Sustainable Care Improvement Research Articles

Infection prevention and control for diverse vulnerable populations: From an emergency response to the COVID-19 pandemic to sustainable improvement.

At the onset of the COVID-19 pandemic in early 2020, organizations providing residential and respite care for individuals with developmental disabilities and complex care needs in the Greater Toronto Area were largely unprepared. As case numbers surged, they lacked the expertise and resources needed to prevent spread across populations that are highly vulnerable to infection and poor outcomes. This article describes how these organizations, led by Safehaven, responded to an unprecedented emergency, and how the response is leading to sustainable improvements in care and safety for diverse vulnerable groups in congregate care settings. As the pandemic advanced, the Safehaven Program evolved with the solidification of the role of Infection Prevention and Control Champion lead role in Ontario and partnership with Reena in York Region.

Patient Safety Education 20 Years After the Institute of Medicine Report: Results From a Cross-sectional National Survey.

Educating healthcare professionals in patient safety is essential to achieving sustainable improvements in care. This study aimed to identify the key constituents of patient safety education alongside its facilitators and barriers from a frontline perspective. An electronic survey was sent to 592 healthcare professionals and educators in patient safety education in the United Kingdom. Two independent reviewers conducted a thematic analysis of the free-text data. Themes focused on effective content, learning practices and facilitators and barriers to patient safety education. Of 592 individuals completing the survey, 545 (92%) submitted analyzable responses. Interrater reliability of coding was high with Cohen k value of 0.86. Participants endorsed experiential and interactive learning as ideal modalities for delivery and expressed a need for content to be based on real clinical cases and tailored to the needs of the learners. The most commonly mentioned facilitators were standardization of methods and assessment (49%), dedicated funding (21%), and culture of openness (20%). Staffing problems and high workload (41%) and lack of accessibility of training (23%) were identified as primary barriers of efficacy and uptake. This study identified key factors to the success of patient safety education in terms of content and delivery alongside facilitators and barriers. Future curricula developers and interventions should improve standardization, funding, culture, and access so as to optimize education programs to enhance patient safety.

Sustainable care improvement programs supported by undergraduate health care education

Background: The Care for Better Region program was developed to achieve sustainable care improvement focusing on fall prevention. Key ingredients involved improvement teams developing and implementing a falls reduction plan, Practice Development; facilitation of improvement teams by lecturers and undergraduate health care students; an implementation phase. This study evaluates the impact of this program on: (1) the number of falls incidents, and (2) the sustainability of care improvement practice.Methods: A realist evaluation design was used. Nine improvement teams participated in the Care for Better Region program. Staff members registered falls incidents in two measurement cycles in the participating teams (N = 143 older adults) and in a control group (N = 93). Data collection on improvement sustainability involved participative observations, interviews, logs of students and lecturer coaches, minutes and evaluations.Results: The falls incidents on the participating wards decreased over 12 months from 13.3% to 1.4%. At the control wards they stabilized. Sustainability of improvement practice: (1) Involvement of improvement teams was enhanced by measurements of falls incidents. However, involvement of ward staff was difficult to accomplish; (2) Students, lecturer coaches and project leaders of the improvement teams learned how to involve stakeholders, implement project management, and how to prevent falls incidents; (3) Network facilitation was promoted by the central meetings. The project leaders’ meetings continued after the project; (4) Students facilitated the improvement teams. The change of students after six and twelve months inspired the teams to renew their focus.Conclusions: This exploratory realist evaluation study shows how the Care for Better Region program improved sustainability of falls incidents reduction. The program also had a positive impact on the sustainability of improvement practice. Nursing education should focus on the development of innovation and facilitation skills in students. Nursing practice may improve by interdisciplinary collaboration with undergraduate health care education in care improvement programs.

Reflective team – a clinical intervention for sustainable care improvement

The aim of this study is to illustrate conditions for the successful implementation of a work model for sustainable care improvement, called Reflecting Team (RT). For this study team leaders were trained in a caring science education programme to lead the reflective processes, and RTs were introduced into two caring contexts. Within the study professional caregivers involved in the implementation of RT were interviewed, and their statements were interpreted according to a life world hermeneutic approach. Dialectic themes emerged that established four prerequisites for successful implementation of RT. A comprehensive understanding suggests that the lowest common denominator for the four prerequisites is mutual interaction. Thus, an atmosphere of sharing was found to be necessary. The challenge of creating such an atmosphere in a caring unit is the focus of the discussion section.

Prerequisites for sustainable care improvement using the reflective team as a work model

Several work models for care improvement have been developed in order to meet the requirement for evidence-based care. This study examines a work model for reflection, entitled the reflective team (RT). The main idea behind RTs is that caring skills exist among those who work closest to the patients. The team leader (RTL) encourages sustainable care improvement, rooted in research and proven experience, by using a lifeworld perspective to stimulate further reflection and a developmental process leading to research-based caring actions within the team. In order to maintain focus, it is important that the RTL has a clear idea of what sustainable care improvement means, and what the prerequisites are for such improvement. The aim of the present study is, therefore, to explore the prerequisites for improving sustainable care, seeking to answer how RTLs perceive these and use RTs for concrete planning. Nine RTLs were interviewed, and their statements were phenomenographically analysed. The analysis revealed three separate qualitative categories, which describe personal, interpersonal, and structural aspects of the prerequisites. In the discussion, these categories are compared with previous research on reflection, and the conclusion is reached that the optimal conditions for RTs to work, when focussed on sustainable care improvement, occur when the various aspects of the prerequisites are intertwined and become a natural part of the reflective work.

Centres for Healthcare Improvement: solution to the quality problem

Centres for Healthcare Improvement: solution to the quality problem

Current experiences and educational preferences of general practitioners and staff caring for people with dementia living in residential facilities

BackgroundResidential care is important for older adults, particularly for those with advanced dementia and their families. Education interventions that achieve sustainable improvement in the care of older adults are critical to quality care. There are few systematic data available regarding the educational needs of Residential Care Facility (RCF) staff and General Practitioners (GPs) relating to dementia, or the sustainability of educational interventions. We sought to determine participation in dementia education, perceived levels of current knowledge regarding dementia, perceived unmet educational needs, current barriers, facilitators and preferences for dementia education.MethodsA mixed methods study design was utilised. A survey was distributed to a convenience sample of general practitioners, and staff in 223 consecutive residential care facilities in Perth, Western Australia. Responses were received from 102 RCF staff working in 10 facilities (out of 33 facilities who agreed to distribute the survey) and 202 GPs (19% of metropolitan GPs). Quantitative survey data were summarised descriptively and chi squared statistics were used to analyse the distribution of categorical variables. Qualitative data were collected from general practitioners, staff in residential care facilities and family carers of people with dementia utilizing individual interviews, surveys and focus groups. Qualitative data were analysed thematically.ResultsAmong RCF staff and GPs attending RCF, participation in dementia education was high, and knowledge levels generally perceived as good. The individual experiences and needs of people with dementia and their families were emphasised. Participants identified the need for a person centred philosophy to underpin educational interventions. Limited time was a frequently mentioned barrier, especially in relation to attending dementia care education. Perceived educational needs relating to behaviours of concern, communication, knowledge regarding dementia, aspects of person centred care, system factors and the multidisciplinary team were consistently and frequently cited. Small group education which is flexible, individualized, practical and case based was sought.ConclusionThe effectiveness and sustainability of an educational intervention based on these findings needs to be tested. In addition, future interventions should focus on supporting cultural change to facilitate sustainable improvements in care.

WFH – the cornerstone of global development: 45 years of progress

The World Federation of Hemophilia (WFH) has been the cornerstone of global development for 45 years. The WFH has identified and optimized the essential elements of a model for the development of a sustainable national care programme. The five elements of the WFH Development Model are integrated and interdependent: ensuring accurate laboratory diagnosis, achieving government support for a national programme, improving the care delivery system, increasing the availability of treatment products and building a strong national patient organization. It can been demonstrated that patient organizations, healthcare providers and the Ministry of Health working together in coalition is essential to achieving sustainable care. Equally important, the provision of care by a multidisciplinary team of trained professionals within a comprehensive care setting is fundamentally important to optimize outcomes. Using data from the WFH Global Survey, it is evident that the WFH Development Model brings about sustainable improvements in care. To support the Model, the WFH has created a vast range of tools, guides and programmes tailored to specific development needs. The Global Alliance for Progress is the preeminent WFH development program. Five years of outcomes data document a narrowing of the care gap between developed and developing nations. To ensure the continued advance towards the WFH vision of Treatment for All, it is vital that global collaboration occur on the research front as well. The WFH is well positioned to meet the challenges ahead and to continue serving as the cornerstone of global collaboration and development.

Comparing audits of cardiovascular risk in patients with diabetes in primary care

Regular audit of clinical standards with appropriate audit standards encourages small but sustainable improvements in care. The National Service Framework for Diabetes in England and Wales, and the Clinical Standards Board for Scotland, have generated a great number of proposals for improvements in the delivery and documentation of cardiovascular disease prevention in diabetes. In the future, advances in information technology and managed clinical networks are proposed to facilitate improvement in diabetes care. This article describes how, over the last few years, some cardiovascular aspects of diabetes care, including blood pressure control and aspirin/statin prescription, have been monitored and improved in general practice in a deprived area.