How to specify healthcare process improvements collaboratively using rapid, remote consensus-building: a framework and a case study of its application

Abstract: Background: Practical methods for facilitating process improvement are needed to support high quality, safe care. How best to specify (identify and define) process improvements – the changes that need to be made in a healthcare process – remains a key question. Methods for doing so collaboratively, rapidly and remotely offer much potential, but are under-developed. We propose an approach for engaging diverse stakeholders remotely in a consensus-building exercise to help specify improvements in a healthcare process, and we illustrate the approach in a case study. Methods: Organised in a five-step framework, our proposed approach is informed by a participatory ethos, crowdsourcing and consensus-building methods: (1) define scope and objective of the process improvement; (2) produce a draft or prototype of the proposed process improvement specification; (3) identify participant recruitment strategy; (4) design and conduct a remote consensus-building exercise; (5) produce a final specification of the process improvement in light of learning from the exercise. We tested the approach in a case study that sought to specify process improvements for the management of obstetric emergencies during the COVID-19 pandemic. We used a brief video showing a process for managing a post-partum haemorrhage in women with COVID-19 to elicit recommendations on how the process could be improved. Two Delphi rounds were then conducted to reach consensus. Results: We gathered views from 105 participants, with a background in maternity care (n = 36), infection prevention and control (n = 17), or human factors (n = 52). The participants initially generated 818 recommendations for how to improve the process illustrated in the video, which we synthesised into a set of 22 recommendations. The consensus-building exercise yielded a final set of 16 recommendations. These were used to inform the specification of process improvements for managing the obstetric emergency and develop supporting resources, including an updated video. Conclusions: The proposed methodological approach enabled the expertise and ingenuity of diverse stakeholders to be captured and mobilised to specify process improvements in an area of pressing service need. This approach has the potential to address current challenges in process improvement, but will require further evaluation

Implication du métabolisme aérobie dans la virulence de Streptococcus agalactiae (exemple de la NADH oxydase de type 2)

CHATENAY M.-PARIS 11-BU Pharma. (920192101) / SudocSudocFranceF

Évaluation des facteurs de pénibilité du travail et évolutions technico-organisationnelles : un défi pour l’ergonomie

Thirty years apart, ergonomists were asked the same question by trade unions and employer associations namely, to assess the occupational risks of rotary press operators and the impact on their health and life expectancy. This paper aims to present the method and main results of two studies led respectively in 1976/1978 and 2007/2009, underlining the interest of a multi-disciplinary approach (ergonomics, ergo-toxicology, socio-epidemiology and statistics) that integrated diverse methods for tackling such a complex issue. The goal of the present study was to identify and assess physical and mental demand factors associated with the technical and organizational changes that have occurred since the early 1980s. These results should, on the one hand, support the collective bargaining process concerning retirement age and, more specifically, compensation measures; and, on the other hand, should help to find better technical and organizational arrangements, in particular, prevention measures, likely to reduce the impact of work on the workers’ health. Regarding the short-, middle-, and long-term impact of ergonomic interventions, these studies question the potential of ergonomics to better address issues that are so crucial from an individual as well as social standpoint. They also question whether the body of knowledge produced by ergonomics can be used to steer public policies on occupational health