Contextual factors of external inspections and mechanisms for improvement in healthcare organizations: a realist evaluation

External inspections constitute a key element of healthcare regulation. Improved quality of care is one of the important goals of inspections but the mechanisms of how inspections might contribute to quality improvement are poorly understood. Drawing on interviews with healthcare professionals and managers and health record data from inspected organizations, we used a realist evaluation approach to explore how twelve inspections of healthcare providers in x= Norway influenced quality improvement. We found that for inspections to contribute to quality improvement, there must be contextual structures present supporting accountability and engaging staff in improvement work. When such structures are present, inspections can contribute to improvement by creating awareness of gaps between desired and current practices, which leads to readiness for change and stimulates intra-organizational reasoning around quality improvement. We discuss our findings using the theory of de- and recoupling, noting how regulators can identify decoupling between intended goals, management systems, practices, and patient outcomes. We further argue that regulators can contribute to a recoupling between these levels by having the capacity to track the providers' clinical performance over time. This will hold the organization accountable for implementing improvement measures and evaluate the effects of the measures on quality of care.publishedVersio

Possible paths to increase detection of child sexual abuse in child and adolescent psychiatry: a meta-synthesis of survivors’ and health professionals’ experiences of addressing child sexual abuse

Background: Efforts are directed both towards prevention and early detection of Child sexual abuse (CSA). Yet, only about 50% of CSA survivors disclose before adulthood, and health professionals rarely are the first disclosure recipients. Increasing the detection rate of CSA within the context of Child and Adolescent Psychiatry (CAP) therefore represents a significant secondary prevention strategy. However, facilitating CSA disclosure when the survivor is reluctant to tell is a highly complex and emotionally demanding clinical task. We therefore argue that efforts to increase detection rates of CSA within CAP need to rest on knowledge of how both survivors and health professionals experience addressing CSA. Method: Using meta-ethnography as method, we present separate sub-syntheses as well an overarching joint synthesis of how survivors and health professionals experience addressing CSA. Results: Results show how both survivors and health professionals facing CSA disclosure feel deeply isolated, they experience the consequences of addressing CSA as highly unpredictable, and they need support from others to counteract the negative impact of CSA. Conclusion: The results indicate that adapting the organization of CAP to knowledge of how the survivors and health professionals experience addressing CSA is critical to facilitate earlier disclosure of CSA within CAP.publishedVersio

Modal analysis of piezoelectrically actuated plates with built-in stress by computationally augmented interferometric experiments

The conventional laser doppler vibrometers for modal analysis of micro-structures are expensive and sometimes inaccessible. In this work, a compact, fiber-based interferometric setup is used to carry out the modal analysis of initially deflected piezo-actuated micro-plates with different designs. The finite element method provides actual mode shapes visualization in the frequency range up to 100 kHz using the spectral results of vibration measurements performed at a few selected spots of the plate. This method is capable of finding the resonance frequencies and distinguishing the mode shapes. It has also allowed us to investigate the impact of bias voltage on the actual values of the resonance frequencies.publishedVersio

Simulation of an Electrostatic Energy Harvester at Large Amplitude Narrow and Wide Band Vibrations

An electrostatic in-plane overlap varying energy harvester is modeled and simulated using a circuit simulator. Both linear and nonlinear models are investigated. The nonlinear model includes mechanical stoppers at the displacement extremes. Large amplitude excitation signals, both narrow and wide band, are used to emulate environmental vibrations. Nonlinear behavior is significant at large displacement due to the impact on mechanical stoppers. For a sinusoidal excitation the mechanical stoppers cause the output power to flatten and weakly decrease. For a wide band excitation, the output power first increases linearly with the power spectral density of the input signal, then grows slower than linearly