Knowledge management infrastructure to support quality improvement: A qualitative study of maternity services in four European hospitals

The influence of multilevel healthcare system interactions on clinical quality improvement (QI) is still largely unexplored. Through the lens of knowledge management (KM) theory, this study explores how hospital managers can enhance the conditions for clinical QI given the specific multilevel and professional interactions in various healthcare systems. The research used an in-depth multilevel analysis in maternity departments in four purposively sampled European hospitals (Portugal, England, Norway and Sweden). The study combines analysis of macro-level policy documents and regulations with semi-structured interviews (96) and non-participant observations (193 hours) of hospital and clinical managers and clinical staff in maternity departments. There are four main conclusions: First, the unique multilevel configuration of national healthcare policy, hospital management and clinical professionals influence the development of clinical QI efforts. Second, these different configurations provide various and often insufficient support and guidance which affect professionals’ action strategies in QI efforts. Third, hospital managers’ opportunities and capabilities for developing a consistent KM infrastructure with reinforcing enabling conditions which merge national policies and guidelines with clinical reality is crucial for clinical QI. Fourth, understanding these interrelationships provides an opportunity for improvement of the KM infrastructure for hospital managers through tailored interventions

Biochar addition persistently increased soil fertility and yields in maizesoybean rotations over 10 years in sub-humid regions of Kenya

Open Access ArticleApplication of biochar has been shown to increase soil fertility and enable soil carbon sequestration, indicating potential for agricultural and environmental benefits from using locally produced biochar on African smallholder farms. However, previous studies have been rather short-term and little is known about the longer-term effects of biochar application on crop yields. Biochar contains ash, but the potential liming effect and nutrient release from ash may be short-lasting. To investigate long-term effects, we set up a series of field trials replicated at three sites in Kenya in 2006. The trials are still on-going and are possibly the longest biochar trials in sub-Saharan Africa. Here, we report effects on crop yield and soil properties over 10 years after applying biochar, produced mainly from Acacia spp., at a rate of 50 + 50 Mg ha−1 during the first two seasons. Maize (Zea mays) and soybean (Glycine max) were grown in rotation, with or without inorganic fertiliser, and crop yield was monitored. For comparison of soil properties, additional plots were kept in bare fallow. Biochar addition slightly increased soil porosity, pH, plant-available phosphorus and soil water-holding capacity. Crop yield responded positively to biochar at all sites and yield responses were similar with and without mineral fertiliser, i.e., the effects of biochar and mineral fertiliser were additive. The seasonal yield increase due to biochar application was in average around 1.2 Mg ha−1 for maize and 0.4 Mg for soybean, independently of fertilisation, over seasons and sites. Application of mineral fertiliser to maize increased maize yield by 1.6 Mg ha−1 and the subsequent, unfertilized soybean yield by 0.6 Mg ha−1, illustrating a carry-over effect. Most importantly, the effect on maize and soybean yield of adding biochar to soil persisted over the whole 10-year period. Analysis of the carbon (C) balance in topsoil indicated that about 40% of biochar C was apparently lost through mineralization, erosion or vertical translocation. Moreover, changes in soil carbon/nitrogen ratios indicated that biochar application increased nitrogen mineralization from native soil organic matter

Translating research on quality improvement in five European countries into a reflective guide for hospital leaders: the 'QUASER Hospital Guide'

Objective The aim was to translate the findings of the QUASER study into a reflective, dialogic guide to help senior hospital leaders develop an organization wide QI strategy. Design The QUASER study involved in depth ethnographic research into QI work and practices in two hospitals in each of five European countries. Three translational stakeholder workshops were held to review research findings and advise on the design of the Guide. An extended iterative process involving researchers from each participant country was then used to populate the Guide. Setting The research was carried out in two hospitals in each of five European countries. Participants In total, 389 interviews with healthcare practitioners and 803 hours of observations. Intervention None. Main outcome measure None. Results The QUASER Hospital Guide was designed for leadership teams to diagnose their organization’s strengths and weaknesses in the eight QI challenges. The Guide supports organizational dialogue about QI challenges, enables leaders to share perspectives, and helps teams to develop solutions to their situated problems. The Guide includes extensive examples of QI strategies drawn from the data and is published online and on paper. Conclusions The QUASER Hospital Guide is empirically based, draws on a dialogical approach to Organizational Development and complexity science and can facilitate hospital leadership teams to identify the best solutions for their organization

Crop yield and soil organic matter effects of four years of soil management interventions in Arsi Negele, South Central Ethiopia

In Lemenih, Mulugeta; Agegnehu, G.; Amde, Tilahun. (Eds.). 2012. Natural resources management for climate change adaptation: proceedings of the 12th Ethiopian Society of Soil Science (ESSS) Conference, Addis Ababa, Ethiopia, 17-18 March 2011. Addis Ababa, Ethiopia: Ethiopian Society of Soil Science (ESSS)

Collaborative and partnership research for improvement of health and social services : researcher's experiences from 20 projects

BACKGROUND: Getting research into policy and practice in healthcare is a recognised, world-wide concern. As an attempt to bridge the gap between research and practice, research funders are requesting more interdisciplinary and collaborative research, while actual experiences of such processes have been less studied. Accordingly, the purpose of this study was to gain more knowledge on the interdisciplinary, collaborative and partnership research process by investigating researchers' experiences of and approaches to the process, based on their participation in an inventive national research programme. The programme aimed to boost collaborative and partnership research and build learning structures, while improving ways to lead, manage and develop practices in Swedish health and social services. METHODS: Interviews conducted with project leaders and/or lead researchers and documentation from 20 projects were analysed using directed and conventional content analysis. RESULTS: Collaborative approaches were achieved by design, e.g. action research, or by involving practitioners from several levels of the healthcare system in various parts of the research process. The use of dual roles as researcher/clinician or practitioner/PhD student or the use of education designed especially for practitioners or 'student researchers' were other approaches. The collaborative process constituted the area for the main lessons learned as well as the main problems. Difficulties concerned handling complexity and conflicts between different expectations and demands in the practitioner's and researcher's contexts, and dealing with human resource issues and group interactions when forming collaborative and interdisciplinary research teams. The handling of such challenges required time, resources, knowledge, interactive learning and skilled project management. CONCLUSIONS: Collaborative approaches are important in the study of complex phenomena. Results from this study show that allocated time, arenas for interactions and skills in project management and communication are needed during research collaboration to ensure support and build trust and understanding with involved practitioners at several levels in the healthcare system. For researchers, dealing with this complexity takes time and energy from the scientific process. For practitioners, this puts demands on understanding a research process and how it fits with on-going organisational agendas and activities and allocating time. Some of the identified factors may be overlooked by funders and involved stakeholders when designing, performing and evaluating interdisciplinary, collaborative and partnership research

Old organic carbon in soil solution DOC after afforestation - evidence from 14C analysis

We analysed the 14C signal in soil solution DOC from the transition zone between the Ap and B horizon at 12 sites representing an afforestation chronosequence ranging from agricultural land to 89-year-old first generation Norway spruce forests. Although DOC concentrations had high spatial and temporal variation, the 14C signal in the DOC was consistent over two separate sampling periods for the individual plots. This indicates that the origin of DOC in the lower part of the A horizon is the same for each individual plot despite variations in DOC concentration in the soil solution. The DOC from the agricultural land had a 14C signal close to contemporary atmospheric values; mean 14C in DOC for 1999 and 2001 was 108 and 107% abs. modern, respectively. After establishment of forest, the 14C values in DOC fall to around 100% abs. modern. This provides evidence that a large part of the DOC in the younger stands is derived from older, pre-bomb carbon. The 14C enrichment gradually increased with stand age due to an increasing influence of decaying litter containing younger carbon, coming from that assimilated by the forest during the period with elevated 14C concentrations in the atmosphere. The average 14C concentration in DOC from the oldest stand was 111% abs. modern. Even if the younger carbon gradually influenced the proportion of 14C in DOC when stand age increased, a substantial part of the DOC must still originate from SOM formed before afforestation. It is hypothesised that 14C enrichment changes along the chronosequence is explained by two simultaneous processes, changes in input of litter and an increased mobilisation of older SOM from the A horizon due to the change in land-use