Performance feedback: An exploratory study to examine the acceptability and impact for interdisciplinary primary care teams

Background - This mixed methods study was designed to explore the acceptability and impact of feedback of team performance data to primary care interdisciplinary teams. // Methods - Seven interdisciplinary teams were offered a one-hour, facilitated performance feedback session presenting data from a comprehensive, previously-conducted evaluation, selecting highlights such as performance on chronic disease management, access, patient satisfaction and team function. // Results - Several recurrent themes emerged from participants' surveys and two rounds of interviews within three months of the feedback session. Team performance measurement and feedback was welcomed across teams and disciplines. This feedback could build the team, the culture, and the capacity for quality improvement. However, existing performance indicators do not equally reflect the role of different disciplines within an interdisciplinary team. Finally, the effect of team performance feedback on intentions to improve performance was hindered by a poor understanding of how the team could use the data. // Conclusions - The findings further our understanding of how performance feedback may engage interdisciplinary team members in improving the quality of primary care and the unique challenges specific to these settings. There is a need to develop a shared sense of responsibility and agenda for quality improvement. Therefore, more efforts to develop flexible and interactive performance-reporting structures (that better reflect contributions from all team members) in which teams could specify the information and audience may assist in promoting quality improvement

The Imperatives of Health and Weight in Primary Care Clinics: Current and Envisioned Practices

Biopower imperatives about body weight, eating, and exercise are embedded in primary care practice. The dominant discourses about body weight frame the body as notably malleable, a direct reflection of eating and exercise behaviours, to the exclusion of other influences. In this dissertation, I aim to open dialogue on the question of how to care well for patients in a time when talking about weight, eating, and exercise is both expected and potentially stigmatizing and/or contributing to health disparities. I observed primary care appointments in three Alberta clinics, and a Canadian Obesity Network 5As of Obesity Management™ continuing professional development workshop. I interviewed the observed primary care clinicians, and key informants in the Canadian Obesity Network. Using analytic insights from discourse analysis, actor-network theory, and visual studies, I analysed both clinical practice and the workshop through the theoretical lenses of governmentality and Mol's logics of choice and care. In the clinic, weight-related talk elicited face-saving and confessional talk from most patients (that is, across body sizes), an indication of the strength of dominant discourses that assume malleability of bodies and behaviours, interpret fatness as failure, and reinforce individual responsibility for health. Clinicians’ responses to patients’ face-saving talk, and the ways in which clinicians used epidemiological knowledge to guide action varied. In the continuing professional development workshop, the Network’s vision moved obesity management closer to the logic of care, in part translating some obesities into a chronic disease frame through the folding in of a physiological theory to re-interpret epidemiological studies and clinical trials. This dissertation adds to conversations about anti-fat stigma and discrimination in health care, making visible some modes by which patients, clinicians, and knowledge brokers use and/or attempt to disrupt individualistic, blame-oriented discourses about fatness. The dissertation foregrounds a range of potential mediators that may influence translation of less-stigmatizing clinical practices into primary care clinics.2 year

Beyond Fighting Fires and Chasing Tails? Chronic Illness Care Plans in Ontario, Canada

PURPOSE Recent work has conceptualized new models for the primary care management of patients with chronic illness. This study investigated the experience of family physicians and patients with a chronic illness management initiative that involved the joint formulation of comprehensive individual patient care plans

Affect, intensity, and moral assemblage in rehabilitation practice

This paper uses the philosophy of Deleuze and Guattari to explore how disability is organized in the clinical setting, focusing on young men with muscular dystrophies. The authors of Capitalism and Schizophrenia present a robust philosophy of affect, used in three ways. First, they allow us to trace the interaction of bodies (natural, social, material or otherwise) in the clinical space. Second, Deleuze and Guattari provide a philosophy of intensity. We use this to explore the emotional intensities surrounding progressive disability in the clinical space. Finally, we argue that affective philosophy allows us to explore spaces of morality and obligation, among patients, parents, and practitioners, alike. Each facet is grounded in ethnographic data. The paper ends looking into disability studies’ critiques of medicalization and capitalism, in relation to critical rehabilitation science. Disability studies and critical rehabilitation science are steeped in affect. There is, however, much more work to do, in tandem

Pseudotumoral pelvic actinomycosis: One should think of it

peer reviewe

Performance feedback: An exploratory study to examine the acceptability and impact for interdisciplinary primary care teams

Abstract Background This mixed methods study was designed to explore the acceptability and impact of feedback of team performance data to primary care interdisciplinary teams. Methods Seven interdisciplinary teams were offered a one-hour, facilitated performance feedback session presenting data from a comprehensive, previously-conducted evaluation, selecting highlights such as performance on chronic disease management, access, patient satisfaction and team function. Results Several recurrent themes emerged from participants' surveys and two rounds of interviews within three months of the feedback session. Team performance measurement and feedback was welcomed across teams and disciplines. This feedback could build the team, the culture, and the capacity for quality improvement. However, existing performance indicators do not equally reflect the role of different disciplines within an interdisciplinary team. Finally, the effect of team performance feedback on intentions to improve performance was hindered by a poor understanding of how the team could use the data. Conclusions The findings further our understanding of how performance feedback may engage interdisciplinary team members in improving the quality of primary care and the unique challenges specific to these settings. There is a need to develop a shared sense of responsibility and agenda for quality improvement. Therefore, more efforts to develop flexible and interactive performance-reporting structures (that better reflect contributions from all team members) in which teams could specify the information and audience may assist in promoting quality improvement.</p

Enhancing the human dimensions of children’s neuromuscular care: piloting a methodology for fostering team reflexivity

For those with chronic, progressive conditions, high quality clinical care requires attention to the human dimensions of illness—emotional, social, and moral aspects—which co-exist with biophysical dimensions of disease. Reflexivity brings historical, institutional, and socio-cultural influences on clinical activities to the fore, enabling consideration of new possibilities. Continuing education methodologies that encourage reflexivity may improve clinical practice and trainee learning, but are rare. We piloted a dialogical methodology with a children’s rehabilitation team to foster reflexivity (patient population: young people with Duchenne’s or Becker’s muscular dystrophy). The methodology involved three facilitated, interactive dialogues with the clinical team. Each dialogue involved clinicians learning to apply a social theory (Mol’s The Logic of Care) to ethnographic fieldnotes of clinical appointments, to make routine practice less familiar and thus open to examination. Discourse analyses that preserve group dynamics were completed to evaluate the extent to which the dialogues spurred reflexive dialogue within the team. Overall, imagining impacts of clinical care on people’s lives—emphasized in the social theory applied to fieldnotes—showed promise, shifting how clinicians interpreted routine practices and spurring many plans for change. However, this reflexive orientation was not sustained throughout, particularly when examining entrenched assumptions regarding ‘best practices’. Clinicians defended institutional practices by co-constructing the metaphor of balancing logics in care delivery. When invoked, the balance metaphor deflected attention from emotional, social, and moral impacts of clinical care on patients and their families. Emergent findings highlight the value of analysing reflexivity-oriented dialogues using discourse analysis methods