Program Redesign Research Articles

Reinforcing Cardiology Training During a Pandemic: An Open Letter to Our Leaders.

Reinforcing Cardiology Training During a Pandemic: An Open Letter to Our Leaders.

Factors influencing access of HIV and sexual and reproductive health services among adolescent key populations in Kenya

ObjectivesThe objective of this study is to identify enablers and barriers in access of HIV and sexual reproductive health (SRH) services among adolescent key populations (KP) in Kenya.MethodsA cross-sectional study using qualitative methods was conducted between October 2015 and April 2016. A total of 9 focus group discussions and 18 in-depth interviews were conducted with 108 adolescent KPs in Mombasa, Kisumu and Nairobi Counties of Kenya. Data were recorded digitally, translated, transcribed and coded in NVivo10 prior to analysis.ResultsAdolescent KPs preferred to access services in private health due to increased confidentiality, limited stigma and discrimination, access to adequate amount of condoms, friendly and fast-tracked services. Negative health provider attitudes made adolescent KPs dislike accessing health care in public health facilities. There was a lack of adolescent key population’s policies and guidelines on HIV and SRH.ConclusionsThe study has demonstrated existing enablers and barriers to provision of HIV/SRH services for an at-risk population for which limited data exist. The results provide a basis for program redesign involving the adolescent KPs to minimize barriers for access to HIV/SRH services.

Approaching EdD Program Redesign as a Problem of Practice

As members of the Carnegie Project on the Education Doctorate (CPED), universities across the United States are restructuring EdD programs to better prepare professional practitioners with the practical skills and theoretical knowledge needed to improve the educational environments that they serve. The hallmark of these programs is often the dissertation in practice, a scholarly investigation within which students define a problem of practice and then systematically test solutions to that problem. In this study, we investigate the experiences of university faculty participating in the redesign of an Educational Leadership EdD program who approach the redesign as a problem of practice. Root causes of identified program issues are presented in addition to the changes implemented in the redesigned program to improve upon the problem of practice.

A Qualitative Case Study of All-but-Dissertation Students at Risk for Dissertation Noncompletion: A New Model for Supporting Candidates to Doctoral Completion

This study identified emergent themes from the interview data of at-risk-for-completion doctoral candidates ( N = 13; 59%), from a diverse demographic, who participated in a successful dissertation completion intervention program. The findings revealed four major themes including extrinsic factors, socioemotional, formal structures of the program, and personal development. The findings highlight the need for conscious processes used by vital leaders to develop program design in four key areas of leadership within a framework of open vital systems. Vital leadership acts as proxy agents to influence development of formal structures in the university leading to equity in educational opportunity for all students. Conclusions and parsimonious explicit implications are provided for doctoral program redesign focused on improving graduate student retention and completion rates for diverse student populations.

Increasing health service access by expanding disease coverage and adding patient navigation: challenges for patient satisfaction

BackgroundCancer control programs have added patient navigation to improve effectiveness in underserved populations, but research has yielded mixed results about their impact on patient satisfaction. This study focuses on three related research questions in a U.S. state cancer screening program before and after a redesign that added patient navigators and services for chronic illness: Did patient diversity increase; Did satisfaction levels improve; Did socioeconomic characteristics or perceived barriers explain improved satisfaction.MethodsRepresentative statewide patient samples were surveyed by phone both before and after the program design. Measures included satisfaction with overall health care and specific services, as well as experience of eleven barriers to accessing health care and self-reported health and sociodemographic characteristics. Multiple regression analysis is used to identify independent effects.ResultsAfter the program redesign, the percentage of Hispanic and African American patients increased by more than 200% and satisfaction with overall health care quality rose significantly, but satisfaction with the program and with primary program staff declined. Sociodemographic characteristics explained the apparent program effects on overall satisfaction, but perceived barriers did not. Further analysis indicates that patients being seen for cancer risk were more satisfied if they had a patient navigator.ConclusionsHealth care access can be improved and patient diversity increased in public health programs by adding patient navigators and delivering more holistic care. Effects on patient satisfaction vary with patient health needs, with those being seen for chronic illness likely to be less satisfied with their health care than those being seen for cancer risk. It is important to use appropriate comparison groups when evaluating the effect of program changes on patient satisfaction and to consider establishing appropriate satisfaction benchmarks for patients being seen for chronic illness.

Understanding Learners' Experiences of Simulated Person Methodology in an Athletic Therapy Program.

IntroductionKey skills required of today’s students include critical thinking, problem-solving, creativity, innovation, collaboration, and communication. The acquisition of these skills is foundational to success in a variety of professions and contexts. This study complements a larger simulated person methodology (SPM) project that utilizes simulators (individuals who are trained to realistically reproduce scenarios by providing specific information, displaying signs and behaviours, and creating a realistic encounter in a consistent manner) to replicate real workplace issues, thus affording students an opportunity to apply knowledge and practice real-life skills necessary to the workplace. The primary objective of this study is to apply this innovative teaching approach in higher education as a means of developing proficient critical-thinking and interpersonal skills.MethodsThis pilot study uses an exploratory mixed-methods design to explore the experiences of 12 students enrolled in an athletic therapy (AT) certificate program that uses SPM. Our hypothesis is that SPM will have a positive impact on student learning and professional development.ResultsThe students responded favourably to the use of SPM. Indeed, 80% “felt challenged and stimulated” and deemed SPM to be a “more effective method” of practicing communication skills than practicing with fellow students. These findings can inform future research and support work towards enhancing this methodology as a pedagogical approach. In tandem, this study and the larger SPM project are poised to provide an effective undergraduate education experience across various faculties at the pilot university. More work is required to align this teaching approach with the AT education program redesign.

Drivers of decoupling and recoupling of crop and livestock systems at farm and territorial scales

Garrett, R. D., J. Ryschawy, L. W. Bell, O. Cortner, J. Ferreira, A. V. N. Garik, J. D. B. Gil, L. Klerkx, M. Moraine, C. A. Peterson, J. C. dos Reis, and J. F. Valentim. 2020. Drivers of decoupling and recoupling of crop and livestock systems at farm and territorial scales. Ecology and Society 25(1):24. https://doi.org/10.5751/ES-11412-250124

라이프스타일 재설계 프로그램이 뇌졸중 노인의 시간 사용과 삶의 질에 미치는 효과

라이프스타일 재설계 프로그램이 뇌졸중 노인의 시간 사용과 삶의 질에 미치는 효과

Economics of Farm Input Subsidies in Africa

Fertilizer and other input subsidies have been prominent components of agricultural policies in many Asian and African countries since the 1960s. Their economic and political rationale is scrutinized with emphasis on the second generation of targeted input subsidy programs that were scaled up in Sub-Saharan Africa after 2005. The extent to which they fulfill the goal of being market smart is assessed after inspecting the potential for such subsidies in Sub-Saharan Africa. The new fertilizer subsidy programs do not live up to the market-smart principles and suffer from severe design and implementation failures. While a clear exit strategy was one of the key principles, this has been neglected, with the result that most current programs are more sticky than smart. They have only partially achieved the intended impacts and have resulted in a number of unintended negative impacts. Subsidy program redesign should start from a pilot stage testing basic mechanisms.

Exploring the Structure and Benefits of an Integrated Yearlong Dual Certification Student Teaching Internship

Many teacher preparation programs offering dual certification have engaged in program redesign to establish greater integration between general education and special education. This article presents findings from an exploratory case study that examined the perspectives of former preservice teacher candidates and school personnel regarding an integrated yearlong dual certification internship. Findings indicated research participants (a) placed value on the breadth and authenticity of the experience; (b) built deep relationships with students and staff that contributed to building confidence; and (c) felt the structure and impact of the model yielded positive outcomes for both the school and for preservice teacher candidates. Implications for practice include suggestions for how teacher preparation programs might move toward integrated models of dual certification teacher preparation and explore the importance of clinically rich partnerships that benefit both preservice teacher candidates and field sites.

Staff and Clinician Work-Life Perceptions after Implementing Systems-Based Improvements to Opioid Management.

The Six Building Blocks Program is an evidence-based approach to primary care redesign for opioid management among patients with chronic pain. This analysis assesses the impact of implementing the Six Building Blocks on the work-life of primary care providers and staff. Six rural and rural-serving primary care organizations with 20 clinic locations implemented the Six Building Blocks with support from a practice facilitator, clinical experts, and an informatics specialist. After 15 months of support, interviews and focus groups were conducted with staff and clinicians in each organization to stimulate reflection on the process and outcomes of implementing the Six Building Blocks Program. Transcripts of interviews and focus groups were coded and analyzed using template analysis. Once a set of themes was agreed on, the primary qualitative analyst revisited the source data to confirm that they accurately reflected the data. Overall, implementing the Six Building Blocks improved provider and staff work-life experience. Reported improvements to work-life included increased confidence and comfort in care provided to patients with long-term opioid therapy, increased collaboration among clinicians and staff, improved ability to respond to external administrative requests, improved relationships with patients using long-term opioid therapy, and an overall decrease in stress. Clinicians and staff reported improvement in their work-life after implementing the Six Building Blocks Program to improve opioid medication management. Further research is needed on patient experiences specific to practice redesign programs.

Of Maslow, motives, and managers: The hierarchy of needs in American business, 1960-1985.

This paper examines the impact of psychologist Abraham Maslow's hierarchy of needs in American management. I trace how a roster of management experts translated the hierarchy of needs into management through case studies of job redesign programs at Texas Instruments and marketing firm Young & Rubicam's management training. The hierarchy of needs resonated with management, I argue, because it seemed to offer both a concrete guide for management, with practical implications for designing management training and work structures, alongside a broader social theory that purported to explain changing social values and economic circumstances in America. For the management theorists who invoked the hierarchy of needs, the corporation served as both the prime site for people to fulfill their higher psychological needs and the ideal site to study and cultivate motivation. This article contributes to histories of psychology that show how psychology became a prominent resource in American public life.

Percutaneous cardiological intervention and cardiac surgery: patient-centered care. Position statement of the Spanish Society of Cardiology.

The percutaneous treatment of coronary artery disease and some structural cardiovascular diseases has undergone spectacular changes. More and more patients with different types of heart disease are being treated by percutaneous or transcatheter interventions, with no such increase in patients undergoing cardiac surgery. This situation has led to different types of approach, requiring an objective analysis that includes all the factors possibly influencing these changes. This document assesses the 2 scenarios where this problem is most evident: coronary revascularization and the treatment of aortic stenosis. The document analyzes the situation of coronary revascularization in Spain, and the causes that may explain the differences between the number of patients who currently undergo percutaneous revascularization and those who undergo coronary surgery. In contrast, treatment of aortic stenosis through transcatheter aortic valve implantation will lead to a foreseeable reduction in the number of candidates for surgical replacement. Several international scientific societies have published the requirements on training and experience and the necessary operator and center volumes to implement a transcatheter aortic valve implantation program, conditions that the Spanish Society of Cardiology, adopting a patient-centered approach, considers absolutely essential. Given that the 2 forms of intervention (percutaneous and surgical) are complementary, multidisciplinary patient assessment (Heart Team) remains crucial to offer the best treatment option. In this scenario of diverse approaches, a key figure is the clinical cardiologist. Finally, the changes currently occurring in the treatment of structural heart disease will, in future, lead to the performance of procedures requiring the participation of professionals from both specialties. This approach will require a redesign of current training programs.

Intervencionismo percutáneo cardiológico y cirugía cardiaca: el paciente en el centro de los procesos. Documento de posicionamiento de la Sociedad Española de Cardiología

The percutaneous treatment of coronary artery disease and some structural cardiovascular diseases has undergone spectacular changes. More and more patients with different types of heart disease are being treated by percutaneous or transcatheter interventions, with no such increase in patients undergoing cardiac surgery. This situation has led to different types of approach, requiring an objective analysis that includes all the factors possibly influencing these changes. This document assesses the 2 scenarios where this problem is most evident: coronary revascularization and the treatment of aortic stenosis. The document analyzes the situation of coronary revascularization in Spain, and the causes that may explain the differences between the number of patients who currently undergo percutaneous revascularization and those who undergo coronary surgery. In contrast, treatment of aortic stenosis through transcatheter aortic valve implantation will lead to a foreseeable reduction in the number of candidates for surgical replacement. Several international scientific societies have published the requirements on training and experience and the necessary operator and center volumes to implement a transcatheter aortic valve implantation program, conditions that the Spanish Society of Cardiology, adopting a patient-centered approach, considers absolutely essential. Given that the 2 forms of intervention (percutaneous and surgical) are complementary, multidisciplinary patient assessment (Heart Team) remains crucial to offer the best treatment option. In this scenario of diverse approaches, a key figure is the clinical cardiologist. Finally, the changes currently occurring in the treatment of structural heart disease will, in future, lead to the performance of procedures requiring the participation of professionals from both specialties. This approach will require a redesign of current training programs.

Lean business models in healthcare: a systematic review

This paper includes the systematic literature review on lean business models used in the healthcare industry to aid in reducing waste, costs, and improving overall patient care and satisfaction. A systematic literature review was conducted to analyze lean business models used in the healthcare industry regarding lean thinking in healthcare, object technology, Six Sigma and quality models, organisational culture and lean implementation, healthcare delivery method study, clinical services redesign program, process improvement cost model, vendor managed inventory, supply chain innovation, strategic customer service orientation, and the model of care in the healthcare industry. The systematic review of the literature on lean business models suggests that the models such as several process improvement cost models, lean thinking models, managerial process improvement, and models of care can be used in the healthcare industry to reduce waste and costs and improve patient satisfaction. Sustaining competitive advantage for accountable care organisations was also found to help in accomplishing the value demands required by customers and competitors. This paper can be used as a guide for implementing lean business models and lean practices and the review can be used to help organisations see the benefits in using lean practices in the healthcare industry.

Digital Management of Solar Energy En Route to Energy Self-Sufficiency.

The Internet of Things approach to manage clean electricity produced from sun, wind, and water is, alongside the hydrogen fuel cell and the Li‐ion battery, the key enabling technology for the transition to 100% renewable energy. Practical examples from distant countries are used to show how today's digital control technology is actually used to ease the generation and utilization of clean, reliable, and cheap solar energy on an annual basis. The conclusions are of relevance also to the redesign of energy education programs in response to dramatic changes in energy technologies.

Teaching Ethics in Medical Schools: A Systematic Review from 2000 to 2018

Background: Ethics education in medical schools enhances ethical reasoning skills and prepares medical students for ethical dilemmas in clinical practice. However, variations in teaching ethics and mounting reports of unethical behaviour amongst medical students have raised questions as to the efficacy and benefit of ethics education in medical schools. A systematic review is undertaken to study the prevailing methods of teaching ethics in undergraduate and postgraduate medical schools to better understand teaching methods and to guide the design and redesign of ethics programs. Methods: Braun and Clarke’s (2006) methodological framework for conducting systematic reviews and PRISMA guidelines were employed in this study. PubMed, ERIC, Embase, and PsycINFO databases were searched for articles published between January 1st, 2000 and December 31st, 2018 on teaching medical ethics in medical schools. Also scrutinised were the ethics curricula of the top 20 medical schools on the 2019 Times Higher Education World University Rankings. Results: 5368 abstracts were identified, 559 full text articles were retrieved, 97 articles were included and thematically analysed in tandem with the curricula from top 20 medical schools. The two themes identified were the structure and approach of prevailing ethics programs. Conclusion: An effective medical ethics curriculum must include ‘core’ and ‘speciality’ topics that must be accompanied by clearly defined learning objectives. A spiralled case-based interactive ethics curriculum must be integrated within the medical curriculum and supported and overseen by the school. The teaching techniques and contents must be regularly reviewed, and tutors must be longitudinally supported and trained to support students as they develop ethical sensitivity and the ability to employ their learning in a clinical context. Keywords: TEACHING; ETHICS; MEDICAL SCHOOL

Restorative occupational therapy for adolescents with chronic kidney disease

Occupational therapy is demonstrated to improve quality of life and enable rehabilitation of patients with various chronic diseases. However, their role in managing children with chronic kidney disease (CKD) remains unclear. Twelve adolescents with CKD managed at a single center in Hong Kong participated in a 4-weeks occupational lifestyle redesign program (OLSRP) comprising 8 sessions of self-initiated individualized activity plans, led by two occupational therapists. Two surveys, the self-management inventory and Chinese version of General Self-efficacy Scale, administered at initiation and end of OLSRP, were used to examine its impact on competence, confidence and self-efficacy scores. Following OLSRP, 91.7% and 75% of 12 adolescents showed significant improvements in composite scores of both scales, with significant increments in self-management concerning disease, social and collaborative skills, diet, proper schedule, medication intake and acceptance of their disease, and problem solving and confidence.

Designing Online Curriculum: Program Revisions and Knowledge Exchange

In this article, I focus on the importance of knowledge exchange and knowledge communities to create an online curriculum that moves from individual course design to shared curriculum design. I draw from current discussions on communities of practice, agoras, and knowledge societies, expanding on the notion that knowledge, in order to benefit society, has to be shared. I show the results of a program redesign at Northern Arizona University achieved through collaboration on online course learning outcomes as well as course design, and I conclude by arguing for continued assessment of current practices to encourage educators to think critically about their contributions to an open knowledge society.

Leadership development in Higher Education: A literature review and implications for programme redesign

AbstractLeadership development (LD) activity and its effectiveness has not been explored rigorously across changing university settings globally. As Higher Education settings change radically throughout the world, Higher Education professionals are operating in more uncertain environments, and leaders are taking increasingly complex and diverse approaches to their leadership roles. LD activities therefore become important in supporting this highly complex context, yet little is known in the literature about LD and its impact in Higher Education. We examine peer‐reviewed work on LD in Higher Education settings globally to understand what may be learned about its content, processes, outcomes and impact. Our results suggest the current literature is small‐scale, fragmented and often theoretically weak, with many different and coexisting models, approaches and methods, and little consensus on what may be suitable and effective in the Higher Education context. We reflect on this state of play and develop a novel theoretical approach for designing LD activity in Higher Education institutions.