ORCID Profile
0000-0003-0296-4957
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 Sociology, Program Evaluation And Social Impact Assessment | Statistics | Applied Statistics | Urban And Regional Studies
Studies in human society | Political science and public policy | Mathematical sciences |
Publisher: MDPI AG
Date: 29-05-2023
Abstract: Cancer is a leading cause of global morbidity and mortality, accounting for 250 Disability-Adjusted Life Years and 10 million deaths in 2019. Minimising unwarranted variation and ensuring appropriate cost-effective treatment across primary and tertiary care to improve health outcomes is a key health priority. There are few studies that have used linked data to explore healthcare utilisation prior to diagnosis in addition to post-diagnosis patterns of care. This protocol outlines the aims of the DaLECC project and key methodological features of the linked dataset. The primary aim of this project is to explore predictors of variations in pre- and post-cancer diagnosis care, and to explore the economic and health impact of any variation. The cohort of patients includes all South Australian residents diagnosed with cancer between 2011 and 2020, who were recorded on the South Australian Cancer Registry. These cancer registry records are being linked with state and national healthcare databases to capture health service utilisation and costs for a minimum of one-year prior to diagnosis and to a maximum of 10 years post-diagnosis. Healthcare utilisation includes state databases for inpatient separations and emergency department presentations and national databases for Medicare services and pharmaceuticals. Our results will identify barriers to timely receipt of care, estimate the impact of variations in the use of health care, and provide evidence to support interventions to improve health outcomes to inform national and local decisions to enhance the access and uptake of health care services.
Publisher: Elsevier BV
Date: 12-2019
Publisher: AMPCo
Date: 04-1999
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: Springer International Publishing
Date: 2019
Publisher: SAGE Publications
Date: 05-2009
Abstract: Incident reporting systems have become a central mechanism of most health services patient safety strategies. In this article we compare health professionals' anonymous, free text responses in an evaluation of a newly implemented electronic incident management system. The professions' answers were compared using classic content analysis and Leximancer, a computer assisted text analysis package. The classic analysis identified issues which differentiated the professions. More doctors commented on lack of feedback following incidents and evaluated the system negatively. More allied health staff found that the system lacked fields necessary to report incidents. More nurses complained incident reporting was time consuming. The Leximancer analysis revealed that while the professions all used the more frequently employed concepts (which described basic components of the reporting system), nurses and allied health shared many additional concepts concerned with actual reporting. Doctors applied fewer and more unique (used only by one profession) concepts when writing about the system. Doctors' unique concepts centred on criticism of the incident management system and the broader implications of safety issues, while the other professions' unique concepts focused on more practical issues. The classic analysis identified specific problems needing to be targeted in ongoing modifications of the system. The Leximancer findings, while complementing the classical analysis results, gave greater insight into professional groups' attitudes that relate to use of the system, e.g. doctors' relatively limited conceptual vocabulary regarding the system was consistent with their lower incident reporting rates. Such professional differences in reaction to healthcare innovations may constrain inter-disciplinary communication and cooperation.
Publisher: SAGE Publications
Date: 24-09-2018
Abstract: Using three data sets, each providing an overview of health service delivery in high-income countries, this article provides a high-level comparative analysis of health system performance against specified key performance indicators in two jurisdictions: Canada and Australia. Several variations, nuances, and points of comparison between delivery and organization of care are discussed. The article examines three policy and structural differences that may help explain the comparatively superior performance of the Australian system on most indicators, and two key areas of improvement for the Canadian system were illuminated: a stronger central government role and a national pharmaceutical plan. It is hoped that this article will empower health leaders to take action in these areas.
Publisher: Springer International Publishing
Date: 12-10-2018
Publisher: SAGE Publications
Date: 12-2005
DOI: 10.1177/183335830503400406
Abstract: Electronic ordering systems provide many potential benefits for improving the efficiency and effectiveness of healthcare delivery. They also have major implications for organisational and communication processes within hospitals. We undertook a qualitative study using focus groups and interviews with doctors, nurses, IT managers, and pathology laboratory managers to investigate the impact of the system on their work processes and relations within a major teaching hospital. This study revealed that the new electronic ordering system involved major alterations to the information management processes within the hospital, which in turn affected communication processes and work relations.
Publisher: Wiley
Date: 05-03-2023
DOI: 10.1111/AJAG.13175
Abstract: Organisational culture is increasingly recognised as influencing the quality of care provided to patients and residents of aged care, both in research and in policy. For ex le, investigations into quality and safety issues in health care frequently highlight cultural problems, but often without adequate theorisation of culture. This study aimed at identifying how cultures of care delivery are considered in the final report of the Royal Commission into Aged Care Quality and Safety, and its subsequent implications. A documentary analysis was performed on the five volumes of the final report using qualitative content analysis. Of 211 references to culture, the majority focussed on organisational culture ( n = 155), followed by the sector's culture ( n = 26), the culture of the agencies involved in managing aged care ( n = 21) and the national culture relating to the treatment of older people ( n = 8). These cultures were discussed in five ways: (1) highlighting poor culture as a problem ( n = 56) (2) showcasing the style of culture that should be aspired to ( n = 45) (3) reinforcing the importance of culture ( n = 38) (4) making attributions about factors contributing to culture ( n = 33) and (5) discussing the need for culture change ( n = 30). The Royal Commission's findings emphasise the importance of care culture and the need for change but provided limited guidance on how this should be achieved, or culture conceptualised.
Publisher: Routledge
Date: 12-05-2022
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: Routledge
Date: 12-05-2022
Publisher: BMJ
Date: 17-05-2018
DOI: 10.1136/BMJ.K2014
Publisher: Emerald
Date: 27-03-2009
DOI: 10.1108/09526860910944601
Abstract: The purpose of this article is to test whether healthcare accreditation survey processes are reliable. The study uses multiple methods to document stakeholder experiences and views on accreditation survey reliability. There were 29 research activities, comprising 25 focus groups, three interviews and a survey questionnaire. In total, 193 stakeholders participated 134 in face‐to‐face activities and 56 via questionnaire. All were voluntary participants. Using open‐ended questioning, stakeholders were asked to reflect upon accreditation survey reliability. Stakeholders perceived healthcare accreditation surveys to be a reliable activity. They identified six interrelated factors that simultaneously promoted and challenged reliability: the accreditation program, including organisational documentation and surveyor accreditation reports members' relationship to the accrediting agency and survey team accreditation agency personnel surveyor workforce renewal surveyor workforce management and survey team conduct including coordinator role. The six factors realised shared expectations and conduct by accreditation stakeholders that is, they enabled accreditation stakeholder self‐governance. Knowledge gained can be used to improve accreditation program reliability, credibility and ongoing self‐governance. The paper is a unique examination of healthcare accreditation surveys the reliability. The findings have potential application to reliability in other healthcare areas.
Publisher: Springer Science and Business Media LLC
Date: 22-02-2013
DOI: 10.1186/S12913-020-05127-3
Abstract: When healthcare professionals’ workloads are greater than available resources, care activities can be missed, omitted or delayed, potentially leading to adverse patient outcomes. Prioritisation, a precursor to missed care, involves decision-making about the order of care task completion based on perceived importance or urgency. Research on prioritisation and missed care has predominantly focused on acute care settings, which differ from residential aged care facilities in terms of funding, structure, staffing levels, skill mix, and approaches to care. The objective of this study was to investigate how care staff prioritise the care provided to residents living in residential aged care. Thirty-one staff members from five Australian residential aged care facilities engaged in a Q sorting activity by ranking 34 cards representing different care activities on a pre-defined grid from ‘Least important’ (− 4) to ‘Most important’ (+ 4). Concurrently, they participated in a think-aloud task, verbalising their decision-making processes. Following sorting, participants completed post-sorting interviews, a demographics questionnaire and semi-structured interviews. Q sort data were analysed using centroid factor analysis and varimax rotation in PQMethod. Factor arrays and data from the think-aloud task, field notes and interviews facilitated interpretation of the resulting factors. A four-factor solution, representing 22 participants and 62% of study variance, satisfied the selection criteria. The four distinct viewpoints represented by the solution were: 1. Prioritisation of clinical care, 2. Prioritisation of activities of daily living, 3. Humanistic approach to the prioritisation of care, and 4. Holistic approach to the prioritisation of care. Participants’ prioritisation decisions were largely influenced by their occupations and perceived role responsibilities. Across the four viewpoints, residents having choices about their care ranked as a lower priority. This study has implications for missed care, as it demonstrates how care tasks deemed outside the scope of staff members’ defined roles are often considered a lower priority. Our research also shows that, despite policy regulations mandating person-centred care and the respect of residents’ preferences, staff members in residential aged care facilities tend to prioritise more task-oriented aspects of care over person-centredness.
Publisher: Wiley
Date: 05-2012
DOI: 10.1111/J.1445-5994.2012.02766.X
Abstract: The objective of the study is to review the evidence on the consequences associated with the introduction of national performance measurement systems in the National Health Service (NHS), with the aim of informing the development of similar national performance measurement programmes proposed for Australia. Narrative review of the published evidence on the unintended and adverse consequences of performance measurement systems in the NHS is the data source. We identified 20 different dysfunctional consequences of national performance measurement systems in the NHS in four headings. These are poor measurement (measurement fixation, tunnel vision, myopia, ossification, anachronism and quantification privileging), misplaced incentives and sanctions (complacency, silo-creation, overcompensation, undercompensation, insensitivity and increased inequality), breach of trust (misrepresentation, gaming, misinterpretation, bullying, erosion of trust and reduced staff morale), and politicisation of performance systems (political grandstanding and creating a ersion). Performance measurement programmes can contribute to systems improvement, delivering benefits to health services and patients, as evidenced by the dramatic reduction in waiting times in the NHS following the incorporation of targets and indicators for waiting times. Nevertheless, experience from the NHS shows that in addition to generating desired improvements, performance measures can induce a range of unintended and dysfunctional consequences. We recommend Australia to heed the lessons of the NHS, and strive to balance effective performance measurement and management against the potential drawbacks and adverse consequences. Any national performance measures need to be piloted and carefully evaluated to assess potential benefits and pitfalls.
Publisher: Springer Science and Business Media LLC
Date: 09-11-2006
DOI: 10.1007/S10728-006-0014-8
Abstract: An examination of the salient literature on hospital clinical directorates (CDs) is presented. A critique of the largely managerialist, instrumental, hortatory and normative extant literature about CDs is offered. In analysing the literature this way the earlier promotional and critical literature is eschewed in favour of an evaluative approach. CDs are then reconceptualised by locating them within two overarching accounts of social structure--formalised, prescribed frameworks, and enacted, patterned interactions--following the kinds of distinctions made by Giddens, Weick, social action and institutional theorists. Social structure as it relates to culture is also considered, following Martin. Such an approach facilitates an understanding of the general weaknesses of health service perspectives and methods of analysis, and exposes the strengths of Giddens-Weick type paradigms.
Publisher: Springer International Publishing
Date: 12-10-2017
Publisher: Oxford University Press (OUP)
Date: 29-09-2015
Abstract: To test our hypothesis that hospitals with higher accreditation scores, specifically in infection control, would be associated with lower Staphylococcus aureus bacteraemia (SAB) rates. A retrospective cohort study. Acute public hospitals (n = 77) in New South Wales, Australia, with reported SAB rates, results from two accreditation surveys and results from at least four hand hygiene audits. We linked three separate data sets comprising SAB rates, accreditation scores and hand hygiene rates. SAB rates were regressed against accreditation scores, hand hygiene audit rates and hospital demographics using a generalized linear model to account for the non-linear nature of our outcome variable. Significant (P < 0.05) findings included the following: SAB rates across all hospitals fell from 1.34 per 10 000 bed days in 2009 to 0.77 per 10 000 bed days in 2012 mean SAB rates in small hospitals (0.62/10 000 bed days) over the study period were lower than those for principal referral hospitals (1.52/10 000 bed days) smaller hospitals with higher accreditation scores had lower SAB rates, but larger hospitals with higher overall accreditation scores had higher SAB rates, although the effect size was small (<2%). There is a strong evidence base for using SAB rates to measure the impact of infection control programs that are assessed during accreditation. However, there is less evidence to support whether accreditation scores accurately reflect implementation of the infection control accreditation standards. This impacts identification of indicators to measure patient safety and quality of care, especially in ensuring these are appropriate across a range of hospital size and activities.
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: Oxford University Press (OUP)
Date: 26-10-2013
Abstract: The smart use of information and communication technologies (ICT) is widely seen as a means of enhancing the quality of aged care services. One of the barriers to ICT diffusion in aged care is the failure to cater for the complex and interdisciplinary requirements of the aged care environment. The aim of this qualitative study was to identify the layers of information exchange and communication and produce a conceptual model that can help to inform decisions related to the design, implementation, and sustainability of ICT. A qualitative study conducted in 2010 within seven Australian residential aged care facilities. It included 11 focus groups involving 47 staff and 54 in idual interviews and observation sessions. The analysis of work processes identified key information exchange components related to the type of information (residential, clinical, and administrative) that is collected, stored, and communicated. This information relies on a erse number of internal and external communication channels that are important for the organization of care. The findings highlight potential areas of communication dysfunction as a consequence of structural holes, fragmentation, or disconnections that can adversely affect the continuity and coordination of care, its safety, and quality.
Publisher: Royal College of General Practitioners
Date: 21-12-2023
Publisher: Wiley
Date: 06-1996
Publisher: Springer Science and Business Media LLC
Date: 14-11-2019
DOI: 10.1186/S12913-019-4704-Y
Abstract: Organisational change in health systems is common. Success is often tied to the actors involved, including their awareness of the change, personal engagement and ownership of it. In many health systems, one of the most common changes we are witnessing is the redevelopment of long-standing hospitals. However, we know little about how hospital staff understand and experience such potentially far-reaching organisational change. The purpose of this study is to explore the understanding and experiences of hospital staff in the early stages of organisational change, using a hospital redevelopment in Sydney, Australia as a case study. Semi-structured interviews were conducted with 46 clinical and non-clinical staff working at a large metropolitan hospital. Hospital staff were moving into a new building, not moving, or had moved into a different building two years prior. Questions asked staff about their level of awareness of the upcoming redevelopment and their experiences in the early stage of this change. Qualitative data were analysed using thematic analysis. Some staff expressed apprehension and held negative expectations regarding the organisational change. Concerns included inadequate staffing and potential for collaboration breakdown due to new layout of workspaces. These fears were compounded by current experiences of feeling uninformed about the change, as well as feelings of being fatigued and under-staffed in the constantly changing hospital environment. Nevertheless, balancing this, many staff reported positive expectations regarding the benefits to patients of the change and the potential for staff to adapt in the face of this change. The results of this study suggest that it is important to understand prospectively how actors involved make sense of organisational change, in order to potentially assuage concerns and alleviate negative expectations. Throughout the processes of organisational change, such as a hospital redevelopment, staff need to be engaged, adequately informed, trained, and to feel supported by management. The use of ch ions of varying professions and lead departments, may be useful to address concerns, adequately inform, and promote a sense of engagement among staff.
Publisher: BMJ
Date: 21-07-2014
Publisher: Palgrave Macmillan UK
Date: 2015
Publisher: Wiley
Date: 02-03-2022
DOI: 10.1111/AJAG.13049
Abstract: Public health initiatives aim to improve health outcomes for populations by preventing disease and ill‐health consequences of environmental hazards and natural or human‐made disasters. Whilst public health initiatives have been used successfully to modify behaviours for chronic diseases, many initiatives targeting reduced dementia risk in older adults suffer from conceptual and statistical flaws that greatly limit their usefulness. The limited success in modifying lifestyle dementia risk factors has led us to fall short in building a successful roadmap to dementia risk reduction. Here we argue for adopting a population‐level, holistic approach to dementia risk reduction strategies across the lifespan. This approach is supplemented by 10 strategies that focus on improving social policies, harnessing existing policy, legislature and incentive schemes, and identifying feasible approaches to increase recreational and transport‐related physical activity to creating best practice health care that supports healthy brain ageing for all.
Publisher: AMPCo
Date: 03-1994
Publisher: BMJ
Date: 07-2021
DOI: 10.1136/BMJOPEN-2020-048271
Abstract: Pregnancy and early parenthood are key opportunities for interaction with health services and connecting to other families at the same life stage. Public antenatal care should be accessible to all, however barriers persist for families from refugee communities to access, navigate and optimise healthcare during pregnancy. Group Pregnancy Care is an innovative model of care codesigned with a community from a refugee background and other key stakeholders in Melbourne, Australia. Group Pregnancy Care aims to provide a culturally safe and supportive environment for women to participate in antenatal care in a language they understand, to improve health literacy and promote social connections and inclusion. This paper outlines Froup Pregnancy Care and provides details of the evaluation framework. The evaluation uses community-based participatory research methods to engage stakeholders in codesign of evaluation methods. The study is being conducted across multiple sites and involves multiple phases, use of quantitative and qualitative methods, and an interrupted time series design. Process and cost-effectiveness measures will be incorporated into quality improvement cycles. Evaluation measures will be developed using codesign and participatory principles informed by community and stakeholder engagement and will be piloted prior to implementation. Ethics approvals have been provided by all six relevant authorities. Study findings will be shared with communities and stakeholders via agreed pathways including community forums, partnership meetings, conferences, policy and practice briefs and journal articles. Dissemination activities will be developed using codesign and participatory principles.
Publisher: Oxford University Press (OUP)
Date: 20-08-2015
Abstract: The current approach to patient safety, labelled Safety I, is predicated on a 'find and fix' model. It identifies things going wrong, after the event, and aims to st them out, in order to ensure that the number of errors is as low as possible. Healthcare is much more complex than such a linear model suggests. We need to switch the focus to what we have come to call Safety II: a concerted effort to enable things to go right more often. The key is to appreciate that healthcare is resilient to a large extent, and everyday performance succeeds much more often than it fails. Clinicians constantly adjust what they do to match the conditions. Facilitating work flexibility, and actively trying to increase the capacity of clinicians to deliver more care more effectively, is key to this new paradigm. At its heart, proactive safety management focuses on how everyday performance usually succeeds rather than on why it occasionally fails, and actively strives to improve the former rather than simply preventing the latter.
Publisher: Emerald
Date: 26-10-2012
DOI: 10.1108/14777261211276961
Abstract: Australian states have embraced clinical networking as a mechanism for managing, organising and improving the quality of care. Using these in idualised state approaches to clinical networks, in this paper the authors aim to examine this Australasian "experimentation" and present lessons for other health systems. The paper draws on current knowledge from the literature on clinical networks. The 2010 Inaugural Australasian Clinical Networks Conference also serves as a primary resource, as well as the authors' extensive discussions with policy-makers, managers and clinicians in Australasian systems. Key themes from the literature include: network type (mandated or natural, and hybrids) network purpose the importance of network objectives drivers of network success and barriers the need for consumer engagement and the difficulty of evaluating network effectiveness. Policy challenges include the establishment of networks for some specialty areas and not others how to develop common standards across networks and the need for performance metrics to assess network impact on patient outcomes. Australian networks report difficulties with achieving greater involvement of rural clinicians and indigenous populations, and with private sector clinical engagement. There are challenges too with implementation, at service level, of models of care and recommendations. Clinical networks are becoming a fundamental vehicle for clinical improvement and change across complex organisational and professional boundaries. How to nurture and sustain effective clinical networks is of import to every health system and the authors invite stakeholders in health systems to network and share their empirical research on clinical networks to assist with distinguishing the evidence from the rhetoric.
Publisher: Springer Science and Business Media LLC
Date: 15-01-2019
Publisher: SAGE Publications
Date: 02-2006
DOI: 10.1258/095148406775322016
Abstract: Hospitals are being restructured more frequently. Increased cost efficiency is the usual justification given for such changes. All 20 major teaching hospitals in Australia's two most populous states were investigated by classifying each over a 5-6 year period in terms of their cost efficiency (average cost per case weighted by Australian diagnosis-related group [AN-DRG] data and adjusted for inflation) and structure, categorized as traditional-professional (TP), clinical- isional (CD), or clinical-institute (CI). In all, 12 hospitals changed structure during the study period. There was slight evidence that CD structures were more efficient than TP structures but this was not supported by other evidence. There were no significant differences in efficiency in the first or second years following changes from either TP to CD or TP to CI structures. All four hospitals changing from CD to CI structure became significantly less efficient. This may be due to frequency rather than type of change as they were the only hospitals that implemented two structural changes. Hospitals that changed or did not change structure were similar in efficiency at the beginning and at the end of the study period, in overall efficiency during the period, and in trends toward efficiency over time. The findings challenge those who advocate restructuring hospitals on the grounds of improving cost efficiency.
Publisher: Springer Science and Business Media LLC
Date: 12-2016
Publisher: Springer Science and Business Media LLC
Date: 06-12-2006
DOI: 10.1007/S10728-006-0025-5
Abstract: The results of two observational studies of clinical directorates (CDs) are presented. The paper exposes fresh perspectives about the management of hospitals and CDs, and suggests that the most important axis on which hospital decision-making rests continues to be profession rather than the CD, even though CDs are designed at least in part to mitigate professional tribalism and bridge professional ides. In empiricising social structural and cultural theories it seems clear that changes to the prescribed organisational framework, which CDs represent, have had negligible effects on behaviour. This being the case, the paper questions the benefits alleged to have accrued from establishing CDs and calls for more effective, micro-behavioural change strategies than merely altering the structure.
Publisher: Oxford University Press (OUP)
Date: 12-01-2015
Publisher: BMJ
Date: 06-2020
DOI: 10.1136/BMJOPEN-2019-034522
Abstract: Effective implementation of a research Program requires an actionable plan to guide execution. To assess the actionability and success of that plan, both scientific and implementation elements must be taken into account. The aim of this study is to assess the ‘Zero Childhood Cancer Personalised Medicine Program’ (the Zero Program), an Australian first-ever and most comprehensive personalised medicine programme for children with high-risk or relapsed cancer, in terms of its structure, process and implementational effect. We will assess Program delivery mechanisms. The development of the implementation and evaluation strategy will concentrate on the work of the Zero Program as a complex whole. This includes the structure of collaborative links across stakeholder groups involved in Program development and delivery, changes to collaborative relationships over time and the impact of group working on Program outcomes. We are applying a mixed-methods design including: a rapid ethnography (observations of stakeholder interactions and informal conversations), Program professionals’ completion of a rapid health implementation proforma and a social network analysis. Formative evaluations of the implementation science effects, applying feedback techniques, for ex le, Formative Evaluation Feedback Loops and the Zero Program professionals’ feedback, will determine where Program tailoring may be needed. A repeat of the social network analysis downstream will examine network changes over time, followed by an expert panel using the expert recommendations for implementing change to assess the integration of implementation strategies into the Program structure. A summative evaluation of the Program will bring the research elements together, leading to comprehensive data triangulation and determining the sustainability and implementational effects of Program delivery. Ethical approval for this study has been granted by Hunter New England Research Ethics Committee, New South Wales, Australia (approval ref: 2019/ETH12025). Knowledge translation will be achieved through publications, reports and conference presentations to healthcare professionals, patients, families and researchers. NCT03336931 Pre-results.
Publisher: Wiley
Date: 09-12-2022
DOI: 10.1111/JOCN.16582
Abstract: The aim of this study is to enhance the understanding of the core elements and influencing factors on the community‐based epilepsy nurse's role and responsibilities. Internationally, epilepsy nurse specialists play a key role in providing person‐centred care and management of epilepsy but there is a gap in understanding of their role in the community. A national three‐stage, mixed‐method study was conducted. One‐on‐one, in‐depth semi‐structured qualitative interviews were conducted online with 12 community‐based epilepsy nurses (Stage 1) retrospective analysis of data collected from the National Epilepsy Line, a nurse‐led community helpline (Stage 2) and focus group conducted with four epilepsy nurses, to delve further into emerging findings (Stage 3). A thematic analysis was conducted in Stages 1 and 3, and a descriptive statistical analysis of Stage 2 data. Consolidated Criteria for Reporting Qualitative studies checklist was followed for reporting. Three key themes emerged: (1) The epilepsy nurse career trajectory highlighted a lack of standardised qualifications, competencies, and career opportunities. (2) The key components of the epilepsy nurse role explored role ersity, responsibilities, and models of practice in the management of living with epilepsy, and experiences navigating complex fragmented systems and practices. (3) Shifting work practices detailed the adapting work practices, impacted by changing service demands, including COVID‐19 pandemic experiences, role boundaries, funding, and resource availability. Community epilepsy nurses play a pivotal role in providing holistic, person‐centred epilepsy management They contribute to identifying and addressing service gaps through innovating and implementing change in service design and delivery. Epilepsy nurses' person‐centred approach to epilepsy management is influenced by the limited investment in epilepsy‐specific integrated care initiatives, and their perceived value is impacted by the lack of national standardisation of their role and scope of practice. Only epilepsy nurses' perspectives were sought.
Publisher: Oxford University Press (OUP)
Date: 20-09-2017
Publisher: Elsevier BV
Date: 09-2010
DOI: 10.1016/J.SOCSCIMED.2010.05.029
Abstract: This study aims to contribute to the limited set of interactional studies of health occupational relations. A "negotiated order" perspective was applied to a multi-site setting to articulate the ways in which clinicians' roles, accountabilities and contributions to patient care are shaped by the care setting and are influenced by the management of patient pathways. The study responds to the polarized debate between a critical perspective that calls for collaboration as the re-distribution of occupational power, and a functionalist view that argues for better coordination of health care teams. The study draws on data from 63 interviews, 68 focus groups and 209 h of observation across acute and non-acute health services within a state/territory in Australia. The paper reveals the exercise of both "competitive power" and "collaborative power" in the negotiated order of health services. Both forms of power are exercised in all settings. Relationships among clinicians in various occupations are mediated by the expectation that doctors assume responsibility for patient management and coordinating roles in health care teams, and the degree of acuity of particular health care settings. The combination of a negotiated order perspective and its unique application across a whole health system shows the continuation of a broad pattern of power by doctors over those in other roles. The paper also reveals novel criteria for evaluating the extent of power-sharing in interprofessional interaction in case conferences, and a unique quantification of such interaction.
Publisher: SAGE Publications
Date: 09-1992
Publisher: JMIR Publications Inc.
Date: 26-07-2022
DOI: 10.2196/36691
Abstract: Mobile apps are becoming increasingly popular, with 5.70 million apps available in early 2021. Smartphones can provide portable and convenient access to health apps. Here, we consider apps for people with one of the estimated 7000 rare conditions, which are defined as having an incidence of in 2000. The needs of people with rare conditions are known to be different from those of people with more common conditions. The former may be socially isolated (not knowing anyone else who has the condition) and may not be able to find reliable information about the disorder. The aim of this review is to search for apps developed specifically for people diagnosed with a rare disease and to assess them for quality using the Mobile App Rating Scale (MARS). We examine features that address 6 identified needs of people with a rare disorder and make recommendations for future developers. Google Play Store (Android) and Apple App Store (iOS) were searched for relevant health-related apps specifically for rare diseases. The search included the names of 10 rare disease groups. App quality was determined using MARS, assessing app engagement, functionality, aesthetics, and information. We found 29 relevant apps (from a total of 2272) addressing 14 rare diseases or disease groups. The most common rare conditions addressed were cystic fibrosis (n=6), hemophilia (n=5), and thalassemia (n=5). The most common app features were web-based information and symptom trackers. The mean MARS score was 3.44 (SD 0.84). Lowest scores were for engagement. Most apps provided factual and visual information, providing tools for self-monitoring and resources to help improve interactions during health consultations. App origin and quality varied greatly. Developers are recommended to consider ways to make appropriate apps more easily identifiable to consumers, to always include high-quality information, improve engagement, provide qualitative evaluations of the app, and include consumers and clinicians in the design.
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: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.INJURY.2017.06.002
Abstract: The prevalence of chronic health conditions such as diabetes among young people is increasing. Limited information is known about the impact of these conditions on young people who have been traumatically injured. Injury is the global leading cause of death and disability in young people. The aim of this study is to compare health outcomes for injured young people with and without chronic health conditions. A retrospective examination of injury in young people aged≤25years with and without a chronic health condition using linked hospitalisation and mortality records during 1 January 2010 to 30 June 2014 in New South Wales, Australia. Health outcomes, including hospital length of stay (LOS), 28-day unplanned hospital readmission, hospital treatment costs, and 30-day and 12-month mortality were examined. A 1:1 matched design was used to determine excess mean hospital LOS and cost for young people with a chronic health conditions versus no health condition. There were 184,819 injury-related hospitalisations of young people 13.8% had a chronic health condition. Compared to young people who did not have a chronic health condition, those with one were found to have double the mean hospital cost, higher unplanned hospital readmission, and a higher rate of mortality. Injured young people had a three times higher likelihood of having a prolonged LOS if they had a chronic health condition (Adjusted odds ratio: 3.89 95% CI: 3.69-4.11). Renal conditions, anaemia, coagulation defects, hypertension, and mental health conditions had the highest excess LOS and anaemia, hypertension, coagulation defects and renal conditions had the highest excess mean cost for matched injured in iduals with and without the health condition. Health outcomes following injury are worse for young people with a chronic health condition. The increasing prevalence of young people with a chronic health condition has implications for treatment, resource use, provision of support services, and survival following traumatic injury.
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/AH14091
Abstract: This paper provides an overview of the developmental history of models of care (MOC) in nursing since Florence Nightingale introduced nurse training programs in a drive to make nursing a discipline-based career option. The four principal choices of models of nursing care delivery (primary nursing, in idual patient allocation, team nursing and functional nursing) are outlined and discussed, and recent MOC literature reviewed. The paper suggests that, given the ways work is being rapidly reconfigured in healthcare services and the pressures on the nursing workforce projected into the future, team nursing seems to offer the best solutions.
Publisher: Wiley
Date: 04-09-2023
DOI: 10.5694/MJA2.52097
Publisher: Springer Science and Business Media LLC
Date: 20-07-2023
DOI: 10.1186/S13012-023-01284-1
Abstract: Disentangling the interplay between experience-based intuition and theory-informed implementation is crucial for identifying the direct contribution theory can make for generating behaviour changes needed for successful evidence translation. In the context of ‘clinicogenomics’, a complex and rapidly evolving field demanding swift practice change, we aimed to (a) describe a combined clinician intuition- and theory-driven method for identifying determinants of and strategies for implementing clinicogenomics, and (b) articulate a structured approach to standardise hypothesised behavioural pathways and make potential underlying theory explicit. Interview data from 16 non-genetic medical specialists using genomics in practice identified three target behaviour areas across the testing process: (1) identifying patients, (2) test ordering and reporting, (3) communicating results. The Theoretical Domains Framework (TDF) was used to group barriers and facilitators to performing these actions. Barriers were grouped by distinct TDF domains, with ‘overarching’ TDF themes identified for overlapping barriers. Clinician intuitively-derived implementation strategies were matched with corresponding barriers, and retrospectively coded against behaviour change techniques (BCTs). Where no intuitive strategies were provided, theory-driven strategies were generated. An algorithm was developed and applied to articulate how implementation strategies address barriers to influence behaviour change. Across all target behaviour areas, 32 identified barriers were coded across seven distinct TDF domains and eight overarching TDF themes. Within the 29 intuitive strategies, 21 BCTs were represented and used on 49 occasions to address 23 barriers. On 10 (20%) of these occasions, existing empirical links were found between BCTs and corresponding distinct TDF-coded barriers. Twenty additional theory-driven implementation strategies (using 19 BCTs on 31 occasions) were developed to address nine remaining barriers. Clinicians naturally generate their own solutions when implementing clinical interventions, and in this clinicogenomics ex le these intuitive strategies aligned with theoretical recommendations 20% of the time. We have matched intuitive strategies with theory-driven BCTs to make potential underlying theory explicit through proposed structured hypothesised causal pathways. Transparency and efficiency are enhanced, providing a novel method to identify determinants of implementation. Operationalising this approach to support the design of implementation strategies may optimise practice change in response to rapidly evolving scientific advances requiring swift translation into healthcare.
Publisher: Wiley
Date: 11-2019
DOI: 10.1111/IMJ.14634
Abstract: Despite the increasing use and costs associated with external management consultancy for healthcare improvement, there is a paucity of formal evaluations examining impact. This paper aims to: (i) discuss the potential benefits and disadvantages of external consultancies in addressing complex healthcare challenges and delivering healthcare improvement in Australia and (ii) explore potential alternative models, including internal consultancy and hybrid models delivered through platforms of collaborative expertise. We propose that the substantive reliance on high cost external management consultancies without demonstrating value or benefit, is unsustainable. An integrative approach that embeds research and capacity building within healthcare services may be of value.
Publisher: Oxford University Press (OUP)
Date: 11-2006
DOI: 10.1197/JAMIA.M2152
Publisher: BMJ
Date: 12-2015
Publisher: BMJ
Date: 27-11-2020
DOI: 10.1136/BMJQS-2019-010088
Abstract: To assess quality of care for children presenting with acute abdominal pain using validated indicators. Audit of care quality for acute abdominal pain according to 21 care quality indicators developed and validated in four stages. Medical records of children aged 1–15 years receiving care in 2012–2013 were s led from 57 general practitioners, 34 emergency departments (ED) and 28 hospitals across three Australian states 6689 medical records were screened for visits for acute abdominal pain and audited by trained paediatric nurses. Adherence to 21 care quality indicators and three bundles of indicators: bundle A-History bundle B-Examination bundle C-Imaging. Five hundred and fourteen children had 696 visits for acute abdominal pain and adherence was assessed for 9785 in idual indicators. The overall adherence was 69.9% (95% CI 64.8% to 74.6%). Adherence to in idual indicators ranged from 21.6% for assessment of dehydration to 91.4% for appropriate ordering of imaging. Adherence was low for bundle A-History (29.4%) and bundle B-Examination (10.2%), and high for bundle C-Imaging (91.4%). Adherence to the 21 indicators overall was significantly lower in general practice (62.7%, 95% CI 57.0% to 68.1%) compared with ED (86.0%, 95% CI 83.4% to 88.4% p .0001) and hospital inpatient settings (87.9%, 95% CI 83.1% to 91.8% p .0001). There was considerable variation in care quality for indicator bundles and care settings. Future work should explore how validated care quality indicator assessments can be embedded into clinical workflows to support continuous care quality improvement.
Publisher: Oxford University Press (OUP)
Date: 17-06-2016
Abstract: Early detection of patient deterioration and prevention of adverse events are key challenges to patient safety. This study investigated clinical staff perceptions of current monitoring practices and the planned introduction of continuous monitoring devices on general wards. Multi-method study comprising structured surveys, in-depth interviews and device trial with log book feedback. Two general wards in a large urban teaching hospital in Sydney, Australia. Respiratory and neurosurgery nursing staff and two doctors. Nurses were confident about their abilities to identify patients at risk of deterioration, using a combination of vital signs and visual assessment. There were concerns about the accuracy of current vital signs monitoring equipment and frequency of intermittent observation. Both the nurses and the doctors were enthusiastic about the prospect of continuous monitoring and perceived it would allow earlier identification of patient deterioration provide reassurance to patients and support interdisciplinary communication. There were also reservations about continuous monitoring, including potential decrease in bedside nurse-patient interactions increase in inappropriate escalations of patient care and discomfort to patients. While continuous monitoring devices were seen as a potentially positive tool to support the identification of patient deterioration, drawbacks, such as the potential for reduced patient contact, revealed key areas that will require close surveillance following the implementation of devices. Training and improved interdisciplinary communication were identified as key requisites for successful implementation.
Publisher: Oxford University Press (OUP)
Date: 12-2018
Abstract: Most research on health systems examines contemporary problems within one, or at most a few, countries. Breaking with this tradition, we present a series of case studies in a book written by key policymakers, scholars and experts, looking at health systems and their projected successes to 2030. Healthcare Systems: Future Predictions for Global Care includes chapters on 52 in idual countries and five regions, covering a total of 152 countries. Synthesised, two key contributions are made in this compendium. First, five trends shaping the future healthcare landscape are analysed: sustainable health systems the genomics revolution emerging technologies global demographics dynamics and new models of care. Second, nine main themes arise from the chapters: integration of healthcare services financing, economics and insurance patient-based care and empowering the patient universal healthcare technology and information technology aging populations preventative care accreditation, standards, and policy and human development, education and training. These five trends and nine themes can be used as a blueprint for change. They can help strengthen the efforts of stakeholders interested in reform, ranging from international bodies such as the World Health Organization, the International Society for Quality in Health Care and the World Bank, through to national bodies such as health departments, quality and safety agencies, non-government organisations (NGO) and other groups with an interest in improving healthcare delivery systems. This compendium offers more than a glimpse into the future of healthcare-it provides a roadmap to help shape thinking about the next generation of caring systems, extrapolated over the next 15 years.
Publisher: SAGE Publications
Date: 2005
Publisher: BMJ
Date: 06-2023
DOI: 10.1136/BMJOPEN-2022-070799
Abstract: Large-scale, multisite hospital improvement initiatives can advance high-quality care for patients. Implementation support is key to adoption of change in this context. Strategies that foster collaboration within local teams, across sites and between initiative developers and users are important. However not all implementation strategies are successful in all settings, sometimes realising poor or unintended outcomes. Our objective here is to develop guiding principles for effective collaborative implementation strategies for multi-site hospital initiatives. Mixed-method realist evaluation. Realist studies aim to examine the underlying theories that explain differing outcomes, identifying mechanisms and contextual factors that may trigger them. We report on collaborative strategies used in four multi-site initiatives conducted in all public hospitals in New South Wales, Australia (n ). Using an iterative process, information was gathered on collaborative implementation strategies used, then initial programme theories hypothesised to underlie the strategies’ outcomes were surfaced using a realist dialogic approach. A realist interview schedule was developed to elicit evidence for the posited initial programme theories. Fourteen participants from 20 key informants invited participated. Interviews were conducted via Zoom, transcribed and analysed. From these data, guiding principles of fostering collaboration were developed. Six guiding principles were distilled: (1) structure opportunities for collaboration across sites (2) facilitate meetings to foster learning and problem-solving across sites (3) broker useful long-term relationships (4) enable support agencies to assist implementers by giving legitimacy to their efforts in the eyes of senior management (5) consider investment in collaboration as effective well beyond the current projects (6) promote a shared vision and build momentum for change by ensuring inclusive networks where everyone has a voice. Structuring and supporting collaboration in large-scale initiatives is a powerful implementation strategy if contexts described in the guiding principles are present.
Publisher: Wiley
Date: 12-1993
Publisher: Springer Science and Business Media LLC
Date: 24-11-2023
DOI: 10.1038/S41431-022-01224-5
Abstract: Recent advances in genomic sequencing have improved the accessibility of reproductive genetic carrier screening (RGCS). As awareness and interest grows, non-genetic health care professionals are increasingly offering RGCS to consumers. We conducted a qualitative interview study informed by behaviour change theory to identify influences on health care professionals considered as ‘early adopters’ offering RGCS through Mackenzie’s Mission, an Australian national research study investigating the implementation of free RGCS to couple’s preconception or in early pregnancy. Interviews were deductively analysed using the Theoretical Domains Framework to examine barriers and enabling factors. In total, we interviewed 31 health care professionals, who were primarily general practitioners ( n = 23) offering RGCS through Mackenzie’s Mission. Upon analysis, 15 barriers and 44 enablers to implementation were identified and categorised across three health care professional target behaviours 1. Engaging with RGCS, 2. Identifying eligible patients, and 3. Offering RGCS. Whilst all Theoretical Domains Framework domains were present, barriers were predominantly categorised as ‘Environmental Context and Resources’ e.g., lack of time, followed by ‘Knowledge’ e.g., lack of understanding about genetics and ‘Beliefs about Capabilities’ e.g., concern about giving high risk results to patients. Although health care professionals expressed a preference for offering RGCS through a comprehensive and supported model of care, such as Mackenzie’s Mission, barriers remain. By understanding what drives current health care professionals’ behaviour towards offering RGCS, behaviour change theory provides an avenue to direct future efforts based on evidence and improve service delivery.
Publisher: Springer Science and Business Media LLC
Date: 05-09-2021
DOI: 10.1186/S12913-021-06952-W
Abstract: Significant resources are spent on hospital accreditation worldwide. However, documentation of the effects of accreditation on processes, quality of care and outcomes in healthcare remain scarce. This study aimed to examine changes in the delivery of patient care in accordance with clinical guidelines (recommended care) after first-time accreditation in a care setting not previously exposed to systematic quality improvement initiatives. We conducted a before and after study based on medical record reviews in connection with introducing first-time accreditation. We included patients with stroke/transient ischemic attack, bleeding gastric ulcer, diabetes, chronic obstructive pulmonary disease (COPD), childbirth, heart failure and hip fracture treated at public, non-psychiatric Faroese hospitals during 2012–2013 (before accreditation) or 2017–2018 (after accreditation). The intervention was the implementation of a modified second version of The Danish Healthcare Quality Program (DDKM) from 2014 to 2016 including an on-site accreditation survey in the Faroese hospitals. Recommended care was assessed using 63 disease specific patient level process performance measures in seven clinical conditions. We calculated the fulfillment and changes in the opportunity-based composite score and the all-or-none score. We included 867 patient pathways (536 before and 331 after). After accreditation, the total opportunity-based composite score was marginally higher though the change did not reach statistical significance (adjusted percentage point difference (%): 4.4% 95% CI: − 0.7 to 9.6). At disease level, patients with stroke/transient ischemic attack, bleeding gastric ulcer, COPD and childbirth received a higher proportion of recommended care after accreditation. No difference was found for heart failure and diabetes. Hip fracture received less recommended care after accreditation. The total all-or-none score, which is the probability of a patient receiving all recommended care, was significantly higher after accreditation (adjusted relative risk (RR): 2.32 95% CI: 2.03 to 2.67). The improvement was particularly strong for patients with COPD (RR: 16.22 95% CI: 14.54 to 18.10). Hospitals were in general more likely to provide recommended care after first-time accreditation.
Publisher: Springer Science and Business Media LLC
Date: 09-09-2021
DOI: 10.1038/S41533-021-00253-9
Abstract: Asthma is the most common chronic condition of childhood. Self-management is integral to good asthma control. This qualitative paper explores how children with asthma and their parents perceive asthma, their experience with asthma, and how they manage symptoms, preventions and medications within and outside the home. We undertook 15 focus groups with 41 school-aged (6–11 years) children with asthma and 38 parents. Parents and their children attended the same focus groups. We used thematic analysis to analyse the transcripts. Our findings show the impact asthma can have on children’s social and emotional wellbeing and highlight how reliant school-aged children are on their parents to effectively manage their asthma. Parents reported being unsure when their child’s symptoms warranted visiting their doctor or hospital. Schools were identified as a source of difficulty regarding asthma management families reported that children may be self-conscious about their asthma and using their inhaler at school. School policies and teachers’ lack of asthma knowledge were reported to exacerbate children’s reluctance to use their inhaler at school. Our results have implications for the design and implementation of children’s self-management interventions for their asthma, particularly when they are at school and away from their parents.
Publisher: Springer Science and Business Media LLC
Date: 25-06-2022
DOI: 10.1186/S12874-022-01661-2
Abstract: Implementation science in healthcare aims to understand how to get evidence into practice. Once this is achieved in one setting, it becomes increasingly difficult to replicate elsewhere. The problem is often attributed to differences in context that influence how and whether implementation strategies work. We argue that realist research paradigms provide a useful framework to express the effect of contextual factors within implementation strategy causal processes. Realist studies are theory-driven evaluations that focus on understanding how and why interventions work under different circumstances. They consider the interaction between contextual circumstances, theoretical mechanisms of change and the outcomes they produce, to arrive at explanations of conditional causality (i.e., what tends to work, for whom, under what circumstances). This Commentary provides ex le applications using preliminary findings from a large realist implementation study of system-wide value-based healthcare initiatives in New South Wales, Australia. If applied judiciously, realist implementation studies may represent a sound approach to help optimise delivery of the right care in the right setting and at the right time.
Publisher: Emerald
Date: 22-07-2021
DOI: 10.1108/JHOM-12-2020-0495
Abstract: Clinical genomics is a complex, innovative medical speciality requiring clinical and organizational engagement to fulfil the clinical reward promised to date. Focus thus far has been on gene discovery and clinicians’ perspectives. The purpose of this study was to use implementation science theory to identify organizational barriers and enablers to implementation of clinical genomics along an organizations’ implementation journey from Preadoption through to Adoption and Implementation . We used a deductive qualitative approach study design drawing on implementation science theory - (1) Translation Science to Population Impact Framework, to inform semi structured interviews with organizational decision-makers collaborating with Australian and Melbourne Genomics, alongside and (2) Theoretical Domains Framework (TDF), to guide data analysis. We identified evolving organizational barriers across the implementation journey from Preadoption to Implementation . Initially the organizational focus is on understanding the value of clinical genomics (TDF code: belief about consequences) and setting the scene (TDF code: goals) before organizational (TDF codes: knowledge and belief about consequences) and clinician (TDF codes: belief about capability and intentions) willingness to adopt is apparent. Once at the stage of Implementation, leadership and clarity in organizational priorities (TDF codes: intentions, professional identity and emotion) that include clinical genomics are essential prerequisites to implementing clinical genomics in practice. Intuitive enablers were identified (e.g. ‘providing multiple opportunities for people to come on board) and mapped hypothetically to barriers. Attention to date has centred on the barriers facing clinicians when introducing clinical genomics into practice. This paper uses a combination of implementation science theories to begin to unravel the organizational perspectives of implementing this complex health intervention.
Publisher: BMJ
Date: 2012
Publisher: BMJ
Date: 07-2023
DOI: 10.1136/BMJOPEN-2023-075008
Abstract: Addressing clinical variation in elective surgery is challenging. A key issue is how to gain consensus between largely autonomous clinicians. Understanding how the consensus process works to develop and implement perioperative pathways and the impact of these pathways on reducing clinical variation can provide important insights into the effectiveness of the consensus process. The primary objective of this study is to understand the implementation of an organisationally supported, consensus approach to implement perioperative care pathways in a private healthcare facility and to determine its impact. A mixed-methods Effectiveness-Implementation Hybrid (type III) pre–post study will be conducted in one Australian private hospital. Five new consensus-based perioperative care pathways will be developed and implemented for specific patient cohorts: spinal surgery, radical prostatectomy, cardiac surgery, bariatric surgery and total hip and knee replacement. The in idual components of these pathways will be confirmed as part of a consensus-building approach and will follow a four-stage implementation process using the Exploration, Preparation, Implementation and Sustainment framework. The process of implementation, as well as barriers and facilitators, will be evaluated through semistructured interviews and focus groups with key clinical and non-clinical staff, and participant observation. We anticipate completing 30 interviews and 15–20 meeting observations. Administrative and clinical end-points for at least 152 participants will be analysed to assess the effectiveness of the pathways. This study received ethical approval from Macquarie University Human Research Ethics Medical Sciences Committee (Reference No: 520221219542374). The findings of this study will be disseminated through peer-reviewed publications, conference presentations and reports for key stakeholders.
Publisher: SAGE Publications
Date: 04-01-2017
Publisher: Springer Science and Business Media LLC
Date: 10-02-2020
DOI: 10.1186/S12913-020-4939-7
Abstract: The adoption of Patient Reported Outcome Measures (PROMs) in cancer care has been widely advocated, but little is known about the evidence for the implementation of PROMs in practice. Qualitative research captures the perspectives of health professionals as end-users of PROMs and can be used to inform adoption efforts. This paper presents a systematic review and synthesis of qualitative research conducted to address the question: What are the attitudes of health professionals towards PROMs in oncology, including any barriers and facilitators to the adoption of PROMS, reported in qualitative evidence? Systematic searches of qualitative evidence were undertaken in four databases and reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies published in English between 1998 and 2018, which reported qualitative findings about the attitudes of health professionals working in oncology towards PROMs were eligible. Studies were assessed using the Critical Appraisal Skills Programme’s Qualitative Research Checklist. A sentiment analysis was conducted on primary text to examine the polarity (neutral, positive or negative) of health professionals’ views of PROMs. Qualitative meta-synthesis was conducted using a constant comparative analysis. From 1227 articles after duplicates were removed, with 1014 excluded against the screening criteria, 213 full text articles remained and were assessed 34 studies met the inclusion criteria and were included. The majority of studies were of good quality. Sentiment analysis on primary text demonstrated an overall positive polarity from the expressed opinions of health professionals. The meta-synthesis showed health professionals’ attitudes in four domains: identifying patient issues and needs using PROMs managing and addressing patient issues the care experience and the integration of PROMs into clinical practice. From the accounts of health professionals, the fit of PROMs with existing practice, how PROMs are valued, capacity to respond to PROMs and the supports in place, formed the key factors which may impede or promote adoption of PROMs in routine practice. To assist policy-makers and services involved in implementing these initiatives, further evidence is required about the relationship between PROMs data collection and corresponding clinical actions. International Prospective Register of Systematic Reviews (PROSPERO) CRD42019119447 , 6th March, 2019.
Publisher: JMIR Publications Inc.
Date: 22-12-2020
DOI: 10.2196/25117
Abstract: Location-based augmented reality (AR) games, such as Pokémon GO and Harry Potter: Wizards Unite, have been shown to have a beneficial impact on the physical activity, social connectedness, and mental health of their players. In March 2020, global social distancing measures related to the COVID-19 pandemic prompted the AR games developer Niantic Inc to implement several changes to ensure continued player engagement with Pokémon GO and Harry Potter: Wizards Unite. We sought to examine how the physical and mental well-being of players of these games were affected during the unprecedented COVID-19 restriction period as well as how their video game engagement was affected. The aims of this study were to examine the impact of COVID-19–related social restrictions on the physical and mental well-being of AR game players to examine the impact of COVID-19–related social restrictions on the use of video games and motivations for their use and to explore the potential role of AR games (and video games in general) in supporting well-being during COVID-19–related social restrictions. A mixed methods web-based self-reported survey was conducted in May 2020, during which COVID-19–related social restrictions were enforced in many countries. Participants were recruited on the web via four subreddits dedicated to Pokémon GO or Harry Potter: Wizards Unite. Data collected included quantitative data on demographics, time spent playing video games, physical activity, and mental health qualitative data included motivations to play and the impact of video games on mental health during COVID-19 lockdown. We report results for 2004 participants (1153/1960 male, 58.8%, average age 30.5 years). Self-reported physical activity during COVID-19–related social restrictions significantly decreased from 7.50 hours per week on average (SD 11.12) to 6.50 hours (SD 7.81) (P .001). More than half of the participants reported poor mental health (925/1766, 52.4% raw World Health Organization–5 Well-Being Index score ). Female gender, younger age, and reduced exercise were significant predictors of poor mental health. Participants reported a significant increase in video game play time from 16.38 hours per week on average (SD 19.12) to 20.82 hours (SD 17.49) (P .001). Approximately three quarters of the participants (n=1102/1427, 77.2%) reported that playing video games had been beneficial to their mental health. The changes made to Pokémon GO and Harry Potter: Wizards Unite were very well received by players, and the players continued to use these games while exercising and to maintain social connection. In addition to seeking an escape during the pandemic and as a form of entertainment, participants reported that they used video games for emotional coping and to lower stress, relax, and alleviate mental health conditions. AR games have the potential to promote physical and mental health during the COVID-19 pandemic. Used by populations under isolation and distress, these games can improve physical and mental health by providing virtual socialization, sustained exercise, temporal routine, and mental structure. Further research is needed to explore the potential of AR games as digital behavioral interventions to maintain human well-being in the wider population.
Publisher: BMJ
Date: 05-2022
DOI: 10.1136/BMJOPEN-2021-058158
Abstract: Realist synthesis. Large-scale hospital improvement initiatives can standardise healthcare across multiple sites but results are contingent on the implementation strategies that complement them. The benefits of these implemented interventions are rarely able to be replicated in different contexts. Realist studies explore this phenomenon in depth by identifying underlying context–mechanism–outcome interactions. To review implementation strategies used in large-scale hospital initiatives and hypothesise initial programme theories for how they worked across different contexts. An iterative, four-step process was applied. Step 1 explored the concepts inherent in large-scale interventions using database searches and snowballing. Step 2 identified strategies used in their implementation. Step 3 identified potential initial programme theories that may explain strategies’ mechanisms. Step 4 focused on one strategy-theory pairing to develop and test context–mechanism–outcome hypotheses. Data was drawn from searches (March–May 2020) of MEDLINE, Embase, PubMed and CINAHL, snowballed from key papers, implementation support websites and the expertise of the research team and experts. Inclusion criteria: reported implementation of a large-scale, multisite hospital intervention. RAMESES reporting standards were followed. Concepts were identified from 51 of 381 articles. Large-scale hospital interventions were characterised by a top–down approach, external and internal support and use of evidence-based interventions. We found 302 reports of 28 different implementation strategies from 31 reviews (from a total of 585). Formal theories proposed for the implementation strategies included Diffusion of Innovation, and Organisational Readiness Theory. Twenty-three context–mechanism–outcome statements for implementation strategies associated with planning and assessment activities were proposed. Evidence from the published literature supported the hypothesised programme theories and were consistent with Organisational Readiness Theory’s tenets. This paper adds to the literature exploring why large-scale hospital interventions are not always successfully implemented and suggests 24 causative mechanisms and contextual factors that may drive outcomes in the planning and assessment stage.
Publisher: BMJ
Date: 07-2020
DOI: 10.1136/BMJDRC-2019-001141
Abstract: To estimate adherence to clinical practice guidelines in selected settings at a population level for Australian children with type 1 diabetes mellitus. Medical records of children with type 1 diabetes mellitus aged 0–15 years in 2012–2013 were targeted for s ling across inpatient, emergency department and community visits with specialist pediatricians in regional and metropolitan areas and tertiary pediatric hospitals in three states where approximately 60% of Australian children reside. Clinical recommendations extracted from two clinical practice guidelines were used to audit adherence. Results were aggregated across types of care (diagnosis, routine care, emergency care). Surveyors conducted 6346 indicator assessments from an audit of 539 healthcare visits by 251 children. Average adherence across all indicators was estimated at 79.9% (95% CI 69.5 to 88.0). Children with type 1 diabetes mellitus have higher rates of behavioral and psychological disorders, but only a third of children (37.9% 95% CI 11.7 to 70.7) with suboptimal glycemic control (eg, hemoglobin A1c % or 86 mmol/mol) were screened for psychological disorders using a validated tool this was the only indicator with % estimated adherence. Adherence by care type was: 86.1% for diagnosis (95% CI 76.7 to 92.7) 78.8% for routine care (95% CI 65.4 to 88.9) and 83.9% for emergency care (95% CI 78.4 to 88.5). Most indicators for care of children with type 1 diabetes mellitus were adhered to. However, there remains room to improve adherence to guidelines for optimization of practice consistency and minimization of future disease burden.
Publisher: Springer Science and Business Media LLC
Date: 15-09-2009
Publisher: Elsevier BV
Date: 1998
DOI: 10.1016/S0277-9536(97)00131-7
Abstract: Increasingly questions are being raised about the ability of many current health reforms to address the challenges that are facing health systems. We investigate this situation by exploring the role of professionalism in the delivery of health services. In contrast to the dominant approach of considering professionalism as a social phenomenon, professionalism is considered as primarily a task-related phenomenon. The characteristics of the task are identified as being high levels of uncertainty and complexity. These characteristics are shown to lead naturally to the key social features that typify professionalism. Hence, the close link between professionalism and the nature of the task is argued. However, health reforms threaten professionalism. They have been based on considerable dissatisfaction with the performance of professionals as well as the emergence of a number of new challenges. In addition, the reforms have been developed without significant consideration of the central role that professionalism has played, and reformers have adopted a simplified view of the task. Thus, the centrality of professionalism has intrinsically been downgraded. However, this simplification can be shown to be inconsistent with the realities and complexities of health service provision, and thus the downgrading of professionalism is unwarranted. This inconsistency generates many of the conflicts and contradictions being reported. The future of health service reform depends on an effective understanding of the nature of the task, recognition of the central role of professionalism and the development of professional and organisational structures that support each other.
Publisher: Wiley
Date: 20-11-2020
DOI: 10.1111/HEX.13154
Publisher: BMJ
Date: 12-07-2007
Publisher: Springer Science and Business Media LLC
Date: 08-04-2021
DOI: 10.1038/S41598-021-87369-7
Abstract: Gastro-oesophageal reflux (GOR) is a common physiological state in infants and young children, with gastro-oesophageal reflux disease (GORD) its pathological manifestation. Management of GOR/GORD requires elimination of possible underlying causes, parental reassurance, modification of feeding and symptom mitigation, monitoring, and referral to paediatricians if warning signs are present. Published clinical practice guidelines (CPGs) seek to support clinicians and improve management. This study aimed to measure the proportion of Australian GOR/GORD paediatric care that was in line with CPG recommendations. National and international CPGs for GOR/GORD were systematically identified and candidate indicators extracted a Delphi process selected 32 indicators relevant to Australian paediatric care in 2012 and 2013. Medical records were identified in General Practices, the offices of general paediatricians, Emergency Departments and inpatient settings. Adherence to indicators was assessed by nine trained paediatric nurses undertaking retrospective medical record review. Medical records were reviewed in 115 healthcare sites identifying 285 children, three-quarters aged 1 year, who had 359 visits for management of GOR/GORD 2250 eligible indicator assessments were performed. Estimated adherence rates are reported for 21 indicators with ≥ 25 assessments. Five indicators recommending differential diagnostic tests (e.g., urinalysis) for infants presenting with recurrent regurgitation and poor weight gain had ~ 10% adherence conversely, avoidance of unrecommended tests (e.g., barium swallow and meal) was high (99.8% adherence: 95% CI 97.0–100). Avoidance of prescription of acid-suppression medication for infants at the first presentation was higher if they were healthy and thriving (86.9% adherence: 95% CI 86.0–96.8), intermediate if they had feeding refusal (73.1%: 95% CI 56.0–86.3) and lower if they presented with irritability and unexplained crying (58.8%: 95% CI 28.2–85.0). A guideline targeting Australian health professionals caring for infants and children with GOR/GORD is warranted, highlighting the importance of differential diagnostic testing and avoidance of acid-suppression medication in infants.
Publisher: BMJ
Date: 03-2019
DOI: 10.1136/BMJOPEN-2018-024681
Abstract: Translating scientific advances in genomic medicine into evidence-based clinical practice is challenging. Studying the natural translation of genomics into ‘early-adopting’ health system sectors is essential. We will (a) examine 29 health systems (Australian and Melbourne Genomics Health Alliance flagships) integrating genomics into practice and (b) combine this learning to co-design and test an evidence-based generalisable toolkit for translating genomics into healthcare. Twenty-nine flagships integrating genomics into clinical settings are studied as complex adaptive systems to understand emergent and self-organising behaviours among inter-related actors and processes. The Effectiveness–Implementation Hybrid approach is applied to gather information on the delivery and potential for real-world implementation. Stages ‘1’ and ‘2a’ (representing hybrid model 1) are the focus of this protocol. The Translation Science to Population Impact (TSci Impact) framework is used to study policy decisions and service provision, and the Theoretical Domains Framework (TDF) is used to understand in idual level behavioural change both frameworks are applied across stages 1 and 2a. Stage 1 synthesises interview data from 32 participants involved in developing the genomics clinical practice systems and approaches across five ‘demonstration-phase’ (early adopter) flagships. In stage 2a, stakeholders are providing quantitative and qualitative data on process mapping, clinical audits, uptake and sustainability (TSci Impact), and psychosocial and environmental determinants of change (TDF). Findings will be synthesised before codesigning an intervention toolkit to facilitate implementation of genomic testing. Study methods to simultaneously test the comparative effectiveness of genomic testing and the implementation toolkit (stage 2b), and the refined implementation toolkit while simply observing the genomics intervention (stage 3) are summarised. Ethical approval has been granted. The results will be disseminated in academic forums and used to refine interventions to translate genomics evidence into healthcare. Non-traditional academic dissemination methods (eg, change in guidelines or government policy) will also be employed.
Publisher: BMJ
Date: 2019
DOI: 10.1136/BMJOPEN-2018-025892
Abstract: There is wide recognition that, if healthcare systems continue along current trajectories, they will become harder to sustain. Ageing populations, accelerating rates of chronic disease, increasing costs, inefficiencies, wasteful spending and low-value care pose significant challenges to healthcare system durability. Sustainable healthcare systems are important to patients, society, policy-makers, public and private funders, the healthcare workforce and researchers. To capture current thinking about improving healthcare system sustainability, we present a protocol for the systematic review of grey literature to capture the current state-of-knowledge and to compliment a review of peer-reviewed literature. The proposed search strategy, based on the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, includes Google Advanced Search, snowballing techniques and targeted hand searching of websites of lead organisations such as WHO, Organisation for Economic Cooperation and Development, governments, public policy institutes, universities and non-government organisations. Documents will be selected after reviewing document summaries. Included documents will undergo full-text review. The following criteria will be used: grey literature document English language published January 2013–March 2018 relevant to the healthcare delivery system the content has international or national scope in high-income countries. Documents will be assessed for quality, credibility and objectivity using validated checklists. Descriptive data elements will be extracted: identified sustainability threats, definitions of sustainability, attributes of sustainable healthcare systems, solutions for improvement and outcome measures of sustainability. Data will be analysed using novel text-mining methods to identify common concept themes and meanings. This will be triangulated with the more traditional analysis and concept theming by the researchers. No primary data will be collected, therefore ethical approval will not be sought. The results will be disseminated in peer-reviewed literature, as conference presentations and as condensed summaries for policy-makers and health system partners. CRD42018103076.
Publisher: Oxford University Press (OUP)
Date: 23-11-2019
Abstract: In Part 2 of this two-part contribution made on behalf of the Innovation and Systems Change Working Group of the International Society for Quality in Health Care (ISQua), we continue the argument for refashioning health systems in response to ageing and other pressures. Massive ageing in many countries and accompanying technological, fiscal and systems changes are causing the tectonic plates of healthcare to shift in ways not yet fully appreciated. In response, while things remain uncertain, we nevertheless have to find ways to proceed. We propose a strategy for stakeholders to pursue, of key importance and relevance to the ISQua: to harness flexible standards and external assessment in support of needed change. Depending on how they are used, healthcare standards and accreditation can promote, or hinder, the changes needed to create better healthcare for all in the future. Standards should support people's care needs across the life cycle, including prevention and health promotion. New standards that emphasise better coordination of care, those that address the entire healthcare journey and standards that reflect and predict technological changes and support new models of care can play a part. To take advantage of these opportunities, governance bodies, external assessment agencies and other authorities will need to be less prescriptive and better at developing more flexible standards that apply to the entire health journey, incorporating new definitions of excellence and acceptability. The ISQua welcomes playing a leadership role.
Publisher: AMPCo
Date: 12-2014
DOI: 10.5694/MJA14.01260
Abstract: Attention was drawn to the safety of patients in acute care hospitals in the early 1990s when studies found large numbers of potentially preventable deaths. Errors were initially ascribed to in idual doctors and nurses, but later it was recognised that errors were mainly related to failure of systems rather than in iduals. Mortality is not necessarily a good measure of hospital safety. It depends more on the nature of the patient's underlying clinical state and the type of intervention than on the safety of the hospital, and its prevention (as a measure of patient safety) contributes to the failure of hospitals to recognise and appropriately manage patients who are naturally at the end of life. It is difficult to find agreement on the best ways to measure patient safety in hospitals and, as a result of the enormous resources devoted to improving and studying safety, it is difficult to show that patient safety has improved. However, the concept of safety is beginning to include post-hospital outcomes, such as quality of life. A rapid response system is an organisation-wide patient safety system which recognises the deterioration of a patient's condition and provides urgent and appropriate care. Evaluating the impact of a rapid response system can provide information on hospital safety, including potentially preventable deaths and cardiac arrests.
Publisher: Elsevier BV
Date: 11-2017
Publisher: Oxford University Press (OUP)
Date: 22-11-2019
Abstract: Health systems are under more pressure than ever before, and the challenges are multiplying and accelerating. Economic forces, new technology, genomics, AI in medicine, increasing demands for care-all are playing a part, or are predicted to increasingly do so. Above all, ageing populations in many parts of the world are exacerbating the disease burden on the system and intensifying the requirements to provide effective care equitably to citizens. In this first of two companion articles on behalf of the Innovation and Systems Change Working Group of the International Society for Quality in Health Care (ISQua), in consultation with representatives from over 40 countries, we assess this situation and discuss the implications for safety and quality. Health systems will need to run ahead of the coming changes and learn how to cope better with more people with more chronic and acute illnesses needing care. This will require collective ingenuity, and a deep desire to reconfigure healthcare and re-engineer services. Chief amongst the successful strategies, we argue, will be preventative approaches targeting both physical and psychological health, paying attention to the determinants of health, keeping people at home longer, experimenting with new governance and financial models, creating novel incentives, upskilling workforces to fit them for the future, redesigning care teams and transitioning from a system delivering episodic care to one that looks after people across the life cycle. There are opportunities for the international community to learn together to revitalise their health systems in a time of change and upheaval.
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: Informa UK Limited
Date: 08-04-2010
DOI: 10.3109/13561820903163801
Abstract: Interprofessional learning (IPL) and interprofessional practice (IPP) are strategies for healthcare services' striving to improve patient care. While health professionals are enacting IPL and IPP, the capacity to understand and comprehensively map IPL and IPP activities has remained elusive. Additionally, understanding and accounting for the impact of organizational context and culture on IPL and IPP requires attention. This paper presents the "interprofessional praxis audit framework" (IPAF), which is a unique tool to address these two issues. The IPAF comprises five components: context, culture, conduct, attitudes and information. Conjoined, the components facilitate examination of an organization's enactment of IPL and IPP. Utilized within an action research methodology, the IPAF enables a synchronized inspection, whereby similarities and differences of the components are considered simultaneously, and the knowledge developed is used to promote change projects to improve patient care.
Publisher: Oxford University Press (OUP)
Date: 12-03-2008
Abstract: An electronic Incident Information Management System implemented system-wide by the Department of Health, New South Wales, Australia was evaluated. We hypothesized that health professionals (i) would support the system via utilization and favourable attitudes and (ii) that their usage and attitudes would vary according to profession with nurses being most, and doctors least, favourably disposed. An online, anonymous questionnaire survey of 2185 health practitioners. Undertaking system training, satisfaction with training, reporting incidents, incident reporting rates since system introduction and attitude questions focusing on use, security and evaluation of the system and workplace safety cultures. The first hypothesis received partial support. The majority of respondents had undertaken training and rated it highly. Most had reported incidents and maintained their previous reporting levels. Most attitudes regarding using the system and its security were favourable. Mixed attitudes were held about workplace safety cultures and the value of the system. Deficiencies in quality of reporting, feedback on incident reports and resources to analyse incident data were problems identified. The second hypothesis was confirmed. Nurses were most, and doctors least, likely to undertake training, report incidents and express favourable attitudes. Allied health responses were intermediate to those of the other professions. The system implementation was relatively successful, but more so with some professions. Problems identified indicated that expectations as to the goals achievable in the short term were optimistic, but these are amenable to planned interventions.
Publisher: Oxford University Press (OUP)
Date: 12-03-2008
Abstract: The purpose of this study was to identify and analyze research into accreditation and accreditation processes. A multi-method, systematic review of the accreditation literature was conducted from March to May 2007. The search identified articles researching accreditation. Discussion or commentary pieces were excluded. From the initial identification of over 3000 abstracts, 66 studies that met the search criteria by empirically examining accreditation were selected. DATA EXTRACTION AND RESULTS OF DATA SYNTHESIS: The 66 studies were retrieved and analyzed. The results, examining the impact or effectiveness of accreditation, were classified into 10 categories: professions' attitudes to accreditation, promote change, organizational impact, financial impact, quality measures, program assessment, consumer views or patient satisfaction, public disclosure, professional development and surveyor issues. The analysis reveals a complex picture. In two categories consistent findings were recorded: promote change and professional development. Inconsistent findings were identified in five categories: professions' attitudes to accreditation, organizational impact, financial impact, quality measures and program assessment. The remaining three categories-consumer views or patient satisfaction, public disclosure and surveyor issues-did not have sufficient studies to draw any conclusion. The search identified a number of national health care accreditation organizations engaged in research activities. The health care accreditation industry appears to be purposefully moving towards constructing the evidence to ground our understanding of accreditation.
Publisher: No publisher found
Date: 2014
Publisher: Public Library of Science (PLoS)
Date: 31-01-2012
Publisher: Springer Science and Business Media LLC
Date: 06-01-2020
DOI: 10.1186/S13063-019-3968-1
Abstract: Randomised controlled trials (RCTs), while still considered the gold standard approach in medical research, can encounter impediments to their successful conduct and the dissemination of results. Pretrial qualitative research can usefully address some of these impediments, including recruitment and retention, ethical conduct, and preferred methods of dissemination. However, pretrial qualitative work is rarely undertaken in audiology. The Comparison of outcomes with hearing aids and cochlear implants in adults with moderately severe-to-profound bilateral sensorineural hearing loss (COACH) is a proposed RCT aiming to clarify when hearing aids (HAs) or cochlear implants (CIs) are the most suitable for different degrees of hearing loss and for which kinds of patients. q-COACH is a pretrial, qualitative study examining stakeholders’ experiences of HAs and CIs, current clinical practices and stakeholders’ perspectives of the design, conduct and dissemination plans for the proposed COACH study. Twenty-four participants including general practitioners, audiologists, adult HA users, and adult support networks undertook either semi-structured in idual or paired interviews and completed demographic questionnaires. Data were analysed thematically. Four key themes arose from this study: 1) rethinking s ling and recruitment strategies, 2) ethical considerations, 3) refining trial conduct, and 4) interconnected, appropriate and accessible methods of results dissemination. This qualitative investigation identified key considerations for the proposed RCT design, conduct and dissemination to help with successful implementation of COACH, and to indicate a plan of action at all RCT stages that would be acceptable to potential participants. By drawing on the perspectives of multiple key stakeholders and including a more general discussion of their experience and opinions of hearing loss, hearing device use and service availability, the study revealed experiential and ethical paradigms in which stakeholders operate. In so doing, q-COACH has exposed the benefits of preliminary qualitative investigations that enable detailed and rich understandings of the phenomenon at stake, forestalling problems and improving the quality of trial design, conduct and dissemination, while informing future RCT development discussions.
Publisher: Springer Science and Business Media LLC
Date: 09-10-2011
Publisher: Springer Science and Business Media LLC
Date: 20-04-2012
Publisher: Elsevier BV
Date: 02-2005
DOI: 10.1016/J.SOCSCIMED.2004.06.024
Abstract: This paper explores the relevance of a specific kind of sensed connectedness or 'teleo-affectivity' to the organisation and enactment of end-of-life care. Referred to as heedful inter-relating, this teleo-affective connectedness has been found to occur among employees as they carry out their highly complex and dangerous work. This paper focuses on the proposals put in the literature for confronting the complexity of end-of-life care in the intensive care unit (ICU), and inquires into the positionings incurred in and around end-of-life care in one specific unit, with the aim of gauging the pertinence of heedful inter-relating to end-of-life care in ICU. The paper argues that while several commentators appear to be calling for enhanced heedful conduct in end-of-life care, ICU practices may not admit the kind of heedful inter-relating that is evident in high-reliability organisations such as nuclear aircraft carriers. We suggest it may be unwise to gauge intensive care units' complexity purely against the brief of realising cultural scripts of the dying, and that ICU in fact manifests a broader societal concern necessitating a more variegated composition: to devise multiple ways to contain the impression and impact of (the meaning) death for society (societies) generally.
Publisher: AMPCo
Date: 06-1998
DOI: 10.5694/J.1326-5377.1998.TB139084.X
Abstract: Casemix funding for hospitals with the use of diagnosis-related groups (DRGs), which organise patients' conditions into similar clinical categories with similar costs, was introduced in Australia five years ago. It has been applied in different ways and to a greater or lesser extent in different Australian States. Only Victoria and South Australia have implemented casemix funding across all healthcare services. Attempts have been made to formally evaluate its impact, but they have not met the required scientific standards in controlling for confounding factors. Casemix funding remains a much-discussed issue. In this Debate, Braithwaite and Hindle take a contrary position, largely to stimulate policy debate Phelan defends the casemix concept and advocates retaining its best features and Hanson adds a plea for consumer input.
Publisher: BMJ
Date: 04-10-2012
DOI: 10.1136/BMJQS-2012-000852
Abstract: To systematically identify and synthesise health service accreditation literature. A systematic identification and narrative synthesis of health service accreditation literature published prior to 2012 were conducted. The search identified 122 empirical studies that examined either the processes or impacts of accreditation programmes. Study components were recorded, including: dates of publication research settings levels of study evidence and quality using established rating frameworks and key results. A content analysis was conducted to determine the frequency of key themes and subthemes examined in the literature and identify knowledge-gaps requiring research attention. The majority of studies (n=67) were published since 2006, occurred in the USA (n=60) and focused on acute care (n=79). Two thematic categories, that is, 'organisational impacts' and 'relationship to quality measures', were addressed 60 or more times in the literature. 'Financial impacts', 'consumer or patient satisfaction' and 'survey and surveyor issues' were each examined fewer than 15 times. The literature is limited in terms of the level of evidence and quality of studies, but highlights potential relationships among accreditation programmes, high quality organisational processes and safe clinical care. Due to the limitations of the literature, it is not prudent to make strong claims about the effectiveness of health service accreditation. Nonetheless, several critical issues and knowledge-gaps were identified that may help stimulate and inform discussion among healthcare stakeholders. Ongoing effort is required to build upon the accreditation evidence-base by using high quality experimental study designs to examine the processes, effectiveness and financial value of accreditation programmes and their critical components in different healthcare domains.
Publisher: Springer Science and Business Media LLC
Date: 18-09-2014
Publisher: BMJ
Date: 10-2017
DOI: 10.1136/BMJOPEN-2016-014048
Abstract: Despite widespread availability of clinical practice guidelines (CPGs), considerable gaps continue between the care that is recommended (‘appropriate care’) and the care provided. Problems with current CPGs are commonly cited as barriers to providing ’appropriate care'. Our study aims to develop and test an alternative method to keep CPGs accessible and up to date. This method aims to mitigate existing problems by using a single process to develop clinical standards (embodied in clinical indicators) collaboratively with researchers, healthcare professionals, patients and consumers. A transparent and inclusive online curated (purpose-designed, custom-built, wiki-type) system will use an ongoing and iterative documentation process to facilitate synthesis of up-to-date information and make available its provenance. All participants are required to declare conflicts of interest. This protocol describes three phases: engagement of relevant stakeholders design of a process to develop clinical standards (embodied in indicators) for ‘appropriate care’ for common medical conditions and evaluation of our processes, products and feasibility. A modified e-Delphi process will be used to gain consensus on ‘appropriate care’ for a range of common medical conditions. Clinical standards and indicators will be developed through searches of national and international guidelines, and formulated with explicit criteria for inclusion, exclusion, time frame and setting. Healthcare professionals and consumers will review the indicators via the wiki-based modified e-Delphi process. Reviewers will declare conflicts of interest which will be recorded and managed according to an established protocol. The provenance of all indicators and suggestions included or excluded will be logged from indicator inception to finalisation. A mixed-methods formative evaluation of our research methodology will be undertaken. Human Research Ethics Committee approval has been received from the University of South Australia. We will submit the results of the study to relevant journals and offer national and international presentations.
Publisher: Springer Science and Business Media LLC
Date: 06-01-2009
Publisher: BMJ
Date: 28-09-2023
Publisher: Wiley
Date: 06-1998
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: AMPCo
Date: 07-2011
Publisher: Springer Science and Business Media LLC
Date: 20-08-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 28-06-2012
Publisher: BMJ
Date: 30-11-2012
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: Springer Science and Business Media LLC
Date: 26-08-2021
DOI: 10.1186/S12883-021-02355-W
Abstract: Spinal cord injury (SCI) is associated with autonomic imbalance and significant secondary conditions, including cardiac and brain dysfunction that adversely impact health and wellbeing. This study will investigate the effectiveness (intention-to-treat) of a neuro-cardiac self-regulation therapy to improve autonomic and neural/brain activity in adults with SCI living in the community. A two-arm parallel, randomised controlled trial in which adults with SCI living in the community post-rehabilitation will be randomly assigned to a treatment or control group. The treatment group ( N = 60) aged 18–70 years with a chronic traumatic or non-traumatic SCI, will receive intervention sessions once per week for 10 weeks, designed to regulate autonomic activity using computer-based feedback of heart rate variability and controlled breathing (called HRV-F). Comprehensive neurophysiological and psychological assessment will occur at baseline, immediate post-treatment, and 6 and 12-months post-treatment. Primary outcome measures include electrocardiography/heart rate variability (to assess autonomic nervous system function) and transcranial doppler sonography (to assess cerebral blood circulation in basal cerebral arteries). Secondary outcomes measures include continuous blood pressure, electroencephalography, functional near-infrared spectroscopy, respiration/breath rate, electrooculography, cognitive capacity, psychological status, pain, fatigue, sleep and quality of life. Controls ( N = 60) will receive usual community care, reading material and a brief telephone call once per week for 10 weeks and be similarly assessed over the same time period as the HRV-F group. Linear mixed model analysis with repeated measures will determine effectiveness of HRV-F and latent class mixture modelling used to determine trajectories for primary and selected secondary outcomes of interest. Treatments for improving autonomic function after SCI are limited. It is therefore important to establish whether a neuro-cardiac self-regulation therapy can result in improved autonomic functioning post-SCI, as well as whether HRV-F is associated with better outcomes for secondary conditions such as cardiovascular health, cognitive capacity and mental health. The study has been prospectively registered with the Australian and New Zealand Clinical Trial Registry ( ACTRN12621000870853 .aspx). Date of Registration: 6th July 2021. Trial Sponsor: The University of Sydney, NSW 2006. Protocol version: 22/07/2021.
Publisher: Elsevier BV
Date: 07-2023
Publisher: SAGE Publications
Date: 2023
DOI: 10.1177/20552076231181201
Abstract: Digital triage tools such as telephone advice and online symptom checkers are now commonplace in health systems internationally. Research has focused on consumers’ adherence to advice, health outcomes, satisfaction, and the degree to which these services manage demand for general practice or emergency departments. Such studies have had mixed findings, leaving equivocal the role of these services in healthcare. We examined stakeholders’ perspectives on Healthdirect, Australia's national digital triage provider, focusing on its role in the health system, and barriers to operation, in the context of the COVID-19 pandemic. Key stakeholders took part in semi-structured interviews conducted online in the third quarter of 2021. Transcripts were coded and thematically analysed. Participants (n = 41) were Healthdirect staff (n = 13), employees of Primary Health Networks (PHNs n = 12), clinicians (n = 9), shareholder representatives (n = 4), consumer representatives (n = 2) and other policymakers (n = 1). Eight themes emerged from the analysis: (1) information and guidance in navigating the system, (2) efficiency through appropriate care, (3) value for consumers? (4) the difficulties in triage at a distance, (5) competition and the unfulfilled promise of integration, (6) challenges in promoting Healthdirect, (7) monitoring and evaluating digital triage services and (8) rapid change, challenge and opportunity from COVID-19. Stakeholders varied in their views of the purpose of Healthdirect's digital triage services. They identified challenges in lack of integration, competition, and the limited public profile of the services, issues largely reflective of the complexity of the policy and health system landscape. There was acknowledgement of the value of the services during the COVID-19 pandemic, and an expectation of them realising greater potential in the wake of the rapid uptake of telehealth.
Publisher: Emerald
Date: 21-06-2011
DOI: 10.1108/14777261111143518
Abstract: This paper aims to be a theoretical examination of the role of in iduals in sponsoring and facilitating effective, systemic change in organisations. Using reports of a number of high‐profile initiatives to improve patient safety, it seeks to analyse the role of in idual health care professionals in developing and facilitating new systems of care that improve safety and quality. The paper uses recent work in sociology that is concerned with the phenomenon of “sociological citizenship”. The authors test whether successful initiators of change in health care can be described as sociological citizens. This notion of sociological citizens is applied to a number of highly successful initiatives to improve safety and quality to extrapolate the factors associated with in idual clinician leadership, which may have affected the success of such endeavours. In each of the ex les analysed the initiators of change can be characterised as sociological citizens. In reviewing the roles of these charismatic in iduals it is evident that they see the relational interdependence between the in iduals and organisations and that they use this information to achieve both professional and organisational objectives. The paper uses a case study method to investigate the usefulness of the role of sociological citizenship in interventions that aim to improve patient safety. The paper reviews the key concepts and uses of the concept of sociological citizenship to produce a framework against which the case studies were assessed. The authors suggest that a goal of policy for improving patient safety should be directed to the problem of how hospitals and health care organisations can create the conditions for encouraging the in idual diligence and care that is needed to support reliable, safe health care practices. Improving the safety and quality of health care is an important public health initiative. It has also proven to be difficult to achieve sustained reductions in the harm caused by the occurrence of adverse events in health care. The process of linking in idual diligence with service outcomes may help to overcome one of the enduring struggles of health care systems around the world: the policy‐practice ide. The paper directs attention towards the role of sociological citizenship in health care systems and organisations.
Publisher: Oxford University Press (OUP)
Date: 21-09-2016
Publisher: Oxford University Press (OUP)
Date: 24-09-2016
Abstract: This study describes the use of, and modifications and additions made to, the Global Trigger Tool (GTT) since its first release in 2003, and summarizes its findings with respect to counting and characterizing adverse events (AEs). Peer-reviewed literature up to 31st December 2014. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Two authors extracted and compiled the demographics, methodologies and results of the selected studies. Of the 48 studies meeting the eligibility criteria, 44 collected data from inpatient medical records and four from general practice records. Studies were undertaken in 16 countries. Over half did not follow the standard GTT protocol regarding the number of reviewers used. 'Acts of omission' were included in one quarter of studies. Incident reporting detected between 2% and 8% of AEs that were detected with the GTT. Rates of AEs varied in general inpatient studies between 7% and 40%. Infections, problems with surgical procedures and medication were the most common incident types. The GTT is a flexible tool used in a range of settings with varied applications. Substantial differences in AE rates were evident across studies, most likely associated with methodological differences and disparate reviewer interpretations. AE rates should not be compared between institutions or studies. Recommendations include adding 'omission' AEs, using preventability scores for priority setting, and re-framing the GTT's purpose to understand and characterize AEs rather than just counting them.
Publisher: Oxford University Press (OUP)
Date: 24-03-2015
DOI: 10.1093/HMG/DDV101
Publisher: Emerald
Date: 18-01-2008
DOI: 10.1108/02683940810849657
Abstract: The purpose of this paper is to investigate in an Anglo and a Confucian‐Asian nation how pressure is exerted on middle managers by their subordinate staff, and the managerial activities affected. In a survey, Australian ( n =251) and Singaporean ( n =340) health managers rated the degree of pressure exerted on them by subordinate staff to devote additional time to various managerial activities. They described the influence strategies employed. Ratings of the average pressure experienced regarding nine managerial activities were identical in both cultures. Australian managers reported significantly greater pressure affecting people and general organisational management. Singaporeans experienced more pressure affecting their quality and data management tasks. Australian subordinates used more direct‐assertive and direct‐persuasive influence strategies. Singaporeans employed more indirect‐assertive tactics, particularly poor work performance. The generalisability of the findings may be limited by having convenience s les from one occupational sector. The cultural differences found are relevant to the increasing numbers of multinational organisations and expatriate and migrant workers. The information will inform discussions on factors affecting the assignment of managers' priorities, which can be at variance with their aspirations. Managers' experiences of pressure from subordinates and how pressure is conveyed have been under‐researched, particularly cross‐culturally.
Publisher: BMJ
Date: 07-2021
DOI: 10.1136/BMJOPEN-2020-043982
Abstract: The study of safety culture and its relationship to patient care have been challenged by variation in definition, dimensionality and methods of assessment. This systematic review aimed to map methods to assess safety culture in hospitals, analyse the prevalence of these methods in the published research literature and examine the dimensions of safety culture captured through these processes. We included studies reporting on quantitative, qualitative and mixed methods to assess safety culture in hospitals. The review was conducted using four academic databases (PubMed, CINAHL, Scopus and Web of Science) with studies from January 2008 to May 2020. A formal quality appraisal was not conducted. Study purpose, type of method and safety culture dimensions were extracted from all studies, coded thematically, and summarised narratively and using descriptive statistics where appropriate. A total of 694 studies were included. A third (n=244, 35.2%) had a descriptive or exploratory purpose, 225 (32.4%) tested relationships among variables, 129 (18.6%) evaluated an intervention, while 13.8% (n=96) had a methodological focus. Most studies exclusively used surveys (n=663 95.5%), with 88 different surveys identified. Only 31 studies (4.5%) used qualitative or mixed methods. Thematic analysis identified 11 themes related to safety culture dimensions across the methods, with ‘Leadership’ being the most common. Qualitative and mixed methods approaches were more likely to identify additional dimensions of safety culture not covered by the 11 themes, including improvisation and contextual pressures. We assessed the extent to which safety culture dimensions mapped to specific quantitative and qualitative tools and methods of assessing safety culture. No single method or tool appeared to measure all 11 themes of safety culture. Risk of publication bias was high in this review. Future attempts to assess safety culture in hospitals should consider incorporating qualitative methods into survey studies to evaluate this multi-faceted construct.
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: SAGE Publications
Date: 2004
Abstract: The aim of this article is to outline in discursive-linguistic terms how doctor-managers (or ‘physician-executives’ as they are termed in the USA) manage the incommensurate dimensions of their boundary position between profession and organization. In order to achieve this we undertook a discourse analytical study of both recorded, situated talk and open interview data focusing on one doctor-manager navigating between profession and organization. The doctor-manager at the centre of this study locates himself on the boundary of at least three discourses which, in many respects, are incommensurate. These are the profession-specific discourse of clinical medicine, the resource-efficiency and systematization discourse of management, and an interpersonalizing discourse devoted to hedging and mitigating contradictions. While this multi-vocality in itself is not surprising, data show that the doctor-manager positions himself across these discourses and manages their inherent incommensurabilities before a heterogeneous audience and on occasions even within the one utterance. In this particular case, boundary management is achieved by weaving incommensurable positions together into the social and linguistic dynamics of a single, heteroglossic stream of talk. This highly complex and dialogic strategy enables the doctor-manager to dissimulate the disjunction between his reluctance to impose organizational rules on his medical colleagues and his perception that such rules, in the future (to some extent at least), will be the appropriate means for managing the clinical work, and through that the organization.
Publisher: Wiley
Date: 05-02-2021
DOI: 10.1111/AJAG.12906
Abstract: To compare the health system utilisation patterns and health outcomes of residential aged care facility (RACF) residents reviewed by a hospital avoidance program to those of RACF residents who received usual care. A retrospective evaluation of a hospital avoidance program provided by a hospital‐based medical and nursing outreach team. Residents reviewed by the program were randomly matched 1:1 to comparison group residents based on age group, sex and number of co‐morbidities. Number of hospital admissions, excess hospital length of stay and excess hospital treatment costs were compared. Residents reviewed by the program spent an average 9‐10 days fewer in hospital with AUD$2,091 to $8,014 lower hospital treatment costs compared to comparison group residents. Rapid provision of outreach services for the management of acute care of RACF residents may reduce the number of days residents spend in hospital, as well as reducing the associated hospital treatment costs.
Publisher: Wiley
Date: 07-12-2018
DOI: 10.1002/CAM4.1915
Publisher: Springer Science and Business Media LLC
Date: 12-02-2022
DOI: 10.1186/S12913-022-07593-3
Abstract: Relatively little is understood about real-world provision of oncology care in ambulatory outpatient clinics (OPCs). This study aimed to: 1) develop an understanding of behaviours and practices inherent in the delivery of cancer services in OPC common areas by characterising the organisation and implementation of this care and 2) identify barriers to, and facilitators of, the delivery of this care in OPC common areas. A purpose-designed ethnographic study was employed in four public hospital OPCs. Informal field scoping activities were followed by in-situ observations, key informant interviews and document review. A view of OPCs as complex adaptive systems was used as a scaffold for the data collection and interpretation, with the intent of understanding ‘work as done’. Data were analysed using an adapted “Qualitative Rapid Appraisal, Rigorous Analysis” approach. Field observations were conducted over 135 h, interviews over 6.5 h and documents were reviewed. Analysis found six themes. Staff working in OPCs see themselves as part of small local teams and as part of a broader multidisciplinary care team. Professional role boundaries could be unclear in practice, as duties expanded to meet demand or to stop patients “falling through the cracks.” Formal care processes in OPCs were supported by relationships, social capital and informal, but invaluable, institutional expertise. Features of the clinic layout, such as the proximity of departments, affected professional interactions. Staff were aware of inter- and intra-service communication difficulties and employed strategies to minimise negative impacts on patients. We found that complexity, coordination, culture and capacity underpin the themes that characterise this care provision. The study advances understanding of how multidisciplinary care is delivered in ambulatory settings and the factors which promote or inhibit effective care practice. Time pressures, communication challenges and competing priorities can pose barriers to care delivery. OPC care is facilitated by: self-organisation of participants professional acumen institutional knowledge social ties and relationships between and within professional groups and commitment to patient-centred care. An understanding of the realities of ‘work-as-done’ may help OPCs to sustain high-quality care in the face of escalating service demand.
Publisher: Informa UK Limited
Date: 09-11-2018
DOI: 10.1080/13561820.2018.1544550
Abstract: This paper provides the first assessment of patterns of interprofessional collaboration in
Publisher: Elsevier BV
Date: 12-2014
DOI: 10.1016/J.IJMEDINF.2014.08.010
Abstract: (1) to describe Emergency Department (ED) physicians' and nurses' perceptions about the sequence of work related to patient management with use of an integrated Emergency Department Information System (EDIS), and (2) to measure changes in the sequence of clinician access to patient information. A mixed method study was conducted in four metropolitan EDs. Each used the same EDIS which is a module of the hospitals' enterprise-wide clinical information system composed of many components of an electronic medical record. This enabled access to clinical and management information relating to patients attending all hospitals in the region. Phase one - data were collected from ED physicians and nurses (n=97) by 69 in-depth interviews, five focus groups (28 participants), and 26 h of observations. Phase two - physicians (n=34) in one ED were observed over 2 weeks. Data included whether and what type of information was accessed from the EDIS prior to first examination of the patient. Clinicians reported, and phase 2 observations confirmed, that the integrated EDIS led to changes to the order of information access, which held implications for when tests were ordered and results accessed. Most physicians accessed patient information using EDIS prior to taking the patients' first medical history (77/116 66.4%, 95% CI: 57.8-75.0%). Previous discharge summaries (74%) and past test results (61%) were most frequently accessed and junior doctors were more likely to access electronic past history information than their senior colleagues (χ(2)=20.717, d.f.=1, p<0.001). The integrated EDIS created new ways of working for ED clinicians. Such changes could hold positive implications for: time taken to reach a diagnosis and deliver treatments length of stay patient outcomes and experiences.
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: Palgrave Macmillan UK
Date: 2005
Publisher: Wiley
Date: 1997
DOI: 10.1002/(SICI)1099-1751(199701)12:1<3::AID-HPM454>3.0.CO;2-6
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.INJURY.2018.07.009
Abstract: Injury is a leading cause of death and disability among children and young people. Recovery may be negatively affected by unwarranted clinical variation such as representation to an emergency department (ED), readmission to a hospital, and mortality. The aim of this study was to examine unwarranted clinical variation across providers of care of children and young people who were hospitalised for injury in New South Wales (NSW). Retrospective population-based cohort study using linked ED, hospital, and mortality data of all children and young people aged ≤25 years who were injured and hospitalised during 1 January 2010-30 June 2014 in NSW. Unwarranted clinical variation across providers was examined using three indicators. That is, for each hospital that treated ≥100 cases per year, risk standardised ratios were calculated with 95% and 99.8% confidence limits using the number of observed and expected events of (1) representations to ED within 72 h, (2) unplanned readmissions to hospital within 28 days, and (3) all-cause mortality within 30 days. There were 189,990 injury-related hospitalisations of children and young people. Of these, 4.4% represented to an ED, 8.7% were readmitted to hospital, and 0.2% died. Of the 45 public hospitals that treated ≥100 cases per year, higher than expected rates of ED representations, hospital readmissions, and mortality were observed in eleven, six, and two hospitals, respectively. The rates of ED representations, hospital readmissions, and mortality among children and young people hospitalised for injury in NSW were similar to the rates reported in other countries. However, unwarranted clinical variation across public hospitals was observed for all three indicators. These findings suggest that by improving routine follow-up support services post-discharge for children and young people and their families, it may be possible to reduce unwarranted clinical variation and improve health outcomes.
Publisher: MDPI AG
Date: 2022
Abstract: There are concerns that involving adolescents bereaved by suicide and other traumatic death in research may cause distress and harm. However, no study has investigated such bereaved adolescents’ research experiences. In addition, no study has looked at the experiences of parents and clinicians as participants in adolescent suicide and traumatic death bereavement research. This study aimed to explore the short-term impact of research participation experienced by adolescents, parents, and clinicians. A total of 61 participants (adolescents, n = 17 parents, n = 12 clinicians, n = 32) filled out a short survey within two weeks of having taken part in a qualitative interview study. Data were analyzed descriptively. Most participants had experienced no distress while participating and no negative effects of participating rather, participation was experienced as helpful for them and they would highly recommend participating in a study like this to others. A few adolescents and parents reported some distress, related to anxiety about participation and the unpleasantness of grief memories. The study clearly indicates that bereaved adolescents, parents and clinicians can safely participate in research interviews regarding their experiences of grief and help after suicide, generally valuing the opportunity to share their experience. To prevent and mitigate potential distress, training of research staff and implementation of appropriate participant distress protocols are imperative. Future studies could include longitudinal follow-up of participants to assess any longer-term consequences.
Publisher: Informa UK Limited
Date: 09-10-2014
DOI: 10.1080/17441692.2014.959541
Abstract: Gender mainstreaming developed as the global strategy for gender equality nearly two decades ago. Since then it has faced criticism for its technocratic application, and its role in the de-politicisation and neutralisation of the women's movement in gender policy-making. In the health sector, this incongruity is exacerbated by a traditional bio-medical approach to women's issues. In this paper, we ask whether gender mainstreaming can be made to work in the health sectors of developing countries where these challenges, as well as women's poor health status, are further complicated by a raft of local traditional, cultural, political and socioeconomic barriers. To answer these questions, we present a case study of Papua New Guinea (PNG), one of the world's most disadvantaged and politically challenging countries. We review data on women's health in PNG and analyse PNG's aspirational and actual performance on gender mainstreaming, looking at: international commitments political will and capacity national policies and programmes and the women's movement along with civil society's participation. We find numerous paradoxes between the aims of gender mainstreaming and the necessary conditions for its success.
Publisher: Public Library of Science (PLoS)
Date: 18-08-2021
DOI: 10.1371/JOURNAL.PONE.0255775
Abstract: The pace-of-life hypothesis is a socio-psychological theory postulating that citizens of different cities transact the business of life at varying paces, and this pace is associated with a number of population level variables. Here we apply the pace-of-life hypothesis to a hospital context to empirically test the association between pace and patient and staff outcomes. As pressure on hospitals grow and pace increases to keep up with demand, is there empirical evidence of a trade-off between a rapid pace and poorer outcomes? We collected data from four large Australian hospitals, inviting all staff (clinical and non-clinical) to complete a survey, and conducted a series of observations of hospital staff’s walking pace and transactional pace. From these data we constructed three measures of pace: staff perception of pace, transactional pace, and walking pace. Outcome measures included: hospital culture, perceived patient safety, and staff well-being outcomes of job satisfaction and burnout. Overall, participants reported experiencing a “fast-paced” “hurried” and “rapid” pace-of-life working in the Australian hospital sector. We found a significant difference in perceived pace across four hospital sites, similar to trends observed for transactional pace. This provides support that the pace-of-life hypothesis may apply to the hospital context. We tested associations between faster perceived pace, hospital culture, staff well-being and patient safety. Results revealed perceived faster pace significantly predicted negative perceptions of organizational culture, greater burnout and lower job satisfaction. However, perceived pace did not predict perceptions of patient safety. Different perceptions of hospital pace-of-life were found between different clinical settings and the type of care delivered staff working in emergency departments reported significantly “faster-paced” work environments than staff working in palliative, aged care, or rehabilitation wards.
Publisher: Oxford University Press (OUP)
Date: 10-2016
Publisher: JMIR Publications Inc.
Date: 18-10-2020
Abstract: ocation-based augmented reality (AR) games, such as Pokémon GO and Harry Potter: Wizards Unite, have been shown to have a beneficial impact on the physical activity, social connectedness, and mental health of their players. In March 2020, global social distancing measures related to the COVID-19 pandemic prompted the AR games developer Niantic Inc to implement several changes to ensure continued player engagement with Pokémon GO and Harry Potter: Wizards Unite. We sought to examine how the physical and mental well-being of players of these games were affected during the unprecedented COVID-19 restriction period as well as how their video game engagement was affected. he aims of this study were to examine the impact of COVID-19–related social restrictions on the physical and mental well-being of AR game players to examine the impact of COVID-19–related social restrictions on the use of video games and motivations for their use and to explore the potential role of AR games (and video games in general) in supporting well-being during COVID-19–related social restrictions. mixed methods web-based self-reported survey was conducted in May 2020, during which COVID-19–related social restrictions were enforced in many countries. Participants were recruited on the web via four subreddits dedicated to Pokémon GO or Harry Potter: Wizards Unite. Data collected included quantitative data on demographics, time spent playing video games, physical activity, and mental health qualitative data included motivations to play and the impact of video games on mental health during COVID-19 lockdown. e report results for 2004 participants (1153/1960 male, 58.8%, average age 30.5 years). Self-reported physical activity during COVID-19–related social restrictions significantly decreased from 7.50 hours per week on average (SD 11.12) to 6.50 hours (SD 7.81) ( i P /i & .001). More than half of the participants reported poor mental health (925/1766, 52.4% raw World Health Organization–5 Well-Being Index score & ). Female gender, younger age, and reduced exercise were significant predictors of poor mental health. Participants reported a significant increase in video game play time from 16.38 hours per week on average (SD 19.12) to 20.82 hours (SD 17.49) ( i P /i & .001). Approximately three quarters of the participants (n=1102/1427, 77.2%) reported that playing video games had been beneficial to their mental health. The changes made to Pokémon GO and Harry Potter: Wizards Unite were very well received by players, and the players continued to use these games while exercising and to maintain social connection. In addition to seeking an escape during the pandemic and as a form of entertainment, participants reported that they used video games for emotional coping and to lower stress, relax, and alleviate mental health conditions. R games have the potential to promote physical and mental health during the COVID-19 pandemic. Used by populations under isolation and distress, these games can improve physical and mental health by providing virtual socialization, sustained exercise, temporal routine, and mental structure. Further research is needed to explore the potential of AR games as digital behavioral interventions to maintain human well-being in the wider population.
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: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.HEALTHPOL.2017.05.006
Abstract: To examine general practice accreditation stakeholders' perspectives and experiences to identify program strengths and areas for improvements. In idual (n=2) and group (n=9) interviews were conducted between September 2011-March 2012 with 52 stakeholders involved in accreditation in Australian general practices. Interviews were recorded, transcribed and thematically analysed. Member checking activities in April 2016 assessed the credibility and currency of the findings in light of current reforms. Overall, participants endorsed the accreditation program but identified several areas of concern. Noted strengths of the program included: program ownership, peer review and collaborative learning access to Practice Incentives Program payments and, improvements in safety and quality. Noted limitations in these and other aspects of the program offer potential for improvement: evidence for the impact of accreditation resource demands clearer outcome measures and, specific experiences of accreditation. The effectiveness of accreditation as a strategy to improve safety and quality was shaped by the attitudes and experience of stakeholders. Strengths and weaknesses in the accreditation program influence, and are influenced by, stakeholder engagement and disengagement. After several accreditation cycles, the sector has the opportunity to reflect on, review and improve the process. This will be important if the continued or extended engagement of practices is to be realised to assure the continuation and effectiveness of the accreditation program.
Publisher: Oxford University Press (OUP)
Date: 15-03-2016
Abstract: Healthcare systems across the world are experiencing increased financial, organizational and social pressures attributable to a range of critical issues including the challenge of ageing populations. Health systems need to adapt, in order to sustainably provide quality care to the widest range of patients, particularly those with chronic and complex diseases, and especially those in vulnerable and low-income groups. We report on a workshop designed to tackle such issues under the auspices of ISQua, with representatives from Argentina, Australia, Canada, Columbia, Denmark, Emirates, France, Ireland, Jordan, Qatar, Malaysia, Norway, Oman, UK, South Africa and Switzerland. We discuss some of the challenges facing healthcare systems in countries ageing rapidly, to those less so, and touch on current and future reform options.
Publisher: SAGE Publications
Date: 03-2013
DOI: 10.1177/183335831304200101
Abstract: Accreditation of health organisations, occurring in over 70 countries, is predicated upon the reliability of survey teams' judgements, but we do not know the extent to which survey teams are reliable. To contribute evidence to this issue, we investigated the reliability of two survey teams simultaneously assessing an organisation. The setting was a large Australian teaching hospital, and data were derived from interviews, observations and survey documents. Participants were from four groups: hospital staff, accreditation agency personnel and surveyors, and research staff. Thematic analysis was employed to identify significant factors that influenced the study. The two survey teams' ratings and recommendations demonstrated high levels of agreement. However, while a common understanding of the study existed, the research was compromised. There were difficulties enacting the study. Contrary to negotiated arrangements, the pressure of the study resulted in surveyors discussing evidence and their interpretation of standards. Uncontrollable circumstances (late changes of personnel), and unexpected events (a breakdown of working relationships), challenged the study. The twin lessons learnt are that a consistent survey outcome is likely to be reached when reliability of process and consistent application of standards are pursued, and research requires negotiating challenges and relationships.
Publisher: Oxford University Press (OUP)
Date: 03-07-2019
Abstract: This commentary highlights the importance of health system responsiveness to older people living with complex health needs. Age-related changes and associated morbidity can present barriers to identifying an in idual’s health needs, expectations, values and preferences, and so sufficient time, skill and resource is required to inform the development of a tailored plan for each in idual. A focus on responsiveness moves thinking beyond the responsibilities of the in idual clinician in the single encounter, and allows us to identify elements of the wider system that may constrain how well the clinician is able to respond. Setting the goal of responsive health care requires us to assess the suitability of wider health system features and processes for meeting the erse needs of in idual people throughout their journey, and the extent to which the system can adapt dynamically as needs change. Standardised approaches to care prescribed across organisations (such as time-based targets or routinised approaches to inpatient nursing care) are likely to result in low responsiveness as in idual complexity grows, disadvantaging patients with needs that do not fit the prescribed approach. Responsiveness is high when in idual practitioners and clinical teams have the resources, decentralised authority, flexibility and autonomy to provide the care required. Building a more responsive health system requires a greater understanding of how these conditions can be achieved.
Publisher: BMJ
Date: 04-04-2016
DOI: 10.1136/MEDHUM-2016-010885
Abstract: There are gaps in our comprehension of patients' subjective experiences as they engage with and transit through the healthcare environments implicated in their treatment trajectories. Patients' stories, unlike patient experience data gathered in questionnaires and surveys, express the deeply personal, narrative nature of the journeys that patients take, creating opportunities for qualitative healthcare research. Yet narrative capabilities and propensities vary with in iduals, and are affected by the stresses of illness and treatment. This article extends the growing interest in narrative competence training for both practitioners and patients with the investigation of a story-telling model that could facilitate patients to narrate their experiences of healthcare systems. This model is derived from the literary arts. In fiction and autobiography, the journey arc of the central character is often one in which he or she is compelled to leave the comfort of everyday life and face a series of extraordinary events involving challenge and change which forces the character towards practical, intellectual, psychological and philosophical adjustments that define, by the end of the story, the character's 'new normal'. This pattern is known as the 'hero journey'. Its parallels with patients' experiences of healthcare and the way people narrate their stories of illness have long been recognised. We present here a new idea for applying this model as a narrative structure by which patients may construct their stories about being in and moving through the healthcare system.
Publisher: Springer Science and Business Media LLC
Date: 13-01-2020
DOI: 10.1186/S12887-020-1911-Y
Abstract: Fever in childhood is a common acute presentation requiring clinical triage to identify the few children who have serious underlying infection. Clinical practice guidelines (CPGs) have been developed to assist clinicians with this task. This study aimed to assess the proportion of care provided in accordance with CPG recommendations for the management of fever in Australian children. Clinical recommendations were extracted from five CPGs and formulated into 47 clinical indicators for use in auditing adherence. Indicators were categorised by phase of care: assessment, diagnosis and treatment. Patient records from children aged 0 to 15 years were s led from general practices (GP), emergency departments (ED) and hospital admissions in randomly-selected health districts in Queensland, New South Wales and South Australia during 2012 and 2013. Paediatric nurses, trained to assess eligibility for indicator assessment and adherence, reviewed eligible medical records. Adherence was estimated by in idual indicator, phase of care, age-group and setting. The field team conducted 14,879 eligible indicator assessments for 708 visits by 550 children with fever in 58 GP, 34 ED and 28 hospital inpatient settings. For the 33 indicators with sufficient data, adherence ranged from 14.7 to 98.1%. Estimated adherence with assessment-related indicators was 51.3% (95% CI: 48.1–54.6), 77.5% (95% CI: 65.3–87.1) for diagnostic-related indicators and 72.7% (95% CI: 65.3–79.3) for treatment-related indicators. Adherence for children 3 months of age was 73.4% (95% CI: 58.0–85.8) and 64.7% (95% CI: 57.0–71.9) for children 3–11 months of age, both significantly higher than for children aged 4–15 years (53.5% 95% CI: 50.0–56.9). The proportion of adherent care for children attending an ED was 77.5% (95% CI: 74.2–80.6) and 76.7% (95% CI: 71.7–81.3) for children admitted to hospital, both significantly higher than for children attending a GP (40.3% 95% CI: 34.6–46.1). This study reports a wide range of adherence by clinicians to 47 indicators of best practice for the management of febrile children, s led from urban and rural regions containing 60% of the Australian paediatric population. Documented adherence was lowest for indicators related to patient assessment, for care provided in GP settings, and for children aged 4–15 years.
Publisher: SAGE Publications
Date: 19-03-2021
Abstract: Staff members in residential aged care facilities (RACFs) make prioritization decisions to determine which aspects of care are most important and thus should be attended to first. Prioritization can potentially result in substandard care if lower priority tasks are delayed or left undone, known as “missed care.” This study investigated the contexts in which prioritization dilemmas arise in RACFs and the influences on prioritization decision-making. Thirty-two staff members participated in a think-aloud task during a prioritization activity, a demographic questionnaire, a post-sorting interview, and a semi-structured interview. Data were analyzed using inductive content analysis. Prioritization dilemmas occurred in response to high workloads, inadequate staffing, unexpected events, and conflicting demands. Seven influences on prioritization decision-making were identified. In some instances, these influences were seen to be in conflict, making prioritization decision-making challenging. Efforts to prevent missed care should consider the influences on staff members’ decision-making and aim to reduce prioritization dilemmas.
Publisher: Routledge
Date: 26-09-2020
Publisher: Springer Science and Business Media LLC
Date: 14-01-2023
DOI: 10.1186/S12875-023-01967-0
Abstract: People with early-onset colorectal cancer, under the age of 50, are more likely to experience diagnostic delay and to be diagnosed at later stages of the disease than older people. Advanced stage diagnosis potentially requires invasive therapeutic management at a time of life when these patients are establishing intimate relationships, raising families, building careers and laying foundations for financial stability. Barriers to timely diagnosis at primary care level have been identified but the patient perspective has not been investigated. Personal accounts of cancer care are increasingly accessed as rich sources of patient experience data. This study uses mixed methods, incorporating quantitative content analysis and qualitative thematic analysis, to investigate patients’ accounts of early-onset colorectal cancer diagnosis published on prominent bowel cancer support websites in the United Kingdom, Australia and New Zealand. Patients’ perceptions ( n = 273) of diagnostic barriers at primary care level were thematically similar across the three countries. Patients perceived that GPs’ low suspicion of cancer due to age under 50 contributed to delays. Patients reported that their GPs seemed unaware of early-onset colorectal cancer and that they were not offered screening for colorectal cancer even when ‘red flag’ symptoms were present. Patients described experiences of inadequate information continuity within GP practices and across primary, specialist and tertiary levels of care, which they perceived contributed to diagnostic delay. Patients also reported tensions with GPs over the patient-centredness of care, describing discord related to symptom seriousness and lack of shared decision-making. Wider dissemination of information about early-onset colorectal cancer at primary care level is imperative given the increasing incidence of the disease, the frequency of diagnostic delay, the rates of late-stage diagnosis and the dissatisfaction with patient experience reported by patients whose diagnosis is delayed. Patient education about diagnostic protocols may help to pre-empt or resolve tensions between GPs’ enactment of value-based care and patients’ concerns about cancer. The challenges of diagnosing early-onset colorectal cancer are significant and will become more pressing for GPs, who will usually be the first point of access to a health system for this growing patient population.
Publisher: Springer Science and Business Media LLC
Date: 16-06-2023
DOI: 10.1186/S12913-023-09653-8
Abstract: Theories of learning are of clear importance to resilience in healthcare since the ability to successfully adapt and improve patient care is closely linked to the ability to understand what happens and why. Learning from both positive and negative events is crucial. While several tools and approaches for learning from adverse events have been developed, tools for learning from successful events are scarce. Theoretical anchoring, understanding of learning mechanisms, and establishing foundational principles for learning in resilience are pivotal strategies when designing interventions to develop or strengthen resilient performance. The resilient healthcare literature has called for resilience interventions, and new tools to translate resilience into practice have emerged but without necessarily stipulating foundational learning principles. Unless learning principles are anchored in the literature and based on research evidence, successful innovation in the field is unlikely to occur. The aim of this paper is to explore: What are key learning principles for developing learning tools to help translate resilience into practice? This paper reports on a two-phased mixed methods study which took place over a 3-year period. A range of data collection and development activities were conducted including a participatory approach which involved iterative workshops with multiple stakeholders in the Norwegian healthcare system. In total, eight learning principles were generated which can be used to help develop learning tools to translate resilience into practice. The principles are grounded in stakeholder needs and experiences and in the literature. The principles are ided into three groups: collaborative, practical, and content elements. The establishment of eight learning principles that aim to help develop tools to translate resilience into practice. In turn, this may support the adoption of collaborative learning approaches and the establishment of reflexive spaces which acknowledge system complexity across contexts. They demonstrate easy usability and relevance to practice.
Publisher: American Association for Cancer Research (AACR)
Date: 12-2007
DOI: 10.1158/1055-9965.EPI-07-0542
Abstract: Although some high-risk ovarian cancer genes have been identified, it is likely that common low penetrance alleles exist that confer some increase in ovarian cancer risk. We have genotyped nine putative functional single-nucleotide polymorphisms (SNP) in genes involved in steroid hormone synthesis (SRD5A2, CYP19A1, HSB17B1, and HSD17B4) and DNA repair (XRCC2, XRCC3, BRCA2, and RAD52) using two Australian ovarian cancer case-control studies, comprising a total of 1,466 cases and 1,821 controls of Caucasian origin. Genotype frequencies in cases and controls were compared using logistic regression. The only SNP we found to be associated with ovarian cancer risk in both of these two studies was SRD5A2 V89L (rs523349), which showed a significant trend of increasing risk per rare allele (P = 0.00002). We then genotyped another SNP in this gene (rs632148 r2 = 0.945 with V89L) in an attempt to validate this finding in an independent set of 1,479 cases and 2,452 controls from United Kingdom, United States, and Denmark. There was no association between rs632148 and ovarian cancer risk in the validation s les, and overall, there was no significant heterogeneity between the results of the five studies. Further analyses of SNPs in this gene are therefore warranted to determine whether SRD5A2 plays a role in ovarian cancer predisposition. (Cancer Epidemiol Biomarkers Prev 2007 (12):2557–9)
Publisher: AMPCo
Date: 11-2018
DOI: 10.5694/MJA17.01261
Publisher: Informa UK Limited
Date: 2018
Publisher: Wiley
Date: 21-05-2019
DOI: 10.1111/AJCO.13166
Publisher: Springer Science and Business Media LLC
Date: 30-04-2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 24-07-2019
DOI: 10.1097/AUD.0000000000000762
Abstract: Hearing loss (HL) affects a significant proportion of adults aged years by impairing communication and social connectedness and, due to its high prevalence, is a growing global concern. Cochlear implants (CIs) are effective devices for many people with severe or greater sensorineural HL who experience limited benefits from hearing aids. Despite this, uptake rates globally are low among adults. This multimethod, multicountry qualitative study aimed to investigate the barriers and facilitators to CI uptake among adults aged ≥50 years. Adult CI and hearing aid users with postlingual severe or greater sensorineural HL, general practitioners, and audiologists were recruited in Australia using purposive s ling, and a comparative s le of audiologists was recruited in England and Wales in the United Kingdom. Participants were interviewed in idually, or in a focus group, completed a demographic questionnaire and a qualitative survey. Data were analyzed using thematic analysis. A total of 143 data capture events were collected from 55 participants. The main barriers to CI uptake related to patients’ concerns about surgery and loss of residual hearing. Limited knowledge of CIs, eligibility criteria, and referral processes acted as barriers to CIs assessment referrals by healthcare professionals. Facilitators for CI uptake included patients’ desire for improved communication and social engagement, and increased healthcare professional knowledge and awareness of CIs. There are numerous complex barriers and facilitators to CI uptake. Knowledge of these can inform the development of targeted strategies to increase CI referral and surgery for potential beneficiaries.
Publisher: Wiley
Date: 21-01-2021
DOI: 10.1111/HEX.13195
Abstract: Eliciting residents’ priorities for their care is fundamental to delivering person‐centred care in residential aged care facilities (RACFs). Prioritization involves ordering different aspects of care in relation to one another by level of importance. By understanding residents’ priorities, care can be tailored to residents’ needs while considering practical limitations of RACFs. To investigate aged care residents’ prioritization of care. A mixed‐methods study comprising Q methodology and qualitative methods. Thirty‐eight residents living in one of five Australian RACFs. Participants completed a card–sorting activity using Q methodology in which they ordered 34 aspects of care on a pre‐defined grid by level of importance. Data were analysed using inverted factor analysis to identify factors representing shared viewpoints. Participants also completed a think‐aloud task, demographic questionnaire, post‐sorting interview and semi‐structured interview. Inductive content analysis of qualitative data was conducted to interpret shared viewpoints and to identify influences on prioritization decision making. Four viewpoints on care prioritization were identified through Q methodology: Maintaining a sense of spirituality and self in residential care information sharing and family involvement self‐reliance and timely access to staff member support. Across the participant s le, residents prioritized being treated with respect, the management of medical conditions, and their independence. Inductive content analysis revealed four influences on prioritization decisions: level of dependency dynamic needs indifference and availability of staff. Recommendations for providing care that align with residents’ priorities include establishing open communication channels with residents, supporting residents’ independence and enforcing safer staffing ratios.
Publisher: Ubiquity Press, Ltd.
Date: 19-12-2018
DOI: 10.5334/IJIC.4168
Publisher: BMJ
Date: 11-2017
DOI: 10.1136/BMJOPEN-2017-017708
Abstract: Every organisation has a unique culture. There is a widely held view that a positive organisational culture is related to positive patient outcomes. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses statement, we systematically reviewed and synthesised the evidence on the extent to which organisational and workplace cultures are associated with patient outcomes. A variety of healthcare facilities, including hospitals, general practices, pharmacies, military hospitals, aged care facilities, mental health and other healthcare contexts. The articles included were heterogeneous in terms of participants. This was expected as we allowed scope for wide-ranging health contexts to be included in the review. Patient outcomes, inclusive of specific outcomes such as pain level, as well as broader outcomes such as patient experience. The search strategy identified 2049 relevant articles. A review of abstracts using the inclusion criteria yielded 204 articles eligible for full-text review. Sixty-two articles were included in the final analysis. We assessed studies for risk of bias and quality of evidence. The majority of studies (84%) were from North America or Europe, and conducted in hospital settings (89%). They were largely quantitative (94%) and cross-sectional (81%). The review identified four interventional studies, and no randomised controlled trials, but many good quality social science studies. We found that overall, positive organisational and workplace cultures were consistently associated with a wide range of patient outcomes such as reduced mortality rates, falls, hospital acquired infections and increased patient satisfaction. Synthesised, although there was no level 1 evidence, our review found a consistently positive association held between culture and outcomes across multiple studies, settings and countries. This supports the argument in favour of activities that promote positive cultures in order to enhance outcomes in healthcare organisations.
Publisher: BMJ
Date: 09-2022
DOI: 10.1136/BMJOPEN-2021-060394
Abstract: Rare diseases are characterised by low incidence, often with little evidence for effective treatments. Isolated patients and specialist centres for rare diseases are increasingly connected, thanks to the internet. This scoping review aimed to identify issues facing people with a rare disease that authors report may be addressed by electronic resources (mobile applications, websites, social media platforms, telehealth and online portals). Scoping review guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Medline, Embase and PsycInfo were searched, supplemented by hand searches of selected journals, in July 2021. Peer-reviewed literature in English was searched using terms for rare disease (incidence :2000), electronic modalities (eg, mobile phone) and patient support terms. No date limit was set. Conference abstracts were included. Data extracted: rare disease/group of diseases, name of the e-resource, need identified in the patient cohort, features of the e-resource, any other findings or observations of interest. From this, a framework was developed synthesising features across diseases and resources. Seventy-two papers were found (from 383). Fifty-six electronic resources were described in 64 papers, while 12 papers were exploratory studies. Cystic fibrosis (n=28) was the most frequently addressed, followed by haemophilia (n=16). Four domains and 23 subdomains of needs were extracted from the papers. The domains of needs were: support for self-management, access to high-quality information, access to appropriate specialist services, and social support. Subdomains are sometimes related to needs of in idual rare diseases (eg, social isolation due to infection risk in people with cystic fibrosis). Fifteen electronic resources were identified that supported parents of children with rare disorders. While it can be argued that rare diseases, per se, may be no less distressing or onerous to care for than a high prevalence disease, rare diseases have unique features: the lengthy odyssey to find a diagnosis, then appropriate specialists, the lack of evidence around effective treatments, guidelines or access to knowledgeable general health service providers. Designers of electronic resources are urged to consult key stakeholders to enhance the effectiveness and usability of resources for people with a rare disease.
Publisher: Wiley
Date: 10-1994
Publisher: Springer Science and Business Media LLC
Date: 14-09-2019
DOI: 10.1186/S12913-019-4508-0
Abstract: Updating, improving and spreading the evidence base for healthcare practices has proven to be a challenge of considerable magnitude – a wicked, multi-dimensional problem. There are many interlinked factors which determine how, why and whether any particular implementation effort or intervention succeeds. Soft Systems Methodology (SSM), strongly grounded in systems ideas and complexity science, offers a structured, yet flexible process for dealing with situations that are perceived as problematical and in need of improvement. The aim of this paper is to propose the use of SSM for managing change in healthcare by way of addressing some of the complexities. The aim is further to illustrate ex les of how SSM has been used in healthcare and discuss the features of the methodology that we believe can be harnessed to improve healthcare. SSM is particularly suited for tackling real world problems that are difficult to define and where stakeholders may have ergent views on the situation and the objectives of change. SSM engages stakeholders in a learning cycle including: finding out about the problematical situation, i.e. the context in which the problem exists, by developing a rich picture of the situation defining it by developing conceptual models and comparing these with the real world taking action to improve it by deciding on desirable and feasible improvements and implementing these in an iterative manner. Although SSM has been widely used in other sectors, it has not been extensively used in healthcare. We make the case for applying SSM to implementation and improvement endeavours in healthcare using the ex le of getting clinicians at the hospital level to use evidence-based guidelines. Applying SSM means taking account of the multi-dimensional nature of care settings, and dealing with entrenched and unique contexts, cultures and socio-political ecosystems – precisely those that manifest in healthcare. There are gains to be made in appreciating complexity and facilitating contextualization of interventions, and by approaching improvements in an iterative learning cycle.
Publisher: BMJ
Date: 27-08-2012
DOI: 10.1136/BMJQS-2011-051755
Abstract: The safety-and-quality movement is now two decades old. Errors persist despite best efforts, indicating that there are entrenched overt and perhaps less explicit barriers limiting the success of improvement efforts. OBJECTIVES AND HYPOTHESES: To examine the perspectives of five groups of healthcare workers (administrative staff, nurses, medical practitioners, allied health and managers) and to compare and contrast their descriptions of quality-and-safety activities within their organisation. Differences in perspectives can be an indicator of ergence in the conceptualisation of, and impetus for, quality-improvement strategies which are intended to engage healthcare professions and staff. Study data were collected in a defined geographical healthcare jurisdiction in Australia, via in idual and group interviews held across four service streams (aged care and rehabilitation mental health community health and cancer services). Data were collected in 2008 and analysed, using data-mining software, in 2009. Clear differences in the perspectives of professional groups were evident, suggesting variations in the perceptions of, and priorities for, quality and safety. The visual representation of quality and safety perspectives provides insights into the conceptual maps currently utilised by healthcare workers. Understanding the similarity and differences in these maps may enable more effective targeting of interprofessional improvement strategies.
Publisher: Wiley
Date: 03-1995
Publisher: BMJ
Date: 12-2020
DOI: 10.1136/BMJOPEN-2020-039158
Abstract: Resilient healthcare (RHC) is an emerging area of theory and applied research to understand how healthcare organisations cope with the dynamic, variable and demanding environments in which they operate, based on insights from complexity and systems theory. Understanding adaptive capacity has been a focus of RHC studies. Previous studies clearly show why adaptations are necessary and document the successful adaptive actions taken by clinicians. To our knowledge, however, no studies have thus far compared RHC across different teams and countries. There are gaps in the research knowledge related to the multilevel nature of resilience across healthcare systems and the team-based nature of adaptive capacity. This cross-country comparative study therefore aims to add knowledge of how resilience is enabled in erse healthcare systems by examining adaptive capacity in hospital teams in six countries. The study will identify how team, organisational and national healthcare system factors support or hinder the ability of teams to adapt to variability and change. Findings from this study are anticipated to provide insights to inform the design of RHC systems by considering how macro-level and meso-level structures support adaptive capacity at the micro-level, and to develop guidance for organisations and policymakers. The study will employ a multiple comparative case study design of teams nested within hospitals, in turn embedded within six countries: Australia, Japan, the Netherlands, Norway, Switzerland and the UK. The design will be based on the Adaptive Teams Framework placing adaptive teams at the centre of the healthcare system with layers of environmental, organisational and system level factors shaping adaptive capacity. In each of the six countries, a focused mapping of the macro-level features of the healthcare system will be undertaken by using documentary sources and interviews with key informants operating at the macro-level. A s ling framework will be developed to select two hospitals in each country to ensure variability based on size, location and teaching status. Four teams will be selected in each hospital—one each of a structural, hybrid, responsive and coordinating team. A total of eight teams will be studied in each country, creating a total s le of 48 teams. Data collection methods will be observations, interviews and document analysis. Within-case analysis will be conducted according to a standardised template using a combination of deductive and inductive qualitative coding, and cross-case analysis will be conducted drawing on the Qualitative Comparative Analysis framework. The overall Resilience in Healthcare research programme of which this study is a part has been granted ethical approval by the Norwegian Centre for Research Data (Ref. No. 8643334 and Ref. No. 478838). Ethical approval will also be sought in each country involved in the study according to their respective regulatory procedures. Country-specific reports of study outcomes will be produced for dissemination online. A collection of case study summaries will be made freely available, translated into multiple languages. Brief policy communications will be produced to inform policymakers and regulators about the study results and to facilitate translation into practice. Academic dissemination will occur through publication in journals specialising in health services research. Findings will be presented at academic, policy and practitioner conferences, including the annual RHC Network meeting and other healthcare quality and safety conferences. Presentations at practitioner and academic conferences will include workshops to translate the findings into practice and influence quality and safety programmes internationally.
Publisher: Elsevier BV
Date: 03-2016
DOI: 10.1016/J.COLEGN.2014.09.005
Abstract: Effective nursing leadership is necessary for the delivery of safe, high quality healthcare. Yet experience and research tells us that nursing leaders are commonly unprepared for their roles. Take The Lead (TTL), a large-scale, multifaceted professional development program was initiated in New South Wales, Australia, to strengthen the capacity of Nursing/Midwifery Unit Managers (N/MUMs). The aim of this study was to examine the effects of TTL on job performance, nursing leadership and patient experience. Nursing/Midwifery Unit Managers (n = 30) and managers of N/MUMs (n = 30) who had completed the TTL program were interviewed between August and December 2010. The semi-structured interviews included a combination of open-ended questions and questions that required respondents to rate statements using a Likert scale. Data from the open-ended questions were thematically analysed to identify and categorise key concepts. The responses to the Likert items were analysed via descriptive statistics. Nursing/Midwifery Unit Managers' participation in TTL engendered improvements in job performance and leadership skills, as well as some improvement in patients' experiences of care. The program facilitated role clarification and helped foster peer-support and learning networks, which were perceived to provide ongoing professional and personal benefits to participants. Our study revealed a consensus about the beneficial outcomes of TTL among those involved with the program. It supports the significant and ongoing value of widely implemented, multifaceted nursing leadership development programs and demonstrates that participants value their informal interactions as highly as they do the formal content. These findings have implications for delivery mode of similar professional development programs.
Publisher: Springer Science and Business Media LLC
Date: 12-2018
Publisher: Wiley
Date: 28-10-2011
Publisher: Springer Science and Business Media LLC
Date: 05-02-2020
Publisher: Emerald
Date: 03-10-2018
DOI: 10.1108/JHOM-09-2017-0239
Abstract: Health service effectiveness continues to be limited by misaligned objectives between policy makers and frontline clinicians. While capturing the discretion workers inevitably exercise, the concept of “street-level bureaucracy” has tended to artificially separate policy makers and workers. The purpose of this paper is to understand the role of social-organizational context in aligning policy with practice. This mixed-method participatory study focuses on a locally developed tool to implement an Australia-wide strategy to engage and respond to mental health services for parents with mental illness. Researchers: completed 69 client file audits administered 64 staff surveys conducted 24 interviews and focus groups (64 participants) with staff and a consumer representative and observed eight staff meetings, in an acute and sub-acute mental health unit. Data were analyzed using content analysis, thematic analysis and descriptive statistics. Based on successes and shortcomings of the implementation (assessment completed for only 30 percent of clients), a model of integration is presented, distinguishing “assimilist” from “externalist” positions. These depend on the degree to which, and how, the work environment affords clinicians the setting to coordinate efforts to take account of clients’ personal and social needs. This was particularly so for allied health clinicians and nurses undertaking sub-acute rehabilitative-transitional work. A new conceptualization of street-level bureaucracy is offered. Rather than as disconnected, it is a process of mutual influence among interdependent actors. This positioning can serve as a framework to evaluate how and under what circumstances discretion is appropriate, and to be supported by managers and policy makers to optimize client-defined needs.
Publisher: BMJ
Date: 02-2020
DOI: 10.1136/BMJOPEN-2019-032636
Abstract: Sentinel lymph node biopsy (SLNB) is a diagnostic procedure developed in the 1990s. It is currently used to stage patients with primary cutaneous melanoma, provide prognostic information and guide management. The Australian Clinical Practice Guidelines state that SLNB should be considered for patients with cutaneous melanoma mm in thickness (or .8 mm with high-risk pathology features). Until recently, sentinel lymph node (SLN) status was used to identify patients who might benefit from a completion lymph node dissection, a procedure that is no longer routinely recommended. SLN status is now also being used to identify patients who might benefit from systemic adjuvant therapies such as anti-programmed cell death 1 (PD1) checkpoint inhibitor immunotherapy or BRAF-directed molecular targeted therapy, treatments that have significantly improved relapse-free survival for patients with resected stage III melanoma and improved overall survival of patients with unresectable stage III and stage IV melanoma. Australian and international data indicate that approximately half of eligible patients receive an SLNB. This mixed-methods study seeks to understand the structural, contextual and cultural factors affecting implementation of the SLNB guidelines. Data collection will include: (1) cross-sectional questionnaires and semistructured interviews with general practitioners and dermatologists (2) semistructured interviews with other healthcare professionals involved in the diagnosis and early definitive care of melanoma patients and key stakeholders including researchers, representatives of professional colleges, training organisations and consumer melanoma groups and (3) documentary analysis of documents from government, health services and non-government organisations. Descriptive analyses and multivariable regression models will be used to examine factors related to SLNB practices and attitudes. Qualitative data will be analysed using thematic analysis. Ethics approval has been granted by the University of Sydney. Results will be disseminated through publications and presentations to clinicians, patients, policymakers and researchers and will inform the development of strategies for implementing SLNB guidelines in Australia.
Publisher: Elsevier BV
Date: 06-2019
Publisher: Emerald
Date: 11-06-2018
DOI: 10.1108/IJHCQA-06-2017-0115
Abstract: The purpose of this paper is to understand how staff at various levels perceive and understand hospital accreditation generally and in relation to quality improvement (QI) specifically. In a newly accredited Danish hospital, the authors conducted semi-structured interviews to capture broad ranging experiences. Medical doctors, nurses, a quality coordinator and a quality department employee participated. Interviews were audio recorded and subjected to framework analysis. Staff reported that The Danish Healthcare Quality Programme affected management priorities: office time and working on documentation, which reduced time with patients and on improvement activities. Organisational structures were improved during preparation for accreditation. Staff perceived that the hospital was better prepared for new QI initiatives after accreditation staff found disease specific requirements unnecessary. Other areas benefited from accreditation. Interviewees expected that organisational changes, owing to accreditation, would be sustained and that the QI focus would continue. Accreditation is a critical and complete hospital review, including areas that often are neglected. Accreditation dominates hospital agendas during preparation and surveyor visits, potentially reducing patient care and other QI initiatives. Improvements are less likely to occur in areas that other QI initiatives addressed. Yet, accreditation creates organisational foundations for future QI initiatives. The authors study contributes new insights into how hospital staff at different organisational levels perceive and understand accreditation.
Publisher: Public Library of Science (PLoS)
Date: 07-11-2019
Publisher: Springer Science and Business Media LLC
Date: 24-06-2015
Publisher: Springer Science and Business Media LLC
Date: 21-04-2022
DOI: 10.1186/S12913-022-07930-6
Abstract: Signs of disorder in neighbourhoods (e.g., litter, graffiti) are thought to influence the behaviour of residents, potentially leading to violations of rules and petty criminal behaviour. Recently, these premises have been applied to the hospital context, with physical and social disorder found to have a negative association with patient safety. Building on these results, the present study investigates whether physical and social disorder differ between hospitals, and their relationship to safety culture. We conducted a cross sectional survey with Likert-style and open response questions administered in four Australian hospitals. All staff were invited to participate in the pilot study from May to September 2018. An analysis of variance (ANOVA) was used to examine differences in disorder by hospital, and hierarchical linear regression assessed the relationship of physical and social disorder to key aspects of safety culture (safety climate, teamwork climate). Open responses were analysed using thematic analysis to elaborate on manifestations of hospital disorder. There were 415 survey respondents. Significant differences were found in perceptions of physical disorder across the four hospitals. There were no significant differences between hospitals in levels of social disorder. Social disorder had a significant negative relationship with safety and teamwork climate, and physical disorder significantly predicted a poorer teamwork climate. We identified five themes relevant to physical disorder and four for social disorder from participants’ open responses the preponderance of these themes across hospitals supported quantitative results. Findings indicate that physical and social disorder are important to consider in attempting to holistically understand a hospital’s safety culture. Interventions that target aspects of physical and social disorder in a hospital may hold value in improving safety culture and patient safety.
Publisher: Emerald
Date: 27-05-2021
DOI: 10.1108/JHOM-08-2020-0347
Abstract: Millions around the world still cannot access safe, timely and affordable surgery. Considering access as a function of efficiency, this paper examines how the latter can be improved within the context of operating theatres. Carried out in France and Australia, this study reveals different types of waste in operating theatres and a series of successful tactics used to increase efficiency and eliminate wastefulness. Data for this qualitative study were collected through 48 semi-structured interviews with operating theatre staff in France ( n = 20) and Australia ( n = 28). Transcripts were coded using a theory-driven thematic analysis to characterise sources of waste in operating theatres and the tactics used to address them. The study confirmed the prominence of seven types of waste in operating theatres commonly found in industry and originally identified by Ohno, the initiator of lean: (1) underutilised operating rooms (2) premature or delayed arrival of patients, staff or equipment (3) need for large onsite storage areas and inventory costs (4) unnecessary transportation of equipment (5) needless staff movements (6) over-processing and (7) quality defects. The tactics used to address each of these types of waste included multiskilling staff, levelling production and implementing just-in-time principles. The tactics identified in this study have the potential of addressing the chronic and structurally embedded problem of waste plaguing health systems' operating theatres, and thus potentially improve access to surgical care. In a global context of resource scarcity, it is increasingly necessary for hospitals to optimise the ways in which surgery is delivered.
Publisher: BMJ
Date: 05-2019
DOI: 10.1136/BMJOPEN-2018-026915
Abstract: To assess the proportion of Australian children aged 0–15 years that received care in line with clinical practice guidelines (CPGs) for upper respiratory tract infections (URTIs). Retrospective medical record review using a multistage s ling strategy. General practices, hospital emergency departments and hospital inpatient service providers in three Australian states. Children aged up to 15 years who received care for URTI in 2012 and 2013. The primary assessment was estimated adherence with 14 indicators of appropriate care as documented in medical records. Indicators were extracted from national and international CPGs and ratified by experts. Secondary assessment was adherence to two bundles of indicators (diagnostic symptoms and medical history taking), where all indicators must be adherent for the bundle to be scored as adherent. There were 1653 children with one or more assessments of URTI care to CPG adherence. Over half of the children were under 3 years of age, with roughly equal numbers of males and females. Three indicators had fewer than 25 visits so were not reported. Overall adherence ranged from 0.5% for ‘documented advice around antibiotics’ to 88.3% for ‘documentation of medical history’. Adherence with Bundle A (documentation of all three definitive symptoms) was 43.1% (95% CI 32.8% to 54.0%) and Bundle B (documentation of all four indicators of medical history) was 30.2% (95% CI 20.9% to 40.9%). URTIs in children are common, usually self-limiting, conditions that are allocated considerable resources. The results suggest that there may be a need for more thorough holistic assessment of the patient and improved documentation. Since inappropriate prescription of antibiotics for URTIs is still a known problem in Australia, there is a need for consistent, clear communication around antibiotics’ lack of impact on symptoms and a high association with undesirable side effects.
Publisher: Oxford University Press (OUP)
Date: 13-08-2013
Abstract: To identify and analyse research on the use of economic evaluation in health services accreditation. Seven online health and economic databases, and key accreditation agency and health department websites were searched between June and December 2011. The selection criteria were English language and published empirical research studies on the topic of economic evaluation of health service accreditation. No formal economic evaluation of health services accreditation has been carried out to date. Empirical data on costs and benefits were analysed in 6 and 15 studies, respectively. Data extraction Meta-analysis was unsuitable due to output variability. Attributes relating to scalability and independence of outcome data were collected. For the benefit studies, we also assessed the strength of claim that accreditation improved patient safety and quality, and sources of potential bias. The incremental costs ranged from 0.2 to 1.7% of total costs averaged over the accreditation cycle. The benefit studies were inconclusive in terms of showing clear evidence that accreditation improves patient safety and quality of care. The lack of formal economic appraisal makes it difficult to evaluate accreditation in comparison to other methods to improve patient safety and quality of care. The lack of a clear relationship between accreditation and the outcomes measured in the benefit studies makes it difficult to design and conduct such appraisals without a more robust and explicit understanding of the costs and benefits involved.
Publisher: Wiley
Date: 05-12-2020
DOI: 10.1111/AJD.13518
Abstract: In melanoma management, sentinel lymph node biopsy (SLNB) is used to stage patients and to indicate prognosis. More recently, it has been used to select patients for adjuvant therapy. This study aimed to report knowledge of and attitudes towards SLNB for patients with melanoma among Australian dermatologists. Mixed methods study using cross‐sectional questionnaires ( n = 88) and semi‐structured interviews ( n = 13), May–September 2019. Of the dermatologists surveyed, 56% thought SLNB had an important role in melanoma management, 26% were unsure and 18% thought SLNB unimportant. Of the 92% who would discuss SLNB with their patients, the main stated value of SLNB was for assessing eligibility for adjuvant therapies (79%) only 60% indicated SLNB was of value for providing prognostic information, and just over half (53%) thought it could improve staging. Interview data indicated that attitudes towards SLNB are shifting among dermatologists, driven by data from landmark clinical trials and the influence of professional networks. Accordingly, interviewees adopted one of three positions in relation to SLNB: (a) believed in utility of SLNB and adhered to the guidelines (b) were unconvinced about utility of SLNB but adhered to the guidelines and (c) were unconvinced about utility of SLNB and did not adhere to the guidelines. Although most of the dermatologists surveyed were familiar with and follow the SLNB recommendations, some disagreement with and distrust of the recommendations was evident. Greater acceptance of the SLNB recommendations appeared to be driven by the improved outcomes demonstrated in stage III patients receiving adjuvant systemic therapy.
Publisher: Elsevier BV
Date: 11-2013
DOI: 10.1016/J.HEALTHPOL.2013.09.002
Abstract: Public disclosure is increasingly a requirement of accrediting agencies and governments. There are few published empirical evaluations of disclosure interventions that inform evidence-based implementation or policy. This study investigated the practices associated with the public disclosure of healthcare accreditation information, in addition to multi-stakeholder perceptions of key challenges and opportunities for improvement. We conducted a mixed methods study comprising analysis of disclosure practices by accreditation agencies, and 47 semi-structured in idual or group interviews involving 258 people. Participants were erse stakeholders associated with Australian primary, acute and residential aged care accreditation programmes. Four interrelated issues were identified. First, there was broad agreement that accreditation information should be publicly disclosed, although the three accreditation agencies differed in the information they made public. Second, two implementation issues emerged: the need to educate the community about accreditation information, and the practical question of the detail to be provided. Third, the impact, both positive and negative, of disclosing accreditation information was raised. Fourth, the lack of knowledge about the impact on consumers was discussed. Public disclosure of accreditation information is an idea that has widespread support. However, translating the idea into practice, so as to produce appropriate, meaningful information, is a challenge.
Publisher: Elsevier BV
Date: 10-2020
Publisher: Oxford University Press (OUP)
Date: 20-06-2005
Abstract: The stunning archaeological find of a new species of human dubbed the hobbit, formally named Homo floresiensis, is a reminder that humans and hobbits are evolved for transient lives, subsisting in an environment radically different from that of contemporary societies. Although the problems facing health systems are well documented, few scholars have taken an evolutionary-level approach to understanding them. By considering the nature of humans as adapted not for modern societies but for hunter-gatherer existence, and examining what humans were evolved for, new light can be shed on contemporary behaviours exposed by the medical inquiries into what is going wrong in acute health systems. Investigation of two of these inquiries shows how health professionals under pressure typically default to tribal behaviours, have recourse to hierarchies and engage in turf protection routines. Those who have conducted studies into iatrogenic harm or presided over the medical inquiries have argued that culture change is the solution to health care's ills. This is likely to be much harder to institute than some people realize, especially given our underlying hunter-gatherer nature. This is an evolutionary cleft stick that has not been factored in by those optimistic about health sector reform. The implications are that we need a deep understanding of human nature in addressing health system problems and to recognize that profound culture change is more challenging than many believe. Paradoxically, it is when humans are faced with seemingly intractable problems that a collective way forward might emerge.
Publisher: Springer Science and Business Media LLC
Date: 20-04-2017
Publisher: Oxford University Press (OUP)
Date: 29-11-2012
Abstract: To compare four health professions' attitudes towards interprofessional collaboration (IPC) and their evaluations of a programme aimed at enhancing IPC across a health system. Questionnaire survey. Australian Capital Territory health services. S le of medical (38), nursing (198), allied health (152) and administrative (30) staff. s) A 4-year action research project to improve IPC. Questionnaire evaluating the project and responses to the 'Attitudes toward Health Care Teams' and 'Readiness for Interprofessional Learning' scales. Significant professional differences occurred in 90% of the evaluation items. Doctors were the least and administrative staff most likely to agree project aims had been met. Nurses made more favourable assessments than did allied health staff. Doctors made the most negative assessments and allied health staff the most neutral ratings. Improved interprofessional sharing of knowledge, teamwork and patient care were among the goals held to have been most achieved. Reduction in interprofessional rivalry and improved trust and communication were least achieved. Average assessment of in idual goals being met was agree (31.9%), neutral (56.9%) and disagree (11.2%). On the two attitude scales, allied health professionals were most supportive of IPC, followed by nurses, administrators and doctors. Although overall attitudes towards IPC were favourable, only a third of participants reported that project goals had been achieved indicating the difficulties of implementing systems change. The response profiles of the professions differed. As in the previous research, doctors were least likely to hold favourable attitudes towards or endorse benefits from social or structural interventions in health care.
Publisher: Elsevier BV
Date: 09-2023
Publisher: Springer Science and Business Media LLC
Date: 12-2006
Abstract: Accreditation has become ubiquitous across the international health care landscape. Award of full accreditation status in health care is viewed, as it is in other sectors, as a valid indicator of high quality organisational performance. However, few studies have empirically demonstrated this assertion. The value of accreditation, therefore, remains uncertain, and this persists as a central legitimacy problem for accreditation providers, policymakers and researchers. The question arises as to how best to research the validity, impact and value of accreditation processes in health care. Most health care organisations participate in some sort of accreditation process and thus it is not possible to study its merits using a randomised controlled strategy. Further, tools and processes for accreditation and organisational performance are multifaceted. To understand the relationship between them a multi-method research approach is required which incorporates both quantitative and qualitative data. The generic nature of accreditation standard development and inspection within different sectors enhances the extent to which the findings of in-depth study of accreditation process in one industry can be generalised to other industries. This paper presents a research design which comprises a prospective, multi-method, multi-level, multi-disciplinary approach to assess the validity, impact and value of accreditation. The accreditation program which assesses over 1,000 health services in Australia is used as an exemplar for testing this design. The paper proposes this design as a framework suitable for application to future international research into accreditation. Our aim is to stimulate debate on the role of accreditation and how to research it.
Publisher: Maad Rayan Publishing Company
Date: 31-12-2022
DOI: 10.34172/HPP.2022.49
Abstract: Background: Social media platforms are frequently used by the general public to access health information, including information relating to complementary and alternative medicine (CAM). The aim of this study was to measure how often naturopathic influencers make evidence-informed recommendations on Instagram, and to examine associations between the level of evidence available or presented, and user engagement. Methods: A retrospective observational study using quantitative content analysis on health-related claims made by naturopathic influencers with 30000 or more followers on Instagram was conducted. Linear regression was used to measure the association between health-related posts and the number of Likes, and Comments. Results: A total of 494 health claims were extracted from eight Instagram accounts, of which 242 (49.0%) were supported by evidence and 34 (6.9%) included a link to evidence supporting the claim. Three naturopathic influencers did not provide any evidence to support the health claims they made on Instagram. Posts with links to evidence had fewer Likes (B=-1343.9, 95% CI=-2424.4 to -263.4, X=-0.1, P=0.02) and fewer Comments (B=-82.0, 95% CI=-145.9 to -18.2, X=-0.2, P=0.01), compared to posts without links to evidence. The most common areas of health were claims relating to ‘women’s health’ (n=94 19.0%), and ‘hair, nail and skin’ (n=74 15.0%). Conclusion: This study is one of the first to look at the evidence available to support health-related claims by naturopathic influencers on Instagram. Our findings indicate that around half of Instagram posts from popular naturopathic influencers with health claims are supported by high-quality evidence.
Publisher: Springer Science and Business Media LLC
Date: 02-01-2020
DOI: 10.1007/S00198-019-05260-8
Abstract: This study examined hip fracture hospitalisation trends and predictors of access to rehabilitation for adults aged ≥ 65 years living with and without dementia. The hospitalisation rate was 2.5 times higher for adults living with dementia and adults who lived in aged care were between 4.8 and 9.3 times less likely to receive rehabilitation. To examine hip fracture hospitalisation temporal trends, health outcomes, and predictors of access to in-hospital rehabilitation for older adults living with and without dementia. A population-based retrospective cohort study of adults aged ≥ 65 years hospitalised with a hip fracture during 2007-2017 in New South Wales, Australia. Of the 69,370 hip fracture hospitalisations, 27.1% were adults living with dementia. The hip fracture hospitalisation rate was 2.5 times higher for adults living with dementia compared with adults with no dementia (1186.6 vs 492.9 per 100,000 population). The rate declined by 6.1% per year (95%CI - 6.6 to - 5.5) for adults living with dementia and increased by 1.0% per year (95%CI 0.5-1.5) for adults with no dementia. Multivariable associations identified that adults living with dementia who experienced high frailty and increasing age were between 1.6 and 1.8 times less likely to receive in-hospital rehabilitation. Adults who were living in long-term aged care facilities were between 4.8 and 9.3 times less likely to receive in-hospital rehabilitation which varied by the presence of dementia or delirium. Consistent criteria should be applied to determine rehabilitation access, and rehabilitation services designed for older adults living with dementia or in aged care are needed. • Adults living with dementia were able to make functional gains following hip fracture rehabilitation. • Need to determine consistent criteria to determine access to hip fracture rehabilitation. • Rehabilitation services specifically designed for adults living with dementia or in aged care are needed.
Publisher: BMJ
Date: 2012
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 Science and Business Media LLC
Date: 27-02-2021
DOI: 10.1186/S12920-021-00910-5
Abstract: Clinical genomics represents a paradigm shifting change to health service delivery and practice across many conditions and life-stages. Introducing this complex technology into an already complex health system is a significant challenge that cannot be managed in a reductionist way. To build robust and sustainable, high quality delivery systems we need to step back and view the interconnected landscape of policymakers, funders, managers, multidisciplinary teams of clinicians, patients and their families, and health care, research, education, and philanthropic institutions as a dynamic whole. This study holistically mapped the landscape of clinical genomics within Australia by developing a complex graphic: a rich picture. Using complex systems theory, we then identified key features, challenges and leverage points of implementing clinical genomics. We used a multi-stage, exploratory, qualitative approach. We extracted data from grey literature, empirical literature, and data collected by the Australian Genomic Health Alliance. Nine key informants working in clinical genomics critiqued early drafts of the picture, and validated the final version. The final graphic depicts 24 stakeholder groups relevant to implementation of genomics into Australia. Clinical genomics lies at the intersection of four nested systems, with interplay between government, professional bodies and patient advocacy groups. Barriers and uncertainties are also shown. Analysis using complexity theory showed far-reaching interdependencies around funding, and identified unintended consequences. The rich picture of the clinical genomic landscape in Australia is the first to show key stakeholders, agencies and processes and their interdependencies. Participants who critiqued our results were instantly intrigued and engaged by the graphics, searching for their place in the whole and often commenting on insights they gained from seeing the influences and impacts of other stakeholder groups on their own work. Funding patterns showed unintended consequences of increased burdens for clinicians and inequity of access for patients. Showing the system as a dynamic whole is the only way to understand key drivers and barriers to largescale interventions. Trial Registration: Not applicable
Publisher: Elsevier BV
Date: 08-2019
Publisher: Equinox Publishing
Date: 29-04-2004
Abstract: This article addresses how professionals working in an intensive care unit in Australia speak about dying, with particular reference to the contradictions and complexities that characterize their work in this setting. The article reflects on the incommensurabilities in these clinicians' talk, and the consequences of this for how different professionals work together and care for extremely ill patients. Ex les are drawn from talk recorded during ward rounds and focus groups. The article argues that intensive care units are settings where being reflexive about one's work and assumptions is especially difficult because it involves negotiating decisions and taking moral responsibility for decisions affecting very sick patients. These decisions and responsibilities put into sharp relief the 'wicked problems and tragic choices' of end-of-life existence and of intensive care in specific. This article shows some of the complex ways in which specific clinicians' discourse absorbs and manifests these tensions and responsibilities. The article concludes that these kinds of complexities are unlikely to be resolved with reference to formal knowledge or in-principle conviction, and that a new interactive basis needs to be found where clinicians can rehearse alternative ways of speaking with which to approach each other, the dying, and their families.
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: SAGE Publications
Date: 08-08-2019
Abstract: We examine the prevalence of quality care (as measured by adherence to recommendations in clinical practice guidelines) for Australian paediatric patients (⩽15 years) with depression and/or anxiety, using data from the CareTrack Kids study a population-based study of the quality of healthcare practice in inpatient and ambulatory healthcare settings. A multistage stratified s le identified records of 6689 children. Of these, 156 records were identified for depression and 356 for anxiety. These were assessed for adherence to 15 depression and 13 anxiety indicators, respectively, using a review of medical records. Adherence to assessment and management guidelines was low for both conditions: assessment bundle (depression = 33%, 95% confidence interval = [20, 48] anxiety = 54%, 95% confidence interval = [43, 64] and depression management bundle = 35%, 95% confidence interval = [15, 60]). Across both conditions, the highest adherence was recorded for indicators that addressed prescription of medications (e.g. venlafaxine, 100% benzodiazepines, 100% selective serotonin reuptake inhibitor, 94% and antidepressants, 91%), while compliance was the lowest for ensuring children with depression had an emergency safety plan (44%), informing parents of the risks and benefits of prescribed anxiety medication (51%) and assessment for other causes (59% for depression 68% for anxiety). These findings suggest that strategies are needed to improve guideline adherence for mental health disorders in children and adolescents, particularly among general practitioners. Learning from these indicators could inform clinical prompts in electronic medical records, as well as links to additional information, to assist in decision-making and streamline work practices.
Publisher: Informa UK Limited
Date: 04-2014
DOI: 10.2147/PPA.S57707
Publisher: Elsevier BV
Date: 03-2005
DOI: 10.1016/J.SOCSCIMED.2004.06.046
Abstract: Clinical directorate service structures (CDs) have been widely implemented in acute settings in the belief that they will enhance efficiency and patient care by bringing teams together and involving clinicians in management. We argue that the achievement of such goals depends not only on changing its formalized structural arrangements but also the culture of the organisation concerned. We conducted comparative observational studies and questionnaire surveys of two large Australian teaching hospitals similar in size, role and CD structure. Martin's conceptualization of culture in terms of integration, differentiation and fragmentation was applied in the analysis of the data. The ethnographic work revealed that compared to Metropolitan Hospital, Royal Hospital was better supported and more favourably viewed by its staff across six categories identified in both settings: leadership, structure, communication, change, finance and human resource management. Royal staff were more optimistic about their organisation's ability to meet future challenges. The surveys revealed that both staff groups preferred CD to traditional structures and shared some favourable and critical views of them. However Royal staff were significantly more positive, reporting many more benefits from CDs e.g. improved working relations, greater accountability and efficiency, better cost management, more devolvement of management to clinicians and a hospital more strategically placed and patient focused. Metropolitan staff were more likely to claim that CDs failed to solve problems and created a range of others including disunity and poor working relationships. There was greater consensus of views among Royal staff and more fragmentation at Metropolitan where both intensely held and uncertain attitudes were more common. The outcomes of implementing CDs in these two similar organisations differed considerably indicating the need to address cultural issues when introducing structural change. Martin's framework provides a useful antidote to researchers' tendency to focus at only one level of culture.
Publisher: Wiley
Date: 12-1995
Publisher: Emerald
Date: 08-2004
DOI: 10.1108/14777260410554269
Abstract: Numerous past articles, many of which consist of idealised prescriptions for success or the occasional case study or practitioner's contribution, have commented on the role of hospital clinician‐managers. Prior work is circumscribed, however, in that it tends to be normative and a priori (how clinician‐managers in principle should manage) rather than descriptive and a posteriori (how clinician‐managers in situ do manage). In addition, it is apparent that an empirically‐grounded, testable model is lacking for the way clinician‐managers work. This paper sets out to balance past normative‐prescriptive accounts with a descriptive‐analytic one, and presents an empirically‐based conceptual model of the behavioural routines of hospital clinician‐managers. The model, based on multiple studies of clinician‐managers' activities, conjectures five major modes of operating and four primary and five secondary pursuits. The paper advances accounts of how clinician‐management work is conducted and the time frames for it, and hypothesises about clinician‐managers' relationships, and how power and control is experienced and exercised. It also briefly discusses some of the implications of both the research program and the findings. However, following Popper, researchers ought to invite attempts to improve rigor through a systematic critique of their findings. Critical analysis of this work under falsification processes is consequently welcomed.
Publisher: American Medical Association (AMA)
Date: 20-03-2018
Publisher: Frontiers Media SA
Date: 09-02-2023
DOI: 10.3389/FPUBH.2023.1089252
Abstract: Hospital organizational change can be a challenging time, especially when staff do not feel informed and ready for the change to come. A supportive workplace culture can mitigate the negative effects allowing for a smooth transition during hospital organizational change. In this paper, we test an exploratory path model by which teamwork culture influences staff attitudes in feeling informed and ready for change, and which are ultimately related to reduced staff burnout. We also examined different types of change communication, identifying the channels that were perceived as most useful for communicating organizational change. In 2019, a cross-sectional online and paper-based survey of all staff (clinical and non-clinical) was conducted at a hospital undergoing major organizational change in Sydney, Australia. The survey included items regarding teamwork culture, communication (feeling informed, communication channels), change readiness (appropriateness, change efficacy), and burnout. With a s le size of 153 (62% clinical staff), regression and path analyses were used to examine relationships between variables. The total effects between teamwork culture and burnout was significant [β (Total) = −0.37, p & 0.001) and explained through a serial mediation. This relationship was found to be mediated by three factors (feeling informed, appropriateness of change and change efficacy) in a full mediation. Further, change readiness (appropriateness of change and change efficacy) mediated the relationship between feeling informed and burnout. The most useful channels of change communication included face-to-face informal communication, emails, and a newsletter specifically about the change. Overall, the results supported the predicted hypotheses and were consistent with past research. In the context of large hospital change, staff with a positive teamwork culture who feel informed are more likely to feel change-ready, heightening the chances of successful organizational change and potentially reducing staff burnout. Understanding the pathways on how culture and communication related to burnout during organizational change provides an explanatory pathway that can be used to heighten the chances of a smooth change transition with minimal disruption to staff and patient care.
Publisher: The Beryl Institute
Date: 22-04-2019
Publisher: Wiley
Date: 22-04-2008
DOI: 10.1002/IJC.23448
Publisher: Emerald
Date: 25-01-2011
Publisher: Oxford University Press (OUP)
Date: 05-05-2014
Abstract: Getting greater levels of evidence into practice is a key problem for health systems, compounded by the volume of research produced. Implementation science aims to improve the adoption and spread of research evidence. A linked problem is how to enhance quality of care and patient safety based on evidence when care settings are complex adaptive systems. Our research question was: according to the implementation science literature, which common implementation factors are associated with improving the quality and safety of care for patients? We conducted a targeted search of key journals to examine implementation science in the quality and safety domain applying PRISMA procedures. Fifty-seven out of 466 references retrieved were considered relevant following the application of exclusion criteria. Included articles were subjected to content analysis. Three reviewers extracted and documented key characteristics of the papers. Grounded theory was used to distil key features of the literature to derive emergent success factors. Eight success factors of implementation emerged: preparing for change, capacity for implementation-people, capacity for implementation-setting, types of implementation, resources, leverage, desirable implementation enabling features, and sustainability. Obstacles in implementation are the mirror image of these: for ex le, when people fail to prepare, have insufficient capacity for implementation or when the setting is resistant to change, then care quality is at risk, and patient safety can be compromised. This review of key studies in the quality and safety literature discusses the current state-of-play of implementation science applied to these domains.
Publisher: The Sax Institute
Date: 2020
DOI: 10.17061/PHRP3042025
Publisher: Springer Science and Business Media LLC
Date: 06-07-2018
Publisher: Wiley
Date: 12-02-1994
DOI: 10.1111/J.1753-6405.1994.TB00263.X
Abstract: This study explores the effects and mechanisms of the long noncoding RNA (lncRNA) Thirty-four pairs of normal adjacent and cancer tissues were collected from cervical cancer patients. Pathology was evaluated by HE staining, and Compared with adjacent normal tissues,
Publisher: CSIRO Publishing
Date: 09-05-2023
DOI: 10.1071/PY23022
Publisher: BMJ
Date: 12-2022
DOI: 10.1136/BMJOPEN-2022-061623
Abstract: With the rate of chronic conditions increasing globally, it is important to understand whether people with chronic conditions have the capacity to find the right care and to effectively engage with healthcare providers to optimise health outcomes. We aimed to examine associations between care navigation, engagement with health providers and having a chronic health condition among Australian adults. This is a cross-sectional, 39-item online survey including the navigation and engagement subscales of the Health Literacy Questionnaire, completed in December 2018, in Australia. Binary variables (low/high health literacy) were created for each item and navigation and engagement subscale scores. Logistic regression analyses (estimating ORs) determined the associations between having a chronic condition and the navigation and engagement scores, while controlling for age, gender, level of education and income. 1024 Australians aged 18–88 years (mean=46.6 years 51% female) recruited from the general population. Over half (n=605, 59.0%) of the respondents had a chronic condition, mostly back pain, mental disorders, arthritis and asthma. A greater proportion of respondents with chronic conditions had difficulty ensuring that healthcare providers understood their problems (32.2% vs 23.8%, p=0.003), having good discussions with their doctors (29.1% vs 23.5%, p=0.05), discussing things with healthcare providers until they understand all they needed (30.5% vs 24.5%, p=0.04), accessing needed healthcare providers (35.7% vs 29.7%, p=0.05), finding the right place to get healthcare services (36.3% vs 29.2%, p=0.02) and services they were entitled to (48.3% vs 40.6%, p=0.02), and working out what is the best healthcare for themselves (34.2% vs 27.7%, p=0.03). Participants with chronic conditions were 1.5 times more likely to have low scores on the engagement (adjusted OR=1.48, p=0.03, 95% CI 1.05 to 2.08) and navigation (adjusted OR=1.43, p=0.026, 95% CI 1.043 to 1.970) subscales after adjusting for age, gender, income and education. Upskilling in engagement and communication for healthcare providers and people with chronic conditions is needed. Codesigned, clearly articulated and accessible information about service entitlements and pathways through care should be made available to people with chronic conditions. Greater integration across health services, accessible shared health records and access to care coordinators may improve navigation and engagement.
Publisher: Elsevier BV
Date: 2024
Publisher: Springer Science and Business Media LLC
Date: 02-11-2012
Publisher: Palgrave Macmillan UK
Date: 2008
Publisher: Public Library of Science (PLoS)
Date: 11-02-2020
Publisher: BMJ
Date: 06-2016
Publisher: Frontiers Media SA
Date: 27-08-2019
Publisher: Springer Science and Business Media LLC
Date: 29-06-2017
Publisher: Informa UK Limited
Date: 03-02-2015
DOI: 10.3109/13561820.2015.1004039
Abstract: Collaborative practice among early career staff is at the bedrock of interprofessional care. This study investigated factors influencing the enactment of interprofessional practice by using the day-to-day role of six junior doctors in three teaching hospitals as a gateway to understand the various professions' interactive behaviours. The contextual framework used for the study was Strauss' theory of negotiated order. Ethnographic techniques were applied to observe the actions and interactions of participants on typical working days in their hospital environments. Field notes were created and thematic analysis was applied to the data. Three themes explored were culture, communication, and collaboration. Issues identified highlight the bounded organisational and professional cultures within which junior doctors work, and systemic problems in interprofessional interaction and communication in the wards of hospitals. There are indications that early career doctors are interprofessional isolates. The constraints of short training terms and pressure from multi-faceted demands on junior doctors can interfere with the establishment of meaningful relationships with nurses and other health professionals. The realisation of sustained interprofessional practice is, therefore, practically and structurally difficult. Enabling factors supporting the sharing of expertise are outweighed by barriers associated with professional and hospital organisational cultures, poor interprofessional communication, and the pressure of competing in idual task demands in the course of daily practice.
Publisher: Emerald
Date: 12-06-2017
DOI: 10.1108/QAOA-07-2016-0028
Abstract: Quality of care in the residential aged sector has changed over the past decade. The purpose of this paper is to examine these changes from the perspectives of staff to identify factors influencing quality of residential aged care, and the role and influence of an aged care accreditation programme. Focus groups were held with 66 aged care staff from 11 Australian aged care facilities. Data from semi-structured interviews were analysed to capture categories representing participant views. Participants reported two factors stimulating change: developments in the aged care regulatory and policy framework, and rising consumer expectations. Four corresponding effects on service quality were identified: increasing complexity of resident care, renewed built environments of aged care facilities, growing focus on resident-centred care and the influence of accreditation on resident quality of life. The accreditation programme was viewed as maintaining minimum standards of quality throughout regulatory and social change, yet was considered to lack capacity of itself to explicitly promote or improve resident quality of life. For an increasingly complex aged care population, regulatory and societal change has led to a shift in service provision from institutional care models to one that is becoming more responsive to consumer expectations. The capacity of long-established and relatively static accreditation standards to better accommodate changing consumer needs comes into question. This is the first study to examine the relationship between accreditation and residential aged care service quality from the perspectives of staff, and offers a nuanced view of “quality” in this setting.
Publisher: Springer Science and Business Media LLC
Date: 21-06-2021
DOI: 10.1186/S12874-021-01309-7
Abstract: Q-methodology is an approach to studying complex issues of human ‘subjectivity’. Although this approach was developed in the early twentieth century, the value of Q-methodology in healthcare was not recognised until relatively recently. The aim of this review was to scope the empirical healthcare literature to examine the extent to which Q-methodology has been utilised in healthcare over time, including how it has been used and for what purposes. A search of three electronic databases (Scopus, EBSCO-CINAHL Complete, Medline) was conducted. No date restriction was applied. A title and abstract review, followed by a full-text review, was conducted by a team of five reviewers. Included articles were English-language, peer-reviewed journal articles that used Q-methodology (both Q-sorting and inverted factor analysis) in healthcare settings. The following data items were extracted into a purpose-designed Excel spreadsheet: study details (e.g., setting, country, year), reasons for using Q-methodology, healthcare topic area, participants (type and number), materials (e.g., ranking anchors and Q-set), methods (e.g., development of the Q-set, analysis), study results, and study implications. Data synthesis was descriptive in nature and involved frequency counting, open coding and the organisation by data items. Of the 2,302 articles identified by the search, 289 studies were included in this review. We found evidence of increased use of Q-methodology in healthcare, particularly over the last 5 years. However, this research remains diffuse, spread across a large number of journals and topic areas. In a number of studies, we identified limitations in the reporting of methods, such as insufficient information on how authors derived their Q-set, what types of analyses they performed, and the amount of variance explained. Although Q-methodology is increasingly being adopted in healthcare research, it still appears to be relatively novel. This review highlight commonalities in how the method has been used, areas of application, and the potential value of the approach. To facilitate reporting of Q-methodological studies, we present a checklist of details that should be included for publication.
Publisher: BMJ
Date: 09-2019
DOI: 10.1136/BMJOPEN-2019-030100
Abstract: Hearing loss is a common chronic problem which can be effectively managed with hearing devices. At present, only a limited number of people with hearing loss use hearing aids (HAs) and cochlear implants (CIs) to improve hearing and sound quality and enhance quality of life. Clinical equipoise, by which we mean healthcare professional uncertainty about which treatment options are the most efficacious due to the lack of evidence-based information, can lead to inconsistent and poorly informed referral processes for hearing devices. A randomised controlled trial (RCT) that offers high-quality, generalisable information is needed to clarify which hearing device (HA or CI) is more suitable for different degrees of hearing loss and for which kinds of patients. Qualitative research can improve this RCT, by gathering the information on patient and provider perspectives, attitudes and values, which can inform design, conduct and information dissemination, either during preparatory stages of an intervention, or as a fully integrated methodology. The Comparison of Outcomes with hearing Aids and Cochlear implants in adults with moderately severe-to-profound bilateral sensorineural Hearing loss (COACH) study is being planned as an RCT with a qualitative arm (the qualitative COACH study, q-COACH), acting as a pretrial intervention examining views of HAs, CIs, equipoise and the impetus for an RCT of this nature. The q-COACH study involves semistructured interviews and a demographic questionnaire which will be collected from four participant cohorts: General Practitioners (GPs) and Ear, Nose and Throat Surgeons (ENTs) audiologists adult HA users and their support networks. Data will be analysed thematically and through descriptive statistics. Macquarie University Human Research Ethics Committee, Australia, granted ethical approval (no. 5201833514848). Peer-reviewed journal articles, research conferences and a final report will present study findings.
Publisher: Elsevier BV
Date: 10-2019
Publisher: Springer Science and Business Media LLC
Date: 19-02-2019
Publisher: Wiley
Date: 18-12-2015
DOI: 10.1111/HEX.12170
Publisher: Wiley
Date: 03-09-2021
DOI: 10.1111/AJAG.12847
Publisher: Wiley
Date: 28-08-2019
Abstract: The aims of this study were twofold: (1) to design and validate a set of clinical indicators of appropriate care for tonsillitis and (2) to measure the level of tonsillitis care that is in line with guideline recommendations in a s le of Australian children. A set of tonsillitis care indicators was developed from available national and international guidelines and validated in 4 stages. This research used the same design as the CareTrack Kids study, which was described in detail elsewhere. S les of patient records from general practices, emergency departments, and hospital admissions were assessed. Patient records of children aged 0 to 15 years were assessed for the presence of, and adherence to, the indicators for care delivered in 2012 and 2013. Eleven indicators were developed. The records of 821 children (mean age, 5.0 years SD, 4.0) with tonsillitis were screened. The reviewers conducted 2354 eligible indicator assessments across 1127 visits. Adherence to 6 indicators could be assessed and ranged from 14.3% to 73.2% (interquartile range 31.5% to 72.2%). Our main findings are consistent with the international literature: the treatment of many children who present with confirmed or suspected tonsillitis is inconsistent with current guidelines. Future research should consider how the indicators could be applied in a structured and automated manner to increase the reliability and efficiency of record reviews and help raise clinicians’ awareness of appropriate tonsillitis management.
Publisher: Springer Science and Business Media LLC
Date: 05-06-2020
DOI: 10.1186/S12874-020-01033-8
Abstract: Person-environment fit, which examines the in idual’s perceptions of if, and in what way, he or she is compatible with aspects of the work context, offers a promising conceptual model for understanding employees and their interactions in health care environments. There are numerous potential ways an in idual feels they “fit” with their environment. The construct was first noted almost thirty years ago, yet still remains elusive. Feelings of fit with one’s environment are typically measured by surveys, but current surveys encompass only a subset of the different components of fit, which may limit the conclusions drawn. Further, these surveys have rarely been conducted in a focused way in health care settings. This article describes the development of a multidimensional survey tool to measure fit in relation to the person’s work group (termed person-group (P-G) fit) and their organisation (person-organisation (P-O) fit). The participants were mental health care employees, volunteers, and university interns ( n = 213 for P-O fit n = 194 for P-G fit). Confirmatory Factor Analyses (CFAs) were conducted using LISREL. Valid and reliable sub-scales were found. This advanced multidimensional survey tool can be used to measure P-O and P-G fit, and illuminates new information about the theoretical structure of the fit construct.
Publisher: Springer Science and Business Media LLC
Date: 22-03-2018
Publisher: Springer Science and Business Media LLC
Date: 04-2011
DOI: 10.2165/11588200-000000000-00000
Abstract: This narrative review includes a summary of research examining prescribing errors, prescription decision making and the role computerized decision support plays in this decision-making process. A reduction in medication prescribing errors, specifically a reduction in the selection of inappropriate medications, is expected to result from the implementation of an effective computerized decision support system. Previous research has investigated the impact of the implementation of electronic systems on medication errors more broadly. This review examines the specific characteristics of decision support systems that may contribute to fewer knowledge-based mistakes in prescribing, and critically appraises the large volume of information available on the decision-making process of selecting medicines for prescription. The results highlight a need for work investigating what decision strategies are used by doctors with different levels of expertise in the prescribing of medications. The nature of the relationship between decision support and decision performance is not well understood and future research is needed to determine the mechanisms by which computerized decision support influences medication selection.
Publisher: Oxford University Press (OUP)
Date: 28-01-2003
DOI: 10.1197/JAMIA.M1285
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: Springer Science and Business Media LLC
Date: 20-11-2021
DOI: 10.1186/S12913-021-07275-6
Abstract: Hospitals are perceived as fast-paced and complex environments in which a missed or incorrect diagnosis or misread chart has the potential to lead to patient harm. However, to date, limited attention has been paid to studying how hospital sociotemporal norms may be associated with staff wellbeing or patient safety. The aim of this study was to use novel network analysis, in conjunction with well-established statistical methods, to investigate and untangle the complex interplay of relationships between hospital staff perceived sociotemporal structures, staff safety attitudes and work-related well-being. Cross-sectional survey data of hospital staff ( n = 314) was collected from four major hospitals in Australia. The survey included subscales from the Organizational Temporality Scale (OTS), two previously established scales of safety attitudes (teamwork climate and safety climate) and measures of staff-related wellbeing (job satisfaction, emotional exhaustion, depersonalisation). Using confirmatory factor analysis, we first tested a 19-item version of the OTS for use in future studies of hospital temporality (the OTS-H). Novel psychological network analysis techniques were then employed, which identified that “pace” (the tempo or rate of hospital activity) occupies the central position in understanding the complex relationship between temporality, safety attitudes and staff wellbeing. Using a path analysis approach, serial mediation further identified that pace has an indirect relationship with safety attitudes through wellbeing factors, that is, pace impacts on staff wellbeing, which in turn affects hospital safety attitudes. The findings of this study are important in revealing that staff wellbeing and safety attitudes can be significantly improved by placing more focus on temporal norms, and in particular hospital pace. There are implications for increasing levels of trust and providing staff with opportunities to exercise greater levels of control over their work.
Publisher: Routledge
Date: 12-05-2022
Publisher: Emerald
Date: 03-2004
DOI: 10.1108/14777270410517700
Abstract: Aims to discover the work hospital clinician managers think they do and observe them in practice. A total of 14 managerial interests and concerns were identified in focus group discussions. Clinician managers’ jobs are pressurised, and are more about negotiation and persuasion than command and control. Their work is of considerable complexity, pace and responsibility and it is predicated more on managing inputs (e.g. money and people) than care processes, systems, outputs and outcomes. Thus the capacity of clinicians in these roles to respond to reforms such as those envisaged in the Bristol Inquiry may be problematic. Qualitative studies are re‐affirmed as important in providing grounded insights into not only clinical activities, but also organisational behaviour and processes.
Publisher: Springer Science and Business Media LLC
Date: 12-07-2012
Publisher: Oxford University Press (OUP)
Date: 02-12-2012
Abstract: To evaluate short notice surveys in accreditation programmes. Two trials using short notice surveys were conducted independently: a study of 20 healthcare organizations with the Australian Council on Healthcare Standards (ACHS) and a study of 7 general practices with the Australian General Practice Accreditation Limited (AGPAL). Participating organizations volunteered. ACHS and AGPAL selected 17 and 13 surveyors, respectively, and provided training for them on short notice surveys. Each agency's short notice surveys were an abbreviated version of their current advanced notification surveys. Short notice surveys assessed accreditation programme criteria or indicators that corresponded to the Australian Commission on Safety and Quality in Health Care's priority issues. Fifteen (out of 45) ACHS criteria and 48 (out of 174) AGPAL indicators that aligned to the Commission's criteria were evaluated. Participating organizations were given 2 days notice prior to the short notice surveys. Ratings from the short notice surveys were compared with those from the most recent advanced notification surveys, and statistical tests were performed to detect differences and potential confounding factors. Surveyors and organizational staff completed a post-survey feedback questionnaire which was analysed thematically and by inferential statistics. The short notice survey approach overall produced ratings congruent with the advanced notification survey for both accreditation programmes. However, for both programmes short notice surveys assessed that more organizations would not reach the accreditation threshold as compared with the previous survey. Organizations in both programmes were judged to have achieved less successful performance against clinical standards by the short notice survey than the advanced notification survey. There was support from surveyors and organizational staff for short notice survey to be adopted. However, there were mixed views about the impact of short notice surveys and whether they validated trial participants' continuous improvement efforts. The study demonstrated that short notice surveys are more critical in their assessment of clinical than administrative or corporate items. Short notice surveys, while broadly comparable with existing advanced notification survey practice, produced different accreditation outcomes for a significant proportion of the study organizations. The overall value and worth of short notice surveys remains to be proved.
Publisher: Springer Science and Business Media LLC
Date: 14-10-2011
Publisher: BMJ
Date: 04-07-2023
Publisher: AMPCo
Date: 10-11-2021
DOI: 10.5694/MJA2.50849
Publisher: Wiley
Date: 12-2015
DOI: 10.5694/MJA14.01432
Publisher: Oxford University Press (OUP)
Date: 13-02-2013
Abstract: To describe global patterns among health-care accreditation organizations (AOs) and to identify determinants of sustainability and opportunities for improvement. Web-based questionnaire survey. Organizations offering accreditation services nationally or internationally to health-care provider institutions or networks at primary, secondary or tertiary level in 2010. s) External relationships, scope and activity public information. Forty-four AOs submitted data, compared with 33 in a survey 10 years earlier. Of the 30 AOs that reported survey activity in 2000 and 2010, 16 are still active and stable or growing. New and old programmes are increasingly linked to public funding and regulation. While the number of health-care AOs continues to grow, many fail to thrive. Successful organizations tend to complement mechanisms of regulation, health-care funding or governmental commitment to quality and health-care improvement that offer a supportive environment. Principal challenges include unstable business (e.g. limited market, low uptake) and unstable politics. Many organizations make only limited information available to patients and the public about standards, procedures or results.
Publisher: SAGE Publications
Date: 03-2012
Abstract: To measure perceptions of Australian medical students and staff about whether key Learning Topics included in the National Patient Safety Education Framework (NPSEF) are being taught and what challenges to patient safety teaching are thought to be operating. A cross-sectional survey of medical deans, educators and students was conducted in 2010. Twenty of twenty-one Australian medical schools participated. Using a five-point Likert scale, respondents rated whether patient safety topics were taught in their medical school and challenges to including patient safety in the curriculum. There were 2413 eligible responses: deans (or nominees) ( n = 14) medical educators ( n = 98) and medical students ( n = 2301). There was most agreement that teaching occurred about communicating effectively (8% neutral or disagreed) and least agreement that there was teaching about adverse events and near misses (35% neutral or disagreed). Deans, educators and students responded positively about available ch ions and expertise and negatively to the curriculum being too full to include patient safety. There were consistent differences between the responses of the stakeholder groups ( P 0.0005 in a non-parametric test). Deans were more positive than educators, who were more positive than students. Strong variability between perceptions of Learning Areas reveals opportunities for improvement in teaching about patient safety, especially in the area of recognizing and addressing adverse events and risks. Consistent differences across stakeholder groups reveal disparities in the perceptions of the teachers and their students. The results indicate targets for improving patient safety learning and closing the feedback loop between students and staff.
Publisher: BMJ
Date: 12-2022
DOI: 10.1136/BMJOPEN-2022-067209
Abstract: Type 1 diabetes (T1D) is a chronic and incurable autoimmune disease, diagnosed in early childhood and managed initially in paediatric healthcare services. In many countries, including Australia, national audit data suggest that management and care of T1D, and consequently glycaemic control, are consistently poor. This can lead to adverse outcomes such as cardiovascular disease and nephropathy. T1D treatment is complex, multidisciplinary, multiagency and life-long and should involve patient-centred, developmentally appropriate care. Although an emerging body of literature describes T1D models of care, their components, implementation determinants and associated outcomes are poorly understood. To provide a study protocol to describe methods to map existing models of care for children and young adults living with T1D. It will identify the gaps and needs in care delivery as viewed by healthcare providers and by children, young people and their families accessing care in metropolitan and rural or remote regions throughout Australia. A mixed-method study that includes provider and consumer-specific surveys and interviews about current T1D care provisions. Data will be analysed thematically (qualitative) and statistically (quantitative) and synthesised to describe the key characteristics of effective and sustainable models of care for T1D and to identify gaps. Ethics approval was granted by the Macquarie University Human Research Ethics Committee in July 2022 (#520221154439676). Results will be disseminated via publication in peer-reviewed journals and at relevant conferences.
Publisher: CSIRO Publishing
Date: 2008
DOI: 10.1071/AH080010
Abstract: Objective: To map the emergence of, and define, clinical governance to discuss current best practices, and to explore the implications of these for boards of directors and executives wishing to promote a clinical governance approach in their health services. Methods: Review and analysis of the published and grey literature on clinical governance from 1966 to 2006. Medline and CINAHL databases, key journals and websites were systematically searched. Results: Central issues were identified in the literature as key to effective clinical governance. These include: ensuring that links are made between health services? clinical and corporate governance the use of clinical governance to promote quality and safety through a focus on quality assurance and continuous improvement the creation of clinical governance structures to improve safety and quality and manage risk and performance the development of strategies to ensure the effective exchange of data, knowledge and expertise and the sponsoring of a patientcentred approach to service delivery. Conclusions: A comprehensive approach to clinical governance necessarily includes the active participation of boards and executives in sponsoring and promoting clinical governance as a quality and safety strategy. Although this is still a relatively recent development, the signs are promising.
Publisher: JMIR Publications Inc.
Date: 15-10-2020
Abstract: oung-onset colorectal cancer is a contemporary issue in need of substantial research input. The incidence of colorectal cancer in adults younger than 50 years is rising in contrast to the decreasing incidence of this cancer in older adults. People with young-onset colorectal cancer may be at that stage of life in which they are establishing their careers, building relationships with long-term partners, raising children, and assembling a financial base for the future. A qualitative study designed to facilitate triangulation with extant quantitative patient-reported data would contribute the first comprehensive resource for understanding how this distinct patient population experiences health services and the outcomes of care throughout the patient pathway. he aim of this study was to undertake a mixed-methods study of qualitative patient-reported data on young-onset colorectal cancer experiences and outcomes. his is a study of web-based unsolicited patient stories recounting experiences of health services and clinical outcomes related to young-onset colorectal cancer. Personal Recollections Organized as Data (PROD) is a novel methodology for understanding patients’ health experiences in order to improve care. PROD pivots qualitative data collection and analysis around the validated domains and dimensions measured in patient-reported outcome and patient-reported experience questionnaires. PROD involves 4 processes: (1) classifying attributes of the contributing patients, their disease states, their routes to diagnosis, and the clinical features of their treatment and posttreatment (2) coding texts into the patient-reported experience and patient-reported outcome domains and dimensions, defined a priori, according to phases of the patient pathway (3) thematic analysis of content within and across each domain and (4) quantitative text analysis of the narrative content. elevant patient stories have been identified, and permission has been obtained for use of the texts in primary research. The approval for this study was granted by the Macquarie University Human Research Ethics Committee in June 2020. The analytical framework was established in September 2020, and data collection commenced in October 2020. We will complete the analysis in March 2021 and we aim to publish the results in mid-2021. he findings of this study will identify areas for improvement in the PROD methodology and inform the development of a large-scale study of young-onset colorectal cancer patient narratives. We believe that this will be the first qualitative study to identify and describe the patient pathway from symptom self-identification to help-seeking through to diagnosis, treatment, and to survivorship or palliation for people with young-onset colorectal cancer. ERR1-10.2196/25056
Publisher: Elsevier BV
Date: 2009
DOI: 10.1016/J.IJMEDINF.2008.09.007
Abstract: To identify the main concerns of a broad range of hospital staff about the implementation of a new Computerized Provider Order Entry (CPOE) system for medication management. The study was conducted in a large Australian teaching hospital using semi-structured interviews (n=20) and focus groups (six focus groups involving a total of 30 participants) from a broad section of health professionals including doctors, nurses, managers, pharmacists and senior health executives. Systematic concurrent analysis of the data was undertaken by a team of researchers. We identified 20 recurrent themes related to nine areas of shared concern including work practices, software/hardware, relationships/communication, education and training, inexperienced staff and de-skilling. A higher level of analysis identified four interrelated constructs that highlight what people are concerned about: (1) Will it help? (2) Will it work? (3) Will we cope? (4) Will it impair existing interaction? The research provides a snapshot overview of perceptions from a range of hospital personnel in the lead up to CPOE implementation. Generalizability is limited by the size of the s le and the contextual circumstances of the hospital being studied. This work contributes valuable evidence about an often-neglected dimension in the evaluation of computer systems in hospitals, namely the pre-implementation concerns of staff. These pre-conceptions can have a significant effect on how technology is implemented and utilised. Acknowledging and addressing people's concerns can contribute to the establishment of durable channels of negotiation and communication. Further research informed by the findings of this study will help advance this process.
Publisher: BMJ
Date: 06-2010
Abstract: Following the introduction of an electronic Incident Information Management System (IIMS) in New South Wales, Australia, the authors investigated enablers and barriers to the use of IIMS and factors associated with increased, static and decreased reporting rates. An online and paper-based, anonymous survey of 2185 health practitioners collected information about their reporting behaviour and experiences of enablers/barriers: training, system accessibility, ease of use, system security, feedback, perceived value of IIMS and workplace safety culture. The 79.3% of respondents who reported on IIMS were distinguished from non-reporters by having undertaken IIMS training and evaluating this highly. Users reporting more incidents post-IIMS were more likely than those with static or decreased reporting rates to evaluate their training highly and to have experienced all enablers. Users reporting fewer incidents were least likely to do so. The relative likelihood of the three reporting groups experiencing various enablers was similar. Those most frequently experienced by all groups were system security and accessibility. Barriers most frequently encountered were more culturally embedded-for ex le, poor workplace safety culture. The 'more' reporting group actually reported most, and the 'static' group least, incidents. LIMITATIONS/IMPLICATIONS: The s le was large but not randomly selected, which limits the generalisability of findings. Interventions to increase reporting should target provision of training that endorses and fosters conditions shown to enhance reporting rates. Enablers to incident reporting have been shown to be associated not only with reporting per se but also with changes to reporting patterns and rates.
Publisher: Elsevier BV
Date: 07-2020
DOI: 10.1016/J.GERINURSE.2019.02.001
Abstract: Care transitions for older people moving from residential aged care facilities (RACFs) to hospital services are associated with greater challenges and poorer outcomes. An integrative review was conducted to investigate models of care designed to avoid or improve transitions for older people residing in RACFs to hospital settings. Twenty-one studies were included in the final analysis. Models of care aimed to either improve or avoid transitions of residents through enhanced primary care in RACFs, promoting quality improvement in RACFs, instilling comprehensive hospital care, conducting outreach services, transferring information, or involved a combination of outreach services and comprehensive hospital care. As standalone interventions, standardised communication tools may improve information transfer between RACFs and hospital services. For more complex models, providing quality improvement and outreach to RACFs may prevent some types of hospital admissions.
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.ANNEMERGMED.2016.08.456
Abstract: Communication is commonly understood by health professional researchers to consist of relatively isolated exchanges of information. The social and organizational context is given limited credit. This article examines the significance of the environmental complexity of the emergency department (ED) in influencing communication strategies and makes the case for adopting a richer understanding of organizational communication. This study draws on approximately 12 months (1,600 hours) of ethnographic observations, yielding approximately 4,500 interactions across 260 clinicians and staff in the EDs of 2 metropolitan public teaching hospitals in Sydney, Australia. The study identifies 5 communication competencies of increasing complexity that emergency clinicians need to accomplish. Furthermore, it identifies several factors-hierarchy, formally imposed organizational boundaries and roles, power, and education-that contribute to the collective function of ensuring smooth patient transfer through and out of the ED. These factors are expressed by and shape external communication with clinicians from other hospital departments. This study shows that handoff of patients from the ED to other hospital departments is a complex communication process that involves more than a series of "checklistable" information exchanges. Clinicians must learn to use both negotiation and persuasion to achieve objectives.
Publisher: Oxford University Press (OUP)
Date: 07-2023
Abstract: Many hospitals continue to use incident reporting systems (IRSs) as their primary patient safety data source. The information IRSs collect on the frequency of harm to patients [adverse events (AEs)] is generally of poor quality, and some incident types (e.g. diagnostic errors) are under-reported. Other methods of collecting patient safety information using medical record review, such as the Global Trigger Tool (GTT), have been developed. The aim of this study was to undertake a systematic review to empirically quantify the gap between the percentage of AEs detected using the GTT to those that are also detected via IRSs. The review was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies published in English, which collected AE data using the GTT and IRSs, were included. In total, 14 studies met the inclusion criteria. All studies were undertaken in hospitals and were published between 2006 and 2022. The studies were conducted in six countries, mainly in the USA (nine studies). Studies reviewed 22 589 medical records using the GTT across 107 institutions finding 7166 AEs. The percentage of AEs detected using the GTT that were also detected in corresponding IRSs ranged from 0% to 37.4% with an average of 7.0% (SD 9.1 median 3.9 and IQR 5.2). Twelve of the fourteen studies found & % of the AEs detected using the GTT were also found in corresponding IRSs. The & -fold gap between the detection rates of the GTT and IRSs is strong evidence that the rate of AEs collected in IRSs in hospitals should not be used to measure or as a proxy for the level of safety of a hospital. IRSs should be recognized for their strengths which are to detect rare, serious, and new incident types and to enable analysis of contributing and contextual factors to develop preventive and corrective strategies. Health systems should use multiple patient safety data sources to prioritize interventions and promote a cycle of action and improvement based on data rather than merely just collecting and analysing information.
Publisher: Springer Science and Business Media LLC
Date: 14-11-2018
Publisher: SAGE Publications
Date: 03-1994
DOI: 10.1177/183335839402400114
Abstract: President Bill Clinton is currently proposing the most sweeping changes to American social policy since the New Deal by Roosevelt in the 1930s. Major concerns about escalating health care costs, a mushrooming health care bureaucracy and a growing proportion of the American population who can no longer afford adequate health care insurance coverage have motivated Clinton's plan for health care reform. Ideas about telemedicine, the electronic medical record and more comprehensive and advanced information systems are already being canvassed during the course of the debate. Australian clinicians and policy makers are following the American debate closely. So too, should health information managers. America watching should prove interesting, stimulating and professionally rewarding.
Publisher: Wiley
Date: 05-05-2021
DOI: 10.1111/HEX.13254
Abstract: Patient‐reported outcome measures (PROMs) are questionnaires that collect health outcomes directly from the people who experience them. This review critically synthesizes information on generic and selected condition‐specific PROMs to describe trends and contemporary issues regarding their development, validation and application. We reviewed academic and grey literature on validated PROMs by searching databases, prominent websites, Google Scholar and Google Search. The identification of condition‐specific PROMs was limited to common conditions and those with a high burden of disease (eg cancers, cardiovascular disorders). Trends and contemporary issues in the development, validation and application of PROMs were critically evaluated. The search yielded 315 generic and condition‐specific PROMs. The largest numbers of measures were identified for generic PROMs, musculoskeletal conditions and cancers. The earliest published PROMs were in mental health‐related conditions. The number of PROMs grew substantially between 1980s and 2000s but slowed more recently. The number of publications discussing PROMs continues to increase. Issues identified include the use of computer‐adaptive testing and increasing concerns about the appropriateness of using PROMs developed and validated for specific purposes (eg research) for other reasons (eg clinical decision making). The term PROM is a relatively new designation for a range of measures that have existed since at least the 1960s. Although literature on PROMs continues to expand, challenges remain in selecting reliable and valid tools that are fit‐for‐purpose from the many existing instruments. Consumers were not directly involved in this review however, its outcome will be used in programmes that engage and partner with consumers.
Publisher: BMJ
Date: 10-02-2016
DOI: 10.1136/BMJ.I563
Publisher: American Roentgen Ray Society
Date: 11-1998
Publisher: Springer Science and Business Media LLC
Date: 31-08-2019
DOI: 10.1007/S10803-019-04195-7
Abstract: Knowledge about the quality of care delivered to children with autism spectrum disorders (ASD) in relation to that recommended by clinical practice guidelines (CPGs) is limited. ASD care quality indicators were developed from CPGs and validated by experts, then used to assess the quality of care delivered by general practitioners (GPs) and pediatricians in Australia. Data were retrospectively collected from the medical records of 228 children (≤ 15 years) with ASD for 2012-2013. Overall quality of care was high, but with considerable variation among indicators, and between GPs and pediatricians-e.g., GPs were less likely to complete the assessment care bundle (61% 95% CI 21-92). Findings highlight potential areas for improvement in the need for standardized criteria for diagnosis.
Publisher: Public Library of Science (PLoS)
Date: 16-12-2022
DOI: 10.1371/JOURNAL.PONE.0279116
Abstract: The burden of cancer is large in Australia, and rates of cancer Clinical Practice Guideline (CPG) adherence is suboptimal across various cancers. The objective of this study is to characterise clinician-perceived barriers and facilitators to cancer CPG adherence in Australia. Semi-structured interviews were conducted to collect data from 33 oncology-focused clinicians (surgeons, radiation oncologists, medical oncologists and haematologists). Clinicians were recruited in 2019 and 2020 through purposive and snowball s ling from 7 hospitals across Sydney, Australia, and interviewed either face-to-face in hospitals or by phone. Audio recordings were transcribed verbatim, and qualitative thematic analysis of the interview data was undertaken. Human research ethics committee approval and governance approval was granted (2019/ETH11722, #52019568810127). Five broad themes and subthemes of key barriers and facilitators to cancer treatment CPG adherence were identified: Theme 1: CPG content Theme 2: In idual clinician and patient factors Theme 3: Access to, awareness of and availability of CPGs Theme 4: Organisational and cultural factors and Theme 5: Development and implementation factors. The most frequently reported barriers to adherence were CPGs not catering for patient complexities, being slow to be updated, patient treatment preferences, geographical challenges for patients who travel large distances to access cancer services and limited funding of CPG recommended drugs. The most frequently reported facilitators to adherence were easy accessibility, peer review, multidisciplinary engagement or MDT attendance, and transparent CPG development by trusted, multidisciplinary experts. CPGs provide a reassuring framework for clinicians to check their treatment plans against. Clinicians want cancer CPGs to be frequently updated utilising a wiki-like process, and easily accessible online via a comprehensive database, coordinated by a well-trusted development body. Future implementation strategies of cancer CPGs in Australia should be tailored to consider these context-specific barriers and facilitators, taking into account both the content of CPGs and the communication of that content. The establishment of a centralised, comprehensive, online database, with living wiki-style cancer CPGs, coordinated by a well-funded development body, along with incorporation of recommendations into point-of-care decision support would potentially address many of the issues identified.
Publisher: Springer Science and Business Media LLC
Date: 20-07-2023
DOI: 10.1186/S12913-023-09644-9
Abstract: Managing the care regimen for Type 1 Diabetes is challenging for emerging adults, as they take on greater responsibility for self-management. A erse range of models of care have been implemented to improve safety and quality of care during transition between paediatric and adult services. However, evidence about acceptability and effectiveness of these is limited. Our aim was to synthesise the evidence for transition models and their components, examine the health related and psychosocial outcomes, and to identify determinants associated with the implementation of person-centred models of transition care. We searched Medline, CINAHL, EMBASE and Scopus. Peer reviewed empirical studies that focused on T1D models of care published from 2010 to 2021 in English, reporting experimental, qualitative, mixed methods, and observational studies were included. Fourteen studies reported on health and psychosocial outcomes, and engagement with healthcare. Three key models of care emerged: structured transition education programs (6 studies), multidisciplinary team transition support (5 studies) and telehealth/virtual care (3 studies). Compared with usual practice, three of the six structured transition education programs led to improvements in maintenance of glycaemic control, psychological well-being, and engagement with health services. Four MDT transition care models reported improved health outcomes, and improved engagement with health services, however, three studies reported no benefit. Reduced diabetes related stress and increased patient satisfaction were reported by two studies, but three reported no benefit. Telehealth and virtual group appointments improved adherence to self-management and reduced diabetes distress but did not change health outcomes. Although some health and psychosocial benefits are reported, the results were mixed. No studies reported on T1D transition model implementation outcomes such as acceptability, adoption, and appropriateness among clinicians or managers implementing these models. This gap needs to be addressed to support future adoption of successful models.
Publisher: Oxford University Press (OUP)
Date: 09-2017
Publisher: Oxford University Press (OUP)
Date: 24-11-2012
Abstract: To investigate the frequency, style and reliability of newspaper reporting of medication errors. Content analysis of articles discussing medication errors that were published in the 10 most widely read Australian daily newspapers between January 2005 and January 2010. Main outcome measure(s) Newspaper source, article type, article topic, leading news actors, identified causes and solutions of medication errors and cited references. Ninety-two articles included discussion of medication errors, with the one national newspaper, The Australian, the main source of articles (n = 24). News items were the most frequent type of articles (n = 73), with the majority (n = 55) primarily focused on broader hospital problems. Government representatives, advocacy groups, researchers, health service staff and private industry groups were prominent news actors. A shortage of hospital resources was identified as the central cause of medication errors (n = 38), with efficient error reporting systems most frequently identified as a solution (n = 25). Government reports were cited on 39 occasions, with peer-reviewed publications infrequently cited (n = 4). Australian newspaper reporting of medication errors was relatively limited. Given the high prevalence of errors and the potential role consumers can play in identifying and preventing errors, there is a clear argument for increasing public awareness and understanding of issues relating to medication safety. Existing coverage of this issue is unrelated to research evidence. This suggests the need for patient safety researchers and advocacy groups to engage more strongly with the media as a strategy to increase the productive public discourse concerning medication errors and gain support for evidence-based interventions.
Publisher: Oxford University Press (OUP)
Date: 11-07-2012
Abstract: To evaluate the effectiveness of utilizing the patient journey survey (PJS) method in healthcare accreditation processes. Randomized trial of the PJS method in parallel with the current accreditation survey (CAS) method of the Australian Council on Healthcare Standards (ACHS). Acute healthcare organizations in Australia. Seventeen organizations, 28 organizational staff, nine surveyors and 38 patients. The results of each surveying method were compared. Participants provided feedback, via 18 interviews and 40 questionnaire surveys, about the benefits and disadvantages of a PJS compared to a CAS. The PJS method is not as comprehensive as the CAS method for accreditation assessment. In matched assessments the majority of items were rated lower by the PJS method than by the CAS. PJSs were shown to be appropriate for assessing mandatory clinical criteria, but were less effective for assessing corporate and support criteria. The two methods erged in their final assessments of which organizations met the accreditation threshold. Participants endorsed the use of PJSs within accreditation processes. The PJS methodology complements but is not a substitute for existing accreditation methods. There is significant stakeholder support for the inclusion of the PJS method within the current accreditation programme.
Publisher: Elsevier BV
Date: 02-2006
Publisher: Oxford University Press (OUP)
Date: 14-10-2011
Abstract: Interprofessionalism (IP) has emerged as a new movement in healthcare in response to workforce shortages, quality and safety issues and professional power dynamics. Stakeholders can push for IP (e.g. education providers to the health system) or pull (e.g. the health system to the education provider). Based on innovation theory, we hypothesized that there would be unequal forces within and across stakeholder domains which would work to facilitate or resist IP. The strongest pull pressures would be from the health system and services push pressures for IP would come from government and higher education with weaker push forces and levels of resistance, from protectionist professional bodies. /st> Our model was tested in a geographically bounded health jurisdiction. Information was gathered and analysed via in idual (n= 99 participants) and group (n= 372 participants) interviews with stakeholders, and through document analysis. /st> The health system and services exerted the strongest pull in demanding IP. The strongest push factor was in idual ch ions in positions of power. Professional bodies balanced their support of IP competencies with their role as advocates for their in idual professions. A weak push factor came from government support for health workforce reform. /st> Our hypothesis was supported, as were our predictions that the strongest pull would be from the providers and the strongest push from government and higher education. Our original model should be extended to account for contextual factors such as large-scale workplace and professional reform, which worked both for and against, IP.
Publisher: Springer Science and Business Media LLC
Date: 04-05-2020
DOI: 10.1186/S12916-020-01563-4
Abstract: Healthcare represents a paradox. While change is everywhere, performance has flatlined: 60% of care on average is in line with evidence- or consensus-based guidelines, 30% is some form of waste or of low value, and 10% is harm. The 60-30-10 Challenge has persisted for three decades. Current top-down or chain-logic strategies to address this problem, based essentially on linear models of change and relying on policies, hierarchies, and standardisation, have proven insufficient. Instead, we need to marry ideas drawn from complexity science and continuous improvement with proposals for creating a deep learning health system. This dynamic learning model has the potential to assemble relevant information including patients’ histories, and clinical, patient, laboratory, and cost data for improved decision-making in real time, or close to real time. If we get it right, the learning health system will contribute to care being more evidence-based and less wasteful and harmful. It will need a purpose-designed digital backbone and infrastructure, apply artificial intelligence to support diagnosis and treatment options, harness genomic and other new data types, and create informed discussions of options between patients, families, and clinicians. While there will be many variants of the model, learning health systems will need to spread, and be encouraged to do so, principally through diffusion of innovation models and local adaptations. Deep learning systems can enable us to better exploit expanding health datasets including traditional and newer forms of big and smaller-scale data, e.g. genomics and cost information, and incorporate patient preferences into decision-making. As we envisage it, a deep learning system will support healthcare’s desire to continually improve, and make gains on the 60-30-10 dimensions. All modern health systems are awash with data, but it is only recently that we have been able to bring this together, operationalised, and turned into useful information by which to make more intelligent, timely decisions than in the past.
Publisher: BMJ
Date: 08-2021
DOI: 10.1136/BMJOPEN-2021-048657
Abstract: There is a clear need for improved care quality and quality monitoring in aged care. Aged care providers collect an abundance of data, yet rarely are these data integrated and transformed in real-time into actionable information to support evidence-based care, nor are they shared with older people and informal caregivers. This protocol describes the co-design and testing of a dashboard in residential aged care facilities (nursing or care homes) and community-based aged care settings (formal care provided at home or in the community). The dashboard will comprise integrated data to provide an ‘at-a-glance’ overview of aged care clients, indicators to identify clients at risk of fall-related hospitalisations and poor quality of life, and evidence-based decision support to minimise these risks. Longer term plans for dashboard implementation and evaluation are also outlined. This mixed-method study will involve (1) co-designing dashboard features with aged care staff, clients, informal caregivers and general practitioners (GPs), (2) integrating aged care data silos and developing risk models, and (3) testing dashboard prototypes with users. The dashboard features will be informed by direct observations of routine work, interviews, focus groups and co-design groups with users, and a community forum. Multivariable discrete time survival models will be used to develop risk indicators, using predictors from linked historical aged care and hospital data. Dashboard prototype testing will comprise interviews, focus groups and walk-through scenarios using a think-aloud approach with staff members, clients and informal caregivers, and a GP workshop. This study has received ethical approval from the New South Wales (NSW) Population & Health Services Research Ethics Committee and Macquarie University’s Human Research Ethics Committee. The research findings will be presented to the aged care provider who will share results with staff members, clients, residents and informal caregivers. Findings will be disseminated as peer-reviewed journal articles, policy briefs and conference presentations.
Publisher: Springer International Publishing
Date: 2017
Publisher: Georg Thieme Verlag KG
Date: 2009
DOI: 10.3414/ME9212
Abstract: Objective: To measure doctors’ and nurses’ perceptions of organisational culture and relate this to their attitudes to, and satisfaction with, a hospital-wide mandatory computerised provider order entry (CPOE) system in order to illuminate cultural compositions in CPOE use. Methods: A cross-sectional survey design was employed. Data were collected by administering an organisational culture survey (Organisational Culture Inventory, OCI) along with a user-satisfaction survey to a population of 103 doctors and nurses from two clinical units in an Australian metropolitan teaching hospital. Clinicians from the hospital had used the CPOE system since 1991 to order and view clinical laboratory and radiology tests electronically for all patients. The OCI provides a measure of culture in terms of three general styles which distinguish between: constructive passive/defensive, and aggressive/defensive cultures. The cluster which best describes the overall culture is the one that has the highest percentile score when the percentile scores of the four cultural norms included in the cluster are averaged. The user satisfaction survey asked questions relating to satisfaction with, and attitudes to, the system. Results: We found identifiable sub-cultures based on professional isions where doctors perceived an aggressive-defensive culture (mean percentile score = 43.8) while nurses perceived a constructive culture (mean percentile score = 61.5). There were significant differences between doctors and nurses on three of the attitude variables with nurses expressing more positive views towards CPOE than doctors. Conclusion: The manifestation of sub-cultures within hospitals and the impact this has on attitudes towards clinical information systems should be recognized and addressed when planning for system implementation. Identification and management of the cultural characteristics of different groups of health professionals may facilitate the successful implementation and use of clinical information systems.
Publisher: Springer Science and Business Media LLC
Date: 24-07-2019
DOI: 10.1007/S00198-019-05096-2
Abstract: This study identified group-based trajectories of hospitalisation for older adults who were living in residential aged care facilities (RACF) or the community for up to 4 years after an index fall injury hospitalisation. Greater than 3 subsequent fall injury hospitalisations and time until move to a RACF were key predictors of RACF and community-living trajectory group memberships, respectively. To examine hospital service use trajectories of people aged ≥ 65 years who had a fall injury hospitalisation and were either living in a residential aged care facility (RACF) or the community at the time of the index fall and to identify factors predictive of their trajectory group membership. A group-based trajectory analysis of hospitalisations of people aged ≥ 65 years who had a fall injury hospitalisation during 2008-2009 in New South Wales, Australia, was conducted. Linked hospitalisation and RACF data were examined for a 5-year period. Group-based trajectory models were derived based on number of subsequent hospital admissions following the index fall injury hospitalisation. Multinominal logistic regression examined predictors of trajectory group membership. There were 24,729 fall injury hospitalisations 78.8% of fallers were living in the community and 21.2% in a RACF. Five distinct trajectory groups were identified for community-living and four trajectory groups for RACF residents. Key predictors of trajectory group membership for both community-living and RACF residents were age group, number of comorbidities and dementia status. For RACF residents, depression, assistance with activities of daily living and number of subsequent fall injury admissions were also predictors of group membership, with time to move to a RACF a predictor of group membership for community living. Identifying trajectories of ongoing hospital use informs targeting of strategies to reduce hospital admissions and design of services to allow community-living in iduals to remain as long as possible within their own residence.
Publisher: JMIR Publications Inc.
Date: 12-11-2021
Abstract: he development and adoption of a learning health system (LHS) has been proposed as a means to address key challenges facing current and future health care systems. The first review of the LHS literature was conducted 5 years ago, identifying only a small number of published papers that had empirically examined the implementation or testing of an LHS. It is timely to look more closely at the published empirical research and to ask the question, Where are we now? 5 years on from that early LHS review. his study performed a scoping review of empirical research within the LHS domain. Taking an “implementation science” lens, the review aims to map out the empirical research that has been conducted to date, identify limitations, and identify future directions for the field. wo academic databases (PubMed and Scopus) were searched using the terms “learning health* system*” for papers published between January 1, 2016, to January 31, 2021, that had an explicit empirical focus on LHSs. Study information was extracted relevant to the review objective, including each study’s publication details primary concern or focus context design data type implementation framework, model, or theory used and implementation determinants or outcomes examined. total of 76 studies were included in this review. Over two-thirds of the studies were concerned with implementing a particular program, system, or platform (53/76, 69.7%) designed to contribute to achieving an LHS. Most of these studies focused on a particular clinical context or patient population (37/53, 69.8%), with far fewer studies focusing on whole hospital systems (4/53, 7.5%) or on other broad health care systems encompassing multiple facilities (12/53, 22.6%). Over two-thirds of the program-specific studies utilized quantitative methods (37/53, 69.8%), with a smaller number utilizing qualitative methods (10/53, 18.9%) or mixed-methods designs (6/53, 11.3%). The remaining 23 studies were classified into 1 of 3 key areas: ethics, policies, and governance (10/76, 13.2%) stakeholder perspectives of LHSs (5/76, 6.6%) or LHS-specific research strategies and tools (8/76, 10.5%). Overall, relatively few studies were identified that incorporated an implementation science framework. lthough there has been considerable growth in empirical applications of LHSs within the past 5 years, paralleling the recent emergence of LHS-specific research strategies and tools, there are few high-quality studies. Comprehensive reporting of implementation and evaluation efforts is an important step to moving the LHS field forward. In particular, the routine use of implementation determinant and outcome frameworks will improve the assessment and reporting of barriers, enablers, and implementation outcomes in this field and will enable comparison and identification of trends across studies.
Publisher: Springer Science and Business Media LLC
Date: 12-2010
Publisher: Springer Science and Business Media LLC
Date: 06-07-2020
Publisher: BMJ
Date: 09-2015
Publisher: Springer International Publishing
Date: 2014
Publisher: Informa UK Limited
Date: 23-07-2019
DOI: 10.1080/09638288.2019.1643418
Abstract: To enhance understanding of access to rehabilitation services in Australian and New Zealand acute care facilities for older adults living with dementia and/or living in residential aged care facilities (RACFs) following a hip fracture. Information on hip fracture rehabilitation was obtained from an online survey of 40 health professionals who were members of the Australian and New Zealand Hip Fracture Registry Network. This information was supplemented with key informant interviews with five geriatricians and five rehabilitation physicians. Availability of hip fracture rehabilitation services differed by region and country. Around one in 10 respondents indicated that their facility had specific rehabilitation protocols for people living in RACFs or who were living with dementia. Barriers to providing hip fracture rehabilitation were commonly related to availability of resources. Rehabilitation pathways were determined according to in idual patient characteristics and perceived potential benefit. Decision making was mainly informed by the patient's pre-fracture morbidity and residence. Three key themes and nine sub-themes emerged from the interviews. The development of consistent decision criteria and pathways for access to hip fracture rehabilitation could provide a standard approach to access to rehabilitation, particularly for patients with cognitive impairment and/or who reside in RACFs.IMPLICATIONS FOR REHABILITATIONNeed to establish evidence-based criteria for patients who will benefit from hip fracture rehabilitation.Consistent decision criteria for access to hip fracture rehabilitation will assist in guiding a standard approach to providing rehabilitation, particularly for patients with cognitive impairment and/or who reside in RACFs.There is a need to ensure the availability of physiotherapy services in RACFs to assist with rehabilitation provision.Rehabilitation provided to patients with cognitive impairment and/or who are living in RACFs should be tailored to their physical and mental ability.
Publisher: Springer Science and Business Media LLC
Date: 24-02-2021
DOI: 10.1186/S12913-021-06148-2
Abstract: In 2017, the European Commission’s Joint Research Centre (JRC) started developing a methodological framework for a guideline-based quality assurance (QA) scheme to improve cancer quality of care. During the first phase of the work, inconsistency emerged about the use of terminology for the definition, the conceptual underpinnings and the way QA relates to health questions that are answered in guidelines. The objective of this final of three articles is to propose a conceptual framework for an integrated approach to guideline and QA development and clarify terms and definitions for key elements. This work will inform the upcoming European Commission Initiative on Colorectal Cancer (ECICC). A multidisciplinary group of 23 experts from key organizations in the fields of guideline development, performance measurement and quality assurance participated in a mixed method approach including face-to-face dialogue and several rounds of virtual meetings. Informed by results of a systematic literature review that indicated absence of an existing framework and practical ex les, we first identified the relations of key elements in guideline-based QA and then developed appropriate concepts and terminology to provide guidance. Our framework connects the three key concepts of quality indicators, performance measures and performance indicators integrated with guideline development. Quality indicators are constructs used as a guide to monitor, evaluate, and improve the quality of the structure, process and outcomes of healthcare services performance measures are tools that quantify or describe measurable elements of practice performance and performance indicators are quantifiable and measurable units or scores of practice, which should be guided by guideline recommendations. The inconsistency in the way key terms of QA are used and defined has confused the field. Our conceptual framework defines the role, meaning and interactions of the key elements for improving quality in healthcare. It directly builds on the questions asked in guidelines and answered through recommendations. These findings will be applied in the forthcoming ECICC and for the future updates of ECIBC. These are large-scale integrated projects aimed at improving healthcare quality across Europe through the development of guideline-based QA schemes this will help in implementing and improving our approach.
Publisher: BMJ
Date: 07-2019
DOI: 10.1136/BMJOPEN-2018-027186
Abstract: Hospital redevelopment projects typically intend to improve hospital functioning and modernise the delivery of care. There is research support for the proposition that redevelopment along evidence-based design principles can lead to improved quality and safety. However, it is not clear how redevelopment influences the wider context of the hospital and its functioning. That is, beyond a limited examination of intended outcomes (eg, improved patient satisfaction), are there additional consequences (positive, negative or unintended) occurring within the hospital after the physical environment is changed? Is new always better? The primary purpose of this study is to explore the ripple effects of how hospital redevelopment may influence the organisation, staff and patients in both intended and unintended ways. We propose to conduct a longitudinal, mixed-methods, case study of a large metropolitan hospital in Australia. The study design consists of a series of measurements over time that are interrupted by the natural intervention of a hospital redevelopment. How hospital redevelopment influences the wider context of the hospital will be assessed in six domains: expectations and reflections of hospital redevelopment, organisational culture, staff interactions, staff well-being, efficiency of care delivery and patient experience. Methods of data collection include a hospital-wide staff survey, semistructured interviews, a network survey, a patient experience survey, analysis of routinely collected hospital data and observations. In addition to a hospital-level analysis, a total of four wards will be examined in-depth, with two acting as controls. Data will be analysed using thematic, statistical and network analyses, respectively, for the qualitative, quantitative and relational data. The study has been reviewed and approved by the relevant Ethics Committee in New South Wales, Australia. The results will be actively disseminated through peer-reviewed journals, conference presentations and in report format to the stakeholders.
Publisher: AMPCo
Date: 1995
Publisher: Wiley
Date: 02-10-2021
DOI: 10.1111/AJAG.12861
Publisher: Frontiers Media SA
Date: 20-10-2022
DOI: 10.3389/FPSYT.2022.1028384
Abstract: Previous research suggests that the COVID-19 pandemic caused significant disruption to the lives and mental health of Australians. In response, health services adapted rapidly to digital modes of treatment, prevention and care. Although a large amount of research emerged in the first year of the pandemic, the longer-term mental health impacts, contributing factors, and population-level utilization of digital health services are unknown. A population-based online survey of 5,100 Australians adults was conducted in October 2021. Psychological distress was assessed with the Kessler 6-item Psychological Distress Scale. Additional survey questions included use and satisfaction with digital health services. Where available, data were compared with our previous survey conducted in 2018, permitting an examination of pre- and post-pandemic digital health service utilization. In 2021, almost a quarter ( n = 1203, 23.6%) of respondents reported serious levels of psychological distress participants with pre-existing health related conditions, of younger age, lower educational attainment, those who lost their job or were paid fewer hours, or living in states with lockdown policies in place were at highest risk of serious psychological distress. Almost half of all respondents ( n = 2177, 42.7%) reported using digital health technologies in 2021, in contrast to just 10.0% in 2018. In 2021, respondents with serious psychological distress were significantly more likely to consult with a healthcare professional via telephone/videoconferencing ( P & 0.001), access healthcare via a telephone advice line ( P & 0.001), or via an email or webchat advice service ( P & 0.001) than those with no serious psychological distress. Those with and without psychological distress were highly satisfied with the care they received via digital health technologies in 2021. Rates of serious psychological distress during the second year of the pandemic remained high, providing further evidence for the serious impact of COVID-19 on the mental health of the general population. Those with psychological distress accessed digital mental health services and were satisfied with the care they received. The results highlight the continued need for mental health support and digital health services, particularly for people living with chronic conditions, younger adults and people most impacted by the COVID-19 pandemic, both in the short term and beyond.
Publisher: Oxford University Press (OUP)
Date: 05-10-2023
Publisher: Springer Science and Business Media LLC
Date: 27-03-2017
Publisher: Oxford University Press (OUP)
Date: 30-10-2012
Abstract: The study aim was twofold: to investigate and describe the organizational attributes of accreditation programmes in low- and middle-income countries (LMICs) to determine how or to what extent these differ from those in higher-income countries (HICs) and to identify contextual factors that sustain or are barriers to their survival. Web-based questionnaire survey. National healthcare accreditation providers and those offering international services. In total, 44 accreditation agencies completed the survey. Income distinctions, accreditation programme features, organizational attributes and cross-national ergence. Accreditation programmes of LMICs exhibit similar characteristics to those of HICs. The consistent model of accreditation worldwide, centres on promoting improvements, applying standards and providing feedback. Where they do differ, the ergence is over specialized features rather than the general logic. LMICs were less likely than HICs to include an evaluation component to programmes, more likely to have certification processes for trainee surveyors and more likely to make decisions on the accreditation status based on a formulaic, mathematically oriented approach. Accreditation programme sustainability, irrespective of country characteristics, is influenced by ongoing policy support from government, a sufficient large healthcare market size, stable programme funding, erse incentives to encourage participation in accreditation by Health Care Organizations as well as the continual refinement and improvement in accreditation agency operations and programme delivery. Understanding the similarities, differences and factors that sustain accreditation programmes in LMICs, and HICs, can be applied to benefit programmes around the world. A flourishing accreditation programme is one element of the institutional basis for high-quality health care.
Publisher: SAGE Publications
Date: 05-2007
DOI: 10.1258/095148407780744688
Abstract: How public health is managed in various settings is an important but under-examined issue. We examine themes in the management literature, contextualize issues facing public health managers and investigate the relative importance placed on their various work pursuits using a 14-activity management model empirically derived from studies of clinician-managers in hospitals. Ethnographic case studies of 10 managers in nine erse public health settings were conducted. The case study accounts of managers' activities were content analysed, and substantive words encapsulating their work were categorized using the model. Managerial activities of the nine public health managers were ranked according to the number of words describing each activity. Kendall's coefficient of concordance yielded W = 0.710, P 0.000, revealing significant similarity between the activity patterns of the public health managers. A rank order correlation between the activity patterns of the average ranks for the public health s le and for the hospital clinician-managers ( n = 52) was R = 0.420, P = 0.131, indicating no significant relationship between relative activity priorities of the two groups. Public health managers put less emphasis on pursuits associated with structure, hierarchy and education, and more on external relations and decision-making. The model of hospital clinician-managers' managerial activities is applicable to public health managers while identifying differences in the way the two groups manage. The findings suggest that public health management work is more managerialist than previously thought.
Publisher: Oxford University Press (OUP)
Date: 10-2023
Publisher: Wiley
Date: 31-03-2017
DOI: 10.1111/JEP.12741
Publisher: Springer Science and Business Media LLC
Date: 22-02-2019
Publisher: Springer Science and Business Media LLC
Date: 19-01-2023
DOI: 10.1186/S12875-022-01955-W
Abstract: Healthcare systems may be resilient and adaptive, but they are not fit for purpose in their current state. Increasing threats to health system sustainability have underscored the need to move towards a learning health system in which research and data are used routinely in clinical practice to facilitate system improvement. This study aimed to establish which elements of the learning health system were being realised within a university-based general practice and determine acceptability from staff to embrace further the transition towards a learning health system. Semi-structured interviews were conducted with practice staff, including clinical and administrative staff, to determine the current state of the learning health system in the practice. An embedded researcher was placed within the general practice on a part-time basis to investigate the learning health system model. Interviews were transcribed and thematically analysed based on the National Academy of Medicine’s framework of learning health systems. In total, 32 (91%) practice staff were interviewed, comprising general practitioners ( n = 15), nurses ( n = 3), administrative staff ( n = 13), and a psychologist ( n = 1). Participants indicated that the practice was operating with several characteristics of a learning health system (e.g., emphasising science and informatics focusing on patient-clinician partnerships applying incentives supporting a continuous learning culture and establishing structures and governance for learning). These measures were supported by the university-based setting, and resultant culture of learning. Nevertheless, there were areas of the practice where the learning health system could be strengthened, specifically relating to the use of patient data and informatics. Staff generally expressed willingness to engage with the process of strengthening the learning health system within their practice. Although the idea of a learning health system has been gaining traction in recent years, there are comparatively few empirical studies presented in the literature. This research presents a case study of a general practice that is operating as a learning health system and highlights the utility of using the learning health system framework.
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: CRC Press
Date: 03-06-2019
Publisher: Oxford University Press (OUP)
Date: 09-2017
Publisher: CRC Press
Date: 03-06-2019
Publisher: Elsevier BV
Date: 08-2019
Publisher: Oxford University Press (OUP)
Date: 10-2016
Publisher: Oxford University Press (OUP)
Date: 10-02-2014
Abstract: Multi-Stakeholder Health Services Research Collaborations (M-SHSRCs) are increasingly pursued internationally to undertake complex implementation research that aims to directly improve the organisation and delivery of health care. Yet the empirical evidence supporting M-SHSRCs' capacity to achieve such goals is limited, and significant impediments to effective implementation are identified in the literature. This dichotomy raises the question, 'is it worth engaging in M-SHSRCs?' In this paper, we contribute to the narrative evidence-base by outlining key issues emerging from our substantial collaborative experience in Australia. Key benefits, challenges and mechanisms that may enable effective implementation of M-SHSRCs in other contexts are highlighted. We conclude that M-SHSRCs are worthwhile and succeed through significant financial, temporal and emotional investments.
Publisher: SAGE Publications
Date: 12-1992
DOI: 10.1177/183335839202200404
Abstract: Changes in the management and financing of health care are resulting in increased demands for better information about patients who are treated on an ambulatory basis in hospitals. A pilot study was conducted with the aim of determining the profile of patients who utilise accident and emergency services at St. Vincent's Hospital, Sydney. The International Classification of Primary Care (ICPC) was used to classify both the diagnoses and treatments of patients in the study. 50% of patients fell into two diagnostic categories, 40% of patients resided outside the Eastern Sydney area, no significant difference in the morbidity profiles according to area of residence of patients was found and 25% of patients returned to the hospital within a five month period. The application of the ICPC in an accident and emergency setting is discussed.
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: Elsevier BV
Date: 2019
Publisher: BMJ
Date: 09-2019
DOI: 10.1136/BMJOPEN-2019-030669
Abstract: Organisational and workplace cultures are fundamental determinants of health systems performance through better understanding of the dimensions of culture there is the potential to influence them, and subsequently improve safety and quality of care, as well as the experiences of both patients and staff. One promising conceptual framework for studying culture in healthcare is person-environment (P-E) fit. Comprising person-organisational (P-O) and person-group (P-G) components, P-E fit is defined as the extent to which in iduals are compatible with their work environment. The aim of this study was to examine the associations of P-O and P-G fit with staff outcomes in mental healthcare. Participants (n=213) were staff and volunteers at 31 primary mental health facilities across six states of Australia. Staff outcomes, comprising burnout (depersonalisation and emotional exhaustion), job satisfaction and work stress. A multidimensional survey tool was used to measure P-O and P-G fit, and staff outcomes. Multiple regression analyses were used to test the associations between fit and outcome measures. The regression analyses indicated that, based on a Bonferroni adjusted alpha value of α=00417, P-O fit accounted for 36.6% of the variability in satisfaction (F=8.951, p≤0.001) 27.7% in emotional exhaustion (F=6.766, p≤0.001) 32.8% in depersonalisation (F=8.646, p≤0.001) and 23.5% in work stress (F=5.439, p≤0.001). The P-G fit results were less conclusive, with P-G fit accounting for 15.8% of the variability in satisfaction (F=4.184, p≤0.001) 10.0% in emotional exhaustion (F=2.488, p=0.014) 28.6% in depersonalisation (F=8.945, p≤0.001) and 10.4% in work stress (F=2.590, p=0.032). There was no statistically significant increase in the variability accounted for when the interaction term of P-O and P-G fit was added to the regression. The findings highlight that staff’s perception of their workplace and organisational culture can have implications for staff well-being.
Publisher: BMJ
Date: 05-2022
DOI: 10.1136/BMJOPEN-2021-059207
Abstract: Increasing health costs, demand and patient multimorbidity challenge the sustainability of healthcare systems. These challenges persist and have been lified by the global pandemic. We aimed to develop an understanding of how the sustainable performance of healthcare systems (SPHS) has been conceptualised, defined and measured. Scoping review of peer-reviewed articles and editorials published from database inception to February 2021. PubMed and Ovid Medline, and snowballing techniques. We included articles that discussed key focus concepts of SPHS: (1) definitions, (2) measurement, (3) identified challenges, (4) identified solutions for improvement and (5) scaling successful solutions to maintain SPHS. After title/abstract screening, full-text articles were reviewed, and relevant information extracted and synthesised under the five focus concepts. Of 142 included articles, 38 (27%) provided a definition of SPHS. Definitions were based mainly on financial sustainability, however, SPHS was also more broadly conceptualised and included acceptability to patients and workforce, resilience through adaptation, and rapid absorption of evidence and innovations. Measures of SPHS were also predominantly financial, but recent articles proposed composite measures that accounted for financial, social and health outcomes. Challenges to achieving SPHS included the increasingly complex patient populations, limited integration because of entrenched fragmented systems and siloed professional groups, and the ongoing translational gaps in evidence-to-practice and policy-to-practice. Improvement strategies for SPHS included developing appropriate workplace cultures, direct community and consumer involvement, and adoption of evidence-based practice and technologies. There was also a strong identified need for long-term monitoring and evaluations to support adaptation of healthcare systems and to anticipate changing needs where possible. To implement lasting change and to respond to new challenges, we need context-relevant definitions and frameworks, and robust, flexible, and feasible measures to support the long-term sustainability and performance of healthcare systems.
Publisher: Wiley
Date: 12-02-1994
DOI: 10.1111/J.1753-6405.1994.TB00219.X
Abstract: The effect of the quality of information obtained by Standards Monitoring Teams on the compliance of 410 Australian nursing homes with Commonwealth regulatory standards is explored. We find that information matters. Lack of openness is a hallmark of a poor quality facility, openness of a high quality facility. Secondly, open flow of information becomes a resource that does enable the regulatory process to improve the quality of care. From an industry perspective, therefore, openness pays because it 1. works against being marked off by an inspection team as a problem facility that is covering up and 2. allows the facility to improve the quality of the service it delivers to the consumer.
Publisher: Oxford University Press (OUP)
Date: 11-2007
DOI: 10.1197/JAMIA.M2462
Publisher: Oxford University Press (OUP)
Date: 03-2008
DOI: 10.1197/JAMIA.M2468
Publisher: Elsevier BV
Date: 07-2019
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: JMIR Publications Inc.
Date: 16-08-2021
Abstract: he COVID-19 pandemic and its mitigation measures and impacts, such as shelter-in-place orders, social isolation, restrictions on freedoms, unemployment, financial insecurity, and disrupted routines, have led to declines in mental health worldwide and concomitant escalating demands for mental health services. Under the circumstances, electronic mental health (e-mental health) programs and services have rapidly become the “new normal.” he aim of this study was to assess key characteristics and evidence gaps in the e-mental health literature published in relation to the COVID-19 pandemic via a scoping review and bibliometric analysis. e conducted a search of four academic databases (ie, MEDLINE, Embase, PsycInfo, and CINAHL) for documents published from December 31, 2019, to March 31, 2021, using keywords for e-mental health and COVID-19. Article information was extracted that was relevant to the review objective, including journal, type of article, keywords, focus, and corresponding author. Information was synthesized by coding these attributes and was then summarized through descriptive statistics and narrative techniques. Article influence was examined from Altmetric and CiteScore data, and a network analysis was conducted on article keywords. total of 356 publications were included in the review. Articles on e-mental health quickly thrived early in the pandemic, with most articles being nonempirical, chiefly commentaries or opinions (n=225, 63.2%). Empirical publications emerged later and became more frequent as the pandemic progressed. The United States contributed the most articles (n=160, 44.9%), though a notable number came from middle-income countries (n=59, 16.6%). Articles were spread across 165 journals and had above-average influence (ie, almost half of the articles were in the top 25% of output scores by Altmetric, and the average CiteScore across articles was 4.22). The network analysis of author-supplied keywords identified key topic areas, including specific mental disorders, eHealth modalities, issues and challenges, and populations of interest. These were further explored via full-text analysis. Applications of e-mental health during the pandemic overcame, or were influenced by, system, service, technology, provider, and patient factors. OVID-19 has accelerated applications of e-mental health. Further research is needed to support the implementation of e-mental health across system and service infrastructures, alongside evidence of the relative effectiveness of e-mental health in comparison to traditional modes of care.
Publisher: Wiley
Date: 25-01-2016
DOI: 10.1111/JEP.12512
Abstract: Accrediting health care organizations against standards is a recognized safety and quality intervention. The credibility of an accreditation programme relies on surveying reliability. We investigated accreditation survey coordinators' perceptions of reliability issues and their continued relevancy, during a period of national accreditation reform. In 2013 and 2014, questionnaire surveys were developed using survey coordinators' feedback of their experiences and concerns regarding the accreditation process. Each year, a purpose-designed questionnaire survey was administered during the accrediting agency survey coordinator training days. Participants reported that survey reliability was informed by five categories of issues: the management of the accreditation process, including standards and health care organizational issues surveyor workforce management survey coordinator role survey team and in idual surveyors. A new accreditation system and programme did not alter the factors reported to shape survey reliability. However, across the reform period, there was a noted change within each category of the specific issues that were of concern. Furthermore, consensus between coordinators that existed in 2013 appears to have diminished in 2014. Across all categories, in 2014 there was greater ersity of opinion than in 2013. The known challenges to the reliability of an accreditation programme retained their potency and relevancy during a period of reform. The ersity of opinion identified across the coordinator workforce could potentially place the credibility and reliability of the new scheme at risk. The study highlights that reliability of an accreditation scheme is an ongoing achievement, not a one-off attainment.
Publisher: Springer Science and Business Media LLC
Date: 26-04-2021
DOI: 10.1186/S12913-021-06344-0
Abstract: Lean management practices are increasingly used in hospitals. However, their impacts on staff have not been systematically synthesised. This scoping review aims to synthesise the evidence on the effects of Lean Management practices on frontline healthcare professionals. A search was conducted in February 2020 on multiple databases to identify relevant sources. Studies had to satisfy the following inclusion criteria to be considered: published in English or French, peer-reviewed, empirical, studied the use of Lean in a healthcare setting and focused on its impacts on frontline workers. The studies included were heterogeneous in terms of participants. Findings were coded and classified using a thematic analysis. The quality and methodological rigour of the reviewed articles were assessed to establish a level of confidence in their findings. Of 998 identified articles, 17 were included in the review. The findings were coded into four themes: (1) Morale, motivation and job satisfaction ( n = 9, 2) work intensification, job strain, anxiety, stress and dehumanisation ( n = 7, 3) teamwork, communication and coordination ( n = 6) and (4) learning, innovation and personal development ( n = 3). Overall, the articles reported positive ( n = 11), negative ( n = 3) and mixed ( n = 3) impacts of Lean on frontline healthcare professionals. This review is the first to synthesise and highlight the gaps in the existing literature examining the impacts of Lean on frontline health professionals. The review revealed a range of both positive, negative and mixed effects, and points to the need for more empirical research to identify the underlying reasons leading to these outcomes.
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.
Publisher: Emerald
Date: 08-02-2008
DOI: 10.1108/17511870810845860
Abstract: The purpose of this paper is to examine the case that health service leadership is more than the sum total of all the health service management activity observed and to advocate for improved leadership in health services through an examination of top‐down management structures and processes which “crowd out” leadership behaviours. Application of historical and contemporary contexts to health service management and health service leadership approaches. The neglect of leadership is discussed and the case is put for a tightly‐crafted position on how leadership should be emphasised and raised to greater prominence. Formulae for conceptualising leadership are presented in order to show the constituent elements underpinning clear descriptions of leadership. Further research on leadership, and more targeted education for leaders, is needed. One way to build leadership capacity is to create a sustainable partnership between health service academics and leaders in the field. Developing formulae for framing leadership is not reductionist per se but specifies with precision the essential elements needed to express health services leadership success.
Publisher: Springer Science and Business Media LLC
Date: 24-06-2021
DOI: 10.1186/S12913-021-06575-1
Abstract: An existing hospital avoidance program, the Aged Care Rapid Response Team (ARRT), rapidly delivers geriatric outreach services to acutely unwell or older people with declining health at risk of hospitalisation. The aim of the current study was to explore health professionals’ perspectives on the factors impacting ARRT utilisation in the care of acutely unwell residential aged care facility residents. Semi-structured interviews were conducted with two Geriatricians, two ARRT Clinical Nurse Consultants, an ED-based Clinical Nurse Specialist, and an Extended Care Paramedic. Interview questions elicited views on key factors regarding care decisions and care transitions for acutely unwell residential aged care facility residents. Thematic analysis was undertaken to identify themes and sub-themes from interviews. Analysis of interviews identified five overarching themes affecting ARRT utilisation in the care of acutely unwell residents: (1) resident care needs (2) family factors (3) enabling factors (4) barriers and (5) adaptability and responsiveness to the COVID-19 pandemic. Various factors impact on hospital avoidance program utilisation in the care of acutely unwell older aged care facility residents. This information provides additional context to existing quantitative evaluations of hospital avoidance programs, as well as informing the design of future hospital avoidance programs.
Publisher: Emerald
Date: 30-10-2009
DOI: 10.1108/14777260911001626
Abstract: This paper aims to analyse the development of patient safety as a field within which patients are peripheral stakeholders. The authors examined the patient safety movement from the perspective of a field in which agents struggle for control over various forms of capital, including economic, social, cultural and symbolic capital. In order to undertake this analysis the authors drew on the literature on errors and patient safety, key inquiries into patient safety, and research conducted with health professionals in New South Wales, Australia. The patient safety movement has created a heightened sense of awareness of errors and risk across health systems, thereby attracting and creating significant amounts of capital. The authors argue that in the process of struggle to constitute and contain a new field of health, patients and their narratives are rendered vulnerable to appropriation and incorporation. By considering patient safety from a sociological rather than a technical framework, it is possible to gain new insights into why reducing the levels of medical errors have proven so difficult. Improved knowledge of how patient safety operates as a field may contribute to more effective strategies in reducing those types of errors. Despite the growth in the number of publications in patient safety there has been only minimal analysis of the field itself, rather than its technical or organisational components. This paper contributes to a new way of conceptualising and enacting patient safety, one that acknowledges the vulnerability of the parties involved, particularly patients.
Publisher: BMJ
Date: 04-2021
DOI: 10.1136/BMJGH-2020-004010
Abstract: Despite acute respiratory infections (ARIs) being the single largest reason for antibiotic use in under-5 children in Bangladesh, the prevalence of antibiotic use in the community for an ARI episode and factors associated with antibiotic use in this age group are unknown. We analysed nationally representative, population-based, household survey data from the Bangladesh Demographic and Health Survey 2014 to determine the prevalence of antibiotic use in the community for ARI in under-5 children. Using a causal graph and multivariable logistical regression, we then identified and determined the sociodemographic and antibiotic source factors significantly associated with the use of antibiotics for an episode of ARI. We analysed data for 2 144 children aged years with symptoms of ARI from 17 300 households. In our s le, 829 children (39%) received antibiotics for their ARI episode (95% CI 35.4% to 42.0%). Under-5 children from rural households were 60% (adjusted OR (aOR): 1.6 95% CI 1.2 to 2.1) more likely to receive antibiotics compared with those from urban households, largely driven by prescriptions from unqualified or traditional practitioners. Private health facilities were 50% (aOR: 0.5 95% CI 0.3 to 0.7) less likely to be sources of antibiotics compared with public health facilities and non-governmental organisations. Age of children, sex of children or household wealth had no impact on use of antibiotics. In this first nationally representative analysis of antibiotic use in under-5 children in Bangladesh, we found almost 40% of children received antibiotics for an ARI episode. The significant prevalence of antibiotic exposure in under-5 children supports the need for coordinated policy interventions and implementation of clinical practice guidelines at point of care to minimise the adverse effects attributed to antibiotic overuse.
Publisher: Oxford University Press (OUP)
Date: 04-2023
Abstract: Healthcare accreditation programmes have been adopted internationally to maintain the quality and safety of services. Accreditation assesses the compliance of organizations to a series of standards. The evidence base supporting the benefits of accreditation is mixed, potentially influenced by differences in local implementation and operationalization of standards. Successful implementation is associated with optimizing regulation, funding, and government commitment. Implementation of accreditation is a complex intervention that needs to be tailored to meet contextual differences across settings. Comparing why and how accreditation is implemented across countries supports the effective implementation of new programmes and refinements to existing systems. This article presents four case studies from Australia, Botswana, Denmark, and Jordan to consider a geographic spread and mix of high- and upper-middle-income countries. The data were derived from a review of accreditation programme documents and follow-up discussions with directors of the accrediting bodies in the countries of interest. Each case study was summarized according to a standardized framework for comparison: (i) goals (why), (ii) programme implementation (how), (iii) outcomes based on pre-post measures (what), and (iv) lessons learned (enablers and barriers). The accreditation programmes were all introduced in the 2000s to improve quality and safety. Documents from each country outlined motivations for introducing an accreditation programme, which was predominantly initiated by the government. The programmes were adopted in demarcated healthcare sectors (e.g. primary care and hospital settings), with a mix of mandatory and voluntary approaches. Implementation support centred on the interpretation and operationalization of standards and follow-up on variation in compliance with standards, after announced surveys. Most standards focused on patient safety, patient centredness, and governance but differed between using standard sets on quality management or supportive processes for patient care. Methods for evaluation of programme success and outcomes measured varied. Frequently reported enablers of successful implementation included strong leadership and ownership of the process. A lack of awareness of quality and safety, insufficient training in quality improvement methods, and transfer of staff represented the most common challenges. This case analysis of accreditation programmes in a variety of countries highlights consistent strategies utilized, key enabling factors, barriers, and the influence of contextual differences. Our framework for describing why, how, what, and lessons learned demonstrates innovation and experimentation in approaches used across high- and upper-middle-income countries, hospital and primary care, and specialist clinics.
Publisher: Springer New York
Date: 06-11-2011
Publisher: AMPCo
Date: 03-2011
DOI: 10.5694/J.1326-5377.2011.TB02960.X
Abstract: We do not have a health system with collaboratively oriented values. Reforms that former prime minister Kevin Rudd initiated, which are now Prime Minister Julia Gillard's to prosecute, do not support such a health system. Reformers have consistently ignored present and potential values. A plan for reform of the health system must take into account differing stakeholders' objectives and values and incorporate new values. This requires an agreement by stakeholders to embrace the common good. It will also need strong leadership and a willingness to embrace fundamental change.
Publisher: BMJ
Date: 03-2023
DOI: 10.1136/BMJGAST-2022-001066
Abstract: The incidence of colorectal cancer (CRC) in people aged years has been increasing dramatically in the past three decades and such patients are known to face difficulties in diagnosis. The objective of this study was to better understand the diagnostic experiences of patients with CRC and explore age-related differences in the proportion with positive experiences. A secondary analysis of the English National Cancer Patient Experience Survey (CPES) 2017 was conducted on the responses of patients with CRC, restricted to those likely to have been diagnosed in the preceding 12 months via pathways other than routine screening. Ten diagnosis-related experience questions were identified, with responses to them categorised as positive, negative or uninformative. Age group-related difference in positive experiences were described and ORs estimated, both raw and adjusted for selected characteristics. Sensitivity analysis was performed by weighting survey responses to 2017 cancer registrations by strata defined by age group, sex and cancer site, to assess whether differential response patterns by these characteristics affected the estimated proportion of positive experiences. The reported experiences of 3889 patients with CRC were analysed. There was a significant linear trend (p .0001) for 9 of 10 experience items, with older patients consistently displaying higher rates of positive experiences and patients aged 55–64 showing rates of positive experience intermediate between younger and older age groups. This was unaffected by differences in patient characteristics or CPES response rates. The highest rates of positive diagnosis-related experiences were reported by patients aged 65–74 or 75 years and older, and this is robust.
Publisher: Springer Science and Business Media LLC
Date: 08-08-2022
DOI: 10.1186/S12884-022-04931-5
Abstract: Gestational diabetes mellitus (GDM) is a condition associated with pregnancy that engenders additional healthcare demand. A growing body of research includes empirical studies focused on pregnant women’s GDM healthcare experiences. The aim of this scoping review is to map findings, highlight gaps and investigate the way research has been conducted into the healthcare experiences of women with GDM. A systematic search of primary research using a number of databases was conducted in September 2021. Studies were included if they had an explicit aim of focusing on GDM and included direct reporting of participants’ experiences of healthcare. Key data from each study was extracted into a purposely-designed form and synthesised using descriptive statistics and thematic analysis. Fifty-seven articles were included in the analysis. The majority of studies used qualitative methodology, and did not have an explicit theoretical orientation. Most studies were conducted in urban areas of high-income countries and recruitment and research was almost fully conducted in clinical and other healthcare settings. Women found inadequate information a key challenge, and support from healthcare providers a critical factor. Experiences of prescribed diet, medication and monitoring greatly varied across settings. Additional costs associated with managing GDM was cited as a problem in some studies. Overall, women reported significant mental distress in relation to their experience of GDM. This scoping review draws together reported healthcare experiences of pregnant women with GDM from around the world. Commonalities and differences in the global patient experience of GDM healthcare are identified.
Publisher: Wiley
Date: 02-2001
DOI: 10.1902/JOP.2001.72.2.196
Abstract: The primary objective of this study is to provide objective, empirical, evidence-based practice management information. This is a hitherto under-researched area of considerable interest for both the practitioner and educator. A questionnaire eliciting a mix of structured and free text responses was administered to a random s le of 480 practitioners who are members of the American Academy of Periodontology. Potential respondents not in private practice were excluded and the next listed person substituted. The results provide demographic and descriptive information about some of the main issues and problems facing practice managers, central to which are information technology (IT), financial, people management, and marketing. Human resource and marketing management appear to represent the biggest challenges. Periodontists running practices would prefer more information, development, and support in dealing with IT, finance, marketing, and people management. The empirical evidence reported here suggests that although tailored educational programs on key management issues at both undergraduate and postgraduate levels have become ubiquitous, nevertheless some respondents seek further training opportunities. Evidence-based practice management information will be invaluable to the clinician considering strategic and marketing planning, and also for those responsible for the design and conduct of predoctoral and postdoctoral programs.
Publisher: Wiley
Date: 26-10-2013
Publisher: BMJ
Date: 02-2009
Publisher: SAGE Publications
Date: 23-04-2021
Abstract: Record linkage of health data has been beneficial to inform the design, delivery and evaluation of health care practices, and to improve the quality of clinical care and patient outcomes. We discuss some of the key strengths and limitations of using record linkage as the basis of an evidentiary approach for improved health services, and for conducting health services research. We illustrate the benefits of linking information from disparate administrative data collections, uncovering new knowledge, and influencing health policy or clinical practice, or both. Continued advancement of data methods and models, infrastructure to support research, and, above all, making administrative data accessible, will help ensure more effective delivery of health care services.
Publisher: Public Library of Science (PLoS)
Date: 25-10-2022
DOI: 10.1371/JOURNAL.PONE.0272251
Abstract: Changes to hospital infrastructure are inevitable in ever-evolving healthcare systems. The redevelopment of hospitals and opening of new buildings can be a complex and challenging time for staff as they must find ways to deliver safe and high-quality care while navigating the complexities and uncertainties of change. This study explores the perspectives and experiences of staff and patients before and after the opening of a new hospital building as part of a large public hospital redevelopment in Sydney, Australia. The study comprised a longitudinal mixed methods case study design. Methods included two rounds of staff surveys (n = 292 participants), two rounds of staff interviews (n = 66), six rounds of patient surveys (n = 255), and analysis of hospital data at tri-monthly intervals over two years. Data were compared before (2019) and after (2020) a new hospital building opened at a publicly funded hospital in Sydney, Australia. Four key themes and perspectives emerged from the interviews including change uncertainty, communication effectiveness, staffing adequacy and staff resilience. Significant differences in staff perceptions of change readiness over time was identified. Specifically, perceptions that the organisational change was appropriate significantly decreased (2019: 15.93 ± 3.86 2020: 14.13 ± 3.62 p .001) and perceptions that staff could deal with the change significantly increased (2019: 17.30 ± 4.77 2020: 19.16 ± 4.36 p = .001) after the building opened compared to before. Global satisfaction scores from patient survey data showed that patient experience significantly declined after the building opened compared to before (2020: 81.70 ± 21.52 2019: 84.43 ± 18.46)), t (254) = -64.55, p 0.05, and improved a few months after opening of the new facilities. This coincided with the improvement in staff perceptions in dealing with the change. Moving into a new hospital building can be a challenging time for staff and patients. Staff experienced uncertainty and stress, and displayed practices of resilience to deliver patient care during a difficult period of change. Policy makers, hospital managers, staff and patients must work together to minimise disruption to patient care and experience. Key recommendations for future hospital redevelopment projects outline the importance of supporting and informing staff and patients during the opening of a new hospital building.
Publisher: BMJ
Date: 07-2016
Publisher: Oxford University Press (OUP)
Date: 16-11-2010
Abstract: Motivated staff are needed to improve quality and safety in healthcare organizations. Stimulating and engaging staff to participate in accreditation processes is a considerable challenge. The purpose of this study was to explore the experiences of health executives, managers and frontline clinicians who participated in organizational accreditation processes: what motivated them to engage, and what benefits accrued? The setting was a large public teaching hospital undergoing a planned review of its accreditation status. A research protocol was employed to conduct semi-structured interviews with a purposive s le of 30 staff with varied organizational roles, from different professions, to discuss their involvement in accreditation. Thematic analysis of the data was undertaken. The analysis identified three categories, each with sub-themes: accreditation response (reactions to accreditation and the value of surveys) survey issues (participation in the survey, learning through interactions and constraints) and documentation issues (self-assessment report, survey report and recommendations). Participants' occupational role focuses their attention to prioritize aspects of the accreditation process. Their motivations to participate and the benefits that accrue to them can be positively self-reinforcing. Participants have a desire to engage collaboratively with colleagues to learn and validate their efforts to improve. Participation in the accreditation process promoted a quality and safety culture that crossed organizational boundaries. The insights into worker motivation can be applied to engage staff to promote learning, overcome organizational boundaries and improve services. The findings can be applied to enhance involvement with accreditation and, more broadly, to other quality and safety activities.
Publisher: BMJ
Date: 24-11-2005
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: Wiley
Date: 04-1995
Abstract: Hospitals are changing. Throughout the OECD the hospital, that enduring and pervasive organization which has delivered the vast majority of acute care services for decades, is being reconceptualized. We briefly analyse trends which clearly indicate that the existing concept of the hospital is rapidly coming to an end. The emerging model consists of a core facility comprising only the most acute services, intensive care, operating theatres and an accident and emergency unit, with all other services and units linked by information technology to each other and to the core facility. We explore some of the management challenges confronting those who will be responsible for taking their organization through the transition to the boundaryless hospital arrangement, discuss a number of the existing problems with today's hospitals which the new model has the propensity to resolve, and deal with some of the emerging issues which it brings with it.
Publisher: BMJ
Date: 02-2010
Abstract: Despite the widespread use of accreditation in many countries, and prevailing beliefs that accreditation is associated with variables contributing to clinical care and organisational outcomes, little systematic research has been conducted to examine its validity as a predictor of healthcare performance. To determine whether accreditation performance is associated with self-reported clinical performance and independent ratings of four aspects of organisational performance. Independent blinded assessment of these variables in a random, stratified s le of health service organisations. Acute care: large, medium and small health-service organisations in Australia. Study participants Nineteen health service organisations employing 16 448 staff treating 321 289 inpatients and 1 971 087 non-inpatient services annually, representing approximately 5% of the Australian acute care health system. Correlations of accreditation performance with organisational culture, organisational climate, consumer involvement, leadership and clinical performance. Results Accreditation performance was significantly positively correlated with organisational culture (rho=0.618, p=0.005) and leadership (rho=0.616, p=0.005). There was a trend between accreditation and clinical performance (rho=0.450, p=0.080). Accreditation was unrelated to organisational climate (rho=0.378, p=0.110) and consumer involvement (rho=0.215, p=0.377). Accreditation results predict leadership behaviours and cultural characteristics of healthcare organisations but not organisational climate or consumer participation, and a positive trend between accreditation and clinical performance is noted.
Publisher: Elsevier BV
Date: 08-2007
DOI: 10.1016/J.IJMEDINF.2006.04.002
Abstract: The purpose of this study was to identify the key implications of the implementation of a computerized physician order entry (CPOE) system on pathology laboratory services. An in-depth qualitative study using observation, focus groups and interviews with pathology staff, managers, clinicians and information systems staff during implementation of a CPOE system in 2004 at a major Australian teaching hospital. Pathology laboratories experienced a shift in their work roles resulting in altered work practices, responsibilities and procedures. These changes were marked by terminological and procedural changes in the test order process from when clinicians issued a request for a test, to the new system that established clinical orders at the point of care. This change was accompanied by some organizational dysfunctions including the emergence of a new category of "frustrated" orders without specimens problems with the procedure of adding tests to previously existing specimens the appearance of discrepancies in the recorded time of specimen collection. In response to these changes, hospital and pathology staff adopted a variety of means to cope with their changed circumstances. These ranged from efforts to increase clinical awareness to compensatory laboratory workarounds and enforced rule changes. CPOE systems can have a major impact on the nature of the work of pathology laboratories. Understanding how and why these changes occur can be enhanced through considering the organizational and social contexts involved. The effectiveness of CPOE systems will rely on how administrators and staff approach and deal with these challenges.
Publisher: Maad Rayan Publishing Company
Date: 12-10-2022
Publisher: Elsevier BV
Date: 05-2011
DOI: 10.1016/J.SOCSCIMED.2011.03.020
Abstract: One of the challenges associated with the implementation of e-health systems is the effect they have on the temporal landscape (how time is conceived, structured and monitored) of an organisation particularly as it relates to the way that work is prioritised, allocated, synchronised and coordinated. This study aims to identify the impact of the introduction of a new e-health system on key aspects of the temporal and organisational functioning of a hospital pathology service. The study employed qualitative methods including interviews, focus groups and observation sessions. It was carried out in the period of August 2005 to August 2008 across a hospital pathology service in Sydney, Australia during the introduction of a new laboratory information system and electronic ordering system. The results revealed a number of temporal layers which can be defined as organisational (how the service synchronises its work with other settings) clinical (coordination of work to ensure the appropriate laboratory contribution to effective patient care) procedural (allocating work according to scientific and pathologic processes) and informational and electronic (how and what information is communicated and accessed). The introduction of a new e-health system was shown to have a major impact on the temporal landscape of the pathology service. Specific ex les of this were revealed in changes to the way the pathology service: (1) tracked and monitored specimens within the laboratory and (2) communicated and coordinated its work internally and externally. The use of qualitative methods longitudinally provided key insights into the way that temporal factors operate within pathology laboratories and their interrelationship with the performance, distribution and allocation of work.
Publisher: No publisher found
Date: 1973
Publisher: American College of Physicians
Date: 05-2022
DOI: 10.7326/M21-3977
Publisher: SAGE Publications
Date: 31-01-2011
Publisher: Springer Science and Business Media LLC
Date: 27-05-2020
DOI: 10.1186/S13012-020-00991-3
Abstract: Clinical Practice Guidelines (CPGs) synthesize the best available evidence to guide clinician and patient decision making. There are a multitude of barriers and facilitators to clinicians adhering to CPGs however, little is known about active cancer treatment CPG adherence specifically. This systematic review sought to identify clinician attitudes, and perceived barriers and facilitators to active cancer treatment CPG adherence. A systematic search was undertaken of five databases Ovid Medline, PsychInfo, Embase, Scopus, CINAHL, and PROQUEST. The retrieved abstracts were screened for eligibility against inclusion criteria, and a full text review was conducted of all eligible studies. Data were extracted, and a quality assessment was conducted of all included studies. The qualitative papers were thematically analyzed. Attitudes, barriers, and facilitating factors extracted from the quantitative papers were categorized within the qualitative thematic framework. The search resulted in the identification of 9676 titles. After duplicates were removed, abstracts screened, and full texts reviewed, 15 studies were included. Four themes were identified which related to negative clinician attitudes and barriers to active cancer treatment CPG adherence: (1) concern over CPG content and currency of CPGs (2) concern about the evidence underpinning CPGs (3) clinician uncertainty and negative perceptions of CPGs and (4) organizational and patient factors. The review also identified four themes related to positive attitudes and facilitators to active cancer treatment CPG adherence: (5) CPG accessibility and ease of use (6) endorsement and dissemination of CPGs and adequate access to treatment facilities and resources (7) awareness of CPGs and belief in their relevance and (8) belief that CPGs support decision making, improve patient care, reduce clinical variation, and reduce costs. These results highlight that adherence to active cancer treatment CPG recommendations by oncology clinicians is influenced by multiple factors such as attitudes, practices, and access to resources. The review has also revealed many similarities and differences in the factors associated with general CPG, and active cancer treatment CPG, adherence. These findings will inform tailored implementation strategies to increase adherence to cancer treatment CPGs. PROSPERO (2019) CRD42019125748 .
Publisher: Wiley
Date: 03-1997
Publisher: Maad Rayan Publishing Company
Date: 19-09-2017
Publisher: Springer Science and Business Media LLC
Date: 15-04-2020
DOI: 10.1186/S12913-020-05177-7
Abstract: This study aimed to examine managers’ attitudes towards and use of a mandatory accreditation program in Denmark, the Danish Healthcare Quality Program (Den Danske Kvalitetsmodel [DDKM]) after it was terminated in 2015. We designed a nationwide cross-sectional online survey of all senior and middle managers in the 31 somatic and psychiatric public hospitals in Denmark. We elicited managers’ attitudes towards and use of DDKM as a management using 5-point Likert scales. Regression analysis examined differences in responses by age, years in current position, and management level. The response rate was 49% with 533 of 1095 managers participating. Overall, managers’ perceptions of accreditation were favorable, highlighting key findings about some of the strengths of accreditation. DDKM was found most useful for standardizing processes, improving patient safety, and clarifying responsibility in the organization. Managers were most negative about DDKM’s ability to improve their hospitals’ financial performance, reshape the work environment, and support the function of clinical teams. Results were generally consistent across age and management level however, managers with greater years of experience in their position had more favorable attitudes, and there was some variation in attitudes towards and use of DDKM between regions. Future attention should be paid to attitudes towards accreditation. Positive attitudes and the effective use of accreditation as a management tool can support the implementation of accreditation, the development of standards, overcoming disagreements and boundaries and improving future quality programs.
Publisher: BMJ
Date: 10-2022
DOI: 10.1136/BMJOPEN-2022-064663
Abstract: To explore a macrolevel Learning Health System (LHS) and examine if an intentionally designed network can foster a collaborative learning community over time. The secondary aim was to demonstrate the application of social network research to the field of LHS. Two longitudinal online questionnaires of the Australian Genomics learning community considering relationships between network members at three time points: 2016, 2018, 2019. The questionnaire included closed Likert response questions on collaborative learning patterns and open-response questions to capture general perceptions of the community. Social network data were analysed and visually constructed using Gephi V.0.9.2 software, Likert questions were analysed using SPSS, and open responses were analysed thematically using NVivo. Australian Genomic Health Alliance. Clinicians, scientists, researchers and community representatives. Australian Genomics members highlighted the collaborative benefits of the network as a learning community to foster continuous learning in the ever-evolving field of clinical genomics. The learning community grew from 186 members (2016), to 384 (2018), to 439 (2019). Network density increased (2016=0.023, 2018=0.043), then decreased (2019=0.036). Key players remained consistent with potential for new members to achieve focal positions in the network. Informal learning was identified as the most influential learning method for genomic practice. This study shows that intentionally building a network provides a platform for continuous learning—a fundamental component for establishing an LHS. The Australian Genomics learning community shows evidence of maturity and sustainability in supporting the continuous learning culture of clinical genomics. The network provides a practical means to spread new knowledge and best practice across the entire field. We show that intentionally designed networks provide the opportunity and means for interdisciplinary learning between erse agents over time and demonstrate the application of social network research to the LHS field.
Publisher: Elsevier BV
Date: 12-2010
DOI: 10.1016/J.SOCSCIMED.2010.08.013
Abstract: Emergency clinicians undertake boundary-work as they facilitate patient trajectories through the Emergency Department (ED). Emergency clinicians must manage the constantly-changing dynamics at the boundaries of the ED and other hospital departments and organizations whose services emergency clinicians seek to integrate. Integrating the care that differing clinical groups provide, the services EDs offer, and patients' needs across this journey is challenging. The journey is usually accounted for in a linear way - as a "continuity of care" problem. In this paper, we instead conceptualize integrated care in the ED using a complex adaptive systems (CAS) perspective. A CAS perspective accounts for the degree to which other departments and units outside of the ED are integrated, and appropriately described, using CAS concepts and language. One year of ethnographic research was conducted, combining observation and semi-structured interviews, in the EDs of two tertiary referral hospitals in Sydney, Australia. We found the CAS approach to be salient to analyzing integrated care in the ED because the processes of categorization, diagnosis and discharge are primarily about the linkages between services, and the communication and negotiation required to enact those linkages, however imperfectly they occur in practice. Emergency clinicians rapidly process large numbers of high-need patients, in a relatively efficient system of care inadequately explained by linear models. A CAS perspective exposes integrated care as management of the patient trajectory within porous, shifting and negotiable boundaries.
Publisher: Elsevier BV
Date: 02-2023
DOI: 10.1016/J.GIM.2022.01.004
Abstract: Clinical genomics demands close interaction of physicians, laboratory scientists, and genetic professionals. Taking genomics to scale requires an understanding of the underlying processes from the perspective of nongenetic physicians who are new to the field. We identified components of the processes amenable to adaptation when scaling up clinical genomics. Semistructured interviews informed by the Theoretical Domains Framework with nongenetic physicians, who were using clinical genomics in practice, were guided by an annotated process map with 7 steps following the patient's journey. Findings from the in idual maps were synthesized into an overview process map and a series of in idual maps by common location and specialty. Interviews were analyzed using the Theoretical Domains Framework. In total, 16 nongenetic physicians (eg, nephrologists, immunologists) participated, generating 1 overview and 10 in idual process maps. Sixteen common steps were identified across clinical specialties and locations, with variations over 9 steps. We report the potential for standardization across these 9 steps. When scaling up complex interventions, it is essential to identify steps where variation can be accommodated. With these results we show how process mapping can be used to identify steps where variation is acceptable during scale up to accommodate adaptation to local context, allowing for the inevitable evolution of factors influencing ongoing implementation and sustainability.
Publisher: Wiley
Date: 21-02-2023
DOI: 10.1111/HEX.13725
Abstract: Preventative healthcare is crucial for improving in idual patient outcomes and is integral to sustainable health systems. The effectiveness of prevention programs is enhanced by activated populations who are capable of managing their own health and are proactive to keep themselves well. However, little is known about the level of activation among people drawn from general populations. We used the Patient Activation Measure (PAM) to address this knowledge gap. A representative, population‐based survey of Australian adults was conducted in October 2021 during the Delta strain outbreak of the COVID‐19 pandemic. Comprehensive demographic information was collected, and the participants completed the Kessler‐6 psychological distress scale (K6) and PAM. Multinomial and binomial logistic regression analyses were performed to determine the effect of demographic factors on PAM scores, which are categorised into four levels: 1—participants disengaged with their health 2—becoming aware of how to manage their health 3—acting on their health and 4—engaging with preventative healthcare and advocating for themselves. Of 5100 participants, 7.8% scored at PAM level 1 13.7% level 2, 45.3% level 3, and 33.2% level 4. The mean score was 66.1, corresponding to PAM level 3. More than half of the participants (59.2%) reported having one or more chronic conditions. Respondents aged 18 to 24 years old were twice as likely to score PAM level 1 compared with people aged 25–44 ( p .001) or people aged over 65 years ( p .05). Speaking a language other than English at home was significantly associated with having low PAM ( p .05). Greater psychological distress scores (K6) were significantly predictive of low PAM scores ( p .001). Overall, Australian adults showed high levels of patient activation in 2021. People with lower incomes, of younger age, and those experiencing psychological distress were more likely to have low activation. Understanding the level of activation enables targeting sociodemographic groups for extra support to increase the capacity to engage in prevention activities. Conducted during the COVID‐19 pandemic, our study provides a baseline for comparison as we move out of the pandemic and associated restrictions and lockdowns. The study and survey questions were co‐designed with consumer researchers from the Consumers Health Forum of Australia (CHF) as equal partners. Researchers from CHF were involved in the analysis of data and production of all publications using data from the consumer sentiment survey.
Publisher: BMJ
Date: 17-01-2011
DOI: 10.1136/BMJQS.2010.047605
Abstract: Methods for improving patient safety are predicated on cooperation between healthcare groups, but are the views of health professionals involved in promoting safety shared by other healthcare workforce staff and managers? To compare patient-safety suggestions from health workforce managerial and staff groups with those of patient-safety specialists. S les of managers (424) and staff (1214) in the South Australian state health system and 131 Australian patient-safety specialists were asked to write suggestions for improving patient safety. Group responses were content analysed and compared. Patient-safety specialists (83.2%) were more likely to make suggestions than were workforce managers (57.8%) or staff (44.1%). Workforce members from clinical professions were more likely than non-clinicians to tender suggestions. No relationship existed between the importance specialists and managers (ρ = -0.062, p = 0.880) and specialists and staff (ρ = -0.046, p = 0.912) attached to nine categories of suggestions. There was a high correlation between the importance that managers and non-managers attached to safety strategies (ρ = 0.817, p = 0.011). Among those who made suggestions, specialists were more likely to suggest implementing reviews and guidelines, and incident reporting. Workforce groups were more likely to recommend increased and improved staffing and staffing conditions, and better equipment and infrastructure. There were no significant differences in the proportions of group members recommending: improving management and leadership increasing staff safety education and supervision communication and teamwork improved patient focus or tackling specific safety projects. Differences between safety specialists' and workforce groups' beliefs about how to improve patient safety may impede the successful implementation of patient-safety programmes.
Publisher: Public Library of Science (PLoS)
Date: 28-09-2020
Publisher: Springer Science and Business Media LLC
Date: 13-09-2023
Publisher: Wiley
Date: 24-05-2011
DOI: 10.1002/HPM.1033
Abstract: We compared health managers' judgements of: (1) the time they spent on nine major work activities, (2) the time they thought they should allocate and (3) the importance they attributed to each pursuit. These and managers' reasons for devoting time to activities were examined in an Anglo and a Confucian-Asian country. A questionnaire survey of Australian (n = 251) and Singaporean health managers (n = 340). In both countries, the correlation between judgements of time spent on activities/activities' importance (1 and 3) was significantly less than the correlation between time spent/time that should be spent (1 and 2), which was less than the correlation between time that should be spent/activities' importance (2 and 3). Singaporeans said they devoted more time to some activities but the importance attached to work pursuits and the reasons given for actual time allocation were similar cross-culturally. There was evidence of considerable disparity between managers' actual and preferred time allocation and of the globalization of health managers' work values. Evidence regarding time use might contribute to a rethink of how managers' efficiency and effectiveness are construed.
Publisher: Springer Science and Business Media LLC
Date: 06-07-2011
DOI: 10.1007/S10728-010-0152-X
Abstract: Although there is a long-standing international debate concerning the privatization and corporatization of health services, there has been relatively little systematic analysis of the ways these types of reform manifest. We examine the impact of privatization and corporatization on public hospitals, and in particular on hospitals' autonomy and accountability, with two aims: to uncover the key themes in the literature, and to consider implementation issues. The review of 2,319 articles was conducted using content analysis and a discussion of selected key issues. Several major themes appear in the privatization and corporatization literature, including their use as tools in health systems reform, and the role of governments in sponsoring the processes. We show that much of the underlying argument is ideological rather than evidence based. Those who promote versions of privatization or corporatization claim that decreased government involvement in the management of hospitals leads inter alia to benefits such as greater efficiency, better quality services, and increased choice for patients. Those who argue against say that increased privatization leads to deleterious outcomes such as decreased equity, compromised efficiency and poorer quality of care. The evidence is often weak and at times conflicting. Privatization and corporatization are difficult to implement, and at best produce mixed results, and their impact seems to depend more on the motivation of the evaluator than the standard of the results. These debates are of a type that is to a large extent only resolvable ideologically.
Publisher: SAGE Publications
Date: 25-11-2017
Abstract: Malignant melanoma is an aggressive, recalcitrant disease. Its impact on people can be compounded by the physical and psychosocial consequences of medical management. Providing melanoma patients with patient-centered care that is effective, safe, and supportive throughout their journey requires knowledge of patients’ progressive experiences and evolving perspectives. With ethical approval, we undertook a meta-narrative study of 214 experiential accounts of melanoma collected from the personal story sections of melanoma and cancer support websites. Using a narrative approach, we qualitatively examined the care experiences represented in these accounts and identified needs for supportive care in a framework reflective of the personal patient journey. We differentiate these across three key periods: lead-up to diagnosis diagnosis, treatment, and recovery and posttreatment and recurrence, and provide a visual representation of the patient journey. This article contributes to the growing body of work that utilizes Internet content as sources of qualitative, experiential health care data.
Publisher: Research Publishing Services
Date: 2020
Publisher: AMPCo
Date: 04-2011
DOI: 10.5694/J.1326-5377.2011.TB03008.X
Abstract: Interprofessional learning and practice can be positively self-reinforcing and can promote improved care. Australia is showing leadership in the field of interprofessional collaboration. Changing attitudes to interprofessional collaboration is a key to improving health care. Implementing interprofessional collaboration requires a multifaceted approach, and research to underpin it.
Publisher: BMJ
Date: 04-2009
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: JMIR Publications Inc.
Date: 06-01-2022
DOI: 10.2196/30027
Abstract: Emerging adulthood is a distinct segment of an in idual’s life course. The defining features of this transitional period include identity exploration, instability, future possibilities, self-focus, and feeling in-between, all of which are thought to affect quality of life, health, and well-being. A longitudinal cohort study with a comprehensive set of measures would be a valuable resource for improving the understanding of the multifaceted elements and unique challenges that contribute to the health and well-being of emerging adults. The main aim of this pilot study was to evaluate the feasibility and acceptability of recruiting university graduates to establish a longitudinal cohort study to inform the understanding of emerging adulthood. This pilot study was conducted among graduates at a large university. It involved collecting web-based survey data at baseline (ie, graduation) and 12 months post baseline, and linking survey responses to health records from administrative data collections. The feasibility outcome measures of interest included the recruitment rate, response rate, retention rate, data linkage opt-out rate, and availability of linked health records. Descriptive statistics were used to evaluate the representativeness of the s le, completeness of the survey responses, and data linkage characteristics. Only 2.8% of invited graduates (238/8532) agreed to participate in this pilot cohort study, of whom 59.7% (142/238) responded to the baseline survey. The retention rate between the baseline and follow-up surveys was 69.7% (99/142). The completeness of the surveys was excellent, with the proportion of answered questions in each survey domain ranging from 87.3% to 100% in both the baseline and follow-up surveys. The data linkage opt-out rate was 32.4% (77/238). The overall recruitment rate was poor, while the completeness of survey responses among respondents ranged from good to excellent. There was reasonable acceptability for conducting data linkage of health records from administrative data collections and survey responses. This pilot study offers insights and recommendations for future research aiming to establish a longitudinal cohort study to investigate health and well-being in emerging adults. Australian New Zealand Clinical Trials Registry number ACTRN12618001364268 eec8wh RR2-10.2196/16108
Publisher: Maad Rayan Publishing Company
Date: 06-07-2021
Publisher: Elsevier BV
Date: 2014
DOI: 10.1016/J.IENJ.2013.01.001
Abstract: Emergency department (ED) overcrowding reduces efficiency and increases the risk of medical error leading to adverse events. Technical solutions and models have done little to redress this. A full year's worth of ethnographic observations of patient flow were undertaken, which involved making hand-written field-notes of the communication and activities of emergency clinicians (doctors and nurses), in two EDs in Sydney, Australia. Observations were complemented by semi-structured interviews. We applied thematic analysis to account for the verbal communication and activity of emergency clinicians in moving patients through the ED. The theoretical model that emerged from the data analysis is the ED "carousel". Emergency clinicians co-construct a moving carousel which we conceptualise visually, and which accounts for the collective agency of ED staff, identified in the findings. The carousel model uniquely integrates diagnosis, treatment and transfer of in idual patients with the intellectual labour of leading and coordinating the department. The latter involves managing staff skill mix and the allocation of patients to particular ED sub-departments. The model extends traditional patient flow representations and underlines the importance of valuing ethnographic methods in health services research, in order to foster organisational learning, and generate creative practical and policy alternatives that may, for ex le, reduce or ameliorate access block and ED overcrowding.
Publisher: Wiley
Date: 26-08-2019
Abstract: It has been 10 years since the ACEM Access Block Solutions Summit and 5 years since the introduction of the Four-Hour Rule/National Emergency Access Target (4HR/NEAT) policy. The impact of this policy on ED management and on ED staff has been poorly understood. The aim of the present study was to identify changes in ED management resulting from the policy based on ED staff experiences. Semi-structured interviews were conducted and transcribed, imported to NVivo 11 and analysed using a combination of content, thematic analysis and phenomenological focus within a theoretical framework known as the 'logic model'. One hundred and nineteen ED staff participated in 2015-2016 to assess the impact of the policy implementation. Participants were drawn from 16 EDs in New South Wales, Queensland, Western Australia and Australian Capital Territory. In relation to ED management, three themes were identified: changes in ED management activities and changes driven by the hospital in relation to 4HR/NEAT and participant experiences in relation to policy compliance by staff. Policy implementation is a complex process that had both positive and negative consequences on how ED staff managed the implementation of the 4HR/NEAT policy and how it changed their work environment. Understanding the perceptions of staff involved in policy implementation has significance for the design of future implementation strategies. The biggest insight from the present study is that ED management is very complex and the policy generated multiple positive and negative changes demonstrating the wide range of processes involved in this area of health services research.
Publisher: Wiley
Date: 04-09-2019
Abstract: The implementation of the time target policy (Four-Hour Rule/National Emergency Access Target [4HR/NEAT]) constituted a major change for ED, and potentially on quality of care. The present study aimed to understand perceptions and experiences of ED staff during 4HR/NEAT implementation. A semi-structured interview was used to explore views and perceptions of 119 ED staff from 16 EDs in New South Wales, Australian Capital Territory, Queensland and Western Australia. The interviews covered aspects such as perceived changes in quality of clinical care, whether the capacity to deliver education was diminished or enhanced and whether the policy affected access to care. Interviews were transcribed, imported to NVivo 11 and analysed using content and thematic analysis. Three themes were identified: quality and safety of care access block and overcrowding and medical education and training. Participants described both positive and negative aspects of the policy. Although some reported negative impacts on care quality and access block, more cited overall improvements in these areas. The majority perceived that medical education and training was negatively affected, mainly because of restricted training opportunities and reduced time for procedural skills. ED staff perceived important effects on quality and safety of care access block and overcrowding and medical education and training. In relation to an optimised ED role, quality of care and access block were overall felt to be improved, while education and training deteriorated. Our study increases understanding of the complexity of policy implementation processes and its impact on staff. Staff perceptions are a valuable measure of system performance and should be incorporated into system change evaluations.
Publisher: BMJ
Date: 2012
Publisher: Elsevier BV
Date: 03-2021
Publisher: Emerald
Date: 22-05-2009
Publisher: BMJ
Date: 28-04-2005
Publisher: Springer Science and Business Media LLC
Date: 15-04-2019
Publisher: Oxford University Press (OUP)
Date: 11-06-2012
Abstract: To use multilevel modelling to compare the patient safety cultures of types of services across a health system and to determine whether differences found can be accounted for by staffs' professions, organizational roles, ages and type of patient care provided. Application of a hierarchical two-level regression model. All services in the South Australian public health system. Approximately half of the health staff (n = 14 054) in the 46 organizations, classified into 18 types of service, which made up the South Australian public health system. Staff completed the Safety Attitudes Questionnaire. Attitudes regarding Teamwork Climate, Safety Climate, Job Satisfaction, Stress Recognition, Perception of Management and Working Conditions in participants' workplaces. All SAQ indices showed statistically significant although modest variations according to service type. However, most of these differences were not accounted for by the differences in the demographic composition of services' staff. Most favourable safety attitudes were found in the breast screening, primary/community health services, community nursing and metropolitan non-teaching hospitals. Poorer cultures were reported in the psychiatric hospital, mental health, metropolitan ambulance services and top-level teaching hospitals. Demographic differences in safety attitudes were observed particularly, clinical, senior managerial, aged care and older staff held more favourable attitudes. Differences in staff attitudes have been demonstrated at a macro-level across the type of health services but for the most part, differences could not be explained by staffing composition.
Publisher: Informa UK Limited
Date: 12-2004
DOI: 10.3402/MEO.V9I.4368
Abstract: The purpose of this paper is to elaborate criteria by which the principles of curriculum reform can be judged. To this end, the paper presents an overview of standard critiques of medical education and examines the ways medical curriculum reforms have responded to these critiques. The paper then sets out our assessment of these curriculum reforms along three parameters: pedagogy, educational context, and knowledge status. Following on from this evaluation of recent curriculum reforms, the paper puts forward four criteria with which to gauge the adequacy medical curriculum reform. These criteria enable us to question the extent to which new curricula incorporate methods and approaches for ensuring that its substance: overcomes the traditional opposition between clinical and resource dimensions of care emphasizes that the clinical work needs to be systematized in so far as that it feasible promotes multi-disciplinary team work, and balances clinical autonomy with accountability to non-clinical stakeholders.
Publisher: BMJ
Date: 08-04-2015
Publisher: BMJ
Date: 08-04-2015
Publisher: BMJ
Date: 06-2019
DOI: 10.1136/BMJOPEN-2019-030988
Abstract: The aged population is increasing rapidly across the world and this is expected to continue. People living in residential aged care facilities (RACFs) represent amongst the sickest and frailest cohort of the aged population, with a high prevalence of chronic conditions and complex comorbidities. Given the vulnerability of RACF residents and the demands on the system, there is a need to determine the extent that care is delivered in line with best practice (‘appropriate care’) in RACFs. There is also a recognition that systems should provide care that optimises quality of life (QoL), which includes support for physical and psychological well-being, independence, social relationships, personal beliefs and a caring external environment. The aims of CareTrack Aged are to develop sets of indicators for appropriate care and processes of care for commonly managed conditions, and then assess the appropriateness of care delivered and QoL of residents in RACFs in Australia. We will extract recommendations from clinical practice guidelines and, using expert review, convert these into sets of indicators for 15 common conditions and processes of care for people living in RACFs. We will recruit RACFs in three Australian states, and residents within these RACFs, using a stratified multistage s ling method. Experienced nurses, trained in the CareTrack Aged methods (‘surveyors’), will review care records of recruited residents within a 1-month period in 2019 and 2020, and assess the care documented against the indicators of appropriate care. Surveyors will concurrently assess residents’ QoL using validated questionnaires. The study has been reviewed and approved by the Human Research Ethics Committee of Macquarie University (5201800386). The research findings will be published in international and national journals and disseminated through conferences and presentations to interested stakeholder groups, including consumers, national agencies, healthcare professionals, policymakers and researchers.
Publisher: BMJ
Date: 08-2020
DOI: 10.1136/BMJOPEN-2020-037611
Abstract: Organisational change in hospitals is a frequent, seemingly inevitable occurrence. A critical precursor to successful organisational change is change readiness. This paper presents the adaptation of a self-report measure of change readiness for hospital staff, examines its reliability and validity, and evaluates the relationship between hospital change readiness (HCR) and staff well-being. The questionnaire was piloted among 153 staff from a large metropolitan, public hospital in Sydney, Australia. The hospital was undergoing a major change involving a multimillion-dollar development project that included a new building and new models of care. Construct validity was evaluated by confirmatory factor analysis (CFA) and reliability was assessed by internal consistency. Differences between professional groups were examined using regression analyses and structural equation modelling (SEM) was used to test the relationship between change readiness and staff well-being (job satisfaction and burnout). The HCR Questionnaire was found to reflect theoretically derived and empirically observed domains and have high internal reliability. CFA identified that a two-factor structure demonstrated excellent fit. Cronbach’s alpha for the two subscales (appropriateness and change efficacy) was 0.85 and 0.75, respectively. No statistically significant differences of HCR were identified between professional groups. SEM revealed that perceiving change as appropriate was significantly positively related to job satisfaction (0.33) and significantly negatively related to burnout (−0.30), and feeling capable in implementing the change was significantly negatively related to burnout (−0.40). The HCR Questionnaire provides reliable information on how prepared hospital staff felt for organisational change and showed significant relationships with staff well-being. This questionnaire is validated for the Australian hospital context, particularly in the case of hospital redevelopment. It can be used to help manage times of hospital organisational change with minimal disruption to the quality and safety of patient care.
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: Emerald
Date: 31-10-2008
DOI: 10.1108/14777260810916551
Abstract: Increased public awareness of clinical failure and rising levels of litigation are spurring health policy makers in industrialized countries to mandate that clinicians report and investigate clinical errors and near misses. This paper seeks to understand the value of root cause analysis (RCA) recommendations for practice improvement purposes. The paper presents an analysis of interviews with nine senior health managers who were asked about their views on RCA as practice improvement method. Interview data were collected as part of a multi‐method evaluation consultancy project investigating a local Health Safety Improvement Program. The interview data were discourse analysed and arranged into over‐arching themes. The analysis reveals rather negative views of the improvement potential of RCA: RCA is subject to too many constraints to be able to produce valuable recommendations RCA recommendations: are perceived to be of “variable quality” generate considerable extra work for senior management to do with vetting RCA recommendations are experienced as contributing in only a limited way to organizational and practice improvement. This study focuses on nine interviewees only and presents an analysis of single (not multiple) interviews. However, these nine interviewees fulfil crucial roles in implementing clinical practice improvement initiatives in their respective geographic areas. The findings suggest that RCA requires much time and negotiation, and that the recommendations produced may not live up to the philosophy of clinical practice improvement's expectations. It may be necessary to reorient the expectations of the power of RCA, or accept that RCA produces communication about clinical processes that would otherwise not have taken place, and whose effects may not be registering for some time to come. Besides drawing out the implications for RCA as investigative practice, the analysis argues that interviewees' responses harbour indications to suggest that these officials are finding themselves engaged in increasing levels of communicative and emotional labour, in having to manage and compensate for the ambiguities, incommensurabilities and conflicting goals inscribed into “post‐bureaucratic” initiatives such as RCA.
Publisher: Springer Science and Business Media LLC
Date: 11-05-2013
Publisher: BMJ
Date: 16-04-2014
DOI: 10.1136/BMJQS-2014-002845
Abstract: While many hospitals are implementing rapid response systems (RRSs) to attend to deteriorating patients in a systematic way, there is little documented evidence on system-wide approaches to adopting RRSs. Here, we report on an initiative which enrolled 220 hospitals in New South Wales, Australia. The 'between the flags' approach was modelled on Australia's surf lifesaving experience, where qualified lifesavers perform thousands of rescues each year. Patients in hospitals who are identified as being 'between the flags' are given special attention, just like beach goers.
Publisher: MDPI AG
Date: 23-02-2023
Abstract: Agency, defined as the ability to identify one’s goals and act upon them, has been recognized as a prominent strategy to access maternal healthcare services (MHS). The purpose of this study was to synthesize evidence of the association between women’s agency and MHS utilization. A systematic review was performed on five academic databases, comprising Scopus, PubMed, Web of Science, Embase, and ProQuest. Meta-analysis was performed with a random-effects method using the STATA™ Version 17 software. A total of 82 studies were selected following the PRISMA guidelines. The meta-analysis demonstrated that an increase in women’s agency was associated with a 34% increase in the odds of receiving skilled antenatal care (ANC) (OR = 1.34, 95% CI = 1.18–1.52) 7% increase in the odds of initiating the first ANC visit during the first trimester of pregnancy (OR = 1.07, 95% CI = 1.01–1.12) 20% increase in the odds of receiving at least one ANC visit (OR = 1.20, 95% CI = 1.04–1.4) 16% increase in the odds of receiving more than four ANC visits during pregnancy (OR = 1.16, 95% CI = 1.12–1.21) 17% increase in the odds of receiving more than eight ANC visits (OR = 1.17, 95% CI = 1.04–1.32) 13% increase in the odds of facility-based delivery (OR = 1.13, 95% CI = 1.09–1.17) 16% increase in the odds of using skilled birth attendants (OR = 1.16, 95% CI = 1.13–1.19) and 13% increase in the odds of receiving postnatal care (OR = 1.13, 95% CI = 1.08–1.19) compared to low level of agency. Any efforts to improve MHS utilization and reduce maternal morbidity and mortality should include the promotion of women’s agency.
Publisher: Informa UK Limited
Date: 20-04-2023
Publisher: Springer Science and Business Media LLC
Date: 28-11-2018
Publisher: SAGE Publications
Date: 14-05-2010
Publisher: Elsevier BV
Date: 07-2004
Publisher: Springer Science and Business Media LLC
Date: 14-05-2011
Publisher: Oxford University Press (OUP)
Date: 16-04-2012
Publisher: AMPCo
Date: 07-2012
DOI: 10.5694/MJA12.10799
Publisher: AMPCo
Date: 05-2006
DOI: 10.5694/J.1326-5377.2006.TB00364.X
Abstract: Self-regulation by the health professions, while improving, is no longer enough external drivers for safer health care include governments, funders and consumers. Enforced self-regulation is often more promising than a "command and control" strategy. Research evidence on the responsive regulatory pyramid and its options offers lessons for health care policy makers and managers. Start at the base of the regulatory pyramid - try persuasion first move up the pyramid to secure compliance, and then be willing to move back down. Use existing capacities and structures, and if possible avoid new bureaucracies of control.
Publisher: AMPCo
Date: 04-2008
Publisher: Oxford University Press (OUP)
Date: 09-2018
Publisher: Maad Rayan Publishing Company
Date: 08-09-2021
Abstract: Background: Coronavirus disease 2019 (COVID-19) has resulted in over 2 million deaths globally. The experience in Australia presents an opportunity to study contrasting responses to the COVID-19 health system shock. We adapted the Hanefeld et al framework for health systems shocks to create the COVID-19 System Shock Framework (CSSF). This framework enabled us to assess innovations and changes created through COVID-19 at the Sydney Children’s Hospitals Network (SCHN), the largest provider of children’s health services in the Southern hemisphere. Methods: We used ethnographic methods, guided by the CSSF, to map innovations and initiatives implemented across SCHN during the pandemic. An embedded field researcher shadowed members of the emergency operations centre (EOC) for nine months. We also reviewed clinic and policy documents pertinent to SCHN’s response to COVID-19 and conducted interviews and focus groups with stakeholders, including clinical directors, project managers, frontline clinicians, and other personnel involved in implementing innovations across SCHN. Results: The CSSF captured SCHN’s complex response to the pandemic. Responses included a COVID-19 assessment clinic, inpatient and infectious disease management services, redeploying and managing a workforce working from home, cohesive communication initiatives, and remote delivery of care, all enabled by a dedicated COVID-19 fund. The health system values that shaped SCHN’s response to the pandemic included principles of equity of healthcare delivery, holistic and integrated models of care, and supporting workforce wellbeing. SCHN’s resilience was enabled by innovation fostered through a non-hierarchical governance structure and responsiveness to emerging challenges balanced with a singular vision. Conclusion: Using the CSSF, we found that SCHN’s ability to innovate was key to ensuring its resilience during the pandemic.
Publisher: Informa UK Limited
Date: 13-01-2020
DOI: 10.1080/13561820.2019.1702515
Abstract: Interprofessional collaboration (IPC) is a common term applied in the healthcare literature, with suggestions it contributes to improved quality and safety of patient care across the globe. Despite worldwide implementation of models of IPC, past systematic or meta-reviews on this topic have concluded that the evidence is mixed. However, these reviews are yet to adequately consider the qualitative and mixed-methods literature on this topic. In this critical review, we synthesize the outcomes and key findings of IPC in hospitals, taking a broader approach by including erse study designs. A total of 4,776 abstracts were screened from three major databases (Medline, CINAHL, Embase). Thirty-four studies fulfilled inclusion criteria. Although outcomes and key findings (e.g., staff turnover, error rates) were mostly positive, there were inconsistencies in the results. The included studies reflected a variety of study designs and different methodological approaches. Overall, our review revealed moderate evidence that IPC can positively influence patient, staff and organizational factors in hospitals, and that inconsistent findings may be due to variation in context (e.g., the cohort of patients). Recommendations from the review are to incorporate qualitative- and mixed-methods approaches to studying IPC in healthcare and tailor evaluations of IPC outcomes specific to the context.
Publisher: Wiley
Date: 20-06-2019
DOI: 10.1111/RESP.13611
Abstract: We conducted a comprehensive assessment of guideline adherence in paediatric asthma care, including inpatient and ambulatory services, in Australia. National and international clinical practice guidelines (CPG) relating to asthma in children were searched and 39 medical record audit indicator questions were developed. Retrospective medical record review was conducted across hospital inpatient admissions, emergency department (ED) presentations, general practice (GP) and paediatrician consultations in three Australian states for children aged ≤15 years receiving care in 2012 and 2013. Eligibility of, and adherence to, indicators was assessed from medical records by nine experienced and purpose-trained paediatric nurses (surveyors). Surveyors conducted 18 453 asthma indicator assessments across 1600 visits for 881 children in 129 locations. Overall, the adherence for asthma care across the 39 indicators was 58.1%, with 54.4% adherence at GP (95% CI: 46.0-62.5), 77.7% by paediatricians (95% CI: 40.5-97.0), 79.9% in ED (95% CI: 70.6-87.3) and 85.1% for inpatient care (95% CI: 76.7-91.5). For 14 acute asthma indicators, overall adherence was 56.3% (95% CI: 47.6-64.7). Lowest adherences were for recording all four types of vital signs in children aged >2 years presenting with asthma attack (15.1%, 95% CI: 8.7-23.7), and reviewing patients' compliance, inhaler technique and triggers prior to commencing a new drug therapy (20.5%, 95% CI: 10.1-34.8). The study demonstrated differences between existing care and CPG recommendations for paediatric asthma care in Australia. Evidence-based interventions to improve adherence to CPG may help to standardize quality of paediatric asthma care and reduce variation of care.
Publisher: Elsevier BV
Date: 08-2007
DOI: 10.1016/J.SOCSCIMED.2007.03.053
Abstract: Studies have identified the importance of hospitals' organisational culture in clinical information system diffusion, but few have quantified its role. This study measured organisational culture in two Australian hospitals to explore whether clinicians' perceptions of culture related to their attitudes to, and satisfaction with, a computerised provider order entry system (CPOE). Data were collected using the Organisational Culture Inventory and a user-satisfaction survey administered to a population of 249 clinicians from the two hospitals. One hospital used CPOE to order clinical laboratory and radiology tests and view results, and the other used the test viewing function only, the ordering facility being planned for later implementation. We found a relationship between culture and clinicians' attitudes, with those in the constructive culture hospital more likely to express positive attitudes towards CPOE, whereas those in the aggressive/defensive hospital were more likely to be negative. The relationship between culture and attitudes towards clinical information systems should be taken into account when planning for their adoption.
Publisher: Elsevier BV
Date: 10-2021
Publisher: Elsevier BV
Date: 04-2016
DOI: 10.1016/J.IJNURSTU.2015.12.007
Abstract: High profile safety failures have demonstrated that recognising early warning signs of clinical and physiological deterioration can prevent or reduce harm resulting from serious adverse events. Early warning scoring systems are now routinely used in many places to detect and escalate deteriorating patients. Timely and accurate vital signs monitoring are critical for ensuring patient safety through providing data for early warning scoring systems, but little is known about current monitoring practices. To establish a profile of nurses' vital signs monitoring practices, related dialogue, and adherence to health service protocol in New South Wales, Australia. Direct observations of nurses' working practices were conducted in two wards. The observations focused on times of the day when vital signs were generally measured. Patient interactions were recorded if occurring any time during the observation periods. Participants (n=42) included nursing staff on one chronic disease medical and one acute surgical ward in a large urban teaching hospital in New South Wales. We observed 441 patient interactions. Measurement of vital signs occurred in 52% of interactions. The minimum five vital signs measures required by New South Wales Health policy were taken in only 6-21% of instances of vital signs monitoring. Vital signs were documented immediately on 93% of vitals-taking occasions and documented according to the policy in the patient's chart on 89% of these occasions. Nurse-patient interactions were initiated for the purpose of taking vital signs in 49% of interactions, with nurse-patient discourse observed during 88% of all interactions. Nurse-patient dialogue led to additional care being provided to patients in 12% of interactions. The selection of appropriate vital signs measured and responses to these appears to rely on nurses' clinical judgement or time availability rather than on policy-mandated frequency. The prevalence of incomplete sets of vital signs may limit identification of deteriorating patients. The findings from this study present an important baseline profile against which to evaluate the impact of introducing continuous monitoring approaches on current hospital practice.
Publisher: Oxford University Press (OUP)
Date: 22-03-2022
Abstract: The aim of accreditation is to improve quality of care and patient safety. However, studies on the effectiveness of accreditation on clinical outcomes are limited and inconsistent. Comparative studies have contrasted accredited with non-accredited hospitals or hospitals without a benchmark, but assessments of clinical outcomes of patients treated at hospitals undergoing accreditation are sparse. The Faroe Islands hospitals were accredited for the first time in 2017, making them an ideal place to study the impact of accreditation. We aimed to investigate the association between first-time hospital accreditation and length of stay (LOS), acute readmission (AR) and 30-day mortality in the unique situation of the Faroe Islands. We conducted a before and after study based on medical record reviews in relation to first-time accreditation. All three Faroese hospitals were voluntarily accredited using a modified second version of the Danish Healthcare Quality Programme encompassing 76 standards. We included inpatients 18 years or older treated at a Faroese hospital with one of six clinical conditions (stroke/transient ischemic attack (TIA), bleeding gastic ulcer, chronic obstructive pulmonary disease (COPD), childbirth, heart failure and hip fracture) in 2012-2013 designated 'before accreditation'or 2017-2018' after accreditation'. The main outcome measures were LOS, all-cause AR and all-cause 30-day mortality. We computed adjusted cause-specific hazard rate (HR) ratios using Cox Proportional Hazard regression with before accreditation as reference. The analyses were controlled for age, sex, cohabitant status, in-hospital rehabilitation, type of admission, diagnosis and cluster effect at patient and hospital levels. The mean LOS was 13.4 days [95% confidence interval (95% CI): 10.8, 15.9] before accreditation and 7.5 days (95% CI: 6.10, 8.89) after accreditation. LOS of patients hospitalized after accreditation was significantly shorter [overall, adjusted HR = 1.23 (95% CI: 1.04, 1.46)]. By medical condition, only women in childbirth had a significantly shorter LOS [adjusted HR = 1.30 (95% CI: 1.04, 1.62)]. In total, 12.3% of inpatients before and 9.5% after accreditation were readmitted acutely within 30 days of discharge, and 30-day mortality was 3.3% among inpatients before and 2.8% after accreditation, respectively. No associations were found overall or by medical condition for AR [overall, adjusted HR = 1.34 (95% CI: 0.82, 2.18)] or 30-day mortality [overall, adjusted HR = 1.33 (95% CI: 0.55, 3.21)]) after adjustment for potential confounding factors. First-time hospital accreditation in the Faroe Islands was associated with a significant reduction in LOS, especially of women in childbirth. Notably, shorter LOS was not followed by increased AR. There was no evidence that first-time accreditation lowered the risk of AR or 30-day mortality.
Publisher: BMJ
Date: 12-2016
Publisher: AMPCo
Date: 08-2018
DOI: 10.5694/MJA18.00390
Publisher: BMJ
Date: 08-04-2015
Publisher: Springer Science and Business Media LLC
Date: 10-08-2012
Publisher: Wiley
Date: 14-02-2022
DOI: 10.5694/MJA2.51424
Publisher: Hindawi Limited
Date: 26-10-2023
DOI: 10.1155/2023/7105751
Publisher: Elsevier BV
Date: 03-2022
Publisher: Springer Science and Business Media LLC
Date: 28-01-2021
DOI: 10.1038/S41525-020-00168-3
Abstract: In scaling up an ultra-rapid genomics program, we used implementation science principles to design and investigate influences on implementation and identify strategies required for sustainable “real-world” services. Interviews with key professionals revealed the importance of networks and relationship building, leadership, culture, and the relative advantage afforded by ultra-rapid genomics in the care of critically ill children. Although clinical geneticists focused on intervention characteristics and the fit with patient-centered care, intensivists emphasized the importance of access to knowledge, in particular from clinical geneticists. The relative advantage of ultra-rapid genomics and trust in consistent and transparent delivery were significant in creating engagement at initial implementation, with appropriate resourcing highlighted as important for longer term sustainability of implementation. Our findings demonstrate where common approaches can be used and, significantly, where there is a need to tailor support by professional role and implementation phase, to maximize the potential of ultra-rapid genomic testing to improve patient care.
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: Oxford University Press (OUP)
Date: 09-2018
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: Emerald
Date: 21-07-2021
DOI: 10.1108/JHOM-02-2021-0056
Abstract: As a discipline, health organisation and management is focused on health-specific, collective behaviours and activities, whose empirical and theoretical scholarship remains under-utilised in the field of implementation science. This under-engagement between fields potentially constrains the understanding of mechanisms influencing the implementation of evidence-based innovations in health care. The aim of this viewpoint article is to examine how a selection of theories, models and frameworks (theoretical approaches) have been applied to better understand phenomena at the micro, meso and macro systems levels for the implementation of health care innovations. The purpose of which is to illustrate the potential applicability and complementarity of embedding health organisation and management scholarship within the study of implementation science. The authors begin by introducing the two fields, before exploring how exemplary theories, models and frameworks have been applied to study the implementation of innovations in the health organisation and management literature. In this viewpoint article, the authors briefly reviewed a targeted collection of articles published in the Journal of Health Organization and Management (as a proxy for the broader literature) and identified the theories, models and frameworks they applied in implementation studies. The authors then present a more detailed exploration of three interdisciplinary theories and how they were applied across three different levels of health systems: normalization process theory (NPT) at the micro in idual and interpersonal level institutional logics at the meso organisational level and complexity theory at the macro policy level. These ex les are used to illustrate practical considerations when implementing change in health care organisations that can and have been used across various levels of the health system beyond these presented ex les. Within the Journal of Health Organization and Management , the authors identified 31 implementation articles, utilising 34 theories, models or frameworks published in the last five years. As an ex le of how theories, models and frameworks can be applied at the micro in idual and interpersonal levels, behavioural theories originating from psychology and sociology (e.g. NPT) were used to guide the selection of appropriate implementation strategies or explain implementation outcomes based on identified barriers and enablers to implementing innovations of interest. Projects aiming to implement change at the meso organisational level can learn from the application of theories such as institutional logics, which help elucidate how relationships at the macro and micro-level have a powerful influence on successful or unsuccessful organisational action. At the macro policy level, complexity theory represented a promising direction for implementation science by considering health care organisations as complex adaptive systems. This paper illustrates the utility of a range of theories, models and frameworks for implementation science, from a health organisation and management standpoint. The authors’ viewpoint article suggests that increased crossovers could contribute to strengthening both disciplines and our understanding of how to support the implementation of evidence-based innovations in health care.
Publisher: AMPCo
Date: 11-2012
DOI: 10.5694/MJA12.11210
Publisher: Elsevier BV
Date: 2010
Publisher: Royal College of General Practitioners
Date: 15-04-2020
DOI: 10.3399/BJGPOPEN20X101028
Abstract: In Australia, melanoma is managed in primary and secondary care settings. An in idual concerned about a suspicious lesion typically presents first to their GP. To identify factors influencing GPs’ decisions to diagnose, treat, or refer patients with suspected melanoma. Semi-structured interviews were undertaken with 23 GPs working in general practice or skin cancer clinics in Australia. The semi-structured interviews were audio-recorded, de-identified, and professionally transcribed. Thematic analysis was used to analyse the data. Considerable variation existed in GPs’ self-reported confidence and involvement in melanoma management. Multiple factors were identified as influencing GPs’ decisions to diagnose, treat, or refer patients with suspected or confirmed melanoma. Health system level factors included the overlapping roles of GPs and specialists, and access to and/or availability of specialists. Practice level factors included opportunities for formal and informal training, and having a GP with a special interest in skin cancer within their practice. GP and patient level factors included the GP’s clinical interests, the clinical features (for ex le, site and size) and histopathology of the suspected melanoma, eligibility for possible sentinel lymph node biopsy, and patient preferences. For some GPs, concerns over misdiagnosis and the option of referring patients at any stage in the melanoma management continuum appeared to affect their interest and confidence in melanoma management. GP involvement in melanoma patient care can extend well beyond cancer screening, prevention and supportive care roles to include provision of definitive melanoma patient management. GPs with an interest in being involved in melanoma management should be encouraged and supported to develop the skills needed to manage these patients, and to refer when appropriate.
Publisher: Oxford University Press (OUP)
Date: 12-2010
Publisher: BMJ
Date: 12-01-2011
DOI: 10.1136/BMJQS.2010.044545
Abstract: Quality and safety improvement programmes advance the standard of care delivered by health organisations but have been shown to be less effective than anticipated. Implementing improvement programmes require a greater understanding of the impact of the social context and strategies that engage staff. To investigate factors that shaped the development of interprofessional improvement initiatives in a health organisation. Data are drawn from a large-scale longitudinal action research study examining interprofessional learning and practice. The setting is an autonomous bounded health jurisdiction in Australia. Within the study, health professionals have conceptualised more than 111 interprofessional improvement projects, of which 76 have evolved into ongoing activities. Textual data were analysed using emergent coding and descriptive statistics. Initiatives were shaped by six determinants: site receptivity team issues leadership impact on healthcare relations impact on quality and safety issues and extent to which the projects became institutionally embedded. Initiatives that engaged participants and progressed were characterised by and displayed flexible leadership, and ongoing refinement and maturity over time. The local organisational context and initiatives coevolved. Improvement initiatives are necessary for improved quality of care and patient safety but are difficult to implement and sustain. The factors identified to develop them are constantly under challenge in health services. Improving healthcare quality will, in part, depend upon the ability to provide more flexible and supportive social contexts.
Publisher: Wiley
Date: 05-05-2021
DOI: 10.1111/JEP.13573
Abstract: Teamworking across sociotechnical boundaries in healthcare is growing as technological advances in medicine abound. With this progress, teams need to find new ways of working together in non‐traditional settings. The novel field of clinical genomics provides the opportunity to rethink the existing approach to teamworking and how it needs to evolve. Our aim was to identify the key factors influencing teamworking in the emerging field of clinical genomics and how can they be applied in practice. We drew on three qualitative datasets from interviews undertaken in Australia, 2018/2019, that explored determinants of implementation of clinical genomics with laboratory scientists ( n = 7), service and programme leads ( n = 21), project officers ( n = 2), clinical genetics staff ( n = 26) and other medical specialists ( n = 21). Data were analysed using a theory‐informed matrix approach to identify themes related to teamworking. We identify that teams in clinical genomics work in an elongated adaptive context where there is rapid evolution of the knowledge base, shifting expectations of staff roles, and fast changes of technology. Delivering care in this setting brings additional challenges to teamworking as members strive to stay abreast of current knowledge and technology. We identify four themes: (a) the role of the team in keeping knowledge up‐to‐date (b) professional identity (c) team adaptability, and (d) practical/organisational considerations. Challenges to teamworking that arise in the elongated adaptive context do not always fit traditional ways of working, and innovative strategies will need to be adopted to ensure the diagnostic advances of clinical genomics are realised. Provision of time and permission for team members to share knowledge and evolve, promoting capacity building, nurturing trustful relationships and establishing boundaries are amongst the practice recommendations for organisational and team leaders, even though these activities may disrupt existing ways of working or hierarchical structures.
Publisher: BMJ
Date: 03-2016
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: Springer Science and Business Media LLC
Date: 09-08-2021
DOI: 10.1186/S13104-021-05724-3
Abstract: There have been few descriptions of how outpatient cancer care is provided to patients from culturally and linguistically erse (CALD) communities. As populations who experience disparities in cancer care access and outcomes, deeper understanding is needed to help identify those factors which can shape the receipt of multidisciplinary care in ambulatory settings. This paper reports on data collected and analysed as part of a multicentre characterisation of care in Australian public hospital cancer outpatient clinics (OPCs). Analysis of data from our ethnographic study of four OPCs identified three themes: “Identifying CALD patient language-related needs” “Capacity and resources to meet CALD patient needs”, and “Making it work for CALD communities.” The care team comprises not only clinicians but also families and non-clinical staff OPCs serve as “touchpoints” facilitating access to a range of therapeutic services. The findings highlight the potential challenges oncology professionals negotiate in providing care to CALD communities and the ways in which clinicians adapt their practices, formulate strategies and use available resources to support care delivery.
Publisher: Springer Science and Business Media LLC
Date: 30-04-2013
Publisher: BMJ
Date: 06-2022
DOI: 10.1136/BMJOPEN-2021-059829
Abstract: Australia has the highest incidence of skin cancer in the world, with two out of three Australians expected to be diagnosed with skin cancer in their lifetime. Such incidence necessitates large-scale, effective skin cancer management practices. General practitioners (in mainstream practice and in skin cancer clinics) play an important role in skin cancer care provision, making decisions based on relevant evidence-based guidelines, protocols, experience and training. Diversity in these decision-making practices can result in unwarranted variation. Quality indicators are frequently implemented in healthcare contexts to measure performance quality at the level of the clinician and healthcare practice and mitigate unwarranted variation. Such measurements can facilitate performance comparisons between peers and a standard benchmark, often resulting in improved processes and outcomes. A standardised set of quality indicators is yet to be developed in the context of primary care skin cancer management. This research aims to identify, develop and generate expert consensus on a core set of quality indicators for skin cancer management in primary care. This mixed-methods study involves (1) a scoping review of the available evidence on quality indicators in skin cancer management in primary care, (2) identification and development of a core set of quality indicators through interviews/qualitative proforma surveys with participants, and (3) a focus group involving discussion of quality indicators according to Nominal Group Technique. Qualitative and quantitative data will be collected and analysed using thematic and descriptive statistical analytical methods. Approval was granted by the university’s Research Ethics Committee (HREC no. 520211051532420). Results from this study will be widely disseminated in publications, study presentations, educational events and reports.
Publisher: JMIR Publications Inc.
Date: 03-05-2021
Abstract: merging adulthood is a distinct segment of an in idual’s life course. The defining features of this transitional period include identity exploration, instability, future possibilities, self-focus, and feeling in-between, all of which are thought to affect quality of life, health, and well-being. A longitudinal cohort study with a comprehensive set of measures would be a valuable resource for improving the understanding of the multifaceted elements and unique challenges that contribute to the health and well-being of emerging adults. he main aim of this pilot study was to evaluate the feasibility and acceptability of recruiting university graduates to establish a longitudinal cohort study to inform the understanding of emerging adulthood. his pilot study was conducted among graduates at a large university. It involved collecting web-based survey data at baseline (ie, graduation) and 12 months post baseline, and linking survey responses to health records from administrative data collections. The feasibility outcome measures of interest included the recruitment rate, response rate, retention rate, data linkage opt-out rate, and availability of linked health records. Descriptive statistics were used to evaluate the representativeness of the s le, completeness of the survey responses, and data linkage characteristics. nly 2.8% of invited graduates (238/8532) agreed to participate in this pilot cohort study, of whom 59.7% (142/238) responded to the baseline survey. The retention rate between the baseline and follow-up surveys was 69.7% (99/142). The completeness of the surveys was excellent, with the proportion of answered questions in each survey domain ranging from 87.3% to 100% in both the baseline and follow-up surveys. The data linkage opt-out rate was 32.4% (77/238). he overall recruitment rate was poor, while the completeness of survey responses among respondents ranged from good to excellent. There was reasonable acceptability for conducting data linkage of health records from administrative data collections and survey responses. This pilot study offers insights and recommendations for future research aiming to establish a longitudinal cohort study to investigate health and well-being in emerging adults. ustralian New Zealand Clinical Trials Registry number ACTRN12618001364268 eec8wh R2-10.2196/16108
Publisher: BMJ
Date: 09-2015
Publisher: Oxford University Press (OUP)
Date: 10-2021
Abstract: Hip fracture is a major public health concern for older adults, requiring surgical treatment for patients presenting at hospitals across Australia. Although guidelines have been developed to drive appropriate care of hip fracture patients in hospitals, data on health outcomes suggest these are not well-followed. This study aims to examine whether clinician measures of safety, teamwork and leadership, and patient perceptions of care are associated with key indicators of hip fracture care and the extent to which there is agreement between clinician perceptions of hip fracture care performance and actual hospital performance of hip fracture care. Retrospective analysis was performed on a series of questionnaires used to assess hospital department- and patient-level measures from the Deepening our Understanding of Quality in Australia study. Data were analysed from 32 public hospitals that encompassed 23 leading hip fracture clinicians, 716 patient medical records and 857 patients from orthopaedic public hospital wards. Aggregated across all hospitals, only 5 of 12 of the key hip fracture indicators had ≥50% adherence. Adherence to indicators requiring actions to be performed within a recommended time period was poor (7.2-25.6%). No Patient Measure of Safety or clinician-based measures of teamwork, safety climate or leadership were associated with adherence to key indicators of hip fracture care. Simple proportionate agreement between clinician perceptions and actual hospital performance was generally strong, but few agreement coefficients were compelling. The development of strong quality management processes requires ongoing effort. The findings of this study provide important insights into the relationship between hospital care and outcomes for hip fracture patients and could drive the design of targeted interventions for improved quality assurance of hip fracture care.
Publisher: Wiley
Date: 24-06-2021
DOI: 10.1111/IMJ.15172
Abstract: With 50% of Australians having chronic disease, health consumer views are an important barometer of the ‘health’ of the healthcare system for system improvement and sustainability. To describe the views of Australian health consumers with and without chronic conditions when accessing healthcare. A survey of a representative s le of 1024 Australians aged over 18 years, distributed electronically and incorporating standardised questions and questions co‐designed with consumers. Respondents were aged 18–88 years (432 males, 592 females) representing all states and territories, and rural and urban locations. General practices (84.6%), pharmacies (62.1%) and public hospitals (32.9%) were the most frequently accessed services. Most care was received through face‐to‐face consultations only 16.5% of respondents accessed care via telehealth. The 605 (59.0%) respondents with chronic conditions were less likely to have private health insurance (50.3% vs 57.9%), more likely to skip doses of prescribed medicines (53.6% vs 28.6%), and miss appointments with doctors (15.3% vs 10.1%) or dentists (52.8% vs 40.4%) because of cost. Among 480 respondents without private health insurance, unaffordability (73.5%) or poor value for money (35.3%) were the most common reasons. Most respondents (87.7%) were confident that they would receive high quality and safe care. However, only 57% of people with chronic conditions were confident that they could afford needed healthcare compared with 71.3% without. Health consumers, especially those with chronic conditions, identified significant cost barriers to access of healthcare. Equitable access to healthcare must be at the centre of health reform.
Publisher: Springer Science and Business Media LLC
Date: 29-04-2013
Publisher: Elsevier BV
Date: 02-2007
DOI: 10.1016/J.IJMEDINF.2006.03.006
Abstract: Online evidence retrieval systems are a potential tool in supporting evidence-based practice. Effective and tested techniques for assessing the impact of these systems on care delivery and patient outcomes are limited. In this study we applied the critical incident (CI) and journey mapping (JM) techniques to assess the integration of an online evidence system into everyday clinical practice and its impact on decision making and patient care. To elicit incidents semi-structured interviews were conducted with 29 clinicians (13 hospital physician specialists, 16 clinical nurse consultants (CNCs)) who were experienced users of the online evidence system. Clinicians were also asked questions about how they had first used the system and how their use and experiences had changed over time. These narrative accounts were then mapped and scored using the journey mapping technique. Clinicians generated 85 critical incidents. Three categories of impact were identified: impact on clinical practice, impact on in idual clinicians and impact on colleagues through the dissemination of information gained from the online evidence system. One quarter of these included specific ex les of system use leading to improvements in patient care. Clinicians obtained an average journey mapping score of 22 out of a possible score of 36, demonstrating a good level of system integration. Average scores of doctors and CNCs were similar. However in iduals with the same scores often had very different journeys in system integration. The CI technique provided clear ex les of the way in which system use had influenced practice and care delivery. The JM technique was found to be a useful method for providing a quantification of the different ways and extent to which, clinicians had integrated system use into practice, and insights into how system use can influence organisational culture. The development of the journey mapping stages provides a structure by which the program logic of a clinical information system and its desired outcomes can be made explicit and be based upon users' experiences in everyday practice. Further work is required using this technique to assess its value as an evaluation method.
Publisher: BMJ
Date: 23-09-2014
Publisher: BMJ
Date: 30-01-2014
DOI: 10.1136/BMJQS-2013-002405
Abstract: Clinical networks have been designed as a cross-organisational mechanism to plan and deliver health services. With recent concerns about the effectiveness of these structures, it is timely to consider an evidence-informed approach for how they can be developed and evaluated. To document an evaluation framework for clinical networks by drawing on the network evaluation literature and a 5-year study of clinical networks. We searched literature in three domains: network evaluation, factors that aid or inhibit network development, and on robust methods to measure network characteristics. This material was used to build a framework required for effective developmental evaluation. The framework's architecture identifies three stages of clinical network development partner selection, network design and network management. Within each stage is evidence about factors that act as facilitators and barriers to network growth. These factors can be used to measure progress via appropriate methods and tools. The framework can provide for network growth and support informed decisions about progress. For the first time in one place a framework incorporating rigorous methods and tools can identify factors known to affect the development of clinical networks. The target user group is internal stakeholders who need to conduct developmental evaluation to inform key decisions along their network's developmental pathway.
Publisher: Emerald
Date: 15-02-2021
DOI: 10.1108/JHOM-06-2020-0256
Abstract: Hospitals are constantly redeveloping to improve functioning and modernise the delivery of safe and high-quality care. In Australia, it is expected that different stakeholders have the opportunity to contribute to the design and planning of hospital redevelopment projects. The purpose of this study is to examine the potential for misalignment between policy (“work as imagined”) and staff experiences of a hospital redevelopment (“work as done”). A case study of a large Australian hospital in a capital city undergoing redevelopment. Forty-six semi-structured interviews were conducted with hospital staff. Staff experiences were identified in corroboration with additional data: key-informant discussions with members of the hospital executive document analysis (e.g. hospital and government documents) and survey responses about experiences of the hospital redevelopment. A disjuncture was identified between policy and the experiences of hospital staff. Over one in every three (36.0%) staff felt uninformed about the redevelopment and 79.4% were not involved in decisions throughout the process of design and redevelopment, which contradicted the procedure laid out in policy for hospital development. Despite the seemingly “good news story” of allocating billions of dollars to redeveloping and modernising health services in Australia, the experiences of staff on the front lines suggest a lack of consultation. Rectifying these concerns may be integral to avoid fragmentation during the challenging circumstances of hospital redevelopment.
Publisher: BMJ
Date: 02-04-2019
DOI: 10.1136/BMJQS-2018-009028
Abstract: Bronchiolitis is the most common cause of respiratory hospitalisation in children aged years. Clinical practice guidelines (CPGs) suggest only supportive management of bronchiolitis. However, the availability of CPGs do not guarantee that they are used appropriately and marked variation in the clinical management exists. We conducted an assessment of guideline adherence in the management of bronchiolitis in children at a subnationally representative level including inpatient and ambulatory services in Australia. We searched for national and international CPGs relating to management of bronchiolitis in children and identified 16 recommendations which were formatted into 40 medical record audit indicator questions. A retrospective medical record review assessing compliance with the CPGs was conducted across three types of healthcare setting: hospital inpatient admissions, emergency department (ED) presentations and general practice (GP) consultations in three Australian states for children aged years receiving care in 2012 and 2013. Purpose-trained surveyors conducted 13 979 eligible indicator assessments across 796 visits for bronchiolitis at 119 sites. Guideline adherence for management of bronchiolitis was 77.3% (95% CI 72.6 to 81.5) for children attending EDs, 81.6% (95% CI 78.0 to 84.9) for inpatients and 52.3% (95% CI 44.8 to 59.7) for children attending GP consultations. While adherence to some in idual indicators was high, overall adherence to documentation of 10 indicators relating to history taking and examination was poorest and estimated at 2.7% (95% CI 1.5 to 4.4). The study is the first to assess guideline-adherence in both hospital (ED and inpatient) and GP settings. Our study demonstrated that while the quality of care for bronchiolitis was generally adherent to CPG indicators, specific aspects of management were deficient, especially documentation of history taking.
Publisher: Springer Science and Business Media LLC
Date: 12-02-2014
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: CRC Press
Date: 02-03-2017
Publisher: Wiley
Date: 10-01-2019
DOI: 10.1111/JEP.13100
Abstract: The field of implementation science has developed in response to slow and inconsistent translation of evidence into practice. Despite utilizing increasingly sophisticated approaches to implementation, including applying a complexity science lens and conducting realist evaluations, challenges remain to getting the kinds of outcomes hoped for by implementation efforts. These include gaining access and buy-in from those implementing the change and accounting for the influence of local context. One emerging approach to address these challenges is embedded implementation research-a collaborative, adaptive approach to improvement. It involves researchers and implementers working together in situ from the outset of, and throughout, an implementation project. Both groups can benefit from the collaboration: it increases the rigor of evaluation, provides opportunities to improve the intervention through direct feedback, and promotes better on-the-ground understanding of the change process. We aimed to examine the potential benefits, and some of the challenges, of increased embeddedness. We performed a multi-case analysis of implementation research projects that varied by degree of embeddedness. Embedded implementation research may offer a range of advantages over dichotomized research-practice designs, including better understanding of local context and direct feedback to improve the implementation along the way. We present a model that spans four approaches: dichotomized research-practice, collaborative linking-up, partially-embedded, and deep immersion. Embedded implementation research approaches hold promise in comparison to traditional dichotomized-research practice designs, where the research is external to the implementation and conducts a summative evaluation. We are only beginning to understand how such partnerships operate in practice and what makes them successful. Our analysis suggests the time has come to consider such approaches.
Publisher: CRC Press
Date: 03-10-2016
Publisher: Maad Rayan Publishing Company
Date: 21-11-2018
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: BMJ
Date: 08-04-2010
Abstract: Cross-fertilisation of ideas across industries, settings and contexts potentially improves learning by providing fresh insights into error pathways. OBJECTIVES AND HYPOTHESES: To investigate six cases of human error drawn from disasters in the space, shipping, aviation, mining, rail and nuclear industries, and to apprehend similarities and differences in the antecedents to errors, the way they manifest, the course of events and the way they are tackled. The extent to which human intervention can exacerbate the problems by introducing new errors, how the cases are resolved and the lessons learnt were examined. Exemplar disaster events drawn from a very large s le of human errors. It is possible to identify and model a generic disaster pathway that applies across several industries, including healthcare. Despite differences between industries, it is clear that learning from disasters in other industries may provide important insights on how to prevent or ameliorate them in healthcare.
Publisher: SAGE Publications
Date: 08-2004
Abstract: Widespread implementation of clinical directorates (CDs) has displaced traditional structures of hospitals over the past 20 years. Responses range from support for involving clinicians in organizational processes along with the associated managerial benefits, to criticism that foreshadows potential negative effects and warns that CDs will not of themselves resolve embedded health sector problems. There is limited empirical evidence about the transition and the views of staff toward CDs. To investigate staff attitudes, a questionnaire was developed and administered in a survey of 107 staff in a large hospital that had introduced CDs three years previously. Attitudes were assessed in terms of their intensity, polarity, uncertainty and positivism toward CDs. Managers and other staff held similar attitudes on 66% of questionnaire items. Significant differences were found in the remaining one-third of items. Managers were positive about CDs, whereas non-managers' approval was limited and muted. Managers' attitudes were more intense, less uncertain and less polarized than were non-managers'. They differed primarily in the areas of working relations and power. Over recent years, CDs seem to have become institutionalized and investigations into their operation have declined. Our results suggest that taking the benefits of CDs for granted is premature.
Publisher: MDPI AG
Date: 04-06-2020
Abstract: The purpose of this study is to investigate the role of the combination of transformational leadership and social capital in safety capacity building. Drawing on the A-G-I-L concept of Talcott Parsons, we test a model for patient safety. The hypothesis is, that good safety management needs a combination of goal attainment (G) and integration (I), here called the GI factor. We tested this hypothesis by using transformational leadership as a surrogate for goal attainment and social capital as a surrogate for integration in a study of the perceptions of chief medical officers in 551 German hospitals. We conducted a cross-sectional hospital survey combined with secondary data analysis in all German hospitals with at least one internal medicine unit and one surgery unit (N = 1224 hospitals) in the year 2008 with a response rate of 45% (N = 551). The regression model explained 17.9% of the variance in perceived clinical risk management. We found that if both requirements for goal-oriented collective action—transformational leadership and social capital—are met, good safety management is more likely. The tentative conclusion is that it takes transformative leaders and cohesive followers together as a social basis to improve safety in hospitals.
Publisher: Springer Science and Business Media LLC
Date: 12-2020
DOI: 10.1186/S12913-020-05974-0
Abstract: Broken windows theory (BWT) proposes that visible signs of crime, disorder and anti-social behaviour – however minor – lead to further levels of crime, disorder and anti-social behaviour. While we acknowledge isive and controversial policy developments that were based on BWT, theories of neighbourhood disorder have recently been proposed to have utility in healthcare, emphasising the potential negative effects of disorder on staff and patients, as well as the potential role of collective efficacy in mediating its effects. The aim of this study was to empirically examine the relationship between disorder, collective efficacy and outcome measures in hospital settings. We additionally sought to develop and validate a survey instrument for assessing BWT in hospital settings. Cross-sectional survey of clinical and non-clinical staff from four major hospitals in Australia. The survey included the Disorder and Collective Efficacy Survey (DaCEs) (developed for the present study) and outcome measures: job satisfaction, burnout, and patient safety. Construct validity was evaluated by confirmatory factor analysis (CFA) and reliability was assessed by internal consistency. Structural equation modelling (SEM) was used to test a hypothesised model between disorder and patient safety and staff outcomes. The present study found that both social and physical disorder were positively related to burnout, and negatively related to job satisfaction and patient safety. Further, we found support for the hypothesis that the relationship from social disorder to outcomes (burnout, job satisfaction, patient safety) was mediated by collective efficacy (social cohesion, willingness to intervene). As one of the first studies to empirically test theories of neighbourhood disorder in healthcare, we found that a positive, orderly, productive culture is likely to lead to wellbeing for staff and the delivery of safer care for patients.
Publisher: Springer Science and Business Media LLC
Date: 12-2005
DOI: 10.1007/S10728-005-8128-Y
Abstract: Within the context of structural theories this paper examines what health professionals say about their clinical service structures. We firstly trace various conceptual perspectives on clinical service structures, discussing multiple theoretical axes. These theories question whether clinical service structures represent either superficial or more profound changes in hospitals. We secondly explore which view is supported though a content analysis of the free text responses of 111 health professionals (44 doctors, 45 nurses and 22 allied health practitioners) about their clinical service structures in a questionnaire survey in two large hospitals that had implemented clinical service structures three years previously. Commentaries unfavourable toward clinical service structures were made by 47.7% of staff, favourable by 24.3%, mixed (both favourable and unfavourable) by 17.1% and non-evaluative statements were made by 10.8%. The most frequent criticisms were inefficient organisation of change (27%), poor management (24.3%), lack of cooperation between staff (15.9%) and failure to empower health practitioners (13.5%). All professions made more negative than positive evaluations of their clinical service structures but the ratio was highest for doctors and lowest for allied health. Ranking of nurses' and allied health staffs' specific evaluations were similar but both differed significantly from doctors'. Unfavourable or negative comments predominated, and change appears more superficial and less profound than advocates of structural contributions hope. Four types of belief systems about clinical service structures are apparent. Some study participants are disposed toward the status quo others toward restructuring yet others are team oriented and a final group is tribally oriented. The implication of this paper for managers is that more work is needed if clinical service structures are to realise the promise of more multi-disciplinarity and less fragmentation across professional groups. For scholars, the implication is that marrying different theoretical frames with empirical data can serve to produce fresh perspectives and perhaps new insights.
Publisher: Elsevier BV
Date: 03-2023
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1016/J.SOCSCIMED.2012.06.024
Abstract: Participatory action research is lauded for its emancipatory potential and practice relevance. Little research has focused on the ethical and political dimensions of power relations between management gatekeepers and staff in large organizations in the negotiation of action research. To illuminate the dynamics of this engagement, this paper is informed by Aristotle's practical ethics of phronesis, arguing that ethics emerge through human interaction. The paper reports on a multi-method study and intervention in inter-professional learning and collaboration, conducted between 2008 and 2010, across an Australian health system. It draws on results from researchers' progress notes, 139 semi-structured interviews and focus groups (492 participants), more than 200 h of organizational document analysis, and more than 200 h of ethnographic observation. From conventional thematic analysis, we note that the project had considerable support from senior managers who were gatekeepers for the research. Such support stemmed from managerialist tendencies, with senior managers explicitly aligning inter-professionalism with prospective health reforms and improvements to quality of care and patient safety. Senior managers were also enthusiastic about standardized processes. Many frontline staff were less supportive, and some were suspicious of or hostile towards management-led processes to improve and evaluate care. Some senior managers' self perceived alignment with and support for the research process changed to resistance once this finding was presented. This paradox in the interplay of research findings and research process evinces the inherent tension between organizational politics and conducting action research that reflexive researchers need to negotiate in knowledge translation, exchange or mobilization exercises.
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: Wiley
Date: 22-03-2023
DOI: 10.1111/IMJ.16052
Abstract: In Australia, 243 000 in iduals live in approximately 2700 residential aged care facilities yearly. In 2019, a National Aged Care Mandatory Quality Indicator programme (QI programme) was implemented to monitor the quality and safety of care in facilities. To examine the validity of the QI programme indicators using explicit measure review criteria. The QI programme manual and reports were reviewed. A modified American College of Physicians Measure Review Criteria was employed to examine the QI programme's eight indicators. Five authors rated each indicator on importance, appropriateness, clinical evidence, specifications and feasibility using a nine‐point scale. A median score of 1–3 was considered to not meet criteria, 4–6 to meet some criteria and 7–9 to meet criteria. All indicators, except polypharmacy, met criteria (median scores = 7–9) for importance, appropriateness and clinical evidence. Polypharmacy met some criteria for importance (median = 6, range 2–8), appropriateness (median = 5, range 2–8) and clinical evidence (median = 6, range 3–8). Pressure injury, physical restraints, significant unplanned weight loss, consecutive unplanned weight loss, falls and polypharmacy indicators met some criteria for specifications validity (all median scores = 5) and feasibility and applicability (median scores = 4 to 6). Antipsychotic use and falls resulting in major injury met some criteria for specifications (median = 6–7, range 4–8) and met criteria for feasibility and applicability (median = 7, range 4–8). Australia's National QI programme is a major stride towards a culture of quality promotion, improvement and transparency. Measures' specifications, feasibility and applicability could be improved to ensure the programme delivers on its intended purposes.
Publisher: Oxford University Press (OUP)
Date: 04-2022
Abstract: People who live in aged care homes have high rates of illness and frailty. Providing evidence-based care to this population is vital to ensure the highest possible quality of life. In this study (CareTrack Aged, CT Aged), we aimed to develop a comprehensive set of clinical indicators for guideline-adherent, appropriate care of commonly managed conditions and processes in aged care. Indicators were formulated from recommendations found through systematic searches of Australian and international clinical practice guidelines (CPGs). Experts reviewed the indicators using a multiround modified Delphi process to develop a consensus on what constitutes appropriate care. From 139 CPGs, 5609 recommendations were used to draft 630 indicators. Clinical experts (n = 41) reviewed the indicators over two rounds. A final set of 236 indicators resulted, mapped to 16 conditions and processes of care. The conditions and processes were admission assessment bladder and bowel problems cognitive impairment depression dysphagia and aspiration end of life alliative care hearing and vision infection medication mobility and falls nutrition and hydration oral and dental care pain restraint use skin integrity and sleep. The suite of CT Aged clinical indicators can be used for research and assessment of the quality of care in in idual facilities and across organizations to guide improvement and to supplement regulation or accreditation of the aged care sector. They are a step forward for Australian and international aged care sectors, helping to improve transparency so that the level of care delivered to aged care consumers can be rigorously monitored and continuously improved.
Publisher: Springer Science and Business Media LLC
Date: 11-10-2013
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: 09-2022
DOI: 10.1136/BMJOPEN-2022-065320
Abstract: Safety culture questionnaires are widely used in healthcare to understand how staff feel at work, their attitudes and views, and the influence this has on safe and high-quality patient care. A known challenge of safety culture questionnaires is achieving high response rates to enhance reliability and validity. This review examines predictors of response rates, explores reasons provided for low response rates and identifies strategies to improve those rates. Four bibliometric databases were searched for studies assessing safety culture in hospitals from January 2008 to May 2022. Data were extracted from 893 studies that included a safety culture questionnaire conducted in the hospital setting. Regression was used to predict response rate based on recruitment and data collection methods (incentives, reminders, method of survey administration) and country income classification. Reasons for low response were thematically analysed and used to identify strategies to improve response rates. Of the 893 studies that used a questionnaire to assess safety culture in hospitals, 75.6% reported a response rate. Response rates varied from 4.2% to 100%, with a mean response rate of 66.5% (SD=21.0). Regression analyses showed that safety culture questionnaires conducted in low-income and middle-income countries were significantly more likely to yield a higher response rate compared with high-income countries. Mode of administration, questionnaire length and timing of administration were identified as key factors. Remote methods of questionnaire data collection (electronic and by post) were significantly less likely to result in a higher response rate. Reasons provided for low response included: survey fatigue, time constraints, and lack of resources. This review presents strategies for researchers and hospital staff to implement when conducting safety culture questionnaires: principally, distribute questionnaires in-person, during meetings or team training sessions use a local ch ion and consider the appropriate time of distribution to manage survey fatigue.
Publisher: MDPI AG
Date: 28-10-2022
DOI: 10.3390/JPM12111781
Abstract: Reproductive genetic carrier screening (RGCS) provides people with information about their chance of having children with autosomal recessive or X-linked genetic conditions, enabling informed reproductive decision-making. RGCS is recommended to be offered to all couples during preconception or in early pregnancy. However, cost and a lack of awareness may prevent access. To address this, the Australian Government funded Mackenzie’s Mission—the Australian Reproductive Genetic Carrier Screening Project. Mackenzie’s Mission aims to assess the acceptability and feasibility of an easily accessible RGCS program, provided free of charge to the participant. In study Phase 1, implementation needs were mapped, and key study elements were developed. In Phase 2, RGCS is being offered by healthcare providers educated by the study team. Reproductive couples who provide consent are screened for over 1200 genes associated with serious, childhood-onset genetic conditions. Those with an increased chance result are provided comprehensive genetic counseling support. Reproductive couples, recruiting healthcare providers, and study team members are also invited to complete surveys and/or interviews. In Phase 3, a mixed-methods analysis will be undertaken to assess the program outcomes, psychosocial implications and implementation considerations alongside an ongoing bioethical analysis and a health economic evaluation. Findings will inform the implementation of an ethically robust RGCS program.
Publisher: Oxford University Press (OUP)
Date: 29-10-2010
DOI: 10.1136/PGMJ.2008.030148REP
Abstract: Cross-fertilisation of ideas across industries, settings and contexts potentially improves learning by providing fresh insights into error pathways. To investigate six cases of human error drawn from disasters in the space, shipping, aviation, mining, rail and nuclear industries, and to apprehend similarities and differences in the antecedents to errors, the way they manifest, the course of events and the way they are tackled. The extent to which human intervention can exacerbate the problems by introducing new errors, how the cases are resolved and the lessons learnt were examined. Exemplar disaster events drawn from a very large s le of human errors. It is possible to identify and model a generic disaster pathway that applies across several industries, including healthcare. Despite differences between industries, it is clear that learning from disasters in other industries may provide important insights on how to prevent or ameliorate them in healthcare.
Publisher: Oxford University Press (OUP)
Date: 13-08-2010
Abstract: Healthcare accreditation has grown rapidly since the 1980s but critics question the value of accreditation rather than certification or inspection. Research has focused more on evidence of impact on provider institutions than on health systems little has been published on the determinants of growth or decline of accreditation organizations and programmes. To describe the development of national accreditation organizations in Europe in relation to incentives, funding and market position in 2009 to identify trends over time using data from previous surveys. Contacts in 24 countries, identified by previous surveys, were invited to complete a web-based questionnaire comprising 183 items seeking numerical data or posing multiple choice options. Preliminary results were verified with respondents and agreed for publication. National healthcare environment, incentives, government policy, legislation, regulation programme governance, development, funding. The survey identified 18 active national accreditation organizations in Europe. Older ones tend to be independent, profession-dominated and self-financing they have shown little growth in activity and coverage of the potential market. Newer ones have broad stakeholder governance, support from government policy and growth sustained by legal or financial incentives-giving wide coverage across the healthcare system. The traditional collegial model of accreditation is moving towards a semi-regulatory model of external assessment which could integrate minimal standards of licensing, public safety and accountability with aspirational standards for organizational development and improvement. The principal challenges to sustainable accreditation appear to be market size, consistency of policy support, programme funding and financial incentives for participation.
Publisher: Elsevier BV
Date: 06-2018
DOI: 10.1016/J.YEBEH.2018.03.028
Abstract: Adult patients with refractory epilepsy who are potential candidates for resective surgery undergo a period of presurgical investigation in tertiary epilepsy centers (TECs), where they engage extensively with healthcare professionals and receive a range of treatment-related information. This qualitative study aimed to examine the experiences of adult patients with refractory epilepsy leading up to and during presurgical investigation and how their perceptions of resective surgery are shaped. In-depth interviews with 12 patients and six epilepsy specialist clinicians and 12 observations of routine patient-clinician consultations took place at two TECs in Sydney, Australia. Data were thematically analyzed via group work. Patients reflected on prior experiences of poor seizure control and inadequate antiepileptic drug management and a lack of clarity about their condition before referral to tertiary care. Poor continuity of care and disrupted care transitions affected patients from regional locations. Tertiary referral increased engagement with personalized information about refractory epilepsy, which intensified during presurgical assessments with additional hospital visits and consultations. Experiential information, such as testimonials of other patients, influenced perceptions of surgery and fostered more trust and confidence towards healthcare professionals. Qualitative inquiry detailed multifaceted effects of information on patients' overall treatment trajectory and experience of healthcare. Earlier patient identification for surgical assessments should be accompanied by access to good quality information at primary and community care levels and strengthened referral processes.
Publisher: SAGE Publications
Date: 30-01-2014
Abstract: Empirical studies of community participation in health services commonly tie effectiveness to the perceived legitimacy of community representatives among health staff. This article examines the underlying assumption that legitimacy is the major pathway to influence for community representatives. It takes a different vantage point from previous research in its examination of data (primarily through 34 in-depth interviews, observation and recording of 26 meetings and other interactions documented in field notes) from a 3-year study of community representatives’ action in a large health region in Australia. The analysis primarily deploys Michel de Certeau’s ideas of Strategy and Tactic to understand the action and effects of the generally ‘weaker players’ in the spaces and places dominated by powerful institutions. Through this lens, we can see the points where community representatives are active participants following their own agenda, tactically capitalising on cracks in the armour of the health service to seize opportunities that present themselves in time to effect change. Being able to see community representatives as active producers of change, not simply passengers following the path of the health service, challenges how we view the success of community participation in health.
Publisher: Springer Science and Business Media LLC
Date: 14-08-2023
DOI: 10.1186/S12913-023-09857-Y
Abstract: Evidence suggests that the culture of healthcare organisations, including residential aged care facilities (RACFs), is linked to the quality of care offered. The number of people living in RACFs has increased globally, and in turn, attention has been placed on care quality. This review aimed to identify how organisational culture is studied, sought to elucidate the results of previous studies, and aimed to establish what interventions are being used to improve organisational culture in RACFs. We employed an integrative review design to provide a comprehensive understanding of organisational culture. Five academic data bases were searched (Ovid Medline, Scopus, PsycInfo, CINAHL, Embase). Articles were included if they were empirical studies, published in peer reviewed journals in English, conducted in a RACF setting, and were focused on organisational culture/climate. Ninety-two articles were included. Fifty-nine studies (64.1%) utilised a quantitative approach, while 24 (26.0%) were qualitative, and nine used mixed methods (9.8%). Twenty-two (23.9%) aimed to describe the culture within RACFs, while 65 (70.7%) attempted to understand the relationship between culture and other variables, demonstrating mixed and indeterminate associations. Only five (5.4%) evaluated an intervention. This review highlights the heterogenous nature of this research area, whereby differences in how culture is demarcated, conceptualised, and operationalised, has likely contributed to mixed findings. Future research which is underpinned by a sound theoretical basis is needed to increase the availability of empirical evidence on which culture change interventions can be based.
Publisher: Scandinavian University Press / Universitetsforlaget AS
Date: 20-11-2020
Publisher: Springer Science and Business Media LLC
Date: 21-05-2020
DOI: 10.1186/S12913-020-05289-0
Abstract: The concept of rapid implementation has emerged in the literature recently, but without a precise definition. Further exploration is required to distinguish the concept’s unique meanings and significance from the perspective of implementation science. The study clarifies the concept of rapid implementation and identifies its attributes, antecedents, and consequences. We present a theoretical definition of rapid implementation to clarify its unique meaning and characteristics. Rodgers evolutionary concept analysis method, combined with a systematic integrative review, were used to clarify the concept of rapid implementation. A comprehensive search of four databases, including EMBASE, MEDLINE, SCOPUS, and WEB OF SCIENCE was conducted, as well as relevant journals and reference lists of retrieved studies. After searching databases, 2442 papers were identified from 1963 to 2019 24 articles were found to fit the inclusion criteria to capture data on rapid implementation from across healthcare settings in four countries. Data analysis was carried out using descriptive thematic analysis. The results locate the introduction of rapid implementation, informed by implementation science. Guidance for further conceptualisation to bridge the gap between research and practice and redefine rigour, adapting methods used (current approaches, procedures and frameworks), and challenging clinical trial design (efficacy-effectiveness-implementation pipeline) is provided. It is possible that we are on the cusp of a paradigm shift within implementation brought about by the need for faster results into practice and policy. Researchers can benefit from a deeper understanding of the rapid implementation concept to guide future implementation of rapid actionable results in clinical practice.
Publisher: Oxford University Press
Date: 02-06-2016
DOI: 10.1093/OXFORDHB/9780198705109.013.16
Abstract: Over the last 25 years we have learned how providers can fall short of their goals, and deliver care which is below expectations. In response, nations and the international community including the World Health Organization have developed strategies to tackle harm and improve the quality of care. Key approaches include strengthening management and leadership designing improvement tools, models and approaches enhancing teamwork, communication and local cultures and leveraging opinion leaders and ch ions. A shift towards a systems perspective, factoring in the challenges of complexity and network characteristics, is evident. A safety-II approach, building on the naturally-occurring resilience of health systems, show much promise. But progress has been slow. We will need to be better at diffusing what we know works, scaling up localized, demonstrated successes, and supporting clinicians’ everyday capacities to succeed under varied conditions. Progress requires partnerships between politicians, policymakers, managers, clinicians, patients, researchers and other groups.
Publisher: Springer Science and Business Media LLC
Date: 24-03-2017
Publisher: BMJ
Date: 05-04-2003
Publisher: AMPCo
Date: 10-2010
DOI: 10.5694/J.1326-5377.2010.TB03968.X
Abstract: Investment in information and communication technology (ICT) in the health sector can bring important benefits. To date, the focus has been on automating clinical work practices such as ordering tests and prescriptions, which significantly improves efficiency and safety. Uptake of ICT has been slow and the results less favourable than anticipated for various reasons, including poor integration of systems into complex clinical work processes, limited training, and the intermittent nature of ICT funding. As a result, many health care organisations have been operating hybrid paper and computer systems that introduce new patient risks, staff frustration, and outcomes below expectation. The focus must shift from automation of clinical work to innovation from evolutionary application of ICT to revolutionary uses. Health professionals must embrace ICT as a "disruptive technology" that will produce significant changes in their roles and responsibilities and lead to real health reform with new, innovative models of health care delivery. As other industries have shown, substitution and role changes are areas in which ICT can lead to the greatest gains.
Publisher: BMJ
Date: 04-2019
DOI: 10.1136/BMJOPEN-2018-026028
Abstract: It is notoriously challenging to implement evidence-based care and to update and improve healthcare practices. One reason for the difficulty is the complexity of healthcare and the powerful influence of context on implementation and improvement efforts. Thus, there is a need for multifaceted, flexible change methods that takes these complexities into consideration. One approach that has the potential in this regard is soft systems methodology (SSM). However, little is known about how SSM has been applied in healthcare settings, making it difficult to assess the usefulness of SSM for implementation science or improvement research. The aim of the proposed scoping review is to examine and map the use and outcomes of SSM in healthcare. The review will adapt the framework outlined by Arksey and O’Malley (2005). Citations will be uncovered through a comprehensive database search of the peer-reviewed literature. Two reviewers will conduct a two-stage review and selection process where the titles/abstracts are examined followed by a screening of full texts of the selected citations. Reference lists of included citations will be snowballed to identify potential additional citations. Inclusion criteria are English language, peer-reviewed empirical papers focusing on the application of SSM in a healthcare setting. Both general information about the citations and information related to the objective of the review will be extracted from the included citations and entered into a data charting form. The extracted information will be reported in diagrams and tables and summarised to present a narrative account of the literature. The proposed review will provide information on the potential for using SSM to affect change in healthcare. No primary data will be collected, and thus ethical permission is unnecessary. Dissemination of results include peer-reviewed publications and conference presentations.
Publisher: Springer Science and Business Media LLC
Date: 29-10-2020
DOI: 10.1186/S12916-020-01739-Y
Abstract: Healthcare is amongst the most complex of human systems. Coordinating activities and integrating newer with older ways of treating patients while delivering high-quality, safe care, is challenging. Three landmark reports in 2018 led by (1) the Lancet Global Health Commission, (2) a coalition of the World Health Organization, the Organisation for Economic Co-operation and Development and the World Bank, and (3) the National Academies of Sciences, Engineering and Medicine of the United States propose that health systems need to tackle care quality, create less harm and provide universal health coverage in all nations, but especially low- and middle-income countries. The objective of this study is to review these reports with the aim of advancing the discussion beyond a conceptual diagnosis of quality gaps into identification of practical opportunities for transforming health systems by 2030. We analysed the reports via text-mining techniques and content analyses to derive their key themes and concepts. Initiatives to make progress include better measurement, using the capacities of information and communications technologies, taking a systems view of change, supporting systems to be constantly improving, creating learning health systems and undergirding progress with effective research and evaluation. Our analysis suggests that the world needs to move from 2018, the year of reports, to the 2020s, the decade of action. We propose three initiatives to support this move: first, developing a blueprint for change, modifiable to each country’s circumstances, to give effect to the reports’ recommendations second, to make tangible steps to reduce inequities within and across health systems, including redistributing resources to areas of greatest need and third, learning from what goes right to complement current efforts focused on reducing things going wrong. We provide ex les of targeted funding which would have major benefits, reduce inequalities, promote universality and be better at learning from successes as well as failures. The reports contain many recommendations, but lack an integrated, implementable, 10-year action plan for the next decade to give effect to their aims to improve care to the most vulnerable, save lives by providing high-quality healthcare and shift to measuring and ensuring better systems- and patient-level outcomes. This article signals what needs to be done to achieve these aims.
Publisher: BMJ
Date: 03-2019
DOI: 10.1136/BMJOPEN-2018-027479
Abstract: Residential aged care facilities (RACFs) are under increasing pressure to provide high-quality, round the clock care to consumers. However, they are often understaffed and without adequate skill mix and resources. As a result, staff must prioritise care by level of importance, potentially leading to care that is missed, delayed or omitted. To date, the literature on prioritisation and missed care has been dominated by studies involving nursing staff, thereby failing to take into account the complex networks of erse stakeholders that RACFs comprise. This study aims to investigate the priorities of residents, family members and care staff in order to make comparisons between how care is prioritised in RACFs by the different stakeholder groups. This study comprises a Q sorting activity using Q methodology, a think-aloud task, a demographics questionnaire and semi-structured interview questions. The study will be conducted in five RACFs across NSW and QLD, Australia. Using purposive s ling, the project will recruit up to 33 participants from each of the three participant groups. Data from the Q sorting activity will be analysed using the analytic software PQMethod to identify common factors (shared viewpoints). Data from the think-aloud task and semi-structured interviews questions will be thematically analysed using the Framework Method and NVivo qualitative data analysis software. The study has been approved by St Vincent’s Health and Aged Care Human Research and Ethics Committee and Macquarie University Human Research Ethics Committee. It is expected that findings from the study will be disseminated: in peer-reviewed journals as an executive report to participating facilities and a summary sheet to participants as a thesis to fulfill the requirements of a Doctor of Philosophy and presented at conferences and seminars.
Publisher: Elsevier BV
Date: 02-2010
DOI: 10.1016/J.SOCSCIMED.2009.11.001
Abstract: This paper examines the relationship between clinical quality and organizational efficiency in emergency departments (EDs). Previous studies have often emphasized the incompatibility of quality and efficiency, or have neglected to account for their inter-relationships. Policy perspectives reflect normative prescriptions for throughput and reduced waiting times which do not always align with clinicians' foci or day-to-day practices. According to Merton's (1957) theory of "value-assimilation", medical students, for instance, are socialized to reconcile seemingly contradictory values. We aimed to explore ethnographically the possibility of the dynamic interactions of quality and efficiency in clinical practice. This study drew on empirical data from ethnographic field work, conducted over one year, including 234 hours of semi-structured observations and 56 semi-structured field interviews in the EDs of two tertiary-referral hospitals in Sydney, Australia. We found that seniority and experience of emergency clinicians intersect with the functions of role-modeling, performance management, and formal and informal learning, to facilitate the care of multiple patients as they progress through the ED. These practices fundamentally embed quality in the ED's enactment of efficiency. The relationship between clinical quality and organizational efficiency can be understood through a sociological lens that highlights the roles of interdependent clinicians in a clinical pecking order, working to provide care, and balancing the two. The paper is novel in expanding "value-assimilation" into the clinical domain, and strives to reconcile policy with everyday practice in emergency settings. It moves the debate about quality versus efficiency to one that emphasizes interdependence.
Publisher: Elsevier BV
Date: 10-2019
Publisher: Maad Rayan Publishing Company
Date: 22-01-2020
Abstract: As healthcare researchers, we know very well our own experiences on the challenges of partnering with those in the health system to do collaborative, internationally-regarded studies aiming for impact. Bowen and colleagues’ study in Canada empirically examines these issues from the other side, interviewing health system leaders about their perspectives of us researchers, research collaborations and the challenges and opportunities these pose. Based on their findings, they propose a need to re-imagine the contours of research. Inspired by that, in this commentary we examine the context for research partnerships and consider some of the emerging models for fostering more meaningful collaborations between researchers and those working in healthcare systems and organisations. Based on principles of embedded research and researchers, these models—including translational research networks (TRNs) and researcher-in-residence models—rely on a complex interplay of personal and interpersonal factors to be successful.
Publisher: Emerald
Date: 03-08-2006
DOI: 10.3316/QRJ0602015
Abstract: This paper discusses video ethnography as part of a multimethod study of the introduction of information technology to streamline pathology test order entry in hospitals and its effect on the work of pathology laboratory scientists. The paper opens with an overview of video research in health care settings. After acknowledging the limitations inherent in video data, the paper offers a description of how video footage served to enhance insight in three ways. First, the footage enhanced the researchers’ own appreciation of the significance of particular facets of the data, which led them to reassess information collected through interviewing, focus groups and research field notes. Second, the footage enhanced the pathology laboratory scientists’ appreciation of the problems they experienced when incorporating the new information technology into their daily work practice, by enabling them to articulate these problems to outside researchers. Third, by being watched (by the video camera) and by watching themselves perform their work they were enabled to redesign their practices. The paper suggests that, as a result of interactively performing their work in front of the camera, the scientists came to apprehend their practices ‘from under a different aspect’. The paper concludes that by allowing video ethnography as a research method to remain underdefined and emergent, the modality of engagement and uptake shown by participants in the video research can be considered as a further enriching aspect of video ethnography as a research process.
Publisher: Elsevier BV
Date: 10-2019
Publisher: Oxford University Press (OUP)
Date: 28-10-2019
Abstract: To determine the extent to which care received by Australian children presenting with croup is in agreement with Clinical Practice Guidelines (CPGs). Retrospective population-based s le survey. Croup clinical indicators were derived from CPGs. Medical records from three healthcare settings were s led for selected visits in 2012 and 2013 in three Australian states. Data were collected by nine experienced paediatric nurses, trained to assess eligibility for indicator assessment and adherence to CPGs. Surveyors undertook criterion-based medical record reviews using an electronic data collection tool. Documented guideline adherence was lower for general practitioners (65.9% 95% CI: 60.8–70.6) than emergency departments (91.1% 95% CI: 89.5–92.5) and inpatient admissions (91.3% 95% CI: 88.1–93.9). Overall adherence was very low for a bundle of 10 indicators related to assessment (4.5% 95% CI: 2.4–7.6) but higher for a bundle of four indicators relating to the avoidance of inappropriate therapy (83.1% 95% CI: 59.5–96.0). Most visits for croup were characterized by appropriate treatment in all healthcare settings. However, most children had limited documented clinical assessments, and some had unnecessary tests or inappropriate therapy, which has potential quality and cost implications. Universal CPG and clinical assessment tools may increase clinical consistency.
Publisher: Wiley
Date: 04-11-2015
DOI: 10.1111/HEX.12300
Publisher: BMJ
Date: 05-2019
DOI: 10.1136/BMJOPEN-2018-026266
Abstract: People interact with their work environment through being, to a greater or lesser extent, compatible with aspects of their setting. This interaction between person and environment is particularly relevant in healthcare settings where compatibility affects not only the healthcare professionals, but also potentially the patient. One way to examine this association is to investigate person–organisation (P-O) fit and person–group (P-G) fit. This systematic review aimed to identify and synthesise knowledge on both P-O fit and P-G fit in healthcare to determine their association with staff outcomes. It was hypothesised that there would be a positive relationship between fit and staff outcomes, such that the experience of compatibility and ‘fitting in’ would be associated with better staff outcomes. A systematic review was conducted based on an extensive search strategy guided by Preferred Reporting Items for Systematic review and Meta-Analyses to identify relevant literature. CINAHL Complete, EMBASE, Ovid MEDLINE, PsycINFO and Scopus. Articles were included if they were empirical studies, published in peer-reviewed journals in English language, set in a healthcare context and addressed the association that staff outcomes have with P-O and/or P-G fit. Included texts were examined for study characteristics, fit constructs examined and types of staff outcomes assessed. The Quality Assessment Tool was used to assess risk of bias. Twenty-eight articles were included in the review. Of these, 96.4% (27/28) reported a significant, positive association between perception of fit and staff outcomes in healthcare contexts, such that a sense of compatibility had various positive implications for staff, including job satisfaction and retention. Although the results, as with all systematic reviews, are prone to bias and definitional ambiguity, they are still informative. Generally, the evidence suggests an association between employees’ perceived compatibility with the workplace or organisation and a variety of staff outcomes in healthcare settings.
Publisher: Palgrave Macmillan UK
Date: 2005
Publisher: BMJ
Date: 09-2021
DOI: 10.1136/BMJOPEN-2021-050912
Abstract: Clinical practice guidelines (CPGs) synthesise the latest evidence to support clinical and patient decision-making. CPG adherent care is associated with improved patient survival outcomes however, adherence rates are low across some cancer streams in Australia. Greater understanding of specific barriers to cancer treatment CPG adherence is warranted to inform future implementation strategies. This paper presents the protocol for a systematic review that aims to determine cancer treatment CPG adherence rates in Australia across a variety of common cancers, and to identify any factors associated with adherence to those CPGs, as well as any associations between CPG adherence and patient outcomes. Five databases will be searched, Ovid Medline, PsychInfo, Embase, Scopus and Web of Science, for eligible studies evaluating adherence rates to cancer treatment CPGs in Australia. A team of reviewers will screen the abstracts in pairs according to predetermined inclusion criteria and then review the full text of eligible studies. All included studies will be assessed for quality and risk of bias. Data will be extracted using a predefined data extraction template. The frequency or rate of adherence to CPGs, factors associated with adherence to those CPGs and any reported patient outcome rates (eg, relative risk ratios or 5-year survival rates) associated with adherence to CPGs will be described. If applicable, a pooled estimate of the rate of adherence will be calculated by conducting a random-effects meta-analysis. The systematic review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Ethics approval will not be required, as this review will present anonymised data from other published studies. Results from this study will form part of a doctoral dissertation (MB), will be published in a journal, presented at conferences, and other academic presentations. CRD42020222962.
Publisher: SAGE Publications
Date: 08-1995
DOI: 10.1177/095148489500800303
Abstract: Hospitals throughout the world are attempting to improve organizational performance through a variety of means. The focus in this paper is on a leading teaching hospital in Australia for a review of current management strategy. In a time of shrinking resources, management adopted a multi-faceted change management program including restructuring the organization, becoming more patient-focused via a product-line management approach and emphasising efficiency and cost-reduction measures. The next stage in management thinking is to place greater emphasis on patient-focused care. It is concluded this has the propensity to yield substantial further benefits, including improved financial and quality of care outcomes, in the Australian as well as the British and wider Organization for Economic Co-operation and Development (OECD) context. ‘Professionally, we have committed ourselves to creating caring environments that promote healing. We cannot meet this goal until we make a commitment to be patient-focused and give up being nurse-focused or facility-focused’ (Kerfort and LeClair, 1991). ‘In a customer-driven [organization], the distribution of roles is different. The organization is decentralized, with responsibility delegated to those who until now have comprised the order-obeying bottom level of the pyramid. The traditional, hierarchical corporate structure, in other words, is beginning to give way to a flattened, more horizontal structure’ (Carlzon, 1987).
Publisher: CRC Press
Date: 03-06-2019
Publisher: BMJ
Date: 12-2006
Publisher: SAGE Publications
Date: 06-1996
DOI: 10.1177/183335839602600208
Abstract: This pilot survey examined the views of a s le of health service managers (HSMs) and health information managers (HIMs) undertaking tertiary studies about the application of information technology (IT) in health care. The survey was based on a questionnaire designed as part of a 1994 study of health service executives (HSEs) commissioned by the Australian College of Health Service Executives (ACHSE). We examined views about current and future IT expenditure, satisfaction with IT, impact of IT on quality and efficiency and the future use of electronic medical records and optical disk storage. Results identify differences and some similarities between respondent groups on these issues. The paper explores these differences and similarities and provides insight into the views held by future HSMs and HIMs.
Publisher: Oxford University Press (OUP)
Date: 09-2018
Publisher: SAGE Publications
Date: 22-09-2017
Abstract: Breast cancer risk classifications are useful for prognosis, yet little is known of their effect on patients. This study clarified women's understandings of risk as they "journeyed" through the health care system. Breast cancer patients and women undergoing genetic investigation were recruited ( N = 25) from a large UK Health Board, 2014-2015, completing a "Book of Experience," and Bio-photographic elicitation interviews. Stakeholder and Participant Feedback Forums were undertaken with key stakeholders, including patients, oncologists, funders, and policy developers, to inform team understanding. Thematic and visual frameworks from multidisciplinary analysis workshops uncovered two themes: "Subjective Understandings of Risk" and "Journeying Toward an Unknown Future." Breast cancer patients and women undergoing investigation experienced risk intuitively. Statistical formulations were often perplexing, erting attention away from concrete life-and-death facts. Following risk classification, care must be co-defined to reduce patients' foreboding about an unknown future, taking into consideration personal risk management strategies and aspirations for a cancer-free future.
Publisher: Palgrave Macmillan
Date: 2015
Publisher: Emerald
Date: 03-04-2007
DOI: 10.1108/02683940710733070
Abstract: The purpose of this paper is to investigate how, and the degree to which, superior and peer managers exerted pressure on middle managers' work cross‐culturally. Australian ( n =251) and Singaporean ( n =340) health managers, respectively of Anglo and Confucian‐Asian cultures, rated the pressures exerted on them by managers, superior and peer (managers at the same level), regarding nine work pursuits, and described the nature of this pressure. Singaporeans reported greater pressure from superiors regarding people, customer, process and quality management. Australians and Singaporeans experienced similar pressure from superiors concerning financial, organisational, data, planning and external relations management. Singaporeans reported more pressure from peers in all work domains. In Singapore superior and peer managers applied pressure to similar activities but areas targeted by Australian peer and superior managers were not significantly related. Singaporean superiors were more likely to apply pressure through deadlines and appraisals. Convenience s les from one occupational sector may limit the generalisability of the results. Knowledge of the degree and sources of stress encountered by middle managers in an Anglo and a Confucian‐Asian culture may enhance organisational communication both within and between these cultures. Although it is a crucial issue, pressures exerted on managers by superior and particularly peer managers regarding specific managerial work pursuits has received little attention, particularly from a cross‐cultural perspective.
Publisher: JMIR Publications Inc.
Date: 19-09-1999
Publisher: JMIR Publications Inc.
Date: 06-12-2021
DOI: 10.2196/32948
Abstract: The COVID-19 pandemic and its mitigation measures and impacts, such as shelter-in-place orders, social isolation, restrictions on freedoms, unemployment, financial insecurity, and disrupted routines, have led to declines in mental health worldwide and concomitant escalating demands for mental health services. Under the circumstances, electronic mental health (e-mental health) programs and services have rapidly become the “new normal.” The aim of this study was to assess key characteristics and evidence gaps in the e-mental health literature published in relation to the COVID-19 pandemic via a scoping review and bibliometric analysis. We conducted a search of four academic databases (ie, MEDLINE, Embase, PsycInfo, and CINAHL) for documents published from December 31, 2019, to March 31, 2021, using keywords for e-mental health and COVID-19. Article information was extracted that was relevant to the review objective, including journal, type of article, keywords, focus, and corresponding author. Information was synthesized by coding these attributes and was then summarized through descriptive statistics and narrative techniques. Article influence was examined from Altmetric and CiteScore data, and a network analysis was conducted on article keywords. A total of 356 publications were included in the review. Articles on e-mental health quickly thrived early in the pandemic, with most articles being nonempirical, chiefly commentaries or opinions (n=225, 63.2%). Empirical publications emerged later and became more frequent as the pandemic progressed. The United States contributed the most articles (n=160, 44.9%), though a notable number came from middle-income countries (n=59, 16.6%). Articles were spread across 165 journals and had above-average influence (ie, almost half of the articles were in the top 25% of output scores by Altmetric, and the average CiteScore across articles was 4.22). The network analysis of author-supplied keywords identified key topic areas, including specific mental disorders, eHealth modalities, issues and challenges, and populations of interest. These were further explored via full-text analysis. Applications of e-mental health during the pandemic overcame, or were influenced by, system, service, technology, provider, and patient factors. COVID-19 has accelerated applications of e-mental health. Further research is needed to support the implementation of e-mental health across system and service infrastructures, alongside evidence of the relative effectiveness of e-mental health in comparison to traditional modes of care.
Publisher: BMJ
Date: 2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-07-2021
Publisher: Oxford University Press (OUP)
Date: 09-08-2017
Abstract: To evaluate attitudes towards accreditation and the Danish Quality Model (DDKM) among hospital employees in Denmark. Negative attitudes led the Danish Government to abolish accreditation in 2015. A cross-sectional survey was carried out via web-based questionnaire. All hospital managers, quality improvement staff (quality managers and employees), and hospital surveyors in Denmark and clinicians (doctors and nurses) within nine selected specialties. Overall response rate was 29% with 5055 of 17 646 valid responses included in the data analysis. The response rate was 82% (5055/6188) among respondents who clicked on the link in the mail containing the questionnaire. A short questionnaire was designed using a 7-point Likert scale ranging from 1 'strongly disagree' to 7 'strongly agree'. To compare mean values between respondent groups, regression analysis using dummy coding of respondent groups and calculation of standardized mean difference effect sizes were performed. Overall attitudes were supportive, with physicians more skeptical. There were different patterns of attitudes in the five Danish regions and between medical professions. A small group of physicians was extremely negative. Clinical attitudes are important, and can affect Government decisions. On the basis of our study, future attention should be paid to attitudes towards accreditation (and attitudes towards other means of quality improvement). Attitudes may reflect political agendas and impede the take-up of improvement programs, cause their demise, or reduce their effectiveness.
Publisher: AMPCo
Date: 08-2008
Publisher: Oxford University Press (OUP)
Date: 14-05-2020
Abstract: Patient and family involvement is high on the international quality and safety agenda. In this paper, we consider possible ways of involving families in investigations of fatal adverse events and how their greater participation might improve the quality of investigations. The aim is to increase awareness among healthcare professionals, accident investigators, policymakers and researchers and examine how research and practice can develop in this emerging field. In contrast to relying mainly on documentation and staff recollections, family involvement can result in the investigation having access to richer information, a more holistic picture of the event and new perspectives on who was involved and can positively contribute to the family’s emotional satisfaction and perception of justice being done. There is limited guidance and research on how to constitute effective involvement. There is a need for co-designing the investigation process, explicitly agreeing the family’s level of involvement, supporting and preparing the family, providing easily accessible user-friendly language and using different methods of involvement (e.g. in idual interviews, focus group interviews and questionnaires), depending on the family’s needs.
Publisher: JMIR Publications Inc.
Date: 26-02-2021
DOI: 10.2196/25056
Abstract: Young-onset colorectal cancer is a contemporary issue in need of substantial research input. The incidence of colorectal cancer in adults younger than 50 years is rising in contrast to the decreasing incidence of this cancer in older adults. People with young-onset colorectal cancer may be at that stage of life in which they are establishing their careers, building relationships with long-term partners, raising children, and assembling a financial base for the future. A qualitative study designed to facilitate triangulation with extant quantitative patient-reported data would contribute the first comprehensive resource for understanding how this distinct patient population experiences health services and the outcomes of care throughout the patient pathway. The aim of this study was to undertake a mixed-methods study of qualitative patient-reported data on young-onset colorectal cancer experiences and outcomes. This is a study of web-based unsolicited patient stories recounting experiences of health services and clinical outcomes related to young-onset colorectal cancer. Personal Recollections Organized as Data (PROD) is a novel methodology for understanding patients’ health experiences in order to improve care. PROD pivots qualitative data collection and analysis around the validated domains and dimensions measured in patient-reported outcome and patient-reported experience questionnaires. PROD involves 4 processes: (1) classifying attributes of the contributing patients, their disease states, their routes to diagnosis, and the clinical features of their treatment and posttreatment (2) coding texts into the patient-reported experience and patient-reported outcome domains and dimensions, defined a priori, according to phases of the patient pathway (3) thematic analysis of content within and across each domain and (4) quantitative text analysis of the narrative content. Relevant patient stories have been identified, and permission has been obtained for use of the texts in primary research. The approval for this study was granted by the Macquarie University Human Research Ethics Committee in June 2020. The analytical framework was established in September 2020, and data collection commenced in October 2020. We will complete the analysis in March 2021 and we aim to publish the results in mid-2021. The findings of this study will identify areas for improvement in the PROD methodology and inform the development of a large-scale study of young-onset colorectal cancer patient narratives. We believe that this will be the first qualitative study to identify and describe the patient pathway from symptom self-identification to help-seeking through to diagnosis, treatment, and to survivorship or palliation for people with young-onset colorectal cancer. DERR1-10.2196/25056
Publisher: Elsevier BV
Date: 08-2020
Publisher: Wiley
Date: 05-06-2016
DOI: 10.1002/HPM.2301
Abstract: The study aim was to investigate the understandings and concerns of stakeholders regarding the evolution of health service accreditation programs in Australia. Stakeholder representatives from programs in the primary, acute and aged care sectors participated in semi-structured interviews. Across 2011-12 there were 47 group and in idual interviews involving 258 participants. Interviews lasted, on average, 1 h, and were digitally recorded and transcribed. Transcriptions were analysed using textual referencing software. Four significant issues were considered to have directed the evolution of accreditation programs: altering underlying program philosophies shifting of program content focus and details different surveying expectations and experiences and the influence of external contextual factors upon accreditation programs. Three accreditation program models were noted by participants: regulatory compliance continuous quality improvement and a hybrid model, incorporating elements of these two. Respondents noted the compatibility or incommensurability of the first two models. Participation in a program was reportedly experienced as ranging on a survey continuum from "malicious compliance" to "performance audits" to "quality improvement journeys". Wider contextual factors, in particular, political and community expectations, and associated media reporting, were considered significant influences on the operation and evolution of programs. A hybrid accreditation model was noted to have evolved. The hybrid model promotes minimum standards and continuous quality improvement, through examining the structure and processes of organisations and the outcomes of care. The hybrid model appears to be directing organisational and professional attention to enhance their safety cultures. Copyright © 2015 John Wiley & Sons, Ltd.
Publisher: BMJ
Date: 2013
Publisher: BMJ
Date: 2012
Publisher: Wiley
Date: 18-03-2022
DOI: 10.1002/LRH2.10265
Abstract: The emergent field of learning health systems (LHSs) has been rapidly evolving as the concept continues to be embraced by researchers, managers, and clinicians. This paper reports on a scoping review and bibliometric analysis of the LHS literature to identify key topic areas and examine the influence and spread of recent research. We conducted a scoping review of LHS literature published between January 2016 and May 2020. The authors extracted publication data (eg, journal, country, authors, citation count, keywords) and reviewed full‐texts to identify: type of study (empirical, non‐empirical, or review), degree of focus (general or specific), and the reference used when defining LHSs. A total of 272 publications were included in this review. Almost two thirds (65.1%) of the included articles were non‐empirical and over two‐thirds (68.4%) were from authors in the United States. More than half of the publications focused on specific areas, for ex le: oncology, cardiovascular care, and genomic medicine. Other key topic areas included: ethics, research, quality improvement, and electronic health records. We identified that definitions of the LHS concept are converging however, many papers focused on data platforms and analytical processes rather than organisational and behavioural factors to support change and learning activities. The literature on LHSs remains largely theoretical with definitions of LHSs focusing on technical processes to reuse data collected during the clinical process and embedding analysed data back into the system. A shift in the literature to empirical LHS studies with consideration of organisational and human factors is warranted.
Publisher: Springer Science and Business Media LLC
Date: 20-09-2012
Publisher: Emerald
Date: 18-07-2008
DOI: 10.1108/09526860810890422
Abstract: This paper aims to investigate how health care accreditation surveyors enact their role with a view to identifying a surveyor styles typology. This study was conducted in two phases. First, observational research was used to examine the conduct of a small survey team during the 2005 accreditation survey of a rural health service in Australia. The survey team was from the Australian Council on Healthcare Standards (ACHS), the major health care accreditation agency in Australia. Second, the emerging typology was reviewed by an expert panel of ACHS surveyors. A typology comprising three unique surveyor styles is identified – interrogator explorer and discusser. Additionally, a further style, the questioner, is hypothesised. The typology has application for development by accreditation agencies to be used with surveyors as a self‐reflection tool to improve learning and development. The knowledge gained about surveyors' styles can be used to match more effectively survey teams to organisations seeking accreditation. Further research is necessary to confirm these styles and examine whether other styles are apparent. This study is an important step in examining the conduct of surveyors and opening up health care accreditation surveyor inter‐rater reliability for further investigation.
Publisher: JMIR Publications Inc.
Date: 04-08-2022
DOI: 10.2196/41424
Publisher: Emerald
Date: 10-06-2014
DOI: 10.1108/JHOM-03-2013-0059
Abstract: – The purpose of this paper is to examine the views of community representatives participating in a large health service in Australia. – Cross-sectional survey of 49 community representatives and interviews with a purposeful s le of representatives ( n =10) and staff ( n =19). – Most community representatives had positive attitudes about their value and potential for influence, citing concrete ex les of impact. Having an external network or group was related to their beliefs in their ability to add value to their health service. Community representatives largely agreed they provided a link to, and represented, the wider community although most thought staff did not understand their role or how to work with them. Some staff questioned representativeness of their community representatives. – Improving community participation is argued to be important in delivering better healthcare services, but effective engagement and representation at the local level is often challenging. Focusing on community representative views takes us beyond debates around representativeness to identify practical strategies to improve practice. The authors recommend health services recruit consumers with strong links to networks in the community, provide a structured and supported program, and improve staff understanding of the range of possible roles for community representatives. Local ex les of community representatives’ impact on policy and practice should be widely communicated. – In giving prominence to the views of consumers using triangulated methods, the authors found most could report with clarity what their role was and how they impacted at their local health service.
Publisher: BMJ
Date: 11-2017
DOI: 10.1136/BMJOPEN-2017-018568
Abstract: The sustainability of healthcare interventions and change programmes is of increasing importance to researchers and healthcare stakeholders interested in creating sustainable health systems to cope with mounting stressors. The aim of this protocol is to extend earlier work and describe a systematic review to identify, synthesise and draw meaning from studies published within the last 5 years that measure the sustainability of interventions, improvement efforts and change strategies in the health system. The protocol outlines a method by which to execute a rigorous systematic review. The design includes applying primary and secondary data collection techniques, consisting of a comprehensive database search complemented by contact with experts, and searching secondary databases and reference lists, using snowballing techniques. The review and analysis process will occur via an abstract review followed by a full-text screening process. The inclusion criteria include English-language, peer-reviewed, primary, empirical research articles published after 2011 in scholarly journals, for which the full text is available. No restrictions on location will be applied. The review that results from this protocol will synthesise and compare characteristics of the included studies. Ultimately, it is intended that this will help make it easier to identify and design sustainable interventions, improvement efforts and change strategies. As no primary data were collected, ethical approval was not required. Results will be disseminated in conference presentations, peer-reviewed publications and among policymaker bodies interested in creating sustainable health systems.
Publisher: Emerald
Date: 22-05-2009
DOI: 10.1108/14777260910960975
Abstract: Inquiries into healthcare organisations have highlighted organisational or system failure, attributed to poor responses to early warning signs. One response, and challenge, is for professionals and academics to build capacity for quality and safety research to provide evidence for improved systems. However, such collaborations and capacity building do not occur easily as there are many stakeholders. Leadership is necessary to unite differences into a common goal. The lessons learned and principles arising from the experience of providing distributed leadership to mobilise capacity for quality and safety research when researching health care accreditation in Australia are presented. A case study structured by temporal bracketing that presents a narrative account of multi‐stakeholder perspectives. Data are collected using in‐depth informal interviews with key informants and ethno‐document analysis. Distributed leadership enabled a collaborative research partnership to be realised. The leadership harnessed the relative strengths of partners and accounted for, and balanced, the interests of stakeholder participants involved. Across three phases, leadership and the research partnership was enacted: identifying partnerships, bottom‐up engagement and enacting the research collaboration. Two principles to maximise opportunities to mobilise capacity for quality and safety research have been identified. First, successful collaborations, particularly multi‐faceted inter‐related partnerships, require distributed leadership. Second, the leadership‐stakeholder enactment can promote reciprocity so that the collaboration becomes mutually reinforcing and beneficial to partners. The paper addresses the need to understand the practice and challenges of distributed leadership and how to replicate positive practices to implement patient safety research.
Publisher: Springer International Publishing
Date: 2021
Publisher: BMJ
Date: 2021
DOI: 10.1136/BMJOPEN-2020-043553
Abstract: Epilepsy is a common neurological condition affecting between 3% and 3.5% of the Australian population at some point in their lifetime. The effective management of chronic and complex conditions such as epilepsy requires person-centred and coordinated care across sectors, from primary to tertiary healthcare. Internationally, epilepsy nurse specialists are frequently identified as playing a vital role in improving the integration of epilepsy care and enhancing patient self-management. This workforce has not been the focus of research in Australia to date. This multistage mixed-method study examines the role and responsibilities of epilepsy nurses, particularly in primary and community care settings, across Australia, including through the provision of a nurse helpline service. A nationwide s le of 30 epilepsy nurses will be purposively recruited via advertisements distributed by epilepsy organisations and through word-of-mouth snowball s ling. Two stages (1 and 3) consist of a demographic questionnaire and semistructured interviews (in idual or group) with epilepsy nurse participants, with the thematic data analysis from this work informing the areas for focus in stage 3. Stage 2 comprises of a retrospective descriptive analysis of phone call data from Epilepsy Action Australia’s National Epilepsy Line service to identify types of users, their needs and reasons for using the service, and to characterise the range of activities undertaken by the nurse call takers. Ethics approval for this study was granted by Macquarie University (HREC: 52020668117612). Findings of the study will be published through peer-reviewed journal articles and summary reports to key stakeholders, and disseminated through public forums and academic conference presentations. Study findings will also be communicated to people living with epilepsy and families.
Publisher: SAGE Publications
Date: 06-09-2022
DOI: 10.1177/10497323221120501
Abstract: We report a novel approach of amalgamating implementation outcomes of acceptability and fidelity alongside context as a new way of qualitatively evaluating implementation outcomes and context of a precision medicine intervention. A rapid qualitative online proforma was co-designed with stakeholders and sent to a purposive s le of healthcare professionals involved in an early-phase clinical trial intervention. Data were analysed using Framework Analysis. A total of 24 out of 68 proformas were returned. Although some participants raised concerns about drug medication access issues, the main intervention was well accepted and understood across professional groups. Comprehension was enhanced through exposure to specialist multidisciplinary meeting arrangements. In conclusion, a rapid data collection tool and framework are now available to assess readily measurable, qualitative indicators of acceptability, fidelity of receipt and contextual fit within the dynamic precision medicine context.
Publisher: AMPCo
Date: 03-2011
Publisher: Oxford University Press (OUP)
Date: 09-2018
Publisher: Springer International Publishing
Date: 2021
Publisher: Springer International Publishing
Date: 2021
Publisher: Springer Science and Business Media LLC
Date: 22-09-2013
Publisher: Oxford University Press (OUP)
Date: 22-11-2018
Abstract: This study aimed to examine and compare middle and senior hospital managers’ perceptions of the effects of a mandatory accreditation program in Denmark, the Danish Healthcare Quality Program (Den Danske Kvalitetsmodel [DDKM]) after it was terminated in 2015. A cross-sectional online questionnaire survey. All 26 somatic and psychiatric public hospitals in Denmark. All senior and middle managers. A questionnaire with open and closed response (five-point Likert scale) questions. Quantitative data were analyzed descriptively and through ordered logistic regression by management level. Qualitative data were subjected to a software-assisted content analysis. The response rate was 49% (533/1059). In both the qualitative and quantitative data sets, participants perceived the DDKM as having: led to an increased focus on registration, documentation and additional and unnecessary procedures. While the DDKM was perceived as increasing a focus on quality, the time required for accreditation was at the expense of patient care. There were significant differences by management level, with middle managers having more negative perceptions of the DDKM related to time spent on documentation and registration. While the DDKM had some perceived benefits for quality improvement, it was ultimately considered time-consuming and outdated or having served its purpose. Including managers, particularly middle managers, in refinements to the new quality improvement model could capitalize on the benefits while redressing the problems with the terminated accreditation program.
Publisher: Wiley
Date: 15-07-2015
DOI: 10.1111/CTS.12188
Publisher: Elsevier BV
Date: 05-2022
Publisher: JMIR Publications Inc.
Date: 23-04-2020
DOI: 10.2196/16108
Abstract: Emerging adulthood is a unique segment of an in idual’s life course. The defining features of this transitional period include identity exploration, instability, future possibilities, self-focus, and feeling in-between adolescence and adulthood, all of which are thought to affect quality of life, health, and well-being. A longitudinal cohort study with a comprehensive set of measures would be a unique and valuable resource for improving the understanding of the multi-faceted elements and unique challenges that contribute to the health and well-being of emerging adults. The main aim of this pilot study is to evaluate the feasibility and acceptability of recruiting university graduates to establish a longitudinal cohort study to inform our understanding of emerging adulthood. This is a pilot longitudinal cohort study of Australian university graduates. It will involve collecting information via online surveys (baseline and 12-month follow-up) and data linkage with health records. Recruitment, response, and retention rates will be calculated. Descriptive analysis of the representativeness of recruited participants and completeness of survey responses will be conducted. Participant recruitment was completed in October 2018, and data collection for the baseline and follow-up surveys was completed in November 2019. As of April 2020, the process of acquiring health records from administrative data collections has commenced. The findings from this pilot study will identify areas for improvement and inform the development of a future longitudinal cohort study of emerging adults. Australian New Zealand Clinical Trials Registry ACTRN12618001364268 eec8wh DERR1-10.2196/16108
Publisher: AMPCo
Date: 07-1998
DOI: 10.5694/J.1326-5377.1998.TB140185.X
Abstract: In Africa, rapid testing for recent HIV infection (RTRI) is being scaled up however, use of the recent infection testing algorithm (RITA), which uses viral load (VL) to confirm RTRI-recent infections, is not a widespread practice. We present results of recently acquired HIV infections among men who have sex with men (MSM), transgender women, and genderqueer (TGW/GQ) in iduals with newly diagnosed HIV infection in Zimbabwe as per the national approach (RTRI) and applying a RITA. In 2019, 1,538 MSM and TGW/GQ in Harare and Bulawayo, Zimbabwe were recruited to participate in a biobehavioral survey using respondent-driven s ling. Consenting participants received HIV testing and all HIV-positive specimens were tested with the RTRI Asanté HIV-1 Rapid Recency Assay, and for VL and CD4 count. RTRI-recent participants with unsuppressed VL (≥1,000 copies/mL) were classified as RITA-recent. Descriptive statistics were used to summarize results among RTRI-recent and RITA-recent participants. Among those tested for HIV (1,511/1,538), 22.5% (340/1,511) tested positive and of those, 55.0% (187/340) self-reported an HIV-negative or unknown status. Among these, 8.6% (16/187) were classified as RTRI-recent and 91.4% (171/187) were classified as RTRI-long term. After accounting for VL, RITA-recency was 1.1% (2/187). Two of 16 (12.5%) RTRI-recent infections were RITA-recent. VL among RITA-recent cases were 9,052 copies/mL and 40,694 copies/mL and both had CD4 counts 85% of RTRI-recent cases were reclassified as RITA-long term. True characterization of recent infections may not be possible without VL testing, which remains challenging in resource-limited settings.
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: 2018
DOI: 10.1136/BMJOPEN-2017-019423
Abstract: Delirium, an acute confusional state, affects up to 29% of acute inpatients aged 65 years and over. The Australian Delirium Clinical Care Standard (the Standard) contains evidence-based, multicomponent interventions, to identify and reduce delirium. This study aims to: (1) conduct a controlled, before-and-after study to assess the clinical effectiveness of the Standard to improve diagnosis and treatment of delirium (2) conduct a cost-effectiveness study of implementing the Standard and (3) evaluate the implementation process. The study will use a controlled, preimplementation and postimplementation mixed-methods study design, including: medical record reviews, activity-based costing analysis and interviews with staff, patients and their family members. The study population will comprise patients 65 years and over, admitted to surgical, medical and intensive care wards in four intervention hospitals and one control hospital. The primary clinical outcome will be the incidence of delirium. Secondary outcomes include: length of stay, severity and duration of delirium, inhospital mortality rates, readmission rates and use of psychotropic drugs. Cost-effectiveness will be evaluated through activity-based costing analysis and outcome data, and the implementation process appraised through the qualitative results. Ethics approval has been received for two hospitals. Additional hospitals have been identified and ethics applications will be submitted once the tools in the pilot study have been tested. The results will be submitted for publication in peer-reviewed journals and presented to national and international conferences. Results seminars will provide a quality feedback mechanism for staff and health policy bodies.
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: 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: JMIR Publications Inc.
Date: 23-02-2022
DOI: 10.2196/34907
Abstract: The development and adoption of a learning health system (LHS) has been proposed as a means to address key challenges facing current and future health care systems. The first review of the LHS literature was conducted 5 years ago, identifying only a small number of published papers that had empirically examined the implementation or testing of an LHS. It is timely to look more closely at the published empirical research and to ask the question, Where are we now? 5 years on from that early LHS review. This study performed a scoping review of empirical research within the LHS domain. Taking an “implementation science” lens, the review aims to map out the empirical research that has been conducted to date, identify limitations, and identify future directions for the field. Two academic databases (PubMed and Scopus) were searched using the terms “learning health* system*” for papers published between January 1, 2016, to January 31, 2021, that had an explicit empirical focus on LHSs. Study information was extracted relevant to the review objective, including each study’s publication details primary concern or focus context design data type implementation framework, model, or theory used and implementation determinants or outcomes examined. A total of 76 studies were included in this review. Over two-thirds of the studies were concerned with implementing a particular program, system, or platform (53/76, 69.7%) designed to contribute to achieving an LHS. Most of these studies focused on a particular clinical context or patient population (37/53, 69.8%), with far fewer studies focusing on whole hospital systems (4/53, 7.5%) or on other broad health care systems encompassing multiple facilities (12/53, 22.6%). Over two-thirds of the program-specific studies utilized quantitative methods (37/53, 69.8%), with a smaller number utilizing qualitative methods (10/53, 18.9%) or mixed-methods designs (6/53, 11.3%). The remaining 23 studies were classified into 1 of 3 key areas: ethics, policies, and governance (10/76, 13.2%) stakeholder perspectives of LHSs (5/76, 6.6%) or LHS-specific research strategies and tools (8/76, 10.5%). Overall, relatively few studies were identified that incorporated an implementation science framework. Although there has been considerable growth in empirical applications of LHSs within the past 5 years, paralleling the recent emergence of LHS-specific research strategies and tools, there are few high-quality studies. Comprehensive reporting of implementation and evaluation efforts is an important step to moving the LHS field forward. In particular, the routine use of implementation determinant and outcome frameworks will improve the assessment and reporting of barriers, enablers, and implementation outcomes in this field and will enable comparison and identification of trends across studies.
Publisher: Oxford University Press (OUP)
Date: 10-2021
Abstract: The impact of hospital accreditation on the experiences of patients remains a weak point in quality improvement research. This is surprising given the time and cost of accreditation and the fact that patient experiences influence outcomes. We investigated the impact of first-time hospital accreditation on patients’ experience of support from health-care professionals, information and involvement in decisions. We aimed to examine the association between first-time hospital accreditation and patient experiences. We conducted a longitudinal study in the three Faroese hospitals that, unlike hospitals on the Danish mainland and elsewhere internationally, had no prior exposure to systematic quality improvement. The hospitals were accredited in 2017 according to a modified second version of the Danish Healthcare Quality program. Study participants were 18 years or older and hospitalized for at least 24 h in 2016 before or 2018 after accreditation. We administered the National Danish Survey of Patient Experiences for acute and scheduled hospitalization. Patients rated their experiences of support, information and involvement in decision-making on a 5-point Likert scale. We calculated in idual and grouped mean item scores, the percentages of scores ≥4, the mean score difference, the relative risk (RR) for high/very high scores (≥4) using Poisson regression and the risk difference. Patient experience ratings were compared using mixed effects linear regression. In total, 400 patients before and 400 after accreditation completed the survey. After accreditation patients reported increased support from health professionals adjusted mean score difference (adj. mean diff.) = 1.99 (95% confidence interval (CI): 1.89, 2.10), feeling better informed before and during the hospitalization adj. mean diff. = 1.14 (95% CI: 1.07 1.20) and more involved in decision-making adj. mean diff. = 1.79 (95% CI: 1.76 1.82). Additionally, the RR for a high/very high score (≥4) was significantly greater on 15 of the 16 questionnaire items. The greatest RR for a high/very high score (≥4) after accreditation, was found for the item ‘Have you had a dialogue with the staff about the advantages and disadvantages of the examination/treatment options available?’ RR= 5.73 (95% CI: 4.51, 7.27). Hospitalized patients experienced significantly more support from health professionals, information and involvement in decision-making after accreditation. Future research on accreditation should include the patients’ perspective.
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.GERINURSE.2017.10.013
Abstract: Person-centred care is achieved through strategies such as effective communication and shared decision-making. Hearing loss can lead to communication breakdown and social isolation in residential aged care. The review aimed to address how hearing loss affects person-centred care in residential aged care settings. Empirical literature was identified through a systematic search of academic databases. Articles were reviewed against an inclusion criteria and general inductive analysis was employed to identify recurring factors across included studies. Six common factors emerged from the data: communication breakdown, the overlap between hearing loss and cognitive impairment, social isolation and reduced social participation, limited access to hearing services, inadequate training provided to care staff, and strategies to improve communication. Recommended strategies to facilitate person-centred care for residents with hearing loss are presented. Further investigation is needed to understand the effects of hearing loss on residents' autonomy and shared decision-making.
Publisher: BMJ
Date: 03-2019
DOI: 10.1136/BMJOPEN-2018-027308
Abstract: To analyse trends in the academic literature applying complexity science to healthcare, focusing specifically on bibliometric characteristics and indicators of influence. This study reports a bibliometric analysis via a systematic search of the academic literature applying complexity science to healthcare. A search of four academic databases was performed on 19 April 2018. Article details were downloaded and screened against inclusion criteria (peer-reviewed journal articles applying complexity science to healthcare). Publication and content data were then collected from included articles, with analysis focusing on trends over time in the types and topics of articles, and where they are published. We also analysed the influence of this body of work through citation and network analyses. Articles on complexity science in healthcare were published in 268 journals, though a much smaller subset was responsible for a substantial proportion of this literature. USA contributed the largest number of articles, followed by the UK, Canada and Australia. Over time, the number of empirical and review articles increased, relative to non-empirical contributions. However, in general, non-empirical literature was more influential, with a series of introductory conceptual papers being the most influential based on both overall citations and their use as index references within a citation network. The most common topics of focus were health systems and organisations generally, and education, with recent uptake in research, policy, and change and improvement. This study identified changes in the types of articles on complexity science in healthcare published over time, and their content. There was evidence to suggest a shift from conceptual work to the application of concrete improvement strategies and increasingly in-depth examination of complex healthcare systems. We also identified variation in the influence of this literature at article level, and to a lesser extent by topic of focus.
Publisher: BMJ
Date: 03-2023
DOI: 10.1136/BMJOPEN-2022-068073
Abstract: People with early-onset colorectal cancer (EOCRC), defined as colorectal cancer (CRC) before the age of 50, now constitute a significant patient population. In empirical and grey literature EOCRC patients report unsatisfactory experiences of care, especially in relation to protracted intervals from first help-seeking to diagnosis. This study is the first to investigate EOCRC patients’ perspectives on ways to improve experiences of care. The objective is to provide foundational knowledge for the development of EOCRC-specific patient-reported experience measures (PREMs). The study was designed as qualitative Internet Mediated Research, involving a thematic analysis of unsolicited narratives recounting personal experiences of EOCRC care. We examined advice-giving statements in 120 online texts written by EOCRC patients and survivors. The Internet is the broad research setting. The host websites of three prominent charitable CRC support organisations were selected as specific research sites: Bowel Cancer Australia, Bowel Cancer UK and Bowel Cancer New Zealand. We found that 90% of texts comprised statements of advice to new patients about the importance of self-advocacy in achieving quality care. Four key contexts for self-advocacy were identified: (1) accessing relevant diagnostic services (2) driving diagnostic investigations when symptoms are not resolved (3) involvement in treatment decision-making and (4) proactivity about preferred outcomes. Over 30% of advice-giving texts also directed statements of advice to healthcare providers, indicating that their youthfulness had been a barrier to timely diagnosis. Healthcare barriers to, and facilitators of, patient self-advocacy may be indicators of quality EORC care. There is a need for greater awareness of the impact of age bias on the responsiveness of clinicians and healthcare services in EOCRC care. Our findings support the development of EOCRC-specific PREMs that can guide age-appropriate policy and practice for this newly identified patient population.
Publisher: Springer Science and Business Media LLC
Date: 12-11-2018
Publisher: Oxford University Press (OUP)
Date: 27-05-2021
Publisher: SAGE Publications
Date: 2022
DOI: 10.1177/16094069221103097
Abstract: Our implementation science study focuses on implementing a new way of practice and offers methodological specificity about how to rapidly investigate an in idually tailored precision medicine intervention. A qualitative study advancing a new methodology for speedily identifying barriers and enablers to implementation in the context of childhood cancer. Data were collected through rapid ethnography, coded using the Consolidated Framework for Implementation Research, and analysed by Sentiment Analysis. Thirty-eight data collection events occurred during 14 multidisciplinary tumour board meetings, 14 curation meetings, and 10 informal conversations. Sentiment Analysis distilled Consolidated Framework for Implementation Research codes to reveal key barriers and enablers to implementation. A traffic light labelling system has been used to present levels of positivity and negativity (green for strong enablers and red for strong barriers), highlighting levels of concern regarding implementation. Within the intervention design characteristics, “Adaptability” was the strongest enabler and “Design quality and safety” the strongest barrier. Among the contextual factors: “Networks and communication” were the strongest enabler, and “Available resources” were the strongest barrier. Overall, there was a higher percentage of negative sentiment towards intervention design characteristics and contextual factors than positive sentiment, while more concerns were raised about intervention design factors than contextual factors. This study offers a rapid qualitative data collection and analytic methodological roadmap for establishing barriers and enablers to a paediatric precision medicine intervention.
Publisher: Public Library of Science (PLoS)
Date: 09-01-2019
Publisher: Wiley
Date: 1993
Abstract: Health service executives are striving to implement the best managerial practices amid the major turbulence and restructuring which is prevalent in many health care systems today. All too often, guidance about what the best practices are needs to be sought from studies contained within the general management literature. It is problematical whether this literature is applicable to health service organizations. This article reports the results of a study which examined the views of 93 executives in 14 hospitals in Britain, Canada and the United States about what constitutes managerial excellence. The hospitals were selected on the basis of their reputed success in health service management. Using grounded theory methodology, eight factors of excellence were derived from the interview data which were supplemented by data made available from hospital documentation supplied by participants. The results of this study are compared with those of Peters and Waterman (1982). This is the most frequently cited study of managerial excellence in the general management literature. The main conclusions drawn are that a current definition of health service management excellence has been identified there was a high degree of unanimity among participant executives about the constituents of success and excellence in health service management and, that there are some marked differences between this definition of excellence and that propounded by Peters and Waterman (1982). The implications of this definition of excellence for health service executives are discussed.
Publisher: Springer Science and Business Media LLC
Date: 12-02-2016
Publisher: National Institute for Health and Care Research
Date: 06-2023
DOI: 10.3310/YTRR9821
Abstract: NHS 111 online offers 24-hour access to health assessment and triage. This study examined pathways to care, differential access and use, and workforce impacts of NHS 111 online. This study compared NHS 111 with Healthdirect (Haymarket, Australia) virtual triage. Interviews with 80 staff and stakeholders in English primary, urgent and emergency care, and 41 staff and stakeholders associated with Healthdirect. A survey of 2754 respondents, of whom 1137 (41.3%) had used NHS 111 online and 1617 (58.7%) had not. NHS 111 online is one of several digital health-care technologies and was not differentiated from the NHS 111 telephone service or well understood. There is a similar lack of awareness of Healthdirect virtual triage. NHS 111 and Healthdirect virtual triage are perceived as creating additional work for health-care staff and inappropriate demand for some health services, especially emergency care. One-third of survey respondents reported that they had not used any NHS 111 service (telephone or online). Older people and those with less educational qualifications are less likely to use NHS 111 online. Respondents who had used NHS 111 online reported more use of other urgent care services and make more cumulative use of services than those who had not used NHS 111 online. Users of NHS 111 online had higher levels of self-reported eHealth literacy. There were differences in reported preferences for using NHS 111 online for different symptom presentations. Greater clarity about what the NHS 111 online service offers would allow better signposting and reduce confusion. Generic NHS 111 services are perceived as creating additional work in the primary, urgent and emergency care system. There are differences in eHealth literacy between users and those who have not used NHS 111 online, and this suggests that ‘digital first’ policies may increase health inequalities. This research bridged the pandemic from 2020 to 2021 therefore, findings may change as services adjust going forward. Surveys used a digital platform so there is probably bias towards some level of e-Literacy, but this also means that our data may underestimate the digital ide. Further investigation of access to digital services could address concerns about digital exclusion. Research comparing the affordances and cost–benefits of different triage and assessment systems for users and health-care providers is needed. Research about trust in virtual assessments may show how duplication can be reduced. Mixed-methods studies looking at outcomes, impacts on work and costs, and ways to measure eHealth literacy, can inform the development NHS 111 online and opportunities for further international shared learning could be pursued. This study is registered at the research registry (UIN 5392). This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research Programme and will be published in full in Health and Social Care Delivery Research Vol. 11, No. 5. See the NIHR Journals Library website for further project information.
Publisher: Wiley
Date: 05-03-2021
DOI: 10.1002/PD.5914
Abstract: As interest in reproductive genetic carrier screening rises, with increased availability, the role of healthcare practitioners is central in guiding uptake aligned with a couples' values and beliefs. Therefore, practitioners' views on implementation are critical to the success of any reproductive genetic carrier screening programme. To explore healthcare practitioners' perceptions of the barriers and enablers to implementation. We undertook a systematic review of the literature searching seven databases using health practitioner, screening and implementation terms returning 490 articles. Screening led to the inclusion of 26 articles for full‐text review. We found three interconnected themes relating to reproductive genetic carrier screening: (i) use and impact, (ii) practitioners' beliefs and expectations and (iii) resources. Barriers and enablers to implementation were present within each theme and grouping these determinants by (a) community for ex le lack of public interest, (b) practitioner for ex le lack of practitioner time and (c) organisation for ex le lack of effective metrics, reveals a preponderance of practitioner barriers and organisational enablers. Linking barriers with potential enablers leaves several barriers unresolved (e.g., costs for couples) implying additional interventions may be required. Future research should draw on the findings from this study to develop and test strategies to facilitate appropriate offering of reproductive genetic carrier screening by healthcare practitioners.
Publisher: Wiley
Date: 22-11-2019
DOI: 10.1111/JEP.13079
Abstract: Uncertainty is a ubiquitous and dynamic presence throughout healthcare systems and encounters, affecting the quality and safety of care. Although previous research has attempted to categorize varieties of uncertainty, it is not clear if these classifications are applicable across various healthcare settings. The purpose of this review was to examine the applicability of the issues of uncertainty delineated in an established taxonomy across erse healthcare domains, professions, and countries and to consider the complexity of these issues. Drawing on empirical research from three databases, we conducted a scoping review of the literature to identify types of uncertainty experienced by healthcare professionals. A framework synthesis design was employed to review and synthesize the literature across multiple healthcare settings. The search identified 2285 articles, of which 94 met the inclusion criteria. Findings from included studies suggested professional uncertainty in healthcare is complex and pervasive. On the basis of our inability to categorize some studies in the issues of uncertainty outlined in the existing taxonomy, we proposed a revised model of uncertainty for healthcare professionals. The revised model of uncertainty, the model of uncertainty in complex healthcare settings (MUCH-S), is applicable to various healthcare ecosystems and proposes a reflexive archetype that recognizes different issues of uncertainty while establishing that these are often interrelated in healthcare systems. This review offers healthcare professionals greater levels of understanding of this complex phenomenon and may support more informed and reflective decision-making, assisting them to better navigate uncertainties experienced in healthcare workplaces.
Publisher: BMJ
Date: 06-2020
DOI: 10.1136/BMJOPEN-2019-036453
Abstract: The sustainability of healthcare delivery systems is challenged by ageing populations, complex systems, increasing rates of chronic disease, increasing costs associated with new medical technologies and growing expectations by healthcare consumers. Healthcare programmes, innovations and interventions are increasingly implemented at the front lines of care to increase effectiveness and efficiency however, little is known about how sustainability is conceptualised and measured in programme evaluations. We aimed to describe theoretical frameworks, definitions and measures of sustainability, as applied in published evaluations of healthcare improvement programmes and interventions. Systematic integrative review. We searched six academic databases, CINAHL, Embase, Ovid MEDLINE, Emerald Management, Scopus and Web of Science, for peer-reviewed English journal articles (July 2011–March 2018). Articles were included if they assessed programme sustainability or sustained outcomes of a programme at the healthcare system level. Six reviewers conducted the abstract and full-text review. Data were extracted on study characteristics, definitions, terminology, theoretical frameworks, methods and tools. Hawker’s Quality Assessment Tool was applied to included studies. Of the 92 included studies, 75.0% were classified as high quality. Twenty-seven (29.3%) studies provided 32 different definitions of sustainability. Terms used interchangeably for sustainability included continuation, maintenance, follow-up or long term. Eighty studies (87.0%) clearly reported the timepoints at which sustainability was evaluated: 43.0% at 1–2 years and 11.3% at months. Eighteen studies (19.6%) used a theoretical framework to conceptualise or assess programme sustainability, including frameworks that were not specifically designed to assess sustainability. The body of literature is limited by the use of inconsistent definitions and measures of programme sustainability. Evaluations of service improvement programmes and interventions seldom used theoretical frameworks. Embedding implementation science and healthcare service researchers into the healthcare system is a promising strategy to improve the rigour of programme sustainability evaluations.
Publisher: CSIRO Publishing
Date: 2001
DOI: 10.1071/AH010003
Abstract: Jeffrey Braithwaite is Senior Lecturer and Director, Graduate Management Programs and Don Hindle isVisiting Professor in the Faculty of Medicine, University of New South Wales.
Publisher: BMJ
Date: 14-12-2009
DOI: 10.1136/BMJ.B5201
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: Springer Science and Business Media LLC
Date: 08-11-2009
Publisher: Springer Science and Business Media LLC
Date: 30-08-2013
Publisher: Wiley
Date: 24-03-2023
DOI: 10.1111/AJD.14023
Abstract: Skin cancer is a growing global problem and a significant health and economic burden. Despite the practical necessity for skin cancer to be managed in primary care settings, little is known about how quality of care is or should be measured in this setting. This scoping review aimed to capture the breadth and range of contemporary evidence related to the measurement of quality in skin cancer management in primary care settings. Six databases were searched for relevant texts reporting on quality measurement in primary care skin cancer management. Data from 46 texts published since 2011 were extracted, and quality measures were catalogued according to the three domains of the Donabedian model of healthcare quality (structure, process and outcome). Quality measures within each domain were inductively analysed into 13 key emergent groups. These represented what were deemed to be the most relevant components of skin cancer management as related to structure, process or outcomes measurement. Four groups related to the structural elements of care provision (e.g. diagnostic tools and equipment), five related to the process of care delivery (e.g. diagnostic processes) and four related to the outcomes of care (e.g. poor treatment outcomes). A broad range of quality measures have been documented, based predominantly on articles using retrospective cohort designs systematic reviews and randomised controlled trials were limited.
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: Elsevier BV
Date: 02-2016
DOI: 10.1016/J.JAMDA.2015.11.015
Abstract: Dementia is a syndrome associated with stigma and social isolation. Forty-two percent of people with dementia in the United States and almost 40% in the United Kingdom live in assisted living and residential care facilities. Up to 90% of residents with dementia experience behavioral and psychological symptoms of dementia (BPSD). Currently psychotropic drugs are often used to manage BPSD, despite the drugs' limited efficacy and adverse effects. Even though psychosocial approaches are as effective as medical ones without side effects, their uptake has been slow. Social networks that investigate the structure of relationships among residents and staff may represent an important resource to increase the uptake of psychosocial approaches and facilitate improvements in care. To conduct a systematic review of social network studies set in long-term care (LTC), including residents with dementia, and identify network factors influencing the care available to residents. Peer-reviewed articles across CINAHL, EMBASE, IBSS, Medline, PsychInfo, Scopus, and Web of Science were searched from January 1994 to December 2014 inclusive, using PRISMA guidelines. Studies included those examining social networks of residents or staff in LTC. Nine articles from studies in the United States, Europe, Asia, and Australia met search criteria. Resident networks had few social connections. One study proposed that residents with high centrality be encouraged to welcome new residents and disseminate information. The high density in 2 staff network studies was associated with the cooperation needed to provide care to residents with dementia. Staff's boundary-spanning led to higher-status nurses becoming more involved in decision-making and problem-solving in one study. In another, the outcome was staff treating residents with more respect and actively caring for them. These studies suggest interventions using a network approach may improve care services in LTC.
Publisher: MDPI AG
Date: 23-02-2021
Abstract: Despite the overwhelming interest in clinical genomics, uptake has been slow. Implementation science offers a systematic approach to reveal pathways to adoption and a theory informed approach to addressing barriers presented. Using case study methodology, we undertook 16 in-depth interviews with nongenetic medical specialists to identify barriers and enablers to the uptake of clinical genomics. Data collection and analysis was guided by two evidence-based behaviour change models: the Theoretical Domains Framework (TDF), and the Capability, Opportunity Motivation Behaviour model (COM-B). Our findings revealed the use of implementation science not only provided a theoretical structure to frame the study but also facilitated uncovering of traditionally difficult to access responses from participants, e.g., “safety in feeling vulnerable” (TDF code emotion/COM-B code motivation). The most challenging phase for participants was ensuring appropriate patients were offered genomic testing. There were several consistent TDF codes: professional identity, social influences, and environmental context and resources and COM-B codes opportunity and motivation, with others varying along the patient journey. We conclude that implementation science methods can maximise the value created by the exploration of factors affecting the uptake of clinical genomics to ensure future interventions are designed to meet the needs of novice nongenetic medical specialists.
Publisher: Frontiers Media SA
Date: 15-06-2023
DOI: 10.3389/FPUBH.2023.1217542
Abstract: The concept of safety culture in healthcare—a culture that enables staff and patients to be free from harm—is characterized by complexity, multifacetedness, and indefinability. Over the years, disparate and unclear definitions have resulted in a proliferation of measurement tools, with lack of consensus on how safety culture can be best measured and improved. A growing challenge is also achieving sufficient response rates, due to “survey fatigue,” with the need for survey optimisation never being more acute. In this paper, we discuss key challenges and complexities in safety culture assessment relating to definition, tools, dimensionality and response rates. The aim is to prompt critical reflection on these issues and point to possible solutions and areas for future research.
Publisher: AMPCo
Date: 05-1995
Publisher: BMJ
Date: 2011
DOI: 10.1136/BMJQS.2009.038885
Abstract: In a previous paper we developed a generic disaster pathway model drawing from disaster inquiries in the space, shipping, aviation, mining, rail and nuclear industries. To test our hypothesis that our generic disaster model can be applied to healthcare errors, we ustilised three exemplar cases featuring different types and sources of errors. We found that it is possible to apply our generic disaster pathway to healthcare errors, and to identify the combination of human, organisational and design risk factors which contribute to the severity and speed at which errors occur. We conclude that error pathways provide a useful tool from which healthcare services can learn to appreciate and potentially circumvent or ameliorate errors, prior to their reaching the no-return threshold.
Publisher: Emerald
Date: 11-09-2007
DOI: 10.1108/14777260710778899
Abstract: The purpose of the paper is to examine the deep conceptual underpinnings of trust and communication breakdowns via selected health inquiries into things that go wrong using evolutionary psychology. This paper explains how this is carried out, and explores some of the adverse consequences for patient care. Evolutionary psychology provides a means of explaining important mental capacities and constructs including theory of mind and the social brain hypothesis. To have a theory of mind is to be able to read others' behaviours, linguistic and non‐verbal cues, and analyse their intentions. To have a social (or Machiavellian) brain means being able to assess, compete with and, where necessary, outwit others. In the tough and complex environment of the contemporary health setting, not too different from the Pleistocene, humans display a well‐developed theory of mind and social brains and, using mental attributes and behavioural repertoires evolved for the deep past in hunter‐gatherer bands, survive and thrive in difficult circumstances. The paper finds that, while such behaviours cannot be justified, armed with an evolutionary approach one can predict survival mechanisms such as turf protection, competitive strategies, sending transgressors and whistleblowers to Coventry, self‐interest, and politics and tribal behaviours. The paper shows that few studies examine contemporary health sector behaviours through an evolutionary psychology lens or via such deep accounts of human nature.
Publisher: Springer Science and Business Media LLC
Date: 16-05-2023
DOI: 10.1186/S13104-023-06356-5
Abstract: Clinical Practice Guidelines (CPGs) are designed to guide treatment decisions, yet adherence rates vary widely. To characterise perceived barriers and facilitators to cancer treatment CPG adherence in Australia, and estimate the frequency of previous qualitative research findings, a survey was distributed to Australian oncologists. The s le is described and validated guideline attitude scores reported for different groups. Differences in mean CPG attitude scores across clinician subgroups and associations between frequency of CPG use and clinician characteristics were calculated with 48 respondents there was limited statistical power to find differences. Younger oncologists ( 50 years) and clinicians participating in three or more Multidisciplinary Team Meetings were more likely to routinely or occasionally use CPGs. Perceived barriers and facilitators were identified. Thematic analysis was conducted on open-text responses. Results were integrated with previous interview findings and presented in a thematic, conceptual matrix. Most barriers and facilitators identified earlier were corroborated by survey results, with minor discordance. Identified barriers and facilitators require further exploration within a larger s le to assess their perceived impact on cancer treatment CPG adherence in Australia, as well as to inform future CPG implementation strategies. This research was Human Research Ethics Committee approved (2019/ETH11722 and 52019568810127, ID:5688).
Publisher: Wiley
Date: 16-01-2020
DOI: 10.1002/JCOP.22309
Abstract: The aim of this review was to scope the growth and development of implementation research of e-mental healthcare programs for anxiety and depression, the research and evaluation tools used, and the specific implementation processes and outcomes examined. A search of four electronic databases (MEDLINE, EMBASE, PsycINFO, and CINAHL) was conducted from January 2000 to January 2019. Of 33 studies identified, most (n = 28) were published in the last five years. Only 10 used an implementation framework to guide implementation or evaluation. Most studies reported on acceptability (n = 28), appropriateness (n = 23), and feasibility (n = 17). Less commonly reported implementation outcomes were fidelity (n = 10) and adoption (n = 7) with penetration (n = 4), sustainability (n = 3), and implementation cost (n = 2) being studied rarely. Of the 21 studies that used surveys to study implementation outcomes, less than half used a previously published survey (n = 9). More rigorous implementation studies, underpinned by strong theory and real-world understanding, are urgently needed.
Publisher: Springer Science and Business Media LLC
Date: 13-06-2014
Publisher: Springer Science and Business Media LLC
Date: 24-02-2021
DOI: 10.1186/S12913-020-05819-W
Abstract: Although quality indicators are frequently derived from guidelines, there is a substantial gap in collaboration between the corresponding parties. To optimise workflow, guideline recommendations and quality assurance should be aligned methodologically and practically. Learning from the European Commission Initiative on Breast Cancer (ECIBC), our objective was to bring the key knowledge and most important considerations from both worlds together to inform European Commission future initiatives. We undertook several steps to address the problem. First, we conducted a feasibility study that included a survey, interviews and a review of manuals for an integrated guideline and quality assurance (QA) scheme that would support the European Commission. The feasibility study drew from an assessment of the ECIBC experience that followed commonly applied strategies leading to separation of the guideline and QA development processes. Secondly, we used results of a systematic review to inform our understanding of methodologies for integrating guideline and QA development. We then, in a third step, used the findings to prepare an evidence brief and identify key aspects of a methodological framework for integrating guidelines QA through meetings with key informants. Seven key themes emerged to be taken into account for integrating guidelines and QA schemes: (1) evidence-based integrated guideline and QA frameworks are possible, (2) transparency is key in clearly documenting the source and rationale for quality indicators, (3) intellectual and financial interests should be declared and managed appropriately, (4) selection processes and criteria for quality indicators need further refinement, (5) clear guidance on retirement of quality indicators should be included, (6) risks of an integrated guideline and QA Group can be mitigated, and (7) an extension of the GIN-McMaster Guideline Development Checklist should incorporate QA considerations. We concluded that the work of guideline and QA developers can be integrated under a common methodological framework and we provided key findings and recommendations. These two worlds, that are fundamental to improving health, can both benefit from integration.
Publisher: Emerald
Date: 09-02-2010
DOI: 10.1108/09526861011017076
Abstract: This paper aims to explore how surveying benefits accreditation surveyors and the organisations in which they are regularly employed. The purpose is to examine from the perspective of senior executives who pursue this form of secondary professional activity, what they seek from being surveyors and what they believe they gain from the experience. The data were collected from recorded interviews with three senior area health executives who also serve as accreditation surveyors for the Australian Council on Healthcare Standards. The interviews comprised a series of open‐ended, semi‐structured questions. One hour was allocated for each interview. The questions were designed to explore why senior executive health professionals seek secondary professional activity as surveyors and their perceptions of the benefits they gain from surveying. The benefits derived from surveying as a secondary professional activity fall into four categories. First, it exposes the surveyor to new methods and innovations. Second, it provides a unique form of ongoing learning. Third, it serves as a resource for acquiring expertise to enhance quality within the institutions in which the participants were regularly employed and, finally, it provides opportunities to contribute to the process of quality improvement and enhance public health beyond the organisations in which the participants were regularly employed. This research identifies a key aspect of the accreditation process that has not been the focus of previous research. It provides a reference point for understanding the value of surveying to the surveyor and to the institutions in which they are regularly employed. The paucity of existing literature on the role of the surveyor – both pre and post accreditation – makes this topic timely and significant. This study is important because almost all accreditation programs world wide rely on external surveyors, and yet we know little about them.
Publisher: Oxford University Press (OUP)
Date: 2021
Publisher: Oxford University Press (OUP)
Date: 30-11-2021
Abstract: The health, social and economic consequences of the severe acute respiratory syndrome coronavirus (SARS-CoV-2, henceforth COVID-19) pandemic have loomed large as every national government made decisions about how to respond. The 40 Health Systems, COVID-19 (40HS, C-19) study aimed to investigate relationships between governments’ capacity to respond (CTR), their response stringency, scope of COVID-19 testing and COVID-19 outcomes. Data over March and April 2020 were extracted for 40 national health systems on prepandemic government CTR (Global Competitiveness Index), stringency measures (Oxford COVID-19 Government Response Tracker Stringency Index), approach to COVID-19 testing and COVID-19 cases and deaths (Our-World-in-Data). Multidimensional scaling (MDS) and cluster analysis were applied to examine latent dimensions and visualize country similarities and dissimilarities. Outcomes were tested using multivariate and one-way analyses of variances and Kruskal–Wallis H tests. The MDS model found three dimensions explaining 91% of the variance and cluster analysis identified five national groupings. There was no association between national governments’ prepandemic CTR and the adoption of early stringent public health measures or approach to COVID-19 testing. Two national clusters applied early stringency measures and reported significantly lower cumulative deaths. The best performing national cluster (comprising Australia, South Korea, Iceland and Taiwan) adopted relatively early stringency measures but broader testing earlier than others, which was associated with a change in disease trajectory and the lowest COVID-19 death rates. Two clusters (one with high CTR and one low) both adopted late stringency measures and narrow testing and performed least well in COVID-19 outcomes. Early stringency measures and intrinsic national capacities to deal with a pandemic are insufficient. Extended stringency measures, important in the short term, are not economically sustainable. Broad-based testing is key to managing COVID-19.
Publisher: Oxford University Press (OUP)
Date: 02-05-2017
Abstract: To identify predictors of the effectiveness of hospital accreditation on process performance measures. A multi-level, longitudinal, stepped-wedge, nationwide study. All patients admitted for acute stroke, heart failure, ulcers, diabetes, breast cancer and lung cancer at Danish hospitals. The Danish Healthcare Quality Programme that was designed to create a framework for continuous quality improvement. Changes in week-by-week trends of hospitals' process performance measures during the study period of 269 weeks prior to, during and post-accreditations. Process performance measures were based on 43 different processes of care obtained from national clinical quality registries. Analyses were stratified according to condition, type of care (i.e. treatment, diagnostics, secondary prevention and patient monitoring) and hospital characteristics (i.e. university affiliation, location, size, experience with accreditation and accreditation compliance). A total of 1 624 518 processes of care were included. The impact of accreditation differed across the conditions. During accreditation, heart failure and breast cancer showed less improvement than other disease areas. Across all conditions, diagnostic processes improved less rapidly than other types of processes. However, after stratifying the data by hospital characteristics, process performance measures improved more uniformly. In respect of the measures that had an unsatisfactory level of quality, the processes related to diabetes, diagnostics and patient monitoring all responded to accreditation and showed an increased improvement during the preparatory work. Hospital characteristics were not found to be predictors for the effects of accreditation, whereas conditions and types of care to some extent predicted the effectiveness.
Publisher: Springer Science and Business Media LLC
Date: 23-05-2011
Publisher: Wiley
Date: 10-2011
DOI: 10.1111/J.1553-2712.2011.01171.X
Abstract: In this hypothesis-generating study, we observe, identify, and analyze how emergency clinicians seek to manage work pressure to maximize patient flow in an environment characterized by delayed patient admissions (access block) and emergency department (ED) crowding. An ethnographic approach was used, which involved direct observation of on-the-ground behaviors, when and where they happened. More than 1,600 hours over a 12-month period were spent observing approximately 4,500 interactions across approximately 260 emergency physicians and nurses, emergency clinicians, and clinicians from other hospital departments. The authors content analyzed and thematically analyzed more than 800 pages of field notes to identify indicators of and responses to pressure in the day-to-day ED work environment. In response to the inability to control inflow, and the reactions of inpatient departments to whom patients might be transferred, emergency clinicians: reconciled urgency and acuity of conditions negotiated and determined patients' admission-discharge status early in their trajectories pursued predetermined but coevolving pathways in response to micro- and macroflow problems and exercised flexibility to reduce work pressure by managing scarce time and space in the ED. To redress the linearity of most literature on patient flow, this study adopts a systems perspective and ethnographic methods to bring to light the dynamic role that in iduals play, interacting with their work contexts, to maintain patient flow. The study provides an empirical foundation, uniquely discernible through qualitative research, about aspects of ED work that previously have been the subject only of discussion or commentary articles. This study provides empirical documentation of the moment-to-moment responses of emergency clinicians to work pressure brought about by factors outside much of their control, establishing the relationship between patient flow and work pressure. We conceptualize the ED as a dynamic system, combining socioprofessional influences to reduce and control work pressure in the ED. Interventions in education, practice, policy, and organizational performance evaluations will be supported by this systematic documentation of the complexity of emergency clinical work. Future research involves testing the five findings using systems dynamic modeling techniques.
Publisher: Elsevier BV
Date: 02-2023
DOI: 10.1016/J.JCLINEPI.2022.04.002
Abstract: Our objective was to develop an extension of the widely used GIN-McMaster Guideline Development Checklist and Tool for the integration of quality assurance and improvement (QAI) schemes with guideline development. We used a mixed-methods approach incorporating evidence from a systematic review, an expert workshop and a survey of experts to iteratively create an extension of the checklist for QAI through three rounds of feedback. As a part of this process, we also refined criteria of a good guideline-based quality indicator. We developed a 40-item checklist extension addressing steps for the integration of QAI into guideline development across the existing 18 topics and created one new topic specific to QAI. The steps span from 'organization, budget, planning and training', to updating of QAI and guideline implementation. The tool supports integration of QAI schemes with guideline development initiatives and it will be used in the forthcoming integrated European Commission Initiative on Colorectal Cancer. Future work should evaluate this extension and QAI items requiring additional support for guideline developers and links to QAI schemes.
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: BMJ
Date: 04-2009
Publisher: Springer New York
Date: 2011
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: 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: Ovid Technologies (Wolters Kluwer Health)
Date: 17-11-2022
Publisher: Oxford University Press (OUP)
Date: 12-07-2022
Abstract: Climate change, human health, and healthcare systems are inextricably linked. As the climate warms due to greenhouse gas (GHG) emissions, extreme weather events, such as floods, fires, and heatwaves, will drive up demand for healthcare. Delivering healthcare also contributes to climate change, accounting for ∼5% of the global carbon emissions. To rein in healthcare’s carbon footprint, clinicians and health policy makers must be able to measure the GHG contributions of healthcare systems and clinical practices. Herein, we scope potential informatics solutions to monitor the carbon footprint of healthcare systems and to support climate-change decision-making for clinicians, and healthcare policy makers. We discuss the importance of methods and tools that can link environmental, economic, and healthcare data, and outline challenges to the sustainability of monitoring efforts. A greater understanding of these connections will only be possible through further development and usage of models and tools that integrate erse data sources.
Publisher: Springer Science and Business Media LLC
Date: 17-08-2021
DOI: 10.1007/S11657-021-00966-X
Abstract: Hip fracture trajectories have not been examined for older adults in aged care or living in the community. Trajectories of health care use were defined by distinct predictive factors. These results can inform the development of targeted strategies to reduce health service use following hip fracture. To examine hospital service use trajectories of older adults who were hospitalised for hip fracture and living in a residential aged care facility (RACF) or the community, and to identify factors predictive of trajectory group membership. These findings may inform future programmes aimed at reducing unexpected hospitalisations and subsequently reduce health care costs. A group-based trajectory analysis of hospitalisations was conducted for adults aged ≥ 65 years hospitalised for hip fracture during 2008-2009 in New South Wales, Australia. Linked hospitalisation and RACF data were examined for a 5-year period. Group-based trajectory models were derived for RACF and community-dwelling older adults based on the number of subsequent hospital admissions following the index hip fracture. Multinomial logistic regression examined predictors of trajectory group membership for subsequent hospital admissions. There were 5752 hip fracture hospitalisations, with two-thirds of hip fractures occurring in community-dwellers. Key predictors of trajectory group membership for both RACF residents and community-dwellers were age group, sex, hospital length of stay and cognitive impairment. Assistance with activities of daily living and complex health care needs were also predictive of group membership in RACF residents. Location of residence and time to move to a RACF were additional predictors of group membership for community-dwellers. Health service use trajectories differed for RACF residents and community-dwellers however, there were similar patient characteristics that defined trajectory group membership. Low users of hospital services living in RACFs or the community included older adults with generally unfavourable health conditions, potentially indicating that palliative care or advanced care directives and community-care initiatives, respectively, have played a part in the lowered frequency of rehospitalisation.
Publisher: AMPCo
Date: 1997
DOI: 10.5694/J.1326-5377.1997.TB138692.X
Abstract: Cardiovascular disease (CVD) is associated with a greater frailty risk, but it remains unknown if pathways that contribute to CVD are associated with the frailty risk. Thus, we aimed to investigate whether elevations in high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) for those without known CVD at baseline are associated with a higher frailty risk. This study used data from the Atherosclerosis Risk in Communities study. Cardiac biomarkers were measured from stored plasma s les collected at Visit 2 (1991-1993). Frailty was recorded at Visit 5 (2011-2013). Cox regression models were used to determine the association of cardiac biomarkers with frailty risk. Overall, 360/5199 (6.9%) participants aged 55.1 ± 5.1 years developed frailty during a median follow-up of 21.7 years. The incidence of frailty was significantly higher in participants with hs-cTnT ≥14 ng/L (vs. < 14 ng/L: 17.9% vs. 6.7%) or NT-proBNP ≥300 pg/ml (vs. < 300 pg/ml: 19.7% vs. 6.8%) (all P < 0.001). Comparing higher vs. lower cut-off levels of either hs-cTnT (14 ng/l) or NT-proBNP (300 pg/ml) demonstrated a greater than two-fold higher frailty risk, with hazard ratios (HRs) of 2.13 (95% confidence interval (CI): 1.130-4.01, P = 0.020) and 2.61 (95% CI: 1.28-5.33, P = 0.008), respectively. In iduals with both elevated hs-cTnT and NT-proBNP had a higher frailty risk than those without it (HR: 4.15 95% CI: 1.50-11.48, P = 0.006). High hs-cTnT and NT-proBNP levels are strongly associated with incident frailty in the community-dwelling population without known CVD. Subclinical cardiac damage (hs-cTnT) and/or wall strain (NT-proBNP) may be the key pathway of CVD patients developing frailty. Detection of hs-cTnT and NT-proBNP may help for early screening of high-risk frailty and providing in idualised intervention. URL: www. gov Unique identifier: NCT00005131 .
Publisher: Springer Science and Business Media LLC
Date: 12-2009
Publisher: Springer Science and Business Media LLC
Date: 12-2019
Publisher: Springer Science and Business Media LLC
Date: 31-07-2023
DOI: 10.1038/S41525-023-00357-W
Abstract: An understanding of factors influencing implementation is essential to realise the benefits of population-based reproductive genetic carrier screening programs. The aim of this study was to synthesise data collected during the Australian Reproductive Genetic Carrier Screening Project (Mackenzie’s Mission) to track how priorities shifted over time and identify important factors during scaling-up and for sustainment. We used a multi-method qualitative approach to integrate longitudinal project data collected from 10 project committees with 16 semi-structured interviews conducted with study team members. Both datasets were analysed using the Consolidated Framework for Implementation Research (CFIR) to identify constructs of interest within early, mid-point, and future implementation phases. Several CFIR constructs were present across implementation. The complexity of implementation presented challenges that were overcome through a quality-designed and packaged product, formal and informal networks and communication, and access to knowledge and information. Addressing the erse consumer needs through resources and increasing community and non-genetic speciality engagement remained a priority throughout and for future sustainment. Going forward, further addressing program complexities and securing funding were emphasised. By applying an implementation framework, findings from this study may be useful for future effort towards building and/or sustaining reproductive genetic carrier screening programs.
Publisher: Springer Science and Business Media LLC
Date: 25-10-2018
Publisher: Public Library of Science (PLoS)
Date: 16-03-2023
DOI: 10.1371/JOURNAL.PONE.0283171
Abstract: Often considered an “invisible disability”, hearing loss is one of the most prevalent chronic diseases and the third leading cause for years lived with disability worldwide. Hearing loss has substantial impacts on communication, psychological wellbeing, social connectedness, cognition, quality of life, and economic independence. The Hearing impairment in Adults: a Longitudinal Outcomes Study (HALOS) aims to evaluate the: (1) impacts of hearing devices (hearing aids and/or cochlear implants), (2) differences in timing of these interventions and in long-term outcomes between hearing aid and cochlear implant users, and (3) cost-effectiveness of early intervention for adult-onset hearing loss among hearing device users. HALOS is a mixed-methods study collecting cross-sectional and longitudinal data on health and social outcomes from 908 hearing aid and/or cochlear implant users aged ≥40 years, recruited from hearing service providers across Australia. The quantitative component will involve an online survey at baseline (time of recruitment), 24-months, and 48-months and will collect audiological, health, psychosocial, functional and employment outcomes using validated instruments. The qualitative component will be conducted in a subset of participants at baseline and involve semi-structured interviews to understand the patient journey and perspectives on the Australian hearing service model. This study has been approved by the Macquarie University Human Research Ethics Committee (ID: 11262) and Southern Adelaide Local Health Network (ID: LNR/22/SAC/88). Dissemination of results: Study findings will be disseminated to participants via a one-page summary, and to the public through publications in peer-reviewed journals and presentations at conferences. Australia New Zealand Clinical Trial Registry (ANZCTR) registration number: ACTRN12622000752763 .
Publisher: Emerald
Date: 16-11-2015
DOI: 10.1108/JHOM-02-2015-0034
Abstract: – Health systems are changing at variable rates. Periods of significant change can create new challenges or lify existing barriers to accreditation program credibility and reliability. The purpose of this paper is to examine, during the transition to a new Australian accreditation scheme and standards, challenges to health service accreditation survey reliability, the salience of the issues and strategies to manage threats to survey reliability. – Across 2013-2014, a two-phase, multi-method study was conducted, involving five research activities (two questionnaire surveys and three group discussions). This paper reports data from the transcribed group discussions involving 100 participants, which was subject to content and thematic analysis. Participants were accreditation survey coordinators employed by the Australian Council on Healthcare Standards. – Six significant issues influencing survey reliability were reported: accreditation program governance and philosophy accrediting agency management of the accreditation process, including the program’s framework survey coordinators survey team dynamics in idual surveyors and healthcare organizations’ approach to accreditation. A change in governance arrangements promoted reliability with an independent authority and a new set of standards, endorsed by Federal and State governments. However, potential reliability threats were introduced by having multiple accrediting agencies approved to survey against the new national standards. Challenges that existed prior to the reformed system remain. – Capturing lessons and challenges from healthcare reforms is necessary if improvements are to be realized. The study provides practical and theoretical strategies to promote reliability in accreditation programs.
Publisher: Springer Science and Business Media LLC
Date: 24-10-2013
Publisher: SAGE Publications
Date: 18-09-2017
Publisher: AMPCo
Date: 2009
DOI: 10.5694/J.1326-5377.2009.TB02282.X
Abstract: The final report of the Special Commission of Inquiry into Acute Care Services in NSW Public Hospitals was published on 27 November 2008. The report acknowledges the challenges facing the New South Wales health system, including increasing numbers of patients, rising treatment costs, workforce pressures, and the breakdown of working relations between clinicians and management. Many of Commissioner Garling's 139 recommendations formalise aspects of clinical care that should and could be happening now if the system were better managed, including better supervision and training of junior staff. Commissioner Garling recommends that change should be driven by clinicians "from the bottom up", but does not adequately describe how this should happen. Implementation of the report's recommendations that will require strong leadership and continuing consultation with clinicians and the community.
Publisher: Oxford University Press (OUP)
Date: 15-07-2016
Abstract: To examine how consumer engagement (CE) can be promoted through Australian accreditation programmes. A nation-wide qualitative study completed in 2012. All eight Australian States and Territories. Two-hundred and fifty-eight healthcare stakeholders from the acute, primary and aged care sectors. Forty-seven in idual and group interviews were undertaken. Questions elicited views on the dimensions and utility of CE promotion by accreditation programmes. Healthcare stakeholders' views on the dimensions and utility of CE promotion by accreditation programmes. Four mechanisms of CE promotion were identified. Two involved requirements for health service organizations to meet CE-related standards related to consumer experience and satisfaction surveys, and consumer participation in organizational governance processes. Two mechanisms for promoting CE through accreditation processes were also identified, concerning consumer participation in the development and revision of standards, and the implementation of accreditation surveys. Accreditation programmes were viewed as important drivers of CE, yet concerns were raised regarding the organizational investments needed to meet programmes' requirements. Accreditation programmes use erse mechanisms as levers for change to promote CE in healthcare. These mechanisms and their inter-relationships require careful consideration by accreditation agencies and health policymakers to maximize their potential benefits, while maintaining stakeholder engagement in programmes.
Publisher: Emerald
Date: 05-09-2008
DOI: 10.1108/14777260810898732
Abstract: The purpose of this paper is to draw on scientific models in conceptualising the evolutionary bases of contemporary behaviours, and make cross‐species comparisons, to account for male managerial activities in situ in health organizations. In the animal world, males of many species display in order to induce females to mate. Such lekking behaviour involves inter alia, strutting, puffing out, catching attention via the use of ornamental physical characteristics, exhibiting gaudily‐coloured body parts, singing or splashing, and other courting and wooing strategies. The paper applies these behavioural repertoires as an explanatory device for male‐dominant organizational lekking in a set of contemporary settings. It draws on six studies of managerial talk, appearance and behaviour in order to do so. Within the organizational lek male managers display mainly by power dressing, positioning, and exercising power and influence via verbal and behavioural means. Social and religious mores prohibit overt sexual coupling in organizations but lekking for other rewards is nevertheless pursued by male managers. The paper explores this managerial patterning, compares it to the lekking behaviour of other species, and discusses points of comparison and departure. It shows how male managers display within various sub‐habitats, and discusses the central issues of appearance, tasks and work assignment, physical interaction structure, and talk and physiognomy. Understanding what makes people tick via deep explanations than are customarily rendered is a vital contribution of scholarship to the practical world of management. The evolutionary bases of contemporary behaviours, and cross‐species accounts, may prove useful paradigms for other theorists and empiricists in organizational studies, and could encourage the development of a new field that might be labeled evolutionary organizational behaviour.
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: 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: Springer Science and Business Media LLC
Date: 21-11-2014
Publisher: BMJ
Date: 10-2019
DOI: 10.1136/BMJOPEN-2019-031179
Abstract: An understanding of the real-world provision of oncology outpatient services can help maintain service quality in the face of escalating demand and tight budgets, by informing the design of interventions that improve the effectiveness or efficiency of provision. The aims of this study are threefold. First, to develop an understanding of cancer services in outpatient clinics by characterising the organisation and practice of multidisciplinary care (MDC). Second, to explore the key areas of: (a) clinical decision-making and (b) engagement with patients’ supportive needs. Third, to identify barriers to, and facilitators of, the delivery of quality care in these settings. A suite of mixed-methods studies will be implemented at six hospitals providing cancer outpatient clinics, with a staged roll-out. In Stage One, we will examine policies, use unstructured observations and undertake interviews with key health professionals to characterise the organisation and delivery of MDC. In Stage Two, observations of practice will continue, to deepen our understanding, and to inform two focused studies. The first will explore decision-making practices and the second will examine how staff engage with patients’ needs both studies involve interviews, to complement observation. As part of the study of supportive care, we will examine the implications of an introduction of patient-reported measures (PRMs) into care, adding surveys to interviews before and after PRMs roll-out. Data analysis will account for site-specific and cross-site issues using an adapted Qualitative Rapid Appraisal, Rigorous Analysis approach. Quantitative data from clinician surveys will be statistically analysed and triangulated with the related qualitative study findings. Ethical approval was granted by South Eastern Sydney Local Health District Human Research Ethics Committee (no. 18/207). Findings will be shared with participating hospitals and widely disseminated through publications and presentations.
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: 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: 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: Oxford University Press (OUP)
Date: 07-2003
Abstract: over 60% of older people have at least one admission to hospital in their last year of life, with the majority of people having multiple admissions. In Bankstown, New South Wales, Australia, we have a erse ethnic and cultural population. We were interested in bed utilisation, documentation, and follow through of "care plans" as well as "not for resuscitation" orders in the last year of life of the older people in our area. we reviewed and collected data from the medical records of patients over 65 years of age who died in our hospital. Reviewers included a medical registrar, a research officer and two geriatricians. We collected a wide range of information pertaining to the 12 months before death. This included demographics, chronic illnesses, geriatric syndromes, number of admissions, bed days, care plans, and not for resuscitation orders as well as other relevant data. 110 patients' records were reviewed. The mean age was 80 years and 31% were from a non English-speaking background. The average number of admissions was 2.4 and the average number of bed days in the last year of life was 25. Sixty-one of the patients had a care plan and a not for resuscitation order, 91% of which were written shortly before death. Using bi-variate analysis of old age (over 80), number of chronic illnesses, or geriatric syndromes present, the number of bed days was positively correlated to care plan and not for resuscitation orders. Logistic multivariate analysis of chronic illnesses revealed that stroke (P=0.024) as well as stroke and fracture (P=0.008) were strongly correlated with care plan and not for resuscitation orders. Only 8 patients had an advanced care plan documented prior to last admission. When advanced care plans were documented, they were generally clearly written and followed through appropriately (7 out of 8). this study showed that in our erse population there were multiple admissions and utilisation of hospital beds for older people in their last year of life. Care plans and not for resuscitation orders were rarely documented prior to last admission. However, when advanced care plans were done, they were usually well documented and followed through appropriately.
Publisher: BMJ
Date: 05-2018
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: Oxford University Press (OUP)
Date: 20-11-2020
Abstract: While in idual countries have gained considerable knowledge and experience in coronavirus disease of 2019 (COVID-19) management, an international, comparative perspective is lacking, particularly regarding the measures taken by different countries to tackle the pandemic. This paper elicits the views of health system staff, tapping into their personal expertise on how the pandemic was initially handled. From May to July 2020, we conducted a cross-sectional, online, purpose-designed survey comprising 70 items. Email lists of contacts provided by the International Society for Quality in Health Care, the Italian Network for Safety in Health Care and the Australian Institute of Health Innovation were used to access healthcare professionals and managers across the world. We snowballed the survey to in iduals and groups connected to these organizations. Key outcome measures were attitudes and information about institutional approaches taken media communication how acute hospitals were re-organized primary health organization personal protective equipment and staffing and training. A total of 1131 survey participants from 97 countries across the World Health Organization (WHO) regions responded to the survey. Responses were from all six WHO regions 57.9% were female and the majority had 10 or more years of experience in healthcare almost half (46.5%) were physicians and all other major clinical professional groups participated. As the pandemic progressed, most countries established an emergency task force, developed communication channels to citizens, organized health services to cope and put in place appropriate measures (e.g. pathways for COVID-19 patients, and testing, screening and tracing procedures). Some countries did this better than others. We found several significant differences between the WHO regions in how they are tackling the pandemic. For instance, while overall most respondents (71.4%) believed that there was an effective plan prior to the outbreak, this was only the case for 31.9% of respondents from the Pan American Health Organization compared with 90.7% of respondents from the South-East Asia Region (SEARO). Issues with swab testing (e.g. delay in communicating the swab outcome) were less frequently reported by respondents from SEARO and the Western Pacific Region compared with other regions. The world has progressed in its knowledge and sophistication in tackling the pandemic after early and often substantial obstacles were encountered. Most WHO regions have or are in the process of responding well, although some countries have not yet instituted widespread measures known to support mitigation, for ex le, effective swab testing and social control measures.
Publisher: Springer Science and Business Media LLC
Date: 24-05-2020
DOI: 10.1186/S12913-020-05334-Y
Abstract: Cochlear implants (CIs) can provide a sound sensation for those with severe sensorineural hearing loss (SNHL), benefitting speech understanding and quality of life. Nevertheless, rates of implantation remain low, and limited research investigates journeys from traditional hearing aids to implantable devices. Fifty-five adults (≥ 50 years), hearing aid users and/or CI users, General Practitioners, and Australian and United Kingdom audiologists took part in a multi-methods study. Focus groups, interviews, and surveys were thematically analysed. One hundred forty-three data-capture events disclosed 2 themes: 1) “ The burden of hearing loss and the impact of Cochlear Implants ”, and 2) “ Professional Support and Practice, and HCPs Roles and Responsibilities” . Care experience can include convoluted, complex journeys towards cochlear implantation. The significant impact of this, as hearing loss progresses, motivates people to consider implants, but they and healthcare professionals need clear supported with defined referral pathways, and less system complexity.
Publisher: Elsevier BV
Date: 09-2006
DOI: 10.1016/J.SOCSCIMED.2006.03.035
Abstract: This paper presents evidence from a root cause analysis (RCA) team meeting that was recently conducted in a Sydney Metropolitan Teaching Hospital to investigate an iatrogenic morphine overdose. Analysis of the meeting transcript reveals on three levels that clinical members of the team struggle with framing the uncertain and contradictory details of situated clinical activity and translating these first into 'root causes', and then into recommendations for practice change. This analysis puts two challenges into special relief. First, RCA team members find themselves in the unusual position of having to derive organizational-managerial generalizations from the specifics of in situ activity. Second, they are constrained by the expectation inscribed into RCA that their recommendations result in 'systems improvements' assumed to flow forth from an extension of formal rules and spread of procedures. We argue that this perspective misrecognizes the importance of RCA as a means to engender solutions that leave the procedural detail of clinical processes unspecified, and produce cross-hospital discussions about the organizational dimensions of care.
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: 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: BMJ
Date: 05-2019
DOI: 10.1136/BMJOPEN-2018-024231
Abstract: Networks are everywhere. Health systems and public health settings are experimenting with multifarious forms. Governments and providers are heavily investing in networks with an expectation that they will facilitate the delivery of better services and improve health outcomes. Yet, we lack a suitable conceptual framework to evaluate the effectiveness and sustainability of clinical and health networks. This paper aims to present such a framework to assist with rigorous research and policy analysis. The framework was designed as part of a project to evaluate the effectiveness and sustainability of health networks. We drew on systematic reviews of the literature on networks and communities of practice in health care, and on theoretical and evidence-based studies of the evaluation of health and non-health networks. Using brainstorming and mind-mapping techniques in expert advisory group sessions, we assessed existing network evaluation frameworks and considered their application to extant health networks. Feedback from stakeholders in network studies that we conducted was incorporated. The framework encompasses network goals, characteristics and relationships at member, network and community levels, and then looks at network outcomes, taking into account intervening variables. Finally, the short-term, medium-term and long-term effectiveness of the network needs to be assessed. The framework provides an overarching contribution to network evaluation. It is sufficiently comprehensive to account for many theoretical and evidence-based contributions to the literature on how networks operate and is sufficiently flexible to assess different kinds of health networks across their life-cycle at community, network and member levels. We outline the merits and limitations of the framework and discuss how it might be further tested.
Publisher: Springer Science and Business Media LLC
Date: 23-11-2020
DOI: 10.1186/S12913-020-05929-5
Abstract: Improving the quality of healthcare has proven to be a challenging task despite longstanding efforts. Approaches to improvements that consider the strong influence of local context as well as stakeholders’ differing views on the situation are warranted. Soft systems methodology (SSM) includes contextual and multi-perspectival features. However, the way SSM has been applied and the outcomes of using SSM to stimulate productive change in healthcare have not been sufficiently investigated. This scoping review aimed to examine and map the use and outcomes of SSM in healthcare settings. The review was based on Arksey and O’Malley’s framework. We searched six academic databases to January 2019 for peer-reviewed journal articles in English. We also reviewed reference lists of included citations. Articles were included if they were empirical studies focused on the application of SSM in a healthcare setting. Two reviewers conducted the abstract review and one reviewer conducted the full-text review and extracted data on study characteristics, ways of applying SSM and the outcomes of SSM initiatives. Study quality was assessed using Hawker’s Quality Assessment Tool. A total of 49 studies were included in the final review. SSM had been used in a range of healthcare settings and for a variety of problem situations. The results revealed an inconsistent use of SSM including departing from Checkland’s original vision, applying different tools and involving stakeholders idiosyncratically. The quality of included studies varied and reporting of how SSM had been applied was sometimes inadequate. SSM had most often been used to understand a problem situation and to suggest potential improvements to the situation but to a lesser extent to implement and evaluate these improvements. SSM is flexible and applicable to a range of problem situations in healthcare settings. However, better reporting of how SSM has been applied as well as evaluation of different types of outcomes, including implementation and intervention outcomes, is needed in order to appreciate more fully the utility and contribution of SSM in healthcare.
Publisher: AMPCo
Date: 02-1994
Publisher: Emerald
Date: 04-1999
DOI: 10.1108/02689239910263163
Abstract: Addresses the issue of empowerment and its possible role in promoting the effectiveness of health services. Empowerment represents the ability of people within organisations to use their own initiative to further organisational interests. However, despite its apparent simplicity, the concept turns out to be quite complex and to have unanticipated implications. We explore some of these implications in health service organisations, and their consequences for health policy. Our conclusion is that many health policies may well act to degrade the empowerment of health service workers, and hence the performance of health service organisations.
Publisher: BMJ
Date: 03-2020
DOI: 10.1136/BMJOPEN-2019-035448
Abstract: Clinical practice guidelines (CPGs) are designed to reduce inappropriate clinical variation and improve the quality of care. Barriers to CPGs include a lack of awareness of CPGs, access to them, time pressures and concerns regarding the evidence underpinning CPG development, implementation and dissemination. The objectives of this study are to assess clinicians’ attitudes to CPGs for cancer treatment and the perceived barriers to and facilitators of CPG adherence in order to inform the implementation of cancer treatment CPGs. A mixed methods study will be conducted using a three-phase, sequential design, with each phase informing the next. In phase 1, a qualitative study using recorded interviews will investigate clinicians’ attitudes to CPGs for cancer treatment and perceptions of barriers and facilitators to CPG adherence (n=30) interview transcripts will be analysed thematically. In phase 2, a survey will quantify the frequency of attitudes, barriers and facilitators identified in phase 1, in a broader clinical s le (n=200). In phase 3, a workshop forum will be held to facilitate discussions examining the implications of phase 1 and 2 findings for cancer CPG implementation strategies (n=40) leading to recommendations for improvements to practice. The workshop discussion will be recorded, and the transcript will be analysed thematically. This study has received ethics approval in New South Wales, Australia (2019/ETH11722, #52019568810127). Study findings will be published in peer-reviewed journals and will form part of a doctoral thesis and be presented at national and international conferences.
Publisher: Springer Science and Business Media LLC
Date: 20-05-2014
Publisher: Wiley
Date: 06-1994
Publisher: SAGE Publications
Date: 2022
DOI: 10.1177/16094069221120748
Abstract: Realist evaluation is a method increasingly adopted to provide an understanding of how and why a program works, for whom, and under what circumstances. Initial program theories (IPT) are the crucial starting point of any realist evaluation, however descriptions about how they are developed in practice remain under-reported in the published literature. This article argues for the value of genuine research-group conversations using David Bohm’s concept of dialogue in realist research. We label it the realist dialogic approach. We draw out the relational qualities as well as the contextual circumstances of dialogue through our development of IPT and interview guides for a research study on the implementation and scaling of a large-system value-based program to transform complex health services. We selected the relevant middle-range theories, conducted a literature review, and drew on informal discussions with key stakeholders, to develop IPT through research-group conversations. The benefits of this approach were: 1) development of rigorous, novel, deep and well-tailored IPT, 2) detailed understanding of the complex intervention under investigation and development of rapport and networks with participants, 3) empirically grounded Context-Mechanism-Outcome (CMO) configurations, predicated on suitable abstract and contextually-contingent middle-range theories, and 4) productive research team interactions which supported the entire research process. The challenges of this approach include: 1) establishing and retaining a sense of humility across the research team, 2) contextual circumstances can hinder dialogic relationship, and 3) time and resource heavy. This paper uses middle-range theory and ethnographic insights to advance the existing practice of realist evaluations and offer transferable lessons to other scholars considering similar approaches. Moreover, we content that the use of middle-range theory to extend the methodological literature is a novel contribution to realist work.
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: 13-07-2021
DOI: 10.1186/S13023-021-01939-6
Abstract: The diagnostic odyssey for people with a rare disease is well known, but difficulties do not stop at diagnosis. Here we investigate the experience of people, or parents of children with a diagnosed mitochondrial respiratory chain disorder (MRCD) in the management of their disease. The work complements ongoing projects around implementation of consensus recommendations for management of people with MRCD. People with or caring for a child with a formally diagnosed MRCD were invited to take part in an hour-long focus group held via videoconference. Questions elicited experiences of receiving management advice or information specific to their MRCD in four areas drawn from the consensus recommendations: diet and supplements, exercise, access to social services, and mental health. Sessions were audio-recorded, transcribed and analysed using a combination of inductive and deductive coding. Focus groups were conducted with 20 participants from five Australian states in June–September 2020. Fourteen adults with a MRCD (three of whom also had a child with a MRCD), and six who cared for a child with a MRCD took part. The overarching finding was that of the need for ongoing negotiation to access the advice and service required to manage their condition. The nature of these negotiations varied across contexts but mostly related to joint decision-making, and more commonly, the need to advocate for their care with non-specialist services (e.g., dieticians, schools). The effort required for this self-advocacy was a prominent theme. While most participants reported receiving adequate advice around supplements, and to a lesser extent diet and exercise, the majority reported no formal advice around mental health or practical assistance accessing social services. These focus groups have revealed several gaps in the system for people with a MRCD, interacting with care providers after diagnosis. Focus group participants had to negotiate with a range of different stakeholders in order to secure appropriate advice or services. Notable was the gap in appropriate generalist services (e.g., dieticians) with sufficient knowledge of MRCD to support people with their day-to-day challenges.
Publisher: Oxford University Press (OUP)
Date: 30-03-2020
Abstract: To describe incidents of retained surgical items, including their characteristics and the circumstances in which they occur. A qualitative content analysis of root cause analysis investigation reports. Public health services in Victoria, Australia, 2010–2015. Incidents of retained surgical items as described by 31 root cause analysis investigation reports. The type of retained surgical item, the length of time between the item being retained and detected and qualitative descriptors of the contributing factors and the circumstances in which the retained surgical items occurred. Surgical packs, drain tubes and vascular devices comprised 68% (21/31) of the retained surgical items. Nearly one-quarter of the retained surgical items were detected either immediately in the post-operative period or on the day of the procedure (7/31). However, about one-sixth (5/31) were only detected after 6 months, with the longest period being 18 months. Contributing factors included complex or multistage surgery the use of packs not specific to the purpose of the surgery and design features of the surgical items. Retained drains occurred in the post-operative phase where surgical counts are not applicable and clinician situational awareness may not be as great. Root cause analysis investigation reports can be a valuable means of characterizing infrequently occurring adverse events such as retained surgical items. They may detect incidents that are not detected by other data collections and can inform the design enhancements and development of technologies to reduce the impact of retained surgical items.
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: BMJ
Date: 24-05-2009
Publisher: SAGE Publications
Date: 28-02-2014
Publisher: Public Library of Science (PLoS)
Date: 08-02-2021
DOI: 10.1371/JOURNAL.PONE.0245916
Abstract: To assess General Practitioner (GP) and pediatrician adherence to clinical practice guidelines (CPGs) for diagnosis, treatment and management of attention deficit hyperactivity disorder (ADHD). Medical records for 306 children aged ≤15 years from 46 GP clinics and 20 pediatric practices in Australia were reviewed against 34 indicators derived from CPG recommendations. At indicator level, adherence was estimated as the percentage of indicators with ‘Yes’ or ‘No’ responses for adherence, which were scored ‘Yes’. This was done separately for GPs, pediatricians and overall and weighted to adjust for s ling processes. Adherence with guidelines was high at 83.6% (95% CI: 77.7–88.5) with pediatricians (90.1% 95% CI: 73.0–98.1) higher than GPs (68.3% 95% CI: 46.0–85.8 p = 0.02). Appropriate assessment for children presenting with signs or symptoms of ADHD was undertaken with 95.2% adherence (95% CI: 76.6–99.9), however ongoing reviews for children with ADHD prescribed stimulant medication was markedly lower for both pediatricians (51.1% 95% CI: 9.6–91.4) and GPs (18.7% 95% CI: 4.1–45.5). Adherence to CPGs for ADHD by pediatricians was generally high. Adherence by GPs was lower across most domains timely recognition of medication side effects is a particular area for improvement.
Publisher: Wiley
Date: 11-12-2015
Abstract: Over the last two decades healthcare quality and safety have risen to the fore of health policy and research. This has largely been informed by theoretical and empirical ideas found in the fields of ergonomics and human factors. These have enabled significant advances in our understanding and management of quality and safety. However, a parallel and at time neglected sociological literature on clinical quality and safety is presented as offering additional, complementary, and at times critical insights on the problems of quality and safety. This review explores the development and contributions of both the mainstream and more sociological approaches to safety. It shows that where mainstream approaches often focus on the influence of human and local environment factors in shaping quality, a sociological perspective can deepen knowledge of the wider social, cultural and political factors that contextualise the clinical micro-system. It suggests these different perspectives can easily complement one another, offering a more developed and layered understanding of quality and safety. It also suggests that the sociological literature can bring to light important questions about the limits of the more mainstream approaches and ask critical questions about the role of social inequality, power and control in the framing of quality and safety.
Publisher: Elsevier BV
Date: 10-2023
Publisher: Wiley
Date: 17-12-2015
Abstract: The contributions to this collection address technologies, practices, experiences and the organisation of quality and safety across a wide range of healthcare contexts. Spanning three continents, from hospital to community, maternity to mental health, they shine a light into the boardrooms, back offices and front-lines of healthcare, offering sociological insights from the perspectives of managers, clinicians and patients. We review these articles and consider how they contribute to some of the dilemmas that confront mainstream approaches to quality and safety and then look ahead to outline future lines of sociological inquiry to progress the theory and practice of quality and safety.
Publisher: SAGE Publications
Date: 12-2005
Publisher: Springer Science and Business Media LLC
Date: 12-2013
Publisher: Elsevier BV
Date: 02-2013
DOI: 10.1016/J.ANNEMERGMED.2012.08.032
Abstract: We identify and describe emergency physicians' and nurses' perceptions of the effect of an integrated emergency department (ED) information system on the quality of care delivered in the ED. A qualitative study was conducted in 4 urban EDs, with each site using the same ED information system. Participants (n=97) were physicians and nurses with data collected by 69 detailed interviews, 5 focus groups (28 participants), and 26 hours of structured observations. Results revealed new perspectives on how an integrated ED information system was perceived to affect incentives for use, awareness of colleagues' activities, and workflow. A key incentive was related to the positive effect of the ED information system on clinical decisionmaking because of improved and quicker access to patient-specific and knowledge-base information compared with the previous stand-alone ED information system. Synchronous access to patient data was perceived to lead to enhanced awareness by in idual physicians and nurses of what others were doing within and outside the ED, which participants claimed contributed to improved care coordination, communication, clinical documentation, and the consultation process. There was difficulty incorporating the use of the ED information system with clinicians' work, particularly in relation to increased task complexity duplicate documentation, and computer issues related to system usability, hardware, and in iduals' computer skills and knowledge. Physicians and nurses perceived that the integrated ED information system contributed to improvements in the delivery of patient care, enabling faster and better-informed decisionmaking and specialty consultations. The challenge of electronic clinical documentation and balancing data entry demands with system benefits necessitates that new methods of data capture, suited to busy clinical environments, be developed.
Publisher: Oxford University Press (OUP)
Date: 16-01-2018
Abstract: To assess the strength of root cause analysis (RCA) recommendations and their perceived levels of effectiveness and sustainability. All RCAs related to sentinel events (SEs) undertaken between the years 2010 and 2015 in the public health system in Victoria, Australia were analysed. The type and strength of each recommendation in the RCA reports were coded by an expert patient safety classifier using the US Department of Veteran Affairs type and strength criteria. Thirty-six public health services. The proportion of RCA recommendations which were classified as 'strong' (more likely to be effective and sustainable), 'medium' (possibly effective and sustainable) or 'weak' (less likely to be effective and sustainable). There were 227 RCAs in the period of study. In these RCAs, 1137 recommendations were made. Of these 8% were 'strong', 44% 'medium' and 48% were 'weak'. In 31 RCAs, or nearly 15%, only weak recommendations were made. In 24 (11%) RCAs five or more weak recommendations were made. In 165 (72%) RCAs no strong recommendations were made. The most frequent recommendation types were reviewing or enhancing a policy/guideline/documentation, and training and education. Only a small proportion of recommendations arising from RCAs in Victoria are 'strong'. This suggests that insights from the majority of RCAs are not likely to inform practice or process improvements. Suggested improvements include more human factors expertise and independence in investigations, more extensive application of existing tools that assist teams to prioritize recommendations that are likely to be effective, and greater use of observational and simulation techniques to understand the underlying systems factors. Time spent in repeatedly investigating similar incidents may be better spent aggregating and thematically analysing existing sources of information about patient safety.
Publisher: Oxford University Press (OUP)
Date: 30-08-2016
Abstract: To assess changes over time in quality of hospital care in relation to the first accreditation cycle in Denmark. We performed a multi-level, longitudinal, stepped-wedge, nationwide study of process performance measures to evaluate the impact of a mandatory accreditation programme in all Danish public hospitals. Patient-level data (n = 1 624 518 processes of care) on stroke, heart failure, ulcer, diabetes, breast cancer and lung cancer care were obtained from national clinical quality registries. The Danish Healthcare Quality Programme was introduced in 2009, aiming to create a framework for continuous quality improvement. Changes in week-by-week trends of hospital care during the study period of 269 weeks prior to, during and post-accreditation. The quality of hospital care improved over time throughout the study period. The overall positive change in trend odds ratio (OR) = 1.002 per week 95% confidence interval (CI: 0.997-1.006) observed when comparing the period during accreditation with the period prior to accreditation was not significant. However, when restricting the analyses to processes of care where the performance did not meet target values for satisfactory quality prior to accreditation, we found a significant positive change in trend (OR = 1.006 per week 95% CI: 1.001-1.011). When comparing the post-accreditation period with the period during accreditation, we found a significantly reduced trend (OR = 0.994 per week 95% CI: 0.988-0.999), indicating the improvement in quality of care continued but at a lower rate than during accreditation. These findings support the hypothesis that hospital accreditation leads to improvements in patient care.
Publisher: Wiley
Date: 18-06-2020
DOI: 10.1111/JOCN.15352
Publisher: SAGE Publications
Date: 02-2007
Publisher: Springer Science and Business Media LLC
Date: 24-04-2020
DOI: 10.1186/S12887-020-02052-6
Abstract: Infections caused by antibiotic resistant pathogens are increasing, with antibiotic overuse a key contributing factor. The CareTrack Kids (CTK) team assessed the care of children in Australia aged 0–15 years in 2012 and 2013 to determine the proportion of care in line with clinical practice guidelines (CPGs) for 17 common conditions. This study analyses indicators relating to paediatric antibiotic overuse to identify those which should be prioritised by antimicrobial stewardship and clinical improvement programs. A systematic search was undertaken for national and international CPGs relevant to 17 target conditions for Australian paediatric care in 2012–2013. Recommendations were screened and ratified by reviewers. The s ling frame comprised three states containing 60% of the Australian paediatric population (South Australia, New South Wales and Queensland). Multi-stage cluster s ling was used to select general practices, specialist paediatric practices, emergency departments and hospital inpatient services, and medical records within these. Medical records were reviewed by experienced paediatric nurses, trained to assess eligibility for indicator assessment and compliance with indicators. Adherence rates were estimated. Ten antibiotic overuse indicators were identified three for tonsillitis and one each for seven other conditions. A total of 2621 children were assessed. Estimated adherence for indicators ranged from 13.8 to 99.5% while the overall estimate of compliance was 61.9% (95% CI: 47.8–74.7). Conditions with high levels of appropriate avoidance of antibiotics were gastroenteritis and atopic eczema without signs of infection, bronchiolitis and croup. Indicators with less than 50% adherence were asthma exacerbation in children aged 2 years (47.1% 95% CI: 33.4–61.1), sore throat with no other signs of tonsillitis (40.9% 95% CI: 16.9, 68.6), acute otitis media in children aged 12 months who were mildly unwell (13.8% 95% CI: 5.1, 28.0), and sore throat and associated cough in children aged 4 years (14.3% 95% CI: 9.9, 19.7). The results of this study identify four candidate indicators (two for tonsillitis, one for otitis media and one for asthma) for monitoring by antibiotic stewardship and clinical improvement programs in ambulatory and hospital paediatric care, and intervention if needed.
Publisher: SAGE Publications
Date: 11-2020
Abstract: A common method of learning about adverse events (AEs) is by reviewing medical records using the global trigger tool (GTT). However, these studies generally report rates of harm. The aim of this study is to characterise paediatric AEs detected by the GTT using descriptive and qualitative approaches. Medical records of children aged 0–15 were reviewed for presence of harm using the GTT. Records from 2012–2013 were s led from hospital inpatients, emergency departments, general practice and specialist paediatric practices in three Australian states. Nurses undertook a review of each record and if an AE was suspected a doctor performed a verification review of a summary created by the nurse. A qualitative content analysis was undertaken on the summary of verified AEs. A total of 232 AEs were detected from 6,689 records reviewed. Over four-fifths of the AEs (193/232, 83%) resulted in minor harm to the patient. Nearly half (112/232, 48%) related to medication/intravenous (IV) fluids. Of these, 83% (93/112) were adverse drug reactions. Problems with medical devices/equipment were the next most frequent with nearly two-thirds (32/51, 63%) of these related to intravenous devices. Problems associated with clinical processes rocedures comprise one in six AEs (38/232, 16%), of which diagnostic problems (12/38, 32%) and procedural complications (11/38, 29%) were the most frequent. Adverse drug reactions and issues with IVs are frequently identified AEs reflecting their common use in paediatrics. The qualitative approach taken in this study allowed AE types to be characterised, which is a prerequisite for developing and prioritising improvements in practice.
Publisher: AMPCo
Date: 07-2012
DOI: 10.5694/MJA12.10510
Start Date: 07-2004
End Date: 05-2006
Amount: $102,900.00
Funder: Australian Research Council
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