scholarly journals A translational case study of empowerment into practice: A realist evaluation of a member-led dementia empowerment service

Dementia ◽  
2018 ◽  
Vol 19 (6) ◽  
pp. 1974-1996 ◽  
Author(s):  
Tracey McConnell ◽  
Paul Best ◽  
Tristan Sturm ◽  
Mabel Stevenson ◽  
Michael Donnelly ◽  
...  
Keyword(s):  
Decision Making ◽  
Northern Ireland ◽  
Social Inclusion ◽  
Realist Evaluation ◽  
Service Development ◽  
Successful Implementation ◽  
Evaluation Approach ◽  
People With Dementia ◽  
Group Members

Involving people with dementia in decision-making is widely accepted as a means of empowering them to lead more independent lives and have more meaningful roles in shaping their care. However, there is a need to conduct rigorous evaluations of empowerment-driven services and policies in order to develop a deeper understanding about how to optimise successful implementation. This paper presents the results of an evaluation of Dementia Northern Ireland, an organisation initiated and led by people with dementia. We used a realist evaluation approach that comprised interviews with 15 people with dementia, three staff and two board members, ethnographic observations, along with documentary analysis to identify ‘what works, for whom, under what circumstances’. The analysis used realist logic to build up context-mechanism-outcome configurations. The Dementia Northern Ireland service model of empowerment revolved around the formation and maintenance of social groups of people with dementia. Facilitators, recruited and selected by people with dementia, supported six groups, consisting of one to four members with mild to moderate cognitive impairment. Facilitators helped expand empowerment groups, facilitate decision-making, awareness raising and consultation opportunities with group members. The ‘Empowerment Groups’ appeared to lead to the development of a shared social identity and a sense of collective strength as indicated by interview and observational data demonstrating an activist mentality among group members to challenge the stigma surrounding dementia. Group members also reported improved quality of life. Widespread implementation of the empowerment model has the potential to lead to reduced stigma and greater social inclusion, increased involvement of people with dementia as active co-producers of policy and service development, better services and support. This case study of Dementia Northern Ireland illustrates that there are boundaries and challenges to empowerment in terms of requiring additional support from staff without dementia. However, despite these challenges, empowerment-driven organisations can and should be committed to involving members in lead roles and key decision-making.

A Model for Make-or-Buy Decisions in Engineering Design Services Sector: A Case Study from Turkey

2018 ◽  
Vol 15 (04) ◽  
pp. 1850038
Author(s):  
Z. Aytan Ediz ◽  
M. Atilla Öner ◽  
Y. Can Erdem ◽  
Nesimi Kaplan
Keyword(s):  
Decision Making ◽  
Cluster Analysis ◽  
Engineering Design ◽  
Administrative Support ◽  
Social Dynamics ◽  
Successful Implementation ◽  
Cluster Membership ◽  
Services Sector ◽  
Engineering Company

Make-or-buy decision is an important factor affecting the profitability of the firms in all sectors. The goal of this study is to propose a model for firms in engineering design services sector for make-or-buy decisions. A survey was conducted to determine the importance percentages given in an engineering company in make-or-buy decisions and a model was developed. The results of the case study show intriguing clusters of company personnel. As the lack of consensus among company managers and personnel may inhibit the successful implementation of the developed strategy, we use K-Means Clustering to determine the different perspectives of different groups of employees (managers, senior engineers, junior engineers, technical and administrative support personnel) which may contribute to the understanding of social dynamics of decision making within the company. 4-cluster and 5-cluster analysis results indicate the need for further study on the dynamics of cluster membership.

scholarly journals 171 Programme Theory to Guide the Adoption of Assisted Decision Making with Older People in Acute Healthcare: Realist Evaluation

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
Carmel Davies ◽  
Deirdre O'Donnell ◽  
Éidín Ní Shé ◽  
Sarah Donnelly ◽  
Francesco Fattori ◽  
...  
Keyword(s):  
Decision Making ◽  
Older People ◽  
Acute Care ◽  
Professional Training ◽  
Legal Framework ◽  
Realist Evaluation ◽  
Shared Responsibility ◽  
Programme Theory ◽  
Key Informants ◽  
People With Dementia

Abstract Background In Ireland, the Assisted Decision-Making (ADM) (Capacity) Act and emerging Codes of Practice provide a legal framework for Healthcare Professionals (HCPs) to enable ADM for patients with impaired capacity. ADM ensures that a person’s will and preference is at the centre of all decisions related to their care. This study conducted a realist evaluation and developed a Programme Theory (PT) to highlight how ADM for older people can be operationalised within an Acute Care (AC) context. Methods Key informants with interest in ADM informed this evaluation. Interviews were conducted in two Acute Care (AC) sites with multidisciplinary HCPs working within older person services (n=20). Interviews with informants that recently received care within an AC setting involved older people (n=3) people with dementia (n=4) and family carers (n=5). Ethnographic observations from AC multidisciplinary team meetings also informed the review. The framework that guided the qualitative analysis was from a PT informed by literature on ADM implementation in healthcare (O'Donnell, Ní Shé, Davies et al.2018). Results The refined PT is supported by credible evidence that is informed by authentic experiences of decision making support in the AC setting. Validation groups (n=4) with the key informants verified the PT. Three mechanisms were identified as a positive climate and receptive environment for the adoption of formal ADM. These are: AC settings that adopt inter-professional accountability and shared responsibility for patient care that is guided by a clear policy process. Acute care and practice that is informed by a shared commitment to person-centred care and shared decision making. HCPs that operate within an AC setting where organisational learning informs practice through inter-professional training, mentorship and peer support. Conclusion Involving stakeholders in PT development enhances the utility, feasibility and applicability of the results. This PT provides a framework for those planning ADM implementation within the AC settings.

How management control systems enable and constrain integrated thinking

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Ruth Dimes ◽  
Charl de Villiers
Keyword(s):  
Decision Making ◽  
Control Systems ◽  
Economic Benefits ◽  
Management Control ◽  
Management Control Systems ◽  
Practical Implementation ◽  
Successful Implementation ◽  
Content Type ◽  
Perceived Trust

Purpose This paper aims to examine how management control systems (MCS) can enable and constrain the successful adoption of integrated thinking in an organisation. Design/methodology/approach The study adopts a case study approach, involving in-depth interviews and documentary evidence. Findings The case study organisation perceived trust to be critical to the successful adoption of integrated thinking, and informal social controls with strong endorsement from senior management frequently substituted for more formal technical controls in helping to develop a trust-based organisational culture. These cultural changes improved collaboration and brought economic benefits by encouraging outcome-based decision-making rather than capital-based decision-making, thereby enabling employees to identify and address poorly performing projects earlier. However, established performance measurement systems geared towards reporting and rewarding accounting profits created tension, constraining the potential benefits of integrated thinking by reinforcing business unit protectionism. Practical implications Integrated thinking can be seen as a form of management with the potential to improve organisational outcomes. An improved understanding of factors that might enable or constrain integrated thinking could facilitate its spread. Originality/value Despite several calls for research on the practical implementation of integrated thinking, this has not been studied extensively. To the best of the authors’ knowledge, this study is one of the firsts to contribute to a better understanding of the role of MCS in the successful implementation of integrated thinking in an organisation. The study also contributes to the MCS literature.

Influence of leadership on implementing Dementia Care Mapping: A multiple case study

Dementia ◽  
2017 ◽  
Vol 18 (6) ◽  
pp. 1976-1993 ◽  
Author(s):  
Tina Quasdorf ◽  
Sabine Bartholomeyczik
Keyword(s):  
Nursing Homes ◽  
Leadership Style ◽  
Qualitative Content Analysis ◽  
Dementia Care ◽  
Primary Study ◽  
Successful Implementation ◽  
People With Dementia ◽  
Care Mapping ◽  
Dementia Care Mapping

Dementia Care Mapping is an internationally applied method for enhancing person-centred care for people with dementia in nursing homes. Recent studies indicate that leadership is crucial for the successful implementation of Dementia Care Mapping; however, research on this topic is rare. This case study aimed to explore the influence of leadership on Dementia Care Mapping implementation in four nursing homes. Twenty-eight interviews with project coordinators, head nurses and staff nurses were analysed using qualitative content analysis. Nursing homes that failed to implement Dementia Care Mapping were characterised by a lack of leadership. The leaders of successful nursing homes promoted person-centred care and were actively involved in implementation. While overall leadership performance was positive in one of the successful nursing homes, conflicts related to leadership style occurred in the other successful nursing homes. Thus, it is important that leaders promote person-centred care in general and Dementia Care Mapping in particular. Furthermore, different types of leadership can promote successful implementation. Trial registration of the primary study: Current Controlled Trials ISRCTN43916381.

scholarly journals Team interventions in acute hospital contexts: protocol for the evaluation of an initial programme theory using realist methods

2021 ◽  
Vol 4 ◽  
pp. 32
Author(s):  
Una Cunningham ◽  
Aoife De Brún ◽  
Mayumi Willgerodt ◽  
Erin Blakeney ◽  
Eilish McAuliffe
Keyword(s):  
Secondary Analysis ◽  
Realist Evaluation ◽  
Acute Hospital ◽  
Healthcare Team ◽  
Programme Theory ◽  
Evaluation Approach ◽  
Middle Range ◽  
Team Interventions ◽  
Structured Approach

Introduction: Literature on multi-disciplinary healthcare team interventions to improve quality and safety of care in acute hospital contexts tends to focus on evaluating the success of the intervention by assessing patient outcomes. In contrast, there is little focus on the team who delivered the intervention, how the team worked to deliver the intervention or the context in which it was delivered. In practice, there is therefore a poor understanding of why some interventions work and are sustained and why others fail. There is little emphasis in the literature on how the team delivering the intervention might impact success or failure. Given that team is the vehicle through which these interventions are introduced, it is important to understand interventions from their perspectives. This research seeks to deepen understanding of enablers and barriers for effective team interventions. Using two case studies, we will evaluate previously developed initial programme theories to understand, what worked for whom, in what conditions, why, to what extent and how? Methods and analysis: A realist evaluation approach will be employed to test the previously formed set of initial programme theories. Two multi-disciplinary acute hospital team interventions in two different geographical and organisational contexts will be identified. In case study 1, a theory based approach to interviewing will be used. In case study 2, interview transcripts obtained using a semi- structured approach for primary research purposes will undergo secondary analysis. This will enable a more sensitive look at patterns and variations in patterns of multi-disciplinary team interventions. Researchers will first iteratively interrogate each respective dataset to identify the characteristics or resources present within the specific context that influenced how the team intervention worked to produce particular outcomes. Data will then be synthesised across contexts in order to produce middle range theories and thereby more generalisable insights.

Have we compromised too much? A critical analysis of nutrition policy in Australia 2007–2018

2020 ◽  
pp. 1-11
Author(s):  
Brandon I ◽  
Phillip Baker ◽  
Mark Lawrence
Keyword(s):  
Decision Making ◽  
Best Practice ◽  
Nutrition Policy ◽  
Policy Framework ◽  
Documentary Analysis ◽  
Government Documents ◽  
Decision Making Processes ◽  
Group Members ◽  
Poor Nutrition

Abstract Objective: A comprehensive nutrition policy containing a broad package of cross-sector and synergistic policy actions is required to attenuate the systemic drivers of poor nutrition. The current study aims to critically analyse trends in the scope of federal nutrition policy actions in Australia between 2007 and 2018 by: (1) describing the changes in nutrition policy actions, benchmarked against an international best-practice policy framework and (2) investigating how and why the scope of these policy actions have changed over time by examining the decision-making processes that led to the establishment of Australia’s Healthy Food Partnership (the Partnership). Design: Qualitative case study involving documentary analysis and key-informant interviews. Australian federal government documents (n 10) were analysed against the NOURISHING framework. Key informants (n 6) were interviewed and asked about the Partnership’s decision-making and establishment processes. Setting: Australia. Participants: Executive Committee (the Partnership’s governing body) and working group members. Results: From 2007 to 2018, the scope of Australian national nutrition policy has fluctuated from evidence-informed recommendations for a comprehensive policy to the mostly discrete policy actions of the Partnership. Themes of ‘pragmatism and compromise’, ‘actor relationships and lobbying’ and ‘political context’ were critical drivers for establishing the Partnership. Conclusion: The narrowing of Australian nutrition policy reflects a response to political expediency and compromise. This political dynamic highlights a dilemma facing nutrition policy advocates: should (and if so, how) a balance be sought between the aspirational but possibly unrealistic goals, and the limited but likely deliverable outcomes during policy-making processes? These findings have relevance for developing a future comprehensive national nutrition policy.

Northern Ireland as a Case Study of Decentralization in Unitary States

1975 ◽  
Vol 27 (3) ◽  
pp. 387-404 ◽  
Author(s):  
Norman Furniss
Keyword(s):  
Decision Making ◽  
Northern Ireland ◽  
Nation States ◽  
Federal Constitutional ◽  
Insight Into

Decentralization is widely advocated as a means of alleviating the perceived central stultification of modern nation-states, especially those lacking federal constitutional structures. The experience of a separate administrative and decision-making structure in Northern Ireland is examined in an effort to gain an insight into the advantages and weaknesses of decentralization in practice.

scholarly journals Identifying Best Implementation Practices for Smoking Cessation in Complex Cancer Settings

2021 ◽  
Vol 28 (1) ◽  
pp. 471-484
Author(s):  
Eleni Giannopoulos ◽  
Janet Papadakos ◽  
Erin Cameron ◽  
Janette Brual ◽  
Rebecca Truscott ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Cancer Diagnosis ◽  
Realist Evaluation ◽  
Successful Implementation ◽  
Referral Rates ◽  
Evaluation Approach ◽  
Acceptance Rates ◽  
Cancer Settings ◽  
Underlying Processes ◽  
Centralized System

Background: In response to evidence about the health benefits of smoking cessation at time of cancer diagnosis, Ontario Health (Cancer Care Ontario) (OH-CCO) instructed Regional Cancer Centres (RCC) to implement smoking cessation interventions (SCI). RCCs were given flexibility to implement SCIs according to their context but were required to screen new patients for tobacco status, advise patients about the importance of quitting, and refer patients to cessation supports. The purpose of this evaluation was to identify practices that influenced successful implementation across RCCs. Methods: A realist evaluation approach was employed. Realist evaluations examine how underlying processes of an intervention (mechanisms) in specific settings (contexts) interact to produce results (outcomes). A realist evaluation may thus help to generate an understanding of what may or may not work across contexts. Results: The RCCs with the highest Tobacco Screening Rates used a centralized system. Regarding the process for advising and referring, three RCCs offered robust smoking cessation training, resulting in advice and referral rates between 80% and 100%. Five RCCs surpassed the target for Accepted Referral Rates; acceptance rates for internal referral were highest overall. Conclusion: Findings highlight factors that may influence successful SCI implementation.

A CONSULTATION GUIDE FOR ASSESSING THE APPLICABILITY OF HEALTH TECHNOLOGIES:A CASE STUDY

2017 ◽  
Vol 33 (5) ◽  
pp. 577-585 ◽  
Author(s):  
Stephanie Polus ◽  
Lisa Pfadenhauer ◽  
Louise Brereton ◽  
Wojciech Leppert ◽  
Philip Wahlster ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Panel Discussion ◽  
Complex Interventions ◽  
Health Technology ◽  
Successful Implementation ◽  
Specific Information ◽  
Health Technologies ◽  
Home Based

Objectives:The translation of research findings into policy and practice is crucially dependent on the applicability of such findings in a given decision-making context. We explored in a case study whether a generic consultation guide to assess the applicability of a health technology could be rapidly deployed and deliver useful insights.Methods:A consultation guide based on the context and implementation for complex interventions (CICI) framework was developed and piloted to assess the applicability of reinforced home-based palliative care in three European countries. Individual consultations in England and Germany and a panel discussion in Poland were completed.Results:Various barriers may hinder successful implementation of reinforced home-based palliative care in the three countries. Whilst the experts across all countries emphasized the lack of funding along with organization and structure as major barriers, information varied by country for many of the other identified barriers and facilitators. Participants in the pilot study provided positive feedback in terms of understanding the topic and purpose of the consultation, and both individual and panel consultations could be easily implemented.Conclusions:In this case study, the consultation guide presented a pragmatic, ready-to-use tool to assess the applicability of a health technology. As shown here, it can be used in a generic manner without discrete empirical information on the technology in question or, ideally, makes use of specific information collected as part of a HTA. Further studies are needed to validate this guide and apply it to other types of health technologies and more diverse decision-making contexts.

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