scholarly journals Use of a maternal newborn audit and feedback system in Ontario: a collective case study

2019 ◽  
Vol 28 (8) ◽  
pp. 635-644 ◽  
Author(s):  
Jessica Reszel ◽  
Sandra I Dunn ◽  
Ann E Sprague ◽  
Ian D Graham ◽  
Jeremy M Grimshaw ◽  
...  
Keyword(s):  
Focus Groups ◽  
Qualitative Content Analysis ◽  
Interdisciplinary Collaboration ◽  
Newborn Care ◽  
Feedback System ◽  
Practice Change ◽  
Audit And Feedback ◽  
Feedback Systems ◽  
Collective Case Study

BackgroundAs part of a larger study examining the effectiveness of the Maternal Newborn Dashboard, an electronic audit and feedback system to improve maternal-newborn care practices and outcomes, the purpose of this study was to increase our understanding of factors explaining variability in performance after implementation of the Dashboard in Ontario, Canada.MethodsA collective case study. A maximum variation sampling approach was used to invite hospitals reflecting different criteria to participate in a 1-day to 2-day site visit by the research team. The visits included: (1) semistructured interviews and focus groups with healthcare providers, leaders and personnel involved in clinical change processes; (2) observations and document review. Interviews and focus groups were audio-recorded and transcribed verbatim. Qualitative content analysis was used to code and categorise the data.ResultsBetween June and November 2016, we visited 14 maternal-newborn hospitals. Hospitals were grouped into four quadrants based on their key indicator performance and level of engagement with the Dashboard. Findings revealed four overarching themes that contribute to the varying success of sites in achieving practice change on the Dashboard key performance indicators, namely, interdisciplinary collaboration and accountability, application of formal change strategies, team trust and use of evidence and data, as well as alignment with organisational priorities and support.ConclusionThe diversity of facilitators and barriers across the 14 hospitals highlights the need to go beyond a ‘one size fits all’ approach when implementing audit and feedback systems. Future work to identify tools to assess barriers to practice change and to evaluate the effects of cointerventions to optimise audit and feedback systems for clinical practice change is needed.

scholarly journals Making way for a clinical feedback system in the narrow space between sessions: navigating competing demands in complex healthcare settings

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Runar Tengel Hovland ◽  
Christian Moltu
Keyword(s):  
Qualitative Methodology ◽  
Public Mental Health ◽  
Feedback System ◽  
Routine Practice ◽  
Feedback Systems ◽  
Clinical Value ◽  
Healthcare Settings ◽  
Clinical Feedback ◽  
Narrow Space

Abstract Background Although substantial empirical research supports the clinical value of routine outcome measures/clinical feedback systems (ROM/CFS), translation into routine practice poses several challenges. The present case study investigated how stakeholders, clinicians, patients and clinical managers related to the implementation of the Norse Feedback (NF) in ordinary practice. Methods We did an in-depth qualitative case study of the implementation of NF in a public mental-health institution. The settings were two outpatient clinics and two in-patient clinics organized under the same health trust. Data were drawn from three sources: archival sources (n = 16), field notes (n = 23), and 43 in-depth interviews with clinicians (n = 19), clinical managers (n = 5) and patients (n = 12). Ten of the participants were interviewed twice. The data were coded inductively and analyzed using a stringent qualitative methodology. Results We present our findings under three inter-related domains. First, we describe what followed the clinical feedback implementation. Second, we present the context experienced as being complex and high on work-pressure. Third, we describe the situated rules about the priority between competing tasks. Conclusions The preliminary results complement and contextualize understandings of known barriers to implementing ROM/CFS in clinical settings. We apply a socio-material perspective to discuss clinicians’ responses to complexity, implementation, and why some incentivized tasks prevailed over others regardless of therapists’ perceived benefits.

scholarly journals What motivates general practitioners to change practice behaviour? A qualitative study of audit and feedback group sessions in Dutch general practice

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e025286 ◽  
Author(s):  
Marije van Braak ◽  
Mechteld Visser ◽  
Marije Holtrop ◽  
Ilona Statius Muller ◽  
Jettie Bont ◽  
...  
Keyword(s):  
Focus Groups ◽  
General Practitioners ◽  
Group Discussion ◽  
Practice Change ◽  
Added Value ◽  
Audit And Feedback ◽  
Care Practice ◽  
Motivation To Change ◽  
Feedback Group ◽  
Group Sessions

ObjectivesAdopting an attributional perspective, the current article investigates how audit and feedback group sessions contribute to general practitioners’ (GPs) motivation to change their practice behaviour to improve care. We focus on the contributions of the audit and feedback itself (content) and the group discussion (process).MethodsFour focus groups, comprising a total of 39 participating Dutch GPs, discussed and compared audit and feedback of their practices. The focus groups were analysed thematically.ResultsAudit and feedback contributed to GPs’ motivation to change in two ways: by raising awareness about aspects of their current care practice and by providing indications of the possible impact of change. For these contributions to play out, the audit and feedback should be reliable and valid, specific, recent and recurrent and concern GPs’ own practices or practices within their own influence sphere. Care behaviour attributed to external, uncontrollable or unstable causes would not induce change. The added value of the group is twofold as well: group discussion contributed to GPs’ motivation to change by providing a frame of reference and by affording insights that participants would not have been able to achieve on their own.ConclusionsIn audit and feedback group sessions, both audit and feedback information and group discussion can valuably contribute to GPs’ motivation to change care practice behaviour. Peer interaction can positively contribute to explore alternative practices and avenues for improvement. Local or regional peer meetings would be beneficial in facilitating reflection and discussion. An important avenue for future studies is to explore the contribution of audit and feedback and small-group discussion to actual practice change.

Improving the development and implementation of audit and feedback systems to support healthcare workers in limiting antimicrobial resistance in the hospital: a scoping review. (Preprint)

2021 ◽  
Author(s):  
Julia Keizer ◽  
Britt E. Bente ◽  
Nashwan Al Naiemi ◽  
Lisette Van Gemert-Pijnen ◽  
Nienke Beerlage-De Jong
Keyword(s):  
Antimicrobial Resistance ◽  
Conceptual Framework ◽  
Scoping Review ◽  
Implementation Strategies ◽  
Implementation Process ◽  
Action Planning ◽  
Feedback System ◽  
Audit And Feedback ◽  
Feedback Systems ◽  
Implementation Processes

BACKGROUND For eHealth technologies in general, and audit and feedback (AF) systems specifically, integrating interdisciplinary theoretical underpinnings is essential as it increases the likelihood of achieving desired outcomes by ensuring a fit between the eHealth technology, stakeholders, and their context. Additionally, reporting on the development and implementation process of AF systems, including substantiations of choices, enables the identification of best practices and accumulation of knowledge across studies, yet is often not elaborated on in publications. OBJECTIVE Therefore, this scoping review aims to 1) provide insights in development and implementation strategies for AF systems for a real-world problem that threatens modern healthcare care: antimicrobial resistance (AMR), and 2) provide an interdisciplinary conceptual framework that can serve as a checklist and guidance to make informed choices in the development and implementation of future AF systems. METHODS A scoping review was conducted by querying PubMed, Scopus, Web of Science, IEEE Xplore Digital Library, and EMBASE (≥2010) for studies describing the development and/or implementation process of an audit and feedback system for AMR or infections in hospitals. Studies reporting on effectiveness or impact only were excluded. Three independent reviewers performed study selection, and two reviewers constructed the conceptual framework through axial and selective coding of often used theories, models and frameworks (TMFs) from literature on AF and eHealth development and implementation. Subsequently, the conceptual framework was used for the systematic extraction and interpretation of studies' descriptions of the AF systems and their development and implementation. RESULTS The search resulted in 2125 studies screened for eligibility, of which 12 studies (2012-2020) were included. These studies described the development and/or implementation processes heterogeneously in terms of study aims, study targets, target groups, methods, and theoretical underpinnings. Few studies explicitly explained how choices for the development and implementation of AF-systems were substantiated by the TMFs. The conceptual framework provided insights in what is reported on the development and implementation process and revealed underreported AF system constructs (e.g. AF system design, engagement with the AF system, and comparison, goal setting and action planning), and development and implementation (e.g. champions) constructs. CONCLUSIONS This scoping review showed current heterogeneous reporting of AF systems and their development and implementation processes and exemplified how interdisciplinary TMFs can (and should) be balanced in a conceptual framework to capture relevant AF system and development/implementation constructs. Thereby, it provides a concrete checklist and overall guidance that supports the professionalization and harmonization of AF system development and implementation. For the development and implementation of future AF-systems, and other eHealth technologies, researchers and HCWs should be supported in selecting and integrating TMFs into their development and implementation process and encouraged to explicitly report on theoretical underpinnings and substantiation of choices.

Caregivers' Perceptions of Speech-Language Pathologist Talk About Child Language and Literacy Disorders

2020 ◽  
Vol 29 (4) ◽  
pp. 2049-2067
Author(s):  
Karmen L. Porter ◽  
Janna B. Oetting ◽  
Loretta Pecchioni
Keyword(s):  
Language And Literacy ◽  
Collective Case Study ◽  
Study Approach ◽  
School Aged Children ◽  
Speech Language Pathologist ◽  
Therapy Goals ◽  
Semistructured Interviews ◽  
Types Of Information

Purpose This study examined caregiver perceptions of their child's language and literacy disorder as influenced by communications with their speech-language pathologist. Method The participants were 12 caregivers of 10 school-aged children with language and literacy disorders. Employing qualitative methods, a collective case study approach was utilized in which the caregiver(s) of each child represented one case. The data came from semistructured interviews, codes emerged directly from the caregivers' responses during the interviews, and multiple coding passes using ATLAS.ti software were made until themes were evident. These themes were then further validated by conducting clinical file reviews and follow-up interviews with the caregivers. Results Caregivers' comments focused on the types of information received or not received, as well as the clarity of the information. This included information regarding their child's diagnosis, the long-term consequences of their child's disorder, and the connection between language and reading. Although caregivers were adept at describing their child's difficulties and therapy goals/objectives, their comments indicated that they struggled to understand their child's disorder in a way that was meaningful to them and their child. Conclusions The findings showed the value caregivers place on receiving clear and timely diagnostic information, as well as the complexity associated with caregivers' understanding of language and literacy disorders. The findings are discussed in terms of changes that could be made in clinical practice to better support children with language and literacy disorders and their families.

Developing design literacy through brand-based artefacts

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Catarina LELIS
Keyword(s):  
Empirical Study ◽  
Focus Groups ◽  
Design Process ◽  
Basic Design ◽  
Willingness To Participate ◽  
Socially Responsible ◽  
Interaction Structure ◽  
Functional Prototype ◽  
High Willingness

The brand is a powerful representational and identification-led asset that can be used to engage staff in creative, sustainable and developmental activities. Being a brand the result of, foremost, a design exercise, it is fair to suppose that it can be a relevant resource for the advancement of design literacy within organisational contexts. The main objective of this paper was to test and validate an interaction structure for an informed co-design process on visual brand artefacts. To carry on the empirical study, a university was chosen as case study as these contexts are generally rich in employee diversity. A non-functional prototype was designed, and walkthroughs were performed in five focus groups held with staff. The latter evidenced a need/wish to engage with basic design principles and high willingness to participate in the creation of brand design artefacts, mostly with the purposeof increasing its consistent use and innovate in its representation possibilities, whilst augmenting the brand’s socially responsible values.

Optimal Model Reference Control Scheme Design for Nonlinear Strict-Feedback Systems

2020 ◽  
Vol 38 (9A) ◽  
pp. 1342-1351
Author(s):  
Musadaq A. Hadi ◽  
Hazem I. Ali
Keyword(s):  
Reference Model ◽  
Feedback System ◽  
Optimization Method ◽  
Feedback Systems ◽  
Model Reference ◽  
Scheme Design ◽  
Model Reference Control ◽  
Control Scheme ◽  
Lyapunov Stability Analysis ◽  
Strict Feedback

In this paper, a new design of the model reference control scheme is proposed in a class of nonlinear strict-feedback system. First, the system is analyzed using Lyapunov stability analysis. Next, a model reference is used to improve system performance. Then, the Integral Square Error (ISE) is considered as a cost function to drive the error between the reference model and the system to zero. After that, a powerful metaheuristic optimization method is used to optimize the parameters of the proposed controller. Finally, the results show that the proposed controller can effectively compensate for the strictly-feedback nonlinear system with more desirable performance.

scholarly journals Blending Indigenous Sharing Circle and Western Focus Group Methodologies for the Study of Indigenous Children’s Health: A Systematic Review

2021 ◽  
Vol 20 ◽  
pp. 160940692110151
Author(s):  
Sarah C. Hunt ◽  
Nancy L. Young
Keyword(s):  
Systematic Review ◽  
Focus Group ◽  
Focus Groups ◽  
Qualitative Content Analysis ◽  
Children's Health ◽  
Children’S Health ◽  
Community Advisory Board ◽  
Original Research ◽  
Research Approach ◽  
Sharing Circles

The primary objective of this systematic review was to investigate how Western focus groups and Indigenous sharing circles have been blended for the study of Indigenous children’s health. The secondary objective of this study was to propose recommendations for adapting focus groups to include elements of sharing circles. This systematic review was conducted using a systematic search of original research articles published between 2009 and 2020 that (a) focused on North American Indigenous children’s health and (b) used group-based qualitative methods including focus groups and sharing circles. Each of the articles was screened for relevance and quality. The methods sections were reviewed, subjected to qualitative content analysis, and codes were analyzed to identify common themes and synthesize results. We identified 29 articles, most of which followed a community-based participatory research approach. In these publications, most included a community advisory board, ethics approval was obtained, and in some cases, community members were included as research assistants. There was evidence that sharing circles and focus group methods had been blended in the recent Indigenous children’s health literature. This was particularly apparent in the authors’ approaches to recruitment, location, facilitation techniques, question format and reimbursement. Several groups have published results that describe approaches that successfully incorporated aspects of Indigenous sharing circles into Western focus groups, thus establishing a research method that is culturally safe and appropriate for the study of Indigenous children’s health.

Counseling during Real Ear Measurements: The Clients' Perspective

2021 ◽  
Author(s):  
Angela Ryall ◽  
Lorienne M. Jenstad ◽  
John Pumford ◽  
Tami Howe ◽  
Garnet Grosjean
Keyword(s):  
Focus Groups ◽  
Hearing Aids ◽  
Visual Information ◽  
Best Practice ◽  
Qualitative Content Analysis ◽  
Hearing Aid ◽  
Added Value ◽  
Centered Care ◽  
Prior Literature ◽  
First Time

Abstract Background When dispensing hearing aids, audiologists must follow validated fitting and verification procedures to ensure that the hearing aids are properly fitted to the client's hearing. Real ear measurements (REMs) are best practice for verifying hearing aids. Prior literature regarding REMs has mainly focused on the clinicians' perspective. Purpose This study investigated informational counseling throughout REMs by gathering perspectives of first-time hearing aid users regarding the content and format of counseling. Research Design The study used an interpretive description approach with focus groups. Study Sample There were 16 adult participants (4 males, 12 females) who were first-time hearing aid users and who all had memory of REMs occurring during their own hearing aid verification. Intervention We investigated the addition of informational counseling during REM verification. Data Collection and Analysis Four focus groups were conducted to elicit feedback on a demonstration of informational counseling during REM hearing aid verification. The data from the focus groups were transcribed verbatim and analyzed using qualitative content analysis. Results Analysis revealed positive aspects, negative aspects, and suggested changes in relation to the verbal and visual information presented during the REM verification demonstration. These data fell into two broad categories: the interaction and transaction of informational counseling. Conclusion Most clients were interested in learning more about REMs if the information was accessible. Results provide recommendations for clinical audiologists and REM system manufacturers to make the information presented during informational counseling more client-friendly and individualized for client-centered care. To continue exploring this new inquiry, further experimental research is required to determine if there is any added value of incorporating informational counseling during REMs.

scholarly journals Hospital managers’ perspectives with implementing quality improvement measures and a new regulatory framework: a qualitative case study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e042847 ◽  
Author(s):  
Sina Furnes Øyri ◽  
Geir Sverre Braut ◽  
Carl Macrae ◽  
Siri Wiig
Keyword(s):  
Quality Improvement ◽  
Adaptive Capacity ◽  
Qualitative Content Analysis ◽  
Regulatory Framework ◽  
Local Context ◽  
Quality And Safety ◽  
Hospital Practice ◽  
Hospital Managers ◽  
Safety Improvement

A new regulatory framework to support local quality and safety efforts in hospitals was introduced to the Norwegian healthcare system in 2017. This study aimed to investigate hospital managers’ perspectives on implementation efforts and the resulting work practices, to understand if, and how, the new Quality Improvement Regulation influenced quality and safety improvement activities.DesignThis article reports one study level (the perspectives of hospital managers), as part of a multilevel case study. Data were collected by interviews and analysed according to qualitative content analysis.SettingThree hospitals retrieved from two regional health trusts in Norway.Participants20 hospital managers or quality advisers selected from different levels of hospital organisations.ResultsFour themes were identified in response to the study aim: (1) adaptive capacity in hospital management and practice, (2) implementation efforts and challenges with quality improvement, (3) systemic changes and (4) the potential to learn. Recent structural and cultural changes to, and development of, quality improvement systems in hospitals were discovered (3). Participants however, revealed no change in their practice solely due to the new Quality Improvement Regulation (2). Findings indicated that hospital managers are legally responsible for quality improvement implementation and participants described several benefits with the new Quality Improvement Regulation (2). This related to adaptation and flexibility to local context, and clinical autonomy as an inevitable element in hospital practice (1). Trust and a safe work environment were described as key factors to achieve adverse event reporting and support learning processes (4).ConclusionsThis study suggests that a lack of time, competence and/or motivation, impacted hospitals’ implementation of quality improvement efforts. Hospital managers’ autonomy and adaptive capacity to tailor quality improvement efforts were key for the new Quality Improvement Regulation to have any relevant impact on hospital practice and for it to influence quality and safety improvement activities.

scholarly journals Conducting Web-Based Focus Groups With Adolescents and Young Adults

2021 ◽  
Vol 20 ◽  
pp. 160940692199687
Author(s):  
Courtney A. Brown ◽  
Anna C. Revette ◽  
Sarah D. de Ferranti ◽  
Holly B. Fontenot ◽  
Holly C. Gooding
Keyword(s):  
Qualitative Research ◽  
Young Adults ◽  
Focus Groups ◽  
Clinical Sample ◽  
Adolescents And Young Adults ◽  
Web Based ◽  
Disease Awareness ◽  
Sex With Men ◽  
Technical Platform

This methodologic paper aims to update researchers working with adolescents and young adults on the potentials and pitfalls associated with web-based qualitative research. We present a case study of synchronous web-based focus groups with 35 adolescents and young women ages 15–24 years old recruited from a clinical sample for a mixed methods study of heart disease awareness. We contrast this with two other studies, one using asynchronous web-based focus groups with 30 transgender youth ages 13 to 24 years old and another using synchronous web-based focus groups with 48 young men who have sex with men ages 18 to 26 years old, both recruited via social media. We describe general and logistical considerations, technical platform considerations, and ethical, regulatory, and research considerations associated with web-based qualitative research. In an era of technology ubiquity and dependence, researchers should consider web-based focus groups a potential qualitative research tool, especially when working with youth.

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