High performing hospitals: a qualitative systematic review of associated factors and practical strategies for improvement.

BACKGROUND: High performing hospitals attain excellence across multiple measures of performance and multiple departments. Studying high performing hospitals can be valuable if factors associated with high performance can be identified and applied. Factors leading to high performance are complex and an exclusive quantitative approach may fail to identify richly descriptive or relevant contextual factors. The objective of this study was to undertake a systematic review of qualitative literature to identify methods used to identify high performing hospitals, the factors associated with high performers, and practical strategies for improvement. METHODS: Methods used to collect and summarise the evidence contributing to this review followed the 'enhancing transparency in reporting the synthesis of qualitative research' protocol. Peer reviewed studies were identified through Medline, Embase and Cinahl (Jan 2000-Feb 2014) using specified key words, subject terms, and medical subject headings. Eligible studies required the use of a quantitative method to identify high performing hospitals, and qualitative methods or tools to identify factors associated with high performing hospitals or hospital departments. Title, abstract, and full text screening was undertaken by four reviewers, and inter-rater reliability statistics were calculated for each review phase. Risk of bias was assessed. Following data extraction, thematic syntheses identified contextual factors important for explaining success. Practical strategies for achieving high performance were then mapped against the identified themes. RESULTS: A total of 19 studies from a possible 11,428 were included in the review. A range of process, output, outcome and other indicators were used to identify high performing hospitals. Seven themes representing factors associated with high performance (and 25 sub-themes) emerged from the thematic syntheses: positive organisational culture, senior management support, effective performance monitoring, building and maintaining a proficient workforce, effective leaders across the organisation, expertise-driven practice, and interdisciplinary teamwork. Fifty six practical strategies for achieving high performance were catalogued. CONCLUSIONS: This review provides insights into methods used to identify high performing hospitals, and yields ideas about the factors important for success. It highlights the need to advance approaches for understanding what constitutes high performance and how to harness factors associated with high performance

In the Round: The Future of Food

In collaboration with PopTech, the Center for Complexity (CfC) hosted a two day convening in March 2019 to discuss the future of food, conducted in-the-round. Conversations-in-the-round offer an experimental and collaborative forum where a variety of perspectives collide to reimagine how we should approach navigating complex challenges. 30 professionals, community leaders, ag-tech startups, policymakers, local activists, global aid administrators, and many other important voices in the food industry were in attendance. We did not set out to create solutions, rather we devoted our time to exploration — a process that allowed us to assess, discover, reality-check, and strategically plan the next phase of the journey. A publication was created to capture the discussions, workshops, proposals, deign principles and actionable next steps. The outcomes of this first convening will guide what comes next. Our aim is to initiate a series of projects conducted by the CfC and our partners to advance the future of food according to shared design principles. We are working with PopTech to host further convenings.https://digitalcommons.risd.edu/cfc_projectsprograms_globalsecurity_futureoffood/1000/thumbnail.jp

Evolving east Asian river systems reconstructed by trace element and Pb and Nd isotope variations in modern and ancient Red River-Song Hong sediments

Author Posting. © American Geophysical Union, 2008. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Geochemistry Geophysics Geosystems 9 (2008): Q04039, doi:10.1029/2007GC001867.Rivers in east Asia have been recognized as having unusual geometries, suggestive of drainage reorganization linked to Tibetan Plateau surface uplift. In this study we applied a series of major and trace element proxies, together with bulk Nd and single K-feldspar grain Pb isotope ion probe isotope analyses, to understand the sediment budget of the modern Red River. We also investigate how this may have evolved during the Cenozoic. We show that while most of the modern sediment is generated by physical erosion in the upper reaches in Yunnan there is significant additional flux from the Song Lo, draining Cathaysia and the SW Yangtze Block. Nd isotope data suggest that 40% of the modern delta sediment comes from the Song Lo. Carbonates in the Song Lo basin make this a major control on the Red River Sr budget. Erosion is not a simple function of monsoon precipitation. Active rock uplift is also required to drive strong erosion. Single grain Pb data show a connection in the Eocene between the middle Yangtze and the Red River, and probably with rivers draining the Songpan Garze terrane. However, the isotope data do not support a former connection with the upper Yangtze, Mekong, or Salween rivers. Drainage capture appears to have occurred throughout the Cenozoic, consistent with surface uplift propagating gradually to the southeast. The middle Yangtze was lost from the Red River prior to 24 Ma, while the connection to the Songpan Garze was cut prior to 12 Ma. The Song Lo joined the Red River after 9 Ma. Bulk sample Pb analyses have limited provenance use compared to single grain data, and detailed provenance is only possible with a matrix of different proxies

Community guidelines to increase the reusability of marine microfossil assemblage data

Data on marine microfossil assemblage composition have multiple applications. Initially, they were primarily used for (chrono)stratigraphy and palaeoecology, but these data are now also widely used to study evolutionary and ecological processes, such as past biodiversity and its links with environmental dynamics, or to provide a basis for conservation efforts and biomonitoring. The large range of potential applications renders microfossil abundance data ideal for reuse. However, the complexity inherent in taxonomic data, which encompass extant and extinct species, coupled with the inherent intricacies of information on biological communities extracted from sedimentary archives, poses considerable hurdles in reusing marine microfossil data, even when they are publicly available. Here, we present guidelines derived from an online survey conducted within the marine micropalaeontological community, aimed at improving the reusability of microfossil assemblage data. These guidelines advocate for clarity and transparency in the documentation of the methods and the outcome, and we outline the data attributes required for effective reuse of micropalaeontological data. These guidelines are intended for researchers who generate microfossil abundance datasets and for reviewers, editors, and data curators at repositories.A total of 113 researchers evaluated the relevance of about 50 data attributes that might be needed to enable and maximise the reuse of marine microfossil abundance datasets. Each property is ranked based on the survey results. All information is, in principle, considered “desired”. Information that improves the reusability is ranked as “recommended”, and information that is required for reuse is ranked as “essential”. Analysis of a selection of datasets available online reveals a rather large gap between data properties deemed essential by survey participants and what is actually contained in publicly available microfossil assemblage datasets. While the survey indicates that the micropalaeontological community values good data stewardship, improving data reusability still requires new efforts to incorporate all the essential information. The guidelines presented here are intended as a step in that direction. Determining the optimal forms and formats for data sharing are obvious next steps the community needs to take

Community guidelines to increase the reusability of marine microfossil assemblage data

Data on marine microfossil assemblage composition have multiple applications. Initially, they were primarily used for (chrono)stratigraphy and palaeoecology, but these data are now also widely used to study evolutionary and ecological processes, such as past biodiversity and its links with environmental dynamics, or to provide a basis for conservation efforts and biomonitoring. The large range of potential applications renders microfossil abundance data ideal for reuse. However, the complexity inherent in taxonomic data, which encompass extant and extinct species, coupled with the inherent intricacies of information on biological communities extracted from sedimentary archives, poses considerable hurdles in reusing marine microfossil data, even when they are publicly available. Here, we present guidelines derived from an online survey conducted within the marine micropalaeontological community, aimed at improving the reusability of microfossil assemblage data. These guidelines advocate for clarity and transparency in the documentation of the methods and the outcome, and we outline the data attributes required for effective reuse of micropalaeontological data. These guidelines are intended for researchers who generate microfossil abundance datasets and for reviewers, editors, and data curators at repositories. A total of 113 researchers evaluated the relevance of about 50 data attributes that might be needed to enable and maximise the reuse of marine microfossil abundance datasets. Each property is ranked based on the survey results. All information is, in principle, considered “desired”. Information that improves the reusability is ranked as “recommended”, and information that is required for reuse is ranked as “essential”. Analysis of a selection of datasets available online reveals a rather large gap between data properties deemed essential by survey participants and what is actually contained in publicly available microfossil assemblage datasets. While the survey indicates that the micropalaeontological community values good data stewardship, improving data reusability still requires new efforts to incorporate all the essential information. The guidelines presented here are intended as a step in that direction. Determining the optimal forms and formats for data sharing are obvious next steps the community needs to take

Robyn Metcalfe on London’s 19th Century Meat Market

Histor

Effects of the Family Check-Up Intervention on Child Outcomes: A Systematic Review and Meta-Analysis

The Family Check-Up (FCU) is a brief, three-session parenting assessment and intervention designed to address child behavioral and emotional concerns by enhancing effective parenting behavior and parent motivation to change. In order to assess the impact on child outcomes, a systematic review and meta-analysis was conducted on randomized controlled trials of the FCU across all age groups to assess overall impacts on child behavior. Additionally, several variables, including both demographic factors (child age, percent of the study sample that is White, and percent of the study sample that is low-socioeconomic status) and implementation factors (sample screening, intervention dosage, the presence of implementation or fidelity concerns, percentage of the intervention group who received the intervention, study retention), were used examined as potential moderators of intervention effects on child outcomes. Fourteen studies (reporting findings in 98 reports) were included in the final analyses, a sample that represents 4598 families. Using intent-to-treat analyses, parents who were randomly assigned to the FCU had children with lower rates of alcohol use (ḡ = 0.15), lower rates of cannabis use (ḡ = 0.14), lower levels of short-term externalizing behavior (ḡ = 0.19; i.e., a one-year follow-up), lower levels of long-term externalizing behavior (ḡ = 0.15; i.e., a two-year follow-up), higher levels of self-regulation skills (ḡ = 0.16), lower levels of peer concerns, (ḡ = 0.13), better health outcomes (ḡ = 0.26), and lower body mass index (ḡ = 0.11) relative to comparison groups that were not assigned to receive the FCU. Very weak evidence was found for the impact of the intervention on internalizing behavior in the short term (ḡ = 0.22) and there was no evidence of an effect of the intervention on tobacco use, long-term internalizing behavior, or school outcomes. These results may under-represent the true intervention effects given the low percentage of families assigned to the FCU who received the intervention in some samples. Moderator analyses were conducted on internalizing and externalizing outcomes. Studies where a higher percentage of the intervention group actually received the FCU had stronger effects on internalizing outcomes. There was evidence of possible publication bias for the analysis examining long-term externalizing behavior (z = 2.23, p = 0.03, b = -.10, 95% CI [-.31, .11]), but a trim and fill analysis suggested that this potential bias was minimal and unlikely to affect the conclusion of beneficial intervention effects. Children of Asian/Pacific Islander, Indigenous American, and Latino/a/e/x descent were underrepresented in the sample, as were fathers and transgender and gender non-conforming parents. This analysis suggests beneficial impacts of the FCU across a range of domains, with additional research needed addressing long-term outcomes, diverse populations, and participant-level moderators of outcomes