Facilitating Participatory Processes that Amplify Youth Voice and Action in Clinical Care Delivery and Research

Purpose – The purpose of this paper is to explore employee perceptions of communication in psychologically safe and unsafe clinical care environments. Design/methodology/approach – Clinical providers at the USA Veterans Health Administration were interviewed as part of planning organizational interventions. They discussed strengths, weaknesses, and desired changes in their workplaces. A subset of respondents also discussed workplace psychological safety (i.e. employee perceptions of being able to speak up or report errors without retaliation or ostracism – Edmondson, 1999). Two trained coders analysed the interview data using a grounded theory-based method. They excerpted passages that discussed job-related communication and summarized specific themes. Subsequent analyses compared frequencies of themes across workgroups defined as having psychologically safe vs unsafe climate based upon an independently administered employee survey. Findings – Perceptions of work-related communication differed across clinical provider groups with high vs low psychological safety. The differences in frequencies of communication-related themes across the compared groups matched the expected pattern of problem-laden communication characterizing psychologically unsafe workplaces. Originality/value – Previous research implied the existence of a connection between communication and psychological safety whereas this study offers substantive evidence of it. The paper summarized the differences in perceptions of communication in high vs low psychological safety environments drawing from qualitative data that reflected clinical providers’ direct experience on the job. The paper also illustrated the conclusions with multiple specific examples. The findings are informative to health care providers seeking to improve communication within care delivery teams.

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Managing the Digital Disruption Associated with COVID-19-Driven Rapid Digital Transformation in Brisbane, Australia

Applied Clinical Informatics ◽

10.1055/s-0041-1740190 ◽

2021 ◽

Vol 12 (05) ◽

pp. 1135-1143

Author(s):

Amalie Dyda ◽

Magid Fahim ◽

Jon Fraser ◽

Marianne Kirrane ◽

Ides Wong ◽

...

Keyword(s):

Care Delivery ◽

Digital Health ◽

Clinical Care ◽

Models Of Care ◽

Digital Transformation ◽

Lessons Learned ◽

Digital Data ◽

Routine Practice ◽

Action Research Project ◽

Digital Disruption

Abstract Background The COVID-19 pandemic has forced rapid digital transformation of many health systems. These innovations are now entering the literature, but there is little focus on the resulting disruption. Objective We describe the implementation of digital innovations during the COVID-19 response of Australia's largest health service, Metro North (in Brisbane, Queensland), the challenges of the subsequent digital disruption, how these were managed, and lessons learned. Methods Prior to the COVID-19 pandemic, the Australian state of Queensland created the Queensland Digital Clinical Charter, which provides guidance for the development of digital health programs. The guidelines utilize three horizons: digitizing workflows, leveraging digital data to transform clinical care, and reimagining new and innovative models of care. The technical response to COVID-19 in Metro North is described across these horizons. The rapid digital response caused significant disruption to health care delivery; management of the disruption and the outcomes are detailed. This is a participatory action research project, with members of the research team assisting with leading the implementation project informing the case report content. Results Several digital innovations were introduced across Metro North during the COVID-19 response. This resulted in significant disruption creating digital hypervigilance, digital deceleration, data discordance, and postdigital “depression.” Successful management of the digital disruption minimized the negative effects of rapid digital transformation, and contributed to the effective management of the pandemic in Queensland. Conclusion The rapid digital transformation in Metro North during COVID-19 was successful in several aspects; however, ongoing challenges remain. These include the need to improve data sharing and increase interoperability. Importantly, the innovations need to be evaluated to ensure that Metro North can capitalize on these changes and incorporate them into long-term routine practice. Moving forward, it will be essential to manage not only the pandemic, but increasingly, the resultant digital disruption.

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The Application of Design Principles to Innovate Clinical Care Delivery

Journal for Healthcare Quality ◽

10.1111/j.1945-1474.2009.00003.x ◽

2009 ◽

Vol 31 (1) ◽

pp. 5-9 ◽

Cited By ~ 6

Author(s):

Michael D. Brennan ◽

Alan K. Duncan ◽

Ryan R. Armbruster ◽

Victor M. Montori ◽

Wayne L. Feyereisn ◽

...

Keyword(s):

Care Delivery ◽

Clinical Care ◽

Design Principles

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Development of a Novel Clinician Decision Support Tool for the Management of Acute Diarrhea in Bangladesh: Formative Qualitative Research (Preprint)

10.2196/preprints.33325 ◽

2021 ◽

Author(s):

Rochelle K Rosen ◽

Stephanie C Garbern ◽

Monique Gainey ◽

Ryan Lantini ◽

Sabiha Nasrin ◽

...

Keyword(s):

Decision Support ◽

Focus Group ◽

Acute Diarrhea ◽

Clinical Utility ◽

Qualitative Data ◽

Care Delivery ◽

Clinical Care ◽

Healthcare Providers ◽

Final Analysis ◽

Support Tool

BACKGROUND The availability of mobile clinical decision-support (CDS) tools has grown substantially with the increased prevalence of smartphone devices and applications (apps). Though healthcare providers express interest in integrating mobile health (mHealth) technologies into their clinical settings, concerns raised include perceived disagreements between information provided by mobile CDS tools and standard guidelines. Despite their potential to transform health care delivery, there remains limited literature on the provider’s perspective of the clinical utility of mobile CDS tools for improving patient outcomes, especially in low- and middle- income countries. OBJECTIVE The aim of this study is to describe providers’ perceptions about the utility of a mobile CDS tool accessed via a smartphone app for diarrhea management in Bangladesh. In addition, feedback was collected on preliminary components of the mobile CDS tool to address clinicians’ concerns and incorporate their preferences. METHODS From November to December 2020, qualitative data were gathered through eight virtual focus group discussions with physicians and nurses from three Bangladeshi hospitals. Each discussion was conducted in the local language, Bangla, and audio recorded for transcription and translation by the local research team. Transcripts and codes were entered into NVivo12 and applied thematic analysis was used to identify themes that explore the clinical utility of a mHealth app to assess dehydration severity in patients with acute diarrhea. Summaries of concepts and themes were generated from reviews of the aggregated coded data, and thematic memos were written and used for the final analysis. RESULTS Of the 27 focus group participants, 14 were nurses and 13 doctors; 15 worked at a diarrhea specialty hospital and 12 worked in government district or subdistrict hospitals. The participants’ experience in their current position ranged from 2 to 14 years, with an average of 10.3 years. Key themes from the qualitative data analysis, including: current experience with CDS, overall perception of the app utility and its potential role in clinical care, barriers and facilitators to app use, considerations of overtreatment and undertreatment, and guidelines for the app’s clinical recommendations. CONCLUSIONS Participants were positive about the mHealth app and its potential to inform diarrhea management. They provided detailed feedback, which developers used to further the design and programming. Participants felt that the tool would initially take time to use, but once learned could be useful during epidemic cholera. Some felt that clinical experience remains an important part of treatment that can be supplemented, but not replaced, by a CDS tool. Additionally, diagnostic information, including mid-upper arm circumference and blood pressure, might not be available to directly inform programming decisions. These formative qualitative data provided timely and relevant feedback to improve the utility of a CDS tool for diarrhea treatment in Bangladesh.

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Palliative and Spiritual Care of Persons with HIV and AIDS

Handbook of AIDS Psychiatry ◽

10.1093/oso/9780195372571.003.0016 ◽

2010 ◽

Author(s):

Mary Ann Cohen ◽

Joseph Z. Lux

Keyword(s):

Palliative Care ◽

Spiritual Care ◽

Cultural Sensitivity ◽

Care Delivery ◽

Clinical Care ◽

Symptom Control ◽

Hiv And Aids ◽

Hiv Care ◽

Hospice Movement ◽

Health Organization

Palliative care of persons with HIV and AIDS has changed over the course of the first three decades of the pandemic. The most radical shifts occurred in the second decade with the introduction of combination antiretroviral therapy and other advances in HIV care. In the United States and throughout the world, progress in prevention of HIV transmission has not kept pace with progress in treatment, thus the population of persons living with AIDS continues to grow. Furthermore, economic, psychiatric, social, and political barriers leave many persons without access to adequate HIV care. As a result, persons who lack access to care may need palliative care for late-stage AIDS while persons with access to AIDS treatments are more likely to need palliative care for multimorbid medical illnesses such as cardiovascular disease, cancer, pulmonary disease, and renal disease. Palliative care of persons with HIV and AIDS cannot be confined to the end of life. We present palliative care on a continuum as part of an effort to alleviate suffering and attend to pain, emotional distress, and existential anxiety during the course of the illness. We will provide guidelines for psychiatric and palliative care and pain management to help persons with AIDS cope better with their illnesses and live their lives to the fullest extent, and minimize pain and suffering for them and their loved ones. This chapter reviews basic concepts and definitions of palliative and spiritual care, as well as the distinct challenges facing clinicians involved in HIV palliative care. Finally, issues such as bereavement, cultural sensitivity, communication, and psychiatric contributions to common physical symptom control are reviewed. The terms palliative care and palliative medicine are often used interchangeably. Modern palliative care has evolved from the hospice movement into a more expansive network of clinical care delivery systems with components of home care and hospital-based services (Butler et al., 1996; Stjernsward and Papallona, 1998). Palliative care must meet the needs of the “whole person,” including the physical, psychological, social, and spiritual aspects of suffering (World Health Organization, 1990).

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The TiME Trial: A Fully Embedded, Cluster-Randomized, Pragmatic Trial of Hemodialysis Session Duration

Journal of the American Society of Nephrology ◽

10.1681/asn.2018090945 ◽

2019 ◽

Vol 30 (5) ◽

pp. 890-903 ◽

Cited By ~ 16

Author(s):

Laura M. Dember ◽

Eduardo Lacson ◽

Steven M. Brunelli ◽

Jesse Y. Hsu ◽

Alfred K. Cheung ◽

...

Keyword(s):

Usual Care ◽

Care Delivery ◽

Clinical Care ◽

Pragmatic Trial ◽

Intervention Group ◽

Time Trial ◽

Hospitalization Rate ◽

Maintenance Hemodialysis ◽

Session Duration ◽

Cluster Randomized

BackgroundData from clinical trials to inform practice in maintenance hemodialysis are limited. Incorporating randomized trials into dialysis clinical care delivery should help generate practice-guiding evidence, but the feasibility of this approach has not been established.MethodsTo develop approaches for embedding trials into routine delivery of maintenance hemodialysis, we performed a cluster-randomized, pragmatic trial demonstration project, the Time to Reduce Mortality in ESRD (TiME) trial, evaluating effects of session duration on mortality (primary outcome) and hospitalization rate. Dialysis facilities randomized to the intervention adopted a default session duration ≥4.25 hours (255 minutes) for incident patients; those randomized to usual care had no trial-driven approach to session duration. Implementation was highly centralized, with no on-site research personnel and complete reliance on clinically acquired data. We used multiple strategies to engage facility personnel and participating patients.ResultsThe trial enrolled 7035 incident patients from 266 dialysis units. We discontinued the trial at a median follow-up of 1.1 years because of an inadequate between-group difference in session duration. For the primary analysis population (participants with estimated body water ≤42.5 L), mean session duration was 216 minutes for the intervention group and 207 minutes for the usual care group. We found no reduction in mortality or hospitalization rate for the intervention versus usual care.ConclusionsAlthough a highly pragmatic design allowed efficient enrollment, data acquisition, and monitoring, intervention uptake was insufficient to determine whether longer hemodialysis sessions improve outcomes. More effective strategies for engaging clinical personnel and patients are likely required to evaluate clinical trial interventions that are fully embedded in care delivery.

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INTEGRATING SOCIAL DETERMINANTS OF HEALTH IN CLINICAL CARE DELIVERY

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(20)31428-5 ◽

2020 ◽

Vol 75 (11) ◽

pp. 801

Author(s):

Anekwe E. Onwuanyi ◽

Diane Wirth ◽

Faith Works-Fleming ◽

Andrea Cafarelli ◽

Michael Knauss ◽

...

Keyword(s):

Social Determinants Of Health ◽

Social Determinants ◽

Care Delivery ◽

Clinical Care ◽

Determinants Of Health

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The LIVESTRONG essential elements of survivorship care: Advancing quality survivorship care in clinical care settings.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.34_suppl.155 ◽

2012 ◽

Vol 30 (34_suppl) ◽

pp. 155-155 ◽

Cited By ~ 1

Author(s):

Sarah R. Arvey ◽

Ruth Rechis

Keyword(s):

Iterative Process ◽

Research Agenda ◽

Care Delivery ◽

Clinical Care ◽

Evidence Base ◽

Essential Elements ◽

Standards Of Care ◽

Survivorship Care ◽

Distress Screening ◽

Care Plans

155 Background: The American College of Surgeons Commission on Cancer (COC) has set a 2015 deadline for oncology practices to comply with new patient-centered standards of care to maintain accreditation. Despite this mandate, there is not a strong evidence base on best practices, or guidance on how to implement quality survivorship care services. In September 2011, the Lance Armstrong Foundation (LAF) and the LIVESTRONG Survivorship Center of Excellence Network (Network) convened researchers, providers, advocates, and cancer survivors who identified and prioritized a list of 20 Essential Elements of survivorship care. LAF and the Network continued work to refine this list with input from stakeholders with the goal of disseminating a framework for survivorship care delivery and advancing a research agenda to strengthen the evidence base for implementing these elements as standard care. Methods: LAF and the Network have refined definitions of the Essential Elements through an iterative process and in late 2012 will facilitate a technology-mediated consensus-building process among a broad group of stakeholders. Results: Refinement of the Essential Elements included defining each element in such detail that “basic” and “enriched” levels of implementation are described to guide providers in real-world settings. This work outlines a research agenda aimed to strengthen the evidence-base of the Essential Elements’ effectiveness in improving survivors’ outcomes. In October 2012, the refined definitions will be disseminated to a broad stakeholder audience and subject to review. Details of this iterative process, resulting definitions, and open-forum feedback will be reported here. Conclusions: Once complete, the Essential Elements will represent a consensus-driven platform that provides the cancer care community with a blueprint for the development and implementation of high-quality survivorship care and research. Additionally, the finalized Essential Elements will further facilitate the broad adoption of the new COC standards including the provision of a treatment summary and survivorship care plans, palliative care, psychosocial distress screening, and care coordination.

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Using implementation science to examine impact of a social responsibility agenda on addressing cancer health disparities in Ceará, Brazil.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e19071 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e19071-e19071

Author(s):

Hermano Alexandre Lima Rocha ◽

Irene Dankwa-Mullan ◽

Pedro Meneleu ◽

Caio Figueiredo Juaçaba ◽

Metasebya Solomon ◽

...

Keyword(s):

Social Responsibility ◽

Implementation Science ◽

Cancer Care ◽

Process Model ◽

Care Delivery ◽

Clinical Care ◽

Evaluation Framework ◽

Northeastern Brazil ◽

Longitudinal Impact ◽

The Impact

e19071 Background: Programs to address disparities in cancer care outcomes in resource-limited settings require attention to social determinants of health (SDoH) to achieve successful clinical care implementation. The Instituto de Câncer do Ceará, the largest cancer center in northeastern Brazil, has implemented a Social Responsibility Agenda (SRA) to guide equitable cancer care delivery. This goal of this study was to develop a framework for an implementation science (IS) study evaluating the longitudinal impact of the SRA on cancer outcomes. Methods: We outlined a mixed-methods and participatory study incorporating a process model, the Consolidated Framework for Implementation Research (CFIR) and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) evaluation framework. A list of constructs and links to measurement tools associated with IS models were identified to guide the study phases. Results: We established a logic model to guide in evaluating the health and economic impact of the SRA. We identified >30 constructs and measures across domains of IS models. The table shows a driver diagram to inform the framework. Conclusions: Understanding determinants, key drivers and change concepts are important initial steps in an ongoing evaluation of the impact of evidence based SDoH interventions to address cancer disparities. [Table: see text]

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Nephrologists’ Attitudes Regarding Psychosocial Care in Hemodialysis Units

Canadian Journal of Kidney Health and Disease ◽

10.1177/20543581211037426 ◽

2021 ◽

Vol 8 ◽

pp. 205435812110374

Author(s):

Aidan Lehecka ◽

David Mendelssohn ◽

Gavril Hercz

Keyword(s):

Health Care ◽

Kidney Failure ◽

Response Rate ◽

Care Delivery ◽

Clinical Care ◽

Psychosocial Care ◽

Survey Questionnaire ◽

Canadian Society ◽

Psychosocial Needs ◽

Survey Responses

Background: There is a high prevalence of psychosocial issues affecting patients with kidney failure. Objective: We sought to examine Canadian nephrologists’ attitudes and opinions regarding the importance of renal patient psychosocial care, nephrologists’ roles, and experience with psychosocial care in addition to what barriers, if any, prevent these physicians from providing psychosocial care to their patients. Design: A self-administered, survey questionnaire. Setting: Online. Sample: Canadian Society of Nephrology members who predominantly work in clinical care with adult, in-center hemodialysis patients. Measurements: Measurements of the survey include demographics, training, and nephrologists’ opinions regarding their role in administering psychosocial care, potential administrative and patient time constraints, accessibility of other health care workers for this activity, and factors that influence or impede physicians’ ability to address their patients’ psychosocial needs. Methods: A self-administered survey was sent to almost 500 members of the Canadian Society of Nephrology between November 2018 and December 2018. The survey questionnaire was designed to gather opinions and attitudes on psychosocial care delivery as well as potential influencing factors on nephrologists’ ability to provide this care. A univariate statistical analysis was used to analyze survey responses. Results: A total of 30 nephrologists responded to the survey, generating a 6% response rate. Respondents varied across provinces, with the majority being staff nephrologists (80%). While over 94% of respondents either agreed or strongly agreed that focus on psychosocial care improves patient outcomes, only 43% felt that staff nephrologists were suited to provide this care to patients; 97% of respondents believed social workers to be the most suited to provide this. Lack of additional supporting health care members, the need for additional training, too many administrative duties, and empathy fatigue were some of the predominant barriers respondents felt prevented them from addressing the psychosocial care of their patients. Limitations: A low response rate for the survey was obtained, roughly 6%, limiting our ability to draw definitive conclusions. Survey answers by respondents may be different from those by nonrespondents. Answers may be subject to social desirability and/or selection bias. Conclusion: Nephrologists believe that the current psychosocial care of patients in hemodialysis units is inadequate. However, further research is necessary to elucidate the barriers nephrologists face in providing psychosocial care and the changes required to most effectively implement optimal psychosocial care for patients with kidney failure in hemodialysis units.

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