Off-site Team Research Articles

Evaluation of the Nurse Practitioner Offsite Model.

Rural older adults residing in assisted living (AL) (herein referred to as residents) have limited access to health care for urgent and chronic management of diseases. The current project aimed to assess rural residents, families, and staff satisfaction with the Nurse Practitioner (NP) Offsite Visit Program. Residents and their families were asked to complete the NP Satisfaction Survey. The survey comprised three subscales (satisfaction, communication, and accessibility) and measured residents' and families' satisfaction. AL staff attended a 1-hour focus interview. Mean survey scores were 81.5 for satisfaction, 26.4 for communication, and 16.9 for accessibility subscales. Focus interview themes included Care Coordination, Prevention of Acute Care Utilization, and Access to Care. Findings suggest that residents, families, and site staff believe the NP Offsite Visit Program was beneficial and improved care coordination between residents and the provider team. The next step is to evaluate the program's impact on residents' health outcomes and further evaluate the Offsite team membership. [Journal of Gerontological Nursing, 49(7), 25-30.].

Ethnobotanical research under the COVID-19 pandemic: assessing a remote method for documenting Indigenous plant-related knowledge

Background: In response to the limitations on fieldwork imposed by the COVID-19 pandemic, we describe and assess a remote method for documenting plant-related knowledge, using smartphones that requires no in-person interaction between an on-site Indigenous community and off-site researchers. Methods: The on-site team identified the Indigenous taxa, created equivalents of photo vouchers, and recorded their names and uses as voice messages using a smartphone, thereby learning about plants from one another. They then sent the data using WhatsApp messages to the off-site team, who identified the botanical names of the taxa, and analyzed the plant-related knowledge. Results: We assess the remote, collaborative, and transdisciplinary quality of the method, factoring in communication, audiovisual documentation, species identification, knowledge exchange, logistics, and ethics. Despite the problems we experienced with identifying taxa growing in high forest and translation issues that complicated the documentation of plant uses, the method was on the whole a success. It allowed the on-site team to activate their passive knowledge of their language and share their knowledge with their relatives. The off-site team identified 57% of the recorded 54 taxa to species level and documented their names and uses as primary audio data, which keep on enhancing the quality of the documentation. Conclusions: Smartphones can be used as research tools during periods of restricted physical access, but also to extend research beyond the fleeting field visits and to elevate the empirical standard of ethnobotany when it comes to language data. We see such remote research solutions not as replacements for in-person collaborations, but as valid and dynamically evolving research methods in their own right. Keywords: smartphones, empiricism, photo vouchers, Taruma, Wapichan, Guyana

P159 Impact of offsite teams on anaesthetic time and decision to delivery interval in category 1 caesarean deliveries

P159 Impact of offsite teams on anaesthetic time and decision to delivery interval in category 1 caesarean deliveries

417 An Athlete-Oriented Holistic Coaching Program Targeting Performance and Wellbeing in Neurosurgery Residents

INTRODUCTION: Neurosurgery residency is a demanding environment, requiring high levels of performance endured over long periods of time. As a result, neurosurgery residency has been associated with significant rates of fatigue, depression, and physician burnout. To address this, the authors instituted a program within the residency, entitled the “Performance Protection Program,” consisting of a personalized program based on principles used with world-class extreme sports athletes designed for residents to achieve sustainably high levels of performance. METHODS: A 12-month coaching program was instituted by a performance coach within a single neurosurgery residency program. Residents attended individual and team-based monthly meetings, engaged in offsite team outings, and completed interactive reflective questions. The program focused on several pillars of performance excellence including mental, emotional, social, physical and physiological domains. RESULTS: Residents engaged in a total of 19 team sessions, 3 team outings, and over 87 individual sessions by mobile device or in-person during which they strategized with the coach on topics including: productivity, communication, regulating emotions under pressure, in-hospital nutrition, meal preparation, efficiency, accountability, posture and strength, job interviewing, confidence, visualization skills, and team leadership dynamics. By demand, a bi-weekly posture and mobility session was incorporated into the program. Early feedback demonstrated a need for adaptive strategies personalized to the resident’s stage of training and life. Most residents expressed need for improvement in nutrition, physical wellness, and communication under fatigue. CONCLUSIONS: Neurosurgery residency is stress-provoking and arduous for trainees. To optimize resident performance while minimizing burnout, a curriculum based on principles in extreme sports was successfully enacted over a 12-month period. Other training programs may utilize similar interventions to promote resident well-being and improve mental and physiological states.

Researching the delivery of health and nutrition interventions for women and children in the context of armed conflict: lessons on research challenges and strategies from BRANCH Consortium case studies of Somalia, Mali, Pakistan and Afghanistan

BackgroundThe BRANCH Consortium recently conducted 10 mixed-methods case studies to investigate the provision of health and nutrition interventions for women and children in conflict-affected countries, aiming to better understand the dominant influences on humanitarian health actors’ programmatic decision-making and how such actors surmount intervention delivery barriers. In this paper, the research challenges encountered and the mitigating strategies employed by the case study investigators in four of the BRANCH case study contexts are discussed: Somalia, Mali, Pakistan and Afghanistan.DiscussionMany of the encountered research challenges were anticipated, with investigators adopting mitigation strategies in advance or early on, but others were unexpected, with implications for how studies were ultimately conducted and how well the original study aims were met. Insecurity was a fundamental challenge in all study contexts, with restricted geographical access and concerns for personal safety affecting sampling and data collection plans, and requiring reliance on digital communications, remote study management, and off-site team meetings wherever possible. The need to navigate complex local sociopolitical contexts required maximum reliance on local partners’ knowledge, expertise and networks, and this was facilitated by early engagement with a wide range of local study stakeholders. Severe lack of reliable quantitative data on intervention coverage affected the extent to which information from different sources could be triangulated or integrated to inform an understanding of the influences on humanitarian actors’ decision-making.ConclusionStrong local partners are essential to the success of any project, contributing not only technical and methodological capacity but also the insight needed to truly understand and interpret local dynamics for the wider study team and to navigate those dynamics to ensure study rigour and relevance. Maintaining realistic expectations of data that are typically available in conflict settings is also essential, while pushing for more resources and further methodological innovation to improve data collection in such settings. Finally, successful health research in the complex, dynamic and unpredictable contexts of conflict settings requires flexibility and adaptability of researchers, as well as sponsors and donors.

HIV patient and provider feedback on a telehealth collaborative care for depression intervention

ABSTRACTIn the HIV Translating Initiatives for Depression into Effective Solutions project, we conducted a randomized controlled effectiveness and implementation trial comparing depression collaborative care with enhanced usual care in Veterans Health Administration HIV clinics in the US. An offsite HIV depression care team including a psychiatrist, a depression care manager (DCM), and a clinical pharmacist provided collaborative care using a stepped-care model of treatment and made recommendations to providers through the electronic health record system. The DCM delivered care management to HIV patients through phone calls, performing routine assessments and providing counseling in self-management and problem-solving. The DCM documented all calls in each patient’s electronic medical record. In this paper we present results from interviews conducted with patients and clinical staff in a multi-stage formative evaluation (FE). We conducted semi-structured FE interviews with 26 HIV patients and 30 clinical staff at the three participating sites during and after the trial period to gather their experiences and perspectives concerning the intervention components. Interviews were transcribed verbatim and analyzed using rapid content analysis techniques. Patients reported high satisfaction with the depression care manager (DCM) phone calls. Both HIV and mental health providers reported that the DCM’s chart notes in the electronic health record were very helpful, and most felt that a dedicated DCM for HIV patients is ideal to meet patient needs. Sites encountered barriers to achieving and maintaining universal depression screening, but had greater success when such screening was incorporated into routine intake processes. FE results demonstrated that depression care management via telehealth from an offsite team is acceptable and helpful to both HIV patients and their providers. Given that a centralized offsite depression care team can deliver effective, cost-effective, cost-saving services for multiple HIV clinics in different locations with high patient and provider satisfaction, broad implementation should be considered.

Communication and Relationship Skills for Rapid Response Teams at Hamilton Health Sciences

Rapid response teams (RRT) are an important safety strategy in the prevention of deaths in patients who are progressively failing outside of the intensive care unit. The goal is to intervene before a critical event occurs. Effective teamwork and communication skills are frequently cited as critical success factors in the implementation of these teams. However, there is very little literature that clearly provides an education strategy for the development of these skills. Training in simulation labs offers an opportunity to assess and build on current team skills; however, this approach does not address how to meet the gaps in team communication and relationship skill management. At Hamilton Health Sciences (HHS) a two-day program was developed in collaboration with the RRT Team Leads, Organizational Effectiveness and Patient Safety Leaders. Participants reflected on their conflict management styles and considered how their personality traits may contribute to team function. Communication and relationship theories were reviewed and applied in simulated sessions in the relative safety of off-site team sessions. The overwhelming positive response to this training has been demonstrated in the incredible success of these teams from the perspective of the satisfaction surveys of the care units that call the team, and in the multi-phased team evaluation of their application to practice. These sessions offer a useful approach to the development of the soft skills required for successful RRT implementation.

Agile Outsourcing Projects

Agile methods are lightweight, iterative software development frameworks used predominantly on small- and mid-sized software development projects. This article introduces a project structure and management practices creating Agile conditions for large software projects outsourced either offshore or onshore. Agility is achieved by slicing a large project into a number of small-sized projects working in Agile settings. Development is divided into R&D activities, located onsite, and production activities, located offsite. The proposed approach makes Agile applicable to the stressed conditions of outsourcing without compromising the quality or pace of the software development effort. Creating an Agile environment in an outsourcing project relies on maintaining a balance between the functions and sizes of onsite and offsite teams, on redefining the developers’ roles, and on reorganizing the information flow between the different development activities to compensate for the lack of customer onsite, team co-location, and tacit project knowledge.