Enhancing the primary care team to provide redesigned care: the roles of practice facilitators and care managers.

PubMed

Taylor, Erin Fries; Machta, Rachel M; Meyers, David S; Genevro, Janice; Peikes, Deborah N

2013-01-01

Efforts to redesign primary care require multiple supports. Two potential members of the primary care team-practice facilitator and care manager-can play important but distinct roles in redesigning and improving care delivery. Facilitators, also known as quality improvement coaches, assist practices with coordinating their quality improvement activities and help build capacity for those activities-reflecting a systems-level approach to improving quality, safety, and implementation of evidence-based practices. Care managers provide direct patient care by coordinating care and helping patients navigate the system, improving access for patients, and communicating across the care team. These complementary roles aim to help primary care practices deliver coordinated, accessible, comprehensive, and patient-centered care.

"Refreshed…reinforced…reflective": A qualitative exploration of interprofessional education facilitators' own interprofessional learning and collaborative practice.

PubMed

Evans, Sherryn; Shaw, Nicole; Ward, Catherine; Hayley, Alexa

2016-11-01

While there is extensive research examining the outcomes of interprofessional education (IPE) for students, minimal research has investigated how facilitating student learning influences the facilitators themselves. This exploratory case study aimed to explore whether and how facilitating IPE influences facilitators' own collaborative practice attitudes, knowledge, and workplace behaviours. Sixteen facilitators of an online pre-licensure IPE unit for an Australian university participated in semi-structured telephone interviews. Inductive thematic analysis revealed three emergent themes and associated subthemes characterising participants' reflexivity as IPE facilitators: interprofessional learning; professional behaviour change; and collaborative practice expertise. Participants experienced interprofessional learning in their role as facilitators, improving their understanding of other professionals' roles, theoretical and empirical knowledge underlying collaborative practice, and the use and value of online communication. Participants also reported having changed several professional behaviours, including improved interprofessional collaboration with colleagues, a change in care plan focus, a less didactic approach to supervising students and staff, and greater enthusiasm impressing the value of collaborative practice on placement students. Participants reported having acquired their prior interprofessional collaboration expertise via professional experience rather than formal learning opportunities and believed access to formal IPE as learners would aid their continuing professional development. Overall, the outcomes of the IPE experience extended past the intended audience of the student learners and positively impacted on the facilitators as well.

What can family medicine practices do to facilitate knowledge management?

PubMed

Orzano, A John; Ohman-Strickland, Pamela A; Patel, Meghal

2008-01-01

Family medicine practices face increasing demands to enhance efficiency and quality of care. Current solutions propose major practice redesign and investment in sophisticated technology. Knowledge management (KM) is a process that increases the capacity of a practice to deliver effective care by finding and sharing information and knowledge among practice members or by developing new knowledge for use by the practice. Our preliminary research in family medicine practices has suggested improved patient outcomes with greater and more effective KM. Research in other organizational settings has suggested that KM can be facilitated by certain organizational characteristics. To identify those organizational characteristics within a family medicine practice that management can effect to enhance KM. We performed a cross-sectional secondary analysis of second-year data from 13 community family medicine practices participating in a practice improvement project. Practice KM, leaderships' promotion of participatory decision making, existence of activities supportive of human resource processes, and effective communication were derived from clinician's, nurses', and staff's responses to a survey eliciting responses on practice organizational characteristics. Hierarchical linear modeling examined relationships between individual practice members' perception of KM and organizational characteristics of the practice, controlling for practice covariates (solo-group, electronic medical record use, and perception of a chaotic practice environment) and staff-level covariates (gender, age, and role). Practices with greater participatory decision making and human resources' processes and effective communication significantly (p < .019, p < .0001, and p < .004) increased odds of reporting satisfactory KM (odds ratio = 2.48, 95% confidence interval = 1.32-4.65; odds ratio = 10.84, 95% confidence interval = 4.04-29.12; and odds ratio = 4.95, 95% confidence interval = 2.02-12.16). The sizes

Shared learning in general practice--facilitators and barriers.

PubMed

van de Mortel, Thea; Silberberg, Peter; Ahern, Christine

2013-03-01

Capacity for teaching in general practice clinics is limited. Shared learning sessions are one form of vertically integrated teaching that may ameliorate capacity constraints. This study sought to understand the perceptions of general practitioner supervisors, learners and practice staff of the facilitators of shared learning in general practice clinics. Using a grounded theory approach, semistructured interviews were conducted and analysed to generate a theory about the topic. Thirty-five stakeholders from nine general practices participated. Facilitators of shared learning included enabling factors such as small group facilitation skills, space, administrative support and technological resources; reinforcing factors such as targeted funding, and predisposing factors such as participant attributes. Views from multiple stakeholders suggest that the implementation of shared learning in general practice clinics would be supported by an ecological approach that addresses all these factors.

Facilitation and practice in verb acquisition.

PubMed

Keren-Portnoy, Tamar

2006-08-01

This paper presents a model of syntax acquisition, whose main points are as follows: Syntax is acquired in an item-based manner; early learning facilitates subsequent learning--as evidenced by the accelerating rate of new verbs entering a given structure; and mastery of syntactic knowledge is typically achieved through practice--as evidenced by intensive use and common word order errors--and this slows down learning during the early stages of acquiring a structure. The facilitation and practice hypotheses were tested on naturalistic production samples of six Hebrew-acquiring children ranging from ages 1;1 to 2;7 (average ages 1;6 to 2;4 months). Results show that most structures did in fact accelerate; the notion of 'practice' is supported by the inverse correlation found between number of verbs and number of errors in the earliest productions in a given structure; and the absence of acceleration in a minority of the structures is due to the fact that they involve relatively less practice.

Practice facilitation for improving cardiovascular care: secondary evaluation of a stepped wedge cluster randomized controlled trial using population-based administrative data.

PubMed

Deri Armstrong, Catherine; Taljaard, Monica; Hogg, William; Mark, Amy E; Liddy, Clare

2016-09-05

Practice facilitation (PF), a multifaceted approach in which facilitators (external health care professionals) help family physicians to improve their adoption of best practices, has been highly successful. Improved Delivery of Cardiovascular Care (IDOCC) was an innovative PF trial designed to improve evidence-based care for people who have, or are at risk of, cardiovascular disease (CVD). The intervention was found to be ineffective as assessed by a patient-level composite score based on chart reviews from a subsample of patients (N = 5292). Here, we used population-based administrative data to examine IDOCC's effect on CVD-related hospitalizations. IDOCC used a pragmatic, stepped wedge cluster randomized controlled design involving primary care providers recruited across Eastern Ontario, Canada. IDOCC's effect on CVD-related hospitalizations was assessed in the 2 years of active intervention and post-intervention years. Marginal and mixed-effects regression analyses were used to account for the study design and to control for patient, physician, and practice characteristics. Secondary and subgroup analyses investigated robustness. Our sample included 262,996 patient/year observations representing 54,085 unique patients who had, or were at risk of, CVD, from 70 practices. There was a strong decreasing secular trend in CVD-related hospitalizations but no statistically significant effect of IDOCC. Relative to patients in the control condition, patients in the intervention condition were estimated to have 4 % lower odds of CVD-related hospitalizations (adjOR = 0.96, 99 % CI 0.83 to 1.11). The nonsignificant result persisted across robustness analyses. Clinical outcomes from administrative databases were examined to form a more complete picture of the (in)effectiveness of a large-scale quality improvement intervention. IDOCC did not have a significant effect on CVD hospitalizations, suggesting that the results from the primary composite adherence score

Strategies facilitating practice change in pediatric cancer: a systematic review.

PubMed

Robinson, Paula D; Dupuis, Lee L; Tomlinson, George; Phillips, Bob; Greenberg, Mark; Sung, Lillian

2016-09-01

By conducting a systematic review, we describe strategies to actively disseminate knowledge or facilitate practice change among healthcare providers caring for children with cancer and we evaluate the effectiveness of these strategies. We searched Ovid Medline, EMBASE and PsychINFO. Fully published primary studies were included if they evaluated one or more professional intervention strategies to actively disseminate knowledge or facilitate practice change in pediatric cancer or hematopoietic stem cell transplantation. Data extracted included study characteristics and strategies evaluated. In studies with a quantitative analysis of patient outcomes, the relationship between study-level characteristics and statistically significant primary analyses was evaluated. Of 20 644 titles and abstracts screened, 146 studies were retrieved in full and 60 were included. In 20 studies, quantitative evaluation of patient outcomes was examined and a primary outcome was stated. Eighteen studies were 'before and after' design; there were no randomized studies. All studies were at risk for bias. Interrupted time series was never the primary analytic approach. No specific strategy type was successful at improving patient outcomes. Literature describing strategies to facilitate practice change in pediatric cancer is emerging. However, major methodological limitations exist. Studies with robust designs are required to identify effective strategies to effect practice change. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Effective Developmental Math Instructional Practices That Facilitate Learning and Academic Success of Community College Students

ERIC Educational Resources Information Center

Little, Pamela Hilson

2017-01-01

The purpose of the qualitative study was to discover instructional practices used by developmental math instructors that facilitate learning and academic success of students in developmental math courses at select community colleges in Alabama in order to generate improved instructional practices in the developmental education field. Emergent data…

The evaluation of a mental health facilitator in general practice: effects on recognition, management, and outcome of mental illness.

PubMed

Bashir, K; Blizard, B; Bosanquet, A; Bosanquet, N; Mann, A; Jenkins, R

2000-08-01

Facilitation uses personal contact between the facilitator and the professional to encourage good practice and better service organisation. The model has been applied to physical illness but not to psychiatric disorders. To determine if a non-specialist facilitator can improve the recognition, management, and outcome of psychiatric illness presenting to general practitioners (GPs). Six practices were visited over an 18-month period by a facilitator whose activities included providing guidelines and organising training initiatives. Six other practices acted as controls. Recognition (identification index of family doctors), management (psychotropic prescribing, psychological consultations with the GP, specialist mental health treatment, and the use of medical interventions and investigations), and patient outcome at four months were assessed before and after intervention. The mean identification index of facilitator GPs rose from 0.51 to 0.64 following intervention, while that of the control GPs fell from 0.67 to 0.59 (P = 0.046). The facilitator had no detectable effect on management or patient outcome. The facilitator improved recognition of psychiatric illness by GPs. Generic facilitators can be trained to take on a mental health role; however, the failure to achieve more fundamental changes in treatment and outcome implies that facilitator intervention requires development.

Barriers and Facilitators Associated with Non-Surgical Treatment Use for Osteoarthritis Patients in Orthopaedic Practice.

PubMed

Hofstede, Stefanie N; Marang-van de Mheen, Perla J; Vliet Vlieland, Thea P M; van den Ende, Cornelia H M; Nelissen, Rob G H H; van Bodegom-Vos, Leti

2016-01-01

International evidence-based guidelines for the management of patients with hip and knee osteoarthritis (OA) recommend to start with (a combination of) non-surgical treatments, and using surgical intervention only if a patient does not respond sufficiently to non-surgical treatment options. Despite these recommendations, there are strong indications that non-surgical treatments are not optimally used in orthopaedic practice. To improve the adoption of non-surgical treatments, more insight is needed into barriers and facilitators of these treatments. Therefore, this study assessed which barriers and facilitators are associated with the use and prescription of different non-surgical treatments before hip and knee OA in orthopaedic practice among patients and orthopaedic surgeons in the Netherlands. We performed two internet-based surveys among 172 orthopaedic surgeons and 174 OA patients. Univariate association and multivariable regression techniques are used to identify barriers and facilitators associated with the use of non-surgical treatments. Most barriers and facilitators among patients were associated with the use of physical therapy, lifestyle advice and dietary therapy. Among orthopaedic surgeons, most were associated with prescription of acetaminophen, dietary therapy and physical therapy. Examples of barriers and facilitators among patients included "People in my environment had positive experiences with a surgery" (facilitator for education about OA), and "Advice of people in my environment to keep on moving" (facilitator for lifestyle and dietary advice). For orthopaedic surgeons, examples were "Lack of knowledge about guideline" (barrier for lifestyle advice), "Agreements/ deliberations with primary care" and "Easy communication with a dietician" (facilitators for dietary therapy). Also the belief in the efficacy of these treatments was associated with increased prescription. Strategies to improve non-surgical treatment use in orthopaedic practice

From workshop to work practice: An exploration of context and facilitation in the development of evidence-based practice.

PubMed

Ellis, Isabelle; Howard, Peter; Larson, Ann; Robertson, Jeanette

2005-01-01

This article examines the process of translating evidence into practice using a facilitation model developed by the Western Australian Centre for Evidence Based Nursing and Midwifery. Using the conceptual framework Promoting Action on Research Implementation in Health Services (PARIHS), the aims of the study were (1) to explore the relative and combined importance of context and facilitation in the successful implementation of a new evidence-based clinical practice protocol and (2) to examine the establishment of more lasting change to individuals and organizations that resulted in greater incorporation of the principles of evidence-based practice (EBP). A pre-workshop, semi-structured telephone survey with 16 nurse managers in six rural hospitals; a summative evaluation immediately post-workshop with 54 participants; and follow-up, semi-structured interviews with 23 workshop participants. The contexts in each of the participating hospitals were very different; of the six hospitals, only one had not implemented the new protocol. Five had reviewed their practices and brought them in line with the protocol developed at the workshop. The rate of adoption varied considerably from 2 weeks to months. The participants reported being better informed about EBP in general and were positive about their ability to improve their practice and search more efficiently for best practice information. Underlying motivations for protocol development should be included in the PARIHS framework. IMPLICATIONS FOR EDUCATION: Good facilitation appears to be more influential than context in overcoming the barriers to the uptake of EBP.

Potential facilitators and barriers to adopting standard treatment guidelines in clinical practice.

PubMed

Sharma, Sangeeta; Pandit, Ajay; Tabassum, Fauzia

2017-04-18

Purpose The purpose of this paper is to assess medicines information sources accessed by clinicians, if sources differed in theory and practice and to find out the barriers and facilitators to effective guideline adoption. Design/methodology/approach In all, 183 doctors were surveyed. Barriers and facilitators were classified as: communication; potential adopters; innovation; organization characteristics and environmental/social/economic context. Findings Most of the clinicians accessed multiple information sources including standard treatment guidelines, but also consulted seniors/colleagues in practice. The top three factors influencing clinical practice guideline adoption were innovation characteristics, environmental context and individual characteristics. The respondents differed in the following areas: concerns about flexibility offered by the guideline; denying patients' individuality; professional autonomy; insights into gaps in current practice and evidence-based practice; changing practices with little or no benefit. Barriers included negative staff attitudes/beliefs, guideline integration into organizational structures/processes, time/resource constraints. Fearing third parties (government and insurance companies) restricting medicines reimbursement and poor liability protection offered by the guidelines emerged as the barriers. Facilitators include aligning organizational structures/processes with the innovation; providing leadership support to guide diffusion; increasing awareness and enabling early innovation during pre/in-service training, with regular feedback on outcomes and use. Practical implications Guideline adoption in clinical practice is partly within doctors' control. There are other key prevailing factors in the local context such as environmental, social context, professional and organizational culture affecting its adoption. Organizational policy and accreditation standards necessitating adherence can serve as a driver. Originality

Use of a structured template to facilitate practice-based learning and improvement projects.

PubMed

McClain, Elizabeth K; Babbott, Stewart F; Tsue, Terance T; Girod, Douglas A; Clements, Debora; Gilmer, Lisa; Persons, Diane; Unruh, Greg

2012-06-01

The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to meet and demonstrate outcomes across 6 competencies. Measuring residents' competency in practice-based learning and improvement (PBLI) is particularly challenging. We developed an educational tool to meet ACGME requirements for PBLI. The PBLI template helped programs document quality improvement (QI) projects and supported increased scholarly activity surrounding PBLI learning. We reviewed program requirements for 43 residency and fellowship programs and identified specific PBLI requirements for QI activities. We also examined ACGME Program Information Form responses on PBLI core competency questions surrounding QI projects for program sites visited in 2008-2009. Data were integrated by a multidisciplinary committee to develop a peer-protected PBLI template guiding programs through process, documentation, and evaluation of QI projects. All steps were reviewed and approved through our GME Committee structure. An electronic template, companion checklist, and evaluation form were developed using identified project characteristics to guide programs through the PBLI process and facilitate documentation and evaluation of the process. During a 24 month period, 27 programs have completed PBLI projects, and 15 have reviewed the template with their education committees, but have not initiated projects using the template. The development of the tool generated program leaders' support because the tool enhanced the ability to meet program-specific objectives. The peer-protected status of this document for confidentiality and from discovery has been beneficial for program usage. The document aggregates data on PBLI and QI initiatives, offers opportunities to increase scholarship in QI, and meets the ACGME goal of linking measures to outcomes important to meeting accreditation requirements at the program and institutional level.

Use of a Structured Template to Facilitate Practice-Based Learning and Improvement Projects

PubMed Central

McClain, Elizabeth K.; Babbott, Stewart F.; Tsue, Terance T.; Girod, Douglas A.; Clements, Debora; Gilmer, Lisa; Persons, Diane; Unruh, Greg

2012-01-01

Background The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to meet and demonstrate outcomes across 6 competencies. Measuring residents' competency in practice-based learning and improvement (PBLI) is particularly challenging. Purpose We developed an educational tool to meet ACGME requirements for PBLI. The PBLI template helped programs document quality improvement (QI) projects and supported increased scholarly activity surrounding PBLI learning. Methods We reviewed program requirements for 43 residency and fellowship programs and identified specific PBLI requirements for QI activities. We also examined ACGME Program Information Form responses on PBLI core competency questions surrounding QI projects for program sites visited in 2008–2009. Data were integrated by a multidisciplinary committee to develop a peer-protected PBLI template guiding programs through process, documentation, and evaluation of QI projects. All steps were reviewed and approved through our GME Committee structure. Results An electronic template, companion checklist, and evaluation form were developed using identified project characteristics to guide programs through the PBLI process and facilitate documentation and evaluation of the process. During a 24 month period, 27 programs have completed PBLI projects, and 15 have reviewed the template with their education committees, but have not initiated projects using the template. Discussion The development of the tool generated program leaders' support because the tool enhanced the ability to meet program-specific objectives. The peer-protected status of this document for confidentiality and from discovery has been beneficial for program usage. The document aggregates data on PBLI and QI initiatives, offers opportunities to increase scholarship in QI, and meets the ACGME goal of linking measures to outcomes important to meeting accreditation requirements at the program and institutional level. PMID

No longer simply a Practice-based Research Network (PBRN) health improvement networks.

PubMed

Williams, Robert L; Rhyne, Robert L

2011-01-01

While primary care Practice-based Research Networks are best known for their original, research purpose, evidence accumulating over the last several years is demonstrating broader values of these collaborations. Studies have demonstrated their role in quality improvement and practice change, in continuing professional education, in clinician retention in medically underserved areas, and in facilitating transition of primary care organization. A role in informing and facilitating health policy development is also suggested. Taking into account this more robust potential, we propose a new title, the Health Improvement Network, and a new vision for Practice-based Research Networks.

Forced Aerobic Exercise Preceding Task Practice Improves Motor Recovery Poststroke.

PubMed

Linder, Susan M; Rosenfeldt, Anson B; Dey, Tanujit; Alberts, Jay L

To understand how two types of aerobic exercise affect upper-extremity motor recovery post-stroke. Our aims were to (1) evaluate the feasibility of having people who had a stroke complete an aerobic exercise intervention and (2) determine whether forced or voluntary exercise differentially facilitates upper-extremity recovery when paired with task practice. Seventeen participants with chronic stroke completed twenty-four 90-min sessions over 8 wk. Aerobic exercise was immediately followed by task practice. Participants were randomized to forced or voluntary aerobic exercise groups or to task practice only. Improvement on the Fugl-Meyer Assessment exceeded the minimal clinically important difference: 12.3, 4.8, and 4.4 for the forced exercise, voluntary exercise, and repetitive task practice-only groups, respectively. Only the forced exercise group exhibited a statistically significant improvement. People with chronic stroke can safely complete intensive aerobic exercise. Forced aerobic exercise may be optimal in facilitating motor recovery associated with task practice. Copyright © 2017 by the American Occupational Therapy Association, Inc.

Using Gemba Boards to Facilitate Evidence-Based Practice in Critical Care.

PubMed

Bourgault, Annette M; Upvall, Michele J; Graham, Alison

2018-06-01

Tradition-based practices lack supporting research evidence and may be harmful or ineffective. Engagement of key stakeholders is a critical step toward facilitating evidence-based practice change. Gemba , derived from Japanese, refers to the real place where work is done. Gemba boards (visual management tools) appear to be an innovative method to engage stakeholders and facilitate evidence-based practice. To explore the use of gemba boards and gemba huddles to facilitate practice change. Twenty-two critical care nurses participated in interviews in this qualitative, descriptive study. Thematic analysis was used to code and categorize interview data. Two researchers reached consensus on coding and derived themes. Data were managed with qualitative analysis software. The code gemba occurred most frequently; a secondary analysis was performed to explore its impact on practice change. Four themes were derived from the gemba code: (1) facilitation of staff, leadership, and interdisciplinary communication, (2) transparency of outcome data, (3) solicitation of staff ideas and feedback, and (4) dissemination of practice changes. Gemba boards and gemba huddles became part of the organizational culture for promoting and disseminating evidence-based practices. Unit-based, publicly located gemba boards and huddles have become key components of evidence-based practice culture. Gemba is both a tool and a process to engage team members and the public to generate clinical questions and to plan, implement, and evaluate practice changes. Future research on the effectiveness of gemba boards to facilitate evidence-based practice is warranted. ©2018 American Association of Critical-Care Nurses.

Facilitation and Practice in Verb Acquisition

ERIC Educational Resources Information Center

Keren-Portnoy, Tamar

2006-01-01

This paper presents a model of syntax acquisition, whose main points are as follows: Syntax is acquired in an item-based manner; early learning facilitates subsequent learning--as evidenced by the accelerating rate of new verbs entering a given structure; and mastery of syntactic knowledge is typically achieved through practice--as evidenced by…

Exploring Dimensions of Critical Reflection in Activist-Facilitator Practice

ERIC Educational Resources Information Center

Hanson, Cindy

2013-01-01

This article explores how 14 diverse, Canadian activist-facilitators working in international development experience and understand "critical reflection" as a component of participatory methodologies in facilitation practices. The findings, based on my doctoral study, demonstrate that although critical reflection is often discussed as…

Facilitators of transforming primary care: a look under the hood at practice leadership.

PubMed

Donahue, Katrina E; Halladay, Jacqueline R; Wise, Alison; Reiter, Kristin; Lee, Shoou-Yih Daniel; Ward, Kimberly; Mitchell, Madeline; Qaqish, Bahjat

2013-01-01

This study examined how characteristics of practice leadership affect the change process in a statewide initiative to improve the quality of diabetes and asthma care. We used a mixed methods approach, involving analyses of existing quality improvement data on 76 practices with at least 1 year of participation and focus groups with clinicians and staff in a 12-practice subsample. Existing data included monthly diabetes or asthma measures (clinical measures) and monthly practice implementation, leadership, and practice engagement scores rated by an external practice coach. Of the 76 practices, 51 focused on diabetes and 25 on asthma. In aggregate, 50% to 78% made improvements within in each clinical measure in the first year. The odds of making practice changes were greater for practices with higher leadership scores (odds ratios = 2.41-4.20). Among practices focused on diabetes, those with higher leadership scores had higher odds of performing nephropathy screening (odds ratio = 1.37, 95% CI, 1.08-1.74); no significant associations were seen for the intermediate outcome measures of hemoglobin A1c, blood pressure, and cholesterol. Focus groups revealed the importance of a leader, typically a physician, who believed in the transformation work (ie, a visionary leader) and promoted practice engagement through education and cross-training. Practices with greater change implementation also mentioned the importance of a midlevel operational leader who helped to create and sustain practice changes. This person communicated and interacted well with, and was respected by both clinicians and staff. In the presence of a vision for transformation, operational leaders within practices can facilitate practice changes that are associated with clinical improvement.

Facilitators of Transforming Primary Care: A Look Under the Hood at Practice Leadership

PubMed Central

Donahue, Katrina E.; Halladay, Jacqueline R.; Wise, Alison; Reiter, Kristin; Lee, Shoou-Yih Daniel; Ward, Kimberly; Mitchell, Madeline; Qaqish, Bahjat

2013-01-01

PURPOSE This study examined how characteristics of practice leadership affect the change process in a statewide initiative to improve the quality of diabetes and asthma care. METHODS We used a mixed methods approach, involving analyses of existing quality improvement data on 76 practices with at least 1 year of participation and focus groups with clinicians and staff in a 12-practice subsample. Existing data included monthly diabetes or asthma measures (clinical measures) and monthly practice implementation, leadership, and practice engagement scores rated by an external practice coach. RESULTS Of the 76 practices, 51 focused on diabetes and 25 on asthma. In aggregate, 50% to 78% made improvements within in each clinical measure in the first year. The odds of making practice changes were greater for practices with higher leadership scores (odds ratios = 2.41–4.20). Among practices focused on diabetes, those with higher leadership scores had higher odds of performing nephropathy screening (odds ratio = 1.37, 95% CI, 1.08–1.74); no significant associations were seen for the intermediate outcome measures of hemoglobin A1c, blood pressure, and cholesterol. Focus groups revealed the importance of a leader, typically a physician, who believed in the transformation work (ie, a visionary leader) and promoted practice engagement through education and cross-training. Practices with greater change implementation also mentioned the importance of a midlevel operational leader who helped to create and sustain practice changes. This person communicated and interacted well with, and was respected by both clinicians and staff. CONCLUSIONS In the presence of a vision for transformation, operational leaders within practices can facilitate practice changes that are associated with clinical improvement. PMID:23690383

Facilitators and barriers in the humanization of childbirth practice in Japan

PubMed Central

2010-01-01

Background Humanizing birth means considering women's values, beliefs, and feelings and respecting their dignity and autonomy during the birthing process. Reducing over-medicalized childbirths, empowering women and the use of evidence-based maternity practice are strategies that promote humanized birth. Nevertheless, the territory of birth and its socio-cultural values and beliefs concerning child bearing can deeply affect birthing practices. The present study aims to explore the Japanese child birthing experience in different birth settings where the humanization of childbirth has been indentified among the priority goals of the institutions concerned, and also to explore the obstacles and facilitators encountered in the practice of humanized birth in those centres. Methods A qualitative field research design was used in this study. Forty four individuals and nine institutions were recruited. Data was collected through observation, field notes, focus groups, informal and semi-structured interviews. A qualitative content analysis was performed. Results All the settings had implemented strategies aimed at reducing caesarean sections, and keeping childbirth as natural as possible. The barriers and facilitators encountered in the practice of humanized birth were categorized into four main groups: rules and strategies, physical structure, contingency factors, and individual factors. The most important barriers identified in humanized birth care were the institutional rules and strategies that restricted the presence of a birth companion. The main facilitators were women's own cultural values and beliefs in a natural birth, and institutional strategies designed to prevent unnecessary medical interventions. Conclusions The Japanese birthing institutions which have identified as part of their mission to instate humanized birth have, as a whole, been successful in improving care. However, barriers remain to achieving the ultimate goal. Importantly, the cultural values and

Maintaining gender sensitivity in the family practice: facilitators and barriers.

PubMed

Celik, Halime; Lagro-Janssen, Toine; Klinge, Ineke; van der Weijden, Trudy; Widdershoven, Guy

2009-12-01

This study aims to identify the facilitators and barriers perceived by General Practitioners (GPs) to maintain a gender perspective in family practice. Nine semi-structured interviews were conducted among nine pairs of GPs. The data were analysed by means of deductive content analysis using theory-based methods to generate facilitators and barriers to gender sensitivity. Gender sensitivity in family practice can be influenced by several factors which ultimately determine the extent to which a gender sensitive approach is satisfactorily practiced by GPs in the doctor-patient relationship. Gender awareness, repetition and reminders, motivation triggers and professional guidelines were found to facilitate gender sensitivity. On the other hand, lacking skills and routines, scepticism, heavy workload and the timing of implementation were found to be barriers to gender sensitivity. While the potential effect of each factor affecting gender sensitivity in family practice has been elucidated, the effects of the interplay between these factors still need to be determined.

Introducing a multimedia course to enhance health professionals' skills to facilitate communities of practice.

PubMed

Jakubec, Sonya L; Parboosingh, John; Colvin, Barbara

2014-01-01

Scholarship about communities of practice (COP) is uncovering evidence that interactivity between community members contributes to improvement in practice. Leadership and facilitation are crucial elements of successful COP implementation. The purpose of this paper is to describe an innovative COP facilitator's course and report on the experiences of participants in the first course. In response to this need and emerging evidence, an on-line COP facilitator's course was developed and implemented in Alberta, Canada, in 2011. This course included a home-based COP practicum, introductory face-to-face session, an on-line discussion board moderated by faculty and on-line learning modules. Evaluation of the course was formalized in a qualitative study incorporating content analysis of postings, semi-structured interviews of successful participants and narrative responses to questions in a post course survey. A total of 15 of 22 participants perceived they acquired basic knowledge about community facilitation by completing the self-learning modules and assignments. Many did not establish home-based COP and only partially participated in the interactive components of the course. Six participants successfully completed the course by establishing home-based COP and actively participating in the social and interactive components of the course. They perceived they met course objectives and greatly benefited from participation in the course, in particular when they pushed themselves to facilitate in new and different ways, and when they were actively engaged with their home-based COP where they could practice and receive feedback. While the main reasons why participants dropped out or failed to complete all course components were reported, the experiences and perceptions of six participants who successfully completed all course components form the major part of the evaluation of the course and hence introduce bias. A more in depth analysis of why learners are reluctant to engage

Advancing knowledge on practice change: linking facilitation to the senses framework.

PubMed

Cooper, Julie; Meyer, Julienne; Holman, Cheryl

2013-06-01

To explore the facilitating factors that enabled staff on a rehabilitation ward for older people engage in change activities. The importance of facilitation in practice change is widely acknowledged; however, little nursing research has taken place in relation to its nature. Following identification in the early phases of an action research study that learned helplessness states and the use of socially structured defence techniques were preventing staff on a rehabilitation ward for older people from engaging in practice development, some change was achieved. What facilitated this to take place needed to be explored. An action research approach was used. Data gained from 13 in-depth interviews with staff and managers together with three years of researcher field notes were analysed using thematic analysis. The continuous presence and neutrality of the researcher who worked together with staff on their issues of concern using a flexible ward-based approach, combined with giving staff the opportunity to explore what it was like for them working in this area, were considered key in helping staff to engage with change. Analysis of findings suggests that the senses framework presents a theoretical approach to facilitation that can help staff move out of learned helplessness states and reduce the need for the use of socially structured defence techniques. This study identifies a facilitation approach that enabled staff to engage with practice change. Although carried out in the UK, its findings have wider relevance through the application of a theoretical perspective for practice change facilitation that has not before been considered in this literature, and which is likely to be of interest to those involved in practice change internationally. © 2013 Blackwell Publishing Ltd.

Simulated settings; powerful arenas for learning patient safety practices and facilitating transference to clinical practice. A mixed method study.

PubMed

Reime, Marit Hegg; Johnsgaard, Tone; Kvam, Fred Ivan; Aarflot, Morten; Breivik, Marit; Engeberg, Janecke Merethe; Brattebø, Guttorm

2016-11-01

Poor teamwork is an important factor in the occurrence of critical incidents because of a lack of non-technical skills. Team training can be a key to prevent these incidents. The purpose of this study was to explore the experience of nursing and medical students after a simulation-based interprofessional team training (SBITT) course and its impact on professional and patient safety practices, using a concurrent mixed-method design. The participants (n = 262) were organized into 44 interprofessional teams. The results showed that two training sequences the same day improved overall team performance. Making mistakes during SBITT appeared to improve the quality of patient care once the students returned to clinical practice as it made the students more vigilant. Furthermore, the video-assisted oral debriefing provided an opportunity to strengthen interprofessional teamwork and share situational awareness. SBITT gave the students an opportunity to practice clinical reasoning skills and to share professional knowledge. The students conveyed the importance of learning to speak up to ensure safe patient practices. Simulated settings seem to be powerful arenas for learning patient safety practices and facilitating transference of this awareness to clinical practice. Copyright © 2016 Elsevier Ltd. All rights reserved.

Effectiveness of a quality-improvement program in improving management of primary care practices.

PubMed

Szecsenyi, Joachim; Campbell, Stephen; Broge, Bjoern; Laux, Gunter; Willms, Sara; Wensing, Michel; Goetz, Katja

2011-12-13

The European Practice Assessment program provides feedback and outreach visits to primary care practices to facilitate quality improvement in five domains (infrastructure, people, information, finance, and quality and safety). We examined the effectiveness of this program in improving management in primary care practices in Germany, with a focus on the domain of quality and safety. In a before-after study, 102 primary care practices completed a practice assessment using the European Practice Assessment instrument at baseline and three years later (intervention group). A comparative group of 102 practices was included that completed their first assessment using this instrument at the time of the intervention group's second assessment. Mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100. We found significant improvements in all domains between the first and second assessments in the intervention group. In the domain of quality and safety, improvements in scores (mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100) were observed in the following dimensions: complaint management (from a mean score of 51.2 at first assessment to 80.7 at second assessment); analysis of critical incidents (from 79.1 to 89.6); and quality development, quality policy (from 40.7 to 55.6). Overall scores at the time of the second assessment were significantly higher in the intervention group than in the comparative group. Primary care practices that completed the European Practice Assessment instrument twice over a three-year period showed improvements in practice management. Our findings show the value of the quality-improvement cycle in the context of practice assessment and the use of established organizational standards for practice management with the Europeaen Practice Assessment.

Improving EHR Capabilities to Facilitate Stage 3 Meaningful Use Care Coordination Criteria.

PubMed

Cross, Dori A; Cohen, Genna R; Nong, Paige; Day, Anya-Victoria; Vibbert, Danielle; Naraharisetti, Ramya; Adler-Milstein, Julia

Primary care practices have been limited in their ability to leverage electronic health records (EHRs) and health information exchange (HIE) to improve care coordination, but will soon be incentivized to do so under proposed Stage 3 meaningful use criteria. We use mixed methods to understand how primary care practices manage, share and reconcile electronic patient information across care settings, and identify innovations in EHR design to support enhanced care coordination. Opportunities identified by practices focused on availability and usability of features that facilitate (1) generation of customized summary of care records, (2) team-based care approaches, and (3) management of the increased volume of electronic information generated and exchanged during care transitions. More broadly, vendors and policymakers need to continue to work together to improve interoperability as the key to effective care coordination. If these EHR innovations were widespread, the value of meeting the proposed Stage 3 care coordination criteria would be substantially enhanced.

The effect of facilitator training on the development and practice of participants in an online induction program for teachers of science and mathematics

NASA Astrophysics Data System (ADS)

Taylor, Peggy Sue

Learning in computer-mediated conferencing systems requires frequent and open interaction in environments that foster sharing and examination of group knowledge and experiences. Written dialogue is the means by which this interaction takes place. This study examined the effects of a training program designed for facilitators in the e-Mentoring for Student Success (eMSS) program, which provides online induction for beginning science and mathematics teachers. The training was designed to improve the quality of dialogue among participants in the program. The intervention consisted of three components: (1) an online training institute prior to beginning of the program year, (2) placement of facilitators in positions within the discussion areas of the program, and (3) ongoing online support for practicing facilitators. Three examinations were conducted in this mixed-method study. First, preintervention program dialogue was quantitatively compared to post-intervention program dialogue through use of a program-specific rubric to code program discussions. Second, case studies were conducted to determine how the training affected the practices of seven program facilitators and which components of the training effected change or growth. Third, pre and post intervention surveys were administered to all participants of the training to obtain their perceptions of their development as a result of the intervention. Comparison of dialogue before and after the intervention indicated a significant improvement in dialogue quality in the discussion areas of the program. Case studies of facilitators' practices revealed areas of the training that impacted the skills and strategies that facilitators used in efforts to foster increased and improved dialogue. Survey results indicated that participants gained a better understanding of what constituted quality dialogue in terms of the eMSS program and how better to foster quality dialogue in an online environment. Components of the training

Management of older adults with hip fractures in India: a mixed methods study of current practice, barriers and facilitators, with recommendations to improve care pathways.

PubMed

Rath, Santosh; Yadav, Lalit; Tewari, Abha; Chantler, Tracey; Woodward, Mark; Kotwal, Prakash; Jain, Anil; Dey, Aparajit; Garg, Bhavuk; Malhotra, Rajesh; Goel, Ashish; Farooque, Kamran; Sharma, Vijay; Webster, Premila; Norton, Robyn

2017-12-01

Evidence-based management can reduce deaths and suffering of older adults with hip fractures. This study investigates the evidence-practice gaps in hip fracture care in three major hospitals in Delhi, potential barriers and facilitators to improving care, and consequently, identifies contextually appropriate interventions for implementing best practice for management of older adults with hip fractures in India. Hip fracture in older adults is a significant public health issue in India. The current study sought to document current practices, identify barriers and facilitators to adopting best practice guidelines and recommend improvements in the management of older adults with hip fractures in Delhi, India. This mixed methods observational study collected data from healthcare providers, patients, carers and medical records from three major public tertiary care hospitals in Delhi, India. All patients aged ≥50 years with an X-ray confirmed hip fracture that were admitted to these hospitals over a 10-week period were recruited. Patients' data were collected at admission, discharge and 30 days post-injury. Eleven key informant interviews and four focus group discussions were conducted with healthcare providers. Descriptive data for key quantitative variables were computed. The qualitative data were analysed and interpreted using a behaviour change wheel framework. A total of 136 patients, 74 (54%) men and 62 women, with hip fracture were identified in the three participating hospitals during the recruitment period and only 85 (63%) were admitted for treatment with a mean age of 66.5 years (SD 11.9). Of these, 30% received surgery within 48 h of hospital admission, 95% received surgery within 39 days of hospital admission and two (3%) had died by 30 days of injury. According to the healthcare providers, inadequate resources and overcrowding prevent adequate caring of the hip fracture patients. They unanimously felt the need for protocol-based management of hip

Effect of Facilitation on Practice Outcomes in the National Demonstration Project Model of the Patient-Centered Medical Home

PubMed Central

Nutting, Paul A.; Crabtree, Benjamin F.; Stewart, Elizabeth E.; Miller, William L.; Palmer, Raymond F.; Stange, Kurt C.; Jaén, Carlos Roberto

2010-01-01

facilitation increases the number of components implemented and improves practices’ adaptive reserve. Longer follow-up is needed to assess the sustained and evolving effects of moving independent practices toward PCMHs PMID:20530393

A care improvement program acting as a powerful learning environment to support nursing students learning facilitation competencies.

PubMed

Jukema, Jan S; Harps-Timmerman, Annelies; Stoopendaal, Annemiek; Smits, Carolien H M

2015-11-01

Change management is an important area of training in undergraduate nursing education. Successful change management in healthcare aimed at improving practices requires facilitation skills that support teams in attaining the desired change. Developing facilitation skills in nursing students requires formal educational support. A Dutch Regional Care Improvement Program based on a nationwide format of change management in healthcare was designed to act as a Powerful Learning Environment for nursing students developing competencies in facilitating change. This article has two aims: to provide comprehensive insight into the program components and to describe students' learning experiences in developing their facilitation skills. This Dutch Regional Care Improvement Program considers three aspects of a Powerful Learning Environment: self-regulated learning; problem-based learning; and complex, realistic and challenging learning tasks. These three aspects were operationalised in five distinct areas of facilitation: increasing awareness of the need for change; leadership and project management; relationship building and communication; importance of the local context; and ongoing monitoring and evaluation. Over a period of 18 months, 42 nursing students, supported by trained lecturer-coaches, took part in nine improvement teams in our Regional Care Improvement Program, executing activities in all five areas of facilitation. Based on the students' experiences, we propose refinements to various components of this program, aimed at strengthenin the learning environment. There is a need for further detailed empirical research to study the impact this kind of learning environment has on students developing facilitation competencies in healthcare improvement. Copyright © 2015 Elsevier Ltd. All rights reserved.

Barriers and facilitators to learn and improve through morbidity and mortality conferences: a qualitative study.

PubMed

de Vos, Marit S; Hamming, Jaap F; Marang-van de Mheen, Perla J

2017-11-12

To explore barriers and facilitators to successful morbidity and mortality conferences (M&M), driving learning and improvement. This is a qualitative study with semistructured interviews. Inductive, thematic content analysis was used to identify barriers and facilitators, which were structured across a pre-existing framework for change in healthcare. Dutch academic surgical department with a long tradition of M&M. An interview sample of surgeons, residents and physician assistants (n=12). A total of 57 barriers and facilitators to successful M&M, covering 18 themes, varying from 'case type' to 'leadership', were perceived by surgical staff. While some factors related to M&M organisation, others concerned individual or social aspects. Eight factors, of which four were at the social level, had simultaneous positive and negative effects (eg, 'hierarchy' and 'team spirit'). Mediating pathways for M&M success were found to relate to available information , staff motivation and realisation processes. This study provides leads for improvement of M&M practice, as well as for further research on key elements of successful M&M. Various factors were perceived to affect M&M success, of which many were individual and social rather than organisational factors, affecting information and realisation processes but also staff motivation. Based on these findings, practical recommendations were formulated to guide efforts towards best practices for M&M. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Improving Inquiry Teaching through Reflection on Practice

NASA Astrophysics Data System (ADS)

Lotter, Christine R.; Miller, Cory

2017-08-01

In this paper, we explore middle school science teachers' learning of inquiry-based instructional strategies through reflection on practice teaching sessions during a summer enrichment program with middle level students. The reflection sessions were part of a larger year-long inquiry professional development program in which teachers learned science content and inquiry pedagogy. The program included a 2-week summer institute in which teachers participated in science content sessions, practice teaching to middle level students, and small group-facilitated reflection sessions on their teaching. For this study, data collection focused on teachers' recorded dialogue during the facilitator - run reflection sessions, the teachers' daily written reflections, a final written reflection, and a written reflection on a videotaped teaching session. We investigated the teachers' reflection levels and the themes teachers focused on during their reflection sessions. Teachers were found to reflect at various reflection levels, from simple description to a more sophisticated focus on how to improve student learning. Recurrent themes point to the importance of providing situated learning environments, such as the practice teaching with immediate reflection for teachers to have time to practice new instructional strategies and gain insight from peers and science educators on how to handle student learning issues.

Effectiveness of a quality-improvement program in improving management of primary care practices

PubMed Central

Szecsenyi, Joachim; Campbell, Stephen; Broge, Bjoern; Laux, Gunter; Willms, Sara; Wensing, Michel; Goetz, Katja

2011-01-01

Background: The European Practice Assessment program provides feedback and outreach visits to primary care practices to facilitate quality improvement in five domains (infrastructure, people, information, finance, and quality and safety). We examined the effectiveness of this program in improving management in primary care practices in Germany, with a focus on the domain of quality and safety. Methods: In a before–after study, 102 primary care practices completed a practice assessment using the European Practice Assessment instrument at baseline and three years later (intervention group). A comparative group of 102 practices was included that completed their first assessment using this instrument at the time of the intervention group’s second assessment. Mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100. Results: We found significant improvements in all domains between the first and second assessments in the intervention group. In the domain of quality and safety, improvements in scores (mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100) were observed in the following dimensions: complaint management (from a mean score of 51.2 at first assessment to 80.7 at second assessment); analysis of critical incidents (from 79.1 to 89.6); and quality development, quality policy (from 40.7 to 55.6). Overall scores at the time of the second assessment were significantly higher in the intervention group than in the comparative group. Interpretation: Primary care practices that completed the European Practice Assessment instrument twice over a three-year period showed improvements in practice management. Our findings show the value of the quality-improvement cycle in the context of practice assessment and the use of established organizational standards for practice management with the

A multi-institutional study of the perceived barriers and facilitators to implementing evidence-based practice.

PubMed

Duncombe, Daphne C

2018-03-01

To examine perceived barriers and facilitators to implementing evidence-based practice among nurses working in psychiatric, geriatric, hospital and community settings in The Bahamas. It is evident from previous studies that a number of factors exist which either obstruct or promote the utilisation of research evidence in nursing practice. Identifying these factors is vital to the successful uptake of evidence-based practice in nursing. Descriptive, comparative study. Data were collected using self-administered questionnaires. A stratified random sample (n = 100) of registered nurses participated; 5-point Likert-like scales were used to examine nurses' perceptions of barriers and facilitators of evidence-based practice. Descriptive statistics were used to describe demographic characteristics and to compare responses of nurses. Participants were predominantly female (98.4%), in the 25 to <35 years age group (45.9%). Of nurses surveyed, 72.1% had never tried to implement evidence-based practice previously. The greatest barriers identified were as follows: "Inadequate resources for implementing research findings" (85.2%; n = 52) and "Inadequate training in research methods" (83.6%; n = 51). The top facilitators identified were as follows: "Training in research methods" (88.5%; n = 54) and "Organisational policies and protocols that are evidence-based" (86.9%; n = 53). Nurses generally expressed that they required additional training in research and evidence-based practice concepts. Although some nurses had a desire to implement evidence-based practice to provide quality care and improve patient outcomes, many expressed that they lacked the required resources. The study draws attention to the need for prioritisation of evidence-based practice both at institutional and governmental levels. Successful adoption of evidence-based practice implies combined efforts of nurses, healthcare providers and policymakers. Further research is needed to determine the best

Practice change in community pharmacy: quantification of facilitators.

PubMed

Roberts, Alison S; Benrimoj, Shalom I; Chen, Timothy F; Williams, Kylie A; Aslani, Parisa

2008-06-01

There has been an increasing international trend toward the delivery of cognitive pharmaceutical services (CPS) in community pharmacy. CPS have been developed and disseminated individually, without a framework underpinning their implementation and with limited knowledge of factors that might assist practice change. The implementation process is complex, involving a range of internal and external factors. To quantify facilitators of practice change in Australian community pharmacies. We employed a literature review and qualitative study to facilitate the design of a 43-item "facilitators of practice change" scale as part of a quantitative survey instrument, using a framework of organizational theory. The questionnaire was pilot-tested (n = 100), then mailed to a random sample of 2000 community pharmacies, with a copy each for the pharmacy owner, employed pharmacist, and pharmacy assistant. The construct validity and reliability of the scale were established using exploratory factor analysis and Cronbach's alpha, respectively. A total of 735 (37%) pharmacies responded, with 1303 individual questionnaires. Factor analysis of the scale yielded 7 factors, explaining 48.8% of the total variance. The factors were: relationship with physicians (item loading range 0.59-0.85; Cronbach's alpha 0.90), remuneration (0.52-0.74; 0.82), pharmacy layout (0.52-0.79; 0.81), patient expectation (0.52-0.85; 0.82), manpower/staff (0.49-0.66; 0.80), communication and teamwork (0.37-0.65; 0.77), and external support/assistance (0.47-0.69; 0.74). All of the factors demonstrated good reliability and construct validity and explained approximately half of the variance. Implementing CPS requires support not only with the clinical aspects of service delivery, but also for the process of implementation itself, and remuneration models must reflect this. The identified facilitators should be used in a multilevel strategy to integrate professional services into the community pharmacy business

Facilitating students' reflective practice in a medical course: literature review.

PubMed

Chaffey, Lisa Jane; de Leeuw, Evelyne Johanna Janet; Finnigan, Gerard Anthony

2012-01-01

Reflection and reflective practice is of increasing importance in medical education curricula. The aim of this review is to summarise the literature published around facilitating reflection in a medical course, and to answer the question : W0 hat is the current evidence regarding learning and development moments across the medical curriculum in developing students' reflective practice? A review of the literature was undertaken using defined databases and the search terms 'medical students', 'medical education', 'reflection', 'reflectFNx01' and 'medicine'. The search was limited to peer-reviewed published material in English and between the years 2001 and 2011, and included research, reviews and opinion pieces. Thirty-six relevant articles were found, identifying enhancing factors and barriers to effectively teaching reflective practice within medical curricula, relating to: The breadth of the meaning of reflection; facilitating reflection by medical educators; using written or web-based portfolios to facilitate reflection; and assessing the reflective work of students. A variety of reflective purposes was found in this literature review. Evidence indicates that, if students are unclear as to the purpose of reflection and do not see educators modelling reflective behaviours, they are likely to undervalue this important skill regardless of the associated learning and development opportunities embedded in the curriculum.

Kinematic and kinetic improvements associated with action observation facilitated learning of the power clean in Australian footballers.

PubMed

Sakadjian, Alex; Panchuk, Derek; Pearce, Alan J

2014-06-01

This study investigated the effectiveness of action observation (AO) on facilitating learning of the power clean technique (kinematics) compared with traditional strength coaching methods and whether improvements in performance (kinetics) were associated with an improvement in lifting technique. Fifteen subjects (age, 20.9 ± 2.3 years) with no experience in performing the power clean exercise attended 12 training and testing sessions over a 4-week period. Subjects were assigned to 2 matched groups, based on preintervention power clean performance and performed 3 sets of 5 repetitions of the power clean exercise at each training session. Subjects in the traditional coaching group (TC; n = 7) received the standard coaching feedback (verbal cues and physical practice), whereas subjects in the AO group (n = 8) received similar verbal coaching cues and physical practice but also observed a video of a skilled model before performing each set. Kinematic data were collected from video recordings of subjects who were fitted with joint center markings during testing, whereas kinetic data were collected from a weightlifting analyzer attached to the barbell. Subjects were tested before intervention, at the end of weeks 2 and 3, and at after intervention at the end of week 4. Faster improvements (3%) were observed in power clean technique with AO-facilitated learning in the first week and performance improvements (mean peak power of the subject's 15 repetitions) over time were significant (p < 0.001). In addition, performance improvement was significantly associated (R = 0.215) with technique improvements. In conclusion, AO combined with verbal coaching and physical practice of the power clean exercise resulted in significantly faster technique improvements and improvement in performance compared with traditional coaching methods.

Variable practice with lenses improves visuo-motor plasticity

NASA Technical Reports Server (NTRS)

Roller, C. A.; Cohen, H. S.; Kimball, K. T.; Bloomberg, J. J.

2001-01-01

Novel sensorimotor situations present a unique challenge to an individual's adaptive ability. Using the simple and easily measured paradigm of visual-motor rearrangement created by the use of visual displacement lenses, we sought to determine whether an individual's ability to adapt to visuo-motor discordance could be improved through training. Subjects threw small balls at a stationary target during a 3-week practice regimen involving repeated exposure to one set of lenses in block practice (x 2.0 magnifying lenses), multiple sets of lenses in variable practice (x 2.0 magnifying, x 0.5 minifying and up-down reversing lenses) or sham lenses. At the end of training, adaptation to a novel visuo-motor situation (20-degree right shift lenses) was tested. We found that (1) training with variable practice can increase adaptability to a novel visuo-motor situation, (2) increased adaptability is retained for at least 1 month and is transferable to further novel visuo-motor permutations and (3) variable practice improves performance of a simple motor task even in the undisturbed state. These results have implications for the design of clinical rehabilitation programs and countermeasures to enhance astronaut adaptability, facilitating adaptive transitions between gravitational environments.

Appreciative Inquiry for quality improvement in primary care practices.

PubMed

Ruhe, Mary C; Bobiak, Sarah N; Litaker, David; Carter, Caroline A; Wu, Laura; Schroeder, Casey; Zyzanski, Stephen J; Weyer, Sharon M; Werner, James J; Fry, Ronald E; Stange, Kurt C

2011-01-01

To test the effect of an Appreciative Inquiry (AI) quality improvement strategy on clinical quality management and practice development outcomes. Appreciative inquiry enables the discovery of shared motivations, envisioning a transformed future, and learning around the implementation of a change process. Thirty diverse primary care practices were randomly assigned to receive an AI-based intervention focused on a practice-chosen topic and on improving preventive service delivery (PSD) rates. Medical-record review assessed change in PSD rates. Ethnographic field notes and observational checklist analysis used editing and immersion/crystallization methods to identify factors affecting intervention implementation and practice development outcomes. The PSD rates did not change. Field note analysis suggested that the intervention elicited core motivations, facilitated development of a shared vision, defined change objectives, and fostered respectful interactions. Practices most likely to implement the intervention or develop new practice capacities exhibited 1 or more of the following: support from key leader(s), a sense of urgency for change, a mission focused on serving patients, health care system and practice flexibility, and a history of constructive practice change. An AI approach and enabling practice conditions can lead to intervention implementation and practice development by connecting individual and practice strengths and motivations to the change objective.

Appreciative Inquiry for Quality Improvement in Primary Care Practices

PubMed Central

Ruhe, Mary C.; Bobiak, Sarah N.; Litaker, David; Carter, Caroline A.; Wu, Laura; Schroeder, Casey; Zyzanski, Stephen; Weyer, Sharon M.; Werner, James J.; Fry, Ronald E.; Stange, Kurt C.

2014-01-01

Purpose To test the effect of an Appreciative Inquiry (AI) quality improvement strategy, on clinical quality management and practice development outcomes. AI enables discovery of shared motivations, envisioning a transformed future, and learning around implementation of a change process. Methods Thirty diverse primary care practices were randomly assigned to receive an AI-based intervention focused on a practice-chosen topic and on improving preventive service delivery (PSD) rates. Medical record review assessed change in PSD rates. Ethnographic fieldnotes and observational checklist analysis used editing and immersion/crystallization methods to identify factors affecting intervention implementation and practice development outcomes. Results PSD rates did not change. Field note analysis suggested that the intervention elicited core motivations, facilitated development of a shared vision, defined change objectives and fostered respectful interactions. Practices most likely to implement the intervention or develop new practice capacities exhibited one or more of the following: support from key leader(s), a sense of urgency for change, a mission focused on serving patients, health care system and practice flexibility, and a history of constructive practice change. Conclusions An AI approach and enabling practice conditions can lead to intervention implementation and practice development by connecting individual and practice strengths and motivations to the change objective. PMID:21192206

Interprofessional collaboration to improve professional practice and healthcare outcomes.

PubMed

Reeves, Scott; Pelone, Ferruccio; Harrison, Reema; Goldman, Joanne; Zwarenstein, Merrick

2017-06-22

months. Eight studies compared an IPC intervention with usual care and evaluated the effects of different practice-based IPC interventions: externally facilitated interprofessional activities (e.g. team action planning; 4 studies), interprofessional rounds (2 studies), interprofessional meetings (1 study), and interprofessional checklists (1 study). One study compared one type of interprofessional meeting with another type of interprofessional meeting. We assessed four studies to be at high risk of attrition bias and an equal number of studies to be at high risk of detection bias.For studies comparing an IPC intervention with usual care, functional status in stroke patients may be slightly improved by externally facilitated interprofessional activities (1 study, 464 participants, low-certainty evidence). We are uncertain whether patient-assessed quality of care (1 study, 1185 participants), continuity of care (1 study, 464 participants) or collaborative working (4 studies, 1936 participants) are improved by externally facilitated interprofessional activities, as we graded the evidence as very low-certainty for these outcomes. Healthcare professionals' adherence to recommended practices may be slightly improved with externally facilitated interprofessional activities or interprofessional meetings (3 studies, 2576 participants, low certainty evidence). The use of healthcare resources may be slightly improved by externally facilitated interprofessional activities, interprofessional checklists and rounds (4 studies, 1679 participants, low-certainty evidence). None of the included studies reported on patient mortality, morbidity or complication rates.Compared to multidisciplinary audio conferencing, multidisciplinary video conferencing may reduce the average length of treatment and may reduce the number of multidisciplinary conferences needed per patient and the patient length of stay. There was little or no difference between these interventions in the number of

Evidence-based practice: how nurse leaders can facilitate innovation.

PubMed

Shirey, Maria R

2006-01-01

Evidence-based nursing practice (EBNP) is the wave of the future. Increasingly, EBNP is being identified as a key to quality and excellence in nursing services. Incorporating evidence into practice is necessary to deliver scientifically sound patient care. In addition, understanding the importance of evidence is crucial for meeting the excellence requirements of Magnet designation. Despite the growing popularity of EBNP and its documented significant benefits, the literature demonstrates that only 15% of the nursing workforce consistently practices within an EBNP framework. If EBNP adoption is to increase in the profession, it will require the active efforts of nurse leaders to pursue an aggressive innovation diffusion strategy. The purpose of this article is to discuss the nurse leader's role in facilitating EBNP in nursing using a theoretical framework grounded in innovation diffusion theory. The article develops 4 areas of focus. First, the components of innovation diffusion theory are discussed. Second, a pertinent empirical review of the EBNP adoption literature is presented. Third, strategies for applying innovation diffusion theory to facilitate EBNP adoption are proposed. Lastly, the article ends with a leadership call to action.

Improving HRD Practice.

ERIC Educational Resources Information Center

Gilley, Jerry W.

This book provides human resource development (HRD) professionals with a practical approach for improving the way they practice their profession and presents a four-part framework for improving HRD practice. Each of the book's four parts is dedicated to one part of the framework: examining HRD strategy; improving perceptions of HRD; improving…

A qualitative study of a primary-care based intervention to improve the management of patients with heart failure: the dynamic relationship between facilitation and context.

PubMed

Tierney, Stephanie; Kislov, Roman; Deaton, Christi

2014-09-18

There is currently a growing emphasis in primary care on upscaling the provision of evidence-based services for specific conditions, such as heart failure (HF), which have traditionally been seen as part of a specialist's domain. While contextual challenges associated with improvement in primary care have been documented previously, we still know relatively little about how the intentional, theory-informed facilitation of evidence-based change is shaped by contextual factors within this healthcare setting. Hence, a qualitative study was conducted to address the question: How is the process of facilitating evidence-based practice affected by the context of primary care? Data collection took place across general practices in northwest England as part of a process evaluation of the Greater Manchester HF Investigation Tool (GM-HFIT) - a programme of work aiming to improve the management of HF in primary care. Semi-structured interviews, with purposefully selected GM-HFIT team members (n = 9) and primary care practitioners (n = 7), were supplemented by observational data and a three-month diary reflecting on facilitation activities. Framework analysis was used to manage and interpret data. We describe a complex and dynamic interplay between facilitation and context, focusing on three major themes: (1) Addressing macro and micro agendas; (2) Forming a facilitative unit; (3) Maintaining momentum. We show that HF specialist nurses (HFSNs) have a high level of professional credibility, which allows them to play a key role in making recommendations to practices for improving patient care. At the same time, we argue that contextual factors, such as top-level endorsement, the necessity to comply with a performance measurement system, and the varying involvement of practice nurses produce tensions that can have both an enabling and constraining effect on the process of facilitation. When facilitating the transfer of evidence, context is an important aspect to consider

Neuro-proprioceptive facilitation in the re-education of functional problems in facial paralysis. A practical approach.

PubMed

Sardaru, D; Pendefunda, L

2013-01-01

Facial paralysis, in the form of Bell's syndrome, is an acute paralysis of idiopathic origin. Disability in patients with this medical condition is the result of impairment or loss of complex and multidimensional functions of the face like emotion expression through facial mimics, facial identity and communication. This study aimed to present new and improved practical manual techniques in the area of facial neuromuscular facilitations and to review the literature for disability indexes and facial nerve grading. We present the practical modality of using neuro-proprioceptive facilitation techniques, such as rhythmic initiation, repeated stretch (repeated contractions), combination of isotonics and percussion, and also report the effects of these techniques in three Bell's syndrome patients which were previously evaluated. Recovery from facial paralysis can be a difficult and long lasting process and the utilization of a grading system may help the physical therapist. The effects of this type of therapy may help_benefit the patient if the therapist is well trained and familiar with the neurophysiological background.

Understanding the importance of teachers in facilitating student success: Contemporary science, practice, and policy.

PubMed

Jimerson, Shane R; Haddock, Aaron D

2015-12-01

Teacher quality has a vital influence on student success or failure. Thus, further research regarding teacher effectiveness, teacher evaluation, teacher well-being, and teacher contributions is essential to inform school psychologists and allied educational professionals who collaborate and consult with teachers to facilitate student success. In this special topic section of School Psychology Quarterly, a series of 6 articles further elucidate teachers' powerful contributions to student outcomes along with concrete, research-based ways for school psychologists to support and collaborate with teachers. The studies included in the special section describe how teacher support facilitates students' positive academic and social-emotional outcomes and how students' attitudes toward learning moderate the association between the classroom environment and students' academic achievement. Studies also report on the development and validation of self-report measures focused on both teacher subjective well-being and teachers' use of evidence-based practices. Finally, the articles included in the special topic section offer insights and ideas for refining teacher evaluation practices, understanding the factors contributing to program implementation fidelity, and improving prevention, early identification, and intervention efforts aimed at fostering school completion and positive youth development. (c) 2015 APA, all rights reserved).

Clinical librarians as facilitators of nurses' evidence-based practice.

PubMed

Määttä, Sylvia; Wallmyr, Gudrun

2010-12-01

The aim of this study was to explore nurses' and ward-based clinical librarians' reflections on ward-based clinical librarians as facilitators for nurses' use of evidences-based practice. Nurses' use of evidence-based practice is reported to be weak. Studies have suggested that clinical librarians may promote evidence-based practice. To date, little is known about clinical librarians participating nurses in the wards. A descriptive, qualitative design was adopted for the study. In 2007, 16 nurses who had been attended by a clinical librarian in the wards were interviewed in focus groups. Two clinical librarians were interviewed by individual interviews. In the analysis, a content analysis was used. Three themes were generated from the interviews with nurses: 'The grip of everyday work', 'To articulate clinical nursing issues' and 'The clinical librarians at a catalyst'. The nurses experienced the grip of everyday work as a hindrance and had difficulties to articulate and formulate relevant nursing issues. In such a state, the nurses found the clinical librarian presence in the ward as enhancing the awareness of and the use of evidence-based practice. Three themes emerged from the analysis with the librarians. They felt as outsiders, had new knowledge and acquired a new role as ward-based clinical librarians. Facilitation is needed if nurses' evidence-based practice is going to increase. The combined use of nurses and clinical librarians' knowledge and skills can be optimised. To achieve this, nurses' skills in consuming and implementing evidence ought to be strengthened. The fusion of the information and knowledge management skill of the ward-based clinical librarian and the clinical expertise of the nurses can be of value. With such a collaborative model, nurse and ward-based clinical librarian might join forces to increase the use of evidence-based practice. © 2010 Blackwell Publishing Ltd.

Improving nutritional care: innovation and good practice.

PubMed

Chapman, Carol; Barker, Mary; Lawrence, Wendy

2015-04-01

This paper presents examples of good practice in nutritional screening and care and identifies methods used to overcome contextual constraints and discusses the implications for nursing practice in hospitals. Nutritional screening is an important step in identifying those at risk of malnutrition, but does not produce improved nutritional care unless it results in a care plan that is acted on. The importance of nutrition and implications for clinical care make it imperative to improve practice. Qualitative investigation. Between January 2011-February 2012, focus groups were held using a semi-structured discussion guide with nine groups of health professionals (n = 80) from one hospital: four with nurses, three with doctors and two with dietitians. Discussions were audio-recorded, transcribed and coded into themes and sub-themes, which were then depicted in a thematic map and illustrated with verbatim quotes. Three strategies for sustaining effective nutritional practice emerged: establishing routines to ensure screening was undertaken; re-organizing aspects of care to promote good practice; developing innovative approaches. Issues to be addressed were the perceived disconnection between mandatory screening and the delivery of effective care, a requirement for nutrition education, organizational constraints of a large university hospital and the complexities of multidisciplinary working. Professionals seeking to improve nutritional care in hospitals need to understand the interaction of system and person to facilitate change. Nursing staff need to be able to exercise autonomy and the hospital system must offer enough flexibility to allow wards to organize nutritional screening and care in a way that meets the needs of individual patients. © 2014 John Wiley & Sons Ltd.

Facilitating interpersonal interaction and learning online: linking theory and practice.

PubMed

Sargeant, Joan; Curran, Vernon; Allen, Michael; Jarvis-Selinger, Sandra; Ho, Kendall

2006-01-01

An earlier study of physicians' perceptions of interactive online learning showed that these were shaped both by program design and quality and the quality and quantity of interpersonal interaction. We explore instructor roles in enhancing online learning through interpersonal interaction and the learning theories that inform these. This was a qualitative study using focus groups and interviews. Using purposive sampling, 50 physicians were recruited based on their experience with interactive online CME and face-to-face CME. Qualitative thematic and interpretive analysis was used. Two facilitation roles appeared key: creating a comfortable learning environment and enhancing the educational value of electronic discussions. Comfort developed gradually, and specific interventions like facilitating introductions and sharing experiences in a friendly, informative manner were helpful. As in facilitating effective small-group learning, instructors' thoughtful use of techniques that facilitated constructive interaction based on learner's needs and practice demands contributed to the educational value of interpersonal interactions. Facilitators require enhanced skills to engage learners in meaningful interaction and to overcome the transactional distance of online learning. The use of learning theories, including behavioral, cognitive, social, humanistic, and constructivist, can strengthen the educational design and facilitation of online programs. Preparation for online facilitation should include instruction in the roles and techniques required and the theories that inform them.

Improving child health promotion practices in multiple sectors – outcomes of the Swedish Salut Programme

PubMed Central

2012-01-01

Background To improve health in the population, public health interventions must be successfully implemented within organisations, requiring behaviour change in health service providers as well as in the target population group. Such behavioural change is seldom easily achieved. The purpose of this study was to examine the outcomes of a child health promotion programme (The Salut Programme) on professionals’ self-reported health promotion practices, and to investigate perceived facilitators and barriers for programme implementation. Methods A before-and-after design was used to measure programme outcomes, and qualitative data on implementation facilitators and barriers were collected on two occasions during the implementation process. The sample included professionals in antenatal care, child health care, dental services and open pre-schools (n=144 pre-implementation) in 13 out of 15 municipalities in a Swedish county. Response rates ranged between 81% and 96% at the four measurement points. Results Self-reported health promotion practices and collaboration were improved in all sectors at follow up. Significant changes included: 1) an increase in the extent to which midwives in antenatal care raised issues related to men’s violence against women, 2) an increase in the extent to which several lifestyle topics were raised with parents/clients in child health care and dental services, 3) an increased use of motivational interviewing (MI) and separate ‘fathers visits’ in child health care 4) improvements in the supply of healthy snacks and beverages in open pre-schools and 5) increased collaboration between sectors. Main facilitators for programme implementation included cross-sectoral collaboration and sector-specific work manuals/questionnaires for use as support in everyday practice. Main barriers included high workload, and shortage of time and staff. Conclusion This multisectoral programme for health promotion, based on sector-specific intervention

Envisaging the use of evidence-based practice (EBP): how nurse academics facilitate EBP use in theory and practice across Australian undergraduate programmes.

PubMed

Malik, Gulzar; McKenna, Lisa; Griffiths, Debra

2017-09-01

This paper is drawn from a grounded theory study that aimed to investigate processes undertaken by academics when integrating evidence-based practice into undergraduate curricula. This paper focuses on how nurse academics facilitated students to apply evidence-based practice in theory and practice. Facilitating undergraduate nursing students to develop skills within an evidence-based practice framework is vital to achieving evidence-based care. Studies on evidence-based practice conducted globally suggests that there is a need to investigate approaches used by nurse academics in facilitating students' understanding and use of evidence-based practice during their nurse education. Employing constructivist grounded theory approach, 23 nurse academics across Australian universities were interviewed and nine observed during their teaching. Some study participants shared their unit guides to enrich analysis. Data analysis was performed by following Charmaz's approach of coding procedures; as a result, four categories were constructed. This paper focuses on the category conceptualised as Envisaging the use of evidence-based practice. Findings revealed that most academics-assisted students to use evidence in academic-related activities. Recognising the importance of evidence-based practice in practice, some also expected students to apply evidence-based practice during clinical experiences. However, the level of students' appreciation for evidence-based practice during clinical experiences was unknown to participants and was influenced by practice-related barriers. Acknowledging these challenges, academics were engaged in dialogue with students and suggested the need for academia-practice collaboration in combating the cited barriers. Ensuring academics are supported to emphasise clinical application of evidence-based practice requires strategies at school and practice levels. Faculty development, engagement of clinical nurses with evidence-based practice, supportive

NGO facilitation of a government community-based maternal and neonatal health programme in rural India: improvements in equity.

PubMed

Baqui, Abdullah H; Rosecrans, Amanda M; Williams, Emma K; Agrawal, Praween K; Ahmed, Saifuddin; Darmstadt, Gary L; Kumar, Vishwajeet; Kiran, Usha; Panwar, Dharmendra; Ahuja, Ramesh C; Srivastava, Vinod K; Black, Robert E; Santosham, Mathuram

2008-07-01

Socio-economic disparities in health have been well documented around the world. This study examines whether NGO facilitation of the government's community-based health programme improved the equity of maternal and newborn health in rural Uttar Pradesh, India. A quasi-experimental study design included one intervention district and one comparison district of rural Uttar Pradesh. A household survey conducted between January and June 2003 established baseline rates of programme coverage, maternal and newborn care practices, and health care utilization during 2001-02. An endline household survey was conducted after 30 months of programme implementation between January and March 2006 to measure the same indicators during 2004-05. The changes in the indicators from baseline to endline in the intervention and comparison districts were calculated by socio-economic quintiles, and concentration indices were constructed to measure the equity of programme indicators. The equity of programme coverage and antenatal and newborn care practices improved from baseline to endline in the intervention district while showing little change in the comparison district. Equity in health care utilization for mothers and newborns also showed some improvements in the intervention district, but notable socio-economic differentials remained, with the poor demonstrating less ability to access health services. NGO facilitation of government programmes is a feasible strategy to improve equity of maternal and neonatal health programmes. Improvements in equity were most pronounced for household practices, and inequities were still apparent in health care utilization. Furthermore, overall programme coverage remained low, limiting the ability to address equity. Programmes need to identify and address barriers to universal coverage and care utilization, particularly in the poorest segments of the population.

Improving Implementation of eMental Health for Mood Disorders in Routine Practice: Systematic Review of Barriers and Facilitating Factors

PubMed Central

Mol, Mayke; Kleiboer, Annet; Bührmann, Leah; Finch, Tracy; Smit, Jan; Riper, Heleen

2018-01-01

Background Electronic mental health interventions (eMental health or eMH) can be used to increase accessibility of mental health services for mood disorders, with indications of comparable clinical outcomes as face-to-face psychotherapy. However, the actual use of eMH in routine mental health care lags behind expectations. Identifying the factors that might promote or inhibit implementation of eMH in routine care may help to overcome this gap between effectiveness studies and routine care. Objective This paper reports the results of a systematic review of the scientific literature identifying those determinants of practices relevant to implementing eMH for mood disorders in routine practice. Methods A broad search strategy was developed with high sensitivity to four key terms: implementation, mental health care practice, mood disorder, and eMH. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework was applied to guide the review and structure the results. Thematic analysis was applied to identify the most important determinants that facilitate or hinder implementation of eMH in routine practice. Results A total of 13,147 articles were screened, of which 48 studies were included in the review. Most studies addressed aspects of the reach (n=33) of eMH, followed by intervention adoption (n=19), implementation of eMH (n=6), and maintenance (n=4) of eMH in routine care. More than half of the studies investigated the provision of mental health services through videoconferencing technologies (n=26), followed by Internet-based interventions (n=20). The majority (n=44) of the studies were of a descriptive nature. Across all RE-AIM domains, we identified 37 determinants clustered in six main themes: acceptance, appropriateness, engagement, resources, work processes, and leadership. The determinants of practices are expressed at different levels, including patients, mental health staff, organizations, and health care system level. Depending on

Improving and ensuring best practice continence management in residential aged care.

PubMed

Heckenberg, Gayle

2008-06-01

Background  Continence Management within residential aged care is an every day component of care that requires assessment, implementation of strategies, resource allocation and evaluation. At times the management of incontinence of aged residents can be challenging and unsuccessful. The project chosen through the Clinical Fellowship program was Continence Management with the aim of raising awareness of best practice to assist in improving and providing person-centred resident care. Aims/objectives •  Review the literature on best practice management of incontinence •  Evaluate current practice in continence management for elderly residents within residential aged care services •  Improve adherence to best practice strategies of care for incontinence •  Raise awareness within the nursing home of the best practice management of incontinence •  Promote appropriate and effective use of resources for continence management •  Deliver individualised person-centred care to residents. •  Ensure best practice in continence management Methods  The Joanna Briggs Institute (JBI) Practical Application of Clinical Evidence System clinical audit tool was utilised to measure current practice against best practice. The results identify gaps that require improvement. The Getting Research into Practice process then allowed analysis of the level of compliance with each of the audit criteria, which would identify any barriers in implementing a selected course of action and aim to improve compliance. The project team was consulted with additional stakeholder consultation to form an action plan and implement strategies to improve practice. Results  Although 100% compliance with all audit criteria in audit 1 and 2 was not achieved, there was improvement in the criteria concerning the documented fluid intake for residents. Further strategies have been identified and implemented and this continues to be a 'work in progress'. Staff now have an acute awareness

Instituting systems-based practice and practice-based learning and improvement: a curriculum of inquiry.

PubMed

Wilper, Andrew P; Smith, Curtis Scott; Weppner, William

2013-09-16

The Accreditation Council for Graduate Medical Education (ACGME) requires that training programs integrate system-based practice (SBP) and practice-based learning and improvement (PBLI) into internal medicine residency curricula. CONTEXT AND SETTING: We instituted a seminar series and year-long-mentored curriculum designed to engage internal medicine residents in these competencies. Residents participate in a seminar series that includes assigned reading and structured discussion with faculty who assist in the development of quality improvement or research projects. Residents pursue projects over the remainder of the year. Monthly works in progress meetings, protected time for inquiry, and continued faculty mentorship guide the residents in their project development. Trainees present their work at hospital-wide grand rounds at the end of the academic year. We performed a survey of residents to assess their self-reported knowledge, attitudes and skills in SBP and PBLI. In addition, blinded faculty scored projects for appropriateness, impact, and feasibility. We measured resident self-reported knowledge, attitudes, and skills at the end of the academic year. We found evidence that participants improved their understanding of the context in which they were practicing, and that their ability to engage in quality improvement projects increased. Blinded faculty reviewers favorably ranked the projects' feasibility, impact, and appropriateness. The 'Curriculum of Inquiry' generated 11 quality improvement and research projects during the study period. Barriers to the ongoing work include a limited supply of mentors and delays due to Institutional Review Board approval. Hospital leadership recognizes the importance of the curriculum, and our accreditation manager now cites our ongoing work. A structured residency-based curriculum facilitates resident demonstration of SBP and practice-based learning and improvement. Residents gain knowledge and skills though this enterprise

Instituting systems-based practice and practice-based learning and improvement: a curriculum of inquiry

PubMed Central

Wilper, Andrew P.; Smith, Curtis Scott; Weppner, William

2013-01-01

Background The Accreditation Council for Graduate Medical Education (ACGME) requires that training programs integrate system-based practice (SBP) and practice-based learning and improvement (PBLI) into internal medicine residency curricula. Context and setting We instituted a seminar series and year-long-mentored curriculum designed to engage internal medicine residents in these competencies. Methods Residents participate in a seminar series that includes assigned reading and structured discussion with faculty who assist in the development of quality improvement or research projects. Residents pursue projects over the remainder of the year. Monthly works in progress meetings, protected time for inquiry, and continued faculty mentorship guide the residents in their project development. Trainees present their work at hospital-wide grand rounds at the end of the academic year. We performed a survey of residents to assess their self-reported knowledge, attitudes and skills in SBP and PBLI. In addition, blinded faculty scored projects for appropriateness, impact, and feasibility. Outcomes We measured resident self-reported knowledge, attitudes, and skills at the end of the academic year. We found evidence that participants improved their understanding of the context in which they were practicing, and that their ability to engage in quality improvement projects increased. Blinded faculty reviewers favorably ranked the projects’ feasibility, impact, and appropriateness. The ‘Curriculum of Inquiry’ generated 11 quality improvement and research projects during the study period. Barriers to the ongoing work include a limited supply of mentors and delays due to Institutional Review Board approval. Hospital leadership recognizes the importance of the curriculum, and our accreditation manager now cites our ongoing work. Conclusions A structured residency-based curriculum facilitates resident demonstration of SBP and practice-based learning and improvement. Residents gain

Instituting systems-based practice and practice-based learning and improvement: a curriculum of inquiry.

PubMed

Wilper, Andrew P; Smith, Curtis Scott; Weppner, William

2013-01-01

Background The Accreditation Council for Graduate Medical Education (ACGME) requires that training programs integrate system-based practice (SBP) and practice-based learning and improvement (PBLI) into internal medicine residency curricula. Context and setting We instituted a seminar series and year-long-mentored curriculum designed to engage internal medicine residents in these competencies. Methods Residents participate in a seminar series that includes assigned reading and structured discussion with faculty who assist in the development of quality improvement or research projects. Residents pursue projects over the remainder of the year. Monthly works in progress meetings, protected time for inquiry, and continued faculty mentorship guide the residents in their project development. Trainees present their work at hospital-wide grand rounds at the end of the academic year. We performed a survey of residents to assess their self-reported knowledge, attitudes and skills in SBP and PBLI. In addition, blinded faculty scored projects for appropriateness, impact, and feasibility. Outcomes We measured resident self-reported knowledge, attitudes, and skills at the end of the academic year. We found evidence that participants improved their understanding of the context in which they were practicing, and that their ability to engage in quality improvement projects increased. Blinded faculty reviewers favorably ranked the projects' feasibility, impact, and appropriateness. The 'Curriculum of Inquiry' generated 11 quality improvement and research projects during the study period. Barriers to the ongoing work include a limited supply of mentors and delays due to Institutional Review Board approval. Hospital leadership recognizes the importance of the curriculum, and our accreditation manager now cites our ongoing work. Conclusions A structured residency-based curriculum facilitates resident demonstration of SBP and practice-based learning and improvement. Residents gain

Implementing patient-reported outcome measures in palliative care clinical practice: a systematic review of facilitators and barriers.

PubMed

Antunes, Bárbara; Harding, Richard; Higginson, Irene J

2014-02-01

Many patient-reported outcome measures have been developed in the past two decades, playing an increasingly important role in palliative care. However, their routine use in practice has been slow and difficult to implement. To systematically identify facilitators and barriers to the implementation of patient-reported outcome measures in different palliative care settings for routine practice, and to generate evidence-based recommendations, to inform the implementation process in clinical practice. Systematic literature review and narrative synthesis. Medline, PsycInfo, Cumulative Index to Nursing and Allied Health Literature, Embase and British Nursing Index were systematically searched from 1985. Hand searching of reference lists for all included articles and relevant review articles was performed. A total of 3863 articles were screened. Of these, 31 articles met the inclusion criteria. First, data were integrated in the main themes: facilitators, barriers and lessons learned. Second, each main theme was grouped into either five or six categories. Finally, recommendations for implementation on outcome measures at management, health-care professional and patient levels were generated for three different points in time: preparation, implementation and assessment/improvement. Successful implementation of patient-reported outcome measures should be tailored by identifying and addressing potential barriers according to setting. Having a coordinator throughout the implementation process seems to be key. Ongoing cognitive and emotional processes of each individual should be taken into consideration during changes. The educational component prior to the implementation is crucial. This could promote ownership and correct use of the measure by clinicians, potentially improving practice and the quality of care provided through patient-reported outcome measure data use in clinical decision-making.

Determining the barriers and facilitators to adopting best practices in the management of poststroke unilateral spatial neglect: results of a qualitative study.

PubMed

Petzold, Anita; Korner-Bitensky, Nicol; Salbach, Nancy M; Ahmed, Sara; Menon, Anita; Ogourtsova, Tatiana

2014-01-01

A gap exists between best and actual management of poststroke unilateral spatial neglect (USN). Given the negative impact of USN on poststroke recovery, knowledge translation efforts are needed to optimize USN management. To date, no study has investigated the specific barriers and facilitators affecting USN management during the acute care process. To identify the facilitators and barriers that affect evidence-based practice use by occupational therapists (the primary discipline managing USN) when treating individuals with acute poststroke USN. Focus group methodology elicited information from 9 acute care occupational therapists. Key barriers identified included lack of basic evidence-based practice skills specific to USN treatment and personal motivation to change current practices and engrained habits. Key facilitators included the presence of a multidisciplinary stroke team, recent graduation, and an environment with access to learning time and resources. Synthesized Web-based learning was also seen as important to uptake of best practices. It is estimated that upwards of 40% of patients experience poststroke USN in the acute phase, and we have evidence of poor early management. This study identified several modifiable factors that prepare the ground for the creation and testing of a multimodal knowledge translation intervention aimed at improving clinicians' best practice management of poststroke USN.

Identifying Perceived Barriers and Facilitators to Culturally Competent Practice for School Social Workers

ERIC Educational Resources Information Center

Teasley, Martell; Gourdine, Ruby; Canfield, James

2010-01-01

This study presents descriptive findings from self-reported qualitative and quantitative data on barriers and facilitators to culturally competent school social work practice. The study highlights the need for the development of evaluative methods for the purpose of examining how elements within the practice environment affect school social work…

Perceived Barriers and Facilitators to School Social Work Practice: A Mixed-Methods Study

ERIC Educational Resources Information Center

Teasley, Martell; Canifield, James P.; Archuleta, Adrian J.; Crutchfield, Jandel; Chavis, Annie McCullough

2012-01-01

Understanding barriers to practice is a growing area within school social work research. Using a convenience sample of 284 school social workers, this study replicates the efforts of a mixed-method investigation designed to identify barriers and facilitators to school social work practice within different geographic locations. Time constraints and…

Learning, Action and Solutions in Action Learning: Investigation of Facilitation Practice Using the Concept of Living Theories

ERIC Educational Resources Information Center

Sanyal, Chandana

2018-01-01

This paper explores the practice of action learning (AL) facilitation in supporting AL set members to address their 'messy' problems through a self-reflexive approach using the concept of 'living theory' [Whitehead, J., and J. McNiff. 2006. "Action Research Living Theory." London: Sage]. The facilitation practice is investigated through…

Facilitators and barriers in expanding scope of practice: findings from a national survey of Irish nurses and midwives.

PubMed

Fealy, Gerard M; Rohde, Daniela; Casey, Mary; Brady, Anne-Marie; Hegarty, Josephine; Kennedy, Catriona; McNamara, Martin; O'Reilly, Pauline; Prizeman, Geraldine

2015-12-01

The aim was to examine current scope of practice among nurses and midwives in Ireland. The objectives were to describe practitioners' self-reported facilitators and barriers to expanding scope of practice and to develop a scope of practice barriers scale. Regulatory authorities permit practice expansion, so long as it falls within accepted parameters of scope of practice. Enduring difficulties in relation to scope of practice include the difficulty of balancing practice restriction with practice expansion. A postal survey design was used to examine registered nurses' and midwives' current scope of practice, including their experiences of facilitators and barriers to expanding practice. A stratified random sample of registered nurses and midwives in Ireland was surveyed using the Scope-QB, a 19-item self-report scope of practice barriers scale. Based on a sample of 1010 respondents, the self-reported perceived barriers to practice expansion included fear of legal consequences, time restrictions and lack of remuneration. Professional satisfaction, patients' needs, organisational support and having access to continuing professional education were perceived as facilitators of practice expansion. Older nurses and midwives as well as nurses and midwives holding more senior promotional grades, such as clinical nurse manager grades, perceived fewer barriers than their younger and more junior counterparts. Nurses and midwives continue to experience difficulties in relation to expanding their practice. Practitioners can operate to optimal scope of practice when practitioner-centred and workplace-based circumstances are optimal. The optimal circumstances for practice expansion exist when the facilitators of practice expansion outweigh the barriers. Given the critical role that nurses and midwives play in modern health services, it is important that they are empowered and enabled to expand their practice and to work to full scope of practice when patient needs and service

Healthy Eating Practices: Perceptions, Facilitators, and Barriers Among Youth With Diabetes

PubMed Central

Gellar, Lauren A.; Schrader, Kelly; Nansel, Tonja R.

2008-01-01

Purpose The purpose of this study was to explore the perceptions of healthy eating by youth with diabetes as well as facilitators of and barriers to healthy eating behavior. Methods One hundred forty youth aged 7 to 16 years with diabetes participated in 18 focus groups. Sample race/ethnicity was 71% white, 18% African American, 6% Hispanic, and 5% other; 69% of the participants were female. Results Healthy eating was defined primarily in terms of eating fruits and vegetables, low fat, low sugar, and eating to keep blood sugar in range. However, there were notable differences in perceptions of healthy eating versus perceptions of eating practices good for diabetes management. Specifically, “free” foods (foods high in fat but low in carbohydrate) were commonly reported as being good for diabetes management. Major barriers to healthy eating included widespread availability of unhealthy foods, preparation time, and social situations. Parental behaviors, including monitoring food choices and positive modeling, were the most commonly reported facilitators of healthy eating. Conclusion Findings suggest that youth with diabetes have a general understanding of healthy eating and face similar barriers and facilitators to healthy eating as nondiabetic children do. However, the diabetes regimen may influence their understanding of healthy eating, sometimes negatively. Diabetes nutrition education sessions should emphasize the connection between healthy eating and both short-and long-term diabetes outcomes, and they should highlight strategies to reduce saturated fat consumption while avoiding excessive carbohydrate consumption. The diabetes educator can play an integral role in promoting healthy dietary practices by facilitating parental involvement, designing action plans for managing social situations, and increasing awareness of healthier alternatives to widely available unhealthy foods. PMID:17684168

When practice transformation impedes practice improvement.

PubMed

Bujold, Edward

2015-01-01

I lead a small practice in rural western North Carolina. We have embraced the patient-centered medical home model and other practice-improvement initiatives, and I have seen our practice transformed in many positive ways. But in the past year alone, my staff and I have spent hundreds of hours studying for and taking exams, certifying for numerous programs, and updating our electronic health records system (EHR) to meet new national requirements and then relearning our EHR. Seeing patients used to be the hardest part of my job. It is now the easiest by far. I am considering walking away from the time-intensive PCMH certification even though it would cause financial hardship. We have more important business at hand-taking excellent care of patients, improving our practice, and meaningfully engaging with our patients. © 2015 Annals of Family Medicine, Inc.

Situational Analysis of Physical Therapist Clinical Instructors' Facilitation of Students' Emerging Embodiment of Movement in Practice.

PubMed

Covington, Kyle; Barcinas, Susan J

2017-06-01

Physical therapists improve the functional ability of patients after injury and disease. A unique component of their practice is the ability to use the movement of their own bodies to effect change in their patients. This ability has been recognized as a distinctive attribute of expert physical therapists. The purpose of this qualitative situational analysis study was to examine how physical therapist clinical instructors perceive and facilitate their students' emerging integration of movement in practice. Data collection and analysis were guided by a theoretical framework for understanding "professional ways of being." Data were analyzed using coding and mapping strategies consistent with situational analysis techniques. The study included 5 physical therapist clinical instructors and their respective 5 physical therapist students. Data were collected during beginning, midterm, and final weeks of the students' clinical internships using participant interviews, observation, and document analysis. Coded data were summarized using situational analysis mapping strategies, resulting in 11 maps. These maps were further analyzed and reduced to 5 thematic behaviors enacted by a clinical instructor as he or she helps facilitate students' use of movement in practice. These behaviors are adapt, prepare, enhance, connect , and develop . The limited number of participants and the relative homogeneity of the student sample may have limited the diversity of data collected. The 5 behaviors are useful when considered as a trajectory of development. To our knowledge, this study marks the first description of how physical therapist clinical instructors develop students' use of movement in practice and how to enact behaviors important in students' continued professional development. The findings are important for clinical instructors and academic programs considering how best to prepare students to use movement and develop their skills early in practice. © 2017 American Physical

Definitions and competencies for practice-based learning and improvement.

PubMed

Hayden, Stephen R; Dufel, Susan; Shih, Richard

2002-11-01

The Outcome Project is a long-term initiative by which the Accreditation Council for Graduate Medical Education (ACGME) is increasing emphasis on educational outcomes in the evaluation of residency programs. The ACGME initiated the Outcome Project to "ensure and improve the quality of graduate medical education." In order to assist program directors in emergency medicine (EM) to begin complying with components of the ACGME Outcome Project, the Council of Residency Directors in Emergency Medicine (CORD-EM) convened a consensus conference in March 2002 in conjunction with several other EM organizations. The working group for the competency of Practice-based Learning and Improvement (PBL) defined the components of PBL as: 1) analyze and assess practice experience and perform practice-based improvement; 2) locate, appraise, and utilize scientific evidence related to the patient's health problems and the larger population from which they are drawn; 3) apply knowledge of study design and statistical methods to critically appraise the medical literature; 4) utilize information technology to enhance personal education and improve patient care; and 5) facilitate the learning of students, colleagues, and other health care professionals in EM principles and practice. Establishing resident portfolios is a preferred method to chronicle resident competence in PBL. Traditional global evaluation of resident performance is de-emphasized. Checklist evaluation is appropriate for assessing any competency that can be broken down into specific behaviors or actions. 360-degree evaluation may be used to assess teamwork, communication skills, management skills, and clinical decision making. Chart-stimulated recall and record review are additional evaluation methods that can be used to assess resident competency in PBL. Simulations and models, such as computer-based scenarios, may be ideal for low-frequency but critical procedures.

Assessing Option Grid® practicability and feasibility for facilitating shared decision making: An exploratory study.

PubMed

Tsulukidze, Maka; Grande, Stuart W; Gionfriddo, Michael R

2015-07-01

To assess the feasibility of Option Grids(®)for facilitating shared decision making (SDM) in simulated clinical consultations and explore clinicians' views on their practicability. We used mixed methods approach to analyze clinical consultations using the Observer OPTION instrument and thematic analysis for follow-up interviews with clinicians. Clinicians achieved high scores on information sharing and low scores on preference elicitation and integration. Four themes were identified: (1) Barriers affect practicability of Option Grids(®); (2) Option Grids(®) facilitate the SDM process; (3) Clinicians are aware of the gaps in their practice of SDM; (4) Training and ongoing feedback on the optimal use of Option Grids(®) are necessary. Use of Option Grids(®) by clinicians with background knowledge in SDM did not facilitate optimal levels of competency on the SDM core concepts of preference elicitation and integration. Future research must evaluate the impact of training on the use of Option Grids(®), and explore how best to help clinicians bridge the gap between knowledge and action. Clinicians proficiently imparting information in simulations struggled to elicit and integrate patient preferences - understanding this gap and developing strategies to close it are the next steps for implementing SDM into clinical practice. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Work System Assessment to Facilitate the Dissemination of a Quality Improvement Program for Optimizing Blood Culture Use: A Case Study Using a Human Factors Engineering Approach.

PubMed

Xie, Anping; Woods-Hill, Charlotte Z; King, Anne F; Enos-Graves, Heather; Ascenzi, Judy; Gurses, Ayse P; Klaus, Sybil A; Fackler, James C; Milstone, Aaron M

2017-11-20

Work system assessments can facilitate successful implementation of quality improvement programs. Using a human factors engineering approach, we conducted a work system assessment to facilitate the dissemination of a quality improvement program for optimizing blood culture use in pediatric intensive care units at 2 hospitals. Semistructured face-to-face interviews were conducted with clinicians from Johns Hopkins All Children's Hospital and University of Virginia Medical Center. Interview data were analyzed using qualitative content analysis. Blood culture-ordering practices are influenced by various work system factors, including people, tasks, tools and technologies, the physical environment, organizational conditions, and the external environment. A clinical decision-support tool could facilitate implementation by (1) standardizing blood culture-ordering practices, (2) ensuring that prescribing clinicians review the patient's condition before ordering a blood culture, (3) facilitating critical thinking, and (4) empowering nurses to communicate with physicians and advocate for adherence to blood culture-ordering guidelines. The success of interventions for optimizing blood culture use relies heavily on the local context. A work system analysis using a human factors engineering approach can identify key areas to be addressed for the successful dissemination of quality improvement interventions. © The Author 2017. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Turning Knowledge Into Action at the Point-of-Care: The Collective Experience of Nurses Facilitating the Implementation of Evidence-Based Practice

PubMed Central

Dogherty, Elizabeth J; Harrison, Margaret B; Graham, Ian D; Vandyk, Amanda Digel; Keeping-Burke, Lisa

2013-01-01

Background: Facilitation is considered a way of enabling clinicians to implement evidence into practice by problem solving and providing support. Practice development is a well-established movement in the United Kingdom that incorporates the use of facilitators, but in Canada, the role is more obtuse. Few investigations have observed the process of facilitation as described by individuals experienced in guideline implementation in North America. AimTo describe the tacit knowledge regarding facilitation embedded in the experiences of nurses implementing evidence into practice. Methods: Twenty nurses from across Canada were purposively selected to attend an interactive knowledge translation symposium to examine what has worked and what has not in implementing evidence in practice. This study is an additional in-depth analysis of data collected at the symposium that focuses on facilitation as an intervention to enhance evidence uptake. Critical incident technique was used to elicit examples to examine the nurses’ facilitation experiences. Participants shared their experiences with one another and completed initial data analysis and coding collaboratively. The data were further thematically analyzed using the qualitative inductive approach of constant comparison. Results: A number of factors emerged at various levels associated with the successes and failures of participants’ efforts to facilitate evidence-based practice. Successful implementation related to: (a) focus on a priority issue, (b) relevant evidence, (c) development of strategic partnerships, (d) the use of multiple strategies to effect change, and (e) facilitator characteristics and approach. Negative factors influencing the process were: (a) poor engagement or ownership, (b) resource deficits, (c) conflict, (d) contextual issues, and (e) lack of evaluation and sustainability. Conclusions: Factors at the individual, environmental, organizational, and cultural level influence facilitation of evidence

Improvement in visual search with practice: mapping learning-related changes in neurocognitive stages of processing.

PubMed

Clark, Kait; Appelbaum, L Gregory; van den Berg, Berry; Mitroff, Stephen R; Woldorff, Marty G

2015-04-01

Practice can improve performance on visual search tasks; the neural mechanisms underlying such improvements, however, are not clear. Response time typically shortens with practice, but which components of the stimulus-response processing chain facilitate this behavioral change? Improved search performance could result from enhancements in various cognitive processing stages, including (1) sensory processing, (2) attentional allocation, (3) target discrimination, (4) motor-response preparation, and/or (5) response execution. We measured event-related potentials (ERPs) as human participants completed a five-day visual-search protocol in which they reported the orientation of a color popout target within an array of ellipses. We assessed changes in behavioral performance and in ERP components associated with various stages of processing. After practice, response time decreased in all participants (while accuracy remained consistent), and electrophysiological measures revealed modulation of several ERP components. First, amplitudes of the early sensory-evoked N1 component at 150 ms increased bilaterally, indicating enhanced visual sensory processing of the array. Second, the negative-polarity posterior-contralateral component (N2pc, 170-250 ms) was earlier and larger, demonstrating enhanced attentional orienting. Third, the amplitude of the sustained posterior contralateral negativity component (SPCN, 300-400 ms) decreased, indicating facilitated target discrimination. Finally, faster motor-response preparation and execution were observed after practice, as indicated by latency changes in both the stimulus-locked and response-locked lateralized readiness potentials (LRPs). These electrophysiological results delineate the functional plasticity in key mechanisms underlying visual search with high temporal resolution and illustrate how practice influences various cognitive and neural processing stages leading to enhanced behavioral performance. Copyright © 2015 the

Improved Temperature Dynamic Model of Turbine Subcomponents for Facilitation of Generalized Tip Clearance Control

NASA Technical Reports Server (NTRS)

Kypuros, Javier A.; Colson, Rodrigo; Munoz, Afredo

2004-01-01

This paper describes efforts conducted to improve dynamic temperature estimations of a turbine tip clearance system to facilitate design of a generalized tip clearance controller. This work builds upon research previously conducted and presented in and focuses primarily on improving dynamic temperature estimations of the primary components affecting tip clearance (i.e. the rotor, blades, and casing/shroud). The temperature profiles estimated by the previous model iteration, specifically for the rotor and blades, were found to be inaccurate and, more importantly, insufficient to facilitate controller design. Some assumptions made to facilitate the previous results were not valid, and thus improvements are presented here to better match the physical reality. As will be shown, the improved temperature sub- models, match a commercially validated model and are sufficiently simplified to aid in controller design.

Sharing Research Models: Using Software Engineering Practices for Facilitation

PubMed Central

Bryant, Stephanie P.; Solano, Eric; Cantor, Susanna; Cooley, Philip C.; Wagener, Diane K.

2011-01-01

Increasingly, researchers are turning to computational models to understand the interplay of important variables on systems’ behaviors. Although researchers may develop models that meet the needs of their investigation, application limitations—such as nonintuitive user interface features and data input specifications—may limit the sharing of these tools with other research groups. By removing these barriers, other research groups that perform related work can leverage these work products to expedite their own investigations. The use of software engineering practices can enable managed application production and shared research artifacts among multiple research groups by promoting consistent models, reducing redundant effort, encouraging rigorous peer review, and facilitating research collaborations that are supported by a common toolset. This report discusses three established software engineering practices— the iterative software development process, object-oriented methodology, and Unified Modeling Language—and the applicability of these practices to computational model development. Our efforts to modify the MIDAS TranStat application to make it more user-friendly are presented as an example of how computational models that are based on research and developed using software engineering practices can benefit a broader audience of researchers. PMID:21687780

Exploring the barriers to and facilitators of implementing research into practice.

PubMed

Johnston, Bridget; Coole, Carol; Narayanasamy, Melanie; Feakes, Ruth; Whitworth, Gillian; Tyrell, Tracy; Hardy, Beth

2016-08-02

District and community nursing roles have changed rapidly in recent years. Community nurses are increasingly being tasked with carrying out multiple roles, which require them to put research into practice and use evidence-based tools and interventions. The implementation of interventions and tools needs to be developed from empirical research, requiring evidence, to be translated into practice. However, this process may be compromised or enhanced by a number of factors. This exploratory, descriptive qualitative study sought to identify barriers and facilitators to community nurses implementing research into practice. Four focus groups were conducted with registered community nurses and district nurses (n=22). Analysis identified four main themes: keeping up to date with evidence; using a clinical tool; education/training and implementation. Findings suggest that there are barriers at a personal, professional and organisational level. Strategies are suggested to overcome these obstacles.

Play@home in practice: health visitors' views of perceived facilitators and barriers to programme implementation.

PubMed

Miller, Irene; Barton, Gil

2013-07-01

Health visitors in Scotland gift 'play@home', a book-based early intervention programme, to parents as part of the universal health visiting service. The provision of health improvement information to parents is recognised as a core function of health visiting and yet evidence shows that not every family receives the play@home resources. This paper discusses the perceived facilitators and barriers to implementing this programme through exploring the views of ten health visitors and four health visiting managers in two health board areas in Scotland. The findings conclude that increasingly vulnerable families, supported by fewer qualified health visitors, present challenges to the health visiting service. The play@home programme is valued by health visitors as a flexible tool with which to engage with families. Collaborative working with other services enhances provision and play@home does become embedded in practice over time. Strategic policy links to raise the profile of play@home are improving.

Understanding facilitators and barriers to reengineering the clinical research enterprise in community-based practice settings.

PubMed

Kukafka, Rita; Allegrante, John P; Khan, Sharib; Bigger, J Thomas; Johnson, Stephen B

2013-09-01

Solutions are employed to support clinical research trial tasks in community-based practice settings. Using the IT Implementation Framework (ITIF), an integrative framework intended to guide the synthesis of theoretical perspectives for planning multi-level interventions to enhance IT use, we sought to understand the barriers and facilitators to clinical research in community-based practice settings preliminary to implementing new informatics solutions for improving clinical research infrastructure. The studies were conducted in practices within the Columbia University Clinical Trials Network. A mixed-method approach, including surveys, interviews, time-motion studies, and observations was used. The data collected, which incorporates predisposing, enabling, and reinforcing factors in IT use, were analyzed according to each phase of ITIF. Themes identified in the first phase of ITIF were 1) processes and tools to support clinical trial research and 2) clinical research peripheral to patient care processes. Not all of the problems under these themes were found to be amenable to IT solutions. Using the multi-level orientation of the ITIF, we set forth strategies beyond IT solutions that can have an impact on reengineering clinical research tasks in practice-based settings. Developing strategies to target enabling and reinforcing factors, which focus on organizational factors, and the motivation of the practice at large to use IT solutions to integrate clinical research tasks with patient care processes, is most challenging. The ITIF should be used to consider both IT and non-IT solutions concurrently for reengineering of clinical research in community-based practice settings. © 2013.

Practice-based learning and improvement: a dream that can become a reality.

PubMed

Manning, Phil R

2003-01-01

Systematically enhancing learning from experience (practice-based learning) dominates the teachings of Sir William Osler and adult learning theorists such as Eduard Lindeman, Malcolm Knowles, and Cyril Houle. Because of time constraints, most physicians have not implemented methods that systematically facilitate learning from day-to-day work, but improvements in information technology offer the promise of making systematic practice-based learning practical. At least four ingredients need to be incorporated to significantly enhance learning from experience: a database that makes it possible to study individual practices; methods for supplying short, quick answers to questions while seeing patients; a reminder system to avoid errors of omission; and the opportunity to discuss practice data with colleagues. Great progress has been made, but significant barriers still must be overcome before a majority of physicians will participate. In particular, methods of data collection must be simplified, the delivery of point-of-care information and reminders must become more automatic, and physicians must develop skills to make the discussion of practice data acceptable, stimulating, and not unduly punitive.

Implementing simulated learning modules to improve students’ pharmacy practice skills and professionalism

PubMed Central

Fejzic, Jasmina; Barker, Michelle

2015-01-01

Background: Effective communication enables healthcare professionals and students to practise their disciplines in a professional and competent manner. Simulated-based education (SBE) has been increasingly used to improve students’ communication and practice skills in Health Education. Objective: Simulated learning modules (SLMs) were developed using practice-based scenarios grounded in effective communication competencies. The effect of the SLMs on Pharmacy students’ (i) Practice skills and (ii) Professionalism were evaluated. Methods: SLMs integrating EXCELL competencies were applied in the classroom to study their effect on a number of learning outcomes. EXcellence in Cultural Experiential Learning and Leadership (EXCELL) Program is a schematic, evidence-based professional development resource centred around developing participants’ self-efficacy and generic communication competencies. Students (N=95) completed three hours of preliminary lectures and eight hours of SLM workshops including six scenarios focused on Pharmacy Practice and Experiential Placements. Each SLM included briefing, role-plays with actors, facilitation, and debriefing on EXCELL social interaction maps (SIMs). Evaluations comprised quantitative and qualitative survey responsed by students before and post-workshops, and post-placements, and teachers’ reflections. Surveys examine specific learning outcomes by using pharmacy professionalism and pharmacy practice effectiveness scales. Responses were measured prior to the commencement of SLMs, after completion of the two workshops and after students completed their block placement. Self-report measures enabled students to self-assess whether any improvements occurred. Results: Student responses were overwhelmingly positive and indicated significant improvements in their Pharmacy practice and professionalism skills, and commitment to professional ethics. Qualitative feedback strongly supported students’ improved communication skills and

Facilitating and obstructing factors for development of learning in clinical practice: a student perspective.

PubMed

Löfmark, A; Wikblad, K

2001-04-01

The aim of this study was to provide information on what the student nurses found facilitating and obstructing for their learning during clinical practice. Earlier studies of experiences of learning in clinical practice have shown that factors as the possibilities of variations of experiences, the culture of the workplace, and communication between the educational institution and health care facilities are of importance. Less is known about the opportunities which students are given in order to practise the skills that they will be expected to perform as new graduate nurses. The experiences of 47 degree student nurses from two colleges in Sweden were gathered in weekly diaries during their final period of clinical practice. A content analysis technique was used to analyse their diaries. The students emphasized responsibility and independence, opportunities to practise different tasks, and receiving feedback as facilitating factors. Other perceived promoting factors included perceptions of control of the situation and understanding of the 'total picture'. Examples of obstructing factors were the nurses as supervisors not relying on the students, supervision that lacked continuity and lack of opportunities to practise. Perception of their own insufficiency and low self-reliance were drawbacks for some students. Recommended proposals are presented to lecturers and supervising staff concerning organizational and educational changes, and changes of attitudes for elucidating the students' experiences of different facilitating and obstructing factors. Changes may contribute to making easier the students' transition into the nursing profession.

How can clinical practice guidelines be adapted to facilitate shared decision making? A qualitative key-informant study.

PubMed

van der Weijden, Trudy; Pieterse, Arwen H; Koelewijn-van Loon, Marije S; Knaapen, Loes; Légaré, France; Boivin, Antoine; Burgers, Jako S; Stiggelbout, Anne M; Faber, Marjan; Elwyn, Glyn

2013-10-01

To explore how clinical practice guidelines can be adapted to facilitate shared decision making. This was a qualitative key-informant study with group discussions and semi-structured interviews. First, 75 experts in guideline development or shared decision making participated in group discussions at two international conferences. Next, health professionals known as experts in depression or breast cancer, experts on clinical practice guidelines and/or shared decision making, and patient representatives were interviewed (N=20). Using illustrative treatment decisions on depression or breast cancer, we asked the interviewees to indicate as specifically as they could how guidelines could be used to facilitate shared decision making. Interviewees suggested some generic strategies, namely to include a separate chapter on the importance of shared decision making, to use language that encourages patient involvement, and to develop patient versions of guidelines. Recommendation-specific strategies, related to specific decision points in the guideline, were also suggested: These include structuring the presentation of healthcare options to increase professionals' option awareness; structuring the deliberation process between professionals and patients; and providing relevant patient support tools embedded at important decision points in the guideline. This study resulted in an overview of strategies to adapt clinical practice guidelines to facilitate shared decision making. Some strategies seemed more contentious than others. Future research should assess the feasibility and impact of these strategies to make clinical practice guidelines more conducive to facilitate shared decision making.

Developing facilitation skills--a narrative.

PubMed

Newton, Jennifer M

2003-07-01

Effective facilitation has been identified in the literature as one of three elements, along with context and evidence, that have a dynamic and coexisting relationship to enable the successful uptake of evidence into practice. This paper presents an overview of the concept of facilitation within the context of practice development, ahead of a personal and professional reflective account of a 'developing facilitator'. In the summer of 2001, the author was instrumental in organising the first Practice Development School in Melbourne. Thrown in at the deep end, she found herself co-facilitating with an experienced practice developer from the United Kingdom. Having never facilitated in the arena of an action learning group, nor worked in the field of practice development, there was initially a sense of impending overload and drowning in the new knowledge and skills that needed to be acquired. Drawing upon the work of narrative inquiry the author shares her experiences in the anticipation that in telling her story it will assist others in their journey of becoming a facilitator.

Launching a Laboratory Testing Process Quality Improvement Toolkit: From the Shared Networks of Colorado Ambulatory Practices and Partners (SNOCAP).

PubMed

Fernald, Douglas; Hamer, Mika; James, Kathy; Tutt, Brandon; West, David

2015-01-01

Family medicine and internal medicine physicians order diagnostic laboratory tests for nearly one-third of patient encounters in an average week, yet among medical errors in primary care, an estimated 15% to 54% are attributed to laboratory testing processes. From a practice improvement perspective, we (1) describe the need for laboratory testing process quality improvements from the perspective of primary care practices, and (2) describe the approaches and resources needed to implement laboratory testing process quality improvements in practice. We applied practice observations, process mapping, and interviews with primary care practices in the Shared Networks of Colorado Ambulatory Practices and Partners (SNOCAP)-affiliated practice-based research networks that field-tested in 2013 a laboratory testing process improvement toolkit. From the data collected in each of the 22 participating practices, common testing quality issues included, but were not limited to, 3 main testing process steps: laboratory test preparation, test tracking, and patient notification. Three overarching qualitative themes emerged: practices readily acknowledge multiple laboratory testing process problems; practices know that they need help addressing the issues; and practices face challenges with finding patient-centered solutions compatible with practice priorities and available resources. While practices were able to get started with guidance and a toolkit to improve laboratory testing processes, most did not seem able to achieve their quality improvement aims unassisted. Providing specific guidance tools with practice facilitation or other rapid-cycle quality improvement support may be an effective approach to improve common laboratory testing issues in primary care. © Copyright 2015 by the American Board of Family Medicine.

Meeting physicians' needs: a bottom-up approach for improving the implementation of medical knowledge into practice.

PubMed

Vaucher, Carla; Bovet, Emilie; Bengough, Theresa; Pidoux, Vincent; Grossen, Michèle; Panese, Francesco; Burnand, Bernard

2016-07-18

Multiple barriers to knowledge translation in medicine have been identified (ranging from information overload to abstraction of models), leading to important implementation gaps. This study aimed at assessing the suggestions of practicing physicians for possible improvements of knowledge translation (KT) effectiveness into clinical practice. We used a mixed methods design. French- German- and Italian-speaking general practitioners, psychiatrists, orthopaedic surgeons, cardiologists, and diabetologists practicing in Switzerland were interrogated through semi-structured interviews, focus group discussions, and an online survey. A total of 985 physicians from three regions of Switzerland participated in the online survey, whereas 39 participated in focus group discussions and 14 in face-to-face interviews. Physicians expressed limitations and difficulties related to KT into their daily practice. Several barriers were identified, including influence and pressure of pharmaceutical companies, non-publication of negative results, mismatch between guidelines and practice, education gaps, and insufficient collaboration between research and practice. Suggestions to overcome barriers were improving education concerning the evaluation of scientific publications, expanding applicability of guidelines, having free and easy access to independent journals, developing collaborations between research and practice, and creating tools to facilitate access to medical information. Our study provides suggestions for improving KT into daily medical practice, matching the views, needs and preferences of practicing physicians. Responding to suggestions for improvements brought up by physicians may lead to better knowledge translation, higher professional satisfaction, and better healthcare outcomes.

Key facilitators and best practices of hotel-style room service in hospitals.

PubMed

Sheehan-Smith, Lisa

2006-04-01

This qualitative study sought to identify the features, advantages, and disadvantages of hotel-style room service; the barriers to, and facilitators for, implementing the process; and "best practices." The study took place in four heterogeneous hospitals. Participants included hospital administrators, managers, and room-service employees. Data-collection methods included semi-structured interviews, observations, and document analysis. Common features of hotel-style room service were meal delivery within 30 to 45 minutes, a restaurant-style menu, procedures to feed ineligible patients, tray assembly on demand, scripting, and waitstaff uniforms for room-service employees. The major barrier to implementing room service was obtaining nursing support. The key facilitators were the hospital's service-oriented culture, using a multidisciplinary planning team, engaging nursing departments early in the planning stages, and intense customer-service training of room-service employees. The overwhelming advantage was patients' control over their food choices. The main disadvantage was cost. Initial best practices in hotel-style room service include: (a) taking a multidisciplinary team approach for developing and implementing the process, (b) customer-service training, (c) using a customer-driven menu, (d) wearing waitstaff uniforms, and (e) using carts with airpots for dispensing hot beverages.

Improving the organization of palliative care: identification of barriers and facilitators in five European countries.

PubMed

van Riet Paap, Jasper; Vernooij-Dassen, Myrra; Brouwer, Frederike; Meiland, Franka; Iliffe, Steve; Davies, Nathan; Leppert, Wojciech; Jaspers, Birgit; Mariani, Elena; Sommerbakk, Ragni; Vissers, Kris; Engels, Yvonne

2014-10-16

Interventions to improve palliative care encounter challenges beyond the usual implementation problems because of palliative care's complex and changing character. In this study, we explored barriers and facilitators faced by health-care professionals in five European countries (England, Germany, Italy, Norway and the Netherlands) with regard to improving the organization of their palliative care service. Semi-structured individual and focus group interviews were conducted with purposefully selected health-care professionals. The constant comparative method was used to analyse the data. Professionals working in hospitals, hospices, nursing homes and primary care facilities who provide palliative care to adult patients were interviewed (n =40) or participated in ten focus group interviews (n =59). Barriers and facilitators were inductively grouped into 16 categories and arranged into five themes: innovation, individual professional level, group dynamics, organizational context and local political-economic context. Although the barriers and facilitators identified differed in scope, context, strength and provenance, they were shared by professionals from different European countries. This study identified barriers and facilitators to organizational change in palliative care. Some of these barriers and facilitators were experienced by professionals in almost all countries and are therefore prerequisites to change. Understanding the barriers to and facilitators of change will help tailor organizational improvements to the needs of individuals and organizations.

Facilitation of an end-of-life care programme into practice within UK nursing care homes: A mixed-methods study.

PubMed

Kinley, Julie; Preston, Nancy; Froggatt, Katherine

2018-06-01

The predicted demographic changes internationally have implications for the nature of care that older people receive and place of care as they age. Healthcare policy now promotes the implementation of end-of-life care interventions to improve care delivery within different settings. The Gold Standards Framework in Care Homes (GSFCH) programme is one end-of-life care initiative recommended by the English Department of Health. Only a small number of care homes that start the programme complete it, which raises questions about the implementation process. To identify the type, role, impact and cost of facilitation when implementing the GSFCH programme into nursing care home practice. A mixed-methods study. Nursing care homes in south-east England. Staff from 38 nursing care homes undertaking the GSFCH programme. Staff in 24 nursing care homes received high facilitation. Of those, 12 also received action learning. The remaining 14 nursing care homes received usual local facilitation of the GSFCH programme. Study data were collected from staff employed within nursing care homes (home managers and GSFCH coordinators) and external facilitators associated with the homes. Data collection included interviews, surveys and facilitator activity logs. Following separate quantitative (descriptive statistics) and qualitative (template) data analysis the data sets were integrated by 'following a thread'. This paper reports study data in relation to facilitation. Three facilitation approaches were provided to nursing home staff when implementing the GSFCH programme: 'fitting it in' facilitation; 'as requested' facilitation; and 'being present' facilitation. 'Being present' facilitation most effectively enabled the completion of the programme, through to accreditation. However, it was not sufficient to just be present. Without mastery and commitment, from all participants, including the external facilitator, learning and initiation of change failed to occur. Implementation of the

Using Reflective Practice to Facilitate Conversations and Transform Instructional Practice for Middle School Science Teachers

NASA Astrophysics Data System (ADS)

Higdon, Robbie L.

The process of teaching, especially inquiry, is complex and requires extended time for developing one's instructional practice (Loucks-Horsley, Stiles, Mundry, Love, & Hewson, 2010). The implementation of a continued cycle of self-reflection can engage teachers in analyzing their prior experiences and understandings about their instructional practice to promote the accommodation of new concepts and transform their practice. However, many teachers have difficulty engaging in the cognitive dissonance needed to identify those problems and promote their own growth without support. As one's professional practice becomes more repetitive and routine, it is difficult for the practitioner to recognize opportunities in which to contemplate one's habitual actions (Schon, 1983). In this multi-case study, two middle school science teachers who were engaged within a sustained professional development initiative participated in a series of one-on-one reflective dialogues regarding the decisions they made about the utilization of inquiry-based instruction. In addition, these teachers were asked to reflect upon the criteria used to determine how and when to implement these inquiry-based practices. These reflective dialogue sessions provided the opportunity to observe teacher conceptions and stimulate teacher cognitive dissonance about instructional practice. Qualitative analysis of data collected from these reflective dialogues along with informal and formal classroom observations of instructional practice uncovered diverse perceptions regarding the implementation of inquiry-based methods into present teaching practice. The use of reflective dialogue within the existing structure of the professional development initiative allowed for the facilitators of the professional development initiative to tailor ongoing support and their effective implementation of inquiry-based instruction. Additional research is needed to investigate the impact of reflective dialogue in achieving

Barriers, facilitators and attitudes influencing health promotion activities in general practice: an explorative pilot study

PubMed Central

2013-01-01

Background The number of chronically ill patients increases every year. This is partly due to an unhealthy lifestyle. However, the frequency and quality of (evidence-based) health promotion activities conducted by Dutch general practitioners (GPs) and practice nurses (PNs) are limited. The aim of this pilot study was to explore which lifestyle interventions Dutch GPs and PNs carry out in primary care, which barriers and facilitators can be identified and what main topics are with respect to attitudes towards health promoting activities. These topic areas will be identified for a future, larger scale study. Method This qualitative study consisted of 25 semi-structured interviews with sixteen GPs and nine PNs. ATLAS.ti was used to analyse the transcripts of the interviews. Results All GPs and PNs said they discuss lifestyle with their patients. Next to this, GPs and PNs counsel patients, and/or refer them to other disciplines. Only few said they refer patients to specific lifestyle programs or interventions in their own practice or in the neighbourhood. Several barriers and facilitators were identified. The main topics as barriers are: a lack of patients’ motivation to make lifestyle changes, insufficient reimbursement, a lack of proven effectiveness of interventions and a lack of overview of health promoting programs in their neighbourhood. The most cited facilitators are availability of a PN, collaboration with other disciplines and availability of interventions in their own practice. With respect to attitudes, six different types of GPs were identified reflecting the main topics that relate to attitudes, varying from ‘ignorer’ to ‘nurturer’. The topics relating to PNs attitudes towards health promotion activities, were almost unanimously positive. Conclusion GPs and PNs all say they discuss lifestyle issues with their patients, but the health promotion activities that are organized in their practice vary. Main topics that hinder or facilitate

Barriers to and Facilitators of Adherence to Exclusive Breastfeeding Practices Among HIV Infected and Non-Infected Women in Jos, Nigeria.

PubMed

Coetzee, Bronwynè; Tomlinson, Mark; Osawe, Sophia; Abimiku, Alash'le; Kagee, Ashraf

2017-04-01

Objectives In Nigeria adherence to exclusive breastfeeding (EBF) practices is currently suboptimal and a better understanding of the factors affecting adherence to EBF is needed. We sought to identify and delineate the barriers to and facilitators of adherence to EBF amongst HIV-infected and uninfected women in Nigeria. Methods We explored the barriers and facilitators to EBF amongst 37 (25 HIV-infected and 12 HIV-uninfected) pregnant women attending an antenatal clinic in Jos, Nigeria. In-depth interviews were conducted with each of the pregnant women in their third trimester of pregnancy and again 1 month after giving birth. Results The themes that emerged were mothers' feeding intentions, significant role players in the decision to breastfeed, perceived barriers (e.g. physiological issues, stigma, employment) and perceived facilitators (e.g. pleasure and enjoyment derived from breastfeeding, natural milk from God, disclosure and family support) associated with EBF. Conclusions Most women preferred EBF and offered it to their infants. However, more efforts are needed to improve support structures at home and at work to accommodate women who choose to do EBF.

Practical Approaches to Quality Improvement for Radiologists.

PubMed

Kelly, Aine Marie; Cronin, Paul

2015-10-01

Continuous quality improvement is a fundamental attribute of high-performing health care systems. Quality improvement is an essential component of health care, with the current emphasis on adding value. It is also a regulatory requirement, with reimbursements increasingly being linked to practice performance metrics. Practice quality improvement efforts must be demonstrated for credentialing purposes and for certification of radiologists in practice. Continuous quality improvement must occur for radiologists to remain competitive in an increasingly diverse health care market. This review provides an introduction to the main approaches available to undertake practice quality improvement, which will be useful for busy radiologists. Quality improvement plays multiple roles in radiology services, including ensuring and improving patient safety, providing a framework for implementing and improving processes to increase efficiency and reduce waste, analyzing and depicting performance data, monitoring performance and implementing change, enabling personnel assessment and development through continued education, and optimizing customer service and patient outcomes. The quality improvement approaches and underlying principles overlap, which is not surprising given that they all align with good patient care. The application of these principles to radiology practices not only benefits patients but also enhances practice performance through promotion of teamwork and achievement of goals. © RSNA, 2015.

It Pays to Be Organized: Organizing Arithmetic Practice around Equivalent Values Facilitates Understanding of Math Equivalence

ERIC Educational Resources Information Center

McNeil, Nicole M.; Chesney, Dana L.; Matthews, Percival G.; Fyfe, Emily R.; Petersen, Lori A.; Dunwiddie, April E.; Wheeler, Mary C.

2012-01-01

This experiment tested the hypothesis that organizing arithmetic fact practice by equivalent values facilitates children's understanding of math equivalence. Children (M age = 8 years 6 months, N = 104) were randomly assigned to 1 of 3 practice conditions: (a) equivalent values, in which problems were grouped by equivalent sums (e.g., 3 + 4 = 7, 2…

The public health nutrition intervention management bi-cycle: a model for training and practice improvement.

PubMed

Hughes, Roger; Margetts, Barrie

2012-11-01

The present paper describes a model for public health nutrition practice designed to facilitate practice improvement and provide a step-wise approach to assist with workforce development. The bi-cycle model for public health nutrition practice has been developed based on existing cyclical models for intervention management but modified to integrate discrete capacity-building practices. Education and practice settings. This model will have applications for educators and practitioners. Modifications to existing models have been informed by the authors' observations and experiences as practitioners and educators, and reflect a conceptual framework with applications in workforce development and practice improvement. From a workforce development and educational perspective, the model is designed to reflect adult learning principles, exposing students to experiential, problem-solving and practical learning experiences that reflect the realities of work as a public health nutritionist. In doing so, it assists the development of competency beyond knowing to knowing how, showing how and doing. This progression of learning from knowledge to performance is critical to effective competency development for effective practice. Public health nutrition practice is dynamic and varied, and models need to be adaptable and applicable to practice context to have utility. The paper serves to stimulate debate in the public health nutrition community, to encourage critical feedback about the validity, applicability and utility of this model in different practice contexts.

Participatory design facilitates Person Centred Nursing in service improvement with older people: a secondary directed content analysis.

PubMed

Wolstenholme, Daniel; Ross, Helen; Cobb, Mark; Bowen, Simon

2017-05-01

To explore, using the example of a project working with older people in an outpatient setting in a large UK NHS Teaching hospital, how the constructs of Person Centred Nursing are reflected in interviews from participants in a Co-design led service improvement project. Person Centred Care and Person Centred Nursing are recognised terms in healthcare. Co-design (sometimes called participatory design) is an approach that seeks to involve all stakeholders in a creative process to deliver the best result, be this a product, technology or in this case a service. Co-design practice shares some of the underpinning philosophy of Person Centred Nursing and potentially has methods to aid in Person Centred Nursing implementation. The research design was a qualitative secondary Directed analysis. Seven interview transcripts from nurses and older people who had participated in a Co-design led improvement project in a large teaching hospital were transcribed and analysed. Two researchers analysed the transcripts for codes derived from McCormack & McCance's Person Centred Nursing Framework. The four most expressed codes were as follows: from the pre-requisites: knowing self; from care processes, engagement, working with patient's beliefs and values and shared Decision-making; and from Expected outcomes, involvement in care. This study describes the Co-design theory and practice that the participants responded to in the interviews and look at how the co-design activity facilitated elements of the Person Centred Nursing framework. This study adds to the rich literature about using emancipatory and transformational approaches to Person Centred Nursing development, and is the first study exploring explicitly the potential contribution of Co-design to this area. Methods from Co-design allow older people to contribute as equals in a practice development project, co-design methods can facilitate nursing staff to engage meaningfully with older participants and develop a shared

Successful Transition to Elementary School and the Implementation of Facilitative Practices Specified in the Reggio-Emilia Philosophy

ERIC Educational Resources Information Center

Schneider, Barry H.; Manetti, Mara; Frattini, Laura; Rania, Nadia; Santo, Jonathan Bruce; Coplan, Robert J.; Cwinn, Eli

2014-01-01

Systematic, mandated facilitation of school transitions is an important but understudied aspect of the Reggio-Emilia approach to early childhood education admired internationally as best practice. We studied the links between Northern Italian transition practices and academic achievement, school liking, cooperativeness, and problem behaviors. We…

Strategic contracting practices to improve procurement of health commodities

PubMed Central

Arney, Leslie; Yadav, Prashant; Miller, Roger; Wilkerson, Taylor

2014-01-01

ABSTRACT Public-sector entities responsible for procurement of essential medicines and health commodities in developing countries often lack the technical capacity to efficiently ensure supply security. Under strict public scrutiny and pressures to be transparent, many agencies continue to use archaic procurement methods and to depend on inflexible forecasts and cumbersome tendering processes. On the basis of semi-structured literature reviews and interviews, we identified framework agreements as a strategic procurement practice used by the U.S. federal government that may also be suitable for global health supply chains. Framework agreements are long-term contracts that provide the terms and conditions under which smaller repeat purchasing orders may be issued for a defined period of time. Such agreements are common in U.S. and United Nations procurement systems and in other developed countries and multilateral organizations. In contrast, framework agreements appear to be seldom used in procurement of health commodities in countries of sub-Saharan Africa. The current practice of floating tenders multiple times a year contributes to long lead times and stock-outs, and it hampers the manufacturer's or supplier's ability to plan and respond to the government's needs. To date, government's use of strategic contracting practices in public procurement of health commodities has not received much attention in most developing countries. It may present an opportunity for substantial improvements in procurement efficiency and commodity availability. Enabling legislation and strengthened technical capacity to develop and manage long-term contracts could facilitate the use of framework contracts in sub-Saharan Africa, with improved supply security and cost savings likely to result. PMID:25276589

Strategic contracting practices to improve procurement of health commodities.

PubMed

Arney, Leslie; Yadav, Prashant; Miller, Roger; Wilkerson, Taylor

2014-08-01

Public-sector entities responsible for procurement of essential medicines and health commodities in developing countries often lack the technical capacity to efficiently ensure supply security. Under strict public scrutiny and pressures to be transparent, many agencies continue to use archaic procurement methods and to depend on inflexible forecasts and cumbersome tendering processes. On the basis of semi-structured literature reviews and interviews, we identified framework agreements as a strategic procurement practice used by the U.S. federal government that may also be suitable for global health supply chains. Framework agreements are long-term contracts that provide the terms and conditions under which smaller repeat purchasing orders may be issued for a defined period of time. Such agreements are common in U.S. and United Nations procurement systems and in other developed countries and multilateral organizations. In contrast, framework agreements appear to be seldom used in procurement of health commodities in countries of sub-Saharan Africa. The current practice of floating tenders multiple times a year contributes to long lead times and stock-outs, and it hampers the manufacturer's or supplier's ability to plan and respond to the government's needs. To date, government's use of strategic contracting practices in public procurement of health commodities has not received much attention in most developing countries. It may present an opportunity for substantial improvements in procurement efficiency and commodity availability. Enabling legislation and strengthened technical capacity to develop and manage long-term contracts could facilitate the use of framework contracts in sub-Saharan Africa, with improved supply security and cost savings likely to result.

Supporting Primary Care Practices in Building Capacity to Use Health Information Data

PubMed Central

Fernald, Douglas; Wearner, Robyn; Dickinson, W. Perry

2014-01-01

Introduction: Our objective was to describe essential support resources and strategies in order to advance the pace and scope of the use of health information technology (HIT) data. Background and Context: Primary data were collected between January 2011 and October 2012. The primary study population comprised 51 primary care practices enrolled in the Colorado Beacon Consortium in western Colorado. Methods: We used qualitative methods embedded in a mixed-method evaluation: monthly narrative reports from practices; interviews with providers and staff; and focused, group discussions with quality improvement (QI) advisors and staff from the Health Information Technology Regional Extension Center. Findings: Practices valued effective support strategies to assist with using HIT, including the following: translating rules and regulations into individual practice settings; facilitating peer-to-peer connections; providing processes and tools for practice improvement; maintaining accountability and momentum; and providing local electronic health record (EHR) technical expertise. Benefits of support included improved quality measures, operational improvements, increased provider and staff engagement, and deeper understanding of EHR data. Discussion: The findings affirm the utility of practice facilitation for HIT-focused aims with personalized attention and cross-fertilization among practices for improvements. Facilitation to sustain ongoing improvements and prepare for future HIT-intensive improvement activities was highly valued. In addition to the general practice facilitator, an EHR technical expert was critical to improving practice capacity to use electronic clinical data. Collaborative learning expands the pool of mentors and teachers, who can further translate their own lessons into practical advice for their peers, yielding the emergence of a stronger sense of community among the practices. Conclusions: Using HIT more effectively in primary care will require

Independent Coactors May Improve Performance and Lower Workload: Viewing Vigilance Under Social Facilitation.

PubMed

Claypoole, Victoria L; Szalma, James L

2018-04-01

The purpose of the present study was to examine the effects of an independent coactor on vigilance task performance. It was hypothesized that the presence of an independent coactor would improve performance in terms of the proportion of false alarms while also increasing perceived workload and stress. Vigilance, or the ability to maintain attention for extended periods, is of great interest to human factors psychologists. Substantial work has focused on improving vigilance task performance, typically through motivational interventions. Of interest to vigilance researchers is the application of social facilitation as a means of enhancing vigilance. Social facilitation seeks to explain how social presence may improve performance. A total of 100 participants completed a 24-min vigil either alone or in the presence of an independent (confederate) coactor. Participants completed measures of perceived workload and stress. The results indicated that performance (i.e., proportion of false alarms) was improved for those who completed the vigil in the presence of an independent coactor. Interestingly, perceived workload was actually lower for those who completed the vigil in the presence of an independent coactor, although perceived stress was not affected by the manipulation. Authors of future research should extend these findings to other forms of social facilitation and examine vigilance task performance in social contexts in order to determine the utility of social presence for improving vigilance. The use of coactors may be an avenue for organizations to consider utilizing to improve performance because of its relative cost-effectiveness and easy implementation.

Facilitation Skills: The Catalyst for Increased Effectiveness in Consultant Practice and Clinical Systems Leadership

ERIC Educational Resources Information Center

Manley, Kim; Titchen, Angie

2017-01-01

Consultant practitioner is the pinnacle of the clinical career ladder for all health care disciplines in the United Kingdom. Consultant nurse, midwife and health visitor roles build on the clinical credibility and expertise characteristic of advanced level practice, but also possess expertise in: clinical systems leadership and the facilitation of…

Best Practices to Promote Diversity and Facilitate Inclusion

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rosenthal, Mark A.; Snyder, Johann D.

The intent of this guide is to provide a set of “best practices” for leaders to promote diversity and facilitate inclusion within their organization and throughout Sandia National Laboratories. These “best practices” are derived from personal experiences and build upon existing resources at Sandia to help us effect change to realize an inclusive work environment. As leaders, we play a critical role in setting the vision and shaping the culture of the organization by communicating expectations and modeling inclusive behavior. The “best practices” in this guide are presented in the spirit of promoting a learning culture that values continuous improvementmore » in the ongoing effort to make diversity and inclusion an integral part of all that we do at Sandia. This guide seeks to articulate the importance of leading through example, taking positive actions, raising awareness of practices that provide an inclusive environment, and creating a space that welcomes diverse perspectives and input.« less

Impact of Company Size on Manufacturing Improvement Practices: An empirical study

NASA Astrophysics Data System (ADS)

Syan, C. S.; Ramoutar, K.

2014-07-01

There is a constant search for ways to achieve a competitive advantage through new manufacturing techniques. Best performing manufacturing companies tend to use world-class manufacturing (WCM) practices. Although the last few years have witnessed phenomenal growth in the use of WCM techniques, their effectiveness is not well understood specifically in the context of less developed countries. This paper presents an empirical study to investigate the impact of company size on improving manufacturing performance in manufacturing organizations based in Trinidad and Tobago (T&T). Empirical data were collected via a questionnaire survey which was send to 218 manufacturing firms in T&T. Five different company sizes and seven different industry sectors were studied. The analysis of survey data was performed with the aid of Statistical Package for Social Sciences (SPSS) software. The study signified facilitating and impeding factors towards improving manufacturing performance. Their relative impact/importance is dependent on varying company size and industry sectors. Findings indicate that T&T manufacturers are still practicing traditional approaches, when compared with world class manufacturers. In the majority of organizations, these practices were not 100% implemented even though they started the implementation process more than 5 years ago. The findings provided some insights in formulating more optimal operational strategies, and later develop action plans towards more effective implementation of WCM in T&T manufacturers.

Sustainability of depression care improvements: success of a practice change improvement collaborative.

PubMed

Nease, Donald E; Nutting, Paul A; Graham, Deborah G; Dickinson, W Perry; Gallagher, Kaia M; Jeffcott-Pera, Michelle

2010-01-01

Long-term sustainment of improvements in care continues to challenge primary care practices. During the 2 years after of our Improving Depression Care collaborative, we examined how well practices were sustaining their depression care improvements. Our study design used a qualitative interview follow-up of a modified learning collaborative intervention. We conducted telephone interviews with practice champions from 15 of the original 16 practices. Interviews were conducted during a 3-month period in 2008, and were recorded and professionally transcribed. Data on each of the depression care improvements and the change management strategy emphasized during the learning collaborative were summarized after review of the primary data and a consensus process to resolve differing interpretations. During the period from 15 months to 3 years since our project began, depression screening or case finding was sustained in 14 of 15 practices. Thirteen practices sustained use of the 9-item Patient Health Questionnaire for depression monitoring, and one additional practice initiated it. Seven practices initiated self-management support and 2 of 3 practices sustained it. In contrast, tracking and case management proved difficult to sustain, with only 4 of 8 practices continuing this activity. Diffusion of use of the 9-item Patient Health Questionnaire to other clinicians in the practice was maintained in all but 3 practices and expanded in one practice. Six of the practices continued to use the change management strategy, including all 4 of the practices that sustained tracking. Practices demonstrated long-term sustained improvement in depression care with the exception of tracking and care management, which may be a more challenging innovation to sustain. We hypothesize that sustaining complex depression care innovations may require active management by the practice.

Development of a Web-based resident profiling tool to support training in practice-based learning and improvement.

PubMed

Lyman, Jason A; Schorling, John; Nadkarni, Mohan; May, Natalie; Scully, Ken; Voss, John

2008-04-01

Multiple factors are driving residency programs to explicitly address practice-based learning and improvement (PBLI), yet few information systems exist to facilitate such training. We developed, implemented, and evaluated a Web-based tool that provides Internal Medicine residents at the University of Virginia Health System with population-based reports about their ambulatory clinical experiences. Residents use Systems and Practice Analysis for Resident Competencies (SPARC) to identify potential areas for practice improvement. Thirty-three (65%) of 51 residents completed a survey assessing SPARC's usefulness, with 94% agreeing that it was a useful educational tool. Twenty-six residents (51%) completed a before-after study indicating increased agreement (5-point Likert scale, with 5=strongly agree) with statements regarding confidence in ability to access population-based data about chronic disease management (mean [SD] 2.5 [1.2] vs. 4.5 [0.5], p < .001, sign test) and information comparing their practice style to that of their peers (2.2 [1.2] vs. 4.6 [0.5], p < .001).

Maintaining Perioperative Normothermia: Sustaining an Evidence-Based Practice Improvement Project.

PubMed

Levin, Rona F; Wright, Fay; Pecoraro, Kathleen; Kopec, Wendy

2016-02-01

Unintentional perioperative hypothermia has been shown to cause serious patient complications and, thus, to increase health care costs. In 2009, an evidence-based practice improvement project produced a significant decrease in unintentional perioperative hypothermia in colorectal surgical patients through monitoring of OR ambient room temperature. Project leaders engaged all interdisciplinary stakeholders in the original project, which facilitated the sustainability of the intervention method. An important aspect of sustainability is ongoing monitoring and evaluation of a new intervention method. Therefore, continued evaluation of outcomes of the protocol developed in 2009 was scheduled at specific time points after the initial small test of change with colorectal patients. This article focuses on how attention to sustainability factors during implementation of an improvement project led to the sustainability of a protocol for monitoring OR ambient room temperature with all types of surgical patients five years after the initial project. Copyright © 2016 AORN, Inc. Published by Elsevier Inc. All rights reserved.

MyPOD: an EMR-Based Tool that Facilitates Quality Improvement and Maintenance of Certification.

PubMed

Berman, Loren; Duffy, Brian; Randall Brenn, B; Vinocur, Charles

2017-03-01

Maintenance of Certification (MOC) was designed to assess physician competencies including operative case volume and outcomes. This information, if collected consistently and systematically, can be used to facilitate quality improvement. Information automatically extracted from the electronic medical record (EMR) can be used as a prompt to compile these data. We developed an EMR-based program called MyPOD (My Personal Outcomes Data) to track surgical outcomes at our institution. We compared occurrences reported in the first 18 months to those captured in the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (ACS NSQIP-P) over the same time period. During the first 18 months of using MyPOD, 691 cases were captured in both MyPOD and NSQIP-P. There were 48 cases with occurrences in NSQIP-P (6.9% occurrence rate). MyPOD captured 33% of the occurrences and 83% of the deaths reported in NSQIP-P. Use of the MyPOD program helped to identify series of complications and facilitated systematic change to improve outcomes. MyPOD provides comparative data that is essential in performance evaluation and facilitates quality improvement in surgery. This program and similar EMR-driven tools are becoming essential components of the MOC process. Our initial review has revealed opportunities for improvement in self-reporting which we can continue to measure by comparison to NSQIP-P. In addition, it has identified systems issues that have led to hospital-wide improvements.

Facilitating the learning process in design-based learning practices: an investigation of teachers' actions in supervising students

NASA Astrophysics Data System (ADS)

Gómez Puente, S. M.; van Eijck, M.; Jochems, W.

2013-11-01

Background: In research on design-based learning (DBL), inadequate attention is paid to the role the teacher plays in supervising students in gathering and applying knowledge to design artifacts, systems, and innovative solutions in higher education. Purpose: In this study, we examine whether teacher actions we previously identified in the DBL literature as important in facilitating learning processes and student supervision are present in current DBL engineering practices. Sample: The sample (N=16) consisted of teachers and supervisors in two engineering study programs at a university of technology: mechanical and electrical engineering. We selected randomly teachers from freshman and second-year bachelor DBL projects responsible for student supervision and assessment. Design and method: Interviews with teachers, and interviews and observations of supervisors were used to examine how supervision and facilitation actions are applied according to the DBL framework. Results: Major findings indicate that formulating questions is the most common practice seen in facilitating learning in open-ended engineering design environments. Furthermore, other DBL actions we expected to see based upon the literature were seldom observed in the coaching practices within these two programs. Conclusions: Professionalization of teachers in supervising students need to include methods to scaffold learning by supporting students in reflecting and in providing formative feedback.

The art and science of cancer education and evaluation: toward facilitating improved patient outcomes.

PubMed

Johnson, Lenora; Ousley, Anita; Swarz, Jeffrey; Bingham, Raymond J; Erickson, J Bianca; Ellis, Steven; Moody, Terra

2011-03-01

Cancer education is a constantly evolving field, as science continues to advance both our understanding of cancer and its effects on patients, families, and communities. Moving discoveries to practice expeditiously is paramount to impacting cancer outcomes. The continuing education of cancer care professionals throughout their practice life is vital to facilitating the adoption of therapeutic innovations. Meanwhile, more general educational programs serve to keep cancer patients, their families, and the public informed of the latest findings in cancer research. The National Cancer Institute conducted an assessment of the current knowledge base for cancer education which involved two literature reviews, one of the general literature of the evaluation of medical and health education efforts, and the other of the preceding 5 years of the Journal of Cancer Education (JCE). These reviews explored a wide range of educational models and methodologies. In general, those that were most effective used multiple methodologies, interactive techniques, and multiple exposures over time. Less than one third of the articles in the JCE reported on a cancer education or communication product, and of these, only 70% had been evaluated for effectiveness. Recommendations to improve the evaluation of cancer education and the educational focus of the JCE are provided.

Development of consensus guidance to facilitate service redesign around pharmacist prescribing in UK hospital practice.

PubMed

Tonna, Antonella; McCaig, Dorothy; Diack, Lesley; West, Bernice; Stewart, Derek

2014-10-01

The last decade has seen a drive towards non-medical prescribing in the United Kingdom (UK). However, there is a dearth of any published literature on applying the principles of service redesign to support pharmacist prescribing in any sphere of practice. To develop consensus guidance to facilitate service redesign around pharmacist prescribing. UK hospital practice. The Delphi technique was used to measure consensus of a panel of expert opinion holders in Scotland. Individuals with key strategic and operational roles in implementing initiatives of pharmacy practice and medicines management were recruited as experts. An electronic questionnaire consisting of 30 statements related to pharmacist prescribing service redesign was developed. These were presented as five-point Likert scales with illustrative quotes. Consensus, defined as 70 % of panel members agreeing (ranked strongly agree/agree) with each statement. Responses were obtained from 35/40 (87.5 %) experts in round one and 29 (72.5 %) in round two. Consensus in round one was achieved for 27/30 of statements relating to aspects of generic 'service development' (e.g. succession planning, multidisciplinary working, quality evaluation, practice development and outcome measures) and 'pharmacist prescribing role development' (e.g. education and future orientation of service). Issues of disagreement were around targeting of pharmacist prescribing to clinical specialities and financial remuneration for prescribing in the hospital setting. Consensus guidance has been developed to facilitate service redesign around hospital pharmacist prescribing.

Behavioural informatics for improving water hygiene practice based on IoT environment.

PubMed

Fu, Yang; Wu, Wenyan

2018-02-01

The development of Internet of Things (IoT) and latest Information and Communication Technologies (ICT) have changed the nature of healthcare monitoring and health behaviour intervention in many applications. Water hygiene and water conservation behaviour intervention as important influence factors to human health are gaining much attentions for improving sustained sanitation practice. Based on face-to-face delivery, typical behaviour intervention method is costly and hardly to provide all day access to personalised intervention guidance and feedbacks. In this study, we presented a behavioural information system and water use behaviour model using IoT platform. Using Expanded Theory of Planned Behaviour (ETPB) and adopted structure equation model, this study offers a solution for understanding the behaviour intervention mechanism and methodology for developing empirical model. A case study of behaviour intervention model is presented by utilising residential water conservation behaviour data collected in China. Results suggested that cultural differences have significant influences on the understanding of intervention drivers, promoting projects and increasing awareness, which could improve the behaviour intervention efficiency and further facilitate the improvement of water hygiene practice. The performance evaluation of water saving dimension is discussed as well in the paper. Copyright © 2017 Elsevier Inc. All rights reserved.

Measures to Improve Diagnostic Safety in Clinical Practice

PubMed Central

Singh, Hardeep; Graber, Mark L; Hofer, Timothy P

2016-01-01

Timely and accurate diagnosis is foundational to good clinical practice and an essential first step to achieving optimal patient outcomes. However, a recent Institute of Medicine report concluded that most of us will experience at least one diagnostic error in our lifetime. The report argues for efforts to improve the reliability of the diagnostic process through better measurement of diagnostic performance. The diagnostic process is a dynamic team-based activity that involves uncertainty, plays out over time, and requires effective communication and collaboration among multiple clinicians, diagnostic services, and the patient. Thus, it poses special challenges for measurement. In this paper, we discuss how the need to develop measures to improve diagnostic performance could move forward at a time when the scientific foundation needed to inform measurement is still evolving. We highlight challenges and opportunities for developing potential measures of “diagnostic safety” related to clinical diagnostic errors and associated preventable diagnostic harm. In doing so, we propose a starter set of measurement concepts for initial consideration that seem reasonably related to diagnostic safety, and call for these to be studied and further refined. This would enable safe diagnosis to become an organizational priority and facilitate quality improvement. Health care systems should consider measurement and evaluation of diagnostic performance as essential to timely and accurate diagnosis and to the reduction of preventable diagnostic harm. PMID:27768655

The integration and evaluation of a social-media facilitated journal club to enhance the student learning experience of evidence-based practice: A case study.

PubMed

Ferguson, Caleb; DiGiacomo, Michelle; Gholizadeh, Leila; Ferguson, Leila E; Hickman, Louise D

2017-01-01

Nurses are required to interpret and apply knowledge so communities will receive care based on best available evidence, as opposed to care that is simply based on tradition or authority. Fostering nursing students' critical appraisal skills will assist in their capacity to engage with, interpret and use best evidence. Journal clubs are frequently used approach to engage learners with research and develop critical appraisal skills. Given new flipped and blended approaches to teaching and learning there is need to rejuvenate how research is utilised and integrated within journal clubs to maximise engagement and translation of evidence. This paper provides a case study of a single site Australian university experience of transitioning a traditional physical journal club, to a social media-facilitated club within a postgraduate health subject to stimulate and facilitate engagement with the chosen manuscripts. This case study is based on our own experiences, supported by literature and includes qualitative comments obtained via student feedback surveys during November 2015. Case study. Social media-facilitated journal clubs offer an efficient way to continue developing critical appraisal skills in nursing students. The integration of a social media-facilitated journal clubs increased student attention, engagement with presented activities and overall student satisfaction within this evidence-based practice subject. Future rigorously-designed, large-scale studies are required to evaluate the impact of online journal clubs on the uptake of evidence-based practice, including those resulting in improved patient outcomes. Copyright © 2016 Elsevier Ltd. All rights reserved.

Practice management companies improve practices' financial position.

PubMed

Dupell, T

1997-11-01

To maintain control over healthcare delivery and financial decisions, as well as increase access to capital markets, some group practices are forming their own physician practice management companies. These companies should be organized to balance the expectations of physicians with the values of capital markets. This organization should include retained earnings, financial reporting in accordance with generally accepted accounting principles (GAAP), predictable earnings and cash flow, physician ownership and leadership, and incentives for high-quality management. Three large, primary care and multispecialty clinics that merged to form a new physician practice management company increased their access to capital markets and improved their overall financial position, which will help them achieve long-term survival.

Exploring reforms while learning to teach science: Facilitating exploration of theory-practice relationships in a teacher education study group

NASA Astrophysics Data System (ADS)

Foster, Jacob G.

This dissertation inserts a new view into an old problem in teacher education. The study explores the theory-practice gap, the large distance between what preservice science teachers experience in schools, are able to enact, and are told they should hold themselves to in their practice. It does so by narrowing the focus of analysis to a secondary science study group and examining how the facilitator uses sociocultural constructivism to promote discussion. The analysis surfaces key communicative moves made by the facilitator and preservice teachers that yield fruitful discussion of theory-practice relationships. Additionally, the study's use of discourse analysis as a methodology and intertextuality as a conceptual framework opens new directions for applied sociolinguistic research and scholarship in science teacher education. Findings from the study focus on what was discussed and how explorations of theory-practice relationships were facilitated. Preservice teachers in the study group engaged in meaningful conversations about constructivist theory and its application to their students and teaching of science. They discussed many science education topics such as planning science lessons that actively engage students, assessment of content understanding, and management of content-based activities. Discussions of broader science education goals, including implementation of inquiry or development of collaborative communities, were not promoted. Examination of the facilitation illuminates a number of strategies found to be helpful in supporting these explorations. This study shows that facilitation can successfully support preservice teachers to construct understanding of social constructivist assumptions underlying the National Science Education Standards (NSES), as well as a few components of the Standards themselves. The focus on the underlying assumptions suggests that science teacher education should focus on these so that preservice teachers can build a strong

Key Elements of Observing Practice: A Data Wise DVD and Facilitator's Guide

ERIC Educational Resources Information Center

Boudett, Kathryn Parker; City, Elizabeth A.; Russell, Marcia K.

2010-01-01

Based on the bestselling book "Data Wise: A Step-by-Step Guide to Using Assessment Results to Improve Teaching and Learning", and its companion volume, "Data Wise in Action", this DVD and Facilitator's Guide offer insight into one of the most challenging steps in capturing data about school performance: observing and analyzing instructional…

Designing a Large-Scale Multilevel Improvement Initiative: The Improving Performance in Practice Program

ERIC Educational Resources Information Center

Margolis, Peter A.; DeWalt, Darren A.; Simon, Janet E.; Horowitz, Sheldon; Scoville, Richard; Kahn, Norman; Perelman, Robert; Bagley, Bruce; Miles, Paul

2010-01-01

Improving Performance in Practice (IPIP) is a large system intervention designed to align efforts and motivate the creation of a tiered system of improvement at the national, state, practice, and patient levels, assisting primary-care physicians and their practice teams to assess and measurably improve the quality of care for chronic illness and…

Practice-based learning can improve osteoporosis care.

PubMed

Hess, Brian J; Johnston, Mary M; Iobst, William F; Lipner, Rebecca S

2013-10-01

To examine physician engagement in practice-based learning using a self-evaluation module to assess and improve their care of individuals with or at risk of osteoporosis. Retrospective cohort study. Internal medicine and subspecialty clinics. Eight hundred fifty U.S. physicians with time-limited certification in general internal medicine or a subspecialty. Performance rates on 23 process measures and seven practice system domain scores were obtained from the American Board of Internal Medicine (ABIM) Osteoporosis Practice Improvement Module (PIM), an Internet-based self-assessment module that physicians use to improve performance on one targeted measure. Physicians remeasured performance on their targeted measures by conducting another medical chart review. Variability in performance on measures was found, with observed differences between general internists, geriatricians, and rheumatologists. Some practice system elements were modestly associated with measure performance; the largest association was between providing patient-centered self-care support and documentation of calcium intake and vitamin D estimation and counseling (correlation coefficients from 0.20 to 0.28, Ps < .002). For all practice types, the most commonly selected measure targeted for improvement was documentation of vitamin D level (38% of physicians). On average, physicians reported significant and large increases in performance on measures targeted for improvement. Gaps exist in the quality of osteoporosis care, and physicians can apply practice-based learning using the ABIM PIM to take action to improve the quality of care. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

Facilitating critical thinking.

PubMed

Hansten, R I; Washburn, M J

2000-01-01

Supporting staff to think effectively is essential to improve clinical systems, decrease errors and sentinel events, and engage staff involvement to refine patient care systems in readiness for new care-delivery models that truly reflect the valued role of the RN. The authors explore practical methods, based on current research and national consulting experience, to facilitate the development of mature critical thinking skills. Assessment tools, a sample agenda for formal presentations, and teaching strategies using behavioral examples that make the important and necessary link of theory to reality are discussed in the form of a critical thinking test as well as a conceptual model for application in problem solving.

Clinicians’ Perceptions of the Usefulness of a Communication Facilitator in the Intensive Care Unit

PubMed Central

Howell, Abby; Nielsen, Elizabeth L.; Turner, Anne M.; Curtis, J. Randall; Engelberg, Ruth A.

2015-01-01

Background Despite its documented importance, communication between clinicians and patients’ families in the intensive care unit often fails to meet families’ needs, and interventions to improve communication are needed. Use of a communication facilitator—an additional staff member—to improve communication between clinicians and patients’ families is the focus of an ongoing randomized trial. The clinical team’s acceptance of the communication facilitator as an integral part of the team is important. Objectives To explore clinicians’ perceptions of the usefulness of a communication facilitator in the intensive care unit. Methods Fourteen semistructured qualitative interviews to assess perspectives of physicians, nurses, and social workers who had experience with the communication facilitator intervention on the intervention and the role of the facilitator. Methods based on grounded theory were used to analyze the data. Results Clinicians’ perceived facilitators as (1) facilitating communication between patients’ families and clinicians, (2) providing practical and emotional support for patients’ families, and (3) providing practical and emotional support for clinicians. Clinicians were enthusiastic about the communication facilitator but concerned about overlapping or conflicting roles. Conclusions Clinicians in the intensive care unit saw the facilitator intervention as enhancing communication and supporting both patients’ families and clinicians. They also identified the importance of the facilitator within the interdisciplinary team. Negative perceptions about the use of a facilitator should be addressed before the intervention is implemented, in order to ensure its effectiveness. PMID:25179033

Facilitation of learning: part 1.

PubMed

Warburton, Tyler; Trish, Houghton; Barry, Debbie

2016-04-06

This article, the fourth in a series of 11, discusses the context for the facilitation of learning. It outlines the main principles and theories for understanding the process of learning, including examples which link these concepts to practice. The practical aspects of using these theories in a practice setting will be discussed in the fifth article of this series. Together, these two articles will provide mentors and practice teachers with knowledge of the learning process, which will enable them to meet the second domain of the Nursing and Midwifery Council's Standards to Support Learning and Assessment in Practice on facilitation of learning.

Facilitating Lecturer Development and Student Learning through Action Research

ERIC Educational Resources Information Center

van der Westhuizen, C. N.

2008-01-01

The aim of the action research project is to improve my own practice as research methodology lecturer to facilitate effective student learning to enable students to become reflective practitioners with responsibility for their own professional development through action research in their own classrooms, and to motivate the students and increase…

Addicted to discovery: Does the quest for new knowledge hinder practice improvement?

PubMed

Perl, Harold I

2011-06-01

Despite the billions of dollars spent on health-focused research and the hundreds of billions spent on delivering health services each year, relatively little money and effort are directed toward investigating how best to connect the two. This results in missed opportunities to assure that research findings inform and improve quality across healthcare in general and for addiction prevention and treatment in particular. There is an asymmetrical focus that favors the identification of new interventions and neglects the implementation of science-based knowledge in actual practice. The consequences of that neglect are severe: significantly diminished progress in research on how to implement treatments that could improve the lives of persons with addiction problems, their families, and the rest of society. While the advancement of knowledge regarding effective implementation is lagging, it is clear that existing systemic incentives in the conduct of science inhibit rather than facilitate widespread adoption of evidence-based practices. This commentary proposes three interrelated strategies for improving the implementation process. First, develop scientific tools to understand implementation better, by expanding investigations on the science of implementation and broadening approaches to the design and execution of research. Second, nurture and support a collaborative implementation workforce comprised of scientists and on-the-ground practitioners, with an explicit focus on enhancing appropriate incentives for both. Third, pay closer attention to crafting research that seeks answers that are most relevant to clinicians' actual needs, primarily by ensuring that the anticipated users of the evidence-based practice are full partners in developing the questions right from the start. Published by Elsevier Ltd.

Development of a Web-based Resident Profiling Tool to Support Training in Practice-based Learning and Improvement

PubMed Central

Schorling, John; Nadkarni, Mohan; May, Natalie; Scully, Ken; Voss, John

2008-01-01

Multiple factors are driving residency programs to explicitly address practice-based learning and improvement (PBLI), yet few information systems exist to facilitate such training. We developed, implemented, and evaluated a Web-based tool that provides Internal Medicine residents at the University of Virginia Health System with population-based reports about their ambulatory clinical experiences. Residents use Systems and Practice Analysis for Resident Competencies (SPARC) to identify potential areas for practice improvement. Thirty-three (65%) of 51 residents completed a survey assessing SPARC’s usefulness, with 94% agreeing that it was a useful educational tool. Twenty-six residents (51%) completed a before–after study indicating increased agreement (5-point Likert scale, with 5=strongly agree) with statements regarding confidence in ability to access population-based data about chronic disease management (mean [SD] 2.5 [1.2] vs. 4.5 [0.5], p < .001, sign test) and information comparing their practice style to that of their peers (2.2 [1.2] vs. 4.6 [0.5], p < .001). PMID:18373150

Integrated Practice Improvement Solutions-Practical Steps to Operating Room Management.

PubMed

Chernov, Mikhail; Pullockaran, Janet; Vick, Angela; Leyvi, Galina; Delphin, Ellise

2016-10-01

Perioperative productivity is a vital concern for surgeons, anesthesiologists, and administrators as the OR is a major source of hospital elective admissions and revenue. Based on elements of existing Practice Improvement Methodologies (PIMs), "Integrated Practice Improvement Solutions" (IPIS) is a practical and simple solution incorporating aspects of multiple management approaches into a single open source framework to increase OR efficiency and productivity by better utilization of existing resources. OR efficiency was measured both before and after IPIS implementation using the total number of cases versus room utilization, OR/anesthesia revenue and staff overtime (OT) costs. Other parameters of efficiency, such as the first case on-time start and the turnover time (TOT) were measured in parallel. IPIS implementation resulted in increased numbers of surgical procedures performed by an average of 10.7%, and OR and anesthesia revenue increases of 18.5% and 6.9%, respectively, with a simultaneous decrease in TOT (15%) and OT for anesthesia staff (26%). The number of perioperative adverse events was stable during the two-year study period which involved a total of 20,378 patients. IPIS, an effective and flexible practice improvement model, was designed to quickly, significantly, and sustainably improve OR efficiency by better utilization of existing resources. Success of its implementation directly correlates with the involvement of and acceptance by the entire OR team and hospital administration.

Facilitating the development of moral insight in practice: teaching ethics and teaching virtue.

PubMed

Begley, Ann M

2006-10-01

Abstract The teaching of ethics is discussed within the context of insights gleaned from ancient Greek ethics, particularly Aristotle and Plato and their conceptions of virtue (arete, meaning excellence). The virtues of excellence of character (moral virtue) and excellence of intelligence (intellectual virtue), particularly practical wisdom and theoretical wisdom, are considered. In Aristotelian ethics, a distinction is drawn between these intellectual virtues: experience and maturity is needed for practical wisdom, but not for theoretical wisdom. In addition to this, excellence of character is acquired through habitual practice, not instruction. This suggests that there is a need to teach more than theoretical ethics and that the ethics teacher must also facilitate the acquisition of practical wisdom and excellence of character. This distinction highlights a need for various educational approaches in cultivating these excellences which are required for a moral life. It also raises the question: is it possible to teach practical wisdom and excellence of character? It is suggested that virtue, conceived of as a type of knowledge, or skill, can be taught, and people can, with appropriate experience, habitual practice, and good role models, develop excellence of character and become moral experts. These students are the next generation of exemplars and they will educate others by example and sustain the practice of nursing. They need an education which includes theoretical ethics and the nurturing of practical wisdom and excellence of character. For this purpose, a humanities approach is suggested.

Organizational and physician perspectives about facilitating handheld computer use in clinical practice: results of a cross-site qualitative study.

PubMed

McAlearney, Ann Scheck; Schweikhart, Sharon B; Medow, Mitchell A

2005-01-01

To describe strategies that organizations select to support physicians' use of handheld computers (HHCs) in clinical practice and to explore issues about facilitating HHC use. A multidisciplinary team used focus groups and interviews with clinical, administrative, and information technology (IT) staff to gather data from 161 informants at seven sites. Transcripts were coded using a combination of deductive and inductive approaches to both answer research questions and identify patterns and themes that emerged in the data. Answers to questions about strategies for HHC support and themes about (1) how to facilitate physician adoption and use and (2) organizational concerns. Three main organizational strategies for HHC support were characterized among sites: (1) active support for broad-based use, (2) active support for niche use, and (3) basic support for individual physician users. Three high-level themes emerged around how to best facilitate physician adoption and use of HHCs: (1) improving usability and usefulness, (2) promoting HHCs and device use, and (3) providing training and support. However, four major themes also emerged related to organizations' concerns about HHC use: (1) security-related concerns, (2) economic concerns, (3) technical concerns, and (4) strategic concerns. An organizational approach to HHC support that involves individualized attention to existing and potential physician users rather than one-size-fits-all, organization-wide implementation efforts was an important facilitator promoting physician use of HHCs. Health care organizations interested in supporting HHC use must consider issues related to security, economics, and IT strategy that may not be prominent concerns for physician users.

Understanding Online Teacher Best Practices: A Thematic Analysis to Improve Learning

ERIC Educational Resources Information Center

Corry, Michael; Ianacone, Robert; Stella, Julie

2014-01-01

The purpose of this study was to examine brick-and-mortar and online teacher best practice themes using thematic analysis and a newly developed theory-based analytic process entitled Synthesized Thematic Analysis Criteria (STAC). The STAC was developed to facilitate the meaningful thematic analysis of research based best practices of K-12…

Improving Student Comfort with Death and Dying Discussions through Facilitated Family Encounters

ERIC Educational Resources Information Center

Schillerstrom, Jason E.; Sanchez-Reilly, Sandra; O'Donnell, Louise

2012-01-01

Objective: The purpose of this study was to explore the educational potential for a collaboration between palliative medicine and psychiatry designed to improve first-year medical students' knowledge and comfort with end-of-life issues through a facilitated small-group discussion with family members of recently-deceased loved ones. Methods: A…

Translating Knowledge Into Practice Through an Academic-Practice Partnership for Exploring Barriers That Impact Management of Homebound Patients With Heart Failure.

PubMed

Echevarria, Mercedes

A knowledge translation project involving an academic-practice partnership and guided by action-oriented research was used for exploring barriers that impact management of homebound heart failure patients. The intervention process followed an action research model of interaction, self-reflection, response, and change in direction. External facilitators (academia) and internal facilitators (practice) worked with clinicians to identify a topic for improvement, explore barriers, locate the evidence compare current practice against evidence-based practice recommendations, introduce strategies to "close the gap" between actual practice and the desired practice, develop audit criteria, and reevaluate the impact.

Vocational rehabilitation: facilitating evidence based practice through participatory action research.

PubMed

Maciver, Donald; Prior, Susan; Forsyth, Kirsty; Walsh, Mike; Meiklejohn, Allison; Irvine, Linda; Pentland, Duncan

2013-04-01

Improving vocational rehabilitation in line with the current evidence base is an area of considerable interest. Aims To describe the strategies used by a multidisciplinary team in the initial stages of a participatory action research (PAR) approach to improving a vocational rehabilitation service. A literature review and PAR process were completed. One hundred and fifteen participants engaged in multifaceted data collection and analysis, building consensus around key principles for a new vocational rehabilitation service. A synthesis of our literature review and PAR process was developed into a set of principles for practice which we plan to implement across the service. We have developed methodologies in interdisciplinary collaborations spanning statutory and non-statutory services. We have developed a set of principles for practice and detailed plans for implementation are being drawn up to inform provision in the future.

Following a natural experiment of guideline adaptation and early implementation: a mixed-methods study of facilitation

PubMed Central

2012-01-01

Background Facilitation is emerging as an important strategy in the uptake of evidence. However, it is not entirely clear from a practical perspective how facilitation occurs to help move research evidence into nursing practice. The Canadian Partnership Against Cancer, also known as the 'Partnership,' is a Pan-Canadian initiative supporting knowledge translation activity for improved care through guideline use. In this case-series study, five self-identified groups volunteered to use a systematic methodology to adapt existing clinical practice guidelines for Canadian use. With 'Partnership' support, local and external facilitators provided assistance for groups to begin the process by adapting the guidelines and planning for implementation. Methods To gain a more comprehensive understanding of the nature of facilitation, we conducted a mixed-methods study. Specifically, we examined the role and skills of individuals actively engaged in facilitation as well as the actual facilitation activities occurring within the 'Partnership.' The study was driven by and builds upon a focused literature review published in 2010 that examined facilitation as a role and process in achieving evidence-based practice in nursing. An audit tool outlining 46 discrete facilitation activities based on results of this review was used to examine the facilitation noted in the documents (emails, meeting minutes, field notes) of three nursing-related cases participating in the 'Partnership' case-series study. To further examine the concept, six facilitators were interviewed about their practical experiences. The case-audit data were analyzed through a simple content analysis and triangulated with participant responses from the focus group interview to understand what occurred as these cases undertook guideline adaptation. Results The analysis of the three cases revealed that almost all of the 46 discrete, practical facilitation activities from the literature were evidenced. Additionally, case

Caregivers' responses to an intervention to improve young child feeding behaviors in rural Bangladesh: a mixed method study of the facilitators and barriers to change.

PubMed

Affleck, William; Pelto, Gretel

2012-08-01

Behavior change communications regarding child feeding have met with mixed success. The present study analyzes responses of 34 Bangladeshi caregivers seven months after they received a responsive feeding intervention. The intervention communicated and demonstrated five feeding interactions: hand-washing, self-feeding, verbal responsivity, managing refusals non-forcefully, and dietary diversity. Seventeen caregivers who adopted key behaviors addressed by the intervention and 17 who did not were compared in terms of socio-demographic variables, but more importantly in terms of their recall of the messages, their reported practice, and reported facilitators and barriers. Both those who changed and those who did not reported similar facilitators and barriers to practicing the new behaviors; there was also no difference in recall or in socio-demographic variables. Key themes identified through a constant comparative analysis helped to focus on common features of the lives of caregivers that made it easy or difficult to perform the practices. Some of these were household constraints such as poverty, shortage of time in which to complete chores, and avoiding waste and messiness; others related to the child's demands. Many caregivers misinterpreted instructions about talking to one's child in response to signals, as opposed to more common forms of supervision. Facilitators such as the child's evident pleasure and the caregiver's satisfaction did not always outweigh the barriers. Recommendations for improving interventions include helping caregivers solve problems tied to barriers and including more family members in the intervention. Copyright © 2012 Elsevier Ltd. All rights reserved.

Barriers and facilitators to implementing continuous quality improvement programs in colonoscopy services: a mixed methods systematic review.

PubMed

Candas, Bernard; Jobin, Gilles; Dubé, Catherine; Tousignant, Mario; Abdeljelil, Anis Ben; Grenier, Sonya; Gagnon, Marie-Pierre

2016-02-01

Continuous quality improvement (CQI) programs may result in quality of care and outcome improvement. However, the implementation of such programs has proven to be very challenging. This mixed methods systematic review identifies barriers and facilitators pertaining to the implementation of CQI programs in colonoscopy services and how they relate to endoscopists, nurses, managers, and patients. We developed a search strategy adapted to 15 databases. Studies had to report on the implementation of a CQI intervention and identified barriers or facilitators relating to any of the four groups of actors directly concerned by the provision of colonoscopies. The quality of the selected studies was assessed and findings were extracted, categorized, and synthesized using a generic extraction grid customized through an iterative process. We extracted 99 findings from the 15 selected publications. Although involving all actors is the most cited factor, the literature mainly focuses on the facilitators and barriers associated with the endoscopists' perspective. The most reported facilitators to CQI implementation are perception of feasibility, adoption of a formative approach, training and education, confidentiality, and assessing a limited number of quality indicators. Receptive attitudes, a sense of ownership and perceptions of positive impacts also facilitate the implementation. Finally, an organizational environment conducive to quality improvement has to be inclusive of all user groups, explicitly supportive, and provide appropriate resources. Our findings corroborate the current models of adoption of innovations. However, a significant knowledge gap remains with respect to barriers and facilitators pertaining to nurses, patients, and managers.

Barriers and facilitators to integration of physician associates into the general practice workforce: a grounded theory approach.

PubMed

Jackson, Ben; Marshall, Michelle; Schofield, Susie

2017-11-01

Physician associates (PAs) are described as one solution to workforce capacity in primary care in the UK. Despite new investment in the role, how effective this will be in addressing unmet primary care needs is unclear. To investigate the barriers and facilitators to the integration of PAs into the general practice workforce. A modified grounded theory study in a region unfamiliar with the PA role. No a priori themes were assumed. Themes generated from stakeholder interviews informed a literature review and theoretical framework, and were then tested in focus groups with GPs, advanced nurse practitioners (ANPs), and patients. Recorded data were transcribed verbatim, and organised using NVivo version 10.2.2, with iterative analysis of emergent themes. A reflexive diary and independent verification of coding and analysis were included. There were 51 participants (30 GPs, 11 ANPs, and 10 patients) in eight focus groups. GPs, ANPs, and patients recognised that support for general practice was needed to improve access. GPs expressed concerns regarding PAs around managing medical complexity and supervision burden, non-prescriber status, and medicolegal implications in routine practice. Patients were less concerned about specific competencies as long as there was effective supervision, and were accepting of a PA role. ANPs highlighted their own negative experiences entering advanced clinical practice, and the need for support to counteract stereotypical and prejudicial attitudes CONCLUSION: This study highlights the complex factors that may impede the introduction of PAs into UK primary care. A conceptual model is proposed to help regulators and educationalists support this integration, which has relevance to other proposed new roles in primary care. © British Journal of General Practice 2017.

Organising Communities-of-Practice: Facilitating Emergence

ERIC Educational Resources Information Center

Akkerman, Sanne; Petter, Christian; de Laat, Maarten

2008-01-01

Purpose: The notion of communities of practice (CoP) has received great attention in educational and organisational practice and research. Although the concept originally refers to collaborative practices that emerge naturally, educational and HRD practitioners are increasingly searching for ways to create these practices intentionally in order to…

Patient Satisfaction Measurement in Occupational and Environmental Medicine Practice.

PubMed

Drury, David L; Adamo, Philip; Cloeren, Marianne; Hegmann, Kurt T; Martin, Douglas W; Levine, Michael J; Olson, Shawn M; Pransky, Glenn S; Tacci, James A; Thiese, Matthew

2018-05-01

: High patient satisfaction is a desirable goal in medical care. Patient satisfaction measures are increasingly used to evaluate and improve quality in all types of medical practices. However, the unique aspects of occupational and environmental medicine (OEM) practice require development of OEM-specific measures and thoughtful interpretation of results. The American College of Occupational and Environmental Medicine has developed and recommends a set of specific questions to measure patient satisfaction in OEM, designed to meet anticipated regulatory requirements, facilitate quality improvement of participating OEM practices, facilitate case-management review, and offer fair and accurate assessment of OEM physicians.

Caring presence in practice: facilitating an appreciative discourse in nursing.

PubMed

du Plessis, E

2016-09-01

To report on an appreciation of caring presence practised by nurses in South Africa in order to facilitate an appreciative discourse in nursing and a return to caring values and attitudes. Appreciative reports on caring presence are often overlooked. Media may provide a platform for facilitating appreciation for caring presence practised by nurses. Such an appreciation may foster further practice of caring presence and re-ignite a caring ethos in nursing. This article provides an appreciative discourse on caring presence in nursing in the form of examples of caring presence practised by nurses. An anecdotal approach was followed. Social media, namely narratives on caring presence shared by nurses on a Facebook page, and formal media, namely news reports in which nurses are appreciated for their efforts, were used. Deductive content analysis was applied to analyse the narratives and news reports in relation to a definition of caring presence and types of caring presence. The analysis of the narratives and news reports resulted in an appreciative discourse in which examples of nurses practising caring presence could be provided. Examples of nurses practising caring presence could be found, and an appreciative discourse could be initiated. Appreciation ignites positive action and ownership of high-quality health care. Leadership should thus cultivate a culture of appreciating nurses, through using media, and encourage nurses to share how caring presence impact on quality in health care. © 2016 International Council of Nurses.

Factors influencing evidence-based practice in prosthetics and orthotics.

PubMed

Andrysek, Jan; Christensen, James; Dupuis, Annie

2011-03-01

The importance of evidence-based practice is being recognized across a broad range of healthcare disciplines as a means for improving patient outcomes and also efficiently managing healthcare resources. The objective of this work was to obtain information from clinicians about the underlying barriers and facilitators relating to evidence-based practice in prosthetics and orthotics. Cross sectional survey. An internet survey was developed and distributed to 300 prosthetists and orthotists currently practicing in Canada. A principal component factor analysis of the survey results revealed ten primary factors affecting evidence-based practice. These include time constraints, workload and system demands, limited relevant evidence from research, and gaps in skills and knowledge required to perform evidence-based practice. Clinicians value research as a means of improving clinical practice, but they are faced with a number of practical barriers in performing evidence-based practice. This study provides empirical data about the underlying barriers and facilitators relating to evidence-based practice in prosthetics and orthotics. Such data are essential in order to inform those involved in improving existing clinical practices, including educators, professional organizations, and governing bodies.

Behavioral interventions to improve infection control practices.

PubMed

Kretzer, E K; Larson, E L

1998-06-01

No single intervention has been successful in improving and sustaining such infection control practices as universal precautions and handwashing by health care professionals. This paper examines several behavioral theories (Health Belief Model, Theory of Reasoned Action and Theory of Planned Behavior, self-efficacy, and the Transtheoretic Model) and relates them to individual factors, also considering interpersonal and organizational factors. Further, this article includes recommendations of individual and organizational components to be addressed when planning a theoretically based intervention for improving infection control practices. A hypothetic framework to enhance handwashing practice is proposed.

The Motivation-Facilitation Theory of Prenatal Care Access.

PubMed

Phillippi, Julia C; Roman, Marian W

2013-01-01

Despite the availability of services, accessing health care remains a problem in the United States and other developed countries. Prenatal care has the potential to improve perinatal outcomes and decrease health disparities, yet many women struggle with access to care. Current theories addressing access to prenatal care focus on barriers, although such knowledge is minimally useful for clinicians. We propose a middle-range theory, the motivation-facilitation theory of prenatal care access, which condenses the prenatal care access process into 2 interacting components: motivation and facilitation. Maternal motivation is the mother's desire to begin and maintain care. Facilitation represents the goal of the clinic to create easy, open access to person-centered beneficial care. This simple model directs the focus of research and change to the interface of the woman and the clinic and encourages practice-level interventions that facilitate women entering and maintaining prenatal care. © 2013 by the American College of Nurse‐Midwives.

Barriers and facilitators to implementing continuous quality improvement programs in colonoscopy services: a mixed methods systematic review

PubMed Central

Candas, Bernard; Jobin, Gilles; Dubé, Catherine; Tousignant, Mario; Abdeljelil, Anis Ben; Grenier, Sonya; Gagnon, Marie-Pierre

2016-01-01

Background and aim: Continuous quality improvement (CQI) programs may result in quality of care and outcome improvement. However, the implementation of such programs has proven to be very challenging. This mixed methods systematic review identifies barriers and facilitators pertaining to the implementation of CQI programs in colonoscopy services and how they relate to endoscopists, nurses, managers, and patients. Methods: We developed a search strategy adapted to 15 databases. Studies had to report on the implementation of a CQI intervention and identified barriers or facilitators relating to any of the four groups of actors directly concerned by the provision of colonoscopies. The quality of the selected studies was assessed and findings were extracted, categorized, and synthesized using a generic extraction grid customized through an iterative process. Results: We extracted 99 findings from the 15 selected publications. Although involving all actors is the most cited factor, the literature mainly focuses on the facilitators and barriers associated with the endoscopists’ perspective. The most reported facilitators to CQI implementation are perception of feasibility, adoption of a formative approach, training and education, confidentiality, and assessing a limited number of quality indicators. Receptive attitudes, a sense of ownership and perceptions of positive impacts also facilitate the implementation. Finally, an organizational environment conducive to quality improvement has to be inclusive of all user groups, explicitly supportive, and provide appropriate resources. Conclusion: Our findings corroborate the current models of adoption of innovations. However, a significant knowledge gap remains with respect to barriers and facilitators pertaining to nurses, patients, and managers. PMID:26878037

Chinese nurses' perceived barriers and facilitators of ethical sensitivity.

PubMed

Huang, Fei Fei; Yang, Qing; Zhang, Jie; Khoshnood, Kaveh; Zhang, Jing Ping

2016-08-01

An overview of ethical sensitivity among Chinese registered nurses is needed to develop and optimize the education programs and interventions to cultivate and improve ethical sensitivity. The study was conducted to explore the barriers to and facilitators of ethical sensitivity among Chinese registered nurses working in hospital settings. A convergent parallel mixed-methods research design was adopted. In the cross-sectional quantitative study, the Chinese Moral Sensitivity Questionnaire-revised version was used to assess the levels of ethical sensitivity among registered nurses, and the scores were correlated with key demographics, training experiences in ethics, and workplace cultural environments (n = 306). In the qualitative study, semi-structured interviews were used to elicit the nurses' perceptions of the barriers and facilitators in nurturing ethical sensitivity (n = 15). The data were collected from February to June 2014. This study was approved by the Institutional Review Boards of Yale University and Central South University. Despite moderately high overall Chinese Moral Sensitivity Questionnaire-revised version scores, the ethical sensitivity among Chinese nurses lags in practice. Barriers to ethical sensitivity include the lack of knowledge related to ethics, lack of working experience as a nurse, the hierarchical organizational climate, and the conformist working attitude. The positive workplace cultural environments and application of ethical knowledge in practice were considered potential facilitators of ethical sensitivity. The findings of this study were compared with studies from other countries to examine the barriers and facilitators of ethical sensitivity in Chinese nurses. This mixed-methods study showed that even though the Chinese nurses have moderately high sensitivity to the ethical issues encountered in hospitals, there is still room for improvement. The barriers to and facilitators of ethical sensitivity identified here offer new and

Practice-based learning: the role of practice education facilitators in supporting mentors.

PubMed

Carlisle, Caroline; Calman, Lynn; Ibbotson, Tracy

2009-10-01

Central to the provision of high quality clinical placements for nursing and midwifery students are mentors who help engender a positive learning environment. In 2004 the Scottish Executive Health Department (now Scottish Government Health Directorates), NHS Scotland, NHS Education for Scotland, NHS Boards and Higher Education Institutions initiated and supported the establishment of the Practice Education Facilitator (PEF) role whose purpose is to ensure that the student experience, at both pre- and post-registration level, is of the highest quality, primarily through the support of mentors. A 3-year project evaluated the implementation and impact of the PEF role across Scotland. The study utilised both quantitative and qualitative data collection, with a sample comprising mentors, PEFs, students and other key stakeholders. This paper reports on selected findings from that study, specifically the perceived impact of the PEF in supporting mentors. Findings indicate that the PEF role has been accepted widely across Scotland and is seen as valuable to the development of quality clinical learning environments. PEFs provide support and guidance for mentors when dealing with 'failing' students, and encourage the identification of innovative learning opportunities. PEFs play an active part in student evaluation of their placements, but further work is needed in order that the feedback to clinical areas and mentors is timely.

Assessing and Improving Student Organizations: Resources for Facilitators CD-ROM. The Assessing and Improving Student Organization (AISO) Program

ERIC Educational Resources Information Center

Nolfi, Tricia; Ruben, Brent D.

2010-01-01

This companion to the "Guide for Students" and "Student Workbook" includes the complete set of PowerPoint slides, a PDF of the Facilitator's Guide in PPT (PowerPoint) slide show format, and PDFs of all scoring sheets, handouts and project planning guides needed for the AISO (Assessing and Improving Student Organization) process. The Assessing and…

Development of an interprofessional lean facilitator assessment scale.

PubMed

Bravo-Sanchez, Cindy; Dorazio, Vincent; Denmark, Robert; Heuer, Albert J; Parrott, J Scott

2018-05-01

High reliability is important for optimising quality and safety in healthcare organisations. Reliability efforts include interprofessional collaborative practice (IPCP) and Lean quality/process improvement strategies, which require skilful facilitation. Currently, no validated Lean facilitator assessment tool for interprofessional collaboration exists. This article describes the development and pilot evaluation of such a tool; the Interprofessional Lean Facilitator Assessment Scale (ILFAS), which measures both technical and 'soft' skills, which have not been measured in other instruments. The ILFAS was developed using methodologies and principles from Lean/Shingo, IPCP, metacognition research and Bloom's Taxonomy of Learning Domains. A panel of experts confirmed the initial face validity of the instrument. Researchers independently assessed five facilitators, during six Lean sessions. Analysis included quantitative evaluation of rater agreement. Overall inter-rater agreement of the assessment of facilitator performance was high (92%), and discrepancies in the agreement statistics were analysed. Face and content validity were further established, and usability was evaluated, through primary stakeholder post-pilot feedback, uncovering minor concerns, leading to tool revision. The ILFAS appears comprehensive in the assessment of facilitator knowledge, skills, abilities, and may be useful in the discrimination between facilitators of different skill levels. Further study is needed to explore instrument performance and validity.

Independent practice associations and physician-hospital organizations can improve care management for smaller practices.

PubMed

Casalino, Lawrence P; Wu, Frances M; Ryan, Andrew M; Copeland, Kennon; Rittenhouse, Diane R; Ramsay, Patricia P; Shortell, Stephen M

2013-08-01

Pay-for-performance, public reporting, and accountable care organization programs place pressures on physicians to use health information technology and organized care management processes to improve the care they provide. But physician practices that are not large may lack the resources and size to implement such processes. We used data from a unique national survey of 1,164 practices with fewer than twenty physicians to provide the first information available on the extent to which independent practice associations (IPAs) and physician-hospital organizations (PHOs) might make it possible for these smaller practices to share resources to improve care. Nearly a quarter of the practices participated in an IPA or a PHO that accounted for a significant proportion of their patients. On average, practices participating in these organizations provided nearly three times as many care management processes for patients with chronic conditions as nonparticipating practices did (10.4 versus 3.8). Half of these processes were provided only by IPAs or PHOs. These organizations may provide a way for small and medium-size practices to systematically improve care and participate in accountable care organizations.

Facilitating Self-Regulated Learning with Technology: Evidence for Student Motivation and Exam Improvement

ERIC Educational Resources Information Center

Barber, Larissa K.; Bagsby, Patricia G.; Grawitch, Matthew J.; Buerck, John P.

2011-01-01

The authors examined the extent to which student access to the MyGrade application in Blackboard may facilitate motivation and exam improvement via grade monitoring. In support of self-regulated learning and feedback principles, students indicated that the MyGrade application helped them better monitor their course performance and increased their…

Facilitating Transfer of Skills and Strategies in Occupational Therapy Practice: Practical Application of Transfer Principles.

PubMed

Babulal, Ganesh M; Foster, Erin R; Wolf, Timothy J

2016-01-01

In Occupational Therapy (OT) practice, practitioners assume that the skills and strategies taught to clients during rehabilitation will transfer to performance and participation in everyday life. Despite transfer serving as a practice foundation, outcome studies conclude that this assumption of transfer is not occurring and it often results in decreased efficacy of rehabilitation. This paper investigated key aspects of transfer and found concepts in the psychology literature that can support transfer of skills and strategies in OT. Six key principles proposed from educational psychology can serve as a guide for practitioners to better train for transfer. In this paper, we discuss the six principles and apply concepts from psychology. Each principle is supported with examples of how they may be incorporated OT practice. If occupational therapists understand these principles and implement them in treatment, the efficacy of treatment may improve for many populations.

A systems approach for implementing practice-based learning and improvement and systems-based practice in graduate medical education.

PubMed

Varkey, Prathibha; Karlapudi, Sudhakar; Rose, Steven; Nelson, Roger; Warner, Mark

2009-03-01

The Accreditation Council for Graduate Medical Education (ACGME) initiated its Outcome Project to better prepare physicians-in-training to practice in the rapidly changing medical environment and mandated assessment of competency in six outcomes, including Practice-Based Learning and Improvement (PBLI) and Systems-Based Practice (SBP). Before the initiation of the Outcome Project, these competencies were not an explicit element of most graduate medical education training programs. Since 1999, directors of ACGME-accredited programs nationwide have been challenged to teach and assess these competencies. The authors describe an institution-wide curriculum intended to facilitate the teaching and assessment of PBLI and SBP competencies in the 115 ACGME-accredited residency and fellowship programs (serving 1,327 trainees) sponsored by Mayo School of Graduate Medical Education. Strategies to establish the curriculum in 2005 included development of a Quality Improvement (QI) curriculum Web site, one-on-one consultations with program directors, a three-hour program director workshop, and didactic sessions for residents and fellows on core topics. An interim program director self-assessment survey revealed a 13% increase in perceived ability to measure competency in SBP, no change in their perceived ability to measure competence in PBLI, a 15% increase in their ability to provide written documentation of competence in PBLI, and a 35% increase in their ability to provide written documentation of competence in SBP between 2005 and 2007. Nearly 70% of the programs had trainees participating in QI projects. Further research is needed to evaluate the cost-effectiveness of such a program and to measure its impact on learner knowledge, skills, and attitudes and, ultimately, on patient outcomes.

Environmental improvement of product supply chains: proposed best practice techniques, quantitative indicators and benchmarks of excellence for retailers.

PubMed

Styles, David; Schoenberger, Harald; Galvez-Martos, Jose-Luis

2012-11-15

Retailers are strategically positioned to leverage environmental improvement over product supply chains through actions targeted at suppliers and consumers. Informed by scientific evidence on environmental hotspots and control points across 14 priority product groups, and a review of 25 major European retailers' actions, this paper proposes a framework to guide and assess retailer best practice in supply chain environmental improvement. Commonly used product standards and improvement measures are classified into "basic" or "good" levels of environmental protection. A hierarchy of eight Best Environmental Management Practices (BEMPs) is proposed to systematically identify and improve the most environmentally damaging supply chains across retail assortments. Widespread third party environmental certification is the most transparent and verifiable mechanism of improvement but may not be appropriate for some supply chains. The enforcement of retailer-defined environmental requirements, and supplier improvement programmes based on performance benchmarking and dissemination of better management practices, are alternative BEMPs that may be used in combination with third party certification. Facilitating consumer selection of frontrunner ecological products is a lower priority BEMP owing to the well documented limitations of this approach. From available data, the highest current or credible-target sales shares of products improved according to the highest priority BEMP and environmental protection level were used to derive "benchmarks of excellence" for each of the 14 product groups. The assessment framework is demonstrated through application to three retailers. Copyright © 2012 Elsevier Ltd. All rights reserved.

A tale of four practices.

PubMed

Miller-Day, Michelle; Applequist, Janelle; Zabokrtsky, Keri; Dalton, Alexandra; Kellom, Katherine; Gabbay, Robert; Cronholm, Peter F

2017-09-18

Purpose The Patient-Centered Medical Home (PCMH) has become a dominant model of primary care re-design. This transformation presents a challenge to many care delivery organizations. The purpose of this paper is to describe attributes shaping successful and unsuccessful practice transformation within four medical practice groups. Design/methodology/approach As part of a larger study of 25 practices transitioning into a PCMH, the current study focused on diabetes care and identified high- and low-improvement medical practices in terms of quantitative patient measures of glycosylated hemoglobin and qualitative assessments of practice performance. A subset of the top two high-improvement and bottom two low-improvement practices were identified as comparison groups. Semi-structured interviews were conducted with diverse personnel at these practices to investigate their experiences with practice transformation and data were analyzed using analytic induction. Findings Results show a variety of key attributes facilitating more successful PCMH transformation, such as empanelment, shared goals and regular meetings, and a clear understanding of PCMH transformation purposes, goals, and benefits, providing care/case management services, and facilitating patient reminders. Several barriers also exist to successful transformation, such as low levels of resources to handle financial expense, lack of understanding PCMH transformation purposes, goals, and benefits, inadequate training and management of technology, and low team cohesion. Originality/value Few studies qualitatively compare and contrast high and low performing practices to illuminate the experience of practice transformation. These findings highlight the experience of organizational members and their challenges in practice transformation while providing quality diabetes care.

How Quality Improvement Practice Evidence Can Advance the Knowledge Base.

PubMed

OʼRourke, Hannah M; Fraser, Kimberly D

2016-01-01

Recommendations for the evaluation of quality improvement interventions have been made in order to improve the evidence base of whether, to what extent, and why quality improvement interventions affect chosen outcomes. The purpose of this article is to articulate why these recommendations are appropriate to improve the rigor of quality improvement intervention evaluation as a research endeavor, but inappropriate for the purposes of everyday quality improvement practice. To support our claim, we describe the differences between quality improvement interventions that occur for the purpose of practice as compared to research. We then carefully consider how feasibility, ethics, and the aims of evaluation each impact how quality improvement interventions that occur in practice, as opposed to research, can or should be evaluated. Recommendations that fit the evaluative goals of practice-based quality improvement interventions are needed to support fair appraisal of the distinct evidence they produce. We describe a current debate on the nature of evidence to assist in reenvisioning how quality improvement evidence generated from practice might complement that generated from research, and contribute in a value-added way to the knowledge base.

Interorganisational Integration: Healthcare Professionals’ Perspectives on Barriers and Facilitators within the Danish Healthcare System

PubMed Central

Godtfredsen, Nina Skavlan; Frølich, Anne

2016-01-01

Introduction: Despite many initiatives to improve coordination of patient pathways and intersectoral cooperation, Danish health care is still fragmented, lacking intra- and interorganisational integration. This study explores barriers to and facilitators of interorganisational integration as perceived by healthcare professionals caring for patients with chronic obstructive pulmonary disease within the Danish healthcare system. Methods: Seven focus groups were conducted in January through July 2014 with 21 informants from general practice, local healthcare centres and a pulmonary department at a university hospital in the Capital Region of Denmark. Results and discussion: Our results can be grouped into five influencing areas for interorganisational integration: communication/information transfer, committed leadership, patient engagement, the role and competencies of the general practitioner and organisational culture. Proposed solutions to barriers in each area hold the potential to improve care integration as experienced by individuals responsible for supporting and facilitating it. Barriers and facilitators to integrating care relate to clinical, professional, functional and normative integration. Especially, clinical, functional and normative integration seems fundamental to developing integrated care in practice from the perspective of healthcare professionals. PMID:27616948

Implementing Instructional Practices to Improve American Indian and Alaska Native Students' Reading Outcomes: An Exploration of Patterns across Teacher, Classroom, and School Characteristics

ERIC Educational Resources Information Center

Vincent, Claudia; Tobin, Tary; Van Ryzin, Mark

2017-01-01

The Native Community strongly recommends integrating Native language and culture (NLC) into reading instruction to improve outcomes for American Indian/Alaska Native (AI/AN) students. However, little is known about the extent to which recommended practices are used and what might facilitate their implementation. The National Indian Education Study…

Improving Nutrition and Physical Activity Policies and Practices in Early Care and Education in Three States, 2014-2016.

PubMed

Smith, Teresa M; Blaser, Casey; Geno-Rasmussen, Cristy; Shuell, Julie; Plumlee, Catherine; Gargano, Tony; Yaroch, Amy L

2017-08-31

The National Early Care and Education Learning Collaboratives (ECELC) project aims to facilitate best practices in nutrition, physical activity, screen time, and breastfeeding support and infant feeding among early care and education (ECE) programs across multiple states. The project uses a train-the-trainer approach with 5, in-person learning-collaborative sessions, technical assistance, and action planning. We describe the longitudinal practice-based evaluation of the project and assess whether ECE programs evaluated (n = 104) sustained changes in policies and practices 1 year after completing the project. The number of best practices increased from pre-assessment to post-assessment (P < .01) but did not change significantly from post-assessment to follow-up assessment. ECELC shows promise as an approach to incorporate professional development and training focused on improving best practices for environment-level child nutrition and physical activity, which is one strategy among many that are warranted for obesity prevention in young children.

Barriers and Facilitators to Implementing a Change Initiative in Long-Term Care Using the INTERACT® Quality Improvement Program.

PubMed

Tappen, Ruth M; Wolf, David G; Rahemi, Zahra; Engstrom, Gabriella; Rojido, Carolina; Shutes, Jill M; Ouslander, Joseph G

Implementation of major organizational change initiatives presents a challenge for long-term care leadership. Implementation of the INTERACT® (Interventions to Reduce Acute Care Transfers) quality improvement program, designed to improve the management of acute changes in condition and reduce unnecessary emergency department visits and hospitalizations of nursing home residents, serves as an example to illustrate the facilitators and barriers to major change in long-term care. As part of a larger study of the impact of INTERACT® on rates of emergency department visits and hospitalizations, staff of 71 nursing homes were called monthly to follow-up on their progress and discuss successful facilitating strategies and any challenges and barriers they encountered during the yearlong implementation period. Themes related to barriers and facilitators were identified. Six major barriers to implementation were identified: the magnitude and complexity of the change (35%), instability of facility leadership (27%), competing demands (40%), stakeholder resistance (49%), scarce resources (86%), and technical problems (31%). Six facilitating strategies were also reported: organization-wide involvement (68%), leadership support (41%), use of administrative authority (14%), adequate training (66%), persistence and oversight on the part of the champion (73%), and unfolding positive results (14%). Successful introduction of a complex change such as the INTERACT® quality improvement program in a long-term care facility requires attention to the facilitators and barriers identified in this report from those at the frontline.

Measures to Improve Diagnostic Safety in Clinical Practice.

PubMed

Singh, Hardeep; Graber, Mark L; Hofer, Timothy P

2016-10-20

Timely and accurate diagnosis is foundational to good clinical practice and an essential first step to achieving optimal patient outcomes. However, a recent Institute of Medicine report concluded that most of us will experience at least one diagnostic error in our lifetime. The report argues for efforts to improve the reliability of the diagnostic process through better measurement of diagnostic performance. The diagnostic process is a dynamic team-based activity that involves uncertainty, plays out over time, and requires effective communication and collaboration among multiple clinicians, diagnostic services, and the patient. Thus, it poses special challenges for measurement. In this paper, we discuss how the need to develop measures to improve diagnostic performance could move forward at a time when the scientific foundation needed to inform measurement is still evolving. We highlight challenges and opportunities for developing potential measures of "diagnostic safety" related to clinical diagnostic errors and associated preventable diagnostic harm. In doing so, we propose a starter set of measurement concepts for initial consideration that seem reasonably related to diagnostic safety and call for these to be studied and further refined. This would enable safe diagnosis to become an organizational priority and facilitate quality improvement. Health-care systems should consider measurement and evaluation of diagnostic performance as essential to timely and accurate diagnosis and to the reduction of preventable diagnostic harm.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

How improving practice relationships among clinicians and nonclinicians can improve quality in primary care.

PubMed

Lanham, Holly J; McDaniel, Reuben R; Crabtree, Benjamin F; Miller, William L; Stange, Kurt C; Tallia, Alfred F; Nutting, Paula

2009-09-01

Understanding the role of relationships health care organizations (HCOs) offers opportunities for shaping health care delivery. When quality is treated as a property arising from the relationships within HCOs, then different contributors of quality can be investigated and more effective strategies for improvement can be developed. Data were drawn from four large National Institutes of Health (NIH)-funded studies, and an iterative analytic strategy and a grounded theory approach were used to understand the characteristics of relationships within primary care practices. This multimethod approach amassed rich and comparable data sets in all four studies, which were all aimed at primary care practice improvement. The broad range of data included direct observation of practices during work activities and of patient-clinician interactions, in-depth interviews with physicians and other key staff members, surveys, structured checklists of office environments, and chart reviews. Analyses focused on characteristics of relationships in practices that exhibited a range of success in achieving practice improvement. Complex adaptive systems theory informed these analyses. Trust, mindfulness, heedfulness, respectful interaction, diversity, social/task relatedness, and rich/lean communication were identified as important in practice improvement. A model of practice relationships was developed to describe how these characteristics work together and interact with reflection, sensemaking, and learning to influence practice-level quality outcomes. Although this model of practice relationships was developed from data collected in primary care practices, which differ from other HCOs in some important ways, the ideas that quality is emergent and that relationships influence quality of care are universally important for all HCOs and all medical specialties.

The Resourceful Facilitator: Teacher Leaders Constructing Identities as Facilitators of Teacher Peer Groups

ERIC Educational Resources Information Center

Allen, David

2016-01-01

The use of teacher peer groups is a prevalent strategy for school-based professional development and instructional improvement. Facilitation of such groups is an increasingly vital dimension of teacher leadership as a component of school improvement efforts. Drawing on a qualitative study of facilitation of teacher peer groups, the article…

Distinguished Practices of Distinguished Schools.

ERIC Educational Resources Information Center

Council for American Private Education, Germantown, MD.

The Blue Ribbon Schools (BRS) program was designed in 1982 with three purposes in mind: to identify and recognize outstanding schools; to provide schools a tool and criteria for self-assessment and improvement; and to facilitate the sharing of best practices among schools. This book presents profiles and best practices of 12 elementary, 2 middle,…

The role of retrieval practice in memory and analogical problem-solving.

PubMed

Hostetter, Autumn B; Penix, Elizabeth A; Norman, Mackenzie Z; Batsell, W Robert; Carr, Thomas H

2018-05-01

Retrieval practice (e.g., testing) has been shown to facilitate long-term retention of information. In two experiments, we examine whether retrieval practice also facilitates use of the practised information when it is needed to solve analogous problems. When retrieval practice was not limited to the information most relevant to the problems (Experiment 1), it improved memory for the information a week later compared with copying or rereading the information, although we found no evidence that it improved participants' ability to apply the information to the problems. In contrast, when retrieval practice was limited to only the information most relevant to the problems (Experiment 2), we found that retrieval practice enhanced memory for the critical information, the ability to identify the schematic similarities between the two sources of information, and the ability to apply that information to solve an analogous problem after a hint was given to do so. These results suggest that retrieval practice, through its effect on memory, can facilitate application of information to solve novel problems but has minimal effects on spontaneous realisation that the information is relevant.

Do Clinical Practice Guidelines Improve Quality?

PubMed

Baldassari, Cristina M

2017-07-01

Controversy exists surrounding how to best define and assess quality in the health care setting. Clinical practice guidelines (CPGs) have been developed to improve the quality of medical care by highlighting key clinical recommendations based on recent evidence. However, data linking CPGs to improvements in outcomes in otolaryngology are lacking. Numerous barriers contribute to difficulties in translating CPGs to improvements in quality. Future initiatives are needed to improve CPG adherence and define the impact of CPG recommendations on the quality of otolaryngologic care provided to our patients.

How Improving Practice Relationships Among Clinicians and Nonclinicians Can Improve Quality in Primary Care

PubMed Central

Lanham, Holly J.; McDaniel, Reuben R.; Crabtree, Benjamin F.; Miller, William L.; Stange, Kurt C.; Tallia, Alfred F.; Nutting, Paul A.

2010-01-01

Background Understanding the role of relationships in health care organizations (HCOs) offers opportunities for shaping health care delivery. When quality is treated as a property arising from the relationships within HCOs, then different contributors of quality can be investigated and more effective strategies for improvement can be developed. Methods Data were drawn from four large National Institutes of Health (NIH)–funded studies, and an iterative analytic strategy and a grounded theory approach were used to understand the characteristics of relationships within primary care practices. This multimethod approach amassed rich and comparable data sets in all four studies, which were all aimed at primary care practice improvement. The broad range of data included direct observation of practices during work activities and of patient-clinician interactions, in-depth interviews with physicians and other key staff members, surveys, structured checklists of office environments, and chart reviews. Analyses focused on characteristics of relationships in practices that exhibited a range of success in achieving practice improvement. Complex adaptive systems theory informed these analyses. Findings Trust, mindfulness, heedfulness, respectful interaction, diversity, social/task relatedness, and rich/lean communication were identified as important in practice improvement. A model of practice relationships was developed to describe how these characteristics work together and interact with reflection, sensemaking, and learning to influence practice-level quality outcomes. Discussion Although this model of practice relationships was developed from data collected in primary care practices, which differ from other HCOs in some important ways, the ideas that quality is emergent and that relationships influence quality of care are universally important for all HCOs and all medical specialties. PMID:19769206

Improving communication between health-care professionals and patients with limited English proficiency in the general practice setting.

PubMed

Attard, Melanie; McArthur, Alexa; Riitano, Dagmara; Aromataris, Edoardo; Bollen, Chris; Pearson, Alan

2015-01-01

Quality service provision and patient safety and satisfaction in encounters with health-care professionals relies on effective communication between the practitioner and patient. This study aimed to identify effective practices for improving communication between clinical staff in general practice and patients with limited English proficiency, and to promote their implementation in general practice. Effective interventions and strategies were identified from a review of international research. Experiences with their use in practice were explored via focus group discussions with general practitioners and practice nurses. The results suggest that, wherever possible, communication in the patient's primary language is preferable; use of a qualified medical interpreter should be promoted, and practices should have a standardised and documented procedure for accessing interpreter services. General practice staff must increase their awareness about services that are available to facilitate communication with patients with limited English proficiency, and also develop attitudes, both individual and organisational, that will maximise the effectiveness of these strategies. These findings were used to develop brief, evidence-based practice guidelines that were disseminated to focus group participants for evaluation of utility and general feedback. This evidence-based guidance is now available to assist clinical and administrative general practice staff across regional and metropolitan South Australia.

Improving Mental Health Reporting Practices in Between Personnel Security Investigations

DTIC Science & Technology

2017-06-01

Improving Mental Health Reporting Practices in Between Personnel Security Investigations Stephanie L. Jaros Donna L. Tadle David Ciani Keith B...2017 Improving Mental Health Reporting Practices in Between Personnel Security Investigations Stephanie L. Jaros, Donna L. Tadle, David Ciani, Keith...COVERED: 4. Improving Mental Health Reporting Practices in Between Personnel Security Investigations 5a. CONTRACT NUMBER: 5b. GRANT NUMBER: 5c

Educating fellows in practice-based learning and improvement and systems-based practice: The value of quality improvement in clinical practice.

PubMed

Carey, William A; Colby, Christopher E

2013-02-01

In 1999, the Accreditation Council for Graduate Medical Education identified 6 general competencies in which all residents must receive training. In the decade since these requirements went into effect, practice-based learning and improvement (PBLI) and systems-based practice (SBP) have proven to be the most challenging competencies to teach and assess. Because PBLI and SBP both are related to quality improvement (QI) principles and processes, we developed a QI-based curriculum to teach these competencies to our fellows. This experiential curriculum engaged our fellows in our neonatal intensive care unit's (NICU's) structured QI process. After identifying specific patient outcomes in need of improvement, our fellows applied validated QI methods to develop evidence-based treatment protocols for our neonatal intensive care unit. These projects led to immediate and meaningful improvements in patient care and also afforded our fellows various means by which to demonstrate their competence in PBLI and SBP. Our use of portfolios enabled us to document our fellows' performance in these competencies quite easily and comprehensively. Given the clinical and educational structures common to most intensive care unit-based training programs, we believe that a QI-based curriculum such as ours could be adapted by others to teach and assess PBLI and SBP. Copyright © 2013 Elsevier Inc. All rights reserved.

Improving nuclear envelope dynamics by EBV BFRF1 facilitates intranuclear component clearance through autophagy.

PubMed

Liu, Guan-Ting; Kung, Hsiu-Ni; Chen, Chung-Kuan; Huang, Cheng; Wang, Yung-Li; Yu, Cheng-Pu; Lee, Chung-Pei

2018-02-26

Although a vesicular nucleocytoplasmic transport system is believed to exist in eukaryotic cells, the features of this pathway are mostly unknown. Here, we report that the BFRF1 protein of the Epstein-Barr virus improves vesicular transport of nuclear envelope (NE) to facilitate the translocation and clearance of nuclear components. BFRF1 expression induces vesicles that selectively transport nuclear components to the cytoplasm. With the use of aggregation-prone proteins as tools, we found that aggregated nuclear proteins are dispersed when these BFRF1-induced vesicles are formed. BFRF1-containing vesicles engulf the NE-associated aggregates, exit through from the NE, and putatively fuse with autophagic vacuoles. Chemical treatment and genetic ablation of autophagy-related factors indicate that autophagosome formation and autophagy-linked FYVE protein-mediated autophagic proteolysis are involved in this selective clearance of nuclear proteins. Remarkably, vesicular transport, elicited by BFRF1, also attenuated nuclear aggregates accumulated in neuroblastoma cells. Accordingly, induction of NE-derived vesicles by BFRF1 facilitates nuclear protein translocation and clearance, suggesting that autophagy-coupled transport of nucleus-derived vesicles can be elicited for nuclear component catabolism in mammalian cells.-Liu, G.-T., Kung, H.-N., Chen, C.-K., Huang, C., Wang, Y.-L., Yu, C.-P., Lee, C.-P. Improving nuclear envelope dynamics by EBV BFRF1 facilitates intranuclear component clearance through autophagy.

Room for improvement? Leadership, innovation culture and uptake of quality improvement methods in general practice.

PubMed

Apekey, Tanefa A; McSorley, Gerry; Tilling, Michelle; Siriwardena, A Niroshan

2011-04-01

Leadership and innovation are currently seen as essential elements for the development and maintenance of high-quality care. Little is known about the relationship between leadership and culture of innovation and the extent to which quality improvement methods are used in general practice. This study aimed to assess the relationship between leadership behaviour, culture of innovation and adoption of quality improvement methods in general practice. Self-administered postal questionnaires were sent to general practitioner quality improvement leads in one county in the UK between June and December 2007. The questionnaire consisted of background information, a 12-item scale to assess leadership behaviour, a seven-dimension self-rating scale for culture of innovation and questions on current use of quality improvement tools and techniques. Sixty-three completed questionnaires (62%) were returned. Leadership behaviours were not commonly reported. Most practices reported a positive culture of innovation, featuring relationship most strongly, followed by targets and information but rated lower on other dimensions of rewards, risk and resources. There was a significant positive correlation between leadership behaviour and the culture of innovation (r = 0.57; P < 0.001). Apart from clinical audit and significant event analysis, quality improvement methods were not adopted by most participating practices. Leadership behaviours were infrequently reported and this was associated with a limited culture of innovation in participating general practices. There was little use of quality improvement methods beyond clinical and significant event audit. Practices need support to enhance leadership skills, encourage innovation and develop quality improvement skills if improvements in health care are to accelerate. © 2010 Blackwell Publishing Ltd.

Adapting total quality management for general practice: evaluation of a programme.

PubMed Central

Lawrence, M; Packwood, T

1996-01-01

OBJECTIVE: Assessment of the benefits and limitations of a quality improvement programme based on total quality management principles in general practice over a period of one year (October 1993-4). DESIGN: Questionnaires to practice team members before any intervention and after one year. Three progress reports completed by facilitators at four month intervals. Semistructured interviews with a sample of staff from each practice towards the end of the year. SETTING: 18 self selected practices from across the former Oxford Region. Three members of each practice received an initial residential course and three one day seminars during the year. Each practice was supported by a facilitator from their Medical Audit Advisory Group. MEASURES: Extent of understanding and implementation of quality improvement methodology. Number, completeness, and evaluation of quality improvement projects. Practice team members' attitudes to and involvement in team working and quality improvement. RESULTS: 16 of the 18 practices succeeded in implementing the quality improvement methods. 48 initiatives were considered and staff involvement was broad. Practice members showed increased involvement in, and appreciation of, strategic planning and team working, and satisfaction from improved patients services. 11 of the practices intend to continue with the methodology. The commonest barrier expressed was time. CONCLUSION: Quality improvement programmes based on total quality management principles produce beneficial changes in service delivery and team working in most general practices. It is incompatible with traditional doctor centred practice. The methodology needs to be adapted for primary care to avoid quality improvement being seen as separate from routine activity, and to save time. PMID:10161529

Can experiential-didactic training improve clinical STD practices?

PubMed

Dreisbach, Susan; Devine, Sharon; Fitch, John; Anderson, Teri; Lee, Terry; Rietmeijer, Cornelis; Corbett, Kitty K

2011-06-01

High rates of sexually transmitted diseases (STDs) present an ongoing costly public health challenge. One approach to reduce STD transmission is to increase the number of clinicians adopting the Centers for Disease Control and Prevention's STD Treatment Guidelines. This evaluation assesses the effectiveness of a 3-day experiential and didactic training to translate recommendations into practice by increasing clinician knowledge and skills and helping participants anticipate and overcome barriers to implementation. Between 2001 and 2004, 110 direct care clinicians from 10 states participated in one of 27 standardized 3-day interactive trainings offered by the Denver STD/human immunodeficiency virus (HIV) Prevention Training Center. STD/HIV knowledge and clinical skills were measured before, immediately after, and 6 months after training. Practice patterns were assessed before training and after 6 months. Structural barriers to implementation were identified 6 months post-training. Trainees demonstrated significant post-training gains in mean knowledge scores immediately post-training (P < 0.001) and 6 months post-training (P = 0.002). After 6 months, self-reported mean skill levels remained significantly improved compared to precourse (P < 0.05) for each of 27 skills including STD risk assessment, clinical examination, diagnosis, and treatment. Self-reported improvement in practice patterns was significant for 23 of 35 practices (P < 0.05) 6 months post-training. Participants indicated that inadequate time (52.9%), facilities/equipment (51.5%), and staffing (47.1%) interfered with implementation of recommended practices. Experiential-didactic STD/HIV training can modestly improve knowledge, clinical skills, and implementation of STD recommended practices 6 months after training. Further research is needed to identify the impact of improved clinical practices on STD/HIV transmission.

Barriers and facilitators to using a web-based tool for diagnosis and monitoring of patients with depression: a qualitative study among Danish general practitioners.

PubMed

Krog, Mette Daugbjerg; Nielsen, Marie Germund; Le, Jette Videbæk; Bro, Flemming; Christensen, Kaj Sparle; Mygind, Anna

2018-06-27

Depression constitutes a significant part of the global burden of diseases. General practice plays a central role in diagnosing and monitoring depression. A telemedicine solution comprising a web-based psychometric tool may reduce number of visits to general practice and increase patient empowerment. However, the current use of telemedicine solutions in the field of general practice is limited. This study aims to explore barriers and facilitators to using a web-based version of the Major Depression Inventory (eMDI) for psychometric testing of potentially depressive patients in general practice. Semi-structured individual interviews were conducted with nine general practitioners (GPs) from eight general practices in the Central Denmark Region. All interviewees had previous experience in using the eMDI in general practice. Determinants for using the eMDI were identified in relation to the GPs' capability, opportunity and motivation to change clinical behaviour (the COM-B system). Our results indicate that the main barriers for using the eMDI are related to limitations in the GPs' opportunity in regards to having the time it takes to introduce change. Further, the use of the eMDI seems to be hampered by the time-consuming login process. Facilitating factors included behavioural aspects of capability, opportunity and motivation. The implementation of the eMDI was facilitated by the interviewees' previous familiarity with the paper-based version of the tool. Continued use of the eMDI was facilitated by a time-saving documentation process and motivational factors associated with clinical core values. These factors included perceptions of improved consultation quality and services for patients, improved possibilities for GPs to prioritise their patients and improved possibilities for disease monitoring. Furthermore, the flexible nature of the eMDI allowed the GPs to use the paper-based MDI for patients whom the eMDI was not considered appropriate. Implementation of a

Pharmacists’ views on involvement in pharmacy practice research: Strategies for facilitating participation

PubMed Central

Armour, Carol; Brillant, Martha; Krass, Ines

In order for community pharmacy practice to continue to evolve, pharmacy practice research on potential new services is essential. This requires the active participation of community pharmacists. At present the level of involvement of community pharmacists in pharmacy practice research is minimal. Objectives To ascertain the attitudes of a group of research-experienced community pharmacists towards participating in research; to investigate the barriers and facilitators to participation; to identify potential strategies to increase the involvement of community pharmacists in research. Methods A focus group was conducted with a purposive sample of 11 research-experienced community pharmacists. A pharmacist academic moderated the focus group using a semi-structured interview guide. The participants were asked about their attitudes towards research, previous involvement in research, barriers to their involvement and strategies to overcome these barriers. The session was audio-taped and notes were taken by an observer. Thematic analysis of the notes and audio-tape transcripts was conducted. Results Three themes emerged around pharmacists’ attitudes towards research: pharmacists’ perception of the purpose of research, pharmacists’ motivation for involvement in research, and pharmacists’ desired role in research. Barriers to research participation were grouped into four themes: pharmacists’ mindset, communication, infrastructure (time, money and staff), and skills/knowledge. Strategies to address each of these barriers were suggested. Conclusions Participants recognised the importance of research towards advancing their profession and this was a motivating factor for involvement in research. They perceived their role in research primarily as data collection. A series of practical strategies to overcome the barriers to participation were offered that researchers may wish to consider when promoting research outcomes and designing research projects. PMID:25214919

Facilitation of learning: part 2.

PubMed

Warburton, Tyler; Houghton, Trish; Barry, Debbie

2016-04-27

The previous article in this series of 11, Facilitation of learning: part 1, reviewed learning theories and how they relate to clinical practice. Developing an understanding of these theories is essential for mentors and practice teachers to enable them to deliver evidence-based learning support. This is important given that effective learning support is dependent on an educator who possesses knowledge of their specialist area as well as the relevent tools and methods to support learning. The second domain of the Nursing and Midwifery Council's Standards to Support Learning and Assessment in Practice relates to the facilitation of learning. To fulfil this domain, mentors and practice teachers are required to demonstrate their ability to recognise the needs of learners and provide appropriate support to meet those needs. This article expands on some of the discussions from part 1 of this article and considers these from a practical perspective, in addition to introducing some of the tools that can be used to support learning.

What If? Promising Practices for Improving Schools

ERIC Educational Resources Information Center

Dunn, Rita, Ed.; Griggs, Shirley A., Ed.

2007-01-01

Today, there is little deviation from the standard, business-as-usual practices in the world of education. This book challenges these stale practices and asks the important questions that can improve schools beyond the current state of mediocrity. Written for administrators, supervisors, teachers, parents--even politicians and corporate…

Overcoming the Barriers of Distance: Using Mobile Technology to Facilitate Moderation and Best Practice in Initial Teacher Training

ERIC Educational Resources Information Center

Leggatt, Simon

2016-01-01

This case study describes the development process of a model using readily-available technology to facilitate collaboration, moderation and the dissemination of best practice in initial teacher training in the UK. Students, mentors, tutors and external examiners from a number of educational institutions in a UK, higher education-led Lifelong…

[How to write, how to implement and how to evaluate a practice guideline in order to improve quality of care?].

PubMed

Moret, L; Lefort, C; Terrien, N

2012-11-01

Initiatives of clinical practices improvement have been gradually developing in France for 20 years. Nevertheless, effective implementation of change is still difficult for numerous reasons. The use of clinical practices guidelines is one of the different ways of improvement. It is however necessary to adapt these national guidelines to the specificities of the hospital and the team, to ensure implementation and appropriation by the professionals. These recommendations are thus translated into applicable and concrete standard operating procedures. These documents have to be built by and for the concerned professionals. They are also communication and training tools, precise, directive, uniform in terms of presentation and attractive visually. Once drafted, they have to be distributed widely to the professionals to facilitate implementation. The simple distribution of the recommendations is insufficient to modify the clinical practices and require association of several methods of promotion for an optimal appropriation. How then to make sure of their effective use? Practices evaluation is one of the steps of continuous professional development, including continuous training and analysis of clinical practices by using methods promoted by the "Haute Autorité de santé". One of them is the clinical audit; use of method assessing non-pertinent treatment is interesting too. Analysis of the non-conformities and gaps between theory and practice allows identifying various possible causes (professional, institutional, organizational or personal) in order to implement corrective action plans, in a logic of continuous improvement. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Facilitating interprofessional evidence-based practice in paediatric rehabilitation: development, implementation and evaluation of an online toolkit for health professionals.

PubMed

Glegg, Stephanie M N; Livingstone, Roslyn; Montgomery, Ivonne

2016-01-01

Lack of time, competencies, resources and supports are documented as barriers to evidence-based practice (EBP). This paper introduces a recently developed web-based toolkit designed to assist interprofessional clinicians in implementing EBP within a paediatric rehabilitation setting. EBP theory, models, frameworks and tools were applied or adapted in the development of the online resources, which formed the basis of a larger support strategy incorporating interactive workshops, knowledge broker facilitation and mentoring. The highly accessed toolkit contains flowcharts with embedded information sheets, resources and templates to streamline, quantify and document outcomes throughout the EBP process. Case examples relevance to occupational therapy and physical therapy highlight the utility and application of the toolkit in a clinical paediatric setting. Workshops were highly rated by learners for clinical relevance, presentation level and effectiveness. Eight evidence syntheses have been created and 79 interventions have been evaluated since the strategy's inception in January 2011. The toolkit resources streamlined and supported EBP processes, promoting consistency in quality and presentation of outputs. The online toolkit can be a useful tool to facilitate clinicians' use of EBP in order to meet the needs of the clients and families whom they support. Implications for Rehabilitation A comprehensive online EBP toolkit for interprofessional clinicians is available to streamline the EBP process and to support learning needs regardless of competency level. Multi-method facilitation support, including interactive education, e-learning, clinical librarian services and knowledge brokering, is a valued but cost-restrictive supplement to the implementation of online EBP resources. EBP resources are not one-size-fits-all; targeted appraisal tools, models and frameworks may be integrated to improve their utility for specific sectors, which may limit them for others.

Online strategies to facilitate health-related knowledge transfer: a systematic search and review.

PubMed

Mairs, Katie; McNeil, Heather; McLeod, Jordache; Prorok, Jeanette C; Stolee, Paul

2013-12-01

Health interventions and practices often lag behind the available research, and the need for timely translation of new health knowledge into practice is becoming increasingly important. The objective of this study was to conduct a systematic search and review of the literature on online knowledge translation techniques that foster the interaction between various stakeholders and assist in the sharing of ideas and knowledge within the health field. The search strategy included all published literature in the English language since January 2003 and used the medline, Cumulative Index to Nursing and Allied Health Literature (cinahl), embase and Inspec databases. The results of the review indicate that online strategies are diverse, yet all are applicable in facilitating online health-related knowledge translation. The method of knowledge sharing ranged from use of wikis, discussion forums, blogs, and social media to data/knowledge management tools, virtual communities of practice and conferencing technology - all of which can encourage online health communication and knowledge translation. Online technologies are a key facilitator of health-related knowledge translation. This review of online strategies to facilitate health-related knowledge translation can inform the development and improvement of future strategies to expedite the translation of research to practice. © 2013 Health Libraries Group of CILIP and John Wiley & Sons Ltd.

An Innovative Program to Support Internationally Educated Health Professionals and Their Instructors: Role of the Clinical Practice Facilitator.

PubMed

Daniel, Sylvia; Lee, Annemarie L; Switzer-McIntyre, Sharon; Evans, Cathy

2016-01-01

Internationally educated health professionals immigrating to other countries may experience difficulty in clinical practice, due to linguistic and cultural factors. An important element of bridging is the opportunity for internationally educated health professionals to practice in a clinical environment. To support these health professionals and their clinical instructors, a Clinical Practice Facilitator (CPF) role was created. This study aimed to examine the CPF from internationally educated health professionals and clinical instructors' perspective. A quantitative survey was conducted with two cohorts (2013 and 2015) of internationally educated physical therapists and clinical instructors who were asked about the nature of interaction with CPFs, mentor, and education roles and the benefits and challenges of the role. Thirty-five internationally educated physical therapists and 37 clinical instructors participated and were satisfied with the interaction with CPFs via face-to-face or e-mail communication. There was strong agreement (>80%) that the CPF educator role was to facilitate learner's reflection on clinical practice while the mentor role (>70%) was to answer questions, provide feedback, and investigate clinical concerns and conflicts. There was insufficient time for access to CPFs and resolution of learners' learning needs. There were differences (P = 0.04) in perspective on the benefit of the CPF in assisting with cultural differences. An innovative CPF role provided support encouragement, clinical, and professional advice. There were discordant views regarding the benefits of the CPF role in addressing cultural issues, which requires further examination.

Improving Video Game Development: Facilitating Heterogeneous Team Collaboration through Flexible Software Processes

NASA Astrophysics Data System (ADS)

Musil, Juergen; Schweda, Angelika; Winkler, Dietmar; Biffl, Stefan

Based on our observations of Austrian video game software development (VGSD) practices we identified a lack of systematic processes/method support and inefficient collaboration between various involved disciplines, i.e. engineers and artists. VGSD includes heterogeneous disciplines, e.g. creative arts, game/content design, and software. Nevertheless, improving team collaboration and process support is an ongoing challenge to enable a comprehensive view on game development projects. Lessons learned from software engineering practices can help game developers to increase game development processes within a heterogeneous environment. Based on a state of the practice survey in the Austrian games industry, this paper presents (a) first results with focus on process/method support and (b) suggests a candidate flexible process approach based on Scrum to improve VGSD and team collaboration. Results showed (a) a trend to highly flexible software processes involving various disciplines and (b) identified the suggested flexible process approach as feasible and useful for project application.

Engaging Primary Care Practices in Studies of Improvement: Did You Budget Enough for Practice Recruitment?

PubMed

Fagnan, Lyle J; Walunas, Theresa L; Parchman, Michael L; Dickinson, Caitlin L; Murphy, Katrina M; Howell, Ross; Jackson, Kathryn L; Madden, Margaret B; Ciesla, James R; Mazurek, Kathryn D; Kho, Abel N; Solberg, Leif I

2018-04-01

The methods and costs to enroll small primary care practices in large, regional quality improvement initiatives are unknown. We describe the recruitment approach, cost, and resources required to recruit and enroll 500 practices in the Northwest and Midwest regional cooperatives participating in the Agency for Healthcare Research and Quality (AHRQ)-funded initiative, EvidenceNOW: Advancing Heart Health in Primary Care. The project management team of each cooperative tracked data on recruitment methods used for identifying and connecting with practices. We developed a cost-of-recruitment template and used it to record personnel time and associated costs of travel and communication materials. A total of 3,669 practices were contacted during the 14- to 18-month recruitment period, resulting in 484 enrolled practices across the 6 states served by the 2 cooperatives. The average number of interactions per enrolled practice was 7, with a total of 29,100 hours and a total cost of $2.675 million, or $5,529 per enrolled practice. Prior partnerships predicted recruiting almost 1 in 3 of these practices as contrasted to 1 in 20 practices without a previous relationship or warm hand-off. Recruitment of practices for large-scale practice quality improvement transformation initiatives is difficult and costly. The cost of recruiting practices without existing partnerships is expensive, costing 7 times more than reaching out to familiar practices. Investigators initiating and studying practice quality improvement initiatives should budget adequate funds to support high-touch recruitment strategies, including building trusted relationships over a long time frame, for a year or more. © 2018 Annals of Family Medicine, Inc.

[Quality assurance and quality improvement in medical practice. Part 3: Clinical audit in medical practice].

PubMed

Godény, Sándor

2012-02-05

The first two articles in the series were about the definition of quality in healthcare, the quality approach, the importance of quality assurance, the advantages of quality management systems and the basic concepts and necessity of evidence based medicine. In the third article the importance and basic steps of clinical audit are summarised. Clinical audit is an integral part of quality assurance and quality improvement in healthcare, that is the responsibility of any practitioner involved in medical practice. Clinical audit principally measures the clinical practice against clinical guidelines, protocols and other professional standards, and sometimes induces changes to ensure that all patients receive care according to principles of the best practice. The clinical audit can be defined also as a quality improvement process that seeks to identify areas for service improvement, develop and carry out plans and actions to improve medical activity and then by re-audit to ensure that these changes have an effect. Therefore, its aims are both to stimulate quality improvement interventions and to assess their impact in order to develop clinical effectiveness. At the end of the article key points of quality assurance and improvement in medical practice are summarised.

Prescribe for health. Improving cancer screening in physician practices serving low-income and minority populations.

PubMed

Manfredi, C; Czaja, R; Freels, S; Trubitt, M; Warnecke, R; Lacey, L

1998-01-01

To evaluate a health maintenance organization (HMO)-sponsored intervention to improve cancer screening in private physician practices serving low-income, minority populations. A randomized controlled trial with preintervention and postintervention measurements. Measurements were obtained by abstracting information from independent random samples of medical charts (N = 2316 at preintervention and 2238 at postintervention). Forty-seven primary care physician practices located in low-income and minority urban neighborhoods in Chicago, Ill. Practices were encouraged to adopt an office chart reminder system and to use a patient health maintenance card. Activities to facilitate the adoption of these items and for compliance with cancer screening guidelines included on-site training and start-up assistance visits, a physician continuing medical education seminar, and quality assurance visits with feedback to physicians. The proportions of patients with a chart-documented mammogram, clinical breast examination, Papanicolaou smear, or fecal occult blood slide test in the 2 years before preintervention and postintervention chart abstractions. Between baseline and postintervention, there was a net increase in the proportion of HMO members in the intervention, compared with the control practices, who received in the preceding 2 years a Papanicolaou smear (11.9%) and a fecal occult blood slide test (14.1%). There was a net increase in the proportion of non-HMO patients in the intervention compared with the control practices who received a clinical breast examination (15.3%) and a fecal occult blood slide test (20.2%). Implementation of an HMO-mediated, multicomponent intervention to improve cancer screening was feasible and effective for the Papanicolaou smear, fecal occult blood slide test, and the clinical breast examination, but not for mammography.

Clinical education facilitators: a literature review.

PubMed

Lambert, Veronica; Glacken, Michèle

2005-07-01

The aim of this literature review, set within an Irish context, is to present a broad overview of former and existing clinical support personnel, explore the concept of facilitation and examine what is known about the role of the clinical education facilitator. The importance of providing a supportive clinical environment to enhance clinical teaching and learning is strongly portrayed in the literature. While the past two decades have borne witness to various clinical support personnel, the literature identifies conflicting demands that these personnel face. No suggestions are advanced as to how to overcome these difficulties, which inevitably influence the quality and quantity of their clinical teaching role. An identifiable gap exists over who has prime responsibility for clinical teaching. It is timely that alternative possibilities for organizing clinical teaching are investigated. A new post emerging in practice settings is that of the clinical education facilitator who is meant to be the key linchpin in clinical areas for reducing the theory-practice gap. Relevant literature for this review was sourced using the computerized databases CINAHL, Medline and Synergy. Manual searching of relevant nursing journals and sourcing of secondary references extended the search. Government reports and other relevant documents were obtained through pertinent websites. Papers that explicitly examined the concept of facilitation and explored the posts of clinical education facilitators were included; six research papers were accessed and reviewed. In addition seven non-empirical papers were included. It is clear that considerable lack of role clarity resides over what constitutes clinical facilitation and the role of the clinical facilitator. Thus, it is paramount to strengthen this support role with Irish empirical evidence. A major advantage in having a ward-based clinical education facilitator is the benefit of having access to someone who can concentrate solely on

From recovery programs to recovery-oriented practice? A qualitative study of mental health professionals' experiences when facilitating a recovery-oriented rehabilitation program.

PubMed

Dalum, Helle Stentoft; Pedersen, Inge Kryger; Cunningham, Harry; Eplov, Lene Falgaard

2015-12-01

The recovery model has influenced mental health services and fostered new standards for best practice. However, knowledge about how mental health care professionals (HCPs) experience recovery-oriented programs is sparse. This paper explores HCPs' experiences when facilitating a recovery-oriented rehabilitation program. The research question is how do HCPs experience a change in their attitude and practice when applying recovery-oriented programs? This paper draws on semi-structured in-depth qualitative interviews conducted with 16 HCPs experienced in facilitating a recovery-oriented rehabilitation program in either the USA or Denmark. Three themes emerged from the HCPs' reflections on changes in attitudes and practices: "Hopeful Attitude" captures a change in the HCPs' attitude toward a more positive view on the future for clients' living with mental illness; "A New Focus in the Dialogue With Clients" thematizes how the HCPs focus more on the individual's own goal for recovery rather than disease-induced goals in the dialog with clients; "A Person-Centered Role" comprises a shift in the professional role whereby the HCPs value the client's own ideas in addition to the professional's standards. This study supports the theory of the recovery model by its empirical findings and indications that when facilitating a recovery-oriented program, HCPs experience recovery-oriented changes in their attitude toward life with mental illness, and it alters their professional practice toward a stronger focus on client's own goals during treatment. More studies are needed to further clarify how changes in HCPs' attitudes translate into changes in mental health practices. Copyright © 2015 Elsevier Inc. All rights reserved.

The impact of the `Getting Practical: Improving Practical Work in Science' continuing professional development programme on teachers' ideas and practice in science practical work

NASA Astrophysics Data System (ADS)

Abrahams, Ian; Reiss, Michael J.; Sharpe, Rachael

2014-09-01

Background:Despite the widespread use of practical work in school it has been recognised that more needs to be done to improve its effectiveness in developing conceptual understanding. The 'Getting Practical' CPD (Continuing Professional Development) programme was designed to contribute towards an improvement in the effectiveness of practical work through initiating changes in teachers' predominantly 'hands-on' approach to practical work to one which manifests a more equitable balance between 'hands-on' and 'minds-on'. Purpose:To evaluate the impact of the Getting Practical: Improving Practical Work in Science CPD programme on teachers' ideas and practice in science practical work in primary and secondary schools in England. Programme description:The CPD programme was designed to improve the effectiveness of science practical work in developing conceptual understanding in primary and secondary schools in England. Sample:Ten teachers of primary science and 20 secondary science teachers. Design and methods:The study employed a condensed fieldwork strategy with data collected using interviews, observational field notes and pre- and post-CPD training observations in practical lessons within 30 schools. Results:Whilst the CPD programme was effective in getting teachers to reflect on the ideas associated with the Getting Practical programme, it was much less effective in bringing about changes in actual teaching practice.