scholarly journals High turnover in clinical dietetics: A qualitative analysis

2020 ◽  
Author(s):  
Sarah J Hewko ◽  
Amirah Oyesegun ◽  
Samantha Clow ◽  
Charlene VanLeeuwen
Keyword(s):  
Life Stage ◽  
Healthcare Providers ◽  
Objective Measure ◽  
Comparative Approach ◽  
Public Healthcare ◽  
Structured Interviews ◽  
High Turnover ◽  
Team Members ◽  
Conflict Cost ◽  
Manager Support

Abstract Background: Relationships between dietitians and other healthcare providers can impact the degree to which patient care is collaborative; inefficient communication can lead to suboptimal care. It takes time for multidisciplinary team members to build collaborative, trusting relationships. For this reason, frequent dietitian turnover is of concern. Consequences include fewer referrals to clinical dietetic services and limited provider continuity. The characteristics of clinical dietetic jobs associated with high turnover have not been identified. We predicted that managers would identify disease prestige as having an impact. In this study, we aimed to explore: 1) characteristics of clinical dietetic jobs associated with the highest turnover, and 2) consequences of high turnover on patients and managers of clinical dietitians. Methods: Research assistants conducted semi-structured interviews with ten managers of clinical dietitians in the Canadian public healthcare system. We employed a constant comparative approach to thematic analysis. We classified themes related to turnover as either avoidable or unavoidable. Results: Sub-themes under avoidable turnover included lack of manager support, growth opportunities, burnout/workload, tension/conflict and hours of work. Sub-themes under unavoidable turnover included life-stage/life-events and geography. We also identified themes related to consequences of turnover, including: burnout/workload, client/patient impact, tension/conflict, cost and gap-specific. As predicted, prestige was perceived as playing a role in triggering dietitian turnover. Managers observed high turnover resulting in low provider continuity and limiting patient access to dietitians. Conclusions: Managers of publicly-employed dietitians identified many factors as contributing to high turnover. Future prospective research, incorporating the objective measure of turnover and multi-method analysis of work characteristics and work setting, would be of value in the identification of characteristics of clinical dietetic jobs associated with high turnover and the consequences of high turnover on patients and managers of these staff.

scholarly journals High turnover in clinical dietetics: A qualitative analysis

2020 ◽  
Author(s):  
Sarah J Hewko ◽  
Amirah Oyesegun ◽  
Samantha Clow ◽  
Charlene VanLeeuwen
Keyword(s):  
Life Stage ◽  
Healthcare Providers ◽  
Objective Measure ◽  
Comparative Approach ◽  
Public Healthcare ◽  
Structured Interviews ◽  
High Turnover ◽  
Team Members ◽  
Conflict Cost ◽  
Manager Support

Abstract Background: Relationships between dietitians and other healthcare providers can impact the degree to which patient care is collaborative; inefficient communication can lead to suboptimal care. It takes time for multidisciplinary team members to build collaborative, trusting relationships. For this reason, frequent dietitian turnover is of concern. Consequences include fewer referrals to clinical dietetic services and limited provider continuity. The characteristics of clinical dietetic jobs associated with high turnover have not been identified. We predicted that managers would identify disease prestige as having an impact. In this study, we aimed to explore: 1) characteristics of clinical dietetic jobs associated with the highest turnover, and 2) consequences of high turnover on patients and managers of clinical dietitians. Methods: Research assistants conducted semi-structured interviews with ten managers of clinical dietitians in the Canadian public healthcare system. We employed a constant comparative approach to thematic analysis. We classified themes related to turnover as either avoidable or unavoidable. Results: Sub-themes under avoidable turnover included lack of manager support, growth opportunities, burnout/workload, tension/conflict and hours of work. Sub-themes under unavoidable turnover included life-stage/life-events and geography. We also identified themes related to consequences of turnover, including: burnout/workload, client/patient impact, tension/conflict, cost and gap-specific. As predicted, prestige was perceived as playing a role in triggering dietitian turnover. Managers observed high turnover resulting in low provider continuity and limiting patient access to dietitians. Conclusions: Managers of publicly-employed dietitians identified many factors as contributing to high turnover. Future prospective research, incorporating the objective measure of turnover and multi-method analysis of work characteristics and work setting, would be of value in the identification of characteristics of clinical dietetic jobs associated with high turnover and the consequences of high turnover on patients and managers of these staff.

scholarly journals High turnover in clinical dietetics: a qualitative analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sarah Hewko ◽  
Amirah Oyesegun ◽  
Samantha Clow ◽  
Charlene VanLeeuwen
Keyword(s):  
Life Stage ◽  
Healthcare Providers ◽  
Objective Measure ◽  
Comparative Approach ◽  
Public Healthcare ◽  
Structured Interviews ◽  
High Turnover ◽  
Team Members ◽  
Conflict Cost ◽  
Manager Support

Abstract Background Relationships between dietitians and other healthcare providers can impact the degree to which patient care is collaborative; inefficient communication can lead to suboptimal care. It takes time for multidisciplinary team members to build collaborative, trusting relationships. For this reason, frequent dietitian turnover is of concern. Consequences include fewer referrals to clinical dietetic services and limited provider continuity. The characteristics of clinical dietetic jobs associated with high turnover have not been identified. We predicted that managers would identify disease prestige as having an impact. In this study, we aimed to explore: 1) characteristics of clinical dietetic jobs associated with the highest turnover, and 2) consequences of high turnover on patients and managers of clinical dietitians. Methods Research assistants conducted semi-structured interviews with ten managers of clinical dietitians in the Canadian public healthcare system. We employed a constant comparative approach to thematic analysis. We classified themes related to turnover as either avoidable or unavoidable. Results Sub-themes under avoidable turnover included lack of manager support, growth opportunities, burnout/workload, tension/conflict and hours of work. Sub-themes under unavoidable turnover included life-stage/life-events and geography. We also identified themes related to consequences of turnover, including: burnout/workload, client/patient impact, tension/conflict, cost and gap-specific. As predicted, prestige was perceived as playing a role in triggering dietitian turnover. Managers observed high turnover resulting in low provider continuity and limiting patient access to dietitians. Conclusions Managers of publicly-employed dietitians identified many factors as contributing to high turnover. Future prospective research, incorporating the objective measure of turnover and multi-method analysis of work characteristics and work setting, would be of value in the identification of characteristics of clinical dietetic jobs associated with high turnover and the consequences of high turnover on patients and managers of these staff.

scholarly journals High turnover in clinical dietetics: A qualitative analysis

2020 ◽  
Author(s):  
Sarah J Hewko ◽  
Amirah Oyesegun ◽  
Samantha Clow ◽  
Charlene VanLeeuwen
Keyword(s):  
Negative Impact ◽  
Healthcare Providers ◽  
Nutrition Therapy ◽  
Public Health Care ◽  
Structured Interviews ◽  
High Turnover ◽  
Team Members ◽  
The Public ◽  
Suboptimal Care ◽  
Clinical Dietetics

Abstract Background: Relationships between dietitians and other healthcare providers can impact the degree to which patient care is collaborative; inefficient communication can lead to suboptimal care. It takes time for multidisciplinary team members to build collaborative, trusting relationships. For this reason, frequent dietitian turnover (or “churn”) is of concern. Consequences include fewer referrals to clinical dietetic services and limited provider continuity. The characteristics of clinical dietetic jobs associated with churn have not been identified. The principal investigator’s professional experience and a review of the literature led us to predict that managers would identify disease prestige as having an impact on churn. In this article, we report the qualitative results of a multi-method study that we conducted to explore: 1) characteristics of clinical dietetic jobs in the public sector associated with the most churn, and 2) consequences of churn on patients and managers of clinical dietitians. Methods: We conducted semi-structured interviews with ten managers of clinical dietitians in the Canadian public health care system. We conducted a thematic analysis that was both inductive and deductive. Results: We identified four themes: i) Avoidable factors that contribute to churn often reflect intersecting human resource management issues; ii) Unavoidable factors that contribute to church frequently result from a decision made by the departing dietitian; iii) High churn in select positions has a disproportionately negative impact on patients served by dietitians in those high churn positions, and iv) Consequences of churn can be long-lasting and result in less efficient dietetic practice and reduced access to medical nutrition therapy. As predicted, prestige was perceived as playing a role in triggering dietitian turnover – however, prestige was more commonly attributed to employment in a respected institution than to providing treatment for a particular disease or condition. Conclusions: Managers of publicly-employed dietitians identified many factors as contributing to churn. Managers observed churn resulting in low provider continuity and limiting patient access to dietitians. More research is needed to better understand factors contributing to churn among Canadian clinical dietitians.Trial Registration: Not applicable.

scholarly journals Exploring the potential for introducing home monitoring of blood pressure during pregnancy into maternity care: current views and experiences of staff—a qualitative study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e037874
Author(s):  
Lisa Hinton ◽  
James Hodgkinson ◽  
Katherine L Tucker ◽  
Linda Rozmovits ◽  
Lucy Chappell ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Maternity Care ◽  
Healthcare Providers ◽  
Home Monitoring ◽  
Structured Interviews ◽  
Group Discussions ◽  
Self Monitoring ◽  
Team Members ◽  
Registration Number ◽  
In Pregnancy

ObjectiveOne in 20 women are affected by pre-eclampsia, a major cause of maternal and perinatal morbidity, death and premature birth worldwide. Diagnosis is made from monitoring blood pressure (BP) and urine and symptoms at antenatal visits after 20 weeks of pregnancy. There are no randomised data from contemporary trials to guide the efficacy of self-monitoring of BP (SMBP) in pregnancy. We explored the perspectives of maternity staff to understand the context and health system challenges to introducing and implementing SMBP in maternity care, ahead of undertaking a trial.DesignExploratory study using a qualitative approach.SettingEight hospitals, English National Health Service.ParticipantsObstetricians, community and hospital midwives, pharmacists, trainee doctors (n=147).MethodsSemi-structured interviews with site research team members and clinicians, interviews and focus group discussions. Rapid content and thematic analysis undertaken.ResultsThe main themes to emerge around SMBP include (1) different BP changes in pregnancy, (2) reliability and accuracy of BP monitoring, (3) anticipated impact of SMBP on women, (4) anticipated impact of SMBP on the antenatal care system, (5) caution, uncertainty and evidence, (6) concerns over action/inaction and patient safety.ConclusionsThe potential impact of SMBP on maternity services is profound although nuanced. While introducing SMBP does not reduce the responsibility clinicians have for women’s health, it may enhance the responsibilities and agency of pregnant women, and introduces a new set of relationships into maternity care. This is a new space for reconfiguration of roles, mutual expectations and the relationships between and responsibilities of healthcare providers and women.Trial registration numberNCT03334149.

scholarly journals Understanding Low-value Care and Associated De-implementation Processes: A Qualitative Study of Choosing Wisely Interventions Across Canadian Hospitals

2021 ◽  
Author(s):  
Gillian Parker ◽  
Monika Kastner ◽  
Karen Born ◽  
Nida Shahid ◽  
Whitney Berta
Keyword(s):  
Process Model ◽  
Healthcare Providers ◽  
Implementation Process ◽  
Choosing Wisely ◽  
Structured Interviews ◽  
Team Members ◽  
Implementation Processes ◽  
Healthcare Settings ◽  
National Campaigns ◽  
The Impact

Abstract Background:Choosing Wisely (CW) is an international movement comprised of national campaigns in more than 20 countries to reduce low-value care (LVC). Hospitals and healthcare providers are examining existing practices and putting interventions in place to reduce practices that offer little to no benefit to patients or may cause them harm. De-implementation, the reduction or removal of a healthcare practice is an emerging field of research. Little is known about the factors which (i) sustain LVC; and (ii) the magnitude of the problem of LVC. In addition, little is known about the processes of de-implementation, and if and how these processes differ from implementation endeavours. The objective of this study was to explicate the myriad factors which impact the processes and outcomes of de-implementation initiatives that are designed to address national Choosing Wisely campaign recommendations.Methods:Semi-structured interviews were conducted with individuals implementing Choosing Wisely Canada recommendations in healthcare settings in four provinces. The interview guide was developed using concepts from the literature and the Implementation Process Model (IPM) as a framework. All interviews were conducted virtually, recorded, and transcribed verbatim. Data were analysed using thematic analysis.Results:Seventeen Choosing Wisely team members were interviewed. Participants identified numerous provider factors, most notably habit, which sustain LVC. Contrary to reporting in recent studies, the majority of LVC in the sample was not ‘patient facing’; therefore, patients were not a significant driver for the LVC, nor a barrier to reducing it. Participants detailed aspects of the magnitude of the problems of LVC, specifically the impact of harm and resources. Unique factors influencing the processes of de-implementation reported were: influence of Choosing Wisely campaigns, availability of data, lack of targets and hard-coded interventions.Conclusions: This study explicates factors ranging from those which impact the maintenance of LVC to factors that impact the success of de-implementation interventions intended to reduce them. The findings draw attention to the significance of unintentional factors, highlight the importance of understanding the impact of harm and resources to reduce LVC and illuminate the overstated impact of patients in de-implementation literature. These findings illustrate the complexities of de-implementation.

scholarly journals Peer support workers as a bridge: a qualitative study exploring the role of peer support workers in the care of people who use drugs during and after hospitalization

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Robin Lennox ◽  
Larkin Lamarche ◽  
Tim O’Shea
Keyword(s):  
Qualitative Study ◽  
Peer Support ◽  
Healthcare Providers ◽  
People Who Use Drugs ◽  
Healthcare Team ◽  
Structured Interviews ◽  
Support Worker ◽  
Team Members ◽  
Key Stakeholders

Abstract Background To describe the key qualities and unique roles of peer support workers in the care of people who inject drugs during and after hospitalization. Methods We conducted a qualitative study. Key stakeholders were recruited including: people who use drugs who had been hospitalized, healthcare team members, peer support workers, and employers of peer support workers. Data were collected from 2019 to 2020 using semi-structured interviews that were audio-recorded, transcribed, and analyzed thematically. Results Fourteen participants were interviewed: 6 people who use drugs who had been hospitalized, 5 healthcare team members, 2 peer support workers, and 1 employer of peer support workers. At the core of the data was the notion of peer workers acting as a bridge. We found four themes that related to functions of this bridge: overcoming system barriers, advocacy, navigating transitions within the healthcare system, and restoring trust between HCPs and PWUD. We found two themes for building a strong bridge and making the role of a peer support worker function effectively (training and mentorship, and establishing boundaries). We found three themes involving characteristics of an effective peer worker (intrinsic qualities, contributions of shared experiences, and personal stability). Conclusion Peer support workers are highly valued by both people who use drugs and members of the healthcare team. Peer support workers act as a bridge between patients and healthcare providers and are critical in establishing trust, easing transitions in care, and providing unique supports to people who use drugs during and after hospitalization.

scholarly journals Investigating the Medical Tourism Supply Chain in Shiraz, Iran: A Hybrid Grounded Theory and Rough DEMATEL Method

2021 ◽  
Author(s):  
Arash Haqbin ◽  
Payam Shojaei ◽  
Mohammad Hossein Ronaghi ◽  
Omid Fazelzadeh
Keyword(s):  
Supply Chain ◽  
Grounded Theory ◽  
Systematic Approach ◽  
Medical Tourism ◽  
Healthcare Providers ◽  
Tourism Industry ◽  
Travel Agency ◽  
Public Healthcare ◽  
Structured Interviews ◽  
Tourism Supply Chain

Abstract Background: This study sought to provide a comprehensive analysis of the medical tourism supply chain (MTSC) in Shiraz, Iran, to improve the city’s potential tourism market share in the post-COVID-19 future. In doing so, the study relied on a mixed research methodology. Primarily, interviews were conducted with 12 stakeholders involved in Shiraz’s MTSC, including general policymakers, managers of private/public healthcare providers, travel agency managers, and managers of medical tourism companies. The data were collected through semi-structured interviews and were then analyzed according to the systematic approach of grounded theory (GT).Results: The results helped to configure a model that analyzed Shiraz’s MTSC, which included 6 main dimensions, 17 sub-dimensions, and 48 criteria. To detect any interrelationships among the criteria, the model was further analyzed quantitatively through the rough Decision making trial and evaluation laboratory (DEMATEL) method.Conclusion: Proposing a novel methodology in medical tourism research, the study could practically contribute to different stakeholders in the medical tourism industry in Shiraz.

scholarly journals Understanding low-value care and associated de-implementation processes: A qualitative study of Choosing Wisely Interventions across Canadian hospitals

2021 ◽  
Author(s):  
Gillian Parker ◽  
Monika Kastner ◽  
Karen Born ◽  
Nida Shahid ◽  
Whitney Berta
Keyword(s):  
Process Model ◽  
Healthcare Providers ◽  
Implementation Process ◽  
Choosing Wisely ◽  
Structured Interviews ◽  
Team Members ◽  
Implementation Processes ◽  
Healthcare Settings ◽  
National Campaigns ◽  
The Impact

Abstract Background:Choosing Wisely (CW) is an international movement comprised of national campaigns in more than 20 countries to reduce low-value care (LVC). Hospitals and healthcare providers are examining existing practices and putting interventions in place to reduce practices that offer little to no benefit to patients or may cause them harm. De-implementation, the reduction or removal of a healthcare practice is an emerging field of research. Little is known about the factors which (i) sustain LVC; and (ii) the magnitude of the problem of LVC. In addition, little is known about the processes of de-implementation, and if and how these processes differ from implementation endeavours. The objective of this study was to explicate the myriad factors which impact the processes and outcomes of de-implementation initiatives that are designed to address national Choosing Wisely campaign recommendations.Methods:Semi-structured interviews were conducted with individuals implementing Choosing Wisely Canada recommendations in healthcare settings in four provinces. The interview guide was developed using concepts from the literature and the Implementation Process Model (IPM) as a framework. All interviews were conducted virtually, recorded, and transcribed verbatim. Data were analysed using thematic analysis.Findings:Seventeen Choosing Wisely team members were interviewed. Participants identified numerous provider factors, most notably habit, which sustain LVC. Contrary to reporting in recent studies, the majority of LVC in the sample was not ‘patient facing’; therefore, patients were not a significant driver for the LVC, nor a barrier to reducing it. Participants detailed aspects of the magnitude of the problems of LVC, specifically the impact of harm and resources. Unique factors influencing the processes of de-implementation reported were: influence of Choosing Wisely campaigns, availability of data, lack of targets and hard-coded interventions. Conclusions: This study explicates factors ranging from those which impact the maintenance of LVC to factors that impact the success of de-implementation interventions intended to reduce them. The findings draw attention to the significance of unintentional factors, highlight the importance of understanding the impact of harm and resources to reduce LVC and illuminate the overstated impact of patients in de-implementation literature. These findings illustrate the complexities of de-implementation.

scholarly journals Peer Support Workers as a Bridge: A Qualitative Study Exploring the Role of Peer Support Workers in the Care of People Who Use Drugs During and After Hospitalization 

2020 ◽  
Author(s):  
Robin Lennox ◽  
Larkin Lamarche ◽  
Tim O'Shea
Keyword(s):  
Qualitative Study ◽  
Peer Support ◽  
Healthcare Providers ◽  
People Who Use Drugs ◽  
Healthcare Team ◽  
Structured Interviews ◽  
Support Worker ◽  
Team Members ◽  
Key Stakeholders

Abstract Background: To describe the key qualities and unique roles of peer support workers in the care of people who inject drugs during and after hospitalization.Methods: We conducted a qualitative study. Key stakeholders were recruited including: people who use drugs who had been hospitalized, healthcare team members, peer support workers, and employers of peer support workers. Data was collected from 2019-2020 using semi-structured interviews that were audio-recorded, transcribed, and analyzed thematically.Results: Fourteen participants were interviewed: 6 people who use drugs who had been hospitalized, 5 healthcare team members, 2 peer support workers, and 1 employer of peer support workers. At the core of the data was the notion of peer workers acting as a bridge to overcome systemic barriers. We found two themes that related to functions of this bridge: advocacy and navigating transitions within the healthcare system. We found two themes for building a strong bridge and making the role of a peer support worker function effectively (training and mentorship, and establishing boundaries). We found three themes involving characteristics of an effective peer worker (intrinsic qualities, contributions of shared experiences, and personal stability). When the bridge works well it ultimately serves to rebuild trust between healthcare providers and people who use drugs.Conclusions: Peer support workers are highly valued by both people who use drugs and members of the healthcare team. Peer support workers act as a bridge between patients and healthcare providers, and are critical in establishing trust, easing transitions in care, and providing unique supports to people who use drugs during and after hospitalization.

Knowledge and Communication of the National Core Standards Tool

2018 ◽  
Vol 20 (2) ◽  
Author(s):  
Winnie Thembisile Maphumulo ◽  
Busisiwe Bhengu
Keyword(s):  
Pearson Correlation ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Sampling Technique ◽  
Quality Of Healthcare ◽  
Survey Study ◽  
Public Healthcare ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Professional Nurses

The National Department of Health in South Africa has introduced the National Core Standards (NCS) tool to improve the quality of healthcare delivery in all public healthcare institutions. Knowledge of the NCS tool is essential among healthcare providers. This study investigated the level of knowledge on NCS and how the NCS tool was communicated among professional nurses. This was a cross-sectional survey study. Purposive sampling technique was used to select hospitals that only offered tertiary services in KwaZulu-Natal. Six strata of departments were selected using simple stratified sampling. The population of professional nurses in the selected hospitals was 3 050. Systematic random sampling was used to recruit 543 participants. The collected data were analysed using SPSS version 25. The study showed that only 16 (3.7%) respondents had knowledge about NCS, using McDonald’s standard of learning outcome measured criteria regarding the NCS tool. The Pearson correlation coefficient between the communication and knowledge was r = 0.055. The results revealed that although the communication scores for the respondents were high their knowledge scores remained low. This study concluded that there is a lack of knowledge regarding the NCS tool and therefore healthcare institutions need to commit themselves to the training of professional nurses regarding the NCS tool. The findings suggest that healthcare institutions implement the allocation of incentives for nurses that attend the workshops for NCS.

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