Health Service Partnership Research Articles

Simulated employment interviews: A collaborative approach to gaining understanding of the graduate midwife employment process

Graduating midwives unsuccessful in gaining employment in their preferred model/location; or finding a job within a year of graduation are more likely to leave the profession. Obtaining post-graduate midwifery employment is competitive with midwifery students needing to confidently sell themselves to potential employers. Whilst midwifery students may be prepared with the requisite midwifery skills and knowledge, there is no guarantee of attaining a midwifery position upon graduation. Increasingly employers are requiring ‘soft skills’ including communication, teamwork, reflexivity and personal attributes of the individual to be able to effectively respond within different contexts. Demonstrating these skills within an employment interview requires confidence and knowledge in how to prepare. Designed with health service partners, simulated employment interviews were introduced into the final year of a Bachelor of Midwifery program as part of a suite of employability strategies connected to the student lifecycle. An exploratory evaluation study of students ‘experiences of a simulated employment interview was undertaken. The simulated interview emulated real employment interviews with students receiving immediate written and oral feedback. Evaluation through surveys, focus groups and individual interviews provided rich data around the effectiveness of this approach. Students, health service partners and academics found the simulated employment interview provided a valuable learning experience, assisting students to reflect, explore and further develop skills sought by employers. Collaboration with health service partners created an authentic process enabling students to receive feedback relevant to the real world of practice. Students were able to work through anxiety, gain confidence and exposure to employers in preparation for employment interviews.

Assessment of Point-of-Care Ultrasound Training for Clinical Educators in Malawi, Tanzania and Uganda

Integrating point-of-care ultrasound (POCUS) to enhance diagnostic availability in resource-limited regions in Africa has become a main initiative for global health services in recent years. In this article, we present lessons learned from introducing POCUS as part of the Global Health Service Partnership (GHSP), a collaboration started in 2012 between the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the Peace Corps and Seed Global Health to provide health care work force education and training in resource-limited countries. A cross-sectional survey of GHSP clinical educators trained to use POCUS and provided with hand-held ultrasound during their 1-y deployment during the period 2013–2017. The survey consisted of 35 questions on the adequacy of the training program and how useful POCUS was to their overall clinical and educational mission. Clinical educators engaged in a series of ultrasound educational initiatives including pre-departure training, bedside training in the host institutions, online educational modules, educational feedback on transmitted images and training of local counterparts. In this study 63 GHSP clinical educators who participated in the POCUS trainings were identified, and 49 were included at the study (78% response rate). They were assigned to academic institutions in Tanzania (n = 24), Malawi (n = 21) and Uganda (n = 18). More than 75% reported use of POCUS in clinical diagnoses and 50% in determining treatment, and 18% reported procedural application of ultrasound in their practice. The top indications for POCUS were cardiac exams, second- and third-trimester obstetric exams, lung and pleura, liver and spleen and gynecology/first-trimester obstetrics. The largest perceived barriers were lack of ultrasound knowledge by the clinical educators, lack of time, equipment security, difficulty accessing the Internet and equipment problems. We concluded that our multiphase POCUS training program has increased the utility, acceptability and usage of POCUS in resource-limited settings.

Building clinical academic leadership capacity: sustainability through partnership.

A national clinical academic training programme has been developed in England for nurses, midwives and allied health professionals but is insufficient to build a critical mass to have a significant impact on improved patient care. We describe a partnership model led by the University of Southampton and its neighbouring National Health Service partners that has the potential to address this capacity gap. In combination with the Health Education England/National Institute of Health Research Integrated Clinical Academic programme, we are currently supporting nurses, midwives and allied health professionals at Master's (n = 28), Doctoral (n = 36), Clinical Lecturer (n = 5) and Senior Clinical Lecturer (n = 2) levels working across seven National Health Service organisations, and three nurses hold jointly funded Clinical Professor posts. Key to the success of our partnership model is the strength of the strategic relationship developed at all levels across and within the clinical organisations involved, from board to ward. We are supporting nurses, midwives and allied health professionals to climb, in parallel, both clinical and academic career ladders. We are creating clinical academic leaders who are driving their disciplines forward, impacting on improved health outcomes and patient benefit. We have demonstrated that our partnership model is sustainable and could enable doctoral capacity to be built at scale.

Improving Neonatal Care Through the Global Health Service Partnership (ghsp)

Improving Neonatal Care Through the Global Health Service Partnership (ghsp)

Leveraging the Global Health Service Partnership Model for Workforce Development in Global Radiation Oncology.

A major contributor to the disparity in cancer outcome across the globe is the limited health care access in low- and middle-income countries that results from the shortfall in human resources for health (HRH), fomented by the limited training and leadership capacity of low-resource countries. In 2012, Seed Global Health teamed up with the Peace Corps to create the Global Health Service Partnership, an initiative that has introduced a novel model for tackling the HRH crises in developing regions of the world. The Global Health Service Partnership has made global health impacts in leveraging partnerships for HRH development, faculty activities and output, scholarship engagement, adding value to the learning environment, health workforce empowerment, and infrastructure development.

Potential and challenges for learning during acute medical/surgical placement for intellectual disability, mental health and midwifery students.

In Ireland nursing and midwifery degree programmes involve four pathways to registration. Three of which, intellectual disability and mental health nursing and midwifery require students to undertake acute medical/surgical placements offering learning opportunities caring for patients with complex needs in settings beyond their core discipline. This paper focuses on findings from a descriptive qualitative study exploring intellectual disability and mental health nursing and midwifery students experiences of such placements. Data analysis identified three themes: Getting ready, Navigating the way and Getting through. Feelings of stress and uncertainty are described by participants when moving from familiarity within a chosen discipline to an unfamiliar environment. Findings have influenced specific placement structures with local health service partners. While our study focuses on an Irish context, findings have relevance for student education in other jurisdictions. Enhancing preparation and support for students undertaking unfamiliar placements needs to be a constant endeavour. Such foundations will foster valuable experiences where students can feel part of a team, gain confidence, enhance skills and transfer meaningful learning to their core practice discipline. Further research is needed to explore the views of preceptors, ward managers and Clinical Placement Coordinators.

Integrated Mental Health Service - A National Multifaceted Approach

Ireland’s health service, the Health Service Executive, provides Mental Health services to the population of Ireland. These services are overseen by the National Mental Health Division. Unlike other parts of the Health Service the Mental Health Division provides services in all settings, for all acuities and all ages. This truly integrated approach is demonstrated in eight abstracts submitted by Irelands Mental Health service. This abstract is a covering abstract which proposes that those submissions which are successful are considered as a body of work – featuring at conference as a Mental Health seminar/stream. This is because each of our abstracts, while addressing a specific topic and theme must be considered as interoperable to appreciate how at national level a whole system national integrated approach operates. The Mental Health abstracts submitted by the Health Service Executive Mental Health Division and partners cover a range of topics which span strategy, clinical care, service user involvement and quality. These include; The development of integrated national quality standards for mental health services (ID 188) Service user and family engagement in integrated service design and delivery (ID 173) An integrated national model of care for eating disorders services in multiple settings (ID 440) Inter-professional education as a building block for collaborative and integrated eating disorder services (ID 443) Assessment and management of self harm in Emergency Departments in Ireland: The National Clinical Programme (ID pending) Developing an integrated approach across government departments for service users with first episode psychosis to achieve employment and educational gaol using an Individual Placement Support model (ID 461) Little Things – making a big difference to promoting positive mental health (ID 492) Advancing Recovery in Ireland – a national initiative aimed at securing the organisational and cultural changes necessary to develop more “Recovery-oriented” services for the population (ID pending) It is proposed that should the above abstracts be accepted by the scientific committee that they would form a body of evidence that in seminar or “Mental Health Stream” format would paint a clear picture of national integration. Integration in this context means integration in a number of senses and the granularity of the meaning of “integration” in the round would be considered (i.e. integration between physical and mental health, between health and other government departments and between components of the health service itself.

The Global Health Service Partnership: An Academic-Clinical Partnership to Build Nursing and Medical Capacity in Africa.

The World Health Organization estimates a global deficit of about 12.9 million skilled health professionals (midwives, nurses, and physicians) by 2035. These shortages limit the ability of countries, particularly resource-constrained countries, to deliver basic health care, to respond to emerging and more complex needs, and to teach, graduate, and retain their future health professionals—a vicious cycle that is perpetuated and has profound implications for health security. The Global Health Service Partnership (GHSP) is a unique collaboration between the Peace Corps, President’s Emergency Plan for AIDS Relief, Seed and host-country institutions, which aims to strengthen the breadth and quality of medical and nursing education and care delivery in places with dire shortages of health professionals. Nurse and physician educators are seconded to host institutions to serve as visiting faculty alongside their local colleagues. They serve for 1 year with many staying longer. Educational and clinical best practices are shared, emphasis is placed on integration of theory and practice across the academic–clinical domains and the teaching and learning environment is expanded to include implementation science and dissemination of locally tailored and sustainable practice innovations. In the first 3 years (2013–2016) GHSP placed 97 nurse and physician educators in three countries (Malawi, Tanzania, and Uganda). These educators have taught 454 courses and workshops to 8,321 trainees, faculty members, and practicing health professionals across the curriculum and in myriad specialties. Mixed-methods evaluation included key stakeholder interviews with host institution faculty and students who indicate that the addition of GHSP enhanced clinical teaching (quality and breadth) resulting in improved clinical skills, confidence, and ability to connect theory to practice and critical thinking. The outputs and outcomes from four exemplars which focus on the translation of evidence to practice through implementation science are included. Findings from the first 3 years of GHSP suggest that an innovative, locally tailored and culturally appropriate multi-country academic–clinical partnership program that addresses national health priorities is feasible and generated new knowledge and best practices relevant to capacity building for nursing and medical education. This in turn has implications for improving the health of populations who suffer a disproportionate burden of global disease.

Promoting integration within the public health domain of physical activity promotion

PurposeThe purpose of this paper is to report and critically reflect on the methodological processes involved in a formal attempt to promote health and social integration in the rarely reported public health domain of physical activity promotion.Design/methodology/approachA quality improvement (QI) methodology was deployed, comprising three elements: a diagnostic tool that assessed strategic and practice positions; a half-day workshop that brought senior leaders together for to reflect this evidence; and a structured process that sought to generate proposals for future integrated action. A mixed-method evaluative approach was used, capturing insights of the integration processes via quantitative and qualitative data collection pre-event, in-event, immediate post-event and at six-month follow-up.FindingsInsights suggested that despite some critical concerns, this QI process can be considered as robust, offering pointers to elements required to successfully promote integration in this domain, including the significance of leadership, the preparatory contribution of a diagnostic tool and position paper, the opportunities for active exchange and planning within a workshop situation and the initiation of a process of integrated work via tangible “pledges”.Originality/valueThe paper offers originality in two respects. Generally, it describes and reflects on the relationship between theoretical and empirical dimensions of a model of integration promotion. Specifically, in offering an account of integrative public health work across health service, local authority and third sector partners, it addressed an area that has received relatively limited prior attention.

Cultivating the Next Generation of Health Care Providers in Sub-Saharan Africa: The Global Health Service Partnership – Update 2016

Cultivating the Next Generation of Health Care Providers in Sub-Saharan Africa: The Global Health Service Partnership – Update 2016

Measuring harm and informing quality improvement in the Welsh NHS: the longitudinal Welsh national adverse events study

Background, objectives and settingDespite global activity over the past 15 years to improve patient safety, the measurement of adverse events (AEs) remains challenging.ObjectivesWe aimed to obtain definitive longitudinal data on harm across NHS Wales and to compare the performance of the Global Trigger Tool (GTT) with the two-stage retrospective review process, using our findings to consolidate an approach to the ongoing surveillance of harm in Wales.Data sourcesEleven of the 13 major Welsh NHS hospitals.Review methodsThe two-stage retrospective review methodology was used to quantify harm across NHS Wales. In total, 4536 inpatient episodes were screened for AEs by research nurses. Records that were highly suggestive of AEs were further assessed by physicians. NHS-led teams undertook GTT reviews on the same case notes.ResultsAt least one AE was determined in 10.3% of episodes of care [95% confidence interval (CI) 9.4% to 11.2%] and 51.5% were preventable (95% CI 46.9% to 56.1%). The percentage of patients identified with AEs using the GTT methodology was lower, at 9.0% (95% CI 8.82% to 9.18%). Differences in AEs were evident across study sites. Methods were developed to profile the risk of AEs in individual organisations by producing signatures of harm for each NHS site. Analysis indicated that neither the GTT nor the two-stage process was a candidate tool for routine surveillance, and a hybrid one-stage tool (Harm2), based on phase 1 findings, was developed for ongoing AE monitoring. Using the Harm2 tool, AEs were identified in 371 out of 3352 randomly selected discharge reviews (11.3%, 95% CI 10.2% to 12.4%), and 59.6% (95% CI 55.3 to 63.9) of these were preventable. In a cohort of randomly selected deceased patient reviews, at least one AE was determined in 315 out of 1018 admissions (30.1%, 95% CI 28.1% to 33.8%), and 61.7% (95% CI 57.5% to 65.9%) of these were preventable. Factors associated with AEs in the randomly selected discharge reviews included having peripheral vascular disease [odds ratio (OR) 2.52], hemiplegia (OR 2.27) or dementia (OR 2.27). No association with chronic disease was identified in the deceased episodes of care.LimitationsThe dependence on our health service partners in identifying notes to be reviewed, along with the small sample examined each month, limits the generalisability of these findings and rates were not standardised for hospital and size and level of services provided. We cannot rule out the possibility that the rates we report may be underestimated.ConclusionThe extent of harm detected across NHS Wales using both the two-stage retrospective review process and the new Harm2 tool conforms to the findings in the literature, but this is the first longitudinal study using these methods. With training and using a structured review process, non-physician reviewers can undertake case note review efficiently and effectively, and the rates of AEs and of the preventability and the breakdown of problems in care conform to those reported in studies in which physicians undertake these classifications. Whether the patient died or was discharged alive significantly influences the rate and composition of AEs. The Harm2 tool performed with moderate reliability in the determination of AEs.Future workFuture large-scale studies should attempt to specify types of AEs, such as hospital-acquired infections and surgical complications, to enable the surveillance of the specific types of harm as well as the overall level of AEs. In the longer term, we need to automate harm surveillance and set measures of harm alongside measures of the beneficial effects of health care.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Medical Students’ Child Health Experience in Primary Schools

This study was designed to explore medical students’ and primary school teachers’ experiences of a new community teaching project. Academic staff and students from the School of Medicine Dundee, National Health Service partners, local education department, and primary school teachers engaged in a collaborative project which has embedded community engagement in the curriculum while encouraging interprofessional education through multiagency working. Influenced by evaluative inquiry, this qualitative study used an online questionnaire, designed to give participants the freedom to respond, and give their own opinions, via free text responses. The results show the value of a real primary school–based situation, and the merit of experiential learning gained throughout the program, in which students interacted with children about health promotion in a meaningful way. The interprofessional and collaborative nature of the project enhanced the value of the experience for all participants in relation to the benefits of teamwork, dispelling the doctor authority and recognition of the roles of others. The experience was an interactive, enjoyable, and expressive way to facilitate learning, and has helped prepare the health care students for future practice.

Creating Sustainable Models for Short-Term Volunteers Through the Global Health Service Partnership

Many countries in sub-Saharan Africa (SSA) have critical shortages of pediatricians who serve as both clinicians and educators. Many African medical schools increase student enrollment to address these shortages; they must also increase faculty. There is an opportunity to assist with faculty placement by tapping into a growing effort by US academic institutions to establish meaningful global health experiences for residents and faculty. Pediatric training is a key focus of the Global Health Service Partnership (GHSP). Between 2013-2015, GHSP placed 15 pediatric educators in medical/nursing schools in SSA for a one-year assignment. These educators taught 41 courses to 1600 trainees, assisted with curriculum development, worked on quality improvement projects, and enhanced teaching methods. Building on this program, a strategy to improve global health experiences is to create partnerships between US academic institutions and GHSP partner sites, where residents and faculty could rotate for shorter periods and be paired with GHSP educators embedded in the local institution. GHSP educators would serve as liaisons and supervisors, have an understanding of sites needs and challenges, and identify educational projects without overburdening local faculty. One model, between University of Washington (UW) and University of Malawi College of Medicine (CoM), demonstrated success. UW family medicine residents rotated at CoM monthly under the supervision of a Malawi-based US educator. Residents completing the rotation oriented their incoming peers and handed over ongoing educational projects. This partnership improved host provider satisfaction, established continuing professional development and quality improvement, and reduced patient referrals to the national hospital. Two UW residents chose to volunteer with GHSP after residency, creating a pipeline of volunteer faculty for the host institution. Similar partnerships between US academic institutions and GHSP could create meaningful and sustainable ways of enabling residents and faculty to serve in resource-limited settings.

Pathology in Southwest Uganda

![Graphic][1] Between August 2014 and July 2015, Dr. Meier taught as a visiting professor at Mbarara University of Science and Technology (MUST) in Uganda, where he mentored pathology resident-equivalents and worked on capacity building in the pathology department. ASCP facilitated support for his time there . MUST, which began 26 years ago as the second medical faculty in Uganda, hosts the Massachusetts General Hospital (MGH) Global Health Collaborative, through which Seed Global Health volunteers come to train and work with Ugandan medical and nursing personnel. As a temporary employee of the pathology department of MGH, I came to Mbarara to contribute to Seed's effort for the academic year 2014-2015. Dr. Meier and Professor Damaris Laffita review a case with MUST pathology MMeds, resident equivalents. My colleagues at MUST included teachers and practitioners from Cuba, Great Britain, Germany, Canada, Australia, New Zealand, and organizations such as Seed and the Peace Corps Response, the latter part of the Global Health Service Partnership. Damaris Laffita, professor of pathology at MUST and an excellent, patient, and kind colleague, is the only full-time onsite pathologist at the university. She combines a knowledge base and technical vocabulary familiar to North American pathologists with experience in making defensible diagnoses in resource-constrained settings, an advantage for practice in Africa. Each semester I taught 20 large-group lectures, all with associated practical sessions. Seventy second-year medical students, as well as another 40 nursing and allied health students, attended lectures on general pathology, and similar numbers of third-year students attended lectures on systemic pathology topics. During the spring 2015 semester, Professor Damaris and I also conducted daylong seminars and tutorials on pathologic topics relevant to residents in surgical specialties (general surgery, obstetrics/gynecology, and ophthalmology) as well as for master's-degree candidates in medical technology. While teaching pathology to medical and other allied health … [1]: /embed/inline-graphic-1.gif

An exemplar of GP commissioning and child and adolescent mental health service partnership

Purpose – The purpose of this paper is to draw attention to commissioning and service structures enabling implementation of evidence-based cost-effective care as illustrated by the “1419” young people’s service treating mild to moderate severity mental health difficulties in teenagers old 14 to 19 years. The authors describe relevant local contextual factors: “relational commissioning”, demand capacity planning and a receptive and safe clinical context. Design/methodology/approach – The authors used a participant observer qualitative research design to describe commissioning and service design. Treatment outcomes were analysed using a quantitative design and found significant improvement in service user mental health and daily function. These results will be reported elsewhere. Findings – The dynamics and structures described here enabled clear shared goals between service user, service purchaser, service provider and service partners. The goals and design of the service were not static and were subject to ongoing development using routine outcome measures and conversations between referrers, commissioners, service users and within the team about what was and was not working. Research limitations/implications – The methods are limited by the lack of a prospective systematic evaluation of the implementation process and by the time limitations of the service. Practical implications – Implementation of whole system change such as that envisioned by Children and Young People’s Improving Access to Psychological Therapies requires consideration of local context and process of implementation. The authors suggest key factors: consideration of “relational commissioning” with purchasers, providers and service users designing services together; case-level collaboration between services and partner agencies; smaller child and adolescent mental health teams eliminating competing task demands, permitting speed of action, providing psychological safety for staff, promoting shared goals and innovation; rigorous demand/capacity planning to inform funding. Social implications – The failings of child and adolescent mental health services (CAMHS) are detailed in the Department of Health report “Future in mind: promoting, protecting and improving our children and young people’s mental health and wellbeing” (2015). The aims of the report are contingent on the ability of local health providers to implement its recommendations. The authors provide a theoretical approach to enable this implementation. Originality/value – To date there are no published papers addressing the key characteristics enabling implementation of evidence-based practice within CAMHS. The unique experience in forming the“1419” service has important implications nationally and brings together evidence of an effective service within a theoretical underpinned context.

The Global Health Service Partnership: An Innovative Program to Address Shortages of Pediatric Health Care Workers in Resource-Limited Settings

The Global Health Service Partnership: An Innovative Program to Address Shortages of Pediatric Health Care Workers in Resource-Limited Settings

Partnership is alive and underpinning healthcare delivery

556 British Journal of Healthcare Management 2015 Vol 21 No 12 © 2 01 5 M A H ea lth ca re L td effective and enhanced performance and create a knowledge and understanding of employee aspirations with attention to the employee’s voice. The employee voice can be expressed in a number of ways and through a variety of two way channels, both cascading down and feeding back up through the most direct routes. Attitude surveys provide another commonly used channel, which is inherently flexible, but not interactive. Broad forms of employee voice include direct involvement in the way work is organised and indirect influence on decisions affecting the broader organisation through works councils or joint consultation committees (Bacon and Samuel, 2009). The employer’s organisational culture and management style impact directly on productivity and performance, and research has shown that employee relations similarly impact on performance. Herein lies the challenge, as key elements of good practice include job design, skills development, and a climate of regular, consistent consultation and involvement; and it is these areas which are highly contested. Theoretically, these areas are associated with good management practice that provides a positive psychological contract based on trust and fairness tied into an organisational culture that delivers positive outcomes linked to performance. In reality, a ‘blame culture’ is still prevalent in many areas of the NHS. When this partnership works, the effect at an employee level is commitment, job satisfaction, and a willingness to produce, but when it fails (for whatever reason) a perverse psychological contract develops, which is inevitably destructive. From an employee’s perspective, either version of this contract is subjective. Assessments of wellbeing at work are affected by a variety of factors including the nature of the work task, social integration in the workplace, participation in decision-making and job security, which link into the total experience of work. Although the contract is individual in nature, there will be work group-, departmentaland organisational-wide aspects, which imply that while structures and relationships adjust, the historical legacy may take time to change (McIntosh and Voyer, 2012). Within the NHS the promotion of partnership between employer, employee and trade unions has emerged as an inclusive mechanism, whereby union relevance is supportive of long-term interests of the Bryan McIntosh, senior lecturer in health management and organisational behaviour at the University of Bradford, explores the role of partnerships in the health service Partnership is alive and underpinning healthcare delivery

Building healthcare capacity: The Global Health Service Partnership.

Building healthcare capacity: The Global Health Service Partnership.

The First Nations Health Authority: A transformation in healthcare for BC First Nations.

More than 10 years of negotiation and a series of political agreements led to the formation of a new First Nations health governance structure in British Columbia and the beginning of new relationships in health between First Nations, federal, and provincial governments. The First Nations Health Authority is the service delivery arm of this structure and the first-of-its-kind for Canada. Equitable and innovative health service and governance partnerships can bring decision-making closer to home and into the hands of First Nations communities and allows using the best of western medicine combined with holistic and traditional practices. Decolonizing old relationships and building new partnerships are leading to greater alignment of culturally safe and effective health services through coordination, integration, and shared decision-making in British Columbia.

Global Health Service Partnership: First Year Findings

The Global Health Service Partnership (GHSP) is a public-private-partnership between Seed Global Health, a US non-profit; Peace Corps, a US Government agency; and host country health education systems. The program attempts to address the global shortage of skilled health professionals by sending US doctors and nurses as medical and nursing educators to training institutions in Uganda, Malawi and Tanzania.