Norms for creativity and implementation in healthcare teams: testing the group innovation inventory

Abstract OBJECTIVE: To test to what extent the four-factor structure of the group innovation inventory (GII) is confirmed for improvement teams participating in a quality improvement collaborative. DESIGN: Quasi-experimental design with baseline and end-measurement after intervention. SETTING: This study included quality improvement teams participating in the Care for Better improvement programme for home care, care for the handicapped and the elderly in the Netherlands between 2006 and 2008. PARTICIPANTS: As part of a larger evaluation study, 261 written questionnaires from team members were collected at baseline (pre-project sample) and 129 questionnaires at end-measurement (post-project sample). MAIN OUTCOME MEASURE: Group innovation inventory. RESULTS: Confirmatory factor analyses revealed the expected four-factor structure and good fit indices. The subscales 'group functioning' and 'speed of action' showed acceptable Cronbach's alphas and high inter-item correlations. The subscales 'support for risk taking' and 'tolerance of mistakes' showed insufficient reliability and validity. CONCLUSIONS: The group functioning and speed of action subscales of the GII showed acceptable psychometric properties and are applicable to quality improvement teams in health care. In order to understand how social expectations within teams working in health care organizations exert influence over attitudes and behaviours thought to stimulate creativity, further conceptualization of the norms for enhancing creativity within health care is needed

Integrating Family Strengths in Child Protection Goals

Over the last decades, child protection workers (CPWs) have largely focused on improving their work with a strength-based approach in order to empower families. This study investigates to what extent CPWs draw on families' strengths, that is, by promoting autonomy and competencies and by involving their informal networks in goal formulation. This quantitative study analysed the goals, as stated in case files, formulated by CPWs for 177 families within a single Dutch child protection service. 48.6% of CPWs prioritise promoting families' autonomy in goal formulation. With regard to competencies, only 40.1% of the goals refer to the families' competencies. In addition, the support system that the goals call upon tends to be dominated by formal rather than informal networks (in 71.2% of cases). While it is true that child protection cases can benefit from the support of a formal networks, CPWs overwhelmingly failed to encourage support from existing informal networks (in 95.5% of cases). There were no relationships between these percentages and the nature of the family problems or the question of whether or to what extent the CPWs identified the specific strengths of families. These findings show that half of the CPWs had integrated a strength-based approach in their daily practice to some extent, and therefore improvements are needed in order to more successfully encourage families to change.</p

Validation of the Caregivers’ Satisfaction with Stroke Care Questionnaire: C-SASC hospital scale

To date, researchers have lacked a validated instrument to measure stroke caregivers’ satisfaction with hospital care. We adjusted a validated patient version of satisfaction with hospital care for stroke caregivers and tested the 11-item caregivers’ satisfaction with hospital care (C-SASC hospital scale) on caregivers of stroke patients admitted to nine stroke service facilities in the Netherlands. Stroke patients were identified through the stroke service facilities; caregivers were identified through the patients. We collected admission demographic data from the caregivers and gave them the C-SASC hospital scale. We tested the instrument by means of structural equation modeling and examined its validity and reliability. After the elimination of three items, the confirmatory factor analyses revealed good indices of fit with the resulting eight-item C-SASC hospital scale. Cronbach’s α was high (0.85) and correlations with general satisfaction items with hospital care ranged from 0.594 to 0.594 (convergent validity). No significant relations were found with health and quality of life (divergent validity). Such results indicate strong construct validity. We conclude that the C-SASC hospital scale is a promising instrument for measuring stroke caregivers’ satisfaction with hospital stroke care

A large-scale longitudinal study indicating the importance of perceived effectiveness, organizational and management support for innovative culture

AbstractTeams participating in QI collaboratives reportedly enhance innovative culture in long-term care, but we currently lack empirical evidence of the ability of such teams to enhance (determinants of) innovative culture over time. The objectives of our study are therefore to explore innovative cultures in QI teams over time and identify its determinants. The study included QI teams participating between 2006 and 2011 in a national Dutch quality program (Care for Better), using an adapted version of the Breakthrough Method. Each QI team member received a questionnaire by mail within one week after the second (2–3 months post-implementation of the collaborative = T0) and final conference (12 months post-implementation = T1). A total of 859 (out of 1161) respondents filled in the questionnaire at T0 and 541 at T1 (47% response). A total of 307 team members filled in the questionnaire at both T0 and T1. We measured innovative culture, respondent characteristics (age, gender, education), perceived team effectiveness, organizational support, and management support. Two-tailed paired t-tests showed that innovative culture was slightly but significantly lower at T1 compared to T0 (12 months and 2–3 months after the start of the collaborative, respectively). Univariate analyses revealed that perceived effectiveness, organizational and management support were significantly related to innovative culture at T1 (all at p ≤ 0.001). Multilevel analyses showed that perceived effectiveness, organizational support, and management support predicted innovative culture. Our QI teams were not able to improve innovative culture over time, but their innovative culture scores were higher than non-participant professionals. QI interventions require organizational and management support to enhance innovative culture in long-term care settings

Disparate Effects of p24α and p24δ on Secretory Protein Transport and Processing

Contains fulltext : 34883.pdf ( ) (Open Access)BACKGROUND: The p24 family is thought to be somehow involved in endoplasmic reticulum (ER)-to-Golgi protein transport. A subset of the p24 proteins (p24alpha(3), -beta(1), -gamma(3) and -delta(2)) is upregulated when Xenopus laevis intermediate pituitary melanotrope cells are physiologically activated to produce vast amounts of their major secretory cargo, the prohormone proopiomelanocortin (POMC). METHODOLOGY/PRINCIPAL FINDINGS: Here we find that transgene expression of p24alpha(3 )or p24delta(2) specifically in the Xenopus melanotrope cells in both cases causes an effective displacement of the endogenous p24 proteins, resulting in severely distorted p24 systems and disparate melanotrope cell phenotypes. Transgene expression of p24alpha(3) greatly reduces POMC transport and leads to accumulation of the prohormone in large, ER-localized electron-dense structures, whereas p24delta(2)-transgenesis does not influence the overall ultrastructure of the cells nor POMC transport and cleavage, but affects the Golgi-based processes of POMC glycomaturation and sulfation. CONCLUSIONS/SIGNIFICANCE: Transgenic expression of two distinct p24 family members has disparate effects on secretory pathway functioning, illustrating the specificity and non-redundancy of our transgenic approach. We conclude that members of the p24 family furnish subcompartments of the secretory pathway with specific sets of machinery cargo to provide the proper microenvironments for efficient and correct secretory protein transport and processing

Creating effective quality-improvement collaboratives: a multiple case study

Objective: To explore whether differences between collaboratives with respect to type of topic, type of targets, measures (systems) are also reflected in the degree of effectiveness. Study setting: 182 teams from long-term healthcare organisation developed improvement initiatives in seven quality-improvement collaboratives (QICs) focusing on patient safety and autonomy. Study design: Multiple case before-after study. Data collection: 75 team leaders completed a written questionnaire at the end of each QIC on achievability and degree of challenge of targets and measurability of progress. Main outcome indicators were collaborative-specific measures (such as prevalence of pressure ulcers). Principal findings: The degree of effectiveness and percentage of teams realising targets varied between collaboratives. Collaboratives also varied widely in perceived measurability (F=6.798 and p=0.000) and with respect to formulating achievable targets (F=6.566 and p=0.000). The Problem Behaviour collaborative scored significantly lower than all other collaboratives on both dimensions. The collaborative on Autonomy and control scored significantly lower on measurability than the other collaboratives. Topics for which there are best practices and evidence of effective interventions do not necessarily score higher on effectiveness, measurability, achievable and challenging targets. Conclusions: The effectiveness of a QIC is associated with the efforts of programme managers to create conditions that provide insight into which changes in processes of care and in client outcomes have been made. Measurability is not an inherent property of the improvement topic. Rather, creating measurability and formulating challenging and achievable targets is one of the crucial tasks for programme managers of QICs

Elderly patients' decision-making embedded in the social context

BACKGROUND: Older patients are increasingly encouraged to be actively involved but how they perceive their role in the decision-making process varies according to their health care providers and their health situation. Their role could be influenced by their social context but more specifically by subjective norms (i.e. patients' view of the role that significant others expect them to play in the decision-making process) and perceived soc

Validation of the self-management ability scale (SMAS) and development and validation of a shorter scale (SMAS-S) among older patients shortly after hospitalisation

Background: The 30-item Self-Management Ability Scale (SMAS) measures self-management abilities (SMA). Objectives of this study were to (1) validate the SMAS among older people shortly after hospitalisation and (2) shorten the SMAS while maintaining adequate validity and reliability. Methods: Our study was conducted among older individuals (>= 65) who had recently been discharged from a hospital. Three months after hospital admission, 296/456 patients (65% response) were interviewed in their homes. We tested the instrument by means of structural equation modelling, and examined its validity and reliability. In addition, we tested internal consistency of the SMAS and SMAS-S among a study sample of patients at risk for cardiovascular diseases. Results: After eliminating 12 items, the confirmatory factor analyses revealed good indices of fit with the resulting 18-item SMAS (SMAS-S). To estimate construct validity of the instrument, we looked at correlations between SMAS subscale scores and overall well-being scores as measured by Social Product Function (SPF-IL) and Cantril's ladder. All SMAS subscales of the original and short version significantly correlated with SPF-IL scores (all at p <= 0.001) and Cantril's ladder (for the cognitive well-being subscale p <= 0.01; all other subscales at p <= 0.001). The findings indicated validity. Analyses of the SMAS and SMAS-S in the sample of patients at risk for cardiovascular diseases showed that both instruments are reliable. Conclusions: The psychometric properties of both the SMAS and SMAS-S are good. The SMAS-S is a promising alternate instrument to evaluate self-management abilities

Cryptic variations in abyssal peridotite compositions : evidence for shallow-level melt infiltration in the oceanic lithosphere

Author Posting. © The Authors, 2009. This is the author's version of the work. It is posted here by permission of Oxford University Press for personal use, not for redistribution. The definitive version was published in Journal of Petrology 51 (2010): 395-423, doi:10.1093/petrology/egp096.Ranges in clinopyroxene trace elements of 2-3 orders of magnitude occur over <2 cm distance in peridotite samples from the Atlantis II Fracture Zone on the Southwest Indian Ridge. This represents the smallest length-scale at which clinopyroxene trace element concentrations have been observed to vary in abyssal peridotites. Due to the absence of any accompanying veins or other macroscopic features of melt-rock interaction, these peridotites are interpreted as being the result of cryptic metasomatism by a low volume melt. The small length-scale of the variations, including porphyroclastic clinopyroxene grains of 2 mm diameter with an order of magnitude variation in light rare earth elements, precludes an ancient origin for these anomalies. Calculation of diffusive homogenization timescales suggests that for the trace element variations to be preserved, metasomatism occurred in the oceanic lithospheric mantle at 1000-1200°C and 10-20 km depth. This observation provides constraints for the on-axis thickness of the lithospheric mantle at an ultra-slow spreading ridge. Trace amounts of plagioclase are present in at least two of the metasomatized samples. Textural and trace element observations indicate that it formed following the trace element metasomatism, indicating that the mantle can be infiltrated multiple times by melt during the final stages of uplift at the ridge axis. The peridotites in this study are from two oceanic core complexes on the Atlantis II Fracture Zone. Our observations of multiple late-stage metasomatic events in the lithospheric mantle agree with current models and observations of melt intrusion into the mantle during oceanic core complex formation. These observations also indicate that heterogeneous lithospheric mantle can be created at ultra-slow spreading ridges.This research was supported by EAR0115433 and EAR0106578 (NS) and the WHOI Academic Programs Office (JMW)