Staff Engagement Research Articles

Implementing nitrous oxide cracking technology in the labour ward to reduce occupational exposure and environmental emissions: a quality improvement study.

Nitrous oxide, a potent greenhouse gas, is a common labour analgesic. One method which may reduce its carbon footprint is to 'crack' the exhaled gas into nitrogen and oxygen using catalytic destruction. In this quality improvement project, based on environmental monitoring and staff feedback, we assessed the impact of nitrous oxide cracking technology in the maternity setting. Mean ambient nitrous oxide levels were recorded during the final 30 minutes of uncomplicated labour in 36 cases and plotted on a run chart. Interventions were implemented in four stages, comprising: stage 1, baseline (12 cases); stage 2, cracking with nitrous oxide delivered and scavenged via a mouthpiece (eight cases); stage 3, cracking with nitrous oxide via a facemask with an air-filled cushion (eight cases); stage 4, cracking with nitrous oxide via a low-profile facemask, and enhanced coaching on the use of the technology (eight cases). The median ambient nitrous oxide levels were 71% lower than baseline in stage 2 and 81% lower in stage 4. Staff feedback was generally positive, though some found the technology to be cumbersome; successful implementation relies on effective staff engagement. Our results indicate that cracking technology can reduce ambient nitrous oxide levels in the obstetric setting, with potential for reductions in environmental impacts and occupational exposure.

Health System Redesign of Cardiac Monitoring Oversight to Optimize Alarm Management, Safety, and Staff Engagement.

The purpose of this quality improvement project was to improve health system patient safety by creating a cardiac monitoring structure aligned with national standards. Excessive alarms pose patient safety threats and are often false or clinically insignificant. The Joint Commission identified reduction of nonactionable alarms as a National Patient Safety Goal. The conversion to structured monitoring occurred in 4 phases: 1) defining health system monitoring structure and processes; 2) co-create sessions; 3) implementation and impact analysis; and 4) ongoing evaluation and optimization. Twenty-two clinical units participated. At the conclusion of phase 4, total 30-day alarm rates decreased by 74% at the academic hospital and by 92% and 95% at the community hospitals and were sustained for 12 months. Decreasing alarm frequency can be safely achieved in academic and community hospitals by creating a system-wide monitoring infrastructure and standardized processes that engage interdisciplinary teams.

Nursing staff as a provider of safe and high-quality medical care

Safe in-hospital environment is a number one priority for any medical organization, with patients’ safety being the key indicator of satisfactory medical care provided. Nursing staff engagement into hospital safety strategy is critical in order for the strategy to function as needed with the best possible patient’s safety outcomes.

Do general practitioners working in or alongside the emergency department improve clinical outcomes or experience? A mixed-methods study

ObjectivesTo examine the effect of general practitioners (GPs) working in or alongside the emergency department (GPED) on patient outcomes and experience, and the associated impacts of implementation on the workforce.DesignMixed-methods...

A mixed-methods evaluation of the national implementation of the Hospital-Acquired Pneumonia Prevention by Engaging Nurses (HAPPEN) initiative.

To describe healthcare provider, veteran, and organizational barriers to, challenges to, and facilitators of implementation of the oral care Hospital-Acquired Pneumonia Prevention by Engaging Nurses (HAPPEN) initiative to prevent non-ventilator-associated hospital-acquired pneumonia (NV-HAP). Concurrent mixed methods. Qualitative interviews of staff and patients were conducted in addition to a larger survey of VA employees regarding implementation. Medical surgical or extended care units in 6 high-complexity (01a-c) VA hospitals. Between January 2020 and February 2021, we interviewed 7 staff and 7 veterans, and we received survey responses from 91 staff. Provide education, support, and oral care supplies to prevent NV-HAP. Barriers to HAPPEN implementation and tracking at the pilot sites included maintaining oral care supplies and completion of oral care documentation. Facilitators for HAPPEN implementation included development of supportive formal and informal nurse leaders, staff engagement, and shared beliefs in the importance of care quality and infection prevention. Nurses worked together as a team to provide consistent oral care. Oral care was viewed as an essential infection control practice (not just "a task") and was considered part of the "culture" and "mission" in caring for veterans. Nurse leaders and direct-care staff were engaged throughout HAPPEN implementation, and most reported feeling supported and well prepared as they walked through the steps. Veterans reported positive experiences and increased knowledge about prevention of pneumonia. Lessons learned included building a community of practice and sharing expertise, which led to the successful replication of the HAPPEN initiative nationwide, improving patient safety and care quality and influencing health policy.

Moving towards patient-reported outcomes in routine clinical practice: implementation lessons from the BREAST-Q.

PurposeLongitudinal, routine utilization of patient-reported outcome measures (PROMs) in clinical care has been challenging. The purpose of this study is to describe a quality improvement initiative to improve patient engagement with the BREAST-Q, a gold-standard PROM for breast reconstruction.MethodsIn 2011, we implemented the BREAST-Q as part of routine care. In 2018, we began a quality improvement initiative to increase BREAST-Q patient participation. The BREAST-Q was administered at every clinic visit via an institutional patient portal or an in-clinic tablet; digital dashboard technologies were used to improve workflow integration, real-time accountability, and immediate data availability at clinic visits. High clinical staff engagement was encouraged by assigning “BREAST-Q Champions.” BREAST-Q completion data and patient characteristics were examined to understand non-response to the assessment.ResultsFollowing quality improvement, the average annual BREAST-Q completion rate increased from 42.8% in 2011–2017 to 87.6% in 2019, the last full year of our study period. High completion rates were maintained January–July 2020; however, a significantly larger proportion of BREAST-Qs were completed at home in 2020 versus the same period in 2019 (49.7 vs. 38.8%, p < 0.001), potentially due to the COVID-19 pandemic. Compared with non-responders, responders were younger (49.7 vs. 52.2 years, p < 0.001), more likely to be white (76.9 vs. 73.6%, p < 0.001), and had private insurance (79.4 vs. 69.8%, p < 0.001).ConclusionOur quality improvement initiative successfully increased routine completion of the BREAST-Q. Similar implementation techniques may prove beneficial at other institutions interested in incorporating PROMs into routine care.

Academic Staff Engagement with Institutional Language Support: Insights into the Navigation of Linguistic Identities in Higher Education

ABSTRACT Enrolment statistics indicate that while the cultural and linguistic landscape of Australian higher education continues to be enriched by widening participation and internationalization, ongoing patterns of underrepresentation of students from traditionally excluded, equity groups persist. There is a need for sector-wide, strengths-based engagement with language as both a complex and dynamic manifestation of sociocultural identities, and a key intersectional factor that shapes participation and inclusion in higher education. This article reports on research regarding an underexplored aspect of this topic: academic staff engagement with institutional language support services. In this small-scale study, participants recounted experiences that suggest nuanced and complex factors related to identity, community, and historically entrenched, linguistically mediated power relations inform their practices. The study offers valuable insights into the complexities of language in higher education, the need for critical conversations about linguistic hierarchies in academia, and the importance of institution-wide, strengths-based engagement with multilingual/multidialectal students’ linguistic repertoires.

The Effects of Education and Sustainable Development on the Palestinian Economy and Business Student Behaviour

Researchers and policymakers have long been interested in education for sustainable development (ESD). Despite a sizable body of research, more thorough empirical investigations are needed to comprehend how sustainable development goals are applied in higher education and how (ESD) could be used to influence sustainable behaviour. The two main drivers behind this sort of study are the lack of studies examining economic and business higher education and the requirement to accurately measure the relationship between (ESD) principles and students' behaviour. In light of this justification, the current study seeks to offer an overview of how students’ perceptions of sustainable campus efforts, teaching staff engagement, and curriculum influence their sustainable behaviour. The statistical and econometric analysis performed on survey data of students from Birzeit University (BZU) (N = 1062) reveals insights into the degree to which students’ knowledge of topics relating to sustainable development is obtained via education results in sustainable behaviour. According to the findings, we contend that a greater emphasis on sustainable development subjects along with efforts by teaching staff to increase student understanding of sustainability concerns are essential to promoting sustainable behaviour in students. On-campus activities are unlikely to alter behaviour unless they are elective rather than mandated. Our findings confirm the essential need for consistency in developing higher education to sustainability challenges, as education is one of the key drivers of sustainable development.

Rules of engagement: The role of mistreatment from patients in the nurse, physician and advanced practice provider experience

The objective of this study is to examine the incidence of reported stress due to mistreatment by patients toward clinicians and the role of mistreatment from patients along with organizational factors in clinician distress. A survey of clinicians was conducted at a large academic medical center, resulting in a final analytic sample of 1,682 physicians, nurses, advanced practice providers and clinical support staff. Nurses reported the greatest incidence of mistreatment by patients as a major stressor (18.69%), followed by Advanced Practice Providers (11.26%), Clinical Support Staff (10.36%), and Physicians (7.69%). Logistic regression analysis was conducted to determine the relationship of individual- and organization-level characteristics with the odds of reporting mistreatment from patients as a major stressor. Overall findings indicate that nurses and those who work in the ER and ambulatory or outpatient clinics were more likely to be stressed from mistreatment by patients than other clinicians. Stress due to mistreatment by patients was also associated with higher Well-Being Index (WBI) distress scores, rapid changes in workflows or policies, ongoing care of COVID-19 patients, under-staffing, and low perceived organizational support. Gender or sexual minorities (not identifying as male or female) and younger (18-34 years of age) healthcare workers were also more likely to experience stress from mistreatment by patients. Individual resilience was not statistically significantly associated with reported stress from mistreatment by patients. Organizations must examine expectations for patient and visitor behavior in tandem with service standards for clinicians toward patients. Experience Framework This article is associated with the Staff & Provider Engagement lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens.

Understanding modern drivers of the employee experience in healthcare

Employee engagement has been considered the guiding metric to convey the health, loyalty, and performance of the healthcare workforce. However, the pandemic created new challenges and stimulated deeper conversations around remote work, systemic racism, inclusivity, trust, well-being, and mental illness, which calls into question whether engagement alone is enough. Using an employee experience model deployed in other industries, we identified key drivers of six employee experience (EX) outcomes. We conducted a panel study with close to 5,000 nurses and physicians to identify and prioritize current key drivers specific to the healthcare employee experience. Relative weights analyses suggest that being treated with respect, strategic alignment, work-life balance, and growth and development are key themes in driving employee experience. Subsequent analysis revealed key differences across physician and nurse experiences, especially in relation to wellbeing, burnout, and intent to stay, where nurses scored significantly lower than physicians across these outcomes. Experience Framework This article is associated with the Staff & Provider Engagement lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens.

Tranquility rooms for team member well-being: Implementation during COVID-19 pandemic

In 2020, the COVID-19 global pandemic changed the landscape of healthcare delivery and with it the need to better address team member well-being. Aside from patients and their families, healthcare professionals were among the most affected and at high risk for suffering psychological distress, including increased stress, depression, anxiety, substance use, and post-traumatic stress disorder. Prior to COVID-19, healthcare workers were already experiencing a high rate of job burnout, depression, and suicide. The pandemic brought in sharp focus the essential and urgent need for healthcare facilities to acknowledge the importance of team member well-being and the provision of spaces such as tranquility rooms for use while at work. This case study shares one health system’s evidence-based implementation plan for tranquility rooms, what was learned, and how team members responded. More research is needed to better understand team member well-being and the impact of tranquility rooms. Experience Framework This article is associated with the Staff & Provider Engagement lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens.

Views on happiness and mental health: A comparison between residents and staff at a senior care facility

Residents and staff members at a senior care facility were questioned about their views on topics related to mental health. The two groups scored similarly on a happiness questionnaire. Differences as well as similarities between residents and staff were revealed through a questionnaire addressing views on mental health, counseling, and medications. The results are discussed in terms of the relationship that develops between older adults and their care givers. We argue that the health and well-being of the residents of a senior care facility may be linked to the health and well-being of the staff. The extent to which the two groups have similar views on issues of health and happiness is probably both a result of, and a basis for, strong relationships between the two. Experience Framework This article is associated with the Staff & Provider Engagement lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens.

Understanding patient and caregiver perspectives using a dyad approach for data collection: A systematic review of the literature

Treatments outside of a clinical setting may be managed independently by the pediatric patient, independently by a caregiver, or by the patient and caregiver together. Best practices for pediatric clinical outcome assessment (COA) recommend patient-reported outcome (PRO) and/or observer-reported outcome (ObsRO) measures to assess the patient experience of a condition or its treatment. However, a dyad approach where patients and caregivers can complete assessments together may be useful for assessing a shared treatment experience that may not be adequately captured by a PRO and/or an ObsRO. A systematic, targeted literature review of empirical literature was conducted to identify and describe published studies detailing dyad patient-caregiver outcome reporting approaches. The search was run in the MEDLINE®, Embase, and PsycINFO® databases using the OvidSP platform and was limited to English-language studies published within 10 years of the conducted search on 28 September 2021, and 13 articles were selected for full-text review based on pre-specified criteria. Advantages and disadvantages for use of a dyad data collection approach are discussed. Though not appropriate for all settings, dyad data collection may be useful for situations where the best practice approach to measurement does not capture all relevant perspectives, or the use of PRO and ObsRO also does not comprehensively capture all relevant concepts. In following, it may offer a pragmatic solution that can minimize the use of proxy assessment and limit missing data, particularly in research involving a shared patient and caregiver treatment experience. Experience Framework This article is associated with the Staff & Provider Engagement lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens.

Effect of wearing masks in the hospital on patient-provider interaction: “They (providers) need to stay safe for their family and keep us safe.”

Since March 2020 when the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic was widespread in the U.S., masks became a primary form of protection for healthcare workers when caring for patients. While wearing masks was not a new phenomenon in the health field, there is little known on how the use of them affects the patient-provider relationship. This study explored the experience of wearing masks on the patient-provider relationship in the hospital. This qualitative study involved interviews with both providers and patients at an academic hospital in the Midwest. At the time of this study, in July 2021, hospital policy required all healthcare providers and staff to wear surgical masks with patients, but patients were not required to wear masks while in their rooms. Interviews were audio-recorded and transcribed; they were coded using MAXQDA. Nine patients and nine providers took part in interviews. There were 4 women and 5 men in each group. The primary benefit of mask-wearing identified by both groups was safety and protection from disease. Connection with patients was a major theme as well. Providers adapted to try to improve connection in four primary ways: showing the patient their face, speaking loudly and clearly, spending additional time with patients, and being more expressive. It was also reassuring that safety was one of the main themes and encouraging that masks were not a substantial barrier to communication with patients. Experience Framework This article is associated with the Staff & Provider Engagement lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens.

Pilot Testing of the Promoting Positive Care Interactions Intervention in Assisted Living.

The current study aimed to test the feasibility and preliminary efficacy of the Promoting Positive Care Interactions (PPCI) intervention designed to establish positive care interactions between staff and residents in assisted living (AL) using an online approach. PPCI was implemented in one AL community using a single group pre-/posttest design; 17 care staff were recruited from the memory care unit. Delivery, receipt, and enactment of the PPCI were assessed for feasibility. Change in staff outcomes and facility outcomes were examined for preliminary efficacy. The four steps of the PPCI were implemented as intended with 100% staff exposure to education and considerable staff engagement in weekly mentoring sessions. Although there was an improvement in AL environment and policy, no significant changes were observed in staff outcomes. Future testing of the PPCI should include a longer timeline and explore a hybrid model that includes online education and in-person mentoring and coaching of staff to improve care interactions. [Journal of Gerontological Nursing, 48(8), 17-25.].

It’s Time for a Turnaround on Turnaround Studies: Putting People and Process First

Unsatisfied with the low success rates of turnarounds, this paper investigates the literature on turnarounds from a process perspective. Using an input-throughput-output model we investigate the causes of decline, the different aspects of turnaround practices, their contextual factors, and the assessment of turnarounds. We conclude that all causes of decline are internal, stemming from dysfunctional leadership habits and human interactions, behaviors, and beliefs. Taking this seriously, turnaround studies should start integrating these organizational pathologies into their research objectives, to advance turnaround practices. We also find that similar turnaround measures under similar conditions show very different results, adding to the notion that content doesn’t matter when it comes to turnaround success, but process does. Still, the interplay between leadership style, the turnaround process, and staff engagement and their relationship to turnaround success is little investigated. We develop an agenda to fill this gap, integrating change management and systems psychodynamic concepts into turnaround studies to advance our understanding of decline and turnarounds and improve turnaround practices around the world.

Extending the scope of practice for experienced assistant practitioners in breast screening and the impact on service resilience

IntroductionHistorically, the NHS Breast Screening Programme (NHSBSP) required Assistant Practitioners (APs), who are non-registered practitioners, to be supervised by and work alongside a registered radiographer (RPs). Following a national pilot looking at the implementation of two APs working remotely without direct supervision by a radiographer, this study seeks to evaluate a local trial of this new model of working. MethodsPairs of APs were deployed to work together on a mobile breast screening unit over a four-month period. Assessments were carried out to review technical performance using established NHSBSP technical repeat and recall rates in the United Kingdom. Notes on any queries from those involved during the dual AP sessions were prospectively collected and reviewed. Feedback from APs and other multi-disciplinary team members were collected and content analysis was applied. ResultsA total of 828 women were screened across the 26 AP clinics that were delivered. Technical repeat and recall rates of participating APs remained stable throughout the pilot period and marginally improved across all participating staff. No women attended the AP clinic who could not be screened and no support from a RP was required during the sessions. Seven normal clinics were converted to AP clinics due to lack of staff on the day, avoiding the cancellation of screening clinics. Feedback from across the screening team was positive. ConclusionsIncreasing the autonomy of experienced APs can significantly contribute to the delivery of a resilient radiographic workforce that maintains service performance. Suitable experience and wider team involvement appear to be keys to success in this case. Implication for practiceIncreasing the autonomy and voice of the APs has a positive effect on the resilience of the wider radiographic workforce and the service as a whole. It also can provide a mechanism for raising their profile with a possible raise in job satisfaction, staff engagement and retention.

Shared medical appointments in English primary care for long-term conditions: a qualitative study of the views and experiences of patients, primary care staff and other stakeholders

BackgroundShared medical appointments (SMAs) or group consultations have been promoted in primary care to improve workload pressures, resource-use efficiency and patient self-management of long-term conditions (LTCs). However, few studies have explored stakeholders’ perspectives of this novel care delivery model in the English NHS context, particularly patients’ views and experiences of SMAs.MethodSemi-structured interviews were used to explore the perspectives of stakeholders (21 patients, 17 primary care staff, 2 commissioners and 2 SMA training providers) with and without SMA experience from a range of geographical and socio-economic backgrounds in the North East and North Cumbrian region of England. Thematic analysis was conducted to examine perceptions around impact on patient care and outcomes and barriers and facilitators to implementation.ResultsThree main themes were identified: ‘Value of sharing’, ‘Appropriateness of group setting’, ‘Implementation processes’. Patients experiences and perceptions of SMAs were largely positive yet several reported reservations about sharing personal information, particularly in close-knit communities where the risk of breaching confidentiality was perceived to be greater. SMAs were considered by patients and staff to be inappropriate for certain personal conditions or for some patient groups. Staff reported difficulties engaging sufficient numbers of patients to make them viable and having the resources to plan and set them up in practice. Whilst patients and staff anticipated that SMAs could deliver high quality care more efficiently than 1:1 appointments, none of the practices had evaluated the impact SMAs had on patient health outcomes or staff time.ConclusionStakeholder experiences of SMA use in English primary care are largely similar to those reported in other countries. However, several important cultural barriers were identified in this setting. Further work is needed to better understand how patient and staff perceptions, experiences and engagement with SMAs change with regular use over time. Concerns regarding staff capacity, additional resource requirements and numbers of eligible patients per practice suggest SMAs may only be feasible in some smaller practices if facilitated by primary care networks. Further mixed-method evaluations of SMAs are needed to inform the evidence base regarding the effectiveness, efficiency and feasibility of SMAs long-term and subsequently their wider roll-out in English primary care.

Interdisciplinary staff perceptions of advance care planning in long-term care homes: a qualitative study

BackgroundResidents living in long-term care homes (LTCH) have complex care needs, multiple chronic conditions, increasing frailty and cognitive impairment. A palliative approach that incorporates advance care planning (ACP) should be integrated with chronic disease management, yet it is not a norm in most LTCHs. Despite its growing need, there remains a lack of staff engagement in the ACP process.ObjectivesThe aim of this study was to explore the perceptions and experiences of interdisciplinary staff related to the practice of ACP in LTCHs.MethodsThis study is part of a larger Canadian project, iCAN ACP, that aims to increase uptake, and access to ACP for older Canadians living with frailty. An exploratory qualitative design using an interpretive descriptive approach was employed utilizing focus groups and semi-structured interviews with staff from four LTCHs in Ontario, Canada.FindingsThere were 98 participants, including nurses (n = 36), physicians (n = 4), personal support workers (n = 34), support staff (n = 23), and a public guardian (n = 1). Three common themes and nine subthemes were derived: a) ongoing nature of ACP; b) complexities around ACP conversations; and c) aspirations for ACP becoming a standard of care in LTCHs.DiscussionThe findings of this study provide important contributions to our understanding of the complexities surrounding ACP implementation as a standard of practice in LTCHs. One of the critical findings relates to a lack of ACP conversations prior to admission in the LTCHs, by which time many residents may have already lost cognitive abilities to engage in these discussions. The hierarchical nature of LTCH staffing also serves as a barrier to the interdisciplinary collaboration required for a successful implementation of ACP initiatives. Participants within our study expressed support for ACP communication and the need for open lines of formal and informal interdisciplinary communication. There is a need for revitalizing care in LTCHs through interdisciplinary care practices, clarification of role descriptions, optimized staffing, capacity building of each category of staff and commitment from the LTCH leadership for such care.ConclusionThe findings build on a growing body of research illustrating the need to improve staff engagement in ACP communication in LTCHs.

Community-based response to the COVID-19 pandemic: case study of a home isolation centre using flexible surge capacity

ObjectivesCoronavirus disease 2019 (COVID-19) has consumed many available resources within contingency plans, necessitating new capacity surges and novel approaches. This study aimed to explore the possibility of implementing the concept of flexible surge capacity to reduce the burden on hospitals by focussing on community resources to develop home isolation centres in Bangkok, Thailand. Study designA qualitative study consisted of observational and semi-structured interview data. MethodsThe development and activities of home isolation centres were observed, and interviews were conducted with leaders and operational workforces. Data were deductively analysed and categorised based on the practical elements necessary in disaster and emergency management. ResultsData were categorised into the seven collaborative elements of the major incident medical management and support model. The command-and-control category demonstrated four subcategories: (1) coordination and collaboration; (2) staff engagement; (3) responsibility clarification; and (4) sustainability. Safety presented two subcategories: (1) patients' information privacy and treatment; and (2) personnel safety and privacy. Communication showed internal and external communications subcategories. Assessment, triage, treatment and transport followed the processes of the COVID-19 treatment protocols according to the World Health Organisation (WHO) guidelines and hospital operations. Several supply- and patient-related challenges were identified and managed during centre development. ConclusionsThe use of community resources, based on the flexible surge capacity concept, is feasible under restricted circumstances and reduced the burden on hospitals during the COVID-19 pandemic. Continuous education among multidisciplinary volunteer teams facilitated their full participation and engagement. The concept of flexible surge capacity may promote an alternative community-based care opportunity, irrespective of emergencies' aetiology.