Practice Team Research Articles

Evaluating the Enablers of Effective Sustainable Management Practices for Public Ultra-Modern Market Infrastructure in Niger-Delta Region

This research investigates the pivotal factors facilitating the successful implementation of sustainable management practices in public ultra-modern markets, essential components of urban landscapes facing numerous challenges. Despite the growing acknowledgment of sustainability in urban development, a significant gap exists in comprehending the specific drivers behind effective management within these bustling market infrastructures. Utilizing a mixed-method approach, combining cross-sectional surveys and personal interviews, 239 administered questionnaires with a 76.7% response rate, reveals this study employs a pragmatic case study design focused on the Niger-Delta Region, Nigeria. Questionnaires were distributed, and interviews and observations conducted in New Town Market (Port Harcourt, Rivers State), Swali Market (Yenegoa, Bayelsa State), and Uvwie Market (Warri, Delta State). The study, based on key enablers of sustainable management, including organizational structure design, teamwork ethos, knowledge sharing, commitment levels, good governance, regular sustainable management meetings, and motivation for the management practice team. Quantitative data were analyzed through frequency tabulation, percentages, mean, and Relative Importance Index (RII), while qualitative data underwent transcription and analysis employing data reduction, content analysis, and thematic analysis. The findings underscore the significance of these enablers in enhancing infrastructure management effectiveness within public ultra-modern markets in Nigeria.

The costs, barriers and enablers of providing PGY2 placements in general practice in Aotearoa New Zealand: a mixed-methods study

Introduction Few mandatory community-based attachments for postgraduate year two doctors (PGY2s) in Aotearoa New Zealand are hosted in general practices, due to space, time and remuneration barriers. Aim This study aimed to explore the costs, barriers and enablers to general practices of hosting PGY2s. Methods A cost analysis for four general practices beginning to host PGY2s was undertaken, including time spent supervising and supporting PGY2s, revenue impact including subsidies and cost of providing clinical space. Interviews with these practices and seven experienced PGY2 host practices were conducted and analysed thematically. Results The estimated mean cost of hosting PGY2s excluding room cost was NZ$4907 per 13-week placement (range $890–$9183), increasing to $13 727 per placement (range $5750–$24 715) when room rental was included. Four themes were identified: working within a small business model; a new learning environment for PGY2s; providing positive experiences for the PGY2s; the relationship between practices and district hospitals that employed the PGY2s, including job sizing. Discussion Tension exists between the small business model of general practice and providing positive experiences for PGY2s in a new learning environment. Guidance and support structures for PGY2 hosting should be developed nationally, and communication and cooperation between practices and employing hospitals needs improvement. Out-of-hours work should be included in community-based attachments so PGY2s’ remuneration is consistent. General practice teams are willing to be part of creating a sustainable workforce. However, the time taken to host and costs of providing training in primary care are barriers. There is urgent need to increase funding to general practices for hosting PGY2s.

Leading primary care under the weight of COVID-19: how leadership was enacted in six australian general practices during 2020.

The COVID-19 pandemic challenged health care delivery globally, providing unique challenges to primary care. Australia's primary healthcare system (primarily general practices) was integral to the response. COVID-19 tested the ability of primary health care to respond to the greater urgency and magnitude than previous pandemics. Early reflections highlighted the critical role of leaders in helping organisations negotiate the pandemic's consequences. This study explores how general practice leadership was enacted during 2020, highlighting how leadership attributes were implemented to support practice teams. We performed secondary analysis on data from a participatory prospective qualitative case study involving six general practices in Melbourne, Victoria, between April 2020 and February 2021. The initial coding template based on Miller et al.'s relationship-centred model informed a reflexive thematic approach to data re-analysis, focused on leadership. Our interpretation was informed by Crabtree et al.'s leadership model. All practices realigned clinical and organisational routines in the early months of the pandemic - hierarchical leadership styles often allowing rapid early responses. Yet power imbalances and exclusive communication channels at times left practice members feeling isolated. Positive team morale and interdisciplinary teamwork influenced practices' ability to foster emergent leaders. However, emergence of leaders generally represented an inherent 'need' for authoritative figures in the crisis, rather than deliberate fostering of leadership. This study demonstrates the importance of collaborative leadership during crises while highlighting areas for better preparedness. Promoting interdisciplinary communication and implementing formal leadership training in crisis management in the general practice setting is crucial for future pandemics.

Statistical Analysis of Effectiveness of Cross-Disciplinary Team Practice in Engineering Project-Based Learning

Statistical Analysis of Effectiveness of Cross-Disciplinary Team Practice in Engineering Project-Based Learning

The fears and tyranny cycle: the movement between mental pain and tyranny in the forensic patient

This article describes a forensic reading of the "fears and tyranny cycle", a concept described by Barcai and Rosenthal (1974) to characterise the behaviour of some children and the dynamic origins of this in the relationship with their parents. This concept can be helpful in developing a formulation of the dynamics between the forensic patient and their professional carers, when a patient behaves in tyrannical and fear-inducing ways. Three clinical illustrations of the development of a formulation are described. The examples pay attention to the unique and unconscious fears of a patient, in a particular set of circumstances, and how this can assist in going beyond a characterisation of fear-driven tyrannical behaviour as being explained simply as institutionalisation, anger, or anxiety. Links to the wider psychoanalytic literature are drawn and the potential value of this approach to thinking with individual clinicians or clinical teams in reflective practice is considered.

Improving goal setting and achieving in geriatric rehabilitation through participatory action research

Introduction/background summary: In geriatric rehabilitation a means to achieve client centered care is to work collaboratively on setting and achieving goals. This might enhance self-efficacy, motivation, adherence to rehabilitation and goal-specific performance. In this participatory action research (PAR) project, a nursing team investigated for itself how to improve goal setting and achieving.
 Who is it for? The actions the nursing team chose and implemented contribute to improved goal setting and achieving and subsequently enhances client centered care.
 Who did you involve and engage with? This research project took place in a Learning and Innovation Network (LIN) on a geriatric rehabilitation ward, in which students and nurses work together on quality improvement projects. The team consisted of fifteen vocational trained nurses and healthcare assistants and eight nursing students, a nurse team leader and a lecturer practitioner spending a day per week on educational activities.
 What did you do? Facilitated by the lecturer practitioner, the nursing team (both staff and students) conducted a participatory action research project: they reflected on the steps they could take to work collaboratively on improving their practice, constantly evaluating their experiences. Data collected during the participatory action research consisted of, amongst others: student’s notes on patient interviews and interviews with nurses of the team, fieldnotes made by the facilitator during the PAR process. During PAR there is a constant need to feedback information and clarify issues. Therefor data analysis in PAR is partly performed concurrently. Data which had been collected by the facilitator or the nurses or students were used as a basis for planning and reflecting in the project group.
 
 Results: The team identified two themes influencing their goal setting and goal achieving with patients. Firstly, continuity of care is sub-optimal; in their opinion all should work on the same goals. Secondly, patients could be better informed about their rehabilitation path. The team chose to work on better preparation of the multidisciplinary care plan meeting with the patient and at the same time updating the patient record to advance continuity of care. A sound evaluation of the rehabilitation process and preparing the multidisciplinary care plan meeting to attain this, is now part of a shared team practice. During their process the team discovered certain barriers to optimally prepare the multidisciplinary care plan meeting, e.g. to optimally evaluate progress on rehabilitation goals the initial plan needs to be complete; certain barriers hamper preparation with the patient, like cognitive abilities or language problems. New actions have been chosen and are being worked on.
 Learning for the international audience: PAR which involves nurses can be seen as advantageous for facilitating change and improving services. Time and setting for reflection and collective learning supports the nursing team to diagnose their current practice and to improve their practice.
 Next steps: The Learning and Innovation Network was a temporary agreement between the nursing home and the nursing college based on research funding. Because of the positive results on team culture of improvement the Learning and Innovation Network might become a permanent facility.

Identifying the Level of Symmetrization of Reaction Time According to Manual Lateralization between Team Sports Athletes, Individual Sports Athletes, and Non-Athletes

The present study aimed to investigate the impact of practicing sports activities on manual skills, focused on reaction time depending on manual laterality. The objectives of the study were to identify the differences in improving simple, optional, and cognitive reaction times in the manual executions of student athletes who practice team sports involving the manual handling of the ball (volleyball, basketball, handball) in comparison with student athletes who practice individual sports and with non-athletic students; to identify the differences regarding the reaction time of the right- and left-handed executions depending on the manual lateralization of the subjects (right- and left-handedness) between the three experimental samples: team sports group (TSG), individual sports group (ISG), and the group of non-athletes (NAG) through the use of computer tests. The study included 335 subjects who were divided into three groups: TSG with 102 subjects, ISG with 112 subjects, and NAG with 121 subjects. The subjects of the study were given five computer tests to evaluate three types of reaction time: simple reaction time (Start/Stop Test), choice reaction time (Check Boxes Test, Hit-the-dot Test), and time of cognitive reaction (Trail making Test part A and B). The results were analyzed regarding right- and left-handedness, as well as the execution hand (right hand or left hand) in solving the tests. The results of the study highlighted significant statistical differences between the three groups: TSG, ISG, and NAG. The best results were recorded by TSG in all tests, and the lowest by NAG. Statistically significant differences were also recorded between the executions with the dominant hand compared to the executions with the non-dominant hand in relation to right- and left-handedness. The study highlighted that the smallest differences in all the study groups were recorded in the simple reaction time test, where the differences between the right-handed and left-handed executions were the lowest, reflecting the best level of symmetrization of the motor executions.

Geriatric patient in the practice of emergency medical teams - observation in 2020-2022.

Analysis of interventions of medical rescue teams for geriatric patients in a three-year period, taking into account the causes, circumstances, medical management, pharmacology. The study included a 3-year retrospective analysis of the trips of medical rescue teams in the northern part of the Lubelskie Voivodeship in the period from January 1, 2020 to December 31, 2022. The data comes from medical documentation. Interventions caused by a health risk in a patient in the 90+ age group were qualified as events. 897 EMT interventions were qualified (2020-327, 2021-269, 2022-301) constituting 4.29% of all interventions carried out in the operational area. In addition, a quantitative analysis of a comparative group of patients aged 80-89 was performed. It was shown that the time of rescue activities was the longest for injuries and the shortest for mental disorders (60 ± 31 vs. 43 ± 21 min). It was shown that specialist EMT teams (S) were statistically significantly more often called for cardiology disorders (63%). It was shown that pharmacological agents were used statistically significantly more often in respiratory disorders (83%) compared to neurology disorders (47%, p < 0.001). It was also shown that patients whose call was caused by neurology disorders were statistically more often transported to the emergency department (N = 76, 76%, p < 0.001). The causes of calls regarding disorders of the circulatory and respiratory systems most often require the implementation of pharmacology during EMT interventions, mainly short-term and symptomatic drugs. Interventions to rural areas dominate in the presented analysis in each year of the analysis and in each group of reasons for calls, which may be associated with more difficult access to a primary care physician. Most EMT interventions concern exacerbation of chronic diseases. Transport to the hospital was necessary mainly due to neurological and traumatic calls.

Injuries in male youth football: a one season prospective cohort study of 223 Danish elite players.

This study prospectively investigated injury prevalence, incidence, and burden in male elite under-17 football players (N = 223) during a full season. The players weekly completed a standardized web-based injury survey (OSTRC-H2) and a physical exposure report throughout the study. Average weekly response rate was 89.5%. Football exposure accounted for 52.4% of total physical exposure. On average (±SD), the players participated in individual football, strength, and rehabilitation practices for 1.2 ± 1.5, 3.0 ± .2.1, and 1.9 ± 3.4 h/week, respectively. In total, 742 health problems were reported. Mean weekly prevalence of health problems, injuries and illnesses were 20.1%, 16.5% and 3.8%, respectively. The injury incidence per 1,000 h of football exposure, match play and team practice were 8.28 (95% CI: 7.54-9.08), 16.77 (95% CI: 13.65-20.4), and 7.24 (95% CI: 6.5-8.04), respectively. Sudden-onset and gradual-onset injuries accounted for 36.7% and 43.4% of the total proportion of health problems. Hip/groin injuries had the highest incidence (1.58/1,000 h), whereas knee injuries had the highest burden (20.86 days lost/1,000 h). On average, the players experienced 3.33 health problems (average duration: 7.8 days). On average pr. player, 2.7 (95% CI: 2.2-3.3) wks of football exposure were lost. Sudden and gradual-onset injuries influenced player availability during the season. Health problem prevalence fluctuated markedly, and injury incidence was higher during match play than training. The players had substantial volumes of training beyond football-specific training and matches. Our findings could assist medical and sports science practitioneers in enhancing training and recovery processes to maximize player availability.

Where the joy comes from: a qualitative exploration of deep GP-patient relationships

BackgroundRelationship-based, whole person care is foundational to quality general practice. Previous research has identified several characteristics of deep General Practitioner (GP)-patient relationships and their association with improved patient concordance, satisfaction and perceived health outcomes. Psychological attachment theory has been used to understand therapeutic relationships, but has only been explored to a limited extent in the general practice context. Additionally, evolving changes in sociocultural and commercial practice contexts may threaten relationship-based care. In view of this, we aimed to explore the nature and experience of deep GP-patient relationships, as identified by patients, from GP and patient perspectives.MethodsSemi-structured interview design. An initial survey assessed patients’ perceived depth of their relationship with their GP, using the Health Care Provider Attachment Figure Survey and Patient-Doctor Depth of Relationship Scale. Patients who reported a deep relationship, and their GPs, were purposively selected for individual interviews exploring their experience of these relationships. A post-interview survey assessed interviewees’ attachment styles, using the Modified and Brief Experiences in Close Relationships Scale. Patient interviewees also rated the patient-centredness of their GP’s clinic using the Person-Centred Primary Care Measure. Transcripts were analysed using thematic analysis.ResultsThirteen patients and five GPs were interviewed. Four themes characterised deep relationships: the ‘professional’; human connection; trust; and ‘above and beyond’. Patient, GP and practice team all contributed to their cultivation.ConclusionsWe present a revised conceptual framework of deep GP-patient relationships. Deep relationships come to the fore in times of patient trouble. Like attachment relationships, they provide a sense of safety, caring and support for patients experiencing vulnerability. They can stretch GP boundaries and capacity for self-care, but also provide joy and vocational satisfaction. Patients may not always desire or need deep relationships with their GP. However, findings highlight the importance of enabling and cultivating these for times of patient hardship, and challenges of doing so within current healthcare climates.

Unlocking the learning potential of simulation-based education.

Simulation is ubiquitous in the training of hospital-based doctors worldwide, often focusing on an individual level in traditional 'skills and drills'-based training. However, there has been an expansion in the use of simulation in healthcare practice and training. Simulation is being adopted into many disciplines that traditionally have not used this form of experiential learning. Moreover, simulation is increasingly being harnessed to enhance team and organisational learning in hospital-based practice. This article shares some insights into simulation-based education and makes the 'familiar unfamiliar' about this important method of learning. The aim is to broaden readers' outlook about what simulation has to offer beyond the classic notion of skills and drills-based training.

P178: Scope of post-diagnostic dementia care by Japanese primary care clinics using team-based care models

Objective:Primary care clinics (PCCs) in Japan have acquired the capacity for screening and diagnosing dementia in its early stage. They face challenges in accommodating the complex care needs of people with early-stage dementia in collaboration with other healthcare providers in the community. The study aims were; 1) to classify team-based care models of PCCs for post-diagnostic care for people with early-stage dementia in Japan’s Community-based Integrative Care System and 2) to compare the scope of care in each model.Methods:We conducted a cross-sectional postal survey to certified Dementia Support Doctors working in PCCs in Tokyo. To classify team-based care models, the questionnaire asked about the members, roles, and collaboration of the community-wide care team for early-stage dementia in which participants’ PCCs were involved. We gathered information on care provision across seven domains that PCCs offered for people with early-stage dementia. Three-step latent class analysis was performed to classify models and analyze differences in the proportions of care provision in each domain. The Tokyo Metropolitan Institute for Geriatrics and Gerontology institutional review board approved the study.Results:From the 188 responses, PCCs’ team practices were categorized into three classes, which we named “co-managed,” carved-out,” and “stand-alone” models. While the first two ran an extended care team through in-person communication across facilities in the community, the last applied a minimal team approach with limited and indirect external interaction. The “co-managed” and “carved-out” models were distinguished by how team members shared decision-making responsibilities for patient care. Maximum likelihood estimation grouped 46.6%, 32.8%, and 20.6% of the PCCs into each model in the above order. The three models significantly differed in the proportions of care provision in five of seven domains. The proportions in each domain were the highest for the “co-managed” model (60.7-100%), followed by the “carved-out” (46.2- 98.2%) and “stand-alone” (25.7-88.6%) models.Conclusion:PCCs in Japan’s Community-based Integrative Care System formed three models of post- diagnostic support for people with early-stage dementia. Considering the application of the team approach and the breadth of care provision, either “co-managed” or “carved-out” models are recommended with available community resources in mind.

Knowledge, Attitude and Practice of the Community General Practice Teams on Dysphagia Complicated with Aspiration Pneumonia after Stroke

This cross-sectional study investigated the knowledge, attitude and practice (KAP) of community general practice (GP) team members on dysphagia complicated with aspiration pneumonia after stroke in Shanghai between October 2022 and November 2022 using a self-administered questionnaire. A total of 551 questionnaires were collected (mean age: 37.59 ± 8.86 years, 443 (80.40%) females), including 383 (69.51%) physicians. The mean KAP scores were 6.30 ± 1.54 (possible range: 0–12), 40.32 ± 5.11 (possible range: 9–45), and 72.54 ± 13.99 (possible range: 18–90), respectively. Multivariable linear regression analyses suggested that attitude (Coef = 1.29, 95%CI: 1.09–1.50), and holding research funding (Coef = −2.70, 95%CI: −5.00–−0.50) were significantly associated with practice toward dysphagia complicated with aspiration pneumonia after stroke of community GP team members. The structural equation model (SEM) indicated that knowledge had a direct influence on attitude (β = 2.029, p &lt; 0.001) and attitude had a direct impact on practice (β = 0.710, p &lt; 0.001). Additionally, knowledge exerted both direct (β = 0.935, p = 0.016) and indirect effects (β = 1.442, p &lt; 0.001) on practice. In conclusion, this study showed that the community GP team members had poor knowledge, favorable attitudes, and proactive practices. Education and training on the management of dysphagia complicated with aspiration pneumonia after stroke are urgently needed.

A service evaluation and stakeholder perspectives of the ‘Pharmacy Support and Development’ Service across a GP Federation

Abstract Introduction Since 2019 in England, introduction of the Additional Roles Reimbursement Scheme (ARRS), which includes pharmacists and pharmacy technicians1, has led to staggering growth in General Practice (GP) pharmacy workforce. According to workforce data, in 2017 there were 584 pharmacists and 0 pharmacy technicians in GP, and in 2021 numbers soared to 4684 and 989, respectively2. In 2022, The King’s Fund explored issues affecting implementation and integration of ARRS roles in GP and found that roles are inadequately supported and not implemented effectively3. They concluded that critical to the effective integration of ARRS roles within GP is support involving clinical supervision and peer support3. In South &amp; East Leeds (SEL) GP Group (a GP Federation), provision of the Pharmacy Support and Development service, consisting of a Head of Clinical Pharmacy and Advanced Education &amp; Training Pharmacist, has been in place since 2019. It aims to facilitate training and provide peer support and clinical supervision for pharmacy professionals employed across the seven Primary Care Networks (PCN), and member practices within SEL GP Group. Aim To evaluate the Pharmacy Support and Development service at SEL GP Group by assessing effectiveness of current provision through exploration of stakeholder perspectives and identifying levels of satisfaction. Methods Two digital surveys were created and sent via email to all SEL GP members (PCN managers and Clinical Directors, n=13) and all SEL GP pharmacy staff (PCN Pharmacy technicians and Pharmacists, n=37). Questions focussed on obtaining perspectives from stakeholders on current provision and seeking suggestions for improvement. Data was collected between January-February 2023. All surveys were anonymous, and participants aware of this before completing the survey. No ethical approval was required for this service evaluation involving only SEL GP employees, and this was agreed within the organisation. Results There were 8 responses (62%) from SEL GP members and 26 (70%) from SEL GP PCN pharmacy staff. For members: 88% felt the service supported retention of pharmacy ARRS staff, 63% felt the service positively influenced their decision to recruit pharmacy ARRS staff, and 88% ‘Agree’ or ‘Strongly Agree’ that offering this service is attractive to prospective employees. Overall, 88% described the service as ‘Outstanding’ or ‘Excellent’. For pharmacy staff: 96% felt the service helped them integrate as new starters, 100% agreed the service supported understanding of their role, 88% ‘Agree’ or ‘Strongly Agree’ that having this service aids recruitment of pharmacy ARRS roles, and 96% felt they receive appropriate support and supervision. Overall, 85% felt ‘Very Satisfied’ with the service. Discussion/Conclusion The findings suggest that the Pharmacy Support and Development service at SEL GP Group is favourably perceived by stakeholders and thus far, has had a positive impact on integration and continued recruitment of pharmacy ARRS staff. Questionnaires were not returned by 38% of SEL GP members and 30% of SEL GP PCN pharmacy staff, and this is a potential limitation. However, since the findings indicate that the Pharmacy Support and Development service has been instrumental to staff retention and integration into practice teams, our next steps are to consider adopting this model for non-pharmacy ARRS staff within SEL GP Group.

The barriers to interprofessional care for cancer cachexia among Japanese healthcare providers: A nationwide survey.

Cancer cachexia is a severe complication of advanced malignancy, with few therapeutic options. To promote interprofessional care for cancer cachexia, healthcare providers' needs should be addressed in detail. This pre-planned subgroup analysis of the Global Educational Needs Evaluation: a systemic interprofessional study in cancer cachexia (GENESIS-CC) survey aimed to identify barriers to interprofessional care of cancer cachexia in Japan. A nationwide survey was electronically conducted for healthcare providers in oncological or general healthcare facilities from January to March 2021 in Japan. The Japanese Regional Advisory Board developed a barrier scoring system with 33 from the 58 original survey items to quantify six domains of barriers: (1) lack of confidence, (2) lack of knowledge, (3) barriers in personal practice, (4) barriers in perception, (5) barriers in team practice and (6) barriers in education. The largest possible barrier score was set at 100 points. We compared the scores by profession. A total of 1227 valid responses were obtained from 302 (24.6%) physicians, 252 (20.5%) pharmacists, 236 (19.2%) nurses, 218 (17.8%) dietitians, 193 (15.7%) rehabilitation therapists and 26 (2.0%) other professionals. Overall, 460 (37.5%) were not very or at all confident about cancer cachexia care, 791 (84.1%) agreed or strongly agreed that care was influenced by reimbursement availability and 774 (81.9%) did not have cancer cachexia as a mandatory curriculum. The largest mean barrier score (±standard deviation) was 63.7±31.3 for education, followed by 55.6±21.8 for team practice, 43.7±32.5 for knowledge, 42.8±17.7 for perception and 36.5±16.7 for personal practice. There were statistically significant interprofessional differences in all domains (P<0.05), especially for pharmacists and nurses with the highest or second highest scores in most domains. There is a need to improve the educational system and team practices of cancer cachexia for most Japanese healthcare providers, especially pharmacists and nurses. Our study suggests the need to reform the mandatory educational curriculum and reimbursement system on cancer cachexia to promote interprofessional care for cancer cachexia in Japan.

Deliberating with purpose: Deliberative civic engagement for health policy

AbstractThis article seeks to understand why deliberative civic engagement is chosen as a method of engagement by policymakers, using two jurisdictions as exploratory cases: the Nova Scotia Health Authority's Community Conversations about Collaborative Family Practice Teams and Algoma Ontario Health Team's Citizen Reference Panel on Integrated Care. The purpose is to interrogate a presumption that deliberative civic engagement is choice driven by an alignment between the goals of engagement and theories of deliberation. I find that in both instances, policymakers chose deliberative civic engagement largely because of situational factors, rather than through the theoretical claims of different methods of engagement and the goals of the engagement activity. I argue that for practitioners seeking to embed deliberative processes, greater consideration should be given to the contextual factors that enable or inhibit the commissioning of such activities.

The Longitudinal Implementation Strategy Tracking System (LISTS): feasibility, usability, and pilot testing of a novel method

BackgroundSystematic approaches are needed to accurately characterize the dynamic use of implementation strategies and how they change over time. We describe the development and preliminary evaluation of the Longitudinal Implementation Strategy Tracking System (LISTS), a novel methodology to document and characterize implementation strategies use over time.MethodsThe development and initial evaluation of the LISTS method was conducted within the Improving the Management of SymPtoms during And following Cancer Treatment (IMPACT) Research Consortium (supported by funding provided through the NCI Cancer MoonshotSM). The IMPACT Consortium includes a coordinating center and three hybrid effectiveness-implementation studies testing routine symptom surveillance and integration of symptom management interventions in ambulatory oncology care settings. LISTS was created to increase the precision and reliability of dynamic changes in implementation strategy use over time. It includes three components: (1) a strategy assessment, (2) a data capture platform, and (3) a User’s Guide. An iterative process between implementation researchers and practitioners was used to develop, pilot test, and refine the LISTS method prior to evaluating its use in three stepped-wedge trials within the IMPACT Consortium. The LISTS method was used with research and practice teams for approximately 12 months and subsequently we evaluated its feasibility, acceptability, and usability using established instruments and novel questions developed specifically for this study.ResultsInitial evaluation of LISTS indicates that it is a feasible and acceptable method, with content validity, for characterizing and tracking the use of implementation strategies over time. Users of LISTS highlighted several opportunities for improving the method for use in future and more diverse implementation studies.ConclusionsThe LISTS method was developed collaboratively between researchers and practitioners to fill a research gap in systematically tracking implementation strategy use and modifications in research studies and other implementation efforts. Preliminary feedback from LISTS users indicate it is feasible and usable. Potential future developments include additional features, fewer data elements, and interoperability with alternative data entry platforms. LISTS offers a systematic method that encourages the use of common data elements to support data analysis across sites and synthesis across studies. Future research is needed to further adapt, refine, and evaluate the LISTS method in studies with employ diverse study designs and address varying delivery settings, health conditions, and intervention types.

A Qualitative Study of the Work Systems and Culture Around End-of-Day Intraoperative Anesthesia Handoffs in a Tertiary Care Center.

Intraoperative handoffs have been implicated as a contributing factor in many perioperative adverse events. Despite conflicting data around their impact on perioperative outcomes, they remain a vulnerable point in the perioperative system with significant attention focused on improving them. This study aimed to understand the processes in place surrounding the point of information transfer in intraoperative handoffs. We used semistructured interviews with anesthesia clinicians to understand the processes and systems surrounding intraoperative handoffs. Interview data were coded deductively using the Systems Engineering Initiative for Patient Safety model as a framework, with subthemes developed inductively. Clinicians do a significant amount of work before and after the point of information transfer to ensure a smooth handoff and safe patient care. Despite not having standardization of handoffs, most clinicians have a typical handoff organization and largely agree on content that should be included. However, there is variability based on clinician and patient characteristics, including clinician discipline and patient acuity. These handoffs are additionally impacted by the overall culture in the operating room, including the teamwork and hierarchies present among the surgical and anesthesia teams. Finally, the broader operating room logistics, including scheduling practices for surgical cases and anesthesia teams, impact the quality of intraoperative handoffs and the ability of clinicians to prepare for these handoffs. Handoffs involve processes beyond the point of information transfer and are embedded in the systems and culture of the operating rooms. These considerations are important when seeking to improve the quality of intraoperative handoffs.

Distributed leadership in health quality improvement collaboratives.

Distributed leadership has been suggested for describing patterns of influence in collaborative settings where public services are performed across professions and organizations. This study explores how leadership in health quality improvement collaboratives (QICs) is characterized by aligned distributed leadership practices, and how these practices relate with experienced progress and achievements in the quality improvement (QI) work. The analysis relied on a qualitative, multicase study of two nationwide Danish QICs. Data consisted of 12 single-person and 21 group interviews with local QI teams and local and regional QIC coordinators (85 informants in total), participant observations of 34 meetings within the QICs, and a collection of documentary material. The collected data were analyzed thematically with NVivo. Leadership practices in local QI teams are characterized by aligned distributed leadership, with leadership activities being widely distributed based on negotiated, emergent practices regarding the aims, roles, and scope of the QI work. However, local quality coordinators play a pivotal role in driving the QI activities, and hierarchical support from hospital/municipal management is a precondition for the contribution of aligned distributed leadership to experienced progress and QIs. Emergent distributed leadership should be balanced by thorough consolidation of the practices to provide the best circumstances for robust QI. The active participation of formal managers and local coordinators plays a pivotal role in this consolidation and is decisive for the increased potential for long-term success and sustainability of the QI work, particularly within complex QICs.

Novel machine learning model to improve performance of an early warning system in hospitalized patients: a retrospective multisite cross-validation study

Threshold-based early warning systems (EWS) are used to predict adverse events (Aes). Machine learning (ML) algorithms that incorporate all EWS scores prior to an event may perform better in hospitalized patients. The deterioration index (DI) is a proprietary EWS. A threshold of DI >60 is used to predict a composite AE: all-cause mortality, cardiac arrest, transfer to intensive care, and evaluation by the rapid response team in practice. The DI scores were collected for adult patients (≥18 y-o) hospitalized on medical or surgical services during 8-23-2021 to 3-31-2022 from four different Mayo Clinic sites in the United States. A novel ML model was developed and trained on a retrospective cohort of hospital encounters. DI scores were represented in a high-dimensional space using random convolution kernels to facilitate training of a classifier and the area under the receiver operator characteristics curve (AUC) was calculated. Multiple time intervals prior to an AE were analyzed. A leave-one-out cross-validation protocol was used to evaluate performance across separate clinic sites. Three different classifiers were trained on 59,617 encounter-derived DI scores in high-dimensional feature space and the AUCs were compared to two threshold models. All three tested classifiers improved the AUC over the threshold approaches from 0.56 and 0.57 to 0.76, 0.85 and 0.94. Time interval analysis of the top performing classifier showed best accuracy in the hour before an event occurred (AUC 0.91), but prediction held up even in the 12h before an AE (AUC 0.80at minus 12h, 0.81at minus 9h, 0.85at minus 6h, and 0.88at minus 3h before an AE). Multisite cross-validation using leave-one-out approach on data from four different clinical sites showed broad generalization performance of the top performing ML model with AUC of 0.91, 0.91, 0.95, and 0.91. A novel ML model that incorporates all the longitudinal DI scores prior to an AE in a hospitalized patient performs better at outcome prediction than the currently used threshold model. The use of clinical data, a generalized ML technique, and successful multisite cross-validation demonstrate the feasibility of our model in clinical implementation. No funding to report.