Informing implementation of quality improvement in Australian primary care

Background: Quality Improvement (QI) initiatives in primary care are effective at improving uptake of evidence based guidelines, but are difficult to implement and sustain. In Australia meso-level health organisations such as Primary health care Organisations (PHCO) offer new opportunities to implement area-wide QI programs. This study sought to identify enablers and barriers to implementation of an existing Australian QI program and to identify strategic directions that PHCOs can use in the ongoing development of QI in this environment. Methods: Semi-structured telephone interviews were conducted with 15 purposively selected program staff and participants from the Australian Primary Care Collaborative (APCC) QI program. Interviewees included seven people involved in design, administration and implementation of the APCC program and eight primary care providers (seven General Practitioners (GPs) and one practice nurse) who had participated in the program from 2004 to 2014. Interviewees were asked to describe their experience of the program and reflect on what enabled or impeded its implementation. Interviews were recorded, transcribed and iteratively analysed, with early analysis informing subsequent interviews. Identified themes and their implications were reviewed by a GP expert reference group. Results: Implementation enablers and barriers were grouped into five thematic areas: (1) leadership, particularly the identification and utilisation of change champions; (2) organisational culture that supports quality improvement; (3) funding incentives that support a culture of quality and innovation; (4) access to and use of accurate data; and 5) design and utilisation of clinical systems that enable and support these issues. In all of these areas, the active involvement of an overarching external support organisation was considered a key ingredient to successful implementation. Conclusion: There are substantial opportunities for PHCOs to play a pivotal role in QI implementation in Australia and internationally. In developing QI programs and policies, such organisations ought to invest their efforts in: (1) identifying and mentoring local leaders; (2) fostering QI culture via development of local peer networks; (3) developing and advocating for alternative funding models to support and incentivise these activities; (4) investing in data and audit tool infrastructure; and (5) facilitation of systems implementation within primary care practices

Research use and Knowledge mobilisation in third sector organisations involved in health care provision

Third sector organisations (TSOs) provide health care in the UK's NHS and other health systems. One of their perceived strengths is distinctive knowledge of the communities with which they work but little is known about the knowledge TSOs possess, how it is developed and used, and how this relates to research-based knowledge. The objective of this PhD is to explore how and why third sector organisations use research and other kinds of knowledge in their work. Scientific Realism (Pawson, 2013) was used to develop causal mechanisms and contexts, in the form of programme theory, to explore the processes of knowledge use. A scoping review, a pilot of a survey tool, and two case studies were used to develop programme theory and to address the research questions. I found that in the healthcare TSOs studied, knowledge encompasses tacit as well as explicit knowledge. Explicit knowledge (“know-that”) tends to be used to prove to external organisations the effectiveness of the TSO or to support organisational development; tacit knowledge (“know-how”) is used by the staff to support clients and users of services to develop knowledge of ‘what works for me’. This tacit knowledge is the distinctive knowledge that TSOs possess. It is mobilised through formal and informal relational processes. I found staff personalised knowledge to individual service-users based on individual and organisational values, implicitly integrating different kinds of knowledge in order to contribute to the benefit and flourishing of all. These findings have implications for TSOs, service commissioners, researchers, and research funders. We need to pay attention to how values influence knowledge use and enable the distinctive knowledge of TSOs to be put into practice

Facilities management knowledge in private finance initiative (PFI) healthcare projects

An organisation's accumulation of knowledge has been identified as a key factor in its progress and survival. This is particularly the case for a business that involves service delivery and is very pertinent to the construction industry. The key to success in managing organisational knowledge is recognising the importance of managing (and maintaining) the knowledge of the staff in the face of staff retention challenges. Knowledge retention is integral to ensuring that the experience and tacit knowledge acquired by the staff during their service will not be lost when the staff leave the organisation. The concept of Knowledge Management (KM) is seen as the solution through the inculcation of knowledge sharing via various tools and techniques in managing the knowledge within parties in construction. The aim of this research is to identify where and how KM initiatives being used within PFI-FM healthcare projects as a result of the unique character of the associated PFI contracts and a wide range of FM services. The complexities involved in managing and delivering services at the operational stage of PFI projects and the vast amount of tasks and services stipulated in the FM context, particularly regarding the planning, types of services, time, place, tools and resources needed, make it a suitable area for KM adoption. This research, which involved exploratory studies, literature reviews, analyses of three case studies involving PFI-FM healthcare projects and structured interviews with the Facilities Managers, has managed to discover the adoption of KM tools in managing FM healthcare services among Facilities Managers in PFI healthcare projects. However, KM has not been used to its fullest potential; the incomplete application of KM initiatives has, thus, created some problems with regard to delivering PFI-FM healthcare services. The outcome has resulted in the formulation of a framework that combines the best practices of KM initiatives with practical approaches of managing organisational knowledge of FM healthcare services which derived from the case studies. The framework has been validated by experts evaluated from the industry and refined to ensure that the framework developed is practical. The most pertinent achievements of this research include demonstrations of the needs for KM initiatives in delivering PFI-FM healthcare services and the development of a framework to enable better service delivery among the PFI-FM healthcare service providers, particularly with regard to addressing the challenges derived from PFI contracts and the vast scope of FM healthcare services. Overall, the study provides a clear justification and indication from a theoretical point of view and empirical evidence from the facilities managers perspective of the significance of KM initiatives in delivering PFI-FM healthcare services in the UK. Furthermore, recommendations have been made to improve and enable comprehension of the framework application and facilitate its implementation in the construction industry

Proceedings of the Salford Postgraduate Annual Research Conference (SPARC) 2011

These proceedings bring together a selection of papers from the 2011 Salford Postgraduate Annual Research Conference(SPARC). It includes papers from PhD students in the arts and social sciences, business, computing, science and engineering, education, environment, built environment and health sciences. Contributions from Salford researchers are published here alongside papers from students at the Universities of Anglia Ruskin, Birmingham City, Chester,De Montfort, Exeter, Leeds, Liverpool, Liverpool John Moores and Manchester

An ethnographic study of the enactment of service level agreements in complex IT-intensive business-to-business services.

Service level agreements (SLAs) for complex IT-intensive business-to-business (CITI-B2B) services are high-level representations of services to be enacted, with predominantly quantifiable performance targets. Inevitably, there is a gap between this representation and the nuanced practices of enactment adapting to emergent conditions over time. Overarching terms in the master agreement anticipate this gap; however, the nature of the practices that manage that gap is not well understood. This study aims to develop a deeper understanding of these everyday practices to identify potential areas for improving value realisation in SLA enactment. We conducted a long-term ethnographic study of the enactment of an SLA by a global IT provider and global financial services company, framed by relational theory of contract. Our analysis showed the gap was bridged by a cycle of enactment in which emergent conditions triggered relational interactions among participants, culminating in decisions to adapt the terms of the SLA in pursuit of value realisation. Further, our analysis showed that this cycle is enabled by informal mechanisms of learning, negotiating, and adapting that we conceptualise as relational capability, which is amenable to representation, refinement, innovation, and capability development. Exploiting this capability and as well as the information produced during the cycle of enactment could inform SLA design and enable the transformation of SLAs as evolving learning instruments

The social reality of initiatives which pursue insight from data

While (big) data promises immense opportunity, initiatives focused on using data to pursue insight have mixed outcomes. The Management Support Systems (MSS) model summarises what we currently understand within Information Systems (IS) about the implementation and use of systems to improve organisations’ use of data. Adopting an ethnographic approach to observe how practitioners in two contrasting organisations actually generate insight from data, this research challenges the implicit information processing and implementation logics of the MMS model. The pragmatic messiness of pursuing insight is described in two monographs, which reveal the socially constructed nature of data in relation to phenomena, and the importance of data engagement to produce insight. Given that this PhD study also seeks to generate insight from data, it is compared and contrasted reflexively to the two cases observed. While the inquiry logic pursued in this study was made explicit, and was regularly reviewed and challenged, the two cases left this largely implicit. The use of tools is shown to facilitate and constrain inquiry, with related data acting as boundary objects between the different practitioner groups involved. An explanatory framework is presented and used to suggest various enhancements to the MSS model. First, the Problem Space is reframed to reflect the distinct, though interdependent logics involved in inquiry versus realising envisaged benefits from insights. Second, the MSS artefact itself is contextualised and Data Engagement rather than MSS or Tool Use is positioned as central. Third, Data are disentangled from the wider MSS artefact, as a critical, distinct construct. Fourth, an Alignment construct is introduced to address the boundary spanning nature of data initiatives. The thesis also highlights the value of using Wenger’s (1998) Communities of Practice (CoP) situated learning framework to study data initiatives, and the related value of mapping groups as a technique for further development. Some questions are provided for practitioners to gain a better understanding of data initiatives. Wider implications are also noted for the socio-material theorising of Data, and distinguishing between Data, Information and Knowledge concepts within the IS discipline

Critical enabling conditions and challenges in the start-up phase of an international new venture : a social entrepreneur's perspective

This thesis explores the enabling conditions and challenges two entrepreneurs interpret critical in their relationships in the start-up phase of 5i, a social entrepreneurial international new venture (INV). The thesis delivers both interpretive ethnographic and auto-ethnographic accounts, weaving the voices of the two co-founders of 5i into a textual dialogue. The reader explores the relationship between the two entrepreneurs, and their relationships with their network partners, as they develop 5i into a small, innovative social entrepreneurial consulting practice that delivers innovative business incubation and financial engineering services from the firm's home base in New Delhi, India into rural markets in Brazil and China, as well as into the company's home market in India. The two entrepreneurs put to use their team and network relationships to mobilize knowledge, know-how, and capital; marshalling resources for their firm far beyond those they control. However, the entrepreneurs' relationships deliver more than functional, resource-based benefits. It is the, shared mission-related values, and the trust and the open communications they engender, in the entrepreneurs' relationships that emerge as key enabling conditions in the development of 5i. When mission-related values are not shared, significant challenges are confronted. The research presented in this thesis emphasizes interpretation and understanding grounded in the formation processes in a new enterprise, there where it is happening, not in rational explanation and prediction. Messy, thick, interpretive ethnographic and auto ethnographic texts provide rich detail which is then provoked through engagement with interpretive grounded theory methods to offer three pragmatic theoretical threads that contribute to our understanding of the roles of TMT and network relationships in the creation of social enterprises that move across international borders from birth. This combination of interpretive methods will not meet the positivist cry for testable hypothesis and universal theories, but it is hoped these methods deliver a compelling, local story. This thesis works to bring the voice of the entrepreneur back into research on entrepreneurship