scholarly journals Investigating the system effect of reporting multidisciplinary care measures for cancer services in New South Wales, Australia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kahren M. White ◽  
Ru K. Kwedza ◽  
Holly Seale ◽  
Reema Harrison
Keyword(s):  
Quality Improvement ◽  
Multidisciplinary Team ◽  
Multidisciplinary Care ◽  
System Level ◽  
Multidisciplinary Teams ◽  
Local Health ◽  
Unique Contribution ◽  
Framework Analysis ◽  
Electronic Documentation ◽  
System Effect

Abstract Background Multidisciplinary cancer care to facilitate the provision of patient centred and evidence-based care is considered best practice internationally. In 2016 multidisciplinary care measures were developed for all local health districts across NSW. The aim of this study was to identify system-level changes and quality improvement activities across the NSW cancer system linked to reporting on these measures. Methods Focus group discussions were used to generate a synergy of ideas from key stakeholders. An exploratory descriptive approach was used within the ontological position of Framework Analysis, the analysis method chosen for this research study, sitting most closely within pragmatism. The use of Framework Analysis in the analytic strategy is because it is well-suited to addressing policy issues and maintaining specific focus within a wider dataset. Results Two focus groups were held with a total of 18 purposively selected participants. Four primary themes emerged: value of electronic documentation; role clarity; relationships; and future development of measures. Key findings included that the reporting of performance measures has expedited the development of electronic documentation and data extraction from the multidisciplinary team meeting (MDT), identified barriers and facilitators to MDT data collection and supported MDT improvement activities across NSW. Conclusions The findings of this study have highlighted that MDTs and their meetings across NSW are harnessing technological advancements to support and further develop their MDTs, as well as the challenges of implementing new processes within the MDTM. This study adds a unique contribution to knowledge of how the reporting of measures can assist in understanding variation in the development and implementation of multidisciplinary teams, as well as highlighting future programs of work to decrease variation in multidisciplinary team meetings and quality improvement activities.

Implementing a tumor program strengthening initiative in western Sydney.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19223-e19223
Author(s):  
Lynleigh Evans ◽  
Yiren Liu ◽  
Terence Kwan ◽  
Brendan Donovan ◽  
Karen Byth ◽  
...  
Keyword(s):  
Decision Making ◽  
Quality Improvement ◽  
Team Performance ◽  
Multidisciplinary Team ◽  
Cancer Care ◽  
Program Improvement ◽  
Multidisciplinary Teams ◽  
Improvement Program ◽  
Annual Survey ◽  
Monitoring Performance

e19223 Background: While multidisciplinary teams (MDTs) are well-established in many healthcare institutions, both how they function and their role in decision making vary widely. This study assessed the effectiveness of a multipronged approach to strengthening multidisciplinary team performance for a cancer service over three years. Methods: The study comprised the introduction of a structured quality improvement program, the Tumour Program Strengthening Initiative (TPSI), to improve MDT performance, and an annual survey to evaluate MDT members’ perceptions of their teams’ performance. Three iterations of the survey have been completed. Results: 12 teams participated in TPSI with 129, 118, and 146 members completing the MDT member survey in 2017, 2018, and 2019 respectively. Of the 18 questions that were asked throughout the study, nine showed significant improvement, and of these, seven were highly significant. Questions related to patient wellbeing and to audits and quality improvement showed no significant change. Conclusions: The Tumour Program Strengthening Initiative resulted in sustained and significant improvement in MDT performance over three years. The MDT survey proved to be useful not only for cancer care teams to identify their strengths and weaknesses and monitoring performance but also for management to flag priority areas for improvement and further support. The significance of this initiative is that overall program improvement reflects the strengthening of the weakest teams as well as further improvement in highly performing MDTs. [Table: see text]

General Practice Based Multidisciplinary Care Teams in Australia: Still some unanswered questions. A discussion paper from the Australian General Practice Network

2007 ◽  
Vol 13 (2) ◽  
pp. 10 ◽  
Author(s):  
Rachel Yates ◽  
Leanne Wells ◽  
Kate Carnell
Keyword(s):  
General Practice ◽  
Multidisciplinary Team ◽  
Policy Development ◽  
Grey Literature ◽  
Multidisciplinary Care ◽  
Multidisciplinary Teams ◽  
Discussion Paper ◽  
Team Working ◽  
Australian General Practice ◽  
Practice Network

Evidence indicates that general practice-based multidisciplinary teams can offer a means of addressing some of the key issues currently facing Western health systems, especially workforce and chronic disease management. Elements of team-working have been addressed in research and policy initiatives both overseas and in Australia, yet some important aspects of primary health care multidisciplinary team-working still remain unclear in the Australian context. This discussion paper has been developed by the Australian General Practice Network (AGPN) to raise awareness of and promote thought on four questions relating to multidisciplinary team-working that AGPN considers important but that, as yet, have not been fully addressed. (Except where indicated, it is not a position statement about AGPN's views on this matter.) Questions considered are: Who is in the team? What makes a successful team? How should teams be funded in Australia? Who coordinates the team? Each question broadly considers what is already known about the area through purposeful literature reviews of the published and grey literature, current policy impacting on the area, and suggested areas for policy development in the context of Australian general practice and primary care.

#69: Improving Communication About the Care and Prevention of Infections in a Pediatric Oncology Unit by Using Patient Daily Goals in Multidisciplinary Rounds

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S22-S22
Author(s):  
Escobedo-Melendez Griselda ◽  
Martinez-Albarran Manuel ◽  
Magaña-Saldivar Isadora ◽  
Jimenez Norma ◽  
Gomez-Huerta Elizabeth ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Pediatric Oncology ◽  
Multidisciplinary Team ◽  
Statistical Significance ◽  
Healthcare Providers ◽  
Multidisciplinary Teams ◽  
Use Of Resources ◽  
Multidisciplinary Rounds ◽  
Prevention Of Infections ◽  
Oncology Unit

Abstract Background In children with cancer infections are the most frequent complication, with fatal outcomes if not addressed promptly. Therefore, care and prevention of infections in these patients require multidisciplinary interventions, with effective communication among healthcare providers to reduce the morbidity, length of stay, and the inappropriate use of resources. We used the Institute of Healthcare Improvement (IHI) model for improving the communication among healthcare providers by using patient daily goals after the oncology pediatric unit multidisciplinary rounds. Methods A multidisciplinary team was identified in the pediatric oncology unit. The team received weekly coaching on the IHI methodology. The methodology used included the creation of a block diagram to understand the baseline processes and a key driver diagram. Then, after a literature review, a data collection plan and measures were identified. The team identified different ideas for changes and prioritized them using an impact-effort matrix. Finally, several rounds of Plan-Do-Study-Act (PDSA) cycles reached the desired changes that organized the patient daily goals for sharing in the form of a worksheet. This worksheet was shared with nurses and pharmacist staff, a chat group was created, and the routine use of the daily goals for patient management was taught and incorporated into the rest of the care team staff. The percentage of excellent communication among all multidisciplinary teams and outcomes (length of stay, intensive care unit admission, and mortality) were recorded at baseline and endline. We determined the statistical significance of the baseline vs. endline difference by using χ 2 and t-tests. Results A total of 105 patients with suspected infections were included over a 6-month period (June through November 2019). We found a significant increase per month in the percent of agreement in excellent communication in the patient daily goals between infectious diseases specialist faculty and fellows, nurses, pharmacist, and pediatric oncology faculty and fellows (33.3% vs. 91.3%) (P = 0.004). Length of stay decreased monthly after our interventions (baseline: mean 14.7 days [SD 12.4] vs. after intervention: mean 6.7 days [SD 2.7]) (P = 0.014). There were only one ICU admission and no deaths during the implementation period. Conclusions Our approach using patient daily goals improved communication among a multidisciplinary team, leading to decreased length of stay and supporting adequate outcomes.

scholarly journals Targeted Assessment for Prevention: A Statewide Collaborative

2020 ◽  
Vol 41 (S1) ◽  
pp. s401-s401
Author(s):  
Cindy Hou ◽  
Shannon Davila ◽  
Mary Miller ◽  
Ashlee Hiester ◽  
Katherine Hosmer ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Infection Prevention ◽  
Local Level ◽  
Central Line ◽  
Interdisciplinary Teams ◽  
System Level ◽  
Healthcare Associated Infection ◽  
Hospital System ◽  
Healthcare Facilities ◽  
Clostridioides Difficile

Background: Infection preventionists (IPs) are the backbone of the quality and safety matrix of their organizations. Tools to help locate potential gaps can provide unique viewpoints from frontline staff. The CDC provides a Targeted Assessment for Prevention (TAP) strategy that identifies vulnerabilities in the prevention of healthcare-associated infection (HAIs). Methods: A statewide quality improvement organization, partnering with the CDC TAP team, administered TAP facility assessments for catheter-associated urinary tract infection (CAUTI), central-line–associated bloodstream infection (CLABSI), and Clostridioides difficile infection (CDI) to a collaborative of 15 acute-care and 2 long-term acute hospitals. More than 800 respondents filled out surveys based on their individualized perceptions of infection prevention practices. Results: The survey results yielded the following lagging indicators: lack of awareness of nursing and physician champions, need for competency-based training of clinical equipment, and feedback on device utilization. At the hospital system level, one improvement team focused on CDI, uncovered leading and lagging areas in general infrastructure, antibiotic stewardship, early detection and appropriate testing, contact precautions, and environmental cleaning. To culminate the TAP collaborative, the cohort of organizations, supported by interdisciplinary teams, participated in a full-day TAP workshop in which they reviewed detailed analyses of their HAI data and assessment results, shared best practices for infection prevention and planned for specific improvement projects using the plan-do-study-act model. Conclusions: Results of a statewide analysis of HAI prevention data and opportunities at a local level were reviewed. The TAP strategy can be used to target opportunities for improvement, to assess gaps in practice, and to develop and implement interventions for improving outcomes. Healthcare facilities and quality improvement organizations can drive infection prevention actions.Funding: NoneDisclosures: None

scholarly journals Examining local perspectives on the influence of climate change on the health of Hamer pastoralists and their livestock in Ethiopia

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Samuel Lumborg ◽  
Samuel Tefera ◽  
Barry Munslow ◽  
Siobhan M. Mor
Keyword(s):  
Climate Change ◽  
Water Scarcity ◽  
Health Workers ◽  
Animal Health ◽  
Disease Outbreaks ◽  
Vulnerable Groups ◽  
Local Health ◽  
Framework Analysis ◽  
Healthcare Facilities ◽  
Grazing Lands

AbstractThis study explores the perceived influence of climate change on the health of Hamer pastoralists and their livestock in south-western Ethiopia. A combination of focus group discussions and key informant interviews were conducted with Hamer communities as well as local health workers, animal health workers and non-governmental organisation (NGO) staff. Thematic framework analysis was used to analyse the data. Reductions in rangeland, erratic rainfall, recurrent droughts and loss of seasonality were perceived to be the biggest climate challenges influencing the health and livelihoods of the Hamer. Communities were travelling greater distances to access sufficient grazing lands, and this was leading to livestock deaths and increases in ethnic violence. Reductions in suitable rangeland were also precipitating disease outbreaks in animals due to increased mixing of different herds. Negative health impacts in the community stemmed indirectly from decreases in livestock production, uncertain crop harvests and increased water scarcity. The remoteness of grazing lands has resulted in decreased availability of animal milk, contributing to malnutrition in vulnerable groups, including children. Water scarcity in the region has led to utilisation of unsafe water sources resulting in diarrhoeal illnesses. Further, seasonal shifts in climate-sensitive diseases such as malaria were also acknowledged. Poorly resourced healthcare facilities with limited accessibility combined with an absence of health education has amplified the community’s vulnerability to health challenges. The resilience and ambition for livelihood diversification amongst the Hamer was evident. The introduction of camels, increase in permanent settlements and new commercial ideas were transforming their livelihood strategies. However, the Hamer lack a voice to express their perspectives, challenges and ambitions. There needs to be collaborative dynamic dialogue between pastoral communities and the policy-makers to drive sustainable development in the area without compromising the values, traditions and knowledge of the pastoralists.

scholarly journals When colocation is not enough: a case study of General Practitioner Super Clinics in Australia

2017 ◽  
Vol 23 (2) ◽  
pp. 107 ◽  
Author(s):  
Riki Lane ◽  
Grant Russell ◽  
Elizabeth A. Bardoel ◽  
Jenny Advocat ◽  
Nicholas Zwar ◽  
...  
Keyword(s):  
Primary Care ◽  
Social Scientist ◽  
Multidisciplinary Care ◽  
Multidisciplinary Teams ◽  
Fee For Service ◽  
Study Approach ◽  
Organisational Routines ◽  
Developed Nations ◽  
Competing Priorities

Developed nations are implementing initiatives to transform the delivery of primary care. New models have been built around multidisciplinary teams, information technology and systematic approaches for chronic disease management (CDM). In Australia, the General Practice Super Clinic (GPSC) model was introduced in 2010. A case study approach was used to illustrate the development of inter-disciplinary CDM over 12 months in two new, outer urban GPSCs. A social scientist visited each practice for two 3–4-day periods. Data, including practice documents, observations and in-depth interviews (n=31) with patients, clinicians and staff, were analysed using the concept of organisational routines. Findings revealed slow, incremental evolution of inter-disciplinary care in both sites. Clinic managers found the facilitation of inter-disciplinary routines for CDM difficult in light of competing priorities within program objectives and the demands of clinic construction. Constraints inherent within the GPSC program, a lack of meaningful support for transformation of the model of care and the lack of effective incentives for collaborative care in fee-for-service billing arrangements, meant that program objectives for integrated multidisciplinary care were largely unattainable. Findings suggest that the GPSC initiative should be considered a program for infrastructure support rather than one of primary care transformation.

scholarly journals Embedding continuous quality improvement processes in multidisciplinary teams in cancer care: exploring the boundaries between quality and implementation science

2017 ◽  
Vol 41 (3) ◽  
pp. 291 ◽  
Author(s):  
Tracy E. Robinson ◽  
Anna Janssen ◽  
Paul Harnett ◽  
Kylie E. Museth ◽  
Pamela J. Provan ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Translational Research ◽  
Implementation Science ◽  
Cancer Care ◽  
Administrative Support ◽  
Quality Data ◽  
Multidisciplinary Teams ◽  
Structured Interviews ◽  
Time Data ◽  
Enabling Factors

Objective The aim of the present study was to identify key enabling factors for engaging multidisciplinary teams (MDTs) in cancer care across the spectrum of translational research and quality improvement (QI) projects. Methods The study was conducted in two large Sydney metropolitan hospitals. Qualitative methods, including structured observations of MDT meetings and semi-structured interviews with MDT leaders and champions, were used to identify how teams interact with and generate research and implementation initiatives. Enabling factors for and barriers to the engagement of MDTs in translational research and QI were identified. Results Four key enabling factors emerged from the analysis of data generated from observing 43 MDT meetings and 18 semi-structured interviews: (1) access to high-quality data around individual and team performance; (2) research-active team leaders; (3) having experts, such as implementation scientists, embedded into teams; and (4) having dedicated research or QI-focused meetings. Barriers included a lack of time, administrative support, research expertise and access to real-time data. Conclusions The identification of enabling factors for and barriers to translational research and QI provides evidence for how multidisciplinary cancer care teams may best be engaged in research and QI that aims to improve service and care outcomes. What is known about the topic? MDTs are key to the delivery of cancer care in Australia, but there is scant research into how teams can best be engaged in translating research from basic science through to implementation science and QI. What does this paper add? This paper provides new evidence from an immersive study of cancer care MDTs in two large metropolitan hospitals in Sydney (NSW, Australia), regarding the key enabling factors for and barriers to successful engagement in translational research and QI in cancer care. What are the implications for practitioners? Cancer care professionals in MDTs are presented with an opportunity to embed translational research and QI into cancer care. MDTs can operate as an ideal vehicle to look beyond individual patient outcomes to broader trends and population health outcomes.

scholarly journals Using the WHO Safe Childbirth Checklist to Improve Essential Care Delivery as Part of the District -Wide Maternal and Newborn Health Quality Improvement Initiative, a Time Series Study

2020 ◽  
Author(s):  
Befikadu Bitewulign ◽  
Dereje Abdissa ◽  
Zewdie Mulissa ◽  
Abiyou Kiflie ◽  
Mehiret Abate ◽  
...  
Keyword(s):  
Time Series ◽  
Quality Improvement ◽  
Newborn Health ◽  
System Level ◽  
Maternal And Newborn Health ◽  
Safe Childbirth Checklist ◽  
Safe Childbirth ◽  
Over Time ◽  
Maternal And Newborn

Abstract Background: Care bundles are a set of three to five evidence-informed practices which, when performed collectively and reliably, may improve health system performance and patient care. To date, many studies conducted to improve the quality of essential birth care practices (EBPs) have focused primarily on provider- level and have fallen short of the predicted impact on care quality, indicating that a systems approach is needed to improve the delivery of reliable quality care. This study evaluates the effectiveness of integrating the use of the World Health Organization Safe Childbirth Checklist (WHO-SCC) into a district-wide system improvement collaborative program designed to improve and sustain the delivery of EBPs as measured by "clinical bundle" adherence over-time.Methods: The WHO-SCC was introduced in the context of a district-wide Maternal and Newborn Health (MNH) collaborative quality of care improvement program in four agrarian Ethiopia regions. Three "clinical bundles" were created from the WHO-SCC: On Admission, Before Pushing, and Soon After Birth bundles. The outcome of each bundle was measured using all- or- none adherence. Adherence was assessed monthly by reviewing charts of live births.A time-series analysis was employed to assess the effectiveness of system-level interventions on clinical bundle adherence. STATA version 13.1 was used to analyze the trend of each bundle adherence overtime. Autocorrelation was checked to assess if the assumption of independence in observations collected overtime was valid. Prais-Winsten was used to minimize the effect of autocorrelation.Findings: Quality improvement interventions targeting the three clinical bundles resulted in improved adherence over time across the four regions. In Tigray region, adherence to “On Admission” bundle was increased monthly on average by B =1.39 (95% CI; 0.47 - 2.32; P<0.005).Similarly, adherence to the “Before Pushing” bundle in Southern Nations, Nationalities and People’s (SNNP) region increased monthly on average by B = 2.3 (95% CI; 0.89 - 3.74; P<0.005). Conclusion: Use of the WHO-SCC paired with a system-wide quality improvement approach improved and sustained quality of EBPs delivery. Further studies should be conducted to evaluate the impact on patient-level outcomes.

scholarly journals Improvement in Company of Development of Technological Solutions

2017 ◽  
Author(s):  
daniel sarcos
Keyword(s):  
Supply Chain ◽  
Multidisciplinary Team ◽  
Swot Analysis ◽  
Current Model ◽  
Multidisciplinary Teams ◽  
Building Projects ◽  
Business Opportunity ◽  
P Supply ◽  
Great Complexity ◽  
Centres Of Expertise

Supply chain between the commercial and consultancy is analyzed. This allows to know the process from creating a business opportunity to sell the final product or service. As a result it is concluded that the company under study has some shortcomings in the current model based on multidisciplinary teams. Although effective in the implementation of projects, it is considered that the current methodology is of great complexity, which accommodates the development of proposals to improve the process.A study of the key to be improved in the supply chain through the SWOT analysis of the same factors ago. Through various interviews and meetings with staff and directors of the company, it is concluded that should improve the chain from three (3) different components: people, processes and technology.Aims to simplify the current model of consulting through the creation of Centres of Expertise and the introduction of the concept of Deliverable. This new methodology industrialization in some way the process for building projects. Each Expertise Center is considered a specialist in one area of activity and not as a multidisciplinary team equipment.

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