Acute Healthcare Organisation Research Articles

Nursing, midwifery, and allied health professions research capacities and cultures: a survey of staff within a university and acute healthcare organisation

BackgroundThere is an increasing focus on the development of research capacity and culture in Nursing, Midwifery and Allied Health Professions (NMAHP). However, better understanding of the existing research success and skills, motivators, barriers, and development needs of NMAHP professionals is required to inform this development. This study sought to identify such factors within a university and an acute healthcare organisation.MethodsAn online survey, incorporating the Research Capacity and Culture tool, was administered to NMAHP professionals and students at a university and an acute healthcare organisation in the United Kingdom. Ratings of success/skill levels of teams and individuals were compared between professional groups using Mann–Whitney U tests. Motivators, barriers, and development needs were reported using descriptive statistics. Descriptive thematic analysis was used for open-ended text responses.ResultsA total of 416 responses were received (N&M n = 223, AHP n = 133, Other n = 60). N&M respondents were more positive than their AHP counterparts about the success/skill levels of their teams. There were no significant differences between N&M and AHP in their ratings of individual successes/skills. Finding and critically reviewing relevant literature were identified as specific individual strengths; with weaknesses in securing research funding, submitting ethics applications, writing for publication, and advising less experienced researchers. The main motivators for research were to develop skills, increased job satisfaction, and career advancement; whilst barriers included lack of time for research and other work roles taking priority. Key support needs identified included mentorship (for teams and individuals) and in-service training. Open-ended questions generated main themes of ‘Employment & staffing’, ‘Professional services support’, ‘Clinical & academic management’, ‘Training & development’, ‘Partnerships’ and ‘Operating principles’. Two cross-cutting themes described issues common to multiple main themes: ‘Adequate working time for research’ and ‘Participating in research as an individual learning journey’.ConclusionsRich information was generated to inform the development of strategies to enhance research capacity and culture in NMAHP. Much of this can be generic but some nuances may be required to address some specific differences between professional groups, particularly related to perceived team success/skills and priorities identified for support and development.

The Value of Merging Medical Data from Ambulance Services and General Practice Cooperatives Using Triple Aim Outcomes.

Background:Acute care services are currently overstretched in many high income countries. Overcrowding also plays a major role in acute care in the Netherlands. In a region of the Netherlands, the general practice cooperative (GPC) and ambulance service have begun to integrate their care, and the rapid and complete transfer of information between these two care organisations is now the basis for delivering appropriate care. The primary aim of this mixed-methods study is to evaluate the Netherlands Triage System (NTS) merger project and answering the question: What is the added value of implementing a digital NTS merger in terms of healthcare use and healthcare costs? A secondary question is: What are the experiences of patients and care professionals in different acute healthcare organisations following implementation of the digital NTS merger?Methods:Patients who made an acute care request during the 12 months before the NTS merge intervention (control period) were compared with matched patients in the 12 months following the start of the NTS merge. Outcomes included difference in healthcare use 30 days after an acute event and patient’ and care professional’ experiences during the intervention period. To assess healthcare costs, we used reference prices updated to 2021.Results:Compared to patients in the control period, patients in the intervention period were hospitalized less often (52.9% vs 64.4%, p = 0.061) and had fewer emergency department (ED) visits (58.7% vs 69.3%, p = 0.074) in the 30 days following the acute care request. The ED costs were significantly lower during the intervention period compared to the control period (p = 0.042). Furthermore, patients in the intervention period were very satisfied overall with the acute care network (4.63 of 5) and care professionals were fairly satisfied with the cooperation to date (2.73 of 4).Conclusion:The Triple Aim for acute care can be met using relatively simple interventions, but medical data merging is a prerequisite for achieving more robust results covering on the various aspects of the Triple Aim. These successes should be communicated so that a common language can be developed that will support the successful further implementation of larger scale initiatives.

Current videofluoroscopy practice in the United Kingdom: A survey of imaging professionals

IntroductionVideofluoroscopy (VFSS) is a frequently used radiological investigation for dysphagia and is conducted within a radiology setting by speech and language therapists (SLTs) working alongside imaging personnel (radiologists and/or radiographers). Previous surveys of SLT practice have reported variability in VFSS protocols and procedures. The aim of this study was to explore current clinical practice for VFSS from the perspective of imaging personnel engaged in VFSS within the United Kingdom. MethodsA comprehensive online survey enabled exploration of current practices of imaging professionals. Target participants were diagnostic imaging personnel (radiographers and radiologists) with experience of working in VFSS clinics. Descriptive statistics describe and summarise the data alongside inferential statistics where appropriate. Results54 survey participants represented 40 unique acute healthcare organisations in the UK, in addition to two respondents from the Republic of Ireland. The survey demonstrated high variance in clinical practice across all stages of the VFSS procedure. Clinicians were not always compliant with current UK guidelines and the roles and responsibilities of different professionals working within the clinics were often not clearly defined. ConclusionFurther research is required to develop new international, interprofessional VFSS guidelines to standardise service delivery for VFSS, improving diagnostic accuracy, efficiency and patient experience. Implications for practiceIn the absence of VFSS guidelines for imaging personnel, practitioners should familiarise themselves with the UK Royal College of Speech and Language Therapists VFSS Position paper; IR (ME)R guidelines and DRLs for the client groups with which they work to guide clinics and improve practice. Clinicians should revisit protocols and clinical governance regarding safe practice in order to improve the quality of care within the VFSS clinic.

Rapid implementation of Microsoft Teams in response to COVID-19: one acute healthcare organisation’s experience

Background COVID-19 presented significant challenges to healthcare organisations, which needed to rapidly remodel their services but were unable to allow staff to meet face to face to minimise infection risk....

Factors influencing junior doctor workplace engagement in research: An Australian study

Introduction: Engaging junior doctors in research can contribute to improved health outcomes, but there is a lack of guidance on how best to support junior doctor research engagement through their workplace experiences. This study aims to identify factors influencing Australian junior doctors’ workplace engagement in research and inform recommendations for building research capacity. Methods: This qualitative interview study, using convenience sampling, explored junior doctors’ perceptions and experiences of research engagement. Seventeen junior doctors working at an Australian teaching hospital were interviewed. Data were analysed using the framework method, informed by workplace learning theory. Results: Junior doctors found it challenging to engage in research activities and attributed this to the lack of a practice-based curriculum to sequence their learning. They described an absence of workplace affordances for research engagement, including time, research-active clinician mentors and accessible projects. Whilst career progression was one motivator for research engagement, a key motivator was engaging in research contributing to patient care. Conclusions: The findings suggested that absence of practice-based curriculum, mentor guidance and engagement in meaningful research activities hampered research engagement. These findings may inform junior doctor research development programs in acute healthcare organisations.

Moving beyond hand hygiene monitoring as a marker of infection prevention performance: Development of a tailored infection control continuous quality improvement tool

Infection control practice compliance is commonly monitored by measuring hand hygiene compliance. The limitations of this approach were recognized in 1 acute health care organization that led to the development of an Infection Control Continuous Quality Improvement tool. The Pronovost cycle, Barriers and Mitigation tool, and Hexagon framework were used to review the existing monitoring system and develop a quality improvement data collection tool that considered the context of care delivery. Barriers and opportunities for improvement including ambiguity, consistency and feasibility of expectations, the environment, knowledge, and education were combined in a monitoring tool that was piloted and modified in response to feedback. Local adaptations enabled staff to prioritize and monitor issues important in their own workplace. The tool replaced the previous system and was positively evaluated by auditors. Challenges included ensuring staff had time to train in use of the tool, time to collect the audit, and the reporting of low scores that conflicted with a target-based performance system. Hand hygiene compliance monitoring alone misses other important aspects of infection control compliance. A continuous quality improvement tool was developed reflecting specific organizational needs that could be transferred or adapted to other organizations.

Recognising and responding to in-hospital clinical deterioration: An integrative review of interprofessional practice issues.

To identify, appraise and synthesise current evidence regarding organisation-wide interprofessional practice issues that facilitate or inhibit effective recognition and response to clinical deterioration, using a theoretical rapid response system model. Recognition and response to clinical deterioration, in adult general medical-surgical ward patients, is embedded as routine interprofessional practice in acute healthcare organisations worldwide. The process of care escalation is complex and sometimes involves multiple health professionals from different disciplines with varying levels of expertise. While a theoretical rapid response system model offers a formalised structured approach to escalate patient care, it is unclear how the implementation of this model, or similar, influences rapid response system-wide interprofessional practices to effectively recognise and respond to clinical deterioration. An integrative review. This review was conducted using key words to systematically search four electronic bibliographic databases (PubMed, CINAHL, ProQuest Central, Cochrane Library). Twenty-nine eligible full-text papers were identified. Quality appraisal of methods was performed using recommended guidelines. Study findings were narratively coded, themed and conceptualised in the context of an organisation-wide rapid response system using an interprofessional collaborative practice framework. Five main themes aligned with the four interprofessional collaborative practice competency domains and a learning continuum of professional development: Organisational culture, Role perceptions and professional accountability, Communication of clinical needs, Team-based practices, and Interprofessional learning opportunities in recognising and responding to clinical deterioration. Within these themes, three notable interprofessional practice issues were highlighted: professional reporting hierarchies (inhibiting), critical care outreach services (facilitating) and interprofessional relationships (facilitating). A unique approach for exploring organisation-wide interprofessional practice issues has been presented using an interprofessional collaborative practice framework. Further interpretive organisation-wide research is necessary to develop a more in-depth and meaningful understanding of interprofessional collaborative practice issues that facilitate or inhibit effective recognition and response to clinical deterioration. This review presents a unique system-wide approach for exploring how health professionals interprofessionally collaborate in practice to effectively recognise and respond to clinical deterioration.

The influence of workplace culture on nurses' learning experiences: a systematic review of qualitative evidence.

A healthy workplace culture enables nurses to experience valuable learning in the workplace. Learning in the workplace enables the provision of evidence-based and continuously improving safe patient care, which is central to achieving good patient outcomes. Therefore, nurses need to learn within a workplace that supports the implementation of evidence-based, professional practice and enables the best patient outcomes; the influence of workplace culture may play a role in this. The purpose of this review was to critically appraise and synthesize the best available qualitative evidence to understand both the nurses' learning experiences within the workplace and the factors within the workplace culture that influence those learning experiences. Registered and enrolled nurses regulated by a nursing and midwifery board and/or recognized health practitioner regulation agency (or their international equivalent). This review considered studies that described two phenomena of interest: the nurses' learning experience, either within an acute healthcare workplace or a workplace-related learning environment and the influence of workplace culture on the nurses' learning experience (within the workplace or workplace-related learning environment). This review considered studies that included nurses working in an acute healthcare organization within a Western culture. This review considered studies that focused on qualitative evidence and included the following research designs: phenomenological, grounded theory and critical theory. Published and unpublished studies in English from 1980 to 2013 were identified using a three-step search strategy, searching various databases, and included hand searching of the reference lists within articles selected for appraisal. For studies meeting the inclusion criteria, methodological quality was assessed using a standardized checklist from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). Qualitative data were extracted from articles included in the review using the standardized data extraction tool from the JBI-QARI. Qualitative research findings were pooled using the Joanna Briggs Institute Qualitative Appraisal and Review Instrument (JBI-QARI). This involved the aggregation and synthesis of findings to generate a set of categories, which were then subjected to a meta-synthesis to produce a single comprehensive set of synthesized findings that could be used as a basis for evidence-based practice. Fourteen articles were identified following appraisal and a total of 105 findings (85 unequivocal and 20 credible) were extracted from included studies and grouped into eight categories based on similarity of meaning. Subsequently, categories were grouped into two synthesized findings. The two synthesized findings were as follows: ORGANIZATIONAL INFLUENCES: Enabling nurses to demonstrate accountability for their own learning, along with clear organizational systems that provide resources, time, adequate staffing and support, demonstrates encouragement for and the value of nurses' learning and education. Nurses value their peers, expert nurses, preceptors, mentors and educators facilitating and encouraging their learning and professional development. An optimal workplace culture is central for nurses to experience valuable and relevant learning in the workplace. To emphasize the importance of nurses' learning in the workplace, working and learning is understood as an integrated experience. Consequently, a dual system that enables nurses to demonstrate accountability for their own learning, along with clear organizational and educational systems, is required to demonstrate the value in nurses' learning and education.

Exploring interprofessional practices in rapid response systems: a case study protocol.

To describe the development of a proposed case study protocol investigating interprofessional relationships in a rapid response system (RRS) in a socioculturally complex clinical environment. Suboptimal care of deteriorating ward patients remains a concern for many acute healthcare organisations. Despite the advent of RRSs, emergency response teams are not always used to their full potential. How and why interprofessional relationships influence practices associated with the care and management of ward patients at risk of clinical deterioration requires investigation. Theoretical and empirical literature describing case study research and RRSs. Review methods An integrative review approach of the literature, focusing on key terms relating to 'case study research' and 'rapid response system', provided context and informed development of the study protocol. A single-site mixed-method instrumental case study protocol was developed using methodological triangulation and a multi-level model to examine interprofessional relationships between a broad range of stakeholders. Concurrent data collection and analysis will occur using document review of clinical scenarios, non-participant observations and semi-structured interviews. Case study research is an effective method for investigating socioculturally complex clinical environments. A strength of this approach is the flexibility in the choice of methods, which allows the researcher to build the design most suitable for the subjects or phenomena being investigated. Although this flexibility may be considered a potential weakness, rigour can be achieved by application of the strategies described. Findings from this research will provide rich descriptive insights into RRS relationships and healthcare professional practices during day-to-day management of acute ward patients at risk of or experiencing clinical deterioration. Description of this structured case study research approach will also inform other researchers.

The evaluation of a communication tool within an acute healthcare organization

Background: Striving to ensure clear, concise and consistent communication, the Situation, Background, Assessment and Recommendations (SBAR) tool was adopted for use within a multisite acute healthcare organization. Objective: To evaluate the use and effectiveness of the SBAR tool on communication within a multisite acute healthcare organization. Methods: This longitudinal study was conducted over one year and was comprised of four phases including: Phase1) pre-implementation, Phase 2) education sessions, Phase 3) post-implementation, and Phase 4) final evaluation. The study used a convenience sample that included all multidisciplinary participants from Lakeridge Health. Results: The entire sample in this study consisted of 705 multidisciplinary participants. The number of participants that completed surveys per phase was as follows: phase 1, n = 259, phase 3, n = 209, and phase 4, n = 237. Post implementation of the SBAR tool, participants identified that the tool positively influenced the level of good communication with patients and families. 59.8% participants felt that good communication existed within their function, 47.4% identified that good communication existed within their discipline, 45% recognized that the SBAR tool would work on their units and 53.6% participants identified that they were familiar with the SBAR tool. During the final evaluation of the SBAR tool, the majority of respondent 66.2% believed the tool would reduce the potential for errors, 70% felt that the SBAR process was useful in facilitating communication with other team members or patients, 53.7% of participants felt communication flow between members of their area or discipline had improved since the implementation of SBAR, 52.1% of participants felt communication flow between themselves and their colleagues had improved since the implementation of SBAR and 71.7% of participants identified that they were satisfied when using SBAR that their message was received and understood. Conclusion: This study is the first study to investigate the use of the SBAR tool across a multisite acute healthcare organization. The tool demonstrated positive results in relation to improving communication with patients and families within the organization. As patients and families are key members of the healthcare team, this finding is important. Although not meeting with a significant change, all of the questions that examined communication, i.e. good communication within function and good interdisciplinary communication, had a positive finding after the implement-tation of the SBAR tool. This study examined the importance of leadership to create and sustain a change and the relevance of the culture that people are working within to advance quality within an organization.

Hearing the Voice of Nurses in Caring Theory-Based Practice

The authors in this paper describe the process and findings of a participatory action research project between a college of nursing and a for-profit acute healthcare organization as practice environment transformation occurred, grounded in caring theory. The participatory action research process and findings emphasize the importance of the intention to know what matters and the required time, courage, and commitment necessary to actualize practice environments that support nursing. Implications show efforts to develop and sustain theory-based practice environments that enable the full expression of nursing and a way of being that honors and celebrates the uniqueness of nurses.

A national clinical indicator database: issues of reliability and validity.

The introduction of performance (clinical) indicators into the accreditation process by the Australian Council on Healthcare Standards is in keeping with global trends and has enabled the establishment of a National Aggregate Database reflecting standards of care in acute health care organisations. The database contains both quantitative and qualitative information on the processes and outcomes of patient care and changes in practice induced through indicator monitoring. Of fundamental importance to the integrity of the database are the issues of indicator validity, responsiveness and reliability. This paper considers these issues, drawing parallels, as appropriate, to other performance indicator programs and studies.