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Professionals' experiences of using an improvement programme: applying quality improvement work in preschool contexts.

ABSTRACT: BACKGROUND:Improvement work can be used in preschools to enrich outdoor environment for children's better health. Effective improvement work can facilitate the necessary changes, but little is known about professionals' experiences of participation in improvement interventions. The aim was to evaluate how preschool staff experience quality improvement work, using the Breakthrough Series Collaborative improvement programme, to enhance outdoor environments. METHODS:An improvement intervention using a breakthrough collaborative was performed at 9 preschools in Sweden and examined with a longitudinal mixed method design. Staff completed questionnaires on 4 occasions (n=45 participants) and interviews took place after the intervention (n=16 participants). RESULTS:The intervention was successful in the sense that the staff were content with the learning seminars, and they had triggered physical changes in the outdoor environment. They integrated the quality improvement work with their ordinary work and increasingly involved the children. The staff tested improvement tools but did not find them entirely appropriate for their work, because they preferred existing methods for reflection. CONCLUSIONS:The challenges in quality improvement work seem to be similar across contexts. Using the Breakthrough Series Collaborative in a public health intervention is promising but needs to be integrated with preunderstandings, current reflections and quality tools and models.

SUBMITTER: Kjellstrom S

PROVIDER: S-EPMC7445333 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Professionals' experiences of using an improvement programme: applying quality improvement work in preschool contexts.

Kjellström Sofia S Andersson Ann-Christine AC Samuelsson Tobias T

BMJ open quality 20200801 3

<h4>Background</h4>Improvement work can be used in preschools to enrich outdoor environment for children's better health. Effective improvement work can facilitate the necessary changes, but little is known about professionals' experiences of participation in improvement interventions. The aim was to evaluate how preschool staff experience quality improvement work, using the Breakthrough Series Collaborative improvement programme, to enhance outdoor environments.<h4>Methods</h4>An improvement in ...[more]

PMID: 32830121

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Project description:BackgroundIndonesia has been shifting from ensuring access to health services towards improving service quality. Accreditation has been used as quality assurance (QA) mechanism, first in hospitals and subsequently in primary health care facilities, including Puskesmas (community health centres). QA provides measures of whether services meet quality targets, but quality improvement (QI) is needed to make change and achieve improvements. QI is a cyclical process with cycles of problem identification, solution testing and observation. We investigated the factors which influenced the process of QI based on experience of maternal health QI teams in three Puskesmas in Cianjur district, West Java province, Indonesia.MethodsQualitative data were collected using 28 in-depth interviews at two points of time: pre- (April 2016) and post- QI intervention (April 2017), involving national, provincial, district and Puskesmas managers; and Puskesmas QI team members. Thematic analysis of transcripts was conducted.ResultsWe found four main factors contributed to the process of QI: 1) leadership, including awareness and attitude of leader(s) towards QI, involvement of leader(s) in the QI process and decision-making in budget allocation for QI; 2) staff enthusiasm and multidisciplinary collaboration; 3) a culture where QI is integrated in existing responsibilities; and 4) the ongoing Puskesmas accreditation process, which increased the value of QI to the organisation.ConclusionMaking QI a success in the decentralised Indonesian system requires action at four levels. At individual level, leadership attributes can create an internal quality environment and drive organisational cultural change. At team level, staff enthusiasm and collaboration can be triggered through engaging and tasking everyone in the QI process and having a shared vision of what quality should look like. At organisational level, QI should be integrated in planned activities, ensuring financial and human resources. Lastly, QI can be encouraged when it is implemented by the wider health system as part of national accreditation programmes.

Project description:PurposeCancer-related cognitive problems (cancer-related cognitive problems) in working cancer survivors are found to affect work outcomes. We aimed to generate in-depth information regarding cancer-related cognitive problems in working cancer survivors, strategies used to cope with cancer-related cognitive problems at work, and needs of cancer survivors and professionals regarding cancer-related cognitive problems at work.MethodsFive focus groups were formed, amongst which three focus groups with cancer survivors (n = 8, n = 7, and n = 8) and two focus groups with professionals (n = 7, n = 8). Thematic analysis of the transcripts was performed to create concepts.ResultsBoth cancer survivors and professionals confirmed that cancer-related cognitive problems, which occurred in several domains of neurocognitive functioning, affect work functioning. Cancer survivors used several strategies (e.g., applying practical adjustments, re-organization of work, and accepting limitations) to cope with cancer-related cognitive problems at work, as did professionals in their attempt at supporting cancer survivors facing these problems. Various needs of cancer survivors (e.g., supportive care options, acknowledgment by others) and professionals (e.g., improvement of expertise, clarity about referral pathways) regarding cancer-related cognitive problems at work were mentioned.ConclusionsDue to the growing number of working cancer survivors dealing with cancer-related cognitive problems, it is essential to sustain their employability. Therefore, cognitive rehabilitation interventions should be developed, taking functioning at work into account. Knowledge amongst professionals regarding cancer-related cognitive problems, as well as coordination of care for cancer-related cognitive problems, should be improved. Ensuring professional education regarding cancer-related cognitive problems, within both the healthcare and occupational setting, is of utmost importance.Implications for cancer survivorsSupport for working cancer survivors who experience cancer-related cognitive problems might increase their employability in the longer term.

Project description:BackgroundTeamwork in the context of ambulance services exhibits unique characteristics, as this environment involves a small core team that must adapt to a dynamic team structure that involves health care professionals and emergency services. It is essential to acquire a deeper understanding of how ambulance teams operate. Therefore, this study aimed to explore the experiences of ambulance professionals with teamwork and how they were influenced by the implementation of a team training programme.MethodsA qualitative descriptive study was conducted involving ambulance professionals who took part in focus group interviews carried out both before and after the implementation of a team training program across seven ambulance stations within a Norwegian hospital trust. The data were analysed using reflexive thematic analysis based on a deductive-inductive approach.ResultsOur analysis revealed 15 subthemes that characterised ambulance professionals' experiences with teamwork and a team training programme, which were organised according to the five main themes of team structure, communication, leadership, situation monitoring, and mutual support. Ambulance professionals' experiences ranged from the significance of team composition and interpersonal and professional relationships to their preferences regarding different communication styles and the necessity of team leaders within the ambulance service. The team training programme raised awareness of teamwork, while the adoption of teamwork tools was influenced by both individual and contextual factors. The Introduction/Identity, Situation, Background, Assessment and Recommendation (ISBAR) communication tool was identified as the most beneficial aspect of the programme due to its ease of use, which led to improvements in the structure and quality of consultations and information handover.ConclusionsThis study documented the diverse characteristics and preferences associated with teamwork among ambulance professionals, emphasising the particular importance of proficient partnerships in this context. Participation in a team training programme was perceived as a valuable reminder of the significance of teamwork, thus providing a foundation for the enhancement of communication skills.Trial registrationClinicalTrials.gov-ID: NCT05244928.

Project description:Concerns about patient safety and reducing harm have led to a particular focus on initiatives that improve healthcare quality. However Quality Improvement (QI) initiatives have in the past typically faltered because they fail to fully engage healthcare professionals, resulting in apathy and resistance amongst this group of key stakeholders. Productive Ward: Releasing Time to Care (PW) is a ward-based QI programme created to help ward-based teams redesign and streamline the way that they work; leaving more time to care for patients. PW is designed to engage and empower ward-based teams to improve the safety, quality and delivery of care.The main objective of this study was to explore whether PW sustains the 'engagement' of ward-based teams by examining the longitudinal effect that the national QI programme had on the 'work-engagement' of ward-based teams in Ireland. Utilising the Utrecht Work Engagement Scale questionnaire (UWES-17), we surveyed nine PW (intervention) sites from typical acute Medical/Surgical, Rehabilitation and Elderly services (representing the entire cohort of a national phase of PW implementation in Ireland) and a cohort of matched control sites. The numbers surveyed from the PW group at T1 (up to 3 months after commencing the programme) totalled 253 ward-team members and 249 from the control group. At T2 (12 months later), the survey was repeated with 233 ward-team members from the PW sites and 236 from the control group.Overall findings demonstrated that those involved in the QI initiative had higher 'engagement' scores at T1 and T2 in comparison to the control group. Total 'engagement' score (TES), and its 3 dimensions, were all significantly higher in the PW group at T1, but only the Vigour dimension remained significantly higher at T2 (p = 0.006).Our results lend some support to the assertions of the PW initiative itself and suggest that when compared to a control group, ward-based teams involved in the QI programme are more likely to be 'engaged' by it and its associated improvement activities and that this is maintained over time. However, only the Vigour dimension of 'engagement' remained significantly higher in the PW over time.

Project description:IntroductionThe Perioperative Quality Improvement Programme (PQIP) is designed to measure complications after major elective surgery and improve these through feedback of data to clinicians. Previous research suggests that despite the significant resources which go into collecting data for national clinical audits, the information they contain is not always used effectively to improve local services.Methods and analysisWe will conduct a formative process evaluation of PQIP comprising a multisited qualitative study to analyse PQIP's programme theory, barriers, facilitators and wider contextual factors that influence implementation. The research will be carried out with the PQIP project team and six National Health Service (NHS) Trusts in England, selected according to geographical location, type of hospital, size and level of engagement with PQIP. We will include one Trust which has not expressed interest in the PQIP for comparison and to explore the role of secular trend in any changes in practice. We will use semi-structured interviews (up to 144 in Trusts and 12 with the project team), non-participant observations (up to 150 ?hours) and documentary analysis. We will track the lifecycle of perioperative data, exploring the transformations it undergoes from creation to use. We will use framework analysis with categories both from our research questions and from themes emerging from the data.Ethics and disseminationEthical approval has been granted from the University College London Research Ethics Committee (ref 10375/001). Permissions to conduct research at NHS Trusts have been granted by local Research and Development offices in coordination with the Health Research Authority. We will follow guidelines for data security, confidentiality and information governance. Findings will be shared at regular time points with the PQIP project team to inform the implementation of the programme, and with participating NHS Trusts to help them reflect on how they currently use data for improvement of perioperative services.

Project description:In the U.S., where the prevalence of type 2 diabetes has reached epidemic proportions, many patients with this disease are treated by primary care physicians in community-based systems, including accountable care organisations (ACOs). To address gaps in the quality of diabetes care, national quality measures have been established, including patient-centered measures adopted by the Centers for Medicare and Medicaid Services for its Shared Savings Program for ACOs. From a patient-centered perspective, high-quality diabetes care depends on effective communication between clinicians and patients, along with patient education and counseling about medications and lifestyle. We designed and implemented a quality improvement (QI) program for 30 primary care physicians treating patients with type 2 diabetes in three structurally similar but geographically diverse ACOs. Retrospective chart audits were conducted before (n = 300) and after (n = 300) each physician participated in accredited continuing medical education (CME) courses that focused on QI strategies. Randomly selected charts were audited to measurably assess essential interventions for improved outcomes in type 2 diabetes including the physicians' documentation of patient counseling and assessment of side effects, and patients' medication adherence status and changes in hemoglobin A1C (A1C) and body mass index (BMI). Paced educational interventions included a private performance improvement Internet live course conducted for each physician, small-group Internet live courses involving peer discussion, and a set of enduring materials, which were also multi-accredited for all clinicians in the physician's practice. Continual improvement cycles were guided by analysis of the baseline chart audits, quantitative survey data, and qualitative feedback offered by participants. To extend the benefit of the education, the enduring materials were offered to the interprofessional team of clinicians throughout the U.S. who did not participate in the QI program. For brevity, this article presents outcomes of the 30 primary care physicians. Baseline to post-education improvements were observed for percentages of charts with documented assessment of medication side effects (+11%) and counseling about medication risks/benefits (+28%), medication adherence (+13%), and lifestyle modifications (+8%). Improvements were also observed for documented adherence to diabetes medications (+24%) and first-to-last visit changes in A1C (-0.16%) and BMI (-2.1). The findings indicate a positive influence of QI education on primary care physicians' performance of patient-centered quality measures and patient outcomes.

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Professionals' experiences of using an improvement programme: applying quality improvement work in preschool contexts.

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Professionals' experiences of using an improvement programme: applying quality improvement work in preschool contexts.

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