Examining the Relationship between Clinical Decision Support and Performance Measurement

In concept and practice, clinical decision support (CDS) and performance measurement represent distinct approaches to organizational change, yet these two organizational processes are interrelated. We set out to better understand how the relationship between the two is perceived, as well as how they jointly influence clinical practice. To understand the use of CDS at benchmark institutions, we conducted semistructured interviews with key managers, information technology personnel, and clinical leaders during a qualitative field study. Improved performance was frequently cited as a rationale for the use of clinical reminders. Pay-for-performance efforts also appeared to provide motivation for the use of clinical reminders. Shared performance measures were associated with shared clinical reminders. The close link between clinical reminders and performance measurement causes these tools to have many of the same implementation challenges

Perceptions of Professional Practice and Work Environment of New Graduates in a Nurse Residency Program

New nurses continue to face challenging work environments and high expectations for professional competence as they enter practice. Nurse residency programs are gaining prominence as a mechanism to ease new graduates’ transition to practice. This study examined new graduates’ perceptions of their professional practice competence and work environment throughout a yearlong nurse residency program. Employing a repeated measures design, data were collected at baseline, at 6 months, and at 12 months. Results showed that job satisfaction was significantly lowest at 6 months and highest at 12 months. Job stress was found to be lowest at 12 months and organizational commitment was highest at baseline. Of the variables related to professional practice, clinical decision-making was highest at 12 months and quality of nursing performance significantly increased at each measurement point. These data add to the growing evidence supporting the efficacy of nurse residency programs

How should we measure psychological resilience in sport performers?

Psychological resilience is important in sport because athletes must constantly withstand a wide range of pressures to attain and sustain high performance. To advance psychologists’ understanding of this area, there exists an urgent need to develop a sport-specific measure of resilience. The purpose of this paper is to review psychometric issues in resilience research and to discuss the implications for sport psychology. Drawing on the wider general psychology literature to inform the discussion, the narrative is divided into three main sections relating to resilience and its assessment: adversity, positive adaptation, and protective factors. The first section reviews the different ways that adversity has been measured and considers the potential problems of using items with varying degrees of controllability and risk. The second section discusses the different approaches to assessing positive adaptation and examines the issue of circularity pervasive in resilience research. The final section explores the various issues related to the assessment of protective factors drawing directly from current measures of resilience in other psychology sub-disciplines. The commentary concludes with key recommendations for sport psychology researchers seeking to develop a measure of psychological resilience in athletes

Measurement Error in Performance Studies of Health Information Technology: Lessons from the Management Literature

Just as researchers and clinicians struggle to pin down the benefits attendant to health information technology (IT), management scholars have long labored to identify the performance effects arising from new technologies and from other organizational innovations, namely the reorganization of work and the devolution of decision-making authority. This paper applies lessons from that literature to theorize the likely sources of measurement error that yield the weak statistical relationship between measures of health IT and various performance outcomes. In so doing, it complements the evaluation literature’s more conceptual examination of health IT’s limited performance impact. The paper focuses on seven issues, in particular, that likely bias downward the estimated performance effects of health IT. They are 1.) negative self-selection, 2.) omitted or unobserved variables, 3.) mis-measured contextual variables, 4.) mismeasured health IT variables, 5.) lack of attention to the specific stage of the adoption-to-use continuum being examined, 6.) too short of a time horizon, and 7.) inappropriate units-of-analysis. The authors offer ways to counter these challenges. Looking forward more broadly, they suggest that researchers take an organizationally-grounded approach that privileges internal validity over generalizability. This focus on statistical and empirical issues in health IT-performance studies should be complemented by a focus on theoretical issues, in particular, the ways that health IT creates value and apportions it to various stakeholders

What difference does ("good") HRM make?

The importance of human resources management (HRM) to the success or failure of health system performance has, until recently, been generally overlooked. In recent years it has been increasingly recognised that getting HR policy and management "right" has to be at the core of any sustainable solution to health system performance. In comparison to the evidence base on health care reform-related issues of health system finance and appropriate purchaser/provider incentive structures, there is very limited information on the HRM dimension or its impact. Despite the limited, but growing, evidence base on the impact of HRM on organisational performance in other sectors, there have been relatively few attempts to assess the implications of this evidence for the health sector. This paper examines this broader evidence base on HRM in other sectors and examines some of the underlying issues related to "good" HRM in the health sector. The paper considers how human resource management (HRM) has been defined and evaluated in other sectors. Essentially there are two sub-themes: how have HRM interventions been defined? and how have the effects of these interventions been measured in order to identify which interventions are most effective? In other words, what is "good" HRM? The paper argues that it is not only the organisational context that differentiates the health sector from many other sectors, in terms of HRM. Many of the measures of organisational performance are also unique. "Performance" in the health sector can be fully assessed only by means of indicators that are sector-specific. These can focus on measures of clinical activity or workload (e.g. staff per occupied bed, or patient acuity measures), on measures of output (e.g. number of patients treated) or, less frequently, on measures of outcome (e.g. mortality rates or rate of post-surgery complications). The paper also stresses the need for a "fit" between the HRM approach and the organisational characteristics, context and priorities, and for recognition that so-called "bundles" of linked and coordinated HRM interventions will be more likely to achieve sustained improvements in organisational performance than single or uncoordinated interventions

Instrument development, data collection, and characteristics of practices, staff, and measures in the Improving Quality of Care in Diabetes (iQuaD) Study

Peer reviewedPublisher PD

Eye quietness and quiet eye in expert and novice golf performance: an electrooculographic analysis

Quiet eye (QE) is the final ocular fixation on the target of an action (e.g., the ball in golf putting). Camerabased eye-tracking studies have consistently found longer QE durations in experts than novices; however, mechanisms underlying QE are not known. To offer a new perspective we examined the feasibility of measuring the QE using electrooculography (EOG) and developed an index to assess ocular activity across time: eye quietness (EQ). Ten expert and ten novice golfers putted 60 balls to a 2.4 m distant hole. Horizontal EOG (2ms resolution) was recorded from two electrodes placed on the outer sides of the eyes. QE duration was measured using a EOG voltage threshold and comprised the sum of the pre-movement and post-movement initiation components. EQ was computed as the standard deviation of the EOG in 0.5 s bins from –4 to +2 s, relative to backswing initiation: lower values indicate less movement of the eyes, hence greater quietness. Finally, we measured club-ball address and swing durations. T-tests showed that total QE did not differ between groups (p = .31); however, experts had marginally shorter pre-movement QE (p = .08) and longer post-movement QE (p < .001) than novices. A group × time ANOVA revealed that experts had less EQ before backswing initiation and greater EQ after backswing initiation (p = .002). QE durations were inversely correlated with EQ from –1.5 to 1 s (rs = –.48 - –.90, ps = .03 - .001). Experts had longer swing durations than novices (p = .01) and, importantly, swing durations correlated positively with post-movement QE (r = .52, p = .02) and negatively with EQ from 0.5 to 1s (r = –.63, p = .003). This study demonstrates the feasibility of measuring ocular activity using EOG and validates EQ as an index of ocular activity. Its findings challenge the dominant perspective on QE and provide new evidence that expert-novice differences in ocular activity may reflect differences in the kinematics of how experts and novices execute skills

Professional Burnout in Social Service Organizations: A Review of Theory, Research and Prevention

This paper provides an overview of research on burnout in human service workers, with an emphasis on findings relevant to social workers and other professionals in child welfare and children’s mental health and the organizations that employ them. It is intended to inform the reader about the developments in burnout research since the phenomenon was initially described, and to identify some issues and questions that need further study. Part one of the paper begins with a discussion of several definitions of burnout and its components. Part two outlines the variables that have been identified by research as antecedent to burnout, and as consequences of burnout. Part three describes several theoretical models that have been used to explain the causes of burnout and its relationship to other forms of stress, coping and organizational processes. Part four reviews and critiques some prevention literature, and offers additional thoughts for consideration when intervention is planned

Examining College Student Athlete Attitudes Towards Concussion Testing and Reporting Concussions

Examining College Student Athlete Attitudes and Behaviors Toward Baseline Neurocognitive Concussion Testing FryK, Anderson, M, Anderson, M, Schatz, P, Elbin, RJ: University of Arkansas, Fayetteville, Arkansas Context: Examining athletes’ attitudes toward concussion diagnosis, management, and treatment can lead to improved multi-faceted management of a concussion injury. Although attitudes towards concussion injuries have been studied, the examination of athletes’ attitudes towards baseline computerized neurocognitive testing is understudied and is warranted. Objective: To examine the relationship between sex, concussion history, and previous exposure to baseline testing on athletes’ perceptions of effort provided during baseline testing and the utility of neurocognitive testing. Methods: College athletes (18-23 years) completing a baseline neurocognitive test (Immediate Post-Concussion Assessment and Cognitive Test: ImPACT) were asked to complete an anonymous 33-item online survey. Survey questions included demographics and inquired about athletes’ effort and utility of baseline and post-concussion neurocognitive testing. A series of chi-square analyses measured the association between sex, concussion history, and previous exposure to baseline testing on effort provided during testing and utility of the test. Level of statistical significance was p \u3c .05. Results: One hundred eighty-two (88 males, 95 females) athletes (M =19.05, SD = 1.15 years) completed the survey. Thirty-eight percent (70/183) reported prior concussion history and 27% (50/182) were first time test takers. Ninety-four percent (172/183) reported providing above average to maximal effort on the baseline test they completed prior to completing the survey. Ninety percent (158/176) and 87% (156/179) of the sample reported that the baseline and post-concussion test results were useful in mitigating premature return to play, respectively. There was no association between sex, concussion history, or previous exposure to baseline testing on reported effort or perceptions of utility for baseline neurocognitive testing (p \u3e .05). Conclusion: The majority of athletes report high effort on baseline neurocognitive testing and recognize the utility of this measure for safe return to play

IDENTITY ADAPTATION AND THE POTENTIAL FOR PSYCHOLOGICAL GROWTH FOLLOWING ADVERSITY FOR INJURED ATHLETES

The study was undertaken to gain a deeper understanding of the transition process out of competitive athletics experienced by competitive athletes after a career-limiting injury by examining three research questions: 1) What is the identity adaptation process of injured athletes? 2) To what extent, if any, do injured athletes experience growth following adversity? 3) What, if any, psychological skills are used in the injury/career transition processes? Nine former elite ath- letes were recruited through key informant sampling. There were three males and six females, with a mean age of 24.6 years. All participants sustained, at minimum, a season-ending injury and no longer participate in high performance athletics. Participants completed a demographic questionnaire, the Athletic Identity Measurement Scale-Plus questionnaire (AIMS-Plus), the Post Traumatic Growth Inventory-42 survey (PTGI-42), and an adapted Change Event Inventory (CEI). Additionally, semi-structured interviews were conducted. Transcripts were analyzed us- ing an Interpretative Phenomenological Analysis and themes and subthemes were identified. Analysis revealed the process of identity adaptation is influenced by pre-injury identity, auton- omy of retirement decision, transition style, current employment and time since the injury. Ac- cess to psychological skills training and competence in psychological skill usage heavily influ- enced the application of psychological skills during the rehabilitation and transition process and the outcome of using these skills. No significant evidence of growth was found using the PTGI- 42; however interview data revealed themes centred on experiencing new opportunities, the ability to transfer sport and psychological skills, changes in social supports/networks, a change in the role of sport, a realization of strength and a desire to assist others. Results indicate injured athletes are able to experience growth following adversity and speak to the dynamic process of identity adaptation. Additionally, the data emphasized the requirement for actively participating in adaptation and in the growth process to increase the opportunities for a desirable outcome for injured athletes. Future studies regarding growth and further understanding the transition process are suggested