Stakeholder views of the development of a clinical quality registry for interventional radiology: a qualitative study

Background Clinical quality registries (CQRs) can likely improve quality in healthcare and research. However, studies indicate that effective use of CQRs is hindered by lack of engagement and interest among stakeholders, as well as factors related to organisational context, registry design and data quality. To fulfil the potential of CQRs, more knowledge on stakeholders’ perceptions of the factors that will facilitate or hamper the development of CQRs is essential to the more appropriate targeting of registry implementation and the subsequent use of the data. The primary aim of this study was to examine factors that can potentially affect the development of a national CQR for interventional radiology in Norway from the perspective of stakeholders. Furthermore, we wanted to identify the intervention functions likely to enable CQR development. Only one such registry, located in Sweden, has been established. To provide a broader context for the Norwegian study, we also sought to investigate experiences with the development of this registry. Methods A qualitative study of ten Norwegian radiologists and radiographers using focus groups was conducted, and an in-depth interview with the initiator of the Swedish registry was carried out. Questions were based on the Capability, Opportunity and Motivation for Behaviour Model and the Theoretical Domains Framework. The participants’ responses were categorised into predefined themes using a deductive process of thematic analysis. Results Knowledge of the rationale used in establishing a CQR, beliefs about the beneficial consequences of a registry for quality improvement and research and an opportunity to learn from a well-developed registry were perceived by the participants as factors facilitating CQR development. The study further identified a range of development barriers related to environmental and resource factors (e.g., a lack of organisational support, time) and individuallevel factors (e.g., role boundaries, resistance to change), as well as several intervention functions likely to be appropriate in targeting these barriers. Conclusion This study provides a deeper understanding of factors that may be involved in the behaviour of stakeholders regarding the development of a CQR. The findings may assist in designing, implementing and evaluating a methodologically rigorous CQR intervention.

Supporting Medical Students To Support Peers: A Qualitative Interview Study

BackgroundStudents may be the first to recognise and respond to psychological distress in other students. Peer support could overcome medical student reluctance to seek help despite their high rates of mental ill-health. Yet, despite the adoption of peer support programs, there is little evidence of impact on students. Peer support programs may assume that medical students accept and view peer support positively. We explored these assumptions by asking students about their experiences and views on peer support. MethodsQualitative semi-structured interviews exploring peer support experiences and views on peer support were conducted with ten medical students at two contrasting medical schools. Informed by a constructivist stance, interview transcripts underwent thematic analysis. ResultsThree groups of themes were identified: participants’ experiences of peer support encounters, concerns about providing support, and views on students’ roles in peer support. Participants readily recalled signs of peer distress. Encounters were ad hoc, informal, and occurred within relationships based on friendship or by being co-located in the same classes or placements. Concerns about initiating and offering support included lack of expertise, maintaining confidentiality, stigma from a mental health diagnosis, and unclear role boundaries, with implications for acceptance of student roles in peer support. Conclusions: Our study emphasised the centrality of social relationships in enabling or discouraging peer support. Relationships developed during medical studies may anticipate the collegial relationships between medical professionals. Nevertheless, only some students are willing to undertake peer support roles. We suggest different strategies for promoting informal peer support that can be offered by any student, to those promoting formal support roles for selected students. Future research focusing on the impact for both the students who receive, and on the students who provide peer support is called for.

Personal and Group Professional Identity in the 21st Century Case Study: The School Counseling Profession

The current study focuses on the concept of professional identity in the school counseling profession, its definition and measurement. According to the definition in this study, the concept of “professional identity” is divided in two: personal professional identity, which is the practitioner’s sense of belonging to and solidarity with the profession, and group professional identity, which includes the features attributed to the profession, both by those who belong to it and by those who do not practice it, and makes it possible to discern between professions. The school counseling profession, occupied mainly by women, is contending with a lack of clarity regarding its role definition, role boundaries, and demands. Therefore, despite the change in the status of the profession in recent years, various issues impede the group professional identity of school counseling and the personal profession identity of its practitioners. This study is the first to examine the professional identity of school counselors on two levels: personal and group, among school counselors in Israel. The study included 174 school counselors who completed two professional identity scales constructed for the purpose of the study. Each scale underwent factor analysis, and a significant association was found between the two scales and the factors they comprised. The research findings indicate that the personal professional identity of school counselors is affected by their group professional identity, and vice versa. The research findings indicate the need to distinguish in future studies between personal and group professional identity, both in the school counseling profession and in other professions, particularly in a world characterized by professional mobility where current professions will become irrelevant while others will be in demand and there may be a need to define the personal and group professional identity of workers.

Vice-principals as leaders: Role ambiguity and role conflicts faced by vice-principals in Singapore

This article examines what vice-principals in Singapore experience as constraints to their leadership practice, and how they deal with these constraints, cognisant that role misalignment for vice-principals presents barriers to schools achieving optimal effectiveness. This qualitative study seeks to hear the voices of vice-principals, to uncover the contextual richness of their experiences through interviews with 28 vice-principals. Coding involved a mix of codes from the literature and from the interviews, with member checking of the findings. Vice-principals in Singapore face two main constraints: role ambiguity and role conflicts. These are mainly a structural issue, given the dual expectations of vice-principals to support their principals and to lead. The problems are heightened when there are clashes of values, with vice-principals conflicted between two sources of authority: administrative and professional. Framing the constraints faced by vice-principals under role ambiguity and role conflicts raises these constraints to a theoretical and organisational level. The study proposes a link between the concepts of role ambiguity and role boundaries and illustrates how role ambiguity and conflicts can be disempowering. However, the study also shows that ambiguity need not always be a constraint but can be positive under some conditions.

Exploring the perceptions of advanced practitioner radiographers at a single breast screening unit in extending their role from delivering benign to malignant biopsy results; a preliminary study

Objective: The study aims to explore the perceptions of advanced practice radiographers (APRs) currently giving benign biopsy results to extend their role to deliver NHS Breast Screening Programme (NHSBSP) malignant outcomes. In the UK, APRs are appropriately trained to deliver results, yet traditionally have been cultured not to. Increasing pressures on NHSBSP units are a key driver for APR evolvement. A significant lack of published research provides the rationale for the study, combined with an identified service need. Methods: Following ethical approval, a grounded theory design was applied to interview six APRs individually in a single breast screening unit. Extracted themes were considered during a subsequent focus group. Results: Five core themes identified; (i) role of the APR, (ii) patient experience, (iii) efficiency, (iv) role boundaries, and (v) delivering results. The findings indicate the ambiguity of radiographers delivering results within their profession, outlining the potential impact on themselves and patients. Mammography APRs are skilled to deliver results, and whilst enforced barriers may restrict extension a supportive environment can overcome these. Additional training is necessary to implement the role in the screening service. Conclusion: Identified within their scope of practice; APRs have the ability with appropriate training and peer support to effectively deliver results with a patient-centred approach. Advances in knowledge: This study has identified important enabling factors and challenges concerning role extension in the delivery of breast biopsy results. The apparent suitability of APRs to communicate results may address breast service pressures, with benefit to patients and the radiology profession.

Organizational secrecy as viewed by the agents of a multinational corporation: A Case Study

abstract: Only a limited number of theoretical studies have been conducted with regards to the issue of organizational secrecy. This study examines similar and different views about secrecy within three executive levels of an industrial multinational organization named Motores. This is achieved through a case study for which the data has been collected by using a survey-like questionnaire and semi-structured interviews. The different maturity levels and process structures in the enterprise account not only for different stages, concerns, and types of knowledge involved in addressing secrecy, but also for the role boundaries among the agents surveyed. Furthermore, while these agents are well acquainted with suppliers and customers, whereby confidentiality is ensured through confidentiality agreements (NDAs) and patent protection, their relationships with institutions and organizations appear to be areas of little or no knowledge, especially when it concerns competitors, class entities, and government relations. Leaks of classified information occur, and the places and situations where they may take place are identified. No potential mitigation situations were identified in our case study, and no systemic protocol exists for dealing with classified topics in the different areas where secrecy is involved, including business strategies. Transparency is recognized and desired; however, its risks and consequences require evaluation.

Rethinking lurking: invisible leading and following in a knowledge transfer ecosystem

© 2015, Association for Information Systems. All rights reserved. The term lurker connotes a low-value role in online communities. Despite making up the majority of members, these invisible individuals are often cast as peripheral players who should be encouraged to participate more fully. We argue that the lurker concept is problematic and that online communities, and the roles associated with them, need to be reconceptualized. We report on a study of online communities in a New Zealand professional development program. We found that two knowledge broker types played key roles in transferring knowledge: connector-leaders, who had a strong online presence, and follower-feeders, who communicated largely invisibly, via side-channels. Despite their different online profiles, both brokers used “lurking” purposively to perform two sets of invisible online activities: managing the knowledge agenda, and mentoring/being mentored. These activities supported their roles as leaders and followers, and sustained a symbiotic relationship. Decisions to “lurk” arose from the need for these brokers to negotiate diverse boundaries: the boundaries of micro-culture associated with communication contexts, the theory-practice boundary, role boundaries, and the online-offline boundary. Combining the concept of polycontextuality with boundary spanning theory, we propose an alternative way of understanding both lurking and online communities: the three-tier knowledge transfer ecosystem (KTE), a system of engagement spaces comprising diverse online and offline contexts in which individuals make continual decisions to cross between less- or more-visible settings. The study illustrates how key phenomena may remain invisible without a shift in level of analysis, and how using an anachronistic concept to frame a study can unintentionally constrain its value.

Rethinking lurking: invisible leading and following in a knowledge transfer ecosystem

© 2015, Association for Information Systems. All rights reserved. The term lurker connotes a low-value role in online communities. Despite making up the majority of members, these invisible individuals are often cast as peripheral players who should be encouraged to participate more fully. We argue that the lurker concept is problematic and that online communities, and the roles associated with them, need to be reconceptualized. We report on a study of online communities in a New Zealand professional development program. We found that two knowledge broker types played key roles in transferring knowledge: connector-leaders, who had a strong online presence, and follower-feeders, who communicated largely invisibly, via side-channels. Despite their different online profiles, both brokers used “lurking” purposively to perform two sets of invisible online activities: managing the knowledge agenda, and mentoring/being mentored. These activities supported their roles as leaders and followers, and sustained a symbiotic relationship. Decisions to “lurk” arose from the need for these brokers to negotiate diverse boundaries: the boundaries of micro-culture associated with communication contexts, the theory-practice boundary, role boundaries, and the online-offline boundary. Combining the concept of polycontextuality with boundary spanning theory, we propose an alternative way of understanding both lurking and online communities: the three-tier knowledge transfer ecosystem (KTE), a system of engagement spaces comprising diverse online and offline contexts in which individuals make continual decisions to cross between less- or more-visible settings. The study illustrates how key phenomena may remain invisible without a shift in level of analysis, and how using an anachronistic concept to frame a study can unintentionally constrain its value.

Action on Elder Abuse: A New South Wales Pilot Project on the Role of Legal and Health Practitioners in Elder Abuse Screening, Response and Prevention

This article reports on a pilot project that involved legal and health practitioners (n=17) in an intervention that aimed to improve detection of and response to elder abuse. Interviews and focus groups elicited practitioners’ experiences and their views on the use of structured screening processes to identify abuse or risk situations. Participants reported they mostly encounter financial exploitation and psychological abuse, perpetrated by adult children against older parents. No practitioners reported the use of an elder-abuse-specific screening tool, but perceived the benefits of screening to enable earlier identification of problems. Barriers to screening included practitioners’ concerns about communication strategies, professional role boundaries, and inadequate response options. Participants supported a ‘triage’ approach, with screening questions and responses scaled to the immediacy and severity of the problem. Respect for the autonomy of older people was emphasised, along with professionals’ role in providing advice and resources to empower their older clients.