Assessing organisational readiness for change: use of diagnostic analysis prior to the implementation of a multidisciplinary assessment for acute stroke care

Hamilton, Sharon; McLaren, Susan; Mulhall, Anne

doi:10.1186/1748-5908-2-21

Cited by 55 publications

(44 citation statements)

References 31 publications

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“…Readiness to change theories focuses more on the subjective disposition of personnel [37][38][39] than receptive context theories, which highlight more objective and external influence [29,40]. Both types of theories helped to explain how the integration could be proposed and accepted by many different stakeholders, and how it could be developed beyond the initial structural integration.…”

Section: Discussionmentioning

confidence: 99%

An integrated health and social care organisation in Sweden: Creation and structure of a unique local public health and social care system

2010

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Section: Discussionmentioning

confidence: 99%

An integrated health and social care organisation in Sweden: Creation and structure of a unique local public health and social care system

2010

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“…[108][109][110] Other work has identified factors such as stakeholder support, team climate and individual attitudes and preferences. 111,112 Exemplars of past successful change are also considered important in giving those involved a sense of confidence that the proposed change can and will be achieved. 113 Research reported in 2006 110 concluded that NHS organisations showed high variability in some of these important readiness factors, for example in the infrastructure for improvement and the use of improvement tools and techniques.…”

Section: Organisational Receptivity and Readiness For Changementioning

confidence: 99%

Evaluation of a national surveillance system for mortality alerts: a mixed-methods study

Aylin

Bottle

Burnett

et al. 2018

Health Serv Deliv Res

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BackgroundSince 2007, Imperial College London has generated monthly mortality alerts, based on statistical process control charts and using routinely collected hospital administrative data, for all English acute NHS hospital trusts. The impact of this system has not yet been studied.ObjectivesTo improve understanding of mortality alerts and evaluate their impact as an intervention to reduce mortality.DesignMixed methods.SettingEnglish NHS acute hospital trusts.ParticipantsEleven trusts were included in the case study. The survey involved 78 alerting trusts.Main outcome measuresRelative risk of mortality and perceived efficacy of the alerting system.Data sourcesHospital Episodes Statistics, published indicators on quality and safety, Care Quality Commission (CQC) reports, interviews and documentary evidence from case studies, and a national evaluative survey.MethodsDescriptive analysis of alerts; association with other measures of quality; associated change in mortality using an interrupted time series approach; in-depth qualitative case studies of institutional response to alerts; and a national cross-sectional evaluative survey administered to describe the organisational structure for mortality governance and perceptions of efficacy of alerts.ResultsA total of 690 mortality alerts generated between April 2007 and December 2014. CQC pursued 75% (154/206) of alerts sent between 2011 and 2013. Patient care was cited as a factor in 70% of all investigations and in 89% of sepsis alerts. Alerts were associated with indicators on bed occupancy, hospital mortality, staffing, financial status, and patient and trainee satisfaction. On average, the risk of death fell by 58% during the 9-month lag following an alert, levelling afterwards and reaching an expected risk within 18 months of the alert. Acute myocardial infarction (AMI) and sepsis alerts instigated institutional responses across all the case study sites, although most sites were undertaking some parallel activities at a more general level to address known problems in care in these and other areas. Responses included case note review and coding improvements, changes in patient pathways, changes in diagnosis of sepsis and AMI, staff training in case note write-up and coding, greater transparency in patient deterioration, and infrastructure changes. Survey data revealed that 86% of responding trusts had a dedicated trust-level lead for mortality reduction and 92% had a dedicated trust-level mortality group or committee in place. Trusts reported that mortality reduction was a high priority and that there was strong senior leadership support for mortality monitoring. The weakest areas reported concerned the accuracy of coding, the quality of specialty-level mortality data and understanding trends in specialty-level mortality data.LimitationsOwing to the correlational nature of our analysis, we could not ascribe a causal link between mortality alerts and reductions in mortality. The complexity of the institutional context and behaviour hindered our capacity to attribute locally reported changes specifically to the effects of the alerts rather than to ongoing institutional strategy.ConclusionsThe mortality alert surveillance system reflects aspects of quality care and is valued by trusts. Alerts were considered a useful focus for identifying problems and implementing interventions around mortality.Future workA further analysis of site visits and survey material, the application of evaluative framework to other interventions, a blinded case note review and the dissemination of findings.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…Barrier factors and facilitator factors identified here can serve as motivators for organizations looking to improve biosafety practices in their institutions. 12 We recommend a reevaluation of biosafety practices regularly to assess the impact of ongoing education and training activities.…”

Section: Barriers To Biosafety Practices In Pakistanmentioning

confidence: 99%

Barriers to Implementation of Optimal Laboratory Biosafety Practices in Pakistan

Shakoor¹,

Shafaq²,

Hasan³

et al. 2016

Health Security

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The primary goal of biosafety education is to ensure safe practices among workers in biomedical laboratories. Despite several educational workshops by the Pakistan Biological Safety Association (PBSA), compliance with safe practices among laboratory workers remains low. To determine barriers to implementation of recommended biosafety practices among biomedical laboratory workers in Pakistan, we conducted a questionnaire-based survey of participants attending 2 workshops focusing on biosafety practices in Karachi and Lahore in February 2015. Questionnaires were developed by modifying the BARRIERS scale in which respondents are required to rate barriers on a 1-4 scale. Nineteen of the original 29 barriers were included and subcategorized into 4 groups: awareness, material quality, presentation, and workplace barriers. Workshops were attended by 64 participants. Among barriers that were rated as moderate to great barriers by at least 50% of respondents were: lack of time to read biosafety guidelines (workplace subscale), lack of staff authorization to change/improve practice (workplace subscale), no career or self-improvement advantages to the staff for implementing optimal practices (workplace subscale), and unclear practice implications (presentation subscale). A lack of recognition for employees' rights and benefits in the workplace was found to be a predominant reason for a lack of compliance. Based on perceived barriers, substantial improvement in work environment, worker facilitation, and enabling are needed for achieving improved or optimal biosafety practices in Pakistan.

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Assessing organisational readiness for change: use of diagnostic analysis prior to the implementation of a multidisciplinary assessment for acute stroke care

Cited by 55 publications

References 31 publications

An integrated health and social care organisation in Sweden: Creation and structure of a unique local public health and social care system

An integrated health and social care organisation in Sweden: Creation and structure of a unique local public health and social care system

Evaluation of a national surveillance system for mortality alerts: a mixed-methods study

Barriers to Implementation of Optimal Laboratory Biosafety Practices in Pakistan

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