Unpacking the black box of improvement

During the Salzburg Global Seminar Session 565-Better Health Care: How do we learn about improvement, participants discussed the need to unpack the black box of improvement. The black box refers to the fact that when quality improvement interventions are described or evaluated, there is a tendency to assume a simple, linear path between the intervention and the outcomes it yields. It is also assumed that it is enough to evaluate the results without understanding the process of by which the improvement took place. However, quality improvement interventions are complex, nonlinear and evolve in response to local settings. To accurately assess the effectiveness of quality improvement and disseminate the learning, there must be a greater understanding of the complexity of quality improvement work. To remain consistent with the language used in Salzburg, we refer to this as unpacking the black box of improvement. To illustrate the complexity of improvement, this article introduces four quality improvement case studies. In unpacking the black box, we present and demonstrate how Cynefin framework from complexity theory can be used to categorize and evaluate quality improvement interventions. Many quality improvement projects are implemented in complex contexts, necessitating an approach defined as probesense- respond. In this approach, teams experiment, learn and adapt their changes to their local setting. Quality improvement professionals intuitively use the probe-sense-respond approach in their work but document and evaluate their projects using language for simple or complicated' contexts, rather than the complex contexts in which they work. As a result, evaluations tend to ask 'How can we attribute outcomes to the intervention, rather than 'What were the adaptations that took place. By unpacking the black box of improvement, improvers can more accurately document and describe their interventions, allowing evaluators to ask the right questions and more adequately evaluate quality improvement interventions.Fil: Ramaswamy, Rohit. University of North Carolina; Estados UnidosFil: Reed, Julie. Nihr Clarch Northwest London; Estados UnidosFil: Livesley, Nigel. Institute for Healthcare Improvement; Estados UnidosFil: Boguslavsky, Victor. University Research Co; Estados UnidosFil: Garcia Elorrio, Ezequiel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Sax, Sylvia. University of Heidelberg; AlemaniaFil: Houleymata, Diarra. Applying Science to Strengthen and Improve Systems Project,; MalíFil: Kimble, Leighann. University Research Co; Estados UnidosFil: Parry, Gareth. Institute of Healthcare Improvement; Estados Unido

Strategies Used by Facilities in Uganda to Integrate Family Planning into HIV Care: What Works and What Doesn't

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Increasing biodiversity in urban green spaces through simple vegetation interventions

Cities are rapidly expanding world-wide and there is an increasing urgency to protect urban biodiversity, principally through the provision of suitable habitat, most of which is in urban green spaces. Despite this, clear guidelines of how to reverse biodiversity loss or increase it within a given urban green space is lacking. We examined the taxa- and species-specific responses of five taxonomically and functionally diverse animal groups to three key attributes of urban green space vegetation that drive habitat quality and can be manipulated over time: the density of large native trees, volume of understorey vegetation and percentage of native vegetation. Using multi-species occupancy-detection models, we found marked differences in the effect of these vegetation attributes on bats, birds, bees, beetles and bugs. At the taxa-level, increasing the volume of understorey vegetation and percentage of native vegetation had uniformly positive effects. We found 30–120% higher occupancy for bats, native birds, beetles and bugs with an increase in understorey volume from 10% to 30%, and 10–140% higher occupancy across all native taxa with an increase in the proportion of native vegetation from 10% to 30%. However, increasing the density of large native trees had a mostly neutral effect. At the species-specific level, the majority of native species responded strongly and positively to increasing understorey volume and native vegetation, whereas exotic bird species had a neutral response. Synthesis and applications. We found the probability of occupancy of most species examined was substantially reduced in urban green spaces with sparse understorey vegetation and few native plants. Our findings provide evidence that increasing understorey cover and native plantings in urban green spaces can improve biodiversity outcomes. Redressing the dominance of simplified and exotic vegetation present in urban landscapes with an increase in understorey vegetation volume and percentage of native vegetation will benefit a broad array of biodiversity.No Full Tex

Native bird data

Data from timed area searches. Only species native to Australia are included. Species scientific names given in supplementary materials of paper

Exotic bird data

Data from timed area searches for birds. Species exotic to Australia are included. Species scientific names given in supplementary materials of paper

Environmental co-variates

Site specific co-variates per green spac

Data from: Increasing biodiversity in urban green spaces through simple vegetation interventions

1. Cities are rapidly expanding worldwide and there is an increasing urgency to protect urban biodiversity, principally through the provision of suitable habitat, most of which is in urban green spaces. Despite this, clear guidelines of how to reverse biodiversity loss or increase it within a given urban green space is lacking. 2. We examined the taxa- and species-specific responses of five taxonomically and functionally diverse animal groups to three key attributes of urban green space vegetation that drive habitat quality and can be manipulated over time: the density of large native trees, volume of understorey vegetation and percentage of native vegetation. 3. Using multi-species occupancy-detection models we found marked differences in the effect of these vegetation attributes on bats, birds, bees, beetles and bugs. At the taxa-level, increasing the volume of understorey vegetation and percentage of native vegetation had uniformly positive effects. We found 30–120% higher occupancy for bats, native birds, beetles and bugs with an increase in understorey volume from 10 to 30%, and 10–140% higher occupancy across all native taxa with an increase in the proportion of native vegetation from 10 to 30%. However, increasing the density of large native trees had a mostly neutral effect. At the species-specific level, the majority of native species responded strongly and positively to increasing understorey volume and native vegetation, whereas exotic bird species had a neutral response. 4. Synthesis and applications. We found the probability of occupancy of most species examined was substantially reduced in urban green spaces with sparse understorey vegetation and few native plants. Our findings provide evidence that increasing understorey cover and native plantings in urban green spaces can improve biodiversity outcomes. Redressing the dominance of simplified and exotic vegetation present in urban landscapes with an increase in understorey vegetation volume and percentage of native vegetation will benefit a broad array of biodiversity

Environmental co-variates

Site specific co-variates per green spac

Bee data

Data on bees, collected using sweep net and coloured pan traps. Species scientific names given in supplementary materials of paper