Intensive care nurses' perceptions of simulation-based team training for building patient safety in intensive care: a descriptive qualitative study.

PubMed

Ballangrud, Randi; Hall-Lord, Marie Louise; Persenius, Mona; Hedelin, Birgitta

2014-08-01

To describe intensive care nurses' perceptions of simulation-based team training for building patient safety in intensive care. Failures in team processes are found to be contributory factors to incidents in an intensive care environment. Simulation-based training is recommended as a method to make health-care personnel aware of the importance of team working and to improve their competencies. The study uses a qualitative descriptive design. Individual qualitative interviews were conducted with 18 intensive care nurses from May to December 2009, all of which had attended a simulation-based team training programme. The interviews were analysed by qualitative content analysis. One main category emerged to illuminate the intensive care nurse perception: "training increases awareness of clinical practice and acknowledges the importance of structured work in teams". Three generic categories were found: "realistic training contributes to safe care", "reflection and openness motivates learning" and "finding a common understanding of team performance". Simulation-based team training makes intensive care nurses more prepared to care for severely ill patients. Team training creates a common understanding of how to work in teams with regard to patient safety. Copyright © 2014 Elsevier Ltd. All rights reserved.

Why the Interdisciplinary Team Approach Works: Insights from Complexity Science.

PubMed

Ciemins, Elizabeth L; Brant, Jeannine; Kersten, Diane; Mullette, Elizabeth; Dickerson, Dustin

2016-07-01

Although an interdisciplinary approach is considered best practice for caring for patients at the end of life, or in need of palliative care (PC) services, there is growing tension between healthcare organizations' need to contain costs and the provision of this beneficial, yet resource-intensive service. To support the interdisciplinary team (IDT) approach by recognizing organizations, teams, patients, and families as complex adaptive systems, illustrated by a qualitative study of the experiences, roles, and attributes of healthcare professionals (HCPs) who work with patients in need of PC services. In-depth, semi-structured interviews of PC health professionals were conducted, transcribed, and independently reviewed using grounded theory methodology and preliminary interpretations. A combined deductive and inductive iterative qualitative approach was used to identify recurring themes. The study was conducted in a physician-led, not-for-profit, multispecialty integrated health system serving three large, Western, rural states. A purposive sample of 10 HCPs who regularly provide PC services were interviewed. A positive team/patient experience was related to individual attributes, including self-awareness, spirit of inquiry, humility, and comfort with dying. IDT attributes included shared purpose, relational coordination, holistic thinking, trust, and respect for patient autonomy. Professional and personal motivations also contributed to a positive team/patient experience. Interdisciplinary PC teams have the potential to significantly impact patient and team experiences when caring for seriously ill patients. Findings from this study support interventions that focus on relationship building and application of a complex systems theory approach to team development.

Interactional Resources for Quality Improvement: Learning From Participants Through a Qualitative Study.

PubMed

Brooks, Joanna Veazey; Gorbenko, Ksenia; Bosk, Charles

Implementing quality improvement in hospitals requires a multifaceted commitment from leaders, including financial, material, and personnel resources. However, little is known about the interactional resources needed for project implementation. The aim of this analysis was to identify the types of interactional support hospital teams sought in a surgical quality improvement project. Hospital site visits were conducted using a combination of observations, interviews, and focus groups to explore the implementation of a surgical quality improvement project. Twenty-six site visits were conducted between October 2012 and August 2014 at a total of 16 hospitals that agreed to participate. All interviews were recorded, transcribed, and coded for themes using inductive analysis. We interviewed 321 respondents and conducted an additional 28 focus groups. Respondents reported needing the following types of interactional support during implementation of quality improvement interventions: (1) a critical outside perspective on their implementation progress; (2) opportunities to learn from peers, especially around clinical innovations; and (3) external validation to help establish visibility for and commitment to the project. Quality improvement in hospitals is both a clinical endeavor and a social endeavor. Our findings show that teams often desire interactional resources as they implement quality improvement initiatives. In-person site visits can provide these resources while also activating emotional energy for teams, which builds momentum and sustainability for quality improvement work. Policymakers and quality improvement leaders will benefit from developing strategies to maximize interactional learning and feedback for quality improvement teams. Further research should investigate the most effective methods for meeting these needs.

Interactional Resources for Quality Improvement: Learning from Participants through a Qualitative Study

PubMed Central

Brooks, Joanna Veazey; Gorbenko, Ksenia; Bosk, Charles

2017-01-01

BACKGROUND Implementing quality improvement in hospitals requires a multi-faceted commitment from leaders, including financial, material, and personnel resources. However, little is known about the interactional resources needed for project implementation. The aim of this analysis was to identify the types of interactional support hospital teams sought in a surgical quality improvement project. METHODS Hospital site visits were conducted using a combination of observations, interviews, and focus groups to explore the implementation of a surgical quality improvement project. Twenty-six site visits were conducted between October 2012 and August 2014 at a total of 16 hospitals that agreed to participate. All interviews were recorded, transcribed, and coded for themes using inductive analysis. RESULTS We interviewed 321 respondents and conducted an additional 28 focus groups. Respondents reported needing the following types of interactional support during implementation of quality improvement interventions: 1) a critical outside perspective on their implementation progress; 2) opportunities to learn from peers, especially around clinical innovations; and 3) external validation to help establish visibility for and commitment to the project. CONCLUSIONS Quality improvement in hospitals is both a clinical and a social endeavor. Our findings show that teams often desire interactional resources as they implement quality improvement initiatives. In-person site visits can provide these resources while also activating emotional energy for teams, which builds momentum and sustainability for quality improvement work. IMPLICATIONS Policymakers and quality improvement leaders will benefit from developing strategies to maximize interactional learning and feedback for quality improvement teams. Further research should investigate the most effective methods for meeting these needs. PMID:28375951

School Performance Review: Port Arthur Independent School District. A Report from the Texas Performance Review.

ERIC Educational Resources Information Center

Sharp, John

This report provides a performance review of a Texas school district. For the review, investigators interviewed district employees, school-board members, students, parents, business leaders, and representatives from community organizations. The review team also held public forums, conducted focus-group sessions and personal interviews, surveyed…

Factors that Facilitated an Alabama School Assistance Team's Success in a Low-Performing School

ERIC Educational Resources Information Center

Roy, Virginia; Kochan, Frances

2012-01-01

This study investigated the perceived factors that enabled an Alabama School Assistance Team (ASAT) to be effective in helping improve a low performing school. A case study was conducted with the ASATs and the Local Education Agency (LEA) site they served. Data were collected from interviews, documents and observations. The perceptions explored in…

Who is Responsible for Training the Civilian Members of the Provincial Reconstruction Teams (PRTs)

DTIC Science & Technology

2010-05-01

Quoted from an interview conducted by AI. Hemingway , "CORDS: Winning Hearts and Minds in Vietnam," Vietnam Magazine, (February 1994). 82 Brig. Gen Dinh...Team-a model for coordination." Air University Review, July-August 1967. Hemingway , AI. "CORDS: Winning Hearts and Minds in Vietnam." Vietnam Magazine

A synthesis of postfire road treatments for BAER teams: methods, treatment effectiveness, and decisionmaking tools for rehabilitation

Treesearch

Randy B. Foltz; Peter R. Robichaud; Hakjun Rhee

2008-01-01

We synthesized post-fire road treatment information to assist BAER specialists in making road rehabilitation decisions. We developed a questionnaire; conducted 30 interviews of BAER team engineers and hydrologists; acquired and analyzed gray literature and other relevant publications; and reviewed road rehabilitation procedures and analysis tools. Post-fire road...

Observing Engineering Student Teams from the Organization Behavior Perspective Using Linguistic Analysis of Student Reflections and Focus Group Interviews

ERIC Educational Resources Information Center

Kearney, Kerri S.; Damron, Rebecca; Sohoni, Sohum

2015-01-01

This paper investigates group/team development in computer engineering courses at a University in the Central USA from the perspective of organization behavior theory, specifically Tuckman's model of the stages of group development. The investigation, conducted through linguistic analysis of student reflection essays, and through focus group…

Social structures in the operating theatre: how contradicting rationalities and trust affect work.

PubMed

Rydenfält, Christofer; Johansson, Gerd; Larsson, Per Anders; Akerman, Kristina; Odenrick, Per

2012-04-01

This article is a report of a study of how healthcare professionals involved in surgery orientate themselves to their common task, and how this orientation can be affected by the social and organizational context. Previous research indicates that surgical teams are not as cohesive as could be expected and that communication failures frequently occur. However, little is known about how these problems are related to their social, cultural and organizational context. Semi-structured interviews were conducted with 15 healthcare professionals, representing all personnel categories of the surgical team. During the interview, a virtual model, visualizing a real operating theatre, was used to facilitate reflection. The interviews were conducted in 2009. Themes were created from the interviews, with a focus on similarities and differences. An activity analysis was conducted based on the themes. Poor team functionality and communication failures in the operating theatre can to some degree be explained by differences in activity orientation between professions and by insufficient support from social and organizational structures. Differences in activity orientation resulted in different views between professional groups in their perceptions of work activities, resulting in tension. Insufficient support resulted in communication thresholds that inhibited the sharing of information. Organizing work to promote cross-professional interaction can help the creation of social relations and norms, providing support for a common view. It can also help to decrease communication thresholds and establish stronger relations of trust. How this organization structure should be developed needs to be further investigated. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

Alcohol brief interventions practice following training for multidisciplinary health and social care teams: A qualitative interview study

PubMed Central

Fitzgerald, Niamh; Molloy, Heather; MacDonald, Fiona; McCambridge, Jim

2015-01-01

Introduction and Aims Few studies of the implementation of alcohol brief interventions (ABI) have been conducted in community settings such as mental health, social work and criminal justice teams. This qualitative interview study sought to explore the impact of training on ABI delivery by staff from a variety of such teams. Design and Methods Fifteen semi-structured telephone interviews were carried out with trained practitioners and with managers to explore the use of, perceived need for and approaches to ABI delivery and recording with clients, and compatibility of ABIs with current practice. Interviews were analysed thematically using an inductive approach. Results Very few practitioners reported delivery of any ABIs following training primarily because they felt ABIs to be inappropriate for their clients. According to practitioners, this was either because they drank too much or too little to benefit. Practitioners reported a range of current activities relating to alcohol, and some felt that their knowledge and confidence were improved following training. One practitioner reported ABI delivery and was considered a training success, while expectations of ABIs did not fit with current practice including assessment procedures for the remainder. Discussion and Conclusions Identified barriers to ABI delivery included issues relating to individual practitioners, their teams, current practice and the ABI model. They are likely to be best addressed by strategic team- and setting-specific approaches to implementation, of which training is only one part. [Fitzgerald N, Molloy H, MacDonald F, McCambridge J. Alcohol brief interventions practice following training for multidisciplinary health and social care teams: A qualitative interview study. Drug Alcohol Rev 2015;34:185–93] PMID:25196713

"Think different": a qualitative assessment of commercial innovation for diabetes information technology programs.

PubMed

Rupcic, Sonia; Tamrat, Tigest; Kachnowski, Stan

2012-11-01

This study reviews the state of diabetes information technology (IT) initiatives and presents a set of recommendations for improvement based on interviews with commercial IT innovators. Semistructured interviews were conducted with 10 technology developers, representing 12 of the most successful IT companies in the world. Average interview time was approximately 45 min. Interviews were audio-recorded, transcribed, and entered into ATLAS.ti for qualitative data analysis. Themes were identified through a process of selective and open coding by three researchers. We identified two practices, common among successful IT companies, that have allowed them to avoid or surmount the challenges that confront healthcare professionals involved in diabetes IT development: (1) employing a diverse research team of software developers and engineers, statisticians, consumers, and business people and (2) conducting rigorous research and analytics on technology use and user preferences. Because of the nature of their respective fields, healthcare professionals and commercial innovators face different constraints. With these in mind we present three recommendations, informed by practices shared by successful commercial developers, for those involved in developing diabetes IT programming: (1) include software engineers on the implementation team throughout the intervention, (2) conduct more extensive baseline testing of users and monitor the usage data derived from the technology itself, and (3) pursue Institutional Review Board-exempt research.

High quality diabetes care: testing the effectiveness of strategies of regional implementation teams.

PubMed

Drach-Zahavy, Anat; Shadmi, Efrat; Freund, Anat; Goldfracht, Margalit

2009-01-01

The purpose of this article is to identify and test the effectiveness of work strategies employed by regional implementation teams to attain high quality care for diabetes patients. The study was conducted in a major health maintenance organization (HMO) that provides care for 70 per cent of Israel's diabetes patients. A sequential mixed model design, combining qualitative and quantitative methods was employed. In-depth interviews were conducted with members of six regional implementation teams, each responsible for the care of 25,000-34,000 diabetic patients. Content analysis of the interviews revealed that teams employed four key strategies: task-interdependence, goal-interdependence, reliance on top-down standardised processes and team-learning. These strategies were used to predict the mean percentage performance of eight evidence-based indicators of diabetes care: percentage of patients with HbA1c < 7 per cent, blood pressure < or = 130/80 and cholesterol < or = 100; and performance of: HbA1c tests, LDL cholesterol tests, blood pressure measurements, urine protein tests, and ophthalmic examinations. Teams were found to vary in their use of the four strategies. Mixed linear models analysis indicated that type of indicator (simple process, compound process, and outcome) and goal interdependence were significantly linked to team effectiveness. For simple-process indicators, reliance on top-down standardised processes led to team effectiveness, but for outcome measures this strategy was ineffective, and even counter-effective. For outcome measures, team-learning was more beneficial. The findings have implications for the management of chronic diseases. The advantage of allowing team members flexibility in the choice of the best work strategy to attain high quality diabetes care is attested.

Western Kentucky University: Documentation of the Teachers for a New Era Learning Network. Case Study

ERIC Educational Resources Information Center

Academy for Educational Development, 2012

2012-01-01

The Academy for Educational Development (AED) sent a research team to Western Kentucky University (WKU) on June 19-20, 2008 to conduct interviews with individuals who play important roles in the university's teacher preparation program (see Appendix A). These interviews, along with additional documentation provided by WKU and identified by the AED…

Montclair State University: Documentation of the Teachers for a New Era Learning Network. Case Study

ERIC Educational Resources Information Center

Academy for Educational Development, 2009

2009-01-01

The Academy for Educational Development (AED) sent a research team to Montclair State University (MSU) on September 25-26, 2008 to conduct interviews with individuals who play important roles in the university's teacher preparation program. These interviews, along with additional documentation provided by MSU and identified by the AED research…

Jackson State University: Documentation of the Teachers for a New Era Learning Network. Case Study

ERIC Educational Resources Information Center

Academy for Educational Development, 2009

2009-01-01

The Academy for Educational Development (AED) sent a research team to Jackson State University (JSU) on October 13-14, 2008 to conduct interviews with individuals who play important roles in the university's teacher preparation program (see Appendix A). These interviews, along with additional documentation provided by JSU and identified by the AED…

Children Achieving: Philadelphia's Education Reform. A Second-Year Evaluation. Executive Summary. Progress Report Series 1996-97.

ERIC Educational Resources Information Center

Consortium for Policy Research in Education, Philadelphia, PA.

The 1996-97 school year was the second year of the Children Achieving reform initiative in Philadelphia (Pennsylvania). This summary describes findings from this second-year evaluation. The evaluation team conducted interviews and observations in 21 schools and 14 clusters, interviewing education reform leaders in the school district and…

Indiana State University: Documentation of the Teachers for a New Era Learning Network. Case Study

ERIC Educational Resources Information Center

Academy for Educational Development, 2009

2009-01-01

The Academy for Educational Development (AED) sent a research team to Indiana State University (ISU) on November 11-12, 2008 to conduct interviews with individuals who play important roles in the university's teacher preparation program. Based upon the nine case studies, the AED research team will prepare a cross-case study that will document and…

Family physicians' perspectives on interprofessional teamwork: Findings from a qualitative study.

PubMed

Szafran, Olga; Torti, Jacqueline M I; Kennett, Sandra L; Bell, Neil R

2018-03-01

The aim of this study was to describe family physicians' perspectives of their role in the primary care team and factors that facilitate and hinder teamwork. A qualitative study was conducted employing individual interviews with 19 academic/community-based family physicians who were part of interprofessional primary care teams in Edmonton, Alberta, Canada. Professional responsibilities and roles of physicians within the team and the facilitators and barriers to teamwork were investigated. Interviews were audiotaped, transcribed and analysed for emerging themes. The study findings revealed that family physicians consistently perceived themselves as having the leadership role on in the primary care team. Facilitators of teamwork included: communication; trust and respect; defined roles/responsibilities of team members; co-location; task shifting to other health professionals; and appropriate payment mechanisms. Barriers to teamwork included: undefined roles/responsibilities; lack of space; frequent staff turnover; network boundaries; and a culture of power and control. The findings suggest that moving family physicians toward more integrative and interdependent functioning within the primary care team will require overcoming the culture of traditional professional roles, addressing facilitators and barriers to teamwork, and providing training in teamwork.

African leaders' views on critical human resource issues for the implementation of family medicine in Africa.

PubMed

Moosa, Shabir; Downing, Raymond; Essuman, Akye; Pentz, Stephen; Reid, Stephen; Mash, Robert

2014-01-17

The World Health Organisation has advocated for comprehensive primary care teams, which include family physicians. However, despite (or because of) severe doctor shortages in Africa, there is insufficient clarity on the role of the family physician in the primary health care team. Instead there is a trend towards task shifting without thought for teamwork, which runs the risk of dangerous oversimplification. It is not clear how African leaders understand the challenges of implementing family medicine, especially in human resource terms. This study, therefore, sought to explore the views of academic and government leaders on critical human resource issues for implementation of family medicine in Africa. In this qualitative study, key academic and government leaders were purposively selected from sixteen African countries. In-depth interviews were conducted using an interview guide. All interviews were audio-recorded, transcribed and thematically analysed. There were 27 interviews conducted with 16 government and 11 academic leaders in nine Sub-Saharan African countries: Botswana, Democratic Republic of Congo, Ghana, Kenya, Malawi, Nigeria, Rwanda, South Africa and Uganda. Respondents spoke about: educating doctors in family medicine suited to Africa, including procedural skills and holistic care, to address the difficulty of recruiting and retaining doctors in rural and underserved areas; planning for primary health care teams, including family physicians; new supervisory models in primary health care; and general human resource management issues. Important milestones in African health care fail to specifically address the human resource issues of integrated primary health care teamwork that includes family physicians. Leaders interviewed in this study, however, proposed organising the district health system with a strong embrace of family medicine in Africa, especially with regard to providing clinical leadership in team-based primary health care. Whilst these leaders focussed positively on entry and workforce issues, in terms of the 2006 World Health Report on human resources for health, they did not substantially address retention of family physicians. Family physicians need to respond to the challenge by respondents to articulate human resource policies appropriate to Africa, including the organisational development of the primary health care team with more sophisticated skills and teamwork.

Pretesting Qualitative Data Collection Procedures to Facilitate Methodological Adherence and Team Building in Nigeria.

PubMed

Hurst, Samantha; Arulogun, Oyedunni S; Owolabi, Ayowa O; Akinyemi, Rufus; Uvere, Ezinne; Warth, Stephanie; Ovbiagele, Bruce

Qualitative methods are becoming widely used and increasingly accepted in biomedical research involving teams formed by experts from developing and developed practice environments. Resources are rare in offering guidance on how to surmount challenges of team integration and resolution of complicated logistical issues in a global setting. In this article we present a critical reflection of lessons learned and necessary steps taken to achieve methodological coherence and international team synergy. A series of 10 pretest interviews were conducted to assess instrumentation rigor and formulate measures to address any limitations or threats to bias and management procedures before carrying out the formal phase of qualitative research, contributing to an evidence-based stroke-preventive care clinical trial study. The experience of pretesting notably helped to identify obstacles and thus increase the methodological and social reliability central to conducting credible qualitative research, while also ensuring both personal and professional fulfillment of our team members.

Patients' and clinicians' experiences of wound care in Canada: a descriptive qualitative study.

PubMed

Woo, K Y; Wong, J; Rice, K; Coelho, S; Haratsidis, E; Teague, L; Rac, V E; Krahn, M

2017-07-01

This study sought to explore patients' and clinicians' perceptions and experiences with the provision of standard care by a home care nurse alone or by a multidisciplinary wound care team. The interviews were conducted using an in-depth semi structured format; following a funnel idea of starting out broad and narrowing down, ensuring that all the necessary topics were covered by the end of the interview. A purposive sample of 16 patients with different wound types were interviewed to ensure that the data would reflect the range and diversity of treatment and care experience. To reflect the diversity of experiences 12 clinicians from various clinical backgrounds were interviewed. Based on the analysis of the interviews, there are four overarching themes: wound care expertise is required across health-care sectors, psychosocial needs of patients with chronic wounds are key barriers to treatment concordance, structured training, and a well-coordinated multidisciplinary team approach. Results of this qualitative study identified different barriers and facilitators that affect the experiences of community-based wound care.

University of Dayton: Documentation of the Teachers for a New Era Learning Network. Case Study

ERIC Educational Resources Information Center

Academy for Educational Development, 2012

2012-01-01

The Academy for Educational Development (AED) sent a research team to the University of Dayton (UD) on November 5-7, 2008, to conduct interviews with individuals who played significant roles in the university's teacher preparation program (see Appendix A). These interviews, along with additional materials provided by UD and identified by the AED…

University of North Carolina Greensboro: Documentation of the Teachers for a New Era Learning Network. Case Study

ERIC Educational Resources Information Center

Academy for Educational Development, 2009

2009-01-01

The Academy for Educational Development (AED) sent a research team to the University of North Carolina at Greensboro (UNCG) on October 23-24, 2008, to conduct interviews with individuals who play important roles in the university's teacher preparation program. These interviews, along with additional documentation provided by UNCG and identified by…

Community Support for the Public Schools in a Large Metropolitan Area. Final Report.

ERIC Educational Resources Information Center

Smith, Ralph V.; And Others

An extensive survey was conducted in 1965 by a team of white and Negro interviewers in an application of ecological theory to a study of the support relationship between the community and its school system. Findings are based upon interview data from a probability sample of 931 respondents selected from the population of persons 21 years of age…

Creating Indices from the Control Structure Interview Through Data Collapsing and Multidimensional Scaling: Approaches to Data Analysis in Project MITT.

ERIC Educational Resources Information Center

Jovick, Thomas D.

This paper discribes the analysis of data in the Management Implications of Team Teaching Project (MITT). It touches on the interviews conducted with teachers and principals, presents the breadth of information obtained in the questionnaire, and explains how the data were aggregated and how issues were grouped. Information collected in the…

Nurse's perceptions of physiotherapists in critical care team: Report of a qualitative study.

PubMed

Gupte, Pranati; Swaminathan, Narasimman

2016-03-01

Interprofessional relationship plays a major role in effective patient care. Specialized units such as critical care require multidisciplinary care where perception about every members role may affect the delivery of patient care. The objective of this study was to find out nurses' perceptions of the role of physiotherapists in the critical care team. Qualitative study by using semi-structured interview was conducted among the qualified nurses working in the Intensive Care Unit of a tertiary care hospital. The interview consisted of 19 questions divided into 3 sections. Interviews were audio recorded and transcribed. In-depth content analysis was carried out to identify major themes in relation to the research question. Analysis identified five major issues which included role and image of a physiotherapist, effectiveness of treatment, communications, teamwork, and interprofessional relations. Physiotherapists were perceived to be an important member of the critical team with the role of mobilizing the patients. The respondents admitted that there existed limitations in interprofessional relationship. Nurses perceived the role of physiotherapist in the critical care unit as an integral part and agreed on the need for inclusion of therapist multidisciplinary critical care team.

The management of dental caries in primary teeth - involving service providers and users in the design of a trial.

PubMed

Marshman, Zoe; Innes, Nicola; Deery, Chris; Hall, Melanie; Speed, Chris; Douglas, Gail; Clarkson, Jan; Rodd, Helen

2012-08-22

There is a lack of evidence for the effective management of dental caries in children's primary teeth. The trial entitled 'Filling Children's Teeth: Indicated Or Not?' (FiCTION) was designed to examine the clinical and cost effectiveness, in primary dental care, of three different approaches to the management of caries in primary teeth. However, before the FiCTION main trial commenced, a pilot trial was designed. Service provider (dentists and other members of the team including dental nurses and practice managers) and participant (child participants and their parents) involvement was incorporated into the pilot trial. The aim of this study is to describe service providers' and users' perspectives on the pilot trial to identify improvements to the conduct and design of the FiCTION main trial. Qualitative interviews (individual and group) were held with dentists, dental team members, children and parents involved in the FiCTION pilot trial. Individual interviews were held with four dentists and a group interview was held with 17 dental team members. Face-to-face interviews were held with four parents and children (four- to eight-years old) representing the three arms of the trial and five telephone interviews were conducted with parents. All interviews were transcribed verbatim. Framework analysis was used. Overall, service providers, children and parents found the pilot trial to be well conducted and an interesting experience. Service providers highlighted the challenges of adhering to research protocols, especially managing the documentation and undertaking new clinical techniques. They indicated that the time and financial commitments were greater than they had anticipated. Particular difficulties were found recruiting suitable patients within the timeframe. For parents recruitment was apparently more related to trusting their dentist than the content of information packs. While some of the older children understood what a study was, others did not understand or were not aware they were enrolled. The findings provided valuable recommendations to improve the method of recruitment of dental practices and patients, the timing and content of the training, the type of support dentists would value and ways to further engage children and parents in the FiCTION main trial. ISRCTN77044005.

Alcohol brief interventions practice following training for multidisciplinary health and social care teams: a qualitative interview study.

PubMed

Fitzgerald, Niamh; Molloy, Heather; MacDonald, Fiona; McCambridge, Jim

2015-03-01

Few studies of the implementation of alcohol brief interventions (ABI) have been conducted in community settings such as mental health, social work and criminal justice teams. This qualitative interview study sought to explore the impact of training on ABI delivery by staff from a variety of such teams. Fifteen semi-structured telephone interviews were carried out with trained practitioners and with managers to explore the use of, perceived need for and approaches to ABI delivery and recording with clients, and compatibility of ABIs with current practice. Interviews were analysed thematically using an inductive approach. Very few practitioners reported delivery of any ABIs following training primarily because they felt ABIs to be inappropriate for their clients. According to practitioners, this was either because they drank too much or too little to benefit. Practitioners reported a range of current activities relating to alcohol, and some felt that their knowledge and confidence were improved following training. One practitioner reported ABI delivery and was considered a training success, while expectations of ABIs did not fit with current practice including assessment procedures for the remainder. Identified barriers to ABI delivery included issues relating to individual practitioners, their teams, current practice and the ABI model. They are likely to be best addressed by strategic team- and setting-specific approaches to implementation, of which training is only one part. © 2014 The Authors. Drug and Alcohol Review published by Wiley Publishing Asia Pty Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.

Using the CanMEDS roles when interviewing for an ophthalmology residency program.

PubMed

Hamel, Patrick; Boisjoly, Hélène; Corriveau, Christine; Fallaha, Nicole; Lahoud, Salim; Luneau, Katie; Olivier, Sébastien; Rouleau, Jacinthe; Toffoli, Daniela

2007-04-01

To improve the admissions process for the Université de Montréal (UdeM) ophthalmology residency program, the interview structure was modified to encompass the seven CanMEDS roles introduced by the Royal College of Physicians and Surgeons of Canada (RCPSC). These roles include an applicant's abilities as a communicator, collaborator, manager, health advocate, professional, scholar, and medical expert. In this retrospective pilot study, the records of all applicants were reviewed by 8 members of the admissions committee, with a high intraclass correlation coefficient of 0.814. Four 2-person interview teams were then formed. The first 3 groups asked the applicants specific questions based on 2-3 of the CanMEDS roles, marking their impressions of each candidate on a visual analogue scale. The last group answered candidates' questions about the program but assigned no mark. The intraclass correlations for the teams were 0.900, 0.739, and 0.585, demonstrating acceptable interrater reliability for 2 of the teams. Pearson correlation coefficients between groups of interviewers were considered adequate at 0.562, 0.432, and 0.417 (p < 0.05). For each interviewer, the Pearson correlation coefficient between record marking and interview scoring was either not statistically significant or very low. By basing the 2006 interview process on the CanMEDS roles defined by the RCPSC, information was obtained about the candidates that could not have been retrieved by a review of the medical students' records alone. Reliability analysis confirmed that this new method of conducting interviews provided sound and reliable judging and rating consistency between all members of the admissions committee.

Conflicting messages: examining the dynamics of leadership on interprofessional teams.

PubMed

Lingard, Lorelei; Vanstone, Meredith; Durrant, Michele; Fleming-Carroll, Bonnie; Lowe, Mandy; Rashotte, Judy; Sinclair, Lynne; Tallett, Susan

2012-12-01

Despite the importance of leadership in interprofessional health care teams, little is understood about how it is enacted. The literature emphasizes a collaborative approach of shared leadership, but this may be challenging for clinicians working within the traditionally hierarchical health care system. Using case study methodology, the authors collected observation and interview data from five interprofessional health care teams working at teaching hospitals in urban Ontario, Canada. They interviewed 46 health care providers and conducted 139 hours of observation from January 2008 through June 2009. Although the members of the interprofessional teams agreed about the importance of collaborative leadership and discussed ways in which their teams tried to achieve it, evidence indicated that the actual enactment of collaborative leadership was a challenge. The participating physicians indicated a belief that their teams functioned nonhierarchically, but reports from the nonphysician clinicians and the authors' observation data revealed that hierarchical behaviors persisted, even from those who most vehemently denied the presence of hierarchies on their teams. A collaborative approach to leadership may be challenging for interprofessional teams embedded in traditional health care, education, and medical-legal systems that reinforce the idea that physicians sit at the top of the hierarchy. By openly recognizing and discussing the tensions between traditional and interprofessional discourses of collaborative leadership, it may be possible to help interprofessional teams, physicians and clinicians alike, work together more effectively.

Highly effective cystic fibrosis clinical research teams: critical success factors.

PubMed

Retsch-Bogart, George Z; Van Dalfsen, Jill M; Marshall, Bruce C; George, Cynthia; Pilewski, Joseph M; Nelson, Eugene C; Goss, Christopher H; Ramsey, Bonnie W

2014-08-01

Bringing new therapies to patients with rare diseases depends in part on optimizing clinical trial conduct through efficient study start-up processes and rapid enrollment. Suboptimal execution of clinical trials in academic medical centers not only results in high cost to institutions and sponsors, but also delays the availability of new therapies. Addressing the factors that contribute to poor outcomes requires novel, systematic approaches tailored to the institution and disease under study. To use clinical trial performance metrics data analysis to select high-performing cystic fibrosis (CF) clinical research teams and then identify factors contributing to their success. Mixed-methods research, including semi-structured qualitative interviews of high-performing research teams. CF research teams at nine clinical centers from the CF Foundation Therapeutics Development Network. Survey of site characteristics, direct observation of team meetings and facilities, and semi-structured interviews with clinical research team members and institutional program managers and leaders in clinical research. Critical success factors noted at all nine high-performing centers were: 1) strong leadership, 2) established and effective communication within the research team and with the clinical care team, and 3) adequate staff. Other frequent characteristics included a mature culture of research, customer service orientation in interactions with study participants, shared efficient processes, continuous process improvement activities, and a businesslike approach to clinical research. Clinical research metrics allowed identification of high-performing clinical research teams. Site visits identified several critical factors leading to highly successful teams that may help other clinical research teams improve clinical trial performance.

13 CFR 107.305 - Evaluation of license applicants.

Code of Federal Regulations, 2013 CFR

2013-01-01

..., any interviews with the applicant's management team, and the results of background investigations, public record searches, and other due diligence conducted by SBA and other Federal agencies. SBA's evaluation will consider factors including the following: (a) Management qualifications, including...

"The pieces fall into place": the views of three Swedish habilitation teams on conductive education and support of disabled children.

PubMed

Lind, Lena

2003-03-01

A survey concerning how Swedish habilitation staff view the support of disabled children and their families was conducted in 2001. It focused on what support the staff knew about, offered and considered good for the children and parents, and on how they viewed conductive education. Interviews were conducted with 25 team members in three habilitation teams in the south of Sweden. The results show that the support habilitation staff most feel children need is the opportunity to investigate their surroundings, play with other children, meet other children in the same situation and try out different activities. The support that parents are felt to need is mainly aid and housing adaptation, relief, financial help, information, medical knowledge, emotional support and to meet others in the same situation. The staff gave information pertaining to different methods of treatment only if the parents specifically asked for it. What the habilitation teams recommended were contracture prophylaxis, motor skills exercises, riding, swimming, splints, standing shells, surgery, injections and medicines. The habilitation staff were of the opinion that conductive education is focused purely on intensive mobility training.

Disruption or innovation? A qualitative descriptive study on the use of electronic patient-physician communication in patients with advanced cancer.

PubMed

Voruganti, Teja; Husain, Amna; Grunfeld, Eva; Webster, Fiona

2018-03-04

In the advanced cancer context, care coordination is often inadequate, leading to suboptimal continuity of care. We evaluated an electronic web-based tool which assembles the patient, their caregivers, and their healthcare providers in a virtual space for team-based communication. We sought to understand participant perceptions on electronic communication in general and the added value of the new tool in particular. We conducted a qualitative descriptive study with participants (patients, caregivers, cancer physicians) who participated in a 3-month pilot trial evaluating the tool. Interviews were thematically analyzed and the perspectives from patients, caregivers, and cancer physicians were triangulated. Interviews from six patients, five of their caregivers, and seven cancer physicians conducted alongside monthly outcome assessments were analyzed. We identified five themes relating participants' perspectives on electronic communication to their experience of care: (1) apparent gaps in care, (2) uncertainty in defining the circle of care, (3) relational aspects of communication, (4) incongruence between technology and social norms of patient-physician communication, and (5) appreciation but apprehension about the team-based communication tool for improving the experience of care. The potential of tools for electronic communication to bring together a team of healthcare providers with the patient and caregivers is significant but may pose new challenges to existing team structure and interpersonal dynamics. Patients and physicians were worried about the impact that electronic communication may have on the patient-physician relationship. Implementation approaches, which build on the relationship and integrate the team as a whole, could positively position electronic communication to enhance the team-based care.

Expectations and requests regarding team training interventions to promote interdisciplinary collaboration in medical rehabilitation--A qualitative study.

PubMed

Müller, C; Plewnia, A; Becker, S; Rundel, M; Zimmermann, L; Körner, M

2015-08-19

Interdisciplinary teamwork and team interventions are highly valued in the rehabilitation sector because they can improve outcomes of care for persons with complex health problems. However, little is known about expectations and requests regarding team interventions, especially in medical rehabilitation. This study aimed to explore how clinical managers and health professionals within multidisciplinary rehabilitation teams describe their expectations and requests regarding team-training interventions in the field of medical rehabilitation. Considering the methodology of qualitative research, data were collected using semi-structured interviews and focus groups at five rehabilitation clinics in Germany. We conducted face-to-face interviews with 5 clinical managers and 13 department heads of health care teams as well as five focus groups with a total of 35 members of interdisciplinary rehabilitation teams. Afterwards, the data were analyzed through qualitative content analysis encompassing data coding and using inductive thematic analysis. The exploration of team members' and clinical managers' descriptions showed that, to them, interdisciplinary team training programs should include a wide array of training contents. Seven common core themes emerged from the interviews, including participation of employees, leadership, communication, team meetings, team composition, coordination, and equal esteem. Additionally, 13 themes were identified by either managers or team members. The body of expectations regarding team training content in healthcare spans the continuum of changes on the team and organizational levels. On the organizational level, a number of structural factors were mentioned (e.g. improving the general conditions for team meetings, organized workshops to exchange interdisciplinary experiences, and leadership training), and on the team level, changes in procedural factors were listed (e.g. optimizing the consecutive planning and coordination of patient treatments, clarity with regard to roles and responsibilities of team members, and mutual esteem and appreciation between different professions). The synthesis underscores that there is meaningful heterogeneity in team training needs; training interventions should be locally adapted for each clinic in terms of training content and training strategies. Tailored team interventions are important for rehabilitation clinics. Future work should evaluate employed team training concepts over time as well as training contents, implementation strategies, and learning outcomes. This includes using robust study designs and evaluating team-training effects.

Teamwork and team decision-making at multidisciplinary cancer conferences: barriers, facilitators, and opportunities for improvement.

PubMed

Lamb, Benjamin W; Sevdalis, Nick; Arora, Sonal; Pinto, Anna; Vincent, Charles; Green, James S A

2011-09-01

Anecdotally, multidisciplinary cancer conferences (MCCs) do not always function optimally. MCC members' experiences with and attitudes toward MCCs are explored, and barriers to and facilitators of effective team-working are identified. A total of 19 semistructured interviews were conducted with surgeons, oncologists, nurses, and administrators. Interviews explored participants' opinions on MCC attendance, information presentation, case discussion, leadership, team decision-making, and possible improvements to MCC meetings. Nonattendance was associated with not having protected time to attend the MCC. Contributions to MCC discussions were unequal among the participants, and patient-centered information was ignored. Good leadership was necessary to foster inclusive case discussion. Members were positive about MCCs, but protected time, improved case selection, and working in a more structured way were possible improvements. Results are consistent with previous research: Members of the MCC are positive about the benefits of MCCs, although improving the way MCCs work is a goal.

Interdiscplinary team processes within an in-home service delivery organization.

PubMed

Gantert, Thomas W; McWilliam, Carol L

2004-01-01

Interdisciplinary teamwork is particularly difficult to achieve in the community context where geographical separateness and solo practices impede face to face contact and collaborative practice. Understanding the processes that occur within interdisciplinary teams is imperative, since client outcomes are influenced by interdisciplinary teamwork. The purpose of this exploratory study was to describe the processes that occur within interdisciplinary teams that deliver in-home care. Applying grounded theory methodology, the researcher conducted unstructured in-depth interviews with a purposeful sample of healthcare providers and used constant comparative analysis to elicit the findings. Findings revealed three key team processes: networking, navigating, and aligning. The descriptions afford several insights that are applicable to in-home healthcare agencies attempting to achieve effective interdisciplinary team functioning.

Distributed leadership in health care teams: Constellation role distribution and leadership practices.

PubMed

Chreim, Samia; MacNaughton, Kate

2016-01-01

Recent literature has been critical of research that adopts a narrow focus on single leaders and on leadership attributes and has called for attention to leadership that is distributed among individuals and to practices in which leaders engage. We conducted a study of health care teams where we attended to role distribution among leadership constellation members and to loose or tight coupling practices between leaders and the remainder of the team. This focus provides insights into how leadership can be practiced and structured to enhance team functioning. A qualitative, multicase study of four teams was conducted. Data collection involved 44 interviews with almost all the members of the teams and 18 team meeting observations. Thematic analysis was conducted by the two authors. Leadership constellations can give rise to leadership role overlaps and gaps that may create ambiguity within teams, ambiguity is diminished if the leaders can agree on which leader assumes ultimate authority in an area, the presence of more leaders does not necessarily entail more comprehensive fulfillment of team needs, and teams' needs for tight or loose leadership practices are influenced by contextual factors that we elaborate. (a) It is important to recognize areas of overlap and gaps in leadership roles and to provide clarity about role boundaries to avoid ambiguity. Role mapping exercises and open discussions should be considered. (b) Attempting to spread formal leadership responsibilities informally among individuals is not always a workable strategy for addressing team needs. (c) Organizations need to examine critically the allocation of resources to leadership activities.

[Multiprofessional family-system training programme in psychiatry--effects on team cooperation and staff strain].

PubMed

Zwack, Julika; Schweitzer, Jochen

2008-01-01

How does the interdisciplinary cooperation of psychiatric staff members change after a multiprofessional family systems training programme? Semi-structured interviews were conducted with 49 staff members. Quantitative questionnaires were used to assess burnout (Maslach Burnout Inventory, MBI) and team climate (Team-Klima-Inventar, TKI). The multiprofessional training intensifies interdisciplinary cooperation. It results in an increased appreciation of the nurses involved and in a redistribution of therapeutic tasks between nurses, psychologists and physicians. Staff burnout decreased during the research period, while task orientation and participative security within teams increased. The multiprofessional family systems training appears suitable to improve quality of patient care and interdisciplinary cooperation and to reduce staff burnout.

Lessons learned from conducting qualitative research in a hospital.

PubMed

Woith, Wendy Mann; Jenkins, Sheryl Henry; Astroth, Kim Schafer; Kennedy, Julie A

2014-11-01

To examine unexpected barriers to the conduct of hospital research during a study of nurses' activation of rapid response teams. We interviewed hospital nurses regarding their decisions to activate rapid response teams and encountered unexpected barriers to the conduct of this study in the hospital setting. Experience of conducting qualitative research with bedside nurses in a community hospital. Review of the reports of others who have conducted hospital research. Barriers related to administrative support, environmental distractors, constraints on nurses' time, apparent lack of investment in research by staff and a cumbersome recruitment process are identified. Recommendations on study site selection, timing of research, gaining access to nurses, scheduling and conducting interviews, and transcribing recorded data are made. As evidence is necessary to deliver safe, quality care, it is important that nurses understand and participate in research. This participation involves not only conducting research, but also serving as subjects. Given the importance of bedside nurses' willingness to engage in research, it is crucial to understand factors that impede or assist their participation. We offer several recommendations to nurses conducting research in hospitals, including: ■ Seek hospitals that are supportive of research, yet not over-invested in the process. ■ Build extra time into data collection schedules to maximize flexibility and accommodate work-place demands. ■ Emphasise the relevance and benefits of the research to nurses.

The management of dental caries in primary teeth - involving service providers and users in the design of a trial

PubMed Central

2012-01-01

Background There is a lack of evidence for the effective management of dental caries in children’s primary teeth. The trial entitled ‘Filling Children’s Teeth: Indicated Or Not?’ (FiCTION) was designed to examine the clinical and cost effectiveness, in primary dental care, of three different approaches to the management of caries in primary teeth. However, before the FiCTION main trial commenced, a pilot trial was designed. Service provider (dentists and other members of the team including dental nurses and practice managers) and participant (child participants and their parents) involvement was incorporated into the pilot trial. The aim of this study is to describe service providers’ and users’ perspectives on the pilot trial to identify improvements to the conduct and design of the FiCTION main trial. Methods Qualitative interviews (individual and group) were held with dentists, dental team members, children and parents involved in the FiCTION pilot trial. Individual interviews were held with four dentists and a group interview was held with 17 dental team members. Face-to-face interviews were held with four parents and children (four- to eight-years old) representing the three arms of the trial and five telephone interviews were conducted with parents. All interviews were transcribed verbatim. Framework analysis was used. Results Overall, service providers, children and parents found the pilot trial to be well conducted and an interesting experience. Service providers highlighted the challenges of adhering to research protocols, especially managing the documentation and undertaking new clinical techniques. They indicated that the time and financial commitments were greater than they had anticipated. Particular difficulties were found recruiting suitable patients within the timeframe. For parents recruitment was apparently more related to trusting their dentist than the content of information packs. While some of the older children understood what a study was, others did not understand or were not aware they were enrolled. Conclusions The findings provided valuable recommendations to improve the method of recruitment of dental practices and patients, the timing and content of the training, the type of support dentists would value and ways to further engage children and parents in the FiCTION main trial. Trial registration ISRCTN77044005 PMID:22913464

How do interprofessional student teams interact in a primary care clinic? A qualitative analysis using activity theory.

PubMed

Kent, Fiona; Francis-Cracknell, Alison; McDonald, Rachael; Newton, Jennifer M; Keating, Jennifer L; Dodic, Miodrag

2016-10-01

Practice based interprofessional education opportunities are proposed as a mechanism for health professionals to learn teamwork skills and gain an understanding of the roles of others. Primary care is an area of practice that offers a promising option for interprofessional student learning. In this study, we investigated what and how students from differing professions learn together. Our findings inform the design of future interprofessional education initiatives. Using activity theory, we conducted an ethnographic investigation of interprofessional education in primary care. During a 5 months period, we observed 14 clinic sessions involving mixed discipline student teams who interviewed people with chronic disease. Teams were comprised of senior medicine, nursing, occupational therapy, pharmacy and physiotherapy entry level students. Semi-structured interviews were also conducted with seven clinical educators. Data were analysed to ascertain the objectives, tools, rules and division of labour. Two integrated activity systems were identified: (1) student teams gathering information to determine patients' health care needs and (2) patients either as health consumers or student educators. Unwritten rules regarding 'shared contribution', 'patient as key information source' and 'time constraints' were identified. Both the significance of software literacy on team leadership, and a pre-determined structure of enquiry, highlighted the importance of careful consideration of the tools used in interprofessional education, and the way they can influence practice. The systems of practice identified provide evidence of differing priorities and values, and multiple perspectives of how to manage health. The work reinforced the value of the patients' voice in clinical and education processes.

Complex collaborative problem-solving processes in mission control.

PubMed

Fiore, Stephen M; Wiltshire, Travis J; Oglesby, James M; O'Keefe, William S; Salas, Eduardo

2014-04-01

NASA's Mission Control Center (MCC) is responsible for control of the International Space Station (ISS), which includes responding to problems that obstruct the functioning of the ISS and that may pose a threat to the health and well-being of the flight crew. These problems are often complex, requiring individuals, teams, and multiteam systems, to work collaboratively. Research is warranted to examine individual and collaborative problem-solving processes in this context. Specifically, focus is placed on how Mission Control personnel-each with their own skills and responsibilities-exchange information to gain a shared understanding of the problem. The Macrocognition in Teams Model describes the processes that individuals and teams undertake in order to solve problems and may be applicable to Mission Control teams. Semistructured interviews centering on a recent complex problem were conducted with seven MCC professionals. In order to assess collaborative problem-solving processes in MCC with those predicted by the Macrocognition in Teams Model, a coding scheme was developed to analyze the interview transcriptions. Findings are supported with excerpts from participant transcriptions and suggest that team knowledge-building processes accounted for approximately 50% of all coded data and are essential for successful collaborative problem solving in mission control. Support for the internalized and externalized team knowledge was also found (19% and 20%, respectively). The Macrocognition in Teams Model was shown to be a useful depiction of collaborative problem solving in mission control and further research with this as a guiding framework is warranted.

What determines successful implementation of inpatient information technology systems?

PubMed

Spetz, Joanne; Burgess, James F; Phibbs, Ciaran S

2012-03-01

To identify the factors and strategies that were associated with successful implementation of hospital-based information technology (IT) systems in US Department of Veterans Affairs (VA) hospitals, and how these might apply to other hospitals. Qualitative analysis of 118 interviews conducted at 7 VA hospitals. The study focused on the inpatient setting, where nurses are the main patient-care providers; thus, the research emphasized the impact of Computerized Patient Record System and Bar Code Medication Administration on nurses. Hospitals were selected to represent a range of IT implementation dates, facility sizes, and geography. The subjects included nurses, pharmacists, physicians, IT staff, and managers. Interviews were guided by a semi-structured interview protocol, and a thematic analysis was conducted, with initial codes drawn from the content of the interview guides. Additional themes were proposed as the coding was conducted. Five broad themes arose as factors which affected the process and success of implementation: (1) organizational stability and implementation team leadership, (2) implementation timelines, (3) equipment availability and reliability, (4) staff training, and (5) changes in work flow Overall IT implementation success in the VA depended on: (1) whether there was support for change from both leaders and staff, (2) development of a gradual and flexible implementation approach, (3) allocation of adequate resources for equipment and infrastructure, hands-on support, and deployment of additional staff, and (4) how the implementation team planned for setbacks, and continued the process to achieve success. Problems that developed in the early stages of implementation tended to become persistent, and poor implementation can lead to patient harm.

Damage and intensity survey

USGS Publications Warehouse

Reagor, G.; Brewer, L.R.

1992-01-01

A field team (the tuhors) from the National Earthquake Information Center (USGS) conducted a damage survey of the epicentral area in the week following the earthquakes. Detailed information about damage and where and how strongly the earthquakes were felt was obtained through interviews with local residents and personal observations. 

A potential role for family members in mental health care delivery: the family community navigation specialist.

PubMed

Myers, Neely Anne Laurenzo; Alolayan, Yazeed; Smith, Kelly; Pope, Susan Alicia; Broussard, Beth; Haynes, Nora; Compton, Michael T

2015-06-01

Opening Doors to Recovery (ODR) in southeast Georgia included a family community navigation specialist (F-CNS) in addition to a peer specialist and a mental health professional. This qualitative study assessed the usefulness of the F-CNS role. Semistructured interviews were conducted with 30 respondents (ten ODR participants with serious mental illnesses; ten family members; and ten ODR leaders and team members, including two F-CNSs). Interviews were recorded and transcribed for qualitative analysis. Many respondents found the F-CNS to be helpful, providing psychosocial support, serving as a communication liaison, and being a team member dedicated to the family. Aspects that might require improvement include insufficient description of the F-CNS role to participants and the limited experience and training of the F-CNSs. The F-CNS represents an unexplored role for family members of persons with serious mental illnesses that may complement the roles of other service providers and strengthen recovery-oriented teams.

Interprofessional collaboration in family health teams

PubMed Central

Goldman, Joanne; Meuser, Jamie; Rogers, Jess; Lawrie, Lynne; Reeves, Scott

2010-01-01

ABSTRACT OBJECTIVE To examine family health team (FHT) members’ perspectives and experiences of interprofessional collaboration and perceived benefits. DESIGN Qualitative case study using semistructured interviews. SETTING Fourteen FHTs in urban and rural Ontario. PARTICIPANTS Purposeful sample of the members of 14 FHTs, including family physicians, nurse practitioners, nurses, dietitians, social workers, pharmacists, and managers. METHODS A multiple case-study approach involving 14 FHTs was employed. Thirty-two semistructured interviews were conducted and data were analyzed by employing an inductive thematic approach. A member-checking technique was also undertaken to enhance the validity of the findings. MAIN FINDINGS Five main themes are reported: rethinking traditional roles and scopes of practice, management and leadership, time and space, interprofessional initiatives, and early perceptions of collaborative care. CONCLUSION This study shows the importance of issues such as roles and scopes of practice, leadership, and space to effective team-based primary care, and provides a framework for understanding different types of interprofessional interventions used to support interprofessional collaboration. PMID:20944025

Medical team training and coaching in the Veterans Health Administration; assessment and impact on the first 32 facilities in the programme.

PubMed

Neily, Julia; Mills, Peter D; Lee, Pamela; Carney, Brian; West, Priscilla; Percarpio, Katherine; Mazzia, Lisa; Paull, Douglas E; Bagian, James P

2010-08-01

Communication is problematic in healthcare. The Veterans Health Administration is implementing Medical Team Training. The authors describe results of the first 32 of 130 sites to undergo the programme. This report is unique; it provides aggregate results of a crew resource-management programme for numerous facilities. Facilities were taught medical team training and implemented briefings, debriefings and other projects. The authors coached teams through consultative phone interviews over a year. Implementation teams self-reported implementation and rated programme impact: 1='no impact' and 5='significant impact.' We used logistic regression to examine implementation of briefing/debriefing. Ninety-seven per cent of facilities implemented briefings and debriefings, and all implemented an additional project. As of the final interview, 73% of OR and 67% of ICU implementation teams self-reported and rated staff impact 4-5. Eighty-six per cent of OR and 82% of ICU implementation teams self-reported and rated patient impact 4-5. Improved teamwork was reported by 84% of OR and 75% of ICU implementation teams. Efficiency improvements were reported by 94% of OR implementation teams. Almost all facilities (97%) reported a success story or avoiding an undesirable event. Sites with lower volume were more likely to conduct briefings/debriefings in all cases for all surgical services (p=0.03). Sites are implementing the programme with a positive impact on patients and staff, and improving teamwork, efficiency and safety. A unique feature of the programme is that implementation was facilitated through follow-up support. This may have contributed to the early success of the programme.

Perspectives of Social Justice Activists: Advocating against Native-Themed Mascots, Nicknames, and Logos

ERIC Educational Resources Information Center

Steinfeldt, Jesse A.; Foltz, Brad D.; LaFollette, Julie R.; White, Mattie R.; Wong, Y. Joel; Steinfeldt, Matthew Clint

2012-01-01

This study investigated perspectives of social justice activists who directly advocate for eliminating Native-themed mascots, nicknames, and logos. Using consensual qualitative research methodology, the research team analyzed transcripts of interviews conducted with 11 social justice activists to generate themes, categories, and domains within the…

Culturally Responsive Pedagogy in Higher Education: A Collaborative Self-Study

ERIC Educational Resources Information Center

Han, Heejeong Sophia; Vomvoridi-Ivanovic, Eugenia; Jacobs, Jennifer; Karanxha, Zorka; Lypka, Andrea; Topdemir, Cindy; Feldman, Allan

2014-01-01

In this article we discuss findings from a collaborative self-study of how seven teacher educators define, enact, and navigate their roles as culturally responsive educators across various programs within a higher education institution. All participants conducted an individual interview with another team member and engaged in prolonged team…

Multi-disciplinary team meetings in stroke rehabilitation: an observation study and conceptual framework.

PubMed

Tyson, S F; Burton, L; McGovern, A

2014-12-01

To explore how multi-disciplinary team meetings operate in stroke rehabilitation. Non-participant observation of multi-disciplinary team meetings and semi-structured interviews with attending staff. Twelve meetings were observed (at least one at each site) and 18 staff (one psychologist, one social worker; four nurses; four physiotherapists four occupational therapists, two speech and language therapists, one stroke co-ordinator and one stroke ward manager) were interviewed in eight in-patient stroke rehabilitation units. Multi-disciplinary team meetings in stroke rehabilitation were complex, demanding and highly varied. A model emerged which identified the main inputs to influence conduct of the meetings were personal contributions of the members and structure and format of the meetings. These were mediated by the team climate and leadership skills of the chair. The desired outputs; clinical decisions and the attributes of apparently effective meetings were identified by the staff. A notable difference between the meetings that staff considered effective and those that were not, was their structure and format. Successful meetings tended to feature a set agenda, structured documentation; formal use of measurement tools; pre-meeting preparation and skilled chairing. These features were often absent in meetings perceived to be ineffective. The main features of operation of multi-disciplinary team meetings have been identified which will enable assessment tools and interventions to improve effectiveness to be developed. © The Author(s) 2014.

Aeronautics Autonomy Testbed Capability (AATC) Team Developed Concepts

NASA Technical Reports Server (NTRS)

Smith, Phillip J.

2018-01-01

In 2015, the National Aeronautics and Space Administration (NASA) formed a multi-center, interdisciplinary team of engineers from three different aeronautics research centers who were tasked with improving NASA autonomy research capabilities. This group was subsequently named the Aeronautics Autonomy Testbed Capability (AATC) team. To aid in confronting the autonomy research directive, NASA contracted IDEO, a design firm, to provide consultants and guides to educate NASA engineers through the practice of design thinking, which is an unconventional method for aerospace design processes. The team then began learning about autonomy research challenges by conducting interviews with a diverse group of researchers and pilots, military personnel and civilians, experts and amateurs. Part of this design thinking process involved developing ideas for products or programs known as concepts that could enable real world fulfillment of the most important latent needs identified through analysis of the interviews. The concepts are intended to be sacrificial, intermediate steps in the design thinking process and are presented in this report to record the efforts of the AATC group. Descriptions are provided in present tense to allow for further ideation and imagining the concept as reality as was attempted during the teams discussions and interviews. This does not indicate that the concepts are actually in practice within NASA though there may be similar existing programs independent of AATC. These concepts were primarily created at two distinct stages during the design thinking process. After the initial interviews, there was a workshop for concept development and the resulting ideas are shown in this work as from the First Round. As part of succeeding interviews, the team members presented the First Round concepts to refine the understanding of existing research needs. This knowledge was then used to generate an additional set of concepts denoted as the Second Round. Some concepts were created by a single person in a few minutes while others were refined by the entire team over several weeks. Thus, certain ideas are more detailed than others but those from the second round are not necessarily more comprehensive than the first round concepts. Primarily, as reported here in the Second Round section, the designs serve to encompass more of the high level end user research needs which were not necessarily known to the team during the prior workshop. In the figures provided throughout this report, illustrations are often provided to represent a concept. Nearly all of the images are informal sketches or renderings and this casualness should, hopefully, not be held to negate the potential insights available within the concepts.

Interprofessional intensive care unit team interactions and medical crises: a qualitative study.

PubMed

Piquette, Dominique; Reeves, Scott; Leblanc, Vicki R

2009-05-01

Research has suggested that interprofessional collaboration could improve patient outcomes in the intensive care unit (ICU). Maintaining optimal interprofessional interactions in a setting where unpredictable medical crises occur periodically is however challenging. Our study aimed to investigate the perceptions of ICU health care professionals regarding how acute medical crises affect their team interactions. We conducted 25 semi-structured interviews of ICU nurses, staff physicians, and respiratory therapists. All interviews were audio-taped and transcribed, and the analysis was undertaken using an inductive thematic approach. Our data indicated that the nature of interprofessional interactions changed as teams passed through three key temporal periods around medical crises. During the "pre-crisis period", interactions were based on the mutual respect of each other's expertise. During the "crisis period", hierarchical interactions were expected and a certain lack of civility was tolerated. During the "post-crisis period", divergent perceptions emerged amongst health professionals. Post-crisis team dispersion left the nurses with questions and emotions not expressed by other team members. Nurses believed that systematic interprofessional feedback sessions held immediately after a crisis could address some of their needs. Further research is needed to establish the possible benefits of strategies addressing ICU health care professionals' specific needs for interprofessional feedback after a medical crisis.

Changes in information behavior in clinical teams after introduction of a clinical librarian service

PubMed Central

Urquhart, Christine; Turner, Janet; Durbin, Jane; Ryan, Jean

2007-01-01

Objectives: The eighteen-month evaluation of a clinical librarian project (October 2003–March 2005) conducted in North Wales, United Kingdom (UK) assessed the benefits of clinical librarian support to clinical teams, the impact of mediated searching services, and the effectiveness of information skills training, including journal club support. Methods: The evaluation assessed changes in teams' information-seeking behavior and their willingness to delegate searching to a clinical librarian. Baseline (n = 69 responses, 73% response rate) and final questionnaire (n = 57, 77% response rate) surveys were complemented by telephone and face-to-face interviews (n = 33) among 3 sites served. Those attending information skills training sessions (n = 130) completed evaluations at the session and were surveyed 1 month after training (n = 24 questionnaire responses, n = 12 interviews). Results: Health professionals in clinical teams reported that they were more willing to undertake their own searching, but also more willing to delegate some literature searching, than at the start of the project. The extent of change depended on the team and the type of information required. Information skills training was particularly effective when organized around journal clubs. Conclusions: Collaboration with a clinical librarian increased clinician willingness to seek information. Clinical librarian services should leverage structured training opportunities such as journal clubs. PMID:17252062

Exploring Context and the Factors Shaping Team-Based Primary Healthcare Policies in Three Canadian Provinces: A Comparative Analysis.

PubMed

Misfeldt, Renée; Suter, Esther; Mallinson, Sara; Boakye, Omenaa; Wong, Sabrina; Nasmith, Louise

2017-08-01

This paper discusses findings from a high-level scan of the contextual factors and actors that influenced policies on team-based primary healthcare in three Canadian provinces: British Columbia, Alberta and Saskatchewan. The team searched diverse sources (e.g., news reports, press releases, discussion papers) for contextual information relevant to primary healthcare teams. We also conducted qualitative interviews with key health system informants from the three provinces. Data from documents and interviews were analyzed qualitatively using thematic analysis. We then wrote narrative summaries highlighting pivotal policy and local system events and the influence of actors and context. Our overall findings highlight the value of reviewing the context, relationships and power dynamics, which come together and create "policy windows" at different points in time. We observed physician-centric policy processes with some recent moves to rebalance power and be inclusive of other actors and perspectives. The context review also highlighted the significant influence of changes in political leadership and prioritization in driving policies on team-based care. While this existed in different degrees in the three provinces, the push and pull of political and professional power dynamics shaped Canadian provincial policies governing team-based care. If we are to move team-based primary healthcare forward in Canada, the provinces need to review the external factors and the complex set of relationships and trade-offs that underscore the policy process. Copyright © 2017 Longwoods Publishing.

DoD’s Multidisciplinary University Research Initiative (MURI) Program: Impact and Highlights from 25 Years of Basic Research

DTIC Science & Technology

2014-09-01

Publication This work was conducted by the Institute for Defense Analyses (IDA) under contract HQ0034-14-D-0001, Project AI-2-3863, “Multidisciplinary...Initiative (MURI) Program is a Department of Defense (DoD) effort that supports academic research teams to conduct basic research addressing...across the govern- ment’s historical records of the MURI grants for a quantitative analysis of the program. In addi- tion, IDA conducted interviews with

Physician education on decision-making capacity assessment: Current state and future directions.

PubMed

Charles, Lesley; Parmar, Jasneet; Brémault-Phillips, Suzette; Dobbs, Bonnie; Sacrey, Lori; Sluggett, Bryan

2017-01-01

To examine FPs' training needs for conducting decision-making capacity assessments (DMCAs) and to determine how training materials, based on a DMCA model, can be adapted for use by FPs. A scoping review of the literature and qualitative research methodology (focus groups and structured interviews). Edmonton, Alta. Nine FPs, who practised in various settings, who chose to attend a focus group on DMCAs. A scoping review of the literature to examine the current status of physician education regarding assessment of decision-making capacity, and a focus group and interviews with FPs to ascertain the educational needs of FPs in this area. Based on the scoping review of the literature, 4 main themes emerged: increasing saliency of DMCAs owing to an aging population, suboptimal DMCA training for physicians, inconsistent approaches to DMCA, and tension between autonomy and protection. The findings of the focus groups and interviews indicate that, while FPs working as independent practitioners or with interprofessional teams are motivated to engage in DMCAs and use the DMCA model for those assessments, several factors impede their conducting DMCAs. The most notable barriers were a lack of education, isolation from interprofessional teams, uneasiness around managing conflict with families, fear of liability, and concerns regarding remuneration. This pilot study has helped to inform ways to better train and support FPs in conducting DMCAs. Family physicians are well positioned, with proper training, to effectively conduct DMCAs. To engage FPs in the process, however, the barriers should be addressed. Copyright© the College of Family Physicians of Canada.

Perspectives of Community Co-Researchers About Group Dynamics and Equitable Partnership Within a Community-Academic Research Team.

PubMed

Vaughn, Lisa M; Jacquez, Farrah; Zhen-Duan, Jenny

2018-04-01

Equitable partnership processes and group dynamics, including individual, relational, and structural factors, have been identified as key ingredients to successful community-based participatory research partnerships. The purpose of this qualitative study was to investigate the key aspects of group dynamics and partnership from the perspectives of community members serving as co-researchers. Semistructured, in-depth interviews were conducted with 15 Latino immigrant co-researchers from an intervention project with Latinos Unidos por la Salud (LU-Salud), a community research team composed of Latino immigrant community members and academic investigators working in a health research partnership. A deductive framework approach guided the interview process and qualitative data analysis. The LU-Salud co-researchers described relationships, personal growth, beliefs/identity motivation (individual dynamics), coexistence (relational dynamics), diversity, and power/resource sharing (structural dynamics) as key foundational aspects of the community-academic partnership. Building on existing CBPR and team science frameworks, these findings demonstrate that group dynamics and partnership processes are fundamental drivers of individual-level motivation and meaning making, which ultimately sustain efforts of community partners to engage with the research team and also contribute to the achievement of intended research outcomes.

Ethical Decisions in Palliative Care: Interprofessional Relations as a Burnout Protective Factor? Results From a Mixed-Methods Multicenter Study in Portugal.

PubMed

Hernández-Marrero, Pablo; Pereira, Sandra Martins; Carvalho, Ana Sofia

2016-09-01

Ethical decisions are part of contemporary practices in palliative care. The need of making such decisions is associated to higher burnout levels and other work related problems among healthcare professionals. As part of the project entitled "Decisions in End-of-Life Care in Spain and Portugal" (DELiCaSP), this study aims to (i) identify the most common ethical decisions made by Portuguese palliative care teams and (ii) understand how the making of such decisions relates to burnout. A mixed methods study was conducted with 9 palliative care teams, using (i) questionnaires of socio-demographic and professional variables, work-related experiences, (ii) the Maslach Burnout Inventory, (iii) interviews and (iv) observations. These teams were geographically dispersed across the country, covering the North, Centrum and South regions, and heterogeneous: Five palliative care units for inpatients; three home care teams; and one hospital support team. A total of 20 interviews and 240 hours of observations were completed until reaching saturation. The most common ethical decisions were related to communication issues (information disclosure of the diagnosis and prognosis), forgoing treatment and sedation. Although perceived as stressful, emotionally demanding and challenging, ethical decisions were not significantly associated with burnout. Making ethical decisions is not associated with higher burnout levels among professionals working in Portuguese palliative care teams. This can be explained by the interprofessional decision-making process followed by these teams, which promotes a sense of shared-decision and team-based empowerment; and by the advanced level of interdisciplinary education in palliative care that these professionals have. © The Author(s) 2015.

Context Matters: Team and Organizational Factors Associated with Reach of Evidence-Based Psychotherapies for PTSD in the Veterans Health Administration.

PubMed

Sayer, Nina A; Rosen, Craig S; Bernardy, Nancy C; Cook, Joan M; Orazem, Robert J; Chard, Kathleen M; Mohr, David C; Kehle-Forbes, Shannon M; Eftekhari, Afsoon; Crowley, Jill; Ruzek, Josef I; Smith, Brandy N; Schnurr, Paula P

2017-11-01

Evidence-based psychotherapies for PTSD are often underused. The objective of this mixed-method study was to identify organizational and clinic factors that promote high levels of reach of evidence-based psychotherapies for PTSD 10 years into their dissemination throughout the Veterans Health Administration. We conducted 96 individual interviews with staff from ten outpatient PTSD teams at nine sites that differed in reach of evidence-based psychotherapies for PTSD. Major themes associated with reach included clinic mission, clinic leader and staff engagement, clinic operations, staff perceptions, and the practice environment. Strategies to improve reach of evidence-based psychotherapies should attend to organizational and team-level factors.

Integrating physiotherapists within primary health care teams: perspectives of family physicians and nurse practitioners.

PubMed

Dufour, Sinéad Patricia; Brown, Judith; Deborah Lucy, S

2014-09-01

The international literature suggests a number of benefits related to integrating physiotherapists into primary health care (PHC) teams. Considering the mandate of PHC teams in Canada, emphasizing healthy living and chronic disease management, a broad range of providers, inclusive of physiotherapists is required. However, physiotherapists are only sparsely integrated into these teams. This study explores the perspectives of "core" PHC team members, family physicians and nurse practitioners, regarding the integration of physiotherapists within Ontario (Canada) PHC teams. Twenty individual semi-structured in-depth interviews were conducted, transcribed verbatim, and then analyzed following an iterative process drawing from an interpretive phenomenological approach. Five key themes emerged which highlighted "how physiotherapists could and do contribute as team members within PHC teams particularly related to musculoskeletal health and chronic disease management". The perceived value of physiotherapists within Ontario, Canada PHC teams was a unanimous sentiment particularly in terms of musculoskeletal health, chronic disease management and maximizing health human resources efficiency to ensure the right care, is delivered by the right practitioner, at the right time.

A patient-centred team-coaching concept for medical rehabilitation.

PubMed

Körner, M; Becker, S; Dinius, J; Müller, C; Zimmermann, L; Rundel, M

2018-01-01

Team coaching enhances teamwork and subsequently improves patient-centredness in medical rehabilitation clinics. Even though interprofessional teamwork is regarded as a crucial factor in medical rehabilitation, to date no evaluated team-coaching approaches are available for improving interprofessional teamwork in medical rehabilitation in Germany. Based on a systematic literature search and interviews with staff, managers, and patients of rehabilitation clinics, we developed a team-coaching approach that is standardized in its process but based on the individual needs and requests of each clinic. It takes a systemic perspective and is goal-oriented and solution-focused. The approach mainly serves to provide impulses to make use of resources within the team and to support a self-directed organisational learning process. It is manualized and can, therefore, be used by professionals aiming to improve interprofessional teamwork in their clinic. A multi-centre, cluster-randomized controlled study that was conducted to evaluate the team-coaching approach showed positive results. Team organization, knowledge integration, and responsibility can be improved, and, therefore, the implementation of the patient-centred team-coaching approach in interprofessional rehabilitation teams can be recommended.

FMEA team performance in health care: A qualitative analysis of team member perceptions.

PubMed

Wetterneck, Tosha B; Hundt, Ann Schoofs; Carayon, Pascale

2009-06-01

: Failure mode and effects analysis (FMEA) is a commonly used prospective risk assessment approach in health care. Failure mode and effects analyses are time consuming and resource intensive, and team performance is crucial for FMEA success. We evaluate FMEA team members' perceptions of FMEA team performance to provide recommendations to improve the FMEA process in health care organizations. : Structured interviews and survey questionnaires were administered to team members of 2 FMEA teams at a Midwest Hospital to evaluate team member perceptions of FMEA team performance and factors influencing team performance. Interview transcripts underwent content analysis, and descriptive statistics were performed on questionnaire results to identify and quantify FMEA team performance. Theme-based nodes were categorized using the input-process-outcome model for team performance. : Twenty-eight interviews and questionnaires were completed by 24 team members. Four persons participated on both teams. There were significant differences between the 2 teams regarding perceptions of team functioning and overall team effectiveness that are explained by difference in team inputs and process (e.g., leadership/facilitation, team objectives, attendance of process owners). : Evaluation of team members' perceptions of team functioning produced useful insights that can be used to model future team functioning. Guidelines for FMEA team success are provided.

How do dentists and their teams incorporate evidence about preventive care? An empirical study.

PubMed

Sbaraini, Alexandra; Carter, Stacy Marie; Evans, Robin Wendell; Blinkhorn, Anthony

2013-10-01

To identify how dentists and their teams adopt evidence-based preventive care. A qualitative study using grounded theory methodology was conducted. We interviewed 23 participants working in eight dental practices about their experience and work processes, while adopting evidence-based preventive care. During the study, Charmaz's grounded theory methodology was employed to examine the social process of adopting preventive dental care in dental practices. Charmaz's iteration of the constant comparative method was used during the data analysis. This involved coding of interview transcripts, detailed memo-writing and drawing diagrams. The transcripts were analyzed as soon as possible after each round of interviews in each dental practice. Coding was conducted primarily by AS, supported by team meetings and discussions when researchers compared their interpretations. Participants engaged in a slow process of adapting evidence-based protocols and guidelines to the existing logistics of the practices. This process was influenced by practical, philosophical, and historical aspects of dental care, and a range of barriers and facilitators. In particular, dentists spoke spontaneously about two deeply held 'rules' underpinning continued restorative treatment, which acted as barriers to provide preventive care: (i) dentists believed that some patients were too 'unreliable' to benefit from prevention; and (ii) dentists believed that patients thought that only tangible restorative treatment offered 'value for money'. During the adaptation process, some dentists and teams transitioned from their initial state - selling restorative care - through an intermediary stage - learning by doing and educating patients about the importance of preventive care - and finally to a stage where they were offering patients more than just restorative care. Resources were needed for the adaptation process to occur, including: the ability to maintain the financial viability of the practice, appropriate technology, time, and supportive dental team relationships. The findings from this study show that with considerable effort, motivation and coordination, it is possible for dental practices to work against the dental 'mainstream' and implement prevention as their clinical norm. This study has shown that dental practice is not purely scientific, but it includes cultural, social, and economic resources that interfere with the provision of preventive care. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A Quasi-experimental Evaluation of Performance Improvement Teams in the Safety-Net: A Labor-Management Partnership Model for Engaging Frontline Staff.

PubMed

Laing, Brian Yoshio; Dixit, Ravi K; Berry, Sandra H; Steers, W Neil; Brook, Robert H

2016-01-01

Unit-based teams (UBTs), initially developed by Kaiser Permanente and affiliated unions, are natural work groups of clinicians, managers, and frontline staff who work collaboratively to identify areas for improvement and implement solutions. We evaluated the UBT model implemented by the Los Angeles County Department of Health Services in partnership with its union to engage frontline staff in improving patient care. We conducted a quasi-experimental study, comparing surveys at baseline and 6 months, among personnel in 10 clinics who received UBT training to personnel in 5 control clinics. We also interviewed staff from 5 clinics that received UBT training and 3 control clinics. We conducted 330 surveys and 38 individual, semi-structured interviews with staff at an outpatient facility in South Los Angeles. Each UBT leader received an 8-hour training in basic performance improvement methods, and each UBT was assigned a team "coach." Our outcome measure was 6-month change in the "adaptive reserve" score, the units' self-reported ability to make and sustain change. We analyzed transcripts of the interviews to find common themes regarding the UBT intervention. The survey response rate was 63% (158/252) at baseline and 75% (172/231) at 6 months. There was a significant difference-in-change in adaptive reserve between UBTs and non-UBTs at 6 months (+0.11 vs -0.13; P = .02). Nine of the 10 UBTs reported increases in adaptive reserve and 8 UBTs reported decreased no-show rates or patient length of stay in clinic. Staff overwhelmingly felt the UBTs were a positive intervention because it allowed all levels of staff to have a voice in improvement. Our results indicate that partnership between management and unions to engage frontline staff in teams may be a useful tool to improve delivery of health care in a safety-net setting.

A human factors systems approach to understanding team-based primary care: a qualitative analysis

PubMed Central

Mundt, Marlon P.; Swedlund, Matthew P.

2016-01-01

Background. Research shows that high-functioning teams improve patient outcomes in primary care. However, there is no consensus on a conceptual model of team-based primary care that can be used to guide measurement and performance evaluation of teams. Objective. To qualitatively understand whether the Systems Engineering Initiative for Patient Safety (SEIPS) model could serve as a framework for creating and evaluating team-based primary care. Methods. We evaluated qualitative interview data from 19 clinicians and staff members from 6 primary care clinics associated with a large Midwestern university. All health care clinicians and staff in the study clinics completed a survey of their communication connections to team members. Social network analysis identified key informants for interviews by selecting the respondents with the highest frequency of communication ties as reported by their teammates. Semi-structured interviews focused on communication patterns, team climate and teamwork. Results. Themes derived from the interviews lent support to the SEIPS model components, such as the work system (Team, Tools and Technology, Physical Environment, Tasks and Organization), team processes and team outcomes. Conclusions. Our qualitative data support the SEIPS model as a promising conceptual framework for creating and evaluating primary care teams. Future studies of team-based care may benefit from using the SEIPS model to shift clinical practice to high functioning team-based primary care. PMID:27578837

The Oral History of Evaluation: The Professional Development of Marvin C. Alkin

ERIC Educational Resources Information Center

American Journal of Evaluation, 2010

2010-01-01

Over the past 7 years, the Oral History Project Team has conducted interviews with individuals who have made signal contributions to evaluation theory and practice, tracing their professional development and contextualizing their work within the social and political climates of the time. By capturing the professional evolution of those who have…

"While I'm Retraining, I Get the Full Whack": Illuminating Narratives of Career Change

ERIC Educational Resources Information Center

Mulvey, Rachel

2014-01-01

This article considers four interviews conducted with French citizens by a team of researchers as part of the research project "Learning for Career and Labour Market Transitions: individual biographies". Funded by the European Centre for the Development of Vocational Training (Cedefop), this study sought to contribute to the development…

A Never Ending Journey: Inclusive Education Is a Principle of Practice, Not an End Game

ERIC Educational Resources Information Center

Kozleski, Elizabeth B.; Yu, Ting; Satter, Allyson L.; Francis, Grace L.; Haines, Shana J.

2015-01-01

A team from Schoolwide Integrated Framework for Transformation (SWIFT), a federally funded technical assistance project focused on creating cascading, aligned systems for inclusive education, conducted a series of focus groups and interviews with school administrators, general and special educators, and related service providers in six schools…

Experiences of Early Transdisciplinary Teams in Pediatric Community Rehabilitation

ERIC Educational Resources Information Center

Aubin, Tamie; Mortenson, Patricia

2015-01-01

Although a transdisciplinary approach (TA) is considered best practice for children aged 0-3 years, there is limited information for professionals on how to successfully implement TA services. Using qualitative inquiry, in-depth interviews were conducted to explore the experiences of 6 service providers and managers who took part in early…

Parents' Perspectives on Braille Literacy: Results from the ABC Braille Study

ERIC Educational Resources Information Center

Kamei-Hannan, Cheryl; Sacks, Sharon Zell

2012-01-01

Introduction: Parents who were the primary caretakers of children in the Alphabetic and Contracted Braille Study (ABC Braille Study) revealed their perspectives about braille literacy. Methods: A 30-item questionnaire was constructed by the ABC Braille research team, and researchers conducted telephone interviews with 31 parents who were the…

The Oral History of Evaluation: The Professional Development of Robert Stake

ERIC Educational Resources Information Center

Miller, Robin Lin; King, Jean A.; Mark, Melvin M.; Caracelli, Valerie

2016-01-01

Over the past 14 years, AEA's Oral History Project Team (Robin Lin Miller, Jean A. King, Valerie Caracelli, and Melvin M. Mark) has conducted interviews with individuals who have made signal contributions to evaluation theory and practice, tracing their professional development and contextualizing their work within the social and political…

Effects of Coaching on Instructional Practices: A Comparative Case Study

ERIC Educational Resources Information Center

Carlson, Rosie M.

2017-01-01

This comparative case study analyzed two styles of coaching, team and individual, and the perceived impact each style has on instructional practices. This study was conducted in two elementary schools that are part of the same charter organization in California. The study identified the challenges and benefits of each style through interviews with…

The Crisis Response to a School-Based Hostage Event: A Case Study

ERIC Educational Resources Information Center

Crepeau-Hobson, Franci; Summers, Laura L.

2011-01-01

During the past two decades there has been increased public, professional, and legislative interest in school crisis prevention and intervention. It is recommended that comprehensive crisis teams be established at the school, district, and community levels. A case study was conducted in which interviews were utilized to facilitate an increased…

Inclusive Education in an International School: A Case Study from Hong Kong

ERIC Educational Resources Information Center

Chan, Twiggy; Yuen, Mantak

2015-01-01

This case study provides an overview of current policy, practices and problems concerning inclusion in one international secondary school in Hong Kong. A total of 13 interviews were conducted with the school management team, teachers, students and parents, supplemented by 12 classroom observations and two "student-shadowing" exercises.…

Facilitators and barriers of independent decisions by midwives during labor and birth.

PubMed

Everly, Marcee C

2012-01-01

The purpose of this study was to explore the factors that affect labor management decisions of midwives in hospitals and freestanding birth centers. A qualitative study was conducted using one-on-one tape recorded interviews of midwives who had experience managing labor and birth in both hospitals and freestanding birth centers. Ten interviews consisting of several open-ended questions were conducted, coded, and analyzed in a stepwise fashion to identify codes, categories, and themes. Seven participants reviewed the final framework and confirmed credibility and trustworthiness. Four overall themes were identified: trust birth, the woman, the environment, and the labor team. When making labor management decisions, midwives are affected by their trust in birth, the woman, the health care team, and the birth environment. Midwives report more resistance when making labor management decisions in hospitals. The findings of this study provide insight into both the decision making of midwives and how factors in different environments, in this case hospitals and freestanding birth centers, influence the ability of midwives to make independent labor management decisions. © 2011 by the American College of Nurse-Midwives.

Who is on the primary care team? Professionals' perceptions of the conceptualization of teams and the underlying factors: a mixed-methods study.

PubMed

Doekhie, Kirti D; Buljac-Samardzic, Martina; Strating, Mathilde M H; Paauwe, Jaap

2017-12-28

Due to the growing prevalence of elderly patients with multi-morbidity living at home, there is an increasing need for primary care professionals from different disciplinary backgrounds to collaborate as primary care teams. However, it is unclear how primary care professionals conceptualize teams and what underlying factors influence their perception of being part of a team. Our research question is: What are primary care professionals' perceptions of teams and team membership among primary care disciplines and what factors influence their perceptions? We conducted a mixed-methods study in the Dutch primary care setting. First, a survey study of 152 professionals representing 12 primary care disciplines was conducted, focusing on their perceptions of which disciplines are part of the team and the degree of relational coordination between professionals from different disciplinary backgrounds. Subsequently, we conducted semi-structured interviews with 32 professionals representing 5 primary care disciplines to gain a deeper understanding of the underlying factors influencing their perceptions and the (mis)alignment between these perceptions. Misalignments were found between perceptions regarding which disciplines are members of the team and the relational coordination between disciplines. For example, general practitioners were viewed as part of the team by helping assistants, (district) nurses, occupational therapists and geriatric specialized practice nurses, whereas the general practitioners themselves only considered geriatric specialized practice nurses to be part of their team. Professionals perceive multidisciplinary primary care teams as having multiple inner and outer layers. Three factors influence their perception of being part of a team and acting accordingly: a) knowing the people you work with, b) the necessity for knowledge exchange and c) sharing a holistic view of caregiving. Research and practice should take into account the misalignment between primary care professionals' perceptions of primary care teams, as our study notes variations in the conceptualization of primary care teams. To enhance teamwork between professionals from different disciplinary backgrounds, professionals acknowledge the importance of three underlying conditions: team familiarity, regular and structured knowledge exchange between all professionals involved in the care process and realizing and believing in the added value for patients of working as a team.

Using a multi-state Learning Community as an implementation strategy for immediate postpartum long-acting reversible contraception.

PubMed

DeSisto, Carla L; Estrich, Cameron; Kroelinger, Charlan D; Goodman, David A; Pliska, Ellen; Mackie, Christine N; Waddell, Lisa F; Rankin, Kristin M

2017-11-21

Implementation strategies are imperative for the successful adoption and sustainability of complex evidence-based public health practices. Creating a learning collaborative is one strategy that was part of a recently published compilation of implementation strategy terms and definitions. In partnership with the Centers for Disease Control and Prevention and other partner agencies, the Association of State and Territorial Health Officials recently convened a multi-state Learning Community to support cross-state collaboration and provide technical assistance for improving state capacity to increase access to long-acting reversible contraception (LARC) in the immediate postpartum period, an evidence-based practice with the potential for reducing unintended pregnancy and improving maternal and child health outcomes. During 2015-2016, the Learning Community included multi-disciplinary, multi-agency teams of state health officials, payers, clinicians, and health department staff from 13 states. This qualitative study was conducted to better understand the successes, challenges, and strategies that the 13 US states in the Learning Community used for increasing access to immediate postpartum LARC. We conducted telephone interviews with each team in the Learning Community. Interviews were semi-structured and organized by the eight domains of the Learning Community. We coded transcribed interviews for facilitators, barriers, and implementation strategies, using a recent compilation of expert-defined implementation strategies as a foundation for coding the latter. Data analysis showed three ways that the activities of the Learning Community helped in policy implementation work: structure and accountability, validity, and preparing for potential challenges and opportunities. Further, the qualitative data demonstrated that the Learning Community integrated six other implementation strategies from the literature: organize clinician implementation team meetings, conduct educational meetings, facilitation, promote network weaving, provide ongoing consultation, and distribute educational materials. Convening a multi-state learning collaborative is a promising approach for facilitating the implementation of new reimbursement policies for evidence-based practices complicated by systems challenges. By integrating several implementation strategies, the Learning Community serves as a meta-strategy for supporting implementation.

Big Hitters: Important Factors Characterizing Team Effectiveness in Professional Cricket.

PubMed

Webster, Leonie V; Hardy, James; Hardy, Lew

2017-01-01

While organizational psychology attests to the multidimensional nature of team effectiveness, insight regarding the most important factors contributing to the effectiveness of sports teams, especially elite teams, is lacking. An abductive method of qualitative enquiry was adopted to capture participants' construal of team effectiveness, drawing on the extant literature in both sport and organizational psychology. Semi-structured interviews were conducted with 21 players, coaches, and psychologists involved in elite cricket, with resultant data analyzed inductively initially, before being reanalyzed deductively. Although, the narratives endorsed the value of many of the deductively derived factors, other constructs more prominent in organizational psychology (e.g., trust and intra-group conflict) appeared to be more important than traditional sport psychology group factors. The results revealed six broad themes; culture and environment, values, communication, understanding, leadership, and unique individuals, with some gender differences apparent throughout. Based on our elite sample's construal of team effectiveness, we propose a new model representing a practical, parsimonious, and novel conceptualization of the most important attributes of team effectiveness in cricket, with conceivable transferability to other team sports.

Big Hitters: Important Factors Characterizing Team Effectiveness in Professional Cricket

PubMed Central

Webster, Leonie V.; Hardy, James; Hardy, Lew

2017-01-01

While organizational psychology attests to the multidimensional nature of team effectiveness, insight regarding the most important factors contributing to the effectiveness of sports teams, especially elite teams, is lacking. An abductive method of qualitative enquiry was adopted to capture participants' construal of team effectiveness, drawing on the extant literature in both sport and organizational psychology. Semi-structured interviews were conducted with 21 players, coaches, and psychologists involved in elite cricket, with resultant data analyzed inductively initially, before being reanalyzed deductively. Although, the narratives endorsed the value of many of the deductively derived factors, other constructs more prominent in organizational psychology (e.g., trust and intra-group conflict) appeared to be more important than traditional sport psychology group factors. The results revealed six broad themes; culture and environment, values, communication, understanding, leadership, and unique individuals, with some gender differences apparent throughout. Based on our elite sample's construal of team effectiveness, we propose a new model representing a practical, parsimonious, and novel conceptualization of the most important attributes of team effectiveness in cricket, with conceivable transferability to other team sports. PMID:28744235

Teaming from Three Perspectives: Interviews with Participatory Action Research Participants

ERIC Educational Resources Information Center

Cain, Judith

2008-01-01

Taking part in the autism spectrum disorder participatory action research (ASD PAR) project was a genuine team effort for the group of people supporting Rose, a primary school student with Asperger syndrome. The following excerpts are from interviews with some of Rose's team. This is a collaborative approach to telling the story of the team's…

Lessons learned: clinicians' post-occupancy perspective of facility design involvement.

PubMed

Reno, Kathy; Okland, Kathy; Finis, Nanne; Lamantia, Gina; Call, Roger; Cardon, Kerrie; Gerber, Deborah; Zeigler, Janet

2014-01-01

The research was conducted to determine clinician knowledge needs for competent involvement with the facility design process as well as to gather lessons learned on building stronger design teams. As clinical stakeholders are invited to the healthcare facility design table, the question arises as to the ability of professionally diverse team members to translate each other's comments and ideas accurately. In the past, hospitals were designed by a handful of hospital leaders and architects. More recently, multiple players have become involved throughout the design and construction of new healthcare facilities. Clinical consultants from two international healthcare companies observed that many clinicians were unprepared to effectively translate their needs to the architectural community or to competently utilize architectural tools and documents. A qualitative, post-occupancy cross-case study was conducted to understand how clinicians could increase their competencies for successful involvement in facility design. Focus group interviews were held with teams from healthcare facilities occupying their new facility for more than 6 months and less than 2 years. Curriculum topics were validated and additional areas recommended based on the interviews. Open-ended questioins on lessons learned provided several new dimensions to the research. Although validating the curriculum was the initial intent, the feedback from the focus groups on lessons learned provided rich concepts for practice implications and further research on post-occupancy. Decision-making, design process, interdisciplinary, planning, post-occupancy.

Communicating with the public about emerging health threats: lessons from the Pre-Event Message Development Project.

PubMed

Wray, Ricardo J; Becker, Steven M; Henderson, Neil; Glik, Deborah; Jupka, Keri; Middleton, Sarah; Henderson, Carson; Drury, Allison; Mitchell, Elizabeth W

2008-12-01

We sought to better understand the challenges of communicating with the public about emerging health threats, particularly threats involving toxic chemicals, biological agents, and radioactive materials. At the request of the Centers for Disease Control and Prevention, we formed an interdisciplinary consortium of investigative teams from 4 schools of public health. Over 2 years, the investigative teams conducted 79 focus group interviews with 884 participants and individual cognitive response interviews with 129 respondents, for a total sample of 1013 individuals. The investigative teams systematically compared their results with other published research in public health, risk communication, and emergency preparedness. We found limited public understanding of emerging biological, chemical, and radioactive materials threats and of the differences between them; demand for concrete, accurate, and consistent information about actions needed for protection of self and family; active information seeking from media, local authorities, and selected national sources; and areas in which current emergency messaging can be improved. The public will respond to a threat situation by seeking protective information and taking self-protective action, underlining the critical role of effective communication in public health emergencies.

Impressions of Early Mobilization of Critically Ill Children-Clinician, Patient, and Family Perspectives.

PubMed

Zheng, Katina; Sarti, Aimee; Boles, Sama; Cameron, Saoirse; Carlisi, Robert; Clark, Heather; Khawaji, Adeeb; Awladthani, Saif; Al-Harbi, Samah; Choong, Karen

2018-04-11

To understand patient, family caregiver, and clinician impressions of early mobilization, the perceived barriers and facilitators to its implementation, and the use of in-bed cycling as a method of mobilization. A qualitative study, conducted as part of the Early Exercise in Critically ill Youth and Children, a preliminary Evaluation (wEECYCLE) Pilot randomized controlled trial. McMaster Children's Hospital PICU, Hamilton, ON, Canada. Clinicians (i.e., physicians, nurses, and physiotherapists), family caregivers, and capable patients age greater than or equal to 8 years old who were enrolled in a clinical trial of early mobilization in critically ill children (wEECYCLE). Semistructured, face-to-face interviews using a customized interview guide for clinicians, caregivers, and patients respectively, conducted after exposure to the early mobilization intervention. Thirty-seven participants were interviewed (19 family caregivers, four patients, and 14 clinicians). Family caregivers and clinicians described similar interrelated themes representing barriers to mobilization, namely low prioritization of mobilization by the medical team, safety concerns, the lack of physiotherapy resources, and low patient motivation. Key facilitators were family trust in the healthcare team, team engagement, an a priori belief that physical activity is important, and participation in research. Increased familiarity and specific features such as the virtual reality component and ability to execute passive and or active mobilization helped to engage critically ill children in in-bed cycling. Clinicians, patients, and families were highly supportive of mobilization in critically ill children; however, concerns were identified with respect to how and when to execute this practice. Understanding key stakeholder perspectives enables the development of strategies to facilitate the implementation of early mobilization and in-bed cycling, not just in the context of a clinical trial but also within the culture of practice in a PICU.

A human factors systems approach to understanding team-based primary care: a qualitative analysis.

PubMed

Mundt, Marlon P; Swedlund, Matthew P

2016-12-01

Research shows that high-functioning teams improve patient outcomes in primary care. However, there is no consensus on a conceptual model of team-based primary care that can be used to guide measurement and performance evaluation of teams. To qualitatively understand whether the Systems Engineering Initiative for Patient Safety (SEIPS) model could serve as a framework for creating and evaluating team-based primary care. We evaluated qualitative interview data from 19 clinicians and staff members from 6 primary care clinics associated with a large Midwestern university. All health care clinicians and staff in the study clinics completed a survey of their communication connections to team members. Social network analysis identified key informants for interviews by selecting the respondents with the highest frequency of communication ties as reported by their teammates. Semi-structured interviews focused on communication patterns, team climate and teamwork. Themes derived from the interviews lent support to the SEIPS model components, such as the work system (Team, Tools and Technology, Physical Environment, Tasks and Organization), team processes and team outcomes. Our qualitative data support the SEIPS model as a promising conceptual framework for creating and evaluating primary care teams. Future studies of team-based care may benefit from using the SEIPS model to shift clinical practice to high functioning team-based primary care. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Improving patient safety culture in general practice: an interview study

PubMed Central

Verbakel, Natasha J; de Bont, Antoinette A; Verheij, Theo JM; Wagner, Cordula; Zwart, Dorien LM

2015-01-01

Background When improving patient safety a positive safety culture is key. As little is known about improving patient safety culture in primary care, this study examined whether administering a culture questionnaire with or without a complementary workshop could be used as an intervention for improving safety culture. Aim To gain insight into how two interventions affected patient safety culture in everyday practice. Design and setting After conducting a randomised control trial of two interventions, this was a qualitative study conducted in 30 general practices to aid interpretation of the previous quantitative findings. Method Interviews were conducted at practice locations (n = 27) with 24 GPs and 24 practice nurses. The theory of communities of practice — in particular, its concepts of a domain, a community, and a practice — was used to interpret the findings by examining which elements were or were not present in the participating practices. Results Communal awareness of the problem was only raised after getting together and discussing patient safety. The combination of a questionnaire and workshop enhanced the interaction of team members and nourished team feelings. This shared experience also helped them to understand and develop tools and language for daily practice. Conclusion In order for patient safety culture to improve, the safety culture questionnaire was more successful when accompanied by a practice workshop. Initial discussion and negotiation of shared goals during the workshop fuelled feelings of coherence and belonging to a community wishing to learn about enhancing patient safety. Team meetings and day-to-day interactions enhanced further liaison and sharing, making patient safety a common and conscious goal. PMID:26622035

Innovating team-based outpatient mental health care in the Veterans Health Administration: Staff-perceived benefits and challenges to pilot implementation of the Behavioral Health Interdisciplinary Program (BHIP).

PubMed

Barry, Catherine N; Abraham, Kristen M; Weaver, Kendra R; Bowersox, Nicholas W

2016-05-01

In the past decade, the demand for Veterans Health Administration (VHA) mental health care has increased rapidly. In response to the increased demand, the VHA developed the Behavioral Health Interdisciplinary Program (BHIP) team model as an innovative approach to transform VHA general outpatient mental health delivery. The present formative evaluation gathered information about pilot implementation of BHIP to understand the struggles and successes that staff experienced during facility transitions to the BHIP model. Using a purposive, nonrandom sampling approach, we conducted 1-on-1, semistructured interviews with 37 licensed and nonlicensed clinical providers and 13 clerical support staff assigned to BHIP teams in 21 facilities across the VHA. Interviews revealed that having actively involved facility mental health leaders, obtaining adequate staffing for teams to meet the requirements of the BHIP model, creating clear descriptions and expectations for team member roles within the BHIP framework, and allocating designated time for BHIP team meetings challenged many VHA sites but are crucial for successful BHIP implementation. Despite the challenges, staff reported that the transition to BHIP improved team work and improved patient care. Staff specifically highlighted the potential for the BHIP model to improve staff working relationships and enhance communication, collaboration, morale, and veteran treatment consistency. Future evaluations of the BHIP implementation process and BHIP team functioning focusing on patient outcomes, organizational outcomes, and staff functioning are recommended for fully understanding effects of transitioning to the BHIP model within VHA general mental health clinics and to identify best practices and areas for improvement. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Ready or Not...: Perspectives on Literacy and Essential Skills in this Economic Downturn--A Canadian Baseline Study

ERIC Educational Resources Information Center

Murray, Janet; Yerichuk, Deanna; Murray-Smith, Nick

2009-01-01

In March 2009, Movement for Canadian Literacy (MCL) commissioned "Resources for Results", a private research and evaluation firm, to conduct a baseline study to explore the effects of the recent economic downturn on literacy and essential skills programs across Canada. The "Resources for Results" research team interviewed 35…

Straight Talking: Explorations on Homosexuality and Homophobia in Secondary Schools in Ireland

ERIC Educational Resources Information Center

O'Higgins-Norman, James

2009-01-01

This paper outlines research that was conducted among students, parents, teachers and senior management teams in six secondary schools in the Greater Dublin area of Ireland. The research involved semi-structured interviews and observations. The findings of this research are significant in that it was the first time any data had been gathered on…

Sociocultural Influences: Evaluations of Indigenous Children for Special Needs in Rural Central Mexico

ERIC Educational Resources Information Center

Mackenzie, Jacqueline Zaleski

2010-01-01

This study examined indigenous infants, children, and youth in rural central Mexico for developmental delays by using a mixed methods approach. A two-person team consisting of a researcher and a translator completed this study. They conducted observations of 665 minors and interviews with their caregivers. A self-designed rubric was the guide to…

Writing for Safety. Facilitating a Team Approach to Writing Operating Instructions. ANTA Leading Edge Training Case Study.

ERIC Educational Resources Information Center

Serle, Oenone

The Australian engineering company, Jaques, and Swinburne University of Technology conducted a joint project to write more than 190 operating instructions for the company's 77 employees. First, the university's Workplace Skills Unit (WSU) interviewed 75 production workers to identify their language, literacy, and training needs. The WSU negotiated…

Promoting the Academic Engagement and Success of Black Male Student-Athletes

ERIC Educational Resources Information Center

Harris, Paul C.; Hines, Erik M.; Kelly, Darren D.; Williams, Derick J.; Bagley, Bethany

2014-01-01

The goal of this study was to provide a qualitative look at the factors associated with the academic engagement and success of Black male student-athletes in high school. The research team employed a thematic analysis to examine semi-structured interviews conducted with two successful Black male student-athletes, along with their principal,…

Parent Partnerships Project for Children's Mental Health Training for Professionals. PHP-c87

ERIC Educational Resources Information Center

PACER Center, 2004

2004-01-01

In the fall of 2003, PACER Center's Parent Partnership Project for Children's Mental Health conducted a survey to better understand what parents and families need from the children?s mental health system in Minnesota. The research team developed a survey questionnaire, a telephone interview, and a focus group session directed at learning what was…

The Oral History of Evaluation: The Professional Development of Thomas D. Cook

ERIC Educational Resources Information Center

Mark, Melvin M.; Caracelli, Valerie; McNall, Miles A.; Miller, Robin Lin

2018-01-01

Since 2003, the Oral History Project Team has conducted interviews with individuals who have made particularly noteworthy contributions to the theory and practice of evaluation. In 2013, Mel Mark, Valerie Caracelli, and Miles McNall sat with Thomas Cook in Washington, D.C., during the American Evaluation Association (AEA) annual conference. The…

Training Reflective Processes in Military Aircrews through Holistic Debriefing: The Importance of Facilitator Skills and Development of Trust

ERIC Educational Resources Information Center

Moldjord, Christian; Hybertsen, Ingunn Dahler

2015-01-01

This paper explores how Holistic Debrief, a new concept in the field of debriefing and reflective processes, can contribute to restitution, reflection and learning in professional teams following stressful events and routine tasks. Interviews were conducted with Norwegian military aircrew mission commanders following deployment to Afghanistan in…

Perceptions of interprofessional teamwork in low-acuity settings: a qualitative analysis.

PubMed

van Schaik, Sandrijn M; O'Brien, Bridget C; Almeida, Sandra A; Adler, Shelley R

2014-06-01

Working effectively in interprofessional teams is a core competency for all health care professionals, yet there is a paucity of instruments with which to assess the associated skills. Published medical teamwork skills assessment tools focus primarily on high-acuity situations, such as cardiopulmonary arrests and crisis events in operating rooms, and may not generalise to non-high-acuity environments, such as in-patient wards and out-patient clinics. We undertook the current study to explore the constructs underlying interprofessional teamwork in non-high-acuity settings and team members' perspectives of essential teamwork attributes. We used an ethnographic approach to study four interprofessional teams in two different low-acuity settings: women's HIV (human immunodeficiency virus) clinics and in-patient paediatric wards. Over a period of 17 months, we collected qualitative data through direct observations, focus groups and individual interviews. We analysed the data using qualitative thematic analysis, following an iterative process: data from our observations (20 hours in total) informed the focus group guide and focus group data informed the interview guide. To enhance the integrity of our analysis, we triangulated data sources and verified themes through member checking. We conducted seven focus groups and 27 individual interviews with a total of 39 study participants representing eight professions. Participants emphasised shared leadership and collaborative decision making, mutual respect, recognition of one's own and others' limitations and strengths, and the need to nurture relationships. Team members also discussed tensions around hierarchy and questioned whether doctor leadership is appropriate for interprofessional teams. Our findings indicate that there are differences in teamwork between low-acuity and high-acuity settings, and also provide insights into potential barriers to effective interprofessional teamwork. Our study delineates essential elements of teamwork in low-acuity settings, including desirable attributes of team members, thus laying the foundation for the development of an individual teamwork skills assessment tool. © 2014 John Wiley & Sons Ltd.

Ontario's emergency department process improvement program: the experience of implementation.

PubMed

Rotteau, Leahora; Webster, Fiona; Salkeld, Erin; Hellings, Chelsea; Guttmann, Astrid; Vermeulen, Marian J; Bell, Robert S; Zwarenstein, Merrick; Rowe, Brian H; Nigam, Amit; Schull, Michael J

2015-06-01

In recent years, Lean manufacturing principles have been applied to health care quality improvement efforts to improve wait times. In Ontario, an emergency department (ED) process improvement program based on Lean principles was introduced by the Ministry of Health and Long-Term Care as part of a strategy to reduce ED length of stay (LOS) and to improve patient flow. This article aims to describe the hospital-based teams' experiences during the ED process improvement program implementation and the teams' perceptions of the key factors that influenced the program's success or failure. A qualitative evaluation was conducted based on semistructured interviews with hospital implementation team members, such as team leads, medical leads, and executive sponsors, at 10 purposively selected hospitals in Ontario, Canada. Sites were selected based, in part, on their changes in median ED LOS following the implementation period. A thematic framework approach as used for interviews, and a standard thematic coding framework was developed. Twenty-four interviews were coded and analyzed. The results are organized according to participants' experience and are grouped into four themes that were identified as significantly affecting the implementation experience: local contextual factors, relationship between improvement team and support players, staff engagement, and success and sustainability. The results demonstrate the importance of the context of implementation, establishing strong relationships and communication strategies, and preparing for implementation and sustainability prior to the start of the project. Several key factors were identified as important to the success of the program, such as preparing for implementation, ensuring strong executive support, creation of implementation teams based on the tasks and outcomes of the initiative, and using multiple communication strategies throughout the implementation process. Explicit incorporation of these factors into the development and implementation of future similar interventions in health care settings could be useful. © 2015 by the Society for Academic Emergency Medicine.

Multi-Stakeholder Collaboration in the Redesign of Family-Centered Rounds Process

PubMed Central

Xie, Anping; Carayon, Pascale; Cartmill, Randi; Li, Yaqiong; Cox, Elizabeth D.; Plotkin, Julie A.; Kelly, Michelle M.

2014-01-01

A human factors approach to healthcare system redesign emphasizes the involvement of multiple healthcare stakeholders (e.g., patients and families, healthcare providers) in the redesign process. This study explores the experience of multiple stakeholders with collaboration in a healthcare system redesign project. Interviews were conducted with ten stakeholder representatives who participated in the redesign of the family-centered rounds process in a pediatric hospital. Qualitative interview data were analyzed using a phenomenological approach. A model of collaborative healthcare system redesign was developed, which defined four phases (i.e., setup of the redesign team, preparation for meetings, collaboration in meetings, follow-up after meetings) and two outcomes (i.e., team outcomes, redesign outcomes) of the collaborative process. Challenges to multi-stakeholder collaboration in healthcare system redesign, such as need to represent all relevant stakeholders, scheduling of meetings and managing different perspectives, were identified. PMID:25124394

Multi-stakeholder collaboration in the redesign of family-centered rounds process.

PubMed

Xie, Anping; Carayon, Pascale; Cartmill, Randi; Li, Yaqiong; Cox, Elizabeth D; Plotkin, Julie A; Kelly, Michelle M

2015-01-01

A human factors approach to healthcare system redesign emphasizes the involvement of multiple healthcare stakeholders (e.g., patients and families, healthcare providers) in the redesign process. This study explores the experience of multiple stakeholders with collaboration in a healthcare system redesign project. Interviews were conducted with ten stakeholder representatives who participated in the redesign of the family-centered rounds process in a pediatric hospital. Qualitative interview data were analyzed using a phenomenological approach. A model of collaborative healthcare system redesign was developed, which defined four phases (i.e., setup of the redesign team, preparation for meetings, collaboration in meetings, follow-up after meetings) and two outcomes (i.e., team outcomes, redesign outcomes) of the collaborative process. Challenges to multi-stakeholder collaboration in healthcare system redesign, such as need to represent all relevant stakeholders, scheduling of meetings and managing different perspectives, were identified. Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Why We Don’t Come: Patient Perceptions on No-Shows

PubMed Central

Lacy, Naomi L.; Paulman, Audrey; Reuter, Matthew D.; Lovejoy, Bruce

2004-01-01

PURPOSE Patients who schedule clinic appointments and fail to keep them have a negative impact on the workflow of a clinic in many ways. This study was conducted to identify the reasons patients in an urban family practice setting give for not keeping scheduled appointments. METHODS Semistructured interviews were conducted with 34 adult patients coming to the clinic for outpatient care. Interviews were audiotaped and transcribed verbatim. A multidisciplinary team used an immersion-crystallization organizing style to analyze the content of the qualitative interviews individually and in team meetings. RESULTS Participants identified 3 types of issues related to missing appointments without notifying the clinic staff: emotions, perceived disrespect, and not understanding the scheduling system. Although they discussed logistical issues of appointment keeping, participants did not identify these issues as key reasons for nonattendance. Appointment making among these participants was driven by immediate symptoms and a desire for self-care. At the same time, many of these participants experienced anticipatory fear and anxiety about both procedures and bad news. Participants did not feel obligated to keep a scheduled appointment in part because they felt disrespected by the health care system. The effect of this feeling was compounded by participants’ lack of understanding of the scheduling system. CONCLUSIONS The results of this study suggest that reducing no-show rates among patients who sometimes attend might be addressed by reviewing waiting times and participants’ perspectives of personal respect. PMID:15576538

Stressors of Korean Disaster Relief Team Members during the Nepal Earthquake Dispatch: a Consensual Qualitative Research Analysis.

PubMed

Lee, Kangeui; Lee, So Hee; Park, Taejin; Lee, Ji Yeon

2017-03-01

We conducted in-depth interviews with 11 Korean Disaster Relief Team (KDRT) members about stress related to disaster relief work and analyzed the interview data using the Consensual Qualitative Research (CQR) method in order to evaluate difficulties in disaster relief work and to develop solutions to these problems in cooperation with related organizations. Results showed that members typically experienced stress related to untrained team members, ineffective cooperation, and the shock and aftermath of aftershock experiences. Stress tended to stem from several factors: difficulties related to cooperation with new team members, the frightening disaster experience, and the aftermath of the disaster. Other stressors included conflict with the control tower, diverse problems at the disaster relief work site, and environmental factors. The most common reason that members participated in KDRT work despite all the stressors and difficulties was pride about the kind of work it involved. Many subjects in this study suffered from various stresses after the relief work, but they had no other choice than to attempt to forget about their experiences over time. It is recommended that the mental health of disaster relief workers will improve through the further development of effective treatment and surveillance programs in the future.

Stressors of Korean Disaster Relief Team Members during the Nepal Earthquake Dispatch: a Consensual Qualitative Research Analysis

PubMed Central

2017-01-01

We conducted in-depth interviews with 11 Korean Disaster Relief Team (KDRT) members about stress related to disaster relief work and analyzed the interview data using the Consensual Qualitative Research (CQR) method in order to evaluate difficulties in disaster relief work and to develop solutions to these problems in cooperation with related organizations. Results showed that members typically experienced stress related to untrained team members, ineffective cooperation, and the shock and aftermath of aftershock experiences. Stress tended to stem from several factors: difficulties related to cooperation with new team members, the frightening disaster experience, and the aftermath of the disaster. Other stressors included conflict with the control tower, diverse problems at the disaster relief work site, and environmental factors. The most common reason that members participated in KDRT work despite all the stressors and difficulties was pride about the kind of work it involved. Many subjects in this study suffered from various stresses after the relief work, but they had no other choice than to attempt to forget about their experiences over time. It is recommended that the mental health of disaster relief workers will improve through the further development of effective treatment and surveillance programs in the future. PMID:28145656

Understanding antibiotic decision making in surgery-a qualitative analysis.

PubMed

Charani, E; Tarrant, C; Moorthy, K; Sevdalis, N; Brennan, L; Holmes, A H

2017-10-01

To investigate the characteristics and culture of antibiotic decision making in the surgical specialty. A qualitative study including ethnographic observation and face-to-face interviews with participants from six surgical teams at a teaching hospital in London was conducted. Over a 3-month period: (a) 30 ward rounds (WRs) (100 h) were observed, (b) face-to-face follow-up interviews took place with 13 key informants, (c) multidisciplinary meetings on the management of surgical patients and daily practice on wards were observed. Applying these methods provided rich data for characterizing the antibiotic decision making in surgery and enabled cross-validation and triangulation of the findings. Data from the interview transcripts and the observational notes were coded and analysed iteratively until saturation was reached. The surgical team is in a state of constant flux with individuals having to adjust to the context in which they work. The demands placed on the team to be in the operating room, and to address the surgical needs of the patient mean that the responsibility for antibiotic decision making is uncoordinated and diffuse. Antibiotic decision making is considered by surgeons as a secondary task, commonly delegated to junior members of their team and occurs in the context of disjointed communication. There is lack of clarity around medical decision making for treating infections in surgical patients. The result is sub-optimal and uncoordinated antimicrobial management. Developing the role of a perioperative clinician may help to improve patient-level outcomes and optimize decision making. Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Leadership training to improve nurse retention.

PubMed

Wallis, Allan; Kennedy, Kathy I

2013-05-01

This paper discusses findings from an evaluation of a training programme designed to promote collaborative, team-based approaches to improve nurse retention within health care organizations. A year-long leadership training programme was designed and implemented to develop effective teams that could address retention challenges in a diverse set of organizations in Colorado ranging from public, private to non-profit. An evaluation, based on a combination of participant observation, group interviews, and the use of standardized tests measuring individual emotional intelligence and team dynamics was conducted to assess the effectiveness of the training programme. What role do the emotional intelligence of individual members and organizational culture play in team effectiveness? Out of five teams participating in the training programme, two performed exceptionally well, one experienced moderate success and two encountered significant problems. Team dynamics were significantly affected by the emotional intelligence of key members holding supervisory positions and by the existing culture and structure of the participating organizations. Team approaches to retention hold promise but require careful development and are most likely to work where organizations have a collaborative problem-solving environment. © 2012 Blackwell Publishing Ltd.

Naturalistic decision making in forensic science: toward a better understanding of decision making by forensic team leaders.

PubMed

Helsloot, Ira; Groenendaal, Jelle

2011-07-01

This study uses the naturalistic decision-making (NDM) perspective to examine how Dutch forensic team leaders (i.e., the officers in charge of criminal forensic research from the crime scene until the use of laboratory assistance) make decisions in real-life settings and identifies the contextual factors that might influence those decisions. First, a focus group interview was conducted to identify four NDM mechanisms in day-to-day forensic decision making. Second, a serious game was conducted to examine the influence of three of these contextual mechanisms. The results uncovered that forensic team leaders (i) were attracted to obtain further information when more information was initially made available, (ii) were likely to devote more attention to emotionally charged cases, and (iii) used not only forensic evidence in the decision making but also tactical, unverified information of the police inquiry. Interestingly, the measured contextual influences did not deviate significantly from a control group of laypeople. © 2011 American Academy of Forensic Sciences.

Identifying Sociological Factors for the Success of Space Exploration

NASA Astrophysics Data System (ADS)

Lundquist, C. A.; Tarter, D.; Coleman, A.

Astrosociology factors relevant to success of future space exploration may best be identified through studies of sociological circumstances of past successful explorations, such as the Apollo-Lunar Missions. These studies benefit from access to primary records of the past programs. The Archives and Special Collections Division of the Salmon Library at the University of Alabama Huntsville (UAH) houses large collections of material from the early periods of the space age. The Huntsville campus of the University of Alabama System had its birth in the mid-1950s at the time when the von Braun rocket team was relocated from Texas to Huntsville. The University, the City of Huntsville and the US Government rocket organizations developed in parallel over subsequent years. As a result, the University has a significant space heritage and focus. This is true not only for the engineering and science disciplines, but also for the social sciences. The life of the University spans the period when Huntsville government and industrial organizations were responsible for producing the rocket vehicles to first take mankind to the Moon. That endeavor was surely as significant sociologically as technologically. In the 1980s, Donald E. Tarter, conducted a series of video interviews with some leading members of the original von Braun team. Although the interviews ranged over many engineering subjects, they also recorded personal features of people involved in the Apollo lunar exploration program and the interactions between these people. Such knowledge was of course an objective. These interviews are now in the collections of the UAH Library Archives, along with extensive documentation from the same period. Under sponsorship of the Archives and the NASA-Marshall Retiree Association, the interview series was restarted in 2006 to obtain comparable oral-history interviews with more than fifty US born members of the rocket team from the 1960s. Again these video interviews are rich with insights into the people involved in the Apollo lunar exploration program. A common thought in the original and recent interviews is that the 1960s rocket team was a unique assembly of people with leadership and modes of operation that has not been reproduced since. If mankind is again going to the Moon, Mars, an asteroid or elsewhere in the solar system, a similar assembly of people and sociological conditions may well be required.

Collaboration and entanglement: An actor-network theory analysis of team-based intraprofessional care for patients with advanced heart failure

PubMed Central

McDougall, A.; Goldszmidt, M.; Kinsella, E.A.; Smith, S.; Lingard, L.

2017-01-01

Despite calls for more interprofessional and intraprofessional team-based approaches in healthcare, we lack sufficient understanding of how this happens in the context of patient care teams. This multi-perspective, team-based interview study examined how medical teams negotiated collaborative tensions. From 2011 to 2013, 50 patients across five sites in three Canadian provinces were interviewed about their care experiences and were asked to identify members of their health care teams. Patient-identified team members were subsequently interviewed to form 50 “Team Sampling Units” (TSUs), consisting of 209 interviews with patients, caregivers and healthcare providers. Results are gathered from a focused analysis of 13 TSUs where intraprofessional collaborative tensions involved treating fluid overload, or edema, a common HF symptom. Drawing on actor-network theory (ANT), the analysis focused on intraprofessional collaboration between specialty care teams in cardiology and nephrology. The study found that despite a shared narrative of common purpose between cardiology teams and nephrology teams, fluid management tools and techniques formed sites of collaborative tension. In particular, care activities involved asynchronous clinical interpretations, geographically distributed specialist care, fragmented forms of communication, and uncertainty due to clinical complexity. Teams ‘disentangled’ fluid in order to focus on its physiological function and mobilisation. Teams also used distinct ‘framings’ of fluid management that created perceived collaborative tensions. This study advances collaborative entanglement as a conceptual framework for understanding, teaching, and potentially ameliorating some of the tensions that manifest during intraprofessional care for patients with complex, chronic disease. PMID:27490299

A qualitative evaluation of foundation dentists' and training programme directors' perceptions of clinical audit in general dental practice.

PubMed

Thornley, P; Quinn, A; Elley, K

2015-08-28

This study reports on an investigation into clinical audit (CA) educational and service delivery outcomes in a dental foundation training (DFT) programme. The aim was to investigate CA teaching, learning and practice from the perspective of foundation dentists (FDs) and to record suggestions for improvement. A qualitative research methodology was used. Audio recordings of focus group interviews with FDs were triangulated by an interview with a group of training programme directors (TPDs). The interviews were transcribed and thematically analysed using a 'Framework' approach within Nvivo Data Analysis Software. FDs report considerable learning and behaviour change. However, TPDs have doubts about the long-term effects on service delivery. There can be substantial learning in the clinical, managerial, communication and professionalism domains, and in the development of time management, organisational and team-working skills. Information is provided about use of resources and interaction with teachers and colleagues. CA provides learning opportunities not produced by other educational activities including 'awkward conversations' with team-members in the context of change management and providing feedback. This is relevant when applying the recommendations of the Francis report. This paper should be useful to any dentist conducting audit or team training. Suggestions are made for improvements to resources and support including right touch intervention. Trainers should teach in the 'Goldilocks Zone'.

Strengths and weaknesses of working with the Global Trigger Tool method for retrospective record review: focus group interviews with team members.

PubMed

Schildmeijer, Kristina; Nilsson, Lena; Perk, Joep; Arestedt, Kristofer; Nilsson, Gunilla

2013-09-24

The aim was to describe the strengths and weaknesses, from team member perspectives, of working with the Global Trigger Tool (GTT) method of retrospective record review to identify adverse events causing patient harm. A qualitative, descriptive approach with focus group interviews using content analysis. 5 Swedish hospitals in 2011. 5 GTT teams, with 5 physicians and 11 registered nurses. 5 focus group interviews were carried out with the five teams. Interviews were taped and transcribed verbatim. 8 categories emerged relating to the strengths and weaknesses of the GTT method. The categories found were: Usefulness of the GTT, Application of the GTT, Triggers, Preventability of harm, Team composition, Team tasks, Team members' knowledge development and Documentation. Gradually, changes in the methodology were made by the teams, for example, the teams reported how the registered nurses divided up the charts into two sets, each being read respectively. The teams described the method as important and well functioning. Not only the most important, but also the most difficult, was the task of bringing the results back to the clinic. The teams found it easier to discuss findings at their own clinics. The GTT method functions well for identifying adverse events and is strengthened by its adaptability to different specialties. However, small, gradual methodological changes together with continuingly developed expertise and adaption to looking at harm from a patient's perspective may contribute to large differences in assessment over time.

Experiences of security and continuity of care: Patients' and families' narratives about the work of specialized palliative home care teams.

PubMed

Klarare, Anna; Rasmussen, Birgit H; Fossum, Bjöörn; Fürst, Carl Johan; Hansson, Johan; Hagelin, Carina Lundh

2017-04-01

Those who are seriously ill and facing death are often living with physical, emotional, social, and spiritual suffering. Teamwork is considered to be necessary to holistically meet the diverse needs of patients in palliative care. Reviews of studies regarding palliative care team outcomes have concluded that teams provide benefits, especially regarding pain and symptom management. Much of the research concerning palliative care teams has been performed from the perspective of the service providers and has less often focused on patients' and families' experiences of care. Our aim was to investigate how the team's work is manifested in care episodes narrated by patients and families in specialized palliative home care (SPHC). A total of 13 interviews were conducted with patients and families receiving specialized home care. Six patients and seven family members were recruited through SPHC team leaders. Interviews were transcribed verbatim and the transcripts qualitatively analyzed into themes. Two themes were constructed through thematic analysis: (1) security ("They are always available," "I get the help I need quickly"); and (2) continuity of care ("They know me/us, our whole situation and they really care"). Of the 74 care episodes, 50 were descriptions of regularly scheduled visits, while 24 related to acute care visits and/or interventions. Patients' and family members' descriptions of the work of SPHC teams are conceptualized through experiences of security and continuity of care. Experiences of security are fostered through the 24/7 availability of the team, sensitivity and flexibility in meeting patients' and families' needs, and practical adjustments to enable care at home. Experiences of continuity of care are fostered through the team's collective approach, where the individual team member knows the patients and family members, including their whole situation, and cares about the little things in life as well as caring for the family unit.

Customisation of an instrument to assess anaesthesiologists' non-technical skills.

PubMed

Jepsen, Rikke M H G; Spanager, Lene; Lyk-Jensen, Helle T; Dieckmann, Peter; Østergaard, Doris

2015-02-22

The objectives of the study were to identify Danish anaesthesiologists' non-technical skills and to customise the Scottish-developed Anaesthetists' Non-Technical Skills instrument for Danish anaesthesiologists. Six semi-structured group interviews were conducted with 31 operating room team members: anaes-thesiologists, nurse anaesthetists, surgeons, and scrub nurses. Interviews were transcribed verbatim and analysed using directed content analysis. Anaesthesiologists' non-technical skills were identified, coded, and sorted using the original instrument as a basis. The resulting prototype instrument was discussed with anaesthesiologists from 17 centres to ensure face validity. Interviews lasted 46-67 minutes. Identified examples of anaesthesiologists' good or poor non-technical skills fit the four categories in the original instrument: situation awareness; decision making; team working; and task management. Anaesthesiologists' leadership role in the operating room was emphasised: the original 'Task Management' category was named 'Leadership'. One new element, 'Demonstrating self-awareness' was added under the category 'Situation Awareness'. Compared with the original instrument, half of the behavioural markers were new, which reflected that being aware of and communicating one's own abilities to the team; working systematically; and speaking up to avoid adverse events were important skills. The Anaesthetists' Non-Technical Skills instrument was customised to a Danish setting using the identified non-technical skills for anaesthesiologists and the original instrument as basis. The customised instrument comprises four categories and 16 underpinning elements supported by multiple behavioural markers. Identifying non-technical skills through semi-structured group interviews and analysing them using direct content analysis proved a useful method for customising an assessment instrument to another setting.

The influence of personality type on decision making in the physical therapy admission process.

PubMed

Bezner, J R; Boucher, B K

2001-01-01

The purpose of this study was to identify the personality types of physical therapy (PT) interviewers and applicants, using the Personality Styles (PS) assessment tool, and to determine whether an interview team's personality type influences the rating score given. The PS was validated in a study of 298 students who completed the Myers-Briggs Type Indicator (MBTI) Form G and a PS assessment. By chi-square analysis the PS model appears to be a valid representation of the MBTI (chi 2 = 86.62, p < 0.00001). Subjects for the interview portion of the study were 282 student applicants, 19 faculty, and 47 clinicians from two PT programs. A randomly assigned faculty/clinician team interviewed each applicant. Two one-way ANOVAs were performed with interview score as the dependent variable and 1) applicant personality type in relation to faculty/clinician team (same, different from both, like one) and 2) applicant personality type as the independent variables. Internal consistency of the interview rating form was alpha = 0.89. Mean interview score was 33.97/42 (SD 4.59). Interview scores were not significantly different between applicants who interviewed with clinician/faculty teams that were "like" compared with "not like" the applicants (F0.864; p = 0.423), but were significantly different between applicants with different PS personality types (F3.159; p = 0.026). Although personality type of the interview team did not impact the score given, thereby refuting the presence of interviewer bias, the rating scores did vary according to personality type of the applicant, suggesting a possible stereotyping bias in the criteria used to rate applicants.

Multidisciplinary team of intensive therapy: humanization and fragmentation of the work process.

PubMed

Evangelista, Viviane Canhizares; Domingos, Thiago da Silva; Siqueira, Fernanda Paula Cerântola; Braga, Eliana Mara

2016-01-01

to understand the meaning of humanized care in intensive care units considering the experience of the multidisciplinary team. descriptive and exploratory qualitative research. For this purpose, we conducted semi-structured interviews with 24 professionals of the heath-care team, and, after transcription, we organized the qualitative data according to content analysis. from two main categories, we were able to understand that humanized care is characterized in the actions of health-care: effective communication, team work, empathy, singularity, and integrality; and mischaracterized in the management processes, specifically in the fragmentation of the work process and health-care, in the precarious work conditions, and in differing conceptual aspects of the political proposal of humanization. care activities in intensive therapy are guided by the humanization of care and corroborate the hospital management as a challenge to be overcome to boost advances in the operationalization of this Brazilian policy.

Organizational socialization in team sport environments.

PubMed

Benson, A J; Evans, M B; Eys, M A

2016-04-01

Socialization tactics are often used to manage initial group member interactions in a way that facilitates transition experiences. Although this process is heavily researched in organizational contexts, we sought to extend this line of inquiry to sport by examining the nature of socialization tactics used to integrate new members into existing teams. Interviews were conducted with 12 coaches and 12 athletes from several Canadian Interuniversity Sport teams to explore the nature of socialization and the circumstances underscoring why certain approaches are taken over others. A key process involved establishing congruency of role expectations between incoming athletes and group leaders, and socialization processes balanced expectations of conformity with encouragement of individual personalities within the group. A conceptual basis to examine socialization into team sport environments is discussed in relation to the extant organizational theories, and the practical implications of delineating sport socialization tactics are forwarded. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Beyond quality improvement: exploring why primary care teams engage in a voluntary audit and feedback program.

PubMed

Wagner, Daniel J; Durbin, Janet; Barnsley, Jan; Ivers, Noah M

2017-12-02

Despite its popularity, the effectiveness of audit and feedback in support quality improvement efforts is mixed. While audit and feedback-related research efforts have investigated issues relating to feedback design and delivery, little attention has been directed towards factors which motivate interest and engagement with feedback interventions. This study explored the motivating factors that drove primary care teams to participate in a voluntary audit and feedback initiative. Interviews were conducted with leaders of primary care teams who had participated in at least one iteration of the audit and feedback program. This intervention was developed by an organization which advocates for high-quality, team-based primary care in Ontario, Canada. Interview transcripts were coded using the Consolidated Framework for Implementation Research and the resulting framework was analyzed inductively to generate key themes. Interviews were completed with 25 individuals from 18 primary care teams across Ontario. The majority were Executive Directors (14), Physician leaders (3) and support staff for Quality Improvement (4). A range of motivations for participating in the audit and feedback program beyond quality improvement were emphasized. Primarily, informants believed that the program would eventually become a best-in-class audit and feedback initiative. This reflected concerns regarding existing initiatives in terms of the intervention components and intentions as well as the perception that an initiative by primary care, for primary care would better reflect their own goals and better support desired patient outcomes. Key enablers included perceived obligations to engage and provision of support for the work involved. No teams cited an evidence base for A&F as a motivating factor for participation. A range of motivating factors, beyond quality improvement, contributed to participation in the audit and feedback program. Findings from this study highlight that efforts to understand how and when the intervention works best cannot be limited to factors within developers' control. Clinical teams may more readily engage with initiatives with the potential to address their own long-term system goals. Aligning motivations for participation with the goals of the audit and feedback initiative may facilitate both engagement and impact.

Criteria for successful multiprofessional cooperation in palliative care teams.

PubMed

Jünger, S; Pestinger, M; Elsner, F; Krumm, N; Radbruch, L

2007-06-01

Team work is considered a central component of palliative care. Within this comparatively young field of medicine, the emergence of new institutions (eg, palliative care units) highlights the challenge of establishing a completely new team. This study focuses on the factors, which enhance both the success and outcome criteria of good team work from the perception of team members in a palliative care unit. The palliative care team at the University Hospital of Aachen (n = 19) was interviewed 1 year after the unit's startup by the means of semistructured interviews. Interview texts were analysed using qualitative content analysis. Factors crucial to cooperation in the team members' views were close communication, team philosophy, good interpersonal relationships, high team commitment, autonomy and the ability to deal with death and dying. Moreover, close communication was by far the most frequently mentioned criteria for cooperation. Team performance, good coordination of workflow and mutual trust underpin the evaluation of efficient team work. Inefficient team work is associated with the absence of clear goals, tasks and role delegation, as well as a lack of team commitment. In a new team, close communication is particularly important for staff as they reorientate themselves to the dynamics of a new peer group. The results confirm the overwhelming importance of clarity, commitment and close, positive exchange among team members for successful team work.

Promoting Action on Research Implementation in Health Services framework applied to TeamSTEPPS implementation in small rural hospitals.

PubMed

Ward, Marcia M; Baloh, Jure; Zhu, Xi; Stewart, Greg L

A particularly useful model for examining implementation of quality improvement interventions in health care settings is the PARIHS (Promoting Action on Research Implementation in Health Services) framework developed by Kitson and colleagues. The PARIHS framework proposes three elements (evidence, context, and facilitation) that are related to successful implementation. An evidence-based program focused on quality enhancement in health care, termed TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety), has been widely promoted by the Agency for Healthcare Research and Quality, but research is needed to better understand its implementation. We apply the PARIHS framework in studying TeamSTEPPS implementation to identify elements that are most closely related to successful implementation. Quarterly interviews were conducted over a 9-month period in 13 small rural hospitals that implemented TeamSTEPPS. Interview quotes that were related to each of the PARIHS elements were identified using directed content analysis. Transcripts were also scored quantitatively, and bivariate regression analysis was employed to explore relationships between PARIHS elements and successful implementation related to planning activities. The current findings provide support for the PARIHS framework and identified two of the three PARIHS elements (context and facilitation) as important contributors to successful implementation. This study applies the PARIHS framework to TeamSTEPPS, a widely used quality initiative focused on improving health care quality and patient safety. By focusing on small rural hospitals that undertook this quality improvement activity of their own accord, our findings represent effectiveness research in an understudied segment of the health care delivery system. By identifying context and facilitation as the most important contributors to successful implementation, these analyses provide a focus for efficient and effective sustainment of TeamSTEPPS efforts.

Patient and Practice Perspectives on Strategies for Controlling Blood Pressure, North Carolina, 2010–2012

PubMed Central

Vu, Maihan B.; Halladay, Jacqueline R.; Miller, Cassandra; Garcia, Beverly A.; Cummings, Doyle M.; Cene, Crystal W.; Hinderliter, Alan; Little, Edwin; Rachide, Marjorie; DeWalt, Darren

2014-01-01

Introduction Patient and practice perspectives can inform development of team-based approaches to improving blood pressure control in primary care. We used a community-based participatory research approach to assess patient and practice perceptions regarding the value of team-based strategies for controlling blood pressure in a rural North Carolina population from 2010 through 2012. Methods In-depth interviews were conducted with 41 adults with hypertension, purposely sampled to include diversity of sex, race, literacy, and blood pressure control, and with key office staff at 5 rural primary care practices in the southeastern US “stroke belt.” Interviews explored barriers to controlling blood pressure, the practice’s role in controlling blood pressure, and opinions on the use of team care delivery. Results Patients reported that provider strategies to optimize blood pressure control should include regular visits, medication adjustment, side-effect discussion, and behavioral counseling. When discussing team-based approaches to hypertension care, patients valued verbal encouragement, calls from the doctor’s office, and the opportunity to ask questions. However, they voiced concerns about the effect of having too many people involved in their care. Practice staff focused on multiple, broad methods to control blood pressure including counseling, regular office visits, media to improve awareness, and support groups. An explicit focus of delivering care as teams was a newer concept. Conclusion When developing a team approach to hypertension treatment, patients value high-quality communication and not losing their primary relationship with their provider. Practice staff members were open to a team-based approach but had limited knowledge of what such an approach would entail. PMID:24762533

Barriers to education of overseas doctors in paediatrics: a qualitative study in South Yorkshire.

PubMed

Mahajan, J; Stark, P

2007-03-01

To explore the factors that may influence the progress of doctors who come from the Indian subcontinent to train in paediatrics in the UK. Overseas doctors training in paediatrics in Rotherham, Sheffield and Doncaster participated in the study. Focus groups were used to collect data; two focus groups, each with 4-5 participants, were conducted at 6-week intervals. Semistructured, one-to-one interviews were conducted to add more understanding and depth to issues highlighted in the focus groups. The focus groups and interviews were audiotaped; the tapes were transcribed and data were analysed using the Grounded Theory; open codes were formed and concepts identified using microanalysis, and initial theories were built. Lack of information about the National Health Service (NHS)/Royal Colleges, inappropriate communication skills, difficulties in team working, difficulties in preparing for Royal College examinations, visa and job hunting, and social and cultural isolation were identified as major barriers. Problems arose not only from difficulties with language but also from use of local and colloquial words, different accents and difficulty in communicating sensitive issues. Lack of understanding of role in teams and difficulties in working in multiprofessional setting all contributed to the problems. Cultural differences inside and outside the workplace, and social isolation were also highlighted. Induction programmes, mentoring, awareness of the issues within the teams, and courses in communication specifically directed at overseas doctors were identified as means to overcome these barriers. Several intercultural factors were identified that could act as barriers to the progress of overseas doctors training in paediatrics in the UK. Increased awareness of these factors within the teams would be the first step in resolving some of the issues.

The Oral History of Evaluation, Part 4: The Professional Evolution of Carol H. Weiss

ERIC Educational Resources Information Center

American Journal of Evaluation, 2006

2006-01-01

During the past 3 years, the Oral History Project Study Team, which comprises Jean King, Mel Mark, and Robin Miller, has conducted interviews with individuals who have made signal contributions to the program evaluation field. Their goal was to capture the professional evolution of those who have contributed to the way evaluation in the United…

An Interview with the 1985 USA Team to the International Mathematical Olympiad.

ERIC Educational Resources Information Center

Page, Warren

1985-01-01

This interview with the six members of the 1985 American team to the International Mathematical Olympiad (IMO) focuses on such areas as their evolving mathematical knowledge, mathematical pursuits, accomplishments, and interests. Also included are biographical sketches of the team members and the 1985 IMO problems (with solutions). (JN)

Involving members of vulnerable populations in the development of patient decision aids: a mixed methods sequential explanatory study.

PubMed

Dugas, Michèle; Trottier, Marie-Ève; Chipenda Dansokho, Selma; Vaisson, Gratianne; Provencher, Thierry; Colquhoun, Heather; Dogba, Maman Joyce; Dupéré, Sophie; Fagerlin, Angela; Giguere, Anik M C; Haslett, Lynne; Hoffman, Aubri S; Ivers, Noah M; Légaré, France; Légaré, Jean; Levin, Carrie A; Menear, Matthew; Renaud, Jean-Sébastien; Stacey, Dawn; Volk, Robert J; Witteman, Holly O

2017-01-19

Patient decision aids aim to present evidence relevant to a health decision in understandable ways to support patients through the process of making evidence-informed, values-congruent health decisions. It is recommended that, when developing these tools, teams involve people who may ultimately use them. However, there is little empirical evidence about how best to undertake this involvement, particularly for specific populations of users such as vulnerable populations. To describe and compare the development practices of research teams that did and did not specifically involve members of vulnerable populations in the development of patient decision aids, we conducted a secondary analysis of data from a systematic review about the development processes of patient decision aids. Then, to further explain our quantitative results, we conducted semi-structured telephone interviews with 10 teams: 6 that had specifically involved members of vulnerable populations and 4 that had not. Two independent analysts thematically coded transcribed interviews. Out of a total of 187 decision aid development projects, 30 (16%) specifically involved members of vulnerable populations. The specific involvement of members of vulnerable populations in the development process was associated with conducting informal needs assessment activities (73% vs. 40%, OR 2.96, 95% CI 1.18-7.99, P = .02) and recruiting participants through community-based organizations (40% vs. 11%, OR 3.48, 95% CI 1.23-9.83, P = .02). In interviews, all developers highlighted the importance, value and challenges of involving potential users. Interviews with developers whose projects had involved members of vulnerable populations suggested that informal needs assessment activities served to center the decision aid around users' needs, to better avoid stigma, and to ensure that the topic truly matters to the community. Partnering with community-based organizations may facilitate relationships of trust and may also provide a non-threatening and accessible location for research activities. There are a small number of key differences in the development processes for patient decision aids in which members of vulnerable populations were or were not specifically involved. Some of these practices may require additional time or resources. To address health inequities, researchers, communities and funders may need to increase awareness of these approaches and plan accordingly.

Working with young adults with Type 1 diabetes: views of a multidisciplinary care team and implications for service delivery.

PubMed

Brierley, S; Eiser, C; Johnson, B; Young, V; Heller, S

2012-05-01

Young adults with Type 1 diabetes experience difficulties achieving glucose targets. Clinic attendance can be poor, although health and self-care tend to be better among those who attend regularly. Our aims were to describe staff views about challenges working with this age-group (16-21 years). Semistructured interviews were conducted with 14 staff from Sheffield Teaching Hospitals diabetes care team. Interviews were audio-recorded, transcribed and analysed using thematic analysis. Three main themes emerged. Unique challenges working with young adults included staff emotional burden, the low priority given to self-care by young adults and the complexity of the diabetes regimen. Working in a multidisciplinary team was complicated by differences in consultation styles, poor team cohesion and communication. An ideal service should include psychological support for the professional team, identification of key workers, and development of individualized care plans. Staff differed in their views about how to achieve optimal management for young adults, but emphasized the need for greater patient-centred care and a range of interventions appropriate for individual levels of need. They also wanted to increase their own skills and confidence working with this age-group. While these results reflect the views of staff working in only one diabetes centre, they are likely to reflect the views of professionals delivering care to individuals of this age; replication is needed to determine their generalizability. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.

Taxonomy of Trauma Leadership Skills: A Framework for Leadership Training and Assessment.

PubMed

Leenstra, Nico F; Jung, Oliver C; Johnson, Addie; Wendt, Klaus W; Tulleken, Jaap E

2016-02-01

Good leadership is essential for optimal trauma team performance, and targeted training of leadership skills is necessary to achieve such leadership proficiency. To address the need for a taxonomy of leadership skills that specifies the skill components to be learned and the behaviors by which they can be assessed across the five phases of trauma care, the authors developed the Taxonomy of Trauma Leadership Skills (TTLS). Critical incident interviews were conducted with trauma team leaders and members from different specialties-emergency physicians, trauma surgeons, anesthesiologists, and emergency ward nurses-at three teaching hospitals in the Netherlands during January-June 2013. Data were iteratively analyzed for examples of excellent leadership skills at each phase of trauma care. Using the grounded theory approach, elements of excellent leadership skills were identified and classified. Elements and behavioral markers were sorted and categorized using multiple raters. In a two-round verification process in late 2013, the taxonomy was reviewed and rated by trauma team leaders and members from the multiple specialties for its coverage of essential items. Data were gathered from 28 interviews and 14 raters. The TTLS details 5 skill categories (information coordination, decision making, action coordination, communication management, and coaching and team development) and 37 skill elements. The skill elements are captured by 67 behavioral markers. The three-level taxonomy is presented according to five phases of trauma care. The TTLS provides a framework for teaching, learning, and assessing team leadership skills in trauma care and other complex, acute care situations.

Positives and negatives of online dating according to women 50.

PubMed

Vandeweerd, Carla; Myers, Jaime; Coulter, Martha; Yalcin, Ali; Corvin, Jaime

2016-01-01

To understand the positives and negatives of online dating according to the lived experience of older women, telephone interviews were conducted with 45 women ages 50+ who date online. Interviews were audio recorded, transcribed verbatim, and thematically team coded. The opportunity to expand one's social network for both friendships and romantic partners, the ability to control dating risks and pace of relationship formation, and knowing more about one's partner were significant reported benefits of online dating. Dating online also includes unique risks, such as pervasive lying, attempted financial exploitation in the form of scammers, and unwanted electronic sexual aggression.

"The Jackson Table Is a Pain in the…": A Qualitative Study of Providers' Perception Toward a Spinal Surgery Table.

PubMed

Asiedu, Gladys B; Lowndes, Bethany R; Huddleston, Paul M; Hallbeck, Susan

2018-03-01

The aim of this study was to define health care providers' perceptions toward prone patient positioning for spine surgery using the Jackson Table, which has not been hitherto explored. We analyzed open-ended questionnaire data and interviews conducted with the spine surgical team regarding the current process of spinal positioning/repositioning using the Jackson Table. Participants were asked to provide an open-ended explanation as to whether they think the current process of spinal positioning/repositioning is safe for the staff or patients. Follow-up qualitative interviews were conducted with 11 of the participants to gain an in-depth understanding of the challenges and safety issues related to prone patient positioning. Data analysis resulted in 6 main categories: general challenges with patient positioning, role-specific challenges, challenges with the Jackson Table and the "sandwich" mechanism, safety concerns for patients, safety concerns for the medical staff, and recommendations for best practices. This study is relevant to everyday practice for spinal surgical team members and advances our understanding of how surgical teams qualitatively view the current process of patient positioning for spinal surgery. Providers recommended best practices for using the Jackson Table, which can be achieved through standardized practice for transfer of patients, educational tools, and checklists for equipment before patient transfer and positioning. This research has identified several important practice opportunities for improving provider and patient safety in spine surgery.

Failure Mode and Effects Analysis: views of hospital staff in the UK.

PubMed

Shebl, Nada; Franklin, Bryony; Barber, Nick; Burnett, Susan; Parand, Anam

2012-01-01

To explore health care professionals' experiences and perceptions of Failure Mode and Effects Analysis (FMEA), a team-based, prospective risk analysis technique. Semi-structured interviews were conducted with 21 operational leads (20 pharmacists, one nurse) in medicines management teams of hospitals participating in a national quality improvement programme. Interviews were transcribed, coded and emergent themes identified using framework analysis. Themes identified included perceptions and experiences of participants with FMEA, validity and reliability issues, and FMEA's use in practice. FMEA was considered to be a structured but subjective process that helps health care professionals get together to identify high risk areas of care. Both positive and negative opinions were expressed, with the majority of interviewees expressing positive views towards FMEA in relation to its structured nature and the use of a multidisciplinary team. Other participants criticised FMEA for being subjective and lacking validity. Most likely to restrict its widespread use were its time consuming nature and its perceived lack of validity and reliability. FMEA is a subjective but systematic tool that helps identify high risk areas, but its time consuming nature, difficulty with the scores and perceived lack of validity and reliability may limit its widespread use.

Communicating With the Public About Emerging Health Threats: Lessons From the Pre-Event Message Development Project

PubMed Central

Becker, Steven M.; Henderson, Neil; Glik, Deborah; Jupka, Keri; Middleton, Sarah; Henderson, Carson; Drury, Allison; Mitchell, Elizabeth W.

2008-01-01

Objectives. We sought to better understand the challenges of communicating with the public about emerging health threats, particularly threats involving toxic chemicals, biological agents, and radioactive materials. Methods. At the request of the Centers for Disease Control and Prevention, we formed an interdisciplinary consortium of investigative teams from 4 schools of public health. Over 2 years, the investigative teams conducted 79 focus group interviews with 884 participants and individual cognitive response interviews with 129 respondents, for a total sample of 1013 individuals. The investigative teams systematically compared their results with other published research in public health, risk communication, and emergency preparedness. Results. We found limited public understanding of emerging biological, chemical, and radioactive materials threats and of the differences between them; demand for concrete, accurate, and consistent information about actions needed for protection of self and family; active information seeking from media, local authorities, and selected national sources; and areas in which current emergency messaging can be improved. Conclusions. The public will respond to a threat situation by seeking protective information and taking self-protective action, underlining the critical role of effective communication in public health emergencies. PMID:18382011

Performance-based management and quality of work: an empirical assessment.

PubMed

Falzon, Pierre; Nascimento, Adelaide; Gaudart, Corinne; Piney, Cécile; Dujarier, Marie-Anne; Germe, Jean-François

2012-01-01

In France, in the private sector as in the public sector, performance-based management tends to become a norm. Performance-based management is supposed to improve service quality, productivity and efficiency, transparency of allotted means and achieved results, and to better focus the activity of employees and of the whole organization. This text reports a study conducted for the French Ministry of Budget by a team of researchers in ergonomics, sociology and management science, in order to assess the impact of performance-based management on employees, on teams and on work organization. About 100 interviews were conducted with employees of all categories and 6 working groups were set up in order to discuss and validate or amend our first analyses. Results concern several aspects: workload and work intensification, indicators and performance management and the transformation of jobs induced by performance management.

The community network: an Aboriginal community football club bringing people together.

PubMed

Thorpe, Alister; Anders, Wendy; Rowley, Kevin

2014-01-01

There are few empirical studies about the role of Aboriginal sporting organisations in promoting wellbeing. The aim of the present study was to understand the impact of an Aboriginal community sporting team and its environment on the social, emotional and physical wellbeing of young Aboriginal men, and to identify barriers and motivators for participation. A literature review of the impact of sport on the health and wellbeing of Aboriginal participants was conducted. This informed a qualitative study design with a grounded theory approach. Four semistructured interviews and three focus groups were completed with nine current players and five past players of the Fitzroy Stars Football Club to collect data about the social, emotional and physical wellbeing impact of an Aboriginal football team on its Aboriginal players. Results of the interviews were consistent with the literature, with common concepts emerging around community connection, cultural values and identity, health, values, racism and discrimination. However, the interviews provided further detail around the significance of cultural values and community connection for Aboriginal people. The complex nature of social connections and the strength of Aboriginal community networks in sports settings were also evident. Social reasons were just as important as individual health reasons for participation. Social and community connection is an important mechanism for maintaining and strengthening cultural values and identity. Barriers and motivators for participation in Aboriginal sports teams can be complex and interrelated. Aboriginal sports teams have the potential to have a profound impact on the health of Aboriginal people, especially its players, by fostering a safe and culturally strengthening environment and encompassing a significant positive social hub for the Aboriginal community.

Effectiveness of a Comprehensive Stress Management Program to Reduce Work-Related Stress in a Medium-Sized Enterprise

PubMed Central

2014-01-01

Objectives To assess the effectiveness of a comprehensive workplace stress management program consisting of participatory action-oriented training (PAOT) and individual management. Methods A comprehensive workplace stress management program was conducted in a medium-sized enterprise. The baseline survey was conducted in September 2011, using the Korean Occupational Stress Scale (KOSS) and Worker’s Stress Response Inventory (WSRI). After implementing both organizational and individual level interventions, the follow up evaluation was conducted in November 2011. Results Most of the workers participated in the organizational level PAOT and made Team-based improvement plans. Based on the stress survey, 24 workers were interviewed by a researcher. After the organizational and individual level interventions, there was a reduction of several adverse psychosocial factors and stress responses. In the case of blue-collar workers, psychosocial factors such as the physical environment, job demands, organizational system, lack of rewards, and occupational climate were significantly improved; in the case of white-collar workers, the occupational climate was improved. Conclusions In light of these results, we concluded that the comprehensive stress management program was effective in reducing work-related stress in a short-term period. A persistent long-term follow up is necessary to determine whether the observed effects are maintained over time. Both team-based improvement activities and individual interviews have to be sustainable and complementary to each other under the long-term plan. PMID:24524591

Parental responses to involvement in rounds on a pediatric inpatient unit at a teaching hospital: a qualitative study.

PubMed

Latta, Linda C; Dick, Ronald; Parry, Carol; Tamura, Glen S

2008-03-01

In pediatric teaching hospitals, medical decisions are traditionally made by the attending and resident physicians during rounds that do not include parents. This structure limits the ability of the medical team to provide "family-centered care" and the attending physician to model communication skills. The authors thus set out to identify how parents responded to participation in interdisciplinary teaching rounds conducted in a large tertiary care children's teaching hospital. A qualitative descriptive study was conducted using data from semistructured interviews of parents who had participated in rounds on the inpatient medical unit of a large academic children's hospital. From December 2004 to April 2005, 18 parents were interviewed after their participation in rounds. Questions assessed their experiences, expectations, preferred communication styles, and suggestions for improvement. Transcripts of the interviews were analyzed using qualitative content analysis. Being able to communicate, understand the plan, and participate with the team in decision making about their child's care were the most frequently cited outcomes of importance to parents. All 18 participants described the overall experience as positive, and 17 of 18 described themselves as "comfortable" with inclusion in rounds. Use of lay terminology and inclusion of nurses in rounds were preferred. Including parents on ward rounds at a teaching hospital was viewed positively by parents. Specific themes of particular importance to parents were identified. Further study is needed to assess the impact of inclusion of parents on rounds on patient outcomes and the resident experience.

Panel Management to Improve Smoking and Hypertension Outcomes by VA Primary Care Teams: A Cluster-Randomized Controlled Trial.

PubMed

Schwartz, Mark D; Jensen, Ashley; Wang, Binhuan; Bennett, Katelyn; Dembitzer, Anne; Strauss, Shiela; Schoenthaler, Antoinette; Gillespie, Colleen; Sherman, Scott

2015-07-01

Panel Management can expand prevention and chronic illness management beyond the office visit, but there is limited evidence for its effectiveness or guidance on how best to incorporate it into practice. We aimed to test the effectiveness of incorporating panel management into clinical practice by incorporating Panel Management Assistants (PMAs) into primary care teams with and without panel management education. We conducted an 8-month cluster-randomized controlled trial of panel management for improving hypertension and smoking cessation outcomes among veterans. Twenty primary care teams from the Veterans Affairs New York Harbor were randomized to control, panel management support, or panel management support plus education groups. Teams included 69 clinical staff serving 8,153 hypertensive and/or smoking veterans. Teams assigned to the intervention groups worked with non-clinical Panel Management Assistants (PMAs) who monitored care gaps and conducted proactive patient outreach, including referrals, mail reminders and motivational interviewing by telephone. Measurements included mean systolic and diastolic blood pressure, proportion of patients with controlled blood pressure, self-reported quit attempts, nicotine replacement therapy (NRT) prescriptions, and referrals to disease management services. Change in mean blood pressure, blood pressure control, and smoking quit rates were similar across study groups. Patients on intervention teams were more likely to receive NRT (OR = 1.4; 95% CI 1.2-1.6) and enroll in the disease management services MOVE! (OR = 1.2; 95% CI 1.1-1.6) and Telehealth (OR = 1.7, 95% CI 1.4-2.1) than patients on control teams. Panel Management support for primary care teams improved process, but not outcome variables among veterans with hypertension and smoking. Incorporating PMAs into teams was feasible and highly valued by the clinical staff, but clinical impact may require a longer intervention.

[Motivations and emotional experiences of the first hospital multidisciplinary team trained to care for people with Ebola in Andalusia, Spain (2014-2016)].

PubMed

Casado-Mejía, Rosa; Brea-Ruiz, Ma Teresa; Torres-Enamorado, Dolores; Albar-Marín, Ma Jesús; Botello-Hermosa, Alicia; Santos-Casado, María; Casado-Rojas, Irene

2016-01-01

The Hospital Universitario Virgen del Rocío (HUVR) of Seville was chosen as the reference Andalusian site to treat possible cases of Ebola. After the health alert (WHO, 2014), a voluntary group of healthcare and non-healthcare professionals was set up, which, after being trained, treated a possible case. In this light, the aim is to understand the motivations and emotional experiences of this group and to identify the facilitators of and obstacles to its operation. Qualitative, interpretative and phenomenological study. Observation unit: professional team of the HUVR trained to treat Ebola cases. Analysis units: teamwork, motivations and emotions. Three interviews with key informants were conducted, as well as three discussion groups involving 23 of the 60 team members (2014-2016). A content analysis of the motivations, emotions and elements affecting the team's operation was conducted with QSRNUDISTVivo10. data sources, techniques and disciplinary perspectives were triangulated. The results were presented to the team, which duly agreed with the findings. Training, professional responsibility, professional self-esteem, risk appetite or loyalty to the leader stood out as motivations to voluntarily join the team. Emotional experiences evolved from fear and stress to self-pressure control, while essential elements for the team's operation were found to be calmness and confidence based on training and teamwork. Family, source department, resources, communication media and emotional management were facilitators of or obstacles to the team's success. An understanding of the key motivational and influential factors may be important in the management of effective and successful multidisciplinary teams during health alerts. Copyright © 2016 SESPAS. Published by Elsevier Espana. All rights reserved.

Identifying and overcoming implementation challenges: Experience of 59 noninstitutional long-term services and support pilot programs in the Veterans Health Administration

PubMed Central

Sullivan, Jennifer L.; Adjognon, Omonyêlé L.; Engle, Ryann L.; Shin, Marlena H.; Afable, Melissa K.; Rudin, Whitney; White, Bert; Shay, Kenneth; Lukas, Carol VanDeusen

2018-01-01

Background: From 2010 to 2013, the Department of Veterans Affairs (VA) funded a large pilot initiative to implement noninstitutional long-term services and supports (LTSS) programs to support aging Veterans. Our team evaluated implementation of 59 VA noninstitutional LTSS programs. Purpose: The specific objectives of this study are to (a) examine the challenges influencing program implementation comparing active sites that remained open and inactive sites that closed during the funding period and (b) identify ways that active sites overcame the challenges they experienced. Methodology: Key informant semistructured interviews occurred between 2011 and 2013. We conducted 217 telephone interviews over four time points. Content analysis was used to identify emergent themes. The study team met regularly to define each challenge, review all codes, and discuss discrepancies. For each follow-up interview with the sites, the list of established challenges was used as a priori themes. Emergent data were also coded. Results: The challenges affecting implementation included human resources and staffing issues, infrastructure, resources allocation and geography, referrals and marketing, leadership support, and team dynamics and processes. Programs were able to overcome challenges by communicating with team members and other areas in the organization, utilizing information technology solutions, creative use of staff and flexible schedules, and obtaining additional resources. Discussion: This study highlights several common challenges programs can address during the program implementation. The most often mentioned strategy was effective communication. Strategies also targeted several components of the organization including organizational functions and processes (e.g., importance of coordination within a team and across disciplines to provide good care), infrastructure (e.g., information technology and human resources), and program fit with priorities in the organization (e.g., leadership support). Implications: Anticipating potential pitfalls of program implementation for future noninstitutional LTSS programs can improve implementation efficiency and program sustainability. Staff at multiple levels in the organization must fully support noninstitutional LTSS programs to address these challenges. PMID:28125459

The impact of an Emergency Medical Technician basic course prior to medical school on medical students.

PubMed

Wyatt, Tasha R; Wood, Elena A; McManus, John; Ma, Kevin; Wallach, Paul M

2018-12-01

Previous research on Emergency Medical Technician (EMT) programs as an early clinical experience indicates that medical students' confidence in patient care and team-building skills increases with participation. However, very little is known about the unplanned, long-term effects of EMT courses on medical students once they enter medical school. This study examined the immediate outcomes produced by the month-long summer EMT course and the unplanned outcomes that students reported 1 year later. Pre/postsurveys were collected on all 25 students who graduated from the EMT course offered before their first year. These survey data were analyzed using a paired-samples t test. A subset of students (N = 14) consented to taking a survey and be interviewed on the lasting impact of their EMT experience. Interviews were conducted 10 months after the 2016 cohort completed the EMT course and at 22 months for the 2015 cohort. They were audio-recorded, transcribed, and analyzed using inductive content analysis. Survey results indicated that students' confidence in patient care and team-building skills increased significantly for all identified skills at the P < 0.05 level. Overall confidence in patient care increased 1.5 points (P = 0.001) on 1-4 Likert-type scale. Overall confidence in team-building skills increased at 0.7 points (P = 0.01). Qualitative analysis of interviews discovered four themes, including the retention and transferability of practical skills, a developed understanding of team communication, comfort with patient interactions, and the development of a framework for assessing patients' needs. Students applied the EMT skills in various extracurricular volunteering experiences and in clinical skills courses. This study concludes that EMT programs have both immediate and lasting effects that seem to assist students with making sense of and navigating other learning opportunities. Specifically, EMT courses offered to students prior to their entry into medical school may help orient them to team-based health care and triaging patient care.

Identifying and overcoming implementation challenges: Experience of 59 noninstitutional long-term services and support pilot programs in the Veterans Health Administration.

PubMed

Sullivan, Jennifer L; Adjognon, Omonyêlé L; Engle, Ryann L; Shin, Marlena H; Afable, Melissa K; Rudin, Whitney; White, Bert; Shay, Kenneth; Lukas, Carol VanDeusen

From 2010 to 2013, the Department of Veterans Affairs (VA) funded a large pilot initiative to implement noninstitutional long-term services and supports (LTSS) programs to support aging Veterans. Our team evaluated implementation of 59 VA noninstitutional LTSS programs. The specific objectives of this study are to (a) examine the challenges influencing program implementation comparing active sites that remained open and inactive sites that closed during the funding period and (b) identify ways that active sites overcame the challenges they experienced. Key informant semistructured interviews occurred between 2011 and 2013. We conducted 217 telephone interviews over four time points. Content analysis was used to identify emergent themes. The study team met regularly to define each challenge, review all codes, and discuss discrepancies. For each follow-up interview with the sites, the list of established challenges was used as a priori themes. Emergent data were also coded. The challenges affecting implementation included human resources and staffing issues, infrastructure, resources allocation and geography, referrals and marketing, leadership support, and team dynamics and processes. Programs were able to overcome challenges by communicating with team members and other areas in the organization, utilizing information technology solutions, creative use of staff and flexible schedules, and obtaining additional resources. This study highlights several common challenges programs can address during the program implementation. The most often mentioned strategy was effective communication. Strategies also targeted several components of the organization including organizational functions and processes (e.g., importance of coordination within a team and across disciplines to provide good care), infrastructure (e.g., information technology and human resources), and program fit with priorities in the organization (e.g., leadership support). Anticipating potential pitfalls of program implementation for future noninstitutional LTSS programs can improve implementation efficiency and program sustainability. Staff at multiple levels in the organization must fully support noninstitutional LTSS programs to address these challenges.

SCOPEOUT: sustainability and spread of quality improvement activities in long-term care- a mixed methods approach.

PubMed

Cranley, Lisa A; Hoben, Matthias; Yeung, Jasper; Estabrooks, Carole A; Norton, Peter G; Wagg, Adrian

2018-03-12

Interventions to improve quality of care for residents of long-term care facilities, and to examine the sustainability and spread of such initiatives, remain a top research priority. The purpose of this exploratory study was to assess the extent to which activities initiated in a quality improvement (QI) collaborative study using care aide led teams were sustained or spread following cessation of the initial project and to identify factors that led to its success. This study used an exploratory mixed methods study design and was conducted in seven residential long-term care facilities in two Canadian provinces. Sustainability and spread of QI activities were assessed by a questionnaire over five time points for 18 months following the collaborative study with staff from both intervention with non-intervention units. Semi-structured interviews were conducted with care managers at six and 12 months. QI team success in applying the QI model was ranked as high, medium, or low using criteria developed by the research team. Descriptive statistics, bivariate analyses, and General Estimating Equations were used to analyze the data. Interview data were analyzed using thematic analysis. In total, 683 surveys were received over the five time periods from 476 unique individuals on a facility unit. Seven managers were interviewed. A total of 533 surveys were analyzed. While both intervention and non-intervention units experienced a decline over time in all outcome measures, this decline was significantly less pronounced on intervention units. Facilities with medium and high success ranking had significantly higher scores in all four outcomes than facilities with a low success ranking. Care aides reported significantly less involvement of others in QI activities, less empowerment and less satisfaction with the quality of their work life than regulated care providers. Manager interviews provided evidence of sustainability of QI activities on the intervention units in four of the seven facilities up to 18 months following the intervention and demonstrated the need for continued staff and leadership engagement. Sustainability of a QI project which empowers and engages care aides is possible and achievable, but requires ongoing staff and leadership engagement.

Practices of weight regulation among elite athletes in combat sports: a matter of mental advantage?

PubMed

Pettersson, Stefan; Ekström, Marianne Pipping; Berg, Christina M

2013-01-01

The combination of extensive weight loss and inadequate nutritional strategies used to lose weight rapidly for competition in weight-category sports may negatively affect athletic performance and health. To explore the reasoning of elite combat-sport athletes about rapid weight loss and regaining of weight before competitions. Qualitative study. With grounded theory as a theoretical framework, we employed a cross-examinational approach including interviews, observations, and Internet sources. Sports observations were obtained at competitions and statements by combat-sport athletes were collected on the Internet. Participants in the interviews were 14 Swedish national team athletes (9 men, 5 women; age range, 18 to 36 years) in 3 Olympic combat sports (wrestling, judo, and taekwondo). Semistructured interviews with 14 athletes from the Swedish national teams in wrestling, judo, and taekwondo were conducted at a location of each participant's choice. The field observations were conducted at European competitions in these 3 sports. In addition, interviews and statements made by athletes in combat sports were collected on the Internet. Positive aspects of weight regulation other than gaining physical advantage emerged from the data during the analysis: sport identity, mental diversion, and mental advantage. Together and individually, these categories point toward the positive aspects of weight regulation experienced by the athletes. Practicing weight regulation mediates a self-image of being "a real athlete." Weight regulation is also considered mentally important as a part of the precompetition preparation, serving as a coping strategy by creating a feeling of increased focus and commitment. Moreover, a mental advantage relative to one's opponents can be gained through the practice of weight regulation. Weight regulation has mentally important functions extending beyond the common notion that combat-sport athletes reduce their weight merely to gain a physical edge over their opponents.

The Role of Emotions in Fieldwork: A Self-Study of Family Research in a Corrections Setting

ERIC Educational Resources Information Center

Arditti, Joyce A.; Joest, Karen S.; Lambert-Shute, Jennifer; Walker, Latanya

2010-01-01

In this study, we document a reflexive process via bracketing techniques and the development of a conceptual map in order to better understand how emotions that arise in the field can inform research design, implementation, and results. We conducted a content analysis of field notes written by a team of researchers who administered an interview to…

Families and Schools in Portugal: An Exploratory Study of the Perspectives of Teachers and Low-Income Parents. IRE Report No. 15.

ERIC Educational Resources Information Center

Davies, Don; And Others

Parent involvement in Portuguese government-sponsored schools is examined, focusing on the relationships between schools and parents of low economic and social status. This study was conducted in spring 1987 by a study team of 18 members, who interviewed more than 257 parents and teachers in nine of the country's districts. A brief…

Differences between British and Japanese perspectives on forensic mental health systems: A preliminary study

PubMed Central

Shiina, Akihiro; Tomoto, Aika; Omiya, Soichiro; Sato, Aiko; Iyo, Masaomi; Igarashi, Yoshito

2017-01-01

AIM To clarify the differences in views on forensic mental health (FMH) systems between the United Kingdom and Japan. METHODS We conducted a series of semi-structured interviews with six leading forensic psychiatrists. Based on a discussion by the research team, we created an interview form. After we finished conducting all the interviews, we qualitatively analyzed their content. RESULTS In the United Kingdom the core domain of FMH was risk assessment and management; however, in Japan, the core domain of FMH was psychiatric testimony. In the United Kingdom, forensic psychiatrists were responsible for ensuring public safety, and psychopathy was identified as a disease but deemed as not suitable for medical treatment. On the other hand, in Japan, psychopathy was not considered a mental illness. CONCLUSION In conclusion, there are considerable differences between the United Kingdom and Japan with regard to the concepts of FMH. Some ideas taken from both cultures for better FMH practice were suggested. PMID:28401045

Conflict on interprofessional primary health care teams--can it be resolved?

PubMed

Brown, Judith; Lewis, Laura; Ellis, Kathy; Stewart, Moira; Freeman, Thomas R; Kasperski, M Janet

2011-01-01

Increasingly, primary health care teams (PHCTs) depend on the contributions of multiple professionals. However, conflict is inevitable on teams. This article examines PHCTs members' experiences with conflict and responses to conflict. This phenomenological study was conducted using in-depth interviews with 121 participants from 16 PHCTs (10 urban and 6 rural) including a wide range of health care professionals. An iterative analysis process was used to examine the verbatim transcripts. The analysis revealed three main themes: sources of team conflict; barriers to conflict resolution; and strategies for conflict resolution. Sources of team conflict included: role boundary issues; scope of practice; and accountability. Barriers to conflict resolution were: lack of time and workload; people in less powerful positions; lack of recognition or motivation to address conflict; and avoiding confrontation for fear of causing emotional discomfort. Team strategies for conflict resolution included interventions by team leaders and the development of conflict management protocols. Individual strategies included: open and direct communication; a willingness to find solutions; showing respect; and humility. Conflict is inherent in teamwork. However, understanding the potential barriers to conflict resolution can assist PHCTs in developing strategies to resolve conflict in a timely fashion.

Teaching strategies used by internal medicine residents on the wards.

PubMed

Smith, Dustin T; Kohlwes, R Jeffrey

2011-01-01

Residents serve as teachers to interns and students in most internal medicine residency programs. The purpose of our study is to explore what internal medicine residents perceive as effective teaching strategies in the inpatient setting and to formulate a guideline for preparing residents to lead their ward teams. Housestaff identified as excellent teaching residents were recruited from a large internal medicine residency program. Focus groups were formed and interviews were conducted using open-ended questions. Transcripts of the interviews were reviewed, analyzed, and compared for accuracy by two investigators. The transcripts were then coded to categorize data into similar subjects from which recurrent themes in resident teaching were identified. Twenty-two residents participated in four focus group interviews held in 2008. We identified five principal themes for effective teaching by residents: (T)aking advantage of teaching opportunities, (E)mpowering learners, (A)ssuming the role of leader, (C)reating a learning environment, and (H)abituating the practice of teaching. Strategies for effective teaching by residents exist. The TEACH mnemonic is a resident-identified method of instruction. Use of this tool could enable residency programs to create instructional curricula to prepare their residents and interns to take on the roles of team leaders and teachers.

The Role of Communication During Trauma Activations: Investigating the Need for Team and Leader Communication Training.

PubMed

Raley, Jessica; Meenakshi, Rani; Dent, Daniel; Willis, Ross; Lawson, Karla; Duzinski, Sarah

Fatal errors due to miscommunication among members of trauma teams are 2 to 4 times more likely to occur than in other medical teams, yet most trauma team members do not receive communication effectiveness training. A needs assessment was conducted to examine trauma team members' miscommunication experiences and research scientists' evaluations of live trauma activations. The purpose of this study is to demonstrate that communication training is necessary and highlight specific team communication competencies that trauma teams should learn to improve communication during activations. Data were collected in 2 phases. Phase 1 required participants to complete a series of surveys. Phase 2 included live observations and assessments of pediatric trauma activations using the assessment of pediatric resuscitation team assessments (APRC-TA) and assessment of pediatric resuscitation leader assessments (APRC-LA). Data were collected at a southwestern pediatric hospital. Trauma team members and leaders completed surveys at a meeting and were observed while conducting activations in the trauma bay. Trained research scientists and clinical staff used the APRC-TA and APRC-LA to measure trauma teams' medical performance and communication effectiveness. The sample included 29 healthcare providers who regularly participate in trauma activations. Additionally, 12 live trauma activations were assessed monday to friday from 8am to 5pm. Team members indicated that communication training should focus on offering assistance, delegating duties, accepting feedback, and controlling emotional expressions. Communication scores were not significantly different from medical performance scores. None of the teams were coded as effective medical performance and ineffective team communication and only 1 team was labeled as ineffective leader communication and effective medical performance. Communication training may be necessary for trauma teams and offer a deeper understanding of the communication competencies that should be addressed. The APRC-TA and APRC-LA both include team communication competencies that could be used as a guide to design training for trauma team members and leaders. Researchers should also continue to examine recommendations for improved team and leader communication during activations using in-depth interviews and focus groups. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Learning mechanisms to limit medication administration errors.

PubMed

Drach-Zahavy, Anat; Pud, Dorit

2010-04-01

This paper is a report of a study conducted to identify and test the effectiveness of learning mechanisms applied by the nursing staff of hospital wards as a means of limiting medication administration errors. Since the influential report ;To Err Is Human', research has emphasized the role of team learning in reducing medication administration errors. Nevertheless, little is known about the mechanisms underlying team learning. Thirty-two hospital wards were randomly recruited. Data were collected during 2006 in Israel by a multi-method (observations, interviews and administrative data), multi-source (head nurses, bedside nurses) approach. Medication administration error was defined as any deviation from procedures, policies and/or best practices for medication administration, and was identified using semi-structured observations of nurses administering medication. Organizational learning was measured using semi-structured interviews with head nurses, and the previous year's reported medication administration errors were assessed using administrative data. The interview data revealed four learning mechanism patterns employed in an attempt to learn from medication administration errors: integrated, non-integrated, supervisory and patchy learning. Regression analysis results demonstrated that whereas the integrated pattern of learning mechanisms was associated with decreased errors, the non-integrated pattern was associated with increased errors. Supervisory and patchy learning mechanisms were not associated with errors. Superior learning mechanisms are those that represent the whole cycle of team learning, are enacted by nurses who administer medications to patients, and emphasize a system approach to data analysis instead of analysis of individual cases.

Leadership and teamwork in medical emergencies: performance of nursing students and registered nurses in simulated patient scenarios.

PubMed

Endacott, Ruth; Bogossian, Fiona E; Cooper, Simon J; Forbes, Helen; Kain, Victoria J; Young, Susan C; Porter, Joanne E

2015-01-01

To examine nursing students' and registered nurses' teamwork skills whilst managing simulated deteriorating patients. Studies continue to show the lack of timely recognition of patient deterioration. Management of deteriorating patients can be influenced by education and experience. Mixed methods study conducted in two universities and a rural hospital in Victoria, and one university in Queensland, Australia. Three simulation scenarios (chest pain, hypovolaemic shock and respiratory distress) were completed in teams of three by 97 nursing students and 44 registered nurses, equating to a total of 32 student and 15 registered nurse teams. Data were obtained from (1) Objective Structured Clinical Examination rating to assess performance; (2) Team Emergency Assessment Measure scores to assess teamwork; (3) simulation video footage; (4) reflective interview during participants' review of video footage. Qualitative thematic analysis of video and interview data was undertaken. Objective structured clinical examination performance was similar across registered nurses and students (mean 54% and 49%); however, Team Emergency Assessment Measure scores differed significantly between the two groups (57% vs 38%, t = 6·841, p < 0·01). In both groups, there was a correlation between technical (Objective Structured Clinical Examination) and nontechnical (Team Emergency Assessment Measure) scores for the respiratory distress scenario (student teams: r = 0·530, p = 0·004, registered nurse teams r = 0·903, p < 0·01) and hypovolaemia scenario (student teams: r = 0·534, p = 0·02, registered nurse teams: r = 0·535, p = 0·049). Themes generated from the analysis of the combined quantitative and qualitative data were as follows: (1) leadership and followership behaviours; (2) help-seeking behaviours; (3) reliance on previous experience; (4) fixation on a single detail; and (5) team support. There is scope to improve leadership, team work and task management skills for registered nurses and nursing students. Simulation appears to be beneficial in enabling less experienced staff to assess their teamwork skills. There is a need to encourage less experienced staff to become leaders and for all staff to develop improved teamwork skills for medical emergencies. © 2014 John Wiley & Sons Ltd.

Team-based primary care: The medical assistant perspective.

PubMed

Sheridan, Bethany; Chien, Alyna T; Peters, Antoinette S; Rosenthal, Meredith B; Brooks, Joanna Veazey; Singer, Sara J

Team-based care has the potential to improve primary care quality and efficiency. In this model, medical assistants (MAs) take a more central role in patient care and population health management. MAs' traditionally low status may give them a unique view on changing organizational dynamics and teamwork. However, little empirical work exists on how team-based organizational designs affect the experiences of low-status health care workers like MAs. The aim of this study was to describe how team-based primary care affects the experiences of MAs. A secondary aim was to explore variation in these experiences. In late 2014, the authors interviewed 30 MAs from nine primary care practices transitioning to team-based care. Interviews addressed job responsibilities, teamwork, implementation, job satisfaction, and learning. Data were analyzed using a thematic networks approach. Interviews also included closed-ended questions about workload and job satisfaction. Most MAs reported both a higher workload (73%) and a greater job satisfaction (86%) under team-based primary care. Interview data surfaced four mechanisms for these results, which suggested more fulfilling work and greater respect for the MA role: (a) relationships with colleagues, (b) involvement with patients, (c) sense of control, and (d) sense of efficacy. Facilitators and barriers to these positive changes also emerged. Team-based care can provide low-status health care workers with more fulfilling work and strengthen relationships across status lines. The extent of this positive impact may depend on supporting factors at the organization, team, and individual worker levels. To maximize the benefits of team-based care, primary care leaders should recognize the larger role that MAs play under this model and support them as increasingly valuable team members. Contingent on organizational conditions, practices may find MAs who are willing to manage the increased workload that often accompanies team-based care.

Implementation of a team-based learning course: Work required and perceptions of the teaching team.

PubMed

Morris, Jenny

2016-11-01

Team-based learning was selected as a strategy to help engage pre-registration undergraduate nursing students in a second-year evidence-informed decision making course. To detail the preparatory work required to deliver a team-based learning course; and to explore the perceptions of the teaching team of their first experience using team-based learning. Descriptive evaluation. Information was extracted from a checklist and process document developed by the course leader to document the work required prior to and during implementation. Members of the teaching team were interviewed by a research assistant at the end of the course using a structured interview schedule to explore perceptions of first time implementation. There were nine months between the time the decision was made to use team-based learning and the first day of the course. Approximately 60days were needed to reconfigure the course for team-based learning delivery, develop the knowledge and expertise of the teaching team, and develop and review the resources required for the students and the teaching team. This reduced to around 12days for the subsequent delivery. Interview data indicated that the teaching team were positive about team-based learning, felt prepared for the course delivery and did not identify any major problems during this first implementation. Implementation of team-based learning required time and effort to prepare the course materials and the teaching team. The teaching team felt well prepared, were positive about using team-based learning and did not identify any major difficulties. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Primary care team working in Ireland: a qualitative exploration of team members' experiences in a new primary care service.

PubMed

Kennedy, Norelee; Armstrong, Claire; Woodward, Oonagh; Cullen, Walter

2015-07-01

Team working is an integral aspect of primary care, but barriers to effective team working can limit the effectiveness of a primary care team (PCT). The establishment of new PCTs in Ireland provides an excellent opportunity to explore team working in action. The aim of this qualitative study was to explore the experiences of team members working in a PCT. Team members (n = 19) from two PCTs were interviewed from May to June 2010 using a semi-structured interview guide. All interviews were audio-recorded and transcribed. Data were analysed using NVivo (version 8). Thematic analysis was used to explore the data. We identified five main themes that described the experiences of the team members. The themes were support for primary care, managing change, communication, evolution of roles and benefits of team working. Team members were generally supportive of primary care and had experienced benefits to their practice and to the care of their patients from participation in the team. Regular team meetings enabled communication and discussion of complex cases. Despite the significant scope for role conflict due to the varied employment arrangements of the team members, neither role nor interpersonal conflict was evident in the teams studied. In addition, despite the unusual team structure in Irish PCTs - where there is no formally appointed team leader or manager - general issues around team working and its benefits and challenges were very similar to those found in other international studies. This suggests, in contrast to some studies, that some aspects of the leadership role may not be as important in successful PCT functioning as previously thought. Nonetheless, team leadership was identified as an important issue in the further development of the teams. © 2014 John Wiley & Sons Ltd.

The researchers' role in knowledge translation: a realist evaluation of the development and implementation of diagnostic pathways for cancer in two United Kingdom localities.

PubMed

Banks, Jon; Wye, Lesley; Hall, Nicola; Rooney, James; Walter, Fiona M; Hamilton, Willie; Gjini, Ardiana; Rubin, Greg

2017-12-13

In examining an initiative to develop and implement new cancer diagnostic pathways in two English localities, this paper evaluates 'what works' and examines the role of researchers in facilitating knowledge translation amongst teams of local clinicians and policy-makers. Using realist evaluation with a mixed methods case study approach, we conducted documentary analysis of meeting minutes and pathway iterations to map pathway development. We interviewed 14 participants to identify the contexts, mechanisms and outcomes (CMOs) that led to successful pathway development and implementation. Interviews were analysed thematically and four CMO configurations were developed. One site produced three fully implemented pathways, while the other produced two that were partly implemented. In explaining the differences, we found that a respected, independent, well-connected leader modelling partnership working and who facilitates a local, stable group that agree about the legitimacy of the data and project (context) can empower local teams to become sufficiently autonomous (mechanism) to develop and implement research-based pathways (outcome). Although both teams designed relevant, research-based cancer pathways, in the site where the pathways were successfully implemented the research team merely assisted, while, in the other, the research team drove the initiative. Based on our study findings, local stakeholders can apply local and research knowledge to develop and implement research-based pathways. However, success will depend on how academics empower local teams to create autonomy. Crucially, after re-packaging and translating research for local circumstances, identifying fertile environments with the right elements for implementation and developing collaborative relationships with local leaders, academics must step back.

Representing complexity well: a story about teamwork, with implications for how we teach collaboration.

PubMed

Lingard, Lorelei; McDougall, Allan; Levstik, Mark; Chandok, Natasha; Spafford, Marlee M; Schryer, Catherine

2012-09-01

In order to be relevant and impactful, our research into health care teamwork needs to better reflect the complexity inherent to this area. This study explored the complexity of collaborative practice on a distributed transplant team. We employed the theoretical lenses of activity theory to better understand the nature of collaborative complexity and its implications for current approaches to interprofessional collaboration (IPC) and interprofessional education (IPE). Over 4 months, two trained observers conducted 162 hours of observation, 30 field interviews and 17 formal interviews with 39 members of a solid organ transplant team in a Canadian teaching hospital. Participants included consultant medical and surgical staff and postgraduate trainees, the team nurse practitioner, social worker, dietician, pharmacist, physical therapist, bedside nurses, organ donor coordinators and organ recipient coordinators. Data collection and inductive analysis for emergent themes proceeded iteratively. Daily collaborative practice involves improvisation in the face of recurring challenges on a distributed team. This paper focuses on the theme of 'interservice' challenges, which represent instances in which the 'core' transplant team (those providing daily care for transplant patients) work to engage the expertise and resources of other services in the hospital, such as those of radiology and pathology departments. We examine a single story of the core team's collaboration with cardiology, anaesthesiology and radiology services to decide whether a patient is appropriate for transplantation and use this story to consider the team's strategies in the face of conflicting expectations and preferences among these services. This story of collaboration in a distributed team calls into question two premises underpinning current models of IPC and IPE: the notion that stable professional roles exist, and the ideal of a unifying objective of 'caring for the patient'. We suggest important elaborations to these premises as they are used to conceptualise and teach IPC in order to better represent the intricacy of everyday collaborative work in health care. © Blackwell Publishing Ltd 2012.

Content Validation and Evaluation of an Endovascular Teamwork Assessment Tool.

PubMed

Hull, L; Bicknell, C; Patel, K; Vyas, R; Van Herzeele, I; Sevdalis, N; Rudarakanchana, N

2016-07-01

To modify, content validate, and evaluate a teamwork assessment tool for use in endovascular surgery. A multistage, multimethod study was conducted. Stage 1 included expert review and modification of the existing Observational Teamwork Assessment for Surgery (OTAS) tool. Stage 2 included identification of additional exemplar behaviours contributing to effective teamwork and enhanced patient safety in endovascular surgery (using real-time observation, focus groups, and semistructured interviews of multidisciplinary teams). Stage 3 included content validation of exemplar behaviours using expert consensus according to established psychometric recommendations and evaluation of structure, content, feasibility, and usability of the Endovascular Observational Teamwork Assessment Tool (Endo-OTAS) by an expert multidisciplinary panel. Stage 4 included final team expert review of exemplars. OTAS core team behaviours were maintained (communication, coordination, cooperation, leadership team monitoring). Of the 114 OTAS behavioural exemplars, 19 were modified, four removed, and 39 additional endovascular-specific behaviours identified. Content validation of these 153 exemplar behaviours showed that 113/153 (73.9%) reached the predetermined Item-Content Validity Index rating for teamwork and/or patient safety. After expert team review, 140/153 (91.5%) exemplars were deemed to warrant inclusion in the tool. More than 90% of the expert panel agreed that Endo-OTAS is an appropriate teamwork assessment tool with observable behaviours. Some concerns were noted about the time required to conduct observations and provide performance feedback. Endo-OTAS is a novel teamwork assessment tool, with evidence for content validity and relevance to endovascular teams. Endo-OTAS enables systematic objective assessment of the quality of team performance during endovascular procedures. Copyright © 2016. Published by Elsevier Ltd.

Professional groups driving change toward patient-centred care: interprofessional working in stroke rehabilitation in Denmark.

PubMed

Burau, Viola; Carstensen, Kathrine; Lou, Stina; Kuhlmann, Ellen

2017-09-16

Patient-centred care based on needs has been gaining momentum in health policy and the workforce. This creates new demand for interprofessional teams and redefining roles and tasks of professionals, yet little is known on how to implement new health policies more effectively. Our aim was to analyse the role and capacity of health professions in driving organisational change in interprofessional working and patient-centred care. A case study of the introduction of interprofessional, early discharge teams in stroke rehabilitation in Denmark was conducted with focus on day-to-day coordination of care tasks and the professional groups' interests and strategies. The study included 5 stroke teams and 17 interviews with different health professionals conducted in 2015. Professional groups expressed highly positive professional interest in reorganised stroke rehabilitation concerning patients, professional practice and intersectoral relations; individual professional and collective interprofessional interests strongly coincided. The corresponding strategies were driven by a shared goal of providing needs-based care for patients. Individual professionals worked independently and on behalf of the team. There was also a degree of skills transfer as individual team members screened patients on behalf of other professional groups. The study identified supportive factors and contexts of patient-centred care. This highlights capacity to improve health workforce governance through professional participation, which should be explored more systematically in a wider range of healthcare services.

Selection of essential medicines for South Africa - an analysis of in-depth interviews with national essential medicines list committee members.

PubMed

Perumal-Pillay, Velisha Ann; Suleman, Fatima

2017-01-07

The South African (SA) public health system has employed an Essential Medicines List (EML) with Standard Treatment Guidelines (STGs) in the public sector since 1996. To date no studies have reported on the process of selection of essential medicines for SA EMLs and how this may have changed over time. This study reports on the decision making process for the selection of essential medicines for SA EMLs, over the years, as described by various members of the National Essential Medicines List Committee (NEMLC) and their task teams. Qualitative in-depth interviews, guided by an interview questionnaire, were conducted with 11 members of the SA NEMLC and their task teams (both past and present members) during the period January - April 2015. Interviews were recorded and transcribed verbatim. Transcripts were then coded by the first author and verified by the second author before being reconciled and input into NVIVO, a qualitative software, to facilitate analysis of the data. The interviews conducted suggest that the NEMLC process of medicine selection has been refined over the years. This together with the EML review process is now essentially predominantly an evidence based process where quality, safety and efficacy of a medicine is considered first followed by cost considerations which includes pharmacoeconomic evaluations, and pricing of medicines. This is the first study in SA to report on how decisions are taken to include or exclude medicines on SA national EMLs and provides insight into the SA EML medicine selection, review and monitoring processes over time. The results show that the NEMLC has undergone tremendous transformation over the years. Whilst the membership of the committee largely remains unchanged, the committee has developed its policies and processes over the years. However there is still a need to strengthen the monitoring and evaluation aspects of the SA EML policy process.

Parents' perceptions of reasons for excess weight loss in obese children: a peer researcher approach.

PubMed

Gillison, Fiona; Cooney, Geraldine; Woolhouse, Valerie; Davies, Angie; Dickens, Fiona; Marno, Penny

2017-01-01

This study reports on the process of conducting participatory research by training peer researchers to conduct interviews and analyse data collected with parents of overweight children. The methodology was chosen as a means of (a) encouraging participation among a hard-to-engage group (i.e., parents of overweight children), and (b) generating novel insights and challenging academic/health professional assumptions through the involvement of parents in the interpretation of findings. Four parents (all female) were recruited as peer researchers and trained in research processes, ethics, and interview skills over three half-day workshops. The intended interviewees were parents of children identified as obese through the National Child Measurement Programme (NCMP) at the start of primary school (age 4-5) but who had lost their excess weight by age 10-11; little is currently known about how this excess weight loss is achieved. Interviews were conducted by peer researchers, transcribed verbatim and analysed thematically by both peer- and university-based investigators. The peer researchers felt confident to conduct interviews after three training sessions. Recruitment of interviewees was challenging, resulting in only four volunteers (all mothers) over a 5-month period; thus peer researchers were only able to conduct one interview each. All interviews were considered good quality in comparison to those conducted by Masters-level research assistants. The process of co-analysis resulted in a change in emphasis from that initially generated by the university research team; the role of health professionals in weight management was de-emphasised, and the importance of 'not singling out' overweight children accentuated. Given the limited number of interviews, the results of the study are only provisional but resulted in three themes: Whole Family Action, Support (and lack of support), and Protecting Childhood. Training peer researchers to conduct and analyse interviews was feasible within a short period of training. Peer researchers found the experience interesting, informative and worthwhile. Two of the four volunteered to be involved in a related study 12 months later. The different perspective brought through co-analysis suggests that this approach to conducting participatory research may be a useful means of working with the public to generate new ideas to tackle intransigent issues.

A mixed methods study of emotional exhaustion: Energizing and depleting work within an innovative healthcare team.

PubMed

Cain, Cindy L; Taborda-Whitt, Caitlin; Frazer, Monica; Schellinger, Sandra; White, Katie M; Kaasovic, Jason; Nelson, Brenda; Chant, Allison

2017-11-01

This mixed methods study documents emotional exhaustion experiences among care team members during the development of an innovative team approach for caring for adults with serious illness. A mixed methods study design was employed to examine depleting work experiences that may produce emotional exhaustion, and energizing aspects of the work that may increase meaningfulness of work, thus reducing emotional exhaustion. The population studied included team members involved in care for adults with serious illness (n = 18). Team members were surveyed quarterly over an 18-month period using the Maslach Burnout Inventory (MBI). The MBI measures burnout, defined as the inability to continue work because of the interactional toll of the work. Analyses of MBI data show that although overall levels of burnout are low, 89% of team members reported moderate/high levels of emotional exhaustion during at least one survey period. In order to understand the kinds of work experiences that may produce or ameliorate emotional exhaustion, qualitative interviews were also conducted with team members at the end of the 18-month period. Major qualitative findings indicate that disputes within the team, environmental pressures, and standardisation of meaningful work leave team members feeling depleted. Having authentic relationships with patients, working as a team, believing in the care model, and practicing autonomy and creativity help team members to restore their emotional energy. Supports for team members' well-being are critical for continued innovation. We conclude with recommendations for improving team members' well-being.

Belonging to a community-based football team: an ethnographic study.

PubMed

Mynard, Lorrae; Howie, Linsey; Collister, Laura

2009-08-01

This study considered the benefits derived from participation in a community-based Australian Rules Football league in Melbourne, Australia. The RecLink league deliberately tackles the social and occupational disadvantages associated with mental illness, addictions, unemployment and homelessness. An ethnographic methodology was used to study one team from the RecLink football league throughout an entire season. Fieldnotes were written following participant observation at training, games and events, and five in-depth interviews were conducted and transcribed. A constant comparative approach to data analysis was adopted. Three major themes were identified: a spirit of inclusion, team-building and meaning of team involvement. The first describes how members were accepted, welcomed and given the opportunity for team involvement, with the expectation that they 'had a go', and 'tried their best'. The second illustrates how the team collectively fostered a culture of friendship, cooperation and support. The third examines the significance of being part of the team, incorporating personal contributions and gains, and meanings attributed to team involvement. These findings demonstrated how football can be used as non-clinical, community-based occupational therapy: enabling participation in a personally meaningful and culturally valued occupation. Occupational therapists are challenged to explore further how such community-based sports programs may complement existing clinical and welfare-based approaches to social disadvantage.

Preserving professional credibility: grounded theory study of medical trainees' requests for clinical support.

PubMed

Kennedy, Tara J T; Regehr, Glenn; Baker, G Ross; Lingard, Lorelei

2009-02-09

To develop a conceptual framework of the influences on medical trainees' decisions regarding requests for clinical support from a supervisor. Phase 1: members of teaching teams in internal and emergency medicine were observed during regular clinical activities (216 hours) and subsequently completed brief interviews. Phase 2: 36 in depth interviews were conducted using videotaped vignettes to probe tacit influences on decisions to request support. Data collection and analysis used grounded theory methods. Three teaching hospitals in an urban setting in Canada. 124 members of teaching teams on general internal medicine wards and in the emergency department, comprising 31 attending physicians, 57 junior and senior residents, 28 medical students, and eight nurses. Purposeful sampling to saturation was conducted. Trainees' decisions about whether or not to seek clinical support were influenced by three issues: the clinical question (clinical importance, scope of practice), supervisor factors (availability, approachability), and trainee factors (skill, desire for independence, evaluation). Trainees perceived that requesting frequent/inappropriate support threatened their credibility and used rhetorical strategies to preserve credibility. These strategies included building a case for the importance of requests, saving requests for opportune moments, making a plan before requesting support, and targeting requests to specific team members. Trainees consider not only clinical implications but also professional credibility when requesting support from clinical supervisors. Exposing the complexity of this process provides the opportunity to make changes to training programmes to promote timely supervision and provides a framework for further exploration of the impact of clinical training on quality of care of patients.

Cooperative Education at LaGuardia Community College: An Assessment and Description of the Initiation of an Innovative Curriculum. Final Report.

ERIC Educational Resources Information Center

Soper Associates, Berne, NY.

La Guardia College (New York) is the only community college in the United States requiring its entire student body to participate in a work-experience program regardless of curriculum choice. This study, conducted by a team of selected consultants, is an assessment of the program based on onsite visits, interviews, and an array of reports and…

Multicultural Ground Teams in Space Programs

NASA Astrophysics Data System (ADS)

Maier, M.

2012-01-01

In the early years of space flight only two countries had access to space. In the last twenty years, there have been major changes in how we conduct space business. With the fall of the iron curtain and the growing of the European Union, more and more players were able to join the space business and space science. By end of the last century, numerous countries, agencies and companies earned the right to be equal partners in space projects. This paper investigates the impact of multicultural teams in the space arena. Fortunately, in manned spaceflight, especially for long duration missions, there are several studies and simulations reporting on multicultural team impact. These data have not been as well explored on the team interactions within the ground crews. The focus of this paper are the teams working on the ISS project. Hypotheses will be drawn from the results of space crew research to determine parallels and differences for this vital segment of success in space missions. The key source of the data will be drawn from structured interviews with managers and other ground crews on the ISS project.

Operational Readiness Review Final Report for K Basin Fuel Transfer System

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

DAVIES, T.H.

2002-10-01

An Operational Readiness Review (ORR) was conducted by the U.S. Department of Energy (DOE), Richland Operations Office (RL) to verify that an adequate state of readiness had been achieved for startup of the K Basin Fuel Transfer System (FTS). The DOE ORR was conducted during the period November 6-18, 2002. The DOE ORR team concluded that the K Basin Fuel Transfer System is ready to start operations, subject to completion and verification of identified pre-start findings. The ORR was conducted in accordance with the Spent Nuclear Fuel (SNF) K Basin Fuel Transfer System (FTS) Operational Readiness Review (ORR) Plan ofmore » Action and the Operational Readiness Review Implementation Plan for K Basin Fuel Transfer System. Review activities consisted of staff interviews, procedure and document reviews, and observations of normal facility operations, operational upset conditions, and an emergency drill. The DOE ORR Team also reviewed and assessed the adequacy of the contractor ORR3 and the RL line management review. The team concurred with the findings and observations identified in these two reports. The DOE ORR for the FTS evaluated the contractor under single-shift operations. Of concern to the ORR Team was that SNF Project management intended to change from a single-shift FTS operation to a two-shift operation shortly after the completion of the DOE ORR. The ORR team did not assess two-shift FTS operations and the ability of the contractor to conduct a smooth transition from shift to shift. However, the DOE ORR team did observe an operational upset drill that was conducted during day shift and carried over into swing shift; during this drill, swing shift was staffed with fewer personnel as would be expected for two-shift operations. The facility was able to adequately respond to the event with the reduced level of staff. The ORR Team was also able to observe a Shift Manager turnover meeting when one shift manager had to be relieved during the middle of the day. The ORR Team did not have the opportunity to observe a shift turnover from one crew to another. The ORR Team has evaluated the risk of not observing this activity and considers the risk to be minimal based on the fact that operating staff are very familiar with the FTS equipment and its procedures, and because existing Conduct of Operations processes and procedures are adequate and implemented. Because the ORR Team has not observed two-shift FTS operations, we recommend that additional RL oversight be provided at the start of two-shift FTS operations to evaluate the adequacy of crew turnovers.« less

Perianesthesia Nurses Are My Second Family: A Qualitative Descriptive Study.

PubMed

Seefeldt, Julanne; Wood, Stacey; Bolton, Pamela; Fitzpatrick, Tara; Stegenga, Kristin; Roberts, Cristine

2017-12-01

Identify the perceptions of perianesthesia nurses regarding behaviors that promote or detract from sustaining a safe, efficient, and satisfying work environment. Two focus groups and seven individual interviews (n=14) were conducted exploring the perceptions regarding team behavior of registered nurses in one pediatric perianesthesia unit. Qualitative descriptive data collection, inductive content analysis. Nurses described a responsive, engaged health care team whose leadership is available and directive when needed, as creating an effective, satisfying work environment. Primary themes that emerged were Leadership Sets the Tone, Playing Fair, No One Gets Hurt, and Why We Stay. This nursing team acknowledged that inattentive, distracted team members cause frustration, work inequities, and care delays, potentially undermining patient safety. Results demonstrate the need to create and sustain consistently respectful perianesthesia work cultures. Research focusing on unit specific approaches to work distribution, communication, leadership, and technology use is needed. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

How to Manage Hospital-Based Palliative Care Teams Without Full-Time Palliative Care Physicians in Designated Cancer Care Hospitals: A Qualitative Study.

PubMed

Sakashita, Akihiro; Kishino, Megumi; Nakazawa, Yoko; Yotani, Nobuyuki; Yamaguchi, Takashi; Kizawa, Yoshiyuki

2016-07-01

To clarify how highly active hospital palliative care teams can provide efficient and effective care regardless of the lack of full-time palliative care physicians. Semistructured focus group interviews were conducted, and content analysis was performed. A total of 7 physicians and 6 nurses participated. We extracted 209 codes from the transcripts and organized them into 3 themes and 21 categories, which were classified as follows: (1) tips for managing palliative care teams efficiently and effectively (7 categories); (2) ways of acquiring specialist palliative care expertise (9 categories); and (3) ways of treating symptoms that are difficult to alleviate (5 categories). The findings of this study can be used as a nautical chart of hospital-based palliative care team (HPCT) without full-time PC physician. Full-time nurses who have high management and coordination abilities play a central role in resource-limited HPCTs. © The Author(s) 2015.

Perspective: a business school view of medical interprofessional rounds: transforming rounding groups into rounding teams.

PubMed

Bharwani, Aleem M; Harris, G Chad; Southwick, Frederick S

2012-12-01

An effective interprofessional medical team can efficiently coordinate health care providers to achieve the collective outcome of improving each patient's health. To determine how current teams function, four groups of business students independently observed interprofessional work rounds on four different internal medicine services in a typical academic hospital and also interviewed the participants. In all instances, caregivers had formed working groups rather than working teams. Participants consistently exhibited parallel interdependence (individuals working alone and assuming their work would be coordinated with other caregivers) rather than reciprocal interdependence (individuals working together to actively coordinate patient care), the hallmark of effective teams. With one exception, the organization was hierarchical, with the senior attending physician possessing the authority. The interns exclusively communicated with the attending physician in one-on-one conversations that excluded all other members of the team. Although nurses and pharmacists were often present, they never contributed their ideas and rarely spoke.The authors draw on these observations to form recommendations for enhancing interprofessional rounding teams. These are to include the bedside nurse, pharmacist, and case manager as team members, begin with a formal team launch that encourages active participation by all team members, use succinct communication protocols, conduct work rounds in a quiet, distraction-free environment, have teams remain together for longer durations, and receive teamwork training and periodic coaching. High-performing businesses have effectively used teams for decades to achieve their goals, and health care professionals should follow this example.

Heavy physical work under time pressure: the garbage collection service--a case study.

PubMed

Camada, Ilza Mitsuko de Oliveira; Pataro, Silvana Maria Santos; Fernandes, Rita de Cássia Pereira

2012-01-01

The increased generation of garbage has become a problem in large cities, with greater demand for collection services. The collector is subjected to high workload. This study describes the work in garbage collection service, highlighting the requirements of time, resulting in physical and psychosocial demands to collectors. Ergonomic Work Analysis (EWA) - a method focused on the study of work in real situations was used. Initially, technical visits, global observations and unstructured interviews with different subjects of a garbage collection company were conducted. The following step of the systematic observations was accompanied by interviews conducted during the execution of tasks, inquiring about the actions taken, and also interviews about the actions, but conducted after the development of the tasks, photographic records and audiovisual recordings, of workers from two garbage collection teams. Contradictions between the prescribed work and activities (actual work) were identified, as well as the variability present in this process, and strategies adopted by these workers to regulate the workload. It was concluded that the insufficiency of means and the organizational structure of management ensue a situation where the collection process is maintained at the expense of hyper-requesting these workers, both physically and psychosocially.

Role Clarification Processes for Better Integration of Nurse Practitioners into Primary Healthcare Teams: A Multiple-Case Study

PubMed Central

D'Amour, Danielle; Contandriopoulos, Damien; Chouinard, Véronique; Dubois, Carl-Ardy

2014-01-01

Role clarity is a crucial issue for effective interprofessional collaboration. Poorly defined roles can become a source of conflict in clinical teams and reduce the effectiveness of care and services delivered to the population. Our objective in this paper is to outline processes for clarifying professional roles when a new role is introduced into clinical teams, that of the primary healthcare nurse practitioner (PHCNP). To support our empirical analysis we used the Canadian National Interprofessional Competency Framework, which defines the essential components for role clarification among professionals. A qualitative multiple-case study was conducted on six cases in which the PHCNP role was introduced into primary care teams. Data collection included 34 semistructured interviews with key informants involved in the implementation of the PHCNP role. Our results revealed that the best performing primary care teams were those that used a variety of organizational and individual strategies to carry out role clarification processes. From this study, we conclude that role clarification is both an organizational process to be developed and a competency that each member of the primary care team must mobilize to ensure effective interprofessional collaboration. PMID:25692039

Team functioning in hospice interprofessional meetings: An exploratory study of providers' perspectives.

PubMed

Washington, Karla T; Guo, Yuqi; Albright, David L; Lewis, Alexandria; Parker Oliver, Debra; Demiris, George

2017-07-01

Interprofessional collaboration is the foundation of hospice service delivery. In the United States, hospice agencies are required to regularly convene interprofessional meetings during which teams review plans of care for the patients and families they serve. A small body of research suggests that team functioning could be significantly enhanced in hospice interprofessional meetings; however, systematic investigation of this possibility has been limited to date. The purpose of this qualitative study was to better understand the experiences and perspectives of hospice providers who regularly participate in interprofessional meetings as a first step toward improving teamwork in this setting. We interviewed 24 hospice providers and conducted a template analysis of qualitative data to identify barriers and facilitators to effective team functioning in interprofessional meetings. Participants recognised the ways meetings supported high-quality, holistic patient and family care but voiced frustrations over meeting inefficiencies, particularly in light of caseloads they perceived as overly demanding. Time constraints were often viewed as prohibiting the inclusion of interprofessional content and full participation of all team members. Findings suggest that modifications to interprofessional meetings such as standardising processes may enhance meeting efficiency and team functioning.

Paediatric team handover: a time to learn?

PubMed

Bradley, Stephen; Egan, John P; Henning, Marcus

2018-06-08

Paediatric team handovers provide medical professionals and students with the opportunity to exchange clinically relevant information about patients. This study explored the extent to which learning opportunities existed and were utilised within paediatric team handovers in New Zealand secondary hospitals. We undertook a qualitative, two-site case study within two paediatric departments in 2014 and 2015, and interviewed 29 participants, including medical students, junior doctors and consultants. We conducted a thematic analysis using a general inductive approach. Participants' narratives revealed that safe transfer of pertinent patient information between clinicians was the primary function of team handover. They described learning as an additional key component. Most learning opportunities were reported to be informal and opportunistic, related to the specific patients whose care was discussed within each handover. Handover team members indicated that implicit learning occurred as a feature of their handover experience. Learning opportunities exist within team handovers and the associated learning frequently occurs either opportunistically or implicitly. Adoption of a reflective approach to learning opportunities is likely to result in improved educational experiences for handover participants, particularly medical students and junior doctors. Handover represents a clinical event within which valuable workplace learning occurs.

Role clarification processes for better integration of nurse practitioners into primary healthcare teams: a multiple-case study.

PubMed

Brault, Isabelle; Kilpatrick, Kelley; D'Amour, Danielle; Contandriopoulos, Damien; Chouinard, Véronique; Dubois, Carl-Ardy; Perroux, Mélanie; Beaulieu, Marie-Dominique

2014-01-01

Role clarity is a crucial issue for effective interprofessional collaboration. Poorly defined roles can become a source of conflict in clinical teams and reduce the effectiveness of care and services delivered to the population. Our objective in this paper is to outline processes for clarifying professional roles when a new role is introduced into clinical teams, that of the primary healthcare nurse practitioner (PHCNP). To support our empirical analysis we used the Canadian National Interprofessional Competency Framework, which defines the essential components for role clarification among professionals. A qualitative multiple-case study was conducted on six cases in which the PHCNP role was introduced into primary care teams. Data collection included 34 semistructured interviews with key informants involved in the implementation of the PHCNP role. Our results revealed that the best performing primary care teams were those that used a variety of organizational and individual strategies to carry out role clarification processes. From this study, we conclude that role clarification is both an organizational process to be developed and a competency that each member of the primary care team must mobilize to ensure effective interprofessional collaboration.

Team communication patterns in emergency resuscitation: a mixed methods qualitative analysis.

PubMed

Calder, Lisa Anne; Mastoras, George; Rahimpour, Mitra; Sohmer, Benjamin; Weitzman, Brian; Cwinn, A Adam; Hobin, Tara; Parush, Avi

2017-12-01

In order to enhance patient safety during resuscitation of critically ill patients, we need to optimize team communication and enhance team situational awareness but little is known about resuscitation team communication patterns. The objective of this study is to understand how teams communicate during resuscitation; specifically to assess for a shared mental model (organized understanding of a team's relationships) and information needs. We triangulated 3 methods to evaluate resuscitation team communication at a tertiary care academic trauma center: (1) interviews; (2) simulated resuscitation observations; (3) live resuscitation observations. We interviewed 18 resuscitation team members about shared mental models, roles and goals of team members and procedural expectations. We observed 30 simulated resuscitation video recordings and documented the timing, source and destination of communication and the information category. We observed 12 live resuscitations in the emergency department and recorded baseline characteristics of the type of resuscitations, nature of teams present and type and content of information exchanges. The data were analyzed using a qualitative communication analysis method. We found that resuscitation team members described a shared mental model. Respondents understood the roles and goals of each team member in order to provide rapid, efficient and life-saving care with an overall need for situational awareness. The information flow described in the interviews was reflected during the simulated and live resuscitations with the most responsible physician and charting nurse being central to team communication. We consolidated communicated information into six categories: (1) time; (2) patient status; (3) patient history; (4) interventions; (5) assistance and consultations; 6) team members present. Resuscitation team members expressed a shared mental model and prioritized situational awareness. Our findings support a need for cognitive aids to enhance team communication during resuscitations.

Accounting for medical communication: parents' perceptions of communicative roles and responsibilities in the pediatric intensive care unit.

PubMed

Gordon, Cynthia; Barton, Ellen; Meert, Kathleen L; Eggly, Susan; Pollacks, Murray; Zimmerman, Jerry; Anand, K J S; Carcillo, Joseph; Newth, Christopher J L; Dean, J Michael; Willson, Douglas F; Nicholson, Carol

2009-01-01

Through discourse analysis of transcribed interviews conducted over the phone with parents whose child died in the Pediatric Intensive Care Unit (PICU) (n = 51), this study uncovers parents' perceptions of clinicians' and their own communicative roles and responsibilities in the context of team-based care. We examine parents' descriptions and narratives of communicative experiences they had with PICU clinicians, focusing on how parents use accounts to evaluate the communicative behaviors they report (n = 47). Findings indicate that parental perceptions of communicative responsibilities are more nuanced than assumed in previous research: Parents identified their own responsibilities as participating as part of the team of care, gathering information, interacting with appropriate affect, and working to understand complex and uncertain medical information. Complementarily, parents identified clinician responsibilities as communicating professionally, providing medical information clearly, managing parents' hope responsibly, and communicating with appropriate affect. Through the accounts they provide, parents evaluate both parental and clinician role-responsibilities as fulfilled and unfulfilled. Clinicians' management of prognostic uncertainty and parents' struggles to understand that uncertainty emerged as key, complementary themes with practical implications for incorporating parents into the PICU care team. The study also highlights insights retrospective interview data bring to the examination of medical communication.

‘On the same level’: facilitators’ experiences running a drug user-led safer injecting education campaign

PubMed Central

2013-01-01

Background Unsafe injection practices play a major role in elevated rates of morbidity and mortality among people who inject drugs (IDU). There is growing interest in the direct involvement of IDU in interventions that seek to address unsafe injecting. This study describes a drug user-led safer injecting education campaign, and explores facilitators’ experiences delivering educational workshops. Methods We conducted semi-structured qualitative interviews with 8 members of the Injection Support (IS) Team who developed and facilitated a series of safer injecting education workshops. Interviews explored facilitator’s perceptions of the workshops, experiences being a facilitator, and perspectives on the educational campaign. Interviews were transcribed verbatim and a thematic analysis was conducted. Results IS Team facilitators described how the workshop’s structure and content enabled effective communication of information about safer injecting practices, while targeting the unsafe practices of workshop participants. Facilitators’ identity as IDU enhanced their ability to relate to workshop participants and communicate educational messages in language accessible to workshop participants. Facilitators reported gaining knowledge and skills from their involvement in the campaign, as well as positive feelings about themselves from the realization that they were helping people to protect their health. Overall, facilitators felt that this campaign provided IDU with valuable information, although facilitators also critiqued the campaign and suggested improvements for future efforts. Conclusions This study demonstrates the feasibility of involving IDU in educational initiatives targeting unsafe injecting. Findings illustrate how IDU involvement in prevention activities improves relevance and cultural appropriateness of interventions while providing individual, social, and professional benefits to those IDU delivering education. PMID:23497293

Situational analysis of services for diabetes and diabetic retinopathy and evaluation of programs for the detection and treatment of diabetic retinopathy in India: Methods for the India 11-city 9-state study.

PubMed

Murthy, G V S; Gilbert, Clare E; Shukla, Rajan; Vashist, Praveen; Shamanna, B R

2016-04-01

Diabetic retinopathy (DR) is a leading cause of visual impairment in India. Available evidence shows that there are more than 60 million persons with diabetes in India and that the number will increase to more than a 100 million by 2030. There is a paucity of data on the perceptions and practices of persons with diabetes and the available infrastructure and uptake of services for DR in India. Assess perception of care and challenges faced in availing eye care services among persons with diabetics and generate evidence on available human resources, infrastructure, and service utilization for DR in India. The cross-sectional, hospital-based survey was conducted in eleven cities across 9 States in India. In each city, public and private providers of eye-care were identified. Both multispecialty and standalone facilities were included. Specially designed semi-open ended questionnaires were administered to the clients. Semi-structured interviews were administered to the service providers (both diabetic care physicians and eye care teams) and observational checklists were used to record findings of the assessment of facilities conducted by a dedicated team of research staff. A total of 859 units were included in this study. This included 86 eye care and 73 diabetic care facilities, 376 persons with diabetes interviewed in the eye clinics and 288 persons with diabetes interviewed in the diabetic care facilities. The findings will have significant implications for the organization of services for persons with diabetes in India.

Consultant's Playbook: A Survey of Pharmacy Consultant Experiences Among Hospitals In the University HealthSystem Consortium.

PubMed

Hicks, Dave; McCarthy, Bryan; Fanikos, John; Emamifar, Amir; Nedved, Andrea; Thompson, Bruce; Bender, Fred; McMahon, Patrick

2013-10-01

Our team surveyed a group of pharmacy directors to learn about their experiences with pharmacy consultants so that the directors might be able to use their consulting resources in a more effective manner. In May 2012, the University HealthSystem Consortium (UHC) Pharmacy Council Financial Performance Committee developed an electronic survey that collectively measured the characteristics, goals, and methodology of historical pharmacy consultant engagements and level of satisfaction. After e-mailing the initial electronic survey, we conducted follow-up telephone interviews with respondents from July through November 2012. These interviews were designed to include questions about expected outcomes, recommendations for evaluation processes, timelines for implementing the recommendations, consultants' expenses, and insights gained. A total of 23 pharmacy directors responded to the initial electronic survey; their organizations had engaged at least one consultant within the previous 5 years. Data were collected for 28 consultant engagements. Subsequent telephone interviews were conducted with 20 of the 23 pharmacy directors (87%) who completed the initial electronic survey, accounting for 25 of the 28 consultant engagements (89%). Cost reduction along with revenue enhancement was most often the focus of these engagements. These engagements were also mainly within the scope of an organization-wide effort initiated by the executive board or executive team. Consultant experiences varied greatly in terms of (1) the degree to which assistance was provided to the organization, (2) benchmarking methodologies and resources, and (3) timelines for implementing the consultants' recommendations. In general, most respondents rated their consultant experience as positive and were able to provide "pearls of wisdom" or lessons learned.

The mixed blessings of smart infusion devices and health care IT.

PubMed

Nemeth, Christopher P; Brown, Jeff; Crandall, Beth; Fallon, Corey

2014-08-01

From July to October 2009, a team of human factors researchers evaluated the use of a commercially available infusion device among nurses at a tertiary care hospital in the Midwest. The study's purpose was to determine the factors that may influence the adoption and "best practice" use of smart infusion devices by identifying the human, technological, environmental, and/or organizational factors and to describe how they support or impede safe practices. The study's aim was to show how technology and individual and team behavior influence each other, as well as care performance and outcomes. Research team members shadowed nursing personnel as they performed routine care activities, and conducted cognitive task analysis interviews with nurses, an engineer, and a pharmacist. They identified key themes, and then made several systematic passes through the data to identify all instances of each theme and to collect examples and illustrative quotes. Although staff members were positive in their comments about the smart pump, observations and interviews revealed discrepancies between prescriptions and infusions, and "workarounds" to cope with the mismatch between interface design and actual care requirements. Despite "smart pump" capabilities, situations continue such as the need for clinicians to perform calculations in order to deliver medications. These workarounds, which make them and patients vulnerable to adverse outcomes, confirm prior published research by Cook, Nemeth, Nunnally, Hollnagel, and Woods. The team provided recommendations based on findings for training and interface design. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

Choosing a miracle: Impoverishment, mistrust, and discordant views in abandonment of treatment of children with cancer in El Salvador.

PubMed

Rossell, Nuria; Challinor, Julia; Gigengack, Roy; Reis, Ria

2017-09-01

In El Salvador, at the only hospital offering pediatric oncology care, the number of children abandoning treatment for cancer has decreased in recent years (13%-3%). An investigation of caregivers' motives for abandonment was performed over 15 months from 2012 to 2014. Caregiver and health team perspectives on abandonment are reported using the explanatory model (EM) framework. Semistructured in-depth interviews and in hospital participant observations were conducted with caregivers of children diagnosed with cancer, who abandoned their child's treatment or were considering abandoning, and with members of the medical team. Of the 41 caregivers interviewed, 26 caregivers (of 19 children) abandoned their child's treatment, returned from a series of missed appointments, or showed a risk of abandoning. Caregivers of 8 children stated that a miraculous cure was the main reason for abandoning; increasing impoverishment and misgivings toward treatment and outcomes were also mentioned. The responses of the medical team demonstrated a discordant EM for the child's cancer and treatment effects and that only biomedical treatment was effective for cure. The caregivers' increasing impoverishment (not only financial) and misgivings about the child's treatment caused them to reconsider their therapeutic choices and rely on their belief in a miraculous cure, thus abandoning. The caregivers and medical team's discordant EM about the child's cancer and treatment must be acknowledged and shared decision making considered, together with consistency in the strategies that currently demonstrate to be effective decreasing abandonment. Copyright © 2016 John Wiley & Sons, Ltd.

Research challenges and lessons learned from conducting community-based research with the Hmong community.

PubMed

Kue, Jennifer; Thorburn, Sheryl; Keon, Karen Levy

2015-05-01

Conducting research with underserved communities with little exposure to research presents a number of challenges and opportunities. Our study used a community-based approach to better understand factors that influence breast and cervical cancer screening among Hmong women. This article shares lessons learned during the process of developing and conducting qualitative research with a Hmong community with limited experience with research. We conducted 17 key informant and 84 in-depth interviews with Hmong women and men. Research team discussions, insights from Hmong research team members, input from our Community Advisory Committee, and project documents were sources of information about the process of conducting research in this community. Lessons learned concern including a cultural insider as an investigator; building community partnerships and support; establishing and working with a community advisory committee; hiring and training bilingual, bicultural staff; and using culturally appropriate materials and methods in a small, kinship-based community. We used multiple strategies to ensure that this study was conducted in a culturally appropriate manner. The lessons learned from our experiences can provide guidance to researchers on methodological and practical issues in conducting research with the Hmong and can inform future research with the Hmong and other similar underserved populations. © 2014 Society for Public Health Education.

Empirical studies of design software: Implications for software engineering environments

NASA Technical Reports Server (NTRS)

Krasner, Herb

1988-01-01

The empirical studies team of MCC's Design Process Group conducted three studies in 1986-87 in order to gather data on professionals designing software systems in a range of situations. The first study (the Lift Experiment) used thinking aloud protocols in a controlled laboratory setting to study the cognitive processes of individual designers. The second study (the Object Server Project) involved the observation, videotaping, and data collection of a design team of a medium-sized development project over several months in order to study team dynamics. The third study (the Field Study) involved interviews with the personnel from 19 large development projects in the MCC shareholders in order to study how the process of design is affected by organizationl and project behavior. The focus of this report will be on key observations of design process (at several levels) and their implications for the design of environments.

Rendezvous, proximity operations and capture quality function deployment report

NASA Technical Reports Server (NTRS)

Lamkin, Stephen L. (Editor)

1991-01-01

Rendezvous, Proximity Operations, and Capture (RPOC) is a missions operations area which is extremely important to present and future space initiatives and must be well planned and coordinated. To support this, a study team was formed to identify a specific plan of action using the Quality Function Deployment (QFD) process. This team was composed of members from a wide spectrum of engineering and operations organizations which are involved in the RPOC technology area. The key to this study's success is an understanding of the needs of potential programmatic customers and the technology base available for system implementation. To this end, the study team conducted interviews with a variety of near term and future programmatic customers and technology development sponsors. The QFD activity led to a thorough understanding of the needs of these customers in the RPOC area, as well as the relative importance of these needs.

Payment for obesity services: examples and recommendations for stage 3 comprehensive multidisciplinary intervention programs for children and adolescents.

PubMed

Slusser, Wendy; Staten, Karan; Stephens, Karen; Liu, Lenna; Yeh, Christine; Armstrong, Sarah; DeUgarte, Daniel A; Haemer, Matthew

2011-09-01

The Reimbursement and Payment Subcommittee of the National Association of Children's Hospitals and Related Institutions FOCUS on a Fitter Future group sought to guide medical providers, patients, and payers to better serve obese children and adolescents to enable optimum health. Recommendations are provided for the essential components of a stage 3 comprehensive multidisciplinary intervention program as defined by the 2007 Expert Committee recommendations. In addition, suggestions are offered for a stepwise approach to implement these recommendations. In 2009, key informant interviews were conducted with 15 children's hospitals participating in FOCUS on a Fitter Future and 1 nonparticipating hospital. Interview transcripts identified 5 financially sustainable stage 3 programs, each funded differently. The stage 3 programs interviewed ranged from being nascent to 21 years old (27%, <2 years; 47%, 2-6 years; 27%, >6 years). All of them had multidisciplinary teams that delivered services through 1 of 3 institutional structures: 60% freestanding; 7% specialty; and 33% hospital within a hospital. One-third of them had 1 to 2 funding sources, and 67% had ≥ 3 sources. The stage 3 programs in this review shared some common strategies for achieving financial stability. All of them followed key strategies of the chronic care model, the details of which led to the following recommendation: stage 3 programs should include a health care team with a medical provider, registered dietitian, physical activity specialist, mental health specialist, and coordinator who, as a team, provide service to overweight and obese children at no less than moderate intensity (26-75 hours).

Consequences of organizational commitment in abolished company sports team - a case study in Japan.

PubMed

Honda, Yuki; Hochi, Yasuyuki; Mizuno, Motoki

2012-01-01

The purpose of this study was to show that how the abolishment of company sports team influenced the organizational commitment in employees. In this study, Three-Component Model of Organizational Commitment (Meyer and Allen, 1997) was tested with 16 employees (10 males, 6 females) of T Company in NAGANO prefecture. The average age of the participants was 44, 50 years (SD=±0.85). And from 16 employees, 3 male employees were measured on organizational commitment with interview test. According to the analysis, the relation between organizational commitment in employees and the abolishment of company sports team was not positive significant correlation. Furthermore, results of interview test did not show the relation between organizational commitment in employees and the abolishment of company sports team. However, results of interview test showed the relation with organizational commitment of players in T Company sports team. Consequently, the goal to possess a sports team in T Company was not to boost organizational commitment in employees. In addition, it is necessary to reconsider the correlation among employees engaged in T Company in the future.

Promoting Local Ownership: Lessons Learned from Process of Transitioning Clinical Mentoring of HIV Care and Treatment in Ethiopia.

PubMed

Kassie, Getnet M; Belay, Teklu; Sharma, Anjali; Feleke, Getachew

2018-01-01

Focus on improving access and quality of HIV care and treatment gained acceptance in Ethiopia through the work of the International Training and Education Center for Health. The initiative deployed mobile field-based teams and capacity building teams to mentor health care providers on clinical services and program delivery in three regions, namely Tigray, Amhara, and Afar. Transitioning of the clinical mentoring program (CMP) began in 2012 through capacity building and transfer of skills and knowledge to local health care providers and management. The initiative explored the process of transitioning a CMP on HIV care and treatment to local ownership and documented key lessons learned. A mixed qualitative design was used employing focus group discussions, individual in-depth interviews, and review of secondary data. The participants included regional focal persons, mentors, mentees, multidisciplinary team members, and International Training and Education Center for Health (I-TECH) staff. Three facilities were selected in each region. Data were collected by trained research assistants using customized guides for interviews and with data extraction format. The interviews were recorded and fully transcribed. Open Code software was used for coding and categorizing the data. A total of 16 focus group discussions and 20 individual in-depth interviews were conducted. The critical processes for transitioning a project were: establishment of a mentoring transition task force, development of a roadmap to define steps and directions for implementing the transition, and signing of a memorandum of understanding (MOU) between the respective regional health bureaus and I-TECH Ethiopia to formalize the transition. The elements of implementation included mentorship and capacity building, joint mentoring, supportive supervision, review meetings, and independent mentoring supported by facility-based mechanisms: multidisciplinary team meetings, case-based discussions, and catchment area meetings. The process of transitioning the CMP to local ownership involved signing an MOU, training of mentors, and building capacity of mentoring in each region. The experience shed light on how to transition donor-supported work to local country ownership, with key lessons related to strengthening the structures of regional health bureaus, and other facilities addressing critical issues and ensuring continuity of the facility-based activities.

Interprofessional rhetoric and operational realities: an ethnographic study of rounds in four intensive care units.

PubMed

Paradis, Elise; Leslie, Myles; Gropper, Michael A

2016-10-01

Morning interprofessional rounds (MIRs) are used in critical care medicine to improve team-based care and patient outcomes. Given existing evidence of conflict between and dissatisfaction among rounds participants, this study sought to better understand how the operational realities of care delivery in the intensive care unit (ICU) impact the success of MIRs. We conducted a year-long comparative ethnographic study of interprofessional collaboration and patient and family involvement in four ICUs in tertiary academic hospitals in two American cities. The study included 576 h of observation of team interactions, 47 shadowing sessions and 40 clinician interviews. In line with best practices in ethnographic research, data collection and analysis were done iteratively using the constant comparative method. Member check was conducted regularly throughout the project. MIRs were implemented on all units with the explicit goals of improving team-based and patient-centered care. Operational conditions on the units, despite interprofessional commitment and engagement, appeared to thwart ICU teams from achieving these goals. Specifically, time constraints, struggles over space, and conflicts between MIRs' educational and care-plan-development functions all prevented teams from achieving collaboration and patient-involvement. Moreover, physicians' de facto control of rounds often meant that they resembled medical rounds (their historical predecessors), and sidelined other providers' contributions. This study suggests that the MIRs model, as presently practiced, might not be well suited to the provision of team-based, patient-centered care. In the interest of interprofessional collaboration, of the optimization of clinicians' time, of high-quality medical education and of patient-centered care, further research on interprofessional rounds models is needed.

Developing an Assessment, Monitoring, and Evaluation Framework for U.S. Department of Defense Security Cooperation

DTIC Science & Technology

2016-09-01

be conducted midstream, at the end of an activity program or LOE, or ex post facto . Not all security cooperation endeavors require evaluation...noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only...iv Developing an AME Framework for DoD Security Cooperation approach, the study team analyzed documents, interviewed subject- matter experts

Tiger Team Assessment of the Sandia National Laboratories, Livermore, California

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

Not Available

1990-08-01

This report provides the results of the Tiger Team Assessment of the Sandia National Laboratories (SNL) in Livermore, California, conducted from April 30 to May 18, 1990. The purpose of the assessment was to provide the Secretary of Energy with the status of environment, safety and health (ES H) activities at SNL, Livermore. The assessment was conducted by a team consisting of three subteams of federal and private sector technical specialists in the disciplines of environment, safety and health, and management. On-site activities for the assessment included document reviews, observation of site operations, and discussions and interviews with DOE personnel,more » site contractor personnel, and regulators. Using these sources of information and data, the Tiger Team identified a significant number of findings and concerns having to do with the environment, safety and health, and management, as well as concerns regarding noncompliance with Occupational Safety and Health Administration (OSHA) standards. Although the Tiger Team concluded that none of the findings or concerns necessitated immediate cessation of any operations at SNL, Livermore, it does believe that a sizable number of them require prompt management attention. A special area of concern identified for the near-term health and safety of on-site personnel pertained to the on-site Trudell Auto Repair Shop site. Several significant OSHA concerns and environmental findings relating to this site prompted the Tiger Team Leader to immediately advise SNL, Livermore and AL management of the situation. A case study was prepared by the Team, because the root causes of the problems associated with this site were believed to reflect the overall root causes for the areas of ES H noncompliance at SNL, Livermore. 4 figs., 3 tabs.« less

Working under a clinic-level quality incentive: primary care clinicians' perceptions.

PubMed

Greene, Jessica; Kurtzman, Ellen T; Hibbard, Judith H; Overton, Valerie

2015-01-01

A key consideration in designing pay-for-performance programs is determining what entity the incentive should be awarded to-individual clinicians or to groups of clinicians working in teams. Some argue that team-level incentives, in which clinicians who are part of a team receive the same incentive based on the team's performance, are most effective; others argue for the efficacy of clinician-level incentives. This study examines primary care clinicians' perceptions of a team-based quality incentive awarded at the clinic level. This research was conducted with Fairview Health Services, where 40% of the primary care compensation model was based on clinic-level quality performance. We conducted 48 in-depth interviews to explore clinicians' perceptions of the clinic-level incentive, as well as an online survey of 150 clinicians (response rate 56%) to investigate which entity the clinicians would consider optimal to target for quality incentives. Clinicians reported the strengths of the clinic-based quality incentive were quality improvement for the team and less patient "dumping," or shifting patients with poor outcomes to other clinicians. The weaknesses were clinicians' lack of control and colleagues riding the coattails of higher performers. There were mixed reports on the model's impact on team dynamics. Although clinicians reported greater interaction with colleagues, some described an increase in tension. Most clinicians surveyed (73%) believed that there should be a mix of clinic and individual-level incentives to maintain collaboration and recognize individual performance. The study highlights the important advantages and disadvantages of using incentives based upon clinic-level performance. Future research should test whether hybrid incentives that mix group and individual incentives can maintain some of the best elements of each design while mitigating the negative impacts. © 2015 Annals of Family Medicine, Inc.

[How did health personnel perceive supervision of obstetric institutions?].

PubMed

Arianson, Helga; Elvbakken, Kari Tove; Malterud, Kirsti

2008-05-15

Through audits, the Norwegian Board of Health supervises and ensures that health institutions adhere to rules and regulations that apply to them. Conduct of such supervision should be predictable and the basis for decisions should be documented and challengeable. Those in charge of the supervision must have the necessary professional competence and be able to integrate and understand the collected information so they can draw the right conclusions. The audit team should demonstrate consideration and respect to those they meet during audits. We therefore wanted to study the experience of being audited among health care providers and leaders of institutions and subsequent adjustments after the audit. We used a questionnaire to evaluate the national audit of 26 (of 60 totally) Norwegian obstetric institutions in 2004. A questionnaire was sent to leaders and health care providers in all institutions that had been inspected (208 persons). Data from semi-structured interviews were used to validate and explore the quantitative findings. 89% responded to the questionnaire. The supervision was well received by leaders and health care providers at the obstetric institutions. The respondents confirmed that the audit team's approach and conduct in principle adhered to the rules within the examined domains. The conclusions presented by the audit teams were accepted as correct by most of the respondents. A large number of adjustments were reported after the audits. We conclude that auditing can lead to improvements and that the described programme probably contributed to improving obstetric services in Norway. The audit team's conduct seems to have an effect on acceptance of the supervision. The performance of the teams may have an impact of the acceptance of auditing, but not on reporting of the adjustments carried out.

Five-year external reviews of the eight Department of Interior Climate Science Centers: Alaska Climate Science Center

USGS Publications Warehouse

Shasby, Mark; Dolloff, C. Andrew; Hicke, Jeffrey A.; Marcot, Bruce G.; McCarl, Bruce; McMahon, Gerard; Morton, John M.

2017-01-01

This report primarily addresses the first two purposes of the review while providing comments on the third as identified by the science review team (SRT). A separate report of recommendations for the recompetition, based upon compiled observation from all three reviews conducted in 2016, was submitted to NCCWSC on April 15, 2016 to assist with the development of recompetition documents. To further address host-university administrative competencies and efficiencies, separate interviews of host-university faculty and administrators were conducted by NCCWSC staff in conjunction with the on-site component of the reviews.

Managing family centered palliative care in aged and acute settings.

PubMed

Street, Annette Fay; Love, Anthony; Blackford, Jeanine

2005-03-01

This paper reports on the management of family centered palliative care in different aged care and acute Australian inpatient settings, following the integration of palliative care with mainstream services. Eighty-eight semistructured interviews were conducted and 425 questionnaires (Palliative Care Practices Questionnaire--PCPQ) were returned, completed from 12 regional and metropolitan locations. Transcribed interviews were analyzed using QSR NVivo and mean PCPQ scores from the four settings were compared. Scores on items from the PCPQ related to family centered care confirmed the analyses. Interviews revealed that factors contributing to the level of support for families offered in the various settings included the core business of the unit; the length of stay of the patients or residents; the acuity or symptom burden; and the coordinated involvement of the multidisciplinary team. Strategies for improving supportive family care are proposed.

Working with 'hands-off' support: a qualitative study of multidisciplinary teams' experiences of home rehabilitation for older people.

PubMed

Randström, Kerstin Björkman; Wengler, Yvonne; Asplund, Kenneth; Svedlund, Marianne

2014-03-01

There is a move towards the provision of rehabilitation for older people in their homes. It is essential to ensure that rehabilitation services promote independence of older people. The aim of the study was to explore multidisciplinary teams' experiences of home rehabilitation for older people. Five focus groups were conducted with multidisciplinary teams based in a municipality in Sweden, covering seven different professions. In total, 28 participants volunteered to participate in these interviews. Interviews were transcribed verbatim and analysed according to content analysis. Two main categories, as well as four subcategories, emerged. The first main category, having a rehabilitative approach in everyday life, consisted of the subcategories: 'giving 'hands-off' support' and 'being in a home environment'. The second main category, working across professional boundaries, consisted of the subcategories: 'coordinating resources' and 'learning from each other'. Common goals, communication skills and role understanding contributed to facilitating the teams' performances of rehabilitation. A potential benefit of home rehabilitation, because the older person is in a familiar environment, is to work a rehabilitative approach into each individual's activity in their everyday life in order to meet their specific needs. At an organisational level, there is a need for developing services to further support older people's psychosocial needs during rehabilitation. Team performance towards an individual's rehabilitation should come from an emerged whole and not only from the performance of a specific professional approach depending on the traditional role of each profession. A rehabilitative approach is based on 'hands-off' support in order to incorporate an individual's everyday activities as a part of their rehabilitation. © 2012 Blackwell Publishing Ltd.

Environmental health and safety independent investigation of the in situ vitrification melt expulsion at the Oak Ridge National Laboratory, Oak Ridge, Tennessee

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

NONE

At about 6:12 pm, EDT on April 21, 1996, steam and molten material were expelled from Pit 1 in situ vitrification (ISV) project at the Oak Ridge National Laboratory (ORNL). At the request of the director of the Environmental Restoration (ER) Division, Department of Energy Oak Ridge Operations (DOE ORO), an independent investigation team was established on April 26, 1996. This team was tasked to determine the facts related to the ORNL Pit 1 melt expulsion event (MEE) in the areas of environment safety and health concerns such as the adequacy of the ISV safety systems; operational control restrictions; emergencymore » response planning/execution; and readiness review, and report the investigation team findings within 45 days from the date of incident. These requirements were stated in the letter of appointment presented in Appendix A of this report. This investigation did not address the physical causes of the MEE. A separate investigation was conducted by ISV project personnel to determine the causes of the melt expulsion and the extent of the effects of this phenomenon. In response to this event, occurrence report ORO-LMES-X10ENVRES-1996-0006 (Appendix B) was filed. The investigation team did not address the occurrence reporting or event notification process. The project personnel (project team) examined the physical evidence at Pit 1 ISV site (e.g., the ejected melt material and the ISV hood), reviewed documents such as the site- specific health and safety plan (HASP), and interviewed personnel involved in the event and/or the project. A listing of the personnel interviewed and evidence reviewed is provided in Appendix C.« less

Overlapping of duties and technical autonomy among nurses of the Family Health Strategy.

PubMed

Feliciano, Katia Virginia de Oliveira; Kovacs, Maria Helena; Sarinho, Silvia Wanick

2010-06-01

To understand how Estratégia Saúde da Família (Family Health Strategy) nurses experience the overlapping of duties and building of technical autonomy. This was a qualitative study performed with 22 nurses, in the city of Recife, Northeastern Brazil, between August 2005 and November 2006. Based on management evaluation (geographic access; conflicts in the team, between team and district and between team and community; and public violence in the area), four teams were selected in each of the six health districts. Semi-structured interviews were conducted. The main themes in the interview guide were about work expectations and relevance, its organization and process, and feelings towards these practices. The results were interpreted under the perspective of burnout. The nurses' opinion on the excessive number of families, insufficient organizational support and pressures from user demands that had not been met was recurrent. Overlapping of health care and management caused work overload, creating anxiety, impotence, frustration and the feeling of being treated unfairly when tasks were divided among team members. The clinical dimension of practice led to a feeling of insecurity of a technical and ethical nature, in addition to the satisfaction for the power and prestige achieved by the professional category. Specialized medical training represented an obstacle to autonomy and responsibility becoming interdependent. Stress, dissatisfaction, becoming physically and mentally ill, recognition of the relevance of work and importance of one's performance, and low work involvement were reported. In view of the lack of expectation of changes in the short term, the overlapping of low professional satisfaction and work overload causes negative attitudes, indicating the importance of health promotion to increase the possibility of influencing and changing work conditions.

Using program evaluation to support knowledge translation in an interprofessional primary care team: a case study.

PubMed

Donnelly, Catherine; Shulha, Lyn; Klinger, Don; Letts, Lori

2016-10-06

Evaluation is a fundamental component in building quality primary care and is ideally situated to support individual, team and organizational learning by offering an accessible form of participatory inquiry. The evaluation literature has begun to recognize the unique features of KT evaluations and has described attributes to consider when evaluating KT activities. While both disciplines have focused on the evaluation of KT activities neither has explored the role of evaluation in KT. The purpose of the paper is to examine how participation in program evaluation can support KT in a primary care setting. A mixed methods case study design was used, where evaluation was conceptualized as a change process and intervention. A Memory Clinic at an interprofessional primary care clinic was the setting in which the study was conducted. An evaluation framework, Pathways of Influence provided the theoretical foundation to understand how program evaluation can facilitate the translation of knowledge at the level of the individual, inter-personal (Memory Clinic team) and the organization. Data collection included questionnaires, interviews, evaluation log and document analysis. Questionnaires and interviews were administered both before and after the evaluation: Pattern matching was used to analyze the data based on predetermined propositions. Individuals gained program knowledge that resulted in changes to both individual and program practices. One of the key themes was the importance clinicians placed on local, program based knowledge. The evaluation had less influence on the broader health organization. Program evaluation facilitated individual, team and organizational learning. The use of evaluation to support KT is ideally suited to a primary care setting by offering relevant and applicable knowledge to primary care team members while being sensitive to local context.

Building flexibility and managing complexity in community mental health: lessons learned in a large urban centre.

PubMed

Stergiopoulos, Vicky; Saab, Dima; Francombe Pridham, Kate; Aery, Anjana; Nakhost, Arash

2018-01-24

Across many jurisdictions, adults with complex mental health and social needs face challenges accessing appropriate supports due to system fragmentation and strict eligibility criteria of existing services. To support this underserviced population, Toronto's local health authority launched two novel community mental health models in 2014, inspired by Flexible Assertive Community Team principles. This study explores service user and provider perspectives on the acceptability of these services, and lessons learned during early implementation. We purposively sampled 49 stakeholders (staff, physicians, service users, health systems stakeholders) and conducted 17 semi-structured qualitative interviews and 5 focus groups between October 23, 2014 and March 2, 2015, exploring stakeholder perspectives on the newly launched team based models, as well as activities and strategies employed to support early implementation. Interviews and focus groups were audio recorded, transcribed verbatim and analyzed using thematic analysis. Findings revealed wide-ranging endorsement for the two team-based models' success in engaging the target population of adults with complex service needs. Implementation strengths included the broad recognition of existing service gaps, the use of interdisciplinary teams and experienced service providers, broad partnerships and collaboration among various service sectors, training and team building activities. Emerging challenges included lack of complementary support services such as suitable housing, organizational contexts reluctant to embrace change and risk associated with complexity, as well as limited service provider and organizational capacity to deliver evidence-based interventions. Findings identified implementation drivers at the practitioner, program, and system levels, specific to the implementation of community mental health interventions for adults with complex health and social needs. These can inform future efforts to address the health and support needs of this vulnerable population.

Using Social Networking to Understand Social Networks: Analysis of a Mobile Phone Closed User Group Used by a Ghanaian Health Team

PubMed Central

Akosah, Eric; Ohemeng-Dapaah, Seth; Sakyi Baah, Joseph; Kanter, Andrew S

2013-01-01

Background The network structure of an organization influences how well or poorly an organization communicates and manages its resources. In the Millennium Villages Project site in Bonsaaso, Ghana, a mobile phone closed user group has been introduced for use by the Bonsaaso Millennium Villages Project Health Team and other key individuals. No assessment on the benefits or barriers of the use of the closed user group had been carried out. Objective The purpose of this research was to make the case for the use of social network analysis methods to be applied in health systems research—specifically related to mobile health. Methods This study used mobile phone voice records of, conducted interviews with, and reviewed call journals kept by a mobile phone closed user group consisting of the Bonsaaso Millennium Villages Project Health Team. Social network analysis methodology complemented by a qualitative component was used. Monthly voice data of the closed user group from Airtel Bharti Ghana were analyzed using UCINET and visual depictions of the network were created using NetDraw. Interviews and call journals kept by informants were analyzed using NVivo. Results The methodology was successful in helping identify effective organizational structure. Members of the Health Management Team were the more central players in the network, rather than the Community Health Nurses (who might have been expected to be central). Conclusions Social network analysis methodology can be used to determine the most productive structure for an organization or team, identify gaps in communication, identify key actors with greatest influence, and more. In conclusion, this methodology can be a useful analytical tool, especially in the context of mobile health, health services, and operational and managerial research. PMID:23552721

Using social networking to understand social networks: analysis of a mobile phone closed user group used by a Ghanaian health team.

PubMed

Kaonga, Nadi Nina; Labrique, Alain; Mechael, Patricia; Akosah, Eric; Ohemeng-Dapaah, Seth; Sakyi Baah, Joseph; Kodie, Richmond; Kanter, Andrew S; Levine, Orin

2013-04-03

The network structure of an organization influences how well or poorly an organization communicates and manages its resources. In the Millennium Villages Project site in Bonsaaso, Ghana, a mobile phone closed user group has been introduced for use by the Bonsaaso Millennium Villages Project Health Team and other key individuals. No assessment on the benefits or barriers of the use of the closed user group had been carried out. The purpose of this research was to make the case for the use of social network analysis methods to be applied in health systems research--specifically related to mobile health. This study used mobile phone voice records of, conducted interviews with, and reviewed call journals kept by a mobile phone closed user group consisting of the Bonsaaso Millennium Villages Project Health Team. Social network analysis methodology complemented by a qualitative component was used. Monthly voice data of the closed user group from Airtel Bharti Ghana were analyzed using UCINET and visual depictions of the network were created using NetDraw. Interviews and call journals kept by informants were analyzed using NVivo. The methodology was successful in helping identify effective organizational structure. Members of the Health Management Team were the more central players in the network, rather than the Community Health Nurses (who might have been expected to be central). Social network analysis methodology can be used to determine the most productive structure for an organization or team, identify gaps in communication, identify key actors with greatest influence, and more. In conclusion, this methodology can be a useful analytical tool, especially in the context of mobile health, health services, and operational and managerial research.

Computer Security Incident Response Team Effectiveness: A Needs Assessment

PubMed Central

Van der Kleij, Rick; Kleinhuis, Geert; Young, Heather

2017-01-01

Computer security incident response teams (CSIRTs) respond to a computer security incident when the need arises. Failure of these teams can have far-reaching effects for the economy and national security. CSIRTs often have to work on an ad hoc basis, in close cooperation with other teams, and in time constrained environments. It could be argued that under these working conditions CSIRTs would be likely to encounter problems. A needs assessment was done to see to which extent this argument holds true. We constructed an incident response needs model to assist in identifying areas that require improvement. We envisioned a model consisting of four assessment categories: Organization, Team, Individual and Instrumental. Central to this is the idea that both problems and needs can have an organizational, team, individual, or technical origin or a combination of these levels. To gather data we conducted a literature review. This resulted in a comprehensive list of challenges and needs that could hinder or improve, respectively, the performance of CSIRTs. Then, semi-structured in depth interviews were held with team coordinators and team members of five public and private sector Dutch CSIRTs to ground these findings in practice and to identify gaps between current and desired incident handling practices. This paper presents the findings of our needs assessment and ends with a discussion of potential solutions to problems with performance in incident response. PMID:29312051

Computer Security Incident Response Team Effectiveness: A Needs Assessment.

PubMed

Van der Kleij, Rick; Kleinhuis, Geert; Young, Heather

2017-01-01

Computer security incident response teams (CSIRTs) respond to a computer security incident when the need arises. Failure of these teams can have far-reaching effects for the economy and national security. CSIRTs often have to work on an ad hoc basis, in close cooperation with other teams, and in time constrained environments. It could be argued that under these working conditions CSIRTs would be likely to encounter problems. A needs assessment was done to see to which extent this argument holds true. We constructed an incident response needs model to assist in identifying areas that require improvement. We envisioned a model consisting of four assessment categories: Organization, Team, Individual and Instrumental. Central to this is the idea that both problems and needs can have an organizational, team, individual, or technical origin or a combination of these levels. To gather data we conducted a literature review. This resulted in a comprehensive list of challenges and needs that could hinder or improve, respectively, the performance of CSIRTs. Then, semi-structured in depth interviews were held with team coordinators and team members of five public and private sector Dutch CSIRTs to ground these findings in practice and to identify gaps between current and desired incident handling practices. This paper presents the findings of our needs assessment and ends with a discussion of potential solutions to problems with performance in incident response.

Role of Cognitive Testing in the Development of the CAHPS® Hospital Survey

PubMed Central

Levine, Roger E; Fowler, Floyd J; Brown, Julie A

2005-01-01

Objective To describe how cognitive testing results were used to inform the modification and selection of items for the Consumer Assessment of Health Providers and Systems (CAHPS®) Hospital Survey pilot test instrument. Data Sources Cognitive interviews were conducted on 31 subjects in two rounds of testing: in December 2002–January 2003 and in February 2003. In both rounds, interviews were conducted in northern California, southern California, Massachusetts, and North Carolina. Study Design A common protocol served as the basis for cognitive testing activities in each round. This protocol was modified to enable testing of the items as interviewer-administered and self-administered items and to allow members of each of three research teams to use their preferred cognitive research tools. Data Collection/Extraction Methods Each research team independently summarized, documented, and reported their findings. Item-specific and general issues were noted. The results were reviewed and discussed by senior staff from each research team after each round of testing, to inform the acceptance, modification, or elimination of candidate items. Principal Findings Many candidate items required modification because respondents lacked the information required to answer them, respondents failed to understand them consistently, the items were not measuring the constructs they were intended to measure, the items were based on erroneous assumptions about what respondents wanted or experienced during their hospitalization, or the items were asking respondents to make distinctions that were too fine for them to make. Cognitive interviewing enabled the detection of these problems; an understanding of the etiology of the problem informed item revisions. However, for some constructs, the revisions proved to be inadequate. Accordingly, items could not be developed to provide acceptable measures of certain constructs such as shared decision making, coordination of care, and delays in the admissions process. Conclusions Cognitive testing is the most direct way of finding out whether respondents understand questions consistently, have the information needed to answer the questions, and can use the response alternatives provided to describe their experiences or their opinions accurately. Many of the candidate questions failed to meet these standards. Cognitive testing only evaluates the way in which respondents understand and answer questions. Although it does not directly assess the validity of the answers, it is a reasonable premise that cognitive problems will seriously compromise validity and reliability. PMID:16316437

Shoestring budgets, band-AIDS, and team work: challenges and motivators in the development of a Web-based resource for undergraduate clinical skills teaching.

PubMed

Simmons, Collan; Nyhof-Young, Joyce; Bradley, John

2005-05-24

Learning how to conduct a medical interview and perform a physical examination is fundamental to the practice of medicine; however, when this project began, the methods used to teach these skills to medical students at the University of Toronto (U of T) had not changed significantly since the early 1990s despite increasing outpatient care, shorter hospital stays, and heavy preceptor workloads. In response, a Web-based clinical skills resource was developed for the first-year undergraduate medical course-The Art and Science of Clinical Medicine I (ASCM I). This paper examines our experiences with the development of the ASCM I website and details the challenges and motivators inherent in the production of a Web-based, multimedia medical education tool at a large Canadian medical school. Interviews and a focus group were conducted with the development team to discover the factors that positively and negatively affected the development process. Motivating factors included team attributes such as strong leadership and judicious use of medical students and faculty volunteers as developers. Other motivators included a growing lack of instructional equivalency across diverse clinical teaching sites and financial and resource support by the Faculty of Medicine. Barriers to development included an administrative environment that did not yet fully incorporate information technology into its teaching vision and framework, a lack of academic incentive for faculty participation, and inadequate technical support, space, and equipment. The success of electronic educational resources such as the ASCM I website has caused a significant cultural shift within the Faculty of Medicine, resulting in the provision of more space, resources, and support for IT endeavours in the undergraduate medical curriculum.

"The Jackson Table Is a Pain in the…": A Qualitative Study of Providers' Perception Toward a Spinal Surgery Table.

PubMed

Asiedu, Gladys B; Lowndes, Bethany R; Huddleston, Paul M; Hallbeck, Susan

2016-01-07

The aim of this study was to define health care providers' perceptions toward prone patient positioning for spine surgery using the Jackson Table, which has not been hitherto explored. We analyzed open-ended questionnaire data and interviews conducted with the spine surgical team regarding the current process of spinal positioning/repositioning using the Jackson Table. Participants were asked to provide an open-ended explanation as to whether they think the current process of spinal positioning/repositioning is safe for the staff or patients. Follow-up qualitative interviews were conducted with 11 of the participants to gain an in-depth understanding of the challenges and safety issues related to prone patient positioning. Data analysis resulted in 6 main categories: general challenges with patient positioning, role-specific challenges, challenges with the Jackson Table and the "sandwich" mechanism, safety concerns for patients, safety concerns for the medical staff, and recommendations for best practices. This study is relevant to everyday practice for spinal surgical team members and advances our understanding of how surgical teams qualitatively view the current process of patient positioning for spinal surgery. Providers recommended best practices for using the Jackson Table, which can be achieved through standardized practice for transfer of patients, educational tools, and checklists for equipment before patient transfer and positioning. This research has identified several important practice opportunities for improving provider and patient safety in spine surgery.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivitives 3.0 License, 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. http://creativecommons.org/licenses/by-nc-nd/3.0.

A qualitative study of hospital pharmacists and antibiotic governance: negotiating interprofessional responsibilities, expertise and resource constraints.

PubMed

Broom, Alex; Plage, Stefanie; Broom, Jennifer; Kirby, Emma; Adams, Jon

2016-02-06

Antibiotic treatment options for common infections are diminishing due to the proliferation of antimicrobial resistance (AMR). The impact of Antimicrobial Stewardship (AMS) programs seeking to preserve viable antibiotic drugs by governing their use in hospitals has hitherto been limited. Pharmacists have been delegated a critical role in antibiotic governance in AMS teams within hospitals but the experience of pharmacists in influencing antibiotic use has received limited attention. In this study we explore the experiences of pharmacists in antibiotic decision-making in two Australian hospitals. We conducted 19 semi-structured interviews to explore hospital-based pharmacists' perceptions and experiences of antibiotic use and governance. The analysis was conducted with NVivo10 software, utilising the framework approach. Three major themes emerged in the pharmacist interviews including (1) the responsibilities of pharmacy in optimising antibiotic use and the interprofessional challenges therein; (2) the importance of antibiotic streamlining and the constraints placed on pharmacists in achieving this; and (3) the potential, but often under-utilised expertise, pharmacists bring to antibiotic optimisation. Pharmacists have a critical role in AMS teams but their capacity to enact change is limited by entrenched interprofessional dynamics. Identifying how hospital pharmacy's antibiotic gatekeeping is embedded in the interprofessional nature of clinical decision-making and limited by organisational environment has important implications for the implementation of hospital policies seeking to streamline antibiotic use. Resource constraints (i.e. time limitation and task prioritisation) in particular limit the capacity of pharmacists to overcome the interprofessional barriers through development of stronger collaborative relationships. The results of this study suggest that to enact change in antibiotic use in hospitals, pharmacists must be supported in their negotiations with doctors, have increased presence on hospital wards, and must be given opportunities to pass on specialist knowledge within multidisciplinary clinical teams.

Emergency care in case of acute psychotic and/or manic symptoms: Lived experiences of patients and their families with the first interventions of a mobile crisis team. A phenomenological study.

PubMed

Daggenvoorde, Thea H; Gijsman, Harm J; Goossens, Peter J J

2017-09-27

To explore the lived experiences of patients with a psychotic or bipolar disorder and their families with emergency care during the first contact with a mobile crisis team. Open individual interviews were held with ten patients and ten family members. Content data-analysis was conducted. Communication and cooperation was difficult in several cases. Personal crisis plans were not always used. Stigma was felt, especially when police-assistance was needed. A calm, understanding attitude was appreciated. Focus explicitly on communication with the patient, despite the acute condition, enhances the chance of cooperation. Taking time for contact is important. © 2017 Wiley Periodicals, Inc.

Models of Integrating Physical Therapists into Family Health Teams in Ontario, Canada: Challenges and Opportunities

PubMed Central

Mandoda, Shilpa; Landry, Michel D.

2011-01-01

ABSTRACT Purpose: To explore the potential for different models of incorporating physical therapy (PT) services within the emerging network of family health teams (FHTs) in Ontario and to identify challenges and opportunities of each model. Methods: A two-phase mixed-methods qualitative descriptive approach was used. First, FHTs were mapped in relation to existing community-based PT practices. Second, semi-structured key-informant interviews were conducted with representatives from urban and rural FHTs and from a variety of community-based PT practices. Interviews were digitally recorded, transcribed verbatim, and analyzed using a categorizing/editing approach. Results: Most participants agreed that the ideal model involves embedding physical therapists directly into FHTs; in some situations, however, partnering with an existing external PT provider may be more feasible and sustainable. Access and funding remain the key issues, regardless of the model adopted. Conclusion: Although there are differences across the urban/rural divide, there exist opportunities to enhance and optimize existing delivery models so as to improve client access and address emerging demand for community-based PT services. PMID:22654231

Health and Social Care Practitioners' Experiences of Assessing Mental Capacity in a Community Learning Disability Team

ERIC Educational Resources Information Center

Ratcliff, Daniel; Chapman, Melanie

2016-01-01

Background: The study explored experiences of health and social care practitioners within a community learning disability team in undertaking mental capacity assessments with people with learning disabilities. Materials and Methods: Eight practitioners were interviewed using a semi-structured interview schedule. Results: The information gained was…

A Transcription and Translation Protocol for Sensitive Cross-Cultural Team Research.

PubMed

Clark, Lauren; Birkhead, Ana Sanchez; Fernandez, Cecilia; Egger, Marlene J

2017-10-01

Assurance of transcript accuracy and quality in interview-based qualitative research is foundational for data accuracy and study validity. Based on our experience in a cross-cultural ethnographic study of women's pelvic organ prolapse, we provide practical guidance to set up step-by-step interview transcription and translation protocols for team-based research on sensitive topics. Beginning with team decisions about level of detail in transcription, completeness, and accuracy, we operationalize the process of securing vendors to deliver the required quality of transcription and translation. We also share rubrics for assessing transcript quality and the team protocol for managing transcripts (assuring consistency of format, insertion of metadata, anonymization, and file labeling conventions) and procuring an acceptable initial translation of Spanish-language interviews. Accurate, complete, and systematically constructed transcripts in both source and target languages respond to the call for more transparency and reproducibility of scientific methods.

Gathering, strategizing, motivating and celebrating: the team huddle in a teaching general practice.

PubMed

Walsh, Allyn; Moore, Ainsley; Everson, Jennifer; DeCaire, Katharine

2018-03-01

To understand how implementing a daily team huddle affected the function of a complex interprofessional team including learners. A qualitative descriptive study using semi-structured interviews in focus groups. An academic general practice teaching practice. All members of one interprofessional team, including nurses, general practitioners, junior doctors, and support staff. Focus group interviews using semi-structured guidance were transcribed and the results analysed using qualitative content analysis. Four interrelated themes were identified: communication and knowledge sharing; efficiency of care; relationship and team building; and shared responsibility for team function. The implementation of the daily team huddle was seen by participants to enhance the collaboration within the team and to contribute to work life enjoyment. Participants perceived that problems were anticipated and solved quickly. Clinical updates and information about patients benefited the team including learners. Junior doctors quickly understood the scope of practice of other team members, but some felt reluctant to offer clinical opinions. The implementation of a daily team huddle was viewed as worthwhile by this large interprofessional general practice team. The delivery of patient care was more efficient, knowledge was readily distributed, and problem solving was shared across the team, including junior doctors.

Difficulties encountered in collaborative care: logistics trumps desire.

PubMed

Legault, Frances; Humbert, Jennie; Amos, Stephanie; Hogg, William; Ward, Natalie; Dahrouge, Simone; Ziebell, Laura

2012-01-01

This study examines the development of collaborative relationships between family physicians (FPs) and Anticipatory And Preventative Team Care (APTCare) team members providing care to medically complex patients who have been identified as at-risk for negative health outcomes. We undertook a qualitative study of a primary health care intervention in a family practice. Interviews were held with FPs and ATPCare intervention nurse practitioners (NPs) and pharmacists. Focus groups were conducted and a survey was administered to participating FPs, NPs, and pharmacists. NPs and pharmacists maintained a log recording their tasks and moments of collaboration. Scheduling demands rendered face-to-face collaboration difficult, leaving the team to rely on technological tools to keep in touch. Limited space meant the APTCare team had to work out of a downstairs office, limiting informal interactions with the practitioners on the main level. We demonstrate that the difficulties inherent in collaborative care are independent of the patient population being cared for. Regardless of the patient population and sector of health care, developing collaborative relationships and learning to work collaboratively is difficult and takes time. What many of these teams need is ongoing support and education about how to make these collaborative care practices work.

Linguistic validation of translation of the self-assessment goal achievement (saga) questionnaire from English

PubMed Central

2012-01-01

Background A linguistic validation of the Self-Assessment Goal Achievement (SAGA) questionnaire was conducted for 12 European languages, documenting that each translation adequately captures the concepts of the original English-language version of the questionnaire and is readily understood by subjects in the target population. Methods Native-speaking residents of the target countries who reported urinary problems/lower urinary tract problems were asked to review a translation of the SAGA questionnaire, which was harmonized among 12 languages: Danish, Dutch, English (UK), Finnish, French, German, Greek, Icelandic, Italian, Norwegian, Spanish, and Swedish. During a cognitive debriefing interview, participants were asked to identify any words that were difficult to understand and explain in their own words the meaning of each sentence in the questionnaire. The qualitative analysis was conducted by local linguistic validation teams (original translators, back translator, project manager, interviewer, and survey research expert). Results Translations of the SAGA questionnaire from English to 12 European languages were well understood by the participants with an overall comprehension rate across language of 98.9%. In addition, the translations retained the original meaning of the SAGA items and instructions. Comprehension difficulties were identified, and after review by the translation team, minor changes were made to 7 of the 12 translations to improve clarity and comprehension. Conclusions Conceptual, semantic, and cultural equivalence of each translation of the SAGA questionnaire was achieved thus confirming linguistic validation. PMID:22525050

Linguistic validation of translation of the Self-Assessment Goal Achievement (SAGA) questionnaire from English.

PubMed

Piault, Elisabeth; Doshi, Sameepa; Brandt, Barbara A; Angün, Çolpan; Evans, Christopher J; Bergqvist, Agneta; Trocio, Jeffrey

2012-04-23

A linguistic validation of the Self-Assessment Goal Achievement (SAGA) questionnaire was conducted for 12 European languages, documenting that each translation adequately captures the concepts of the original English-language version of the questionnaire and is readily understood by subjects in the target population. Native-speaking residents of the target countries who reported urinary problems/lower urinary tract problems were asked to review a translation of the SAGA questionnaire, which was harmonized among 12 languages: Danish, Dutch, English (UK), Finnish, French, German, Greek, Icelandic, Italian, Norwegian, Spanish, and Swedish. During a cognitive debriefing interview, participants were asked to identify any words that were difficult to understand and explain in their own words the meaning of each sentence in the questionnaire. The qualitative analysis was conducted by local linguistic validation teams (original translators, back translator, project manager, interviewer, and survey research expert). Translations of the SAGA questionnaire from English to 12 European languages were well understood by the participants with an overall comprehension rate across language of 98.9%. In addition, the translations retained the original meaning of the SAGA items and instructions. Comprehension difficulties were identified, and after review by the translation team, minor changes were made to 7 of the 12 translations to improve clarity and comprehension. Conceptual, semantic, and cultural equivalence of each translation of the SAGA questionnaire was achieved thus confirming linguistic validation.

Exploring varieties of knowledge in safe work practices - an ethnographic study of surgical teams

PubMed Central

2011-01-01

Background Within existing research in health and medicine, the nature of knowledge on how teams conduct safe work practices has yet to be properly explored. Methods We address this concern by exploring the varieties in which knowledge is expressed during interdisciplinary surgical operations. Specifically, the study was conducted in a surgical section of a Norwegian regional general hospital, between January and April of 2010, by means of an ethnographic design combining detailed non-participant observations, conversations and semi-structured interviews. Results Based on an analysis of the gathered data, we identify three particular themes in how knowledge is expressed by operating room personnel: (i) the ability and variety individuals demonstrate in handling multiple sources of information, before reaching a particular decision, (ii) the variety of ways awareness or anticipation of future events is expressed, and (iii) the different ways sudden and unexpected situations are handled by the individual team members. Conclusions We conclude that these facets of knowledge bring different insights into how safe work practices are achieved at an individual and team level in surgical operations, thus adding to the existing understanding of the nature of knowledge in safe work practices in surgical operations. Future research should focus on exploring and documenting the relationships between various elements of knowledge and safe work practices, in different surgical settings and countries. PMID:21914183

Development and Process Evaluation of a Primary Care Internet-Based Intervention to Prevent Depression in Emerging Adults

PubMed Central

Van Voorhees, Benjamin W.; Ellis, Justin M.; Gollan, Jackie K.; Bell, Carl C.; Stuart, Scott S.; Fogel, Joshua; Corrigan, Patrick W.; Ford, Daniel E.

2007-01-01

Background: Primary care is a potential setting for implementation of depression prevention interventions using cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT). The purpose of this study was to develop and conduct a process evaluation of a primary care/ Internet-based intervention that addresses key dissemination barriers in a community setting. Method: We used an interdisciplinary team of investigators in a multistep intervention development process among a sample of primary care patients (aged 18 to 24 years). The intervention included an initial primary care motivational interview to engage the participant, 11 Internet-based modules based on CBT (to counter pessimistic thinking) and IPT (to activate social networks and strengthen relationship skills), and a follow-up motivational interview in primary care to enhance behavior change. Each component of the intervention was rated with regard to dissemination barriers of (1) fidelity, (2) motivation, (3) dose, (4) perceived helpfulness (rated on a Likert scale), and (5) potential costs. The study was conducted from April through June of 2004. Results: Fidelity checklist and serial reviews were satisfactory (100% core concepts translated into intervention). Key motivations for participation included (1) risk reduction, (2) intervention effectiveness, (3) “resiliency,” and (4) altruism. In terms of dose, 13 of 14 participants engaged the Internet-based components, completing a mean of 7.2 modules (SD = 3.9). The 2 primary care interviews and the self-assessment and resiliency modules received the highest helpfulness ratings. The duration of the 2 motivational interviews was approximately 17–18 minutes, which is similar to a typical primary care visit. Conclusions: By using multidisciplinary teams and incorporating the opinions of potential users, complex preventive mental health interventions can be translated into primary care settings with adequate fidelity, motivation, dose, and perceived helpfulness, and at a reasonably low cost. PMID:17998953

Practices of Weight Regulation Among Elite Athletes in Combat Sports: A Matter of Mental Advantage?

PubMed Central

Pettersson, Stefan; Ekström, Marianne Pipping; Berg, Christina M

2013-01-01

Context The combination of extensive weight loss and inadequate nutritional strategies used to lose weight rapidly for competition in weight-category sports may negatively affect athletic performance and health. Objective To explore the reasoning of elite combat-sport athletes about rapid weight loss and regaining of weight before competitions. Design Qualitative study. Setting With grounded theory as a theoretical framework, we employed a cross-examinational approach including interviews, observations, and Internet sources. Sports observations were obtained at competitions and statements by combat-sport athletes were collected on the Internet. Patients or Other Participants Participants in the interviews were 14 Swedish national team athletes (9 men, 5 women; age range, 18 to 36 years) in 3 Olympic combat sports (wrestling, judo, and taekwondo). Data Collection and Analysis Semistructured interviews with 14 athletes from the Swedish national teams in wrestling, judo, and taekwondo were conducted at a location of each participant's choice. The field observations were conducted at European competitions in these 3 sports. In addition, interviews and statements made by athletes in combat sports were collected on the Internet. Results Positive aspects of weight regulation other than gaining physical advantage emerged from the data during the analysis: sport identity, mental diversion, and mental advantage. Together and individually, these categories point toward the positive aspects of weight regulation experienced by the athletes. Practicing weight regulation mediates a self-image of being “a real athlete.” Weight regulation is also considered mentally important as a part of the precompetition preparation, serving as a coping strategy by creating a feeling of increased focus and commitment. Moreover, a mental advantage relative to one's opponents can be gained through the practice of weight regulation. Conclusions Weight regulation has mentally important functions extending beyond the common notion that combat-sport athletes reduce their weight merely to gain a physical edge over their opponents. PMID:23672331

Unobtrusive Monitoring of Spaceflight Team Functioning

NASA Technical Reports Server (NTRS)

Maidel, Veronica; Stanton, Jeffrey M.

2010-01-01

This document contains a literature review suggesting that research on industrial performance monitoring has limited value in assessing, understanding, and predicting team functioning in the context of space flight missions. The review indicates that a more relevant area of research explores the effectiveness of teams and how team effectiveness may be predicted through the elicitation of individual and team mental models. Note that the mental models referred to in this literature typically reflect a shared operational understanding of a mission setting such as the cockpit controls and navigational indicators on a flight deck. In principle, however, mental models also exist pertaining to the status of interpersonal relations on a team, collective beliefs about leadership, success in coordination, and other aspects of team behavior and cognition. Pursuing this idea, the second part of this document provides an overview of available off-the-shelf products that might assist in extraction of mental models and elicitation of emotions based on an analysis of communicative texts among mission personnel. The search for text analysis software or tools revealed no available tools to enable extraction of mental models automatically, relying only on collected communication text. Nonetheless, using existing software to analyze how a team is functioning may be relevant for selection or training, when human experts are immediately available to analyze and act on the findings. Alternatively, if output can be sent to the ground periodically and analyzed by experts on the ground, then these software packages might be employed during missions as well. A demonstration of two text analysis software applications is presented. Another possibility explored in this document is the option of collecting biometric and proxemic measures such as keystroke dynamics and interpersonal distance in order to expose various individual or dyadic states that may be indicators or predictors of certain elements of team functioning. This document summarizes interviews conducted with personnel currently involved in observing or monitoring astronauts or who are in charge of technology that allows communication and monitoring. The objective of these interviews was to elicit their perspectives on monitoring team performance during long-duration missions and the feasibility of potential automatic non-obtrusive monitoring systems. Finally, in the last section, the report describes several priority areas for research that can help transform team mental models, biometrics, and/or proxemics into workable systems for unobtrusive monitoring of space flight team effectiveness. Conclusions from this work suggest that unobtrusive monitoring of space flight personnel is likely to be a valuable future tool for assessing team functioning, but that several research gaps must be filled before prototype systems can be developed for this purpose.

Team communications in the operating room: talk patterns, sites of tension, and implications for novices.

PubMed

Lingard, Lorelei; Reznick, Richard; Espin, Sherry; Regehr, Glenn; DeVito, Isabella

2002-03-01

Although the communication that occurs within health care teams is important to both team function and the socialization of novices, the nature of team communication and its educational influence are not well documented. This study explored the nature of communications among operating room (OR) team members from surgery, nursing, and anesthesia to identify common communicative patterns, sites of tension, and their impact on novices. Paired researchers observed 128 hours of OR interactions during 35 procedures from four surgical divisions at one teaching hospital. Brief, unstructured interviews were conducted following each observation. Field notes were independently read by each researcher and coded for emergent themes in the grounded theory tradition. Coding consensus was achieved via regular discussion. Findings were returned to insider "experts" for their assessment of authenticity and adequacy. Patterns of communication were complex and socially motivated. Dominant themes were time, safety and sterility, resources, roles, and situation. Communicative tension arose regularly in relation to these themes. Each procedure had one to four "higher-tension" events, which often had a ripple effect, spreading tension to other participants and contexts. Surgical trainees responded to tension by withdrawing from the communication or mimicking the senior staff surgeon. Both responses had negative implications for their own team relations. Team communications in the OR follow observable patterns and are influenced by recurrent themes that suggest sites of team tension. Tension in team communication affects novices, who respond with behaviors that may intensify rather than resolve interprofessional conflict.

Primary health-care teams as adaptive organizations: exploring and explaining work variation using case studies in rural and urban Scotland.

PubMed

Farmer, Jane; West, Christina; Whyte, Bruce; Maclean, Margaret

2005-08-01

It is acknowledged, internationally, that health-care practitioners' work differs between and urban areas. While several factors affect individual teams' activities, there is little understanding about how patterns of work evolve. Consideration of work in relation to local circumstances is important for training, devising contracts and redesigning services. Six case studies centred on Scottish rural and urban general practices were used to examine, in-depth, the activity of primary health-care teams. Quantitative workload data about patient contacts were collected over 24 months. Interviews and diaries revealed insightful qualitative data. Findings revealed that rural general practitioners and district nurses tended to conduct more consultations per practice patient compared with their urban counterparts. Conditions seen and work tasks varied between case study teams. Qualitative data suggested that the key reasons for variation were: local needs and circumstances; choices made about deployment of available time, team composition and the extent of access to other services. Primary care teams might be viewed as adaptive organization, with co-evolution of services produced by health professionals and local people. The study highlights limitations in the application of workload data and suggests that understanding the nature of work in relation to local circumstances is important in service redesign.

Barriers and facilitators to home computer and internet use among urban novice computer users of low socioeconomic position.

PubMed

Kontos, Emily Z; Bennett, Gary G; Viswanath, K

2007-10-22

Despite the increasing penetration of the Internet and amount of online health information, there are significant barriers that limit its widespread adoption as a source of health information. One is the "digital divide," with people of higher socioeconomic position (SEP) demonstrating greater access and usage compared to those from lower SEP groups. However, as the access gap narrows over time and more people use the Internet, a shift in research needs to occur to explore how one might improve Internet use as well as website design for a range of audiences. This is particularly important in the case of novice users who may not have the technical skills, experience, or social connections that could help them search for health information using the Internet. The focus of our research is to investigate the challenges in the implementation of a project to improve health information seeking among low SEP groups. The goal of the project is not to promote health information seeking as much as to understand the barriers and facilitators to computer and Internet use, beyond access, among members of lower SEP groups in an urban setting. The purpose was to qualitatively describe participants' self-identified barriers and facilitators to computer and Internet use during a 1-year pilot study as well as the challenges encountered by the research team in the delivery of the intervention. Between August and November 2005, 12 low-SEP urban individuals with no or limited computer and Internet experience were recruited through a snowball sampling. Each participant received a free computer system, broadband Internet access, monthly computer training courses, and technical support for 1 year as the intervention condition. Upon completion of the study, participants were offered the opportunity to complete an in-depth semistructured interview. Interviews were approximately 1 hour in length and were conducted by the project director. The interviews were held in the participants' homes and were tape recorded for accuracy. Nine of the 12 study participants completed the semistructured interviews. Members of the research team conducted a qualitative analysis based on the transcripts from the nine interviews using the crystallization/immersion method. Nine of the 12 participants completed the in-depth interview (75% overall response rate), with three men and six women agreeing to be interviewed. Major barriers to Internet use that were mentioned included time constraints and family conflict over computer usage. The monthly training classes and technical assistance components of the intervention surfaced as the most important facilitators to computer and Internet use. The concept of received social support from other study members, such as assistance with computer-related questions, also emerged as an important facilitator to overall computer usage. This pilot study offers important insights into the self-identified barriers and facilitators in computer and Internet use among urban low-SEP novice users as well as the challenges faced by the research team in implementing the intervention.

Composite chronicles: A study of the lessons learned in the development, production, and service of composite structures

NASA Technical Reports Server (NTRS)

Vosteen, Louis F.; Hadcock, Richard N.

1994-01-01

A study of past composite aircraft structures programs was conducted to determine the lessons learned during the programs. The study focused on finding major underlying principles and practices that experience showed have significant effects on the development process and should be recognized and understood by those responsible for using of composites. Published information on programs was reviewed and interviews were conducted with personnel associated with current and past major development programs. In all, interviews were conducted with about 56 people representing 32 organizations. Most of the people interviewed have been involved in the engineering and manufacturing development of composites for the past 20 to 25 years. Although composites technology has made great advances over the past 30 years, the effective application of composites to aircraft is still a complex problem that requires experienced personnel with special knowledge. All disciplines involved in the development process must work together in real time to minimize risk and assure total product quality and performance at acceptable costs. The most successful programs have made effective use of integrated, collocated, concurrent engineering teams, and most often used well-planned, systematic development efforts wherein the design and manufacturing processes are validated in a step-by-step or 'building block' approach. Such approaches reduce program risk and are cost effective.

What constitutes meaningful engagement for patients and families as partners on research teams?

PubMed

Black, Agnes; Strain, Kimberly; Wallsworth, Christine; Charlton, Sara-Grey; Chang, Wilma; McNamee, Kate; Hamilton, Clayon

2018-01-01

Objective There is growing emphasis on health care organizations to ensure that lay people are meaningfully engaged as partners on research teams. Our aim was to explore the perspectives of patients, family members and informal caregivers who have been involved on health care research teams in Canada and elicit their recommendations for meaningful engagement. Methods We conducted a qualitative study guided by thematic analysis of transcripts of focus groups and interviews of 19 experienced patient research partners in Canada. Results We identified four main themes: research environment, expectations, support and value, which highlight participants' combined perspectives on important factors to ensure their engagement in research is meaningful. Conclusions Our findings add to the evolving evidence base on the perspectives of lay people involved in health care research and their recommendations for research leaders on meaningful engagement. Our study suggests that research leaders should provide a welcoming research environment, outline appropriate expectations for patient research partners on research teams, support patient research partners' engagement in projects and recognize the value patient research partners bring to health research.

Reported implementation lessons from a national quality improvement initiative; Productive Ward: Releasing Time to Care™. A qualitative, ward-based team perspective.

PubMed

White, Mark; Butterworth, Tony; Wells, John S G

2017-10-01

To explore the experiences of participants involved in the implementation of the Productive Ward: Releasing Time to Care™ initiative in Ireland, identifying key implementation lessons. A large-scale quality improvement programme Productive Ward: Releasing Time to Care™ was introduced nationwide into Ireland in 2011. We captured accounts from ward-based teams in an implementation phase during 2013-14 to explore their experiences. Semi-structured, in-depth interviews with a purposive sample of 24 members of ward-based teams from nine sites involved in the second national phase of the initiative were conducted. Interviews were analysed and coded under themes, using a seven-stage iterative process. The predominant theme identified was associated with the implementation and management of the initiative and included: project management; training; preparation; information and communication; and participant's negative experiences. The most prominent challenge reported related to other competing clinical priorities. Despite the structured approach of Productive Ward: Releasing Time to Care™, it appears that overstretched and busy clinical environments struggle to provide the right climate and context for ward-based teams to engage and interact actively with quality improvement tools, methods and activities. Findings highlight five key aspects of implementation and management that will help facilitate successful adoption of large-scale, ward-based quality improvement programmes such as Productive Ward: Releasing Time to Care™. Utilising pre-existing implementation or quality frameworks to assess each ward/unit for 'readiness' prior to commencing a quality improvement intervention such as Productive Ward: Releasing Time to Care™ should be considered. © 2017 John Wiley & Sons Ltd.

Qualitative study exploring surgical team members' perception of patient safety in conflict-ridden Eastern Democratic Republic of Congo

PubMed Central

Labat, Francoise; Sharma, Anjali

2016-01-01

Objective To identify potential barriers to patient safety (PS) interventions from the perspective of surgical team members working in an operating theatre in Eastern Democratic Republic of Congo (DRC). Design In-depth interviews were conducted and analysed using qualitative content analysis. Setting Governmental referral teaching hospital in Eastern DRC. Participants We purposively selected 2–4 national and expatriate surgical team members from each specialisation. Of the 31 eligible surgical health workers (HWs), 17 volunteered to be interviewed. Results Economics issues affected PS throughout the entire health system, from human resources and hospital management, to access to healthcare for patients. Surgical team members seemed embedded in a paternalistic organisational structure and blame culture accompanied by perceived inefficient support services and low salaries. The armed conflict did not only worsen these system failures, it also carried direct threats to patients and HWs, and resulted in complex indirect consequences compromising PS. The increased corruption within health organisations, and population impoverishment and substance abuse among health staff adversely altered safe care. Simultaneously, HWs’ reported resilience and resourcefulness to address barrier to PS. Participants had varying views on external aid depending on its relevance. Conclusions The complex links between war and PS emphasise the importance of a comprehensive approach including occupational health to strengthen HWs' resilience, external clinical audits to limit corruption, and educational programmes in PS to support patient-centred care and address blame culture. Finally, improvement of equity in the health financing system seems essential to ensure access to healthcare and safe perioperative outcomes for all. PMID:27113232

Evaluation of a practice-based intervention to improve the management of pediatric asthma.

PubMed

Ragazzi, Helen; Keller, Adrienne; Ehrensberger, Ryan; Irani, Anne-Marie

2011-02-01

Pediatric asthma remains a significant burden upon patients, families, and the healthcare system. Despite the availability of evidence-based best practice asthma management guidelines for over a decade, published studies suggest that many primary care physicians do not follow them. This article describes the Provider Quality Improvement (PQI) intervention with six diverse community-based practices. A pediatrician and a nurse practitioner conducted the year-long intervention, which was part of a larger CDC-funded project, using problem-based learning within an academic detailing model. Process and outcome assessments included (1) pre- and post-intervention chart reviews to assess eight indicators of quality care, (2) post-intervention staff questionnaires to assess contact with the intervention team and awareness of practice changes, and (3) individual semi-structured interviews with physician and nurse champions in five of the six practices. The chart review indicated that all six practices met predefined performance improvement criteria for at least four of eight indicators of quality care, with two practices meeting improvement criteria for all eight indicators. The response rate for the staff questionnaires was high (72%) and generally consistent across practices, demonstrating high staff awareness of the intervention team, the practice "asthma champions," and changes in practice patterns. In the semi-structured interviews, several respondents attributed the intervention's acceptability and success to the expertise of the PQI team and expressed the belief that sustaining changes would be critically dependent on continued contact with the team. Despite significant limitations, this study demonstrated that interventions that are responsive to individual practice cultures can successfully change practice patterns.

Leadership and Cultural Challenges in Operating the International Space Station

NASA Technical Reports Server (NTRS)

Clement, J. L.; Ritsher, J. B.; Saylor, S. A.; Kanas, N.

2006-01-01

Operating the International Space Station (ISS) involves an indefinite, continuous series of long-duration international missions, and this requires an unprecedented degree of cooperation across multiple sites, organizations, and nations. ISS flight controllers have had to find ways to maintain effective team performance in this challenging new context. The goal of this study was to systematically identify and evaluate the major leadership and cultural challenges faces by ISS flight controllers, and to highlight the approaches that they have found most effective to surmount these challenges. We conducted a qualitative survey using a semi-structured interview. Subjects included 14 senior NASA flight controllers who were chosen on the basis of having had substantial experience working with international partners. Data were content analyzed using an iterative process with multiple coders and consensus meetings to resolve discrepancies. To further explore the meaning of the interview findings, we also conducted some new analyses of data from a previous questionnaire study of Russian and American ISS mission control personnel. The interview data showed that respondents had substantial consensus on several leadership and cultural challenges and on key strategies for dealing with them, and they offered a wide range of specific tactics for implementing these strategies. Surprisingly few respondents offered strategies for addressing the challenge of working with team members whose native language is not American English. The questionnaire data showed that Americans think it is more important than Russians that mission control personnel speak the same dialect of one shared common language. Although specific to the ISS program, our results are consistent with recent management, cultural, and aerospace research. We aim to use our results to improve training for current and future ISS flight controllers.

A framework for understanding international medical graduate challenges during transition into fellowship programs.

PubMed

Sockalingam, Sanjeev; Khan, Attia; Tan, Adrienne; Hawa, Raed; Abbey, Susan; Jackson, Timothy; Zaretsky, Ari; Okrainec, Allan

2014-01-01

Previous studies have highlighted unique needs of international medical graduates (IMG) during their transition into medical training programs; however, limited data exist on IMG needs specific to fellowship training. We conducted the following mixed-method study to determine IMG fellow training needs during the transition into fellowship training programs in psychiatry and surgery. The authors conducted a mixed-methods study consisting of an online survey of IMG fellows and their supervisors in psychiatry or surgery fellowship training programs and individual interviews of IMG fellows. The survey assessed (a) fellows' and supervisors' perceptions on IMG challenges in clinical communication, health systems, and education domains and (b) past orientation initiatives. In the second phase of the study, IMG fellows were interviewed during the latter half of their fellowship training, and perceptions regarding orientation and adaptation to fellowship in Canada were assessed. Survey data were analyzed using descriptive and Mann-Whitney U statistics. Qualitative interviews were analyzed using grounded theory methodology. The survey response rate was 76% (35/46) and 69% (35/51) for IMG fellows and supervisors, respectively. Fellows reported the greatest difficulty with adapting to the hospital system, medical documentation, and balancing one's professional and personal life. Supervisors believed that fellows had the greatest difficulty with managing language and slang in Canada, the healthcare system, and an interprofessional team. In Phase 2, fellows generated themes of disorientation, disconnection, interprofessional team challenges, a need for IMG fellow resources, and a benefit from training in a multicultural setting. Our study results highlight the need for IMG specific orientation resources for fellows and supervisors. Maslow's Hierarchy of Needs may be a useful framework for understanding IMG training needs.

Patient experience with discharge instructions in postdischarge recovery: a qualitative study.

PubMed

Horstman, Molly J; Mills, Whitney L; Herman, Levi I; Cai, Cecilia; Shelton, George; Qdaisat, Tareq; Berger, David H; Naik, Aanand D

2017-02-22

We examined the role of discharge instructions in postoperative recovery for patients undergoing colorectal surgery and report themes related to patient perceptions of discharge instructions and postdischarge experience. Semistructured interviews were conducted as part of a formative evaluation of a Project Re-Engineered Discharge intervention adapted for surgical patients. Michael E. DeBakey VA Medical Center, a tertiary referral centre in Houston, Texas. Twelve patients undergoing elective colorectal surgery. Interviews were conducted at the two-week postoperative appointment. Participants demonstrated understanding of the content in the discharge instructions. During the interviews, participants reported several positive roles for discharge instructions in their postdischarge care: a sense of security, a reminder of inhospital education, a living document and a source of empowerment. Despite these positive associations, participants reported that the instructions provided insufficient information to promote access to care that effectively addressed acute issues following discharge. Participants noted difficulty reaching providers after discharge, which resulted in the adoption of workarounds to overcome system barriers. Despite concerted efforts to provide patient-centred instructions, the discharge instructions did not provide enough context to effectively guide postdischarge interactions with the healthcare system. Insufficient information on how to access and communicate with the most appropriate personnel in the healthcare system is an important barrier to patients receiving high-quality postdischarge care. Tools and strategies from team training programmes, such as team strategies and tools to enhance performance and patient safety, could be adapted to include patients and provide them with structured methods for communicating with healthcare providers post discharge. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Project on Elite Athlete Commitment (PEAK): III. An examination of the external validity across gender, and the expansion and clarification of the Sport Commitment Model.

PubMed

Scanlan, Tara K; Russell, David G; Magyar, T Michelle; Scanlan, Larry A

2009-12-01

The Sport Commitment Model was further tested using the Scanlan Collaborative Interview Method to examine its generalizability to New Zealand's elite female amateur netball team, the Silver Ferns. Results supported or clarified Sport Commitment Model predictions, revealed avenues for model expansion, and elucidated the functions of perceived competence and enjoyment in the commitment process. A comparison and contrast of the in-depth interview data from the Silver Ferns with previous interview data from a comparable elite team of amateur male athletes allowed assessment of model external validity, tested the generalizability of the underlying mechanisms, and separated gender differences from discrepancies that simply reflected team or idiosyncratic differences.

Exploring community resilience in workforce communities of first responders serving Katrina survivors.

PubMed

Wyche, Karen Fraser; Pfefferbaum, Rose L; Pfefferbaum, Betty; Norris, Fran H; Wisnieski, Deborah; Younger, Hayden

2011-01-01

Community resilience activities were assessed in workplace teams that became first responders for Hurricane Katrina survivors. Community resilience was assessed by a survey, focus groups, and key informant interviews. On the survey, 90 first responders ranked their team's disaster response performance as high on community resilience activities. The same participants, interviewed in 11 focus groups and 3 key informant interviews, discussed how their teams engaged in community resilience activities to strengthen their ability to deliver services. Specifically, their resilient behaviors were characterized by: shared organizational identity, purpose, and values; mutual support and trust; role flexibility; active problem solving; self-reflection; shared leadership; and skill building. The implications for research, policy, practice, and education of professionals are discussed. © 2011 American Orthopsychiatric Association.

Introducing a quality improvement programme to primary healthcare teams

PubMed Central

Hearnshaw, H.; Reddish, S.; Carlyle, D.; Baker, R.; Robertson, N.

1998-01-01

OBJECTIVES: To evaluate a programme in which quality improvement was facilitated, based on principles of total quality management, in primary healthcare teams, and to determine its feasibility, acceptability, effectiveness, and the duration of its effect. METHOD: Primary healthcare teams in Leicestershire (n = 147) were invited to take part in the facilitated programme. The programme comprised seven team meetings, led by a researcher, plus up to two facilitated meetings of quality improvement subgroups, appointed by each team to consider specific quality issues. OUTCOME MEASURES: To assess the effect and feasibility of the programme on improving the quality of care provided, the individual quality improvement projects undertaken by the teams were documented and opportunities for improvement were noted at each session by the facilitator. The programme's acceptability was assessed with questionnaires issued in the final session to each participant. To assess the long term impact on teams, interviews with team members were conducted 3 years after the programme ended. RESULTS: 10 of the 27 teams that initially expressed interest in the programme agreed to take part, and six started the programme. Of these, five completed their quality improvement projects and used several different quality tools, and three completed all seven sessions of the programme. The programme was assessed as appropriate and acceptable by the participants. Three years later, the changes made during the programme were still in place in three of the six teams. Four teams had decided to undertake the local quality monitoring programme, resourced and supported by the Health Authority. CONCLUSIONS: The facilitated programme was feasible, acceptable, and effective for a few primary healthcare teams. The outcomes of the programme can be sustained. Research is needed on the characteristics of teams likely to be successful in the introduction and maintenance of quality improvement programmes. PMID:10339022

Organizational and Teamwork Factors of Tele-Intensive Care Units.

PubMed

Wilkes, Michael S; Marcin, James P; Ritter, Lois A; Pruitt, Sherilyn

2016-09-01

Use of tele-intensive care involves organizational and teamwork factors across geographic locations. This situation adds to the complexity of collaboration in providing quality patient-centered care. To evaluate cross-agency teamwork of health care professionals caring for patients in tele-intensive care units in rural and urban regions. A national qualitative study was conducted in 3 US geographic regions with tele-intensive care programs. Discussions and interviews were held with key participants during site visits at 3 hub sites (specialist services location) and 8 rural spoke sites (patient location). The effects of communication and culture between the hub team and the spoke team on use of the services and effectiveness of care were evaluated. A total of 34 participants were interviewed. Specific organizational and teamwork factors significantly affect the functionality of a tele-intensive care unit. Key operational and cultural barriers that limit the benefits of the units include unrealistic expectations about operational capabilities, lack of trust, poorly defined leadership, and a lack of communication policies. Potential solutions include education on spoke facility resources, clearly defined expectations and role reversal education, team-building activities, and feedback mechanisms to share concerns, successes, and suggestions. Proper administration and attention to important cultural and teamwork factors are essential to making tele-intensive care units effective, practical, and sustainable. ©2016 American Association of Critical-Care Nurses.

Barriers and facilitators to recruitment of physicians and practices for primary care health services research at one centre.

PubMed

Johnston, Sharon; Liddy, Clare; Hogg, William; Donskov, Melissa; Russell, Grant; Gyorfi-Dyke, Elizabeth

2010-12-13

While some research has been conducted examining recruitment methods to engage physicians and practices in primary care research, further research is needed on recruitment methodology as it remains a recurrent challenge and plays a crucial role in primary care research. This paper reviews recruitment strategies, common challenges, and innovative practices from five recent primary care health services research studies in Ontario, Canada. We used mixed qualitative and quantitative methods to gather data from investigators and/or project staff from five research teams. Team members were interviewed and asked to fill out a brief survey on recruitment methods, results, and challenges encountered during a recent or ongoing project involving primary care practices or physicians. Data analysis included qualitative analysis of interview notes and descriptive statistics generated for each study. Recruitment rates varied markedly across the projects despite similar initial strategies. Common challenges and creative solutions were reported by many of the research teams, including building a sampling frame, developing front-office rapport, adapting recruitment strategies, promoting buy-in and interest in the research question, and training a staff recruiter. Investigators must continue to find effective ways of reaching and involving diverse and representative samples of primary care providers and practices by building personal connections with, and buy-in from, potential participants. Flexible recruitment strategies and an understanding of the needs and interests of potential participants may also facilitate recruitment.

Midwifery-led care embedded within primary care: consumer satisfaction with a model in New Zealand.

PubMed

Pullon, Sue; Gray, Ben; Steinmetz, Monika; Molineux, Claire

2014-12-01

Providing quality maternity care for high-needs, socially deprived women from ethnic minority groups is challenging. Consumer satisfaction with maternity services is an important aspect of service evaluation for this group. This pilot study aimed to investigate the feasibility of using focus groups and interviews to gauge consumer satisfaction of maternity care by high-needs women, and to explore their perceptions of the Newtown Union Health Service (NUHS) model of a midwifery-led service embedded in primary care in Wellington, New Zealand (NZ). Following a previous audit of consumer satisfaction surveys collected over a six-year period, a qualitative pilot study using a thematic analytic approach was conducted at the NUHS in late 2011. The study assessed use of focus groups and interviews, interpreted where necessary, and considered the experiences reported by women about the model of care. Interviews and focus groups were successfully conducted with 11 women: two NZ European (individual interviews), six Cambodian (five in a focus group, one interview), and three Samoan (focus group). Using a thematic analytic approach, key themes identified from the focus group and interviews were: issues with survey form-filling; importance of accessibility and information; and relationships and communication with the midwifery team. Interviews and focus groups were well received, and indicated positive endorsement of the model of care. They also revealed some hitherto unknown concerns. Good quality feedback about satisfaction with a range of maternal and child health services helps service providers to provide the best possible start in life for children in high-needs families.

Building Capacity for Data-Driven Decision Making in African HIV Testing Programs: Field Perspectives on Data Use Workshops.

PubMed

Courtenay-Quirk, Cari; Spindler, Hilary; Leidich, Aimee; Bachanas, Pam

2016-12-01

Strategic, high quality HIV testing services (HTS) delivery is an essential step towards reaching the end of AIDS by 2030. We conducted HTS Data Use workshops in five African countries to increase data use for strategic program decision-making. Feedback was collected on the extent to which workshop skills and tools were applied in practice and to identify future capacity-building needs. We later conducted six semistructured phone interviews with workshop planning teams and sent a web-based survey to 92 past participants. The HTS Data Use workshops provided accessible tools that were readily learned by most respondents. While most respondents reported increased confidence in interpreting data and frequency of using such tools over time, planning team representatives indicated ongoing needs for more automated tools that can function across data systems. To achieve ambitious global HIV/AIDS targets, national decision makers may continue to seek tools and skill-building opportunities to monitor programs and identify opportunities to refine strategies.

Environmental Survey preliminary report, Naval Petroleum Reserves in California (NPRC), Tupman, California

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

Not Available

1989-02-01

This report presents the preliminary environmental findings from the first phase of the Environmental Survey of the US Department of Energy (DOE) Naval Petroleum Reserves 1 (NPR-1) and 2 (NPR-2) in California (NPRC), conducted May 9--20, 1988. The Survey is being conducted by an interdisciplinary team of environmental specialists, led and managed by the Office of Environment Safety and Health's Office of Environmental Audit. Individual team specialists are outside experts being supplied by a private contractor. The objective of the Survey is to identify environmental problems and areas of environmental risk associated with NPRC. The Survey covers all environmental mediamore » and all areas of environmental regulation. It is being performed in accordance with the DOE Environmental Survey Manual. The on-site phase of the Survey involved the review of existing site environmental data, observations of the operations carried on at NPRC, and interviews with site personnel. 120 refs., 28 figs., 40 tabs.« less

Interdisciplinary team interactions: a qualitative study of perceptions of team function in simulated anaesthesia crises.

PubMed

Weller, Jennifer M; Janssen, Anna L; Merry, Alan F; Robinson, Brian

2008-04-01

We placed anaesthesia teams into a stressful environment in order to explore interactions between members of different professional groups and to investigate their perspectives on the impact of these interactions on team performance. Ten anaesthetists, 5 nurses and 5 trained anaesthetic assistants each participated in 2 full-immersion simulations of critical events using a high-fidelity computerised patient simulator. Their perceptions of team interactions were explored through questionnaires and semi-structured interviews. Written questionnaire data and interview transcriptions were entered into N6 qualitative software. Data were analysed by 2 investigators for emerging themes and coded to produce reports on each theme. We found evidence of limited understanding of the roles and capabilities of team members across professional boundaries, different perceptions of appropriate roles and responsibilities for different members of the team, limited sharing of information between team members and limited team input into decision making. There was a perceived impact on task distribution and the optimal utilisation of resources within the team. Effective management of medical emergencies depends on optimal team function. We have identified important factors affecting interactions between different health professionals in the anaesthesia team, and their perceived influences on team function. This provides evidence on which to build appropriate and specific strategies for interdisciplinary team training in operating theatre staff.

Advancing team-based primary health care: a comparative analysis of policies in western Canada.

PubMed

Suter, Esther; Mallinson, Sara; Misfeldt, Renee; Boakye, Omenaa; Nasmith, Louise; Wong, Sabrina T

2017-07-17

We analyzed and compared primary health care (PHC) policies in British Columbia, Alberta and Saskatchewan to understand how they inform the design and implementation of team-based primary health care service delivery. The goal was to develop policy imperatives that can advance team-based PHC in Canada. We conducted comparative case studies (n = 3). The policy analysis included: Context review: We reviewed relevant information (2007 to 2014) from databases and websites. Policy review and comparative analysis: We compared and contrasted publically available PHC policies. Key informant interviews: Key informants (n = 30) validated narratives prepared from the comparative analysis by offering contextual information on potential policy imperatives. Advisory group and roundtable: An expert advisory group guided this work and a key stakeholder roundtable event guided prioritization of policy imperatives. The concept of team-based PHC varies widely across and within the three provinces. We noted policy gaps related to team configuration, leadership, scope of practice, role clarity and financing of team-based care; few policies speak explicitly to monitoring and evaluation of team-based PHC. We prioritized four policy imperatives: (1) alignment of goals and policies at different system levels; (2) investment of resources for system change; (3) compensation models for all members of the team; and (4) accountability through collaborative practice metrics. Policies supporting team-based PHC have been slow to emerge, lacking a systematic and coordinated approach. Greater alignment with specific consideration of financing, reimbursement, implementation mechanisms and performance monitoring could accelerate systemic transformation by removing some well-known barriers to team-based care.

Experiences from a pilot study on how to conduct a qualitative multi-country research project regarding use of antibiotics in Southeast Europe.

PubMed

Kaae, Susanne; Sporrong, Sofia Kälvemark; Traulsen, Janine Morgall; Wallach Kildemoes, Helle; Nørgaard, Lotte Stig; Jakupi, Arianit; Raka, Denis; Gürpinar, Emre Umut; Alkan, Ali; Hoxha, Iris; Malaj, Admir; Cantarero, Lourdes Arevalo

2016-01-01

In 2014, a qualitative multi-country research project was launched to study the reasons behind the high use of antibiotics in regions of Southeast Europe by using previously untrained national interviewers (who were engaged in other antibiotic microbial resistance-related investigations) to conduct qualitative interviews with local patients, physicians and pharmacists. Little knowledge exists about how to implement qualitative multi-country research collaborations involving previously untrained local data collectors. The aim of this paper was therefore to contribute to the knowledge regarding how to conduct these types of research projects by evaluating a pilot study of the project. Local data collectors conducted the study according to a developed protocol and evaluated the study with the responsible researcher-team from University of Copenhagen. The pilot study focused on 'local ownership', 'research quality' and 'feasibility' with regard to successful implementation and evaluation. The evaluation was achieved by interpreting 'Skype' and 'face to face' meetings and email correspondence by applying 'critical common sense'. Local data collectors achieved a sense of joint ownership. Overall, the protocol worked well. Several minor challenges pertaining to research quality and feasibility were identified, in particular obtaining narratives when conducting interviews and recruiting patients for the study. Furthermore, local data collectors found it difficult to allocate sufficient time to the project. Solutions were discussed and added to the protocol. Despite the challenges, it was possible to achieve an acceptable scientific level of research when conducting qualitative multi-country research collaboration under the given circumstances. Specific recommendations to achieve this are provided by the authors.

Exploring dialectical behaviour therapy clinicians' experiences of team consultation meetings.

PubMed

Walsh, Cian; Ryan, Patrick; Flynn, Daniel

2018-01-01

This article presents a detailed idiographic analysis of Dialectical Behaviour Therapy (DBT) clinicians' experiences of team consultation meetings. DBT is an evidence-based psychological intervention with a demonstrated efficacy in the treatment of borderline personality disorder (BPD). Team consultation meetings encompass one of the primary components involved in this treatment model; where DBT clinicians regularly meet to discuss client work and enhance further learning. The present study's aim was to assess what are DBT clinicians' experiences of the consultation meeting component and whether it is useful or not. Semi-structured interviews were completed with 11 DBT clinicians (nine females, two males) from three different consultation teams. The research project utilised an interpretative phenomenological analysis (IPA) framework. Audio-recorded interview data was analysed using this framework. Four superordinate themes emerged from the interview data, which included ten subordinate themes. The superordinate themes focused on: (1) the acquisition of DBT technical knowledge and other MDT related expertise (2) participants' emotional experiences of DBT and consultation meetings, and how this can evolve over time (3) the underlying processes that occur in the consultation team including the development of a team bond and the impact of membership changes and (4) the largely consistent and reliable nature of consultation meetings and how they help maintain clinician motivation. Team consultation meetings were found to be supportive; playing an important role in maintaining clinician motivation through the availability of team support, opportunities to reflect and learn, and assistance in regulating emotions. Challenges arose in relation to team membership changes and acclimatisation to the type of feedback utilised in team consultation. The study's implications for practise are considered.

The communication in industrialised building system (IBS) construction project: Virtual environment

NASA Astrophysics Data System (ADS)

Pozin, Mohd Affendi Ahmad; Nawi, Mohd Nasrun Mohd

2017-10-01

Large portion of numbers team organization in the IBS construction sector is known are being fragmented. That is contributed from a segregation of construction activity thus create team working in virtually. Virtual team are the nature when teams are working in distributed area, across culture and time. Therefore, teams can be respond to the task without relocating to the site project and settle down a problem through information and communication technology (ICT). The emergence of virtual team are carry out by advancements in communication technologies as a medium to improve project team communication in project delivery process on IBS construction. Based on literature review from previous study and data collected from interviewing, this paper aim to identified communication challenges among project team members according to current project development practices in IBS construction project. Hence, in attempt to develop effective communication through the advantages of virtual team approach for IBS construction project. In order to ensure the data is gathered comprehensively and accurately, the data was collected from project managers by using semi structured interview method. It was found that virtual team approach could be enable competitive challenges on complexity in the construction project management process.

Beyond Magnet® Designation: Perspectives From Nurse Managers on Factors of Sustainability and High-Performance Programming.

PubMed

Hayden, Margaret A; Wolf, Gail A; Zedreck-Gonzalez, Judith F

2016-10-01

The aim of this study was to identify patterns of high-performing behaviors and nurse manager perceptions of the factors of Magnet® sustainability at a multidesignated Magnet organization. The Magnet program recognizes exemplary professional nursing practice and is challenging to achieve and sustain. Only 10% (n = 42) of Magnet hospitals sustained designation for 12 years or longer. This study explored the perspectives of Magnet nurse managers regarding high-performing teams and the sustainability of Magnet designation. A qualitative study of nurse managers was conducted at 1 multidesignated Magnet organization (n = 13). Interview responses were analyzed using pattern recognition of Magnet model domains and characteristics of high-performing teams and then related to factors of Magnet sustainability. Transformational leadership is both an essential factor for sustainability and a potential barrier to sustainability of Magnet designation. Transformational nursing leaders lead high-performing teams and should be in place at all levels as an essential factor in sustaining Magnet redesignation.

Using Qualitative Methods to Evaluate a Family Behavioral Intervention for Type 1 Diabetes

PubMed Central

Herbert, Linda Jones; Sweenie, Rachel; Kelly, Katherine Patterson; Holmes, Clarissa; Streisand, Randi

2013-01-01

Introduction The objectives of this study were to qualitatively evaluate a dyadic adolescent-parent type 1 diabetes (T1D) program developed to prevent deterioration in diabetes care among adolescents with T1D and provide recommendations for program refinement. Method Thirteen adolescent-parent dyads who participated in the larger RCT, the TeamWork Project, were interviewed regarding their perceptions of their participation in the program and current T1D challenges. Interviews were transcribed and coded to establish broad themes. Results Adolescents and parents thought the TeamWork Project sessions were helpful and taught them new information. Five themes catalog findings from the qualitative interviews: TeamWork content, TeamWork structure, transition of responsibility, current and future challenges, and future intervention considerations. Discussion Addressing T1D challenges as a parent-adolescent dyad via a behavioral clinic program is helpful to families during adolescence. Findings highlight the utility of qualitative evaluation to tailor interventions for the unique challenges related to pediatric chronic illness. PMID:24269281

Identifying the latent failures underpinning medication administration errors: an exploratory study.

PubMed

Lawton, Rebecca; Carruthers, Sam; Gardner, Peter; Wright, John; McEachan, Rosie R C

2012-08-01

The primary aim of this article was to identify the latent failures that are perceived to underpin medication errors. The study was conducted within three medical wards in a hospital in the United Kingdom. The study employed a cross-sectional qualitative design. Interviews were conducted with 12 nurses and eight managers. Interviews were transcribed and subject to thematic content analysis. A two-step inter-rater comparison tested the reliability of the themes. Ten latent failures were identified based on the analysis of the interviews. These were ward climate, local working environment, workload, human resources, team communication, routine procedures, bed management, written policies and procedures, supervision and leadership, and training. The discussion focuses on ward climate, the most prevalent theme, which is conceptualized here as interacting with failures in the nine other organizational structures and processes. This study is the first of its kind to identify the latent failures perceived to underpin medication errors in a systematic way. The findings can be used as a platform for researchers to test the impact of organization-level patient safety interventions and to design proactive error management tools and incident reporting systems in hospitals. © Health Research and Educational Trust.

Performance Data Report: Space Medicine Division, Human Research Program, Behavioural Health and Performance Research Element

NASA Technical Reports Server (NTRS)

Shea, Camille; Keeton, Kathryn E.; Schmidt, Lacey L.; Slack, Kelley J.; Patterson, Holly N.; Leveton, Lauren B.; Holland, Albert W.

2012-01-01

This report is the result of a collaborative effort between NASA?s Behavioral Health & Performance (BHP) Research and Operations Group to investigate and determine the availability of data pertaining to behavioral performance (and other pertinent variables) that have been collected by the laboratories at NASA?s Johnson Space Center. BHP?s Operations and Research groups collaborated to systematically identify what types of performance data are needed in relevant BHP performance domains and also to conduct structured interviews with NASA personnel to identify which data do or do not exist currently (and for instances where such data exist, to evaluate the type, quality, accessibility, and confidentiality of those data). The authors defined outcome categories of performance that encapsulate BHP performance domains, mapped BHP Research Risks and Gaps onto those performance outcome categories, and identified and prioritized indicators for each outcome category. The team identified key points of contact (subject matter experts [SMEs]) as potential interviewees, created a template for structured interview questions about sources and accessibility of performance data, and coordinated and conducted structured interviews with the SMEs. The methodology, results, and implications of this effort, as well as forward work needed, are discussed in this report.

Free Speech Tensions: Responding to Bias on College and University Campuses

ERIC Educational Resources Information Center

Miller, Ryan A.; Guida, Tonia; Smith, Stella; Ferguson, S. Kiersten; Medina, Elizabeth

2018-01-01

Despite the increasing development of bias response teams on college and university campuses, little scholarship has examined these teams and, in particular, team leaders' approaches to understanding the role of free speech in responding to bias. Through semi-structured interviews, administrators who served on bias response teams at 19…

Factors affecting fire suppression costs as identified by incident management teams

Treesearch

Janie Canton-Thompson; Brooke Thompson; Krista Gebert; David Calkin; Geoff Donovan; Greg Jones

2006-01-01

This study uses qualitative sociological methodology to discover information and insights about the role of Incident Management Teams in wildland fire suppression costs. We interviewed 48 command and general staff members of Incident Management Teams throughout the United States. Interviewees were asked about team structure, functioning, and decision making as a...

Teaching Engineering Students Team Work

NASA Technical Reports Server (NTRS)

Levi, Daniel

1998-01-01

The purpose of this manual is to provide professor's in engineering classes which the background necessary to use student team projects effectively. This manual describes some of the characteristics of student teams and how to use them in class. It provides a set of class activities and films which can be used to introduce and support student teams. Finally, a set of teaching modules used in freshmen, sophomore, and senior aeronautical engineering classes are presented. This manual was developed as part of a NASA sponsored project to improve the undergraduate education of aeronautical engineers. The project has helped to purchase a set of team work films which can be checked out from Cal Poly's Learning Resources Center in the Kennedy Library. Research for this project has included literature reviews on team work and cooperative learning; interviews, observations, and surveys of Cal Poly students from Industrial and Manufacturing Engineering, Aeronautical Engineering and Psychology; participation in the Aeronautical Engineering senior design lab; and interviews with engineering faculty. In addition to this faculty manual, there is a student team work manual which has been designed to help engineering students work better in teams.

A Qualitative Evaluation of Clinical Audit in UK Dental Foundation Training.

PubMed

Thornley, Peter; Quinn, Alyson

2017-11-10

Clinical Audit (CA) has been recognized as a useful tool for tool for improving service delivery, clinical governance, and the education and performance of the dental team. This study develops the discussion by investigating its use as an educational tool within UK Dental Foundation Training (DFT). The aim was to investigate the views of Foundation Dentists (FDs) and Training Programme Directors (TPDs) on the CA module in their FD training schemes, to provide insight and recommendations for those supervising and undertaking CA. A literature review was conducted followed by a qualitative research methodology, using group interviews. The interviews were transcribed and thematically analyzed using NVIVO, a Computer-Assisted Qualitative Data Analysis tool. CA was found to be a useful tool for teaching management and professionalism and can bring some improvement to clinical practice, but TPDs have doubts about the long-term effects on service delivery. The role of the Educational Supervisor (ES) is discussed and recommendations are given for those supervising and conducting CA.

A Qualitative Evaluation of Clinical Audit in UK Dental Foundation Training

PubMed Central

Quinn, Alyson

2017-01-01

Clinical Audit (CA) has been recognized as a useful tool for tool for improving service delivery, clinical governance, and the education and performance of the dental team. This study develops the discussion by investigating its use as an educational tool within UK Dental Foundation Training (DFT). The aim was to investigate the views of Foundation Dentists (FDs) and Training Programme Directors (TPDs) on the CA module in their FD training schemes, to provide insight and recommendations for those supervising and undertaking CA. A literature review was conducted followed by a qualitative research methodology, using group interviews. The interviews were transcribed and thematically analyzed using NVIVO, a Computer-Assisted Qualitative Data Analysis tool. CA was found to be a useful tool for teaching management and professionalism and can bring some improvement to clinical practice, but TPDs have doubts about the long-term effects on service delivery. The role of the Educational Supervisor (ES) is discussed and recommendations are given for those supervising and conducting CA. PMID:29563436

Environmental Survey preliminary report, Oak Ridge Gaseous Diffusion Plant, Oak Ridge, Tennessee

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

Not Available

1989-02-01

This report presents the preliminary findings from the first phase of the Environmental Survey of the US Department of Energy's (DOE) Oak Ridge Gaseous Diffusion Plant (ORGDP) conducted March 14 through 25, 1988. The Survey is being conducted by an interdisciplinary team of environmental specialists, led and managed by the Office of Environment, Safety and Health's Office of Environmental Audit. Individual team components are being supplied by a private contractor. The objective of the Survey is to identify environmental risk associated with ORGDP. The Survey covers all environmental media and all areas of environmental regulation. It is being performed inmore » accordance with the DOE Environmental Survey Manual. This phase of the Survey involves the review of existing site environmental data, observations of the operations carried on at ORGDP, and interviews with site personnel. The Survey team developed a Sampling and Analysis Plan to assist in further assessing certain of the environmental problems identified during is on-site activities. The Sampling and Analysis Plan will be executed by Idaho National Engineering Laboratory (INEL). When completed, the results will be incorporated into the ORGDP Survey findings for in inclusion into the Environmental Survey Summary Report. 120 refs., 41 figs., 74 tabs.« less

Environmental Survey preliminary report, Kansas City Plant, Kansas City, Missouri

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

Not Available

1988-01-01

This report presents the preliminary findings from the first phase of the Environmental Survey of the United States Department of Energy (DOE), Kansas City Plant (KCP), conducted March 23 through April 3, 1987. The Survey is being conducted by a multidisciplinary team of environmental specialists, led and managed by the Office of Environment, Safety and Health's Office of Environmental Audit. Individual team members are outside experts being supplied by a private contractor. The objective of the Survey is to identify environmental problems and areas of environmental risk associated with the KCP. The Survey covers all environmental media and all areasmore » of environmental regulations. It is being performed in accordance with the DOE Environmental Survey Manual. This phase of the Survey involves the review of existing site environmental data observations of the operations performed at the KCP, and interviews with site personnel. The Survey team developed a Sampling and Analysis Plan to assist in further assessing certain environmental problems identified during its on-site activities. The Sampling and Analysis Plan is being executed by DOE's Argonne National Laboratory. When completed, the results will be incorporated into the KCP Environmental Survey Interim Report. The Interim Report will reflect the final determinations of the KCP Survey. 94 refs., 39 figs., 55 tabs.« less

Evaluation of telemedicine centres in Madhya Pradesh, Central India.

PubMed

Bali, Surya; Gupta, Arti; Khan, Asif; Pakhare, Abhijit

2016-04-01

In a developing country such as India, there is substantial inequality in health care distribution. Telemedicine facilities were established in Madhya Pradesh in 2007-2008. The purpose of this study was to evaluate the infrastructure, equipment, manpower, and functional status of Indian Space and Research Organisation (ISRO) telemedicine nodes in Madhya Pradesh. All district hospitals and medical colleges with nodes were visited by a team of three members. The study was conducted from December 2013-January 2014. The team recorded the structural facility situation and physical conditions on a predesigned pro forma. The team also conducted interviews with the nodal officers, data entry operator and other relevant people at these centres. Of the six specialist nodes, four were functional and two were non-functional. Of 10 patient nodes, two nodes were functional, four were semi-functional and four were non-functional. Most of the centres were not working due to a problem with their satellite modem. The overall condition of ISRO run telemedicine centres in Madhya Pradesh was found to be poor. Most of these centres failed to provide telemedicine consultations. We recommend replacing this system with another cost effective system available in the state wide area network (SWAN). We suggest the concept of the virtual out-patient department. © The Author(s) 2015.

Environmental Survey preliminary report, Brookhaven National Laboratory, Upton, New York

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

Not Available

1988-06-01

This report presents the preliminary findings from the first phase of the Environmental Survey of the United States Department of Energy (DOE) Brookhaven National Laboratory (BNL) conducted April 6 through 17, 1987. The Survey is being conducted by an interdisciplinary team of environmental specialists, led and managed by the Office of Environment, Safety and Health's Office of Environmental Audit. Individual team components are being supplied by a private contractor. The objective of the Survey is to identify environmental problems and areas of environmental risk associated with BNL. The Survey covers all environmental media and all areas of environmental regulation. Itmore » is being performed in accordance with the DOE Environmental Survey Manual. This phase of the Survey involves the review of existing site environmental data, observations of the operations carried on at BNL, and interviews with site personnel. The Survey team developed a Sampling and Analysis Plan to assist in further assessing specific environmental problems identified during its on-site activities. The Sampling and Analysis Plan will be executed by Oak Ridge National Laboratory. When completed, the results will be incorporated into the BNL Environmental Survey Interim Report. The Interim Report will reflect the final determinations of the BNL Survey. 80 refs., 24 figs., 48 tabs.« less

Non-technical skills for obstetricians conducting forceps and vacuum deliveries: qualitative analysis by interviews and video recordings.

PubMed

Bahl, Rachna; Murphy, Deirdre J; Strachan, Bryony

2010-06-01

Non-technical skills are cognitive and social skills required in an operational task. These skills have been identified and taught in the surgical domain but are of particular relevance to obstetrics where the patient is awake, the partner is present and the clinical circumstances are acute and often stressful. The aim of this study was to define the non-technical skills of an operative vaginal delivery (forceps or vacuum) to facilitate transfer of skills from expert obstetricians to trainee obstetricians. Qualitative study using interviews and video recordings. The study was conducted at two university teaching hospitals (St. Michael's Hospital, Bristol and Ninewells Hospital, Dundee). Participants included 10 obstetricians and eight midwives identified as experts in conducting or supporting operative vaginal deliveries. Semi-structured interviews were carried out using routine clinical scenarios. The experts were also video recorded conducting forceps and vacuum deliveries in a simulation setting. The interviews and video recordings were transcribed verbatim and analysed using thematic coding. The anonymised data were independently coded by the three researchers and then compared for consistency of interpretation. The experts reviewed the coded data for respondent validation and clarification. The themes that emerged were used to identify the non-technical skills required for conducting an operative vaginal delivery. The final skills list was classified into seven main categories. Four categories (situational awareness, decision making, task management, and team work and communication) were similar to the categories identified in surgery. Three further categories unique to obstetrics were also identified (professional relationship with the woman, maintaining professional behaviour and cross-monitoring of performance). This explicitly defined skills taxonomy could aid trainees' understanding of the non-technical skills to be considered when conducting an operative vaginal delivery and potentially reduce morbidity and improve the experience of delivery for the mother. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

Strategies to Improve the Integration of Community Health Workers Into Health Care Teams: "A Little Fish in a Big Pond".

PubMed

Allen, Caitlin G; Escoffery, Cam; Satsangi, Anamika; Brownstein, J Nell

2015-09-17

The Patient Protection and Affordable Care Act acknowledges the value of community health workers (CHWs) as frontline public health workers. Consequently, growing attention has been placed on promoting CHWs as legitimate partners to provide support to health care teams and patients in the prevention, management, and control of chronic disease, particularly among diverse populations and high-need individuals. Using a mixed-methods research approach, we investigated the integration of CHWs into health care teams from the CHW perspective. We conducted a survey of 265 CHWs and interviews with 23 CHWs to better understand and describe their experience and their perceived opportunities and challenges regarding their integration within the context of health care reform. Feelings of organizational support were positively correlated with the number of CHWs in the organization. CHWs reported the following facilitators to integration: having team meetings (73.7%), training inside (70.4%) and outside of the organization (81.6%), access to electronic health records, and ability for CHWs to stay connected to the community. The perspectives of CHWs on their positive and negative experiences offer useful and innovative insight into ways of maximizing their impact on the health care team, patients, and their role as key emissaries between clinical services and community resources.

The organization of scientists and its relation to scientific productivity: Perceptions of Chinese stem cell researchers

PubMed Central

Zhang, Joy Yueyue

2013-01-01

Chinese government funding of R&D ranks third in the world. Yet China ranks only 17th in terms of scientific productivity per unit of investment. The author recently conducted fieldwork on the team structure of 22 Chinese stem cell research groups. Interview data suggest that although Chinese research groups closely resemble their international counter-parts in many respects, there are also significant differences which are perceived by interviewees to affect levels of scientific productivity. One characteristic of Chinese research teams is a common deficiency in middle-layer positions. This shortage of experienced professionals is perceived by scientists participating in this study to have led to two consequences. First, inexperienced student researchers often form the backbone of scientific teams in China, which leads to frequent interruptions of research and extended laboratory training. Second, research teams consist of a relatively small number of personnel. These structural features are seen to create excessive social boundaries, which impede the exchange of information and further worsens the segmentation of resources. This article engages the question of the extent to which interviewees’ local ‘embedded’ understandings of these difficulties may make a productive contribution to the analysis of the structural, and infra-structural, organization of Chinese professional bioscience teams. PMID:24143153

Pain-QuILT: assessing clinical feasibility of a Web-based tool for the visual self-report of pain in an interdisciplinary pediatric chronic pain clinic.

PubMed

Lalloo, Chitra; Stinson, Jennifer N; Brown, Stephen C; Campbell, Fiona; Isaac, Lisa; Henry, James L

2014-11-01

To evaluate clinical feasibility of the Pain-QuILT (previously known as the Iconic Pain Assessment Tool) from the perspective of adolescents with chronic pain and members of their interdisciplinary health team. The Pain-QuILT (PQ), a web-based tool that records the visual self-report of sensory pain in the form of time-stamped records, was directly compared with standard interview questions that were transformed to a paper-based tool. Qualitative, semi-structured interviews were used to refine the PQ. Adolescents with chronic pain aged 12 to 18 years used the PQ and comparator tool (randomized order) to self-report pain before a scheduled clinic appointment, and then took part in a semi-structured interview. The health team used these pain reports (PQ and comparator) during patient appointments, and later participated in focus group interviews. Interview audio recordings were transcribed verbatim and underwent a simple line-by-line content analysis to identify key concepts. A total of 17 adolescents and 9 health team members completed the study. All adolescents felt that the PQ was easy to use and understand. The median time required for completion of the PQ and comparator tool was 3.3 and 3.6 minutes, respectively. Overall, 15/17 (88%) of adolescents preferred the PQ to self-report their pain versus the comparator. The health team indicated that the PQ was a clinically useful tool and identified minor barriers to implementation. Consultations with adolescents and their health team indicate that the PQ is a clinically feasible tool for eliciting detailed self-report records of the sensory experience of chronic pain.

Experiences from implementing value-based healthcare at a Swedish University Hospital - an longitudinal interview study.

PubMed

Nilsson, Kerstin; Bååthe, Fredrik; Andersson, Annette Erichsen; Wikström, Ewa; Sandoff, Mette

2017-02-28

Implementing the value-based healthcare concept (VBHC) is a growing management trend in Swedish healthcare organizations. The aim of this study is to explore how representatives of four pilot project teams experienced implementing VBHC in a large Swedish University Hospital over a period of 2 years. The project teams started their work in October 2013. An explorative and qualitative design was used, with interviews as the data collection method. All the participants in the four pilot project teams were individually interviewed three times, with interviews starting in March 2014 and ending in November 2015. All the interviews were transcribed and analyzed using qualitative analysis. Value for the patients was experienced as the fundamental drive for implementing VBHC. However, multiple understandings of what value for patients' means existed in parallel. The teams received guidance from consultants during the first 3 months. There were pros and cons to the consultant's guidance. This period included intensive work identifying outcome measurements based on patients' and professionals' perspectives, with less interest devoted to measuring costs. The implementation process, which both gave and took energy, developed over time and included interventions. In due course it provided insights to the teams about the complexity of healthcare. The necessity of coordination, cooperation and working together inter-departmentally was critical. Healthcare organizations implementing VBHC will benefit from emphasizing value for patients, in line with the intrinsic drive in healthcare, as well as managing the process of implementation on the basis of understanding the complexities of healthcare. Paying attention to the patients' voice is a most important concern and is also a key towards increased engagement from physicians and care providers for improvement work.

Primary Care Providers’ Views of Patient Portals: Interview Study of Perceived Benefits and Consequences

PubMed Central

Latulipe, Celine; Melius, Kathryn A; Quandt, Sara A; Arcury, Thomas A

2016-01-01

Background The United States government is encouraging physicians to adopt patient portals—secure websites that allow patients to access their health information. For patient portals to recognize their full potential and improve patient care, health care providers’ acceptance and encouragement of their use will be essential. However, little is known about provider concerns or views of patient portals. Objective We conducted this qualitative study to determine how administrators, clinic staff, and health care providers at practices serving a lower income adult population viewed patient portals in terms of their potential benefit, areas of concern, and hopes for the future. Methods We performed in-depth interviews between October 2013 and June 2014 with 20 clinic personnel recruited from health centers in four North Carolina counties. Trained study personnel conducted individual interviews following an interviewer guide to elicit perceptions of the benefits and disadvantages of patient portals. Interviews were recorded and transcribed. Research team members reviewed transcribed interviews for major themes to construct a coding dictionary. Two researchers then coded each transcript with any coding discrepancies resolved through discussion. Results The interviews revealed that clinic personnel viewed patient portals as a mandated product that had potential to improve communication and enhance information sharing. However, they expressed many concerns including portals’ potential to generate more work, confuse patients, alienate non-users, and increase health disparities. Clinic personnel expected few older and disadvantaged patients to use a portal. Conclusions Given that clinic personnel have significant concerns about portals’ unintended consequences, their uptake and impact on care may be limited. Future studies should examine ways portals can be implemented in practices to address providers’ concerns and meet the needs of vulnerable populations. PMID:26772771

How do primary health care teams learn to integrate intimate partner violence (IPV) management? A realist evaluation protocol.

PubMed

Goicolea, Isabel; Vives-Cases, Carmen; San Sebastian, Miguel; Marchal, Bruno; Kegels, Guy; Hurtig, Anna-Karin

2013-03-23

Despite the existence of ample literature dealing, on the one hand, with the integration of innovations within health systems and team learning, and, on the other hand, with different aspects of the detection and management of intimate partner violence (IPV) within healthcare facilities, research that explores how health innovations that go beyond biomedical issues-such as IPV management-get integrated into health systems, and that focuses on healthcare teams' learning processes is, to the best of our knowledge, very scarce if not absent. This realist evaluation protocol aims to ascertain: why, how, and under what circumstances primary healthcare teams engage (if at all) in a learning process to integrate IPV management in their practices; and why, how, and under what circumstances team learning processes lead to the development of organizational culture and values regarding IPV management, and the delivery of IPV management services. This study will be conducted in Spain using a multiple-case study design. Data will be collected from selected cases (primary healthcare teams) through different methods: individual and group interviews, routinely collected statistical data, documentary review, and observation. Cases will be purposively selected in order to enable testing the initial middle-range theory (MRT). After in-depth exploration of a limited number of cases, additional cases will be chosen for their ability to contribute to refining the emerging MRT to explain how primary healthcare learn to integrate intimate partner violence management. Evaluations of health sector responses to IPV are scarce, and even fewer focus on why, how, and when the healthcare services integrate IPV management. There is a consensus that healthcare professionals and healthcare teams play a key role in this integration, and that training is important in order to realize changes. However, little is known about team learning of IPV management, both in terms of how to trigger such learning and how team learning is connected with changes in organizational culture and values, and in service delivery. This realist evaluation protocol aims to contribute to this knowledge by conducting this project in a country, Spain, where great endeavours have been made towards the integration of IPV management within the health system.

'It's a cultural expectation...' The pressure on medical trainees to work independently in clinical practice.

PubMed

Kennedy, Tara J T; Regehr, Glenn; Baker, G Ross; Lingard, Lorelei A

2009-07-01

Medical trainees demonstrate a reluctance to ask for help unless they believe it is absolutely necessary, a situation which could impact on the safety of patients. This study aimed to develop a theoretical exploration of the pressure on medical trainees to be independent and to generate theory-based approaches to the implications for patient safety of this pressure towards independent working. In Phase 1, 88 teaching team members from internal and emergency medicine were observed during clinical activities (216 hours), and 65 participants completed brief interviews. In Phase 2, 36 in-depth interviews were conducted using video vignettes. Data collection and analysis employed grounded theory methodology. Participants conceived that the pressure towards independence in clinical work originated in trainees' desire to lay claim to the identity of a doctor (as a member of a group of autonomous high achievers), and in organisational issues such as heavy workloads and constant evaluations. The identity and organisational issues related to the pressure towards independence were explored through the lenses of established theories from education and psychology. Consideration of Lave and Wenger's situated learning theory suggests that giving attention to the 'independent doctor' ideal, through measures such as involving trainees when their supervisors ask for help, could impact the safety of teaching team practice. Amalberti et al.'s migration model explains how pressures to maximise productivity and individual gain may cause teaching teams to migrate beyond the boundaries of safe practice and suggests that managing triggers (such as workload and high-stakes evaluations) for violations of safe practice might improve safety. Implementation and evaluation of these theory-based approaches to the safety of teaching team practice would contribute to a better understanding of the links between trainee independence and patient safety.

Inpatient geriatric care in Sweden-Important factors from an inter-disciplinary team perspective.

PubMed

Åberg, Anna Cristina; Ehrenberg, Anna

2017-09-01

The purpose of this study was to describe factors of importance for the quality of inpatient geriatric care from an inter-disciplinary team perspective, an area that has not been previously studied to our knowledge. The study design was qualitative descriptive with data being collected from focus-group interviews with members of geriatric care teams. The data collection was conducted at a Swedish university hospital with 69 beds for geriatric care. It comprised five group interviews with a total of 32 staff members, including representatives of all the seven professions working with geriatric care. Data was analysed using qualitative content analysis and a thematic framework approach. Three main themes were identified as being perceived as characterising important factors essential for quality geriatric care: Interactive assessment processes, A holistic care approach, and Proactive non-hierarchical interaction. Aspects of Time and Goal-Orientation were additionally running like common threads through these themes and informed them. Accessibility, open communication, and staff continuity were experienced as prerequisites for well-functioning teamwork. Including patients and relatives in care planning and implementation was seen as essential for good care, but was at risk due to budget cuts that imposed shortened hospital stays. To meet the care demands of the growing population of older frail people, more specialised team-based care according to the concept of Comprehensive Geriatric Assessment - which is possibly best provided by older-friendly hospitals - appears as a constructive solution for reaching high degrees of both staff and patient satisfaction in geriatric care. More research is needed in this area. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

Use of a Night Float System to Comply With Resident Duty Hours Restrictions: Perceptions of Workplace Changes and Their Effects on Professionalism.

PubMed

Sun, Ning-Zi; Gan, Runye; Snell, Linda; Dolmans, Diana

2016-03-01

Although some evidence suggests that resident duty hours reforms can lead to shift-worker mentality and loss of patient ownership, other evidence links long hours and fatigue to poor work performance and loss of empathy, suggesting the restrictions could positively affect professionalism. The authors explored perceived impacts of a 16-hour duty restriction, achieved using a night float (NF) system, on the workplace and professionalism. In 2013, the authors conducted semistructured interviews with 18 residents, 9 staff physicians, and 3 residency program directors in the McGill University core internal medicine residency program regarding their perceptions of the program's 12-hour shift-based NF system. Interviews were transcribed and coded for common themes. The authors used a descriptive qualitative methodology. Participants viewed implementation of the NF system as leading to decreased physical and mental exhaustion, more consistent interaction with patients, and more stable team structure within shifts compared with the previous 24-hour call system. These workplace changes were felt to improve teamwork and patient ownership within shifts, quality of work performed, and empathy. Across shifts, however, more frequent sign-overs, stricter application of shift time boundaries, and loose integration between daytime and NF teams were perceived as leading to emergence of shift-worker mentality around sign-over. Perceptions of optimal patient ownership changed from the traditional single-physician-24/7 model to team-based shared ownership. Duty hours restrictions, as exemplified by an NF system, have both positive and negative impacts on professionalism. Interventions and training toward effective team-based care are needed to curb emergence of shift-worker mentality.

Qualitative study exploring surgical team members' perception of patient safety in conflict-ridden Eastern Democratic Republic of Congo.

PubMed

Labat, Francoise; Sharma, Anjali

2016-04-25

To identify potential barriers to patient safety (PS) interventions from the perspective of surgical team members working in an operating theatre in Eastern Democratic Republic of Congo (DRC). In-depth interviews were conducted and analysed using qualitative content analysis. Governmental referral teaching hospital in Eastern DRC. We purposively selected 2-4 national and expatriate surgical team members from each specialisation. Of the 31 eligible surgical health workers (HWs), 17 volunteered to be interviewed. Economics issues affected PS throughout the entire health system, from human resources and hospital management, to access to healthcare for patients. Surgical team members seemed embedded in a paternalistic organisational structure and blame culture accompanied by perceived inefficient support services and low salaries. The armed conflict did not only worsen these system failures, it also carried direct threats to patients and HWs, and resulted in complex indirect consequences compromising PS. The increased corruption within health organisations, and population impoverishment and substance abuse among health staff adversely altered safe care. Simultaneously, HWs' reported resilience and resourcefulness to address barrier to PS. Participants had varying views on external aid depending on its relevance. The complex links between war and PS emphasise the importance of a comprehensive approach including occupational health to strengthen HWs' resilience, external clinical audits to limit corruption, and educational programmes in PS to support patient-centred care and address blame culture. Finally, improvement of equity in the health financing system seems essential to ensure access to healthcare and safe perioperative outcomes for all. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Integrating Depression Care Management into Medicare Home Health Reduces Risk of 30 and 60 Day Hospitalization: The Depression CAREPATH Cluster-Randomized Trial

PubMed Central

Bruce, Martha L.; Lohman, Matthew C.; Greenberg, Rebecca L.; Bao, Yuhua; Raue, Patrick J.

2016-01-01

OBJECTIVES To determine whether a depression care management intervention among Medicare home health recipients decreases risks of hospitalization. DESIGN Cluster-randomized trial. Nurse teams were randomized to Intervention (12 teams) or Enhanced Usual Care (EUC; 9 teams). SETTING Six home health agencies from distinct geographic regions. Patients were interviewed at home and by telephone. PARTICIPANTS Patients age>65 who screened positive for depression on nurse assessments (N=755), and a subset who consented to interviews (N=306). INTERVENTION The Depression CAREPATH (CARE for PATients at Home) guides nurses in managing depression during routine home visits. Clinical functions include weekly symptom assessment, medication management, care coordination, patient education, and goal setting. Researchers conducted biweekly telephone conferences with team supervisors. MEASUREMENTS The study examined acute-care hospitalization and days to hospitalization. H1 used data from the home health record to examine hospitalization over 30-day and 60-day periods while a home health patient. H2 used data from both home care record and research assessments to examine 30-day hospitalization from any setting. RESULTS The adjusted hazard ratio (HR) of being admitted to hospital directly from home health within 30 days of start of home health care was 0.65 (p=.013) for CAREPATH compared to EUC patients, and 0.72 (p=.027) within 60 days. In patients referred to home health directly from hospital, the relative hazard of being rehospitalized was approximately 55% lower (HR = 0.45, p=.001) among CAREPATH patients. CONCLUSION Integrating CAREPATH depression care management into routine nursing practice reduces hospitalization and rehospitalization risk among older adults receiving Medicare home health nursing services. PMID:27739067

Integrating Depression Care Management into Medicare Home Health Reduces Risk of 30- and 60-Day Hospitalization: The Depression Care for Patients at Home Cluster-Randomized Trial.

PubMed

Bruce, Martha L; Lohman, Matthew C; Greenberg, Rebecca L; Bao, Yuhua; Raue, Patrick J

2016-11-01

To determine whether a depression care management intervention in Medicare home health recipients decreases risk of hospitalization. Cluster-randomized trial. Nurse teams were randomized to intervention (12 teams) or enhanced usual care (EUC; 9 teams). Six home health agencies from distinct geographic regions. Home health recipients were interviewed at home and over the telephone. Individuals aged 65 and older who screened positive for depression on nurse assessments (N = 755) and a subset who consented to interviews (n = 306). The Depression CARE for PATients at Home (CAREPATH) guides nurses in managing depression during routine home visits. Clinical functions include weekly symptom assessment, medication management, care coordination, patient education, and goal setting. Researchers conducted telephone conferences with team supervisors every 2 weeks. Hospitalization while receiving home health services was assessed using data from the home health record. Hospitalization within 30 days of starting home health, regardless of how long recipients received home health services, was assessed using data from the home care record and research assessments. The relative hazard of being admitted to the hospital directly from home health was 35% lower within 30 days of starting home health care (hazard ratio (HR) = 0.65, P = .01) and 28% lower within 60 days (HR = 0.72, P = .03) for CAREPATH participants than for participants receiving EUC. In participants referred to home health directly from the hospital, the relative hazard of being rehospitalized was approximately 55% lower (HR = 0.45, P = .001) for CAREPATH participants. Integrating CAREPATH depression care management into routine nursing practice reduces hospitalization and rehospitalization risk in older adults receiving Medicare home health nursing services. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Building an inclusive research team: the importance of team building and skills training.

PubMed

Strnadová, Iva; Cumming, Therese M; Knox, Marie; Parmenter, Trevor

2014-01-01

Inclusive research teams typically describe their experiences and analyse the type of involvement of researchers with disability, but the process of building research teams and the need for research training still remain underexplored in the literature. Four researchers with intellectual disabilities and four academic researchers developed an inclusive research team. The team conducted 15 research training sessions, focused on investigating the well-being of older women with intellectual disabilities. They used mobile technology to support research skills acquisition. Findings included the experiences of all team members regarding the team building during training. To become an effective inclusive research team, all team members, regardless of ability, need to bring their own experiences and also learn necessary research skills. This paper highlights the need for team building, joint research training among all members of the research team and strategies supporting the peer-mentoring within the team. We are a team of four researchers with intellectual disabilities and four academic researchers without an intellectual disability. Our aim has been to learn about research together. We want to do this so that we can carry out a research project together about how older women with intellectual disabilities live. We have decided to call our team 'Welcome to our Class'. We have been working together for 9 months. In this time we have had 15 research training meetings. We have learned What research is How to work out a research question, that is what we want to find out about How to get information on what we want to find out. Here we thought of interview questions we could ask older women with intellectual disabilities. We are now meeting once a month, and have just begun our research on finding out how older women with intellectual disabilities live. We are now starting to use what we have learned. © 2013 John Wiley & Sons Ltd.

Prevention of falls, malnutrition and pressure ulcers among older persons - nursing staff's experiences of a structured preventive care process.

PubMed

Lannering, Christina; Ernsth Bravell, Marie; Johansson, Linda

2017-05-01

A structured and systematic care process for preventive work, aimed to reduce falls, pressure ulcers and malnutrition among older people, has been developed in Sweden. The process involves risk assessment, team-based interventions and evaluation of results. Since development, this structured work process has become web-based and has been implemented in a national quality registry called 'Senior Alert' and used countrywide. The aim of this study was to describe nursing staff's experience of preventive work by using the structured preventive care process as outlined by Senior Alert. Eight focus group interviews were conducted during 2015 including staff from nursing homes and home-based nursing care in three municipalities. The interview material was subjected to qualitative content analysis. In this study, both positive and negative opinions were expressed about the process. The systematic and structured work flow seemed to only partly facilitate care providers to improve care quality by making better clinical assessments, performing team-based planned interventions and learning from results. Participants described lack of reliability in the assessments and varying opinions about the structure. Furthermore, organisational structures limited the preventive work. © 2016 John Wiley & Sons Ltd.

'A bridge to the hospice': the impact of a Community Volunteer Programme in Uganda.

PubMed

Jack, Barbara A; Kirton, J; Birakurataki, J; Merriman, A

2011-10-01

In Africa, the need for palliative care provision is escalating with an increasing number of people living with HIV/AIDS, coupled with rising cancer and AIDS-related cancer diagnoses. In Uganda there is a shortage of doctors, particularly in rural areas. To address this Hospice Africa Uganda developed a Community Volunteer Programme to train volunteers to help by providing support to patients in their own homes. The aim of this qualitative study was to evaluate the impact of the Community Volunteer Programme. Sixty-four interviews, with patients (21), community volunteer workers (CVWs) (32), and the hospice clinical teams (11) were conducted, using semi-structured digitally recorded individual, group and focus group interviews, at the Hospice Africa Uganda sites. The results reported the value of the Community Volunteer Programme, including the impact on patients and families, and how the CVWs acted as a 'bridge to the hospice' in identifying patients. Developing financial challenges that are emerging which could potentially impact on the programme were reported. The Community Volunteer Programme appears to be having a positive impact on patients, families and the hospice team, and is a model worthy of consideration by other developing countries to allow the expansion of palliative care.

Herpes simplex virus: 'to disclose or not to disclose.' An exploration of the multi-disciplinary team's role in advising patients about disclosure when diagnosed with genital herpes simplex virus.

PubMed

Caulfield, Pauline; Willis, Diane

2017-07-01

The first UK prosecution for genital herpes simplex virus (HSV) transmission in 2011 attracted strong criticism from medical experts. To address the dearth of research on the topic, this study aimed to explore the nature of advice given to patients by the multidisciplinary team (MDT) in the West of Scotland on HSV disclosure to partners. Ten semi-structured interviews with members of the MDT were conducted and the interviews were analysed using Burnard's Thematic Content Analysis. Four themes emerged which explored practitioners' knowledge of HSV and their feelings regarding the emotional aspects of the diagnosis on clients including the challenges of discussing disclosure. Within this framework, participants' attitudes to the legal prosecution were also surveyed. This study revealed that participants had good knowledge about HSV. Furthermore, participants believed disclosure to be the patient's choice and had not altered their practice to advise disclosure to all partners in accordance with local protocol. However, there was a general consensus that disclosure was not required due to the prevalence of HSV and prevalence was used to dissipate emotional reactions to HSV diagnosis.

Prime movers: Advanced practice professionals in the role of stroke coordinator.

PubMed

Rattray, Nicholas A; Damush, Teresa M; Luckhurst, Cherie; Bauer-Martinez, Catherine J; Homoya, Barbara J; Miech, Edward J

2017-07-01

Following a stroke quality improvement clustered randomized trial and a national acute ischemic stroke (AIS) directive in the Veterans Health Administration in 2011, this comparative case study examined the role of advanced practice professionals (APPs) in quality improvement activities among stroke teams. Semistructured interviews were conducted at 11 Veterans Affairs medical centers annually over a 3-year period. A multidisciplinary team analyzed interviews from clinical providers through a mixed-methods, data matrix approach linking APPs (nurse practitioners and physician assistants) with Consolidated Framework for Implementation Research constructs and a group organization measure. Five of 11 facilities independently chose to staff stroke coordinator positions with APPs. Analysis indicated that APPs emerged as boundary spanners across services and disciplines who played an important role in coordinating evidence-based, facility-level approaches to AIS care. The presence of APPs was related to engaging in group-based evaluation of performance data, implementing stroke protocols, monitoring care through data audit, convening interprofessional meetings involving planning activities, and providing direct care. The presence of APPs appears to be an influential feature of local context crucial in developing an advanced, facility-wide approach to stroke care because of their boundary spanning capabilities. ©2017 American Association of Nurse Practitioners.

Unobtrusive Monitoring of Spaceflight Team Functioning. Literature Review and Operational Assessment for NASA Behavioral Health and Performance Element

NASA Technical Reports Server (NTRS)

Maidel, Veronica; Stanton, Jeffrey M.

2010-01-01

This document contains a literature review suggesting that research on industrial performance monitoring has limited value in assessing, understanding, and predicting team functioning in the context of space flight missions. The review indicates that a more relevant area of research explores the effectiveness of teams and how team effectiveness may be predicted through the elicitation of individual and team mental models. Note that the mental models referred to in this literature typically reflect a shared operational understanding of a mission setting such as the cockpit controls and navigational indicators on a flight deck. In principle, however, mental models also exist pertaining to the status of interpersonal relations on a team, collective beliefs about leadership, success in coordination, and other aspects of team behavior and cognition. Pursuing this idea, the second part of this document provides an overview of available off-the-shelf products that might assist in extraction of mental models and elicitation of emotions based on an analysis of communicative texts among mission personnel. The search for text analysis software or tools revealed no available tools to enable extraction of mental models automatically, relying only on collected communication text. Nonetheless, using existing software to analyze how a team is functioning may be relevant for selection or training, when human experts are immediately available to analyze and act on the findings. Alternatively, if output can be sent to the ground periodically and analyzed by experts on the ground, then these software packages might be employed during missions as well. A demonstration of two text analysis software applications is presented. Another possibility explored in this document is the option of collecting biometric and proxemic measures such as keystroke dynamics and interpersonal distance in order to expose various individual or dyadic states that may be indicators or predictors of certain elements of team functioning. This document summarizes interviews conducted with personnel currently involved in observing or monitoring astronauts or who are in charge of technology that allows communication and monitoring. The objective of these interviews was to elicit their perspectives on monitoring team performance during long-duration missions and the feasibility of potential automatic non-obtrusive monitoring systems. Finally, in the last section, the report describes several priority areas for research that can help transform team mental models, biometrics, and/or proxemics into workable systems for unobtrusive monitoring of space flight team effectiveness. Conclusions from this work suggest that unobtrusive monitoring of space flight personnel is likely to be a valuable future tool for assessing team functioning, but that several research gaps must be filled before prototype systems can be developed for this purpose.

Cultural dimensions in the transition of overseas medical graduates to the UK workplace.

PubMed

Morrow, Gill; Rothwell, Charlotte; Burford, Bryan; Illing, Jan

2013-10-01

Historically, overseas-qualified doctors have been essential for meeting service needs in the UK National Health Service (NHS). However, these doctors encounter many cultural differences, in relation to training, the healthcare system and the doctor-patient relationship and training. To examine whether Hofstede's cultural model may help us understand the changes doctors from other countries experience on coming to work in the UK, and to identify implications for supervisors and clinical teams. Telephone interviews were conducted with overseas medical graduates before starting work as a Foundation Year One (F1) doctor, followed up after four months and 12 months; and with educational supervisors. Data were analysed using a confirmatory thematic approach. Sixty-four initial interviews were conducted with overseas doctors, 56 after four months, and 32 after 12 months. Twelve interviews were conducted with educational supervisors. The changes doctors experienced related particularly to Hofstede's dimensions of power distance (e.g. in relation to workplace hierarchies and inter-professional relationships), uncertainty avoidance (e.g. regarding ways of interacting) and individualism-collectivism (e.g., regarding doctor-patient/family relationship; assertiveness of individuals). Hofstede's cultural dimensions may help us understand the adaptations some doctors have to make in adjusting to working in the UK NHS. This may promote awareness and understanding and greater 'cultural competence' amongst those working with them or supervising them in their training.

Barriers and Facilitators to Home Computer and Internet Use Among Urban Novice Computer Users of Low Socioeconomic Position

PubMed Central

Bennett, Gary G; Viswanath, K

2007-01-01

Background Despite the increasing penetration of the Internet and amount of online health information, there are significant barriers that limit its widespread adoption as a source of health information. One is the “digital divide,” with people of higher socioeconomic position (SEP) demonstrating greater access and usage compared to those from lower SEP groups. However, as the access gap narrows over time and more people use the Internet, a shift in research needs to occur to explore how one might improve Internet use as well as website design for a range of audiences. This is particularly important in the case of novice users who may not have the technical skills, experience, or social connections that could help them search for health information using the Internet. The focus of our research is to investigate the challenges in the implementation of a project to improve health information seeking among low SEP groups. The goal of the project is not to promote health information seeking as much as to understand the barriers and facilitators to computer and Internet use, beyond access, among members of lower SEP groups in an urban setting. Objective The purpose was to qualitatively describe participants’ self-identified barriers and facilitators to computer and Internet use during a 1-year pilot study as well as the challenges encountered by the research team in the delivery of the intervention. Methods Between August and November 2005, 12 low-SEP urban individuals with no or limited computer and Internet experience were recruited through a snowball sampling. Each participant received a free computer system, broadband Internet access, monthly computer training courses, and technical support for 1 year as the intervention condition. Upon completion of the study, participants were offered the opportunity to complete an in-depth semistructured interview. Interviews were approximately 1 hour in length and were conducted by the project director. The interviews were held in the participants’ homes and were tape recorded for accuracy. Nine of the 12 study participants completed the semistructured interviews. Members of the research team conducted a qualitative analysis based on the transcripts from the nine interviews using the crystallization/immersion method. Results Nine of the 12 participants completed the in-depth interview (75% overall response rate), with three men and six women agreeing to be interviewed. Major barriers to Internet use that were mentioned included time constraints and family conflict over computer usage. The monthly training classes and technical assistance components of the intervention surfaced as the most important facilitators to computer and Internet use. The concept of received social support from other study members, such as assistance with computer-related questions, also emerged as an important facilitator to overall computer usage. Conclusions This pilot study offers important insights into the self-identified barriers and facilitators in computer and Internet use among urban low-SEP novice users as well as the challenges faced by the research team in implementing the intervention. PMID:17951215

Protecting our Khmer daughters: ghosts of the past, uncertain futures, and the human papillomavirus vaccine.

PubMed

Burke, Nancy J; Do, Huyen H; Talbot, Jocelyn; Sos, Channdara; Ros, Srey; Taylor, Victoria M

2015-01-01

The FDA approved the first human papillomavirus (HPV) vaccine in 2006. Research into parental decision-making and concerns about HPV vaccination highlights questions about parenting and parents' role in the crafting of their daughters' future sexuality. In contrast to much of this literature, we explore narratives from interviews with Cambodian mothers of HPV vaccine-age eligible daughters who experienced genocide and came to the USA as refugees. We conducted in-depth, in-person interviews with 25 Cambodian mothers of HPV vaccine-age eligible daughters. Interviews were conducted in Khmer and translated into English for analysis. We followed standard qualitative analysis techniques including iterative data review, multiple coders, and 'member checking.' Five members of the research team reviewed all transcripts and two members independently coded each transcript for concepts and themes. Interview narratives highlight the presence of the past alongside desires for protection from uncertain futures. We turn to Quesada and colleagues' concept structural vulnerability to outline the constraints posed by these women's positionalities as genocide survivors when faced with making decisions in an area with which they have little direct knowledge or background: cervical cancer prevention. Our study sheds light on the prioritization of various protective health practices, including but not exclusive to HPV vaccination, for Khmer mothers, as well as the rationalities informing decision-making regarding their daughters' health.

Protecting our Khmer daughters: Ghosts of the past, uncertain futures, and the HPV vaccine

PubMed Central

Burke, Nancy J.; Do, Huyen H.; Talbot, Jocelyn; Sos, Channdara; Ros, Srey; Taylor, Victoria M.

2014-01-01

Objectives The FDA approved the first HPV vaccine in 2006. Research into parental decision-making and concerns about HPV vaccination highlight questions about parenting and parents’ role in the crafting of their daughters’ future sexuality. In contrast to much of this literature, we explore narratives from interviews with Cambodian mothers of HPV vaccine age-eligible daughters who experienced genocide and came to the United States as refugees. Design We conducted in-depth, in-person interviews with 25 Cambodian mothers of HPV vaccine-age eligible daughters. Interviews were conducted in Khmer and translated into English for analysis. We followed standard qualitative analysis techniques including iterative data review, multiple coders, and ‘member checking’. Five members of the research team reviewed all transcripts and two members independently coded each transcript for concepts and themes. Results Interview narratives highlight the presence of the past alongside desires for protection from uncertain futures. We turn to Quesada and colleagues’ (2011) concept structural vulnerability to outline the constraints posed by these women’s positionalities as genocide survivors when faced with making decisions in a area with which they have little direct knowledge or background: cervical cancer prevention. Conclusion Our study sheds light on the prioritization of various protective health practices, including but not exclusive to HPV vaccination, for Khmer mothers, as well as the rationalities informing decision-making regarding their daughters’ health. PMID:24905057

Stakeholder Perspectives on Changes in Hypertension Care Under the Patient-Centered Medical Home.

PubMed

O'Donnell, Alison J; Bogner, Hillary R; Cronholm, Peter F; Kellom, Katherine; Miller-Day, Michelle; McClintock, Heather F de Vries; Kaye, Elise M; Gabbay, Robert

2016-02-25

Hypertension is a major modifiable risk factor for cardiovascular and kidney disease, yet the proportion of adults whose hypertension is controlled is low. The patient-centered medical home (PCMH) is a model for care delivery that emphasizes patient-centered and team-based care and focuses on quality and safety. Our goal was to investigate changes in hypertension care under PCMH implementation in a large multipayer PCMH demonstration project that may have led to improvements in hypertension control. The PCMH transformation initiative conducted 118 semistructured interviews at 17 primary care practices in southeastern Pennsylvania between January 2011 and January 2012. Clinicians (n = 47), medical assistants (n = 26), office administrators (n = 12), care managers (n = 11), front office staff (n = 7), patient educators (n = 4), nurses (n = 4), social workers (n = 4), and other administrators (n = 3) participated in interviews. Study personnel used thematic analysis to identify themes related to hypertension care. Clinicians described difficulties in expanding services under PCMH to meet the needs of the growing number of patients with hypertension as well as how perceptions of hypertension control differed from actual performance. Staff and office administrators discussed achieving patient-centered hypertension care through patient education and self-management support with personalized care plans. They indicated that patient report cards were helpful tools. Participants across all groups discussed a team- and systems-based approach to hypertension care. Practices undergoing PCMH transformation may consider stakeholder perspectives about patient-centered, team-based, and systems-based approaches as they work to optimize hypertension care.

Quality of working life indicators in Canadian health care organizations: a tool for healthy, health care workplaces?

PubMed

Cole, Donald C; Robson, Lynda S; Lemieux-Charles, Louise; McGuire, Wendy; Sicotte, Claude; Champagne, Francois

2005-01-01

Quality-of-work-life (QWL) includes broad aspects of the work environment that affect employee learning and health. Canadian health care organizations (HCOs) are being encouraged to monitor QWL, expanding existing occupational health surveillance capacities. To investigate the understanding, collection, diffusion and use of QWL indicators in Canadian HCOs. We obtained cooperation from six diverse public HCOs managing 41 sites. We reviewed documentation relevant to QWL and conducted 58 focus groups/team interviews with strategic, support and programme teams. Group interviews were taped, reviewed and analysed for themes using qualitative data techniques. Indicators were classified by purpose and HCO level. QWL indicators, as such, were relatively new to most HCOs yet the data managed by human resource and occupational health and safety support teams were highly relevant to monitoring of employee well-being (119 of 209 mentioned indicators), e.g. sickness absence. Monitoring of working conditions (62/209) was also important, e.g. indicators of employee workload. Uncommon were indicators of biomechanical and psychosocial hazards at work, despite their being important causes of morbidity among HCO employees. Although imprecision in the definition of QWL indicators, limited links with other HCO performance measures and inadequate HCO resources for implementation were common, most HCOs cited ways in which QWL indicators had influenced planning and evaluation of prevention efforts. Increase in targeted HCO resources, inclusion of other QWL indicators and greater integration with HCO management systems could all improve HCO decision-makers' access to information relevant to employee health.

Perceived distributed effort in team ball sports.

PubMed

Beniscelli, Violeta; Tenenbaum, Gershon; Schinke, Robert Joel; Torregrosa, Miquel

2014-01-01

In this study, we explored the multifaceted concept of perceived mental and physical effort in team sport contexts where athletes must invest individual and shared efforts to reach a common goal. Semi-structured interviews were conducted with a convenience sample of 15 Catalan professional coaches (3 women and 12 men, 3 each from the following sports: volleyball, basketball, handball, soccer, and water polo) to gain their views of three perceived effort-related dimensions: physical, psychological, and tactical. From a theoretical thematic analysis, it was found that the perception of effort is closely related to how effort is distributed within the team. Moreover, coaches viewed physical effort in relation to the frequency and intensity of the players' involvement in the game. They identified psychological effort in situations where players pay attention to proper cues, and manage emotions under difficult circumstances. Tactical effort addressed the decision-making process of players and how they fulfilled their roles while taking into account the actions of their teammates and opponents. Based on these findings, a model of perceived distributed effort was developed, which delineates the elements that compose each of the aforementioned dimensions. Implications of perceived distributed effort in team coordination and shared mental models are discussed.

Evaluation of two educative models in a primary care hypertension programme.

PubMed

Martínez-Amenós, A; Fernández Ferré, M L; Mota Vidal, C; Alsina Rocasalbas, J

1990-08-01

This study was planned in the context of a regional high blood pressure programme, to compare the efficacy of two educative methods. The group of 722 hypertensive patients (58.8% women), mean age 61 years, was randomly selected from 19 primary care centres. Initial assessment was based on a patient interview including 22 questions on high blood pressure, its consequences and treatment. Patients agreeing to participate in an active education team programme were distributed into three groups: individual education, team education and a control group. Those who declined to participate formed two groups: individual education and controls. Team education consisted of two audiovisual sessions attended by groups of 8-12 patients and conducted by treating physicians and nurses. Individual education included comments related to the 22 questions. Follow-up assessment was made after two months. An increase in the level of hypertension control was observed only in the accepting group, in which educative action was followed by increased knowledge. Results were similarly favourable for both the individual and team education groups and suggested the need to consider educational factors together with those influencing patient attitude towards an active educational programme.

Aims and harvest of moral case deliberation.

PubMed

Weidema, Froukje C; Molewijk, Bert A C; Kamsteeg, Frans; Widdershoven, Guy A M

2013-09-01

Deliberative ways of dealing with ethical issues in health care are expanding. Moral case deliberation is an example, providing group-wise, structured reflection on dilemmas from practice. Although moral case deliberation is well described in literature, aims and results of moral case deliberation sessions are unknown. This research shows (a) why managers introduce moral case deliberation and (b) what moral case deliberation participants experience as moral case deliberation results. A responsive evaluation was conducted, explicating moral case deliberation experiences by analysing aims (N = 78) and harvest (N = 255). A naturalistic data collection included interviews with managers and evaluation questionnaires of moral case deliberation participants (nurses). From the analysis, moral case deliberation appeals for cooperation, team bonding, critical attitude towards routines and nurses' empowerment. Differences are that managers aim to foster identity of the nursing profession, whereas nurses emphasize learning processes and understanding perspectives. We conclude that moral case deliberation influences team cooperation that cannot be controlled with traditional management tools, but requires time and dialogue. Exchanging aims and harvest between manager and team could result in co-creating (moral) practice in which improvements for daily cooperation result from bringing together perspectives of managers and team members.

Communication between the elderly person and the family health team: is there integrality?

PubMed

de Almeida, Rita Tereza; Ciosak, Suely Itsuko

2013-01-01

to verify the forms of communication used in four Primary Health Units with Family Health Program teams in Porto Feliz, São Paulo, and how they impact in the care and control of the health of elderly people. this qualitative study sought to capture the communication between elderly people and healthcare professionals. Interviews were conducted with 20 elderly people of both sexes. from the discourses and observations, assertive communication and blocked communication emerged as the central analysis themes, the verbal and nonverbal elements of which, unveiled subjectivity of the communication process, of the local culture and of the psychosocial factors positively and negatively contributing to the healthcare for elderly people. The nursing teams of the Family Health Strategy showed forms of communication that favored the adherence of the elderly people to the care and control of their health. Negatives aspects did not have completely prejudicial consequences, however, should be avoided, in order to facilitate integral care to elderly people. it is worth reinforcing the need for improvement of the nursing team and other healthcare professionals regarding health communication as an innovative technology, bringing credibility to the health promotion and prevention programs with elderly users.

Cognitive Aids for Role Definition (CARD) to improve interprofessional team crisis resource management: An exploratory study.

PubMed

Renna, Tania Di; Crooks, Simone; Pigford, Ashlee-Ann; Clarkin, Chantalle; Fraser, Amy B; Bunting, Alexandra C; Bould, M Dylan; Boet, Sylvain

2016-09-01

This study aimed to assess the perceived value of the Cognitive Aids for Role Definition (CARD) protocol for simulated intraoperative cardiac arrests. Sixteen interprofessional operating room teams completed three consecutive simulated intraoperative cardiac arrest scenarios: current standard, no CARD; CARD, no CARD teaching; and CARD, didactic teaching. Each team participated in a focus group interview immediately following the third scenario; data were transcribed verbatim and qualitatively analysed. After 6 months, participants formed eight new teams randomised to two groups (CARD or no CARD) and completed a retention intraoperative cardiac arrest simulation scenario. All simulation sessions were video recorded and expert raters assessed team performance. Qualitative analysis of the 16 focus group interviews revealed 3 thematic dimensions: role definition in crisis management; logistical issues; and the "real life" applicability of CARD. Members of the interprofessional team perceived CARD very positively. Exploratory quantitative analysis found no significant differences in team performance with or without CARD (p > 0.05). In conclusion, qualitative data suggest that the CARD protocol clarifies roles and team coordination during interprofessional crisis management and has the potential to improve the team performance. The concept of a self-organising team with defined roles is promising for patient safety.

Influences on Infant Feeding: Perceptions of Mother-Father Parent Dyads.

PubMed

Majee, Wilson; Thullen, Matthew J; Davis, Alexandra N; Sethi, Tarunjot K

The purpose of this study was to examine interrelational-, organizational-, and community-level influences on how coparents collaborate about infant and toddler feeding. Using qualitative methods, we interviewed mother-father parent dyads to explore the potential influences on infant and toddler feeding. Participants were purposively recruited from two Midwest, rural, university-system pediatric clinics. Thematic analysis was used to code the data. Mother-father dyadic interviews were conducted using a semistructured interview schedule. Twenty-four mother-father dyads who had a child between the ages of 6 and 36 months were interviewed together. Major themes include interpersonal factors (peer behavior reinforcement, dyad and important others infant feeding conflict, conflict resolution proactiveness), organizational factors (healthcare provider infant-feeding support, workplace flexibility), and community factors (public perception on breastfeeding and social media influence). Community-based collaboration can be a platform for mother-father dyads, researchers, public health nurses, and other healthcare providers to proactively create interventions that include opportunity for building coparenting skills and infant-feeding knowledge that promote team management of common early childhood feeding challenges.

The development of specialized palliative care in the community: A qualitative study of the evolution of 15 teams.

PubMed

Seow, Hsien; Bainbridge, Daryl

2018-05-01

Interprofessional specialized palliative care teams at home improve patient outcomes, reduce healthcare costs, and support many patients to die at home. However, practical details about how to develop home-based teams in different regions and health systems are scarce. To examine how a variety of home-based specialized palliative care teams created and grew their team over time and to identify critical steps in their evolution. A qualitative study was designed based on a grounded theory approach, using semi-structured interviews and other documentation. In all, 15 specialized palliative care teams from Ontario, Canada, representing rural and urban areas. Data were collected from core members of the teams, including nurses, physicians, personal support workers, spiritual counselors, and administrators. In all, 122 individuals where interviewed, ranging from 4 to 10 per team. The analysis revealed four stages in team evolution: Inception, Start-up (n = 4 teams), Growth (n = 5), and Mature (n = 6). In the Inception stage, a champion provider was required to leverage existing resources to form the team. Start-up teams were testing and adjusting care processes to solidify their presence in the community. Growth teams had core expertise, relationships with fellow providers, and 24/7 support. Mature teams were fully integrated in the community, but still engaged in continuous quality improvement. Understanding the developmental stages of teams can help to inform the progress of other community-based teams. Appropriate outcome measures at each stage are also critical for team motivation and steady progress.

Interviews with Apollo Lunar Surface Astronauts in Support of EVA Systems Design

NASA Technical Reports Server (NTRS)

Eppler, Dean

2010-01-01

A 3-person team interviewed 8 of the 11 surviving Apollo crewmembers in a series of focused interviews to discuss their experiences on the lunar surface. Eppler presented the results of these interviews, along with recommendations for the design of future lunar surface systems.

Assessing the impact of general practitioner team service on perceived quality of care among patients with non-communicable diseases in China: a natural experimental study.

PubMed

Yin, Jia; Wei, Xiaolin; Li, Haitao; Jiang, Yanling; Mao, Chunfang

2016-10-01

China issued the national primary care policy of promoting general practitioner (GP) team service in 2011. We conducted this study to assess the impact of the GP team service on quality of primary care as perceived by patients with non-communicable diseases (NCDs). Natural experimental study. This study was conducted in Shanghai, where the policy was effectively implemented, and Kunming, where the policy was not implemented. In both cities, NCD patients were interviewed with primary care assessment tool (PCAT) after their clinical consultations in their community health centers. The implementation of GP team service policy. Multiple linear regressions were employed to compare PCAT scores between the two rounds of the surveys in each city. Difference-in-difference (DID) analysis was used to identify the changes between two cities over time. A total of 663 and 587 patients in Shanghai, and 400 and 441 patients in Kunming were surveyed in 2011 and 2013, respectively. The DID analysis showed that the total primary care quality scores improved in Shanghai compared with Kunming between 2011 and 2013 (β = 1.30, 95% CI: 0.74, 1.87). In Shanghai, care quality in 2013 improved significantly for the total score and the six components when compared with those in 2011. No significant changes were observed in Kunming in the same period. Primary care policies that promote long-term provider-patient relationships, coordinated service with hospitals and capitation payment for the GP team may contribute to the improvement of care quality in Shanghai. © 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.

From words to action: visibility of management in supporting interdisciplinary team working in an acute rehabilitative geriatric hospital.

PubMed

Buttigieg, Sandra C; Cassar, Vincent; Scully, Judy W

2013-01-01

The following case study aims to explore management's, health professionals' and patients' experiences on the extent to which there is visibility of management support in achieving effective interdisciplinary team working, which is explicitly declared in the mission statement of a 60-bed acute rehabilitative geriatric hospital in Malta. A total of 21 semi-structured interviews were conducted with the above-mentioned key stakeholders. Three main distinct yet interdependent themes emerged as a result of thematic analysis: "managing a team-friendly hospital", "interdisciplinary team components", and "interdisciplinary team processes". The findings show that visibility of management support and its alignment with the process and content levels of interdisciplinary teamwork are key to integrated care for acute rehabilitative geriatric patients. The emerging phenomena may not be reproducible in a different context; although many of the emerging themes could be comfortably matched with the existing literature. The implications are geared towards raising the consciousness and conscientiousness of good practice in interdisciplinary teamwork in hospitals, as well as in emphasizing organizational and management support as crucial factors for team-based organizations. Interdisciplinary teamwork in acute rehabilitative geriatrics provides optimal quality and integrated health care delivery with the aim that the older persons are successfully discharged back to the community. The authors draw on solid theoretical frameworks--the complexity theory, team effectiveness model and the social identity theory--to support their major finding, namely the alignment of organizational and management support with intra-team factors at the process and content level.

Trauma facilities in Denmark - a nationwide cross-sectional benchmark study of facilities and trauma care organisation.

PubMed

Weile, Jesper; Nielsen, Klaus; Primdahl, Stine C; Frederiksen, Christian A; Laursen, Christian B; Sloth, Erik; Mølgaard, Ole; Knudsen, Lars; Kirkegaard, Hans

2018-03-27

Trauma is a leading cause of death among adults aged < 44 years, and optimal care is a challenge. Evidence supports the centralization of trauma facilities and the use multidisciplinary trauma teams. Because knowledge is sparse on the existing distribution of trauma facilities and the organisation of trauma care in Denmark, the aim of this study was to identify all Danish facilities that care for traumatized patients and to investigate the diversity in organization of trauma management. We conducted a systematic observational cross-sectional study. First, all hospitals in Denmark were identified via online services and clarifying phone calls to each facility. Second, all trauma care manuals on all facilities that receive traumatized patients were gathered. Third, anesthesiologists and orthopedic surgeons on call at all trauma facilities were contacted via telephone for structured interviews. A total of 22 facilities in Denmark were found to receive traumatized patients. All facilities used a trauma care manual and all had a multidisciplinary trauma team. The study found three different trauma team activation criteria and nine different compositions of teams who participate in trauma care. Training was heterogeneous and, beyond the major trauma centers, databases were only maintained in a few facilities. The study established an inventory of the existing Danish facilities that receive traumatized patients. The trauma team activation criteria and the trauma teams were heterogeneous in both size and composition. A national database for traumatized patients, research on nationwide trauma team activation criteria, and team composition guidelines are all called for.

Why teams don't work. Interview by Diane Coutu.

PubMed

Hackman, J Richard

2009-05-01

The belief that teams make us more creative and productive--and are the best way to get things done--is deeply entrenched. But Hackman, a professor of organizational psychology at Harvard and a leading expert on teams, is having none of it. Research, he says, consistently shows that teams underperform despite all their extra resources. In an interview with senior editor Diane Coutu, Hackman explains where teams go wrong. Shockingly, most of the time members don't agree on what the team is supposed to be doing or even on who is on the team. The belief that bigger is better also compounds problems; as a team grows, the effort needed to manage links between members increases almost exponentially. Leaders need to be ruthless about defining teams and keeping them small (fewer than 10 members), and some individuals (like team destroyers) should simply be forced off. The leader also must set a compelling direction for the team--but in so doing, may encounter intense resistance that puts him or her at great risk. Hackman explores other fallacies about teams--for instance, that teams whose members have been together a long time become stale. In fact, research reveals that new teams make 50% more mistakes than established teams. To avoid complacency, though, every team needs a deviant--someone who is willing to make waves and open up the group to more ideas. Unfortunately, such individuals often get thrown off the team, robbing it of its chance to be magical. Leaders can't make a team do well. However, by being disciplined about how a team is set up and managed, instituting the right support systems, and providing coaching in group processes, they can increase the likelihood that a team will be great.

[Role-specific targets and teamwork in the operating room].

PubMed

Hoeper, K; Kriependorf, M; Felix, C; Nyhuis, P; Tecklenburg, A

2017-12-01

The primary goal of a surgical team is the successful performance of an operation on a patien; however, this primary goal can show discrepancies from the goals of individual team members. The main causes for differences of interests can be variations in subjective preferences and organizational differences. Subjective preferences are due to the values held by those involved. These values are of an intrinsic nature and therefore difficult to change. Another reason for individual goals is that hospitals and universities are professional bureaucracies. Experts working in professional bureaucracies are known to identify themselves to a greater extent with their respective profession than with their institution; however, teams in the operating room (OR) have to work together in multidisciplinary teams. The main goal of this analysis is to document role-specific targets and motivations within teams. This was a case study at a university hospital with 40 operating rooms. The data collection resulted from the three pillars of the goal documentation instrument, which includes expert interviews, a utility analysis and card placement as a basis for communicative validation. The results were analyzed with a systematic method as a qualitative content analysis. The four-pillar success model, which maps aspects of a successful hospital, was used as a deductive coding scheme. The four pillars represent the level of medical quality (process, structure and outcome quality), economy and efficiency, client satisfaction (patients and referring physicians) and employee satisfaction. At a university hospital an additional focus is on research and teaching. In addition to the four pillar success model as a deductive coding scheme, an inductive coding scheme was introduced. Approximately 10% of the employees from each professional group (surgeons, anesthesiologists, OR nurses, nurse anesthetists) were interviewed resulting in 65 interviews overall. The interviews were conducted within a time span of 4 months. Considering the main categories quality of medical care, economy and efficiency, patient satisfaction and employee satisfaction as well as research and teaching, surgeons thought the categories of economy and efficiency (37%) and quality of medical care (34%) to be the most important. For anesthesiologists, however, the category of employee satisfaction (38%) was most important, followed by the category of economy and efficiency (31%). For the OR nurses as well as for the nurse anesthetists the category of employee satisfaction was of highest priority (61% and 57%, respectively). The results show that considering the main categories no dimension is equally important for the participating professional groups. This can result in goal conflicts. Additionally, the ad hoc teams make it impossible for team building to occur, making it difficult for the professional groups to adapt to each other and the individual goals. This presents a high potential for conflict. The difference in the perception of the importance of employee satisfaction is a crucial factor for emerging conflicts in the OR, as employee satisfaction correlates with productivity and patient satisfaction. Knowing and communicating the different goals is a first step for optimizing the OR management system.

Pioneering the Transdisciplinary Team Science Approach: Lessons Learned from National Cancer Institute Grantees

PubMed Central

Vogel, Amanda L; Stipelman, Brooke A; Hall, Kara L; Nebeling, Linda; Stokols, Daniel; Spruijt-Metz, Donna

2014-01-01

The National Cancer Institute has been a leader in supporting transdisciplinary (TD) team science. From 2005-2010, the NCI supported Transdisciplinary Research on Energetic and Cancer I (TREC I), a center initiative fostering the TD integration of social, behavioral, and biological sciences to examine the relationships among obesity, nutrition, physical activity and cancer. In the final year of TREC I, we conducted qualitative in-depth-interviews with 31 participating investigators and trainees to learn more about their experiences with TD team science, including challenges, facilitating factors, strategies for success, and impacts. Five main challenges emerged: (1) limited published guidance for how to engage in TD team science, when TREC I was implemented; (2) conceptual and scientific challenges inherent to efforts to achieve TD integration; (3) discipline-based differences in values, terminology, methods, and work styles; (4) project management challenges involved in TD team science; and (5) traditional incentive and reward systems that do not recognize or reward TD team science. Four main facilitating factors and strategies for success emerged: (1) beneficial attitudes and beliefs about TD research and team science; (2) effective team processes; (3) brokering and bridge-building activities by individuals holding particular roles in a research center; and (4) funding initiative characteristics that support TD team science. Broad impacts of participating in TD team science in the context of TREC I included: (1) new positive attitudes about TD research and team science; (2) new boundary-crossing collaborations; (3) scientific advances related to research approaches, findings, and dissemination; (4) institutional culture change and resource creation in support of TD team science; and (5) career advancement. Funding agencies, academic institutions, and scholarly journals can help to foster TD team science through funding opportunities, institutional policies on extra-departmental and cross-school collaboration, promotion and tenure policies, and publishing opportunities for TD research. PMID:25554748

Assessment and Next Generation Standards: An Interview with Olivia Gude

ERIC Educational Resources Information Center

Sweeny, Robert

2014-01-01

This article provides a transcript of an interview with Olivia Gude, member of the National Coalition for Core Arts Standards Writing Team. In the interview, Gude provides an overview of the process for writing the new visual arts standards.

Increasing Responsiveness of the Army Rapid Acquisition Process: The Army Rapid Equipping Force

DTIC Science & Technology

2011-06-01

System Increment 2 (JNBCRS2) Joint Urgent Operational Needs (JUON) effort. These interviews played a critical role in providing information on the...Operational Assessment. 91 Interview by the authors with JNBCRS2 ATEC System Team: Mr. Dough Cunningham, DTC, and Ms. Emily Yost, AEC, Aberdeen...Mr. Dough Cunningham, DTC, and Ms. Emily Yost, AEC, Aberdeen Proving Ground, MD, October 2010. 110 Major Scott Schroer, JNBCRS2 Team Lead, and the

The patient centered medical home: mental models and practice culture driving the transformation process.

PubMed

Cronholm, Peter F; Shea, Judy A; Werner, Rachel M; Miller-Day, Michelle; Tufano, Jim; Crabtree, Benjamin F; Gabbay, Robert

2013-09-01

The Patient-Centered Medical Home (PCMH) has become a dominant model of primary care re-design. The PCMH model is a departure from more traditional models of healthcare delivery and requires significant transformation to be realized. To describe factors shaping mental models and practice culture driving the PCMH transformation process in a large multi-payer PCMH demonstration project. Individual interviews were conducted at 17 primary care practices in South Eastern Pennsylvania. A total of 118 individual interviews were conducted with clinicians (N = 47), patient educators (N = 4), office administrators (N = 12), medical assistants (N = 26), front office staff (N = 7), nurses (N = 4), care managers (N = 11), social workers (N = 4), and other stakeholders (N = 3). A multi-disciplinary research team used a grounded theory approach to develop the key constructs describing factors shaping successful practice transformation. Three central themes emerged from the data related to changes in practice culture and mental models necessary for PCMH practice transformation: 1) shifting practice perspectives towards proactive, population-oriented care based in practice-patient partnerships; 2) creating a culture of self-examination; and 3) challenges to developing new roles within the practice through distribution of responsibilities and team-based care. The most tension in shifting the required mental models was displayed between clinician and medical assistant participants, revealing significant barriers towards moving away from clinician-centric care. Key factors driving the PCMH transformation process require shifting mental models at the individual level and culture change at the practice level. Transformation is based upon structural and process changes that support orientation of practice mental models towards perceptions of population health, self-assessment, and the development of shared decision-making. Staff buy-in to the new roles and responsibilities driving PCMH transformation was described as central to making sustainable change at the practice level; however, key barriers related to clinician autonomy appeared to interfere with the formation of team-based care.

Student Teachers' Team Teaching during Field Experiences: An Evaluation by Their Mentors

ERIC Educational Resources Information Center

Simons, Mathea; Baeten, Marlies

2016-01-01

Since collaboration within schools gains importance, teacher educators are looking for alternative models of field experience inspired by collaborative learning. Team teaching is such a model. This study explores two team teaching models (parallel and sequential teaching) by investigating the mentors' perspective. Semi-structured interviews were…

The How Project: understanding contextual challenges to global surgical care provision in low-resource settings

PubMed Central

Raykar, Nakul P; Yorlets, Rachel R; Liu, Charles; Goldman, Roberta; Greenberg, Sarah L M; Kotagal, Meera; Farmer, Paul E; Meara, John G; Roy, Nobhojit; Gillies, Rowan D

2016-01-01

Introduction 5 billion people around the world do not have access to safe, affordable, timely surgical care. This series of qualitative interviews was launched by The Lancet Commission on Global Surgery (LCoGS) with the aim of understanding the contextual challenges—the specific circumstances—faced by surgical care providers in low-resource settings who care for impoverished patients, and how those providers overcome these challenges. Methods From January 2014 to February 2015, 20 LCoGS collaborators conducted semistructured interviews with 148 surgical providers in low-resource settings in 21 countries. Stratified purposive sampling was used to include both rural and urban providers, and reputational case selection identified individuals. Interviewers were trained with an implementation manual. Following immersion into de-identified texts from completed interviews, topical coding and further analysis of coded texts was completed by an independent analyst with periodic validation from a second analyst. Results Providers described substantial financial, geographic and cultural barriers to patient access. Rural surgical teams reported a lack of a trained workforce and insufficient infrastructure, equipment, supplies and banked blood. Urban providers face overcrowding, exacerbated by minimal clinical and administrative support, and limited interhospital care coordination. Many providers across contexts identified national health policies that do not reflect the realities of resource-poor settings. Some findings were region-specific, such as weak patient–provider relationships and unreliable supply chains. In all settings, surgical teams have created workarounds to deliver care despite the challenges. Discussion While some differences exist between countries, the barriers to safe surgery and anaesthesia are overall consistent and resource-dependent. Efforts to advance and expand global surgery must address these commonalities, while local policymakers can tailor responses to key contextual differences. PMID:28588976

The participant's perspective: learning from an aggression management training course for nurses. Insights from a qualitative interview study.

PubMed

Heckemann, Birgit; Breimaier, Helga Elisabeth; Halfens, Ruud J G; Schols, Jos M G A; Hahn, Sabine

2016-09-01

Aggression management training for nurses is an important part of a comprehensive strategy to reduce patient and visitor aggression in healthcare. Although training is commonplace, few scientific studies examine its benefits. To explore and describe, from a nurse's perspective, the learning gained from attending aggression management training. This was a descriptive qualitative interview study. We conducted semi-structured individual interviews with seven nurses before (September/October 2012) and after they attended aggression management training (January/February 2013). Interview transcripts were content-analysed qualitatively. The study plan was reviewed by the responsible ethics committees. Participants gave written informed consent. Aggression management training did not change nurses' attitude. Coping emotionally with the management of patient and visitor aggression remained a challenge. Nurses' theoretical knowledge increased, but they did not necessarily acquire new strategies for managing patient/visitor aggression. Instead, the course refreshed or activated existing knowledge of prevention, intervention and de-escalation strategies. The training increased nurses' environmental and situational awareness for early signs of patient and visitor. They also acquired some strategies for emotional self-management. Nurses became more confident in dealing with (potentially) aggressive situations. While the training influenced nurses' individual clinical practice, learning was rarely shared within teams. Aggression management training increases skills, knowledge and confidence in dealing with patient or visitor aggression, but the emotional management remains a challenge. Future research should investigate how aggression management training courses can strengthen nurses' ability to emotionally cope with patient and visitor aggression. More knowledge is needed on how the theoretical and practical knowledge gained from the training may be disseminated more effectively within teams and thus contributed to the creation of low-conflict ward cultures. © 2016 Nordic College of Caring Science.

The How Project: understanding contextual challenges to global surgical care provision in low-resource settings.

PubMed

Raykar, Nakul P; Yorlets, Rachel R; Liu, Charles; Goldman, Roberta; Greenberg, Sarah L M; Kotagal, Meera; Farmer, Paul E; Meara, John G; Roy, Nobhojit; Gillies, Rowan D

2016-01-01

5 billion people around the world do not have access to safe, affordable, timely surgical care. This series of qualitative interviews was launched by The Lancet Commission on Global Surgery (LCoGS) with the aim of understanding the contextual challenges-the specific circumstances-faced by surgical care providers in low-resource settings who care for impoverished patients, and how those providers overcome these challenges. From January 2014 to February 2015, 20 LCoGS collaborators conducted semistructured interviews with 148 surgical providers in low-resource settings in 21 countries. Stratified purposive sampling was used to include both rural and urban providers, and reputational case selection identified individuals. Interviewers were trained with an implementation manual. Following immersion into de-identified texts from completed interviews, topical coding and further analysis of coded texts was completed by an independent analyst with periodic validation from a second analyst. Providers described substantial financial, geographic and cultural barriers to patient access. Rural surgical teams reported a lack of a trained workforce and insufficient infrastructure, equipment, supplies and banked blood. Urban providers face overcrowding, exacerbated by minimal clinical and administrative support, and limited interhospital care coordination. Many providers across contexts identified national health policies that do not reflect the realities of resource-poor settings. Some findings were region-specific, such as weak patient-provider relationships and unreliable supply chains. In all settings, surgical teams have created workarounds to deliver care despite the challenges. While some differences exist between countries, the barriers to safe surgery and anaesthesia are overall consistent and resource-dependent. Efforts to advance and expand global surgery must address these commonalities, while local policymakers can tailor responses to key contextual differences.

Integrating the results of user research into medical device development: insights from a case study.

PubMed

Martin, Jennifer L; Barnett, Julie

2012-07-19

It is well established that considering users is an important aspect of medical device development. However it is also well established that there are numerous barriers to successfully conducting user research and integrating the results into product development. It is not sufficient to simply conduct user research, it must also be effectively integrated into product development. A case study of the development of a new medical imaging device was conducted to examine in detail how users were involved in a medical device development project. Two user research studies were conducted: a requirements elicitation interview study and an early prototype evaluation using contextual inquiry. A descriptive in situ approach was taken to investigate how these studies contributed to the product development process and how the results of this work influenced the development of the technology. Data was collected qualitatively through interviews with the development team, participant observation at development meetings and document analysis. The focus was on investigating the barriers that exist to prevent user data from being integrated into product development. A number of individual, organisational and system barriers were identified that functioned to prevent the results of the user research being fully integrated into development. The user and technological aspects of development were seen as separate work streams during development. The expectations of the developers were that user research would collect requirements for the appearance of the device, rather than challenge its fundamental concept. The manner that the user data was communicated to the development team was not effective in conveying the significance or breadth of the findings. There are a range of informal and formal organisational processes that can affect the uptake of user data during medical device development. Adopting formal decision making processes may assist manufacturers to take a more integrated and reflective approach to development, which should result in improved business decisions and a higher quality end product.

Integrating the results of user research into medical device development: insights from a case study

PubMed Central

2012-01-01

Background It is well established that considering users is an important aspect of medical device development. However it is also well established that there are numerous barriers to successfully conducting user research and integrating the results into product development. It is not sufficient to simply conduct user research, it must also be effectively integrated into product development. Methods A case study of the development of a new medical imaging device was conducted to examine in detail how users were involved in a medical device development project. Two user research studies were conducted: a requirements elicitation interview study and an early prototype evaluation using contextual inquiry. A descriptive in situ approach was taken to investigate how these studies contributed to the product development process and how the results of this work influenced the development of the technology. Data was collected qualitatively through interviews with the development team, participant observation at development meetings and document analysis. The focus was on investigating the barriers that exist to prevent user data from being integrated into product development. Results A number of individual, organisational and system barriers were identified that functioned to prevent the results of the user research being fully integrated into development. The user and technological aspects of development were seen as separate work streams during development. The expectations of the developers were that user research would collect requirements for the appearance of the device, rather than challenge its fundamental concept. The manner that the user data was communicated to the development team was not effective in conveying the significance or breadth of the findings. Conclusion There are a range of informal and formal organisational processes that can affect the uptake of user data during medical device development. Adopting formal decision making processes may assist manufacturers to take a more integrated and reflective approach to development, which should result in improved business decisions and a higher quality end product. PMID:22812565

Study Protocol--Improving Access to Kidney Transplants (IMPAKT): a detailed account of a qualitative study investigating barriers to transplant for Australian Indigenous people with end-stage kidney disease.

PubMed

Devitt, Jeannie; Cass, Alan; Cunningham, Joan; Preece, Cilla; Anderson, Kate; Snelling, Paul

2008-02-04

Indigenous Australians are slightly more than 2% of the total Australian population however, in recent years they have comprised between 6 and 10% of new patients beginning treatment for end-stage kidney disease (ESKD). Although transplant is considered the optimal form of treatment for many ESKD patients there is a pronounced disparity between the rates at which Indigenous ESKD patients receive transplants compared with their non-Indigenous counterparts. The IMPAKT (Improving Access to Kidney Transplants) Interview study investigated reasons for this disparity through a large scale, in-depth interview study involving patients, nephrologists and key decision-making staff at selected Australian transplant and dialysis sites. The design and conduct of the study reflected the multi-disciplinary membership of the core IMPAKT team. Promoting a participatory ethos, IMPAKT established partnerships with a network of hospital transplant units and hospital dialysis treatment centres that provide treatment to the vast majority of Indigenous patients across Australia. Under their auspices, the IMPAKT team conducted in-depth interviews in 26 treatment/service centres located in metropolitan, regional and remote Australia. Peer interviewing supported the engagement of Indigenous patients (146), and nephrologists (19). In total IMPAKT spoke with Indigenous and non-Indigenous patients (241), key renal nursing and other (non-specialist) staff (95) and a small number of relevant others (28). Data analysis was supported by QSR software. At each site, IMPAKT also documented educational programs and resources, mapped an hypothetical 'patient journey' to transplant through the local system and observed patient care and treatment routines. The national scope, inter-disciplinary approach and use of qualitative methods in an investigation of a significant health inequality affecting Indigenous people is, we believe, an Australian first. An exceptionally large cohort of Indigenous participants provided evaluative comment on their health services in relation to dialysis and transplant. Additionally, the data includes extensive parallel commentary from a cohort of specialists, nurses and other staff. The study considers a 'patient journey' to transplant within a diverse range of Australian treatment centre/workplace settings. The IMPAKT Interview study protocol may contribute to improvements in multi-disciplinary, flexible design health services research with hard to reach or vulnerable populations in Australia and elsewhere.

Study Protocol – Improving Access to Kidney Transplants (IMPAKT): A detailed account of a qualitative study investigating barriers to transplant for Australian Indigenous people with end-stage kidney disease

PubMed Central

Devitt, Jeannie; Cass, Alan; Cunningham, Joan; Preece, Cilla; Anderson, Kate; Snelling, Paul

2008-01-01

Background Indigenous Australians are slightly more than 2% of the total Australian population however, in recent years they have comprised between 6 and 10% of new patients beginning treatment for end-stage kidney disease (ESKD). Although transplant is considered the optimal form of treatment for many ESKD patients there is a pronounced disparity between the rates at which Indigenous ESKD patients receive transplants compared with their non-Indigenous counterparts. The IMPAKT (Improving Access to Kidney Transplants) Interview study investigated reasons for this disparity through a large scale, in-depth interview study involving patients, nephrologists and key decision-making staff at selected Australian transplant and dialysis sites. Methods The design and conduct of the study reflected the multi-disciplinary membership of the core IMPAKT team. Promoting a participatory ethos, IMPAKT established partnerships with a network of hospital transplant units and hospital dialysis treatment centres that provide treatment to the vast majority of Indigenous patients across Australia. Under their auspices, the IMPAKT team conducted in-depth interviews in 26 treatment/service centres located in metropolitan, regional and remote Australia. Peer interviewing supported the engagement of Indigenous patients (146), and nephrologists (19). In total IMPAKT spoke with Indigenous and non-Indigenous patients (241), key renal nursing and other (non-specialist) staff (95) and a small number of relevant others (28). Data analysis was supported by QSR software. At each site, IMPAKT also documented educational programs and resources, mapped an hypothetical ‘patient journey’ to transplant through the local system and observed patient care and treatment routines. Discussion The national scope, inter-disciplinary approach and use of qualitative methods in an investigation of a significant health inequality affecting Indigenous people is, we believe, an Australian first. An exceptionally large cohort of Indigenous participants provided evaluative comment on their health services in relation to dialysis and transplant. Additionally, the data includes extensive parallel commentary from a cohort of specialists, nurses and other staff. The study considers a ‘patient journey’ to transplant within a diverse range of Australian treatment centre/workplace settings. The IMPAKT Interview study protocol may contribute to improvements in multi-disciplinary, flexible design health services research with hard to reach or vulnerable populations in Australia and elsewhere. PMID:18248667

Green shoots of recovery: a realist evaluation of a team to support change in general practice.

PubMed

Bartlett, Maggie; Basten, Ruth; McKinley, Robert K

2017-02-08

A multidisciplinary support team for general practice was established in April 2014 by a local National Health Service (NHS) England management team. This work evaluates the team's effectiveness in supporting and promoting change in its first 2 years, using realist methodology. Primary care in one area of England. Semistructured interviews were conducted with staff from 14 practices, 3 key senior NHS England personnel and 5 members of the support team. Sampling of practice staff was purposive to include representatives from relevant professional groups. The team worked with practices to identify areas for change, construct action plans and implement them. While there was no specified timescale for the team's work with practices, it was tailored to each. In realist evaluations, outcomes are contingent on mechanisms acting in contexts, and both an understanding of how an intervention leads to change in a socially constructed system and the resultant changes are outcomes. The principal positive mechanisms leading to change were the support team's expertise and its relationships with practice staff. The 'external view' provided by the team via its corroborative and normalising effects was an important mechanism for increasing morale in some practice contexts. A powerful negative mechanism was related to perceptions of 'being seen as a failing practice' which included expressions of 'shame'. Outcomes for practices as perceived by their staff were better communication, improvements in patients' access to appointments resulting from better clinical and managerial skill mix, and improvements in workload management. The support team promoted change within practices leading to signs of the 'green shoots of recovery' within the time frame of the evaluation. Such interventions need to be tailored and responsive to practices' needs. The team's expertise and relationships between team members and practice staff are central to success. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Conducting a team-based multi-sited focused ethnography in primary care.

PubMed

Bikker, A P; Atherton, H; Brant, H; Porqueddu, T; Campbell, J L; Gibson, A; McKinstry, B; Salisbury, C; Ziebland, S

2017-09-12

Focused ethnography is an applied and pragmatic form of ethnography that explores a specific social phenomenon as it occurs in everyday life. Based on the literature a problem-focused research question is formulated before the data collection. The data generation process targets key informants and situations so that relevant results on the pre-defined topic can be obtained within a relatively short time-span. As part of a theory based evaluation of alternative forms of consultation (such as video, phone and email) in primary care we used the focused ethnographic method in a multisite study in general practice across the UK. To date there is a gap in the literature on using focused ethnography in healthcare research.The aim of the paper is to build on the various methodological approaches in health services research by presenting the challenges and benefits we encountered whilst conducing a focused ethnography in British primary care. Our considerations are clustered under three headings: constructing a shared understanding, dividing the tasks within the team, and the functioning of the focused ethnographers within the broader multi-disciplinary team.As a result of using this approach we experienced several advantages, like the ability to collect focused data in several settings simultaneously within in a short time-span. Also, the sharing of experiences and interpretations between the researchers contributed to a more holistic understanding of the research topic. However, mechanisms need to be in place to facilitate and synthesise the observations, guide the analysis, and to ensure that all researchers feel engaged. Reflection, trust and flexibility among the team members were crucial to successfully adopt a team focused ethnographic approach. When used for policy focussed applied healthcare research a team-based multi-sited focused ethnography can uncover practices and understandings that would not be apparent through surveys or interviews alone. If conducted with care, it can provide timely findings within the fast moving context of healthcare policy and research.

Alaska Humans Factors Safety Study: The Southern Coastal Area

NASA Technical Reports Server (NTRS)

Chappell, Sheryl L.; Reynard, William (Technical Monitor)

1995-01-01

At the request of the Alaska Air Carriers Association, researchers from the NASA Aviation Safety Reporting System, at NASA Ames Research Center, conducted a study on aspects of safety in Alaskan Part 135 air taxi operations. An interview form on human factors safety issues was created by a representative team from the FAA-Alaska, NTSB-Alaska, NASA-ASRS, and representatives of the Alaska Air Carriers Association which was subsequently used in the interviews of pilots and managers. Because of the climate and operational differences, the study was broken into two geographical areas, the southern coastal areas and the northern portion of the state. This presentation addresses the southern coastal areas, specifically: Anchorage, Dillingham, King Salmon, Kodiak, Cold Bay, Juneau, and Ketchikan. The interview questions dealt with many of the potential pressures on pilots and managers associated with the daily air taxi operations in Alaska. The impact of the environmental factors such as the lack of available communication, navigation and weather information systems was evaluated. The results of this study will be used by government and industry working in Alaska. These findings will contribute important information on specific Alaska safety issues for eventual incorporation into training materials and policies that will help to assure the safe conduct of air taxi flights in Alaska.

QMHC interview: Peter R. Scholtes [by Marie E. Sinioris].

PubMed

Scholtes, P R

1993-01-01

Peter R. Scholtes has a unique perspective on what it takes to build a world-class quality organization: A transformation of the relationships, environment, and dynamics within and between individuals and groups throughout an organization. He brings an organizational development perspective to quality management and, in particular, to the approach and practices advocated by W. Edwards Deming. This interview explores Mr. Scholtes' in-depth understanding and sometimes controversial views on quality improvement teams, team training, and performance appraisal.

Exploring dental student participation in interdisciplinary care team conferences in long-term care.

PubMed

Huynh, Jeremy; Donnelly, Leeann R; Brondani, Mario A

2017-06-01

The purpose of this study was to explore how the participation of dental hygiene students in interdisciplinary care conferences conducted in long-term care (LTC) facilities influenced the staff's awareness of oral health, the student's provision of care as well as the student's ability to work on an interdisciplinary team. Oral health in LTC continues to be poor despite many educational and clinical interventions. The care of a frail elder requires an interdisciplinary team approach, yet dental professionals are often absent from these teams. As an educational intervention, dental hygiene students, in addition to providing clinical care to residents and education to staff in a LTC facility, have been participating in interdisciplinary care conferences for 4 years. Nine LTC facility staff and eight students participated in two focus groups and five personal interviews to discuss their experiences of the care conferences. Narratives were transcribed verbatim and thematic analysis was conducted. Four major themes emerged that described the essence of the experience of involving dental professionals within interdisciplinary care conference: (i) addressing oral health, (ii) reciprocal learning, (iii) dealing with complexity and (iv) impact of collaborative care. Overall, students found the educational intervention to be worthwhile that allowed for the development of interdisciplinary skills and a greater understanding of dental geriatrics. The dental support in care conferences was welcomed by the staff as it facilitated a new way of exchanging knowledge and experiences so that a more holistic approach to care could be undertaken by all. © 2017 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

Multidisciplinary obstetric simulated emergency scenarios (MOSES): promoting patient safety in obstetrics with teamwork-focused interprofessional simulations.

PubMed

Freeth, Della; Ayida, Gubby; Berridge, Emma Jane; Mackintosh, Nicola; Norris, Beverley; Sadler, Chris; Strachan, Alasdair

2009-01-01

We describe an example of simulation-based interprofessional continuing education, the multidisciplinary obstetric simulated emergency scenarios (MOSES) course, which was designed to enhance nontechnical skills among obstetric teams and, hence, improve patient safety. Participants' perceptions of MOSES courses, their learning, and the transfer of learning to clinical practice were examined. Participants included senior midwives, obstetricians, and obstetric anesthetists, including course faculty from 4 purposively selected delivery suites in England. Telephone or e-mail interviews with MOSES course participants and facilitators were conducted, and video-recorded debriefings that formed integral parts of this 1-day course were analyzed. The team training was well received. Participants were able to check out assumptions and expectations of others and develop respect for different roles within the delivery suite (DS) team. Skillful facilitation of debriefing after each scenario was central to learning. Participants reported acquiring new knowledge or insights, particularly concerning the role of communication and leadership in crisis situations, and they rehearsed unfamiliar skills. Observing peers working in the simulations increased participants' learning by highlighting alternative strategies. The learning achieved by individuals and groups was noticeably dependent on their starting points. Some participants identified limited changes in their behavior in the workplace following the MOSES course. Mechanisms to manage the transfer of learning to the wider team were weakly developed, although 2 DS teams made changes to their regular update training. Interprofessional, team-based simulations promote new learning.

Sustaining innovations in complex healthcare environments: A multiple-case study of rapid response teams

PubMed Central

Stolldorf, Deonni P; Havens, Donna S.; Jones, Cheryl B

2015-01-01

Objectives Rapid response teams are one innovation previously deployed in U.S. hospitals with the goal to improve the quality of care. Sustaining rapid response teams is important to achieve the desired implementation outcomes, reduce the risk of program investments losses, and prevent employee disillusionment and dissatisfaction. This study sought to examine factors that do and do not support the sustainability of Rapid Response Teams. Methods The study was conceptually guided by an adapted version of the Planning Model of Sustainability. A multiple-case study was conducted using a purposive sample of two hospitals with high RRT sustainability scores and two hospitals with low RRT sustainability scores. Data collection methods included: (a) a hospital questionnaire that was completed by a nurse administrator at each hospital; (b) semi-structured interviews with leaders, RRT members, and those activating RRT calls; and, (c) review of internal documents. Quantitative data were analyzed using descriptive statistics; qualitative data were analyzed using content analysis. Results Few descriptive differences were found between hospitals. However, there were notable differences in the operationalization of certain factors between high- and low-sustainability hospitals. Additional sustainability factors other than those captured by the Planning Model of Sustainability were also identified. Conclusions The sustainability of rapid response teams is optimized through effective operationalization of organizational and project design and implementation factors. Two additional factors—individual and team characteristics—should be included in the Planning Model of Sustainability and considered as potential facilitators (or inhibitors) of RRT sustainability. PMID:26756725

Teachers' perceptions of the role of nurses: caring for children who are technology-dependent in mainstream schools.

PubMed

Shimizu, Fumie; Katsuda, Hitomi

2015-01-01

This study explored special education teachers' perceptions of the role of nurses who specialize in providing nursing care to children who are technology-dependent in mainstream schools. Semistructured interviews with 11 teachers were conducted, and data were analyzed using inductive content analysis. The teachers surveyed thought that the most important role of nurses was to maintain good health and safety, as well as to support children's education as members of the educational team. Teachers desired that nurses give advice based on their professional knowledge to maintain the children's good health and safety. In supporting education, nurses were required to support the children's autonomy and education, and to act as members of the educational team. Study findings suggest that, for an optimal relationship with teachers, nurses who provide nursing care for children who are technology-dependent in mainstream schools need not only fulfill medical functions, but also support the education of children as members of the educational team. © 2014 The Authors. Japan Journal of Nursing Science © 2014 Japan Academy of Nursing Science.

Balancing performance-based expectations with a holistic perspective on coaching: a qualitative study of Swedish women's national football team coaches' practice experiences.

PubMed

Lindgren, Eva-Carin; Barker-Ruchti, Natalie

2017-12-01

The purpose of this study was to explore how an exclusive sample of women's national football team coaches described how they implement careful coaching while facing social and organizational pressure to win medals. To consider coaches' negotiations, we drew on Noddings' concept of caring. Using an interpretive research paradigm, we conducted in-depth interviews with five Swedish women's national football team coaches. An abductive approach was used to simultaneously process the theoretical framework of "ethics of care" and the empirical data. The coaches unanimously adopted a holistic perspective to coaching. The coaching strategies they described included promoting players' development, well-being, and sustainable elite performance; listening to the players' voices and engaging in dialogue; and creating a positive environment and promoting fair play. These findings demonstrate that the women coaches, despite performance pressure, adopt caring coaching in the form of Noddings' pedagogical modelling, dialogue, and confirmation strategies, and provide an example of how coaches can adopt caring, holistic, and athlete-centred coaching while working at the highest level of competitive sport and achieving competitive success.

Collaborating across the Departments of Veterans Affairs and Defense to integrate mental health and chaplaincy services.

PubMed

Nieuwsma, Jason A; Jackson, George L; DeKraai, Mark B; Bulling, Denise J; Cantrell, William C; Rhodes, Jeffrey E; Bates, Mark J; Ethridge, Keith; Lane, Marian E; Tenhula, Wendy N; Batten, Sonja V; Meador, Keith G

2014-12-01

Recognizing that clergy and spiritual care providers are a key part of mental health care systems, the Department of Veterans Affairs (VA) and Department of Defense (DoD) jointly examined chaplains' current and potential roles in caring for veterans and service members with mental health needs. Our aim was to evaluate the intersection of chaplain and mental health care practices in VA and DoD in order to determine if improvement is needed, and if so, to develop actionable recommendations as indicated by evaluation findings. A 38-member multidisciplinary task group partnered with researchers in designing, implementing, and interpreting a mixed methods study that included: 1) a quantitative survey of VA and DoD chaplains; and 2) qualitative interviews with mental health providers and chaplains. Quantitative: the survey included all full-time VA chaplains and all active duty military chaplains (n = 2,163 completed of 3,464 invited; 62 % response rate). Qualitative: a total of 291 interviews were conducted with mental health providers and chaplains during site visits to 33 VA and DoD facilities. Quantitative: the online survey assessed intersections between chaplaincy and mental health care and took an average of 37 min to complete. Qualitative: the interviews assessed current integration of mental health and chaplain services and took an average of 1 h to complete. When included on interdisciplinary mental health care teams, chaplains feel understood and valued (82.8-100 % of chaplains indicated this, depending on the team). However, findings from the survey and site visits suggest that integration of services is often lacking and can be improved. Closely coordinating with a multidisciplinary task group in conducting a mixed method evaluation of chaplain-mental health integration in VA and DoD helped to ensure that researchers assessed relevant domains and that findings could be rapidly translated into actionable recommendations.

Knowledge translation lessons from an audit of Aboriginal Australians with acute coronary syndrome presenting to a regional hospital

PubMed Central

Haynes, Emma; Hohnen, Harry; Katzenellenbogen, Judith M; Scalley, Benjamin D; Thompson, Sandra C

2016-01-01

Objective: Translation of evidence into practice by health systems can be slow and incomplete and may disproportionately impact disadvantaged populations. Coronary heart disease is the leading cause of death among Aboriginal Australians. Timely access to effective medical care for acute coronary syndrome substantially improves survival. A quality-of-care audit conducted at a regional Western Australian hospital in 2011–2012 compared the Emergency Department management of Aboriginal and non-Aboriginal acute coronary syndrome patients. This audit is used as a case study of translating knowledge processes in order to identify the factors that support equity-oriented knowledge translation. Methods: In-depth interviews were conducted with a purposive sample of the audit team and further key stakeholders with interest/experience in knowledge translation in the context of Aboriginal health. Interviews were analysed for alignment of the knowledge translation process with the thematic steps outlined in Tugwell’s cascade for equity-oriented knowledge translation framework. Results: In preparing the audit, groundwork helped shape management support to ensure receptivity to targeting Aboriginal cardiovascular outcomes. Reporting of audit findings and resulting advocacy were undertaken by the audit team with awareness of the institutional hierarchy, appropriate timing, personal relationships and recognising the importance of tailoring messages to specific audiences. These strategies were also acknowledged as important in the key stakeholder interviews. A follow-up audit documented a general improvement in treatment guideline adherence and a reduction in treatment inequalities for Aboriginal presentations. Conclusion: As well as identifying outcomes such as practice changes, a useful evaluation increases understanding of why and how an intervention worked. Case studies such as this enrich our understanding of the complex human factors, including individual attributes, experiences and relationships and systemic factors that shape equity-oriented knowledge translation. Given the potential that improving knowledge translation has to close the gap in Aboriginal health disparities, we must choose strategies that adequately take into account the unique contingencies of context across institutions and cultures. PMID:27516880

Knowledge translation lessons from an audit of Aboriginal Australians with acute coronary syndrome presenting to a regional hospital.

PubMed

Haynes, Emma; Hohnen, Harry; Katzenellenbogen, Judith M; Scalley, Benjamin D; Thompson, Sandra C

2016-01-01

Translation of evidence into practice by health systems can be slow and incomplete and may disproportionately impact disadvantaged populations. Coronary heart disease is the leading cause of death among Aboriginal Australians. Timely access to effective medical care for acute coronary syndrome substantially improves survival. A quality-of-care audit conducted at a regional Western Australian hospital in 2011-2012 compared the Emergency Department management of Aboriginal and non-Aboriginal acute coronary syndrome patients. This audit is used as a case study of translating knowledge processes in order to identify the factors that support equity-oriented knowledge translation. In-depth interviews were conducted with a purposive sample of the audit team and further key stakeholders with interest/experience in knowledge translation in the context of Aboriginal health. Interviews were analysed for alignment of the knowledge translation process with the thematic steps outlined in Tugwell's cascade for equity-oriented knowledge translation framework. In preparing the audit, groundwork helped shape management support to ensure receptivity to targeting Aboriginal cardiovascular outcomes. Reporting of audit findings and resulting advocacy were undertaken by the audit team with awareness of the institutional hierarchy, appropriate timing, personal relationships and recognising the importance of tailoring messages to specific audiences. These strategies were also acknowledged as important in the key stakeholder interviews. A follow-up audit documented a general improvement in treatment guideline adherence and a reduction in treatment inequalities for Aboriginal presentations. As well as identifying outcomes such as practice changes, a useful evaluation increases understanding of why and how an intervention worked. Case studies such as this enrich our understanding of the complex human factors, including individual attributes, experiences and relationships and systemic factors that shape equity-oriented knowledge translation. Given the potential that improving knowledge translation has to close the gap in Aboriginal health disparities, we must choose strategies that adequately take into account the unique contingencies of context across institutions and cultures.

Professional's Perspectives on Care Management of Young People with Perinatally Acquired HIV during Transition: A Qualitative Study in Adult Care Setting.

PubMed

Le Roux, Enora; Gottot, Serge; Aupiais, Camille; Girard, Thomas; Teixeira, Maria; Alberti, Corinne

2017-01-01

Increasing numbers of young people with perinatally acquired HIV are surviving to adulthood. When they come of age, they leave pediatric services in which they were followed and have to be transferred to the adult health care system. Difficulties in adaptation to adult care and the numbers of young people lost to follow up after transfer to adult care have been reported. This transition phase and their retention in adult care are crucial in maintaining the clinical status of these young with HIV in adulthood. Our study aimed to explore how HIV professionals working in adult care perceive and adapt their practices to young people in transition. Qualitative interviews were conducted with 18 health and social services professionals in hospitals or patient associations in France. A thematic analysis was conducted. Adult care professionals were found to be making a distinction between these young people and their patients who were infected during adulthood. On the basis of the healthcare teams' experience, a simplified categorization of these young people into four levels can be used: those "who have everything good"; those who have some deficiencies that must be addressed; those "who have everything bad"; and those lost to follow up. Professionals interviewed highlighted the difficulties they encountered with young people in transition. Three types of problematic situations were identified: problems of acceptance of the disease; communication problems; and problems of disorientation in the new care environment. Despite the lack of specific training or national policy recommendations for the integration of young people with perinatally acquired HIV into adult services, all the adult healthcare teams interviewed tried to adapt their practice to this population. The results suggested that professional involvement during transition should depend on the characteristics of the patient, not be limited to a single transition model and that a dedicated structure for transition care is not appropriate for all young people.

After the Liverpool Care Pathway—development of heuristics to guide end of life care for people with dementia: protocol of the ALCP study

PubMed Central

Davies, N; Manthorpe, J; Sampson, E L; Iliffe, S

2015-01-01

Introduction End of life care guidance for people with dementia is lacking and this has been made more problematic in England with the removal of one of the main end of life care guidelines which offered some structure, the Liverpool Care Pathway. This guidance gap may be eased with the development of heuristics (rules of thumb) which offer a fast and frugal form of decision-making. Objective To develop a toolkit of heuristics (rules of thumb) for practitioners to use when caring for people with dementia at the end of life. Method and analysis A mixed-method study using a co-design approach to develop heuristics in three phases. In phase 1, we will conduct at least six focus groups with family carers, health and social care practitioners from both hospital and community care services, using the ‘think-aloud’ method to understand decision-making processes and to develop a set of heuristics. The focus group topic guide will be developed from the findings of a previous study of 46 interviews of family carers about quality end-of-life care for people with dementia and a review of the literature. A multidisciplinary development team of health and social care practitioners will synthesise the findings from the focus groups to devise and refine a toolkit of heuristics. Phase 2 will test the use of heuristics in practice in five sites: one general practice, one community nursing team, one hospital ward and two palliative care teams working in the community. Phase 3 will evaluate and further refine the toolkit of heuristics through group interviews, online questionnaires and semistructured interviews. Ethics and dissemination This study has received ethical approval from a local NHS research ethics committee (Rec ref: 15/LO/0156). The findings of this study will be presented in peer-reviewed publications and national and international conferences. PMID:26338688

Using research evidence to inform staff learning needs in cross-cultural communication in aged care homes.

PubMed

Gillham, David; De Bellis, Anita; Xiao, Lily; Willis, Eileen; Harrington, Ann; Morey, Wendy; Jeffers, Lesley

2018-04-01

Developed countries worldwide are facing an unprecedented demand for aged care services, with recent migrants of diverse linguistic and cultural backgrounds increasingly recruited as care workers while at the same time there is growing cultural diversity among aged care residents. This situation is compounded by rapidly changing technology and varied educational levels of care workers from diverse backgrounds. The objectives were threefold: to identify staff learning needs to enable them to provide high-quality cross-cultural care; to improve team cohesion; and identify preferred learning approaches. An interpretive qualitative study utilising focus group and interview data informed the development of an education resource. Fifty six care workers from four residential aged care facilities participated in either focus groups or interviews conducted in private meeting rooms within the care facilities. Participants included personal care attendants, registered and clinical nurses, managers, hospitality staff and allied health professionals. Focus group and interview data were categorised and thematically analysed. Data relevant to cross-cultural care, team cohesion and preferred learning approaches informed education resource development, including case studies. Major themes identified the need to promote cultural awareness and understanding, and strategies for cross-cultural care and communication. Themes related to team cohesion demonstrated that staff were already sympathetic and sensitive to cross-cultural issues, and that culturally and linguistically diverse staff add value to the workforce and are supported by the organisation. Staff required clear, uncomplicated education resources to equip them with skills to address problematic cultural situations. Preferred learning approaches varied and highlighted the need for varied educational materials and approaches, as well as time efficient, opportunistic education strategies for the busy workplace. An education package was developed to value cultural diversity in the aged care workplace for staff and residents, and provide an exemplar for evidence informed education. Copyright © 2018 Elsevier Ltd. All rights reserved.

Environmental Survey preliminary report, Los Alamos National Laboratory, Los Alamos, New Mexico

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

Not Available

1988-01-01

This report presents the preliminary findings from the first phase of the Environmental Survey of the United States Department of Energy's (DOE) Los Alamos National Laboratory (LANL), conducted March 29, 1987 through April 17, 1987. The Survey is being conducted by an interdisciplinary team of environmental specialists, led and managed by the Office of Environment, Safety and Health's Office of Environmental Audit. Individual team components are outside experts being supplied by a private contractor. The objective of the Survey is to identify environmental problems and areas of environmental risk associated with the LANL. The Survey covers all environmental media andmore » all areas of environmental regulation. It is being performed in accordance with the DOE Environmental Survey Manual. The on-site phase of the Survey involves the review of existing site environmental data, observations of the operations carried on at the LANL, and interviews with site personnel. The Survey team developed Sampling and Analysis Plan to assist in further assessing certain of the environmental problems identified during its on-site activities. The Sampling and Analysis Plan will be executed by the Idaho National Engineering Laboratory. When completed, the results will be incorporated into the LANL Environmental Survey Interim Report. The Interim Report will reflect the final determinations of the Survey for the LANL. 65 refs., 68 figs., 73 tabs.« less

Environmental Survey preliminary report, Pantex Facility, Amarillo, Texas

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

Not Available

This report presents the preliminary findings from the first phase of the Environmental Survey of the United States Department of Energy (DOE) Pantex Facility, conducted November 3 through 14, 1986.The Survey is being conducted by an interdisciplinary team of environmental specialist, led and managed by the Office of Environment, Safety and Health's Office of Environmental Audit. Individual team components are outside experts being supplied by a private contractor. The objective of the Survey is to identify environmental problems and areas of environmental risk associated with the Pantex Facility. The Survey covers all environmental media and all areas of environmental regulation.more » It is being performed in accordance with the DOE Environmental Survey Manual. The on-site phase of the Survey involves the review of existing site environmental data, observations of the operations carried on at the Pantex Facility, and interviews with site personnel. The Survey team developed a Sampling and Analysis Plan to assist in further assessing certain of the environmental problems identified during its on-site activities. The Sampling and Analysis Plan will be executed by the Oak Ridge National Laboratory. When completed, the results will be incorporated into the Pantex Facility Environmental Survey Interim Report. The Interim Report will reflect the final determinations of the Survey for the Pantex Facility. 65 refs., 44 figs., 27 tabs.« less

The Essence of Using Collaborative Technology for Virtual Team Members: A Study Using Interpretative Phenomenology

ERIC Educational Resources Information Center

Houck, Christiana L.

2013-01-01

This interpretative phenomenological study used semi-structured interviews of 10 participants to gain a deeper understanding of the experience for virtual team members using collaborative technology. The participants were knowledge workers from global software companies working on cross-functional project teams at a distance. There were no…

The Perspective of Women Managing Research Teams in Social Sciences

ERIC Educational Resources Information Center

Tomas, Marina; Castro, Diego

2013-01-01

This article presents a research study that focuses on how women manage research teams. More specifically, the study aims to ascertain the perception of female researchers who are leaders of research groups in social sciences with regard to the formation, operation and management of their research teams. Fifteen interviews were carried out, eight…

Team Building OD Interventions and Outcomes in a Public School.

ERIC Educational Resources Information Center

Patterson, Wade N.; DeVille, Anthony P.

This paper describes a study of an organization development intervention with an eight-person teaching-support-administrative team in a suburban elementary school. Data for the study were gathered through observation by two participant-observers, through interviews with all eight direct participants in the team-building project, and through a…

A longitudinal interprofessional simulation curriculum for critical care teams: Exploring successes and challenges.

PubMed

Leclair, Laurie W; Dawson, Mary; Howe, Alison; Hale, Sue; Zelman, Eric; Clouser, Ryan; Garrison, Garth; Allen, Gilman

2018-05-01

Interprofessional care teams are the backbone of intensive care units (ICUs) where severity of illness is high and care requires varied skills and experience. Despite this care model, longitudinal educational programmes for such workplace teams rarely include all professions. In this article, we report findings on the initial assessment and evaluation of an ongoing, longitudinal simulation-based curriculum for interprofessional workplace critical care teams. The study had two independent components, quantitative learner assessment and qualitative curricular evaluation. To assess curriculum effectiveness at meeting learning objectives, participant-reported key learning points identified using a self-assessment tool administered immediately following curricular participation were mapped to session learning objectives. To evaluate the curriculum, we conducted a qualitative study using a phenomenology approach involving purposeful sampling of nine curricular participants undergoing recorded semi-structured interviews. Verbatim transcripts were reviewed by two independent readers to derive themes further subdivided into successes and barriers. Learner self-assessment demonstrated that the majority of learners, across all professions, achieved at least one intended learning objective with senior learners more likely to report team-based objectives and junior learners more likely to report knowledge/practice objectives. Successes identified by curricular evaluation included authentic critical care curricular content, safe learning environment, and team comradery from shared experience. Barriers included unfamiliarity with the simulation environment and clinical coverage for curricular participation. This study suggests that a sustainable interprofessional curriculum for workplace ICU critical care teams can achieve the desired educational impact and effectively deliver authentic simulated work experiences if barriers to educational engagement and participation can be overcome.

Impacts of dairy diagnostic teams on herd performance.

PubMed

Weinand, D; Conlin, B J

2003-05-01

This study evaluated impacts of educational diagnostic teams of consultants used to transfer technology to dairy farms. Herd management performance changes were measured by comparing Dairy Herd Improvement data from 38 project farms to data from herds that were geographical contemporaries. The value of focused goals for effecting change was also assessed. Interviews provided producers' perception of project outcomes and insight on organization and conduct of dairy diagnostic teams. Changes observed in project herds were small compared with controls with tendencies for increased herd size and improved milk production per cow. Focused goals had greater impacts on increasing herd size, milk per cow, first lactation peak milk, reducing age at first calving, and percentages of cows with subclinical mastitis. Time, money, facility limitations, labor, and alternative priorities were the most cited constraints to implementing changes. Satisfaction scores of producers were significantly related to the degree that team recommendations were followed. Improved attitudes, quality of life, and financial well-being were benefits listed by a majority of producers from participation in the project. If similar projects were to be offered, 83% said they would participate again, and 69% indicated they would pay at least some of the costs. Project farms served as demonstration farms for 1930 other producers in their respective locales, resulting in a multiplier effect of original advice given by consultant teams. Suggestions by farmer participants for improvements in dairy diagnostic teams included needs for at least some unbiased team members, more frequent meetings, more follow-up on recommendations, and consistency of recommendations with family goals.

Team communication amongst clinical teachers in a formal meeting of post graduate medical training.

PubMed

Slootweg, Irene A; Scherpbier, Albert; van der Leeuw, Renée; Heineman, Maas Jan; van der Vleuten, Cees; Lombarts, Kiki M J M H

2016-03-01

The importance of team communication, or more specifically speaking up, for safeguarding quality of patient care is increasingly being endorsed in research findings. However, little is known about speaking up of clinical teachers in postgraduate medical training. In order to determine how clinical teachers demonstrate speaking up in formal teaching team meetings and what factors influence this, the authors carried out an exploratory study based on ethnographic principles. The authors selected 12 teaching teams and observed, audio recorded and analysed the data. Subsequently, during an interview, the program directors reflected on speaking up of those clinical teachers present during the meeting. Finally, the authors analysed iteratively all data, using a template analysis, based on Edmondson's behaviours of speaking up. The study was conducted from October 2013 to July 2014 and ten teams participated. During the teaching team meetings, the clinical teachers exhibited most of the behaviours of speaking up. "Sharing information" strongly resembles providing information and "talking about mistakes" occurs in a general sense and without commitment of improvement activities. "Asking questions" was often displayed by closed questions and at times several questions simultaneously. The authors identified factors that influence speaking up by clinical teachers: relational, cultural, and professional. The clinical teachers exhibit speaking up, but there is only limited awareness to discuss problems or mistakes and the discussion centred mainly on the question of blame. It is important to take into account the factors that influence speaking up, in order to stimulate open communication during the teaching team meetings.

A Multimethod Analysis of Shared Decision-Making in Hospice Interdisciplinary Team Meetings Including Family Caregivers

PubMed Central

Washington, Karla T.; Oliver, Debra Parker; Gage, L. Ashley; Albright, David L.; Demiris, George

2015-01-01

Background Much of the existing research on shared decision-making in hospice and palliative care focuses on the provider-patient dyad; little is known about shared decision-making that is inclusive of family members of patients with advanced disease. Aim We sought to describe shared decision-making as it occurred in hospice interdisciplinary team meetings that included family caregivers as participants using video-conferencing technology. Design We conducted a multimethod study in which we used content and thematic analysis techniques to analyze video-recordings of hospice interdisciplinary team meetings (n = 100), individual interviews of family caregivers (n = 73) and hospice staff members (n = 78), and research field notes. Setting/participants Participants in the original studies from which data for this analysis were drawn were hospice family caregivers and staff members employed by one of five different community-based hospice agencies located in the Midwestern United States. Results Shared decision-making occurred infrequently in hospice interdisciplinary team meetings that included family caregivers. Barriers to shared decision-making included time constraints, communication skill deficits, unaddressed emotional needs, staff absences, and unclear role expectations. The hospice philosophy of care, current trends in health care delivery, the interdisciplinary nature of hospice teams, and the designation of a team leader/facilitator supported shared decision-making. Conclusions The involvement of family caregivers in hospice interdisciplinary team meetings using video-conferencing technology creates a useful platform for shared decision-making; however, steps must be taken to transform family caregivers from meeting attendees to shared decision-makers. PMID:26281854

A multimethod analysis of shared decision-making in hospice interdisciplinary team meetings including family caregivers.

PubMed

Washington, Karla T; Oliver, Debra Parker; Gage, L Ashley; Albright, David L; Demiris, George

2016-03-01

Much of the existing research on shared decision-making in hospice and palliative care focuses on the provider-patient dyad; little is known about shared decision-making that is inclusive of family members of patients with advanced disease. We sought to describe shared decision-making as it occurred in hospice interdisciplinary team meetings that included family caregivers as participants using video-conferencing technology. We conducted a multimethod study in which we used content and thematic analysis techniques to analyze video-recordings of hospice interdisciplinary team meetings (n = 100), individual interviews of family caregivers (n = 73) and hospice staff members (n = 78), and research field notes. Participants in the original studies from which data for this analysis were drawn were hospice family caregivers and staff members employed by one of five different community-based hospice agencies located in the Midwestern United States. Shared decision-making occurred infrequently in hospice interdisciplinary team meetings that included family caregivers. Barriers to shared decision-making included time constraints, communication skill deficits, unaddressed emotional needs, staff absences, and unclear role expectations. The hospice philosophy of care, current trends in healthcare delivery, the interdisciplinary nature of hospice teams, and the designation of a team leader/facilitator supported shared decision-making. The involvement of family caregivers in hospice interdisciplinary team meetings using video-conferencing technology creates a useful platform for shared decision-making; however, steps must be taken to transform family caregivers from meeting attendees to shared decision-makers. © The Author(s) 2015.

Error or "act of God"? A study of patients' and operating room team members' perceptions of error definition, reporting, and disclosure.

PubMed

Espin, Sherry; Levinson, Wendy; Regehr, Glenn; Baker, G Ross; Lingard, Lorelei

2006-01-01

Calls abound for a culture change in health care to improve patient safety. However, effective change cannot proceed without a clear understanding of perceptions and beliefs about error. In this study, we describe and compare operative team members' and patients' perceptions of error, reporting of error, and disclosure of error. Thirty-nine interviews of team members (9 surgeons, 9 nurses, 10 anesthesiologists) and patients (11) were conducted at 2 teaching hospitals using 4 scenarios as prompts. Transcribed responses to open questions were analyzed by 2 researchers for recurrent themes using the grounded-theory method. Yes/no answers were compared across groups using chi-square analyses. Team members and patients agreed on what constitutes an error. Deviation from standards and negative outcome were emphasized as definitive features. Patients and nurse professionals differed significantly in their perception of whether errors should be reported. Nurses were willing to report only events within their disciplinary scope of practice. Although most patients strongly advocated full disclosure of errors (what happened and how), team members preferred to disclose only what happened. When patients did support partial disclosure, their rationales varied from that of team members. Both operative teams and patients define error in terms of breaking the rules and the concept of "no harm no foul." These concepts pose challenges for treating errors as system failures. A strong culture of individualism pervades nurses' perception of error reporting, suggesting that interventions are needed to foster collective responsibility and a constructive approach to error identification.

CE: Original Research: Exploring Clinicians' Perceptions About Sustaining an Evidence-Based Fall Prevention Program.

PubMed

Porter, Rebecca B; Cullen, Laura; Farrington, Michele; Matthews, Grace; Tucker, Sharon

2018-05-01

: Purpose: This study aimed to address the knowledge gap between implementing and sustaining evidence-based fall prevention practices for hospitalized patients by exploring perspectives of the interprofessional health care team. A qualitative design was used to capture insights from clinicians across disciplines in a large midwestern academic medical center. Four homogenous semistructured focus groups and three individual interviews involving a total of 20 clinicians were conducted between October 2013 and March 2014. Audio-recorded data were transcribed and analyzed using inductive qualitative analysis. Two primary themes emerged from participants regarding the sustainability of an evidence-based fall prevention program: communication patterns within the interprofessional health care team and influences of hospital organizational practices and elements. Several subthemes also emerged. Participants gave nursing staff primary responsibility for fall risk assessment and prevention. Individual professional perceptions and practices, as well as organizational characteristics, affect the sustainability of evidence-based fall prevention practices. While all team members recognized patient falls as a significant quality and safety issue, most believed that direct care nurses hold primary responsibility for leading fall prevention efforts. The data support the importance of effective interprofessional team communication and organizational practices in sustaining an evidence-based fall prevention program across inpatient units. Furthermore, the data call into question the wisdom in labeling quality indicators as "nursing sensitive"; the evidence indicates that a team approach is best.

Primary Care Clinic Re-Design for Prescription Opioid Management.

PubMed

Parchman, Michael L; Von Korff, Michael; Baldwin, Laura-Mae; Stephens, Mark; Ike, Brooke; Cromp, DeAnn; Hsu, Clarissa; Wagner, Ed H

The challenge of responding to prescription opioid overuse within the United States has fallen disproportionately on the primary care clinic setting. Here we describe a framework comprised of 6 Building Blocks to guide efforts within this setting to address the use of opioids for chronic pain. Investigators conducted site visits to thirty primary care clinics across the United States selected for their use of team-based workforce innovations. Site visits included interviews with leadership, clinic tours, observations of clinic processes and team meetings, and interviews with staff and clinicians. Data were reviewed to identify common attributes of clinic system changes around chronic opioid therapy (COT) management. These concepts were reviewed to develop narrative descriptions of key components of changes made to improve COT use. Twenty of the thirty sites had addressed improvements in COT prescribing. Across these sites a common set of 6 Building Blocks were identified: 1) providing leadership support; 2) revising and aligning clinic policies, patient agreements (contracts) and workflows; 3) implementing a registry tracking system; 4) conducting planned, patient-centered visits; 5) identifying resources for complex patients; and 6) measuring progress toward achieving clinic objectives. Common components of clinic policies, patient agreements and data tracked in registries to assess progress are described. In response to prescription opioid overuse and the resulting epidemic of overdose and addiction, primary care clinics are making improvements driven by a common set of best practices that address complex challenges of managing COT patients in primary care settings. © Copyright 2017 by the American Board of Family Medicine.

Adapting the Patient-Centered Medical Home to Address Psychosocial Adversity: Results of a Qualitative Study.

PubMed

Vu, Cecilia; Rothman, Emily; Kistin, Caroline J; Barton, Kelly; Bulman, Barb; Budzak-Garza, Ann; Olson-Dorff, Denyse; Bair-Merritt, Megan H

The patient-centered medical home (PCMH) seeks to improve population health. However, PCMH models often focus on improving treatment of chronic diseases rather than on addressing psychosocial adversity. We sought to gather key stakeholder input about how PCMHs might feasibly and sustainably address psychosocial adversity within their patient populations. We conducted 25 semistructured interviews with key stakeholders, such as physicians, nurses, medical assistants, and patients. The audiorecorded interviews focused on participants' perceptions of the best ways to modify the PCMH to address patients' psychosocial adversity. To facilitate information gathering, a fictional patient case was presented. Analyses were conducted using a 3-stage content-analysis process. Participants identified provider-related and systems-level changes necessary for addressing these psychosocial adversities effectively. On the provider level, participants thought that practitioners should foster trusting relationships with patients and should be emotionally present as patients describe their life experiences. Participants also emphasized that providers need to have sensitive conversations about adversity and resilience. On a systems level, participants discussed that documentation must balance privacy and include relevant information in the medical record. In addition, care should be delivered not by a single provider but by a team that has a longitudinal relationship with the patient; this care team should include behavioral health support. Participants provided practical strategies and highlighted provider and systems level changes to adequately address patients' prior psychosocial adversity. Future studies need to assess the degree to which such a trauma-informed approach improves patient access, outcomes, and care quality, and reduces cost. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

"It's very complicated": a qualitative study of medicines management in intermediate care facilities in Northern Ireland.

PubMed

Millar, Anna N; Hughes, Carmel M; Ryan, Cristín

2015-06-02

Intermediate care (IC) describes a range of services targeted at older people, aimed at preventing unnecessary hospitalisation, promoting faster recovery from illness and maximising independence. Older people are at increased risk of medication-related adverse events, but little is known about the provision of medicines management services in IC facilities. This study aimed to describe the current provision of medicines management services in IC facilities in Northern Ireland (NI) and to explore healthcare workers' (HCWs) and patients' views of, and attitudes towards these services and the IC concept. Semi-structured interviews were conducted, recorded, transcribed verbatim and analysed using a constant comparative approach with HCWs and patients from IC facilities in NI. Interviews were conducted with 25 HCWs and 18 patients from 12 IC facilities in NI. Three themes were identified: 'concept and reality', 'setting and supply' and 'responsibility and review'. A mismatch between the concept of IC and the reality was evident. The IC facility setting dictated prescribing responsibilities and the supply of medicines, presenting challenges for HCWs. A lack of a standardised approach to responsibility for the provision of medicines management services including clinical review was identified. Whilst pharmacists were not considered part of the multidisciplinary team, most HCWs recognised a need for their input. Medicines management was not a concern for the majority of IC patients. Medicines management services are not integral to IC and medicine-related challenges are frequently encountered. Integration of pharmacists into the multidisciplinary team could potentially improve medicines management in IC.

Using Interprofessional Learning for Continuing Education: Development and Evaluation of the Graduate Certificate Program in Health Professional Education for Clinicians.

PubMed

Henderson, Saras; Dalton, Megan; Cartmel, Jennifer

2016-01-01

Health professionals may be expert clinicians but do not automatically make effective teachers and need educational development. In response, a team of health academics at an Australian university developed and evaluated the continuing education Graduate Certificate in Health Professional Education Program using an interprofessional learning model. The model was informed by Collins interactional expertise and Knowles adult learning theories. The team collaboratively developed and taught four courses in the program. Blended learning methods such as web-based learning, face-to-face workshops, and online discussion forums were used. Twenty-seven multidisciplinary participants enrolled in the inaugural program. Focus group interview, self-report questionnaires, and teacher observations were used to evaluate the program. Online learning motivated participants to learn in a collaborative virtual environment. The workshops conducted in an interprofessional environment promoted knowledge sharing and helped participants to better understand other discipline roles, so they could conduct clinical education within a broader health care team context. Work-integrated assessments supported learning relevance. The teachers, however, observed that some participants struggled because of lack of computer skills. Although the interprofessional learning model promoted collaboration and flexibility, it is important to note that consideration be given to participants who are not computer literate. We therefore conducted a library and computer literacy workshop in orientation week which helped. An interprofessional learning environment can assist health professionals to operate outside their "traditional silos" leading to a more collaborative approach to the provision of care. Our experience may assist other organizations in developing similar programs.

Essential features influencing collaboration in team-based non-specific back pain rehabilitation: Findings from a mixed methods study

PubMed Central

Hellman, Therese; Jensen, Irene; Bergström, Gunnar; Brämberg, Elisabeth Björk

2016-01-01

ABSTRACT The aim of the study presented in this article was to explore how professionals, without guidelines for implementing interprofessional teamwork, experience the collaboration within team-based rehabilitation for people with back pain and how this collaboration influences their clinical practice. This study employed a mixed methods design. A questionnaire was answered by 383 participants and 17 participants were interviewed. The interviews were analysed using content analysis. The quantitative results showed that the participants were satisfied with their team-based collaboration. Thirty percent reported that staff changes in the past year had influenced their clinical practice, of which 57% reported that these changes had had negative consequences. The qualitative findings revealed that essential features for an effective collaboration were shared basic values and supporting each other. Furthermore, aspects such as having enough time for reflection, staff continuity, and a shared view of the team members’ roles were identified as aspects which influenced the clinical practice. Important clinical implications for nurturing and developing a collaboration in team-based rehabilitation are to create shared basic values and a unified view of all team members’ roles and their contributions to the team. These aspects need to be emphasised on an ongoing basis and not only when the team is formed. PMID:27152534

Integrating pharmacists into primary care teams: barriers and facilitators.

PubMed

Jorgenson, Derek; Laubscher, Tessa; Lyons, Barry; Palmer, Rebecca

2014-08-01

This study evaluated the barriers and facilitators that were experienced as pharmacists were integrated into 23 existing primary care teams located in urban and rural communities in Saskatchewan, Canada. Qualitative design using data from one-on-one telephone interviews with pharmacists, physicians and nurse practitioners from the 23 teams that integrated a new pharmacist role. Four researchers from varied backgrounds used thematic analysis of the interview transcripts to determine key themes. The research team met on multiple occasions to agree on the key themes and received written feedback from an external auditor and two of the original interviewees. Seven key themes emerged describing the barriers and facilitators that the teams experienced during the pharmacist integration: (1) relationships, trust and respect; (2) pharmacist role definition; (3) orientation and support; (4) pharmacist personality and professional experience; (5) pharmacist presence and visibility; (6) resources and funding; and (7) value of the pharmacist role. Teams from urban and rural communities experienced some of these challenges in unique ways. Primary care teams that integrated a pharmacist experienced several common barriers and facilitators. The negative impact of these barriers can be mitigated with effective planning and support that is individualized for the type of community where the team is located. © 2013 Royal Pharmaceutical Society.

Can hospital audit teams identify case management problems, analyse their causes, identify and implement improvements? A cross-sectional process evaluation of obstetric near-miss case reviews in Benin.

PubMed

Borchert, Matthias; Goufodji, Sourou; Alihonou, Eusèbe; Delvaux, Thérèse; Saizonou, Jacques; Kanhonou, Lydie; Filippi, Véronique

2012-10-11

Obstetric near-miss case reviews are being promoted as a quality assurance intervention suitable for hospitals in low income countries. We introduced such reviews in five district, regional and national hospitals in Benin, West Africa. In a cross-sectional study we analysed the extent to which the hospital audit teams were able to identify case management problems (CMPs), analyse their causes, agree on solutions and put these solutions into practice. We analysed case summaries, women's interview transcripts and audit minutes produced by the audit teams for 67 meetings concerning one woman with near-miss complications each. We compared the proportion of CMPs identified by an external assessment team to the number found by the audit teams. For the latter, we described the CMP causes identified, solutions proposed and implemented by the audit teams. Audit meetings were conducted regularly and were well attended. Audit teams identified half of the 714 CMPs; they were more likely to find managerial ones (71%) than the ones relating to treatment (30%). Most identified CMPs were valid. Almost all causes of CMPs were plausible, but often too superficial to be of great value for directing remedial action. Audit teams suggested solutions, most of them promising ones, for 38% of the CMPs they had identified, but recorded their implementation only for a minority (8.5%). The importance of following-up and documenting the implementation of solutions should be stressed in future audit interventions. Tools facilitating the follow-up should be made available. Near-miss case reviews hold promise, but their effectiveness to improve the quality of care sustainably and on a large scale still needs to be established.

Can hospital audit teams identify case management problems, analyse their causes, identify and implement improvements? A cross-sectional process evaluation of obstetric near-miss case reviews in Benin

PubMed Central

2012-01-01

Background Obstetric near-miss case reviews are being promoted as a quality assurance intervention suitable for hospitals in low income countries. We introduced such reviews in five district, regional and national hospitals in Benin, West Africa. In a cross-sectional study we analysed the extent to which the hospital audit teams were able to identify case management problems (CMPs), analyse their causes, agree on solutions and put these solutions into practice. Methods We analysed case summaries, women’s interview transcripts and audit minutes produced by the audit teams for 67 meetings concerning one woman with near-miss complications each. We compared the proportion of CMPs identified by an external assessment team to the number found by the audit teams. For the latter, we described the CMP causes identified, solutions proposed and implemented by the audit teams. Results Audit meetings were conducted regularly and were well attended. Audit teams identified half of the 714 CMPs; they were more likely to find managerial ones (71%) than the ones relating to treatment (30%). Most identified CMPs were valid. Almost all causes of CMPs were plausible, but often too superficial to be of great value for directing remedial action. Audit teams suggested solutions, most of them promising ones, for 38% of the CMPs they had identified, but recorded their implementation only for a minority (8.5%). Conclusions The importance of following-up and documenting the implementation of solutions should be stressed in future audit interventions. Tools facilitating the follow-up should be made available. Near-miss case reviews hold promise, but their effectiveness to improve the quality of care sustainably and on a large scale still needs to be established. PMID:23057707

Pediatric residents' experiences of a clinical rotation in Adolescent Medicine

PubMed Central

2010-01-01

Background Although Adolescent Medicine is a pediatric subspecialty, it addresses many issues that differ from other aspects of pediatrics clinical training. The aim of this study was to explore the general experiences of pediatric residents during their rotations in Adolescent Medicine. Methods Qualitative methods were applied. Semi-structured individual interviews were conducted with pediatric residents who had completed a rotation in Adolescent Medicine. Emergent themes were identified. Results Three key themes emerged: gaining exposure, taking on a professional role, and achieving self-awareness. Subcategories were also identified. There was particular emphasis on the multidisciplinary team and the biopsychosocial approach to adolescent health care. Conclusions The experiences in Adolescent Medicine reflected residents' learning, notably gains in the "non-expert" as well as "medical expert" physician competencies. Future studies should explore how the interprofessional nature of an Adolescent Medicine team and the patient populations themselves contribute to this learning. PMID:21122143

Interprofessional student teams augmenting service provision in residential aged care.

PubMed

Kent, Fiona; Lai, Francis; Beovich, Bronwyn; Dodic, Miodrag

2016-09-01

The aim of this study was to determine the usefulness of student-led interprofessional consultations within residential aged care in augmenting patient care and enhancing student education. Volunteer fourth and final year health-care students conducted interprofessional consultations. In a mixed methods design, residents' health-care changes and perspectives were collected prospectively, and student and educator perceptions were measured by survey and interview. Sixteen aged care residents were consulted by interprofessional teams. Students identified two new health issues and proposed 17 recommendations for referrals and five changes to medication management. At six-weeks follow-up, two recommendations had been acted upon clinically, and two medication changes had been implemented. Reasons for the low uptake of recommendations were determined. Residents, students and educators reported high levels of satisfaction. Residential care facilities offer a useful interprofessional learning environment. Student consultations are positively regarded by patients, students and educators and may augment existing health services. © 2016 AJA Inc.

Inadequate performance measures affecting practices, organizations and outcomes of Ontario's family health teams.

PubMed

Ashcroft, Rachelle

2014-01-01

Emphasis on quantity as the main performance measure may be posing challenges for Family Health Team (FHT) practices and organizational structures. This study asked: What healthcare practices and organizational structures are encouraged by the FHT model? An exploratory qualitative design guided by discourse analysis was used. This paper presents findings from in-depth semi-structured interviews conducted with seven policy informants and 29 FHT leaders. Participants report that performance measures value quantity and are not inclusive of the broad scope of attributes that comprise primary healthcare. Performance measures do not appear to be accurately capturing the demand for healthcare services, or the actual amount of services being provided by FHTs. RESULTS suggest that unintended consequences of performance measures may be posing challenges to access and health outcomes. It is recommended that performance measures be developed and used to measure, support and encourage FHTs to achieve the goals of PHC. Copyright © 2014 Longwoods Publishing.

Creating Conditions for Patients’ Values to Emerge in Clinical Conversations: Perspectives of Health Care Team Members

PubMed Central

Berry, Andrew B.L.; Lim, Catherine; Hartzler, Andrea L.; Hirsch, Tad; Ludman, Evette; Wagner, Edward H.; Ralston, James D.

2017-01-01

Eliciting, understanding, and honoring patients’ values— the things most important to them in daily life—is a cornerstone of patient-centered care. However, this rarely occurs explicitly as a routine part of clinical practice. This is particularly problematic for individuals with multiple chronic conditions (MCC) because they face difficult choices about how to balance competing demands for self-care in accordance with their values. In this study, we sought to inform the design of interventions to support conversations about patient values between patients with MCC and their health care providers. We conducted a field study that included observations of 21 clinic visits for patients who have MCC, and interviews with 16 care team members involved in those visits. This paper contributes a practice-based account of ways in which providers engage with patient values, and discusses how future work in interactive systems design might extend and enrich these engagements. PMID:28890950

Teamwork and delegation in medical homes: primary care staff perspectives in the Veterans Health Administration.

PubMed

True, Gala; Stewart, Greg L; Lampman, Michelle; Pelak, Mary; Solimeo, Samantha L

2014-07-01

The patient-centered medical home (PCMH) relies on a team approach to patient care. For organizations engaged in transitioning to a PCMH model, identifying and providing the resources needed to promote team functioning is essential. To describe team-level resources required to support PCMH team functioning within the Veterans Health Administration (VHA), and provide insight into how the presence or absence of these resources facilitates or impedes within-team delegation. Semi-structured interviews with members of pilot teams engaged in PCMH implementation in 77 primary care clinics serving over 300,000 patients across two VHA regions covering the Mid-Atlantic and Midwest United States. A purposive sample of 101 core members of pilot teams, including 32 primary care providers, 42 registered nurse care managers, 15 clinical associates, and 12 clerical associates. Investigators from two evaluation sites interviewed frontline primary care staff separately, and then collaborated on joint analysis of parallel data to develop a broad, comprehensive understanding of global themes impacting team functioning and within-team delegation. We describe four themes key to understanding how resources at the team level supported ability of primary care staff to work as effective, engaged teams. Team-based task delegation was facilitated by demarcated boundaries and collective identity; shared goals and sense of purpose; mature and open communication characterized by psychological safety; and ongoing, intentional role negotiation. Our findings provide a framework for organizations to identify assets already in place to support team functioning, as well as areas in need of improvement. For teams struggling to make practice changes, our results indicate key areas where they may benefit from future support. In addition, this research sheds light on how variation in medical home implementation and outcomes may be associated with variation in team-based task delegation.

"The era of single disease cowboys is out": evaluating the experiences of students, faculty, and collaborators in an interdisciplinary global health training program.

PubMed

Kalbarczyk, Anna; Martin, Nina A; Combs, Emily; Ward, Marie; Winch, Peter J

2018-03-01

Global Health is an inherently interdisciplinary field but overseas training in global health, particularly among health science institutions, has been an 'individual' or 'individual discipline' experience. Team-based training is an approach to global health education which is increasing in popularity; research on team-training demonstrates that teams are more productive than individuals. In 2015, the Johns Hopkins Center for Global Health (CGH) developed the Global Established Multidisciplinary Sites (GEMS) program, an interdisciplinary training program which was designed to establish a new norm in global health training by bringing interdisciplinary teams of faculty and students together to identify and solve complex global health challenges. This research aims to evaluate the program's first year and contribute to the literature on interdisciplinary team training. We conducted 22 in-depth interviews with students, faculty, and local collaborators from 3 GEMS project sites. Findings were analyzed for themes through a framework approach. The program exposed students, faculty, and collaborators to a wide range of disciplines in global health. Students' desire to learn how other disciplines contribute to global health solutions was an important motivator for joining GEMS; many participants including faculty and collaborators valued exposure to multiple disciplines. Mentorship and communication were a challenge across all teams in part due to members having distinct "disciplinary languages". Balancing disciplinary representation on teams and establishing work plans were also key challenges. Based on the data the CGH provides four recommendations for institutions developing global health interdisciplinary teams to optimize team functioning and address challenges in mentorship, language, and roles: 1) address interdisciplinary communication early, 2) develop work plans during group formation, 3) meet as a team prior to travel, and 4) establish regular check ins. This article provides first-hand reflections on interdisciplinary team experiences in a global context and provides a pathway for the development of innovative strategies in global health training.

Silence of male child sexual abuse in India: Qualitative analysis of barriers for seeking psychiatric help in a multidisciplinary unit in a general hospital

PubMed Central

Subramaniyan, Vyjayanthi Kanugodu Srinivasa; Reddy, Praveen; Chandra, Girish; Rao, Chandrika; Rao, T. S. Sathyanarayana

2017-01-01

Introduction: In 2007, Ministry of Women and Child Welfare, supported by United Nations Children's Fund, save the children and Prayas conducted a study to understand the magnitude of child abuse in India, they found that 53.22% children faced one or more forms of sexual abuse; among them, the number of boys abused was 52.94%. Aim: The aim of this study was to explore the barriers for seeking psychiatric help by qualitative analysis of stake holders of male victims of child abuse. Materials and Methods: All the statements made by the stakeholders regarding psychiatric assessment and treatment were recorded in each referral made to the psychiatrist. Semistructured interviews and in-depth interviews were conducted to explore the topic of understanding the need for psychiatric treatment to the victims. Results: Collaborative child response unit, a multidisciplinary team, to tackle child sexual abuse in a general hospital received three referrals of male child abuse among the 27 referrals in 20 months. The main theme of the barrier that was generated by interviewing the stakeholders of male child victims of abuse was the misconception of superiority of a male victim due to gender (patriarchy) an expectation that he will outgrow the experience. In-depth interviews of three cases of homosexual abuse explored the theme. Conclusion: Patriarchy is oppressing male children and acts as a barrier to seek psychiatric help in collaborative child response unit. PMID:28827868

Computer-aided personal interviewing. A new technique for data collection in epidemiologic surveys.

PubMed

Birkett, N J

1988-03-01

Most epidemiologic studies involve the collection of data directly from selected respondents. Traditionally, interviewers are provided with the interview in booklet form on paper and answers are recorded therein. On receipt at the study office, the interview results are coded, transcribed, and keypunched for analysis. The author's team has developed a method of personal interviewing which uses a structured interview stored on a lap-sized computer. Responses are entered into the computer and are subject to immediate error-checking and correction. All skip-patterns are automatic. Data entry to the final data-base involves no manual data transcription. A pilot evaluation with a preliminary version of the system using tape-recorded interviews in a test/re-test methodology revealed a slightly higher error rate, probably related to weaknesses in the pilot system and the training process. Computer interviews tended to be longer but other features of the interview process were not affected by computer. The author's team has now completed 2,505 interviews using this system in a community-based blood pressure survey. It has been well accepted by both interviewers and respondents. Failure to complete an interview on the computer was uncommon (5 per cent) and well-handled by paper back-up questionnaires. The results show that computer-aided personal interviewing in the home is feasible but that further evaluation is needed to establish the impact of this methodology on overall data quality.

Physicians' perceptions of capacity building for managing chronic disease in seniors using integrated interprofessional care models.

PubMed

Lee, Linda; Heckman, George; McKelvie, Robert; Jong, Philip; D'Elia, Teresa; Hillier, Loretta M

2015-03-01

To explore the barriers to and facilitators of adapting and expanding a primary care memory clinic model to integrate care of additional complex chronic geriatric conditions (heart failure, falls, chronic obstructive pulmonary disease, and frailty) into care processes with the goal of improving outcomes for seniors. Mixed-methods study using quantitative (questionnaires) and qualitative (interviews) methods. Ontario. Family physicians currently working in primary care memory clinic teams and supporting geriatric specialists. Family physicians currently working in memory clinic teams (n = 29) and supporting geriatric specialists(n = 9) were recruited as survey participants. Interviews were conducted with memory clinic lead physicians (n = 16).Statistical analysis was done to assess differences between family physician ratings and geriatric specialist ratings related to the capacity for managing complex chronic geriatric conditions, the role of interprofessional collaboration within primary care, and funding and staffing to support geriatric care. Results from both study methods were compared to identify common findings. Results indicate overall support for expanding the memory clinic model to integrate care for other complex conditions. However, the current primary care structure is challenged to support optimal management of patients with multiple comorbidities, particularly as related to limited funding and staffing resources. Structured training, interprofessional teams, and an active role of geriatric specialists within primary care were identified as important facilitators. The memory clinic model, as applied to other complex chronic geriatric conditions, has the potential to build capacity for high-quality primary care, improve health outcomes,promote efficient use of health care resources, and reduce healthcare costs.

Identification of Barriers to Pediatric Care in Limited-Resource Settings: A Simulation Study.

PubMed

Shilkofski, Nicole; Hunt, Elizabeth A

2015-12-01

Eighty percent of the 10 million annual deaths in children aged <5 years in developing countries are estimated to be avoidable, with improvements in education for pediatric emergency management being a key factor. Education must take into account cultural considerations to be effective. Study objectives were: (1) to use simulation to identify factors posing barriers to patient care in limited resource settings (LRS); and (2) to understand how simulations in LRS can affect communication and decision-making processes. A qualitative study was conducted at 17 different sites in 12 developing countries in Asia, Latin America, and Africa. Data from observations of 68 in situ simulated pediatric emergencies were coded for thematic analysis. Sixty-two different "key informants" were interviewed regarding perceived benefit of simulations. Coding of observations and interviews yielded common themes: impact of culture on team hierarchy, impact of communication and language barriers on situational awareness, systematic emergency procedures, role delineation, shared cognition and resource awareness through simulation, logistic barriers to patient care, and use of recognition-primed decision-making by experienced clinicians. Changes in clinical environments were implemented as a result of simulations. Ad hoc teams in LRS face challenges in caring safely for patients; these include language and cultural barriers, as well as environmental and resource constraints. Engaging teams in simulations may promote improved communication, identification of systems issues and latent threats to target for remediation. There may be a role for training novices in use of recognition-primed or algorithmic decision-making strategies to improve rapidity and efficiency of decisions in LRS. Copyright © 2015 by the American Academy of Pediatrics.

Exploring the potential of constructionist therapy: deaf clients, hearing therapists and a reflecting team.

PubMed

Munro, L; Knox, M; Lowe, R

2008-01-01

This article explores the use of constructionist therapy with a reflecting team of hearing therapists seeing deaf clients. Using findings from two in-depth interviews, postsession reflections and a review of the literature, we propose that this model has the potential to cater to the diversity of the lived experiences of deaf people and also to address issues of power and tensions between medical, social, and cultural models of deafness. The interviews found there was real value in sharing multiple perspectives between the reflecting team of hearing therapists and these deaf clients. In addition, the clients reported feeling safe and comfortable with this model of counseling. Other information that emerged from the interviews supports previous findings regarding consistency in interpreting and the importance of hearing therapists having an understanding of the distinctions between Deaf and hearing worlds. As the first investigation of its kind in Australia, this article provides a map for therapists to incorporate reflecting teams with interpreters, deaf clients, and hearing therapists. The value of this article also lies in providing a much needed platform for future research into counseling outcomes and the efficacy of this constructionist model of therapy.

Radiologist participation in multi-disciplinary teams in breast cancer improves reflective practice, decision making and isolation.

PubMed

Alcantara, S B; Reed, W; Willis, K; Lee, W; Brennan, P; Lewis, S

2014-09-01

This study aims to explore Australian radiologists' experiences of participating in breast cancer multi-disciplinary team (MDT) meetings to identify enablers and barriers to participation as well their perception of confidence and patient care. Qualitative methods incorporating observation and interviews were used. Twenty-one breast cancer MDT meetings were observed across Sydney to study the dynamics of the meetings, the level of participation by radiologists and their most important interactions. Qualitative semi-structured interviews were conducted with 10 radiologists participating in these meetings regarding participation, educational opportunities and improvements to work practices. Radiologists' participation in breast cancer MDT meetings is influenced by the type of meeting they attend with higher levels of participation and a more dominant 'valued' role being evident in pre-interventional meetings. The key themes to emerge from the data include the importance of 'sharing experiences', the 'radiologist-pathologist relationship' and the value of 'continuing participation'. Radiologists believed their confidence in their clinical decision making increased when there was immediate feedback from pathologists. This study highlights the benefits of radiologists regularly participating in breast cancer MDT meetings in terms of continuing professional education resulting from collegial experiential learning. Radiologists' perceived patient care and workplace isolation were improved by sharing experiences with other cancer care colleagues. © 2013 John Wiley & Sons Ltd.

Factors that influence influenza vaccination rates among the elderly: nurses' perspectives.

PubMed

Ellen, Moriah

2018-03-01

To explore which factors nurses perceive to help and hinder influenza vaccination rates among the elderly. Influenza-related illnesses and deaths have disproportionately high prevalence among the elderly. Vaccination is an effective tool to prevent complications. Semistructured interviews were conducted with nurses focusing on barriers, facilitators and health care providers' roles in influencing patients to be vaccinated. Interviews were recorded, transcribed and thematically analysed. Nurses identified that the prevalent barriers were fear of the vaccine's side effects, feelings of good health and technical considerations. Facilitators included ease of access and encouragement from health providers, media and social networks. The health care team was influential in raising vaccination rates through direct recommendation, providing concrete information or leading by example. The health care team can influence patients to vaccinate. Investments in training nurses in the knowledge and skills needed to educate patients, and providing nurses with the necessary resources to engage patients in these discussions may be beneficial. Nurse managers can be instrumental in enhancing nurses' roles and actions to increase influenza vaccination rates among the elderly. It is essential to reinforce the nurses' role in promoting vaccination among seniors. Given that nurses are the largest number of health professionals, their potential outreach to large numbers of people is strong. © 2017 John Wiley & Sons Ltd.

Getting safely through the shift: a qualitative exploration of the administrative supervisor role.

PubMed

Weaver, Susan H; Lindgren, Teri G

2017-09-01

The purpose of this qualitative study was to explore the administrative supervisors' perspective of their managerial practices and how these practices contribute to nurse and patient safety. The position of administrative supervisor, often referred to as house supervisor on the evening and night shifts, lacks empirical data supporting efficacy. A focused ethnographic study was conducted with 30 administrative supervisors from acute care hospitals, using in-depth interviews and job descriptions. Regardless of the size, location or type of hospital, the interviews revealed the administrative supervisor as the hospital shift leader, who achieves nurse and patient safety when performing his/her role responsibilities, despite being disconnected from the nursing management team. To support patient care quality and safety, the administrative supervisor competencies need to be developed along with role-specific education programmes. Additionally, there is a need to recognise these off-shift leaders as a key stakeholder on the nursing leadership team. Although nurse leaders in many countries may believe they understand this role, this is among the first empirical studies. These results can lead discussions on enhancing nurse and patient safety with additional support for administrative supervisors, along with the discussion of a best practice model for off-shift leadership. © 2017 John Wiley & Sons Ltd.

Using Beta-Version mHealth Technology for Team-Based Care Management to Support Stroke Prevention: An Assessment of Utility and Challenges.

PubMed

Ramirez, Magaly; Wu, Shinyi; Ryan, Gery; Towfighi, Amytis; Vickrey, Barbara G

2017-05-23

Beta versions of health information technology tools are needed in service delivery models with health care and community partnerships to confirm the key components and to assess the performance of the tools and their impact on users. We developed a care management technology (CMT) for use by community health workers (CHWs) and care managers (CMs) working collaboratively to improve risk factor control among recent stroke survivors. The CMT was expected to enhance the efficiency and effectiveness of the CHW-CM team. The primary objective was to describe the Secondary Stroke Prevention by Uniting Community and Chronic Care Model Teams Early to End Disparities (SUCCEED) CMT and investigate CM and CHW perceptions of the CMT's usefulness and challenges for team-based care management. We conducted qualitative interviews with all users of the beta-version SUCCEED CMT, namely two CMs and three CHWs. They were asked to demonstrate and describe their perceptions of the CMT's ease of use and usefulness for completing predefined key care management activities. They were also probed about their general perceptions of the CMT's information quality, ease of use, usefulness, and impact on CM and CHW roles. Interview transcripts were coded using a priori codes. Coded excerpts were grouped into broader themes and then related in a conceptual model of how the CMT facilitated care management. We also conducted a survey with 14 patients to obtain their perspective on CHW tablet use during CHW-patient interactions. Care managers and community health workers expressed that the CMT helped them keep track of patient interactions and plan their work. It guided CMs in developing and sharing care plans with CHWs. For CHWs, the CMT enabled electronic collection of clinical assessment data, provided decision support, and provided remote access to patients' risk factor values. Long loading times and downtimes due to outages were the most significant challenges encountered. Additional issues included extensive use of free-text responses and manual data transfer from the electronic medical record. Despite these challenges, patients overall did not perceive the tablet as interfering with CHW-patient interactions. Our findings suggest useful functionalities of CMTs supporting health care and community partners in collaborative chronic care management. However, usability issues need to be addressed during the development process. The SUCCEED CMT is an initial step toward the development of effective health information technology tools to support collaborative, team-based models of care and will need to be modified as the evidence base grows. Future research should assess the CMT's effects on team performance. ©Magaly Ramirez, Shinyi Wu, Gery Ryan, Amytis Towfighi, Barbara G Vickrey. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 23.05.2017.

The association between team climate at work and mental health in the Finnish Health 2000 Study.

PubMed

Sinokki, M; Hinkka, K; Ahola, K; Koskinen, S; Klaukka, T; Kivimäki, M; Puukka, P; Lönnqvist, J; Virtanen, M

2009-08-01

Depression, anxiety and alcohol use disorders are common mental health problems in the working population. However, the team climate at work related to these disorders has not been studied using standardised interview methods and it is not known whether poor team climate predicts antidepressant use. This study investigated whether team climate at work was associated with DSM-IV depressive, anxiety and alcohol use disorders and subsequent antidepressant medication in a random sample of Finnish employees. The nationally representative sample comprised 3347 employees aged 30-64 years. Team climate was measured with a self-assessment scale. Diagnoses of depressive, anxiety and alcohol use disorders were based on the Composite International Diagnostic Interview. Data on the purchase of antidepressant medication in a 3-year follow-up period were collected from a nationwide pharmaceutical register of the Social Insurance Institution. In the risk factor adjusted models, poor team climate at work was significantly associated with depressive disorders (OR 1.61, 95% CI 1.10 to 2.36) but not with alcohol use disorders. The significance of the association between team climate and anxiety disorders disappeared when the model was adjusted for job control and job demands. Poor team climate also predicted antidepressant medication (OR 1.53, 95% CI 1.02 to 2.30). A poor team climate at work is associated with depressive disorders and subsequent antidepressant use.

Video Taping and Abnormal Psychology: Dramatized Clinical Interviews.

ERIC Educational Resources Information Center

Lyons, Michael J.; And Others

1984-01-01

Students in an abnormal psychology course worked in teams to produce dramatizations of diagnostic interviews and then presented them in class. Positive and negative aspects of the activity are discussed. (RM)

[Mental health of adolescents in the juvenile detention system: the relationship between the system's staff and external mental health services].

PubMed

Ribeiro, Débora Stephanie; Ribeiro, Fernanda Mendes Lages; Deslandes, Suely Ferreira

2018-03-12

The aim of this article is to analyze how professionals in the mental health teams of the juvenile detention system in Rio de Janeiro, Brazil, perceive the relations with the external Network of Psychosocial Care in dealing with mental health issues in adolescents serving time in juvenile detention centers. Nine interviews were held with mental health professionals in the system, and the results were presented with Fairclough's critical discourse analysis as the reference. The results were organized in three parts: the relationship between the juvenile detention system's mental health teams and the external services, difficulties experienced by the teams from the detention centers and the external network's services, and prospects and proposals. The logic of the arguments' development showed that the weakness in the agreements between administrators of the Brazilian Unified National Health System and the juvenile detention system has a daily impact on mental health activities conducted by the centers' teams. This scenario is aggravated by other structural problems such as lack of transportation and personnel to accompany adolescents on extramural appointments, and resistance on the part of professionals both inside and outside the detention centers. The study showed that both the adolescents and professionals were isolated in relation to mental health activities and policies.

Interprofessional Collaboration between General Physicians and Emergency Department Teams in Belgium: A Qualitative Study

PubMed Central

Tricas-Sauras, Sandra; Darras, Elisabeth; Macq, Jean

2017-01-01

This study aimed to assess interprofessional collaboration between general physicians and emergency departments in the French speaking regions of Belgium. Eight group interviews were conducted both in rural and urban areas, including in Brussels. Findings showed that the relational components of collaboration, which are highly valued by individuals involved, comprise mutual acquaintanceship and trust, shared power and objectives. The organizational components of collaboration included out-of-hours services, role clarification, leadership and overall environment. Communication and patient’s role were also found to be key elements in enhancing or hindering collaboration across these two levels of care. Relationships between general physicians and emergency departments’ teams were tightly linked to organizational factors and the general macro-environment. Health system regulation did not appear to play a significant role in promoting collaboration between actors. A better role clarification is needed in order to foster multidisciplinary team coordination for a more efficient patient management. Finally, economic power and private practice impeded interprofessional collaboration between the care teams. In conclusion, many challenges need to be addressed for achievement of a better collaboration and more efficient integration. Not only should integration policies aim at reinforcing the role of general physicians as gatekeepers, also they should target patients’ awareness and empowerment. PMID:29588632

They Lift My Spirit Up: Stakeholders' Perspectives on Support Teams for African Americans Facing Serious Illness

ERIC Educational Resources Information Center

Jackson, LeRon C.; Hanson, Laura C.; Hayes, Michelle; Green, Melissa; Peacock, Stacie; Corbie-Smith, Giselle

2014-01-01

Background: Active social and spiritual support for persons with cancer and other serious illnesses has been shown to improve psychological adjustment to illness and quality of life. Objective: To evaluate a community-based support team intervention within the African American community using stakeholder interviews. Methods: Support team members…

77 FR 73668 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-11

... interviews with callers and counselors). In total this effort includes three data collection instruments and...-up telephone interviews with callers to assess their emotions and behaviors following their... interview. Counselors will state that the caller may be contacted by the research team if randomly selected...

Methodology Series Module 10: Qualitative Health Research

PubMed Central

Setia, Maninder Singh

2017-01-01

Although quantitative designs are commonly used in clinical research, some studies require qualitative methods. These designs are different from quantitative methods; thus, researchers should be aware of data collection methods and analyses for qualitative research. Qualitative methods are particularly useful to understand patient experiences with the treatment or new methods of management or to explore issues in detail. These methods are useful in social and behavioral research. In qualitative research, often, the main focus is to understand the issue in detail rather than generalizability; thus, the sampling methods commonly used are purposive sampling; quota sampling; and snowball sampling (for hard to reach groups). Data can be collected using in-depth interviews (IDIs) or focus group discussions (FGDs). IDI is a one-to-one interview with the participant. FGD is a method of group interview or discussion, in which more than one participant is interviewed at the same time and is usually led by a facilitator. The commonly used methods for data analysis are: thematic analysis; grounded theory analysis; and framework analysis. Qualitative data collection and analysis require special expertise. Hence, if the reader plans to conduct qualitative research, they should team up with a qualitative researcher. PMID:28794545

Methodology Series Module 10: Qualitative Health Research.

PubMed

Setia, Maninder Singh

2017-01-01

Although quantitative designs are commonly used in clinical research, some studies require qualitative methods. These designs are different from quantitative methods; thus, researchers should be aware of data collection methods and analyses for qualitative research. Qualitative methods are particularly useful to understand patient experiences with the treatment or new methods of management or to explore issues in detail. These methods are useful in social and behavioral research. In qualitative research, often, the main focus is to understand the issue in detail rather than generalizability; thus, the sampling methods commonly used are purposive sampling; quota sampling; and snowball sampling (for hard to reach groups). Data can be collected using in-depth interviews (IDIs) or focus group discussions (FGDs). IDI is a one-to-one interview with the participant. FGD is a method of group interview or discussion, in which more than one participant is interviewed at the same time and is usually led by a facilitator. The commonly used methods for data analysis are: thematic analysis; grounded theory analysis; and framework analysis. Qualitative data collection and analysis require special expertise. Hence, if the reader plans to conduct qualitative research, they should team up with a qualitative researcher.

The surgical residency interview: a candidate-centered, working approach.

PubMed

Seabott, Heather; Smith, Ryan K; Alseidi, Adnan; Thirlby, Richard C

2012-01-01

The interview process is a pivotal, differentiating component of the residency match. Our bias is toward a working interview, producing better fulfillment of the needs of both parties, and a more informed match selection for the candidates and program. We describe a "candidate-centered" approach for integrating applicant interviews into our daily work schedule. Applicants are informed upon accepting the interview of the working interview model. Our program offers 33 interview days over a 12-week period. A maximum of 5 applicants are hosted per day. Applicants are assigned to 1 of our general, thoracic, vascular, or plastic surgery teams. The interview day begins with the applicant changing into scrubs, attending a morning conference, and taking part in a program overview by a Chief Resident. Applicants join their host team where 4-8 hours are spent observing the operative team, on rounds and sharing lunch. The faculty and senior residents are responsible for interviewing and evaluating applicants though the Electronic Residency Application Service. A total of 13 surgeons are involved in the interview process resulting in broad-based evaluations. Each surgeon interviewed between 3 and 12 applicants. Faculty rate this interview approach highly because it allows them to maintain a rigorous operative schedule while interacting with applicants. Current residents are engaged in welcoming applicants to view the program. Faculty and residents believe cooperating in a real world manner aids their assessment of the applicant. Applicants routinely provide positive feedback, relaying this approach is informative, transparent, and should be the "standard." Applicants believe they are presented a realistic view of the program. Ultimately, this candidate-centered process may be attributable to our resident cohort who exhibit high satisfaction, excellent resident morale, and very low dropout rate. We present a candidate-centered, working interview approach used in the selection of general surgery residents. While it may require more resources than the traditional approach, it harbors advantages for the applicant and the program. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Motivators of couple HIV counseling and testing (CHCT) uptake in a rural setting in Uganda.

PubMed

Nannozi, Victoria; Wobudeya, Eric; Matsiko, Nicholas; Gahagan, Jacqueline

2017-01-23

Couple HIV Counseling and Testing (CHCT) is one of the key preventive strategies used to reduce the spread of HIV. In Uganda, HIV prevalence among married/living together is 7.2% among women and 7.6% among men. CHCT can help ease disclosure of HIV-positive status, which in turn may help increase opportunities to get social support and reduce new infections. The uptake of CHCT among attendees of health facilities in rural Uganda is as high as 34%. The purpose of this study was to explore the motivators of CHCT uptake in Mukono district, a rural setting in Uganda. The study was conducted in two sub-counties in a rural district (Mukono district) about 28 km east of the capital Kampala, using a descriptive and explorative qualitative research design. Specifically, we conducted focus group discussions and key informant interviews with HIV focal persons, village health team (VHT) members, religious leaders and political leaders. We also interviewed persons in couple relationships. Data was analysed using NVivo 8 software. Ethical clearance was received from the Mengo Hospital Research Review Board and from the Uganda National Council of Science and Technology. The study was conducted from June 2013 to July 2013 We conducted 4 focus group discussions, 10 key informant interviews and interviewed 53 persons in couple relationships. None of the participants were a couple. The women were 68% (36/53) and 49% (26/53) of them were above 29 years old. The motivators of CHCT uptake were; perceived benefit of HIV testing, sickness of a partner or child in the family and suspicion of infidelity. Other important motivators were men involvement in antenatal care (ANC) attendance and preparation for marriage. The motivators for CHCT uptake included the perceived benefit of HIV testing, sickness of a partner or child, preparation for marriage, lack of trust among couples and men involvement in antenatal care. Greater attention to enhancers of CHCT programming is needed in trying to strengthen its uptake.

Spreading improvements for advanced COPD care through a Canadian Collaborative.

PubMed

Rocker, Graeme M; Amar, Claudia; Laframboise, Wendy L; Burns, Jane; Verma, Jennifer Y

2017-01-01

A year-long pan-Canadian quality improvement collaborative (QIC) led by the Canadian Foundation for Healthcare Improvement (CFHI) supported the spread of the successful Halifax, Nova Scotia-based INSPIRED COPD Outreach Program™ to 19 teams in the 10 Canadian provinces. We describe QIC results, addressing two main questions: 1) Can the results of the Nova Scotia INSPIRED model be replicated elsewhere in Canada? 2) How did the teams implement and evaluate their versions of the INSPIRED program? Collaborative faculty selected measures that were evidence-based, relatively simple to collect, and relevant to local context. Chosen process and outcome measures are related to four quality domains: 1) patient- and family-centeredness, 2) coordination, 3) efficiency, and 4) appropriateness. Evaluation of a complex intervention followed a mixed-methods approach. Most participants were nurse managers and/or COPD educators. Only 8% were physicians. Fifteen teams incorporated all core INSPIRED interventions. All teams carried out evaluation. Thirteen teams actively involved patients and families in customized, direct care planning, eg, asking them to complete evaluative surveys and/or conducting interviews. Patients consistently reported greater self-confidence in symptom management, a return to daily activities, and improvements to quality of life. Twelve teams collected data on care transitions using the validated three-item Care Transitions Measure (CTM-3). Twelve teams used the Lung Information Needs Questionnaire (LINQ). Admissions, emergency room visits, and patient-related costs fell substantially for two teams described in detail (combined enrollment 208 patients). Most teams reported gaining deeper knowledge around complexities of COPD care, optimizing patient care through action plans, self-management support, psychosocial support, advance care planning, and coordinating community partnerships. Quality-of-care gains are achievable in the short term among different teams across diverse geographical and social contexts. A well-designed, adequately funded public-private partnership can deliver widespread beneficial outcomes for the health care system and for those living with advanced COPD.

Care management and nursing governance in a maternity ward: grounded theory.

PubMed

Copelli, Fernanda Hannah da Silva; Oliveira, Roberta Juliane Tono de; Santos, José Luís Guedes Dos; Magalhães, Aline Lima Pestana; Gregório, Vitória Regina Petters; Erdmann, Alacoque Lorenzini

2017-01-01

To understand the care management strategies used by nurses in the governance of nursing practice in a maternity ward. Qualitative study based on grounded theory conducted with 27 participants, partitioned into four sample groups. The data were collected through semi-structured interviews and analyzed through open, axial, and selective coding. The care management strategies used by the nurses were: planning professional practice, leading the nursing team, search for scientific knowledge, and training inthe best practices in obstetric care. Associating care management with nursing governance can foster better care outcomes and strengthen nursing autonomy when coordinating nursing work in maternity wards.

Putting children forward for epilepsy surgery: A qualitative study of UK parents' and health professionals' decision-making experiences.

PubMed

Heath, Gemma; Abdin, Shanara; Begum, Rahima; Kearney, Shauna

2016-08-01

Against a backdrop of recommendations for increasing access to and uptake of early surgical intervention for children with medically intractable epilepsy, it is important to understand how parents and professionals decide to put children forward for epilepsy surgery and what their decisional support needs are. The aim of this study was to explore how parents and health professionals make decisions regarding putting children forward for pediatric epilepsy surgery. Individual interviews were conducted with nine parents of children who had undergone pediatric epilepsy surgery at a specialist children's hospital and ten healthcare professionals who made up the children's epilepsy surgery service multidisciplinary healthcare team (MDT). Three MDT meetings were also observed. Data were analyzed thematically. Four themes were generated from analysis of interviews with parents: presentation of surgery as a treatment option, decision-making, looking back, and interventions. Three themes were generated from analysis of interviews/observations with health professionals: triangulating information, team working, and patient and family perspectives. Parents wanted more information and support in deciding to put their child forward for epilepsy surgery. They attempted to balance the potential benefits of surgery against any risks of harm. For health professionals, a multidisciplinary approach was seen as crucial to the decision-making process. Advocating for the family was perceived to be the responsibility of nonmedical professionals. Decision-making can be supported by incorporating families into discussions regarding epilepsy surgery as a potential treatment option earlier in the process and by providing families with additional information and access to other parents with similar experiences. Copyright © 2016 Elsevier Inc. All rights reserved.

Factors that affect implementation of a nurse staffing directive: results from a qualitative multi-case evaluation.

PubMed

Robinson, Claire H; Annis, Ann M; Forman, Jane; Krein, Sarah L; Yankey, Nicholas; Duffy, Sonia A; Taylor, Beth; Sales, Anne E

2016-08-01

To assess implementation of the Veterans Health Administration staffing methodology directive. In 2010 the Veterans Health Administration promulgated a staffing methodology directive for inpatient nursing units to address staffing and budget forecasting. A qualitative multi-case evaluation approach assessed staffing methodology implementation. Semi-structured telephone interviews were conducted from March - June 2014 with Nurse Executives and their teams at 21 facilities. Interviews focused on the budgeting process, implementation experiences, use of data, leadership support, and training. An implementation score was created for each facility using a 4-point rating scale. The scores were used to select three facilities (low, medium and high implementation) for more detailed case studies. After analysing interview summaries, the evaluation team developed a four domain scoring structure: (1) integration of staffing methodology into budget development; (2) implementation of the Directive elements; (3) engagement of leadership and staff; and (4) use of data to support the staffing methodology process. The high implementation facility had leadership understanding and endorsement of staffing methodology, confidence in and ability to work with data, and integration of staffing methodology results into the budgeting process. The low implementation facility reported poor leadership engagement and little understanding of data sources and interpretation. Implementation varies widely across facilities. Implementing staffing methodology in facilities with complex and changing staffing needs requires substantial commitment at all organizational levels especially for facilities that have traditionally relied on historical levels to budget for staffing. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

Meeting the complex needs of the health care team: identification of nurse-team communication practices perceived to enhance patient outcomes.

PubMed

Propp, Kathleen M; Apker, Julie; Zabava Ford, Wendy S; Wallace, Nancy; Serbenski, Michele; Hofmeister, Nancee

2010-01-01

Nurses occupy a central position in today's increasingly collaborative health care teams that place a premium on quality patient care. In this study we examined critical team processes and identified specific nurse-team communication practices that were perceived by team members to enhance patient outcomes. Fifty patient-care team members were interviewed to uncover forms of nurse communication perceived to improve team performance. Using a grounded theory approach and constant comparative analysis, study findings reveal two critical processes nurses contribute to as the most central and consistent members of the health care team: ensuring quality decisions and promoting a synergistic team. Moreover, the findings reveal 15 specific nurse-team communication practices that comprise these processes, and thereby are theorized to improve patient outcomes.

Best Practices in Military Design Teams

DTIC Science & Technology

2015-03-01

this assessment. 10 metacognitive thinkers, and can reflect and comment on how the team is thinking about a particular topic. These findings...planning team employed a thorough and intentional selection process that included assessment instruments, several interviews, and a writing assignment...Myers-Briggs Type Indicator (MBTI), StrengthsFinder, and the Kirton Adaption-Innovation Inventory. • Writing samples and other examples of work

The Team Process: Realizing Effective Group Work and Enhancing School Improvement Plans (S.I.P.).

ERIC Educational Resources Information Center

Beiter, David J.; And Others

The use of the team process in school improvement plans may play a role in how effective the group is in achieving its goals and objectives. Representative efforts and perceptions of the use of teams in local educational agencies were surveyed in multiple measurements, such as interviews, self-assessments, self-perceptions, and observations. The…

A qualitative analysis of interprofessional healthcare team members' perceptions of patient barriers to healthcare engagement.

PubMed

Powell, Rhea E; Doty, Amanda; Casten, Robin J; Rovner, Barry W; Rising, Kristin L

2016-09-20

Healthcare systems increasingly engage interprofessional healthcare team members such as case managers, social workers, and community health workers to work directly with patients and improve population health. This study elicited perspectives of interprofessional healthcare team members regarding patient barriers to health and suggestions to address these barriers. This is a qualitative study employing focus groups and semi-structured interviews with 39 interprofessional healthcare team members in Philadelphia to elicit perceptions of patients' needs and experiences with the health system, and suggestions for positioning health care systems to better serve patients. Themes were identified using a content analysis approach. Three focus groups and 21 interviews were conducted with 26 hospital-based and 13 ambulatory-based participants. Three domains emerged to characterize barriers to care: social determinants, health system factors, and patient trust in the health system. Social determinants included insurance and financial shortcomings, mental health and substance abuse issues, housing and transportation-related limitations, and unpredictability associated with living in poverty. Suggestions for addressing these barriers included increased financial assistance from the health system, and building a workforce to address these determinants directly. Health care system factors included poor care coordination, inadequate communication of hospital discharge instructions, and difficulty navigating complex systems. Suggestions for addressing these barriers included enhanced communication between care sites, patient-centered scheduling, and improved patient education especially in discharge planning. Finally, factors related to patient trust of the health system emerged. Participants reported that patients are often intimidated by the health system, mistrusting of physicians, and fearful of receiving a serious diagnosis or prognosis. A suggestion for mitigating these issues was increased visibility of the health system within communities to foster trust and help providers gain a better understanding of unique community needs. This work explored interprofessional healthcare team members' perceptions of patient barriers to healthcare engagement. Participants identified barriers related to social determinants of health, complex system organization, and patient mistrust of the health system. Participants offered concrete suggestions to address these barriers, with suggestions supporting current healthcare reform efforts that aim at addressing social determinants and improving health system coordination and adding new insight into how systems might work to improve patient and community trust.

Assessing organisational readiness for change: use of diagnostic analysis prior to the implementation of a multidisciplinary assessment for acute stroke care

PubMed Central

Hamilton, Sharon; McLaren, Susan; Mulhall, Anne

2007-01-01

Background Achieving evidence-based practice in health care is integral to the drive for quality improvement in the National Health Service in the UK. Encapsulated within this policy agenda are challenges inherent in leading and managing organisational change. Not least of these is the need to change the behaviours of individuals and groups in order to embed new practices. Such changes are set within a context of organisational culture that can present a number of barriers and facilitators to change. Diagnostic analysis has been recommended as a precursor to the implementation of change to enable such barriers and facilitators to be identified and a targeted implementation strategy developed. Although diagnostic analysis is recommended, there is a paucity of advice on appropriate methods to use. This paper addresses the paucity and builds on previous work by recommending a mixed method approach to diagnostic analysis comprising both quantitative and qualitative data. Methods Twenty staff members with strategic accountability for stroke care were purposively sampled to take part in semi-structured interviews. Six recently discharged patients were also interviewed. Focus groups were conducted with one group of registered ward-based nurses (n = 5) and three specialist registrars (n = 3) purposively selected for their interest in stroke care. All professional staff on the study wards were sent the Team Climate Inventory questionnaire (n = 206). This elicited a response rate of 72% (n = 148). Results A number of facilitators for change were identified, including stakeholder support, organisational commitment to education, strong team climate in some teams, exemplars of past successful organisational change, and positive working environments. A number of barriers were also identified, including: unidisciplinary assessment/recording practices, varying in structure and evidence-base; weak team climate in some teams; negative exemplars of organisational change; and uncertainty created by impending organisational merger. Conclusion This study built on previous research by proposing a mixed method approach for diagnostic analysis. The combination of qualitative and quantitative data were able to capture multiple perspectives on barriers and facilitators to change. These data informed the tailoring of the implementation strategy to the specific needs of the Trust. PMID:17629929

Assessing organisational readiness for change: use of diagnostic analysis prior to the implementation of a multidisciplinary assessment for acute stroke care.

PubMed

Hamilton, Sharon; McLaren, Susan; Mulhall, Anne

2007-07-14

Achieving evidence-based practice in health care is integral to the drive for quality improvement in the National Health Service in the UK. Encapsulated within this policy agenda are challenges inherent in leading and managing organisational change. Not least of these is the need to change the behaviours of individuals and groups in order to embed new practices. Such changes are set within a context of organisational culture that can present a number of barriers and facilitators to change. Diagnostic analysis has been recommended as a precursor to the implementation of change to enable such barriers and facilitators to be identified and a targeted implementation strategy developed. Although diagnostic analysis is recommended, there is a paucity of advice on appropriate methods to use. This paper addresses the paucity and builds on previous work by recommending a mixed method approach to diagnostic analysis comprising both quantitative and qualitative data. Twenty staff members with strategic accountability for stroke care were purposively sampled to take part in semi-structured interviews. Six recently discharged patients were also interviewed. Focus groups were conducted with one group of registered ward-based nurses (n = 5) and three specialist registrars (n = 3) purposively selected for their interest in stroke care. All professional staff on the study wards were sent the Team Climate Inventory questionnaire (n = 206). This elicited a response rate of 72% (n = 148). A number of facilitators for change were identified, including stakeholder support, organisational commitment to education, strong team climate in some teams, exemplars of past successful organisational change, and positive working environments. A number of barriers were also identified, including: unidisciplinary assessment/recording practices, varying in structure and evidence-base; weak team climate in some teams; negative exemplars of organisational change; and uncertainty created by impending organisational merger. This study built on previous research by proposing a mixed method approach for diagnostic analysis. The combination of qualitative and quantitative data were able to capture multiple perspectives on barriers and facilitators to change. These data informed the tailoring of the implementation strategy to the specific needs of the Trust.

Coordination of cancer care between family physicians and cancer specialists

PubMed Central

Easley, Julie; Miedema, Baukje; Carroll, June C.; Manca, Donna P.; O’Brien, Mary Ann; Webster, Fiona; Grunfeld, Eva

2016-01-01

Abstract Objective To explore health care provider (HCP) perspectives on the coordination of cancer care between FPs and cancer specialists. Design Qualitative study using semistructured telephone interviews. Setting Canada. Participants A total of 58 HCPs, comprising 21 FPs, 15 surgeons, 12 medical oncologists, 6 radiation oncologists, and 4 GPs in oncology. Methods This qualitative study is nested within a larger mixed-methods program of research, CanIMPACT (Canadian Team to Improve Community-Based Cancer Care along the Continuum), focused on improving the coordination of cancer care between FPs and cancer specialists. Using a constructivist grounded theory approach, telephone interviews were conducted with HCPs involved in cancer care. Invitations to participate were sent to a purposive sample of HCPs based on medical specialty, sex, province or territory, and geographic location (urban or rural). A coding schema was developed by 4 team members; subsequently, 1 team member coded the remaining transcripts. The resulting themes were reviewed by the entire team and a summary of results was mailed to participants for review. Main findings Communication challenges emerged as the most prominent theme. Five key related subthemes were identified around this core concept that occurred at both system and individual levels. System-level issues included delays in medical transcription, difficulties accessing patient information, and physicians not being copied on all reports. Individual-level issues included the lack of rapport between FPs and cancer specialists, and the lack of clearly defined and broadly communicated roles. Conclusion Effective and timely communication of medical information, as well as clearly defined roles for each provider, are essential to good coordination of care along the cancer care trajectory, particularly during transitions of care between cancer specialist and FP care. Despite advances in technology, substantial communication challenges still exist. This can lead to serious consequences that affect clinical decision making. PMID:27737996

Coordination of cancer care between family physicians and cancer specialists: Importance of communication.

PubMed

Easley, Julie; Miedema, Baukje; Carroll, June C; Manca, Donna P; O'Brien, Mary Ann; Webster, Fiona; Grunfeld, Eva

2016-10-01

To explore health care provider (HCP) perspectives on the coordination of cancer care between FPs and cancer specialists. Qualitative study using semistructured telephone interviews. Canada. A total of 58 HCPs, comprising 21 FPs, 15 surgeons, 12 medical oncologists, 6 radiation oncologists, and 4 GPs in oncology. This qualitative study is nested within a larger mixed-methods program of research, CanIMPACT (Canadian Team to Improve Community-Based Cancer Care along the Continuum), focused on improving the coordination of cancer care between FPs and cancer specialists. Using a constructivist grounded theory approach, telephone interviews were conducted with HCPs involved in cancer care. Invitations to participate were sent to a purposive sample of HCPs based on medical specialty, sex, province or territory, and geographic location (urban or rural). A coding schema was developed by 4 team members; subsequently, 1 team member coded the remaining transcripts. The resulting themes were reviewed by the entire team and a summary of results was mailed to participants for review. Communication challenges emerged as the most prominent theme. Five key related subthemes were identified around this core concept that occurred at both system and individual levels. System-level issues included delays in medical transcription, difficulties accessing patient information, and physicians not being copied on all reports. Individual-level issues included the lack of rapport between FPs and cancer specialists, and the lack of clearly defined and broadly communicated roles. Effective and timely communication of medical information, as well as clearly defined roles for each provider, are essential to good coordination of care along the cancer care trajectory, particularly during transitions of care between cancer specialist and FP care. Despite advances in technology, substantial communication challenges still exist. This can lead to serious consequences that affect clinical decision making. Copyright© the College of Family Physicians of Canada.

Implementing the patient-centered medical home in complex adaptive systems: Becoming a relationship-centered patient-centered medical home.

PubMed

Flieger, Signe Peterson

This study explores the implementation experience of nine primary care practices becoming patient-centered medical homes (PCMH) as part of the New Hampshire Citizens Health Initiative Multi-Stakeholder Medical Home Pilot. The purpose of this study is to apply complex adaptive systems theory and relationship-centered organizations theory to explore how nine diverse primary care practices in New Hampshire implemented the PCMH model and to offer insights for how primary care practices can move from a structural PCMH to a relationship-centered PCMH. Eighty-three interviews were conducted with administrative and clinical staff at the nine pilot practices, payers, and conveners of the pilot between November and December 2011. The interviews were transcribed, coded, and analyzed using both a priori and emergent themes. Although there is value in the structural components of the PCMH (e.g., disease registries), these structures are not enough. Becoming a relationship-centered PCMH requires attention to reflection, sensemaking, learning, and collaboration. This can be facilitated by settings aside time for communication and relationship building through structured meetings about PCMH components as well as the implementation process itself. Moreover, team-based care offers a robust opportunity to move beyond the structures to focus on relationships and collaboration. (a) Recognize that PCMH implementation is not a linear process. (b) Implementing the PCMH from a structural perspective is not enough. Although the National Committee for Quality Assurance or other guidelines can offer guidance on the structural components of PCMH implementation, this should serve only as a starting point. (c) During implementation, set aside structured time for reflection and sensemaking. (d) Use team-based care as a cornerstone of transformation. Reflect on team structures and also interactions of the team members. Taking the time to reflect will facilitate greater sensemaking and learning and will ultimately help foster a relationship-centered PCMH.

Implementing the patient-centered medical home in complex adaptive systems: Becoming a relationship-centered patient-centered medical home

PubMed Central

Flieger, Signe Peterson

2017-01-01

Background This study explores the implementation experience of nine primary care practices becoming patient-centered medical homes (PCMH) as part of the New Hampshire Citizens Health Initiative Multi-Stakeholder Medical Home Pilot. Purpose The purpose of this study is to apply complex adaptive systems theory and relationship-centered organizations theory to explore how nine diverse primary care practices in New Hampshire implemented the PCMH model and to offer insights for how primary care practices can move from a structural PCMH to a relationship-centered PCMH. Methodology/Approach Eighty-three interviews were conducted with administrative and clinical staff at the nine pilot practices, payers, and conveners of the pilot between November and December 2011. The interviews were transcribed, coded, and analyzed using both a priori and emergent themes. Findings Although there is value in the structural components of the PCMH (e.g., disease registries), these structures are not enough. Becoming a relationship-centered PCMH requires attention to reflection, sensemaking, learning, and collaboration. This can be facilitated by settings aside time for communication and relationship building through structured meetings about PCMH components as well as the implementation process itself. Moreover, team-based care offers a robust opportunity to move beyond the structures to focus on relationships and collaboration. Practice Implications (a) Recognize that PCMH implementation is not a linear process. (b) Implementing the PCMH from a structural perspective is not enough. Although the National Committee for Quality Assurance or other guidelines can offer guidance on the structural components of PCMH implementation, this should serve only as a starting point. (c) During implementation, set aside structured time for reflection and sensemaking. (d) Use team-based care as a cornerstone of transformation. Reflect on team structures and also interactions of the team members. Taking the time to reflect will facilitate greater sensemaking and learning and will ultimately help foster a relationship-centered PCMH. PMID:26939031

78 FR 9933 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-12

... interviews with callers and counselors). In total this effort includes three data collection instruments and... include follow-up telephone interviews with callers to assess their emotions and behaviors following their... interview. Counselors will state that the caller may be contacted by the research team if randomly selected...

Interprofessional Health Team Communication About Hospital Discharge: An Implementation Science Evaluation Study.

PubMed

Bahr, Sarah J; Siclovan, Danielle M; Opper, Kristi; Beiler, Joseph; Bobay, Kathleen L; Weiss, Marianne E

The Consolidated Framework for Implementation Research guided formative evaluation of the implementation of a redesigned interprofessional team rounding process. The purpose of the redesigned process was to improve health team communication about hospital discharge. Themes emerging from interviews of patients, nurses, and providers revealed the inherent value and positive characteristics of the new process, but also workflow, team hierarchy, and process challenges to successful implementation. The evaluation identified actionable recommendations for modifying the implementation process.

Aircraft digital flight control technical review

NASA Technical Reports Server (NTRS)

Davenport, Otha B.; Leggett, David B.

1993-01-01

The Aircraft Digital Flight Control Technical Review was initiated by two pilot induced oscillation (PIO) incidents in the spring and summer of 1992. Maj. Gen. Franklin (PEO) wondered why the Air Force development process for digital flight control systems was not preventing PIO problems. Consequently, a technical review team was formed to examine the development process and determine why PIO problems continued to occur. The team was also to identify the 'best practices' used in the various programs. The charter of the team was to focus on the PIO problem, assess the current development process, and document the 'best practices.' The team reviewed all major USAF aircraft programs with digital flight controls, specifically, the F-15E, F-16C/D, F-22, F-111, C-17, and B-2. The team interviewed contractor, System Program Office (SPO), and Combined Test Force (CTF) personnel on these programs. The team also went to NAS Patuxent River to interview USN personnel about the F/A-18 program. The team also reviewed experimental USAF and NASA systems with digital flight control systems: X-29, X-31, F-15 STOL and Maneuver Technology Demonstrator (SMTD), and the Variable In-Flight Stability Test Aircraft (VISTA). The team also discussed the problem with other experts in the field including Ralph Smith and personnel from Calspan. The major conclusions and recommendations from the review are presented.

Multidimensional evaluation of a radio frequency identification wi-fi location tracking system in an acute-care hospital setting

PubMed Central

Okoniewska, Barbara; Graham, Alecia; Gavrilova, Marina; Wah, Dannel; Gilgen, Jonathan; Coke, Jason; Burden, Jack; Nayyar, Shikha; Kaunda, Joseph; Yergens, Dean; Baylis, Barry

2012-01-01

Real-time locating systems (RTLS) have the potential to enhance healthcare systems through the live tracking of assets, patients and staff. This study evaluated a commercially available RTLS system deployed in a clinical setting, with three objectives: (1) assessment of the location accuracy of the technology in a clinical setting; (2) assessment of the value of asset tracking to staff; and (3) assessment of threshold monitoring applications developed for patient tracking and inventory control. Simulated daily activities were monitored by RTLS and compared with direct research team observations. Staff surveys and interviews concerning the system's effectiveness and accuracy were also conducted and analyzed. The study showed only modest location accuracy, and mixed reactions in staff interviews. These findings reveal that the technology needs to be refined further for better specific location accuracy before full-scale implementation can be recommended. PMID:22298566

I'm Still Me: Inspiration and Instruction from Individuals with Brain Cancer.

PubMed

Piderman, Katherine M; Egginton, Jason S; Ingram, Cory; Dose, Ann Marie; Yoder, Timothy J; Lovejoy, Laura A; Swanson, Spence W; Hogg, James T; Lapid, Maria I; Jatoi, Aminah; Remtema, Megan S; Tata, Beba S; Breitkopf, Carmen Radecki

2017-01-01

Individuals with brain cancer face many challenges, including threats to cognition, personality, and sensory and motor functioning. These can alter one's sense of identity and result in despair. Chaplain-led spiritual interviews were conducted with 19 patients with brain cancer as part of a larger spiritual legacy intervention called "Hear My Voice." The majority was female (58%), married (68%) and had aggressive/advanced tumors (63%). Participants were 22-68 years of age and expressed the following religious affiliations: Protestant (42%), Catholic (21%), Muslim (5%), and none (32%). Framework analysis was applied to reduce and understand the interview data. Primary codes were relationships with: God or the spiritual, others, and self. Brain cancer was reported to deepen and enrich patients' commitment to these relationships. Struggle and grief were also revealed. Results suggest the continued vitality, growth and generativity of these participants and provide insight for chaplains and others on the medical team.

Developing content for an interprofessional training on fear of cancer recurrence (FCR): Key informant interviews of healthcare professionals, researchers and cancer survivors.

PubMed

Berrett-Abebe, Julie; Cadet, Tamara; Vitello, Joan; Maramaldi, Peter

2018-04-10

Growing numbers of cancer survivors are receiving healthcare through primary care practitioners, who often lack cancer-specific expertise to effectively treat survivors' concerns. Addressing that gap, this study aimed to develop content for a training on fear of cancer recurrence (FCR), a common concern in survivorship. Grounded in naturalistic inquiry, 42 key-informant interviews were conducted, transcribed, and analyzed for themes. Participants were healthcare professionals, researchers, and cancer survivors Results: Results included themes ranging from: rich conceptualizations of FCR, opportunities and challenges for addressing FCR in healthcare settings, interventions to address FCR, and important information to include in a training on FCR. This paper provides content for an interprofessional training and highlights the importance of developing trainings for interprofessional teams, given identified barriers that physicians face in addressing FCR and other psychosocial concerns of survivors in primary care.

Case Managers' Perspectives On What They Need To Do Their Job

PubMed Central

Eack, Shaun M.; Greeno, Catherine G.; Christian-Michaels, Stephen; Dennis, Amy; Anderson, Carol M.

2013-01-01

Objective To identify the perceived training needs of case managers working on community support teams in a community mental health center serving a semi-rural/suburban area. Methods Semi-structured interviews were conducted with 18 case managers and 3 supervisors to inquire about areas of training need in case management. Interviews were coded and analyzed for common themes regarding training needs and methods of training improvement. Results Identified training needs called for a hands-on, back to basics approach that included education on the symptoms of severe mental illness, co-morbid substance use problems, and methods of engaging consumers. A mentoring model was proposed as a potential vehicle for disseminating knowledge in these domains. Conclusions Case managers identify significant training needs that would address their basic understanding of severe mental illness. Programs targeting these needs may result in improved outcomes for case managers and the individuals with psychiatric disabilities. PMID:19346211

Impact of Robotic Surgery on Decision Making: Perspectives of Surgical Teams

PubMed Central

Randell, Rebecca; Alvarado, Natasha; Honey, Stephanie; Greenhalgh, Joanne; Gardner, Peter; Gill, Arron; Jayne, David; Kotze, Alwyn; Pearman, Alan; Dowding, Dawn

2015-01-01

There has been rapid growth in the purchase of surgical robots in both North America and Europe in recent years. Whilst this technology promises many benefits for patients, the introduction of such a complex interactive system into healthcare practice often results in unintended consequences that are difficult to predict. Decision making by surgeons during an operation is affected by variables including tactile perception, visual perception, motor skill, and instrument complexity, all of which are changed by robotic surgery, yet the impact of robotic surgery on decision making has not been previously studied. Drawing on the approach of realist evaluation, we conducted a multi-site interview study across nine hospitals, interviewing 44 operating room personnel with experience of robotic surgery to gather their perspectives on how robotic surgery impacts surgeon decision making. The findings reveal both potential benefits and challenges of robotic surgery for decision making. PMID:26958244

Family members' perceptions of augmentative and alternative communication device use.

PubMed

Bailey, Rita L; Parette, Howard P; Stoner, Julia B; Angell, Maureen E; Carroll, Kathleen

2006-01-01

Although advancements in technology have expanded the use of augmentative and alternative communication (AAC) devices for children with disabilities, the use of AAC devices in school and home settings is often inconsistent. The purpose of this study was to examine family members' perceptions regarding the use of AAC devices. Factors that were perceived to affect student's use of AAC devices, family expectations, and benefits of AAC device use were explored. Semistructured interviews were conducted with 6 family members (primary caregivers) of 7 youth who primarily use AAC devices to communicate in the school environment. The interviews were analyzed using cross-case analysis. A variety of common perspectives emerged from the data, including four thematic categories: expectations, facilitators, barriers, and benefits of AAC device use. Information gained in this investigation may be used to improve professional-family and teaming relationships and serve to benefit AAC users in school and home settings.

Surgical swab counting: a qualitative analysis from the perspective of the scrub nurse.

PubMed

D'Lima, D; Sacks, M; Blackman, W; Benn, J

2014-05-01

The aim of the study was to conduct a qualitative exploration of the sociotechnical processes underlying retained surgical swabs, and to explore the fundamental reasons why the swab count procedure and related protocols fail in practice. Data was collected through a set of 27 semistructured qualitative interviews with scrub nurses from a large, multi-site teaching hospital. Interview transcripts were analysed using established constant comparative methods, moving between inductive and deductive reasoning. Key findings were associated with interprofessional perspectives, team processes and climate and responsibility for the swab count. The analysis of risk factors revealed that perceived social and interprofessional issues played a significant role in the reliability of measures to prevent retained swabs. This work highlights the human, psychological and organisational factors that impact upon the reliability of the process and gives rise to recommendations to address contextual factors and improve perioperative practice and training.

Examining the Relationship Between Intimate Partner Violence and Concern for Animal Care and Safekeeping.

PubMed

Wuerch, Melissa A; Giesbrecht, Crystal J; Price, Jill A B; Knutson, Tracy; Wach, Frances

2017-03-01

The current study examined the knowledge and experience of animal welfare and human service providers in urban and rural communities of Saskatchewan, Canada. Nine exploratory qualitative interviews were conducted to gather a more in-depth understanding of whether the concern for animal care and safekeeping impacts the decision to leave situations of intimate partner violence. The interviews were semistructured and guided by four questions, which were designed, reviewed, and revised based on feedback from a community-based research team. Thematic analysis highlighted important findings, allowing for the generation of suggestions for improvement of current supports and services offered. The current study findings suggest that concern for animal care and safekeeping creates significant barriers regarding the decision to leave situations of intimate partner violence and abuse, warranting further research to inform support services and resources within a Canadian context.

Multidimensional evaluation of a radio frequency identification wi-fi location tracking system in an acute-care hospital setting.

PubMed

Okoniewska, Barbara; Graham, Alecia; Gavrilova, Marina; Wah, Dannel; Gilgen, Jonathan; Coke, Jason; Burden, Jack; Nayyar, Shikha; Kaunda, Joseph; Yergens, Dean; Baylis, Barry; Ghali, William A

2012-01-01

Real-time locating systems (RTLS) have the potential to enhance healthcare systems through the live tracking of assets, patients and staff. This study evaluated a commercially available RTLS system deployed in a clinical setting, with three objectives: (1) assessment of the location accuracy of the technology in a clinical setting; (2) assessment of the value of asset tracking to staff; and (3) assessment of threshold monitoring applications developed for patient tracking and inventory control. Simulated daily activities were monitored by RTLS and compared with direct research team observations. Staff surveys and interviews concerning the system's effectiveness and accuracy were also conducted and analyzed. The study showed only modest location accuracy, and mixed reactions in staff interviews. These findings reveal that the technology needs to be refined further for better specific location accuracy before full-scale implementation can be recommended.

Impact of Robotic Surgery on Decision Making: Perspectives of Surgical Teams.

PubMed

Randell, Rebecca; Alvarado, Natasha; Honey, Stephanie; Greenhalgh, Joanne; Gardner, Peter; Gill, Arron; Jayne, David; Kotze, Alwyn; Pearman, Alan; Dowding, Dawn

2015-01-01

There has been rapid growth in the purchase of surgical robots in both North America and Europe in recent years. Whilst this technology promises many benefits for patients, the introduction of such a complex interactive system into healthcare practice often results in unintended consequences that are difficult to predict. Decision making by surgeons during an operation is affected by variables including tactile perception, visual perception, motor skill, and instrument complexity, all of which are changed by robotic surgery, yet the impact of robotic surgery on decision making has not been previously studied. Drawing on the approach of realist evaluation, we conducted a multi-site interview study across nine hospitals, interviewing 44 operating room personnel with experience of robotic surgery to gather their perspectives on how robotic surgery impacts surgeon decision making. The findings reveal both potential benefits and challenges of robotic surgery for decision making.

Exploring safety systems for dispensing in community pharmacies: focusing on how staff relate to organizational components.

PubMed

Harvey, Jasmine; Avery, Anthony J; Ashcroft, Darren; Boyd, Matthew; Phipps, Denham L; Barber, Nicholas

2015-01-01

Identifying risk is an important facet of a safety practice in an organization. To identify risk, all components within a system of operation should be considered. In clinical safety practice, a team of people, technologies, procedures and protocols, management structure and environment have been identified as key components in a system of operation. To explore risks in relation to prescription dispensing in community pharmacies by taking into account relationships between key components that relate to the dispensing process. Fifteen community pharmacies in England with varied characteristics were identified, and data were collected using non-participant observations, shadowing and interviews. Approximately 360 hours of observations and 38 interviews were conducted by the team. Observation field notes from each pharmacy were written into case studies. Overall, 52,500 words from 15 case studies and interview transcripts were analyzed using thematic and line-by-line analyses. Validation techniques included multiple data collectors co-authoring each case study for consensus, review of case studies by members of the wider team including academic and practicing community pharmacists, and patient safety experts and two presentations (internally and externally) to review and discuss findings. Risks identified were related to relationships between people and other key components in dispensing. This included how different levels of staff communicated internally and externally, followed procedures, interacted with technical systems, worked with management, and engaged with the environment. In a dispensing journey, the following categories were identified which show how risks are inextricably linked through relationships between human components and other key components: 1) dispensing with divided attention; 2) dispensing under pressure; 3) dispensing in a restricted space or environment; and, 4) managing external influences. To identify and evaluate risks effectively, an approach that includes understanding relationships between key components in dispensing is required. Since teams of people in community pharmacies are a key dispensing component, and therefore part of the operational process, it is important to note how they relate to other components in the environment within which they operate. Pharmacies can take the opportunity to reflect on the organization of their systems and review in particular how they can improve on the four key categories identified. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Understanding Implementation of Complex Interventions in Primary Care Teams.

PubMed

Luig, Thea; Asselin, Jodie; Sharma, Arya M; Campbell-Scherer, Denise L

2018-01-01

The implementation of interventions to support practice change in primary care settings is complex. Pragmatic strategies, grounded in empiric data, are needed to navigate real-world challenges and unanticipated interactions with context that can impact implementation and outcomes. This article uses the example of the "5As Team" randomized control trial to explore implementation strategies to promote knowledge transfer, capacity building, and practice integration, and their interaction within the context of an interdisciplinary primary care team. We performed a qualitative evaluation of the implementation process of the 5As Team intervention study, a randomized control trial of a complex intervention in primary care. We conducted thematic analysis of field notes of intervention sessions, log books of the practice facilitation team members, and semistructured interviews with 29 interdisciplinary clinician participants. We used and further developed the Interactive Systems Framework for dissemination and implementation to interpret and structure findings. Three themes emerged that illuminate interactions between implementation processes, context, and outcomes: (1) facilitating team communication supported collective and individual sense-making and adoption of the innovation, (2) iterative evaluation of the implementation process and real-time feedback-driven adaptions of the intervention proved crucial for sustainable, context-appropriate intervention impact, (3) stakeholder engagement led to both knowledge exchange that contributes to local problem solving and to shaping a clinical context that is supportive to practice change. Our findings contribute pragmatic strategies that can help practitioners and researchers to navigate interactions between context, intervention, and implementation factors to increase implementation success. We further developed an implementation framework that includes sustained engagement with stakeholders, facilitation of team sense-making, and dynamic evaluation and intervention design as integral parts of complex intervention implementation. NCT01967797. 18 October 2013. © Copyright 2018 by the American Board of Family Medicine.

Investigation on musculoskeletal discomfort and ergonomics risk factors among production team members at an automotive component assembly plant

NASA Astrophysics Data System (ADS)

Aziz, Fazilah Abdul; Ghazalli, Zakri; Zuki Mohamed, Nik Mohd; Isfar, Amri

2017-10-01

Musculoskeletal discomfort (MSD) is very common condition in automotive industry. MSD is affecting the worker’s health, well-being and lower down the productivity. Therefore, the main objective of this study was to identify the prevalence of MSD and ergonomics risk factors among the production team members at a selected automotive component manufacturer in Malaysia. MSD data were collected by conducting structure interview with all participants by referring to the Cornell Musculoskeletal Disorder Questionnaire (CMDQ). Those production team members who achieved a total discomfort score for all body regions more than 100 was selected for job task assessment. The physical exposure risk factors of work related musculoskeletal disorders (WMSD) has evaluated by using Quick Exposure Check (QEC) techniques. The results of the study identified the severe MSD associated with production assembly team members. It is expected that the prevalence of MSD for those production assembly team members was lower back (75.4%), upper back (63.2%), right shoulder (61.4%), and right wrist (60%). The QEC analysis discovered that about 70% of job tasks had very high risks for neck posture and 60% had high risks for the back (in moving condition) and shoulder/arm postures. There were 80% of respondents have produced a high score for exposure risk to vibration. As a conclusion, the main implication of the current study is that special attention should be paid to the physical and psychosocial aspects in production team members with musculoskeletal discomfort to improve their safety, health, and well-being, maintain work ability and productivity.

Preparing rehabilitation healthcare providers in the 21st century: implementation of interprofessional education through an academic-clinical site partnership.

PubMed

Sheldon, Michael; Cavanaugh, James T; Croninger, William; Osgood, Wendy; Robnett, Regi; Seigle, Janice; Simonsen, Linda

2012-01-01

Health profession education programs often struggle with barriers to implementing interprofesssional educational (IPE) initiatives, limiting early and consistent exposure of students to core IPE competencies. Few published reports are available to guide the implementation of IPE programs into practice. This article describes a successful and evolving partnership between an independent university and a tertiary care hospital. The IPE goals of this partnership were to expose students to roles of other disciplines in the complex hospital environment and integrate acute care exposure throughout the Doctor of Physical Therapy and Master of Science in Occupational Therapy curricula. Faculty and students, patients and families, and occupational and physical therapy clinicians participated in a series of learning activities in an acute care setting involving interprofessional teams of students. Activities included observations of OT and PT clinicians providing standard patient care, practice conducting team patient interviews, and interactive treatment planning sessions conducted live via videoconferencing technology between a patient's hospital room and an academic classroom on the university campus. The activities generally were designed to improve student preparedness for working as part of an interprofessional team in an acute care setting. Student and clinician feedback support the early development of student IPE competencies, including the appreciation and understanding of professional roles in the team approach to patient care and the development of effective communication skills. The partnership between the academic institution and tertiary care hospital is an effective vehicle to deliver and sustain IPE educational initiatives in the acute care setting. Current and planned IPE curriculum integration are discussed along with a preliminary analysis of IPE outcomes.

Acceptability of participatory social network analysis for problem-solving in Australian Aboriginal health service partnerships

PubMed Central

2012-01-01

Background While participatory social network analysis can help health service partnerships to solve problems, little is known about its acceptability in cross-cultural settings. We conducted two case studies of chronic illness service partnerships in 2007 and 2008 to determine whether participatory research incorporating social network analysis is acceptable for problem-solving in Australian Aboriginal health service delivery. Methods Local research groups comprising 13–19 partnership staff, policy officers and community members were established at each of two sites to guide the research and to reflect and act on the findings. Network and work practice surveys were conducted with 42 staff, and the results were fed back to the research groups. At the end of the project, 19 informants at the two sites were interviewed, and the researchers conducted critical reflection. The effectiveness and acceptability of the participatory social network method were determined quantitatively and qualitatively. Results Participants in both local research groups considered that the network survey had accurately described the links between workers related to the exchange of clinical and cultural information, team care relationships, involvement in service management and planning and involvement in policy development. This revealed the function of the teams and the roles of workers in each partnership. Aboriginal workers had a high number of direct links in the exchange of cultural information, illustrating their role as the cultural resource, whereas they had fewer direct links with other network members on clinical information exchange and team care. The problem of their current and future roles was discussed inside and outside the local research groups. According to the interview informants the participatory network analysis had opened the way for problem-solving by “putting issues on the table”. While there were confronting and ethically challenging aspects, these informants considered that with flexibility of data collection to account for the preferences of Aboriginal members, then the method was appropriate in cross-cultural contexts for the difficult discussions that are needed to improve partnerships. Conclusion Critical reflection showed that the preconditions for difficult discussions are, first, that partners have the capacity to engage in such discussions, second, that partners assess whether the effort required for these discussions is balanced by the benefits they gain from the partnership, and, third, that “boundary spanning” staff can facilitate commitment to partnership goals. PMID:22682504

Creating and testing regulatory focus messages to enhance medication adherence.

PubMed

O'Connor, Ashley; Ladebue, Amy; Peterson, Jamie; Davis, Ryan; Jung Grant, Susan; McCreight, Marina; Lambert-Kerzner, Anne

2018-01-01

Objectives Strategies were explored to improve patient adherence to cardioprotective medications by borrowing from a motivational framework used in psychology, regulatory focus theory. The current study is part of a larger randomized control trial and was aimed at understanding what written educational messages, based on patients' regulatory focus tendency, resonated with each individual as a potential reminder to take medications. This study was also aimed at understanding why messages resonated with the patients. Methods Twenty veterans were tested for regulatory fitand presented with messages dependent on focus tendency. In-person semi-structured interviews were conducted to collect feedback of messages. An iterative analysis drawing primarily on matrix and reflexive team analyses was conducted. Result Six promotion and six prevention messages emerged, such as "team up with your provider to create a combination of medications to prevent illness" and "Live your best life - Take your medications". Five themes related to types of health messages that spoke to patients' regulatory fit were discovered: relatability; empowerment and control; philosophy on life; relationship with provider and medications; and vocabulary effect on the impact of messages. Discussion Motivational messages based on regulatory fit may be useful in improving patient medication adherence, leading to improved cardiovascular outcomes.

Facilitators to promoting health in schools: is school health climate the key?

PubMed

Lucarelli, Jennifer F; Alaimo, Katherine; Mang, Ellen; Martin, Caroline; Miles, Richard; Bailey, Deborah; Kelleher, Deanne K; Drzal, Nicholas B; Liu, Hui

2014-02-01

Schools can promote healthy eating in adolescents. This study used a qualitative approach to examine barriers and facilitators to healthy eating in schools. Case studies were conducted with 8 low-income Michigan middle schools. Interviews were conducted with 1 administrator, the food service director, and 1 member of the coordinated school health team at each school. Barriers included budgetary constraints leading to low prioritization of health initiatives; availability of unhealthy competitive foods; and perceptions that students would not eat healthy foods. Schools had made improvements to foods and increased nutrition education. Support from administrators, teamwork among staff, and acknowledging student preferences facilitated positive changes. Schools with a key set of characteristics, (presence of a coordinated school health team, nutrition policies, and a school health champion) made more improvements. The set of key characteristics identified in successful schools may represent a school's health climate. While models of school climate have been utilized in the educational field in relation to academic outcomes, a health-specific model of school climate would be useful in guiding school health practitioners and researchers and may improve the effectiveness of interventions aimed at improving student dietary intake and other health behaviors. © 2014, American School Health Association.

Virtual gaming to develop students' pediatric nursing skills: A usability test.

PubMed

Verkuyl, Margaret; Atack, Lynda; Mastrilli, Paula; Romaniuk, Daria

2016-11-01

As competition for specialty clinical placements increases, there is an urgent need to create safe, stimulating, alternative learning environments for students. To address that clinical gap, our team developed a virtual game-based simulation to help nursing students develop their pediatric nursing skills. A usability study was conducted using the Technology Acceptance Model as a research framework. The study was conducted at a community college and included nursing students, nursing faculty/clinicians and two gaming experts. The two experts evaluated the game using a heuristic checklist after playing the game. Participants engaged in a think-aloud activity while playing the game and completed a survey and interview based on the Technology Acceptance Model to explore ease of use and utility of the game. We found a high degree of user satisfaction with the game. Students reported that they had learned about pediatric care, they had become immersed in the game and they were keen to keep playing. Several design changes were recommended. Usability testing is critical in the early stages of simulation development and the study provided useful direction for the development team in the next stage of game development. Copyright © 2016 Elsevier Ltd. All rights reserved.

Facilitators to Promoting Health in Schools: Is School Health Climate the Key?*

PubMed Central

Lucarelli, Jennifer F.; Alaimo, Katherine; Mang, Ellen; Martin, Caroline; Miles, Richard; Bailey, Deborah; Kelleher, Deanne K.; Drzal, Nicholas B.; Liu, Hui

2017-01-01

BACKGROUND Schools can promote healthy eating in adolescents. This study used a qualitative approach to examine barriers and facilitators to healthy eating in schools. METHODS Case studies were conducted with 8 low-income Michigan middle schools. Interviews were conducted with 1 administrator, the food service director, and 1 member of the coordinated school health team at each school. RESULTS Barriers included budgetary constraints leading to low prioritization of health initiatives; availability of unhealthy competitive foods; and perceptions that students would not eat healthy foods. Schools had made improvements to foods and increased nutrition education. Support from administrators, teamwork among staff, and acknowledging student preferences facilitated positive changes. Schools with a key set of characteristics, (presence of a coordinated school health team, nutrition policies, and a school health champion) made more improvements. CONCLUSIONS The set of key characteristics identified in successful schools may represent a school’s health climate. While models of school climate have been utilized in the educational field in relation to academic outcomes, a health-specific model of school climate would be useful in guiding school health practitioners and researchers and may improve the effectiveness of interventions aimed at improving student dietary intake and other health behaviors. PMID:25099428

Challenges of interprofessional team training: a qualitative analysis of residents' perceptions.

PubMed

van Schaik, Sandrijn; Plant, Jennifer; O'Brien, Bridget

2015-01-01

Simulation-based interprofessional team training is thought to improve patient care. Participating teams often consist of both experienced providers and trainees, which likely impacts team dynamics, particularly when a resident leads the team. Although similar team composition is found in real-life, debriefing after simulations puts a spotlight on team interactions and in particular on residents in the role of team leader. The goal of the current study was to explore residents' perceptions of simulation-based interprofessional team training. This was a secondary analysis of a study of residents in the pediatric residency training program at the University of California, San Francisco (United States) leading interprofessional teams in simulated resuscitations, followed by facilitated debriefing. Residents participated in individual, semi-structured, audio-recorded interviews within one month of the simulation. The original study aimed to examine residents' self-assessment of leadership skills, and during analysis we encountered numerous comments regarding the interprofessional nature of the simulation training. We therefore performed a secondary analysis of the interview transcripts. We followed an iterative process to create a coding scheme, and used interprofessional learning and practice as sensitizing concepts to extract relevant themes. 16 residents participated in the study. Residents felt that simulated resuscitations were helpful but anxiety provoking, largely due to interprofessional dynamics. They embraced the interprofessional training opportunity and appreciated hearing other healthcare providers' perspectives, but questioned the value of interprofessional debriefing. They identified the need to maintain positive relationships with colleagues in light of the teams' complex hierarchy as a barrier to candid feedback. Pediatric residents in our study appreciated the opportunity to participate in interprofessional team training but were conflicted about the value of feedback and debriefing in this setting. These data indicate that the optimal approach to such interprofessional education activities deserves further study.

Exploring leadership and team communication within the organizational environment of a dental practice.

PubMed

Chilcutt, Alexa Stough

2009-10-01

A lack of training in leadership and communication skills can place dentists at a disadvantage, leading to high degrees of staff-related stress and turnover. A dentist's leadership style directly affects an office's communication practices, and specific leadership behaviors affect the degree of team identity, interdependence and social distance (a measure of the influential power of team members). The author recruited 10 dental offices to take part in a study. Qualitative methods included in-depth interviews of one dentist, one senior staff member and one newer staff member from each office. The interview findings show that clear and definable relationships exist between leadership behaviors--hierarchical or team-oriented organizational perspectives, proactive or laissez-faire leadership styles, and autocratic or participative decision-making processes--and the team's communication practices. Decision-making processes directly affect the degree of team identification experienced by staff members, and conflict-management tactics affect team members' sense of interdependence and social distance. The findings of this study indicate that dentists should engage in participative decision-making processes that include staff members, thereby communicating their value to the practice and empowering employees. They also must become proactive in facilitating an environment that encourages collaboration and confrontation as healthy forms of conflict management. These leadership and communication behaviors are the most significant in creating a real rather than nominal team culture, which, in turn, leads to increased overall productivity, an enhanced level of services provided to patients and improved team member satisfaction.

Interview-based Qualitative Research in Emergency Care Part II: Data Collection, Analysis and Results Reporting.

PubMed

Ranney, Megan L; Meisel, Zachary F; Choo, Esther K; Garro, Aris C; Sasson, Comilla; Morrow Guthrie, Kate

2015-09-01

Qualitative methods are increasingly being used in emergency care research. Rigorous qualitative methods can play a critical role in advancing the emergency care research agenda by allowing investigators to generate hypotheses, gain an in-depth understanding of health problems or specific populations, create expert consensus, and develop new intervention and dissemination strategies. In Part I of this two-article series, we provided an introduction to general principles of applied qualitative health research and examples of its common use in emergency care research, describing study designs and data collection methods most relevant to our field (observation, individual interviews, and focus groups). Here in Part II of this series, we outline the specific steps necessary to conduct a valid and reliable qualitative research project, with a focus on interview-based studies. These elements include building the research team, preparing data collection guides, defining and obtaining an adequate sample, collecting and organizing qualitative data, and coding and analyzing the data. We also discuss potential ethical considerations unique to qualitative research as it relates to emergency care research. © 2015 by the Society for Academic Emergency Medicine.

Interview-Based Qualitative Research in Emergency Care Part II: Data Collection, Analysis and Results Reporting

PubMed Central

Ranney, Megan L.; Meisel, Zachary; Choo, Esther K.; Garro, Aris; Sasson, Comilla; Morrow, Kathleen

2015-01-01

Qualitative methods are increasingly being used in emergency care research. Rigorous qualitative methods can play a critical role in advancing the emergency care research agenda by allowing investigators to generate hypotheses, gain an in-depth understanding of health problems or specific populations, create expert consensus, and develop new intervention and dissemination strategies. In Part I of this two-article series, we provided an introduction to general principles of applied qualitative health research and examples of its common use in emergency care research, describing study designs and data collection methods most relevant to our field (observation, individual interviews, and focus groups). Here in Part II of this series, we outline the specific steps necessary to conduct a valid and reliable qualitative research project, with a focus on interview-based studies. These elements include building the research team, preparing data collection guides, defining and obtaining an adequate sample, collecting and organizing qualitative data, and coding and analyzing the data. We also discuss potential ethical considerations unique to qualitative research as it relates to emergency care research. PMID:26284572

An investigation of how university sports team athletic therapists and physical therapists experience ethical issues.

PubMed

Riendeau, Catherine; Parent-Houle, Valérie; Lebel-Gabriel, Marie Eve; Gauvin, Patrick; Liu, Le Yu; Pearson, Isabelle; Hunt, Matthew R

2015-03-01

Qualitative study using interpretive description methodology. The purpose of this study was to better understand how ethical issues are experienced by university sports team athletic therapists and physical therapists. In clinical practice, sports teams are associated with a range of ethical issues. Issues commonly reported in the literature include confidentiality, return-to-play decisions, conflicts of interest, advertising, doping, and use of local anesthetic. To date, there has been limited examination of how athletic therapists and physical therapists involved with sports teams experience these ethical issues, and limited exploration of how these ethical issues, when encountered, are shaped by therapists' professional roles and responsibilities. Semi-structured interviews were conducted with 11 athletic or physical therapists working with sports teams in 5 Canadian provinces. The data were analyzed inductively, using a recursive approach and constant comparative techniques. Four key themes were developed relating to the participants' experiences of ethical issues: establishing and maintaining professional boundaries, striving for respectful and effective collaboration, seeking answers to ethical concerns, and living with the repercussions of challenging decisions. While many ethical issues reported by participants resemble those faced by sports medicine physicians, they are experienced in distinctive ways, due to differences in professional roles and identities. Issues concerning professional boundaries were also more prominent for the study participants than the literature has reported them to be for sports medicine physicians. Effective communication and enhanced collaboration appear to be key elements in managing these ethical challenges.

The healthcare team's perception of the role of the perioperative nurse: A qualitative study.

PubMed

Espinoza, Pilar; Galaz Letelier, Luz Maria; Cunill Leppe, María Dolores; Yercic Bravo, Margarita; Ferdinand, Constanza; Ferrer Lagunas, Lilian

2016-09-01

The surgical process requires the coordination of a number of professionals who understand their own roles and responsibilities, as well as those of the team. In the perioperative setting, expectations are established around behaviors and competencies of every team member. These expectations are influenced by knowledge, training and experience, and may ultimately influence results and the ability to adapt and respond to work demands. In Chile, there exists an ambiguity and lack of definition in the role of the nurse. The objective of this study was to examine the healthcare team's perception of the current role of the perioperative nurse, as well as the expected and desired characteristics of the role from the team's perspective. A qualitative, descriptive case study was carried out, using semi-structured interviews conducted with a purposive sample of surgeons, anaesthesiologists, professional nurses and technical nurses from three hospitals in Santiago, Chile. The accounts were analysed using an inductive, thematic format. It was found that the current perioperative nursing role, with a predominance of administrative charting, recordkeeping and guidelines for the management of safety, quality control and human and material resources, restricts direct patient care. Expected characteristics of the role included comprehensive theoretical and practical training and the development of relational skills for teamwork, direct patient care and advocacy in the surgical context. These results provided initial steps towards redefining the role of the perioperative nurse, strengthening collaborative efforts and optimising patient care during a time of high vulnerability. Copyright the Association for Perioperative Practice.

Transdisciplinary research for impact: protocol for a realist evaluation of the relationship between transdisciplinary research collaboration and knowledge translation

PubMed Central

Archibald, Mandy M; Harvey, Gillian; Kitson, Alison L

2018-01-01

Introduction Transdisciplinary teams are increasingly regarded as integral to conducting effective research. Similarly, knowledge translation is often seen as a solution to improving the relevance and benefits of health research. Yet, whether, how, for whom and under which circumstances transdisciplinary research influences knowledge translation is undertheorised, which limits its potential impact. The proposed research aims to identify the contexts and mechanisms by which transdisciplinary research contributes to developing shared understandings and behaviours of knowledge translation between team members. Methods and analysis Using a longitudinal case-study design approach to realist evaluation, we outline a study protocol examining whether, how, if and for whom transdisciplinary collaboration can impact knowledge translation understandings and behaviours within a 5-year transdisciplinary Centre of Research Excellence. Data are being collected between February 2017 and December 2020 over four rounds of theory development, refinement and testing using interviews, observation, document review and visual elicitation as data sources. Ethics and dissemination The Health Research Ethics Committee of the University of Adelaide approved this study. Findings will be communicated with team members at scheduled intervals throughout the study verbally and by means of creative reflective approaches (eg, arts elicitation, journalling). This research will be used to help support optimal team functioning by identifying strategies to support knowledge sharing and communication within and beyond the team to facilitate attainment of research objectives. Academic dissemination will occur through publication and presentations. PMID:29627820

Evaluation of Usage of Information Diagnostic Technology in Family and General Medicine

PubMed Central

Sivic, Suad; Masic, Izet; Zunic, Lejla; Huseinagic, Senad

2010-01-01

Summary Introduction: In recent decades, the development and improvement of technology is rapidly advancing. The development of science, new materials, information technology, new procedures and other modern achievements were his first confirmation sought to improve living conditions, particularly in achieving better health conditions. In an effort to improve living conditions, solve the problem of severe diseases and to facilitate treatment, new technologies, almost always find its first application in medicine. In such conditions of general pressure of new modern technologies, health professionals often succumb to uncritically use these technologies. Methodology: Analyzing data collected from 30,000 research papers that have done 30 doctors of family medicine and 30 doctors of general medicine, and from interviews conducted with all 60 doctors who participated in the research. Results: a) Teams of family medicine have a significantly higher professional education, and it should be noted that there was no significant difference in length of service of employees; b) Teams of family medicine have significantly less committed population on which the care; c) Teams of family medicine in an average have fewer visits per day than the teams in general medicine; d) Information diagnostic technologies are more accessible to family medicine teams. Conclusion: It is necessary to introduce a technology assessment as a standard scientific methods in decision making and the creation of the health system. In fact, it is necessary to establish and enable institutions to assess health technologies and join the developed world in creating better health care. PMID:24493985

Usefulness of Interprofessional Education (Tsurumai-Meijo IPE) in Program Collaborating with Simulated Patients.

PubMed

Goto, Aya; Hanya, Manako; Yoshimi, Akira; Uchida, Mizuki; Takeuchi, Saori; Aida, Nobuko; Suematsu, Mina; Abe, Keiko; Yasui, Hiroki; Kamei, Hiroyuki; Noda, Yukihiro

2017-01-01

Collaboration with multiple healthcare professionals is important to provide safer and higher quality care. Interprofessional education (IPE) promotes the practice of team-based care. The establishment of Tsurumai-Meijo IPE, including interprofessional education and practice (IPEP) and video-teaching materials, was conducted in collaboration with school of medicine/nursing in Nagoya University and Fujita Health University, because Meijo University does not have its own clinical settings and faculties except for pharmacy. In the established Tsurumai-Meijo IPE, pharmacy, medicine, and nursing students interviewed simulated patients (SP) together or separately and practiced team-based care through Tsurumai-Meijo IPEP. Students could learn in advance and on their own about each professional's knowledge related to patient care by using video-teaching materials from the Meijo IPE homepage. Using a questionnaire survey at the end of program, this study was examined whether Tsurumai-Meijo IPEP, and video-teaching materials were useful for understanding importance of team-based care. More than 83% of students indicated that Tsurumai-Meijo IPE is useful on future clinical practice. This suggests that the program and materials are beneficial to the medical student education. In the optional survey of some clinical pharmacists, who had participated in Tsurumai-Meijo IPE before graduation, they utilized it in their work and it facilitated their work related to team-based care. Tsurumai-Meijo IPE collaborating with SP is likely to contribute to provide high quality and safe team-based care by taking advantage of specialized professional ability of healthcare professionals.

Patients' Perceptions of a Pressure Ulcer Prevention Care Bundle in Hospital: A Qualitative Descriptive Study to Guide Evidence-Based Practice.

PubMed

Roberts, Shelley; Wallis, Marianne; McInnes, Elizabeth; Bucknall, Tracey; Banks, Merrilyn; Ball, Lauren; Chaboyer, Wendy

2017-10-01

Pressure ulcers place a significant burden on patients and hospitals. Our team developed and tested a pressure ulcer prevention care bundle (PUPCB) in a cluster randomized trial. As part of the process evaluation conducted alongside the trial, we explored patients' perceptions of the intervention. To identify patients' perceptions and experiences of a PUPCB in hospital. This qualitative descriptive study explored the perceptions of a subset of patients who participated in a trial testing the PUPCB across four intervention hospitals. A trained interviewer conducted semistructured interviews, which were digitally recorded, transcribed, and analyzed using thematic analysis. Nineteen patients were interviewed across the four hospitals. Three main themes emerged: (a) importance of personal contact in PUPCB delivery; (b) understanding pressure ulcer prevention (PUP) enhances participation; and (c) individual factors impact patients' engagement in PUP. The extent to which patients adopted the intervention appeared to be influenced by the complexity of education materials, compatibility with patients' existing knowledge and beliefs, and perceived advantage of the intervention; ability for human interaction; and patient-related facilitators and barriers to participating in PUP care. This study found patients accepted a PUPCB that encouraged participation in care, particularly as it involved personal and positive interactions with nurses and provision of information that was easy to understand and resonated with patients. © 2017 Sigma Theta Tau International.

An adaptive CBPR approach to create weight management materials for a school-based health center intervention.

PubMed

Sussman, Andrew L; Montoya, Carolyn; Werder, Olaf; Davis, Sally; Wallerstein, Nina; Kong, Alberta S

2013-01-01

From our previous clinical work with overweight/obese youth, we identified the need for research to create an effective weight management intervention to address the growing prevalence of adolescent metabolic syndrome. Formative assessment through an adaptive community-based participatory research (CBPR) approach was conducted toward the development of a nutritional and physical activity (DVD) and clinician toolkit for a school-based health center (SBHC) weight management intervention. We first conducted parent and adolescent interviews on views and experiences about obesity while convening a community advisory council (CAC) recruited from two participating urban New Mexico high schools. Thematic findings from the interviews were analyzed with the CAC to develop culturally and developmentally appropriate intervention materials. Themes from the parent and adolescent interviews included general barriers/challenges, factors influencing motivation, and change facilitators. The CAC and university-based research team reached consensus on the final content of nutrition and physical activity topics to produce a DVD and clinician toolkit through six monthly sessions. These materials used in the SBHC intervention resulted in a greater reduction of body mass index when compared to adolescents receiving standard care. Formative assessment using an adaptive CBPR approach resulted in the creation of culturally and age appropriate weight reduction materials that were acceptable to study participants. This trial is registered with ClinicalTrials.gov NCT00841334.

Advancing organizational health literacy in health care organizations serving high-needs populations: a case study.

PubMed

Weaver, Nancy L; Wray, Ricardo J; Zellin, Stacie; Gautam, Kanak; Jupka, Keri

2012-01-01

Health care organizations, well positioned to address health literacy, are beginning to shift their systems and policies to support health literacy efforts. Organizations can identify barriers, emphasize and leverage their strengths, and initiate activities that promote health literacy-related practices. The current project employed an open-ended approach to conduct a needs assessment of rural federally qualified health center clinics. Using customized assessment tools, the collaborators were then able to determine priorities for changing organizational structures and policies in order to support continued health literacy efforts. Six domains of organizational health literacy were measured with three methods: environmental assessments, patient interviews, and key informant interviews with staff and providers. Subsequent strategic planning was conducted by collaborators from the academic and clinic teams and resulted in a focused, context-appropriate action plan. The needs assessment revealed several gaps in organizational health literacy practices, such as low awareness of health literacy within the organization and variation in perceived values of protocols, interstaff communication, and patient communication. Facilitators included high employee morale and patient satisfaction. The resulting targeted action plan considered the organization's culture as revealed in the interviews, informing a collaborative process well suited to improving organizational structures and systems to support health literacy best practices. The customized needs assessment contributed to an ongoing collaborative process to implement organizational changes that aided in addressing health literacy needs.

Examining Perceptions of a Smartphone-Based Intervention System for Alcohol Use Disorders

PubMed Central

Bacon, Samantha; King, Diane K.; Dulin, Patrick; Gonzalez, Vivian

2014-01-01

Abstract Background: This study presents results from qualitative interviews conducted with participants in a study on the effectiveness of the Location-Based Monitoring and Intervention System for Alcohol Use Disorders (LBMI-A), a smartphone-based, stand-alone intervention application (app) for adults with alcohol use disorders. Materials and Methods: Participants were provided an LBMI-A-enabled smartphone to use during a 6-week pilot study. The LBMI-A was composed of psychoeducational modules, assessment and feedback of alcohol use patterns, geographic high-risk location monitoring and alerts, and in vivo assessment and intervention for alcohol cravings and help with managing psychological distress. Semistructured interviews were conducted with all participants following 6 weeks of interacting with the LBMI-A app (n=26). Interviews explored user perceptions of the ease and utility of LBMI-A features, module helpfulness, barriers to use, and recommendations for improvements to the program. Researchers applied a systematic qualitative coding process to transcripts that included both a priori themes identified as important by the research team and new themes that emerged during the coding process. Results and Conclusions: Narrative analysis found the emergence of five main themes identified by LBMI-A users as the most helpful functions of the phone: (1) Awareness, (2) Accountability, (3) Skill Transference, (4) Tracking Progress, and (5) Prompts. These themes are explored, and implications of these findings for future smartphone-based interventions are discussed. PMID:25243480

An empirically based conceptual framework for fostering meaningful patient engagement in research.

PubMed

Hamilton, Clayon B; Hoens, Alison M; Backman, Catherine L; McKinnon, Annette M; McQuitty, Shanon; English, Kelly; Li, Linda C

2018-02-01

Patient engagement in research (PEIR) is promoted to improve the relevance and quality of health research, but has little conceptualization derived from empirical data. To address this issue, we sought to develop an empirically based conceptual framework for meaningful PEIR founded on a patient perspective. We conducted a qualitative secondary analysis of in-depth interviews with 18 patient research partners from a research centre-affiliated patient advisory board. Data analysis involved three phases: identifying the themes, developing a framework and confirming the framework. We coded and organized the data, and abstracted, illustrated, described and explored the emergent themes using thematic analysis. Directed content analysis was conducted to derive concepts from 18 publications related to PEIR to supplement, confirm or refute, and extend the emergent conceptual framework. The framework was reviewed by four patient research partners on our research team. Participants' experiences of working with researchers were generally positive. Eight themes emerged: procedural requirements, convenience, contributions, support, team interaction, research environment, feel valued and benefits. These themes were interconnected and formed a conceptual framework to explain the phenomenon of meaningful PEIR from a patient perspective. This framework, the PEIR Framework, was endorsed by the patient research partners on our team. The PEIR Framework provides guidance on aspects of PEIR to address for meaningful PEIR. It could be particularly useful when patient-researcher partnerships are led by researchers with little experience of engaging patients in research. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

An international model for staffing maternal and child health research: the use of undergraduate students.

PubMed

Wallis, Anne Baber; Chereches, Răzvan; Oprescu, Florin; Brînzaniuc, Alexandra; Dungy, Claibourne I

2007-09-01

Constrained resources in Central and Eastern Europe limit the capacity of local and national health ministries to study breastfeeding practices or implement evidence-based breastfeeding support programs. This paper describes an innovative model for studying an important maternal and child health (MCH) problem by training undergraduate students to strengthen local capacity for research. An international team of researchers from Romania and the United States designed a study conducted at Babeş-Bolyai University and two academic maternity hospitals in Cluj-Napoca, Romania. The objectives were to (1) spark interest in breastfeeding research among undergraduates, (2) develop empirical knowledge about breastfeeding, and (3) train a team of undergraduate students to collect, manage, and enter study data. A team of carefully selected undergraduate students was trained in survey design, data collection, data entry, and interviewing skills. Internet technology was used to facilitate communication and to transfer data. The project resulted in a trained cadre of undergraduate students able to conduct survey research on breastfeeding practices with skills ranging from questionnaire design and implementation to descriptive data analysis. Empirical data obtained from the study will be used for student projects, to stimulate new breastfeeding support policies and programs, and to apply for research grants. Undergraduate students in developing countries in Central and Eastern Europe are a valuable, untapped resource for expanding MCH capacity. We recommend adoption of this cost-effective approach to foster high-quality MCH research.

How can insulin initiation delivery in a dual-sector health system be optimised? A qualitative study on healthcare professionals' views.

PubMed

Lee, Ping Yein; Lee, Yew Kong; Ng, Chirk Jenn

2012-04-30

The prevalence of type 2 diabetes is increasing at an alarming rate in developing countries. However, glycaemia control remains suboptimal and insulin use is low. One important barrier is the lack of an efficient and effective insulin initiation delivery approach. This study aimed to document the strategies used and proposed by healthcare professionals to improve insulin initiation in the Malaysian dual-sector (public-private) health system. In depth interviews and focus group discussions were conducted in Klang Valley and Seremban, Malaysia in 2010-11. Healthcare professionals consisting of general practitioners (n = 11), medical officers (n = 8), diabetes educators (n = 3), government policy makers (n = 4), family medicine specialists (n = 10) and endocrinologists (n = 2) were interviewed. We used a topic guide to facilitate the interviews, which were audio recorded, transcribed verbatim and analysed using a thematic approach. Three main themes emerged from the interviews. Firstly, there was a lack of collaboration between the private and public sectors in diabetes care. The general practitioners in the private sector proposed an integrated system for them to refer patients to the public health services for insulin initiation programmes. There could be shared care between the two sectors and this would reduce the disproportionately heavy workload at the public sector. Secondly, besides the support from the government health authority, the healthcare professionals wanted greater involvement of non-government organisations, media and pharmaceutical industry in facilitating insulin initiation in both the public and private sectors. The support included: training of healthcare professionals; developing and disseminating patient education materials; service provision by diabetes education teams; organising programmes for patients' peer group sessions; increasing awareness and demystifying insulin via public campaigns; and subsidising glucose monitoring equipment. Finally, the healthcare professionals proposed the establishment of multidisciplinary teams as a strategy to increase the rate of insulin initiation. Having team members from different ethnic backgrounds would help to overcome language and cultural differences when communicating with patients. The challenges faced by a dual-sector health system in delivering insulin initiation may be addressed by greater collaborations between the private and public sectors and governmental and non-government organisations, and among different healthcare professionals.

How can insulin initiation delivery in a dual-sector health system be optimised? A qualitative study on healthcare professionals’ views

PubMed Central

2012-01-01

Background The prevalence of type 2 diabetes is increasing at an alarming rate in developing countries. However, glycaemia control remains suboptimal and insulin use is low. One important barrier is the lack of an efficient and effective insulin initiation delivery approach. This study aimed to document the strategies used and proposed by healthcare professionals to improve insulin initiation in the Malaysian dual-sector (public–private) health system. Methods In depth interviews and focus group discussions were conducted in Klang Valley and Seremban, Malaysia in 2010–11. Healthcare professionals consisting of general practitioners (n = 11), medical officers (n = 8), diabetes educators (n = 3), government policy makers (n = 4), family medicine specialists (n = 10) and endocrinologists (n = 2) were interviewed. We used a topic guide to facilitate the interviews, which were audio recorded, transcribed verbatim and analysed using a thematic approach. Results Three main themes emerged from the interviews. Firstly, there was a lack of collaboration between the private and public sectors in diabetes care. The general practitioners in the private sector proposed an integrated system for them to refer patients to the public health services for insulin initiation programmes. There could be shared care between the two sectors and this would reduce the disproportionately heavy workload at the public sector. Secondly, besides the support from the government health authority, the healthcare professionals wanted greater involvement of non-government organisations, media and pharmaceutical industry in facilitating insulin initiation in both the public and private sectors. The support included: training of healthcare professionals; developing and disseminating patient education materials; service provision by diabetes education teams; organising programmes for patients’ peer group sessions; increasing awareness and demystifying insulin via public campaigns; and subsidising glucose monitoring equipment. Finally, the healthcare professionals proposed the establishment of multidisciplinary teams as a strategy to increase the rate of insulin initiation. Having team members from different ethnic backgrounds would help to overcome language and cultural differences when communicating with patients. Conclusion The challenges faced by a dual-sector health system in delivering insulin initiation may be addressed by greater collaborations between the private and public sectors and governmental and non-government organisations, and among different healthcare professionals. PMID:22545648

Role construction and boundaries in interprofessional primary health care teams: a qualitative study.

PubMed

MacNaughton, Kate; Chreim, Samia; Bourgeault, Ivy Lynn

2013-11-24

The move towards enhancing teamwork and interprofessional collaboration in health care raises issues regarding the management of professional boundaries and the relationship among health care providers. This qualitative study explores how roles are constructed within interprofessional health care teams. It focuses on elucidating the different types of role boundaries, the influences on role construction and the implications for professionals and patients. A comparative case study was conducted to examine the dynamics of role construction on two interprofessional primary health care teams. The data collection included interviews and non-participant observation of team meetings. Thematic content analysis was used to code and analyze the data and a conceptual model was developed to represent the emergent findings. The findings indicate that role boundaries can be organized around interprofessional interactions (giving rise to autonomous or collaborative roles) as well as the distribution of tasks (giving rise to interchangeable or differentiated roles). Different influences on role construction were identified. They are categorized as structural (characteristics of the workplace), interpersonal (dynamics between team members such as trust and leadership) and individual dynamics (personal attributes). The implications of role construction were found to include professional satisfaction and more favourable wait times for patients. A model that integrates these different elements was developed. Based on the results of this study, we argue that autonomy may be an important element of interprofessional team functioning. Counter-intuitive as this may sound, we found that empowering team members to develop autonomy can enhance collaborative interactions. We also argue that while more interchangeable roles could help to lessen the workloads of team members, they could also increase the potential for power struggles because the roles of various professions would become less differentiated. We consider the conceptual and practical implications of our findings and we address the transferability of our model to other interprofessional teams.

Role construction and boundaries in interprofessional primary health care teams: a qualitative study

PubMed Central

2013-01-01

Background The move towards enhancing teamwork and interprofessional collaboration in health care raises issues regarding the management of professional boundaries and the relationship among health care providers. This qualitative study explores how roles are constructed within interprofessional health care teams. It focuses on elucidating the different types of role boundaries, the influences on role construction and the implications for professionals and patients. Methods A comparative case study was conducted to examine the dynamics of role construction on two interprofessional primary health care teams. The data collection included interviews and non-participant observation of team meetings. Thematic content analysis was used to code and analyze the data and a conceptual model was developed to represent the emergent findings. Results The findings indicate that role boundaries can be organized around interprofessional interactions (giving rise to autonomous or collaborative roles) as well as the distribution of tasks (giving rise to interchangeable or differentiated roles). Different influences on role construction were identified. They are categorized as structural (characteristics of the workplace), interpersonal (dynamics between team members such as trust and leadership) and individual dynamics (personal attributes). The implications of role construction were found to include professional satisfaction and more favourable wait times for patients. A model that integrates these different elements was developed. Conclusions Based on the results of this study, we argue that autonomy may be an important element of interprofessional team functioning. Counter-intuitive as this may sound, we found that empowering team members to develop autonomy can enhance collaborative interactions. We also argue that while more interchangeable roles could help to lessen the workloads of team members, they could also increase the potential for power struggles because the roles of various professions would become less differentiated. We consider the conceptual and practical implications of our findings and we address the transferability of our model to other interprofessional teams. PMID:24267663

The Rosetta video approach: An overview and lessons learned so far

NASA Astrophysics Data System (ADS)

Zender, J.; Schwehm, G.; Wilke, M.

2008-01-01

After an interplanetary cruise of 10 years, the Rosetta spacecraft and Philae lander, will arrive in 2014 at comet Churyomov-Gerasimenkov. All involved parties are aware of the knowledge decrease during these years and the potential complications that might arise during problem resolution before or during cometary operations. The Rosetta Science Operations Center (RSOC) supports the Rosetta orbiter experimenters in the preservation of their knowledge. The author will present the overall efforts that are done within the RSOC team to ensure the preservation of the existing information—address databases, documentation, etc.—but will emphasis on the effort to preserve existing experience using a video approach. The video approach included the visit of all orbiter experimenter teams for several days, executing interviews with engineers, technicians and scientists. During the interviews a table of content with attached keywords was generated. The final video was transferred into a computer readable form and connected with the table of content. We will present the methodology that was used to prepare and execute the interviews, to prepare the final video material and the storage and structure of the table of content and keyword. The experimenter interviews at their home institutes and the follow-up work are finished. The feedback we received so far from experimenters and the lessons learned from the interview team will be presented. In the meantime, the approach is continued during the Rosetta commissioning and interviews are executed after each instrument commissioning slot. The author will give an outlook of potential further usage of this approach.

Creating student sleuths: how a team of graduate students helped solve an outbreak of Salmonella Heidelberg infections associated with kosher broiled chicken livers.

PubMed

Hanson, Heather; Hancock, W Thane; Harrison, Cassandra; Kornstein, Laura; Waechter, HaeNa; Reddy, Vasudha; Luker, John; Malavet, Michelle; Huth, Paula; Gieraltowski, Laura; Balter, Sharon

2014-08-01

Since 2009, the New York City Department of Health and Mental Hygiene (DOHMH) has received FoodCORE funding to hire graduate students to conduct in-depth food exposure interviews of salmonellosis case patients. In 2011, an increase in the number of Salmonella Heidelberg infections with pulsed-field gel electrophoresis Xba I pattern JF6X01.0022 among observant Jewish communities in New York and New Jersey was investigated. As this pattern is common nationwide, some cases identified were not associated with the outbreak. To reduce the number of background cases, DOHMH focused on the community initially identified in the outbreak and defined a case as a person infected with the outbreak strain of Salmonella Heidelberg with illness onset from 1 April to 17 November 2011 and who consumed a kosher diet, spoke Yiddish, or self-identified as Jewish. Nationally, 190 individuals were infected with the outbreak strain of Salmonella Heidelberg; 63 New York City residents met the DOHMH case definition. In October 2011, the graduate students (Team Salmonella) interviewed three case patients who reported eating broiled chicken livers. Laboratory testing of chicken liver samples revealed the outbreak strain of Salmonella Heidelberg. Although they were only partially cooked, the livers appeared fully cooked, and consumers and retail establishment food handlers did not cook them thoroughly before eating or using them in a ready-to-eat spread. This investigation highlighted the need to prevent further illnesses from partially cooked chicken products. Removing background cases helped to focus the investigation. Training graduate students to collect exposure information can be a highly effective model for conducting foodborne disease surveillance and outbreak investigations for local and state departments of public health.

Aggression, Violence and Injury in Minor League Ice Hockey: Avenues for Prevention of Injury.

PubMed

Cusimano, Michael D; Ilie, Gabriela; Mullen, Sarah J; Pauley, Christopher R; Stulberg, Jennifer R; Topolovec-Vranic, Jane; Zhang, Stanley

2016-01-01

In North America, more than 800,000 youth are registered in organized ice hockey leagues. Despite the many benefits of involvement, young players are at significant risk for injury. Body-checking and aggressive play are associated with high frequency of game-related injury including concussion. We conducted a qualitative study to understand why youth ice hockey players engage in aggressive, injury-prone behaviours on the ice. Semi-structured interviews were conducted with 61 minor ice hockey participants, including male and female players, parents, coaches, trainers, managers and a game official. Players were aged 13-15 playing on competitive body checking teams or on non-body checking teams. Interviews were manually transcribed, coded and analyzed for themes relating to aggressive play in minor ice hockey. Parents, coaches, teammates and the media exert a large influence on player behavior. Aggressive behavior is often reinforced by the player's social environment and justified by players to demonstrate loyalty to teammates and especially injured teammates by seeking revenge particularly in competitive, body-checking leagues. Among female and male players in non-body checking organizations, aggressive play is not reinforced by the social environment. These findings are discussed within the framework of social identity theory and social learning theory, in order to understand players' need to seek revenge and how the social environment reinforces aggressive behaviors. This study provides a better understanding of the players' motivations and environmental influences around aggressive and violent play which may be conducive to injury. The findings can be used to help design interventions aimed at reducing aggression and related injuries sustained during ice hockey and sports with similar cultures and rules.

Aggression, Violence and Injury in Minor League Ice Hockey: Avenues for Prevention of Injury

PubMed Central

Cusimano, Michael D.; Ilie, Gabriela; Mullen, Sarah J.; Pauley, Christopher R.; Stulberg, Jennifer R.; Topolovec-Vranic, Jane; Zhang, Stanley

2016-01-01

Background In North America, more than 800,000 youth are registered in organized ice hockey leagues. Despite the many benefits of involvement, young players are at significant risk for injury. Body-checking and aggressive play are associated with high frequency of game-related injury including concussion. We conducted a qualitative study to understand why youth ice hockey players engage in aggressive, injury-prone behaviours on the ice. Methods Semi-structured interviews were conducted with 61 minor ice hockey participants, including male and female players, parents, coaches, trainers, managers and a game official. Players were aged 13–15 playing on competitive body checking teams or on non-body checking teams. Interviews were manually transcribed, coded and analyzed for themes relating to aggressive play in minor ice hockey. Results Parents, coaches, teammates and the media exert a large influence on player behavior. Aggressive behavior is often reinforced by the player’s social environment and justified by players to demonstrate loyalty to teammates and especially injured teammates by seeking revenge particularly in competitive, body-checking leagues. Among female and male players in non-body checking organizations, aggressive play is not reinforced by the social environment. These findings are discussed within the framework of social identity theory and social learning theory, in order to understand players’ need to seek revenge and how the social environment reinforces aggressive behaviors. Conclusion This study provides a better understanding of the players’ motivations and environmental influences around aggressive and violent play which may be conducive to injury. The findings can be used to help design interventions aimed at reducing aggression and related injuries sustained during ice hockey and sports with similar cultures and rules. PMID:27258426

A qualitative study on cross-cultural communication in post-accident in-patient rehabilitation of migrant and ethnic minority patients in Austria.

PubMed

Dressler, Dominique; Pils, Peter

2009-01-01

The objective of this study was to examine how the staff of a post-accident in-patient rehabilitation centre in Austria perceived cross-cultural communication between the staff and migrant and ethnic minority patients. A qualitative study was conducted with 28 semi-structured expert interviews with staff members in a post-accident in-patient rehabilitation centre in Austria. The interviews were conducted along the pathway of rehabilitation. Migrant and ethnic minority patients constitute about one-third of the patients, and often speak little or no German. Staff members (apart from those with migrant/ethnic minority origin) do not speak the languages of the majority of migrant and ethnic minority patients. The language barriers affect the whole rehabilitation process. The staff is unsure whether patients understand; it is difficult to explain the aim of therapies or rehabilitation, and therapies therefore hampered or impossible. To overcome these barriers, non-trained persons are used as interpreters, but the resulting communication is often perceived as unsatisfactory. External professional interpreters are used rarely because they are costly and difficult to organise. Cultural aspects also affect cross-cultural communication. Aspects mostly relating to daily life are dealt with in a pragmatic way. However, cultural aspects directly impacting rehabilitation, and particularly pain behaviour, are seen as more difficult to deal with. Effective and intensive communication between the individual patient and the rehabilitation team is essential for the outcome of rehabilitation, as patients must undertake their own rehabilitation and the rehabilitation team must be able to investigate the objectives, views and dreams of the individual patient to establish rehabilitation objectives in keeping with the patient's wishes.

"You can save time if…"-A qualitative study on internal factors slowing down clinical trials in Sub-Saharan Africa.

PubMed

Vischer, Nerina; Pfeiffer, Constanze; Limacher, Manuela; Burri, Christian

2017-01-01

The costs, complexity, legal requirements and number of amendments associated with clinical trials are rising constantly, which negatively affects the efficient conduct of trials. In Sub-Saharan Africa, this situation is exacerbated by capacity and funding limitations, which further increase the workload of clinical trialists. At the same time, trials are critically important for improving public health in these settings. The aim of this study was to identify the internal factors that slow down clinical trials in Sub-Saharan Africa. Here, factors are limited to those that exclusively relate to clinical trial teams and sponsors. These factors may be influenced independently of external conditions and may significantly increase trial efficiency if addressed by the respective teams. We conducted sixty key informant interviews with clinical trial staff working in different positions in two clinical research centres in Kenya, Ghana, Burkina Faso and Senegal. The study covered English- and French-speaking, and Eastern and Western parts of Sub-Saharan Africa. We performed thematic analysis of the interview transcripts. We found various internal factors associated with slowing down clinical trials; these were summarised into two broad themes, "planning" and "site organisation". These themes were consistently mentioned across positions and countries. "Planning" factors related to budget feasibility, clear project ideas, realistic deadlines, understanding of trial processes, adaptation to the local context and involvement of site staff in planning. "Site organisation" factors covered staff turnover, employment conditions, career paths, workload, delegation and management. We found that internal factors slowing down clinical trials are of high importance to trial staff. Our data suggest that adequate and coherent planning, careful assessment of the setting, clear task allocation and management capacity strengthening may help to overcome the identified internal factors and allow clinical trials to proceed more efficiently.

Early supported discharge following mild stroke: a qualitative study of patients' and their partners' experiences of rehabilitation at home.

PubMed

Lou, Stina; Carstensen, Kathrine; Møldrup, Marie; Shahla, Seham; Zakharia, Elias; Nielsen, Camilla Palmhøj

2017-06-01

Early supported discharge (ESD) allows mild-to-moderate stroke patients to return home as soon as possible and continue rehabilitation at their own pace in familiar surroundings. Thus, the main responsibility for continued rehabilitation is in the hands of patients and their partners, who must collaborate to adjust to poststroke everyday life. However, couples' joint experiences of stroke, early discharge and rehabilitation at home remain minimally investigated. To investigate how mild stroke patients' and their partners' experience and manage everyday life in a context of ESD. We conducted qualitative interviews with a purposive sample of 22 ESD patients and 18 partners. Interviews were conducted 3-6 weeks after stroke, and we used thematic analysis to analyse the data. The analysis identified three themes. First, 'Home as a healing place' involved the couples' experiences of a well-informed discharge from hospital. They trusted the health professionals' assessment that the patient was ready to go home. They described home as a comforting and calm place, where recovery could meaningfully take place. The second theme, 'Flow of everyday life', comprised the experiences of adapting to and continuing everyday life. Most of the interviewees had relatively minor physical and cognitive impairments, and the patients and their partners were hopeful for a full recovery in the foreseeable future. Finally, 'Professional safety net' involved the much appreciated stroke team. Although most of the participants only had one visit from the team, knowing that they were an accessible resource was very important to the couples. ESD was experienced as a meaningful and adequate rehabilitation service that allowed patients and partners to collaboratively reinvent and rebuild their flow of everyday life by jointly adjusting routines, activities and their relationship. © 2016 Nordic College of Caring Science.

NASA's New Technology Reporting System: A Review and Future Prospects

NASA Technical Reports Server (NTRS)

Chapman, Richard L.

1985-01-01

This report represents a systematic effort to describe how NASA's new technology reporting system operates today, and how that system might be enhanced. Although the system has run for more than two decades, it is not well documented in terms of organization, operational practices, or other program benchmarks. The study seeks to identify and assess incentives or disincentives to reporting, program management, program follow through, and the feasibility of various means for improving the general process. Initially, it was hoped that the study team might uncover the kind of information that would permit the determination of some 'average' sequence of events (or a time line) from the point of identifying a solution to technical 'need' to the point where its solution was actually reported to NASA. Information regarding this objective proved to be too elusive, primarily because early probes revealed that con- tractor awareness of the new technology requirements generally was too poor to provide useful information. The report that follows is based primarily upon documents furnished by NASA Headquarters, by Field Center technology utilization officers, and interviews with persons knowledgeable about the system. Visits were made to seven Field Centers: Ames Research Center, Goddard Space Flight Center, Jet Propulsion Laboratory, Johnson Space Center, Langley Research Center, Lewis Research Center, and Marshall Space Flight Center. Other documents were furnished by officials of major aerospace corporations. Detailed interviews were conducted with Field Center technology utilization officials, project engineers or scientists, patent counsels, and other Field Center officials who had knowledge about the new technology reporting system. Interviews also were conducted with knowledgeable officials from a number of the primary aerospace companies. Numeric data was obtained from regular NASA reports, from original sources such as, NASA Tech Briefs, or from contractor reports. I am indebted to dozens of persons in both NASA and industry who took time to assist in the data collection by being interviewed, and through answering follow up questions on the telephone. Individuals interviewed and their affiliations are shown in Appendix A. I am most grateful to them for their kind assistance. A note of thanks is due to the other members of the DRI study team: Jody Briles, Kathy Hirst, and Joel Johnson. The responsibility for this report, its accuracy, and the nature of the observations and conclusions rest solely with the author. Text or citations in the numbered footnotes are to be found at the end of each chapter.

Examining family meetings at end of life: The model of practice in a hospice inpatient unit.

PubMed

Meeker, Mary Ann; Waldrop, Deborah P; Seo, Jin Young

2015-10-01

Our purpose was to rigorously examine the nature of family meetings as conducted in an inpatient hospice care unit in order to generate an inductive theoretical model. In this two-phase project, we first interviewed eight members of the interdisciplinary care team who participated in multiple family meetings each week. Interview questions explored why and how they conducted family meetings. Using an observation template created from these interview data, we subsequently conducted ethnographic observations during family meetings. Using the methods of grounded theory, our findings were synthesized into a theoretical model depicting the structure and process of formal family meetings within this setting. The core of the family meeting was characterized by cognitive and affective elements aimed at supporting the family and facilitating quality care by clarifying the past, easing the present, and protecting the future. This inductive model was subsequently found to be highly aligned with a sense of coherence, an important influence on coping, and adaptation to the stress of a life-limiting illness. Provider communication with family members is particularly critical during advanced illness and end-of-life care. The National Consensus Project clinical practice guidelines for quality palliative care list regular family meetings among the recommended practices for excellent communication during end-of-life care, but do not provide specific guidance on how and when to provide such meetings. Our findings provide a theoretical model that can inform the design of a family meeting to address family members' needs for meaningful and contextualized information, validation of their important contributions to care, and preparation for the patient's death.

Towards personalized smart wheelchairs: Lessons learned from discovery interviews.

PubMed

Padir, Taşkin

2015-01-01

We posit that it is necessary to investigate the personalization of smart wheelchairs in three aspects interfaces for interaction, controllers for action (top-level, middle-level, and low-level), and feedback in interaction. Our team has been selected as an Innovation Corps (I-Corps) Team by the National Science Foundation to pursue customer discovery research to explore the commercial viability of smart wheelchairs. Through the process, our team has performed more than 110 interviews with powered wheelchair users, manufacturers, therapists, policy makers, and non-profit organization staff. Our findings revealed that the acceptability of fully autonomous systems by the users is still challenging and highly-dependent on the severity of the disability. Furthermore, the cost, ease-of-use and personalization are the most important factors in commercializing smart wheelchair technologies.

Maximizing Team Performance: The Critical Role of the Nurse Leader.

PubMed

Manges, Kirstin; Scott-Cawiezell, Jill; Ward, Marcia M

2017-01-01

Facilitating team development is challenging, yet critical for ongoing improvement across healthcare settings. The purpose of this exemplary case study is to examine the role of nurse leaders in facilitating the development of a high-performing Change Team in implementing a patient safety initiative (TeamSTEPPs) using the Tuckman Model of Group Development as a guiding framework. The case study is the synthesis of 2.5 years of critical access hospital key informant interviews (n = 50). Critical juncture points related to team development and key nurse leader actions are analyzed, suggesting that nurse leaders are essential to maximize clinical teams' performance. © 2016 Wiley Periodicals, Inc.

Parent education in youth-directed nutrition interventions.

PubMed

Crockett, S J; Mullis, R; Perry, C L; Luepker, R V

1989-07-01

Since parents play a pivotal role in helping their children to implement eating pattern changes, interest in parent education in youth-directed nutrition interventions is likely to increase along with heightened interest in primary prevention. Previous experience indicates, however, that it may be difficult to recruit and sustain parent involvement. This article describes an evaluation of the effect on parents of two youth-directed interventions with a parent component, a classroom curriculum called Hearty Heart and Friends and a mailed-home, parent-taught approach called Hearty Heart Home Team. Using incentives, a participation rate of 85.6% was achieved in Hearty Heart Home Team. This parent-taught intervention had significantly greater impact on parent than did the school-only curriculum in the following areas: knowledge about diet and heart disease; attitudes of efficacy, intention, outcome expectation and modeling; and parent-child communication and child involvement in food or nutrition-related issues in the home. In addition, the parent-taught approach influenced foods present in the home as evidenced by Home Team groups having significantly more encouraged foods and more positive choices in six scores on a shelf inventory measure conducted by in-home interviewers.

Balancing performance-based expectations with a holistic perspective on coaching: a qualitative study of Swedish women’s national football team coaches’ practice experiences

PubMed Central

Lindgren, Eva-Carin; Barker-Ruchti, Natalie

2017-01-01

ABSTRACT Purpose: The purpose of this study was to explore how an exclusive sample of women’s national football team coaches described how they implement careful coaching while facing social and organizational pressure to win medals. Method: To consider coaches’ negotiations, we drew on Noddings’ concept of caring. Using an interpretive research paradigm, we conducted in-depth interviews with five Swedish women’s national football team coaches. An abductive approach was used to simultaneously process the theoretical framework of “ethics of care” and the empirical data. Results: The coaches unanimously adopted a holistic perspective to coaching. The coaching strategies they described included promoting players’ development, well-being, and sustainable elite performance; listening to the players’ voices and engaging in dialogue; and creating a positive environment and promoting fair play. Conclusions: These findings demonstrate that the women coaches, despite performance pressure, adopt caring coaching in the form of Noddings’ pedagogical modelling, dialogue, and confirmation strategies, and provide an example of how coaches can adopt caring, holistic, and athlete-centred coaching while working at the highest level of competitive sport and achieving competitive success. PMID:28812449

ORNL engineering design and construction reengineering report

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

McNeese, L.E.

1998-01-01

A team composed of individuals representing research and development (R and D) divisions, infrastructure support organizations, and Department of Energy (DOE)-Oak Ridge Operations was chartered to reengineer the engineering, design, and construction (ED and C) process at Oak Ridge National Laboratory (ORNL). The team recognized that ED and C needs of both R and D customers and the ORNL infrastructure program have to be met to maintain a viable and competitive national laboratory. Their goal was to identify and recommend implementable best-in-class ED and C processes that will efficiently and cost-effectively support the ORNL R and D staff by beingmore » responsive to their programmatic and infrastructure needs. The team conducted process mapping of current and potential ED and C approaches, developed idealized versions of ED and C processes, and identified potential barriers to an efficient ED and C process. Eight subteams were assigned to gather information and to evaluate the significance of potential barriers through benchmarking, surveys, interviews, and reviews of key topical areas in order to determine whether the perceived barriers were real and important and whether they resulted from laws or regulations over which ORNL has no control.« less

Paternal mental health following perceived traumatic childbirth.

PubMed

Inglis, Christian; Sharman, Rachael; Reed, Rachel

2016-10-01

the objective behind the current study was to explore the experiences and perceptions of fathers after childbirth trauma, an area of minimal research. This is part two of a two-part series conducted in 2014 researching the mental health of fathers after experiencing a perceived traumatic childbirth. qualitative methodology using semi-structured interviews and reporting of qualitative questions administered in part one's online survey (Inglis, 2014). interviews conducted face-to-face at an Australian University or on Skype. sixty-nine responded to the online qualitative questions and of these seven were interviewed. thematic analysis of verbal and written qualitative responses. thematic analysis of qualitative survey data and interviews found a global theme 'standing on the sideline' which encompassed two major themes of witnessing trauma: unknown territory, and the aftermath: dealing with it, and respective subthemes. according to the perceptions and experiences of the fathers, there was a significant lack of communication between birthing teams and fathers, and fathers experienced a sense of marginalisation before, during, and after the traumatic childbirth. The findings of this study suggest that these factors contributed to the perception of trauma in the current sample. Whilst many fathers reported the negative impact of the traumatic birth on themselves and their relationships, some reported post-traumatic growth from the experience and others identified friends and family as a valuable source of support. improved communication between midwifery staff and fathers before, during and after childbirth may reduce the rates of paternal postpartum mental health difficulties and experiences of trauma. Copyright © 2016 Elsevier Ltd. All rights reserved.

Dysphonia, Perceived Control, and Psychosocial Distress: A Qualitative Study.

PubMed

Misono, Stephanie; Haut, Caroline; Meredith, Liza; Frazier, Patricia A; Stockness, Ali; Michael, Deirdre D; Butcher, Lisa; Harwood, Eileen M

2018-05-11

The purpose of this qualitative study was to examine relationships between psychological factors, particularly perceived control, and voice symptoms in adults seeking treatment for a voice problem. Semistructured interviews of adult patients with a clinical diagnosis of muscle tension dysphonia were conducted and transcribed. Follow-up interviews were conducted as needed for further information or clarification. A multidisciplinary team analyzed interview content using inductive techniques. Common themes and subthemes were identified. A conceptual model was developed describing the association between voice symptoms, psychological factors, precipitants of ongoing voice symptoms, and perceived control. Thematic saturation was reached after 23 interviews. No participants reported a direct psychological cause for their voice problem, although half described significant life events preceding voice problem onset (eg, miscarriage and other health events, interpersonal conflicts, and family members' illnesses, injuries, and deaths). Participants described psychological influences on voice symptoms that led to rapid exacerbation of their voice symptoms. Participants described the helpfulness of speech therapy and sometimes also challenges of applying techniques in daily life. They also discussed personal coping strategies that included behavioral (eg, avoiding triggers and seeking social support) and psychological (eg, mind-body awareness and emotion regulation) components. Voice-related perceived control was associated with adaptive emotional and behavioral responses, which appeared to facilitate symptom improvement. In this qualitative pilot study, participant narratives suggested that psychological factors and emotions influence voice symptoms, facilitating development of a preliminary conceptual model of how adaptive and maladaptive responses develop and how they influence vocal function. Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Primary care physicians’ perspectives on facilitating older patients’ access to community support services

PubMed Central

Ploeg, Jenny; Denton, Margaret; Hutchison, Brian; McAiney, Carrie; Moore, Ainsley; Brazil, Kevin; Tindale, Joseph; Lam, Annie

2017-01-01

Abstract Objective To understand how family physicians facilitate older patients’ access to community support services (CSSs) and to identify similarities and differences across primary health care (PHC) models. Design Qualitative, multiple-case study design using semistructured interviews. Setting Four models of PHC delivery, specifically 2 family health teams (FHTs), 4 non-FHTs family health organizations, 4 fee-for-service practices, and 2 community health centres in urban Ontario. Participants Purposeful sampling of 23 family physicians in solo and small and large group practices within the 4 models of PHC. Methods A multiple-case study approach was used. Semistructured interviews were conducted and data were analyzed using within- and cross-case analysis. Case study tactics to ensure study rigour included memos and an audit trail, investigator triangulation, and the use of multiple, rather than single, case studies. Main findings Three main themes were identified: consulting and communicating with the health care team to create linkages; linking patients and families to CSSs; and relying on out-of-date resources and ineffective search strategies for information on CSSs. All participants worked with their team members; however, those in FHTs and community health centres generally had a broader range of health care providers available to assist them. Physicians relied on home-care case managers to help make linkages to CSSs. Physicians recommended the development of an easily searchable, online database containing available CSSs. Conclusion This study shows the importance of interprofessional teamwork in primary care settings to facilitate linkages of older patients to CSSs. The study also provides insight into the strategies physicians use to link older persons to CSSs and their recommendations for change. This understanding can be used to develop resources and approaches to better support physicians in making appropriate linkages to CSSs. PMID:28115458

Open access in the patient-centered medical home: lessons from the Veterans Health Administration.

PubMed

True, Gala; Butler, Anneliese E; Lamparska, Bozena G; Lempa, Michele L; Shea, Judy A; Asch, David A; Werner, Rachel M

2013-04-01

The Veterans Health Administration (VHA) has undertaken a 5-year initiative to transform to a patient-centered medical home model. An early focus of implementation was on creating open access, defined as continuity and capacity in primary care. We describe the impact of readiness for implementation on efforts of pilot teams to make changes to improve access and identify successful strategies used by early adopters to overcome barriers to change. A qualitative, formative evaluation of the first 18 months of implementation in one Veterans Integrated Service Network (VISN) spread across six states. Members of local implementation teams including administrators, primary care providers, and staff from primary care clinics located at 10 medical centers and 45 outpatient clinics. We conducted site visits during the first 6 months of implementation, observations at Learning Collaboratives, semi-structured interviews, and review of internal organizational documents. All data collection took place between April 2010 and December 2011. Early adopters employed various strategies to enhance access, with a focus on decreasing demand for face-to-face care, increasing supply of different types of primary care encounters, and improving clinic efficiencies. Our interviews with key contacts revealed three important areas where readiness for implementation (or lack thereof) had an impact on interventions to improve access: leadership engagement, staffing resources, and access to information and knowledge. Key factors related to readiness for implementation had an impact on which interventions pilot teams could put into place, as well as the viability and sustainability of access gains. Wide variations in interventions to improve access occurring across sites situated within one organization have important implications for efforts to measure the impact of enhanced access on patient outcomes, costs, and other systems-level indicators of the Medical Home.

Physicians’ perceptions of capacity building for managing chronic disease in seniors using integrated interprofessional care models

PubMed Central

Lee, Linda; Heckman, George; McKelvie, Robert; Jong, Philip; D’Elia, Teresa; Hillier, Loretta M.

2015-01-01

Abstract Objective To explore the barriers to and facilitators of adapting and expanding a primary care memory clinic model to integrate care of additional complex chronic geriatric conditions (heart failure, falls, chronic obstructive pulmonary disease, and frailty) into care processes with the goal of improving outcomes for seniors. Design Mixed-methods study using quantitative (questionnaires) and qualitative (interviews) methods. Setting Ontario. Participants Family physicians currently working in primary care memory clinic teams and supporting geriatric specialists. Methods Family physicians currently working in memory clinic teams (n = 29) and supporting geriatric specialists (n = 9) were recruited as survey participants. Interviews were conducted with memory clinic lead physicians (n = 16). Statistical analysis was done to assess differences between family physician ratings and geriatric specialist ratings related to the capacity for managing complex chronic geriatric conditions, the role of interprofessional collaboration within primary care, and funding and staffing to support geriatric care. Results from both study methods were compared to identify common findings. Main findings Results indicate overall support for expanding the memory clinic model to integrate care for other complex conditions. However, the current primary care structure is challenged to support optimal management of patients with multiple comorbidities, particularly as related to limited funding and staffing resources. Structured training, interprofessional teams, and an active role of geriatric specialists within primary care were identified as important facilitators. Conclusion The memory clinic model, as applied to other complex chronic geriatric conditions, has the potential to build capacity for high-quality primary care, improve health outcomes, promote efficient use of health care resources, and reduce health care costs. PMID:25932482

Factors influencing recruitment to research: qualitative study of the experiences and perceptions of research teams

PubMed Central

2014-01-01

Background Recruiting the required number of participants is vital to the success of clinical research and yet many studies fail to achieve their expected recruitment rate. Increasing research participation is a key agenda within the NHS and elsewhere, but the optimal methods of improving recruitment to clinical research remain elusive. The aim of this study was to identify the factors that researchers perceive as influential in the recruitment of participants to clinically focused research. Methods Semi-structured interviews were conducted with 11 individuals from three clinical research teams based in London. Sampling was a combination of convenience and purposive. The interviews were audio recorded, transcribed verbatim and analysed using the framework method to identify key themes. Results Four themes were identified as influential to recruitment: infrastructure, nature of the research, recruiter characteristics and participant characteristics. The main reason individuals participate in clinical research was believed to be altruism, while logistical issues were considered important for those who declined. Suggestions to improve recruitment included reducing participant burden, providing support for individuals who do not speak English, and forming collaborations with primary care to improve the identification of, and access to, potentially eligible participants. Conclusions Recruiting the target number of research participants was perceived as difficult, especially for clinical trials. New and diverse strategies to ensure that all potentially eligible patients are invited to participate may be beneficial and require further exploration in different settings. Establishing integrated clinical and academic teams with shared responsibilities for recruitment may also facilitate this process. Language barriers and long journey times were considered negative influences to recruitment; although more prominent, these issues are not unique to London and are likely to be important influences in other locations. PMID:24456229

A year in transition: a qualitative study examining the trajectory of first year residents’ well-being

PubMed Central

2013-01-01

Background It is generally understood that trainees experience periods of heightened stress during first year residency, yet there is little information on variations in stress and well-being over the transition period or those factors that contribute to these variations. This qualitative study explored the trajectory of well-being described by first year residents in the context of challenges, supports and adaptations over time. Methods In-depth interviews were conducted face-to-face with 17 first year residents at the University of Toronto. Participants drew a graph of their well-being over the course of their first year and described critical periods of challenge and adaptation. Interviews were audio-taped and transcribed. Results were organized into a thematic analysis using NVivo software. Results Residents described a pattern of well-being that varied in accordance with changes in rotations. Well-being increased when residents perceived high levels of team support, felt competent and experienced valued learning opportunities. Well-being decreased with low team support, heavy work demands, few learning opportunities and poor orientations. Anxiety and excitement in the beginning of the year gave way to heightened confidence but increased fatigue and apathy towards the year’s end. Residents used a number of cognitive, behavioural and self-care strategies to cope with transitional challenges. Conclusions Residents experienced a pattern of highly fluctuating well-being that coincided with changes in rotations. Residents’ well-being varied according to levels of supervisor and colleague support, learning opportunities, and work demands. Residents’ well-being may be improved by program interventions that facilitate better team and supervisory supports, maintain optimal service to learning ratios, establish effective fatigue and risk management systems, offer wellness support services and integrate skills based resiliency training into the curriculum. PMID:23842470

Enhancing Supportive-Educative Nursing Systems to Reduce Risk of Post-Breast Cancer Lymphedema.

PubMed

Armer, Jane M; Shook, Robin P; Schneider, Melanie K; Brooks, Constance W; Peterson, Julie; Stewart, Bob R

2009-10-01

This study describes the use of data regarding self-care agency to enhance a supportive-educative nursing system for breast cancer survivors to reduce the risk of developing lymphedema post surgery. Impetus for this study came from the analysis of participant feedback from a parent study (Lance Armstrong Foundation pilot study) that sought to plan an educational program for nurses that will improve their supportive-educative nursing system when working with breast cancer survivors. The goal is to enable these women to reduce the risk of lymphedema post surgery. The parent study examined a bundled behavioral-educative intervention, which included standard lymphedema education coupled with Modified Manual Lymph Drainage (MMLD) to reduce the risk of developing lymphedema in newly-diagnosed breast cancer survivors. Based upon the feedback received from the parent study, the research team recognized that many of the participants were not fully following the recommendations of the intervention protocol. In order for nurses to help patients develop self-care agency (SCA) (Orem, 2001) to engage in actions that addressed the self-care requisites associated with post-breast cancer surgery, these nurses needed to refine their intervention skills. Prior to the development of a program for the nurses, the research team conducted a study to explore the state of power related to SCA of the study participants. The information obtained from this was then used in the development of an educational program for bundled intervention. Both motivational interviewing (Miller & Rollnick, 2002) and solution-focused therapy (Berg & DeJong, 1996) were incorporated into the educational program for the research nurse team to strengthen and improve supportive-educative nursing systems. Supportive-educative systems of care that integrate self-care deficit nursing theory, motivational interviewing, and solution-focused therapy can assist patients to develop and sustain self-care agency.

An exploration of NHS staff views on tuberculosis service delivery in Scottish NHS boards

PubMed Central

Spence, William

2013-01-01

Tuberculosis (TB) is a bacterial disease and major worldwide killer with an increased UK incidence rate. This study aimed to explore the views of National Health Service (NHS) staff on TB service delivery models of care in NHS boards across Scotland. Eighteen semi-structured interviews were conducted with 13 nurse specialists and five consultants in public health medicine (CPHM) across five Scottish NHS boards. Five main themes emerged and findings showed that: directly observed treatment (DOT) was provided only to patients assessed to be at high risk of poor treatment adherence; contact tracing was conducted by participating NHS boards but screening at ports was thought to be weak; all NHS boards implemented TB awareness campaigns for TB health professionals; three NHS boards conducted team meetings that monitored TB patient progress; participants believed that TB funding should be increased; contact tracing was routinely conducted by TB nurses. Improved TB screening at airports was recommended and a need for TB health education for high risk groups was identified. PMID:28989349

Stakeholder analysis for a maternal and newborn health project in Eastern Uganda.

PubMed

Namazzi, Gertrude; N, Kiwanuka Suzanne; Peter, Waiswa; John, Bua; Olico, Okui; A, Allen Katharine; A, Hyder Adnan; Elizabeth, Ekirapa Kiracho

2013-03-04

Based on the realization that Uganda is not on track to achieving Millennium Development Goals 4 and 5, Makerere University School of Public Health in collaboration with other partners proposed to conduct two community based maternal/newborn care interventions aimed at increasing access to health facility care through transport vouchers and use of community health workers to promote ideal family care practices. Prior to the implementation, a stakeholder analysis was undertaken to assess and map stakeholders' interests, influence/power and position in relation to the interventions; their views regarding the success and sustainability; and how this research can influence policy formulation in the country. A stakeholder analysis was carried out in March 2011 at national level and in four districts of Eastern Uganda where the proposed interventions would be conducted. At the national level, four key informant interviews were conducted with the ministry of health representative, Member of Parliament, and development partners. District health team members were interviewed and also engaged in a workshop; and at community level, twelve focus group discussions were conducted among women, men and motorcycle transporters. This analysis revealed that district and community level stakeholders were high level supporters of the proposed interventions but not drivers. At community level the mothers, their spouses and transporters were of low influence due to the limited funds they possessed. National level and district stakeholders believed that the intervention is costly and cannot be affordably scaled up. They advised the study team to mobilize and sensitize the communities to contribute financially from the start in order to enhance sustainability beyond the study period. Stakeholders believed that the proposed interventions will influence policy through modeling on how to improve the quality of maternal/newborn health services, male involvement, and improved accessibility of services. Most of the stakeholders interviewed were supporters of the proposed maternal and newborn care intervention because of the positive benefits of the intervention. The analysis highlighted stakeholder concerns that will be included in the final project design and that could also be useful in countries of similar setting that are planning to set up programmes geared at increasing access to maternal and new born interventions. Key among these concerns was the need to use both human and financial resources that are locally available in the community, to address supply side barriers that influence access to maternal and child healthcare. Research to policy translation, therefore, will require mutual trust, continued dialogue and engagement of the researchers, implementers and policy makers to enable scale up.

Stakeholder analysis for a maternal and newborn health project in Eastern Uganda

PubMed Central

2013-01-01

Background Based on the realization that Uganda is not on track to achieving Millennium Development Goals 4 and 5, Makerere University School of Public Health in collaboration with other partners proposed to conduct two community based maternal/newborn care interventions aimed at increasing access to health facility care through transport vouchers and use of community health workers to promote ideal family care practices. Prior to the implementation, a stakeholder analysis was undertaken to assess and map stakeholders’ interests, influence/power and position in relation to the interventions; their views regarding the success and sustainability; and how this research can influence policy formulation in the country. Methods A stakeholder analysis was carried out in March 2011 at national level and in four districts of Eastern Uganda where the proposed interventions would be conducted. At the national level, four key informant interviews were conducted with the ministry of health representative, Member of Parliament, and development partners. District health team members were interviewed and also engaged in a workshop; and at community level, twelve focus group discussions were conducted among women, men and motorcycle transporters. Results This analysis revealed that district and community level stakeholders were high level supporters of the proposed interventions but not drivers. At community level the mothers, their spouses and transporters were of low influence due to the limited funds they possessed. National level and district stakeholders believed that the intervention is costly and cannot be affordably scaled up. They advised the study team to mobilize and sensitize the communities to contribute financially from the start in order to enhance sustainability beyond the study period. Stakeholders believed that the proposed interventions will influence policy through modeling on how to improve the quality of maternal/newborn health services, male involvement, and improved accessibility of services. Conclusion Most of the stakeholders interviewed were supporters of the proposed maternal and newborn care intervention because of the positive benefits of the intervention. The analysis highlighted stakeholder concerns that will be included in the final project design and that could also be useful in countries of similar setting that are planning to set up programmes geared at increasing access to maternal and new born interventions. Key among these concerns was the need to use both human and financial resources that are locally available in the community, to address supply side barriers that influence access to maternal and child healthcare. Research to policy translation, therefore, will require mutual trust, continued dialogue and engagement of the researchers, implementers and policy makers to enable scale up. PMID:23497057

Student Journalists in the Field: Bridging the Gap Between Science and Communication

NASA Astrophysics Data System (ADS)

Glotch, T. D.; Jones, A. P.; Bleacher, L.; Selvin, B.; Firstman, R.

2015-12-01

The Remote, In Situ, and Synchrotron Studies for Science and Exploration (RIS4E) team is one of nine nodes of NASA's Solar System Exploration Research Virtual Institute. A core goal of the RIS4E Education and Communication (E&C) plan is to increase the accessibility of science to the general public, both by teaching scientists how to communicate their work to the public and by training the next generation of science journalists. During the Spring 2015 semester, eight Stony Brook University journalism students, ranging from Sophomores through M.A. students, participated in a new Science Journalism course in the School of Journalism. During the semester, the students learned about the science being conducted by the RIS4E team, took field trips to labs, interviewed scientists and graduate students, and produced print and video pieces about the science and the scientists. As a capstone project, five of the students, along with a professor and TA, were embedded with the RIS4E field geology team during their 2015 field season at the 1974 Kilauea lava flow on the Big Island of Hawaii. During their time in Hawaii, the journalism students had complete access to the field team, both during work and after-work hours. For each of the students, it was their first exposure to the practice of science, made possible through the experience of watching scientists formulate and test hypotheses in real time. They posted daily blog updates about the work being done by the field team and acquired dozens of hours of video footage to be produced into longer pieces. This presentation will describe the unique Stony Brook Science Journalism course and the experiences of the students both in the classroom and in the field. We will highlight both the successes and the lessons learned, for both the students and the scientists involved, and discuss our plans to conduct a second class in 2017, when the students will accompany the RIS4E field team to the Potrillo Volcanic Field in New Mexico.

Use of telehealth to treat and manage chronic viral hepatitis in regional Queensland.

PubMed

Keogh, Kandice; Clark, Paul; Valery, Patricia C; McPhail, Steven M; Bradshaw, Candise; Day, Melany; Smith, Anthony C

2016-12-01

For regional and rural Queenslanders, chronic viral hepatitis treatment is a major unmet health need, with restricted access to specialists outside of tertiary, largely metropolitan hospitals. To increase treatment of chronic viral hepatitis in regional Queensland, a team-based telehealth model was expanded. This expansion embedded an initial nursing consultation prior to specialist telehealth consultation. We conducted a retrospective audit of the introduction and expansion of hepatology telehealth services. Activity from July 2014-June 2015 (pre-expansion) was compared with July 2015- June 2016 (post-expansion). Interviews were conducted with key staff to determine factors contributing to success of the service and identify ongoing challenges to the service model. A greater than four-fold increase in clinical consultation was observed (131 telehealth consultations pre-expansion vs 572 post-expansion; p < 0.001). The failure to attend rate decreased (13.0% vs 6.5%, pre vs post-expansion respectively; p = 0.030), suggesting engagement with the service increased. Staff cited nurse-conducted primary assessment prior to specialist consultation and personalised patient treatment packs as key contributors to increased patient flow and engagement. This expanded team approach appears effective in delivering specialised treatment to an underserved area in regional Central Queensland. It may serve as a model to further expand telehealth management of chronic disease for regional Queenslanders. © The Author(s) 2016.

Re-evaluating disability assessment in war veterans with posttraumatic stress disorder.

PubMed

Samardžić, Radomir M; Živić, Bratislav; Krstić, Dragan; Joković, Danilo; Dolić, Mirko; Stojanović, Zvezdana; Eror, Aleksandar; Đokić, Milan; Milojević, Slavoljub; Mandić-Gajić, Gordana

2016-10-01

Sametimes war veterans may resort to such strategies as preducing exaggerated symptoms and malingerating in order to obtain material compensation rights. The aim of this study was to assess the accuracy of the diagnosis of posttraumatic stress disorder (PTSD) on the basis of which war veterans were entitled to a financial compensation due to their disability. The diagnoses of 259 war veterans were re-evaluated. Veterans were previously diagnosed by a psychiatrist on local level, while regional state medical commission determined the degree of disability and the right to a financial compensation. A team of experts, consisting of psychiatrists with research experience in the field of traumatic stress and who were trained to use a structured interview for PTSD, conducted the evaluation of medical data from veterans’ military records. The diagnostic process was conducted using the standardized diagnostic interview (Clinician-Administered PTSD Scale – CAPS), after which the diagnosis was reaffirmed or reviewed. This influenced disability status and consequential financial compensation. There was a remarkable difference between the first diagnostic assessment of PTSD, conducted by the psychiatrists on local level, and the second evaluation conducted by the team of experts. In more than half of 259 veterans (52.1%) diagnosed with PTSD in the first assessment the diagnosis was not confirmed. The diagnosis was confirmed in 31.7% of veterans. Those veterans who were diagnosed with lifetime PTSD (7.3%) should also be treated as accuratelly diagnosed. This means that a total of 39% of the diagnoses were accurate. The rest (8.9%) were diagnosed with other diagnoses, but not PTSD, as was the case in the initial assessment. The possibility for war veterans to obtain the right to disability and financial compensation due to a diagnosis of PTSD might interfere with the proper diagnostic assessment and thus the treatment outcome. During the procedures for the obtention of these rights, exaggeration or simulation of symptoms are common. The quality of the diagnostic assessment of PTSD can be improved by applying evidence based standardized procedures.

Positive deviance as a novel tool in malaria control and elimination: methodology, qualitative assessment and future potential.

PubMed

Shafique, Muhammad; Edwards, Hannah M; De Beyl, Celine Zegers; Thavrin, Bou Kheng; Min, Myo; Roca-Feltrer, Arantxa

2016-02-16

Positive deviance (PD) is an asset-based, community-driven approach to behaviour change that has successfully been applied to address many health and social problems. It is yet to have been assessed for malaria control but may represent a promising tool for malaria elimination given its suitability in targeting small and remote population groups, apparent sustainability and ability to instil a high amount of community mobilisation. Here, the PD methodology as applied to malaria is explained, with focus upon and qualitative assessment of a proof of concept study in Cambodia. Three villages in Battambang, northwestern Cambodia were selected for the intervention, with an estimated population of 5036 including both residents and migrant workers. In August 2010, field teams conducted a 1 week PD process to sensitise and mobilise the community, establish normative behaviours in relation to malaria control and prevention, identify positive deviant behaviours from within the community, and identify PD volunteers. Until March 2011, PD volunteers were supported by field teams via monthly meetings to conduct activities in their respective communities to increase practice of PD behaviours. In February 2012, 1 year following the end of external support, evaluative interviews were conducted with community members to qualitatively assess community acceptance and interpretation of the PD intervention, perceived behaviour changes, and perceived positive outcomes. Qualitative data from focus group discussions and in-depth interviews showed that the PD approach was well-accepted into the communities and created a strong sense of community empowerment. Positive behaviour change was linked to the PD intervention, including greater usage of nets by forest goers, and use of public health facilities for malaria diagnosis and treatment. One year following the end of external assistance, PD volunteers were still conducting activities in their respective communities. PD offers a promising tool in malaria control and elimination settings. Work is ongoing to quantitatively measure impact of PD on behaviours and malaria transmission and once gathered, national malaria control programmes should be encouraged to look at including PD as part of their national strategies. Feasibility of scale-up, cost-effectiveness, and applicability to other settings and diseases is also currently being explored.

Athletic Trainers' Roles and Responsibilities Regarding Academic Adjustments as Part of the Concussion-Management Process in the Secondary School Setting.

PubMed

Bacon, Cailee E Welch; Kay, Melissa C; McLeod, Tamara C Valovich

2017-10-01

  Athletic trainers (ATs) play a vital role in managing the care of student-athletes after a sport-related concussion, yet little is known about their specific involvement in the implementation of academic adjustments as part of the concussion-management plan.   To explore ATs' perceived roles and responsibilities regarding the implementation of academic adjustments for concussed student-athletes.   Qualitative study.   Individual telephone interviews.   Sixteen ATs employed in the secondary school setting (8 women, 8 men; age = 39.6 ± 7.9 years; athletic training experience = 15.1 ± 5.6 years), representing 12 states, were interviewed.   One telephone interview was conducted with each participant. After the interviews were transcribed, the data were analyzed and coded into themes and categories, which were determined via consensus of a 4-person research team. To decrease researcher bias, triangulation occurred through participant member checking, the inclusion of multiple researchers, and an internal auditor.   Several categories related to participants' perceptions regarding their roles and responsibilities within the academic-adjustments process emerged from data analysis: (1) understanding of academic adjustments, (2) perceptions of their roles in academic adjustments, (3) initiation of academic adjustments, (4) facilitation of academic adjustments, and (5) lack of a role in the academic-adjustments process. Although most ATs perceived that they had a role in the initiation and facilitation of academic adjustments for concussed student-athletes, some reported they did not want a role in the process. Regardless, participants frequently suggested the need for further education.   These findings highlight that ATs either wanted to be involved in the implementation of academic adjustments but felt further education was needed or they did not want to be involved because they felt that it was not in their area of expertise. To create a cohesive concussion-management team, it is vital that ATs understand their individual and collaborative roles in the secondary school setting.

Using interviews and focus groups with resource managers to explore risk perceptions and responses to climate scenarios

NASA Astrophysics Data System (ADS)

Clifford, K. R.; Travis, W.; Rangwala, I.; Rondeau, R.; Young, L.

2016-12-01

Resource managers in the western U.S. are increasingly tasked to incorporate climate change into management decisions and long-term planning, but this task is complicated by multiple challenges, among them the need to bridge between the differing perspectives and prerogatives of scientists and resource managers. As part of a larger, iterative, interdisciplinary, multi-landscape research project that built on a prior climate vulnerability research, we conducted more than 50 semi-structured interviews and four focus groups with resource managers in the Gunnison Basin in western Colorado. The interviews addressed the managers' risk perceptions and knowledge about the resources and landscapes, while the focus groups asked resource managers to reflect on their own resource decision-making in light of three narrative future climate scenarios created by scientists on the research team. While time-intensive, the interviews and focus groups produced important insights into the managers' understanding of both the resources in question and the future climate scenarios. We found that the managers' mental models of their systems, and their conceptions of landscape changes and future threats, were diverse and sometimes in conflict with those held by the research team. The managers' responses to the climate scenarios reflected divergent and nuanced perceptions of risk, adaptation and uncertainty, heavily shaped by personal experience—which could be a constraint under rapidly changing future conditions. Our deployment of social science methodologies facilitated the co-production of climate adaptation strategies and a bridge between and among scientists and managers. The participants found the focus groups helpful since they (1) provided space to focus on decision-making under climate change, rather than fixate on details of the science, and (2) facilitated interaction with colleagues from other agencies. Climate scientists used participant feedback to inform future scenario development. The use of small focus groups to engage with climate scenarios could add value to other ongoing efforts to promote landscape-scale adaptation.

A description of the "event manager" role in resuscitations: A qualitative study of interviews and focus groups of resuscitation participants.

PubMed

Taylor, Katherine L; Parshuram, Christopher S; Ferri, Susan; Mema, Briseida

2017-06-01

Communication during resuscitation is essential for the provision of coordinated, effective care. Previously, we observed 44% of resuscitation communication originated from participants other than the physician team leader; 65% of which was directed to the team, exclusive of the team leader. We called this outer-loop communication. This institutional review board-approved qualitative study used grounded theory analysis of focus groups and interviews to describe and define outer-loop communication and the role of "event manager" as an additional "leader." Participants were health care staff involved in the medical management of resuscitations in a quaternary pediatric academic hospital. The following 3 domains were identified: the existence and rationale of outer-loop communication; the functions fulfilled by outer-loop communication; and the leadership and learning of event manager skills. The role was recognized by all team members and evolved organically as resuscitation complexity increased. A "good" manager has similar qualities to a "good team leader" with strong nontechnical skills. Event managers were not formally identified and no specific training had occurred. "Outer-loop" communication supports resuscitation activities. An event manager gives direction to the team, coordinates activities, and supports the team leader. We describe a new role in resuscitation in light of structural organizational theory and cognitive load with a view to incorporating this structure into resuscitation training. Copyright © 2017 Elsevier Inc. All rights reserved.

Medical Education to Enhance Critical Consciousness: Facilitators' Experiences.

PubMed

Zaidi, Zareen; Vyas, Rashmi; Verstegen, Danielle; Morahan, Page; Dornan, Tim

2017-11-01

To analyze educators' experiences of facilitating cultural discussions in two global health professions education programs and what these experiences had taught them about critical consciousness. A multicultural research team conducted in-depth interviews with 16 faculty who had extensive experience facilitating cultural discussions. They analyzed transcripts of the interviews thematically, drawing sensitizing insights from Gramsci's theory of cultural hegemony. Collaboration and conversation helped the team self-consciously examine their positions toward the data set and be critically reflexive. Participant faculty used their prior experience facilitating cultural discussions to create a "safe space" in which learners could develop critical consciousness. During multicultural interactions they recognized and explicitly addressed issues related to power differentials, racism, implicit bias, and gender bias. They noted the need to be "facile in attending to pain" as learners brought up traumatic experiences and other sensitive issues including racism and the impact of power dynamics. They built relationships with learners by juxtaposing and exploring the sometimes-conflicting norms of different cultures. Participants were reflective about their own understanding and tendency to be biased. They aimed to break free of such biases while role modeling how to have the courage to speak up. Experience had given facilitators in multicultural programs an understanding of their responsibility to promote critical consciousness and social justice. How faculty without prior experience or expertise could develop those values and skills is a topic for future research.

A feeling of flow: exploring junior scientists' experiences with dictation of scientific articles.

PubMed

Spanager, Lene; Danielsen, Anne Kjaergaard; Pommergaard, Hans-Christian; Burcharth, Jakob; Rosenberg, Jacob

2013-08-10

Science involves publishing results, but many scientists do not master this. We introduced dictation as a method of producing a manuscript draft, participating in writing teams and attending a writing retreat to junior scientists in our department. This study aimed to explore the scientists' experiences with this process. Four focus group interviews were conducted and comprised all participating scientists (n = 14). Each transcript was transcribed verbatim and coded independently by two interviewers. The coding structure was discussed until consensus and from this the emergent themes were identified. Participants were 7 PhD students, 5 scholarship students and 2 clinical research nurses. Three main themes were identified: 'Preparing and then letting go' indicated that dictating worked best when properly prepared. 'The big dictation machine' described benefits of writing teams when junior scientists got feedback on both content and structure of their papers. 'Barriers to and drivers for participation' described flow-like states that participants experienced during the dictation. Motivation and a high level of preparation were pivotal to be able to dictate a full article in one day. The descriptions of flow-like states seemed analogous to the theoretical model of flow which is interesting, as flow is usually deemed a state reserved to skilled experts. Our findings suggest that other academic groups might benefit from using the concept including dictation of manuscripts to encourage participants' confidence in their writing skills.

The Good Clinical Practice guideline and its interpretation - perceptions of clinical trial teams in sub-Saharan Africa.

PubMed

Vischer, N; Pfeiffer, C; Joller, A; Klingmann, I; Ka, A; Kpormegbe, S K; Burri, C

2016-08-01

To explore the advantages and challenges of working with the Good Clinical Practice (GCP)-International Conference of Harmonization (ICH) E6 guideline and its interpretation from the perspective of clinical trial teams based in sub-Saharan Africa. We conducted 60 key informant interviews with clinical trial staff at different levels in clinical research centres in Kenya, Ghana, Burkina Faso and Senegal and thematically analysed the responses. Clinical trial teams perceived working with ICH-GCP as highly advantageous and regarded ICH-GCP as applicable to their setting and efficiently applied. Only for informed consent did some clinical trial staff (one-third) perceive the guideline as insufficiently applicable. Specific challenges included meeting the requirements for written and individual consent, conditions for impartial witnesses for illiterates or legally acceptable representatives for children, guaranteeing voluntary participation and ensuring full understanding of the consent given. It was deemed important to have ICH-GCP compliance monitored by relevant ethics committees and regulatory authorities, without having guidelines applied overcautiously. Clinical trial teams in sub-Saharan Africa perceived GCP as a helpful guideline, despite having been developed by northern organisations and despite the high administrative burden of implementing it. To mitigate consent challenges, we suggest adapting GCP and making use of the flexibility it offers. © 2016 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

A Study of Preschool Special Education Teams in New York City as Reported by the Parents and Legal Guardians of Preschoolers with Special Needs

ERIC Educational Resources Information Center

Sheppard, Mary Erin

2012-01-01

This is a descriptive study that examines the form and function of preschool special education teams in New York City. The results are based upon the perceptions of teams as reported by parents and guardians of preschoolers with disabilities in NYC. These perceptions were collected through surveys and interviews. In addition, documents about…

Comparing Perceptions of Teamness between Adult, First- and Second-Generation Mexican American and All Other Students Enrolled in a Cohort-Based, Accelerated, Bachelor's Degree Program

ERIC Educational Resources Information Center

Lincoln, Tami

2010-01-01

Purpose: The purpose of this study was to determine if there is a difference in the perception of the degree of teamness, as measured by the Characteristics of Effective Teams Survey (Harvey & Drolet, 2004), interviews, and archival data, between adult first- and second-generation Mexican American students and adult non-first- and…

Successful participation of patients in interprofessional team meetings: A qualitative study.

PubMed

van Dongen, Jerôme Jean Jacques; Habets, Iris Gerarda Josephine; Beurskens, Anna; van Bokhoven, Marloes Amantia

2017-08-01

The number of people with multiple chronic conditions increases as a result of ageing. To deal with the complex health-care needs of these patients, it is important that health-care professionals collaborate in interprofessional teams. To deliver patient-centred care, it is often recommended to include the patient as a member of the team. To gain more insight into how health-care professionals and patients, who are used to participate in interprofessional team meetings, experience and organize patient participation in the team meetings. A qualitative study including observations of meetings (n=8), followed by semi-structured interviews with participating health-care professionals (n=8), patients and/or relatives (n=11). Professionals and patients were asked about their experiences of patient participation immediately after the team meetings. Results from both observations and interviews were analysed using content analysis. The findings show a variety of influencing factors related to patient participation that can be divided into five categories: (i) structure and task distribution, (ii) group composition, (iii) relationship between professionals and patients or relatives, (iv) patients' characteristics and (v) the purpose of the meeting. Patient participation during team meetings was appreciated by professionals and patients. A tailored approach to patient involvement during team meetings is preferable. When considering the presence of patients in team meetings, it is recommended to pay attention to patients' willingness and ability to participate, and the necessary information shared before the meeting. Participating patients seem to appreciate support and preparation for the meeting. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

Preparing healthcare students who participate in interprofessional education for interprofessional collaboration: A constructivist grounded theory study protocol.

PubMed

Bianchi, Monica; Bagnasco, Annamaria; Aleo, Giuseppe; Catania, Gianluca; Zanini, Milko Patrick; Timmins, Fiona; Carnevale, Franco; Sasso, Loredana

2018-05-01

This article presents a qualitative research protocol to explore and understand the interprofessional collaboration (IPC) preparation process implemented by clinical tutors and students of different professions involved in interprofessional education (IPE). Many studies have shown that IPE initiatives improve students' understanding of the roles and responsibilities of other professionals. This improves students' attitudes towards other professions, facilitating mutual respect, and IPC. However, there is limited information about how students are prepared to work collaboratively within interprofessional teams. This is a constructivist grounded theory (GT) study, which will involve data collection through in-depth semi-structured interviews (to 9-15 students and 6-9 clinical tutors), participant observations, and the analysis of documentation. After analysing, coding, integrating, and comparing the data if necessary, a second round of interviews could be conducted to explore any particularly interesting aspects or clarify any issues. This will then be followed by focused and theoretical coding. Qualitative data analysis will be conducted with the support of NVivo 10 software (Victoria, Australia). A better conceptual understanding will help to understand if IPE experiences have contributed to the acquisition of competencies considered important for IPC, and if they have facilitated the development of teamwork attitudes.

Issues affecting the motivation of nuclear medicine technologists in Kuwait.

PubMed

Ali, Layla; Abdelsalam, Amal; Muddei, Sara; Brindhaban, Ajit

2013-01-01

The demand for nuclear medicine technologists (NMTs) in Kuwait has increased, especially with the introduction of multimodality imaging systems. In order to increase the number of NMTs in the workforce and retain the existing NMTs, there should be a better way to motivate them. To find out how satisfied NMTs are and the factors that motivate them. An interview was conducted with 40 randomly selected NMTs to explore deep-seated emotions and attitudes that were related to motivation. Questions about the recognition NMTs receive from the general public, whether they are acknowledged as significant contributors to health services, ways to improve the standing of NMTs in society, and the clarity of the job description were included. A questionnaire survey was then conducted with 100 randomly selected NMTs. The questions were designed to elicit wider perspective of the information obtained from the interviews. The results show a need for attention in the Ministry of Health to NMTs for recognition, motivation, and improvement. Giving the NMTs their own identity and opportunities to be part of decision-making in the health team would influence more students to join nuclear medicine departments and give more self-confidence to the existing NMTs.

FY1 doctors' ethicolegal challenges in their first year of clinical practice: an interview study.

PubMed

Vivekananda-Schmidt, Pirashanthie; Vernon, Bryan

2014-04-01

There is little evidence of junior trainee perspectives in the design and implementation of medical ethics and law (MEL) curriculum in UK medical schools. To determine the ethical issues the foundation year 1 (FY1) doctors (first year after graduation)  encountered during clinical practice and the skills and knowledge of MEL, which were useful in informing MEL curriculum development. The National Research Ethics Service gave ethical approval. Eighteen one-to-one interviews were conducted in each school with FY1 doctors. Interviews were recorded and transcribed verbatim; a thematic analysis was undertaken with the transcriptions and saturation of themes was achieved. Themes closely overlapped between the two study sites. (1) Knowing my place as an FY1 (this theme consisted of four subthemes: challenging the hierarchy, being honest when the team is titrating the truth, taking consent for unfamiliar procedures and personal safety vs competing considerations); (2) Do not attempt resuscitation)/end-of-life pathway and its implications; (3) 'You have to be there' (contextualising ethics and law teaching through cases or role plays to allow students to explore future work situations); and (4) advanced interpersonal skills competency for ethical clinical practice. The data provide a snapshot of the real challenges faced by MEL FY1 doctors in early clinical practice: they may feel ill-prepared and sometimes unsupported by senior members of the team. The key themes suggest areas for development of undergraduate and postgraduate MEL curricula. We will work to develop our own curriculum accordingly. We intend to further investigate the applicability of our findings to UK medical ethics and law curriculum.

Undeclared exposure to St. John's Wort in hospitalized patients

PubMed Central

Martin-Facklam, Meret; Rieger, Karin; Riedel, Klaus-Dieter; Burhenne, Jürgen; Walter-Sack, Ingeborg; Haefeli, Walter E

2004-01-01

Aim The herbal medicine St. John's Wort (SJW) causes substantial decreases in the plasma concentrations of a range of co-administered drugs. Therefore, we evaluated the extent of systemic exposure to hyperforin and hypericin, two of the main constituents of SJW, in patients on admission and during hospital stay, and compared the results with known use of SJW as documented in the drug chart and detected in additional interviews. Methods One hundred and fifty patients aged ≥ 18 years and admitted, between August 2000 and February 2002, to an internal medicine ward of a large German university hospital were included. Hyperforin and hypericin was determined in plasma by a sensitive liquid chromotography/mass spectometry (LC/MS/MS) method. To assess undeclared use of SJW the data were compared to information obtained from drug charts and from up to three interviews that had a particular focus on intake of herbal medicines and self-medication during hospitalization. Results Hyperforin was detected in 12 patients (plasma concentration on the first day of hospitalization = 12–100 ng ml−1 in five patients and <3 ng ml−1 in seven), and hypericin in five patients (0.5–4.3 ng ml−1). Nine patients (6%) were taking/had taken SJW without the knowledge of the medical team and the pharmacist, who conducted the additional interviews, and 11 (7.3%) were taking/had taken SJW without the knowledge of the medical team alone. Seven of these patients were treated concurrently with drugs that can interact with SJW. Conclusions Unrecognized use of SJW is frequent and may have an important influence on the effectiveness and safety of drug therapy during hospital stay. PMID:15373938

[Enhancement of quality by employing qualification-oriented staff and team-oriented cooperation].

PubMed

Meyenburg-Altwarg, Iris; Tecklenburg, Andreas

2010-01-01

Taking three practical examples from a university hospital the present article describes how quality can be improved by linking deployment of qualification-oriented staff with team-oriented cooperation, especially with regard to the professional groups of physicians and nurses. In the first example, a cross-professional work group defined tasks which--in a legally acceptable manner--allow selected activities to be transferred from physicians to nurses, improving the work processes of all persons concerned. Work and duty profiles, training and modified work processes were created and implemented according to the PDCA circle-based process. The first evaluation took place after nine months using interviews, questionnaires (patients, physicians, and nurses) as well as CIRS. In the second example, emphasis was placed on offers of supplementary services for private patients resulting in a lightening of the workload on the nursing staff. These supplementary services are intended to enhance the wellbeing of the patients. Special external-service staff provide high standard hotel services. These services consistently receive high ratings from the patients. The methods used for introduction and evaluation are analogous to those used in the first example. The third example is concerned with the extension of nursing care and patient empowerment beyond the boundaries of ward and hospital. The guidelines were the implementation of the national expert standard for discharge management according to the DNQP. The methods of introduction were analogous to those used in example 1. For the evaluation interviews were conducted with all participating groups. In all examples actual quantitative measures (key ratios) are not yet available; however, the data collected from the interviews and questionnaires of all the participants are promising.

Surveyor Management of Hospital Accreditation Program: A Thematic Analysis Conducted in Iran.

PubMed

Teymourzadeh, Ehsan; Ramezani, Mozhdeh; Arab, Mohammad; Rahimi Foroushani, Abbas; Akbari Sari, Ali

2016-05-01

The surveyors in hospital accreditation program are considered as the core of accreditation programs. So, the reliability and validity of the accreditation program heavily depend on their performance. This study aimed to identify the dimensions and factors affecting surveyor management of hospital accreditation programs in Iran. This qualitative study used a thematic analysis method, and was performed in Iran in 2014. The study participants included experts in the field of hospital accreditation, and were derived from three groups: 1. Policy-makers, administrators, and surveyors of the accreditation bureau, the ministry of health and medical education, Iranian universities of medical science; 2. Healthcare service providers, and 3. University professors and faculty members. The data were collected using semi-structured in-depth interviews. Following text transcription and control of compliance with the original text, MAXQDA10 software was used to code, classify, and organize the interviews in six stages. The findings from the analysis of 21 interviews were first classified in the form of 1347 semantic units, 11 themes, 17 sub-themes, and 248 codes. These were further discussed by an expert panel, which then resulted in the emergence of seven main themes - selection and recruitment of the surveyor team, organization of the surveyor team, planning to perform surveys, surveyor motivation and retention, surveyor training, surveyor assessment, and recommendations - as well as 27 sub-themes, and 112 codes. The dimensions and variables affecting the surveyors' management were identified and classified on the basis of existing scientific methods in the form of a conceptual framework. Using the results of this study, it would certainly be possible to take a great step toward enhancing the reliability of surveys and the quality and safety of services, while effectively managing accreditation program surveyors.

Assessing Emergency Preparedness and Response Capacity Using Community Assessment for Public Health Emergency Response Methodology: Portsmouth, Virginia, 2013.

PubMed

Kurkjian, Katie M; Winz, Michelle; Yang, Jun; Corvese, Kate; Colón, Ana; Levine, Seth J; Mullen, Jessica; Ruth, Donna; Anson-Dwamena, Rexford; Bayleyegn, Tesfaye; Chang, David S

2016-04-01

For the past decade, emergency preparedness campaigns have encouraged households to meet preparedness metrics, such as having a household evacuation plan and emergency supplies of food, water, and medication. To estimate current household preparedness levels and to enhance disaster response planning, the Virginia Department of Health with remote technical assistance from the Centers for Disease Control and Prevention conducted a community health assessment in 2013 in Portsmouth, Virginia. Using the Community Assessment for Public Health Emergency Response (CASPER) methodology with 2-stage cluster sampling, we randomly selected 210 households for in-person interviews. Households were questioned about emergency planning and supplies, information sources during emergencies, and chronic health conditions. Interview teams completed 180 interviews (86%). Interviews revealed that 70% of households had an emergency evacuation plan, 67% had a 3-day supply of water for each member, and 77% had a first aid kit. Most households (65%) reported that the television was the primary source of information during an emergency. Heart disease (54%) and obesity (40%) were the most frequently reported chronic conditions. The Virginia Department of Health identified important gaps in local household preparedness. Data from the assessment have been used to inform community health partners, enhance disaster response planning, set community health priorities, and influence Portsmouth's Community Health Improvement Plan.

The psychosocial impacts of multimedia biographies on persons with cognitive impairments.

PubMed

Damianakis, Thecla; Crete-Nishihata, Masashi; Smith, Karen L; Baecker, Ronald M; Marziali, Elsa

2010-02-01

The purpose of this feasibility pilot project was to observe Alzheimer's disease (AD) and mild cognitive impairment (MCI) patients' responses to personalized multimedia biographies (MBs). We developed a procedure for using digital video technology to construct DVD-based MBs of persons with AD or MCI, documented their responses to observing their MBs, and evaluated the psychosocial benefits. An interdisciplinary team consisting of multimedia biographers and social workers interviewed 12 family members of persons with AD and MCI and collected archival materials to best capture the families' and patients' life histories. We filmed patients' responses to watching the MBs and conducted follow-up interviews with the families and patients at 3 and 6 months following the initial viewing. Qualitative analytic strategies were used for extracting themes and key issues identified in both the filmed and the interview response data. Analysis of the interview and video data showed how evoked long-term memories stimulated reminiscing, brought mostly joy but occasionally moments of sadness to the persons with cognitive impairments, aided family members in remembering and better understanding their loved ones, and stimulated social interactions with family members and with formal caregivers. This study demonstrates the feasibility of using readily available digital video technology to produce MBs that hold special meaning for individuals experiencing AD or MCI and their families.

"A steep learning curve": junior doctor perspectives on the transition from medical student to the health-care workplace.

PubMed

Sturman, Nancy; Tan, Zachary; Turner, Jane

2017-05-26

The transition from medical student to hospital-based first year junior doctor (termed "intern" in Australia) is known to be challenging, and recent changes in clinical learning environments may reduce graduate preparedness for the intern workplace. Although manageable challenges and transitions are a stimulus to learning, levels of burnout in junior medical colleagues are concerning. In order to prepare and support medical graduates, educators need to understand contemporary junior doctor perspectives on this transition. Final-year University of Queensland medical students recruited junior doctors working in diverse hospital settings, and videorecorded individual semi-structured interviews about their transition from medical student to working as a junior doctor. Two clinical academics (NS and JT) and an intern (ZT) independently conducted a descriptive analysis of interview transcripts, and identified preliminary emerging concepts and themes, before reaching agreement by consensus on the major overarching themes. Three key themes emerged from the analysis of 15 interviews: internship as a "steep learning curve"; relationships and team; and seeking help. Participants described the intern transition as physically, mentally and emotionally exhausting. They learned to manage long days, administrative and clinical tasks, frequent interruptions and time pressures; identify priorities; deal with criticism without compromising key relationships; communicate succinctly; understand team roles (including their own status within hospital hierarchies); and negotiate conflict. Participants reported a drop in self-confidence, and difficulty maintaining self-care and social relationships. Although participants emphasised the importance of escalating concerns and seeking help to manage patients, they appeared more reluctant to seek help for personal issues and reported a number of barriers to doing so. Findings may assist educators in refining their intern preparation and intern training curricula, and ensuring that medical school and intern preparation priorities are not seen as competing. Insights from non-medical disciplines into the organisational and relational challenges facing junior doctors and their health-care teams may enhance inter-professional learning opportunities. Workplace support and teaching, especially from junior colleagues, is highly valued during the demanding intern transition.

After the Liverpool Care Pathway--development of heuristics to guide end of life care for people with dementia: protocol of the ALCP study.

PubMed

Davies, N; Manthorpe, J; Sampson, E L; Iliffe, S

2015-09-02

End of life care guidance for people with dementia is lacking and this has been made more problematic in England with the removal of one of the main end of life care guidelines which offered some structure, the Liverpool Care Pathway. This guidance gap may be eased with the development of heuristics (rules of thumb) which offer a fast and frugal form of decision-making. To develop a toolkit of heuristics (rules of thumb) for practitioners to use when caring for people with dementia at the end of life. A mixed-method study using a co-design approach to develop heuristics in three phases. In phase 1, we will conduct at least six focus groups with family carers, health and social care practitioners from both hospital and community care services, using the 'think-aloud' method to understand decision-making processes and to develop a set of heuristics. The focus group topic guide will be developed from the findings of a previous study of 46 interviews of family carers about quality end-of-life care for people with dementia and a review of the literature. A multidisciplinary development team of health and social care practitioners will synthesise the findings from the focus groups to devise and refine a toolkit of heuristics. Phase 2 will test the use of heuristics in practice in five sites: one general practice, one community nursing team, one hospital ward and two palliative care teams working in the community. Phase 3 will evaluate and further refine the toolkit of heuristics through group interviews, online questionnaires and semistructured interviews. This study has received ethical approval from a local NHS research ethics committee (Rec ref: 15/LO/0156). The findings of this study will be presented in peer-reviewed publications and national and international conferences. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Team social cohesion, professionalism, and patient-centeredness: Gendered care work, with special reference to elderly care - a mixed methods study.

PubMed

Öhman, Ann; Keisu, Britt-Inger; Enberg, Birgit

2017-06-02

Healthcare organisations are facing large demands in recruiting employees with adequate competency to care for the increasing numbers of elderly. High degrees of turnover and dissatisfaction with working conditions are common. The gendered notion of care work as 'women's work', in combination with low salaries and status, may contribute to negative work experiences. There is abundant information about the negative aspects of elderly care health services, but little is known about positive aspects of this work. The study aim was to investigate work satisfaction from a gender perspective among Swedish registered nurses, physiotherapists, and occupational therapists, focusing specifically on healthcare services for the elderly. A mixed methods approach was adopted in which we combined statistics and open-ended responses from a national survey with qualitative research interviews with healthcare professionals in elderly care organisations. The survey was administered to a random sample of 1578 registered nurses, physiotherapists, and occupational therapists. Qualitative interviews with 17 professionals were conducted in six elderly care facilities. Qualitative and quantitative content analyses, chi 2 and constructivist grounded theory were used to analyse the data. There was a statistically significant difference in overall work satisfaction between those who worked in elderly care and those who did not (64 and 74,4% respectively, p <0.001). Nine themes were derived from open-ended responses in the questionnaire. The qualitative interviews revealed four prominent storylines: 'Team social cohesion', 'Career development and autonomy', 'Client-centeredness', and 'Invisible and ignored power structures'. The results show the complexity of elderly care work and describe several aspects that are important for work satisfaction among health professionals. The results reveal that work satisfaction is dependent on social interrelations and cohesion in the work team, in possibilities to use humour and to have fun together, and in the ability to work as professionals to provide client-centered elderly care. Power relations such as gendered hierarchies were less visible or even ignored aspects of work satisfaction. The storylines are clearly linked to the two central discourses of professionalism and gender equality.

Health promotion: the impact of beliefs of health benefits, social relations and enjoyment on exercise continuation.

PubMed

Nielsen, G; Wikman, J M; Jensen, C J; Schmidt, J F; Gliemann, L; Andersen, T R

2014-08-01

The aim of this study was to explore how and why participants in structured exercise intervention programs continue or stop exercising after the program is finished. We conducted four focus group interviews with four groups of middle-aged and elderly men (total n = 28) who had participated in exercise interventions involving playing either a team sport (football) or a more individually focused activity (spinning and crossfit). Our results show that different social, organizational and material structures inherent in the different activities shape the subjects' enjoyment of exercise participation, as well as their intention and ability to continue being active. In conclusion, team sport activities seem to be intrinsically motivating to the participants through positive social interaction and play. They are therefore more likely to result in exercise continuation than activities that rely primarily on extrinsic motivation such as the expectation of improved health and well-being. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Collaborative Drug Therapy Management: Case Studies of Three Community-Based Models of Care

PubMed Central

Snyder, Margie E.; Earl, Tara R.; Greenberg, Michael; Heisler, Holly; Revels, Michelle; Matson-Koffman, Dyann

2015-01-01

Collaborative drug therapy management agreements are a strategy for expanding the role of pharmacists in team-based care with other providers. However, these agreements have not been widely implemented. This study describes the features of existing provider–pharmacist collaborative drug therapy management practices and identifies the facilitators and barriers to implementing such services in community settings. We conducted in-depth, qualitative interviews in 2012 in a federally qualified health center, an independent pharmacy, and a retail pharmacy chain. Facilitators included 1) ensuring pharmacists were adequately trained; 2) obtaining stakeholder (eg, physician) buy-in; and 3) leveraging academic partners. Barriers included 1) lack of pharmacist compensation; 2) hesitation among providers to trust pharmacists; 3) lack of time and resources; and 4) existing informal collaborations that resulted in reduced interest in formal agreements. The models described in this study could be used to strengthen clinical–community linkages through team-based care, particularly for chronic disease prevention and management. PMID:25811494

[Management of technology in intensive care].

PubMed

Madureira, C R; Veiga, K; Sant'ana, A F

2000-12-01

The lives of hospitalized patients depend on diagnostic-therapeutic procedures and on the care provided by the health team. It also depends on the quality and availability of factors such as: physical structure and material and human and financial resources. The need to optimize these resources and re-establish patients' health has brought about the Intensive Care Units (ICU), whose design must consider the physical environment and clinical equipment which are indispensable in health care. Aiming at identifying the level of knowledge of health professionals as to technical and operational information in equipment manuals and the perception of the interviewed professionals in relation to the adequacy of the physical and electrical installations of such units, we conducted a descriptive study in an ICU of a public hospital in Salvador, Brazil. The results show that such installations were considered to be unsuitable for the safe development of activities and that most of the health team members did not know the technical or operational specifications in the equipment manuals.

Integration of human factors and ergonomics during medical device design and development: it's all about communication.

PubMed

Vincent, Christopher James; Li, Yunqiu; Blandford, Ann

2014-05-01

Manufacturers of interactive medical devices, such as infusion pumps, need to ensure that devices minimise the risk of unintended harm during use. However, development teams face challenges in incorporating Human Factors. The aim of the research reported here was to better understand the constraints under which medical device design and development take place. We report the results of a qualitative study based on 19 semi-structured interviews with professionals involved in the design, development and deployment of interactive medical devices. A thematic analysis was conducted. Multiple barriers to designing for safety and usability were identified. In particular, we identified barriers to communication both between the development organisation and the intended users and between different teams within the development organisation. We propose the use of mediating representations. Artefacts such as personas and scenarios, known to provide integration across multiple perspectives, are an essential component of designing for safety and usability. Copyright © 2013 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Challenges and Approaches to Make Multidisciplinary Team Meetings Interoperable - The KIMBo Project.

PubMed

Krauss, Oliver; Holzer, Karl; Schuler, Andreas; Egelkraut, Reinhard; Franz, Barbara

2017-01-01

Multidisciplinary team meetings (MDTMs) are already in use for certain areas in healthcare (e.g. treatment of cancer). Due to the lack of common standards and accessibility for the applied IT systems, their potential is not yet completely exploited. Common requirements for MDTMs shall be identified and aggregated into a process definition to be automated by an application architecture utilizing modern standards in electronic healthcare, e.g. HL7 FHIR. To identify requirements, an extensive literature review as well as semi-structured expert interviews were conducted. Results showed, that interoperability and flexibility in terms of the process are key requirements to be addressed. An architecture blueprint as well as an aggregated process definition were derived from the insights gained. To evaluate the feasibility of identified requirements, methods of explorative prototyping in software engineering were used. MDTMs will become an important part of modern and future healthcare but the need for standardization in terms of interoperability is imminent.

The impact of organisational and individual factors on team communication in surgery: a qualitative study.

PubMed

Gillespie, Brigid M; Chaboyer, Wendy; Longbottom, Paula; Wallis, Marianne

2010-06-01

Effective teamwork and communication is a crucial determinant of patient safety in the operating room. Communication failures are often underpinned by the inherent differences in professional practices across disciplines, and the ways in which they collaborate. Despite the overwhelming international support to improve team communication, progress has been slow. The aim of this paper is to extend understanding of the organisational and individual factors that influence teamwork in surgery. This qualitative study used a grounded theory approach to generate a theoretical model to explain the relations between organisational and individual factors that influence interdisciplinary communication in surgery. A purposive sample of 16 participants including surgeons, anaesthetists, and nurses who worked in an operating room of a large metropolitan hospital in south east Queensland, Australia, were selected. Participants were interviewed during 2008 using semi-structured individual and group interviews. All interviews were recorded and transcribed. Using a combination of inductive and deductive approaches, thematic analyses uncovered individual experiences in association with teamwork in surgery. Analysis generated three themes that identified and described causal patterns of interdisciplinary teamwork practices; interdisciplinary diversity in teams contributes to complex interpersonal relations, the pervasive influence of the organisation on team cohesion, and, education is the panacea to improving team communications. The development of shared mental models has the potential to improve teamwork in surgery, and thus enhance patient safety. This insight presents a critical first step towards the development teambuilding interventions in the operating room that would specifically address communication practices in surgery. (c) 2009 Elsevier Ltd. All rights reserved.

Impact of clinical leadership development on the clinical leader, nursing team and care-giving process: a case study.

PubMed

Dierckx de Casterlé, Bernadette; Willemse, An; Verschueren, Marc; Milisen, Koen

2008-09-01

This study explored the dynamics related to a leadership development programme and their impact on the clinical leader, the nursing team and the care-giving process. While there is a growing conviction about the need to invest in transformational leadership in nursing, further insight into the true complexity of leadership development and, more specifically, how leadership can make a difference in nursing and patient outcomes is essential. A single instrumental case study was conducted in a unit of a large academic hospital where a Clinical Leadership development Project (CLP) was implemented successfully. We used mixed methods with multiple sources of data to capture the complexity of leadership development. Data were collected through individual interviews, focus groups and observation of participants. A purposive sample of 17 participants representing a wide variety of team members has permitted data saturation. The data were categorized and conceptualized and finally organized into a framework describing leadership development on the unit and its impact on the leader, the nursing team and the care-giving process. Leadership development is an ongoing, interactive process between the clinical leader and the co-workers. The head nurse became more effective in areas of self-awareness, communication skills, performance and vision. The nursing team benefited because more effective leadership promoted effective communication, greater responsibility, empowerment and job clarity. Improved clinical leadership seemed also to influence patient-centred communication, continuity of care and interdisciplinary collaboration. The results of the study give more insight into the processes underlying the leader's progress towards attaining a transformational leadership style and its impact on the team members. The impact of leadership on the care-giving process, however, remains difficult to describe. The interactive nature of leadership development makes CLP a challenge for the leader as well for the team members. Through its impact on the leader and the nursing team, CLP is a valuable instrument for improving work environments of nurses, contributing positively to patient-centred care.

The 'weekend effect' in acute medicine: a protocol for a team-based ethnography of weekend care for medical patients in acute hospital settings.

PubMed

Tarrant, Carolyn; Sutton, Elizabeth; Angell, Emma; Aldridge, Cassie P; Boyal, Amunpreet; Bion, Julian

2017-04-05

It is now well-recognised that patients admitted to hospital on weekends are at higher risk of death than those admitted during weekdays. However, the causes of this 'weekend effect' are poorly understood. Some contend that there is a deficit of medical staff on weekends resulting in poorer quality care, whereas others find that patients admitted to hospital on weekends are sicker and therefore at higher risk of adverse outcomes. Clarifying the causal pathway is clearly important in order to identify effective solutions. In this article we describe an ethnographic approach to evaluating the organisation and delivery of medical care on weekends compared with weekdays, with a specific focus on the role of medical staff as part of National Health Service England's plan to implement 7-day services. We will conduct an ethnographic study of 20 acute hospitals in England between April 2016 and March 2018 as part of the High-intensity Specialist-Led Acute Care project (www.hislac.org). Data will be collected through observations and shadowing, and interviews with staff, in 10 hospitals with higher intensity specialist (consultant) staffing on weekends and 10 with lower intensity specialist staffing. Interviews will be conducted with up to 20 patients sampled from two high-intensity and two low-intensity sites. We will coordinate, compare and contrast observations across our team of ethnographers. Analysis will be both in-depth and cross-cutting, exploring specific features within individual sites and making comparisons between them. We outline how data collection and analysis will be facilitated and organised. The project has received ethics approval from the South West Wales Research Ethics Committee: Reference 13/WA/0372. Informed consent will be obtained for all interview participants. The findings will be disseminated through peer-reviewed publications in high-quality journals and at national and international conferences. © 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.

Crisis averted: How consumers experienced a police and clinical early response (PACER) unit responding to a mental health crisis.

PubMed

Evangelista, Eloisa; Lee, Stuart; Gallagher, Angela; Peterson, Violeta; James, Jo; Warren, Narelle; Henderson, Kathryn; Keppich-Arnold, Sandra; Cornelius, Luke; Deveny, Elizabeth

2016-08-01

When mental health crisis situations in the community are poorly handled, it can result in physical and emotional injuries. The purpose of this study was to ascertain the experiences and opinions of consumers about the way police and mental health services worked together, specifically via the Alfred Police and Clinical Early Response (A-PACER) model, to assist people experiencing a mental health crisis. Semi-structured in-depth interviews were conducted with 12 mental health consumers who had direct contact with the A-PACER team between June 2013 and March 2015. The study highlighted that people who encountered the A-PACER team generally valued and saw the benefit of a joint police-mental health clinician team response to a mental health crisis situation in the community. In understanding what worked well in how the A-PACER team operated, consumers perspectives can be summarized into five themes: communication and de-escalation, persistence of the A-PACER team, providing a quick response and working well under pressure, handover of information, and A-PACER helped consumers achieve a preferred outcome. All consumers acknowledged the complementary roles of the police officer and mental health clinician, and described the A-PACER team's supportive approach as critical in gaining their trust, engagement and in de-escalating the crises. Further education and training for police officers on how to respond to people with a mental illness, increased provision of follow-up support to promote rehabilitation and prevent future crises, and measures to reduce public scrutiny for the consumer when police responded, were proposed opportunities for improvement. © 2016 Australian College of Mental Health Nurses Inc.

The development and psychometric evaluation of a safety climate measure for primary care.

PubMed

de Wet, C; Spence, W; Mash, R; Johnson, P; Bowie, P

2010-12-01

Building a safety culture is an important part of improving patient care. Measuring perceptions of safety climate among healthcare teams and organisations is a key element of this process. Existing measurement instruments are largely developed for secondary care settings in North America and many lack adequate psychometric testing. Our aim was to develop and test an instrument to measure perceptions of safety climate among primary care teams in National Health Service for Scotland. Questionnaire development was facilitated through a steering group, literature review, semistructured interviews with primary care team members, a modified Delphi and completion of a content validity index by experts. A cross-sectional postal survey utilising the questionnaire was undertaken in a random sample of west of Scotland general practices to facilitate psychometric evaluation. Statistical methods, including exploratory and confirmatory factor analysis, and Cronbach and Raykov reliability coefficients were conducted. Of the 667 primary care team members based in 49 general practices surveyed, 563 returned completed questionnaires (84.4%). Psychometric evaluation resulted in the development of a 30-item questionnaire with five safety climate factors: leadership, teamwork, communication, workload and safety systems. Retained items have strong factor loadings to only one factor. Reliability coefficients was satisfactory (α = 0.94 and ρ = 0.93). This study is the first stage in the development of an appropriately valid and reliable safety climate measure for primary care. Measuring safety climate perceptions has the potential to help primary care organisations and teams focus attention on safety-related issues and target improvement through educational interventions. Further research is required to explore acceptability and feasibility issues for primary care teams and the potential for organisational benchmarking.

Achieving health for a lifetime: a community engagement assessment focusing on school-age children to decrease obesity in Durham, North Carolina.

PubMed

Corsino, Leonor; McDuffie, Jennifer R; Kotch, Jonathan; Coeytaux, Remy; Fuemmeler, Bernard F; Murphy, Gwen; Miranda, Marie Lynn; Poirier, Brenda; Morton, Janet; Reese, David; Baker, Sharon; Carter, Heidi; Freeman, Rebecca; Blue, Colleen; Yancy, William S

2013-01-01

Obesity is a prominent problem in the United States and in North Carolina. One way of combating it is with community-engaged interventions that foster collaboration between health-oriented organizations and community residents. Our purpose was to assemble a multifaceted group in Durham, North Carolina, to identify factors affecting obesity-related lifestyle behaviors; assess policies, resources, and the population's perception of the problem of obesity; and develop plans to improve health outcomes related to obesity. A team consisting of more than 2 dozen partners was assembled to form Achieving Health for a Lifetime (AHL) in order to study and address obesity in the community, initially focusing on elementary school-age children. The team developed a resource guide by collecting information by telephone interviews of provider organizations; geospatial resource maps were created using high-resolution geographic information systems, Duke's Data Support Repository, and county and city records; and focus groups were conducted using the nominal group technique. The AHL team, in collaboration with 2 other teams focused on diabetes and cardiovascular disease, identified 32 resources for diabetes, 20 for obesity, and 13 for cardiovascular disease. Using Geographic Information Systems (GIS), the team identified an area of Durham that had only 1 supermarket, but 34 fast-food restaurants and 84 convenience stores. The focus on particular neighborhoods means that the information obtained might not pertain to all neighborhoods. The AHL team was able to assemble a large community partnership in Durham that will allow the members of the community to continue to work toward making residents healthier. Communities facing similar challenges can learn from this experience.

Defining Role in the New Classroom Teams.

ERIC Educational Resources Information Center

Thomas, Gary

1991-01-01

Interviews with four teachers, one parent, one assistant, and two ancillary helpers found that classroom teams possess little structure with minimal role definition. Participants erect defenses against the lack of definition and use a process termed "fraternity" to get along with one another and camouflage uncertainties and tensions. (SK)

Towards a Competence Profile for Inter-Organizational Learning in Open Innovation Teams

ERIC Educational Resources Information Center

du Chatenier, Elise; Verstegen, Jos; Biemans, Harm; Mulder, Martin

2008-01-01

While inter-organizational learning in open innovation teams has received much attention lately, research into its human dimension is lacking. This paper, therefore, explores the competencies professionals need for this process. Three studies were executed: a theoretical study, explorative interviews and focus groups. A competence profile was…