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Journal of Health Organization and... Feb 2020The importance of hospital board engagement in the work of governing healthcare quality has been demonstrated in the literature. Research into influences on effective... (Comparative Study)
Comparative Study
PURPOSE
The importance of hospital board engagement in the work of governing healthcare quality has been demonstrated in the literature. Research into influences on effective corporate governance has traditionally focused on board architecture. Emerging research is bringing to light the importance of governance dynamics. This paper contributes to emerging research through highlighting how communication and leadership underpin effective engagement in governing healthcare quality.
DESIGN/METHODOLOGY/APPROACH
A comparative case study of eight Australian public hospitals was undertaken involving document review, interviews and observations. Case studies were allocated into high- or low-engagement categories based on evidence of governance processes being undertaken, in order to compare and contrast influencing factors. Thematic analysis was undertaken to explore how communication and leadership influence healthcare governance.
FINDINGS
Several key components of communication and leadership are shown to influence healthcare quality governance. Clear logical narratives in reporting, open communication, effective questioning and challenge from board members are important elements of communication found to influence engagement. Leadership that has a focus on healthcare excellence and quality improvement are aligned and promote effective meeting processes is also found to foster governance engagement. Effective engagement in these communication and leadership processes facilitate valuable reflexivity at the governance level.
PRACTICAL IMPLICATIONS
The findings highlight the way in which boards and senior managers can strengthen governance effectiveness through attention to key aspects of communication and leadership.
ORIGINALITY/VALUE
The case study approach allows the exploration of communication and leadership in greater depth than previously undertaken at the corporate governance level in the healthcare setting.
Topics: Australia; Communication; Databases, Factual; Delivery of Health Care; Hospitals, Public; Interviews as Topic; Leadership; Observation; Organizational Case Studies
PubMed: 32239875
DOI: 10.1108/JHOM-07-2019-0194 -
PM & R : the Journal of Injury,... Sep 2017Cancer and its treatments introduce various adverse effects that may affect survivors' physical, cognitive and psychological functioning. Frequently both tolerance to... (Review)
Review
Cancer and its treatments introduce various adverse effects that may affect survivors' physical, cognitive and psychological functioning. Frequently both tolerance to activity and exercise are affected as well. Rehabilitation providers should have substantive knowledge about the effect of cancer progression and common side effects associated with antineoplastic treatment to safely integrate rehabilitation interventions. Rehabilitation may mitigate loss of function and disability; however, these patients are among the most medically complex that providers treat. This report provides a focused review that synthesizes the current evidence regarding disease progression and oncology-directed treatment side effects within the context of safety considerations for rehabilitation interventions throughout the continuum of cancer care. Descriptive information regarding the evidence for precautions and contraindications is provided so that rehabilitation providers can promote a safe plan of rehabilitation care. It is incumbent upon but also challenging for rehabilitation providers to stay up to date on the many advances in cancer treatment, and there are many gaps in the literature regarding safety issues. Although further research is needed to inform care, this review provides clinicians with a framework to assess patients with the goal of safely initiating rehabilitation interventions.
Topics: Adult; Aged; Combined Modality Therapy; Disability Evaluation; Female; Humans; Male; Middle Aged; Neoplasms; Patient Safety; Patient Selection; Physical Therapy Modalities; Risk Assessment; Safety Management; Survivors
PubMed: 28942913
DOI: 10.1016/j.pmrj.2017.08.403 -
Quality in Health Care : QHC Sep 1998The argument put forward in this paper is that successful implementation of research into practice is a function of the interplay of three core elements--the level and...
The argument put forward in this paper is that successful implementation of research into practice is a function of the interplay of three core elements--the level and nature of the evidence, the context or environment into which the research is to be placed, and the method or way in which the process is facilitated. It also proposes that because current research is inconclusive as to which of these elements is most important in successful implementation they all should have equal standing. This is contrary to the often implicit assumptions currently being generated within the clinical effectiveness agenda where the level and rigour of the evidence seems to be the most important factor for consideration. The paper offers a conceptual framework that considers this imbalance, showing how it might work in clarifying some of the theoretical positions and as a checklist for staff to assess what they need to do to successfully implement research into practice.
Topics: Evidence-Based Medicine; Health Services Research; Humans; Models, Organizational; Practice Guidelines as Topic; Research Design; State Medicine; United Kingdom
PubMed: 10185141
DOI: 10.1136/qshc.7.3.149 -
The Journal of Investigative Dermatology Jun 2015
Topics: Academic Medical Centers; Diffusion of Innovation; Humans; Models, Organizational; Research Design; Research Support as Topic; Translational Research, Biomedical; Universities
PubMed: 25964262
DOI: 10.1038/jid.2015.5 -
BMJ Health & Care Informatics Aug 2020Electronic medication systems (EMS) have been highly effective in reducing prescribing errors, but little research has investigated their effects on medication...
Changes in medication administration error rates associated with the introduction of electronic medication systems in hospitals: a multisite controlled before and after study.
BACKGROUND
Electronic medication systems (EMS) have been highly effective in reducing prescribing errors, but little research has investigated their effects on medication administration errors (MAEs).
OBJECTIVE
To assess changes in MAE rates and types associated with EMS implementation.
METHODS
This was a controlled before and after study (three intervention and three control wards) at two adult teaching hospitals. Intervention wards used an EMS with no bar-coding. Independent, trained observers shadowed nurses and recorded medications administered and compliance with 10 safety procedures. Observational data were compared against medication charts to identify errors (eg, wrong dose). Potential error severity was classified on a 5-point scale, with those scoring ≥3 identified as serious. Changes in MAE rates preintervention and postintervention by study group, accounting for differences at baseline, were calculated.
RESULTS
7451 administrations were observed (4176 pre-EMS and 3275 post-EMS). At baseline, 30.2% of administrations contained ≥1 MAE, with wrong intravenous rate, timing, volume and dose the most frequent. Post-EMS, MAEs decreased on intervention wards relative to control wards by 4.2 errors per 100 administrations (95% CI 0.2 to 8.3; p=0.04). Wrong timing errors alone decreased by 3.4 per 100 administrations (95% CI 0.01 to 6.7; p<0.05). EMS use was associated with an absolute decline in potentially serious MAEs by 2.4% (95% CI 0.8 to 3.9; p=0.003), a 56% reduction in the proportion of potentially serious MAEs. At baseline, 74.1% of administrations were non-compliant with ≥1 of 10 procedures and this rate did not significantly improve post-EMS.
CONCLUSIONS
Implementation of EMS was associated with a modest, but significant, reduction in overall MAE rate, but halved the proportion of MAEs rated as potentially serious.
Topics: Drug Administration Schedule; Efficiency, Organizational; Hospitals, Teaching; Humans; Medication Errors; Medication Systems, Hospital; Pharmaceutical Preparations
PubMed: 32796084
DOI: 10.1136/bmjhci-2020-100170 -
Quality & Safety in Health Care Oct 2004Ineffective team communication is frequently at the root of medical error. The objective of this study was to describe the characteristics of communication failures in...
BACKGROUND
Ineffective team communication is frequently at the root of medical error. The objective of this study was to describe the characteristics of communication failures in the operating room (OR) and to classify their effects. This study was part of a larger project to develop a team checklist to improve communication in the OR.
METHODS
Trained observers recorded 90 hours of observation during 48 surgical procedures. Ninety four team members participated from anesthesia (16 staff, 6 fellows, 3 residents), surgery (14 staff, 8 fellows, 13 residents, 3 clerks), and nursing (31 staff). Field notes recording procedurally relevant communication events were analysed using a framework which considered the content, audience, purpose, and occasion of a communication exchange. A communication failure was defined as an event that was flawed in one or more of these dimensions.
RESULTS
421 communication events were noted, of which 129 were categorized as communication failures. Failure types included "occasion" (45.7% of instances) where timing was poor; "content" (35.7%) where information was missing or inaccurate, "purpose" (24.0%) where issues were not resolved, and "audience" (20.9%) where key individuals were excluded. 36.4% of failures resulted in visible effects on system processes including inefficiency, team tension, resource waste, workaround, delay, patient inconvenience and procedural error.
CONCLUSION
Communication failures in the OR exhibited a common set of problems. They occurred in approximately 30% of team exchanges and a third of these resulted in effects which jeopardized patient safety by increasing cognitive load, interrupting routine, and increasing tension in the OR.
Topics: Anesthesia Department, Hospital; Communication Barriers; Humans; Interprofessional Relations; Medical Errors; Observation; Operating Rooms; Patient Care Team; Problem Solving; Quality Indicators, Health Care; Safety; Sentinel Surveillance; Surgery Department, Hospital; Surgical Procedures, Operative; Systems Analysis; Vascular Surgical Procedures
PubMed: 15465935
DOI: 10.1136/qhc.13.5.330 -
The Journal of Thoracic and... Apr 2006
Topics: Heart Diseases; Heart Transplantation; Humans; Patient Selection; Registries; Resource Allocation; Tissue and Organ Procurement; United States; Waiting Lists
PubMed: 16580432
DOI: 10.1016/j.jtcvs.2005.11.032 -
European Urology Nov 2017The importance of evidence from randomised trials is now widely recognised, although recruitment is often difficult. Qualitative research has shown promise in... (Review)
Review
CONTEXT
The importance of evidence from randomised trials is now widely recognised, although recruitment is often difficult. Qualitative research has shown promise in identifying the key barriers to recruitment, and interventions have been developed to reduce organisational difficulties and support clinicians undertaking recruitment.
OBJECTIVE
This article provides an introduction to qualitative research techniques and explains how this approach can be used to understand-and subsequently improve-recruitment and informed consent within a range of clinical trials.
EVIDENCE ACQUISITION
A literature search was performed using Medline, Embase, and CINAHL. All studies with qualitative research methods that focused on the recruitment activity of clinicians were included in the review.
EVIDENCE SYNTHESIS
The majority of studies reported that organisational difficulties and lack of time for clinical staff were key barriers to recruitment. However, a synthesis of qualitative studies highlighted the intellectual and emotional challenges that arise when combining research with clinical roles, particularly in relation to equipoise and patient eligibility. To support recruiters to become more comfortable with the design and principles of randomised controlled trials, interventions have been developed, including the QuinteT Recruitment Intervention, which comprises in-depth investigation of recruitment obstacles in real time, followed by implementation of tailored strategies to address these challenges as the trial proceeds.
CONCLUSIONS
Qualitative research can provide important insights into the complexities of recruitment to trials and inform the development of interventions, and provide support and training initiatives as required. Investigators should consider implementing such methods in trials expected to be challenging or recruiting below target.
PATIENT SUMMARY
Qualitative research is a term used to describe a range of methods that can be implemented to understand participants' perspectives and behaviours. Data are gathered from interviews, focus groups, or observations. In this review, we demonstrate how this approach can be used to understand-and improve-recruitment to clinical trials. Taken together, our review suggests that healthcare professionals can find recruiting to trials challenging and require support with this process.
Topics: Attitude of Health Personnel; Emotions; Health Knowledge, Attitudes, Practice; Humans; Patient Selection; Qualitative Research; Randomized Controlled Trials as Topic; Research Personnel; Sample Size; Workflow; Workload
PubMed: 28578829
DOI: 10.1016/j.eururo.2017.04.036 -
Implementation Science : IS Feb 2020Application of knowledge translation (KT) theories, models, and frameworks (TMFs) is one method for successfully incorporating evidence into clinical care. However,...
BACKGROUND
Application of knowledge translation (KT) theories, models, and frameworks (TMFs) is one method for successfully incorporating evidence into clinical care. However, there are multiple KT TMFs and little guidance on which to select. This study sought to identify and describe available full-spectrum KT TMFs to subsequently guide users.
METHODS
A scoping review was completed. Articles were identified through searches within electronic databases, previous reviews, grey literature, and consultation with KT experts. Search terms included combinations of KT terms and theory-related terms. Included citations had to describe full-spectrum KT TMFs that had been applied or tested. Titles/abstracts and full-text articles were screened independently by two investigators. Each KT TMF was described by its characteristics including name, context, key components, how it was used, primary target audience, levels of use, and study outcomes. Each KT TMF was also categorized into theoretical approaches as process models, determinant frameworks, classic theories, implementation theories, and evaluation frameworks. Within each category, KT TMFs were compared and contrasted to identify similarities and unique characteristics.
RESULTS
Electronic searches yielded 7160 citations. Additional citations were identified from previous reviews (n = 41) and bibliographies of included full-text articles (n = 6). Thirty-six citations describing 36 full-spectrum were identified. In 24 KT TMFs, the primary target audience was multi-level including patients/public, professionals, organizational, and financial/regulatory. The majority of the KT TMFs were used within public health, followed by research (organizational, translation, health), or in multiple contexts. Twenty-six could be used at the individual, organization, or policy levels, five at the individual/organization levels, three at the individual level only, and two at the organizational/policy level. Categorization of the KT TMFs resulted in 18 process models, eight classic theories, three determinant frameworks, three evaluation frameworks, and four that fit more than one category. There were no KT TMFs that fit the implementation theory category. Within each category, similarities and unique characteristics emerged through comparison.
CONCLUSIONS
A systematic compilation of existing full-spectrum KT TMFs, categorization into different approaches, and comparison has been provided in a user-friendly way. This list provides options for users to select from when designing KT projects and interventions.
TRIAL REGISTRATION
A protocol outlining the methodology of this scoping review was developed and registered with PROSPERO (CRD42018088564).
Topics: Delivery of Health Care; Humans; Models, Organizational; Research Design; Translational Research, Biomedical
PubMed: 32059738
DOI: 10.1186/s13012-020-0964-5 -
Health Research Policy and Systems Feb 2020Billions of dollars are lost annually in health research that fails to create meaningful benefits for patients. Engaging in research co-design - the meaningful... (Review)
Review
BACKGROUND
Billions of dollars are lost annually in health research that fails to create meaningful benefits for patients. Engaging in research co-design - the meaningful involvement of end-users in research - may help address this research waste. This rapid overview of reviews addressed three related questions, namely (1) what approaches to research co-design exist in health settings? (2) What activities do these research co-design approaches involve? (3) What do we know about the effectiveness of existing research co-design approaches? The review focused on the study planning phase of research, defined as the point up to which the research question and study design are finalised.
METHODS
Reviews of research co-design were systematically identified using a rapid overview of reviews approach (PROSPERO: CRD42019123034). The search strategy encompassed three academic databases, three grey literature databases, and a hand-search of the journal Research Involvement and Engagement. Two reviewers independently conducted the screening and data extraction and resolved disagreements through discussion. Disputes were resolved through discussion with a senior author (PB). One reviewer performed quality assessment. The results were narratively synthesised.
RESULTS
A total of 26 records (reporting on 23 reviews) met the inclusion criteria. Reviews varied widely in their application of 'research co-design' and their application contexts, scope and theoretical foci. The research co-design approaches identified involved interactions with end-users outside of study planning, such as recruitment and dissemination. Activities involved in research co-design included focus groups, interviews and surveys. The effectiveness of research co-design has rarely been evaluated empirically or experimentally; however, qualitative exploration has described the positive and negative outcomes associated with co-design. The research provided many recommendations for conducting research co-design, including training participating end-users in research skills, having regular communication between researchers and end-users, setting clear end-user expectations, and assigning set roles to all parties involved in co-design.
CONCLUSIONS
Research co-design appears to be widely used but seldom described or evaluated in detail. Though it has rarely been tested empirically or experimentally, existing research suggests that it can benefit researchers, practitioners, research processes and research outcomes. Realising the potential of research co-design may require the development of clearer and more consistent terminology, better reporting of the activities involved and better evaluation.
Topics: Biomedical Research; Community-Based Participatory Research; Humans; Interinstitutional Relations; Research Design; Systematic Reviews as Topic
PubMed: 32046728
DOI: 10.1186/s12961-020-0528-9