A REFORM PROPOSAL FOR MATERNITY SERVICES IN AUSTRALIA

The purpose of this paper is to outline a policy framework for improving the standard of maternity services in Australia. This framework does not address many of the longer-term issues under consideration by the Rudd government’s current review of maternity services – the consistently poorer outcomes for rural and Indigenous women, limited access to health professionals and maternity services in rural and remote areas, the high proportion of births taking place in hospitals, high caesarean and intervention rates, and low breastfeeding rates (1). While the overall goal for maternity services in Australia is to ensure seamless and coordinated antenatal, birthing and postnatal care for women and babies, this paper focuses specifically on risk management and better integration of care during pregnancy and birth because these two critical issues are amenable to change in the short-term

From healthcare professional to degree apprentice

Background: In the UK, new degree apprenticeship opportunities are enabling non-medical practitioners to develop advanced roles. Frameworks to structure and standardise this development are also becoming more common. Knowing that historically healthcare professionals moving into advanced roles have experienced a transition period, we undertook a qualitative study to explore how this role transition – from healthcare professional to Advanced Clinical Practitioner (ACP) – was experienced in a degree apprentice programme. Methods: First year ACP degree apprentices were purposively selected from a cohort of 28 enrolled on a 3-year Masters programme at a UK University in 2021/22. Consenting participants took part in in-depth qualitative online semi-structured interviews, which were recorded, transcribed and analysed thematically. Findings: The five participants were in their first year of ACP training and represented core professional groups and primary, secondary and tertiary healthcare sectors. Five themes were identified: 1. what ACP apprentices bring; 2. reflections on how they see themselves; 3. how others see them; 4. effects of employing organisation's support; and 5. experience of Masters level learning. Conclusion: ACP apprentices experienced a strong and often difficult transition period at the beginning of their training. The themes identified as influencing this could be used by higher education providers and clinical workplaces to better understand this period in training. Specifically, having a clear transition point to a defined role; a reduced workload during the transition period; and improved information sharing to better prepare workplaces for trainees, could all improve the experience.</p

A scoping review of the unmet needs of patients diagnosed with idiopathic pulmonary fibrosis (IPF)

Aims: Patients diagnosed with idiopathic pulmonary fibrosis (IPF) have a high symptom burden and numerous needs that remain largely unaddressed despite advances in available treatment options. There is a need to comprehensively identify patients’ needs and create opportunities to address them. This scoping review aimed to synthesise the available evidence and identify gaps in the literature regarding the unmet needs of patients diagnosed with IPF. Methods: The protocol for the review was registered with Open Science Framework (DOI 10.17605/OSF.IO/SY4KM). A systematic search was performed in March 2022, in CINAHL, MEDLINE, Embase, PsychInfo, Web of Science Core Collection and ASSIA Applied Social Science Index. A comprehensive review of grey literature was also completed. Inclusion criteria included patients diagnosed with IPF and date range 2011–2022. A range of review types were included. Data was extracted using a data extraction form. Data was analysed using descriptive and thematic analysis. A total of 884 citations were reviewed. Ethical approval was not required. Results: 52 citations were selected for final inclusion. Five themes were identified: 1.) psychological impact of an IPF diagnosis. 2.) adequate information and education: at the right time and in the right way. 3.) high symptom burden support needs. 4.) referral to palliative care and advance care planning (ACP). 5.) health service provision-a systems approach. Conclusion: This review highlights the myriad of needs patients with IPF have and highlights the urgent need for a systems approach to care, underpinned by an appropriately resourced multi-disciplinary team. The range of needs experienced by patients with IPF are broad and varied and require a holistic approach to care including targeted research, coupled with the continuing development of patient-focused services and establishment of clinical care programmes

Physiotherapy assessment of breathing pattern disorder: a qualitative evaluation

OBJECTIVES: To explore physiotherapists' opinions of physiotherapy assessment of Breathing Pattern Disorder (BPD). METHODS: Qualitative study using focus groups (FGs) with reflexive thematic analysis and survey methods. The survey was distributed via social media and email to UK specialist physiotherapy interest groups. Two FGs, conducted in different settings, included physiotherapists based in hospital outpatients/community, private practice and higher education. RESULTS: One-hundred-and-three physiotherapists completed the survey. Respondents identified a lack of consensus in how to define BPD, but some agreement in the components to include in assessment. Fifteen physiotherapists participated in the FGs. Three themes emerged from FG discussions: (1) nomenclature and language of breathing, (2) BPD and breathlessness and (3) The value of assessment of breathlessness. CONCLUSION: The inconsistent nomenclature of dysfunctional breathing pattern impacts assessment, management and understanding of the diagnosis. Clarity in diagnosis, informing consistency in assessment, is fundamental to improving recognition and treatment of BPD. The findings are useful in the planning of education, training, future research and guideline development in BPD assessment

Telehealth for patients with interstitial lung diseases (ILD):Results of an international survey of clinicians

Introduction: Clinicians and policymakers are promoting widespread use of home technology including spirometry to detect disease progression for patients with interstitial lung disease (ILD); the COVID-19 pandemic has accelerated this. Data collating clinicians' views on the potential utility of telehealth in ILD are limited. Aim: This survey investigated clinicians' opinions about contemporary methods and practices used to monitor disease progression in patients with ILD using telehealth. Methods: Clinicians were invited to participate in a cross-sectional survey (SurveyMonkey) of 13 questions designed by an expert panel. Telehealth was defined as home monitoring of symptoms and physiological parameters with regular automatic transmission of data from the patient's home to the clinician. Data are presented as percentages of respondents. Results: A total of 207 clinicians from 23 countries participated in the survey. A minority (81, 39%) reported using telehealth. 50% (n=41) of these respondents completed a further question about the effectiveness of telehealth. A majority of respondents (32, 70%) rated it to be quite or more effective than face-to-face visit. There were a greater number of respondents using telehealth from Europe (94, 45%) than Asia (51, 25%) and America (24%). Clinicians reported the most useful telehealth monitoring technologies as smartphone apps (59%) and wearable sensors (30%). Telehealth was most frequently used for monitoring disease progression (70%), quality of life (63%), medication use (63%) and reducing the need for in-person visits (63%). Clinicians most often monitored symptoms (93%), oxygen saturation (74%) and physical activity (72%). The equipment perceived to be most effective were spirometers (43%) and pulse oximeters (33%). The primary barriers to clinicians' participation in telehealth were organisational structure (80%), technical challenges (63%) and lack of time and/or workload (63%). Clinicians considered patients' barriers to participation might include lack of awareness (76%), lack of knowledge using smartphones (60%) and lack of confidence in telehealth (56%). Conclusion:G</p

Thought leadership in marketing theory and method

As we write this editorial, we are sitting in our respective homes, during a period when we would usually attend annual academic conferences. These conferences provide the opportunity to share research, to have conversations with colleagues regarding what we are working on, hear about new areas of research, new approaches and new methods. Often, we return home tired, but refreshed and inspired. At the same time, such conferences can result in group think, we sometimes recycle old ideas and structures; as pressures of work increase, time and space to think about new approaches or areas of research may decrease. We can often work in isolation in our home institutions as the sheer breath of the field of marketing and consumer research means that departments house colleagues with widely divergent research interests and philosophical and methodological approaches. The tried and tested conference format of short presentations where we distil the highlights of our studies, followed by a few questions from the audience, is often insufficient for the thoughtful dialogue needed when wishing to move our research forward. If we are lucky, we end up in a session with similar papers, likeminded authors and an engaged audience and our discussion can spill out into the coffee or lunch break. But, all too often, such conversations are rushed and end abruptly in an attempt to get to the next session, grab some fresh air, drink bad coffee, or go off in search of better coffee, review the publisher stands or check in at home. For this reason, we proposed a new format for the annual Academy of Marketing Conference starting from 2018. With the introduction of conference workshops aimed at 'cutting edge theory, methods or pedagogy' we aimed to bring together a critical mass of colleagues already working on specific theoretical, methodological or pedagogical approaches or interested in finding out more about what we hoped would be rewarding engagement

Towards achieving interorganisational collaboration between health-care providers:a realist evidence synthesis

Background Interorganisational collaboration is currently being promoted to improve the performance of NHS providers. However, up to now, there has, to the best of our knowledge, been no systematic attempt to assess the effect of different approaches to collaboration or to understand the mechanisms through which interorganisational collaborations can work in particular contexts. Objectives Our objectives were to (1) explore the main strands of the literature about interorganisational collaboration and to identify the main theoretical and conceptual frameworks, (2) assess the empirical evidence with regard to how different interorganisational collaborations may (or may not) lead to improved performance and outcomes, (3) understand and learn from NHS evidence users and other stakeholders about how and where interorganisational collaborations can best be used to support turnaround processes, (4) develop a typology of interorganisational collaboration that considers different types and scales of collaboration appropriate to NHS provider contexts and (5) generate evidence-informed practical guidance for NHS providers, policy-makers and others with responsibility for implementing and assessing interorganisational collaboration arrangements. Design A realist synthesis was carried out to develop, test and refine theories about how interorganisational collaborations work, for whom and in what circumstances. Data sources Data sources were gathered from peer-reviewed and grey literature, realist interviews with 34 stakeholders and a focus group with patient and public representatives. Review methods Initial theories and ideas were gathered from scoping reviews that were gleaned and refined through a realist review of the literature. A range of stakeholder interviews and a focus group sought to further refine understandings of what works, for whom and in what circumstances with regard to high-performing interorganisational collaborations. Results A realist review and synthesis identified key mechanisms, such as trust, faith, confidence and risk tolerance, within the functioning of effective interorganisational collaborations. A stakeholder analysis refined this understanding and, in addition, developed a new programme theory of collaborative performance, with mechanisms related to cultural efficacy, organisational efficiency and technological effectiveness. A series of translatable tools, including a diagnostic survey and a collaboration maturity index, were also developed. Limitations The breadth of interorganisational collaboration arrangements included made it difficult to make specific recommendations for individual interorganisational collaboration types. The stakeholder analysis focused exclusively on England, UK, where the COVID-19 pandemic posed challenges for fieldwork. Conclusions Implementing successful interorganisational collaborations is a difficult, complex task that requires significant time, resource and energy to achieve the collaborative functioning that generates performance improvements. A delicate balance of building trust, instilling faith and maintaining confidence is required for high-performing interorganisational collaborations to flourish. Future work Future research should further refine our theory by incorporating other workforce and user perspectives. Research into digital platforms for interorganisational collaborations and outcome measurement are advocated, along with place-based and cross-sectoral partnerships, as well as regulatory models for overseeing interorganisational collaborations. Study registration The study is registered as PROSPERO CRD42019149009. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 6. See the NIHR Journals Library website for further project information

How, when, and why do inter-organisational collaborations in healthcare work? A realist evaluation

BackgroundInter-organisational collaborations (IOCs) in healthcare have been viewed as an effective approach to performance improvement. However, there remain gaps in our understanding of&nbsp;what&nbsp;helps IOCs function, as well as&nbsp;how&nbsp;and&nbsp;why&nbsp;contextual elements affect their implementation. A realist review of evidence drawing on 86 sources has sought to elicit and refine context-mechanism-outcome configurations (CMOCs) to understand and refine these phenomena, yet further understanding can be gained from interviewing those involved in developing IOCs.MethodsWe used a realist evaluation methodology, adopting prior realist synthesis findings as a theoretical framework that we sought to refine. We drew on 32 interviews taking place between January 2020 and May 2021 with 29 stakeholders comprising IOC case studies, service users, as well as regulatory perspectives in England. Using a retroductive analysis approach, we aimed to test CMOCs against these data to explore whether previously identified mechanisms, CMOCs, and causal links between them were affirmed, refuted, or revised, and refine our explanations of how and why interorganisational collaborations are successful.ResultsMost of our prior CMOCs and their underlying mechanisms were supported in the interview findings with a diverse range of evidence. Leadership behaviours, including showing vulnerability and persuasiveness, acted to shape the core mechanisms of collaborative functioning. These included our prior mechanisms of trust, faith, and confidence, which were largely ratified with minor refinements. Action statements were formulated, translating theoretical findings into practical guidance.ConclusionAs the fifth stage in a larger project, our refined theory provides a comprehensive understanding of the causal chain leading to effective collaborative inter-organisational relationships. These findings and recommendations can support implementation of IOCs in the UK and elsewhere. Future research should translate these findings into further practical guidance for implementers, researchers, and policymakers.</p