findings will be disseminated widely through international peer-reviewed journal articles, public and academic presentations, plain language summaries for participants and an executive summary for the project funder. This work was supported by Cochlear Limited (Cochlear Ltd). The funder will have no role in conducting or reporting on the study.
Publisher: Springer Science and Business Media LLC
Date: 29-08-2015
Publisher: BMJ
Date: 2013
Publisher: BMJ
Date: 02-2023
DOI: 10.1136/BMJOPEN-2022-066270
Abstract: To undertake a synthesis of evidence-based research for seven innovative models of care to inform the development of new hospitals. Umbrella review. Interventions delivered inside and outside of acute care settings. Children and adults with one or more identified acute or chronic health conditions. PsycINFO, Ovid MEDLINE and CINAHL. Clinical indicators and mortality, healthcare utilisation, quality of life, self-management and self-care and patient knowledge. A total of 66 reviews were included, synthesising evidence from 1272 primary studies across the 7 models of care. Virtual care was the most common model studied, addressed by 47 (73%) of the reviews. Common outcomes evaluated across reviews were clinical indicators and mortality, healthcare utilisation, self-care and self-management, patient knowledge, quality of life and cost-effectiveness. The findings indicate that the innovative models of healthcare we identified in this review may be effective in managing patients with a range of acute and chronic conditions. Most of the included reviews reported evidence of comparable or improved care. A consideration of local infrastructure and in idual patient characteristics, such as health literacy, may be critical in determining the suitability of models of care for patients and their implementation in local health systems. 10.17605/OSF.IO/PS6ZU.
Publisher: IOS Press
Date: 22-06-2023
DOI: 10.3233/SHTI230380
Abstract: Implementing ethics is a complex problem requiring stakeholders engagement. Engaging in fair and transparent way with stakeholders is part of the complexity. This qualitative study applies principles and techniques of Critical Systems Thinking while engaging with stakeholders in the context of implementing ethics for a COVID-19 AI. In a reflexive manner, the study examines the participatory process and its output leading to recommendations.
Publisher: Wiley
Date: 05-2018
DOI: 10.12788/JHM.2850
Abstract: Previous research has shown that interdisciplinary ward rounds have the potential to improve team functioning and patient outcomes. A convergent parallel multimethod approach to evaluate a hospital interdisciplinary ward round intervention and ward restructure. An acute medical unit in a large tertiary care hospital in regional Australia. Thirty‐two clinicians and inpatients aged 15 years and above, with acute episode of care, discharged during the year prior and the year of the intervention. A daily structured interdisciplinary bedside round combined with a ward restructure. Qualitative measures included contextual factors and measures of change and experiences of clinicians. Quantitative measures included length of stay (LOS), monthly “calls for clinical review,'” and cost of care delivery. Clinicians reported improved teamwork, communication, and understanding between and within the clinical professions, and between clinicians and patients, after the intervention implementation. There was no statistically significant difference between the intervention and control wards in the change in LOS over time (Wald χ 2 = 1.05 degrees of freedom [df] = 1 P = .31), but a statistically significant interaction for cost of stay, with a drop in cost over time, was observed in the intervention group, and an increase was observed in the control wards (Wald χ 2 = 6.34 df = 1 P = .012). The medical wards and control wards differed significantly in how the number of monthly “calls for clinical review” changed from prestructured interdisciplinary bedside round (SIBR) to during SIBR (F (1,44) = 12.18 P = .001). Multimethod evaluations are necessary to provide insight into the contextual factors that contribute to a successful intervention and improved clinical outcomes.
Publisher: Public Library of Science (PLoS)
Date: 02-05-2023
DOI: 10.1371/JOURNAL.PONE.0285207
Abstract: This study examined how the Australian news media have portrayed public hospital Emergency Departments (EDs) over the last two decades. A systematic review and media frame analysis, searching Factiva and Australia and New Zealand News Stream for digital and print news articles published between January 2000 and January 2020. Eligibility criteria were (1) discussed EDs in public hospitals (2) the primary focus of the article was the ED (3) focused on the Australian context (4) were published by one of the Australian state-based news outlets (e.g., The Sydney Morning Herald, Herald Sun). A pair of reviewers independently screened 242 articles for inclusion according to the pre-established criteria. Discrepancies were resolved via discussion. 126 articles met the inclusion criteria. Pairs of independent reviewers identified frames in 20% of the articles using an inductive approach to develop a framework for coding the remaining articles. News media rely heavily on reporting problems within and with the ED, while also proposing a cause. Praise for EDs was minimal. Opinions were primarily from government spokespeople, professional associations, and doctors. ED performance was often reported as fact, with no reference to the source of the information. Rhetorical framing devices, such as hyperbole and imagery, were used to emphasise dominant themes. The negative bias inherent in news media reporting of EDs could potentially damage public awareness of ED functioning, with implications for the likelihood of the public’s accessing ED services. Like in the film Groundhog Day, news media reporting is stuck in a loop reporting the same narrative over and over again.
Publisher: SAGE Publications
Date: 09-03-2021
Abstract: Emergency departments (EDs) are complex socio-technical work systems that require staff to manage patients in an environment of fluctuating resources and demands. To better understand the purpose, and pressures and constraints for designing new ED facilities, we developed an abstraction hierarchy model as part of a work domain analysis (WDA) from the cognitive work analysis (CWA) framework. The abstraction hierarchy provides a model of the structure of the ED, encompassing the core objects, processes, and functions relating to key values and the ED’s overall purpose. Reviews of relevant national and state policy, guidelines, and protocol documents applicable to care delivery in the ED were used to construct a WDA. The model was validated through focus groups with ED clinicians and subsequently validated using a series of WDA prompts. The model shows that the ED system exhibits extremely interconnected and complex features. Heavily connected functions introduce vulnerability into the system with function performance determined by resource availability and prioritization, leading to a trade-off between time and safety priorities. While system processes (e.g., triage, fast-track) support care delivery in ED, this delivery manifests in complex ways due to the personal and disease characteristics of patients and the dynamic state of the ED system. The model identifies system constraints that create tension in care delivery processes (e.g., electronic data entry, computer availability) potentially compromising patient safety. The model identified aspects of the ED system that could be leveraged to improve ED performance through innovative ED system design.
Publisher: Springer Science and Business Media LLC
Date: 24-06-2015
Publisher: BMJ
Date: 07-2016
Publisher: Elsevier BV
Date: 10-2023
Publisher: Springer Science and Business Media LLC
Date: 03-09-2021
Publisher: Public Library of Science (PLoS)
Date: 17-10-2022
DOI: 10.1371/JOURNAL.PONE.0276178
Abstract: The healthcare system is frequently subject to unpredictable conditions such as organisational changes and pandemics. In order to perform as required under these conditions (i.e. exhibiting resilient behaviour), it is necessary to know the current position of the organisation with respect to the four resilient potentials i.e. respond, monitor, learn and anticipate. The study aimed to understand and assess resilient performance of an Internal Medicine Department in a public hospital in Denmark using the resilience assessment grid (RAG). A modified Delphi method was used to develop the context specific RAG, using interviews to generate items, two rounds of expert panel reviews and pilot testing the developed RAG questionnaire. The four sets of structured RAG questions were tested and revised until satisfactory face and content validity for application was achieved. The final version of the RAG (28-item Likert scale) questionnaire was sent electronically to 87 healthcare professionals (clinicians and managers) in January 2021 and 2022. The data was statistically analysed and illustrated in radar charts to assist in interpreting the resilience profiles. While the resilience profiles in 2021 and 2022 were similar, the scores in 2022 were slightly lower for some of the sub-indicators. The results indicate areas for improvement, especially related to the Internal Medicine Department’s potential to respond and learn. The results from the RAG were presented to the chief clinical consultants and managers to identify initiatives for quality improvement and for planning a new workflow at the Internal Medicine Department. The RAG is a managerial tool to assess the potential resilient performance of the organisation in respect to the four resilience potentials, i.e., responding, monitoring, learning, and anticipating. It can be used to construct the resilience profile of the system over time to manage organisational changes.
Publisher: BMJ
Date: 11-2022
DOI: 10.1136/BMJOPEN-2021-059330
Abstract: To address the challenges of rapidly changing healthcare, governments and health services are increasingly emphasising healthcare delivery models that are flexible, person centred, cost-effective and integrate hospital services more closely with primary healthcare and social services. In addition, such models increasingly embed consumer codesign, integration of services, and leverage digital technologies such as telehealth and sophisticated medical records systems. This paper provides a study protocol to describe a method to elicit consumer and healthcare provider needs and expectations for the development of innovative care models. A literature review identified six key models of care, supported by a common theme of consumer-focused care, along with the international evidence supporting the efficacy of these models. A mixed-methods study of the needs and expectations of consumer members and health providers who reside or work in the area of a new hospital catchment will be undertaken. They will complete a community-specific and provider-specific, short demographic questionnaire (delivered during the recruitment process) and be assigned to facilitator-coordinated online workshops comprising small focus groups. Follow-up interviews will be offered. Culturally and linguistically erse members and Aboriginal and Torres Strait Islander Elders and their communities will also be consulted. Data will be analysed thematically (qualitative) and statistically (quantitative), and findings synthesised using a triangulated approach. The results will be actively disseminated through peer-reviewed journals, conference presentations and in a report to stakeholders. This study was reviewed and approved by the relevant Ethics Committee in New South Wales, Australia.
Publisher: Springer Science and Business Media LLC
Date: 23-03-2022
DOI: 10.1186/S12910-022-00771-2
Abstract: The development and deployment of medical devices, along with most areas of healthcare, has been significantly impacted by the COVID-19 pandemic. This has had variable ethical implications, two of which we will focus on here. First, medical device regulations have been rapidly amended to expedite approvals of devices ranging from face masks to ventilators. Although some regulators have issued cessation dates, there is inadequate discussion of triggers for exiting these crisis standards, and evidence that this may not be feasible. Given the relatively low evidence standards currently required for regulatory approval of devices, this further indefinite reduction in standards raises serious ethical issues. Second, the pandemic has disrupted the usual operations of device representatives in hospitals, providing an opportunity to examine and refine this potentially ethically problematic practice. In this paper we explain and critically analyse the ethical implications of these two pandemic-related impacts on medical devices and propose suggestions for their management. These include an endpoint for pandemic-related adjustments to device regulation or a mechanism for continued refinement over time, together with a review of device research conducted under crisis conditions, support for the removal and replacement of emergency approved devices, and a review of device representative credentialling.
Publisher: Wiley
Date: 17-07-2020
DOI: 10.1111/JPC.14560
Abstract: Acute otitis media (AOM) is the most common infectious disease for which antibiotics are prescribed its management is costly and has the potential to increase the antimicrobial resistance of this infection. This study measured the levels of adherence to the clinical practice guidelines (CPGs) of AOM and otitis media with effusion (OME) management in Australian children. We searched for national and international CPGs relating to AOM and OME in children and created 37 indicators for assessment. We reviewed medical records for adherence to these indicators in 120 locations, across one inpatient and three ambulatory health-care settings. Our review s le was obtained from three Australian states that contain 60% of the nation's children. We reviewed the records of 1063 children with one or more assessments of CPG adherence for otitis media. Of 22 indicators with sufficient data, estimated adherence ranged from 7.4 to 99.1%. Overuse of treatment, particularly overprescribing of antibiotics, was more common than underuse. A frequent lack of adherence with recommended care was observed for children aged between 1 and 2 years with AOM. Adherence varied by health-care setting, with emergency departments and inpatient settings more adherent to CPGs than general practices. Our assessment of a number of indicators in the common settings in which otitis media is treated found that guideline adherence varied widely between in idual indicators. Internationally agreed standards for diagnosis and treatment, coupled with clinician education on the existence and content of CPGs and clinical decision support, are needed to improve the management of children presenting with AOM and OME.
Publisher: Springer Science and Business Media LLC
Date: 21-10-2020
DOI: 10.1186/S13012-020-01049-0
Abstract: Studies of clinical effectiveness have demonstrated the many benefits of programmes that avoid unnecessary hospitalisations. Therefore, it is imperative to examine the factors influencing implementation of these programmes to ensure these benefits are realised across different healthcare contexts and settings. Numerous factors may act as determinants of implementation success or failure (facilitators and barriers), by either obstructing or enabling changes in healthcare delivery. Understanding the relationships between these determinants is needed to design and tailor strategies that integrate effective programmes into routine practice. Our aims were to describe the implementation determinants for hospital avoidance programmes for people with chronic conditions and the relationships between these determinants. An electronic search of four databases was conducted from inception to October 2019, supplemented by snowballing for additional articles. Data were extracted using a structured data extraction tool and risk of bias assessed using the Hawker Tool. Thematic synthesis was undertaken to identify determinants of implementation success or failure for hospital avoidance programmes for people with chronic conditions, which were categorised according to the Consolidated Framework for Implementation Research (CFIR). The relationships between these determinants were also mapped. The initial search returned 3537 articles after duplicates were removed. After title and abstract screening, 123 articles underwent full-text review. Thirteen articles (14 studies) met the inclusion criteria. Thematic synthesis yielded 23 determinants of implementation across the five CFIR domains. ‘Availability of resources’, ‘compatibility and fit’, and ‘engagement of interprofessional team’ emerged as the most prominent determinants across the included studies. The most interconnected implementation determinants were the ‘compatibility and fit’ of interventions and ‘leadership influence’ factors. Evidence is emerging for how chronic condition hospital avoidance programmes can be successfully implemented and scaled across different settings and contexts. This review provides a summary of key implementation determinants and their relationships. We propose a hypothesised causal loop diagram to represent the relationship between determinants within a complex adaptive system. PROSPERO 162812
Publisher: BMJ
Date: 21-07-2014
Publisher: Springer Science and Business Media LLC
Date: 24-02-2022
DOI: 10.1186/S12913-022-07633-Y
Abstract: Unnecessary referrals in Danish hospitals may be contributing to inefficient use of health services already stretched and under pressure and may lead to delayed treatment for patients. Despite a growing awareness in the literature and in practice of issues related to referrals, there has been relatively little research on referrals between specialists in hospital outpatient clinics and how it can be improved. This study aimed to describe the referral patterns to and within the Medical Department at the University Hospital of Southern Denmark. The Medical Department consists of the following medical specialist outpatient clinics nephrology, pulmonology, endocrinology, cardiovascular, wound outpatient clinic, and a day hospital. Two specialist physicians assessed all referrals to the medical specialist outpatient clinics over one month (from 01 September 2019 to 30 September 2019) using data drawn from the Danish electronic patient record system (Cosmic). Data on referral pattern, and patient age and sex, were statistically analysed to identify and characterise patterns of referral. Four hundred seventy-one (100%) referrals were included in the study. 49.5% (233) of the referrals were from the hospital and 50.5% (238) from general practitioners (GPs). Of the 233 referrals from the hospitals, 31% (72) were from the Medical Department. The high rate of referrals (31%) from own Medical Department or outpatient clinics may reflect an inefficient internal referral process within the department. Improved collaboration between specialists could have the potential to improve health outcomes, timely access to care and more appropriate healthcare resource utilisation.
Publisher: Maad Rayan Publishing Company
Date: 12-10-2022
Publisher: Springer Science and Business Media LLC
Date: 15-05-2020
DOI: 10.1186/S12913-020-05316-0
Abstract: High-risk patients presenting for surgery require complex decision-making and perioperative management. However, given there is no gold standard for identifying high-risk patients, doing so may be challenging for clinicians in practice. Before a gold standard can be established, the state of current practice must be determined. This study aimed to understand how working clinicians define and identify high-risk surgical patients. Clinicians involved in the care of high-risk surgical patients at a public hospital in regional Australia were interviewed as part of an ongoing study evaluating a new shared decision-making process for high-risk patients. The new process, Patient-Centred Advanced Care Planning (PC-ACP) engages patients, families, and clinicians from all relevant specialties in shared decision-making in line with the patient’s goals and values. The semi-structured interviews were conducted before the implementation of the new process and were coded using a modified form of the ‘constant comparative method’ to reveal key themes. Themes concerning patient risk, clinician’s understanding of high risk, and methods for identifying high-risk surgical patients were extricated for close examination. Thirteen staff involved in high-risk surgery at the hospital at which PC-ACP was to be implemented were interviewed. Analysis revealed six sub-themes within the major theme of factors related to patient risk: (1) increase in high-risk patients, (2) recognising frailty, (3) risk-benefit balance, (4) suitability and readiness for surgery, (5) avoiding negative outcomes, and (6) methods in use for identifying high-risk patients. There was considerable variability in clinicians’ methods of identifying high-risk patients and regarding their definition of high risk. This variability occurred even among clinicians within the same disciplines and specialties. Although clinicians were confident in their own ability to identify high-risk patients, they acknowledged limitations in recognising frail, high-risk patients and predicting and articulating possible outcomes when consenting these patients. Importantly, little consistency in clinicians’ reported methods for identifying high-risk patients was found. Consensus regarding the definition of high-risk surgical patients is necessary to ensure rigorous decision-making.
Publisher: Wiley
Date: 15-07-2015
DOI: 10.1111/CTS.12188
Publisher: BMJ
Date: 11-2016
Publisher: BMJ
Date: 04-2023
DOI: 10.1136/BMJOPEN-2022-069951
Abstract: To address challenges regarding the delivery of healthcare, governments and health services are focusing on the implementation of models that are flexible, person-centred, cost-effective and integrate hospital services more closely with primary healthcare and social services. Such models increasingly embed consumer codesign, multidisciplinary teams and leverage digital technologies, such as telehealth, attempting to deliver care more seamlessly and to continually improve services. This paper provides a study protocol to describe a method to explore Aboriginal and/or Torres Strait Islander consumer and healthcare provider needs and expectations for the design and development of a new healthcare facility in Australia. A qualitative study of consumer members’ and health providers’ needs and expectations. Data collection includes a short consumer-specific and provider-specific, demographic questionnaire and culturally appropriate facilitator-coordinated consultation workshops. Data will be analysed thematically (qualitatively). The results will be actively disseminated through peer-reviewed journals, conference presentations, reports to stakeholders and community meetings. This study was reviewed and approved by a health service-based Ethics Committee in New South Wales, Australia and the Aboriginal Health and Medical Research Committee.
Publisher: AMPCo
Date: 03-2018
DOI: 10.5694/MJA16.01268
Publisher: Springer International Publishing
Date: 15-12-2021
DOI: 10.1007/978-3-030-59403-9_27
Abstract: Over the past two decades, prominent researchers such as Greenhalgh [1], Plsek [2], Leykum [3], Lanham [4], Petticrew [5] and Hawe [6, 7] and their colleagues and teams have promoted using complexity theory to describe and analyse the various dimensions of healthcare organisation [8–12]. Internationally, in parallel, governments have recognised the need to ‘think differently’ about healthcare policy and service delivery, but without much traction on how that might be done and what it might mean. Nevertheless, it has now become more common—but by no means universal—to apply a complexity lens to understanding healthcare services and to improving them. This involves greater appreciation of elaborate, intricate, multi-faceted care networks, healthcare ecosystems, layered parts in composite settings, contextual differences across care settings, clinical cultures, multi-agent environments, and the convoluted, challenging, wicked problems [13] these systems throw up. However, with some relatively limited exceptions, the quality and safety fields’ interest in complexity has, to date, been largely superficial, both theoretically and empirically [1].
Publisher: BMJ
Date: 08-2021
DOI: 10.1136/BMJOPEN-2021-050377
Abstract: To identify the risk factors associated with complaints, malpractice claims and impaired performance in medical practitioners. Systematic review. Ovid-Medline, Ovid Embase, Scopus and Cochrane Central Register of Controlled Trials were searched from 2011 until March 2020. Reference lists and Google were also handsearched. Sixty-seven peer-reviewed papers and three grey literature publications from 2011 to March 2020 were reviewed by pairs of independent reviewers. Twenty-three key factors identified, which were categorised as demographic or workplace related. Gender, age, years spent in practice and greater number of patient lists were associated with higher risk of malpractice claim or complaint. Risk factors associated with physician impaired performance included substance abuse and burn-out. It is likely that risk factors are interdependent with no single factor as a strong predictor of a doctor’s risk to the public. Risk factors for malpractice claim or complaint are likely to be country specific due to differences in governance structures, processes and funding. Risk factors for impaired performance are likely to be specialty specific due to differences in work culture and access to substances. New ways of supporting doctors might be developed, using risk factor data to reduce adverse events and patient harm. PROSPERO registration number: CRD42020182045.
Publisher: Springer Science and Business Media LLC
Date: 07-08-2023
DOI: 10.1186/S12913-023-09839-0
Abstract: The COVID-19 pandemic has presented many multi-faceted challenges to the maintenance of service quality and safety, highlighting the need for resilient and responsive healthcare systems more than ever before. This review examined empirical investigations of Resilient Health Care (RHC) in response to the COVID-19 pandemic with the aim to: identify key areas of research synthesise findings on capacities that develop RHC across system levels (micro, meso, macro) and identify reported adverse consequences of the effort of maintaining system performance on system agents (healthcare workers, patients). Three academic databases were searched (Medline, EMBASE, Scopus) from 1st January 2020 to 30th August 2022 using keywords pertaining to: systems resilience and related concepts healthcare and healthcare settings and COVID-19. Capacities that developed and enhanced systems resilience were synthesised using a hybrid inductive-deductive thematic analysis. Fifty publications were included in this review. Consistent with previous research, studies from high-income countries and the use of qualitative methods within the context of hospitals, dominated the included studies. However, promising developments have been made, with an emergence of studies conducted at the macro-system level, including the development of quantitative tools and indicator-based modelling approaches, and the increased involvement of low- and middle-income countries in research (LMIC). Concordant with previous research, eight key resilience capacities were identified that can support, develop or enhance resilient performance, namely: structure, alignment, coordination, learning, involvement, risk awareness, leadership, and communication. The need for healthcare workers to constantly learn and make adaptations, however, had potentially adverse physical and emotional consequences for healthcare workers, in addition to adverse effects on routine patient care. This review identified an upsurge in new empirical studies on health system resilience associated with COVID-19. The pandemic provided a unique opportunity to examine RHC in practice, and uncovered emerging new evidence on RHC theory and system factors that contribute to resilient performance at micro, meso and macro levels. These findings will enable leaders and other stakeholders to strengthen health system resilience when responding to future challenges and unexpected events.
Publisher: Hindawi Limited
Date: 30-11-2022
DOI: 10.1111/HSC.13665
Abstract: People with disabilities are often subject to intersecting layers of social and economic disadvantage and other barriers that drive health inequity. As a result, they frequently experience worse health than people without disabilities, beyond the direct effects of their health condition or impairment. The aim of this overview of systematic reviews was to summarise the evidence on the impact of socio-environmental factors (i.e. social, physical or attitudinal) on the health outcomes of disabled people. A systematic search of five databases (MEDLINE, PsycINFO, Embase, CINAHL and Scopus) for English-language articles from January 2000 to April 2021 was conducted. Abstracts were screened by two reviewers and reviews were critically appraised. Key data were extracted by topic, population, disability type, critical appraisal method, socio-environmental themes and health outcomes. There were 23 systematic reviews identified examining adult (60.9%) or child and young (8.7%) disabled people, with 30.4% not specifying an age range. Reviews examined people with neurological or physical (39.1%), intellectual (17.4%), sensory (8.7%) or a range of (34.8%) disabilities. Three key health outcomes (i.e. access to healthcare, health-promoting behaviour and care quality) and several recurring socio-environmental themes related to the health outcomes of disabled people were identified. Disabled people encounter common social, physical and attitudinal factors that hinder their health outcomes in terms of access to services and quality healthcare. Many preventive health services were identified as either inaccessible or not meeting the needs of disabled people. Greater involvement of disabled people in service design and awareness raising is essential.
Publisher: BMJ
Date: 09-2017
DOI: 10.1136/BMJOPEN-2016-014474
Abstract: Despite common assumptions that doctors are well placed to lead hospitals and healthcare organisations, the peer-reviewed literature contains little evidence on the performance of doctors in leadership roles in comparison with that of non-medical managers. To determine whether there is an association between the leader’s medical background and management performance in terms of organisational performance or patient outcomes. We searched for peer-reviewed, English language studies using Medline, Embase and Emerald Management between 2005 and 2017. We included quantitative, qualitative and mixed method empirical studies on the performance of senior healthcare managers where participants were described as doctors or leaders and where comparative performance data were provided on non-medical leaders. Studies without full text available, or no organisational, leadership behaviour or patient measures, were excluded. The search, conducted in Medline (n=3395), Embase (n=1913) and Emerald Management (n=454) databases, yielded 3926 entries. After the application of inclusion and exclusion criteria, 16 studies remained. Twelve studies found that there were positive differences between medical and non-medical leaders, and eight studies correlated those findings with hospital performance or patient outcomes. Six studies examined the composition of boards of directors otherwise, there were few common areas of investigation. Five inter-related themes emerged from a narrative analysis: the impact of medical leadership on outcomes doctors on boards contribution of qualifications and experience the medical leader as an in idual or part of a team and doctors transitioning into the medical leadership role. A modest body of evidence supports the importance of including doctors on organisational governing boards. Despite many published articles on the topic of whether hospitals and healthcare organisations perform better when led by doctors, there were few empirical studies that directly compared the performance of medical and non-medical managers. This is an under-researched area that requires further funding and focus.
Publisher: Elsevier BV
Date: 10-2021
Publisher: BMJ
Date: 12-2015
Publisher: Springer Science and Business Media LLC
Date: 11-07-2023
DOI: 10.1186/S12913-023-09769-X
Abstract: Resilience, the capacity to adapt and respond to challenges and disturbances, is now considered fundamental to understanding how healthcare systems maintain required levels of performance across varying conditions. Limited research has examined healthcare resilience in the context of implementing healthcare improvement programs across multiple system levels, particularly within community-based mental health settings or systems. In this study, we explored resilient characteristics across varying system levels (in idual, team, management) during the implementation of a large-scale community-based suicide prevention intervention. Semi-structured interviews ( n =53) were conducted with coordinating teams from the four intervention regions and the central implementation management team. Data were audio-recorded, transcribed, and imported into NVivo for analysis. A thematic analysis of eight transcripts involving thirteen key personnel was conducted using a deductive approach to identify characteristics of resilience across multiple system levels and an inductive approach to uncover both impediments to, and strategies that supported, resilient performance during the implementation of the suicide prevention intervention. Numerous impediments to resilient performance were identified (e.g., complexity of the intervention, and incompatible goals and priorities between system levels). Consistent with the adopted theoretical framework, indicators of resilient performance relating to anticipation, sensemaking, adaptation and tradeoffs were identified at multiple system levels. At each of the system levels, distinctive strategies were identified that promoted resilience. At the in idual and team levels, several key strategies were used by the project coordinators to promote resilience, such as building relationships and networks and carefully prioritising available resources. At the management level, strategies included teambuilding, collaborative learning, building relationships with external stakeholders, monitoring progress and providing feedback. The results also suggested that resilience at one level can shape resilience at other levels in complex ways most notably we identified that there can be a downside to resilience, with negative consequences including stress and burnout, among in iduals enacting resilience. The importance of considering resilience from a multilevel systems perspective, as well as implications for theory and future research, are discussed.
Publisher: BMJ
Date: 02-2017
Publisher: Wiley
Date: 27-01-2022
DOI: 10.1002/HFM.20947
Abstract: Although the COVID pandemic has challenged the resilience of health services in general, this impact has been most visible in intensive care units (ICUs). This paper presents an exploratory study of how ICUs in Brazil have coped with the complexity stemming from the pandemic. Five guidelines for coping with complexity were adopted as analytical framework. The guidelines were concerned with slack resources, ersity of perspectives, visibility, work‐as‐done, and unintended consequences. There were three main sources of data: (i) a survey with respondents from 33 ICUs, which indicated their agreement with 23 statements related to the use of the complexity guidelines (ii) semistructured interviews with seven survey respondents and two public health officials and (iii) 20 h of observations of the meetings of a municipal bed management committee. Seventy resilience practices were identified from these data sources. Most of these practices ( n = 30) were related to the guideline on slack resources, which were commonly obtained from other hospital units. As for the survey data, the statement related to the availability of extra or standby human resources obtained the lowest score, reinforcing the key role of slack resources. Five lessons learned for coping with complexity in ICUs were drawn from our data one lesson for each guideline. Furthermore, the survey questionnaire is a potential ICU assessment tool, which can be adapted to other health services.
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/AH18050
Abstract: In September 2017, the Royal Australasian College of Medical Administrators adopted a new clinical governance framework that recognised healthcare as a complex adaptive system, and embraced the need for resilient thinking and understanding the differences between work-as-imagined by managers and work-as-done at the front line of patient care. Directors of medical services may soon be implementing the framework in health services across Australia. This perspective describes a new conceptual model that underpins the Royal Australasian College of Medical Administrators framework, and characterises the challenges faced by all healthcare professionals when trying to achieve safe care for patients in an environment of variable complexity and unpredictability.
Publisher: Maad Rayan Publishing Company
Date: 06-07-2021
Publisher: Wiley
Date: 04-07-2022
DOI: 10.1111/HEX.13556
Abstract: Reflections on the response to the COVID‐19 pandemic often evoke the concept of ‘resilience’ to describe the way health systems adjusted and adapted their functions to withstand the disturbance of a crisis, and in some cases, improve and transform in its wake. Drawing from this, this study focuses on the role of consumer representatives in healthcare services in initiating changes to the way they participated in the pandemic response in the state of New South Wales in Australia. In‐depth interviews were conducted with two cohorts of consumer representatives. Cohort A included experienced and self‐identified consumer leaders, who worked together in a COVID‐19 Consumer Leaders Taskforce Cohort B included participants outside of this group, and purposively included consumer representatives from rural and regional areas, and culturally and linguistically erse communities. The pause in consumer engagement to support health service decision‐making in responding to the pandemic forced consumer representatives to consider alternative approaches to participate. Some initiated networking with each other, forming new collaborations to produce consumer‐led research and guidelines on pandemic‐related patient care. Others mobilized support from community and politicians to lobby for specific healthcare issues in their local areas. The response to the COVID‐19 pandemic made visible the brittle nature of previous engagement processes of involving consumers in organizational design and governance. However, the momentum for proactive self‐organization in an unexpected crisis created space for consumer representatives to reset and reimagine their role as active partners in health services. Their ability to adapt and adjust ways of working are key assets for a resilient health system. This project is a collaborative study between academic researchers and health consumer (patient and public) representatives. It followed the principles of codesign and coresearch, whereby both consumer representatives and academic researchers contributed equally to all stages of the project. The study was cofunded by both academic institutions and consumer representative organizations.
Publisher: The Sax Institute
Date: 2020
DOI: 10.17061/PHRP3042025
Publisher: Springer Science and Business Media LLC
Date: 12-02-2016
Publisher: Maad Rayan Publishing Company
Date: 25-04-2022
Publisher: Springer International Publishing
Date: 2023
Publisher: BMJ
Date: 12-05-2015
Publisher: Springer Science and Business Media LLC
Date: 04-01-2023
DOI: 10.1186/S12913-022-08997-X
Abstract: Integrated care is a model recognised internationally, however, there is limited evidence about its usability in the community. This study aimed to elicit community and provider views about integrated care and how implementation could meet their healthcare needs in a new hospital. Using a qualitative approach, consumer and provider views on the strengths, barriers and enablers for integrated care were collected via a series of online workshops and supplementary interviews. A total of 22 consumers and 49 providers participated in 11 focus groups all perceived integrated care to be an accessible and efficient model that offers a high level of care which enhanced staff and patient well-being. Providers expressed concerns about longer waiting times and safety risks associated with communication gaps and insufficient staff. Enablers include supporting consumers in navigating the integrated care process, co-ordinating and integrating primary care into the model as well as centralising patient electronic medical records. Primary, tertiary and community linkages are key for integrated care. Successful interoperability of services and networks requires an investment in resources and infrastructure to build the capability for providers to seamlessly access information at all points along the patient pathway. Integrated care is perceived by consumers and providers to be a flexible and patient-focused model of healthcare that offers benefits for a hospital of the future.
Publisher: Wiley
Date: 19-07-2023
DOI: 10.1002/HPM.3688
Abstract: One of the most difficult challenges in healthcare involves equitable allocation of resources. Our review aimed to identify international funding models in Organisation for Economic Co‐operation and Development (OECD) countries for government‐funded public hospitals and evidence underpinning their efficacy, via review of the peer‐reviewed and grey literature. Ovid‐Medline, Ovid Embase, Scopus, and PubMed were searched for peer‐reviewed literature. Advanced Google searches and targeted hand searches of relevant organisational websites identified grey literature. Inclusion criteria were: English language, published between 2011 and 2022, and that the article: (1) focused on healthcare funding (2) reported on or identified specific factors, indexes, algorithms or formulae associated with healthcare funding and (3) referred to countries that are members of the OECD, excluding the United States (US). For peer‐reviewed literature 1189 abstracts and 35 full‐texts were reviewed six articles met the inclusion criteria. For grey literature, 2996 titles or abstracts and 37 full‐texts were reviewed five articles met the inclusion criteria. Healthcare funding arrangements employed in 15 OECD countries (Australia, Belgium, Canada, Finland, France, Germany, Israel, Italy, the Netherlands, New Zealand, Norway, Spain, Sweden, Switzerland, and the United Kingdom [UK specifically, England, Scotland, Wales and Northern Ireland]) were identified, but papers reported population‐based funding arrangements for specific regions rather than hospital‐specific models. While some models adjusted for deprivation and ethnicity factors, none of the identified documents reported on health systems that adjusted funding allocation for social determinants such as health literacy levels.
Publisher: Springer Science and Business Media LLC
Date: 04-07-2023
DOI: 10.1186/S12913-023-09715-X
Abstract: A broad-based international shift to virtual care models over recent years has accelerated following COVID-19. Although there are increasing numbers of studies and reviews, less is known about clinicians’ and consumers’ perspectives concerning virtual modes in contrast to inpatient modes of delivery. We conducted a mixed-methods study in late 2021 examining consumers’ and providers’ expectations of and perspectives on virtual care in the context of a new facility planned for the north-western suburbs of Sydney, Australia. Data were collected via a series of workshops, and a demographic survey. Recorded qualitative text data were analysed thematically, and surveys were analysed using SPSS v22. Across 12 workshops, 33 consumers and 49 providers from varied backgrounds, ethnicities, language groups, age ranges and professions participated. Four advantages, strengths or benefits of virtual care reported were: patient factors and wellbeing, accessibility, better care and health outcomes, and additional health system benefits, while four disadvantages, weaknesses or risks of virtual care were: patient factors and wellbeing, accessibility, resources and infrastructure , and quality and safety of care . Virtual care was widely supported but the model is not suitable for all patients. Health and digital literacy and appropriate patient selection were key success criteria, as was patient choice. Key concerns included technology failures or limitations and that virtual models may be no more efficient than inpatient care models. Considering consumer and provider views and expectations prior to introducing virtual models of care may facilitate greater acceptance and uptake.
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.
Publisher: JMIR Publications Inc.
Date: 20-05-2021
Abstract: he success of electronic medical records (EMRs) is dependent on implementation features, such as usability and fit with clinical processes. The use of EMRs in mental health settings brings additional and specific challenges owing to the personal, detailed, narrative, and exploratory nature of the assessment, diagnosis, and treatment in this field. Understanding the determinants of successful EMR implementation is imperative to guide the future design, implementation, and investment of EMRs in the mental health field. e intended to explore evidence on effective EMR implementation for mental health settings and provide recommendations to support the design, adoption, usability, and outcomes. he scoping review combined two search strategies that focused on clinician-facing EMRs, one for primary studies in mental health settings and one for reviews of peer-reviewed literature in any health setting. Three databases (Medline, EMBASE, and PsycINFO) were searched from January 2010 to June 2020 using keywords to describe EMRs, settings, and impacts. The Proctor framework for implementation outcomes was used to guide data extraction and synthesis. Constructs in this framework include adoption, acceptability, appropriateness, feasibility, fidelity, cost, penetration, and sustainability. Quality assessment was conducted using a modified Hawker appraisal tool and the Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. his review included 23 studies, namely 12 primary studies in mental health settings and 11 reviews. Overall, the results suggested that adoption of EMRs was impacted by financial, technical, and organizational factors, as well as clinician perceptions of appropriateness and acceptability. EMRs were perceived as acceptable and appropriate by clinicians if the system did not interrupt workflow and improved documentation completeness and accuracy. Clinicians were more likely to value EMRs if they supported quality of care, were fit for purpose, did not interfere with the clinician-patient relationship, and were operated with readily available technical support. Evidence on the feasibility of the implemented EMRs was mixed the primary studies and reviews found mixed impacts on documentation quality and time one primary study found downward trends in adverse events, whereas a review found improvements in care quality. Five papers provided information on implementation outcomes such as cost and fidelity, and none reported on the penetration and sustainability of EMRs. he body of evidence relating to EMR implementation in mental health settings is limited. Implementation of EMRs could benefit from methods used in general health settings such as co-designing the software and tailoring EMRs to clinical needs and workflows to improve usability and acceptance. Studies in mental health and general health settings rarely focused on long-term implementation outcomes such as penetration and sustainability. Future evaluations of EMRs in all settings should consider long-term impacts to address current knowledge gaps.
Publisher: BMJ
Date: 04-07-2018
DOI: 10.1136/MEDETHICS-2018-104804
Abstract: Despite concerns about the relationships between health professionals and the medical device industry, the issue has received relatively little attention. Prevalence data are lacking however, qualitative and survey research suggest device industry representatives, who are commonly present in clinical settings, play a key role in these relationships. Representatives, who are technical product specialists and not necessarily medically trained, may attend surgeries on a daily basis and be available to health professionals 24 hours a day, 7 days a week, to provide advice. However, device representatives have a dual role: functioning as commissioned sales representatives at the same time as providing advice on approaches to treatment. This duality raises the concern that clinical decision-making may be unduly influenced by commercial imperatives. In this paper, we identify three key ethical concerns raised by the relationship between device representatives and health professionals: (1) impacts on healthcare costs, (2) the outsourcing of expertise and (3) issues of accountability and informed consent. These ethical concerns can be addressed in part through clarifying the boundary between the support and sales aspects of the roles of device representatives and developing clear guidelines for device representatives providing support in clinical spaces. We suggest several policy options including hospital provision of expert support, formalising clinician conduct to eschew receipt of meals and payments from industry and establishing device registries.
Publisher: BMJ
Date: 06-2016
Publisher: Oxford University Press (OUP)
Date: 16-04-2012
Publisher: Elsevier BV
Date: 06-2014
DOI: 10.1016/J.IJMEDINF.2014.02.005
Abstract: To conduct a systematic review to examine evidence of associations between clinical leadership and successful information technology (IT) adoption in healthcare organisations. We searched Medline, Embase, Cinahl, and Business Source Premier for articles published between January 2000 to May 2013 with keywords and subject terms related to: (1) the setting--healthcare provider organisations (2) the technology--health information technology (3) the process--adoption and (4) the intervention--leadership. We identified 3121 unique citations, of which 32 met our criteria and were included in the review. Data extracted from the included studies were assessed in light of two frameworks: Bassellier et al.'s IT competence framework and Avgar et al.'s health IT adoption framework. The results demonstrate important associations between the attributes of clinical leaders and IT adoption. Clinical leaders who have technical informatics skills and prior experience with IT project management are likely to develop a vision that comprises a long-term commitment to the use of IT. Leaders who possess such a vision believe in the value of IT, are motivated to adopt it, and can maintain confidence and stability through the adversities that IT adoptions often entail. This leads to proactive leadership behaviours and partnerships with IT professionals that are associated with successful organisational and clinical outcomes. This review provides evidence that clinical leaders can positively contribute to successful IT adoption in healthcare organisations. Clinical leaders who aim for improvements in the processes and quality of care should cultivate the necessary IT competencies, establish mutual partnerships with IT professionals, and execute proactive IT behaviours to achieve successful IT adoption.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 24-01-2022
Publisher: AMPCo
Date: 08-2018
DOI: 10.5694/MJA18.00390
Publisher: BMJ
Date: 06-2021
DOI: 10.1136/BMJOPEN-2020-047394
Abstract: In 2014, an escalation plan and morning handover meetings were implemented in an intensive care unit (ICU) to reduce access block for post-operative care. In this study, the improvement intervention is revisited 5 years on with the objective to see if the changes are sustained and to understand factors contributing to sustainability. A mixed-method approach was used, with quantitative analysis of ICU administrative data and qualitative analysis of interviews with hospital management and ICU staff. ICU with mixed surgical and non-surgical cases in a regional hospital in Australia. Interview participants: ICU nurses (four), ICU doctors (four) and hospital management (four). Monthly number of elective surgeries were cancelled due to unavailability of ICU beds. Staff perceptions of the interventions and factors contributed to sustainability. After a decline in elective surgeries being cancelled in the first year after the intervention, there was an increase in cancellations in the following years (χ 2 =16.38, p=0.003). Lack of knowledge about the intervention and competitive interests in the management of patient flow were believed to be obstacles for sustained effects of the original intervention. So were communication deficiencies that were reported within the ICU and between ICU and other departments. There are discrepancies between how nurses and doctors use the escalation plan and regard the availability of ICU beds. Improvement interventions in healthcare that appear initially to be successful are not necessarily sustained over time, as was the case in this study. In healthcare, there is no such thing as a ‘fix and forget’ solution for interventions. Management commitment to support communication within and between microsystems, and to support healthcare staff understanding of the underlying reasons for intervention, are important implications for change and change management across healthcare systems.
Publisher: Hindawi Limited
Date: 26-10-2023
DOI: 10.1155/2023/7105751
Publisher: JMIR Publications Inc.
Date: 07-09-2021
DOI: 10.2196/30564
Abstract: The success of electronic medical records (EMRs) is dependent on implementation features, such as usability and fit with clinical processes. The use of EMRs in mental health settings brings additional and specific challenges owing to the personal, detailed, narrative, and exploratory nature of the assessment, diagnosis, and treatment in this field. Understanding the determinants of successful EMR implementation is imperative to guide the future design, implementation, and investment of EMRs in the mental health field. We intended to explore evidence on effective EMR implementation for mental health settings and provide recommendations to support the design, adoption, usability, and outcomes. The scoping review combined two search strategies that focused on clinician-facing EMRs, one for primary studies in mental health settings and one for reviews of peer-reviewed literature in any health setting. Three databases (Medline, EMBASE, and PsycINFO) were searched from January 2010 to June 2020 using keywords to describe EMRs, settings, and impacts. The Proctor framework for implementation outcomes was used to guide data extraction and synthesis. Constructs in this framework include adoption, acceptability, appropriateness, feasibility, fidelity, cost, penetration, and sustainability. Quality assessment was conducted using a modified Hawker appraisal tool and the Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. This review included 23 studies, namely 12 primary studies in mental health settings and 11 reviews. Overall, the results suggested that adoption of EMRs was impacted by financial, technical, and organizational factors, as well as clinician perceptions of appropriateness and acceptability. EMRs were perceived as acceptable and appropriate by clinicians if the system did not interrupt workflow and improved documentation completeness and accuracy. Clinicians were more likely to value EMRs if they supported quality of care, were fit for purpose, did not interfere with the clinician-patient relationship, and were operated with readily available technical support. Evidence on the feasibility of the implemented EMRs was mixed the primary studies and reviews found mixed impacts on documentation quality and time one primary study found downward trends in adverse events, whereas a review found improvements in care quality. Five papers provided information on implementation outcomes such as cost and fidelity, and none reported on the penetration and sustainability of EMRs. The body of evidence relating to EMR implementation in mental health settings is limited. Implementation of EMRs could benefit from methods used in general health settings such as co-designing the software and tailoring EMRs to clinical needs and workflows to improve usability and acceptance. Studies in mental health and general health settings rarely focused on long-term implementation outcomes such as penetration and sustainability. Future evaluations of EMRs in all settings should consider long-term impacts to address current knowledge gaps.
Publisher: Oxford University Press (OUP)
Date: 2020
Abstract: Healthcare accreditation surveyors are well positioned to gain access to hospitals and apply their existing data collection skills to research. Consequently, we contracted and trained a surveyor cohort to collect research data for the Deepening our Understanding of Quality in Australia (DUQuA) project. The aim of this study is to explore and compare surveyors’ perceptions and experiences in collecting quality and safety data for accreditation and for health services research. A qualitative, comparative study. Ten surveyors participated in semi-structured interviews, which were audio recorded, transcribed and coded using Nvivo11. Interview transcripts of participants were analysed thematically and separately, providing an opportunity for comparison and for identifying common themes and subthemes. None. Topics addressed data collection for healthcare accreditation and research, including preparation and training, structure, organization, attitudes and behaviours of staff and perceptions of their role. Five themes and ten subthemes emerged from the interviews: (1) overlapping facilitators for accreditation and research data collection, (2) accreditation-specific facilitators, (3) overlapping barriers for accreditation and research data collection, (4) research data collection-specific barriers and (5) needs and recommendations. Subthemes were (1.1) preparation and training availability, (1.2) prior knowledge and experiences (2.1) ease of access, (2.2) high staff engagement, (3.1) time, (4.1) poor access and structure, (4.2) lack of staff engagement, (4.3) organizational changes (5.1) short-notice accreditation and (5.2) preparation for future research. Although hospital accreditation and research activities require different approaches to data collection, we found that suitably trained accreditation surveyors were able to perform both activities effectively. The barriers surveyors encountered when collecting data for research provide insight into the challenges that may be faced when visiting hospitals for short-notice accreditation.
Publisher: Elsevier BV
Date: 03-2022
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.
Publisher: Routledge
Date: 12-05-2022
Publisher: Springer Science and Business Media LLC
Date: 03-09-2014
Abstract: While health care services are beginning to implement system-wide patient safety interventions, evidence on the efficacy of these interventions is sparse. We know that uptake can be variable, but we do not know the factors that affect uptake or how the interventions establish change and, in particular, whether they influence patient outcomes. We conducted a systematic review to identify how organisational and cultural factors mediate or are mediated by hospital-wide interventions, and to assess the effects of those factors on patient outcomes. A systematic review was conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Database searches were conducted using MEDLINE from 1946, CINAHL from 1991, EMBASE from 1947, Web of Science from 1934, PsycINFO from 1967, and Global Health from 1910 to September 2012. The Lancet , JAMA , BMJ , BMJ Quality and Safety , The New England Journal of Medicine and Implementation Science were also hand searched for relevant studies published over the last 5 years. Eligible studies were required to focus on organisational determinants of hospital- and system-wide interventions, and to provide patient outcome data before and after implementation of the intervention. Empirical, peer-reviewed studies reporting randomised and non-randomised controlled trials, observational, and controlled before and after studies were included in the review. Six studies met the inclusion criteria. Improved outcomes were observed for studies where outcomes were measured at least two years after the intervention. Associations between organisational factors, intervention success and patient outcomes were undetermined: organisational culture and patient outcomes were rarely measured together, and measures for culture and outcome were not standardised. Common findings show the difficulty of introducing large-scale interventions, and that effective leadership and clinical ch ions, adequate financial and educational resources, and dedicated promotional activities appear to be common factors in successful system-wide change. The protocol has been registered in the international prospective register of systematic reviews, PROSPERO (Registration No. CRD42103003050).
Publisher: Wiley
Date: 07-03-2023
DOI: 10.1111/AJCO.13948
Abstract: Adherence to cancer treatment clinical practice guidelines (CPGs) varies enormously across Australia, despite being associated with improved patient outcomes. This systematic review aims to characterize adherence rates to active‐cancer treatment CPGs in Australia and related factors to inform future implementation strategies. Five databases were systematically searched, abstracts were screened for eligibility, a full‐text review and critical appraisal of eligible studies performed, and data extracted. A narrative synthesis of factors associated with adherence was conducted, and the median adherence rates within cancer streams calculated. A total of 21,031 abstracts were identified. After duplicates were removed, abstracts screened, and full texts reviewed, 20 studies focused on adherence to active‐cancer treatment CPGs were included. Overall adherence rates ranged from 29% to 100%. Receipt of guideline recommended treatments was higher for patients who were younger (diffuse large B‐cell lymphoma [DLBCL], colorectal, lung, and breast cancer) female (breast and lung cancer), and male (DLBCL and colorectal cancer) never smokers (DLBCL and lung cancer) non‐Indigenous Australians (cervical and lung cancer) with less advanced stage disease (colorectal, lung, and cervical cancer), without comorbidities (DLBCL, colorectal, and lung cancer) with good‐excellent Eastern Cooperative Oncology Group performance status (lung cancer) living in moderately accessible places (colon cancer) and treated in metropolitan facilities (DLBLC, breast and colon cancer). This review characterized active‐cancer treatment CPG adherence rates and associated factors in Australia. Future targeted CPG implementation strategies should account for these factors, to redress unwarranted variation particularly in vulnerable populations, and improve patient outcomes (Prospero number: CRD42020222962).
Publisher: BMJ
Date: 04-2020
DOI: 10.1136/BMJOPEN-2019-034699
Abstract: Diabetic eye disease is a leading cause of blindness but can be mitigated by regular eye assessment. A framework of issues, developed from the literature of barriers to eye assessment, was used to structure an examination of perceptions of a new model of care for diabetic retinopathy from the perspective of staff using the model, and health professionals referring patients to the new service. Multimethod: interviews and focus groups, and a separate survey. A new clinic based on an integrated model of care was established at a hospital in outer metropolitan Sydney, Australia in 2017. Funded jointly by Centre for Eye Health (CFEH) and the hospital, the clinic was equipped and staffed by optometrists who work alongside the ophthalmologists in the existing hospital eye clinic. Five (of seven) hospital staff working in the clinic (ophthalmologists and administrative officers) or referring to it from other departments (endocrinologists) nine optometrists from CFEH who developed or worked in the clinic 10 community-based optometrists as potential referrers. The new clinic was considered to have addressed known barriers to eye assessment, including access, assistance for patients unable/unwilling to organise eye checks and efficient management of human resources. The clinic optimised known drivers of this model of care: providing clear scope of practice and protocols for shared care between optometrists and ophthalmologists, good communication between referrers and eye professionals and a collegial approach promoting interprofessional trust. Remaining areas of concern were few referrals from general practitioners, fewer referrals from hospital endocrinologists than expected and issues with stretched administrative capacity. There were also perceived mismatches between the priorities of hospital management and aims of the clinic. The new model was considered to have addressed many of the barriers to assessment. While there remain issues with the model, there were also unexpected benefits.
Publisher: BMJ
Date: 12-2020
DOI: 10.1136/BMJOPEN-2020-044049
Abstract: Value-based healthcare delivery models have emerged to address the unprecedented pressure on long-term health system performance and sustainability and to respond to the changing needs and expectations of patients. Implementing and scaling the benefits from these care delivery models to achieve large-system transformation are challenging and require consideration of complexity and context. Realist studies enable researchers to explore factors beyond ‘what works’ towards more nuanced understanding of ‘what tends to work for whom under which circumstances’. This research proposes a realist study of the implementation approach for seven large-system, value-based healthcare initiatives in New South Wales, Australia, to elucidate how different implementation strategies and processes stimulate the uptake, adoption, fidelity and adherence of initiatives to achieve sustainable impacts across a variety of contexts. This exploratory, sequential, mixed methods realist study followed RAMESES II (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) reporting standards for realist studies. Stage 1 will formulate initial programme theories from review of existing literature, analysis of programme documents and qualitative interviews with programme designers, implementation support staff and evaluators. Stage 2 envisages testing and refining these hypothesised programme theories through qualitative interviews with local hospital network staff running initiatives, and analyses of quantitative data from the programme evaluation, hospital administrative systems and an implementation outcome survey. Stage 3 proposes to produce generalisable middle-range theories by synthesising data from context–mechanism–outcome configurations across initiatives. Qualitative data will be analysed retroductively and quantitative data will be analysed to identify relationships between the implementation strategies and processes, and implementation and programme outcomes. Mixed methods triangulation will be performed. Ethical approval has been granted by Macquarie University (Project ID 23816) and Hunter New England (Project ID 2020/ETH02186) Human Research Ethics Committees. The findings will be published in peer-reviewed journals. Results will be fed back to partner organisations and roundtable discussions with other health jurisdictions will be held, to share learnings.
Publisher: Elsevier
Date: 2023
Publisher: Maad Rayan Publishing Company
Date: 14-12-2020
Abstract: Background : Despite increasing investments in academic health science centres (AHSCs) in Australia and an expectation that they will serve as vehicles for knowledge translation and exchange, there is limited empirical evidence on whether and how they deliver impact. The aim of this study was to examine and compare the early development of four Australian AHSCs to explore how they are enacting their impact-focused role. Methods : A descriptive qualitative methodology was employed across four AHSCs located in erse health system settings in urban and regional locations across Australia. Data were collected via semi-structured interviews with 15 academic, industry and executive board members of participating AHSCs. The analysis combined inductive and deductive elements, with inductive categories mapped to deductive themes corresponding to the study aims. Results : AHSCs in Australia are in an emergent state of development and are following different pathways. Whilst varied approaches to support research translation are apparent, there is a dominant focus on structure and governance, as opposed to action-oriented roles and processes to deliver strategic goals. Balancing collaboration and competition between partners presents a challenge, as does identifying appropriate ways to evaluate impact. Conclusion : The early stage of development of AHSCs in Australia presents an important opportunity for formative learning and evaluation to optimise their enactment of knowledge mobilisation processes for impact.
Publisher: Springer Science and Business Media LLC
Date: 03-02-2020
DOI: 10.1186/S12913-020-4938-8
Abstract: Good workspace design is key to the quality of work, safety, and wellbeing for workers, yet we lack vital knowledge about optimal hospital design to meet healthcare workforce needs. This study used novel mobile methods to examine the concept of Work-as-Done and the effect of workspace-use on healthcare professional practice, productivity, health and safety in an Australian university hospital. This pilot study took place in one gastroenterological surgical unit between 2018 and 2019. Data collection involved 50 h of observations and informal conversations, followed by interpretation of five architectural plans and 45 photographs. Fieldnotes were thematically analysed and corroborated by analysis of visual data using a predefined taxonomy. Six themes were identified, revealing spaces that both support and hinder Work-as-Done. Fit-for-purpose spaces facilitated effective communication between staff, patients and families, conferred relative comfort and privacy, and supported effective teamwork. Unfit-for-purpose spaces were characterised by disruptions to work practices, disharmony among team members, and physical discomfort for staff. Staff employed workarounds to manage unfit-for-purpose spaces. The results identified negative impacts of negotiating unfit-for-purpose workspaces on the work and wellbeing of staff. While the use of workarounds and adaptations enable staff to maintain everyday working practices, they can also lead to unexpected consequences. Results indicated the need to identify and support fit-for-purpose spaces and minimize the detrimental qualities of unfit-for-purpose spaces. This study showed that mobile methods were suitable for examining Work-as-Done in a fast-moving, adaptive hospital setting.
Publisher: American Geophysical Union (AGU)
Date: 10-2007
DOI: 10.1029/2006WR005837
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2012
Publisher: Springer Science and Business Media LLC
Date: 15-06-2020
DOI: 10.1186/S13049-020-00749-2
Abstract: Over the last two decades, Emergency Department (ED) crowding has become an increasingly common occurrence worldwide. Crowding is a complex and challenging issue that affects EDs’ capacity to provide safe, timely and quality care. This review aims to map the research evidence provided by reviews to improve ED performance. We performed a scoping review, searching Cochrane Database of Systematic Reviews, Scopus, EMBASE, CINAHL and PubMed (from inception to July 9, 2019 prospectively registered in Open Science Framework osf.io/gkq4t/ ). Eligibility criteria were: (1) review of primary research studies, published in English (2) discusses a) how performance is measured in the ED, b) interventions used to improve ED performance and their characteristics, c) the role(s) of patients in improving ED performance, and d) the outcomes attributed to interventions used to improve ED performance (3) focuses on a hospital ED context in any country or healthcare system. Pairs of reviewers independently screened studies’ titles, abstracts, and full-texts for inclusion according to pre-established criteria. Discrepancies were resolved via discussion. Independent reviewers extracted data using a tool specifically designed for the review. Pairs of independent reviewers explored the quality of included reviews using the Risk of Bias in Systematic Reviews tool. Narrative synthesis was performed on the 77 included reviews. Three reviews identified 202 in idual indicators of ED performance. Seventy-four reviews reported 38 different interventions to improve ED performance: 27 interventions describing changes to practice and process (e.g., triage, care transitions, technology), and a further nine interventions describing changes to team composition (e.g., advanced nursing roles, scribes, pharmacy). Two reviews reported on two interventions addressing the role of patients in ED performance, supporting patients’ decisions and providing education. The outcomes attributed to interventions used to improve ED performance were categorised into five key domains: time, proportion, process, cost, and clinical outcomes. Few interventions reported outcomes across all five outcome domains. ED performance measurement is complex, involving automated information technology mechanisms and manual data collection, reflecting the multifaceted nature of ED care. Interventions to improve ED performance address a broad range of ED processes and disciplines.
Publisher: Emerald
Date: 21-09-2015
DOI: 10.1108/JHOM-11-2013-0254
Abstract: – The purpose of this paper is to report on a process evaluation of a randomised controlled trial (RCT) intervention study that tested the effectiveness of classroom- and simulation-based crew resource management courses, alone and in combination, and identifies organisational barriers and facilitators to implementation of team training programmes in healthcare. – The RCT design consisted of a before and after study with a team training intervention. Quantitative data were gathered on utility and affective reactions to training, and on teamwork knowledge, attitudes, and behaviours of the learners. A s le of participants was interviewed at the conclusion of the study. Interview responses were analysed, alongside qualitative elements of the classroom course critique, to search for evidence, context, and facilitation clues to the implementation process. – The RCT method provided scientifically robust data that supported the benefits of classroom training. Qualitative data identified a number of facilitators to implementation of team training, and shed light on some of the ways that learning was diffused throughout the organisation. Barriers to successful implementation were also identified, including hospital time and resource constraints and poor organisational communication. – Quantitative randomised methods have intermittently been used to evaluate team training interventions in healthcare. Despite two decades of team training trials, however, the authors do not know as well as the authors would like what goes on inside the “black box” of such RCTs. While results are usually centred on outcomes, this study also provides insight into the context and mechanisms associated with those outcomes and identifies barriers and facilitators to successful intervention implementation.
Publisher: Emerald
Date: 20-03-2018
DOI: 10.1108/JHOM-12-2017-0333
Abstract: The purpose of this paper is to evaluate the effectiveness of negotiation training delivered to senior clinicians, managers and executives, by exploring whether staff members implemented negotiation skills in their workplace following the training, and if so, how and when. This is a qualitative study involving face-to-face interviews with 18 senior clinicians, managers and executives who completed a two-day intensive negotiation skills training course. Interviews were transcribed verbatim, and inductive interpretive analysis techniques were used to identify common themes. Research setting was a large tertiary care hospital and health service in regional Australia. Participants generally reported positive affective and utility reactions to the training, and attempted to implement at least some of the skills in the workplace. The main enabler was provision of a Negotiation Toolkit to assist in preparing and conducting negotiations. The main barrier was lack of time to reflect on the principles and prepare for upcoming negotiations. Participants reported that ongoing skill development and retention were not adequately addressed suggestions for improving sustainability included provision of refresher training and mentoring. Limitations include self-reported data, and interview questions positively elicited ex les of training translation. The training was well matched to participant needs, with negotiation a common and daily activity for most healthcare professionals. Implementation of the skills showed potential for improving collaboration and problem solving in the workplace. Practical ex les of how the skills were used in the workplace are provided. To the authors’ knowledge, this is the first international study aimed at evaluating the effectiveness of an integrative bargaining negotiation training program targeting executives, senior clinicians and management staff in a large healthcare organization.
Publisher: Routledge
Date: 12-05-2022
Publisher: Springer Science and Business Media LLC
Date: 14-08-2017
Publisher: Oxford University Press (OUP)
Date: 03-12-2020
Abstract: This study aimed to refine and validate a tool to measure safety culture and leadership in Australian hospitals. The clinician safety culture and leadership questionnaire was constructed by combining and refining the following two previously validated scales: Safety Attitudes Questionnaire and the Leadership Effectiveness Survey. Statistical processes were used to explore the factor structure, reliability, validity and descriptive statistics of the new instrument. Thirty-two large Australian public hospitals. 1382 clinicians (doctors, nurses and allied health professionals). Descriptive statistics, structure and validity of clinician safety culture and leadership scale. We received 1334 valid responses from participants. The distribution of ratings was left-skewed, with a small ceiling effect, meaning that scores were clustered toward the high end of the scale. Using confirmatory factor analysis, we confirmed the structure of the three scales as a combined measure of safety culture and leadership. The data were ided into equal calibration and validation datasets. For the calibration dataset, the Chi-square: df ratio was 4.4, the root mean square error of approximation RMSEA (a measure of spread of the data) was 0.071, the standardized root mean square residual SRMR (an absolute measure of the fit of the data) was 0.058 and the Confirmatory Fit Index (CFI) (another test confirming the fit of the data) was 0.82 while none of the indices suggested good fit, all but CFI fell within acceptable thresholds. All factors demonstrated adequate internal consistency and construct reliability, as desired. All three domains achieved discriminant validity through cross-loadings, meaning that the three domains were determined to be independent constructs. Results for the validation dataset were effectively identical to those found in the calibration dataset. While the model may benefit from additional refinement, we have validated the tool for measuring clinician safety culture and leadership in our Australian s le. The DUQuA safety culture and leadership scale can be used by Australian hospitals to assess clinician safety culture and leadership, and is readily modifiable for other health systems depending on their needs.
Publisher: Oxford University Press (OUP)
Date: 2020
Abstract: We aimed to examine whether Emergency Department (ED) quality strategies, safety culture and leadership were associated with patient-level outcomes, after controlling for other organization-level factors, in 32 large Australian hospitals. Quantitative observational study, using linear and multi-level modelling to identify relationships between quality management systems at organization level quality strategies at ED level for acute myocardial infarction (AMI), hip fracture and stroke clinician safety culture and leadership and patient-level outcomes of waiting time and length of stay. Thirty-two large Australian public hospitals. Audit of quality management processes at organization and ED levels, senior quality manager at each of the 32 participating hospitals, 394 ED clinicians (doctors, nurses and allied health professionals). Within the multi-level model, associations were assessed between organization-level quality measures and ED quality strategies organization-level quality measures and ED quality strategies and ward-level clinician measures of teamwork climate (TC), safety climate (SC) and leadership for AMI, hip fracture and stroke treatment conditions and organization-level quality measures and ED quality strategies and ward-level clinician measures of TC, SC and leadership, and ED waiting time and length of stay (performance). We found seven statistically significant associations between organization-level quality systems and ED-level quality strategies four statistically significant associations between quality systems and strategies and ED safety culture and leadership and nine statistically significant associations between quality systems and strategies and ED safety culture and leadership, and ED waiting time and length of stay. Organization-level quality structures influence ED-level quality strategies, clinician safety culture and leadership and, ultimately, waiting time and length of stay for patients. By focusing only on time-based measures of ED performance we risk punishing EDs that perform well on patient safety measures. We need to better understand the trade-offs between implementing safety culture and quality strategies and improving patient flow in the ED, and to place more emphasis on other ED performance measures in addition to time.
Publisher: Emerald
Date: 16-08-2021
Abstract: The complex and occasionally chaotic nature of health care has been previously described in the literature, as has the broadening recognition that different management approaches are required for different types of problems rather than a “one size fits all” approach. The CYNEFIN framework from Snowden outlines a consistent cognitive approach that offers the leader and leadership team an ability to urgently apply the correct actions to a given situation. This paper proposes a variant CYNEFIN approach for healthcare. Consistent and accurate decision-making within health care is the hallmark of an effective and pragmatic leader and leadership team. An awareness of how one’s cognitive biases and heuristics may adversely impact on this cognitive process is paramount, as is an understanding of the calibration between fast and slow thinking. The authors propose a variant CYNEFIN approach for health care of “act-probe-sense-respond” to resolve complex and time-critical emergency scenarios, using the differing contexts of a cardiac arrest and an evolving crisis management problem as ex les. The variant serves as a pragmatic sense-making framework for the health-care leader and leadership team that can be adopted for many time-critical crisis situations. The variant serves as a pragmatic sense-making framework for the health-care leader that can be adopted for many crisis situations.
Publisher: Oxford University Press (OUP)
Date: 2020
Abstract: Healthcare organisations vary in the degree to which they implement quality and safety systems and strategies. Large-scale cross-sectional studies have been implemented to explore whether this variation is associated with outcomes relevant at the patient level. The Deepening our Understanding of Quality in Australia (DUQuA) study draws from earlier research of this type, to examine these issues in 32 Australian hospitals. This paper outlines the key implementation and analysis challenges faced by DUQuA. Many of the logistical difficulties of implementing DUQuA derived from compliance with the administratively complex and time-consuming Australian ethics and governance system designed principally to protect patients involved in clinical trials, rather than for low-risk health services research. The complexity of these processes is compounded by a lack of organizational capacity for multi-site health services research research is expected to be undertaken in addition to usual work, not as part of it. These issues likely contributed to a relatively low recruitment rate for hospitals (41% of eligible hospitals). Both sets of issues need to be addressed by health services researchers, policymakers and healthcare administrators, if health services research is to flourish. Large-scale research also inevitably involves multiple measurements. The timing for applying these measures needs to be coherent, to maximise the likelihood of finding real relationships between quality and safety systems and strategies, and patient outcomes this timing was less than ideal in DUQuA, in part due to administrative delays. Other issues that affected our study include low response rates for measures requiring recruitment of clinicians and patients, missing data and a design that necessarily included multiple statistical comparisons. We discuss how these were addressed. Successful completion of these projects relies on mutual and ongoing commitment, and two-way communication between the research team and hospital staff at all levels. This will help to ensure that enthusiasm and engagement are established and maintained.
Publisher: Oxford University Press (OUP)
Date: 2020
Abstract: This study aimed to explore the associations between the organization-level quality arrangements, improvement and implementation and department-level safety culture and leadership measures across 32 large Australian hospitals. Quantitative observational study, using linear and multi-level modelling to identify relationships between quality management systems and clinician safety culture and leadership. Thirty-two large Australian public hospitals. Quality audit at organization level, senior quality manager at each participating hospital, 1382 clinicians (doctors, nurses and allied health professionals). Associations between organization-level quality measures and department-level clinician measures of teamwork climate, safety climate and leadership for acute myocardial infarction (AMI), hip fracture and stroke treatment conditions. We received 1332 valid responses from participants. The quality management systems index (QMSI, a questionnaire-based measure of the hospitals’ quality management structures) was ‘positively’ associated with all three department-level scales in the stroke department, with safety culture and leadership in the emergency department, but with none of the three scales in the AMI and hip fracture departments. The quality management compliance index (QMCI, an external audit-based measure of the quality improvement activities) was ‘negatively’ associated with teamwork climate and safety climate in AMI departments, after controlling for QMSI, but not in other departments. There was no association between QMCI and leadership in any department, after controlling for QMSI, and there was no association between the clinical quality implementation index (CQII, an external audit-based measure of the level of implementation of quality activities) and any of the three department-level scales in any of the four departments, after controlling for both QMSI and QMCI. The influence of organization-level quality management systems on clinician safety culture and leadership varied depending on the hospital department, suggesting that whilst there was some consistency on patient safety attitudes and behaviours throughout the organizations, there were also other factors at play.
Publisher: Routledge
Date: 12-05-2022
Publisher: Oxford University Press (OUP)
Date: 10-12-2019
Abstract: With this paper, we initiate the Supplement on Deepening our Understanding of Quality in Australia (DUQuA). DUQuA is an at-scale, cross-sectional research programme examining the quality activities in 32 large hospitals across Australia. It is based on, with suitable modifications and extensions, the Deepening our Understanding of Quality improvement in Europe (DUQuE) research programme, also published as a Supplement in this Journal, in 2014. First, we briefly discuss key data about Australia, the health of its population and its health system. Then, to provide context for the work, we discuss previous activities on the quality of care and improvement leading up to the DUQuA studies. Next, we present a selection of key interventional studies and policy and institutional initiatives to date. Finally, we conclude by outlining, in brief, the aims and scope of the articles that follow in the Supplement. This first article acts as a framing vehicle for the DUQuA studies as a whole. Aggregated, the series of papers collectively attempts an answer to the questions: what is the relationship between quality strategies, both hospital-wide and at department level? and what are the relationships between the way care is organised, and the actual quality of care as delivered? Papers in the Supplement deal with a multiplicity of issues including: how the DUQuA investigators made progress over time, what the results mean in context, the scales designed or modified along the way for measuring the quality of care, methodological considerations and provision of lessons learnt for the benefit of future researchers.
Publisher: Oxford University Press (OUP)
Date: 2020
Abstract: Little is known about the influence that hospital quality systems have on quality at department level, in Australia and elsewhere. This study assessed the relationships between organizational-level quality management systems, and the extent to which hospital-level quality management systems and department-level quality management strategies are related. A multi-level, cross-sectional, mixed-method study. As part of the Deepening our Understanding of Quality in Australia (DUQuA) project, we invited all large hospitals in Australia (~200 or more beds) which provided acute myocardial infarction (AMI), hip fracture and stroke care. The quality managers of these hospitals were the respondents for one of seven measures of hospital quality management systems and strategies. Data across the six remaining measures were collected through site visits by external surveyors assessing the participating hospitals. Relationships were assessed between three organization-level quality management system measures: a self-report measure assessing organization-level quality activities (quality management systems index, QMSI) externally assessed organization-level compliance to procedures used to plan, monitor and improve quality of care (quality management compliance index, QMCI) and externally assessed implementation of quality systems (clinical quality implementation index, CQII). Associations were also assessed between organization-level quality management systems and department-level quality management strategies: how clinical responsibilities are assigned for a particular condition whether department organization processes are organized to facilitate evidence-based care recommendations compliance with selected recommendations of international agencies and whether clinical reviews are performed systematically. Of 78 invited hospitals, 32 participated in the study. QMSI was positively associated with QMCI and CQII, but after controlling for QMSI, no relationship was found between QMCI and CQII. There appears to be a cluster of relationships between QMSI and department-level measures, but this was not consistent across all departments. This is the first national study undertaken in Australia to assess relationships within and between organization-level and department-level quality management systems. These quality management system tools align with many components of accreditation standards and may be useful for hospitals in continuously monitoring and driving improvement.
Publisher: Oxford University Press (OUP)
Date: 10-11-2009
Abstract: The purpose of this study was to determine the optimum content of a 1-day classroom-based crew resource management (CRM) course for health-care personnel working in ad hoc teams in complex, time-critical hospital departments such as surgery, intensive care or emergency. A two-round modified Delphi panel. selected teamwork competency components suitable for inclusion in 1 day of training from a list developed via literature review. Participants Fifteen experts in health care, CRM and training. Knowledge, skill and attitude competency components for a 1-day CRM course. Of the 110 knowledge, skill and attitude CRM competency components, 40 components were selected by greater than 70% of respondents, whereas the remaining 62 components were selected by fewer than 55% of respondents. These 40 competency components ranged across five competency domains: communication, task management, situational awareness, decision-making and leadership, and provided a consensus on the most critical areas for inclusion in training for health-care personnel. This new competency model is now available for use. Although the s le size was limited, a high degree of consensus was reached after only two rounds. A modified Delphi technique within the context of competencies first refined from the literature was a useful and cost-effective method for determining the content of a 1-day CRM training course for health-care workers.
Publisher: Elsevier BV
Date: 2020
DOI: 10.1016/J.APERGO.2019.102920
Abstract: This study aimed to operationalise and use the World Health Organisation's International Classification for Patient Safety (ICPS) to identify incident characteristics and contributing factors of deaths involving complications of medical or surgical care in Australia. A s le of 500 coronial findings related to patient deaths following complications of surgical or medical care in Australia were reviewed using a modified-ICPS (mICPS). Over two-thirds (69.0%) of incidents occurred during treatment and 27.4% occurred in the operating theatre. Clinical process and procedures (55.9%), medication/IV fluids (11.2%) and healthcare-associated infection/complications (10.4%) were the most common incident types. Coroners made recommendations in 44.0% of deaths and organisations undertook preventive actions in 40.0% of deaths. This study demonstrated that the ICPS was able to be modified for practical use as a human factors taxonomy to identify sequences of incident types and contributing factors for patient deaths. Further testing of the mICPS is warranted.
Publisher: Oxford University Press (OUP)
Date: 03-12-2020
Abstract: The Deepening our Understanding of Quality in Australia (DUQuA) project is a multisite, multi-level, cross-sectional study of 32 of the largest hospitals in Australia. This overview examines relationships between (i) organization-level quality management systems and department-level quality management strategies and (ii) patient-level measures (clinical treatment processes, patient-reported perceptions of care and clinical outcomes) within Australian hospitals. We examined hospital quality improvement structures, processes and outcomes, collecting data at organization, department and patient levels for acute myocardial infarction (AMI), hip fracture and stroke. Data sources included surveys of quality managers, clinicians and patients, hospital visits, medical record reviews and national databases. Outcomes data and patient admissions data were analysed. Relationships between measures were evaluated using multi-level models. We based the methods on the Deepening our Understanding of Quality Improvement in Europe (DUQuE) framework, extending that work in parts and customizing the design to Australian circumstances. The 32 hospitals, containing 119 participating departments, provided wide representation across metropolitan, inner and outer regional Australia. We obtained 31 quality management, 1334 clinician and 857 patient questionnaires, and conducted 2401 medical record reviews and 151 external assessments. External data via a secondary source comprised 14 460 index patient admissions across 14 031 in idual patients. Associations between hospital, Emergency Department (ED) and department-level systems and strategies and five patient-level outcomes were assessed: 19 of 165 associations (11.5%) were statistically significant, 12 of 79 positive associations (15.2%) and 7 of 85 negative associations (8.2%). We did not find clear relationships between hospital-level quality management systems, ED or department quality strategies and patient-level outcomes. ED-level clinical reviews were related to adherence to clinical practice guidelines for AMI, hip fracture and stroke, but in different directions. The results, when considered alongside the DUQuE results, are suggestive that front line interventions may be more influential than department-level interventions when shaping quality of care and that multi-pronged strategies are needed. Benchmark reports were sent to each participating hospital, stimulating targeted quality improvement activities. We found no compelling relationships between the way care is organized and the quality of care across three targeted patient-level outcome conditions. The study was cross-sectional, and thus we recommend that the relationships studied should be assessed for changes across time. Tracking care longitudinally so that quality improvement activities are monitored and fed back to participants is an important initiative that should be given priority as health systems strive to develop their capacity for quality improvement over time.
Publisher: Springer Science and Business Media LLC
Date: 13-09-2007
Abstract: Inter-professional learning (IPL) and inter-professional practice (IPP) are thought to be critical determinants of effective care, improved quality and safety and enhanced provider morale, yet few empirical studies have demonstrated this. Whole-of-system research is even less prevalent. We aim to provide a four year, multi-method, multi-collaborator action research program of IPL and IPP in defined, bounded health and education systems located in the Australian Capital Territory (ACT). The project is funded by the Australian Research Council under its industry Linkage Program. The program of research will examine in four inter-related, prospective studies, progress with IPL and IPP across tertiary education providers, professional education, regulatory and registration bodies, the ACT health system's streams of care activities and teams, units and wards of the provider facilities of the ACT health system. One key focus will be on push-pull mechanisms, ie, how the education sector creates student-enabled IPP and the health sector demands IPL-oriented practitioners. The studies will examine four research aims and meet 20 research project objectives in a comprehensive evaluation of ongoing progress with IPL and IPP. IPP and IPL are said to be cornerstones of health system reforms. We will measure progress across an entire health system and the clinical and professional education systems that feed into it. The value of multi-methods, partnership research and a bi-directional push-pull model of IPL and IPP will be tested. Widespread dissemination of results to practitioners, policymakers, managers and researchers will be a key project goal.
Publisher: Oxford University Press (OUP)
Date: 2020
Abstract: This paper examines the principles of benchmarking in healthcare and how benchmarking can contribute to practice improvement and improved health outcomes for patients. It uses the Deepening our Understanding of Quality in Australia (DUQuA) study published in this Supplement and DUQuA’s predecessor in Europe, the Deepening our Understanding of Quality improvement in Europe (DUQuE) study, as models. Benchmarking is where the performances of institutions or in iduals are compared using agreed indicators or standards. The rationale for benchmarking is that institutions will respond positively to being identified as a low outlier or desire to be or stay as a high performer, or both, and patients will be empowered to make choices to seek care at institutions that are high performers. Benchmarking often begins with a conceptual framework that is based on a logic model. Such a framework can drive the selection of indicators to measure performance, rather than their selection being based on what is easy to measure. A Donabedian range of indicators can be chosen, including structure, process and outcomes, created around multiple domains or specialties. Indicators based on continuous variables allow organizations to understand where their performance is within a population, and their interdependencies and associations can be understood. Benchmarking should optimally target providers, in order to drive them towards improvement. The DUQuA and DUQuE studies both incorporated some of these principles into their design, thereby creating a model of how to incorporate robust benchmarking into large-scale health services research.
Publisher: CRC Press
Date: 03-10-2016
Publisher: BMJ
Date: 11-2021
DOI: 10.1136/BMJOPEN-2021-054143
Abstract: The aim of this study is to examine the pathways by which work–life balance influences safety climate in hospital settings. A national cross-sectional survey on patient safety culture. Healthcare workers from 56 hospitals in Taiwan, covering three work settings: intensive care units, operation rooms and emergency departments. 14 345 healthcare workers took part in the survey and were included in the present analysis. The Safety Attitudes, Maslach’s Burn-out Inventory and Work–life balance questionnaires were used to measure patient safety culture, teamwork, leadership, emotional exhaustion and work–life balance. Path analysis was conducted to determine the relationship between work–life balance and safety climate. We tested for mediating and moderating factors influencing this relationship. The path between work–life balance and safety climate was found to be significant (b=0.32, p .001) and explained through a serial mediation. This relationship was found to be mediated by emotional exhaustion followed by teamwork climate in a full mediation. Leadership factors such as identifying as a manager, moderated the indirect pathway between work–life balance and safety climate through teamwork climate (index of moderation: b=0.083, bias corrected 95% CI 0.044 to 0.120) but not through emotional exhaustion or the serial pathway. Subgroup analysis from non-managers on their perception of management was also found to moderate this relationship. We found work–life balance to be associated with safety climate through a fully mediated model. The mediation pathways are moderated by self-identified leadership and perceptions of leadership. Understanding the pathways on how work–life balance influences safety climate provides an explanatory model that can be used when designing effective interventions for implementation in system-based approaches to improve patient safety culture in hospital settings.
Publisher: Oxford University Press (OUP)
Date: 18-03-2020
Abstract: Accident models and theoretical foundations underpinning safety investigations are key to understanding how investigators construct causality and make recommendations. Safety science has devoted large efforts to investigating and theorizing about accidents. Why doesn’t healthcare pay more interest to these theories when investigating healthcare accidents? We use established accident theories to suggest how these can support safety investigations in healthcare and provide new lenses to investigatory bodies. We reflect on ex les from research and practice in healthcare systems and other high-risk industries. Investigation processes and reports serve multiple purposes. We argue there is an untapped improvement potential for healthcare safety investigations and suggest new ways of integrating different accident theoretical reflections with investigatory practice.
Publisher: SAGE Publications
Date: 2020
Abstract: To the disbenefit of qualitative health services research, the generation of study design is too often implied as a logical consequence of aims or questions. Limited space is afforded to describing the critical processes we go through to devise our research for the ever-complex services we seek to understand. This article offers an in-depth examination of qualitative health services research design and the considerations inherent in the process. To illustrate, we present a worked ex le of our experience developing an investigation to characterize and explore multidisciplinary cancer service provision in hospital outpatient clinics. We map the development of our investigation from the a priori conceptualization of the phenomena of inquiry through to the detailed research plan, explicating the design choices made along the way. We engage with key issues for qualitative health researchers, which include how we make sense of and account for context address multisite research considerations design with and for stakeholder engagement ensure epistemological, ontological, and methodological coherence and select analytical and interpretative strategies. We arrive at a complex staged investigation that employs mixed and multi-methods to be conducted across a range of settings. Our purpose is to stimulate thinking about many of the contemporary design challenges researchers negotiate.
Publisher: Oxford University Press (OUP)
Date: 03-12-2020
Abstract: This final article in our 12-part series articulating a suite of quality improvement studies completes our report on the Deepening our Understanding of Quality in Australia (DUQuA) program of work. Here, we bring the Supplement’s key findings and contributions together, tying up loose ends. Traversing the DUQuA articles, we first argued the case for the research, conducted so that an in-depth analysis of one country’s health system, completed 5 years after the landmark Deepening our Understanding of Quality Improvement in Europe (DUQuE), was available. We now provide a digest of the learning from each article. Essentially, we have contributed an understanding of quality and safety activities in 32 of the largest acute settings in Australia, developed a series of scales and tools for use within Australia, modifiable for other purposes elsewhere, and provided a platform for future studies of this kind. Our main message is, despite the value of publishing an intense study of quality activities in 32 hospitals in one country, there is no gold standard, one-size-fits-all methodology or guarantee of success in quality improvement activities, whether the initiatives are conducted at departmental, organization-wide or whole-of-systems levels. Notwithstanding this, armed with the tools, scales and lessons from DUQuA, we hope we have provided many more options and opportunities for others going about strengthening their quality improvement activities, but we do not claim to have solved all problems or provided a definitive approach. In our view, quality improvement initiatives are perennially challenging, and progress hard-won. Effective measurement, evaluating progress over time, selecting a useful suite of quality methods and having the persistence to climb the improvement gradient over time, using all the expertise and tools available, is at the core of the work of quality improvement and will continue to be so.
Publisher: Oxford University Press (OUP)
Date: 03-12-2020
Abstract: Patients can provide a unique perspective on the safety of care in hospitals. Understanding that the extent to which the way hospitals are organized for quality and safety is associated with patient perceptions of care is becoming increasingly valued and necessary for the direction of targeted interventions across healthcare systems. The UK-developed patient measure of safety (PMOS) assesses eight domains of ward safety from the patient point of view and has recently been adapted and piloted in Australia. The aim of this study is to test the psychometric properties of PMOS-Australia (PMOS-A) amongst a large cohort of hospitalized patients. Cross-sectional questionnaire validation assessment. As part of the DUQuA project, the PMOS-A survey was distributed within acute myocardial infarction, hip fracture and stroke departments across 32 large public hospitals in Australia. Patients could complete the PMOS-A independently, or request the assistance of a family member/guardian, or staff on the wards—space was included to record mode of completion. Confirmatory factor analysis (CFA) was undertaken on a calibration s le to generate the model, and a validation s le was used to cross-validate the model. A subset of only those participants who received assistance for PMOS-A completion was also tested using CFA on a calibration and validation s le. Model fit indices (chi-square to degrees of freedom ratio [Chi-square:DF], root mean square error of approximation [RMSEA], comparative fit indices [CFI], standardized root mean squared residual [SRMR]), Cronbach’s α, average inter-item correlations, construct reliability and cross-loadings were examined with reference to recommended thresholds to establish the extent of convergent validity and discriminant validity. A marker of criterion validity was assessed through testing associations between the PMOS-A and adherence to clinical guidelines. Across the calibration and validation s les of the full (N = 911) and assisted completers only subset (N = 490), three (Chi-square:DF, SRMR, RMSEA) of the four indices consistently or almost always met thresholds for acceptable model fit. CFI indices did not meet the recommended limits (0.72–0.78, against a target & 0.9). Positive relationships were found for all tests between PMOS-A and adherence to clinical guidelines, and these were significant when assessed in the calibration datasets for the full and assisted completion s les. A sufficiently reliable and valid measure of patient perceptions of safety has been developed. These findings should provide adequate support to justify the use of this measure to assess patient perceptions of safety in Australian hospitals and can be modified for use elsewhere.
Publisher: BMJ
Date: 03-2019
DOI: 10.1136/BMJOPEN-2018-025041
Abstract: To evaluate the implementation of an intensive care unit (ICU) intervention designed to establish rules for making ICU decisions about postsurgery beds. Preintervention ostintervention case study using a multimethod approach, involving two phases of staff interviews, process mapping and collection of administrative data. ICU in a 700-bed regional tertiary care hospital in Australia. 31 interview participants. Phases 1 and 2 participants drawn from three groups of staff: bedside nursing staff in the ICU, ICU specialist doctors and senior management staff involved in oversight of ICU operations. Phase 2 included an additional participant group: staff from surgery and emergency departments. Implementation of an ICU escalation plan and introduction of a multidisciplinary morning meeting to determine ICU bed status in accordance with the plan. Interview data consisted of preintervention staff perceptions of ICU workplace cohesiveness with bed pressure, and postintervention staff perceptions of the escalation plan and ICU performance. Administrative data consisted of bed status (red, amber or green), monthly number of planned elective surgeries requiring an ICU bed and monthly number of elective surgeries cancelled due to unavailability of ICU beds. Improved internal communication, decision making and cohesion within the ICU and better coordination between ICU and other hospital departments. Significant reduction in elective surgeries cancelled due to unavailability of ICU beds, χ 2 1 =24.9, p .0001. By establishing rules for decision making around ICU bed allocation, the intervention improved internal professional relationships within the ICU as well as between the ICU and external departments and reduced the number of elective surgeries cancelled.
Publisher: Wiley
Date: 02-10-2021
DOI: 10.1111/AJAG.12861
Publisher: Oxford University Press (OUP)
Date: 2020
Abstract: The aim of this study was to develop and refine indices to measure organization and care pathway-level quality management systems in Australian hospitals. A questionnaire survey and audit tools were derived from instruments validated as part of the Deepening Our Understanding of Quality improvement in Europe (DUQuE) study, adapted for Australian hospitals through expert opinion. Statistical processes were used to explore the factor structure, reliability and non-redundancy and descriptive statistics of the scales. Thirty-two large Australian public hospitals. Audit of quality management processes at organization-level and care pathway processes at department level for three patient conditions (acute myocardial infarction (AMI), hip fracture and stroke) and senior quality manager, at each of the 32 participating hospitals. The degree of quality management evident at organization and care pathway levels. Analysis yielded seven quality systems and strategies scales. The three hospital-level measures were: the Quality Management Systems Index (QMSI), the Quality Management Compliance Index (QMCI) and the Clinical Quality Implementation Index (CQII). The four department-level measures were: Specialised Expertise and Responsibility (SER), Evidence-Based Organisation of Pathways (EBOP), Patient Safety Strategies (PSS) and Clinical Review (CR). For QMCI, and for seven out of eight subscales in QMSI, adequate internal consistency (Cronbach’s $\\alpha$ & .8) was achieved. For CQII, lack of variation and ceiling effects in the data resulted in very low internal consistency scores, but items were retained for theoretical reasons. Internal consistency was high for CR (Cronbach’s $\\alpha$ 0.74–0.88 across the three conditions), and this was supported by all item-total correlations exceeding the desired threshold. For EBOP, Cronbach’s $\\alpha$ was acceptable for hip fracture (0.80) and stroke (0.76), but only moderate for AMI (0.52). PSS and SER scales were retained for theoretical reasons, although internal consistencies were only moderate (SER) to poor (PSS). The Deepening our Understanding of Quality in Australia (DUQuA) organization and department scales can be used by Australian hospital managers to assess and measure improvement in quality management at organization and department levels within their hospitals and are readily modifiable for other health systems depending on their needs.
Publisher: BMJ
Date: 02-2019
DOI: 10.1136/BMJOPEN-2018-024473
Abstract: The objective of this study is to investigate whether papers reporting research on Chinese transplant recipients comply with international professional standards aimed at excluding publication of research that: (1) involves any biological material from executed prisoners (2) lacks Institutional Review Board (IRB) approval and (3) lacks consent of donors. Scoping review based on Arksey and O’Mallee’s methodological framework. Medline, Scopus and Embase were searched from January 2000 to April 2017. We included research papers published in peer-reviewed English-language journals reporting on outcomes of research involving recipients of transplanted hearts, livers or lungs in mainland China. Data were extracted by in idual authors working independently following training and benchmarking. Descriptive statistics were compiled using Excel. 445 included studies reported on outcomes of 85 477 transplants. 412 (92.5%) failed to report whether or not organs were sourced from executed prisoners and 439 (99%) failed to report that organ sources gave consent for transplantation. In contrast, 324 (73%) reported approval from an IRB. Of the papers claiming that no prisoners’ organs were involved in the transplants, 19 of them involved 2688 transplants that took place prior to 2010, when there was no volunteer donor programme in China. The transplant research community has failed to implement ethical standards banning publication of research using material from executed prisoners. As a result, a large body of unethical research now exists, raising issues of complicity and moral hazard to the extent that the transplant community uses and benefits from the results of this research. We call for retraction of this literature pending investigation of in idual papers.
Publisher: BMJ
Date: 03-2019
DOI: 10.1136/BMJOPEN-2018-025320
Abstract: Effective researcher assessment is key to decisions about funding allocations, promotion and tenure. We aimed to identify what is known about methods for assessing researcher achievements, leading to a new composite assessment model. We systematically reviewed the literature via the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols framework. All Web of Science databases (including Core Collection, MEDLINE and BIOSIS Citation Index) to the end of 2017. (1) English language, (2) published in the last 10 years (2007–2017), (3) full text was available and (4) the article discussed an approach to the assessment of an in idual researcher’s achievements. Articles were allocated among four pairs of reviewers for screening, with each pair randomly assigned 5% of their allocation to review concurrently against inclusion criteria. Inter-rater reliability was assessed using Cohen’s Kappa (ĸ). The ĸ statistic showed agreement ranging from moderate to almost perfect (0.4848–0.9039). Following screening, selected articles underwent full-text review and bias was assessed. Four hundred and seventy-eight articles were included in the final review. Established approaches developed prior to our inclusion period (eg, citations and outputs, h-index and journal impact factor) remained dominant in the literature and in practice. New bibliometric methods and models emerged in the last 10 years including: measures based on PageRank algorithms or ‘altmetric’ data, methods to apply peer judgement and techniques to assign values to publication quantity and quality. Each assessment method tended to prioritise certain aspects of achievement over others. All metrics and models focus on an element or elements at the expense of others. A new composite design, the Comprehensive Researcher Achievement Model (CRAM), is presented, which supersedes past anachronistic models. The CRAM is modifiable to a range of applications.
Publisher: Oxford University Press (OUP)
Date: 10-2016
Publisher: Wiley
Date: 31-03-2017
DOI: 10.1111/JEP.12741
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2014
DOI: 10.1002/CHP.21218
Abstract: Evidence suggests that Crew Resource Management (CRM), a form of team training, is beneficial. In CRM training, participants learn in idual portable team skills such as communication and decision making through group discussion and activities. However, the usual 1-day course format is not always compatible with health care organizational routines. A modular training format, while theoretically sound, is untested for interprofessional team training. The aim of this study was to explore the potential for modularized CRM training to be delivered to a group of interprofessional learners. Modularized CRM training, consisting of two 2-hour workshops, was delivered to health care workers in an Australian tertiary hospital. Kirkpatrick's evaluation model provided a framework for the study. Baseline attitude surveys were conducted prior to each workshop. Participants completed a written questionnaire at the end of each workshop that examined their motivations, reactions to the training, and learner demographics. An additional survey, administered 6 weeks post training, captured self-assessed behavior data. Twenty-three in iduals from a range of professions and clinical streams participated. One in 5 participants (22%) reported that they translated teamwork skills to the workplace. While positive about the workshop format and content, many respondents identified personal, team, and organizational barriers to the application of the workshop techniques. CRM training when delivered in a modular format has positive outcomes. Following the training, some respondents overcame workplace barriers to attempt to change negative workplace behavior. This progress provides cautious optimism for the potential for modular CRM training to benefit groups of interprofessional health staff.
Publisher: Public Library of Science (PLoS)
Date: 04-11-2022
DOI: 10.1371/JOURNAL.PONE.0277289
Abstract: The Resilience Assessment Grid (RAG) has attracted increasing interest in recent healthcare discourse as an instrument to understand and measure the resilience performance of socio-technical systems. Despite its growing popularity in healthcare, its applicability and utility remain unclear. This scoping review aims to understand the practical application of RAG method and its outcomes in healthcare. We followed the Arksey and O’Malley, and the Levac and colleagues’ framework for scoping reviews and the PRISMA-ScR Checklist. We conducted searches of three electronic databases [Medline, Embase and Web of Science] in May 2021. Supplementary searches included Google Scholar, web and citation searches, and hand searches of the nine seminal edited books on Resilience Engineering and Resilient Health Care. All English language, empirical studies of RAG application in the healthcare setting were included. Open Science Framework [Registration-DOI. 10.17605/OSF.IO/GTCZ3 ]. Twelve studies met the inclusion criteria. Diversities were found across study designs and methodologies. Qualitative designs and literature reviews were most frequently used to develop the RAG and applied it in practice. Eight of the studies had qualitative designs, three studies had mixed-methods designs and one study had a quantitative design. All studies reported that the RAG was very helpful for understanding how frontline healthcare professionals manage the complexity of everyday work. While the studies gained insights from applying the RAG to analyze organizational resilience and identify areas for improvement, it was unclear how suggestions were implemented and how they contributed to quality improvement. The RAG is a promising tool to manage some of the current and future challenges of the healthcare system. To realise the potential benefits of the RAG, it is important that we move beyond the development phase of the RAG tool and use it to guide implementation and management of quality initiatives.
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.YEBEH.2018.11.027
Abstract: This paper offers a new way of understanding the course of a chronic, neurological condition through a comprehensive model of patient-reported determinants of health and wellbeing: The Patient Reported ImpleMentation sciEnce (PRIME) model is the first model of its kind to be based on patient-driven insights for the design and implementation of initiatives that could improve tertiary, primary, and community healthcare services for patients with refractory epilepsy, and has broad implications for other disorders PRIME focuses on: patient-reported determinants of health and wellbeing, pathways through care, gaps in treatment and other system delays, patient need and expectation, and barriers and facilitators to high-quality care provision PRIME highlights that in the context of refractory epilepsy, patients value appropriate, clear, and speedy referrals from primary care practitioners and community neurologists to specialist healthcare professionals based in tertiary epilepsy centers. Many patients also want to share in decisions around treatment and care, and gain a greater understanding of their debilitating disease, so as to find ways to self-manage their illness more effectively and plan for the future. Here, PRIME is presented using refractory epilepsy as the exemplar case, while the model remains flexible, suitable for adaptation to other settings, patient populations, and conditions PRIME comprises six critical levels: 1) The In idual Patient Model 2) The Patient Relationships Model 3) The Patient Care Pathways Model 4) The Patient Transitions Model 5) The Pre- and Postintervention Model and 6) The Comprehensive Patient Model. Each level is dealt with in detail, while Levels 5 and 6 are presented in terms of where the gaps lie in our current knowledge, in particular in relation to patients' journeys through healthcare, system intersections, and in iduals adaptive behavior following resective surgery, as well as others' views of the disease, such as family members.
Publisher: BMJ
Date: 19-09-2013
DOI: 10.1136/BMJ.F5570
Publisher: BMJ
Date: 04-2019
DOI: 10.1136/BMJOPEN-2018-027636
Abstract: Workspaces are socially constructed environments where social relationships are produced, reproduced, challenged and transformed. Their primary function is to support high-quality service delivery to the benefit of ‘patients’. They are also settings where employees can work effectively, in a safe and healthy environment, delivering a high-quality service according to a ‘Work-As-Done’ rather than a ‘Work-As-Imagined’ model. However, hospital design is currently based on a managerial understanding of work accomplishments, often falling short of understanding what is actually happening on the ground. Furthermore, the research landscape lacks rigorous assessment of these complex sociological and health research concepts, either within the Australian context where this protocol is set, or internationally. This paper describes an innovative protocol aimed at examining healthcare employees’ and organisations’ concerns and beliefs in workspace design. It outlines research investigating the effect of workspace use on productivity, health and safety and worker satisfaction, to clarify Work-As-Done, while creating healthy and more fulfilling environments. This is a proof-of-concept study, taking place between June 2018 and April 2019, employing a multimethod, qualitative approach for in-depth assessment of one Australian, private, university hospital environment, using as its ‘case’ the Gastroenterology Surgical Unit. It involves (1) observations and informal interviews (shadowing) with employees and patients as they traverse hospital spaces and (2) visual data of spatial use. Fieldnotes will be analysed thematically, and visual data analysed using a predefined schematic framework (a visual taxonomy). Overarching themes and categories will be considered corroboratively, mixing visual and textual data to build an iterative and dynamic picture. Ethical considerations will be discussed, while approval has been granted by the University’s Human Research Ethics Committee (HREC/5201800282), along with Governance approved by the Health Clinical Research Executive (CRG2018005). Study results will be disseminated through publications, research conferences and public reports.
Publisher: Springer Science and Business Media LLC
Date: 18-06-2021
DOI: 10.1186/S12913-021-06598-8
Abstract: A key characteristic of healthcare systems that deliver high quality and cost performance in a sustainable way is a systematic approach to capacity and capability building for quality improvement. The aim of this research was to explore the factors that lead to successful implementation of a program of quality improvement projects and a capacity and capability building program that facilitates or support these. Between July 2018 and February 2020, the Southern Adelaide Local Health Network (SALHN), a network of health services in Adelaide, South Australia, conducted three capability-oriented capacity building programs that incorporated 82 longstanding in idual quality improvement projects. Qualitative analysis of data collected from interviews of 19 project participants and four SALHN Improvement Faculty members and ethnographic observations of seven project team meetings were conducted. We found four interacting components that lead to successful implementation of quality improvement projects and the overall program that facilitates or support these: an agreed and robust quality improvement methodology, a skilled faculty to assist improvement teams, active involvement of leadership and management, and a deep understanding that teams matter. A strong safety culture is not necessarily a pre-requisite for quality improvement gains to be made indeed, undertaking quality improvement activities can contribute to an improved safety culture. For most project participants in the program, the time commitment for projects was significant and, at times, maintaining momentum was a challenge. Healthcare systems that wish to deliver high quality and cost performance in a sustainable way should consider embedding the four identified components into their quality improvement capacity and capability building strategy.
Publisher: Informa UK Limited
Date: 21-10-2021
DOI: 10.1080/00140139.2021.1992004
Abstract: Patient flow between the emergency department (ED) and hospital wards becomes problematic when bed availability is limited. To better understand the constraints that shape patient flow and everyday work in the ED, we applied Control Task Analysis (i.e. Contextual Activities Template, CAT) and Social Organisational Cooperation Analysis (SOCA) phases from the Cognitive Work Analysis framework to identify ways in which to optimise patient flow. The model and analysis were created through observations in the ED of clinicians (e.g. nurses, doctors), and professional staff (e.g. ward personnel, clerks). The CAT and SOCA-CAT models illustrate workspaces, patient journey phases, and patient volume within the department that are heavily loaded with tasks and human and non-human agents performing these tasks, while others are underutilised. The findings suggest that an ED's adaptive capacity could be strengthened through the integration of additional human and non-human agents allowing the redistribution of clinical and non-clinical tasks.
Publisher: Elsevier BV
Date: 10-2019
Publisher: Elsevier BV
Date: 2020
Publisher: Routledge
Date: 12-05-2022
Publisher: Wiley
Date: 15-07-2021
DOI: 10.1111/JEP.13600
Abstract: Implementation science (IS) should contribute to maintaining high standards of care across healthcare systems and enhancing care practices. However, despite the evident need for greater and more rapid uptake and integration of evidence in practice, IS design and methodology fall short of the needs of effective translation. In this paper we examine what it is about IS that makes it so appealing for effective uptake of interventions in routine practice, and yet so difficult to achieve. We propose a number of ways that implementation scientists could build mutual relationships with healthcare practitioners and other stakeholders including public members to ensure greater shared care practices, and highlight the value of IS training, collaborative educational events, and co‐designed research. More consideration should be given to IS applications in healthcare contexts. Implementation scientists can make a valuable contribution by mobilizing theory and improving practice. However, goals for an evidence‐based system may be more appropriately achieved through greater outreach and collaboration, with methods that are flexible to support rapid implementation in complex adaptive systems. Collective learning and mutual trust can be cultivated by embedding researchers into healthcare services while offering greater opportunities for practitioners to learn about, and engage in, implementation research. To bridge the worlds of healthcare practice and IS, researchers could be more consistent in the relationships they build with professionals and the public, communicating through a shared language and co‐joining practical approaches to effective implementation. This will build capacity for improved collaboration and foster respectful, interdisciplinary relationships.
Publisher: CRC Press
Date: 03-06-2019
Publisher: Oxford University Press (OUP)
Date: 02-04-2013
Abstract: To test the hypotheses that classroom and simulation-based crew resource management (CRM) training interventions improve teamwork attitudes and behaviours of participants and that classroom training combined with simulation-based training provide synergistic improvements. A randomized controlled trial. Area Health Service in New South Wales, Australia. A total of 157 doctors, nurses and midwives randomized into one of four groups, consisting of three intervention groups and a control group. One-day CRM-based classroom course one-day CRM style simulation-based training or classroom training followed by simulation-based training. Pre- and post-test quantitative participant teamwork attitudes, and post-test quantitative trainee reactions, knowledge and behaviour. Ninety-four doctors, nurses and midwives completed pre-intervention attitude questionnaires and 60 clinicians completed post-intervention assessments. No positive changes in teamwork attitudes were found associated with classroom or simulation training. Positive changes were found in knowledge (mean difference 1.50, 95% confidence interval (CI) 0.58-2.43, P = 0.002), self-assessed teamwork behaviour (mean difference 2.69, 95% CI 0.90-6.13, P = 0.009) and independently observed teamwork behaviour (mean difference 2.30, 95% CI 0.30-4.30, P = 0.027) when classroom-only trained group was compared with control however, these changes were not found in the group that received classroom followed by simulation training. Classroom-based training alone resulted in improvements in participant knowledge and observed teamwork behaviour. The study found no additional impact of simulation training.
Start Date: 03-2020
End Date: 03-2025
Amount: $311,000.00
Funder: Australian Research Council
View Funded Activity