A Multivariate Approach to Facebook Data for Marketing Communication

[EN] The aim of this paper is to propose a method to explore and synthesize social media data in order to aid businesses to make their communication decisions. The research was conducted at the end of 2014 on 5607 Italian Facebook subjects interested in drugs and health. In this study, we refer to the pharmaceutical market that is characterized by strict legal constraints, which prevent any promotional activities (such as advertising) of companies on prescription drugs. Thus, pharmaceutical businesses tend to promote their corporate brand instead of a single product brand. In such context, social media offer the opportunity to gather customers’ information about their attitudes and preferences, helpful to address marketing activities. Through a multivariate statistical approach on Facebook data, we have highlighted the associations existing between TV channels and users’ profiles. Therefore, depending on the value proposition to promote, every business could choose, first, the target group to reach and, then, the nearest suitable channel where to develop the corporate brand communication.Arrigo, E.; Liberati, C.; Mariani, P. (2016). A Multivariate Approach to Facebook Data for Marketing Communication. En CARMA 2016: 1st International Conference on Advanced Research Methods in Analytics. Editorial Universitat Politècnica de València. 66-74. https://doi.org/10.4995/CARMA2016.2016.2974OCS667

IL RUOLO DELLA FORMAZIONE NELLO SVILUPPO DELLE RISORSE UMANE. IL CASO CONTINENTAL AUTOMOTIVE ITALY SPA.

La tesi ha sviluppato l'analisi dei processi di formazione in Continental automotive Italiy s.p.a. La struttura della tesi è organizzata nel seguente modo: cap I analisi della formazione, processi, attori. Cap II presentazione azienda Continental Automotive Italy s.p.a, struttura dell'azienda corporate, struttura della sede operativa di Pisa, prodotti, clienti Cap III La formazione in Continental processi di sviluppo delle competenze cap IV analisi del caso conclusioni/considerazioni personal

A mixed-methods study of challenges experienced by clinical teams in measuring improvement.

OBJECTIVE: Measurement is an indispensable element of most quality improvement (QI) projects, but it is undertaken to variable standards. We aimed to characterise challenges faced by clinical teams in undertaking measurement in the context of a safety QI programme that encouraged local selection of measures. METHODS: Drawing on an independent evaluation of a multisite improvement programme (Safer Clinical Systems), we combined a qualitative study of participating teams' experiences and perceptions of measurement with expert review of measurement plans and analysis of data collected for the programme. Multidisciplinary teams of frontline clinicians at nine UK NHS sites took part across the two phases of the programme between 2011 and 2016. RESULTS: Developing and implementing a measurement plan against which to assess their improvement goals was an arduous task for participating sites. The operational definitions of the measures that they selected were often imprecise or missed important details. Some measures used by the teams were not logically linked to the improvement actions they implemented. Regardless of the specific type of data used (routinely collected or selected ex novo), the burdensome nature of data collection was underestimated. Problems also emerged in identifying and using suitable analytical approaches. CONCLUSION: Measurement is a highly technical task requiring a degree of expertise. Simply leveraging individual clinicians' motivation is unlikely to defeat the persistent difficulties experienced by clinical teams when attempting to measure their improvement efforts. We suggest that more structural initiatives and broader capability-building programmes should be pursued by the professional community. Improving access to, and ability to use repositories of validated measures, and increasing transparency in reporting measurement attempts, is likely to be helpful.This study was funded by the Health Foundation, charity number 286967. This work was also supported by MDW’s Wellcome Trust Investigator award WT09789. MDW is a National Institute for Health Research (NIHR) Senior Investigator. MDW and EL are supported by the Health Foundation’s grant to the University of Cambridge for The Healthcare Improvement Studies (THIS) Institute. THIS Institute is supported by the Health Foundation – an independent charity committed to bringing about better health and health care for people in the UK. TW was supported by the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) programme for North West London, and through an Improvement Science Fellowship from the Health Foundation. The views expressed in this publication are those of the authors and not necessarily those of the Health Foundation, the NHS, the NIHR, or the Department of Health and Social Care

Learning from high risk industries may not be straightforward: a qualitative study of the hierarchy of risk controls approach in healthcare.

OBJECTIVE: Though healthcare is often exhorted to learn from 'high-reliability' industries, adopting tools and techniques from those sectors may not be straightforward. We sought to examine the hierarchies of risk controls approach, used in high-risk industries to rank interventions according to supposed effectiveness in reducing risk, and widely advocated as appropriate for healthcare. DESIGN: Classification of risk controls proposed by clinical teams following proactive detection of hazards in their clinical systems. Classification was based on a widely used hierarchy of controls developed by the US National Institute for Occupational Safety and Health (NIOSH). SETTING AND PARTICIPANTS: A range of clinical settings in four English NHS hospitals. RESULTS: The four clinical teams in our study planned a total of 42 risk controls aimed at addressing safety hazards. Most (n = 35) could be classed as administrative controls, thus qualifying among the weakest type of interventions according to the HoC approach. Six risk controls qualified as 'engineering' controls, i.e. the intermediate level of the hierarchy. Only risk control qualified as 'substitution', classified as the strongest type of intervention by the HoC. CONCLUSIONS: Many risk controls introduced by clinical teams may cluster towards the apparently weaker end of an established hierarchy of controls. Less clear is whether the HoC approach as currently formulated is useful for the specifics of healthcare. Valuable opportunities for safety improvement may be lost if inappropriate hierarchical models are used to guide the selection of patient safety improvement interventions. Though learning from other industries may be useful, caution is needed

IMproving the practice of intrapartum electronic fetal heart rate MOnitoring with cardiotocography for safer childbirth (the IMMO programme): protocol for a qualitative study.

INTRODUCTION: Suboptimal electronic fetal heart rate monitoring (EFM) in labour using cardiotocography (CTG) has been identified as one of the most common causes of avoidable harm in maternity care. Training staff is a frequently proposed solution to reduce harm. However, current approaches to training are heterogeneous in content and format, making it difficult to assess effectiveness. Technological solutions, such as digital decision support, have not yet demonstrated improved outcomes. Effective improvement strategies require in-depth understanding of the technical and social mechanisms underpinning the EFM process. The aim of this study is to advance current knowledge of the types of errors, hazards and failure modes in the process of classifying, interpreting and responding to CTG traces. This study is part of a broader research programme aimed at developing and testing an intervention to improve intrapartum EFM. METHODS AND ANALYSIS: The study is organised into two workstreams. First, we will conduct observations and interviews in three UK maternity units to gain an in-depth understanding of how intrapartum EFM is performed in routine clinical practice. Data analysis will combine the insights of an ethnographic approach (focused on the social norms and interactions, values and meanings that appear to be linked with the process of EFM) with a systems thinking approach (focused on modelling processes, actors and their interactions). Second, we will use risk analysis techniques to develop a framework of the errors, hazards and failure modes that affect intrapartum EFM. ETHICS AND DISSEMINATION: This study has been approved by the West Midlands-South Birmingham Research Ethics Committee, reference number: 18/WM/0292. Dissemination will take the form of academic articles in peer-reviewed journals and conferences, along with tailored communication with various stakeholders in maternity care

How to be a very safe maternity unit: An ethnographic study.

Maternity care continues to be associated with avoidable harm that can result in serious disability and profound anguish for women, their children, and their families, and in high costs for healthcare systems. As in other areas of healthcare, improvement efforts have typically focused either on implementing and evaluating specific interventions, or on identifying the contextual features that may be generative of safety (e.g. structures, processes, behaviour, practices, and values), but the dialogue between these two approaches has remained limited. In this article, we report a positive deviance case study of a high-performing UK maternity unit to examine how it achieved and sustained excellent safety outcomes. Based on 143 h of ethnographic observations in the maternity unit, 12 semi-structured interviews, and two focus groups with staff, we identified six mechanisms that appeared to be important for safety: collective competence; insistence on technical proficiency; monitoring, coordination, and distributed cognition; clearly articulated and constantly reinforced standards of practice, behaviour, and ethics; monitoring multiple sources of intelligence about the unit's state of safety; and a highly intentional approach to safety and improvement. These mechanisms were nurtured and sustained through both a specific intervention (known as the PROMPT programme) and, importantly, the unit's contextual features: intervention and context shaped each other in both direct and indirect ways. The mechanisms were also influenced by the unit's structural conditions, such as staffing levels and physical environment. This study enhances understanding of what makes a maternity unit safe, paving the way for better design of improvement approaches. It also advances the debate on quality and safety improvement by offering a theoretically and empirically grounded analysis of the interplay between interventions and context of implementation

What can Safety Cases offer for patient safety? A multisite case study

Background The Safety Case is a regulatory technique that requires organisations to demonstrate to regulators that they have systematically identified hazards in their systems and reduced risks to being as low as reasonably practicable. It is used in several high-risk sectors, but only in a very limited way in healthcare. We examined the first documented attempt to apply the Safety Case methodology to clinical pathways. Methods Data are drawn from a mixed-methods evaluation of the Safer Clinical Systems programme. The development of a Safety Case for a defined clinical pathway was a centrepiece of the programme. We base our analysis on 143 interviews covering all aspects of the programme and on analysis of 13 Safety Cases produced by clinical teams. Results The principles behind a proactive, systematic approach to identifying and controlling risk that could be curated in a single document were broadly welcomed by participants, but was not straightforward to deliver. Compiling Safety Cases helped teams to identify safety hazards in clinical pathways, some of which had been previously occluded. However, the work of compiling Safety Cases was demanding of scarce skill and resource. Not all problems identified through proactive methods were tractable to the efforts of front-line staff. Some persistent hazards, originating from institutional and organisational vulnerabilities, appeared also to be out of the scope of control of even the board level of organisations. A particular dilemma for organisational senior leadership was whether to prioritise fixing the risks proactively identified in Safety Cases over other pressing issues, including those that had already resulted in harm. Conclusions The Safety Case approach was recognised by those involved in the Safer Clinical Systems programme as having potential value. However, it is also fraught with challenge, highlighting the limitations of efforts to transfer safety management practices to healthcare from other sectors

Influences on patient safety in intrapartum electronic fetal heart rate monitoring with cardiotocography (iSafe): protocol for a systematic scoping review

Intrapartum electronic fetal monitoring (EFM) using cardiotocography (CTG) is the recommended method for monitoring the fetal heart rate during labour for high-risk births in England. An abnormal CTG indicates the need for further review and management including potential urgent intervention (e.g. expediting birth) to minimise risk of serious long-term harm to the baby or stillbirth. In the UK, as other European countries, sub-optimal intrapartum EFM management is implicated in a large share of cerebral palsy, birth asphyxia, peripartum hypoxic brain injuries and obstetric malpractice claims. In addition to the psychosocial and social impact of stillbirth or life-long disability on parents and babies, obstetric brain injury is costly, potentially resulting in settlements for millions of pounds to support families over a lifetime of care. Every baby born in the NHS in England now incurs indemnity costs of £1,100. Of the total Clinical Negligence Scheme for Trusts provision of £78bn, 70% relates to maternity. Though maternity claims made up just 10% of the number of clinical negligence claims received by NHS Resolution in 2018-19, they accounted for 50% of the total value of claims. The need for action to improve safety of intrapartum EFM is now urgent, but questions remain about how it can best be achieved. We propose that reducing avoidable harm linked to intrapartum EFM requires sound understanding of the influences on sub-optimal practice. A perhaps more fruitful approach than one that focuses solely on CTG interpretation, more technology and/or solely on training, is to look more broadly at influences on safety. Such an approach would be consistent with the literature in patient safety that has advocated a systems approach to understanding and addressing the effects and interactions of real-world contexts such as teamwork, tasks, equipment, workspace, culture and organisation on clinical performance. It is also consistent with a well-established definition of safety as an attribute of health systems. This systematic scoping review aims to identify what is known in the published literature about such influences on patient safety in intrapartum electronic fetal heart rate monitoring with cardiotocography.This work is part of THIS Institute’s research programme and is funded by the Health Foundation’s grant for THIS Institute to the University of Cambridge. The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK. The Health Foundation have had no involvement in the development of this protocol

A qualitative study of experiences of NHS mental healthcare workers during the Covid-19 pandemic.

BackgroundThe Covid-19 pandemic has imposed extraordinary strains on healthcare workers. But, in contrast with acute settings, relatively little attention has been given to those who work in mental health settings. We aimed to characterise the experiences of those working in English NHS secondary mental health services during the first wave of the pandemic.MethodsThe design was a qualitative interview-based study. We conducted semi-structured, remote (telephone or online) interviews with 35 members of staff from NHS secondary (inpatient and community) mental health services in England. Analysis was based on the constant comparative method.ResultsParticipants reported wide-ranging changes in the organisation of secondary mental health care and the nature of work in response to the pandemic, including pausing of all services deemed to be "non-essential", deployment of staff across services to new and unfamiliar roles, and moves to remote working. The quality of participants' working life was impaired by increasing levels of daily challenge associated with trying to provide care in trying and constrained circumstances, the problems of forging new ways of working remotely, and constraints on ability to access informal support. Participants were confronted with difficult dilemmas relating to clinical decision-making, prioritisation of care, and compromises in ability to perform the therapeutic function of their roles. Other dilemmas centred on trying to balance the risks of controlling infection with the need for human contact. Many reported features of moral injury linked to their perceived failures in providing the quality or level of care that they felt service users needed. They sometimes sought to compensate for deficits in care through increased advocacy, taking on additional tasks, or making exceptions, but this led to further personal strain. Many experienced feelings of grief, helplessness, isolation, distress, and burnout. These problems were compounded by sometimes poor communication about service changes and by staff feeling that they could not take time off because of the potential impact on others. Some reported feeling poorly supported by organisations.ConclusionsMental health workers faced multiple adversities during the pandemic that were highly consequential for their wellbeing. These findings can help in identifying targets for support

Remote care for mental health:qualitative study with service users, carers and staff during the COVID-19 pandemic

Objectives: To explore the experiences of service users, carers and staff seeking or providing secondary mental health services during the COVID-19 pandemic. Design: Qualitative interview study, co-designed with mental health service users and carers. Methods: We conducted semi-structured, telephone or online interviews with a purposively constructed sample; a lived experience researcher conducted and analysed interviews with service users. Analysis was based on the constant comparison method. Setting: NHS secondary mental health services in England between June and August 2020. Participants: Of 65 participants, 20 had either accessed or needed to access English secondary mental healthcare during the pandemic; 10 were carers of people with mental health difficulties; 35 were members of staff working in NHS secondary mental health services during the pandemic. Results: Experiences of remote care were mixed. Some service users valued the convenience of remote methods in the context of maintaining contact with familiar clinicians. Most participants commented that a lack of non-verbal cues and the loss of a therapeutic ‘safe space’ challenged therapeutic relationship building, assessments, and identification of deteriorating mental wellbeing. Some carers felt excluded from remote meetings and concerned that assessments were incomplete without their input. Like service users, remote methods posed challenges for clinicians who reported uncertainty about technical options and a lack of training. All groups expressed concern about intersectionality exacerbating inequalities and the exclusion of some service user groups if alternatives to remote care are lost. Conclusions: Though remote mental healthcare is likely to become increasingly widespread in secondary mental health services, our findings highlight the continued importance of a tailored, personal approach to decision-making in this area. Further research should focus on which types of consultations best suit face-to-face interaction, and for whom and why, and which can be provided remotely and by which medium.This research was funded by The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge. THIS Institute is supported by the Health Foundation, an independent charity committed to bringing about better health and healthcare for people in the UK. Grant number not applicable. All contracted parties contributed to the study under agreements through the same funding. PBJ is supported by the NIHR Applied Research Collaboration East of England and by RP-PG-0161-20003. Mary Dixon-Woods is an NIHR Senior Investigator (NF-SI-0617-10026)