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

Development and testing of the capacity of organisations for system practices scale

Background: Systems change approaches are increasingly adopted in public health to address complex problems. It is important that measures of systems change be developed so that the effects of systems change on health outcomes can be evaluated. Organisational practices are potential levers for systems change. However, robust measures of organisational capacity to engage in these practices are lacking. Informed by the Theory of Systems Change, we developed and tested the Capacity of Organisations for System Practices (COSP) scale. The COSP scale comprises four inter-related system practices within organisations—adaptation, alignment, collaboration and evidence-driven action and learning. Methods: We applied a three-stage process: (1) Item generation; (2) Scale pre-testing; and (3) Structural analyses. Item response theory tests and semantic review, together with factor analytic techniques, were applied to refine the item set and determine the scale structure. Results: An initial pool of 97 items was generated and pre-tested with six content experts and four target audience representatives. Modifications resulted in 60 items. In total, 126 participants provided data for the structural analysis. A second-order hierarchical four-factor model fit the data better than the more basic correlated factor model (Δχ2 = 1.758, p =.415). The fit indices for the final 31-item model were acceptable (RMSEA =.084, TLI =.819). Conclusions: The COSP scale is ready for further testing to ensure construct validity, stability and utility. So What?: Once validated, the Capacity of Organisations for System Practices (COSP) scale has the potential to advance the theory and practice of systems change approaches

Scoping review of practice-focused resources to support the implementation of place-based approaches

Issue Addressed There is increasing interest across public health research, policy, and practice in place‐based approaches to improve health outcomes. Practice‐focused resources, such as grey literature, courses and websites, are utilised by practitioners to support the implementation of place‐based approaches. Methods A detailed search of two search engines: Google and DuckDuckGo to identify free practice‐focused resources was conducted. Results Forty‐one resources met inclusion criteria, including 26 publications, 13 web‐based resources and two courses. They were mainly focused on collaboration, developed by not‐for‐profit organisations, focused on a broad target audience, and supported people living with disadvantage. The publications we reviewed generally: clearly stated important information, such as the author of the publication; used their own evaluations, professional experience and other grey literature as supporting evidence; included specific, practical implementation strategies; and were easy to read. Conclusions Based on findings, we recommend that: (1) the development of resources to support evidence‐informed practice and governance be prioritised; (2) resources clearly state their target audience and tailor communication to this audience; (3) resources draw on evidence from a range of sources; (4) resources continue to include practical implementation strategies supported by examples and (5) resource content be adaptable to different contexts (e.g., different settings and/or target populations). So What? This is the first review of practice‐focused resources to support the implementation of place‐based approaches and the findings can be used to reduce duplication of efforts and inform future research, policy, and practice, particularly the refinement of existing resources and the development of future resources

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

Perceived clinical readiness of senior medical students asoutcomes of online clerkship in the Philippines: newnormal in medical education

NTRODUCTION: COVID-19 formed new challenges to the medical institutions; itresulted in the transition from the usual face-to-face classes and direct clerkship training withinthe hospital to a new remote learning with online lectures and virtual clinical experience. Giventhe new online interactive setting, problems were raised given the limited patient care andinteraction as well as restricted bedside teaching opportunities and its impact on how medicalstudents can acquire and hone their clinical skills. OBJECTIVE: To determine the perceived clinicalreadiness of the medical clerks in the new normal setting in the Philippines. METHODOLOGY:Convenience sampling was used to gather respondents who were asked to answer an onlinesurvey questionnaire. The questions pertained to: academic training profile, clinical skills, patientmanagement, communication, understanding clinical guidelines, and personal development. Afteranalyzing the data, the scales of readiness from these subjects were gathered. RESULTS: Themedical clerks in the Philippines perceived that they were ready with regards to understandingclinical guidelines, communication, personal development, and patient management. They weremoderately ready in the different clinical skills in the departments of Family and CommunityMedicine, Internal Medicine, Pediatrics, Surgery and Obstetrics and Gynecology with somespecific skills in Surgery and Obstetrics and Gynecology being perceived as less ready than therest. CONCLUSION: The impact of the pandemic has disrupted the student’s confidence andreadiness. This shows that online clerkship in this time of pandemic may have provided learningto a certain degree but it is not enough to replace what face-to-face training could offer

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

Addressing complexity in chronic disease prevention research

There is wide agreement on the need for systems thinking to address complexity in chronic disease prevention but there is insufficient understanding of how such approaches are operationalised in prevention research. Ison and Straw propose that to address complexity, the right balance must be struck between ‘systemic’ and ‘systematic’ paradigms. We examined the nature and characteristics of this relationship in a series of six qualitative case studies of prevention research. Data comprised 29 semi-structured interviews with 16 participants, and online documents. The analysis combined inductive methods from grounded theory with a theoretically-informed framework analysis. Sys-temic and systematic ways of working varied across each case as a whole, and within the dimensions of each case. Further, the interplay of systemic and systematic approaches was described along a dynamic continuum of variable proportions; with greater emphasis on systemic aspects balanced by lesser focus on the systematic, and vice versa. By expanding the boundaries for exploring prevention research, we gained empirical understanding of the potential and scope of systemic and systematic paradigms for addressing complexity in prevention research. There is inherent value in being more explicitly conscious and bilingual in both systemic and systematic paradigms, so that their respective value and strengths may be utilised. Our findings propose a coherent theoretical frame to better understand existing approaches for addressing complexity in prevention research