The OneTogether collaborative approach to reduce the risk of surgical site infection: identifying the challenges to assuring best practice

Background: Surgical site infections (SSI) account for 16% of healthcare associated infections, and are associated with considerable morbidity, mortality and increased costs of care. Ensuring evidence-based practice to prevent SSI is incorporated across the patient’s surgical journey is complex. OneTogether is a quality improvement collaborative of infection prevention and operating department specialists, formed to support the spread and adoption of best practice to prevent SSI. This paper describes the findings of an expert workshop on infection prevention in operating departments. Methods: A total of 84 delegates from 75 hospitals attended the workshop, comprising 46 (55%) theatre nurses/operating department practitioners; 16 (19%) infection control practitioners and 22 (26%) other healthcare practitioners. Discussion focused on evidence, policy implementation and barriers to best practice. Responses were synthesised into a narrative review. Results: Delegates reported significant problems in translating evidence-based guidance into everyday practice, lack of local polices and poor compliance. Major barriers were lack of leadership, poorly defined responsibilities, and lack of knowledge/training. Conclusions: This workshop has provided important insights into major challenges in assuring compliance with best practice in relation to the prevention of SSI. The OneTogether partnership aims to support healthcare practitioners to improve the outcomes of patients undergoing surgery by reducing the risk of SSI

Applications of lean thinking: a briefing document

This report has been put together by the Health and Care Infrastructure Research and Innovation Centre (HaCIRIC) at the University of Salford for the Department of Health. The need for the report grew out of two main simple questions, o Is Lean applicable in sectors other than manufacturing? o Can the service delivery sector learn from the success of lean in manufacturing and realise the benefits of its implementation?The aim of the report is to list together examples of lean thinking as it is evidenced in the public and private service sector. Following a review of various sources a catalogue of evidence is put together in an organised manner which demonstrates that Lean principles and techniques, when applied rigorously and throughout an entire organization/unit, they can have a positive impact on productivity, cost, quality, and timely delivery of services

Duke University Hospital: Organizational and Tactical Strategies to Enhance Patient Satisfaction

Highlights organizational and tactical strategies for realizing high patient satisfaction, including the use of communication boards in each room stating the plan of care, a "Balanced Scorecard" evaluation tool, and Six Sigma improvement methodology

From theory to 'measurement' in complex interventions: methodological lessons from the development of an e-health normalisation instrument

<b>Background</b> Although empirical and theoretical understanding of processes of implementation in health care is advancing, translation of theory into structured measures that capture the complex interplay between interventions, individuals and context remain limited. This paper aimed to (1) describe the process and outcome of a project to develop a theory-based instrument for measuring implementation processes relating to e-health interventions; and (2) identify key issues and methodological challenges for advancing work in this field.<p></p> <b>Methods</b> A 30-item instrument (Technology Adoption Readiness Scale (TARS)) for measuring normalisation processes in the context of e-health service interventions was developed on the basis on Normalization Process Theory (NPT). NPT focuses on how new practices become routinely embedded within social contexts. The instrument was pre-tested in two health care settings in which e-health (electronic facilitation of healthcare decision-making and practice) was used by health care professionals.<p></p> <b>Results</b> The developed instrument was pre-tested in two professional samples (N = 46; N = 231). Ratings of items representing normalisation 'processes' were significantly related to staff members' perceptions of whether or not e-health had become 'routine'. Key methodological challenges are discussed in relation to: translating multi-component theoretical constructs into simple questions; developing and choosing appropriate outcome measures; conducting multiple-stakeholder assessments; instrument and question framing; and more general issues for instrument development in practice contexts.<p></p> <b>Conclusions</b> To develop theory-derived measures of implementation process for progressing research in this field, four key recommendations are made relating to (1) greater attention to underlying theoretical assumptions and extent of translation work required; (2) the need for appropriate but flexible approaches to outcomes measurement; (3) representation of multiple perspectives and collaborative nature of work; and (4) emphasis on generic measurement approaches that can be flexibly tailored to particular contexts of study

Committed to Safety: Ten Case Studies on Reducing Harm to Patients

Presents case studies of healthcare organizations, clinical teams, and learning collaborations to illustrate successful innovations for improving patient safety nationwide. Includes actions taken, results achieved, lessons learned, and recommendations

Assessing Culture Competence Among Nurses in an Acute Care Setting

The aim of the study was to assess cultural competence among nurses in an acute care setting. A 25-item questionnaire developed by Campinha-Bacote (2003) titled Inventory to Assess Cultural Competence Among Health Care Providers (IAPCC-R) along with a demographic survey were utilized to assess cultural competence among 100 nurses in an acute care hospital. The results of the study indicated that 70% of nurses (n=63) were culturally aware and 30% (n=27) were culturally competent. There was no statistical significance between the level of cultural competence and years of experience, educational degree or self rating of \u27being culturally competent\u27. The findings of the study provide direction to strengthen cultural competence education and training among nurses and strategies to enhance the structure and processes of organization\u27s efforts to deal with diversity

Implementation of TeamSTEPPS

This scholarly project focused on implementing Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) in an emergency room (ER). The aim of TeamSTEPPS is to improve patient outcomes by educating healthcare professionals on communication and teamwork skills. TeamSTEPPS teaches healthcare professionals leadership skills, shared mental models, mutual trust, and closed loop communication. The purpose of the scholarly project was to improve teamwork and communication. The study method was descriptive analysis of 51 pre and posttest questionnaires, specifically looking for increased knowledge of TeamSTEPPS tools. The participants included: ER physicians, ER nurses, ER certified nursing assistants/health unit coordinators, a pharmacy technician, public safety officers, and patient revenue management organization (PRMO). Further research is needed to evaluate how to significantly increase staff knowledge on TeamSTEPPS tools in a class setting

Mayo Clinic: Multidisciplinary Teamwork, Physician-Led Governance, and Patient-Centered Culture Drive World-Class Health Care

Describes Fund-defined attributes of an ideal care delivery system, Mayo's model of multidisciplinary practice with salary-based compensation, and best practices, including a shared electronic health record and innovations to implement research quickly

FIRE (facilitating implementation of research evidence) : a study protocol

Research evidence underpins best practice, but is not always used in healthcare. The Promoting Action on Research Implementation in Health Services (PARIHS) framework suggests that the nature of evidence, the context in which it is used, and whether those trying to use evidence are helped (or facilitated) affect the use of evidence. Urinary incontinence has a major effect on quality of life of older people, has a high prevalence, and is a key priority within European health and social care policy. Improving continence care has the potential to improve the quality of life for older people and reduce the costs associated with providing incontinence aids

Hutcheson Medical Center: Focusing on Personal Interactions

Outlines elements of a strategy for high patient satisfaction focused on patient-staff interactions and patients' needs, including a culture of customer service, shared governance, better data collection, more visible leaders, and evidence-based practice