A qualitative evaluation of the role of simulation in policy development for service improvement

2017 ◽  
Vol 4 (1) ◽  
pp. 19-22 ◽  
Author(s):  
Thomas Blanks ◽  
Nicholas Woodier ◽  
Bryn Baxendale ◽  
Mark Fores ◽  
Lynn Fullerton
Keyword(s):  
Drug Administration ◽  
Policy Development ◽  
Direct Injection ◽  
Qualitative Evaluation ◽  
Service Improvement ◽  
Semistructured Interview ◽  
Training Requirements ◽  
Wide Range ◽  
Simulation Based ◽  
New Policies

ObjectiveTo evaluate the efficacy of simulation-based techniques to prospectively assess developing polices prior to implementation.MethodsA self-selected sample of nursing staff from a local, acute hospital reviewed a draft intravenous drug administration policy before simulating drug administration of either an infusion or direct injection. The participants completed a postsimulation questionnaire regarding the new policy and simulation, took part in a semistructured interview and were observed during the simulation with their consent.Results10 staff attended the simulation. The emergent themes identified a wide range of factors relating to the everyday usability and practicalities of the policy. There were issues surrounding inconsistent language between different clinical teams and training requirements for the new policy.ConclusionSimulation, using simple scenarios, allows the safe evaluation of new policies before publication to ensure they are appropriate for front-line use. It engages staff in user-centred design in their own healthcare system.

scholarly journals Evaluating the impact of a national clinical leadership fellow scheme

BMJ Leader ◽  
2019 ◽  
Vol 3 (2) ◽  
pp. 37-42 ◽  
Author(s):  
Judy McKimm ◽  
Donna Hickford ◽  
Peter Lees ◽  
Kirsten Armit
Keyword(s):  
Policy Development ◽  
Success Factors ◽  
Service Improvement ◽  
Healthcare Leadership ◽  
Leadership And Management ◽  
Clinical Leadership ◽  
Healthcare Improvement ◽  
Wide Range ◽  
Unique Experience ◽  
The Impact

BackgroundThe drive towards engaging UK doctors in clinical leadership and management has involved a number of initiatives at various levels, including specific fellowships for doctors in training which enable them to take a year out of programme to work with senior leaders on service improvement or policy development projects.ObjectivesThis paper reports on the findings of an impact evaluation of a national Fellowship Scheme for doctors in training. The evaluation aimed to determine: What were the key success factors and areas for improvement of the Scheme? How did the Fellows experience the Scheme and how has this influenced their subsequent engagement, behaviours and thinking about healthcare leadership and management? What was the perceived impact of the Scheme?ParticipantsSix cohorts of Fellows and key stakeholders were involved in the evaluation .ResultsThe evaluation has clearly demonstrated the impact of this long-standing national Fellowship Scheme and the huge benefits for the individuals and organisations involved. For the Fellows, a national scheme such as this provides a unique experience, allowing them to learn first-hand from a range of senior decision-makers and engage in policy and strategic developments and processes.ConclusionsThis evaluation has demonstrated the wide impact of the Scheme but has also highlighted that more evaluations are needed of the wide range of fellowship schemes on offer to evidence broader impact, and raised issues around some of the difficulties these Fellows encounter on their return to practice in using their new skills to engage in service and healthcare improvement initiatives.

scholarly journals Back to the future. How scenarios of future globalisation, biotechnology, disease and climate change can inform present animal genetic resources policy development

2007 ◽  
Vol 41 ◽  
pp. 75-89 ◽  
Author(s):  
A.G. Drucker ◽  
S.J. Hiemstra ◽  
N. Louwaars ◽  
J.K. Oldenbroek ◽  
M.W. Tvedt ◽  
...  
Keyword(s):  
Climate Change ◽  
Genetic Resources ◽  
Policy Development ◽  
Future Perspective ◽  
Future Scenarios ◽  
Food And Agriculture ◽  
Animal Genetic Resources ◽  
Livestock Sector ◽  
Wide Range ◽  
New Policies

SummaryWith the aim of assessing how exchange practices regarding Animal Genetic Resources for Food and Agriculture (AnGR) affect the various stakeholders in the livestock sector and to identify policies and regulatory options that could guide the global exchange, use and conservation of AnGR, an exploration of future scenarios was used as a complementary approach to reviewing the current situation, as well as to identify stakeholders’ views on AnGR policy development.Four 2050 future scenarios were developed and included:1. Globalization and regionalization.2. Biotechnology development.3. Climate change and environmental degradation.4. Diseases and disasters.Having developed the scenarios, these were then used as an input point for a wide range of stakeholder consultations.The findings show that such an approach has been a useful analytical tool. The ‘far’ future perspective appeared to make people less defensive, especially in a situation where current exchange problems were not yet particularly visible or well documented. Many interviewees broadly considered that it was not a question of ‘if’ the scenarios would happen, but rather a question of ‘when’. This implies that we might do well to consider the need to respond to future challenges through the proactive development of new policies or regulations. Such a finding is partly in contrast with the general perception of the current regulatory situation being broadly acceptable.

Qualitative Evaluation of Just-in-Time Simulation-Based Learning

2013 ◽  
Vol 8 (1) ◽  
pp. 43-48 ◽  
Author(s):  
Gunjan Kamdar ◽  
David O. Kessler ◽  
Lindsey Tilt ◽  
Geetanjali Srivastava ◽  
Kajal Khanna ◽  
...  
Keyword(s):  
Qualitative Evaluation ◽  
Just In Time ◽  
Time Simulation ◽  
Simulation Based

Abstract TP132: Selection and Activation of Sites in a Large Multi-Center Randomized Clinical Trial

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Bart M Demaerschalk ◽  
Robert D Brown ◽  
Virginia J Howard ◽  
MeeLee Tom ◽  
Mary E Longbottom ◽  
...  
Keyword(s):  
Site Selection ◽  
Performance Metrics ◽  
Interventional Neuroradiology ◽  
Interquartile Range ◽  
Carotid Revascularization ◽  
Training Requirements ◽  
Medical Centers ◽  
Wide Range ◽  
The Times ◽  
And Training

Introduction: Careful selection and timely activation of clinical sites in multicenter clinical trials is critical for successful enrollment, subject safety, and generalizability of results. Methods: In the Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST-2), a multidisciplinary Site Selection Committee evaluated applicants referred via participation in CREST, CREST principal investigators (PIs) and other investigators, StrokeNet and industry partners. Data for consideration included performance metrics in CREST and other carotid trials and a site selection questionnaire containing information on the investigators as well as quantitative data on carotid procedures performed. Any FDA warning letters were reviewed. Results: The Committee met bi-weekly for 36 months (n=64 meetings). Applications from 176 sites between March 2014 and July 2016 were evaluated: 153 were approved, 7 are under Committee review, 5 were approved but withdrew, 5 were placed on a waiting list, and 6 were rejected. One-hundred-four sites have completed the regulatory and training requirements to randomize: 51 (49%) academic medical centers, 31 (30%) private hospital-based centers, 16 (15%) private office-based practices, and 6 (6%) Veterans Administration medical centers. The mean times from application-to- approval was 5.2 weeks (interquartile range, 1.9, 6.2), and from approval-to-randomization status was 46.7 weeks (interquartile range, 35.4, 51.7). Specialties of the 104 site PIs are vascular surgery for 35 (33.7%), cardiology for 30 (28.8%), neurology for 25 (24%), neurosurgery for 8 (7.7%), interventional radiology for 4 (3.8%), and interventional neuroradiology for 2 (1.9%). Conclusions: Careful site selection is time-consuming for prospective sites and for trial leadership. Times from application-to-site-approval were modest (mean = 5.2 weeks), in contrast to the times for completing regulatory and training requirements (mean = 46.7 weeks). However, subject enrollment by teams from a wide range of medical centers led by a multi-disciplinary cohort of PIs will promote the generalizability of trial results.

scholarly journals From behavioural simulation to computer models: how simulation can be used to improve healthcare management and policy

2018 ◽  
Vol 6 (2) ◽  
pp. 95-102 ◽  
Author(s):  
Guillaume Lamé ◽  
Rebecca K Simmons
Keyword(s):  
Computer Simulations ◽  
Policy Making ◽  
Simulation Method ◽  
Healthcare Management ◽  
Policies And Procedures ◽  
Simulation Based ◽  
Behavioural Simulation ◽  
Human Participants ◽  
New Policies

Simulation is a technique that evokes or replicates substantial aspects of the real world, in order to experiment with a simplified imitation of an operations system, for the purpose of better understanding and/or improving that system. Simulation provides a safe environment for investigating individual and organisational behaviour and a risk-free testbed for new policies and procedures. Therefore, it can complement or replace direct field observations and trial-and-error approaches, which can be time consuming, costly and difficult to carry out. However, simulation has low adoption as a research and improvement tool in healthcare management and policy-making. The literature on simulation in these fields is dispersed across different disciplinary traditions and typically focuses on a single simulation method. In this article, we examine how simulation can be used to investigate, understand and improve management and policy-making in healthcare organisations. We develop the rationale for using simulation and provide an integrative overview of existing approaches, using examples of in vivo behavioural simulations involving live participants, pure in silico computer simulations and intermediate approaches (virtual simulation) where human participants interact with computer simulations of health organisations. We also discuss the combination of these approaches to organisational simulation and the evaluation of simulation-based interventions.

scholarly journals Clinical risk management and child mental health

2003 ◽  
Vol 9 (5) ◽  
pp. 319-326 ◽  
Author(s):  
Fiona Subotsky
Keyword(s):  
Mental Health ◽  
Risk Management ◽  
Health Services ◽  
Child Mental Health ◽  
Policy Development ◽  
Clinical Governance ◽  
Clinical Risk Management ◽  
New Paradigm ◽  
Adult Services ◽  
Wide Range

Risk management is a requirement of clinical governance and a new paradigm for child and adolescent mental health services. Issues are different from those of adult services and a wide range need to be considered, which include not only the risk of harm to self, to others and from others but also from the system (by omission or commission) and to the staff. Systematic policy development, using information from audits, complaints, incidents and inquiries, will be helpful and interagency agreements necessary to promote coordination. The complex regulatory framework is discussed.

scholarly journals A Pilot Study of Clinicians' Perceptions of Feasibility, Client-Centeredness, and Usability of the Systematic Tailored Assessment for Responding to Suicidality Protocol

Crisis ◽  
2021 ◽  
Author(s):  
Jacinta Hawgood ◽  
Tamara Ownsworth ◽  
Helen Mason ◽  
Susan H. Spence ◽  
Ella Arensman ◽  
...  
Keyword(s):  
Pilot Study ◽  
Online Survey ◽  
Community Setting ◽  
Ease Of Use ◽  
Diverse Populations ◽  
Semistructured Interview ◽  
Psychosocial Needs ◽  
Convenience Sample ◽  
Training Requirements ◽  
Assessment Protocol

Abstract. Background: The Systematic Tailored Assessment for Responding to Suicidality (STARS) is a client-centered, psychosocial needs-based assessment protocol. This semistructured interview obtains client prioritized indicators that contribute to suicidality and informs commensurate care responses for preventing suicide. Aim: To pilot the feasibility, client-centeredness, and usability of the STARS protocol, including clinicians' perceptions of ease of use; content validity; and administration within the community setting. Method: A convenience sample of clinicians who undertook assessment and/or intervention with suicidal persons and had used STARS between mid-2016 and early 2017 completed an online survey assessing feasibility, client-centeredness, and usability of STARS. Results: Of the 51 clinicians who entered the survey, 42 (82.3%; aged 25–74; 69% female) completed it. Overall, perceptions of feasibility and usability of STARS were positive, particularly regarding client-centeredness of the protocol and confidence in information obtained for screening suicidality and informing needs-based priority responses. Limitations: The pilot findings are limited by the use of a small convenience sample and the low completion rate of clinicians with STARS training. Conclusion: STARS was perceived as a feasible and useful psychosocial needs-based assessment protocol. Suggestions for improving STARS, training requirements, and application to diverse populations are outlined.

scholarly journals Developing Best Practice in Linking and Sharing Administrative Data – A Comparison of Views in Health and Higher Education

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Jackie Street ◽  
Annette Braunack-Mayer ◽  
Stacy Carter ◽  
Tam Ha ◽  
Xiaoqi Feng ◽  
...  
Keyword(s):  
Higher Education ◽  
Administrative Data ◽  
Policy Development ◽  
Best Practice ◽  
Ethical Issues ◽  
Health Sector ◽  
Clear Understanding ◽  
Data Governance ◽  
Sensitive Data ◽  
Wide Range

IntroductionLarge administrative datasets are now being used for secondary purposes across a wide range of public sector organisations, including in health and higher education. However, governance, regulation and policy surrounding the use of these datasets are at different stages of development in these sectors. Our aim was to explore similarities and differences in the use of administrative data between the health and higher education sectors to inform policy development. Objectives and ApproachWe investigated views on the use of administrative data in both the health and higher education sectors. We conducted 18 qualitative in-depth interviews with key stakeholders, to provide insight into the ethical, social and legal issues associated with the use of big data in these settings. The interviews were transcribed and thematically coded. ResultsParticipants indicated the rapid pace of technological change and large volume of potentially sensitive data collected raises governance, infrastructure and ethical issues in both settings. Common challenges include communication, staff capabilities, delays in access, multiple policies and governance committees, and technical and operational issues. In the health sector, there was clear understanding of the issues and governance structures to address these issues, whereas this understanding was more variable in the higher education sector. Trust in government (to use responsibly and store securely) was raised in the health sector but not in universities. Conclusion / ImplicationsUnderstanding and use of administrative data are at quite different levels of development in the higher education and health sectors. Higher education needs policy and ethical guidance and higher level governance and greater consultation across the sector. Both sectors would benefit from a national approach to data governance.

scholarly journals Depolarization-Induced Ca2+ Entry Preferentially Evokes Release of Large Quanta in the Developing Xenopus Neuromuscular Junction

2010 ◽  
Vol 104 (5) ◽  
pp. 2730-2740 ◽  
Author(s):  
Xiao-Ping Sun ◽  
Bo-Ming Chen ◽  
Olav Sand ◽  
Yoshi Kidokoro ◽  
Alan D. Grinnell
Keyword(s):  
Synaptic Vesicles ◽  
Channel Blocker ◽  
Direct Injection ◽  
External Solution ◽  
Neuromuscular Synapses ◽  
Quantal Size ◽  
Amplitude Histogram ◽  
Wide Range ◽  
Patch Pipette ◽  
Second Peak

The amplitude histogram of spontaneously occurring miniature synaptic currents (mSCs) is skewed positively at developing Xenopus neuromuscular synapses formed in culture. To test whether the quantal size of nerve-evoked quanta (eSCs) distributes similarly, we compared the amplitude histogram of single quantum eSCs in low external Ca2+ with that of mSCs and found that nerve stimulation preferentially released large quanta. Depolarization of presynaptic terminals by elevating [K+] in the external solution or by direct injection of current through a patch pipette increased the mSC frequency and preferentially, but not exclusively, evoked the release of large quanta, resulting in a second broad peak in the amplitude histogram. Formation of the second peak under these conditions was blocked by the N-type Ca2+ channel blocker, ω-conotoxin GVIA. In contrast, when the mSC frequency was elevated by thapsigargin- or caffeine-induced mobilization of internal Ca2+, formation of the second peak did not occur. We conclude that the second peak in the amplitude histogram is generated by Ca2+ influx through N-type Ca2+ channels, causing a local elevation of internal Ca2+. The mSC amplitude in the positively skewed portion of the histogram varied over a wide range. A competitive blocker of acetylcholine (ACh) receptors, d-tubocurarine, reduced the amplitude of smaller mSCs in this range relatively more than that of larger mSCs, suggesting that this variation in the mSC amplitude is due to variable amounts of ACh released from synaptic vesicles. We suggest that Ca2+ influx through N-type Ca2+ channels preferentially induces release of vesicles with large ACh content.

Abstract 2524: Increasing the Proportion of Patients Treated with Stroke Thrombolysis: Reducing In-hospital Delays has Substantially More Impact than Extension of the Time Window

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Martin A James ◽  
Thomas Monks ◽  
Ken Stein ◽  
Martin Pitt
Keyword(s):  
Time Window ◽  
Discrete Event ◽  
Fold Increase ◽  
Service Improvement ◽  
Disability Benefit ◽  
Prospective Data ◽  
Stroke Service ◽  
Event Simulation ◽  
Simulation Based ◽  
The Impact

Background Pooled analyses show the benefit of IV alteplase for ischemic stroke up to 4·5 hours after onset, and expert guidelines have been updated to reflect this. However, the benefit from thrombolysis is critically time-dependent, and the additional benefit from extending the time window may be jeopardised by in-hospital delays. Methods We developed a discrete-event simulation based on prospective data from 1142 acute stroke patients arriving at our large district hospital over a two-year period to April 2011, modelling the time spent in the ED for triage and assessment, brain imaging and, if applicable, thrombolysis. Outputs from the model included arrival to treatment times (ATT), percentage of strokes thrombolysed, and the number of thrombolysed patients with a 90 day modified Rankin Scale (mRS) of 0-1. We sought to model the current stroke pathway (treatment <3 hours of onset), and compare it with developmental scenarios exploring the impact of extending treatment from 3 to 4.5 hours, of ED staff alerting the stroke service at triage, of ambulance pre-alert to the stroke service, and combinations of these measures. Results The model illustrates that extending the treatment window modestly increases the percentage of acute strokes thrombolysed, from 5% to 6% (95% CI 5.8-6.1%), and increases the number of thrombolysed patients with mRS 0-1 by 7 per year (95% CI 5.9-8.0). Both the triage alert and ambulance pre-alert scenarios increase thrombolysis rates to 15% (95% CI 14.9% to 15.7%); but the ambulance pre-alert reduces ATT by a mean of 27 mins (95% CI 26.3-28.4) compared to the triage alert scenario. The ambulance pre-alert scenario increases the number of thrombolysed patients with mRS 0-1 by 35/year (95% CI 32.9-37.7) compared to 22 (95% CI 20.4-23.5) in the triage alert scenario. Combining the treatment extension with either alerting measure does not increase the thrombolysis rate further (15%, 95% CI 14.7-15.1%). Sensitivity analysis illustrates that the pre-alert system is the least vulnerable to a drop in compliance rates. Conclusions Our simulation model shows that the greatest disability benefit accrues from measures to substantially reduce in-hospital delays to alteplase treatment - a potential three-fold increase in the proportion of patients treated. Compared to extending the time window for alteplase from 3 to 4.5 hours, eradicating in-hospital delays to treatment offers a five-fold greater disability benefit, and this should be the pre-eminent focus of service improvement for all emergency receiving hospitals.

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