What Does a Systems Approach to Quality Improvement Look Like in Practice?

Universally improving healthcare systems is difficult to achieve in practice with organisations implementing a range of quality improvement (QI) approaches, in varying and changing contexts, and efforts ranging from project-based improvements to whole system change. This study aimed to identify how organisations overcome the challenges to improving the quality of the services they deliver. Drawing on the eight challenges from the ‘Quality and Safety in Europe by Research (QUASER) hospital guide, we assessed eight cases reported by the UK-based regulator Care Quality Commission as improving their performance. A thematic analysis of these secondary data established that all eight challenges had been addressed or considered in varying degrees. Education and physical and technological challenges seemed less prominent than developments made to address other challenges such as developing leadership, structure, and culture to support improving quality. This paper relies on the analysis of secondary case data and one framework to assess improvement efforts. Further research is required to consider other models and frameworks and to collate longitudinal data to capture the dynamics and increasing the maturity of improving healthcare systems in practice

Community recovery as a public health intervention: The contagion of hope

There is a growing evidence base for recovery as a journey that involves reduced relapse risk, improved citizenship, and better global health and well-being. Although this is the case, there is a risk of omitting one of the prime benefits of a diverse range of recovery activities—the impact on families and the wider community. What the current article does is to summarize evidence around the “social contagion” of recovery through communities and its potential role in transmitting hope and the belief that recovery is possible even to those who are not yet ready to commit to abstinence. And further, that in doing so, visible recovery increases community cohesion and challenges stigmatisation and exclusion of recovery populations. The implications for public health from an emerging visible and high-profile social identity of recovery is discussed

How important is ‘implementation science’ for national genomics policy?

The traditional translation pathway of ‘bench- to-bedside’ will not be enough to integrate genomics into routine clinical care. It requires the use of validated and systematic ‘implementation science’ methods. Within the pipeline of evidence-based translation of new technologies, implementation science is the phase that informs policy regarding the appropriateness, adoption, feasibility, acceptability, fidelity, penetration, and sustainability of technologies being transferred from research settings into the real world. Without implementation science, barriers can emerge unchecked and key drivers neglected. Health services researchers now have a large knowledge base which identifies barriers and drivers for implementation of new technologies into healthcare

Prudence or speed: Health and social care innovation in rural Wales

As social enterprise and third sector organisations have become more central to traditional public sector provision in Wales, there has been increased use in rural areas of multi-agency teams to deliver services. This paper draws on a study of twenty projects delivered under the auspices of NHS Wales and the first implementation phase of the Rural Health Plan (2010-11); key themes of which include access, integration and, community cohesion and engagement. The need for speed of induced innovation emphasises reactivity in some instances and transfer of practices from more developed (or urban) environments to rural communities without acknowledgement of cultural, social and economic contexts and conditions. Inclusion of social enterprise practitioners, particularly those with community development and capacity building expertise in co-production of services may allow for the development of integrated and innovative working across health and social care, which may also be more aligned with a Welsh focus on prudent healthcare. In this respect, the paper considers the role of social enterprise in identifying and fostering innovation in low income, rural areas in ways that provide close-to-patient/service user services and address local issues and health determinants to provide more sustainable and resilient community based health and social care provision

Demographic and Socioeconomic Factors Associated With HPV Vaccination in Georgia’s South Central Health District

Background: Human Papillomavirus (HPV) subtypes are the primary cause of cervical cancer. Despite introduction of the HPV vaccine in 2006, vaccination percentages remain low across Georgia counties. The primary objective of this research was to conduct a descriptive epidemiological study of HPV vaccination coverage among individuals in the South Central Health District (SCHD) to provide guidance for targeted vaccination campaigns aimed at adolescents residing in rural communities. Methods: Data from the Georgia Registry of Immunization Transactions and Services and AEGIS.net, Inc. were used to analyze demographic and socioeconomic factors associated with HPV vaccine uptake among individuals visiting county health departments in the SCHD from 2007-2014. Descriptive statistics were used to evaluate the relationship between sex, age at first vaccination, county of vaccine administration, race, and insurance status to vaccine series completion. Results: In the SCHD, Johnson County had the highest completion percentage (50%); Montgomery County had the lowest (20%). However, Montgomery County had the fastest time to completion (334 days). Throughout the district, males were fully vaccinated at much lower percentages than females (p \u3c 0.001). Race was a significant variable (p=0.011) for vaccine completion. Compared to other racial groups, more White individuals completed the HPV vaccine. Absolute counts of HPV vaccine doses peaked in the study population during 2010 (n=507). Conclusions: Due to overall low rates, community-based intervention methods should be considered to increase HPV vaccine uptake across the SCHD. School-based programs may be useful in targeting at-risk populations and increasing rates of HPV vaccine initiation and completion. Expanded efforts are needed to determine the best structure for effective school-based programs

Cues disseminated by professional associations that represent 5 health care professions across 5 nations : lexical analysis of tweets

Background: Collaboration across health care professions is critical in efficiently and effectively managing complex and chronic health conditions, yet interprofessional care does not happen automatically. Professional associations have a key role in setting a profession’s agenda, maintaining professional identity, and establishing priorities. The associations’ external communication is commonly undertaken through social media platforms, such as Twitter. Despite the valuable insights potentially available into professional associations through such communication, to date, their messaging has not been examined. Objective: This study aimed to identify the cues disseminated by professional associations that represent 5 health care professions spanning 5 nations. Methods: Using a back-iterative application programming interface methodology, public tweets were sourced from professional associations that represent 5 health care professions that have key roles in community-based health care: general practice, nursing, pharmacy, physiotherapy, and social work. Furthermore, the professional associations spanned Australia, Canada, New Zealand, the United Kingdom, and the United States. A lexical analysis was conducted of the tweets using Leximancer (Leximancer Pty Ltd) to clarify relationships within the discourse. Results: After completing a lexical analysis of 50,638 tweets, 7 key findings were identified. First, the discourse was largely devoid of references to interprofessional care. Second, there was no explicit discourse pertaining to physiotherapists. Third, although all the professions represented in this study support patients, discourse pertaining to general practitioners was most likely to be connected with that pertaining to patients. Fourth, tweets pertaining to pharmacists were most likely to be connected with discourse pertaining to latest and research. Fifth, tweets about social workers were unlikely to be connected with discourse pertaining to health or care. Sixth, notwithstanding a few exceptions, the findings across the different nations were generally similar, suggesting their generality. Seventh and last, tweets pertaining to physiotherapists were most likely to refer to discourse pertaining to profession. Conclusions: The findings indicate that health care professional associations do not use Twitter to disseminate cues that reinforce the importance of interprofessional care. Instead, they largely use this platform to emphasize what they individually deem to be important and advance the interests of their respective professions. Therefore, there is considerable opportunity for professional associations to assert how the profession they represent complements other health care professions and how the professionals they represent can enact interprofessional care for the benefit of patients and carers

An altered secretome is an early marker of the pathogenesis of CLN6 Batten disease

Neuronal ceroid lipofuscinoses (NCLs) are a group of inherited childhood neurodegenerative disorders. In addition to the accumulation of auto-fluorescent storage material in lysosomes, NCLs are largely characterised by region-specific neuroinflammation that can predict neuron loss. These phenotypes suggest alterations in the extracellular environment—making the secretome an area of significant interest. This study investigated the secretome in the CLN6 (ceroid-lipofuscinosis neuronal protein 6) variant of NCL. To investigate the CLN6 secretome, we co-cultured neurons and glia isolated from Cln6nclf or Cln6± mice, and utilised mass spectrometry to compare protein constituents of conditioned media. The significant changes noted in cathepsin enzymes, were investigated further via western blotting and enzyme activity assays. Viral-mediated gene therapy was used to try and rescue the wild-type phenotype and restore the secretome—both in vitro in co-cultures and in vivo in mouse plasma. In Cln6nclf cells, proteomics revealed a marked increase in catabolic and cytoskeletal-associated proteins—revealing new similarities between the pathogenic signatures of NCLs with other neurodegenerative disorders. These changes were, in part, corrected by gene therapy intervention, suggesting these proteins as candidate in vitro biomarkers. Importantly, these in vitro changes show promise for in vivo translation, with Cathepsin L (CTSL) activity reduced in both co-cultures and Cln6nclf plasma samples post gene-therapy. This work suggests the secretome plays a role in CLN6 pathogenesis and highlights its potential use as an in vitro model. Proteomic changes present a list of candidate biomarkers for monitoring disease and assessing potential therapeutics in future studies