ORCID Profile
0000-0002-6498-9722
Current Organisation
University of Technology Sydney
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Publisher: BMJ
Date: 09-2022
DOI: 10.1136/BMJOPEN-2022-061513
Abstract: General practitioners (GPs) and their staff have been at the frontline of the SARS-CoV-2 pandemic in Australia. However, their experiences of responding to and managing the risks of viral transmission within their facilities are poorly described. The aim of this study was to describe the experiences, and infection prevention and control (IPC) strategies adopted by general practices, including enablers of and challenges to implementation, to contribute to our understanding of the pandemic response in this critical sector. Semistructured interviews were conducted in person, by telephone or online video conferencing software, between November 2020 and August 2021. Twenty general practice personnel working in New South Wales, Australia, including nine GPs, one general practice registrar, four registered nurses, one nurse practitioner, two practice managers and two receptionists. Participants described implementing wide-ranging repertoires of IPC strategies—including telehealth, screening of patients and staff, altered clinic layouts and portable outdoor shelters, in addition to appropriate use of personal protective equipment (PPE)—to manage the demands of the SARS-CoV-2 pandemic. Strategies were proactive, influenced by the varied contexts of different practices and the needs and preferences of in idual GPs as well as responsive to local, state and national requirements, which changed frequently as the pandemic evolved. Using the ‘hierarchy of controls’ as a framework for analysis, we found that the different strategies adopted in general practice often functioned in concert with one another. Most strategies, particularly administrative and PPE controls, were subjected to human variability and so were less reliable from a human factors perspective. However, our findings highlight the creativity, resilience and resourcefulness of general practice staff in developing, implementing and adapting their IPC strategies amidst constantly changing pandemic conditions.
Publisher: BMJ
Date: 23-07-2015
Publisher: JMIR Publications Inc.
Date: 30-06-2023
DOI: 10.2196/50419
Publisher: Elsevier BV
Date: 07-2020
Publisher: SAGE Publications
Date: 24-01-2017
Publisher: BMJ
Date: 05-2021
DOI: 10.1136/BMJOPEN-2021-049873
Abstract: Hospitals commonly examine patient safety culture and other quality indicators to evaluate and improve performance in relation to quality and safety. A growing body of research has separately examined relationships between patient safety culture and patient experience on clinical outcomes and other quality indicators. However, there is a knowledge gap regarding the relationship between these two important domains. This article describes the protocol for a scoping review of published literature examining the relationship between patient safety culture and patient experience in hospital settings. The scoping review will provide an overview of research into the relationship between patient safety culture and patient experience in hospital contexts, map key concepts underpinning these domains and identify research gaps for further study. The scoping review will be conducted using the five stages of Arksey and O’Malley’s framework: identify the research question identify relevant studies study selection chart data and collate, summarise and report the results. The inclusion criteria will be applied using the Population, Concept and Context Framework. Searches will be conducted in the CINAHL, Cochrane Library, ProQuest, MEDLINE, PsycINFO, Scopus and SciELO databases, without applying date range limits. Hand-searching of grey literature will also be performed to find relevant, non-indexed literature. Data will be extracted using a standardised data extraction form developed by the Joanna Briggs Institute. Both descriptive and thematic analyses will be undertaken to scope key concepts within the body of reviewed literature. This type of study does not require an ethics review. The results will be submitted for publication in a peer-reviewed journal and presented at conferences.
Publisher: Elsevier BV
Date: 08-2020
Publisher: BMJ
Date: 03-2023
DOI: 10.1136/BMJGH-2022-011182
Abstract: It is common for aspects of the COVID-19 response—and other public health initiatives before it—to be described as polarised. Public health decisions emerge from an interplay of facts, norms and preferred courses of action. What counts as ‘evidence’ is erse and contestable, and disagreements over how it should be interpreted are often the product of differing choices between competing values. We propose a definition of polarisation for the context of public health expertise that acknowledges and accounts for epistemic and social values as part of evidence generation and its application to public health practice. The ‘polarised’ label should be used judiciously because the descriptor risks generating or exacerbating the problem by oversimplifying complex issues and positions and creating groups that seem dichotomous. ‘Independence’ as a one-size-fits-all answer to expert polarisation is insufficient this solution is premised on a scientistic account of the role of evidence in decision making and does not make room for the value difference that is at the heart of both polarisation and evidence-based decision making.
Publisher: Elsevier BV
Date: 05-2022
Publisher: Wiley
Date: 07-02-2015
DOI: 10.1111/JOCN.12779
Abstract: This paper explores patients' perspectives on infection prevention and control. Healthcare-associated infections are the most frequent adverse event experienced by patients. Reduction strategies have predominantly addressed front-line clinicians' practices patients' roles have been less explored. Video-reflexive ethnography. Fieldwork undertaken at a large metropolitan hospital in Australia involved 300 hours of ethnographic observations, including 11 hours of video footage. This paper focuses on eight occasions, where video footage was shown back to patients in one-on-one reflexive sessions. Viewing and discussing video footage of clinical care enabled patients to become articulate about infection risks, and to identify their own roles in reducing transmission. Barriers to detailed understandings of preventative practices and their roles included lack of conversation between patients and clinicians about infection prevention and control, and being ignored or contradicted when challenging perceived suboptimal practice. It became evident that to compensate for clinicians' lack of engagement around infection control, participants had developed a range of strategies, of variable effectiveness, to protect themselves and others. Finally, the reflexive process engendered closer scrutiny and a more critical attitude to infection control that increased patients' sense of agency. This study found that patients actively contribute to their own safety. Their success, however, depends on the quality of patient-provider relationships and conversations. Rather than treating patients as passive recipients of infection control practices, clinicians can support and engage with patients' contributions towards achieving safer care. This study suggests that if clinicians seek to reduce infection rates, they must start to consider patients as active contributors to infection control. Clinicians can engage patients in conversations about practices and pay attention to patient feedback about infection risk. This will broaden clinicians' understandings of infection control risks and behaviours, and assist them to support appropriate patient self-care behaviour.
Publisher: BMJ
Date: 10-09-2014
DOI: 10.1136/BMJQS-2014-002835
Abstract: The built environment in acute care settings is a new focus in patient safety research, with few studies focusing primarily on the design of ward environments and the location and choice of material objects such as light fittings and hand-washing basins. We report on an interventionist video-reflexive ethnographic (VRE) study that explored how clinicians used the built environment to achieve safe communication in an intensive care unit (ICU) in a metropolitan Sydney hospital. We conducted 40 semistructured interviews, 5 weeks of observation and four reflexive focus groups with a total of 87 participants (including medical, nursing, allied health and clerical staff). We found that the accessibility of staff and patients in the open spaces of the ICU was both a safety feature and a safety risk, enabling safe communication flow, but also allowing potentially unsafe interruptions. Staff managed interruptions while allowing for a safe degree of accessibility by creating temporary protected spaces, using physical markers such as curtains, tape and signs as well as behavioural cues, movement and the development of policies restricting activities at certain areas. Furthermore, clinicians were able to use the VRE method to gain insight into their own practices and problems, and to develop meaningful solutions for other problematic spaces. ICU staff enable safe communication in their wards by creating temporary spaces that are both 'connected' and 'protected'. The flexibility of these 'soft' strategies is especially well suited to the fast-paced clinical context of intensive care.
Publisher: Elsevier BV
Date: 12-2022
Publisher: Elsevier BV
Date: 09-2021
Publisher: Elsevier BV
Date: 11-2022
Publisher: SAGE Publications
Date: 12-07-2018
Abstract: This article reports on a study of clinicians’ responses to footage of their enactments of infection prevention and control. The study’s approach was to elicit clinicians’ reflections on and clarifications about the connections among infection control activities and infection control rules, taking into account their awareness, interpretation and in situ application of those rules. The findings of the study are that clinicians responded to footage of their own infection prevention and control practices by articulating previously unheeded tensions and constraints including infection control rules that were incomplete, undergoing change, and conflicting material obstructions limiting infection control efforts and habituated and ergent rule enactments and rule interpretations that were problematic but disregarded. The reflexive process is shown to elicit clinicians’ learning about these complexities as they affect the accomplishment of effective infection control. The process is further shown to strengthen clinicians’ appreciation of infection control as necessitating deliberation to decide what are locally appropriate standards, interpretations, assumptions, habituations and enactments of infection control. The article concludes that clinicians’ ‘practical wisdom’ is unlikely to reach its full potential without video-assisted scrutiny of and deliberation about in situ clinical work. This enables clinicians to anchor their in situ enactments, reasonings and interpretations to local agreements about the intent, applicability, limits and practical enactment of rules.
Publisher: Elsevier BV
Date: 03-2023
Publisher: BMJ
Date: 10-2021
DOI: 10.1136/BMJOPEN-2021-052985
Abstract: To test the efficacy and acceptability of video-reflexive methods for training medical interns in the use of personal protective equipment (PPE). Mixed methods study. A tertiary-care teaching hospital, Sydney, January 2018–February 2019. 72 of 90 medical interns consented to participate. Of these, 39 completed all three time points. Participants received a standard infection prevention and control (IPC) education module during their hospital orientation. They were then allocated alternately to a control or video group. At three time points (TPs) over the year, participants were asked to don/doff PPE items based on hospital protocol. At the first two TPs, all participants also participated in a reflexive discussion. At the second and third TPs, all participants were audited on their performance. The only difference between groups was that the video group was videoed while donning/doffing PPE, and they watched this footage as a stimulus for reflexive discussion. The efficacy and acceptability of the intervention were assessed using: (1) comparisons of audit performance between and within groups over time, (2) comparisons between groups on survey responses for evaluation of training and self-efficacy and (3) thematic analysis of reflexive discussions. Both groups improved in their PPE competence over time, although there was no consistent pattern of significant differences within and between groups. No significant differences were found between groups on reported acceptability of training, or self-efficacy for PPE use. However, analysis of reflexive discussions shows that the effects of the video-reflexive intervention were tangible and different in important respects from standard training. Video reflexivity in group-based training can assist new clinicians in engagement with, and better understanding of, IPC in their clinical practice. Our study also highlights the need for ongoing and targeted IPC training during medical undergraduate studies as well as regular workplace refresher training.
Publisher: Springer Science and Business Media LLC
Date: 03-09-2021
DOI: 10.1186/S12913-021-06838-X
Abstract: Australian federally-funded cognitive pharmacy services (CPS) (e.g. medication management and reconciliation services) have not been translated into practice consistently. These health services are purportedly accessible across all Australian community pharmacies, yet are not delivered as often as pharmacists would like. There are international indicators that pharmacists lack the complete behavioural control required to prioritise CPS, despite their desire to deliver them. This requires local investigation. To explore Australian pharmacists’ perspectives [1] as CPS providers on the micro level, and [2] on associated meso and macro level CPS implementation issues. Registered Australian community pharmacists were recruited via professional organisations and snowball s ling. Data were collected via an online demographic survey and semi-structured interviews until data saturation was reached. Interview transcripts were de-identified then verified by participants. Content analysis was performed to identify provider perspectives on the micro level. Framework analysis using RE-AIM was used to explore meso and macro implementation issues. Twenty-three participants across Australia gave perspectives on CPS provision. At the micro level, pharmacists did not agree on a single definition of CPS. However, they reported complexity in interactional work and patient considerations, and in idual pharmacist factors that affected them when deciding whether to provide CPS. There was an overall deficiency in pharmacy workplace resources reported to be available for implementation and innovation. Use of an implementation evaluation framework suggested CPS implementation is lacking sufficient structural support, whilst reach into target population, service consistency and maintenance for CPS were not specifically considered by pharmacists. This analysis of pharmacist CPS perspectives suggests slow uptake may be due to a lack of evidence-based, focused, multi-level implementation strategies that take ongoing pharmacist role transition into account. Sustained change may require external change management and implementation support, engagement of frontline clinicians in research, and the development of appropriate pharmacist practice models to support community pharmacists in their CPS roles. This study was not a clinical intervention trial. It was approved by the University of Technology Sydney Human Research Ethics Committee (UTS HREC 19–3417) on the 26th of April 2019.
Publisher: Palgrave Macmillan
Date: 2015
Publisher: Center for Open Science
Date: 11-04-2022
Abstract: AbstractBackgroundThe longstanding problem of infection prevention and control (IPC) in residential aged care facilities (RACFs) has been highlighted and seriously exacerbated by the COVID-19 pandemic. The risk of severe illness and death from COVID-19 among aged care residents is increased by age, comorbidities and the congregate living arrangements, which often also function as healthcare settings. Implementation of IPC practices are intended to protect residents and staff from infectious disease risks, but can also impact on other dimensions of wellbeing and safety. ObjectivesTo identify evidence of effective IPC strategies in RACFs and their impacts on resident or staff safety or wellbeing, during both ‘business as usual’ and infectious disease outbreaks. Methods We will search relevant databases for original research articles, published in 2000 or later, that examine (1) IPC measures and/or (2) infectious disease outbreaks in (3) in residential aged care settings, whilst (4) considering resident and/or staff wellbeing and/or safety. Following Preferred Reporting of Systematic Review and Meta-Analysis for Scoping Reviews (PRISMA-SCR) and consultation with a university librarian, we have devised a search strategy for review of relevant key articles. One author customised the search strategy for each database (CINAHL, Embase, Cochrane, MEDLINE, Scopus and Web of Science) and reviewed each term before inclusion. After deletion of duplicates, 2-4 reviewers will screen references by title and abstract, then review full texts of selected articles. Items included will be charted with respect to publication details and quality assessment performed. Results will be grouped according to thematic contributions.ResultsSystematic searches began at the end of 2021 and data extraction will progress in early 2022, followed by data analyses and writing. Anticipated conclusions Implementation of IPC practices in RACFs must balance effectiveness, feasibility, and wellbeing and safety of residents and staff. This review will summarise, and identify gaps in, evidence for how best to protect residents and staff from infection in long term aged care settings. SupportPartial financial support for this project has been provided by the Sydney Institute for Infectious Diseases, University of Sydney.
Publisher: Elsevier BV
Date: 11-2022
Publisher: Elsevier
Date: 2022
Publisher: Wiley
Date: 04-2008
DOI: 10.5694/J.1326-5377.2008.TB01683.X
Abstract: To determine which aspects of open disclosure "work" for patients and health care staff, based on an evaluation of the National Open Disclosure Pilot. Qualitative analysis of semi-structured and open-ended interviews conducted between March and October 2007 with 131 clinical staff and 23 patients and family members who had participated in one or more open disclosure meetings. 21 of 40 pilot hospital sites, in New South Wales, South Australia, Victoria and Queensland, were included in the evaluation. Participating health care staff comprised 49 doctors, 20 nurses, and 62 managerial and support staff. In-depth qualitative data analysis involved mapping of discursive themes and subthemes across the interview transcripts. Interviewees broadly supported open disclosure they expressed uncertainty about its deployment and consequences, and made detailed suggestions of ways to optimise the experience, including careful pre-planning, participation by senior medical staff, and attentiveness to consumers' experience of the adverse event. Despite some uncertainties, the national evaluation indicates strong support for open disclosure from both health care staff and consumers, as well as a need to resource this new practice.
Publisher: Wiley
Date: 07-01-2014
DOI: 10.1111/JOCN.12464
Publisher: Wiley
Date: 23-05-2013
DOI: 10.1111/JRH.12024
Abstract: Health care-associated infection (HAI) is costly to hospitals and potentially life-threatening to patients. Numerous infection prevention programs have been implemented in hospitals across the United States. Yet, little is known about infection prevention practices and implementation in rural hospitals. The purpose of this study was to understand the infection prevention practices used by rural Veterans' Affairs (VA) hospitals and the unique factors they face in implementing these practices. This study used a sequential, mixed methods approach. Survey data to identify the HAI prevention practices used by rural VA hospitals were collected, analyzed, and used to inform the development of a semistructured interview guide. Phone interviews were conducted followed by site visits to rural VA hospitals. We found that most rural VA hospitals were using key recommended infection prevention practices. Nonetheless, a number of challenges with practice implementation were identified. The 3 most prominent themes were: (1) lack of human capital including staff with HAI expertise (2) having to cultivate needed resources and (3) operating as a system within a system. Rural VA hospitals are providing key infection prevention services to ensure a safe environment for the veterans they serve. However, certain factors, such as staff expertise, limited resources, and local context impacted how and when these practices were used. The creative use of more accessible alternative resources as well as greater flexibility in implementing HAI-related initiatives may be important strategies to further improve delivery of these important services by rural VA hospitals.
Publisher: Emerald
Date: 29-09-2023
Publisher: Springer Science and Business Media LLC
Date: 23-09-2020
DOI: 10.1186/S12909-020-02238-7
Abstract: The current COVID-19 pandemic has demonstrated that personal protective equipment (PPE) is essential, to prevent the acquisition and transmission of infectious diseases, yet its use is often sub-optimal in the clinical setting. Training and education are important to ensure and sustain the safe and effective use of PPE by medical interns, but current methods are often inadequate in providing the relevant knowledge and skills. The purpose of this study was to explore medical graduates’ experiences of the use of PPE and identify opportunities for improvement in education and training programmes, to improve occupational and patient safety. This study was undertaken in 2018 in a large tertiary-care teaching hospital in Sydney, Australia, to explore medical interns’ self-reported experiences of PPE use, at the beginning of their internship. Reflexive groups were conducted immediately after theoretical and practical PPE training, during hospital orientation. Transcripts of recorded discussions were analysed, using a thematic approach that drew on the COM-B (capability, opportunity, motivation - behaviour) framework for behaviour. 80% of 90 eligible graduates participated. Many interns had not previously received formal training in the specific skills required for optimal PPE use and had developed potentially unsafe habits. Their experiences as medical students in clinical areas contrasted sharply with recommended practice taught at hospital orientation and impacted on their ability to cultivate correct PPE use. Undergraduate teaching should be consistent with best practice PPE use, and include practical training that embeds correct and safe practices.
Publisher: Elsevier BV
Date: 06-2020
Publisher: Elsevier BV
Date: 11-2021
Publisher: SAGE Publications
Date: 23-01-2013
Abstract: In the last decade, the field of patient safety has grappled with the complexity of health-care systems by attending to the activity of frontline clinicians. This article extends the field by highlighting the activity of patients and their carers in determining the safety of these systems. We draw on data from three studies exploring patients’ accounts of their health-care experiences in Australia and internationally, to show how patients and carers are currently contributing to the safety of their own care. Furthermore, we emphasise the importance of patient–clinician collaboration in ensuring the success of these activities. We argue that it is no longer sufficient to discuss if patients should be involved with ensuring their own safety. Given that patients are already involved, we propose a new conceptualisation of safety and systems that acknowledges their involvement and supports patient–provider collaboration to achieve safer care.
Publisher: Springer Science and Business Media LLC
Date: 23-09-2022
DOI: 10.1186/S12909-022-03742-8
Abstract: With the advent of COVID-19, many healthcare workers (HWs) in Australia requested access to powered air purifying respirators (PAPR) for improved respiratory protection, comfort and visibility. The urgency of the response at our hospital required rapid deployment of innovative training to ensure the safe use of PAPRs, in particular, a video-feedback training option to prepare HWs for PAPR competency. To explore the feasibility, acceptability, and utility of video-feedback in PAPR training and competency assessment. Semi-structured interviews were conducted with 12 HWs, including clinicians from Intensive Care, Anaesthetics and Respiratory Medicine, at a large teaching hospital in Australia. Participants believed that the use of video-feedback in PAPR training was feasible, acceptable and useful. They described a variety of benefits to learning and retention, from a variety of ways in which they engaged with the personal video-feedback. Participants also described the impact of reviewing personalised practice footage, compared to generic footage of an ideal performance. By conceptualising video-feedback using a pedagogical approach, this study contributes to knowledge around optimising methods for training HWs in PPE use, particularly when introducing a new and complex PPE device during an infectious disease outbreak.
Publisher: Palgrave Macmillan UK
Date: 2016
Publisher: Elsevier BV
Date: 2021
Publisher: BMJ
Date: 30-11-2016
DOI: 10.1136/BMJQS-2016-005878
Abstract: Hospital-acquired infections are the most common adverse event for inpatients worldwide. Efforts to prevent microbial cross-contamination currently focus on hand hygiene and use of personal protective equipment (PPE), with variable success. Better understanding is needed of infection prevention and control (IPC) in routine clinical practice. We report on an interventionist video-reflexive ethnography study that explored how healthcare workers performed IPC in three wards in two hospitals in New South Wales, Australia: an intensive care unit and two general surgical wards. We conducted 46 semistructured interviews, 24 weeks of fieldwork (observation and videoing) and 22 reflexive sessions with a total of 177 participants (medical, nursing, allied health, clerical and cleaning staff, and medical and nursing students). We performed a postintervention analysis, using a modified grounded theory approach, to account for the range of IPC practices identified by participants. We found that healthcare workers' routine IPC work goes beyond hand hygiene and PPE. It also involves, for instance, the distribution of team members during rounds, the choreography of performing aseptic procedures and moving 'from clean to dirty' when examining patients. We account for these practices as the logistical work of moving bodies and objects across boundaries, especially from contaminated to clean/vulnerable spaces, while restricting the movement of micro-organisms through cleaning, applying barriers and buffers, and trajectory planning. Attention to the logistics of moving people and objects around healthcare spaces, especially into vulnerable areas, allows for a more comprehensive approach to IPC through better contextualisation of hand hygiene and PPE protocols, better identification of transmission risks, and the design and promotion of a wider range of preventive strategies and solutions.
Publisher: Informa UK Limited
Date: 02-01-2023
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/AH11044
Abstract: This paper describes the ethics approval processes for two multicentre, nationwide, qualitative health service research projects. The paper explains that the advent of the National Ethics Application Form has brought many improvements, but that attendant processes put in place at local health network and Human Research Ethics Committee levels may have become significantly more complicated, particularly for innovative qualitative research projects. The paper raises several questions based on its analysis of ethics application processes currently in place. What is known about the topic? The complexity of multicentre research ethics applications for research in health services has been addressed by the introduction of the National Ethics Application Form. Uptake of the form across the country’s human research ethics committees has been uneven. What does this paper add? This paper adds detailed insight into the ethics application process as it is currently enacted across the country. The paper details this process with reference to difficulties faced by multisite and qualitative studies in negotiating access to research sites, ethics committees’ relative unfamiliarity with qualitative research, and apparent tensions between harmonisation and local sites’ autonomy in approving research. What are the implications for practitioners? Practitioners aiming to engage in research need to be aware that ethics approval takes place in an uneven procedural landscape, made up of variable levels of ethics approval harmonisation and intricate governance or site-specific assessment processes.
Publisher: Palgrave Macmillan UK
Date: 2015
Publisher: Elsevier BV
Date: 11-2018
Publisher: Elsevier BV
Date: 03-2022
Publisher: Elsevier BV
Date: 11-2021
Publisher: SAGE Publications
Date: 17-05-2010
Abstract: In this article, we examine the current and increasing emphasis on accountability and patient safety in health care, focusing on practices of incident reporting and management in New South Wales, Australia. We describe the frames of accountability associated with an incident reporting system, and explore how this system manifests in practice. In contrast to literature that situates incident reporting and local practices as oppositional, we used ethnographic methods to observe the incident management practices of clinical staff in a hospital, and found evidence to characterize this relationship differently. We found that accountability has multiple conceptualizations, and we present three findings that demonstrate how the reporting system and incident management policy are interwoven with local enactments of accountability. We suggest that systematic efforts toward improvement cannot be orced from the local context, and emphasize the importance of local ecologies of practice in facilitating the meaningful utilization of such incident reporting systems.
Publisher: The Beryl Institute
Date: 12-11-2015
No related grants have been discovered for Su-yin Hor.