What works for whom: A realist synthesis of neighbourhood interventions for families in the community

Policy makers often legitimize bids for major sport events and public funding of elite sports by trickle-down effects, suggesting that hosting events, sporting success, and athlete role models inspire the population to participate themselves in sport and physical activity. According to previous review articles, empirical evidence of trickle-down effects are mixed, with several studies citing marginal or no effect. The purpose of this study is to apply a realist synthesis approach to evaluate under which conditions trickle-down effects occur (i.e., what works for whom under which circumstances?). Using rapid evidence assessment methodology, 58 empirical articles were identified in the search process and critically analyzed through the lens of realist synthesis evaluation. The analysis identified six conditions under which trickle-down effects have occurred: Event leveraging initiatives, capacity of community sport to cater for new participants, live spectating experiences, consumption possibilities on television or other media, and communities housing event venues. The findings have implications for the sustainability of sport policy decisions and public finance, as the likelihood of trickle-down effects increases with integrated planning and sustainable spending related to the above six conditions.

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Realist synthesis of intentional rounding in hospital wards: exploring the evidence of what works, for whom, in what circumstances and why

BMJ Quality & Safety ◽

10.1136/bmjqs-2017-006757 ◽

2018 ◽

Vol 27 (9) ◽

pp. 743-757 ◽

Cited By ~ 7

Author(s):

Sarah Sims ◽

Mary Leamy ◽

Nigel Davies ◽

Katy Schnitzler ◽

Ros Levenson ◽

...

Keyword(s):

Well Being ◽

Realist Synthesis ◽

Patient Comfort ◽

Standards Of Care ◽

Routine Practice ◽

Daily Routine ◽

Patient Contact ◽

Limited Evidence ◽

Stakeholder Consultation ◽

What Works

BackgroundIntentional rounding (IR) is a structured process whereby nurses conduct one to two hourly checks with every patient using a standardised protocol.ObjectiveA realist synthesis of the evidence on IR was undertaken to develop IR programme theories of what works, for whom, in what circumstances and why.MethodsA three-stage literature search and a stakeholder consultation event was completed. A variety of sources were searched, including AMED, CINAHL, MEDLINE, PsycINFO, HMIC, Google and Google Scholar, for published and unpublished literature. In line with realist synthesis methodology, each study’s ‘fitness for purpose’ was assessed by considering its relevance and rigour.ResultsA total of 44 papers met the inclusion criteria. To make the programme theories underpinning IR explicit, we identified eight a priori propositions: (1) when implemented in a comprehensive and consistent way, IR improves healthcare quality and satisfaction, and reduces potential harms; (2) embedding IR into daily routine practice gives nurses ‘allocated time to care’; (3) documenting IR checks increases accountability and raises fundamental standards of care; (4) when workload and staffing levels permit, more frequent nurse–patient contact improves relationships and increases awareness of patient comfort and safety needs; (5) increasing time when nurses are in the direct vicinity of patients promotes vigilance, provides reassurance and reduces potential harms; (6) more frequent nurse–patient contact enables nurses to anticipate patient needs and take pre-emptive action; (7) IR documentation facilitates teamwork and communication; and (8) IR empowers patients to ask for what they need to maintain their comfort and well-being. Given the limited evidence base, further research is needed to test and further refine these propositions.ConclusionsDespite widespread use of IR, this paper highlights the paradox that there is ambiguity surrounding its purpose and limited evidence of how it works in practice.

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The effects of interoperable information technology networks on patient safety: a realist synthesis

Health Services and Delivery Research ◽

10.3310/hsdr08400 ◽

2020 ◽

Vol 8 (40) ◽

pp. 1-162

Author(s):

Justin Keen ◽

Maysam Abdulwahid ◽

Natalie King ◽

Judy Wright ◽

Rebecca Randell ◽

...

Keyword(s):

Information Technology ◽

Patient Safety ◽

Health Services ◽

Realist Synthesis ◽

Economies Of Scope ◽

Patient Specific ◽

Future Research ◽

What Works ◽

Health And Social Care ◽

At Home

Background Interoperable networks connect information technology systems of different organisations, allowing professionals in one organisation to access patient data held in another one. Health policy-makers in many countries believe that they will improve the co-ordination of services and, hence, the quality of services and patient safety. To the best of our knowledge, there have not been any previous systematic reviews of the effects of these networks on patient safety. Objectives The aim of the study was to establish how, why and in what circumstances interoperable information technology networks improved patient safety, failed to do so or increased safety risks. The objectives of the study were to (1) identify programme theories and prioritise theories to review; (2) search systematically for evidence to test the theories; (3) undertake quality appraisal, and use included texts to support, refine or reject programme theories; (4) synthesise the findings; and (5) disseminate the findings to a range of audiences. Design Realist synthesis, including consultation with stakeholders in nominal groups and semistructured interviews. Settings and participants Following a stakeholder prioritisation process, several domains were reviewed: older people living at home requiring co-ordinated care, at-risk children living at home and medicines reconciliation services for any patients living at home. The effects of networks on services in health economies were also investigated. Intervention An interoperable network that linked at least two organisations, including a maximum of one hospital, in a city or region. Outcomes Increase, reduction or no change in patients’ risks, such as a change in the risk of taking an inappropriate medication. Results We did not find any detailed accounts of the ways in which interoperable networks are intended to work and improve patient safety. Theory fragments were identified and used to develop programme and mid-range theories. There is good evidence that there are problems with the co-ordination of services in each of the domains studied. The implicit hypothesis about interoperable networks is that they help to solve co-ordination problems, but evidence across the domains showed that professionals found interoperable networks difficult to use. There is insufficient evidence about the effectiveness of interoperable networks to allow us to establish how and why they affect patient safety. Limitations The lack of evidence about patient-specific measures of effectiveness meant that we were not able to determine ‘what works’, nor any variations in what works, when interoperable networks are deployed and used by health and social care professionals. Conclusions There is a dearth of evidence about the effects of interoperable networks on patient safety. It is not clear if the networks are associated with safer treatment and care, have no effects or increase clinical risks. Future work Possible future research includes primary studies of the effectiveness of interoperable networks, of economies of scope and scale and, more generally, on the value of information infrastructures. Study registration This study is registered as PROSPERO CRD42017073004. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 40. See the NIHR Journals Library website for further project information.

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NHS managers’ use of nursing workforce planning and deployment technologies: a realist synthesis

Health Services and Delivery Research ◽

10.3310/hsdr06360 ◽

2018 ◽

Vol 6 (36) ◽

pp. 1-176 ◽

Cited By ~ 3

Author(s):

Christopher R Burton ◽

Jo Rycroft-Malone ◽

Lynne Williams ◽

Siân Davies ◽

Anne McBride ◽

...

Keyword(s):

Patient Care ◽

Positive Impact ◽

Phase 1 ◽

Workforce Planning ◽

Realist Synthesis ◽

Future Research ◽

Programme Theory ◽

What Works ◽

The Impact ◽

Professional Judgement

BackgroundPolicy and reviews of health-care safety and quality emphasise the role of NHS managers in ensuring safe, good-quality patient care through effective staffing. Guidance requires that NHS managers combine professional judgement with evidence-based workforce planning and deployment tools and technologies (WPTs). Evidence has focused on the effectiveness of WPTs, but little is known about supporting their implementation, or the impact of using WPTs across settings.ObjectivesThe review answered the following question: ‘NHS managers’ use of workforce planning and deployment technologies and their impacts on nursing staffing and patient care: what works, for whom, how and in what circumstances?’.DesignA realist synthesis was conducted. A programme theory was formulated and expressed as hypotheses in the form of context, mechanisms and outcomes; this considered how, through using WPTs, particular conditions produced responses to generate outcomes. There were four phases: (1) development of a theoretical territory to understand nurse workforce planning and deployment complexity, resulting in an initial programme theory; (2) retrieval, review and synthesis of evidence, guided by the programme theory; (3) testing and refinement of the programme theory for practical application; and (4) actionable recommendations to support NHS managers in the implementation of WPTs for safe staffing.ParticipantsNHS managers, patient and public representatives and policy experts informed the programme theory in phase 1, which was validated in interviews with 10 NHS managers. In phase 3, 11 NHS managers were interviewed to refine the programme theory.ResultsWorkforce planning and deployment tools and technologies can be characterised functionally by their ability to summarise and aggregate staffing information, communicate about staffing, allocate staff and facilitate compliance with standards and quality assurance. NHS managers need to combine local knowledge and professional judgement with data from WPTs for effective staffing decisions. WPTs are used in a complex workforce system in which proximal factors (e.g. the workforce satisfaction with staffing) can influence distal factors (e.g. organisational reputation and potential staff recruitment). The system comprises multiple organisational strategies (e.g. professional and financial), which may (or may not) align around effective staffing. The positive impact of WPTs can include ensuring that staff are allocated effectively, promoting the patient safety agenda within an organisation, learning through comparison about ‘what works’ in effective staffing and having greater influence in staffing work. WPTs appear to have a positive impact when they visibly integrate data on needs and resources and when there is technical and leadership support. A collaborative process appears to be best for developing and implementing WPTs, so that they are fit for purpose.LimitationsThe evidence, predominantly from acute care, often lacked detail on how managers applied professional judgement to WPTs for staffing decisions. The evidence lacked specificity about how managers develop skills on communicating staffing decisions to patients and the public.Conclusions and recommendationsThe synthesis produced initial explanations of the use and impact of WPTs for decision-making and what works to support NHS managers to use these effectively. It is suggested that future research should further evaluate the programme theory.Study registrationThis study is registered as PROSPERO CRD42016038132.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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A realist synthesis of quality improvement curricula in undergraduate and postgraduate medical education: what works, for whom, and in what contexts?

BMJ Quality & Safety ◽

10.1136/bmjqs-2020-010887 ◽

2020 ◽

pp. bmjqs-2020-010887 ◽

Cited By ~ 1

Author(s):

Allison Brown ◽

Kyle Lafreniere ◽

David Freedman ◽

Aditya Nidumolu ◽

Matthew Mancuso ◽

...

Keyword(s):

Medical Education ◽

Quality Improvement ◽

Clinical Outcomes ◽

Postgraduate Medical Education ◽

Grey Literature ◽

Realist Synthesis ◽

Programme Theory ◽

Protected Time ◽

What Works ◽

Competency Area

BackgroundWith the integration of quality improvement (QI) into competency-based models of physician training, there is an increasing requirement for medical students and residents to demonstrate competence in QI. There may be factors that commonly facilitate or inhibit the desired outcomes of QI curricula in undergraduate and postgraduate medical education. The purpose of this review was to synthesise attributes of QI curricula in undergraduate and postgraduate medical education associated with curricular outcomes.MethodsA realist synthesis of peer-reviewed and grey literature was conducted to identify the common contexts, mechanisms, and outcomes of QI curricula in undergraduate and postgraduate medical education in order to develop a programme theory to articulate what works, for whom, and in what contexts.Results18854 records underwent title and abstract screening, full texts of 609 records were appraised for eligibility, data were extracted from 358 studies, and 218 studies were included in the development and refinement of the final programme theory. Contexts included curricular strategies, levels of training, clinical settings, and organisational culture. Mechanisms were identified within the overall QI curricula itself (eg, clear expectations and deliverables, and protected time), in the didactic components (ie, content delivery strategies), and within the experiential components (eg, topic selection strategies, working with others, and mentorship). Mechanisms were often associated with certain contexts to promote educational and clinical outcomes.ConclusionThis research describes the various pedagogical strategies for teaching QI to medical learners and highlights the contexts and mechanisms that could potentially account for differences in educational and clinical outcomes of QI curricula. Educators may benefit from considering these contexts and mechanisms in the design and implementation of QI curricula to optimise the outcomes of training in this competency area.

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A realist synthesis of pharmacist-conducted medication reviews in primary care after leaving hospital: what works for whom and why?

BMJ Quality & Safety ◽

10.1136/bmjqs-2020-011418 ◽

2020 ◽

pp. bmjqs-2020-011418

Author(s):

Karen Luetsch ◽

Debra Rowett ◽

Michael J Twigg

Keyword(s):

Primary Care ◽

Medication Review ◽

Healthcare Professionals ◽

Clinical Skills ◽

Healthcare Setting ◽

Realist Synthesis ◽

Sources Of Information ◽

Programme Theory ◽

What Works ◽

Medication Reviews

BackgroundMedication reviews for people transitioning from one healthcare setting to another potentially improve health outcomes, although evidence for outcome benefits varies. It is unclear when and why medication reviews performed by pharmacists in primary care for people who return from hospital to the community lead to beneficial outcomes.ObjectiveA realist synthesis was undertaken to develop a theory of what works, for whom, why and under which circumstances when pharmacists conduct medication reviews in primary care for people leaving hospital.MethodsThe realist synthesis was performed in accordance with Realist And MEta-narrative Evidence Syntheses: Evolving Standards reporting standards. An initial programme theory informed a systematic literature search of databases (PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature, International Pharmaceutical Abstracts, OpenGrey, Trove), augmented by agency and government sources of information. Documents were synthesised by exploring interactions between contexts, intervention, outcomes and causal mechanisms.ResultsThe synthesis identified 9 contexts in which 10 mechanisms can be activated to influence outcomes of pharmacist medication reviews conducted in primary care postdischarge. For a medication review to take place these include trust patients have in healthcare professionals, their healthcare priorities postdischarge, capacity to participate, perceptions of benefit and effort, and awareness required by all involved. For the medication review process, mechanisms which issue an invitation to collaborate between healthcare professionals, enable pharmacists employing clinical skills and taking responsibility for medication review outcomes were linked to more positive outcomes for patients.ConclusionsMedication reviews after hospital discharge seem to work successfully when conducted according to patient preferences, programmes promote coordination and collaboration between healthcare professionals and establish trust, and pharmacists take responsibility for outcomes. Findings of this realist synthesis can inform postdischarge medication review service models.

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Job Crafting Interventions: What Works, for Whom, Why, and in Which Contexts? Research Protocol for a Realist Synthesis With Coincidence Analysis

10.21203/rs.3.rs-603011/v1 ◽

2021 ◽

Author(s):

Marta Roczniewska ◽

Anna Rogala ◽

Magdalena Marszałek ◽

Henna Hasson ◽

Arnold B. Bakker ◽

...

Keyword(s):

Well Being ◽

Job Design ◽

Realist Synthesis ◽

Job Crafting ◽

Related Factors ◽

Training Interventions ◽

Theoretical Approaches ◽

What Works ◽

Multiple Alternative ◽

Complex Solutions

Abstract Background:Job crafting (JC) refers to self-initiated changes that employees introduce to their jobs to optimize their job design and increase the fit between the job and their needs and preferences. These behaviors can be stimulated by job crafting training interventions, which aim to change how individual employees design, organize, or manage their work. However, knowledge on JC interventions and their effects is still scarce. Additionally, the findings are spread across distinct theoretical approaches and the interventions are implemented in various ways. We have yet to determine which context and intervention factors are necessary or sufficient to achieve desired outcomes. The overall aim of this project will be to investigate how to implement effective JC interventions. Specifically, we will detect what factors are minimally sufficient and/or necessary to produce a successful JC intervention, as well as the multiple alternative paths to their success.Methods: We will perform a realist synthesis of the JC interventions literature combined with coincidence analysis (CNA). We will search electronic databases of journals and utilize Rayyan software to make decisions regarding inclusion. Data regarding context (e.g., fit), intervention (e.g., types of activities), mechanisms (e.g., intention implementation), and outcomes (e.g., employee well-being, job performance) will be extracted using a pre-piloted form and coded into a crisp-set (factor present vs. absent). Analyses will be carried out using CNA package in R.Discussion:This realist synthesis will address gaps in knowledge about the context, intervention and mechanism-related factors that may impact the effects of JC interventions. Consequently, this review will help develop a program theory for JC interventions that explains what works, how and under which circumstances. Applying CNA to synthesize these complex solutions across multiple studies provides an innovative method that may be used in future realist syntheses evaluating the implementation of interventions. Finally, our synthesis will provide knowledge relevant to organizational practitioners and scholars who want to implement JC interventions.Systematic review registration:https://osf.io/2q7cn (registration pending)

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What Works to Improve and Manage Fecal Incontinence in Care Home Residents Living With Dementia? A Realist Synthesis of the Evidence

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2017.05.025 ◽

2017 ◽

Vol 18 (9) ◽

pp. 752-760.e1 ◽

Cited By ~ 7

Author(s):

Marina Buswell ◽

Claire Goodman ◽

Brenda Roe ◽

Bridget Russell ◽

Christine Norton ◽

...

Keyword(s):

Fecal Incontinence ◽

Care Home ◽

Realist Synthesis ◽

What Works

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System wide learning from first wave Covid 19: A realist synthesis of what works?

10.21203/rs.3.rs-115647/v1 ◽

2020 ◽

Author(s):

Carolyn Jackson ◽

Kim Manley ◽

Jonathan Webster ◽

Sally Hardy

Keyword(s):

Realist Synthesis ◽

Lessons Learned ◽

Synthesis Methods ◽

System Transformation ◽

Front Line ◽

Line Staff ◽

What Works ◽

Health And Social Care ◽

Staff Wellbeing ◽

Staff Experiences

Abstract Background This paper presents a thematic analysis of 176 interview transcripts from front line staff working during the first wave of COVID-19 in the East of England. Methods Presented as a descriptive case study it reflects the complexity and numerous variables that influenced staff experiences of delivering care and support across the health and social care system between April and August 2020. Drawing upon the methodology of realist synthesis, it addresses the question “What works for whom and in what contexts and why?” to help illuminate real-world issues that people have faced. Results Thirty-one themes were distilled highlighting lessons learned from things that went well compared with those that did not; challenges compared with the celebrations and outcomes; learning and insights gained; impact on role; and system headlines. Four tentative theories of system transformation are presented to highlight support mechanisms that are needed to enable front line teams to be effective in further waves of the pandemic, capitalising on system wide learning, patient, resident and staff wellbeing. Conclusions This paper presents a unique insight into front line staff experiences of working during the first wave of the Covid-19 pandemic using realist synthesis methods to distil key themes and tentative theories about what strategies work to enable and empower front line teams to be effective and to support system wide learning and transformation.

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What Works?

ASHA Leader ◽

10.1044/leader.scm1.12052007.10 ◽

2007 ◽

Vol 12 (5) ◽

pp. 10-10

Author(s):

Wayne A. Secord

Keyword(s):

What Works

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