scholarly journals Supporting healthcare workers to improve the quality and safety of care through AMR stewardship: A bottom-up participatory approach to audit and feedback as a learning and improvement strategy

2022 ◽  
Author(s):  
Julia Keizer
Keyword(s):  
Healthcare Workers ◽  
Participatory Approach ◽  
Audit And Feedback ◽  
Quality And Safety ◽  
Improvement Strategy ◽  
Bottom Up

Reducing Unnecessary Respiratory Viral Testing to Promote High-Value Care

PEDIATRICS ◽  
2022 ◽  
Author(s):  
Olivia Ostrow ◽  
Deena Savlov ◽  
Susan E. Richardson ◽  
Jeremy N. Friedman
Keyword(s):  
Control Charts ◽  
Respiratory Infections ◽  
Audit And Feedback ◽  
Improvement Strategy ◽  
Statistical Process ◽  
Process Control Charts ◽  
Statistical Process Control Charts ◽  
Viral Testing ◽  
Return Visits ◽  
Viral Respiratory Infections

BACKGROUND AND OBJECTIVES: Viral respiratory infections are common in children, and practice guidelines do not recommend routine testing for typical viral illnesses. Despite results often not impacting care, nasopharyngeal swabs for viral testing are frequently performed and are an uncomfortable procedure. The aim of this initiative was to decrease unnecessary respiratory viral testing (RVT) in the emergency department (ED) and the pediatric medicine wards (PMWs) by 50% and 25%, respectively, over 36 months. METHODS: An expert panel reviewed published guidelines and appropriate evidence to formulate an RVT pathway using plan-do-study-act cycles. A multifaceted improvement strategy was developed that included implementing 2 newer, more effective tests when testing was deemed necessary; electronic order modifications with force functions; audit and feedback; and education. By using statistical process control charts, the outcomes analyzed were the percentage of RVT ordered in the ED and the rate of RVT ordered on the PMWs. Balancing measures included return visits leading to admission and inpatient viral nosocomial outbreaks. RESULTS: The RVT rate decreased from a mean of 3.0% to 0.5% of ED visits and from 44.3 to 30.1 per 1000 patient days on the PMWs and was sustained throughout the study. Even when accounting for the new rapid influenza test available in the ED, a 50% decrease in overall ED RVT was still achieved without any significant impact on return visits leading to admission or inpatient nosocomial infections. CONCLUSIONS: Through implementation of a standardized, electronically integrated RVT pathway, a decrease in unnecessary RVT was successfully achieved. Audit and feedback, reminders, and biannual education all supported long-term sustainability of this initiative.

The effectiveness of leadership: meta-analysis of trial, cross-sectional, and before after studies

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
V Restivo ◽  
M Gaeta ◽  
A Odone ◽  
C Trucchi ◽  
A Battaglini ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Evidence Based Practice ◽  
Meta Analysis ◽  
Healthcare Setting ◽  
Risk Difference ◽  
Audit And Feedback ◽  
Evidence Based ◽  
Cross Sectional ◽  
Cross Sectional Studies ◽  
Private Setting

Abstract Background The clinical and surgical procedures are often based on scientifical evidence but 30-40% of patients do not receive treatment according to evidence based medicine. The main aim of this review and meta-analysis is to assess the effectiveness of leadership in healthcare setting. Methods It was conducted a literature research on MEDLINE, Pubmed and Scopus with publication year between 2015 and 2019. The inclusion criteria were studies involving healthcare workers that evaluated effectiveness of opinion leaders in improving behaviour of healthcare workers, according to clinical or patient related outcomes. The quality of studies were assesed with the NHLBI for before after studies and the NOS for other study designs. The effect of leadership was assessed as risk difference for all studies with the exception of cross sectional studies. For the last it was evaluated correlation between leadership level and outcome measurment. Results A total of 3,155 articles were screened and 284 were fully assessed including 22 of them in the final database: 1 randomized trial, 9 cross sectional and 12 before after studies. For the cross-sectional studies there was a correlation of 0.22 (95% CI 0.15-0.28) between leadership level and outcome measurment. In the metaregression analysis the only factor that increased the correlation was private setting (meta regression coefficent =0.52, p = 0.022). The pooled efficacy was 24% (95% CI 10%-17%) for before after studies. Furthermore, a higher effectiveness was revealed in studies conducted on multi professional (24%) than single professional (9%) healthcare workers. Conclusions According to results, the guidelines adherence and task performance increased in a setting with leadership implementation. The leadership effectiveness appears comparable to other strategies as audit and feedback used to implement evidence-based practice in worldwide healthcare. Key messages The translation of evidence into clinical practice is often difficult but this study suggests that leaderhip can had higher effectiveness in multiprofessional healthcare workers and private setting. The effectiveness of leadership in this review suggests that it can be of help in order to make aware healthcare professionals about effectiveness of comply with evidence-based practice.

scholarly journals Pendekatan Participatory Planning pada Perencanaan Ruang Belajar Pendidikan Anak Usia Dini (PAUD)

2019 ◽  
Vol 2 (3) ◽  
pp. 155
Author(s):  
Julindiani Iskandar ◽  
Dedes Nur Gandarum
Keyword(s):  
Sense Of Belonging ◽  
Participatory Approach ◽  
Participatory Planning ◽  
Transfer Of Knowledge ◽  
Community Learning ◽  
Bottom Up ◽  
Childhood Education ◽  
Sense Of Ownership ◽  
Planning Approach ◽  
Residential District

Planning for Ananda's Early Childhood Education (PAUD) learning room, located in a densely populated and densely populated residential district of Tambora District, West Jakarta, was carried out due to lack of knowledge and funds to build and carry out maintenance. Therefore, additional knowledge, assistance and a pilot of healthy learning environment facilities are needed. Counseling, assistance and demonstration conducted are bottom up through a participatory planning approach. This is done so that the planning, design, and maintenance of environmental facilities are in accordance with the needs and abilities of the community, can be accepted by the community, as well as a medium for community learning or transfer of knowledge related to the planning, design and maintenance of environmental facilities, especially PAUD facilities. In addition, with this participatory approach it is hoped that a strong sense of ownership will emerge as a basis for self-supporting and sustainable maintenance and development of public facilities.Perencanaan ruang belajar Pendidikan Anak Usia Dini (PAUD) Ananda yang terletak di pemukiman padat penduduk dan padat bangunan Kecamatan Tambora, Jakarta Barat dilakukan karena kurangnya pengetahuan dan biaya untuk membangun dan melakukan perawatan. Oleh sebab itu diperlukan pengetahuan tambahan, pendampingan serta percontohan tentang fasilitas lingkungan belajar yang sehat. Penyuluhan, pendampingan serta percontohan yang dilakukan bersifat bottom up melalui pendekatan partisipatory planning. Hal ini dilakukan agar perencanaan, perancangan, dan perawatan fasilitas lingkungan tersebut sesuai dengan kebutuhan dan kemampuan masyarakat, dapat diterima oleh masyarakat, serta menjadi media pembelajaran masyarakat atau transfer of knowledge terkait perencanaan, perancangan, dan perawatan fasilitas lingkungan, khususnya fasilitas PAUD. Selain itu dengan pendekatan partisipatif ini diharapkan timbul rasa kepemilikan yang kuat (sense of belonging) yang akan menjadi modal dasar bagi pemeliharaan dan pengembangan fasilitas publik secara swadaya dan berkelanjutan.

scholarly journals The impact of audit and feedback to support change behaviour in healthcare organisations - a cross-sectional qualitative study of primary care centre managers

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anna H. Glenngård ◽  
Anders Anell
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Audit And Feedback ◽  
Primary Care Centre ◽  
Research Approach ◽  
Care Centre ◽  
Bottom Up ◽  
Complex Change ◽  
Facilitators And Barriers ◽  
The Impact

Abstract Background This article addresses the role of audit and feedback (A&F) to support change behaviour and quality improvement work in healthcare organisations. It contributes to the sparse literature on primary care centre (PCC) managers´ views on A&F practices, taking into account the broad scope of primary care. The purpose was to explore if and how different types of A&F support change behaviour by influencing different forms of motivation and learning, and what contextual facilitators and barriers enable or obstruct change behaviour in primary care. Methods A qualitative research approach was used. We explored views about the impact of A&F across managers of 27 PCCs, in five Swedish regions, through semi-structured interviews. A purposeful sampling was used to identify both regions and PCC managers, in order to explore multiple perspectives. We used the COM-B framework, which describes how Capability, Opportunity and Motivation interact and generate change behaviour and how different factors might act as facilitators or barriers, when collecting and analysing data. Results Existing forms of A&F were perceived as coercive top-down interventions to secure adherence to contractual obligations, financial targets and clinical guidelines. Support to bottom-up approaches and more complex change at team and organisational levels was perceived as limited. We identified five contextual factors that matter for the impact of A&F on change behaviour and quality improvement work: performance of organisations, continuity in staff, size of organisations, flexibility in leadership and management, and flexibility offered by the external environment. Conclusions External A&F, perceived as coercive by recipients of feedback, can have an impact on change behaviour through ‘know-what’ and ‘know-why’ types of knowledge and ‘have-to’ commitment but provide limited support to complex change. ‘Want-to’ commitment and bottom-up driven processes are important for more complex change. Similar to previous research, identified facilitators and barriers of change consisted of factors that are difficult to influence by A&F activities. Future research is needed on how to ensure co-development of A&F models that are perceived as legitimate by health care professionals and useful to support more complex change.

scholarly journals Top-Down or Bottom-Up: Approaches for Addressing Land Degradation in Swaziland and Botswana

2013 ◽  
Vol 3 (1) ◽  
pp. 32-40 ◽  
Author(s):  
Josh Baller
Keyword(s):  
Land Tenure ◽  
Land Degradation ◽  
Participatory Approach ◽  
Political Organization ◽  
Central Administration ◽  
Top Down ◽  
Bottom Up ◽  
Political Background ◽  
Democratic Country ◽  
Land Tenure Systems

The strategies taken by a particular government are largely based upon their socio-cultural and political background. This paper will examine two countries that, while sharing regional proximity and similar conditions surrounding land degradation, have drastically different forms of governance: Swaziland and Botswana. We will examine the problem of land degradation in these countries generally and what aspects of socio-political organization in each country have affected the rate and severity of the problem. This paper will highlight the policy paths taken by Swaziland and Botswana and examine the irony of their methods. Despite Swaziland’s central administration and land tenure systems, they have adopted a more participatory approach to addressing land degradation compared to Botswana, a democratic country.

Hand hygiene practices among healthcare workers in a newborn unit of a tertiary referral hospital in Kenya

2018 ◽  
Vol 20 (3) ◽  
pp. 132-138
Author(s):  
Serah K Ngugi ◽  
Florence V Murila ◽  
Rachel N Musoke
Keyword(s):  
Hand Hygiene ◽  
Healthcare Workers ◽  
Compliance Rate ◽  
Referral Hospital ◽  
World Health ◽  
Tertiary Referral ◽  
Improvement Strategy ◽  
Tertiary Referral Hospital ◽  
Effective Measure ◽  
Hospitalised Patients

Background: Health care-associated infection (HCAI) is a significant cause of morbidity and mortality among hospitalised patients, particularly neonates. Compliance with hand hygiene (HH) recommendations is the simplest and most effective measure in preventing this infection. Objectives: To determine the HH practices among healthcare workers (HCWs) in the newborn unit of a tertiary referral hospital in Kenya, their knowledge and perceptions regarding HCAI and importance of HH, and barriers to the recommended HH practices. Methods: A descriptive cross-sectional study was conducted to evaluate the HCWs’ compliance with the World Health Organization (WHO) ‘5 Moments for Hand Hygiene’ and a structured self-administered questionnaire adopted from the WHO knowledge and perception of HCW questionnaires was used to answer the secondary objectives. Results: The overall HH compliance rate was 15%. HCWs were twice more likely to take a HH action ‘after’ than ‘before’ a patient care procedure (odds ratio [OR] = 2.05; 95% confidence interval [CI] = 1.02–4.19; P = 0.03). Nurses and nursing students had statistically significant lower compliance (OR 0.41; 95% CI = 0.18-0.91; p=0.016) and (OR 0.21; 95% CI = 0.06-0.70; p = 0.004) respectively, compared to the doctors. More than half (52%) of the HCWs were unaware of the five moments/indication for HH. Lack of supplies, forgetfulness and use of gloves were the commonly cited barriers to HH compliance. Discussion: HH compliance rate among HCWs in the newborn unit of the tertiary referral hospital was very low. The observed and reported barriers to optimal HH compliance demonstrate a necessity for the adoption of the WHO recommended multimodal HH improvement strategy in this unit.

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