Improving the normalization of complex interventions: measure development based on normalization process theory (NoMAD): study protocol

<b>Background</b> Understanding implementation processes is key to ensuring that complex interventions in healthcare are taken up in practice and thus maximize intended benefits for service provision and (ultimately) care to patients. Normalization Process Theory (NPT) provides a framework for understanding how a new intervention becomes part of normal practice. This study aims to develop and validate simple generic tools derived from NPT, to be used to improve the implementation of complex healthcare interventions.<p></p> <b>Objectives</b> The objectives of this study are to: develop a set of NPT-based measures and formatively evaluate their use for identifying implementation problems and monitoring progress; conduct preliminary evaluation of these measures across a range of interventions and contexts, and identify factors that affect this process; explore the utility of these measures for predicting outcomes; and develop an online users’ manual for the measures.<p></p> <b>Methods</b> A combination of qualitative (workshops, item development, user feedback, cognitive interviews) and quantitative (survey) methods will be used to develop NPT measures, and test the utility of the measures in six healthcare intervention settings.<p></p> <b>Discussion</b> The measures developed in the study will be available for use by those involved in planning, implementing, and evaluating complex interventions in healthcare and have the potential to enhance the chances of their implementation, leading to sustained changes in working practices

The organizational dynamics enabling patient portal impacts upon organizational performance and patient health: a qualitative study of Kaiser Permanente.

BackgroundPatient portals may lead to enhanced disease management, health plan retention, changes in channel utilization, and lower environmental waste. However, despite growing research on patient portals and their effects, our understanding of the organizational dynamics that explain how effects come about is limited.MethodsThis paper uses qualitative methods to advance our understanding of the organizational dynamics that influence the impact of a patient portal on organizational performance and patient health. The study setting is Kaiser Permanente, the world's largest not-for-profit integrated delivery system, which has been using a portal for over ten years. We interviewed eighteen physician leaders and executives particularly knowledgeable about the portal to learn about how they believe the patient portal works and what organizational factors affect its workings. Our analytical framework centered on two research questions. (1) How does the patient portal impact care delivery to produce the documented effects?; and (2) What are the important organizational factors that influence the patient portal's development?ResultsWe identify five ways in which the patient portal may impact care delivery to produce reported effects. First, the portal's ability to ease access to services improves some patients' satisfaction as well as changes the way patients seek care. Second, the transparency and activation of information enable some patients to better manage their care. Third, care management may also be improved through augmented patient-physician interaction. This augmented interaction may also increase the 'stickiness' of some patients to their providers. Forth, a similar effect may be triggered by a closer connection between Kaiser Permanente and patients, which may reduce the likelihood that patients will switch health plans. Finally, the portal may induce efficiencies in physician workflow and administrative tasks, stimulating certain operational savings and deeper involvement of patients in medical decisions. Moreover, our analysis illuminated seven organizational factors of particular importance to the portal's development--and thereby ability to impact care delivery: alignment with financial incentives, synergy with existing IT infrastructure and operations, physician-led governance, inclusive decision making and knowledge sharing, regional flexibility to implementation, continuous innovation, and emphasis on patient-centered design.ConclusionsThese findings show how organizational dynamics enable the patient portal to affect care delivery by summoning organization-wide support for and use of a portal that meets patient needs

Police Knowledge Exchange: Full Report 2018

[Executive Summary] This report was commissioned to explore the enablers and barriers to sharing within and between police forces and between police forces and partners, including the public. This was completed from an interdisciplinary review of international literature covering sharing, knowledge exchange, learning and organisational learning. The literature broke down into four main factors; who, why, what and how. An introduction to the literature is presented with ‘Who’ is sharing which considers both personal identity and different institutional issues. The ‘Why’ literature covers issues of cultural and community motivators and barriers. The ‘What’ segment reviews concepts of data, information and knowledge and related legislative issues. Finally, the ‘how’ section spans face to face sharing approaches to technologies that produce both enablers and barriers. A series of 42 in-depth interviews and focus groups were completed and combined with 47 survey responses . The aim of the interviews, focus groups and survey was to show perceptions and beliefs around knowledge sharing from a small sample across policing in order to complement the findings from the literature review. The survey was adapted from a standardised questionnaire (Biggs, 1987). The Biggs questionnaire focused on what motivated students to learn and how they approached their learning. Our adapted survey looked at what motivated police to share, and how they approached sharing. The responses showed a trend, across the police, towards a motivation for sharing to develop a deeper understanding of issues. However, the approaches and the strategies they used to share with others, which were primarily driven by achieving and surface approaches (to get promoted and get the job done). According to Biggs (1987) this could leave them discontented as they never progress to a deeper understanding of issues. Scaffolding sharing within the police through processes that are clearly defined, effective and valued could help to overcome these issues. Within the interviews and focus group findings a similar structured approach to sharing was adopted. Within the ‘who’ section some key aspects around personal relationships, reciprocity and reputation were identified. The ‘why’ the police share was one of the largest discussion points. Not only was there a deep motivation to solve key policing issues there was an approach of reciprocity. Police sharing was deeply motivated to support ‘good practice’ in the prevention and detection of crime. However, a sharing barrier was identified in the parity of value given to different types of knowledge for example between professional judgement and research evidence knowledge. Sharing was achieved when there were reciprocal benefits, in particular with personal networks or face to face sharing which was noted as ‘safe’. Again, this was inhibited by misunderstandings around the ‘risks’ of sharing, frequently attributed to data protection legislation; producing cautious reactions and as an avoidance tactic to save time and effort sharing. However, a divide was noted between technical users and those who avoided any online systems for sharing; often due to poorly designed systems and a lack of confidence in how to use systems. The police culture was identified as being risk-adverse, and competitive due to multiple factors, a lack of supported time to share, Her Majesty’s Inspectorate of Constabulary (HMIC) reviews and promotion criteria. The result was perceived to be a poor cultural ability to learn from mistakes and a likelihood to repeat errors. A set of strategic recommendations are given and include the use of a sharing authorised professional practice for HMIC reviews, sharing networks and training. A further set of operational recommendations are given such as; sharing impact cases for evidence based practice, data sharing officers and evaluating mechanisms for sharing. This full report is supported by the Police Knowledge Exchange Summary Report 2018 which gives an overview of the findings and recommendations

Development of a platform to align education and practice: bridging academia and the profession in Portugal

Limited fitness for practice may result from a mismatch between education and practice. Aiming to meet the common interests of academics and practitioners, the Portuguese Pharmaceutical Society (PPS) developed the Education and Practice Platform (EPP). The EPP includes one representative from each pharmacy faculty, and all Councils of Speciality Boards of Practice. Brainstorming with involved parties enabled sharing of interests, concerns and identifying a common path. Aims, mission, vision and values were set. The EPP's mission is to: act as an enabler to foster the quality and adequacy of education through sharing best practices, ultimately leading to facilitate professional integration, and to foster quality development in teaching practices with recognition for autonomy in freedom to teach and to learn. Its vision is an alignment of education and practice with the PPS' statutes to ensure validation of the competences defined for each practice area, and compliance with international guidance. Key performance indicators (KPIs) were set. Activities developed include the creation of a national forum to discuss education and practice, development of workshops on teaching methods and pharmacy internships, enhanced representation in international events and response to global and national requests. Ongoing work focuses on the creation of a common training framework in hospital and community pharmacy practice adapted to Portugal. The EPP is a worldwide case study, encouraging the development of discussion contributing to an open climate of sharing best practices, indirectly leading to foster a better alignment between education and practice. Many of these results are so far intangible in scientific terms but worth describing.info:eu-repo/semantics/publishedVersio

"Are you accepting new patients?" A pilot field experiment on telephone-based gatekeeping and Black patients' access to pediatric care.

STUDY OBJECTIVES: To determine whether name and accent cues that the caller is Black shape physician offices' responses to telephone-based requests for well-child visits. METHOD AND DATA: In this pilot study, we employed a quasi-experimental audit design and examined a stratified national sample of pediatric and family practice offices. Our final data include information from 205 audits (410 completed phone calls). Qualitative data were blind-coded into binary variables. Our case-control comparisons using McNemar's tests focused on acceptance of patients, withholding information, shaping conversations, and misattributions. FINDINGS: Compared to the control group, "Black" auditors were less likely to be told an office was accepting new patients and were more likely to experience both withholding behaviors and misattributions about public insurance. The strength of associations varied according to whether the cue was based on name or accent. Additionally, the likelihood and ways office personnel communicated that they were not accepting patients varied by region. CONCLUSIONS: Linguistic profiling over the telephone is an aspect of structural racism that should be further studied and perhaps integrated into efforts to promote equitable access to care. Future research should look reactions to both name and accent, taking practice characteristics and regional differences into consideration

Using patient-reported measures to drive change in healthcare: the experience of the digital, continuous and systematic PREMs observatory in Italy

BACKGROUND: The use of Patient Reported Experience Measures (PREMs) has great potential in healthcare service improvement, but a limited use. This paper presents an empirical case of PREMs innovation in Italy, to foster patient data use up to the ward level, by keeping strengths and addressing weaknesses of previous PREMs survey experiences. The paper reports key lessons learned in this ongoing experience of action research, directly involving practitioners. METHODS: The aim of this paper is to present the results of an ongoing action research, encompassing the innovation of PREMs collection, reporting and use, currently adopted by 21 hospitals of two Italian regions. The continuous and systematic PREMs collection has been implemented between 2017 and 2019 and includes: a continuous web-based administration, using web-services; an augmented and positive questionnaire matching standard closed-ended questions with narrative sections; the inclusion and benchmarking of patient data within a shared performance evaluation system; public disclosure of aggregated anonymized data; a multi-level and real-time web-platform for reporting PREMs to professionals. The action research was carried out with practitioners in a real-life and complex context. The authors used multiple data sources and methods: observations, feedback of practitioners, collected during several workshops and meetings, and analysis of preliminary data on the survey implementation. RESULTS: A continuous and systematic PREMs observatory was developed and adopted in two Italian regions. PREMs participation and response rates tend to increase over time, reaching stable percentages after the first months. Narrative feedback provide a 'positive narration' of episodes and behaviours that made the difference to patients and can inform quality improvement actions. Real-time reporting of quantitative and qualitative data is enabling a gratifying process of service improvement and people management at all the hospitals' levels. CONCLUSIONS: The PREMs presented in this paper has been recognized by healthcare professionals and managers as a strategic and positive tool for improving an actual use of PREMs at system and ward levels, by measuring and highlighting positive deviances, such as compassionate behaviours

Impact of Continuing Education on Clinicians' Self- Reported Knowledge of Tobacco Dependence and Tobacco Control Interventions

Purpose: To assess a tobacco cessation continuing education (CE) program for Indiana dental and medical providers. Methods: A 26-item immediate post-CE survey and a 19-item 3-month follow-up survey assessed changes in participants’ self-reported knowledge of tobacco dependence and tobacco control interventions. De-identified data were analyzed using descriptive statistics, Spearman correlation coefficients, and Mantel- Haenszel chi-square tests. Results: Participants totaled 252 across 6 programs statewide. Immediate post-CE course survey response was 98.4% (N=248): dental assistants (2%), dental hygienists (83%), dentists (8.5%), and other healthcare professionals (6.45%). Participants reported less knowledge before than immediately after CE (p< .0001) and 3 months after (p<.0001). Reported knowledge at 3 months was less than after CE (p< .002). Participants reported on their intention to apply program communication strategies (99%), implement brief tobacco interventions (85%), and refer patients to local cessation resources (95%), Indiana Quitline (96%). Follow-up survey response rate was 54% (N=136). Participants reported active engagement in tobacco interventions (48%, 78), applying CE communication strategies (85%, 109), and implementing brief interventions (71%, 90). Participants reported referring few patients to local or state quitline counselors. Conclusion:Tobacco dependence CE may enhance health care practitioners’ knowledge and willingness to integrate tobacco interventions in their healthcare settings but it does not ensure a change in clinical tobacco control intervention

Answering the Calls of "What's Next" and "Library Workers Cannot Live by Love Alone" through Certification and Salary Research

Members and staff of the American Library Association (ALA) worked diligently over more than a decade to develop a certification program for public library managers. Spurred by a long-standing trend in many other terminal-degree professions that have post-degree, voluntary certifications, the Certified Public Library Administrator Program was born. Legal authority recommended the establishment of a service organization, a 501(c)(6) to manage the program, which has become one of several programs that will be offered to library employees under the imprimatur of ALA. After the American Library Association???Allied Professional Association (ALA-APA) was instituted, advocacy for salary improvement initiatives was appended to the mission. One means of salary advocacy was to improve available data by expanding the scope and usefulness of the ALA Survey of Librarian Salaries, which resulted in the ALA-APA Salary Survey: Non-MLS???Public and Academic, conducted in 2006 and 2007 to collect salary data from more than sixty positions in the field that do not require a master's degree in Library Science. The experience of establishing two certification programs, the Certified Public Library Administrator Program (CPLA??) and the Library Support Staff Certification Program, has been a study in creating new national models of professional development. This article will also discuss the insights that have emerged from fulfilling elements of ALA strategic plans concerning the needs of support staff through certification and the salary survey.published or submitted for publicatio