What initiatives do healthcare leaders agree are needed for healthcare system improvement? Results of a modified-Delphi study

2018 ◽  
Vol 32 (8) ◽  
pp. 1002-1012
Author(s):  
Stuart Barson ◽  
Robin Gauld ◽  
Jonathon Gray ◽  
Goran Henriks ◽  
Christina Krause ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Healthcare System ◽  
Professional Training ◽  
Delphi Process ◽  
Content Type ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Health And Social Care ◽  
System Leaders ◽  
Practical Implications

Purpose The purpose of this paper is to identify five quality improvement initiatives for healthcare system leaders, produced by such leaders themselves, and to provide some guidance on how these could be implemented. Design/methodology/approach A multi-stage modified-Delphi process was used, blending the Delphi approach of iterative information collection, analysis and feedback, with the option for participants to revise their judgments. Findings The process reached consensus on five initiatives: change information privacy laws; overhaul professional training and work in the workplace; use co-design methods; contract for value and outcomes across health and social care; and use data from across the public and private sectors to improve equity for vulnerable populations and the sickest people. Research limitations/implications Information could not be gathered from all participants at each stage of the modified-Delphi process, and the participants did not include patients and families, potentially limiting the scope and nature of input. Practical implications The practical implications are a set of findings based on what leaders would bring to a decision-making table in an ideal world if given broad scope and capacity to make policy and organisational changes to improve healthcare systems. Originality/value This study adds to the literature a suite of recommendations for healthcare quality improvement, produced by a group of experienced healthcare system leaders from a range of contexts.

scholarly journals Caregiver-Centered Care Health Workforce Competencies: Developing Consistent Support for Family Caregivers

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 15-15
Author(s):  
Jasneet Parmar ◽  
Sharon Anderson ◽  
Lisa Poole ◽  
Wendy Duggleby ◽  
Jayna Holyroyd-Leduc ◽  
...  
Keyword(s):  
Health System ◽  
Family Caregivers ◽  
Health Providers ◽  
Care Providers ◽  
Modified Delphi ◽  
Healthcare Settings ◽  
Delphi Approach ◽  
People With Dementia ◽  
Health And Social Care ◽  
Centered Care

Abstract Family caregivers [FCGs] are the backbone of the health system. They provide over 80% of the care for people with dementia, chronic illnesses and impairments. Despite evidence of their contributions and consequences of caregiving, support for FCGs has not been a health system priority. Education to prepare health providers to effectively identify, engage, assess, and support FCGs throughout the care trajectory is an innovative approach in addressing inconsistent system of supports for FCGs. We report on development and validation of the Caregiver-Centered Care Competency Framework to help with curricular design and subsequent evaluation of effectiveness of care providers working within healthcare settings to engage and support FCGs. We used a three round modified Delphi approach. An expert panel of 42 international, national, and provincial stakeholders agreed to participate. In the first 2 rounds, multi-level, interdisciplinary participants, rated the indicators in terms of importance and relevance. In the 3rd round consensus meeting, participants validated the six competency domains, including indicators in small group sessions. Thirty-four experts (81%) participated in the round 1, 36 (85.7%) in round 2, and 42 people (100%) in round 3. There was stable consensus across all three rounds, 96.07% of participants rated the indicators as essential or important (Round 1, 95.81%; Round 2, 94.15; Round 3, 98.23%). FCG research has been primarily focussed on educating FCGs to provide care. These competencies will shape the design of educational curricula and interdisciplinary training programs aimed at supporting the health and social care workforce to provide caregiver-centered care.

scholarly journals The importance of a room with a view for older people with limited mobility

2018 ◽  
Vol 19 (4) ◽  
pp. 273-285 ◽  
Author(s):  
Charles Musselwhite
Keyword(s):  
Older People ◽  
Design Methodology ◽  
Social Care ◽  
Structured Interviews ◽  
Content Type ◽  
Limited Mobility ◽  
Human Element ◽  
Health And Social Care ◽  
Vantage Points ◽  
Practical Implications

Purpose The purpose of this paper is to examine how older people who are almost entirely housebound use a view from their window to make sense of the world and stay connected to the outside space that they cannot physically inhabit. Design/methodology/approach Semi-structured interviews with 42 individuals were carried out who were living at home, were relatively immobile and had an interesting view outside they liked from one or more of their windows. Findings The findings suggest that immobile older people enjoy watching a motion-full, changing, world going on outside of their own mobility and interact and create meaning and sense, relating themselves to the outside world. Practical implications Findings suggest that those working in health and social care must realise the importance of older people observing the outdoors and create situations where that is enabled and maintained through improving vantage points and potentially using technology. Originality/value This study builds and updates work by Rowles (1981) showing that preference for views from the window involves the immediate surveillance zone but also further afield. The view can be rural or urban but should include a human element from which older people can interact through storytelling. The view often contains different flows, between mundane and mystery and intrigue, and between expected and random.

Assumption, the mother of all foul ups: a fundamental reason for the continuing abuse of adults at risk

2018 ◽  
Vol 20 (3/4) ◽  
pp. 129-143 ◽  
Author(s):  
Steve Moore
Keyword(s):  
At Risk ◽  
Policy And Practice ◽  
Partial Explanation ◽  
Content Type ◽  
Health And Social Care ◽  
Fundamental Reason ◽  
English Society ◽  
Vulnerable Adults ◽  
Lay Public ◽  
Practical Implications

Purpose The purpose of this paper is to introduce the concept of the assumption of altruism argued by the author to be a tendency among both the lay public, professionals and politicians, a generalised assumption that contributes to the long standing and obstinate presence of abuse of adults who are at risk throughout England, particularly older people living in care and nursing homes. Design/methodology/approach By examining available figures that depict the continuing abuse of vulnerable adults, and by drawing on research, the author offers a partial explanation for the longevity of abuse in English society. Findings The paper demonstrates how the concept of the assumption of altruism can explain to a degree the apparent enduring levels of abuse of adults who are at risk. Practical implications The paper offers the opportunity for the reader to consider some of the fundamental, higher order reasons for the persistent levels of abuse in England, abuse that endures despite the oversight by government of care provided to adults who maybe at risk by virtue of the activities of the statutory regulator and health and social care commissioners. Originality/value By presenting the incontrovertible evidence of enduring abuse, the paper introduces the concept of the assumption of altruism as a partial explanation for its continuing occurrence despite decades of policy and practice guidance designed to overcome it.

Health service engagement with consumers and community in Australia for issue

2019 ◽  
Vol 24 (4) ◽  
pp. 274-283 ◽  
Author(s):  
Shane Rendalls ◽  
Allan D. Spigelman ◽  
Catherine Goodwin ◽  
Nataliya Daniel
Keyword(s):  
Quality Improvement ◽  
Health Service ◽  
Community Engagement ◽  
Service Planning ◽  
Programme Evaluation ◽  
Consumer Engagement ◽  
Health Service Planning ◽  
Content Type ◽  
Service Engagement ◽  
Practical Implications

Purpose The purpose of this paper is to provide an overview of consumer and community engagement in health service planning, quality improvement and programme evaluation in Australia, and key components and importance of a strong suite of tools for achieving effective outcomes. Design/methodology/approach This paper is a non-systematic review of Australian national, state and territory websites in relation to policy commitment to consumer engagement, best practice framework for consumer engagement and recent project example. Findings Consumer engagement is a recognised component of the Australian health system. It is reflected in the national and state health policy and is a mandatory requirement of hospital accreditation. The application of co-design principles is gaining increasing popularity in health service planning and programme evaluation. Co-design is an important enabler of patient/community-centred service planning and evaluation; however, on its own it may lead to poorer outcomes. Co-design must occur within a broader systemic framework. Practical implications The research identifies a conceptual framework, approaches and tools of value to health service management and planners. Originality/value Consumer and community engagements are critical to the development of consumer-centric services. However, this should complement and add value to, not divert attention away from established principles of service planning, continuous quality improvement and programme evaluation. To do so may result in poorer quality health and well-being outcomes, reduced efficiency and ultimately reduced consumer and community satisfaction with services. This paper examines consumer and community engagement within the broader planning and quality improvement framework and practical implications for keeping planning, research and evaluation on track.

scholarly journals LO41: The development of a standardized provincial massive hemorrhage protocol with a built-in continuous quality improvement framework

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S21-S22
Author(s):  
C. Yeh ◽  
S. Cope ◽  
T. Thompson ◽  
S. McGilvray ◽  
A. Petrosoniak ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Factor Viia ◽  
Stakeholder Analysis ◽  
Massive Hemorrhage ◽  
Delphi Process ◽  
Blood Component ◽  
Evidence Based ◽  
Process Measures ◽  
Modified Delphi ◽  
Working Groups

Background: Massive hemorrhage protocols (MHPs) streamline the complex logistics required for prompt care of the bleeding patient, but their uptake has been variable and few regions have a system to measure outcomes from these events. Aim Statement: We aim to implement a standardized MHP with uniform quality improvement (QI) metrics to increase uptake of evidence-based MHPs across 150-hospitals in Ontario between 2017 and 2021. Measures & Design: We performed ongoing PDSA cycles; 1) stakeholder analysis by surveying the Ontario Regional Blood Coordinating Network (ORBCoN), 2) problem characterization and Ishikawa analysis for key QI metrics based on areas of MHP variability in 150 Ontario hospitals using a web-based survey, 3) creation of a consensus MHP via a modified Delphi process, 4) problem characterization at ORBCoN for the design of a freely available toolkit for provincial implementation by expert working groups, 5) design of 8 key QI metrics by a modified Delphi process, and 6) identification of process measures for QI data collection by implementation metrics. Evaluation/Results: PDSA1-2; 150-hospitals were surveyed. 33% of hospitals lacked MHPs, mostly in smaller sites. Major areas for QI were related to activation criteria, hemostatic agents, protocolized hypothermia management, variable MHP naming, QI metrics and serial blood work requirements. PDSA3; 3 Delphi rounds were held to reach 100% expert consensus for 42 statements and 8 CQI metrics. Major areas for modification were protocol name, laboratory resuscitation targets, cooler configurations, and role of factor VIIa. PDSA4; adaptable toolkit is under development by the steering committee and expert working groups. Implementation is scheduled for Spring 2020. PDSA5; the 8 CQI metrics are: TXA administration < 1 h, RBC transfusion < 15 min, call to transfer for definitive care < 60 min, temp >35°C at end of protocol, Hgb kept between 60-110g/L, transition to group-specific RBC by 90 min, appropriate activation defined by ≥6 units RBC in the first 24 hours, and any blood component wastage. Discussion/Impact: MHP uptake, content, and tracking is variable. A standardized MHP that is adaptable to diverse settings decreases complexity, improves use of evidence-based practices, and provides a platform for continuous QI. PDSA6 will occur after implementation; we will complete an implementation survey, and design a pilot and feasibility study for prospective tracking of patient outcomes using existing prospectively collected inter-hospital and provincial databases.

Healthcare leaders’ views on successful quality improvement initiatives and context

2017 ◽  
Vol 31 (1) ◽  
pp. 54-63 ◽  
Author(s):  
Stuart Barson ◽  
Fiona Doolan-Noble ◽  
Jonathon Gray ◽  
Robin Gauld
Keyword(s):  
Quality Improvement ◽  
Critical Success Factors ◽  
Success Factors ◽  
Contextual Factors ◽  
Structured Interviews ◽  
Content Type ◽  
Critical Success ◽  
Source Of Information ◽  
Practical Implications ◽  
Healthcare Leaders

Purpose The purpose of this paper is to investigate the contextual factors contributing to the sustainability of healthcare quality improvement (QI) initiatives. Design/methodology/approach Themes from semi-structured interviews with international healthcare leaders are compared with Kaplan and Provost et al.’s (2012) model for understanding success in quality (MUSIQ). Critical success factors within these themes are shown in detail. Findings The interviews provide a rich source of information on critical success factors. The themes largely correspond with MUSIQ, reinforcing its robustness. An important factor emerging from the interviews was the importance of engagement with patients and families in QI, and this needs consideration in seeking to understand context in QI. Research limitations/implications Interview participants represent a limited set of western countries and health systems. Their experiences may not hold true in other settings. Practical implications The detail on critical success factors provides QI practitioners with guidance on designing and implementing sustainable initiatives. Originality/value Including consideration of contextual factors for engagement with patients and families in frameworks for context in QI appears to be an original idea that will add value to such frameworks. Researchers in patient engagement are starting to address contextual factors and connections should be made with this work.

scholarly journals Framing quality improvement tools and techniques in healthcare

2013 ◽  
Vol 27 (2) ◽  
pp. 209-224 ◽  
Author(s):  
Ross Millar
Keyword(s):  
Quality Improvement ◽  
Service Improvement ◽  
Content Type ◽  
Healthcare Settings ◽  
The Social ◽  
Health And Social Care ◽  
Formed Part ◽  
Tools And Techniques ◽  
Social Act

PurposeThe purpose of this paper is to present a study of how quality improvement tools and techniques are framed within healthcare settings.Design/methodology/approachThe paper employs an interpretive approach to understand how quality improvement tools and techniques are mobilised and legitimated. It does so using a case study of the NHS Modernisation Agency Improvement Leaders' Guides in England.FindingsImprovement Leaders' Guides were framed within a service improvement approach encouraging the use of quality improvement tools and techniques within healthcare settings. Their use formed part of enacting tools and techniques across different contexts. Whilst this enactment was believed to support the mobilisation of tools and techniques, the experience also illustrated the challenges in distributing such approaches.Originality/valueThe paper provides an important contribution in furthering our understanding of framing the “social act” of quality improvement. Given the ongoing emphasis on quality improvement in health systems and the persistent challenges involved, it also provides important information for healthcare leaders globally in seeking to develop, implement or modify similar tools and distribute leadership within health and social care settings.

Perception and awareness of Islamic accounting: student perspectives

2015 ◽  
Vol 23 (3) ◽  
pp. 306-320 ◽  
Author(s):  
Dodik Siswantoro
Keyword(s):  
Professional Training ◽  
Accounting Students ◽  
Primary Data ◽  
Certified Public Accountant ◽  
Content Type ◽  
Academic Courses ◽  
Sample Test ◽  
Narrow Gaps ◽  
Practical Implications ◽  
Public Accountant

Purpose – The purpose of this paper is to investigate the perception and awareness of Islamic accounting of undergraduate accounting students at Universitas Indonesia. The Indonesian Institute of Accountants has an Islamic Accounting Certification and a Certified Public Accountant (CPA) test, meaning that the course’s competency should satisfy both Islamic and CPA certification standards to be effective. Design/methodology/approach – The researcher used primary data obtained from a questionnaire. This research was based on the students’ understanding of Islamic accounting at the beginning of the class and at the middle of the semester. The sample test included questions based on the course’s syllabus. Each statement in the questionnaire represented the main topic of each week of the class. Data were analyzed using descriptive statistics, correlation analysis and tests of differences between groups of the sample. Findings – The results showed that few students were aware of Islamic accounting, but the course effectively improved comprehension. In general, respondents believed that Islamic accounting has better norms and value than conventional accounting. In fact, Muslims’ marks in the midterm test are lower than non-Muslims’ marks. This was unexpected, as Muslims had learned similar concepts about Islamic teaching. The students assumed that the course covered only common concepts, not dogma. Research limitations/implications – The sample was limited to students taking an Islamic accounting course at Universitas Indonesia. The results cannot be generalized to other cases. Practical implications – This research can narrow gaps between the needs of the accounting profession and the content of the Islamic accounting academic courses taken by students. To minimize fraud and emphasize Islamic teaching, the curriculum should feature strong and inherent Islamic principles. Originality/value – This may be the first paper to describe students’ perception and awareness of Islamic accounting after taking a course on this topic. Education on this subject should be incorporated into professional training where appropriate.

scholarly journals Professional training in organic food production: a cross-country experience

2017 ◽  
Vol 34 (3) ◽  
pp. 259-273
Author(s):  
Raquel Guiné ◽  
Daniela Costa ◽  
Paula Correia ◽  
Cristina Costa ◽  
Helena Correia ◽  
...  
Keyword(s):  
Distance Learning ◽  
Design Methodology ◽  
Professional Training ◽  
Agricultural Activity ◽  
Content Type ◽  
Training Activities ◽  
Cross Country ◽  
Level Of Significance ◽  
Past Experiences ◽  
Practical Implications

Purpose The purpose of this paper is to characterize the agricultural activities and past experiences in professional training in the context of mobile learning in different countries (Portugal, Spain, Slovakia, Hungary, UK, Italy and Turkey). Design/methodology/approach For the survey, a questionnaire was prepared in English and Portuguese and then translated into the languages of the participating countries. It was delivered electronically for answering online by adults only. The participation was voluntary and in the end 133 consented valid questionnaires were obtained. For the treatment of the data, SPSS was used and basic descriptive statistics tools were applied, together with tests, namely, crosstabs and χ2 tests, considering a level of significance of 5 percent. Findings The results showed that the majority of the participants presently have some agricultural activity and one-third is thinking about starting one in the future. Most of the participants want to produce food organically, with significant differences among the countries studied in this paper. Most of the participants were enrolled in training activities in agriculture, especially those with higher education. This participation showed significant differences between countries as well as according to the dimension of the farms owned by the participants. A significant association was found between being a teacher in forming activities related to agriculture and being a farmer. When compared to distance learning, the training activities in classroom were the most frequent, with significant differences among the countries. Practical implications This study allowed characterizing the learning activities in the field of organic agriculture and established vision for planning of future training programs, in different countries, with maybe different social, educational and cultural realities. Originality/value Because the study included the participation of people from several countries all around Europe, the results obtained enrich the scientific area of training in organic farming, in view of distance learning vs classroom learning on a more global basis.

Professionalizing public service delivery

2015 ◽  
Vol 29 (5) ◽  
pp. 22-24
Keyword(s):  
Service Delivery ◽  
Public Service ◽  
New Technologies ◽  
Professional Status ◽  
Public Service Delivery ◽  
Content Type ◽  
Health And Social Care ◽  
The Uk ◽  
Ideological Tensions ◽  
Practical Implications

Purpose – To consider the concepts of amateurism and professionalism, distinguishing these from professional or amateur status. Design/methodology/approach – Outlines the drive for the professionalization of public service delivery in Europe. Explains how the divide between professional and amateur status has developed and considers its implications. Findings – You are about to have an operation: would you prefer a professionally qualified surgeon or an enthusiastic amateur? Professional status provides reassurance about competence, qualifications and standards. The professionalization of service delivery – particularly in the areas of education, health and social care – has been an issue for some time, especially in the UK. But more attention is also now being given to the contribution made by non-professionals such as teaching assistants, family carers and volunteers. Practical implications – Draws attention to the way new technologies are blurring the distinction between amateur and professional in many areas and providing new opportunities for them to work productively together. Social implications – Highlights the ideological tensions underlying the debate about professionalization, qualifications and how public services are delivered. Originality/value – Presents a wide-ranging discussion of the amateur–professional divide, the contributions made by each and the opportunities for further research in this area.

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