Forskning ved fjæra

23.-27. mai 2011 ble den 12. Workshopen i kunnskapsbasert praksis arrangert, denne gangen på Holmsbu Spa & Resort. Arrangør er Nasjonalt kunnskapssenter for helsetjenesten. Deltakerne, om lag 70 stykker, var rekruttert fra 11 land og med ulik yrkesbakgrunn. Klinikere møter de som arbeider med helsepolitikk, forskning og medisinsk bibliotektjeneste. Med andre ord en gjeng med ulike innfallsvinkler, forståelse og bruk av kunnskapsbasert praksis. Alle deltakerne var på forhånd delt inn i grupper på ca. seks, enten etter arbeidssted, yrkesbakgrunn eller arbeidsområde. Dette ga spennende konstellasjoner, fleksibilitet og mulighet for læring etter gruppas behov og litt ulikt innhold i gruppearbeidet

The use and experience of an audit & feedback cycle when implementing a clinical practice guideline in specialist mental health care in Norway: A qualitative case study

Implementation research in health services is needed to optimise use of clinical practice guidelines (CPGs). Audit and feedback (A&F) is a circular process measuring practice against CPGs, were reflecting on results, agreeing on improvement and developing improvement plans is essential. The aim was to add to the knowledge of the use and experience of A&F in specialist mental health care in Norway. This was done by exploring an A&F cycle over a year from different angles: by observing team meetings at the outset and focus group interviews of staff and individual interviews of first-line managers at the end of the cycle. A key message is that A&F is experienced as useful, confirmed good practice and brought forth competencies hidden in everyday practice. A&F contributed to clarify the patients’ needs in a local context and at a micro level as it illuminated consequences for each unit, for individuals’ everyday work and in relation to the broader system with which the staff cooperates. Discussions on lack and sources of knowledge exposed insufficient information competency. Staff and first-line managers felt being flooded with initiatives (such as CPGs and procedures) from superior authorities and saw them more as directives than as decision aids. No one took full responsibility for follow-up on decided actions and insufficient organisational support limited accomplishment and impact of the full A&F cycle. Despite first-line managers having a positive attitude and declared responsibility, administrative daily tasks and lack of support caused focus to fade slowly. Additionally, the roles of the first-line managers and the psychiatrist could be complex regarding decisions. Stronger links between evidence-based practice, information competency and A&F could lead to better understanding and ownership of the full A&F cycle, and thus its effect as an implementation strategy to increase use of CPGs in mental health care, suggesting stronger focus on implementation leadership

First-line managers' experience of the use of audit and feedback cycle in specialist mental health care: A qualitative case study

Abstract Background Audit and feedback was the main strategy to facilitate implementation of The National Guideline for Persons with Concurrent Substance Use Disorders and Mental Disorders in specialist mental health services. Studies have shown that leadership support contributes to implementation success. The aim of the study was to explore how first-line managers in a District Psychiatric Centre experienced using audit and feedback cycle. Method The study had a qualitative case study design with individual interviews with five first-line managers from a District Psychiatric Centre in Norway. Qualitative content analysis was conducted. Results First-line managers were positive to contribute to better practice for the patient group and apply available tools. Four themes emerged: 1) Lack of endurance, where first-line managers saw their role as being process leaders, but failed to persist, 2) Lack of support in the process, where first-line managers called for a stronger organisational focus 3) Lack of ownership, where first-line managers felt the process was imposed on them, and 4) Lack of leader autonomy, where first-line managers seemed insecure about their role between professional leadership and own management. Conclusion First-line managers were not sufficiently experienced or equipped to solve the implementation process satisfactorily. They were torn between different commitments, without the autonomy to act as process drivers or facilitators, and without taking the necessary leadership role. The potential impact of the use of audit and feedback may thus not be fully realized, in part, because of limited organisational support and capacity to respond effectively

Audit and feedback in mental healthcare: staff experiences

Purpose Audit and feedback (A&F) often underlie implementation projects, described as a circular process; i.e. an A&F cycle. They are widely used, but effect varies with no apparent explanation. We need to understand how A&F work in real-life situations. The purpose of this paper, therefore, is to describe and explore mental healthcare full A&F cycle experiences. Design/methodology/approach This is a naturalistic qualitative study that uses four focus groups and qualitative content analysis. Findings Staff accepted the initial A&F stages, perceiving it to enhance awareness and reassure them about good practice. They were willing to participate in the full cycle and implement changes, but experienced poor follow-up and prioritization, not giving them a chance to own to the process. An important finding is the need for an A&F cycle facilitator. Practical implications Research teams cannot be expected to be involved in implementing clinical care. Guidelines will keep being produced to improve service quality and will be expected to be practiced. This study gives insights into planning and tailoring A&F cycles. Originality/value Tools to ease implementation are not enough, and the key seems to lie with facilitating a process using A&F. This study underscores leadership, designated responsibility and facilitation throughout a full audit cycle

Prosedyrearbeid – meningsløst mangfold?

NORSK: Bakgrunn Fagprosedyrer skal være en støtte for helsepersonell i det daglige arbeidet og bidra til god og forutsigbar kvalitet av tjenesten. Antall fagprosedyrer i norske helseforetak og måten de blir produsert på, er ukjent. Materiale og metode Vi gjennomførte en spørreundersøkelse med 25 spørsmål om omfang, kvalitet og koordinering av fagprosedyrer, sommeren 2009. 29 av 30 helseforetak svarte på spørsmålene. Resultater Mer enn 4700 ansatte i norske helseforetak er involvert i utvikling og håndtering av fagprosedyrer. Det totale antallet fagprosedyrer er over 45 000. De fleste foretakene koordinerer ikke prosedyrearbeidet med andre helseforetak. To foretak formidler foretakets praksis over internett. 15 av de 29 foretakene oppgir at de systematisk kvalitetssikrer fagprosedyrene. Fortolkning Det foregår trolig mye dobbeltarbeid knyttet til utvikling av fagprosedyrer ved norske foretak. Prosedyrene blir i regelen ikke delt med andre fagfolk og med befolkningen. Kvaliteten er ofte uviss, og bør undersøkes nærmere