Staff perceptions of how changes occur in an emergency department: a qualitative study

BMJ Leader ◽  
2020 ◽  
Vol 4 (4) ◽  
pp. 214-219
Author(s):  
Savithiri Ratnapalan ◽  
Daniel Lang
Keyword(s):  
Emergency Department ◽  
Secondary Analysis ◽  
Evaluation Process ◽  
University Teaching ◽  
System Level ◽  
Senior Managers ◽  
Staff Perceptions ◽  
Financial Cost ◽  
Paediatric Emergency Care ◽  
The Uk

IntroductionChanges in healthcare organisations often incur significant financial costs and disrupt of normal operations. The objective of this research was to explore staff perceptions of changes at a university teaching hospital in the UK.MethodsGrounded theory methodology was used to perform a secondary analysis of 41 interview transcripts from participants consisting of 20 physicians, 13 nurses, 2 support workers and 6 managers involved in paediatric emergency care at the hospital.ResultsFour major themes identified from the analysis were types of changes, change readiness, change triggers and challenges to implementing changes. Both planned and emergent changes can occur simultaneously, and emergency department staff are ready to manage them although external pressures seem to be the main trigger for changes, emergent changes appear to occur as initiatives to improve performance or improve services. Emergent changes at a systemic level have an inclusive planning, implementation and evaluation process. They have to be implemented at minimal cost and show the value of changes.Discussion and conclusionThese results suggest that emergent changes that were to be implemented at a system level had higher scrutiny of their value and to occur with zero or minimum financial cost. Planned changes implemented by senior management as top–down process should have similar procedures and scrutiny to emergent changes arising from staff, to ensure value for cost. Policy makers and senior managers should encourage and evaluate group or system level changes that arise as a bottom–up process and assess associated financial cost.

The Impact of Computer-Based Alternatives on the Use of Animals in Undergraduate Teaching: A Pilot Study

1995 ◽  
Vol 23 (4) ◽  
pp. 521-530
Author(s):  
David Dewhurst ◽  
Linda Jenkinson
Keyword(s):  
Pilot Study ◽  
Academic Staff ◽  
University Teaching ◽  
Undergraduate Teaching ◽  
Computer Assisted ◽  
Staff Perceptions ◽  
Alternative Approach ◽  
Computer Based ◽  
The Uk ◽  
The Impact

— The impact of computer-assisted learning (CAL) packages on the use of animals in university teaching has been investigated in universities in the UK and abroad. The pilot study has focused on two issues: a) academic staff perceptions of the usability of CAL packages designed to offer an alternative to animal practicals in physiology and pharmacology; and b) whether the use of such programs has led to a reduction in the number of animals used. A questionnaire survey of purchasers of a minimum of three commercially available programs, which offer an alternative approach to traditional laboratory experiments, was conducted. The study found that in most departments the packages were used in a staff-supervised learning situation, to either replace or support a practical class. Their use saved academic and non-academic staff time, and they were considered to be less expensive and an effective and enjoyable mode of student learning. It was also clear that their use had contributed to a significant reduction in animal use.

Has the SARS-CoV-2 outbreak had an impact on uptake of digital cessation support in UK smokers? An interrupted time series analysis (Preprint)

2020 ◽  
Author(s):  
Olga Perski ◽  
Aleksandra Herbec ◽  
Lion Shahab ◽  
Jamie Brown
Keyword(s):  
Time Series ◽  
Smoking Cessation ◽  
Secondary Analysis ◽  
Interrupted Time Series ◽  
Step Change ◽  
Outcome Variable ◽  
Primary Analysis ◽  
Increasing Trend ◽  
The Uk ◽  
Temporary Closure

BACKGROUND The SARS-CoV-2 outbreak may motivate smokers to attempt to stop in greater numbers. However, given the temporary closure of UK stop smoking services and vape shops, smokers attempting to quit may instead seek out digital support, such as websites and smartphone apps. OBJECTIVE We examined, using an interrupted time series approach, whether the SARS-CoV-2 outbreak has been associated with a step change or increasing trend in UK downloads of an otherwise popular smoking cessation app, Smoke Free. METHODS Data were from daily and non-daily adult smokers in the UK who had downloaded the Smoke Free app between 1 January 2020 and 31 March 2020 (primary analysis) and 1 January 2019 and 31 March 2020 (secondary analysis). The outcome variable was the number of downloads aggregated at the 12-hourly (primary analysis) or daily level (secondary analysis). The explanatory variable was the start of the SARS-CoV-2 outbreak, operationalised as 1 March 2020 (primary analysis) and 15 January 2020 (secondary analysis). Generalised Additive Mixed Models adjusted for relevant covariates were fitted. RESULTS Data were collected on 45,105 (primary analysis) and 119,881 (secondary analysis) users. In both analyses, there was no evidence for a step change or increasing trend in downloads attributable to the start of the SARS-CoV-2 outbreak. CONCLUSIONS In the UK, between 1 January 2020 and 31 March 2020, and between 1 January 2019 and 31 March 2020, there was no evidence that the SARS-CoV-2 outbreak has been associated with a surge in downloads of a popular smoking cessation app. CLINICALTRIAL osf.io/zan2s

scholarly journals Drivers of Broad-Spectrum Antibiotic Overuse across Diverse Hospital Contexts—A Qualitative Study of Prescribers in the UK, Sri Lanka and South Africa

Antibiotics ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 94
Author(s):  
Carolyn Tarrant ◽  
Andrew M. Colman ◽  
David R. Jenkins ◽  
Edmund Chattoe-Brown ◽  
Nelun Perera ◽  
...  
Keyword(s):  
South Africa ◽  
Sri Lanka ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Low Income ◽  
System Level ◽  
Comparative Approach ◽  
Structured Interviews ◽  
Public And Private ◽  
The Uk

Antimicrobial stewardship programs focus on reducing overuse of broad-spectrum antibiotics (BSAs), primarily through interventions to change prescribing behavior. This study aims to identify multi-level influences on BSA overuse across diverse high and low income, and public and private, healthcare contexts. Semi-structured interviews were conducted with 46 prescribers from hospitals in the UK, Sri Lanka, and South Africa, including public and private providers. Interviews explored decision making about prescribing BSAs, drivers of the use of BSAs, and benefits of BSAs to various stakeholders, and were analyzed using a constant comparative approach. Analysis identified drivers of BSA overuse at the individual, social and structural levels. Structural drivers of overuse varied significantly across contexts and included: system-level factors generating tensions with stewardship goals; limited material resources within hospitals; and patient poverty, lack of infrastructure and resources in local communities. Antimicrobial stewardship needs to encompass efforts to reduce the reliance on BSAs as a solution to context-specific structural conditions.

scholarly journals Dysphagia Prevalence, Time Course, and Association with Probable Sarcopenia, Inactivity, Malnutrition, and Disease Status in Older Patients Admitted to an Emergency Department: A Secondary Analysis of Cohort Study Data

Geriatrics ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 46
Author(s):  
Tina Hansen ◽  
Rikke Lundsgaard Nielsen ◽  
Morten Baltzer Houlind ◽  
Juliette Tavenier ◽  
Line Jee Hartmann Rasmussen ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Cohort Study ◽  
Systemic Inflammation ◽  
Older Patients ◽  
Time Course ◽  
Assessment Tool ◽  
Handgrip Strength ◽  
Secondary Analysis ◽  
Disease Status

There is evolving evidence for an association between dysphagia and sarcopenia in older adults. For optimizing the acute health care initiative across health care settings, this study investigated prevalence and time-course of dysphagia in older patients admitted to an emergency department (ED) as well as its association with parameters for probable sarcopenia, inactivity, malnutrition, disease status, and systemic inflammation. A secondary analysis of data from the FAM-CPH cohort study on acutely admitted older medical patients (n = 125). Data were collected upon ED admission as well as four and 56 weeks after discharge. Using the Eating Assessment Tool cut-off score ≥ 2, signs of dysphagia were present in 34% of the patients at ED admission and persisted in 25% of the patients 56 weeks after discharge. Signs of dysphagia at 56-week follow-up were significantly (p < 0.05) associated with probable sarcopenia (low handgrip strength (OR = 3.79), low leg muscle strength (OR = 8.14), and low physical performance (OR = 5.68)) and with baseline swallowing inactivity (OR = 5.61), malnutrition (OR = 4.35), and systemic inflammation (OR = 1.33). Signs of dysphagia in older patients admitted to an ED was prevalent, persisted 56 weeks after discharge, and was associated with probable sarcopenia and related conditions; all modifiable targets for management of dysphagia in older patients.

scholarly journals Shape-shifting and pushing against the odds: staff perceptions of the experiences of first generation students in South Africa and the UK

2021 ◽  
Author(s):  
Rachel Forsyth ◽  
Claire Hamshire ◽  
Danny Fontaine-Rainen ◽  
Leza Soldaat
Keyword(s):  
Higher Education ◽  
South Africa ◽  
First Generation ◽  
Teaching Practice ◽  
First Generation Students ◽  
Staff Perceptions ◽  
Staff Members ◽  
Diversity And Inclusion ◽  
University Life ◽  
The Uk

AbstractThe principles of diversity and inclusion are valued across the higher education sector, but the ways in which these principles are translated into pedagogic practice are not always evident. Students who are first in their family to attend university continue to report barriers to full participation in university life. They are more likely to leave their studies early, and to achieve lower grades in their final qualifications, than students whose families have previous experience of higher education. The purpose of this study was to explore whether a mismatch between staff perceptions and students’ experiences might be a possible contributor to these disparities. The study explored and compared staff discourses about the experiences of first generation students at two universities, one in the United Kingdom (UK), and the other in South Africa (SA). One-to-one interviews were carried out with 40 staff members (20 at each institution) to explore their views about first generation students. The results showed that staff were well aware of challenges faced by first generation students; however, they were unsure of their roles in relation to shaping an inclusive environment, and tended not to consider how to use the assets that they believed first generation students bring with them to higher education. This paper explores these staff discourses; and considers proposals for challenging commonly-voiced assumptions about students and university life in a broader context of diversity and inclusive teaching practice.

scholarly journals ‘Not just a piece of skin in front of you’—a qualitative exploration of the experiences of adolescents with eczema and psoriasis with healthcare professionals

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e041108
Author(s):  
Isabella Joy de Vere Hunt ◽  
Abigail McNiven ◽  
Amanda Roberts ◽  
Himesh Parmar ◽  
Tess McPherson
Keyword(s):  
Young People ◽  
Skin Disease ◽  
Healthcare Professionals ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Secondary Analysis ◽  
Emotional Impact ◽  
Skin Conditions ◽  
The Uk ◽  
Qualitative Exploration

BackgroundThere is little qualitative research in the UK focussing on adolescents’ experience of their healthcare providers, and inflammatory skin conditions are a common heath problem in adolescence.AimTo explore the experiences of adolescents with eczema and psoriasis with healthcare professionals, and to distil the participants’ key messages for their healthcare providers.DesignThis is a secondary thematic analysis of interviews with adolescents with eczema or psoriasis.ParticipantsThere were a total of 41 text transcripts of interviews with young people with eczema or psoriasis who had given permission for secondary analysis; 23 of the participants had eczema, and 18 psoriasis. Participants were living in the UK at time of interview, and aged 15–24 years old.ResultsWe have distilled the following key messages from young people with eczema and psoriasis for healthcare providers: (1) address the emotional impact; (2) give more information, with the subtheme and (3) appreciate patient research. We identified the following eczema-specific themes: (ECZ-4) ‘It’s not taken seriously’; (ECZ-5) offer choice in treatment and (ECZ-6) lack of structure/conflicting advice. Two psoriasis-specific themes were identified: (PSO-4) feeling dehumanised/treat me as a person; and (PSO-5) think about how treatments will affect daily life.ConclusionThis qualitative data analysis highlights the need for greater recognition of the emotional impact of skin disease in adolescence, and for more comprehensive provision of information about the conditions. We call for greater sensitivity and flexibility in our approach to adolescents with skin disease, with important implications for healthcare delivery to this group.

scholarly journals Overt acts of perceived discrimination reported by British working-age adults with and without disability

2019 ◽  
Author(s):  
Eric Emerson ◽  
Allison Milner ◽  
Zoe Aitken ◽  
Lauren Krnjacki ◽  
Cathy Vaughan ◽  
...  
Keyword(s):  
Public Health ◽  
Negative Impact ◽  
Policy Research ◽  
Secondary Analysis ◽  
People With Disabilities ◽  
Public Health Problem ◽  
Health Staff ◽  
Cross Sectional ◽  
Increased Risk ◽  
The Uk

Abstract Background Exposure to discrimination can have a negative impact on health. There is little robust evidence on the prevalence of exposure of people with disabilities to discrimination, the sources and nature of discrimination they face, and the personal and contextual factors associated with increased risk of exposure. Methods Secondary analysis of de-identified cross-sectional data from the three waves of the UK’s ‘Life Opportunities Survey’. Results In the UK (i) adults with disabilities were over three times more likely than their peers to be exposed to discrimination, (ii) the two most common sources of discrimination were strangers in the street and health staff and (iii) discrimination was more likely to be reported by participants who were younger, more highly educated, who were unemployed or economically inactive, who reported financial stress or material hardship and who had impairments associated with hearing, memory/speaking, dexterity, behavioural/mental health, intellectual/learning difficulties and breathing. Conclusions Discrimination faced by people with disabilities is an under-recognised public health problem that is likely to contribute to disability-based health inequities. Public health policy, research and practice needs to concentrate efforts on developing programs that reduce discrimination experienced by people with disabilities.

Can you measure IT? The UK experience of TechQual+

2014 ◽  
Vol 15 (1/2) ◽  
pp. 32-40 ◽  
Author(s):  
Ian Hall ◽  
Jessica Stephens ◽  
Sarah Kennedy
Keyword(s):  
Data Protection ◽  
Senior Managers ◽  
Web Based ◽  
Content Type ◽  
Survey Tool ◽  
Technology Services ◽  
Protection Legislation ◽  
The Uk ◽  
The University

Purpose – The University of York Library, part of its Information Directorate, has successfully run an annual user survey using LibQUAL+ since 2008. The tool has proven invaluable in understanding user needs and measuring improvements. The ability to benchmark performance has been well received by university senior managers. Following this positive experience, the Directorate piloted the TechQual+ survey to assess its technology services. TechQual+ is a total market-survey tool developed on the same principles as LibQUAL+. York was the first university in the UK to do this. The purpose of this paper is to reflect upon the experience and its relevance to information services. Design/methodology/approach – A team was established to co-ordinate the distribution of the survey, which was e-mailed to all university members. The survey was conducted over a period of three weeks in December 2011 using their web-based tool. The team worked with the survey providers to make amendments in order to comply with UK Data Protection legislation. Findings – The TechQual+ tool provided a rich set of data on the IT needs of University of York students and staff, including a wealth of comments. As the first use of the tool in the UK, a number of outcomes arose from the pilot: methods for running the survey in order to meet UK data protection requirements; feedback on the tool itself, with some questions not understood from a UK context; a rich set of results data, with some similarities (and several differences) to those available through LibQUAL+. Originality/value – The paper presents the first application of the TechQual+ survey in UK and discusses the issues faced when implementing it in a UK context. The case study will be of interest to libraries or converged services interested in assessing their IT provision.

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