Using a dark logic model to explore adverse effects in audit and feedback: a qualitative study of gaming in colonoscopy.

2021 ◽  
Author(s):  
Jamie Catlow ◽  
Rashmi Bhardwaj-Gosling ◽  
Linda Sharp ◽  
M D Rutter ◽  
Falko Sniehotta
Keyword(s):  
Qualitative Study ◽  
Adverse Effects ◽  
A Priori ◽  
Improve Patient Care ◽  
Medical Professional ◽  
Logic Model ◽  
Audit And Feedback ◽  
Negative Effects ◽  
Data Saturation ◽  
Clinical Background

Abstract Background Audit and feedback (A&F) interventions improve patient care but may result in negative effects. To evaluate plausible harms and maximise benefits, a-priori theorisation using dark logic models can be useful. We aimed to assess the unintended adverse effects of A&F in colonoscopy using Feedback Intervention Theory (FIT) based dark logic model. Methods As part of the National Endoscopy Database Automated Performance Reports to Improve Quality Outcomes Trial we undertook a qualitative study exploring current A&F practices in colonoscopy. Interviews were undertaken with endoscopists from six NHS endoscopy centres across England, purposively sampled for clinical background and professional experience. A framework method analysis of A&F in endoscopy was performed, mapping themes of paradoxical outcomes and patient harm to FIT and the theory of planned behaviour (TPB). Results Data saturation was achieved on 19th participant, with endoscopists from nursing, surgical and medical professional backgrounds and a median of 7 years’ endoscopy experience (range 2–29 years).

scholarly journals Using a dark logic model to explore adverse effects in audit and feedback: a qualitative study of gaming in colonoscopy

2021 ◽  
pp. bmjqs-2021-013588
Author(s):  
Jamie Catlow ◽  
Rashmi Bhardwaj-Gosling ◽  
Linda Sharp ◽  
Matthew David Rutter ◽  
Falko F Sniehotta
Keyword(s):  
Qualitative Study ◽  
Adverse Effects ◽  
Improve Patient Care ◽  
Unintended Consequences ◽  
Logic Model ◽  
Audit And Feedback ◽  
Patient Comfort ◽  
Framework Analysis ◽  
Cognitive Interference ◽  
Detection Rates

BackgroundAudit and feedback (A&F) interventions improve patient care but may result in unintended consequences. To evaluate plausible harms and maximise benefits, theorisation using logic models can be useful. We aimed to explore the adverse effects of colonoscopy A&F using a feedback intervention theory (FIT) dark logic model before the National Endoscopy Database Automated Performance Reports to Improve Quality Outcomes Trial study.MethodsWe undertook a qualitative study exploring A&F practices in colonoscopy. Interviews were undertaken with endoscopists from six English National Health Service endoscopy centres, purposively sampled for professional background and experience. A thematic framework analysis was performed, mapping paradoxical effects and harms using FIT and the theory of planned behaviour.ResultsData saturation was achieved on the 19th participant, with participants from nursing, surgical and medical backgrounds and a median of 7 years’ experience.When performance was below aspirational targets participants were falsely reassured by social comparisons. Participants described confidence as a requirement for colonoscopy. Negative feedback without a plan to improve risked reducing confidence and impeding performance (cognitive interference). Unmet targets increased anxiety and prompted participants to question messages’ motives and consider gaming.Participants described inaccurate documentation of subjective measures, including patient comfort, to achieve targets perceived as important. Participants described causing harm from persevering to complete procedures despite patient discomfort and removing insignificant polyps to improve detection rates without benefiting the patient.ConclusionOur dark logic model highlighted that A&F interventions may create both desired and adverse effects. Without a priori theorisation evaluations may disregard potential harms. In colonoscopy, improved patient experience measures may reduce harm. To address cognitive interference the motivation of feedback to support improvement should always be clear, with plans targeting specific behaviours and offering face-to-face support for confidence.Trial registration numberISRCTN11126923.

scholarly journals Risk of Increased Acceptance for Organizational Nepotism and Cronyism during the COVID-19 Pandemic

Risks ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 59
Author(s):  
Grzegorz Ignatowski ◽  
Łukasz Sułkowski ◽  
Bartłomiej Stopczyński
Keyword(s):  
Qualitative Study ◽  
Quantitative Methods ◽  
Research Work ◽  
Negative Effects ◽  
Qualitative And Quantitative ◽  
Qualitative And Quantitative Methods ◽  
Work Related ◽  
Social And Economic Development ◽  
The Times ◽  
The Impact

Nepotism and cronyism are forms of favoritism towards certain people in the workplace. For this reason, they constitute a problem for organization managers, ethicists and psychologists. Identifying the impact of COVID-19 pandemic on the increase of nepotism and cronyism may provide a basis for organizations to assess their extent and to take possible measures to prevent their negative effects. At the same time, the research presented in the article may provide a basis for further research work related to nepotism and cronyism at the times of other threats, different from the pandemic. The aim of the article is to examine the impact of the COVID-19 pandemic on growing acceptance for nepotism and cronyism in Polish enterprises. Qualitative and quantitative methods have been included in the conducted research. Qualitative study aimed at improving knowledge of nepotism and cronyism and the impact of the COVID-19 pandemic on these phenomena, followed by a quantitative study conducted in order to verify the information obtained in the qualitative study. This research has demonstrated that Nepotism and cronyism in the workplace, are phenomenon that are basically evaluated negatively. They adversely influences social and economic development, but the impact of COVID-19 pandemic on nepotism and cronyism is not significant.

scholarly journals A process evaluation of the improving wisely intervention: a peer-to-peer data intervention to reduce overuse in surgery

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christine Fahim ◽  
William E. Bruhn ◽  
John G. Albertini ◽  
Marty A. Makary
Keyword(s):  
Process Evaluation ◽  
Improve Patient Care ◽  
Peer To Peer ◽  
Audit And Feedback ◽  
Implementation Quality ◽  
Participant Responsiveness ◽  
Key Informant ◽  
Improvement Interventions ◽  
Perceived Impact ◽  
Quality Improvement Interventions

Abstract Background The Improving Wisely intervention is a peer-to-peer audit and feedback intervention to reduce overuse of Mohs Micrographic Surgery (MMS). The objective of this study was to conduct a process evaluation to evaluate Mohs surgeons’ perceptions of the implementation quality and perceived impact of the Improving Wisely intervention. Methods Surgeons in the Improving Wisely intervention arm, comprised of members of the American College of Mohs Surgeons (ACMS) who co-led the intervention, were invited to complete surveys and key informant interviews. Participants described perceptions of implementation quality (evaluated via dose, quality of implementation, reach and participant responsiveness), perceived impact of the Improving Wisely intervention (evaluated on a 1–5 Likert and qualitatively), and barriers and facilitators to changing surgeons’ clinical practice patterns to reduce Mohs overuse. Results Seven hundred thirty-seven surgeons participated in the survey. 89% were supportive of the intervention. Participants agreed that the intervention would improve patient care and reduce the annual costs of Mohs surgery. Thirty surgeons participated in key informant interviews. 93% were interested in receiving additional data reports in the future. Participants recommended the reports be disseminated annually, that the reports be expanded to include appropriateness data, and that the intervention be extended to non ACMS members. Six themes identifying factors impacting potential MMS overuse were identified. Conclusions Participants were strongly supportive of the intervention. We present the template used to design and implement the Improving Wisely intervention and provide suggestions for specialty societies interested in leading similar quality improvement interventions among their members.

An Analysis of the Structure of Trade Between Australia and China: An Australian Perspective

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Andrew Marks
Keyword(s):  
Adverse Effects ◽  
Employment Growth ◽  
Strategic Trade Policy ◽  
Negative Effects ◽  
Trade Surplus ◽  
Strategic Trade ◽  
Primary Products ◽  
The World ◽  
Balance Of Trade ◽  
Structure Of Trade

AbstractThe structure of exports from Australia to China reveals the dominance of primary products with the structure of imports from this country reflecting the over-reliance on manufacturing goods. This has restrained and led to fluctuations in the balance of trade surplus in Australia thereby leading to lower than otherwise and more volatile output and employment growth. The pattern of trade between Australia and China is representative of trade between Australia and the rest of the world thereby magnifying these adverse effects. Strategic trade policy has the potential to alleviate these negative effects on output and employment growth in Australia.

scholarly journals Ethical challenges of caring for burn patients: a qualitative study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mostafa Bijani ◽  
Fateme Mohammadi
Keyword(s):  
Qualitative Study ◽  
Personal Identity ◽  
Clinical Decision ◽  
Vulnerable Groups ◽  
Burn Patients ◽  
Ethical Challenges ◽  
Data Saturation ◽  
Field Notes ◽  
Improved Performance ◽  
Colaizzi's Method

Abstract Background Burn patients are among the most vulnerable groups of patients requiring principled ethical care. Caring for these patients often brings various ethical challenges for the members of the health care teams, especially nurses, which affect the clinical decisions made for these patients. A limited number of studies have addressed the ethical challenges of caring for burn patients for the responsible caregivers, so the present study attempted to identify these challenges. The present study aimed to explore the health professionals' experiences of the ethical challenges during caring for burn patients. Methods This was a qualitative study with a descriptive, phenomenological design. 22 health professional practiced in public burn centers in Iran who met the inclusion criteria of the study were selected via purposeful sampling to participate in the study from June to August 2019. Data were collected using semi-structured, in-depth interviews with the individuals as well as field notes. Sampling was continued up to the data saturation. Thereafter, the collected data were analyzed using Colaizzi's method. Results The findings of the study yielded 3 themes, including respect for the patient's privacy, respect for the patient's personal identity, and care challenges, as well as 9 categories. Conclusion The findings of this study showed that the burn patients’ caregivers face some challenges in the domains of maintaining the patient's privacy, respecting the patient’s personal identity, and making the best clinical decision. Thus, providing the cultural, professional, and organizational requirements of meeting the challenges of caring for burn patients can consequently result in the caregivers’ inner peace and the improved performance.

From the Frontlines: A Qualitative Study of Staff Experiences With Clinical Event Debriefing

2021 ◽  
Author(s):  
Meghan M. Galligan ◽  
Mary Haggerty ◽  
Heather A. Wolfe ◽  
Dawn Debrocco ◽  
Katherine Kellom ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Inductive Reasoning ◽  
Improve Patient Care ◽  
Barriers And Facilitators ◽  
Clinical Event ◽  
Frontline Staff ◽  
Factors Affecting ◽  
Participant Engagement ◽  
Practice Recommendations ◽  
Staff Experiences

OBJECTIVES Clinical event debriefing (CED) can improve patient care and outcomes, but little is known about CED across inpatient settings, and participant experiences have not been well described. In this qualitative study, we sought to characterize and compare staff experiences with CED in 2 hospital units, with a goal of generating recommendations for a hospital-wide debriefing program. METHODS We conducted 32 semistructured interviews with clinical staff who attended a CED in the previous week. We explored experiences with CED, with a focus on barriers and facilitators. We used content analysis with constant comparative coding to understand priorities identified by participants. We used inductive reasoning to develop a set of CED practice recommendations to match participant priorities. RESULTS Three primary themes emerged related to CED barriers and facilitators. (1) Factors affecting attendance: most respondents voiced a need for frontline staff inclusion in CED, but they also cited competing clinical duties and scheduling conflicts as barriers. (2) Factors affecting participant engagement: respondents described factors that influence participant engagement in reflective discussion. They described that the CED leader must cultivate a psychologically safe environment in which participants feel empowered to speak up, free from judgment. (3) Factors affecting learning and systems improvement: respondents emphasized that the CED group should generate a plan for improvement with accountable stakeholders. Collectively, these priorities propose several recommendations for CED practice, including frontline staff inclusion. CONCLUSIONS In this study, we propose recommendations for CED that are derived from first-hand participant experiences. Future study will explore implementation of CED practice recommendations.

scholarly journals Beleweniswêreld van die straatkind in Hillbrow

Curationis ◽  
1998 ◽  
Vol 21 (1) ◽  
Author(s):  
R. Hatting ◽  
M. Poggenpoel ◽  
C.P.H. Myburgh
Keyword(s):  
Qualitative Study ◽  
Living Environment ◽  
Point Of View ◽  
Child Life ◽  
Street Child ◽  
Negative Effects ◽  
Educational Psychologist ◽  
The Family ◽  
Developmental Opportunities ◽  
Gaining Insight

The street child that is driven by circumstances to live outside the supportive structure of the family, is on his own. He doesn’t have the educational developmental opportunities that children who grow up in families and societies do. He finds himself in a unique educational and living environment. From an educational psychologist’s point of view, this environment is abnormal. It is therefore a great challenge for the educational psychologist to try and avoid or resolve negative effects of the child's living environment. An exploratory-, descriptive-, contextual- and qualitative study was done, with the aim of gaining insight and understanding into the life of the street child in Hillbrow as well as his experiences of his situation. The results obtained from the interviews were placed in four categories. These categories are: The street child’s continuous struggle to survive, his need for a “normal child life” , his inability to accept responsibility and the presence of a normative awareness within the street child. In conclusion it is clear that the experiential world of the street child is multi-facetted. In general it appears that the street child has many limitations and difficulties which he experiences, and that input by an educational psychologist can have meaningful influence in his life.

scholarly journals PEDESTRIANS’ PERSPECTIVES ON ENVIRONMENTAL PROBLEMS, AWARENESS AND WILLINGNESS IN CHANGING CURRENT MODE TO WALKING IN A POSSIBLE WAY TO REDUCE EXPOSURE OF O3 CONCENTRATIONS TO SCHOOLCHILDREN

2018 ◽  
Vol 80 (5) ◽  
Author(s):  
Nazatul Syadia Zainordin ◽  
Nor Azam Ramli ◽  
Ahmad Zia Ul-Saufie Mohamad ◽  
Muhammad Rizal Razman ◽  
Ahmad Shukri Yahya ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Air Pollutants ◽  
Current Mode ◽  
Ground Level ◽  
Environmental Problems ◽  
Negative Effects ◽  
Ground Level Ozone ◽  
Distance Travel ◽  
The Given ◽  
Level Of Agreement

Increasing ground level ozone has become an important issue because of its adverse effects on health and the environment. Increasing numbers of vehicles is known to be one of the sources of its precursors where gas emissions from vehicle exhausts lead to the production of ground level ozone.  Active transports, mainly walking have been found to be the most effective way to reduce the use of private vehicles especially for short-distance travel.  In this study, pedestrians’ perspectives on the existence of environmental problems and awareness regarding negative effects of these issues and their perceptions towards changing the current mode to active mode were evaluated. According to the surveys conducted at the four selected schools, by referring to the gender, as compared to male respondents, female respondents mostly testified that there were local environmental problems occurred at their area and are aware  of the adverse effects of air pollutants exposed to human. As for types of respondents, teachers were much concern with the environmental problems as they spent more time in schools compared than other types of respondents. In terms of race, Indian and Malay respondents were more aware of the negative effects of air pollutants and most willingly to change from current mode to walking. From the analysis of one-way ANOVA and independent t-test, respondents’ level of agreement with environmental problems, awareness and potential in changing the current mode to walking were related to the gender, types of respondents and race. Nevertheless, factor of travel distance did not influence the given level of agreement by respondents.

Barriers to self-care in elderly people with hypertension: a qualitative study

2018 ◽  
Vol 22 (4) ◽  
pp. 243-251
Author(s):  
Hanieh Gholamnejad ◽  
Ali Darvishpoor Kakhki ◽  
Fazlollah Ahmadi ◽  
Camelia Rohani
Keyword(s):  
Data Collection ◽  
Qualitative Study ◽  
Elderly People ◽  
Self Care ◽  
Content Type ◽  
Common Chronic Disease ◽  
Face To Face ◽  
Purposeful Sampling ◽  
Data Saturation ◽  
Conventional Content Analysis

Purpose Hypertension is the most common chronic disease throughout the world. Self-care is the key criteria in determining the final course of the disease. However, the majority of elderly people do not observe self-care behaviors. The purpose of this paper is to analyze the experiences of elderly people with hypertension in order to understand the barriers of their self-care behaviors. Design/methodology/approach This is a qualitative study with a conventional content analysis approach conducted in Tehran, Iran in 2017. Data collection was done among 23 participants – 14 elderly people; 6 cardiologists, geriatric physicians and nurses working in the cardiovascular ward; and 3 caregivers – who were selected by purposeful sampling. Using semi-structured, face-to-face interviews, data collection was continued until data saturation. Findings Three main categories, including attitude limitations, inefficient supportive network and desperation, all showed barriers to self-care by the experiences of elderly people with hypertension. Originality/value Lack of knowledge of the disease and its treatment process is one of the main barriers to self-care in elderly people with hypertension. Deficient supportive resources along with economic and family problems exacerbate the failure to do self-care behaviors.

scholarly journals Integrating tobacco cessation into routine dental practice: protocol for a qualitative study

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e028792
Author(s):  
Rachana Shah ◽  
Rupal Shah ◽  
Sujal Shah ◽  
Upendra Bhojani
Keyword(s):  
Qualitative Study ◽  
Tobacco Cessation ◽  
Sample Population ◽  
Cross Sectional ◽  
Doctoral Research ◽  
Dental Patients ◽  
Data Saturation ◽  
Ethical Approval ◽  
Indian City ◽  
The Government

IntroductionCombined efforts to encompass different aspects of tobacco control have been in place for some time. Despite the recognition of the need to offer support to tobacco users to quit tobacco use, such support remains highly inadequate in India. However, little is known about the practice of oral health professionals (OHP) and the experiences and expectations of dental patients in the context of tobacco cessation (TC) services. In this article, we describe the protocol of a doctoral research project that explores OHPs and their patients in an Indian city. The aims are (A) to understand the functioning of the oral healthcare system towards TC and what changes to it will be needed to benefit TC and (B) to capture the views of dental patients on TC services provided by OHPs.Methods and analysisA cross-sectional qualitative study based on individual interviews with OHPs and dental patients will be carried out in the city of Ahmedabad, Gujarat, India. The OHP will be purposively selected from two major organisation types: (1) single-doctor dental clinics and (2) dental hospital attached to teaching institutions. The sample population will be divided into two subgroups: general OHP (dentists practising general dentistry irrespective of their qualification) and prosthodontists (dentists with a specialisation in prosthodontics). We will sample dental patients through convenient sampling from a public teaching hospital and select private dental care facilities. The sampling of OHPs and dental patients will continue until we reach data saturation. Interviews will be audio recorded, transcribed verbatim and coded by hand. The interview transcript will subsequently be analysed using thematic content analysis.Ethics and disseminationThe study received ethical approval from the Institutional Ethical Committee of the Government Dental College and Hospital, Ahmedabad. The findings will be disseminated through conference presentations, peer-reviewed publications and to the study participants.

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