IntroductionSuccessful implementation and embedding of new health care practices relies on co-ordinated, collective behaviour of individuals working within the constraints of health care settings. Normalization Process Theory (NPT) provides a theory of implementation that emphasises collective action in explaining, and shaping, the embedding of new practices. To extend the practical utility of NPT for improving implementation success, an instrument (NoMAD) was developed and validated.MethodsDescriptive analysis and psychometric testing of an instrument developed by the authors, through an iterative process that included item generation, consensus methods, item appraisal, and cognitive testing. A 46 item questionnaire was tested in 6 sites implementing health related interventions, using paper and online completion. Participants were staff directly involved in working with the interventions. Descriptive analysis and consensus methods were used to remove redundancy, reducing the final tool to 23 items. Data were subject to confirmatory factor analysis which sought to confirm the theoretical structure within the sample.ResultsWe obtained 831 completed questionnaires, an average response rate of 39% (range: 22–77%). Full completion of items was 50% (n = 413). The confirmatory factor analysis showed the model achieved acceptable fit (CFI = 0.95, TLI = 0.93, RMSEA = 0.08, SRMR = 0.03). Construct validity of the four theoretical constructs of NPT was supported, and internal consistency (Cronbach’s alpha) were as follows: Coherence (4 items, α = 0.71); Collective Action (7 items, α = 0.78); Cognitive Participation (4 items, α = 0.81); Reflexive Monitoring (5 items, α = 0.65). The normalisation scale overall, was highly reliable (20 items, α = 0.89).ConclusionsThe NoMAD instrument has good face validity, construct validity and internal consistency, for assessing staff perceptions of factors relevant to embedding interventions that change their work practices. Uses in evaluating and guiding implementation are proposed.Electronic supplementary materialThe online version of this article (10.1186/s12874-018-0591-x) contains supplementary material, which is available to authorized users.

Contexts: An evidence base for CAM consumption within general populations is emerging. However, research data on CAM use for headache disorders remains poorly documented. This paper, constituting the first critical review of literature on this topic, provides a synopsis and evaluation of the research findings on CAM use amongst patients with headache and migraine.Methods: A comprehensive search of literature from 2000 to 2011 in CINAHL, MEDLINE, AMED, and Health Sources was conducted. The search was confined to peer-reviewed articles published in English reporting empirical research findings of CAM use among people with primary headache or migraine.Results: The review highlights a substantial level of CAM use among people with headache and migraine. There is also evidence of many headache and migraine sufferers using CAM concurrent to their conventional medicine use. Overall, the existing studies have been methodologically weak and there is a need for further rigorous research employing mixed method designs and utilizing large national samples. Discussion:The critical review highlights the substantial prevalence of CAM use amongst people with headache and migraine as a significant health care delivery issue and healthcare professionals should be prepared to enquire and discuss possible CAM use with their patients during consultations. Healthcare providers should also pay attention to the possible adverse effects of CAM or interactions between CAM and conventional medical treatments amongst headache and migraine patients. KeywordsHeadache, migraine, complementary and alternative medicine, prevalence, review Over recent decades, the evidence base for CAM consumption within general populations has emerged. 9-13 However, research data on CAM use for specific health or clinical conditions remains less well documented and the use of CAM specifically for headache and migraine is no exception. This paper provides the first critical, systematic examination of the evidence-base of this crucial healthcare issue, synthesizing empirical research findings and highlighting a number of gaps and challenges facing future research in this increasingly important practice area. Headache and Migraine: The Significance of Exploring CAM UseHeadache and migraine is a very common health condition and according to the International Headache Society the percentage of the global adult population with an active general headache disorder is 46% with 11% suffering from migraines, 42% suffering tension-type headaches and 3% suffering chronic daily headache. 14 A systematic review has identified the global prevalence of chronic migraine at 0-5.1%, 4 with estimates typically in the range of 1.4-2.2% of the general population. 15 The impact of headache disorders is substantial and the World Health Organization ranks headache disorders as some of the most disabling conditions for both men and women. 14 Given the substantial effect of headache and migraine on the quality of life of the sufferer and the significant disruption to work, family ...

Background: In increasingly constrained healthcare budgets worldwide, efforts to improve quality and reduce costs are vital. Quality Improvement Collaboratives (QICs) are often used in healthcare settings to implement proven clinical interventions within local and national programs. The cost of this method of implementation, however, is cited as a barrier to use. This systematic review aims to identify and describe studies reporting on costs and cost-effectiveness of QICs when used to implement clinical guidelines in healthcare. Methods: Multiple databases (CINAHL, MEDLINE, PsycINFO, EMBASE, EconLit and ProQuest) were searched for economic evaluations or cost studies of QICs in healthcare. Studies were included if they reported on economic evaluations or costs of QICs. Two authors independently reviewed citations and full text papers. Key characteristics of eligible studies were extracted, and their quality assessed against the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). Evers CHEC-List was used for full economic evaluations. Cost-effectiveness findings were interpreted through the Johanna Briggs Institute 'three by three dominance matrix tool' to guide conclusions. Currencies were converted to United States dollars for 2018 using OECD and World Bank databases. Results: Few studies reported on costs or economic evaluations of QICs despite their use in healthcare. Eight studies across multiple healthcare settings in acute and long-term care, community addiction treatment and chronic disease management were included. Five were considered good quality and favoured the establishment of QICs as cost-effective implementation methods. The cost savings to the healthcare setting identified in these studies outweighed the cost of the collaborative itself. Conclusions: Potential cost savings to the health care system in both acute and chronic conditions may be possible by applying QICs at scale. However, variations in effectiveness, costs and elements of the method within studies, indicated that caution is needed. Consistent identification of costs and description of the elements applied in QICs would better inform decisions for their use and may reduce perceived barriers. Lack of studies with negative findings may have been due to publication bias. Future research should include economic evaluations with societal perspectives of costs and savings and the cost-effectiveness of elements of QICs.

Background: Implementing high reliability organization principles can enhance quality and safety in healthcare. Evidence-based instructions on how to effectively change the organizational culture in healthcare setting are required. Objectives:  A systematic review investigating methods, facilitators, and barriers to assist healthcare organizations in becoming a high reliability organization. Method: Literature searches were performed in PubMed, MEDLINE, CINAHL-Complete, EMBASE, and Scopus for articles published between January 2012 and October 2017. The included articles were case reports, case studies, and protocol development studies on implementing high reliability organization principles. The articles were appraised using a modified Critical Appraisal Skills Programme tool. Thematic synthesis was conducted using manual coding.  Results: Of the 14 eligible articles nine were case studies, four were case reports, and one was a framework development report. The study populations varied from whole healthcare systems to a single department of a hospital. The most common methods were supportive leadership, staff education, and analysing the safety events and sharing the knowledge. Cost was one of the barriers. Remuneration came in reduction of safety events and costs avoided. Conclusion Implementing high reliability organization principles in healthcare settings is slow and challenging, but doing so improves quality, resilience, and safety, thus increasing productivity.

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Background: Implementing high reliability organization principles can enhance quality and safety in healthcare. Evidence-based instructions on how to effectively change the organizational culture in healthcare setting are required.Objectives: A systematic review investigating methods, facilitators, and barriers to assist healthcare organizations in becoming a high reliability organization. Method:Literature searches were performed in PubMed, MEDLINE, CINAHL-Complete, EMBASE, and Scopus for articles published between January 2012 and October 2017. The included articles were case reports, case studies, and protocol development studies on implementing high reliability organization principles. The articles were appraised using a modified Critical Appraisal Skills Programme tool. Thematic synthesis was conducted using manual coding. Results:Of the 14 eligible articles nine were case studies, four were case reports, and one was a framework development report. The study populations varied from whole healthcare systems to a single department of a hospital. The most common methods were supportive leadership, staff education, and analysing the safety events and sharing the knowledge. Cost was one of the barriers. Remuneration came in reduction of safety events and costs avoided. ConclusionImplementing high reliability organization principles in healthcare settings is slow and challenging, but doing so improves quality, resilience, and safety, thus increasing productivity.

Background Factors that influence utilisation rates of patient reported outcome measures (PROMs) for low back pain (LBP) within the chiropractic profession of Australia are currently unknown. This study aimed to examine whether factors, including age, sex, experience level, clinical title (principal vs associate), or a clinicians’ perceived value of PROMs, are predictive of the frequency and/or type of PROMs used by chiropractors in the management of LBP. Methods A cross sectional online survey was distributed to members of the Chiropractic Association of Australia (CAA now known as Australian Chiropractors Association-ACA) and Chiropractic Australia (CA). 3,014 CAA members and 930 CA members were invited to participate totaling 3,944, only respondents that were using PROMs were included in the analysis (n = 370). Ordinal logistic regression was used to examine associations between clinician demographics and perceived value of PROMs, and the frequency of pain, health, and functional patient reported outcome measure (PROM) usage by chiropractors. Results Principal chiropractors were more likely (Wald = 4.101, p = 0.04, OR = 1.4 (1.0–2.1)) than associate chiropractors to frequently use pain-related PROMs for the management of patients with LBP. The remaining demographic factors (age, sex, and experience level) were not associated with the frequency of PROM usage; nor were the perceived value clinicians place on PROMs in clinical practice. Conclusion Principal chiropractors were more likely to frequently use pain-related PROMs for the management of patients with LBP when compared to associate chiropractors. Demographic factors, appear to have little influence on PROM usage. While chiropractors place high value on PROMs, these beliefs are not associated with increased frequency of PROM usage for the management of LBP.

In increasingly constrained health and aged care services, strategies are needed to improve quality and translate evidence into practice. In dementia care, recent failures in quality and safety have led the WHO to prioritise the translation of known evidence into practice. While quality improvement collaboratives have been widely used in healthcare, there are few examples in dementia care.We describe a recent quality improvement collaborative to improve dementia care across Australia and assess the implementation outcomes of acceptability and feasibility of this strategy to translate known evidence into practice. A realist-informed process evaluation was used to analyse how, why and under what circumstances a quality improvement collaborative built knowledge and skills in clinicians working in dementia care.This realist-informed process evaluation developed, tested and refined the programme theory of a quality improvement collaborative. Data were collected pre-intervention and post-intervention using surveys and interviews with participants (n=28). A combined inductive and deductive data analysis process integrated three frameworks to examine the context and mechanisms of knowledge and skill building in participant clinicians.A refined program theory showed how and why clinicians built knowledge and skills in quality improvement in dementia care. Six mechanisms were identified: motivation, accountability, identity, collective learning, credibility and reflective practice. These mechanisms, in combination, operated to overcome constraints, role boundaries and pessimism about improved practice in dementia care.A quality improvement collaborative designed for clinicians in different contexts and roles was acceptable and feasible in building knowledge, skills and confidence of clinicians to improve dementia care. Supportive reflective practice and a credible, flexible and collaborative process optimised quality improvement knowledge and skills in clinicians working with people with dementia.Trial registration numberACTRN12618000268246.