Assessing the implementation processes of a large-scale, multi-year quality improvement initiative: survey of health care providers

There is a significant knowledge-to-action gap in cancer survivorship care for First Nations (FN) communities. To date, many approaches to survivorship have not been culturally responsive or community-based. This study is using an Indigenous knowledge translation (KT) approach to mobilize community-based knowledge about cancer survivorship into health-care programs. Our team includes health-care providers and cancer survivors from an FN community in Canada and an urban hospital that delivers Cancer Care Ontario’s Aboriginal Cancer Program. Together, we will study the knowledge-to-action process to inform future KT research with Indigenous peoples for improving health-care delivery and outcomes. The study will be conducted in settings where research relations and partnerships have been established through our parent study, The National Picture Project. The inclusion of community liaisons and the continued engagement of participants from our parent study will foster inclusiveness and far-reaching messaging. Knowledge about unique cancer survivorship needs co-created with FN people in the parent study will be mobilized to improve cancer follow-up care and to enhance quality of life. Findings will be used to plan a large-scale implementation study across Canada.

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Crossing Knowledge Boundaries: Health Care Providers’ Perceptions and Experiences of What is Important to Achieve More Person-Centered Patient Pathways For Older People

10.21203/rs.3.rs-145825/v1 ◽

2021 ◽

Author(s):

Cecilie Olsen ◽

Astrid Bergland ◽

Asta Bye ◽

Jonas Debesay ◽

Anne Langaas

Keyword(s):

Health Care ◽

Quality Improvement ◽

Older People ◽

Health Care Providers ◽

Transitional Care ◽

Care Providers ◽

Quality Improvement Collaborative ◽

Patient Journey ◽

Patient Pathways

Abstract Background: Improving the transitional care of older people, especially hospital-to-home transitions, is a salient concern worldwide. Older people’s patient pathways may be unpredictable and complex, posing significant challenges for health care providers (HCPs). In particular, appropriate follow-up in primary care after discharge is key. Current research in the field endorses person-centered care as crucial to improving the patient pathways of older people. The aim of this study was to explore HCPs’ perceptions and experiences of what is important to achieve more person-centered patient pathways for older people.Methods: This was a qualitative study. We performed individual semistructured interviews with 20 HCPs and three key persons who participated in a Norwegian quality improvement collaborative. In addition, participant observation of 22 meetings in the quality improvement collaborative was performed. Results: A thematic analysis resulted in five themes: 1) Finding common ground through the mapping of the patient journey; 2) the importance of understanding the whole patient pathway; 3) the significance of getting to know the older patient; 4) the key role of home care providers in the patient pathways of older people; and 5) ambiguity toward checklists and practice implementation. Conclusion: To understand the findings, it proved useful to see them in light of knowledge sharing and boundary crossing, which are central concepts in the literature on transitional care. HCPs in the collaborative shared and coproduced new knowledge of the patient pathways of older people based on a patient journey perspective. Mapping the patient journey and asking, “What matters to you?” facilitated the crossing of knowledge boundaries between the HCPs; hence, a new and more holistic view of the patient pathways of older people in the current context emerged. The centrality of getting to know the patient and the special role of providers working in home care services was a central finding. The study adds to existing knowledge by suggesting that the achievement of person-centered patient pathways for older people does not only depend on the crossing of knowledge boundaries among HCPs, but also between HCPs and older persons.

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P023: Code Resus - using a quality improvement approach to improve health care provider response during resuscitations

CJEM ◽

10.1017/cem.2016.199 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S86-S86

Author(s):

L.B. Chartier ◽

S. Hansen ◽

D. Lim ◽

S. Yi ◽

B. McGovern ◽

...

Keyword(s):

Health Care ◽

Quality Improvement ◽

Health Care Providers ◽

Rating Scale ◽

Tertiary Care ◽

Care Hospital ◽

Care Providers ◽

Change Initiatives ◽

Chi Square ◽

Before And After

Introduction: In order to achieve the best possible outcomes for patients requiring resuscitation (PRRs) in the emergency department (ED), health care providers (HCPs) must provide an efficient, multi-disciplinary and coordinated response. A quality improvement (QI) project was undertaken to improve HCP response to PRRs at two tertiary care hospital EDs in Toronto. Methods: We conducted a before-and-after mixed-method survey to evaluate the perception of the adequacy of HCP response and clarity of HCP role when responding to PRRs. The results were compared using the Chi-square test. Qualitative responses to the first survey were also used to inform the development of the QI project. Through interviews of key stakeholders and with continuous input from front-line ED HCPs, a multi-disciplinary team modified the ED resuscitation protocol. This included standardized pre-hospital communication form with paramedics, ED-wide overhead announcement of ‘Code Resus’, dedicated HCPs assigned to respond to PRRs, and specific duties assigned to each responder. Change initiatives were reinforced through education and posters in the ED. Six months after implementation, a second survey was conducted to evaluate the sustained effects of the intervention. Results: Baseline measures indicated that 16 of 52 (30.8%) nurses surveyed believed their role was often or always apparent to themselves and others when they attended to a PRR (on a 5-point rating scale). This proportion increased to 35 of 55 (63.6%) nurses in the post-implementation survey (p < 0.001). Regarding adequacy of the number of HCPs responding to PRRs, 17 of 39 (43.6%) physicians and 23 of 53 (43.4%) nurses surveyed thought the appropriate number of HCPs responded to PRRs; the remainder thought that there were too few or too many HCPs. In the post-implementation survey, 34 of 41 (82.9%) physicians (p < 0.001) and 36 of 56 (64.3%) nurses (p = 0.029) surveyed felt that the appropriate number of HCPs attended to PRRs. Conclusion: Using a quality improvement approach, we identified and quantified perceived deficiencies in HCP response to PRRs in the ED. Through feedback-based modifications of the ED resuscitation protocol and by engaging HCP stakeholders, change initiatives were implemented to improve HCP response. As a result, this project achieved significant and sustained improvements in HCPs’ perceived response to PRRs.

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The Impact of Relationship Stage on the Determinants of Trust in the Pharmacist–Client Relationship: Results from a Social Marketing Campaign

Social Marketing Quarterly ◽

10.1080/15245004.2010.522766 ◽

2010 ◽

Vol 16 (4) ◽

pp. 18-40 ◽

Cited By ~ 1

Author(s):

Chiara Maniscalco ◽

Kim Daniloski ◽

David Brinberg

Keyword(s):

Health Care ◽

Social Marketing ◽

Health Care Providers ◽

Large Scale ◽

Medical Advice ◽

Care Providers ◽

Marketing Campaign ◽

Social Marketing Campaign ◽

Client Relationship ◽

The Impact

The relationship between clients and their health care providers has an important impact on health promotion and disease prevention. Perhaps the most important element of patients' relationships with their health care providers is trust. Enhancing clients' trust in their health care provider has been shown to lead to greater adherence to medical advice, continuity of care, and better overall health outcomes. Pharmacists are beginning to take on the role of primary health care providers to meet the increasing need for affordable, quality medical care. As pharmacists begin to dispense medical advice as well as medicine, there is an increased need for research on the determinants of trust in the pharmacist-client relationship. In this article, we conduct in-depth interviews and a large-scale field survey to develop a social marketing campaign to increase clients' trust in their pharmacists. We implement the campaign through a randomized field experiment and find evidence that emphasizing relational benefits in the developing stages of the pharmacist–client relationship increases trust.

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Cultivating Innovative Pragmatic Cluster-Randomized Registry Trials Embedded in Hemodialysis Care: Workshop Proceedings From 2018

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358119894394 ◽

2019 ◽

Vol 6 ◽

pp. 205435811989439 ◽

Cited By ~ 3

Author(s):

Elliot J. Lee ◽

Aakil Patel ◽

Rey R. Acedillo ◽

Jovina C. Bachynski ◽

Ian Barrett ◽

...

Keyword(s):

Health Care ◽

Health Care Providers ◽

Large Scale ◽

Poor Quality ◽

Care Providers ◽

Group Discussions ◽

High Quality Research ◽

Life Sustaining Treatment ◽

Cluster Randomized ◽

Health Administrators

Hemodialysis is a life-sustaining treatment for persons with kidney failure. However, those on hemodialysis still face a poor quality of life and a short life expectancy. High-quality research evidence from large randomized controlled trials is needed to identify interventions that improve the experiences, outcomes, and health care of persons receiving hemodialysis. With the support of the Canadian Institutes of Health Research and its Strategy for Patient-Oriented Research, the Innovative Clinical Trials in Hemodialysis Centers initiative brought together Canadian and international kidney researchers, patients, health care providers, and health administrators to participate in a workshop held in Toronto, Canada, on June 2 and 3, 2018. The workshop served to increase knowledge and awareness about the conduct of innovative, pragmatic, cluster-randomized registry trials embedded into routine hemodialysis care and provided an opportunity to discuss and build support for new trial ideas. The workshop content included structured presentations, facilitated group discussions, and expert panel feedback. Partnerships and promising trial ideas borne out of the workshop will continue to be developed to support the implementation of future large-scale trials.

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Public release of performance data and quality improvement: internal responses to external data by US health care providers

Quality in Health Care ◽

10.1136/qhc.10.2.104 ◽

2001 ◽

Vol 10 (2) ◽

pp. 104-110 ◽

Cited By ~ 31

Author(s):

H T O Davies

Keyword(s):

Health Care ◽

Quality Improvement ◽

Health Care Providers ◽

Performance Data ◽

Care Providers ◽

External Data

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Quality Improvement for Neonatal Nurses, Part II: Using a PDSA Quality Improvement Cycle Approach to Implement an Oral Feeding Progression Guideline for Premature Infants

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/0730-0832.31.4.215 ◽

2012 ◽

Vol 31 (4) ◽

pp. 215-222 ◽

Cited By ~ 7

Author(s):

Lenora Marcellus ◽

Adele Harrison ◽

Kathleen MacKinnon

Keyword(s):

Health Care ◽

Quality Improvement ◽

Parent Education ◽

Health Care Providers ◽

Health Care Professionals ◽

Neonatal Intensive Care ◽

Guideline Implementation ◽

Oral Feeding ◽

Care Providers ◽

Pdsa Cycle

The development of clinical practice guidelines involving multiple health care providers presents a challenge in the neonatal intensive care unit (NICU). Implementation and evaluation of the guideline is as important as the development of the guideline itself. We explored the use of a quality improvement approach in the implementation of a feeding framework. A Plan-Do-Study-Act (PDSA) quality improvement cycle model was used to implement and evaluate a stepwise oral infant feeding guideline with emphasis on parent and care provider satisfaction. Three PDSA cycles were conducted, with each cycle resulting in modifications to use of the framework and development of knowledge translation and parent education techniques and tools. A PDSA cycle approach can be used effectively in guideline implementation and evaluation involving multidisciplinary health care professionals. This is Part II of a two-part series. Part I introduced the concept of quality improvement and tools for advancing practice changes.

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Spotlight on International Quality: COVID-19 and Its Impact on Quality Improvement in Cancer Care

JCO Global Oncology ◽

10.1200/go.21.00281 ◽

2021 ◽

pp. 1513-1521

Author(s):

Douglas W. Blayney ◽

Giovanni Bariani ◽

Devika Das ◽

Shaheenah Dawood ◽

Michael Gnant ◽

...

Keyword(s):

Health Care ◽

Quality Improvement ◽

United Arab Emirates ◽

Health Care Providers ◽

Cancer Care ◽

Care Delivery ◽

Global Scale ◽

The Philippines ◽

Care Providers ◽

The Impact

This report from ASCO's International Quality Steering Group summarizes early learnings on how the COVID-19 pandemic and its stresses have disproportionately affected cancer care delivery and its delivery systems across the world. This article shares perspectives from eight different countries, including Austria, Brazil, Ghana, Honduras, Ireland, the Philippines, South Africa, and the United Arab Emirates, which provide insight to their unique issues, challenges, and barriers to quality improvement in cancer care during the pandemic. These perspectives shed light on some key recommendations applicable on a global scale and focus on access to care, importance of expanding and developing new treatments for both COVID-19 and cancer, access to telemedicine, collecting and using COVID-19 and cancer registry data, establishing measures and guidelines to further enhance quality of care, and expanding communication among governments, health care systems, and health care providers. The impact of the COVID-19 pandemic on cancer care and quality improvement has been and will continue to be felt across the globe, but this report aims to share these experiences and learnings and to assist ASCO's international members and our global fight against the pandemic and cancer.

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Development and Testing of Responsive Feeding Counseling Cards in Ghana (OR03-07-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz048.or03-07-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Amber Hromi-Fiedler ◽

Grace Carroll ◽

Madelynn Tice ◽

Adam Sandow ◽

Richmond Aryeetey ◽

...

Keyword(s):

Health Care ◽

Health Care Providers ◽

Large Scale ◽

Care Providers ◽

Or Education ◽

Community Based ◽

Child Feeding ◽

Young Child Feeding ◽

Education In Ghana ◽

Project Objectives

Abstract Objectives The United Nations Children Fund (UNICEF) Community based Infant and Young Child Feeding (IYCF) counselling package currently lacks comprehensive responsive feeding curriculum, thus limiting dissemination of these messages within IYCF counselling. Thus, project objectives were to: a) develop counselling cards based on recent evidence-based responsive feeding guidelines and b) test their feasibility in Ghana. Methods Five counselling cards were developed addressing the responsive feeding topics of: enjoying eating with family; hunger/satiety cues; introducing new foods; food texture as a function of child development; soothing a child. The UNICEF image bank was used to develop counselling cards with images compatible with the UNICEF Community based IYCF counselling package. Two peri-urban focus groups (FG) were conducted with Ghanaian mothers (N = 7) and fathers (N = 6) of children < 3 years to assess the cultural appropriateness of the cards. Card revisions were made and re-tested in two rural FGs with the same target audience (N = 10 mothers; N = 4 fathers). Feasibility of including the cards as part of IYCF counselling was tested via: a) in-depth interviews with health care providers providing IYCF training and/or education (N = 14) and b) systematically observing eight educational sessions utilizing the cards with Ghanaian mothers (N = 20) and fathers (N = 18) of children < 3 years. Results FG findings led to changes to card images for each topic to ensure they were culturally and health literacy appropriate. Educational session findings strongly suggest the counselling cards provide important responsive feeding messages that are specific, clear, and feasible for mothers and fathers of children < 3 years to implement. Health care providers strongly endorsed the need for and utility of the responsive feeding counselling cards. Furthermore, they felt the cards and corresponding messages were feasible and important to integrate into the UNICEF Community based IYCF counselling package currently being used to deliver IYCF training and education in Ghana. Conclusions The counselling cards developed and tested have a strong potential to add the key responsive feeding dimension to IYCF training, education, and counselling in Ghana on a large scale. Funding Sources Yale Global Health Leadership Institute.

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