scholarly journals How, why and under what circumstances does a quality improvement collaborative build knowledge and skills in clinicians working with people with dementia? A realist informed process evaluation

2021 ◽  
Vol 10 (2) ◽  
pp. e001147
Author(s):  
Lenore de la Perrelle ◽  
Monica Cations ◽  
Gaery Barbery ◽  
Gorjana Radisic ◽  
Billingsley Kaambwa ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Reflective Practice ◽  
Process Evaluation ◽  
Aged Care ◽  
Dementia Care ◽  
Quality Improvement Collaborative ◽  
Programme Theory ◽  
Post Intervention ◽  
Knowledge And Skills ◽  
People With Dementia

In increasingly constrained health and aged care services, strategies are needed to improve quality and translate evidence into practice. In dementia care, recent failures in quality and safety have led the WHO to prioritise the translation of known evidence into practice. While quality improvement collaboratives have been widely used in healthcare, there are few examples in dementia care.We describe a recent quality improvement collaborative to improve dementia care across Australia and assess the implementation outcomes of acceptability and feasibility of this strategy to translate known evidence into practice. A realist-informed process evaluation was used to analyse how, why and under what circumstances a quality improvement collaborative built knowledge and skills in clinicians working in dementia care.This realist-informed process evaluation developed, tested and refined the programme theory of a quality improvement collaborative. Data were collected pre-intervention and post-intervention using surveys and interviews with participants (n=28). A combined inductive and deductive data analysis process integrated three frameworks to examine the context and mechanisms of knowledge and skill building in participant clinicians.A refined program theory showed how and why clinicians built knowledge and skills in quality improvement in dementia care. Six mechanisms were identified: motivation, accountability, identity, collective learning, credibility and reflective practice. These mechanisms, in combination, operated to overcome constraints, role boundaries and pessimism about improved practice in dementia care.A quality improvement collaborative designed for clinicians in different contexts and roles was acceptable and feasible in building knowledge, skills and confidence of clinicians to improve dementia care. Supportive reflective practice and a credible, flexible and collaborative process optimised quality improvement knowledge and skills in clinicians working with people with dementia.Trial registration numberACTRN12618000268246.

scholarly journals HOW, WHY AND UNDER WHAT CIRCUMSTANCES DOES A QUALITY IMPROVEMENT COLLABORATIVE BUILD KNOWLEDGE AND SKILLS IN CLINICIANS WORKING WITH PEOPLE WITH DEMENTIA? A REALIST INFORMED PROCESS EVALUATION

2020 ◽  
Author(s):  
Lenore A de la Perrelle ◽  
Monica Cations ◽  
Gaery Barbery ◽  
Garjana Radisic ◽  
Billingsley Kaambwa ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Process Evaluation ◽  
World Health Organisation ◽  
Dementia Care ◽  
Program Theory ◽  
World Health ◽  
Quality Improvement Collaborative ◽  
Post Intervention ◽  
Knowledge And Skills ◽  
People With Dementia

In increasingly constrained health and aged care services, strategies are needed to improve quality and translate evidence into practice. In dementia care, recent failures in quality and safety have led the World Health Organisation to prioritise the translation of known evidence into practice. While quality improvement collaboratives have been widely used in healthcare, there are few examples in dementia care. We describe a recent quality improvement collaborative to improve dementia care across Australia and assess the implementation outcomes of acceptability and feasibility of this strategy to translate known evi-dence into practice. A realist-informed process evaluation was used to analyse how, why and under what circumstances a quality improvement collaborative built knowledge and skills in clinicians working in dementia care. This realist-informed process evaluation developed, tested, and refined the program theory of a quality improvement collaborative. Data were collected pre-and post-intervention using surveys and interviews with participants (n=24). A combined inductive and deductive data analysis process integrated three frameworks to examine the context and mechanisms of knowledge and skill building in participant clinicians. A refined program theory showed how and why clinicians built knowledge and skills in quality improvement in dementia care. Seven mechanisms were identified: motivation, accountability, identity, collective learning, credibility, and reflective practice. Each of these mechanisms operated differently according to context. A quality improvement collaborative designed for clinicians in different contexts and roles was acceptable and feasible in building knowledge and skills of clinicians to improve dementia care. A supportive setting and a credible, flexible, and collaborative process optimises quality improvement knowledge and skills in clinicians working with people with dementia.

scholarly journals Improving adherence to guideline recommendations in dementia care through establishing a quality improvement collaborative of agents of change: an interrupted time series study

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Kate Laver ◽  
Monica Cations ◽  
Gorjana Radisic ◽  
Lenore de la Perrelle ◽  
Richard Woodman ◽  
...  
Keyword(s):  
Time Series ◽  
Quality Improvement ◽  
Health Professionals ◽  
Interrupted Time Series ◽  
Aged Care ◽  
Dementia Care ◽  
Trial Registration ◽  
Guideline Recommendation ◽  
Quality Improvement Collaborative ◽  
People With Dementia

Abstract Background Non-pharmacological interventions including physical activity programmes, occupational therapy and caregiver education programmes have been shown to lead to better outcomes for people with dementia and their care partners. Yet, there are gaps between what is recommended in guidelines and what happens in practice. The aim of this study was to bring together clinicians working in dementia care and establish a quality improvement collaborative. The aim of the quality improvement collaborative was to increase self-reported guideline adherence to three guideline recommendations. Methods Interrupted time series. We recruited health professionals from community, hospital and aged care settings across Australia to join the collaborative. Members of the collaborative participated in a start-up meeting, completed an online learning course with clinical and quality improvement content, formed a quality improvement plan which was reviewed by a team of experts, received feedback following an audit of their current practice and were able to share experiences with their peers. The primary outcome was self-reported adherence to their guideline recommendation of interest which was measured using checklists. Data were collected monthly over a period of 18 months, and the study used an interrupted time series design and multilevel Poisson regression analysis to evaluate changes in self-reported adherence. Results A total of 45 health professionals (78% therapists) from different sites joined the collaborative and 28 completed all requirements. Data from 1717 checklists were included in the analyses. Over the duration of the project, there was a significant increase in clinician self-reported adherence to guideline recommendations with a 42.1% immediate increase in adherence (incidence rate ratio = 1.42; 95% confidence interval = 1.08–1.87; p = 0.012). Conclusion Health professionals working with people with dementia are interested in and willing to join a quality improvement collaborative with the goal of improving non-pharmacological aspects of care. Participation in the collaborative improved the quality of care for people with dementia as measured through self-reported adherence to guideline recommendations. Although there are challenges in implementation of guideline recommendations within dementia care, the quality improvement collaborative method was considered successful. A strength was that it equipped and empowered clinicians to lead improvement activities and allowed for heterogeneity in terms of service and setting. Trial registration ACTRN12618000268246

scholarly journals Improving the quality of dementia care through establishing a quality improvement collaborative of Agents of Change: an interrupted time series study

2020 ◽  
Author(s):  
Kate Laver ◽  
Monica Cations ◽  
Gorjana Radisic ◽  
Lenore de la Perrelle ◽  
Richard Woodman ◽  
...  
Keyword(s):  
Time Series ◽  
Quality Improvement ◽  
Health Professionals ◽  
Interrupted Time Series ◽  
Aged Care ◽  
Dementia Care ◽  
Guideline Recommendation ◽  
Quality Improvement Collaborative ◽  
People With Dementia

Abstract Background: Non-pharmacological interventions including physical activity programs, occupational therapy and caregiver education programs have been shown to lead to better outcomes for people with dementia and their care partners. Yet, there are gaps between what is recommended in guidelines and what happens in practice. The aim of this study was to bring together clinicians working in dementia care and establish a quality improvement collaborative. The aim of the quality improvement collaborative was to increase guideline adherence to three guideline recommendations. Methods: We recruited health professionals from community, hospital and aged care settings across Australia to join the collaborative. Members of the collaborative participated in a start-up meeting, completed an online learning course with clinical and quality improvement content, formed a quality improvement plan which was reviewed by a team of experts, received feedback following an audit of their current practice and were able to share experiences with their peers. The primary outcome was adherence to their guideline recommendation of interest which was measured using checklists. Data were collected monthly over a period of 18 months and the study used an interrupted time series design to evaluate changes in adherence. Results: A total of 45 health professionals (78% therapists) from different sites joined the collaborative and 28 completed all requirements. Data from 1717 checklists were included in the analyses. Over the duration of the project there was a significant increase in clinician adherence to guideline recommendations with a 42.1% immediate increase in adherence (Incidence Rate Ratio =1.42; 95% Confidence Interval =1.08-1.87; p=0.012). Conclusion: Health professionals working with people with dementia are interested and willing in joining a quality improvement collaborative with the goal of improving non-pharmacological aspects of care. Participation in the collaborative improved the quality of care for people with dementia as measured through adherence to guideline recommendations. Although there are challenges in implementation of guideline recommendations within dementia care the quality improvement collaborative method was well suited as it equipped and empowered clinicians to lead improvement activities and allowed for heterogeneity in terms of service and setting.

scholarly journals Quality improvement collaborative aiming for Proactive HEAlthcare of Older People in Care Homes (PEACH): a realist evaluation protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e023287 ◽  
Author(s):  
Reena Devi ◽  
Julienne Meyer ◽  
Jay Banerjee ◽  
Claire Goodman ◽  
John Raymond Fletcher Gladman ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Older People ◽  
Care Home ◽  
Realist Evaluation ◽  
Evaluation Framework ◽  
Care Homes ◽  
Quality Improvement Initiative ◽  
Quality Improvement Collaborative ◽  
Programme Theory ◽  
Health And Social Care

IntroductionThis protocol describes a study of a quality improvement collaborative (QIC) to support implementation and delivery of comprehensive geriatric assessment (CGA) in UK care homes. The QIC will be formed of health and social care professionals working in and with care homes and will be supported by clinical, quality improvement and research specialists. QIC participants will receive quality improvement training using the Model for Improvement. An appreciative approach to working with care homes will be encouraged through facilitated shared learning events, quality improvement coaching and assistance with project evaluation.Methods and analysisThe QIC will be delivered across a range of partnering organisations which plan, deliver and evaluate health services for care home residents in four local areas of one geographical region. A realist evaluation framework will be used to develop a programme theory informing how QICs are thought to work, for whom and in what ways when used to implement and deliver CGA in care homes. Data collection will involve participant observations of the QIC over 18 months, and interviews/focus groups with QIC participants to iteratively define, refine, test or refute the programme theory. Two researchers will analyse field notes, and interview/focus group transcripts, coding data using inductive and deductive analysis. The key findings and linked programme theory will be summarised as context-mechanism-outcome configurations describing what needs to be in place to use QICs to implement service improvements in care homes.Ethics and disseminationThe study protocol was reviewed by the National Health Service Health Research Authority (London Bromley research ethics committee reference: 205840) and the University of Nottingham (reference: LT07092016) ethics committees. Both determined that the Proactive HEAlthcare of Older People in Care Homes study was a service and quality improvement initiative. Findings will be shared nationally and internationally through conference presentations, publication in peer-reviewed journals, a graphical illustration and a dissemination video.

scholarly journals A process evaluation of the quality improvement collaborative for a community-based family planning learning site in Uganda

2019 ◽  
Vol 3 ◽  
pp. 1481
Author(s):  
Christine Kim ◽  
Ramadhan Kirunda ◽  
Frederick Mubiru ◽  
Nilufar Rakhmanova ◽  
Leigh Wynne
Keyword(s):  
Quality Improvement ◽  
Family Planning ◽  
Process Evaluation ◽  
Health Workers ◽  
Scale Up ◽  
Data Interpretation ◽  
Quality Improvement Collaborative ◽  
Community Based ◽  
Village Health Team ◽  
Facility Level

Background: High-quality family planning (FP) services have been associated with increased FP service demand and use, resulting in improved health outcomes for women. Community-based family planning (CBFP) is a key strategy in expanding access to FP services through community health workers or Village Health Team (VHTs) members in Uganda. We established the first CBFP learning site in Busia district, Uganda, using a quality improvement collaborative (QIC) model. This process evaluation aims to understand the QIC adaptation process, supportive implementation factors and trends in FP uptake and retention.Methods:We collected data from two program districts: Busia (learning site) and Oyam (scale-up). We used a descriptive mixed-methods process evaluation design: desk review of program documents, program monitoring data and in-depth interviews and focus group discussions.Results:The quality improvement (QI) process strengthened linkages between health services provided in communities and health centers. Routine interaction of VHTs, clients and midwives generated improvement ideas. Participants reported increased learning through midwife mentorship of VHTs, supportive supervision, monthly meetings, data interpretation and learning sessions. Three areas for potential sustainability and institutionalization of the QI efforts were identified: the integration of QI into other services, district-level plans and support for the QIC and motivation of QI teams. Challenges in the replication of this model include the community-level capacity for data recording and interpretation, the need to simplify QI terminology and tools for VHTs and travel reimbursements for meetings. We found positive trends in the number of women on an FP method, the number of returning clients and the number of couples counseled.Conclusions:A QIC can be a positive approach to improve VHT service delivery. Working with VHTs on QI presents specific challenges compared to working at the facility level. To strengthen the implementation of this CBFP QIC and other community-based QICs, we provide program-relevant recommendations.

scholarly journals Advance care planning with people with dementia: a process evaluation of an educational intervention for general practitioners

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Bram Tilburgs ◽  
Raymond Koopmans ◽  
Henk Schers ◽  
Carolien Smits ◽  
Myrra Vernooij-Dassen ◽  
...  
Keyword(s):  
Process Evaluation ◽  
General Practitioners ◽  
Advance Care Planning ◽  
Educational Intervention ◽  
Contextual Factors ◽  
Heterogeneous Group ◽  
Care Planning ◽  
Post Intervention ◽  
People With Dementia ◽  
Advance Care

Abstract Background General practitioners (GPs) are advised to offer advance care planning (ACP) to people with dementia (PWD). In a randomized controlled trial, an educational intervention for GPs aimed at initiating and optimizing ACP proved to be effective. During the intervention most GPs were accompanied by their practice nurse (PN). To provide insights into the intervention’s successful components and what could be improved, we conducted a process evaluation and explored implementation, mechanisms of impact and contextual factors. Methods We used the Medical Research Council guidance for process evaluations. Implementation was explored identifying reach and acceptability. We performed descriptive analyses of participants’ characteristics; selection, inclusion and intervention attendance; a GP post-intervention survey on initiating ACP; a post intervention focus group with trainers of the intervention. Mechanisms of impact were explored identifying adoption and appropriateness. We used: participants’ intervention ratings; a GP post-intervention survey on conducting ACP; ACP documentation in PWD’s medical files; post-intervention interviews with PWD/FC dyads. All data was used to identify contextual factors. Results The intervention was implemented by a small percentage of the total Dutch GP population invited, who mostly included motivated PWD/FC dyads with relatively little burden, and PWD with limited cognitive decline. The mechanisms of impact for GPs were: interactively learning to initiate ACP with training actors with a heterogeneous group of GPs and PNs. For PWD/FCs dyads, discussing non-medical preferences was most essential regarding their SDM experience and QoL. Some dyads however found ACP stressful and not feasible. Younger female GPs more often initiated ACP. Male PWD and those with mild dementia more often had had ACP. These characteristics and the safe and intimate training setting, were important contextual facilitators. Conclusion We recommend Interventions aimed at improving ACP initiation with PWD by GPs to include interactive components and discussion of non-medical preferences. A safe environment and a heterogeneous group of participants facilitates such interventions. However, in practice not all FC/PWD dyads will be ready to start. Therefore, it is necessary to check their willingness when ACP is offered.

scholarly journals Qualitative process evaluation of the Perioperative Quality Improvement Programme (PQIP): study protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e030214 ◽  
Author(s):  
Duncan Wagstaff ◽  
S Ramani Moonesinghe ◽  
Naomi J Fulop ◽  
Cecilia Vindrola-Padros
Keyword(s):  
Quality Improvement ◽  
Process Evaluation ◽  
Elective Surgery ◽  
Project Team ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Programme Theory ◽  
Hospital Size ◽  
Quality Improvement Programme ◽  
Improvement Programme

IntroductionThe Perioperative Quality Improvement Programme (PQIP) is designed to measure complications after major elective surgery and improve these through feedback of data to clinicians. Previous research suggests that despite the significant resources which go into collecting data for national clinical audits, the information they contain is not always used effectively to improve local services.Methods and analysisWe will conduct a formative process evaluation of PQIP comprising a multisited qualitative study to analyse PQIP’s programme theory, barriers, facilitators and wider contextual factors that influence implementation. The research will be carried out with the PQIP project team and six National Health Service (NHS) Trusts in England, selected according to geographical location, type of hospital, size and level of engagement with PQIP. We will include one Trust which has not expressed interest in the PQIP for comparison and to explore the role of secular trend in any changes in practice. We will use semi-structured interviews (up to 144 in Trusts and 12 with the project team), non-participant observations (up to 150  hours) and documentary analysis. We will track the lifecycle of perioperative data, exploring the transformations it undergoes from creation to use. We will use framework analysis with categories both from our research questions and from themes emerging from the data.Ethics and disseminationEthical approval has been granted from the University College London Research Ethics Committee (ref 10375/001). Permissions to conduct research at NHS Trusts have been granted by local Research and Development offices in coordination with the Health Research Authority. We will follow guidelines for data security, confidentiality and information governance. Findings will be shared at regular time points with the PQIP project team to inform the implementation of the programme, and with participating NHS Trusts to help them reflect on how they currently use data for improvement of perioperative services.

scholarly journals Large-scale training in the essentials of dementia care in Australia: Dementia Care Skills for Aged Care Workers project

2009 ◽  
Vol 21 (S1) ◽  
pp. S53-S57 ◽  
Author(s):  
Richard Fleming ◽  
Diana FitzGerald
Keyword(s):  
Large Scale ◽  
Aged Care ◽  
Dementia Care ◽  
Cultural Backgrounds ◽  
Research Education ◽  
People With Dementia ◽  
Care Workers ◽  
Wide Range ◽  
Making A Difference ◽  
National Programs

ABSTRACTDementia has been identified as a national health priority in Australia. National programs in the areas of research, education and training have been established. The Dementia Care Skills for Aged Care Workers program is a three-year project that commenced in 2006. It has the goal of providing training in the essentials of dementia care to 17,000 staff of aged care services across Australia. Successful completion of the training results in the award of a nationally recognized qualification. Although the delivery of the training has been difficult in some areas – because of the long distances to be covered by trainers and trainees, a wide range of cultural backgrounds, and difficulties in finding staff to cover for people attending the training – the seven training organizations providing this training are on target to meet the goal. The project is being evaluated independently. The anecdotal reports available to date strongly suggest that the training is being well received and is making a difference to practice.A surprisingly large proportion of attendees (9%) have been registered nurses, which demonstrates the need among this group of staff for training in the care of people with dementia.

scholarly journals Interiority of a Disconnected Mind

2021 ◽  
Author(s):  
◽  
Sarah Cheetham
Keyword(s):  
New Zealand ◽  
Care Facility ◽  
Aged Care ◽  
Dementia Care ◽  
Living Environment ◽  
Rural People ◽  
Urban Living ◽  
People With Dementia ◽  
Rural Context ◽  
Staffing Requirements

<p>As the population of New Zealand ages, the rate of people with dementia is also increasing, creating greater demand for specialised dementia facilities. However, few of these are located in the rural context that New Zealand is known for. In addition, as a society we have created a stigma around aged care, and tend to design un-home-like and institutional centres. The importance of creating a space that provides contextual features, appropriate wayfinding and therapeutic characteristics has been overtaken by the need to design for efficiency of staffing requirements. Current settings and the relocation to a more urban living environment increases the confusion for those rural people with dementia, as there is little to prompt their memory or make them feel at home. This thesis proposes the design of a dementia care facility that reflects the lifestyle rural people have come from. It examines how these three aspects: context, wayfinding and therapeutic design can be included to enhance the design of a dementia facility, as well as create a space that is enlivening for the residents.</p>

scholarly journals A process evaluation of the quality improvement collaborative for a community-based family planning learning site in Uganda

2019 ◽  
Vol 3 ◽  
pp. 1481
Author(s):  
Christine Kim ◽  
Ramadhan Kirunda ◽  
Frederick Mubiru ◽  
Nilufar Rakhmanova ◽  
Leigh Wynne
Keyword(s):  
Quality Improvement ◽  
Family Planning ◽  
Process Evaluation ◽  
Health Workers ◽  
Scale Up ◽  
Data Interpretation ◽  
Quality Improvement Collaborative ◽  
Community Based ◽  
Village Health Team ◽  
Facility Level

Background: High-quality family planning (FP) services have been associated with increased FP service demand and use, resulting in improved health outcomes for women. Community-based family planning (CBFP) is a key strategy in expanding access to FP services through community health workers or Village Health Team (VHTs) members in Uganda. We established the first CBFP learning site in Busia district, Uganda, using a quality improvement collaborative (QIC) model. This process evaluation aims to understand the QIC adaptation process, supportive implementation factors and trends in FP uptake and retention.Methods:We collected data from two program districts: Busia (learning site) and Oyam (scale-up). We used a descriptive mixed-methods process evaluation design: desk review of program documents, program monitoring data and in-depth interviews and focus group discussions.Results:The quality improvement (QI) process strengthened linkages between health services provided in communities and health centers. Routine interaction of VHTs, clients and midwives generated improvement ideas. Participants reported increased learning through midwife mentorship of VHTs, supportive supervision, monthly meetings, data interpretation and learning sessions. Three areas for potential sustainability and institutionalization of the QI efforts were identified: the integration of QI into other services, district-level plans and support for the QIC and motivation of QI teams. Challenges in the replication of this model include the community-level capacity for data recording and interpretation, the need to simplify QI terminology and tools for VHTs and travel reimbursements for meetings. We found positive trends in the number of women on an FP method, the number of returning clients and the number of couples counseled.Conclusions:A QIC can be a positive approach to improve VHT service delivery. Working with VHTs on QI presents specific challenges compared to working at the facility level. To strengthen the implementation of this CBFP QIC and other community-based QICs, we provide program-relevant recommendations.

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