Determining research knowledge infrastructure for healthcare systems: a qualitative study

<p>Abstract</p> <p>Background</p> <p>This study examines research knowledge infrastructures (RKIs) found in health systems. An RKI is defined as any instrument (<it>i.e</it>., programs, interventions, tools) implemented in order to facilitate access, dissemination, exchange, and/or use of evidence in healthcare organisations. Based on an environmental scan (17 key informant interviews) and scoping review (26 studies), we found support for a framework that we developed that outlines components that a health system can have in its RKI. The broad domains are climate for research use, research production, activities used to link research to action, and evaluation.</p> <p>The objective of the current study is to profile the RKI of three types of health system organisations--regional health authorities, primary care practices, and hospitals--in two Canadian provinces to determine the current mix of components these organisations have in their RKI, their experience with these components, and their views about future RKI initiatives.</p> <p>Methods</p> <p>This study will include semistructured telephone interviews with a purposive sample region of a senior management team member, library/resource centre manager, and a 'knowledge broker' in three regional health authorities, five or six purposively sampled hospitals, and five or six primary care practices in Ontario and Quebec, for a maximum of 71 interviewees. The interviews will explore (a) which RKI components have proven helpful, (b) barriers and facilitators in implementing RKI components, and (c) views about next steps in further development of RKIs.</p> <p>Discussion</p> <p>This is the first qualitative examination of potential RKI efforts that can increase the use of research evidence in health system decision making. We anticipate being able to identify broadly applicable insights about important next steps in building effective RKIs. Some of the identified RKI components may increase the use of research evidence by decision makers, which may then lead to more informed decisions.</p

Auditors' understanding of evidence: A performance audit of an urban development programme

This article uses a case study to analyse two main dilemmas that performance auditors face when auditing complex interventions in governance. The first dilemma, concerning the performance auditors’ roles as improvement agents and independent controllers, is that the improvement agenda often implies interacting closely with the auditees whereas controlling requires independence. The second dilemma pertains to the auditors’ choice of pre-planned audit criteria which limit what evidence the auditors can document. This choice affects the auditors’ role of holding a government to account. It also affects the type of information divulged to stakeholders concerning the social intervention that is evaluated

"It's Like Piecing Together Small Pieces of a Puzzle". Difficulties in Reporting Abuse and Neglect of Disabled Children to the Social Services

According to Swedish law, the Child and Youth Habilitation Services are obliged to report abuse and neglect of disabled children to the Social Services. Only a small proportion of all children who are suspected of being victims of abuse or neglect are however reported to the Social Services. The aim of this study is to discuss why some cases of abuse and neglect of disabled children are considered difficult to report by the Child and Youth Habilitation Services. The qualitative data were collected during individual and natural group interviews with fourteen members of the staff of a regional division of this authority. The study shows that reporting was seen as a “last resort”, and was used only when all other remedies had been exhausted. The main obstacles to reporting were to be found in the perceived closeness between staff members and the disabled children’s families. Other obstacles to reporting were habilitation ideals, cultural ideas about the family, a lack of evidence of abuse and neglect, and uncertainty about the children’s future after reporting. Factors that facilitated reporting were visible proof of abuse and neglect, and the disabled children’s ability to communicate. Furthermore, certain criminal acts against the children were seen as more reprehensible than others and thus easier to report