April 16, 2018

Implementing effective interventions in healthcare requires organizations to be ready to support change. This study aimed to develop, adapt transculturally, and assess the content and face validity of the Organizational Readiness for Knowledge Translation (OR4KT) tool. The OR4KT was designed to measure the readiness of healthcare organizations to implement evidence-informed change across a variety of services. Methods Based on systematic reviews of the literature, a Delphi exercise, and expert consultation, we first generated an initial pool of items. Second, we developed and assessed content validity of the pilot OR4KT questionnaire in English. Third, we created French and Spanish versions using a sequential forward and backward translation approach, and transcultural adaptation by a consensus process. Finally, we conducted pilot studies in three contexts: the Basque country region (Spain), and the provinces of Quebec and Ontario (Canada) where 30 experts assessed the face validity of the three versions of OR4KT. Results We selected 59 items, grouped in 6 dimensions (organizational climate, context, change content, leadership, organizational support, and motivation) for the final English version of OR4KT. Translation and transcultural adaptation did not identify any content or language problems. Our findings indicate that the English, French and Spanish versions of OR4KT are linguistically equivalents and have high face validity. Only minor revisions to the wording of some items were recommended. Conclusion The OR4KT holds promise as a measure of readiness for knowledge translation (KT) in healthcare organizations. The validity and reliability of the three versions of the OR4KT will be assessed in real-life contexts.

The application deadline for the Emerging Leaders Forum is fast approaching. Led by Dr John Beard, the forum will host emerging leaders in the field of ageing and will focus on the varied qualities that make a leader, exploring the distinct capabilities of attendees, understanding the dynamic processes and relationships associated with leadership and considering how individuals can use their diverse capacities in a range of settings.

Leaders are essential in every organization to achieve patient safety and healthy work environments. Authentic leadership is a relational leadership style purported to promote healthy work environments that influence staff performance and organizational outcomes. Given recent growth in authentic leadership research in healthcare and the importance of new knowledge to inform leadership development, there is an obligation to determine what is known about the antecedents and outcomes of authentic leadership in healthcare settings and clarify mechanisms by which authentic leadership affects healthcare staff and patient outcomes.; BackgroundLeaders are essential in every organization to achieve patient safety and healthy work environments. Authentic leadership is a relational leadership style purported to promote healthy work environments that influence staff performance and organizational outcomes. Given recent growth in authentic leadership research in healthcare and the importance of new knowledge to inform leadership development, there is an obligation to determine what is known about the antecedents and outcomes of authentic leadership in healthcare settings and clarify mechanisms by which authentic leadership affects healthcare staff and patient outcomes.

The Global Evidence and Implementation Summit 2018 (GEIS) will bring together experts from across the world to talk about their experiences in generating and implementing evidence for better policy and practice. The summit will explore the evidence for designing, implementing and reviewing effective programs and policies. Expected to reach 700 delegates from 30 countries, GEIS 2018 will share the latest evidence synthesis and implementation science research and practice strategies for improving the lives of individuals, families and communities worldwide.

The AAL Call 2018 is open to collaborative projects developing ICT-based solutions targeting any application area(s) within the AAL domain, with a focus on specified markets (Consult AAL website for more information on different markets). The solutions need to be embedded into the strategies of the participating end-user organizations, service providers and business partners. The wishes and aspirations of older adults, in combination with the demands from the other stakeholders involved – e.g. providers and payers – will have a critical role in shaping useful and attractive AAL solutions with a high market potential.

New scientific knowledge and innovation are often slow to disseminate. In other cases, providers rush into adopting what appears to be a clinically relevant innovation, based on a single clinical trial. In reality, adopting innovations without appropriate translation and repeated testing of practical application is problematic. In this article we provide examples of clinical innovations (for example, tight glucose control in critically ill patients) that were adopted inappropriately and that caused what we term a malfunction. To address the issue of malfunctions, we review various examples and suggest frameworks for the diffusion of knowledge leading to the adoption of useful innovations. The resulting model is termed an integrated road map for coordinating knowledge transformation and innovation adoption. We make recommendations for the targeted development of practice change procedures, practice change assessment, structured descriptions of tested interventions, intelligent knowledge management technologies, and policy support for knowledge transformation, including further standardization to facilitate sharing among institutions.

In Canada, all nurses are required to engage in evidence-based practice (EBP) as an entry-to-practice competency; however, there is little research that examines Licensed Practical Nurses’ (LPNs’) information seeking behaviors or preferred sources of knowledge to conduct EBP. AIMS: Due to the differences in education and roles of LPNs and Registered Nurses (RNs), it is both necessary and important to gain an understanding of how LPNs utilize evidence in their unique nursing practice. The purpose of this study was to investigate how LPNs source knowledge for their nursing practice. METHODS: A descriptive, cross-sectional survey of LPNs from Alberta, Canada asked participants to rank sources of knowledge that inform their practice. Responses were correlated with age and years of practice. Analysis of variance was used to determine if there were significant mean differences between average scores and place of employment. RESULTS: LPN participants used similar sources of knowledge as RNs. The top source of knowledge for both RNs and LPNs was the information they learn about each individual client and the least utilized sources of knowledge were articles published in nursing, medical, and research journals, tradition, and popular media. This finding is consistent with previous studies on RNs that found nurses do not often access current research evidence to inform their practice. LINKING EVIDENCE TO ACTION: Since relatively few LPNs access nursing and research journals, it is important to tailor EBP education information to the workplace context. Future avenues of research might explore the potential of using in-services and webinars to disseminate information and skills training on EBP to the LPNs, as this was a popular source of practice knowledge.

One way to understand medical overuse at the clinician level is in terms of clinical decision-making processes that are normally adaptive but become maladaptive. In psychology, dual process models of cognition propose 2 decision-making processes. Reflective cognition is a conscious process of evaluating options based on some combination of utility, risk, capabilities, and/or social influences. Automatic cognition is a largely unconscious process occurring in response to environmental or emotive cues based on previously learned, ingrained heuristics. De-implementation strategies directed at clinicians may be conceptualized as corresponding to cognition: (1) a process of unlearning based on reflective cognition and (2) a process of substitution based on automatic cognition. RESULTS: We define unlearning as a process in which clinicians consciously change their knowledge, beliefs, and intentions about an ineffective practice and alter their behaviour accordingly. Unlearning has been described as “the questioning of established knowledge, habits, beliefs and assumptions as a prerequisite to identifying inappropriate or obsolete knowledge underpinning and/or embedded in existing practices and routines.” We hypothesize that as an unintended consequence of unlearning strategies clinicians may experience “reactance,” ie, feel their professional prerogative is being violated and, consequently, increase their commitment to the ineffective practice. We define substitution as replacing the ineffective practice with one or more alternatives. A substitute is a specific alternative action or decision that either precludes the ineffective practice or makes it less likely to occur. Both approaches may work independently, eg, a substitute could displace an ineffective practice without changing clinicians’ knowledge, and unlearning could occur even if no alternative exists. For some clinical practice, unlearning and substitution strategies may be most effectively used together. CONCLUSIONS: By taking into account the dual process model of cognition, we may be able to design de-implementation strategies matched to clinicians’ decision-making processes and avoid unintended consequence.

Transdisciplinary teams are increasingly regarded as integral to conducting effective research. Similarly, knowledge translation is often seen as a solution to improving the relevance and benefits of health research. Yet, whether, how, for whom and under which circumstances transdisciplinary research influences knowledge translation is undertheorised, which limits its potential impact. The proposed research aims to identify the contexts and mechanisms by which transdisciplinary research contributes to developing shared understandings and behaviours of knowledge translation between team members. METHODS AND ANALYSIS: Using a longitudinal case-study design approach to realist evaluation, we outline a study protocol examining whether, how, if and for whom transdisciplinary collaboration can impact knowledge translation understandings and behaviours within a 5-year transdisciplinary Centre of Research Excellence. Data are being collected between February 2017 and December 2020 over four rounds of theory development, refinement and testing using interviews, observation, document review and visual elicitation as data sources. ETHICS AND DISSEMINATION: The Health Research Ethics Committee of the University of Adelaide approved this study. Findings will be communicated with team members at scheduled intervals throughout the study verbally and by means of creative reflective approaches (eg, arts elicitation, journalling). This research will be used to help support optimal team functioning by identifying strategies to support knowledge sharing and communication within and beyond the team to facilitate attainment of research objectives. Academic dissemination will occur through publication and presentations.

Quality healthcare is increasingly measured through the integration of research findings into clinical practice. Individuals recognized as facilitators are essential to bridging the chasm between knowledge generation and translation.; BackgroundQuality healthcare is increasingly measured through the integration of research findings into clinical practice. Individuals recognized as facilitators are essential to bridging the chasm between knowledge generation and translation.

The primary aim was to measure resident safety culture in six nursing homes in northern Belgium (Flanders). In addition, differences in safety culture perceptions between professions were also examined. Finally, results of the present study were compared with the Nursing Home Comparative Database from the Agency for Healthcare Research and Quality (USA). METHODS: A cross-sectional study was conducted by administering the Nursing Home Survey on Patient Safety Culture in six nursing homes in Belgium (Flanders). Each nursing home has 92 to 170 licensed nursing home beds. Data collection occurred between December 2016 and January 2017. RESULTS: Highest mean scores were found for “feedback and communication about incidents” (mean [SD] = 4.20 [0.58]), “overall perceptions of resident safety” (mean [SD] = 4.07 [0.52]), and “supervisor expectations and actions promoting resident safety” (mean [SD] = 4.04 [0.70]). The lowest mean score was found for “staffing” (mean [SD] = 2.99 [0.61]). In addition, managers/supervisors scored significantly higher on all resident safety dimensions, with the exception of the dimensions “teamwork” and “supervisor expectations and actions promoting resident safety.” Finally, the present study scored higher on the dimensions “teamwork,” “nonpunitive response to mistakes,” “handoffs,” “feedback and communication about incidents,” and “communication openness” than the benchmarking data from the Nursing Home Comparative Database. CONCLUSIONS: More work is necessary to improve the safety of resident care in nursing homes, especially regarding staffing issues and turnover rates. The present research findings serve to shine a light on an often-overlooked patient population and emphasize the need to develop improvement strategies for preventing resident safety incidents in nursing homes.

To determine applicability of environment assessment tools in guiding minor refurbishments of Australian residential aged care facilities. METHOD: Studies conducted in residential aged care settings using assessment tools which address the physical environment were eligible for inclusion in a systematic review. Given these studies are limited, tools which have not yet been utilised in research settings were also included. Tools were analysed using a critical appraisal screen. RESULTS: Forty-three publications met the inclusion criteria. Ten environment assessment tools were identified, of which four addressed all seven minor refurbishment domains of lighting, colour and contrast, sound, flooring, furniture, signage and way finding. Only one had undergone reliability and validity testing. CONCLUSION: There are four tools which may be suitable to use for minor refurbishment of Australian residential aged care facilities. Data on their reliability, validity and quality are limited.

The limited access to oral care for older people living in residential aged care facilities (RACFs) has been noted repeatedly in the literature. The aim of this study was to explore RACF staff perspectives on how to engage dental professionals in the provision of oral care for RACF residents. Semi-structured interviews were conducted with 30 staff from six purposively selected RACFs located in high socioeconomic areas to gain understanding of the multidimensional issues that influenced the engagement of dental professionals from a carer perspective. Analysis revealed that staff perceived tensions regarding affordability, availability, accessibility and flexibility of dental professionals as significant barriers to better oral care for their residents. Participants raised a series of options for how to better engage dental professionals and reduce these barriers. Their ideas included: the engagement of RACF staff in collaborative discussions with representatives of public and private dental services, dental associations, corporate partners and academics; the use of hygienists/oral health therapists to educate and motivate RACF staff; the promotion of oral health information for troubleshooting and advice on how to deal with residents’ dental pain while waiting for support; the encouragement of onsite training for dental professionals; and the importance of gerodontology (geriatric dentistry). Findings highlighted the need to explore alternative approaches to delivering oral care that transcend the model of private clinical practice to focus instead on the needs of RACFs and take into account quality of end-of-life oral care.

Policy and practice guidelines recommend person-centred care to support people to live well with dementia in long-term care. Therefore, staff working in long-term care settings need to be trained in dementia awareness and person-centred care. However, the access to, content of and reach of training across long-term care settings can be varied. Data on current and ongoing access to person-centred care training can form an important component of data gathered on usual care in research studies, in particular clinical trials within long-term care. However, no suitable assessment tools are available to measure dementia awareness and person-centred care training availability, content and reach. This paper describes the development of a training audit tool to meet this need for a usual care measure of dementia awareness and person-centred care training. The ‘Assessment of Dementia Awareness and Person-centred care Training’ tool was based on a review of published person-centred care literature and consultation with dementia and aged care experts. The Assessment of Dementia Awareness and Person-centred care Training tool was piloted in 13 long-term care facilities the UK and Australia, before being used to assess the content of dementia and person-centred care awareness training in 50 UK settings in a randomized controlled trial as part of usual care recording. Following pilot testing, modifications to the Assessment of Dementia Awareness and Person-centred care Training tool’s wording were made to enhance item clarity. When implemented in the randomized controlled trial, pre-baseline training assessment data showed that the Assessment of Dementia Awareness and Person-centred care Training tool was able to differentiate between the training in different long-term care settings and identify settings where further dementia awareness training was required. The Assessment of Dementia Awareness and Person-centred care Training tool was then used as a method of recording data on dementia awareness and person-centred care training as part of ongoing usual care data collection. The Assessment of Dementia Awareness and Person-centred care Training tool is suitable for use by researchers to establish the availability, content and reach of dementia and person-centred care awareness training to staff within research studies.

Patient care quality is a key concern for long-term care facilities and is directly related to effective collaboration between healthcare professionals. The use of agency staff in long-term care facilities creates important challenges in terms of coordination and communication within work units. OBJECTIVES: The purpose of this study is to assess the mediating effect of common in-group identity in the relationship between permanent employees’ perceptions regarding the use of agency workers -namely distributive justice, perceptions of threat, perceived similarities with agency workers, and leader inclusiveness toward agency staff- and the permanent employees’ adoption of collaborative behaviours. DESIGN: Cross-sectional study. SETTINGS: Three long-term care facilities. PARTICIPANTS: 290 regular healthcare employees (nurses and care attendants). METHODS: Data were obtained through questionnaires filled out by employees. Hypotheses were tested using structural equation analyses. RESULTS: The results showed the indirect effects of perceived distributive justice, perceived similarity and leader inclusiveness toward agency workers on permanent employees’ cooperation behaviours through common group identification. Perceptions of threat were not related to common group identification or collaborative behaviours. The results also showed that common in-group identification is related to cooperation behaviours only for employees without previous experience as agency workers. CONCLUSIONS: This study suggests that permanent healthcare employees who feel they are fairly compensated relative to agency workers, who consider these workers as similar to them, and who believe their supervisor appreciates agency workers’ contributions tend to develop a common in-group identity, which fosters collaborative behaviours. Managers of long-term care facilities who wish to foster collaboration among their blended workforce should thus create an environment conducive of a more inclusive identity, particularly if their employees have no previous experience as agency workers.

Despite the increasing complexity of nursing home care, the role of physicians caring for residents is largely unexplored. This international, exploratory study sought to learn about physicians’ roles, responsibilities, and tasks as well as investigate the unique qualities of medical practice in nursing homes. We conducted interviews with 18 physicians, who reported making important contributions to the quality of resident care, including clarifying the goals of care, working to reduce unnecessary medication and hospitalization, as well as contributing to staff education. Nursing home practice involved physicians in networks of relations that were instrumental to the quality of medical care and physicians’ job satisfaction. The importance of these relationships disrupts the oft-drawn boundary between the medical and the social, suggesting that good medical practice depends on good social practice. Reflecting the exploratory nature of the study, we recommend research to better understand and support the relational dimensions of nursing home medicine.

Staffing practices in long-term care lack a clear evidence base and often seem to be guided by opinions instead of evidence. While stakeholders believe intuitively that there is a positive relationship between staffing levels and quality in nursing homes, the research literature is contradictory. In this editorial we consider the evidence found in a literature study that we conducted for the Dutch Ministry of Health, Welfare and Sports (VWS). The aim of this study was to summarize all available evidence on the relationship between staffing and quality in nursing homes. Specifically, we focused on the quantity and the educational background of staff and quality in nursing homes.

Potentially inappropriate drug prescribing (PIDP) is frequent in nursing home (NH) residents. We aimed to investigate whether a geriatric intervention on quality of care reduced PIDP. METHODS: We performed an ancillary study within a multicentric individually-tailored controlled trial (IQUARE trial). All NH received a baseline and 18-month audit regarding drug prescriptions and other quality of care indicators. After the initial audit, NHs of the intervention group benefited of an in-site intervention (geriatric education for NH staff) provided by a geriatrician from the closest hospital. The analysis included 629 residents of 159 NHs. The main outcome was PIDP, defined as the presence of at least 1 of the following criteria: (1) drug with an unfavorable benefit-to-risk ratio; (2) with questionable efficacy; (3) absolute contraindication; (4) significant drug-drug interaction. Multivariable multilevel logistic regression models were performed including residents and NH factors as confounders. RESULTS: PIDP was 65.2% (-3.6% from baseline) in the intervention group (n=339) and 69.9% (-2.3%) in the control group (n=290). The intervention significantly decreased PIDP (OR=0.63; 95% CI (0.40 to 0.99)), as a special care unit in NH (OR=0.60; (0.42 to 0.85)), and a fall in the last 12 months (OR=0.63; (0.44 to 0.90)). Charlson Comorbidity Index (ORCCI=1 versus 0 =1.38; (0.87 to 2.19), ORCCI >/= 2 versus 0 =2.01; (1.31 to 3.08)) and psychiatric advice and/or hospitalization in a psychiatric unit (OR=1.53; (1.07 to 2.18)) increased the likelihood of PIDP. CONCLUSION: This intervention based on a global geriatric education resulted in a significant reduction of PIDP at patient’s level.

Productivity trend information is valuable in developing policy and for understanding changes in the ‘value for money’ of the care system. In this paper, we consider approaches to measuring productivity of adult social care (ASC), and particularly care home services. Productivity growth in the public sector is traditionally measured by comparing change in total output to change in total inputs, but has not accounted for changes in service quality and need. In this study, we propose a method to estimate ‘quality adjusted’ output based on indicators of the Adult Social Care Outcomes Toolkit (ASCOT), using data collected in the annual adult social care survey (ASCS). When combined with expenditure and activity data for 2010 to 2012, we found that this approach was feasible to implement with current data and that it altered the productivity results compared with non-adjusted productivity metrics. Overall, quality-adjusted productivity grew in most regions between 2010 and 2011 and remained unchanged for most regions from 2011 to 2012.

Pressure ulcers are areas of localised damage to the skin and underlying tissue; and can cause pain, immobility, and delay recovery, impacting on health-related quality of life. The individuals who are most at risk of developing a pressure ulcer are those who are seriously ill, elderly, have impaired mobility and/or poor nutrition; thus, many nursing home residents are at risk. OBJECTIVES: To understand the context of pressure ulcer prevention in nursing homes and to explore the potential barriers and facilitators to evidence-informed practices. METHODS: Semi-structured interviews were conducted with nursing home nurses, healthcare assistants and managers, National Health Service community-based wound specialist nurses (known in the UK as tissue viability nurses) and a nurse manager in the North West of England. The interview guide was developed using the Theoretical Domains Framework to explore the barriers and facilitators to pressure ulcer prevention in nursing home residents. Data were analysed using a framework analysis and domains were identified as salient based on their frequency and the potential strength of their impact. FINDINGS: 25 participants (nursing home: 2 managers, 7 healthcare assistants, 11 qualified nurses; National Health Service community services: 4 tissue viability nurses, 1 manager) were interviewed. Depending upon the behaviours reported and the context, the same domain could be classified as both a barrier and a facilitator. We identified seven domains as relevant in the prevention of pressure ulcers in nursing home residents mapping to four “barrier” domains and six “facilitator” domains. The four “barrier” domains were knowledge, physical skills, social influences and environmental context and resources and the six “facilitator” domains were interpersonal skills, environmental context and resources, social influences, beliefs about capabilities, beliefs about consequences, social influences and social/professional role and identity). Knowledge and insight into these barriers and facilitators provide a theoretical understanding of the complexities in preventing pressure ulcers with reference to the staff capabilities, opportunities and motivation related to pressure ulcer prevention. CONCLUSION: Pressure ulcer prevention in nursing home residents is complex and is influenced by several factors. The findings will inform a theory and evidence-based intervention to aid the prevention of pressure ulcers in nursing home settings.

To empirically compare the measurement properties of the DEMQOL-U and DEMQOL-Proxy-U instruments to the EQ-5D-5L and its proxy version (CEQ-5D-5L) in a population of frail older people living in residential aged care in the post-hospitalisation period following a hip fracture. METHODS: A battery of instruments to measure health-related quality of life (HRQoL), cognition, and clinical indicators of depression, pain and functioning were administered at baseline and repeated at 4 weeks’ follow-up. Descriptive summary statistics were produced and psychometric analyses were conducted to assess the levels of agreement, convergent validity and known group validity between clinical indicators and HRQoL measures. RESULTS: There was a large divergence in mean (SD) utility scores at baseline for the EQ-5D-5L and DEMQOL-U [EQ-5D-5L mean 0.21 (0.19); DEMQOL-U mean 0.79 (0.14)]. At 4 weeks’ follow-up, there was a marked improvement in EQ-5D-5L scores whereas DEMQOL-U scores had deteriorated. [EQ-5D-5L mean 0.45 (0.38); DEMQOL-U mean 0.58 (0.38)]. The EQ-5D and CEQ-5D-5L were more responsive to the physical recovery trajectory experienced by frail older people following surgery to repair a fractured hip, whereas the DEMQOL-U and DEMQOL-Proxy-U appeared more responsive to the changes in delirium and dementia symptoms often experienced by frail older people in this period. CONCLUSIONS: This study presents important insights into the HRQoL of a relatively under-researched population of post-hospitalisation frail older people in residential care. Further research should investigate the implications for economic evaluation of self-complete versus proxy assessment of HRQoL and the choice of preference-based instrument for the measurement and valuation of HRQoL in older people exhibiting cognitive decline, dementia and other co-morbidities.

Variations across Finland in the use of six different long-term care (LTC) services among old people in their last 2 years of life, and the effects of characteristics of municipalities on the variations were studied. We studied variations in the use of residential home, sheltered housing, regular home care and inpatient care in health centre wards by using national registers. We studied how the use of LTC was associated with characteristics of the individuals and in particular characteristics of the municipalities in which they lived. Analyses were conducted with multilevel binary logistic regression. Data included all individuals (34,753) who died in the year 2008 at the age of 70 or over. Of those, 58.3% used some kind of LTC during their last 2 years of life. We found considerable variations between municipalities in the use of different kinds of LTC. A portion of the variation was explained by municipality characteristics. The size and location of the municipality had the strongest association with the use of different kinds of LTC. The economic status of the municipality and morbidity at the population level were poorly associated with LTC use, whereas old-age dependency showed no association. When individual-level characteristics were added to the models, these associations did not alter. Results indicated that the delivery system characteristics had an important effect on the use of LTC services. The considerable variation in LTC services also poses questions with respect to equity in access and to quality of LTC across the country.

The gap between implementers and researchers of quality improvement (QI) has hampered the degree and speed of change needed to reduce avoidable suffering and harm in health care. Underlying causes of this gap include differences in goals and incentives, preferred methodologies, level and types of evidence prioritized and targeted audiences. The Salzburg Global Seminar on ‘Better Health Care: How do we learn about improvement?’ brought together researchers, policy makers, funders, implementers, evaluators from low-, middle- and high-income countries to explore how to increase the impact of QI. In this paper, we describe some of the reasons for this gap and offer suggestions to better bridge the chasm between researchers and implementers. Effectively bridging this gap can increase the generalizability of QI interventions, accelerate the spread of effective approaches while also strengthening the local work of implementers. Increasing the effectiveness of research and work in the field will support the knowledge translation needed to achieve quality Universal Health Coverage and the Sustainable Development Goals.

This scoping review examines what is known about the processes of quality improvement (QI) teams, particularly related to how teams impact outcomes. The aim is to provide research-informed guidance for QI leaders and to inform future research questions. Data sources: Databases searched included: MedLINE, EMBASE, CINAHL, Web of Science and SCOPUS. Study selection: Eligible publications were written in English, published between 1999 and 2016. Articles were included in the review if they examined processes of the QI team, were related to healthcare QI and were primary research studies. Studies were excluded if they had insufficient detail regarding QI team processes. Data extraction: Descriptive detail extracted included: authors, geographical region and health sector. The Integrated (Health Care) Team Effectiveness Model was used to synthesize findings of studies along domains of team effectiveness: task design, team process, psychosocial traits and organizational context. Results of data synthesis: Over two stages of searching, 4813 citations were reviewed. Of those, 48 full-text articles are included in the synthesis. This review demonstrates that QI teams are not immune from dysfunction. Further, a dysfunctional QI team is not likely to influence practice. However, a functional QI team alone is unlikely to create change. A positive QI team dynamic may be a necessary but insufficient condition for implementing QI strategies. Conclusions: Areas for further research include: interactions between QI teams and clinical microsystems, understanding the role of interprofessional representation on QI teams and exploring interactions between QI team task, composition and process.

This paper reviews the role of space in facilitating innovation. It draws on the sociology of space in exploring the social practices, institutional forces and material complexity of how people and spaces interact. We assess how space influences the development of innovative solutions to challenges in the health sector. Our aim is to advance an understanding of the social production of space for healthcare innovation. We draw empirical examples from the Innovation Hub at Groote Schuur Hospital in Cape Town to illustrate that innovation does not take place in an institutional vacuum, but requires space that facilitates interaction of different players. This paper demonstrates that space matters in promoting innovation, particularly through its influence on social relationships and networks. An attractive and novel space, which is different from the usual workplace, stimulates innovation, mainly through being a base for the creation of an ecosystem for the productive interaction of different players. The interaction is important in inspiring new ideas, facilitating creative thought processes, maintaining the flow of information and bringing innovation to life.

Beginning in 2012, Lean was introduced to improve health care quality and promote patient-centredness throughout the province of Saskatchewan, Canada with the aim of producing coordinated, system-wide change. Significant investments have been made in training and implementation, although limited evaluation of the outcomes have been reported. In order to better understand the complex influences that make innovations such as Lean “workable” in practice, Normalization Process Theory guided this study. The objectives of the study were to: a) evaluate the implementation processes associated with Lean implementation in the Saskatchewan health care system from the perspectives of health care professionals; and b) identify demographic, training and role variables associated with normalization of Lean. METHODS: Licensed health care professionals were invited through their professional associations to complete a cross-sectional, modified, online version of the NoMAD questionnaire in March, 2016. Analysis was based on 1032 completed surveys. Descriptive and univariate analyses were conducted. Multivariate multinomial regressions were used to quantify the associations between five NoMAD items representing the four Normalization Process Theory constructs (coherence, cognitive participation, collective action and reflexive monitoring). RESULTS: More than 75% of respondents indicated that neither sufficient training nor resources (collective action) had been made available to them for the implementation of Lean. Compared to other providers, nurses were more likely to report that Lean increased their workload. Significant differences in responses were evident between: leaders vs. direct care providers; nurses vs. other health professionals; and providers who reported increased workload as a result of Lean vs. those who did not. There were no associations between responses to normalization construct proxy items and: completion of introductory Lean training; participation in Lean activities; age group; years of professional experience; or employment status (full-time or part-time). Lean leader training was positively associated with proxy items reflecting coherence, cognitive participation and reflexive monitoring. CONCLUSIONS: From the perspectives of the cross-section of health care professionals responding to this survey, major gaps remain in embedding Lean into healthcare. Strategies that address the challenges faced by nurses and direct care providers, in particular, are needed if intended goals are to be achieved.

In this editorial essay I explore the possibilities of ‘improvement scholarship’ in order to set the scene for the theme of, and the other papers in, this issue. I contrast a narrow conception of quality improvement (QI) research with a much broader and more inclusive conception, arguing that we should greatly extend the existing dialogue between ‘problem-solving’ and ‘critical’ currents in improvement research. I have in mind the potential for building a much larger conversation between those people in ‘improvement science’ who are expressly concerned with tackling the problems facing healthcare and the wider group of colleagues who are engaged in health-related scholarship but who do not see themselves as particularly interested in quality improvement, indeed who may be critical of the language or concerns of QI. As one contribution to that conversation I suggest that that the increasing emphasis on theory and rigour in improvement research should include more focus on normative theory and rigour. The remaining papers in the issue are introduced including the various ways in which they handle the ‘implicit normativity’ of QI research and practice, and the linked theme of combining relatively ‘tidy’ and potentially ‘unruly’ forms of knowledge.

Despite criticisms that many quality improvement (QI) initiatives fail due to incomplete programme theory, there is no defined way to evaluate how programme theory has been articulated. The objective of this research was to develop, and assess the usability and reliability of scoring criteria to evaluate programme theory diagrams. Methods: Criteria development was informed by published literature and QI experts. Inter-rater reliability was tested between two evaluators. About 63 programme theory diagrams (42 driver diagrams and 21 action-effect diagrams) were reviewed to establish whether the criteria could support comparative analysis of different approaches to constructing diagrams. Results: Components of the scoring criteria include: assessment of overall aim, logical overview, clarity of components, cause-effect relationships, evidence and measurement. Independent reviewers had 78% inter-rater reliability. Scoring enabled direct comparison of different approaches to developing programme theory; action-effect diagrams were found to have had a statistically significant but moderate improvement in programme theory quality over driver diagrams; no significant differences were observed based on the setting in which driver diagrams were developed. Conclusions: The scoring criteria summarise the necessary components of programme theory that are thought to contribute to successful QI projects. The viability of the scoring criteria for practical application was demonstrated. Future uses include assessment of individual programme theory diagrams and comparison of different approaches (e.g. methodological, teaching or other QI support) to produce programme theory. The criteria can be used as a tool to guide the production of better programme theory diagrams, and also highlights where additional support for QI teams could be needed.

There are many challenges in the development, implementation and evaluation of healthcare policy. One challenge is understanding how different stakeholders view a particular policy and what impact these views may have during implementation. Q-methodology is one approach that can be used to help policy makers and researchers actively engage with those who are important in policy implementation, and anticipate their responses. Q-methodology combines qualitative and quantitative research methods to systematically explore and describe the range of viewpoints about a topic. Participants are required to rank a set of predefined statements relating to the topic, according to their own viewpoint. Factor analytic techniques then identify people who are like-minded in the way they view the topic and enable areas of consensus and divergence in viewpoint to be clearly defined. This mapping of viewpoints allows those working in policy implementation to anticipate likely barriers and levers in implementing new policies.

The Nuffield Trust was commissioned by the Barking and Dagenham, Havering and Redbridge Clinical Commissioning Groups to evaluate a new primary care service that was being piloted in four nursing homes in the London Borough of Havering that had previously had difficulty accessing GP services. The service’s main features were the assignment of a single GP practice to all residents; access to health care professionals with expertise in caring for older people with complex needs; extended access beyond normal GP hours; care guidance to nursing home staff; improved medicines management; and new approaches for managing people who are at the end of life. The evaluation suggests that there are benefits in providing proactive primary care for nursing homes, delivered by a consistent GP within a service that specialises in older people with complex care needs.

Health-system policymakers are increasingly expected to use research evidence in their day-to-day activities. Growing calls for ‘evidence-based’ or ‘evidence-informed’ policymaking highlight the need to use the best available research evidence – systematically and transparently – in the time available to set agendas, formulate policies, implement policies, and monitor and evaluate policies. This rapid synthesis aims to identify what is known about strategies to foster an organizational culture supportive of evidence-informed policymaking.

Systematic reviews are generally placed above narrative reviews in an assumed hierarchy of secondary research evidence. We argue that systematic reviews and narrative reviews serve different purposes and should be viewed as complementary. Conventional systematic reviews address narrowly focused questions; their key contribution is summarising data. Narrative reviews provide interpretation and critique; their key contribution is deepening understanding.

To examine care characteristics related to desirable care as reported by formal and informal caregivers in Dutch Psycho-geriatric nursing homes for patients with dementia. Design: Qualitative exploratory study. Methods: The sample consisted of four nursing homes. In each home, semi-structured interviews were conducted with a manager, a quality advisor or head nurse, a daily care supervisor and an informal caregiver. The findings were analysed by labelling and coding the text fragments. Results: The 16 semi-structured interviews contained 60 discussion items. The 16 items that were shared by the four interviewee categories were clustered into the following six major themes: good quality of care; poor quality of care; elements of a vision; extra hands; bureaucracy; and formal caregivers.

Dehydration in the older people is a prevalent problem that is often associated with physiological changes, physical limitations and environmental conditions. OBJECTIVES: The scoping review was carried out to identify risk factors associated with dehydration in older people living in nursing homes. DESIGN: The revised scoping methodology framework of Arksey and O’Malley (2005) was applied. Study selection was carried out in accordance with Davis et al. (2009) and focused on the inclusion criteria (people over 65 years old and living in nursing homes). Risk factors were classified using the geriatric assessment. DATA SOURCES: An electronic database search was performed in PubMed, Scopus and CINAHL. The literature search was carried out between October 2016 and January 2017. REVIEW METHODS: Thematic reporting was performed and study findings were validated through interdisciplinary meetings of experts. The quality of the papers consulted was also evaluated using the Newcastle-Ottawa Scale adapted for cross-sectional, cohort and case-control studies. RESULTS: In all, 16 papers were analysed, all of which were observational studies. The risk of bias ranged from very low (n=1), to medium (n=13) and high (n=2). The risk factors were classified in line with the different components of the geriatric assessment. In the socio-demographic characteristics age and gender were identified. In the clinical component, infections, renal and cardiovascular diseases and end-of-life situations were the most common factors highlighted in the papers analysed. With reference to the functional component, its limitation was associated with dehydration, while for factors of mental origin, it was related to dementia and behavioural disorders. Finally, the factors relating to the social component were institutionalisation, requiring a skilled level of care and it being winter. CONCLUSIONS: The most commonly repeated factors highlighted in the review were age, gender, infections, end of life and dementia, with it being important to highlight the large number of factors in the clinical component. Even so, the great majority of the factors were unmodifiable conditions associated typically associated with the physiology of ageing.

It is critical to ensure that long-term care (LTC) homes are sensitive to the needs of lesbian, gay, bisexual, and transgender (LGBT) older adults. However, the extent to which the LTC home sector has adopted recommended strategies is unknown. This qualitative study reports findings from two initiatives: Semi-structured telephone interviews with Canadian LTC home administrators on strategies adopted to support LGBT inclusivity (n = 32), and discussions with participants attending a 2-day meeting on supporting LGBT inclusivity in LTC (n = 25). We found that LGBT inclusivity training was the most commonly adopted strategy among the LTC homes surveyed. Study findings further suggested that practices more visible to residents and families, such as LGBT-themed programming, inclusive language and symbols, or joint initiatives with LGBT communities, were less commonly adopted because of anticipated negative resident/family reactions. The importance and benefits of comprehensive strategies that include staff, residents, and family are discussed.

The Canadian Knowledge Mobilization Forum was founded in 2012 by Knowledge Mobilization Works – a consulting company founded by Peter Norman Levesque – to support a growing international community in knowledge mobilization. The success of the event and input from a broad range of people led to the creation and crowd funding of the Institute for Knowledge Mobilization – who is now the host and organizer of the Forum.

The workshop is for individuals and teams interested in learning about how to develop proposals for, organize, and write about DBIR research projects. The workshop is designed for both individual researchers and practitioners in K-12, higher education, and informal settings, as well as for teams that comprise both researchers and practitioners from these settings. Teams may be composed of participants from either newly forming or mature research-practice partnerships

The Masterclass is a two-day course designed for health professionals, researchers, patients and service users, policymakers, commissioners and managers. The Masterclass includes lectures, group work, and guidance to help participants work more effectively on implementation projects.

The aim of this workshop is to introduce participants to the idea of human-centred design. Participants will discuss and try different human-centred design methods; co-design solutions to identify what works, what doesn’t, what needs to change and why; and plan not only the tool but also its implementation plan. Participants will work in groups of three to five people, applying the aforementioned concepts in a variety of ways. This will allow participants to understand the value of human-centred design when developing and refining knowledge translation tools and strategies.

This course is open to students and researchers interested in drawing upon cognitive and behaviour change theories to promote changing practice to improve healthcare delivery (no prior experience required). Priority spaces for University of Ottawa graduate students.

The Institute Healthcare Institute (IHI) and HarvardX — Harvard University’s branch of the online learning venture edX — have collaborated to produce a free massive open online course (MOOC) on improvement science in health and health care. The course, Practical Improvement Science in Health Care: A Roadmap for Getting Results, starts on April 18, 2018 and lasts for seven weeks. Each week, learners will dive into engaging, interactive materials and relevant resources to start building an improvement toolkit that will serve them long after the seven-week course ends.

The Clinical Quality Improvement Program (CQIP) is a 10-month course designed to build capability in leading improvement work, with a focus on clinical quality improvement projects. The program includes a mix of theory and experiential learning, along with individual coaching and a community of practice. CQIP is a sister program to Intermountain Healthcare’s internationally recognized mini-Advanced Training program that has been adapted for Saskatchewan’s health care system.

Aging Matters: Living with Alzheimer’s and Dementia explores the impact these diseases are having on individuals, families and communities by weaving together the personal stories of those who are living with dementia, their care partners and commentary from leading experts in dementia. The program reveals the myths and stigmas that have hindered better living and better caring and examines the heavy burden of the costs associated with the disease, whether financial, physical or psychological by laying the foundation for a better understanding of the disease process, ways to care for those with dementia and the support systems families need in order to provide that care.

Alzheimer’s: Every Minute Counts is an urgent wake-up call about the national threat posed by Alzheimer’s disease. Many know the unique tragedy of this disease, but few know that Alzheimer’s is one of the most critical public health crises facing America. This powerful documentary illuminates the social and economic consequences for the country unless a medical breakthrough is discovered for this currently incurable disease.

The guide provides signposting, information and support for colleagues in health, social and community care settings, around advance care planning for people living with dementia. It identifies key actions from the point of an initial diagnosis of dementia through to the advanced condition, in order to highlight and prompt best practice irrespective of care setting.

This publication highlights some notable and innovative practice by councils in supporting people living with dementia after their diagnosis.

It’s often said that knowledge to tackle big problems in the world – food, water, climate, energy, biodiversity, disease and war – has to be ‘co-produced’. Tackling these problems is not just about solving ‘grand challenges’ with big solutions, it’s also about grappling with the underlying causal social and political drivers. But what does co-production actually mean, and how can it help to create knowledge that leads to real transformation?

A Kaiser Health News analysis of federal inspection records shows that nursing home inspectors labeled mistakes in infection control as serious for only 161 of the 12,056 homes they have cited since 2014.

We work with people and try to help them to develop — a task that requires much more of us than our academic training. If we’re not psychologically healthy, it’s near-impossible to do our jobs well. Here are some suggestions for making it through the semester.

Westmount Long-Term Care Residence met and surpassed their target for reducing potentially inappropriate use of antipsychotics among their resident population, as outlined in their Quality Improvement Plan progress report from 2017/18.

“When it comes to silencing women,” writes Mary Beard, “Western culture has had thousands of years of practice.” Academe is no exception. A recent conference at Stanford University featured 30 speakers — all of them men, all of them white. The incident sparked ridicule and outrage, as well as a sense that higher education is facing a reckoning. Over the past few months, amid mounting revelations of sexual harassment, The Chronicle Review asked presidents and adjuncts, scientists and humanists, senior scholars and junior professors to take on the theme of women and power in academe. Here are their responses.

Academic careers, then, are often determined by so-called evidence that is flimsy at best, from teaching evaluations that are unrelated to student learning, to professional writing that is rarely if ever read, to service that is difficult if not impossible to evaluate. Further, the bias introduced by factors such as race and gender in each of these areas is unacceptable. The author suggests three alternative approaches to evaluating a candidate for tenure.

In 2016, the co-produced pathway to impact (CPPI) with PREVNet was published. It describes the processes that supported research to impact. Working with Kids Brain Health Network, KMb York has made some small and not so small additions to the pathway.

The latest report on the state of research and development in Canada calls to mind Lewis Carroll’s Red Queen, who famously had to keep running at top speed to stay in one place. The problem is that Canada’s innovation efforts may not amount to even that much, as other countries surge forward with investments that leverage science and technology and reap the economic rewards.

The more sophisticated science becomes, the harder it is to communicate results. Papers today are longer than ever and full of jargon and symbols. They depend on chains of computer programs that generate data, and clean up data, and plot data, and run statistical models on data. These programs tend to be both so sloppily written and so central to the results that it’s contributed to a replication crisis, or put another way, a failure of the paper to perform its most basic task: to report what you’ve actually discovered, clearly enough that someone else can discover it for themselves. Perhaps the paper itself is to blame.

Globe and mail personal piece by a nurse at a nursing home.

As President & CEO, you will have a pan-Canadian focus, supporting healthcare organizations as they adopt, implement and measure improvements in patient care, population health and value-for-money. You will lead a team of over 70 dedicated staff, promoting a proactive, collaborative, and service-oriented culture and a healthy work-life balance during a period of growth and change. Reporting to a Board of Directors, you and your team will develop and deliver on CFHI’s strategic priorities, working in close collaboration with key partners and stakeholders across the country, including healthcare administrators, governments, policy makers, clinicians, patients and families, private sector leaders and professional associations.