Effect of an evidence based quality improvement framework on patient safety

Objectives To investigate the impact of the introduction of The Productive Ward Program™ on two patient safety indicators; patient falls and medication errors. Design Retrospective quantitative study. Setting The study was conducted at a major metropolitan acute care hospital in Sydney, Australia. Subjects This study was conducted in a medical, surgical and two aged care wards, with a combined total of 120 inpatient beds over a 32 month time period. Main Outcome Measures The number of patient falls and medication errors for each of the participating wards. Results The implementation of The Productive Ward Program™, did not have an overall significant statistical reduction in the number of falls and medication incidents. Aged Care 1, had a reduction of 13 falls between intervention and post intervention phase, these results were not statistically significant (OR 1.17; 95% CI 0.86, 1.59). For Aged Care 1 ward there was a statistically significant reduction in medication errors from 66 errors pre intervention to 27 medication errors post intervention (OR 2.73;95% CI 1.71, 4.38). Conclusion The results of this small study indicate that the implementation of The Productive Ward Program™, did not have an overall significant statistical reduction in the number of falls and medication errors. This paper highlights the need for future research on the impact of the Productive Ward Program on patient safety

Theorising Interventions as Events in Systems

Abstract Conventional thinking about preventive interventions focuses over simplistically on the ''package'' of activities and/or their educational messages. An alternative is to focus on the dynamic properties of the context into which the intervention is introduced. Schools, communities and worksites can be thought of as complex ecological systems. They can be theorised on three dimensions: (1) their constituent activity settings (e.g., clubs, festivals, assemblies, classrooms); (2) the social networks that connect the people and the settings; and (3) time. An intervention may then be seen as a critical event in the history of a system, leading to the evolution of new structures of interaction and new shared meanings. Interventions impact on evolving networks of person-time-place interaction, changing relationships, displacing existing activities and redistributing and transforming resources. This alternative view has significant implications for how interventions should be evaluated and how they could be made more effective. We explore this idea, drawing on social network analysis and complex systems theory

The C-CAP process: a comprehensive approach to community resource mapping

Introduction Place-based systems change approaches are gaining popularity to address the complex problems associated with locational disadvantage. An important stage of place-based systems change involves understanding the context that surrounds (re)produces a target problem. Community resource mapping can be used to establish the context and identify the strengths of a community that might be leveraged through systems change efforts. Approaches to community resource mapping draw on a range of philosophical assumptions and methodological frameworks. However, comprehensive, practical guidance for researchers and practitioners to conduct community resource mapping is scarce. Method Drawing on the learnings from a literature review, scoping workshops, and reflective practice sessions, we developed a flexible, methodologically robust process called the Contextualize, Collect, Analyze, and Present (C-CAP) process: a four-phase approach to preparing for, conducting, and reporting on community resource mapping. The C-CAP process was co-developed by researchers and practitioners and was tested and refined in two different communities. Results The C-CAP process provides robust guidance for conducting and reporting on a community resource mapping project. The C-CAP process can be applied by public health practitioners and researchers and adapted for use across different communities, problems, and target groups. We encourage others guided by differing theoretical perspectives to apply C-CAP and share the learnings. Conclusion Application of the C-CAP process has the potential to improve the comparability and comprehensiveness of findings from community resource mapping projects and avoids duplication of effort by reducing the need to design new processes for each new community resource mapping activity

Collaborative networks in chronic disease prevention: what factors inhibit partnering for funding?

Inter-organisational partnering is seen as an effective mechanism for improving the delivery of chronic disease interventions in communities. Yet even in communities where organisations across multiple sectors are well connected and collaborative in other ways, when it comes to partnering for joint-funding, multiple barriers inhibit the establishment of formal partnerships. To understand why this is so, we examined quantitative and qualitative data from organisations in an Australian community and compared the findings with a review of the published literature in this area. We found that even organisations which are well connected through informal network arrangements face pressure from funding bodies to form more formalised inter-organisational partnerships. Community based organisations also recognise that partnerships are desirable mechanisms for service improvement; however, barriers to joint-funding partnerships exist which include restrictions imposed by funding bodies on the way grants are designed, implemented, and administered. Additional barriers at the community level include organisational capacity for partnership work, intra-organisational restrictions and timing issues. Policy makers must recognise and address the barriers to partnerships which exist within funding structures and at the community level in order to increase partnering opportunities to improve service delivery

From Understanding to Impactful Action: Systems Thinking for Systems Change in Chronic Disease Prevention Research

Within the field of chronic disease prevention, research efforts have moved to better understand, describe, and address the complex drivers of various health conditions. Change-making is prominent in this paper, and systems thinking and systems change are prioritised as core elements of prevention research. We report how the process of developing a theory of systems change can assist prevention research to progress from understanding systems, towards impactful action within those systems. Based on Foster-Fishman and Watson’s ABLe change framework, a Prevention Systems Change Framework (PSCF) was adapted and applied to an Australian case study of the drivers of healthy and equitable eating as a structured reflective practice. The PSCF comprises four components: building a systemic lens on prevention, holding a continual implementation focus, integrating the systemic lens and implementation focus, and developing a theory of change. Application of the framework as part of a systemic evaluation process enabled a detailed and critical assessment of the healthy and equitable eating project goals and culminated in the development of a theory of prevention systems change specific to that project, to guide future research and action. Arguably, if prevention research is to support improved health outcomes, it must be more explicitly linked to creating systems change

A review of programs that targeted environmental determinants of Aboriginal and Torres Strait Islander health

Objective: Effective interventions to improve population and individual health require environmental change as well as strategies that target individual behaviours and clinical factors. This is the basis of implementing an ecological approach to health programs and health promotion. For Aboriginal People and Torres Strait Islanders, colonisation has made the physical and social environment particularly detrimental for health. Methods and Results: We conducted a literature review to identify Aboriginal health interventions that targeted environmental determinants of health, identifying 21 different health programs. Program activities that targeted environmental determinants of health included: Caring for Country; changes to food supply and/or policy; infrastructure for physical activity; housing construction and maintenance; anti-smoking policies; increased workforce capacity; continuous quality improvement of clinical systems; petrol substitution; and income management. Targets were categorised according to Miller’s Living Systems Theory. Researchers using an Indigenous community based perspective more often identified interpersonal and community-level targets than were identified using a Western academic perspective. Conclusions: Although there are relatively few papers describing interventions that target environmental determinants of health, many of these addressed such determinants at multiple levels, consistent to some degree with an ecological approach. Interpretation of program targets sometimes differed between academic and community-based perspectives, and was limited by the type of data reported in the journal articles, highlighting the need for local Indigenous knowledge for accurate program evaluation. Implications: While an ecological approach to Indigenous health is increasingly evident in the health research literature, the design and evaluation of such programs requires a wide breadth of expertise, including local Indigenous knowledge

Outcomes and care practices for preterm infants born at less than 33 weeks’ gestation: A quality-improvement study

BACKGROUND: Preterm birth is the leading cause of morbidity and mortality in children younger than 5 years. We report the changes in neonatal outcomes and care practices among very preterm infants in Canada over 14 years within a national, collaborative, continuous quality-improvement program. METHODS: We retrospectively studied infants born at 23–32 weeks’ gestation who were admitted to tertiary neonatal intensive care units that participated in the Evidence-based Practice for Improving Quality program in the Canadian Neonatal Network from 2004 to 2017. The primary outcome was survival without major morbidity during the initial hospital admission. We quantified changes using process-control charts in 6-month intervals to identify special-cause variations, adjusted regression models for yearly changes, and interrupted time series analyses. RESULTS: The final study population included 50 831 infants. As a result of practice changes, survival without major morbidity increased significantly (56.6% [669/1183] to 70.9% [1424/2009]; adjusted odds ratio [OR] 1.08, 95% confidence interval [CI] 1.06–1.10, per year) across all gestational ages. Survival of infants born at 23–25 weeks’ gestation increased (70.8% [97/137] to 74.5% [219/294]; adjusted OR 1.03, 95% CI 1.02–1.05, per year). Changes in care practices included increased use of antenatal steroids (83.6% [904/1081] to 88.1% [1747/1983]), increased rates of normothermia at admission (44.8% [520/1160] to 67.5% [1316/1951]) and reduced use of pulmonary surfactant (52.8% [625/1183] to 42.7% [857/2009]). INTERPRETATION: Network-wide quality-improvement activities that include better implementation of optimal care practices can yield sustained improvement in survival without morbidity in very preterm infants