Nominal Group Research Articles

Reducing turnaround time for routine outpatient biochemical tests through Lean Six Sigma: A case study in China.

Routine clinical biochemistry tests are crucial for clinical diagnostics and play a key role in enhancing outpatient turnover efficiency and patient satisfaction. This study aimed to implement Lean Six Sigma in the biochemistry laboratory of a hospital in China to improve efficiency and quality by reducing turnaround time. The study was conducted from January to December 2023, using the DMAIC (Define, Measure, Analyze, Improve, Control) framework, and employed tools such as the voice of the customer, Value Stream Mapping, '5 whys' technique, Nominal Group Technique, and Pareto chart. The turnaround time for outpatient routine clinical biochemistry tests was reduced from 139 min to 58 min (p < 0.05), effectively increasing both patient and physician satisfaction. Lean Six Sigma aimed to reduce the turnaround time for biochemical tests have significant advantages. This study confirms the effectiveness of Lean Six Sigma in a Chinese clinical laboratory setting and provides guidance for optimizing efficiency in global clinical laboratories with limited implementation experience, constrained technical and equipment resources, and high demand for medical diagnostics.

Obstetrics clinical learning needs: Priorities of undergraduate medical students

Background. The obstetrics clinical learning environment is complex and often not conducive to learning. Understanding the priority clinical learning needs of students with experience in this setting is essential for designing effective educational interventions to optimise clinical learning. Objective. To describe the priority obstetrics-related clinical learning needs of undergraduate medical students informed by their experience of the clinical learning environment. Methods. A multigroup nominal group technique (NGT) was applied to a purposively sampled group of medical students who had experienced obstetrics-related clinical placements in facilities at various levels of care, from primary to tertiary. Individual group priorities were further integrated into themes. Results. Seven priorities emerged: (i) perinatal procedural skills, (ii) teaching approaches to obstetrics, (iii) pregnancy-related screening and complications, (iv) postnatal support for women, (v) interprofessional and gender roles, (vi) orientation to patient care and the clinical environment, and (vii) psychological preparation of students. Conclusion. Educational interventions to optimise the obstetrics clinical learning environment must consider students’ priorities. These priorities extend beyond procedural skills and include collaborative practice and psychological preparation.

Identifying and Prioritizing Factors to Improve Implementation of an Evidence-Based Program for Child Maltreatment Prevention in Rural Missouri Communities

AbstractPrevention of child abuse and maltreatment is critical in the Ozark region of Missouri where rates are higher than in other areas of the state. Community-based organizations seeking to address these issues in rural areas face significant challenges both internal and external to the organization. Guided by the Consolidated Framework for Implementation Research (CFIR), Whole Kids Outreach (WKO) utilized a modified concept mapping approach to identify strategies needed to address these challenges and more effectively implement the Healthy Families America (HFA) program in seven counties in the rural Missouri Ozark region. Semi-structured interviews were used to identify barriers and supports to the implementation of HFA. Statements were generated via in-person and telephone interviews with key stakeholders (WKO internal staff and external partners). These stakeholders then sorted statements into like piles and rated them according to importance. Concept mapping systems software, using multidimensional scaling and hierarchical cluster analysis, was used to determine the most salient cluster solution. The resulting cluster map depicted six thematic clusters and provided a visual representation of relationships between clusters. Stakeholders were then guided through a nominal group process to prioritize key issues and begin to develop strategies to address them.

The ballistic articular structure injury classification (BASIC) system: clarifying ballistic articular injuries.

This study aims to (1) devise a classification system to categorize and manage ballistic fractures of the knee, hip, and shoulder; (2) assess the reliability of this classification compared to current classification schemas; and (3) determine the association of this classification with surgical management. We performed a retrospective review of a prospectively collected trauma database at an urban level 1 trauma centre. The study included 147 patients with 169 articular fractures caused by ballistic trauma to the knee, hip, and shoulder. Injuries were selected based on radiographic criteria from plain radiographs and CT scans. The AO/OTA classification system's reliability was compared to that of the novel ballistic articular injury classification system (BASIC), developed using a nominal group approach. The BASIC system's ability to guide surgical decision-making, aiming to achieve stable fixation and minimize post-traumatic arthritis, was also evaluated. The BASIC system was created after analysing 73 knee, 62 hip, and 34 shoulder fractures. CT scans were used in 88% of cases, with 44% of patients receiving surgery. The BASIC classification comprises five subgroups, with a plus sign indicating the need for soft tissue intervention. Interrater reliability showed fair agreement for AO/OTA (k = 0.373) and moderate agreement for BASIC (k = 0.444). The BASIC system correlated strongly with surgical decisions, with an 83% concurrence in treatment choices based on chart reviews. Conventional classification systems provide limited guidance for ballistic articular injuries. The BASIC system offers a pragmatic and reproducible alternative, with potential to inform treatment decisions for knee, hip, and shoulder ballistic injuries. Further research is needed to validate this system and its correlation with patient outcomes. Level III, Diagnostic Study.

Development of an intervention for patients following an anterior cruciate ligament rupture: an online nominal group technique consensus study

Objectives(1) To develop an intervention for to support patients diagnosed with an anterior cruciate ligament (ACL) rupture with decision-making regarding treatment. (2) To define evidence-based recommendations for the treatment of...

A corpus-based study of live grammatical metaphor in English academic writing

ABSTRACT Nominalization is an important resource for creating grammatical metaphor (GM). Previous research shows that nominalization is characteristic of academic writing but does not demonstrate discipline sensitivity within the academic genre. The reason might be that some nominalizations have developed into dead GM. This study aims to identify nominalizations that create live GM and explore the discipline sensitivity of live GMs based on a corpus of academic article abstracts across three discipline groups. The findings indicate that a clause construes an event or a status, which is either conveyed by the verbal group or a nominal group functioning as a participant of the verbal group. Verb nominalizations construing events and adjective nominalizations construing statuses are the key factors in identifying live GM. Notably, nominalizations not cooccurring with verbalizations are not necessarily dead GMs. The corpus-based research shows that both verb and adjective nominalizations exhibit discipline sensitivity. Verb nominalizations are more prevalent in natural science texts, whereas adjective nominalizations are more prevalent in the humanities and social science texts. However, live GMs are not inherently discipline sensitive; rather, it is those GMs contributing to the lexical density of the text that are discipline sensitive.

Identifying the Key Quality of Takaful Agents Influence on Takaful Penetration: The Nominal Group technique approach

Agents are the most influential channel and act as intermediaries for marketing Takaful products. This article discusses the Nominal Group Technique (NGT) as an alternative method to develop a list of quality elements for efficient agent services. Based on the expert consensus, ten essential recommendations regarding quality elements to improve agent quality services have been proposed. The NGT approach allowed researchers to easily and quickly obtain element validation. Expert discussion, appraisal, and voting were conducted after identifying items derived from relevant literature. The study presents the findings and future research directions for academic and Takaful industry references.

Cardiomyopathies matter: a multistakeholder european initiative to improve patient outcomes through effective health policies

Abstract Background/Introduction Cardiomyopathies are common and affect up to 1:250 of the population. Despite conferring a risk for sudden cardiac death and substantial disease burdens that could be reduced through better awareness, detection and care, cardiomyopathy care is rarely incorporated in European and national health policies. New European Society of Cardiology cardiomyopathy guidelines (1) could substantially benefit care but need to be supported by effective policies. Cardiomyopathies Matter is a Europe-wide, multistakeholder initiative aiming to raise awareness about cardiomyopathies and to ensure they receive the policy attention they warrant from EU and national decision-makers. Methods Cardiomyopathies Matters participants include experts from the fields of cardiology, cardiac nursing, economics, and patient advocacy, coordinated by a Secretariat, representing 36 countries and 6 patient advocacy groups (PAGs). A Policy Roadmap and other publications were co-created based on i) reviews of published and grey literature, and ii) input from topic experts and PAGs through 2 group workshops, individual consultation meetings, and a modified nominal group technique reviewing successive drafts toward consensus approval. Results The Roadmap (2) identifies unmet needs and challenges throughout the patient care pathway and offers holistic EU and national policy recommendations to address these and improve patient outcomes (Figure 1). These include policy measures to support early and accurate diagnosis, access to expert multidisciplinary care, guidelines-informed disease investigation and management, holistic support and empowerment of patients and carers, and research and innovation. Key aspects for nurses and allied health professionals include the need for 1)improved knowledge and awareness to promote early diagnosis; 2)rapid referral systems to multidisciplinary care and access to specialist cardiomyopathy or heart failure nurses care coordination, 3)genetic counselling (index cases and cascade/family screening), and 4)support of patients and families. Building on existing examples of good practice at national expert centre networks (e.g. France, Spain, UK),Cardiomyopathies Matter published updated policy recommendations for the European Union mandate (3), which are now being adopted more widely. National initiatives are underway or in development in Belgium, Hungary, Italy, Netherlands, Poland, and Spain. Local actions include multistakeholder roundtables and events, national Roadmap publications, events, educational activities, and media outreach. Conclusions EU and national Cardiovascular Health Action Plans are needed, with specific attention to cardiomyopathies and other inherited CVDs. Cardiomyopathies Matter fosters collaboration between healthcare professionals, PAGs and policymakers to promote policies that ensure all patients and families have access to guidelines-informed care.Figure 1Cardiomyopathy Priorities

Breast Cancer Patients’ Emotional Acceptance: Nominal Group Technique (NGT) approach

Many individuals diagnosed with breast cancer experience emotional stress that interferes with their psychological functioning and quality of life. Thus, this study aims to explore the level and experience of emotional acceptance when individuals are diagnosed with breast cancer. This study’s main objective is to determine the emotional acceptance process of patients diagnosed with breast cancer in Malaysia. This study uses the Nominal Group Technique (NGT) and has involved a total of 11 experts who have faced breast cancer. Changing the patient's emotional acceptance depends on the influence of the cancer patient's internal and external positive motivation.

Approaches in Training for Non-Option Special Education Teacher at Private Early Intervention Center: The Nominal Group Technique Approach

In the past, studies only focused on approaches to training for teachers in the special education field. Hence, this study develops approaches for training non-option Special Education Teachers (SETs) in private early intervention centers, addressing their lack of specialized qualifications. Seven panel experts participated in this study using the Nominal Group Technique (NGT). The findings using this approach indicate that observation, reflection, and co-teaching are essential for SET at private early intervention centers. This study aims to enhance professional development and improve educational outcomes for children with special needs by tackling the unique challenges these educators face.

Strategic Approaches to Enhancing School Performance through Instructional Leadership in Malaysia

The Nominal Group Technique (NGT) was employed in this study to suggest ways to enhance the performance of Malaysian schools. By relying on the opinions and consensus of experts, the study has tackled the problem of school performance using this technique. The nine suggestions for enhancing the school's performance were outlined in the summary of the experts' recommendations. Given that the NGT approach involves experts debating and voting on components derived from literature reviews, the validation of elements can be achieved straightforwardly.

Developing Crisis Coping Strategies using Nominal Group Technique for Psychological Distress Management

This article solicits the opinions of seven professionals in the field of mental health in order to provide solutions for dealing with psychological crises through the application of the Nominal Group Technique (NGT). Four expert-approved approaches received acceptance scores between 90.48% and 100%. NGT facilitated quick and reliable validation of elements derived from literature reviews and expert consultations. Those working on individualised therapy modules for mental illness should be involved in future studies aimed at improving these approaches.

Fostering Innovative Work Behaviour of Public Sector Employees: A Nominal Group Technique

Innovative work behaviour has received significant attention in research that benefits individuals, groups and organisations. However, factors that affect innovative work behaviour, specifically among public sector employees, are rarely studied. Hence, this paper proposes solutions to increase innovative work behaviour using the Nominal Group Technique (NGT). The experts provided an overview of 11 potential solutions to enhance the public sector employee's innovative work behaviour. The NGT approach facilitated the quick and readily validation of literature elements that experts subsequently discussed and voted on. This paper references future studies on human resource management and practices.

Preparation and validation of the instrument "QualiAPS digital-Brazil" for assessing digital health care in primary health care: a required tool.

The use of Information and Communication Technologies in the field of health is increasing across the world, demarcating the field of digital health. The goal of this study is to formulate and validate a matrix of indicators, design assessment scripts and indicate data collection techniques for assessing the quality of digital health care in Brazilian Primary Health Care (PHC). This is a validation study divided into three phases: preparation of the instrument, analysis of validity and pilot study. The instrument was prepared based on the PHC assessment model from a literature review; the analysis of validity used the Delphi technique associated with the nominal group and the evidence from the literature reference. In the pilot study, audio-recorded interviews were conducted with strategic primary care actors. The matrix of indicators "QualiAPS Digital-Brazil" introduces a set of 37 indicators, distributed into three distinct components and their respective dimensions. The component "Structure" includes the dimension "Resources"; the component "Processes" includes the dimensions "Technical," "Organizational" and "Relational"; and the component "Results" includes the dimensions "Short-Term Results" and "Medium-Term Results." The general values obtained for CVI and IRR were 0.89 and 1.00; respectively. Therefore, it was possible to design assessment scripts and indicate qualitative data collection techniques for assessing digital health in Brazilian PHC. The instrument presented was validated regarding its relevance, content and theoretical support to evaluate the quality of digital health care, supporting decision-making by managers and health professionals in the search for improving remote primary care provided to the population.

The validation of aphasia united best practice recommendations with people with aphasia and their caregivers in Vietnam: a nominal group technique study

ABSTRACT Background Speech and language therapy is a relatively new profession in Vietnam and to date, 79 individuals have graduated from Master and Bachelor programs. For the few therapists working with adult populations, clinical guidance tailored to the Vietnamese context is limited. The Aphasia United Best Practice Recommendations were developed to provide multi-national guidance for the management of post-stroke aphasia and have been translated into 29 languages, including Vietnamese. To date however, their applicability to low-middle income countries with emerging speech and language services such as Vietnam has not been explored. Aims To determine the relevance, comprehensibility, and comprehensiveness of the Aphasia United Best Practice Recommendations to people with aphasia and caregivers in Vietnam. Methods and Procedures People with aphasia and their caregivers participated in focus groups, utilising the nominal group technique. Participants were recruited from four hospitals in Ho Chi Minh City. Participants with aphasia were sampled for severity of aphasia, age, sex, time-post onset, geographic location, employment status, and relationship. Participants reviewed the recommendations, rated relevance and comprehensibility (clarity), and made suggestions for improvement. Participants assessed the comprehensiveness of the recommendations and additional items were generated and prioritised. Data were analysed using descriptive statistics and qualitative content analysis. Outcomes and Results People with aphasia (n = 11) and caregivers (n = 17) participated in one of nine focus groups. People with aphasia rated all recommendations as relevant. Levels of agreement varied for caregivers and fell < 85% for one recommendation only (Recommendation 4 – relating to the need for all people with aphasia to have some means of communication prior to discharge). Both participant groups suggested changes to content and wording to reflect the context and culture of Vietnam. Three common themes within the newly proposed recommendations were identified across both participants with aphasia and caregiver groups: (1) easier access to speech and language therapy services and information about aphasia, (2) the need for psychological and social support for people with aphasia and (3) the need for increased community awareness and supports for people with aphasia and their caregivers. Conclusions and Implications The Aphasia United Best Practice Recommendations were perceived to be relevant, however new recommendations reflecting the unique cultural, economic and healthcare environment of Vietnam were identified. Recommendations relating to access to services and community-based rehabilitation were prioritised, supporting the need for continued growth and advocacy for the speech and language therapy profession in Vietnam.

Exploring barriers and solutions to consumer involvement in health service research using a nominal group technique

BackgroundConsumer involvement in health research is when patients, their families and caregivers work with researchers on research projects. Despite the growing expectation for health services to facilitate the involvement of consumers in research, the practical integration of this approach is an ongoing process, with limited research conducted into how Australian health services can support this practice. This study explored consumer perspectives on the barriers and solutions to enabling consumer involvement in research within an Australian tertiary hospital and health service, and staff perspectives on the solutions to facilitating consumer involvement. A prior survey had identified barriers to consumer involvement from the staff perspective. The broad aim was to inform the development of a framework to help promote consumer involvement in research within the health service.MethodsA Nominal Group Technique (NGT) was utilised with groups comprised of health service consumers and staff. Three health consumers were co-researchers in the full life-cycle of this study and are included as authors.ResultsTen consumers and 14 staff participated across three sessions ranging from one to three hours. For consumers, barriers to their involvement were grouped into seven domains: (1) lack of connection with researchers/research projects, (2) low research literacy, (3) structural barriers, (4) lack of acknowledgement, (5) implementation challenges, (6) inadequate information provision, and (7) representation concerns. Solutions to enabling involvement were grouped into five domains: (1) support to connect with researchers/research projects, (2) adequate information provision, (3) incentive for involvement, (4) acknowledgement, and (5) balanced representation. Staff ideas for solutions were grouped into five domains: (1) support to connect with consumers, (2) support to involve consumers, (3) access to funds to remunerate consumers, (4) more time to involve consumers, and (5) staff training.ConclusionThrough an NGT methodology, this study delivered a nuanced comprehension of perspectives on involving consumers in research from both health service consumers and staff. These findings serve as a foundation for identifying strategies that foster enhanced and refined relationships between consumers and researchers, advancing the collaborative landscape in health research. The findings from this project offer valuable strategies for researchers to better engage consumers in research and for consumer groups to enhance their involvement. Additionally, these insights could be used by other health services to advocate for essential resources.

Adopting a systems-thinking approach to optimise dietary and exercise referral practices for cancer survivors

PurposeService referrals are required for cancer survivors to access specialist dietary and exercise support. Many system-level factors influence referral practices within the healthcare system. Hence, the aim of this study was to identify system-level factors and their interconnectedness, as well as strategies for optimising dietary and exercise referral practices in Australia.MethodsA full-day workshop involving national multidisciplinary key stakeholders explored system-level factors impacting dietary and exercise referral practices. Facilitated group discussions using the nominal group technique identified barriers and facilitators to referral practices based on the six World Health Organisation (WHO) building blocks. The systems-thinking approach generated six cognitive maps, each representing a building block. A causal loop diagram was developed to visualise factors that influence referral practices. Additionally, each group identified their top five strategies by leveraging facilitators and addressing barriers relevant to their WHO building block.ResultsTwenty-seven stakeholders participated in the workshop, including consumers (n = 2), cancer specialists (n = 4), nursing (n = 6) and allied health professionals (n = 10), and researchers, representatives of peak bodies, not-for-profit organisations, and government agencies (n = 5). Common system-level factors impacting on referral practices included funding, accessibility, knowledge and education, workforce capacity, and infrastructure. Fifteen system-level strategies were identified to improve referral practices.ConclusionThis study identified system-level factors and strategies that can be applied to policy planning and practice in Australia.

Strategy actions to include students in a private hospital's nursing teams: A qualitative study.

Student nurse education focusses on preparing competent professionals integral to nursing teams. To develop strategic actions to include student nurses within the nursing team. A private healthcare group in South Africa. A qualitative approach in three phases was used. Thirty purposively sampled participants recorded reflective journals in phase one. Tesch's eight steps were utilised for analysis. Phase two involved non-probability volunteer sampling of 11 participants for the nominal group technique analysis. In phase three, total population sampling recruited nine panellists for an e-Delphi technique that provided data that were open coded. Phase one identified themes, including perceptions of responsibilities, support needs, recognition, conflict and communication issues. Phase two revealed five strategic actions: fair treatment, aligned work allocation, active participation, respect and acknowledgement of contributions. Phase three validated 19 strategic statements underpinning the strategic actions. Unit managers play a key role in fostering inclusivity, impacting student nurse retention. Enhancing team cohesion can improve workplace wellness and patient outcomes while aiding in retention and recruitment efforts.

Accommodating persons with communication disabilities in court: Perspectives of law students.

Individuals with communication disabilities encounter obstacles in attaining equal access to justice compared to others. Despite experiencing widespread violence and abuse, they come across as challenges in seeking remedies through the legal system. One barrier is the lack of awareness among legal practitioners regarding suitable accommodations that would facilitate effective participation in court for individuals with communication disabilities. This study explores the awareness of final-year law students concerning court accommodations available for individuals with communication disabilities, allowing them to testify in a South African court. The findings can serve as inspiration for expanding the current curriculum for law students. This qualitative study used a modified six-step nominal group technique whereby participants (six law students identified through snowball sampling) generated, discussed and reached a consensus on accommodations needed by individuals with communication disabilities, enabling them to provide testimony in court. Data were analysed using thematic analysis principles. The study found that although participants had not received any instruction on disability rights, access to justice or court accommodations during their legal training at the undergraduate level, they were able to perceive and learn about four main types of court accommodations for persons with communication disabilities to enable their testimony. Final-year law students are aware of court accommodations despite not having received formal instruction in disability law. The inclusion of disability rights and court accommodations is recommended at the undergraduate level to ensure that when in practice, lawyers have knowledge on ensuring access to justice for persons with communication disabilities.

A plea for urgent action: Addressing the critical shortage of cardiothoracic surgical workforce in the COSECSA region.

The College of Surgeons of East, Central, and Southern Africa (COSECSA) comprises 14 countries, many of which currently grapple with an increasing burden of cardiothoracic surgical (CTS) diseases. Health and economic implications of unaddressed CTS conditions are profound and require a robust regional response. This study aimed to define the status of CTS specialist training in the region (including the density of specialists, facilities, and active training posts), examine implications, and proffer recommendations. A desk review of COSECSA secretariat documents and program accreditation records triangulated with information from surgical societies was performed in May 2022 and September 2023 as part of education quality improvement. A modified nominal group process involving contextual experts was used to develop a relevant action framework. Only 6 of 14 (43%) of COSECSA countries offered active training programs with annual intake of only 18 trainees. Significant training gaps existed in Burundi, Botswana, Malawi, Rwanda, South Sudan, Zambia, and Zimbabwe. Country specialist density ranged from 1 per 400,000 (Namibia) to 1 per 8,000,000 (Ethiopia). Overall, the region had 0.2 CTS specialists per million population as compared with 7.15 surgeons per million in High-Income Countries. Surgical education experts proposed an action framework to address the training crisis including increasing investments in CTS education, establishing regional centers of excellence, retention incentives and opportunities for women, and leveraging international partnerships. Proactive investments in infrastructure, human resources, training, and collaborative efforts by national governments, regional intergovernmental organizations, and international partners are critical to expanding regional CTS training.