Factors that influence the sustainability of structured allied health journal clubs: a qualitative study

Background: Structured journal clubs are a widely used tool to promote evidence-based practice in health professionals, however some journal clubs (JC) are more effectively sustained than others. To date, little research has provided insights into factors which may influence sustainability of JCs within health care settings. As part of a larger randomised controlled study, this research aimed to gain understanding of clinicians' experiences of sustaining a structured JC format (TREAT- Tailoring Research Evidence and Theory) within their clinical context. The study also aimed to identify which strategies may assist longer term sustainability and future implementation of the TREAT format. Methods: We employed a qualitative methodology, informed by behaviour change theory. Clinicians (n=19) from five different JCs participated in focus groups to explore their experience in sustaining the JC format six months after the formal trial period had completed. Clinicians were asked to describe factors which they perceived helped or hindered sustaining components of the JC format within their local context. Following a descriptive summary of the data, barriers and enablers were thematically analysed according to behaviour change theory domains: capability, motivation and opportunity and further mapped to targeted implementation strategies. Results: Participants reported perceived benefits of maintaining the TREAT format and described several components that promoted its sustainability. Sustaining factors linked to individuals' capability included building research knowledge and skills and having access to research experts. Sustaining factors that enhanced opportunities for behaviour change included management expectation to attend and a team culture which values evidence based practice, while factors found to enhance individuals' motivation included the JC having close application to practice and clinicians sensing ownership of the JC. Several implementation strategies to enhance these factors are described including graduated support to clinicians in facilitation of JCs and greater engagement with managers. Conclusions: Long-term sustainability of a structured JC is dependent on both individual and service level factors and a balance of implementation strategies that enhance capability, opportunity and motivation. Consideration of how clinicians can be engaged to take ownership and build their own capability from the commencement of the JC is important. Trial registration: ACTRN12616000811404

Developing occupational therapists' capabilities for decision-making capacity assessments: how does a support role facilitate workplace learning?

Introduction: Healthcare practitioners are required to develop capabilities in an effective and efficient manner. Yet, developing capabilities in healthcare settings can be challenging due to the unpredictable nature of practice and increasing workloads. Unsurprisingly, healthcare practitioner development is often situated outside of practice, for example in formal teaching sessions. Supporting practitioners to develop capabilities through engagement with day-to-day practice, whilst advantageous in terms of authenticity and being highly valued, remains a\ua0key challenge for healthcare educators. This qualitative interview study aimed to explain, from the learner’s perspective, how a\ua0dedicated support role develops occupational therapists’ capability to contribute to decision-making capacity assessments. Methods: Individual semi-structured interviews were conducted with a\ua0purposive sample of 12\ua0occupational therapists. Informed by workplace learning theory, interview transcripts were analyzed using thematic analysis process. Results: Participants provided rich descriptions of how they developed in their capability to engage in decision-making capacity assessments. Participants reported that their learning was facilitated by the dedicated support role in three key ways: 1)\ua0structuring a\ua0journey of learning, 2)\ua0providing tailored guidance, and 3)\ua0fostering a\ua0supportive learning environment. Discussion: Participants valued the authentic workplace learning opportunities afforded by the dedicated support role. Findings suggest that capabilities, such as decision-making capacity assessment, can be developed through practice when enriched by a\ua0dedicated support role. However, further research examining the sustainability and transferability of this model and its application to other capabilities are warranted

Patterns of ‘leakage’ in the utilisation of clinical guidelines: a systematic review

Background Research evidence is insufficient to change physicians' behaviour. In 1996, Pathman developed a four step model: that physicians need to be aware of, agree with, adopt, and adhere to guidelines. Objective To review evidence in different settings on the patterns of 'leakage' in the utilisation of clinical guidelines using Pathman's awareness-to-adherence model. Methods A systematic review was conducted in June 2010. Primary studies were included if they reported on rates of awareness and agreement and adoption and/or adherence. Results 11 primary studies were identified, reporting on 29 recommendations. Descriptive analyses of patterns and causes of leakage were tabulated and graphed. Leakage was progressive across all four steps. Median adherence from all recommendations was 34%, suggesting that potential benefits for patients from health research may be lost. There was considerable variation across different types of guidelines. Recommendations for drug interventions, vaccination and health promotion activities showed high rates of awareness. Leakage was most pronounced between adoption and adherence for drug recommendations and between awareness and agreement for medical management recommendations. Barriers were reported differentially for all steps of the model. Conclusion Leakage from research publication to guideline utilisation occurs in a wide variety of clinical settings and at all steps of the awareness-to-adherence pathway. This review confirms that clinical guidelines are insufficient to implement research and suggests there may be different factors influencing clinicians at each step of this pathway. Recommendations to improve guideline adherence need to be tailored to each step

Understanding how and why quality circles improve standards of practice, enhance professional development and increase psychological well-being of general practitioners: a realist synthesis.

OBJECTIVES To understand how and why participation in quality circles (QCs) improves general practitioners' (GPs) psychological well-being and the quality of their clinical practice. To provide evidence-informed and practical guidance to maintain QCs at local and policy levels. DESIGN A theory-driven mixed method. SETTING Primary healthcare. METHOD We collected data in four stages to develop and refine the programme theory of QCs: (1) coinquiry with Swiss and European expert stakeholders to develop a preliminary programme theory; (2) realist review with systematic searches in MEDLINE, Embase, PsycINFO and CINHAL (1980-2020) to inform the preliminary programme theory; (3) programme refinement through interviews with participants, facilitators, tutors and managers of QCs and (4) consolidation of theory through interviews with QC experts across Europe and examining existing theories. SOURCES OF DATA The coinquiry comprised 4 interviews and 3 focus groups with 50 European experts. From the literature search, we included 108 papers to develop the literature-based programme theory. In stage 3, we used data from 40 participants gathered in 6 interviews and 2 focus groups to refine the programme theory. In stage 4, five interviewees from different healthcare systems consolidated our programme theory. RESULT Requirements for successful QCs are governmental trust in GPs' abilities to deliver quality improvement, training, access to educational material and performance data, protected time and financial resources. Group dynamics strongly influence success; facilitators should ensure participants exchange knowledge and generate new concepts in a safe environment. Peer interaction promotes professional development and psychological well-being. With repetition, participants gain confidence to put their new concepts into practice. CONCLUSION With expert facilitation, clinical review and practice opportunities, QCs can improve the quality of standard practice, enhance professional development and increase psychological well-being in the context of adequate professional and administrative support. PROSPERO REGISTRATION NUMBER CRD42013004826

Effects and mechanisms of an allied health research position in a Queensland regional and rural health service: a descriptive case study

The aim of the present case study is to illustrate the outcomes of a dedicated allied health (AH) research position within a large Queensland regional and rural health service. The secondary aim of the case study is to describe the enabling and hindering mechanisms to the success of the role. Semistructured interviews were conducted with the Executive Director of Allied Health and the current AH research fellow incumbent within the health service. A focus group was also undertaken with six stakeholders (e.g. clinicians, team leaders) who had engaged with the research position. Outcomes of the AH research fellow included clinical and service improvements, enhanced research culture and staff up-skilling, development of research infrastructure and the formation of strategic research collaborations. Despite being a sole position in a geographically expansive health service with constrained resources, key enabling mechanisms to the success of the role were identified, including strong advocacy and regular communication with the Executive. In conclusion, the case study highlights the potential value of an AH research position in building research capacity within a large non-metropolitan health service. Factors to facilitate ongoing success could include additional research and administrative funding, as well as increased use of technology and team-based research. What is known about the topic?: Dedicated research positions embedded within health care settings are a well cited strategy to increase research capacity building of allied health professionals (AHPs). However the majority of these positions are within metropolitan health settings and unique challenges exist for these roles in regional and rural areas. Few studies have described the impact of dedicated AH research positions within regional health centres or the factors which facilitate or hinder their role. What does this paper add?: Dedicated research positions within a non-metropolitan Australian health service may have a positive impact on AH clinical services, research culture, staff upskilling, research infrastructure and research collaborations. Key enabling mechanisms to support the role may include advocacy from higher level management, strong networks and communication channels. Additional research and administrative funding, the use of technology and team based research may enhance sustainability of such roles. What are the implications for practitioners?: AH research positions have potential value in building research capacity within a large non-metropolitan health service. Health managers and researchers should be aware of the unique challenges to these roles and consider mechanisms that may best enhance and sustain outcomes of the positions including: the development of infrastructure (i.e. technology, website of resources), networks, and communication strategies (i.e. regular meetings with leadership and promotion internally)

A Practical Toolkit of Strategies for Building Research Capacity in Allied Health

Objectives: The objectives of this project were firstly to develop a practical toolkit of evidence-informed strategies for building research capacity in allied health, and secondly to disseminate and apply this toolkit to inform tailored research capacity building plans for allied health teams.  Design: This project used a plan, do, study, act (PDSA) service quality improvement methodology to develop, disseminate and apply a toolkit which was based on the results of a recent systematic review of allied health research capacity building frameworks and a narrative review of other interventions and theoretical recommendations.  Setting: Eight allied health professional teams in a publicly funded tertiary health service were supported to develop tailored research capacity building plans based on their specific needs, goals and context.  Main outcome measures: The outcomes of this project were evaluated using process measures including whether a research capacity building plan was developed and to what extent short-term goals were achieved within three months.  Results: A practical toolkit was developed which consolidates existing evidence-informed strategies and organises these around three components including ‘supporting clinicians in research’, ‘working together’ and ‘valuing research for excellence’ and 17 sub-components. Several barriers and facilitators to applying the toolkit to teams were identified and this paper suggests some recommendations and future directions for addressing these. Conclusions: This toolkit may be a useful resource to inform the development of team-based research capacity building plans for allied health. The application of the toolkit may be enhanced by a needs assessment and facilitation from a researcher.&nbsp

Outcomes of a funding initiative to promote allied health research activity: a qualitative realist evaluation

Providing funding for clinicians to have protected time to undertake research can address a commonly cited barrier to research - lack of time. However, limited research has evaluated the impact or mechanisms of such funding initiatives. In the current economic environment, it is important that funding is used efficiently and judiciously and that mechanisms and contexts that may assist with maximising outcomes of funding initiatives are identified. This study aimed to describe the medium-term outcomes of a funding initiative to promote allied health research activity and to identify the key mechanisms and contexts that facilitated these outcomes.We used a qualitative research design informed by a realist evaluation, to conduct 10 semi-structured interviews with allied health professionals who had participated in a funding initiative 1-3 years ago. Questions explored outcomes, mechanisms and contexts of the funding initiative. Data was thematically coded into context-mechanism-outcome configurations.Medium term outcomes included increased individual research opportunities, influence on team research culture and impact on clinical work/practice. Other outcomes included increased clinician confidence, knowledge and skill, and research outputs. However, some participants still had difficulties progressing research. Four context-mechanism-outcome configurations were identified to explain which contexts and mechanisms produced these outcomes. Examples of contexts included perception of managerial support, undertaking a research-based higher degree and joint applications, while mechanisms included accessing infrastructure and resources as well as individual researcher factors like motivation.Providing funding to allied health professionals to undertake and complete research can lead to important outcomes, including increased research opportunities, capacity and culture, increased research outputs, and changes to clinical practice. Outcomes are influenced by unique contexts and mechanisms and these should be considered in future implementation of similar funding initiatives