Rapid Cycle Implementation and Retrospective Evaluation of a SARS-CoV-2 Checklist in Labor and Delivery

Background Preparedness efforts for a COVID-19 outbreak required redesign and implementation of a perioperative workflow for the management of obstetric patients. In this report we describe factors which influenced rapid cycle implementation of a novel comprehensive checklist for the perioperative care of the COVID-19 parturient. Methods Within our labour and delivery unit, implementation of a novel checklist for the COVID-19 parturient requiring perioperative care was accomplished through rapid cycling, debriefing and on-site walkthroughs. Post-implementation, consistent use of the checklist was reported for all obstetric COVID-19 perioperative cases (100% workflow checklist utilization). Retrospective analysis of the factors influencing implementation was performed using a group deliberation approach, mapped against the Consolidated Framework for Implementation Research (CFIR). Results Analysis of factors influencing implementation using CFIR revealed domains of process implementation and innovation characteristics as overwhelming facilitators for success. Constructs within the outer setting, inner setting, and characteristic of individuals (external pressures, baseline culture, and personal attributes) were perceived to act as early barriers. Constructs such as communication culture and learning climate, shifted in influence over time. Conclusion We describe the influential factors of implementing a novel comprehensive obstetric workflow for care of the COVID-19 perioperative parturient during the first surge of the pandemic using the CFIR framework. Early workflow adoption was facilitated primarily by two domains, namely thoughtful innovation design and careful implementation planning in the setting of a long-standing culture of improvement. Factors initially assessed as barriers such as communication, culture and learning climate, transitioned into facilitators once a perceived benefit was experienced by healthcare teams. These results provide important information for the implementation of rapid change during a time of crisis.

Using WhatsApp for focus group discussions: ecological validity, inclusion and deliberation

WhatsApp’s ubiquity in many people’s everyday lives points at new possibilities for conducting online and mobile focus groups. Yet, research on the benefits and potential pitfalls of this is negligible. This paper offers new empirical insights from using the method as part of a digital ethnography with young activists in Western Kenya. The presence of WhatsApp in participants’ everyday lives offers a context with high ecological validity. The paper suggests that this opens up new options for designing online focus groups, transcending the traditional categorisation between synchronous and asynchronous interactions and some limitations of both approaches. WhatsApp also offers opportunities for creating more inclusive group discussions. Using discourse analysis of the WhatsApp focus group, the paper also finds that this familiarity and inclusivity affords the potential for group deliberation, which can be particularly valuable in participatory research.

Rapid Cycle Implementation and Retrospective Evaluation of a SARS-CoV-2 Checklist in Labor and Delivery

Background: Preparedness efforts for a COVID-19 outbreak required redesign and implementation of a perioperative workflow for the management of obstetric patients. In this report we describe factors which influenced rapid cycle implementation a novel comprehensive perioperative checklist for care of the COVID-19 parturient.Methods: Implementation of a novel workflow for the COVID-19 parturient requiring perioperative care was accomplished through rapid cycling, debriefing and on-site walkthroughs. Post-implementation, consistent use of the workflow was reported for all obstetric COVID-19 perioperative cases (100% workflow checklist utilization). Retrospective analysis of the factors influencing implementation was performed using a group deliberation approach, mapped against the Consolidated Framework for Implementation Research (CFIR). Results: Analysis of factors influencing implementation using CFIR revealed domains of process implementation and innovation characteristics as overwhelming facilitators for success. Constructs within the outer setting, inner setting, and characteristic of individuals (external pressures, baseline culture, and personal attributes) were perceived to act as early barriers. Constructs such as communication culture and learning climate, shifted in influence over time.Conclusion: We describe the influential factors of implementing a novel comprehensive obstetric workflow for care of the COVID-19 perioperative parturient during the first surge of the pandemic using the CFIR framework. Early workflow adoption was facilitated primarily by two domains, namely thoughtful innovation design and careful implementation planning in the setting of a long-standing culture of improvement. Factors initially assessed as barriers such as communication, culture and learning climate, transitioned into facilitators once a perceived benefit was experienced by healthcare teams. These results provide important information for the implementation of rapid change during a time of crisis.

Mechanisms of Deliberating Together

Chapter 5 discusses the mechanisms allowing citizens to deliberate together on an everyday basis: their social-qua-communicative networks. It distinguishes between two models of deliberation: synchronic-group deliberation and serial-diachronic deliberation. The first is exemplified by mini-publics and other formally organized group deliberative events, the second by informal networked deliberation occurring everyday among citizens. The chapter argues that informal networked deliberation can serve as the main platform for a real existing deliberative democracy. It can satisfy at the macro level the classic deliberative-democratic standards of inclusion, equality, and reciprocity that small-scale organized group deliberations can achieve only in micro settings.

Rapid Cycle Implementation and Retrospective Evaluation of a SARS-CoV-2 Checklist in Labor and Delivery

Background: Preparedness efforts for a COVID-19 outbreak required redesign and implementation of a perioperative workflow for the management of obstetric patients. In this report we describe the rapid cycle implementation of a comprehensive perioperative checklist for care of the COVID-19 parturient and a retrospective analysis of the factors which influenced implementation success.Methods: A newly designed workflow for COVID-19 parturients requiring perioperative care was produced as a checklist, intended for use as a cognitive aid. Implementation and refinement of the workflow was accomplished through rapid-cycling, debriefing and on-site walkthroughs. Retrospective evaluation of the implementation experience was performed using a group deliberation approach, mapped against the Consolidated Framework for Implementation Research (CFIR). Results: Post-implementation, consistent use of the workflow was reported for all obstetric COVID-19 perioperative cases (100% compliance). Evaluation of our implementation using CFIR revealed domains of process implementation and innovation characteristics as overwhelming facilitators for success. Constructs within the outer setting, inner setting and characteristic of individuals (external pressures, baseline culture, and personal attributes) were felt to act as barriers. Constructs such as communication, shifted in influence over time.Conclusion: We describe the implementation of a comprehensive obstetric workflow checklist for care of the COVID-19 perioperative patient. A retrospective evaluation of our implementation experience was possible using CFIR, which enabled identification of barriers and facilitators for change within our unit. Furthermore, we observed that implementation success was possible, despite facilitation being perceived within only two domains at baseline. Emerging themes from this study highlight the importance of thoughtful innovation design, careful implementation planning and the establishment of a long-standing culture of improvement, in order to facilitate implementation of change during a time of crisis.

TEAM IDEA MAPPING METHOD: A BRAIN STORMING SESSION FOR ENHANCING PROBLEM SOLVING SKILLS IN POSTGRADUATE MEDICAL BIOCHEMISTRY STUDENTS AS ASSESSED BY SELF-EFFICACY (Preprint)

BACKGROUND Team idea mapping (TIM) method is a type of brain storming technique for group deliberation in a non judgmental and friendly environment. It encourages participation by all the members, thereby instilling confidence. Such deliberations can enhance problem solving skills of postgraduate (PG) students. OBJECTIVE The present study was conducted to evaluate the effect of TIM sessions on the problem solving skills of PG students of Biochemistry, as deduced from retro-pre self-efficacy questionnaire. METHODS The study was conducted enrolling students pursuing PG-MD course in Medical Biochemistry in a premier medical college. First TIM session was preceded by sensitization of PG students and departmental faculty. In total, four TIM sessions were conducted. Retro-pre self efficacy questionnaire was administered 3 months after the last session. Feedback from the students was collected immediately after last session and satisfaction index was also calculated. RESULTS The satisfaction index was highest (100) for items stating that TIM sessions promoted interactivity and participatory behavior and lowest (78) for item stating that TIM sessions promoted reflective behavior respectively. The students expressed enhanced self-efficacy in understanding Biochemistry concepts, clinical application of Biochemistry, problem solving skills in Biochemistry, interpreting laboratory reports, participation in group works and clarifying problems with peers and seniors. However, the sessions were not as effective in instilling technical skills like trouble shooting for analyzer breakdowns. CONCLUSIONS TIM is an effective tool for instilling problem solving skills in medical PG students, additionally fortifying their attitude to work in groups. CLINICALTRIAL NA

Rapid Cycle Implementation and Retrospective Evaluation of a SARS-CoV-2 Checklist in Labor and Delivery

Background Preparedness efforts for a COVID-19 outbreak required redesign and implementation of a perioperative workflow for the management of obstetric patients. In this report we describe the rapid cycle implementation of a comprehensive perioperative checklist for care of the COVID-19 parturient and a retrospective analysis of the factors which influenced implementation success. Methods A newly designed workflow for COVID-19 parturients requiring perioperative care was produced as a checklist, intended for use as a cognitive aid. Implementation and refinement of the workflow was accomplished through rapid-cycling, debriefing and on-site walkthroughs. Retrospective evaluation of the implementation experience was performed using a group deliberation approach, mapped against the Consolidated Framework for Implementation Research (CFIR). Results Post-implementation, consistent use of the workflow was reported for all obstetric COVID-19 perioperative cases (100% compliance). Evaluation of our implementation using CFIR revealed domains of process implementation and innovation characteristics as overwhelming facilitators for success. Constructs within the outer setting, inner setting and characteristic of individuals (external pressures, baseline culture, and personal attributes) were felt to act as barriers. Constructs such as communication, shifted in influence over time. Conclusion We describe the implementation of a comprehensive obstetric workflow checklist for care of the COVID-19 perioperative patient. A retrospective evaluation of our implementation experience was possible using CFIR, which enabled identification of barriers and facilitators for change within our unit. Furthermore, we observed that implementation success was possible, despite facilitation being perceived within only two domains at baseline. Emerging themes from this study highlight the importance of thoughtful innovation design, careful implementation planning and the establishment of a long-standing culture of improvement, in order to facilitate implementation of change during a time of crisis.

The practice of balancing in clinical ethics case consultation

Models for clinical ethics case consultation often make reference to ‘balancing’ or ‘weighing’ moral considerations, without further detail. In this paper, we investigate balancing in clinical ethics case consultation. We suggest that, while clinical ethics services cannot resolve ongoing deep philosophical debates about the nature of ethical reasoning, clinical ethicists can and should be more systematic and transparent when balancing considerations in case consultations. We conceptualise balancing on a spectrum from intuitive to deliberative, and argue that good balancing in case consultation involves articulating reasons for giving something more or less weight. We develop a framework of four practical strategies for better balancing in clinical ethics case consultation: intuitions as a launchpad, drilling down, pairwise comparison and group deliberation.