Accreditation of health services: is it money and time well spent?

The research evidence shows that accreditation is a useful tool for stimulating improvements in the quality and safety of health services. Accreditation programs are deployed widely to monitor and promote safety and quality in healthcare. Governments, health service organisations and accreditation agencies have invested considerable resources into accreditation programs, but to date evidence of their effectiveness is limited and varied in some areas. Without more robust evidence – on what aspects of accreditation programs work, in what contexts and why – policymakers will have to continue drawing on expert opinion, small-scale program evaluations and cautious comparative assessments of the literature when reviewing, revising or implementing  accreditation programs

Learning from incidents in health care : critique from a Safety-II perspective

Patients are continually being put at risk of harm, and health care organisations are struggling to learn effectively from past experiences in order to improve the safe delivery and management of care. Learning from incidents in health care is based on the traditional safety-engineering paradigm, where safety is defined by the absence of negative events (Safety-I). In this paper we make suggestions for the policy and practice of learning from incidents in health care by offering a critique based on a Safety-II perspective. In Safety-II thinking safety is defined as an ability - to make dynamic trade-offs and to adjust performance in order to meet changing demands and to deal with disturbances and surprises. The paper argues that health care organisations might improve their ability to learn from past experience by studying not only what goes wrong (i.e. incidents), but also by considering what goes right, i.e. by learning from everyday clinical work

Bridges, brokers and boundary spanners in collaborative networks: a systematic review

BackgroundBridges, brokers and boundary spanners facilitate transactions and the flow of information between people or groups who either have no physical or cognitive access to one another, or alternatively, who have no basis on which to trust each other. The health care sector is a context that is rich in isolated clusters, such as silos and professional “tribes,” in need of connectivity. It is a key challenge in health service management to understand, analyse and exploit the role of key agents who have the capacity to connect disparate groupings in larger systems. MethodsThe empirical, peer reviewed, network theory literature on brokerage roles was reviewed for the years 1994 to 2011 following PRISMA guidelines. ResultsThe 24 articles that made up the final literature set were from a wide range of settings and contexts not just healthcare. Methods of data collection, analysis, and the ways in which brokers were identified varied greatly. We found four main themes addressed in the literature: identifying brokers and brokerage opportunities, generation and integration of innovation, knowledge brokerage, and trust. The benefits as well as the costs of brokerage roles were examined. ConclusionsCollaborative networks by definition, seek to bring disparate groups together so that they can work effectively and synergistically together. Brokers can support the controlled transfer of specialised knowledge between groups, increase cooperation by liaising with people from both sides of the gap, and improve efficiency by introducing “good ideas” from one isolated setting into another. There are significant costs to brokerage. Densely linked networks are more efficient at diffusing information to all their members when compared to sparsely linked groups. This means that while a bridge across a structural hole allows information to reach actors that were previously isolated, it is not the most efficient way to transfer information. Brokers who become the holders of, or the gatekeepers to, specialised knowledge or resources can become overwhelmed by the role and so need support in order to function optimally

Network structure and the role of key players in a translational cancer research network: a study protocol

Introduction: Translational research networks are a deliberate strategy to bridge the gulf between biomedical research and clinical practice through interdisciplinary collaboration, supportive funding and infrastructure. The social network approach examines how the structure of the network and players who hold important positions within it constrain or enable function. This information can be used to guide network management and optimise its operations. The aim of this study was to describe the structure of a translational cancer research network (TCRN) in Australia over its first year, identify the key players within the network and explore these players'opportunities and constraints in maximising important network collaborations. Methods and analysis: This study deploys a mixed-method longitudinal design using social network analysis augmented by interviews and review of TCRN documents. The study will use network documents and interviews with governing body members to explore the broader context into which the network is embedded as well as the perceptions and expectations of members. Of particular interest are the attitudes and perceptions of clinicians compared with those of researchers. A co-authorship network will be constructed of TCRN members using journal and citation databases to assess the success of past pre-network collaborations. Two whole network social network surveys will be administered 12 months apart and parameters such as density, clustering, centrality and betweenness centrality computed and compared using UCINET and Netdraw. Key players will be identified and interviewed to understand the specific activities, barriers and enablers they face in that role. Ethics and dissemination: Ethics approvals were obtained from the University of New South Wales, South Eastern Sydney Northern Sector Local Health Network and Calvary Health Care Sydney. Results will be discussed with members of the TCRN, submitted to relevant journals and presented as oral presentations to clinicians, researchers and policymakers.8 page(s

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

To what degree and how do healthcare professionals in nursing homes and homecare practice user involvement? A mixed methods study

Background: Involving patients and users may contribute to sound quality and safety in healthcare services. We examined the degree to which and how user involvement is practiced in daily work and in quality improvement in nursing homes and homecare. Methods: Mixed methods design. Focus groups and individual interviews with managers (n=45), and employees (n= 40) from 15 Norwegian care settings were conducted. Data were analyzed via systematic text condensation. Survey data from four homecare services (N=139) and four nursing homes (N=165) were analyzed using descriptive statistics and t-tests. Results: Participants focused on supporting independence in users and involved them in activities that increased coping. Knowing users was an important prerequisite. Challenges related to poor communication leading to several cross-pressures between users, relatives and healthcare professionals. There were no differences between nursing homes and homecare on the degree of user involvement in daily work and in quality improvement; both scored significantly lower on the latter. Conclusion: User involvement is an important part of the daily work of healthcare professionals in care settings. Participants seemed to lack knowledge on how to use patients’ experience to inform quality improvement. A key remedial strategy is training healthcare professionals in involving users in quality improvement.publishedVersio

Who are the key players in a new translational research network?

BackgroundProfessional networks are used increasingly in health care to bring together members from different sites and professions to work collaboratively. Key players within these networks are known to affect network function through their central or brokerage position and are therefore of interest to those who seek to optimise network efficiency. However, their identity may not be apparent. This study using social network analysis to ask: (1) Who are the key players of a new translational research network (TRN)? (2) Do they have characteristics in common? (3) Are they recognisable as powerful, influential or well connected individuals? MethodsTRN members were asked to complete an on-line, whole network survey which collected demographic information expected to be associated with key player roles, and social network questions about collaboration in current TRN projects. Three questions asked who they perceived as powerful, influential and well connected. Indegree and betweenness centrality values were used to determine key player status in the actual and perceived networks and tested for association with demographic and descriptive variables using chi square analyses. ResultsResponse rate for the online survey was 76.4% (52/68). The TRN director and manager were identified as key players along with six other members. Only two of nine variables were associated with actual key player status; none with perceived. The main finding was the mismatch between actual and perceived brokers. Members correctly identified two of the three central actors (the two mandated key roles director and manager) but there were only three correctly identified actual brokers among the 19 perceived brokers. Possible reasons for the mismatch include overlapping structures and weak knowledge of members. ConclusionsThe importance of correctly identifying these key players is discussed in terms of network interventions to improve efficiency

Patterns of collaboration in complex networks: The example of a translational research network

BackgroundThis paper examines collaboration in a complex translational cancer research network (TRN) made up of a range of hospital-based clinicians and university-based researchers. We examine the phenomenon of close-knit and often introspective clusters of people (silos) and test the extent that factors associated with this clustering (geography, profession and past experience) influence patterns of current and future collaboration on TRN projects. Understanding more of these patterns, especially the gaps or barriers between members, will help network leaders to manage subgroups and promote connectivity crucial to efficient network function.MethodsAn on-line, whole network survey was used to collect attribute and relationship data from all members of the new TRN based in New South Wales, Australia in early 2012. The 68 members were drawn from six separate hospital and university campuses. Social network analysis with UCInet tested the effects of geographic proximity, profession, past research experience, strength of ties and previous collaborations on past, present and future intended partnering.ResultsGeographic proximity and past working relationships both had significant effects on the choice of current collaboration partners. Future intended collaborations included a significant number of weak ties and ties based on other members’ reputations implying that the TRN has provided new opportunities for partnership. Professional grouping, a significant barrier discussed in the translational research literature, influenced past collaborations but not current or future collaborations, possibly through the mediation of network brokers.ConclusionsSince geographic proximity is important in the choice of collaborators a dispersed network such as this could consider enhancing cross site interactions by improving virtual communication technology and use, increasing social interactions apart from project related work, and maximising opportunities to meet members from other sites. Key network players have an important brokerage role facilitating linkages between groups