Does team reflexivity impact teamwork and communication in interprofessional hospital-based healthcare teams? A systematic review and narrative synthesis

BackgroundTeamwork and communication are recognised as key contributors to safe and high-quality patient care. Interventions targeting process and relational aspects of care may therefore provide patient safety solutions that reflect the complex nature of healthcare. Team reflexivity is one such approach with the potential to support improvements in communication and teamwork, where reflexivity is defined as the ability to pay critical attention to individual and team practices with reference to social and contextual information.ObjectiveTo systematically review articles that describe the use of team reflexivity in interprofessional hospital-based healthcare teams.MethodsFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, six electronic databases were searched to identify literature investigating the use of team reflexivity in interprofessional hospital-based healthcare teams.The review includes articles investigating the use of team reflexivity to improve teamwork and communication in any naturally occurring hospital-based healthcare teams. Articles’ eligibility was validated by two second reviewers (5%).ResultsFifteen empirical articles were included in the review. Simulation training and video-reflexive ethnography (VRE) were the most commonly used forms of team reflexivity. Included articles focused on the use of reflexive interventions to improve teamwork and communication within interprofessional healthcare teams. Communication during interprofessional teamworking was the most prominent focus of improvement methods. The nature of this review only allows assessment of team reflexivity as an activity embedded within specific methods. Poorly defined methodological information relating to reflexivity in the reviewed studies made it difficult to draw conclusive evidence about the impact of reflexivity alone.ConclusionThe reviewed literature suggests that VRE is well placed to provide more locally appropriate solutions to contributory patient safety factors, ranging from individual and social learning to improvements in practices and systems.Trial registration numberCRD42017055602.

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Efficacy and safety of aliskiren combination therapy: a protocol for an umbrella review

BMJ Open ◽

10.1136/bmjopen-2020-043807 ◽

2021 ◽

Vol 11 (3) ◽

pp. e043807

Author(s):

Jiantong Shen ◽

Wenming Feng ◽

Yike Wang ◽

Qiyuan Zhao ◽

Billong Laura Flavorta ◽

...

Keyword(s):

Combination Therapy ◽

Systematic Reviews ◽

Cochrane Library ◽

Umbrella Review ◽

Quality Of Reporting ◽

Ethical Approval ◽

Registration Number ◽

Third Person ◽

Meta Analyses ◽

The Impact

IntroductionEfficacy of aliskiren combination therapy with other antihypertensive has been evaluated in the treatment of patients with hypertension in recent systematic reviews. However, most previous reviews only focused on one single health outcome or one setting, none of them made a full summary that assessed the impact of aliskiren combination treatment comprehensively. As such, this umbrella review based on systematic reviews and meta-analyses is aimed to synthesise the evidences on efficacy, safety and tolerability of aliskiren-based therapy for hypertension and related comorbid patients.Methods and analysisA comprehensive search of PubMed, EMBASE, Cochrane Library, CNKI published from inception to August 2020 will be conducted. The selected articles are systematic reviews which evaluated efficacy, safety and tolerability of aliskiren combination therapy. Two reviewers will screen eligible articles, extract data and evaluate quality independently. Any disputes will be resolved by discussion or the arbitration of a third person. The quality of reporting evidence will be assessed using the Assessment of Multiple Systematic Reviews V.2 tool tool. We will take a mixed-methods approach to synthesising the review literatures, reporting summary of findings tables and iteratively mapping the results.Ethics and disseminationEthical approval is not required for the study, as we would only collect data from available published materials. This umbrella review will be also submitted to a peer-reviewed journal for publication after completion.PROSPERO registration numberCRD42020192131.

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The Optimal Time of Applying Enteral Immunonutrition in Esophageal Cancer Patients Receiving Esophagectomy: A Network Meta-Analysis of Randomized Clinical Trials

10.21203/rs.3.rs-235527/v1 ◽

2021 ◽

Author(s):

Xu Tian ◽

Yan-Fei Jin ◽

Zhao-Li Zhang ◽

Hui Chen ◽

Wei-Qing Chen ◽

...

Keyword(s):

Esophageal Cancer ◽

Cancer Patients ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Infectious Complications ◽

Cochrane Library ◽

Optimal Time ◽

Registration Number ◽

Meta Analyses ◽

The Impact

Abstract Background: Enteral immunonutrition (EIN) has been extensively applied in cancer patients, however its role in esophageal cancer (EC) patients receiving esophagectomy remains unclear. We performed this network meta-analysis to investigate the impact of EIN on patients undergoing surgery for EC and further determine the optimal time of applying EIN.Methods: We searched PubMed, EMBASE, Cochrane library, and China National Knowledgement Infrastructure (CNKI) to identify eligible studies. Categorical data was expressed as the odds ratio with 95% confidence interval (CI), and continuous data was expressed as mean difference (MD) with 95% CI. Pair-wise and network meta-analysis was performed to evaluate the impact of EIN on clinical outcomes using RevMan 5.3 and ADDIS V.1.16.8 softwares. The surface under the cumulative ranking curve (SUCRA) was calculated to rank all nutritional regimes.Results: Total 14 studies involving 1071 patients were included. Pair-wise meta-analysis indicated no difference between EIN regardless of the application time and standard EN (SEN), however subgroup analyses found that postoperative EIN was associated with decreased incidence of total infectious complications (OR=0.47; 95%CI=0.26 to 0.84; p=0.01) and pneumonia (OR=0.47; 95%CI=0.25 to 0.90; p=0.02) and shortened LOH (MD=-1.01; 95%CI=-1.44 to -0.57; p<0.001) compared to SEN, which were all supported by network meta-analyses. Ranking probability analysis further indicated that postoperative EIN has the highest probability of being the optimal option in terms of these three outcomes.Conclusions: Postoperative EIN should be preferentially utilized in EC patients undergoing esophagectomy because it has optimal potential of decreasing the risk of total infectious complications and pneumonia and shortening LOH.OSF registration number: 10.17605/OSF.IO/KJ9UY.

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Non-adherence to immunosuppressants following renal transplantation: a protocol for a systematic review

BMJ Open ◽

10.1136/bmjopen-2016-015411 ◽

2017 ◽

Vol 7 (9) ◽

pp. e015411 ◽

Cited By ~ 6

Author(s):

Abigail Hucker ◽

Frances Bunn ◽

Lewis Carpenter ◽

Christopher Lawrence ◽

Ken Farrington ◽

...

Keyword(s):

Systematic Review ◽

Renal Transplant ◽

Data Extraction ◽

Meta Analysis ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Data Extraction Form ◽

Registration Number ◽

Meta Analyses ◽

The Impact

IntroductionAdherence to immunosuppressant medication is essential for renal transplant recipients. This review aims to summarise what is known about non-adherence, with a view to providing comprehensive evidence to inform strategies aimed at advancing adherent behaviour.Methods and analysisA systematic review of quantitative studies that report adherence to immunosuppressants in adult (over 18 years) renal transplant recipients. The review will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines; study quality will be assessed using the Downs and Black checklist. Systematic searches will be completed across relevant databases. Two reviewers will independently extract data using a predefined data extraction form. We will summarise the operationalisation of adherence across studies and use narrative synthesis to identify factors associated with non-adherence. A meta-analysis will be conducted if there is sufficient homogeneity, and available data, across studies to estimate the prevalence of non-adherence in renal transplant recipients. Heterogeneity will be assessed using the I2test. Survival analysis will be conducted to estimate hazard ratios to explore the impact of non-adherence on graft survival, graft failure and patient survival.Ethics and disseminationFindings will be published in a peer-reviewed journal and disseminated at conferences for professionals and researchers. Review outcomes will help support clinical practice by highlighting the extent of non-adherence among adults, and in doing so, signpost the need for suitable intervention.Trial registration numberPROSPERO registration number (CRD42016038751).

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The impact of hospital accreditation on the quality of healthcare: a systematic literature review

BMC Health Services Research ◽

10.1186/s12913-021-07097-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mohammed Hussein ◽

Milena Pavlova ◽

Mostafa Ghalwash ◽

Wim Groot

Keyword(s):

Empirical Studies ◽

Hospital Setting ◽

Quality Of Healthcare ◽

Hospital Accreditation ◽

Hospital Readmission Rate ◽

Reasonable Evidence ◽

Registration Number ◽

Meta Analyses ◽

The Impact

Abstract Background Accreditation is viewed as a reputable tool to evaluate and enhance the quality of health care. However, its effect on performance and outcomes remains unclear. This review aimed to identify and analyze the evidence on the impact of hospital accreditation. Methods We systematically searched electronic databases (PubMed, CINAHL, PsycINFO, EMBASE, MEDLINE (OvidSP), CDSR, CENTRAL, ScienceDirect, SSCI, RSCI, SciELO, and KCI) and other sources using relevant subject headings. We included peer-reviewed quantitative studies published over the last two decades, irrespective of its design or language. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, two reviewers independently screened initially identified articles, reviewed the full-text of potentially relevant studies, extracted necessary data, and assessed the methodological quality of the included studies using a validated tool. The accreditation effects were synthesized and categorized thematically into six impact themes. Results We screened a total of 17,830 studies, of which 76 empirical studies that examined the impact of accreditation met our inclusion criteria. These studies were methodologically heterogeneous. Apart from the effect of accreditation on healthcare workers and particularly on job stress, our results indicate a consistent positive effect of hospital accreditation on safety culture, process-related performance measures, efficiency, and the patient length of stay, whereas employee satisfaction, patient satisfaction and experience, and 30-day hospital readmission rate were found to be unrelated to accreditation. Paradoxical results regarding the impact of accreditation on mortality rate and healthcare-associated infections hampered drawing firm conclusions on these outcome measures. Conclusion There is reasonable evidence to support the notion that compliance with accreditation standards has multiple plausible benefits in improving the performance in the hospital setting. Despite inconclusive evidence on causality, introducing hospital accreditation schemes stimulates performance improvement and patient safety. Efforts to incentivize and modernize accreditation are recommended to move towards institutionalization and sustaining the performance gains. PROSPERO registration number CRD42020167863.

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Redefining the Classroom

Online Course Management ◽

10.4018/978-1-5225-5472-1.ch037 ◽

2018 ◽

pp. 693-708

Author(s):

Shikha Gupta ◽

Sheetal Taneja ◽

Naveen Kumar

Keyword(s):

Higher Education ◽

Online Courses ◽

Conclusive Evidence ◽

Training Design ◽

Educational Training ◽

Higher Education System ◽

Education Practice ◽

Meta Analyses ◽

Start Ups ◽

The Impact

The printing technology revolutionized the dissemination of knowledge at a pace never conceived of earlier. In recent times, radio and television brought education within the reach of masses. More recently, the multimedia technology, and Internet have revolutionized the delivery of education. Top universities of the world have collaborated to develop massive open online courses (MOOCs) that are made available to public either free of charge or at a nominal cost. Mainly supported by start-ups such as Coursera, Udacity, and EdX, MOOCs are mostly created by universities in United States and Europe. This essay reviews the impact of these changes on higher education using available reports, articles, and meta-analyses. Although there is no conclusive evidence of the impact of MOOCs, there is a strong possibility of MOOCs leaving a lasting mark on the traditional higher education system. This chapter falls within the book section ‘RIA and education practice of MOOCs,' aligning to the discussion on the topic of ‘educational training design.'

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Conceptualizing a Quantitative Measurement Suite to Evaluate Healthcare Teams

Simulation & Gaming ◽

10.1177/10468781211066348 ◽

2022 ◽

pp. 104687812110663

Author(s):

John T. Paige ◽

Camille L. Rogers ◽

Kathryn E. Kerdolff ◽

Deborah D. Garbee ◽

Laura S. Bonanno ◽

...

Keyword(s):

Patient Safety ◽

Quantitative Measurement ◽

Complex Nature ◽

Portable Devices ◽

Assessment Instruments ◽

Healthcare Teams ◽

Team Assessment ◽

Quantitative Measurements ◽

Measurement Suite ◽

Construct Measurement

Background Current team assessment instruments in healthcare tend to involve rater-based evaluations that are susceptible to well-known biases. Recent advances in technology include portable devices to measure team-based activities. Consequently, the possibility exists to move away from rater-based assessments of team function by identifying quantitative measures to replace them. Aim This article aims to provide potential approaches to developing quantitative measurement suites involving large amounts of data to address the challenges of assessment presented by the complex nature of teamwork. Conclusion By addressing construct, measurement, and context components, we provide a practical approach to developing a suite to capture quantitative measurements that, through incorporation of social network analysis and aggregated other values, aligns with the Team Strategies & Tools to Enhance Performance and Patient SafetyTM (TeamSTEPPSTM) dimensions for fostering teamwork.

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P92 Power dynamics in healthcare teams – a barrier to team effectiveness and patient safety: A systematic review

BJS Open ◽

10.1093/bjsopen/zrab032.091 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

Emma Kearns ◽

Zuneera Khurshid ◽

Sabrina Anjara ◽

Aoife De Brún ◽

Brendan Rowan ◽

...

Keyword(s):

Systematic Review ◽

Patient Safety ◽

Team Effectiveness ◽

Negative Impact ◽

Cochrane Library ◽

Power Dynamics ◽

Team Communication ◽

Speaking Up ◽

Healthcare Teams ◽

The Impact

Abstract Introduction Hierarchies in healthcare teams are pervasive and widely acknowledged as impacting on working cultures. This review explores the impact of power dynamics in multidisciplinary healthcare teams on patient safety and team effectiveness. Methods A systematic review was conducted using five academic databases (PubMed, CINAHL, PsycInfo, Cochrane Library, Embase) between January 2010-2020. Potentially relevant articles were selected based on title and abstract review, followed by full text review, data extraction and data appraisal. Consistent with PRISMA guidelines, two researchers independently carried out all stages, from data screening to quality appraisal. A narrative synthesis was conducted. Results The databases searches yielded a total of 869 studies. 28 studies met the eligibility criteria and were included in the synthesis. Of these, 20 articles associated power dynamics with team effectiveness and 19 linked power dynamics to patient safety outcomes. Hierarchical power dynamics inhibit team communication and speaking up behaviours, which impacts team effectiveness and patient safety. Barriers to speaking up include workplace policies; respect for seniors’ experience; time pressures; feelings of intimidation and powerlessness; fears of reprisal and repercussions; perceived poor self-efficacy; lack of confidence and role clarity. Conclusion Hierarchies and power dynamics have a profoundly negative effect on patient safety and team effectiveness through their negative impact on communication and speaking up behaviours. Whilst hierarchies cannot be abolished, to improve team communication and collaboration, healthcare organisations and training programmes should consider initiatives that break down silos and promote an inclusive approach to patient care. Initiatives that target the practice of collective leadership and an open and supportive work environment have been shown to improve communication and team effectiveness. Theme: Cross-disciplinary research

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The impact of Huddles on a multidisciplinary healthcare teams’ work engagement, teamwork, and job satisfaction: a systematic review

10.22541/au.163398165.51988115/v1 ◽

2021 ◽

Author(s):

Brendan Rowan ◽

Sabrina Anjara ◽

Aoife De Brún ◽

Steve MacDonald ◽

Emma Kearns ◽

...

Keyword(s):

Systematic Review ◽

Job Satisfaction ◽

Work Engagement ◽

Positive Impact ◽

Improve Patient Safety ◽

Meta Analysis ◽

Healthcare Team ◽

Healthcare Staff ◽

Healthcare Teams ◽

The Impact

Job satisfaction and retention of healthcare staff remains an ongoing issue in many health systems. Huddles have been endorsed as a mechanism to improve patient safety by improving teamwork, collaboration, and communication in teams. This study synthesizes the literature to investigate the impact of huddles on job satisfaction, teamwork, and work engagement in multidisciplinary healthcare teams. Five academic databases were searched to conduct a systematic review of peer-reviewed literature published from January 2000 – January 2020. Articles were included if they (1) featured a daily huddle, were conducted in a healthcare setting, and involved a multidisciplinary team and (2) measured variables including job satisfaction, work engagement, or teamwork. Results were reported in accordance with the Systematic Synthesis Without Meta-analysis (SWiM) and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We identified 445 articles of which 12 met the eligibility criteria and are included in this review. All 12 studies found a predominantly positive impact on teamwork and job satisfaction. None of the studies discussed or reported evidence of the impact of huddles on work engagement. This review highlights the value of a daily multidisciplinary healthcare team huddle in improving job satisfaction and teamwork for the healthcare staff involved. However, there is a dearth of high-quality, peer-reviewed evidence regarding the direct impact of huddles on job satisfaction, teamwork and in particular on work engagement. Further research – particularly controlled studies on adoption, implementation, and outcomes for healthcare team culture – is needed to further assess this intervention.

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Redefining the Classroom

Macro-Level Learning through Massive Open Online Courses (MOOCs) - Advances in Educational Technologies and Instructional Design ◽

10.4018/978-1-4666-8324-2.ch010 ◽

2015 ◽

pp. 168-182 ◽

Cited By ~ 1

Author(s):

Shikha Gupta ◽

Sheetal Taneja ◽

Naveen Kumar

Keyword(s):

Higher Education ◽

Online Courses ◽

Conclusive Evidence ◽

Training Design ◽

Educational Training ◽

Higher Education System ◽

Education Practice ◽

Meta Analyses ◽

Start Ups ◽

The Impact

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Does Tax Increment Financing Pass the “But-for” Test in Missouri?

Economic Development Quarterly ◽

10.1177/0891242419859097 ◽

2019 ◽

Vol 33 (3) ◽

pp. 187-202

Author(s):

Ahmed Rachid El-Khattabi ◽

T. William Lester

Keyword(s):

Economic Development ◽

Kansas City ◽

Time Series Data ◽

Local Level ◽

Conclusive Evidence ◽

Series Data ◽

Tax Increment Financing ◽

Data Set ◽

Development Indicators ◽

The Impact

The use of tax increment financing (TIF) remains a popular, yet highly controversial, tool among policy makers in their efforts to promote economic development. This study conducts a comprehensive assessment of the effectiveness of Missouri’s TIF program, specifically in Kansas City and St. Louis, in creating economic opportunities. We build a time-series data set starting 1990 through 2012 of detailed employment levels, establishment counts, and sales at the census block-group level to run a set of difference-in-differences with matching estimates for the impact of TIF at the local level. Although we analyze the impact of TIF on a wide set of indicators and across various industry sectors, we find no conclusive evidence that the TIF program in either city has a causal impact on key economic development indicators.

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