Health professionals' enactment of their accountability obligations: Doing the best they can

Freeman, Andrew; McWilliam, Carol L.; MacKinnon, Joyce R.; DeLuca, Sandra; Rappolt, Susan

doi:10.1016/j.socscimed.2009.07.025

Cited by 31 publications

(41 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Reflecting on clinical quality interventions in general, occupational therapists noted that avoiding censure—e.g. through thorough documentation—was an important incentive for complying with these interventions ( [65]; General).…”

Section: Resultsmentioning

confidence: 99%

“…In a study, occupational therapists argued that, in the face of various “accountability dilemmas”, professionals had to choose about how to enact their various obligations. This involved setting “accountability priorities” ( [65]; General). On the other hand, lack of consistency of clinical quality interventions with clinicians’ goals and priorities could be a barrier to the implementation of these interventions.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Can the theoretical domains framework account for the implementation of clinical quality interventions?

Lipworth

Taylor

Braithwaite

2013

BMC Health Serv Res

View full text Add to dashboard Cite

BackgroundThe health care quality improvement movement is a complex enterprise. Implementing clinical quality initiatives requires attitude and behaviour change on the part of clinicians, but this has proven to be difficult. In an attempt to solve this kind of behavioural challenge, the theoretical domains framework (TDF) has been developed. The TDF consists of 14 domains from psychological and organisational theory said to influence behaviour change. No systematic research has been conducted into the ways in which clinical quality initiatives map on to the domains of the framework. We therefore conducted a qualitative mapping experiment to determine to what extent, and in what ways, the TDF is relevant to the implementation of clinical quality interventions.MethodsWe conducted a thematic synthesis of the qualitative literature exploring clinicians’ perceptions of various clinical quality interventions. We analysed and synthesised 50 studies in total, in five domains of clinical quality interventions: clinical quality interventions in general, structural interventions, audit-type interventions, interventions aimed at making practice more evidence-based, and risk management interventions. Data were analysed thematically, followed by synthesis of these themes into categories and concepts, which were then mapped to the domains of the TDF.ResultsOur results suggest that the TDF is highly relevant to the implementation of clinical quality interventions. It can be used to map most, if not all, of the attitudinal and behavioural barriers and facilitators of uptake of clinical quality interventions. Each of these 14 domains appeared to be relevant to many different types of clinical quality interventions. One possible additional domain might relate to perceived trustworthiness of those instituting clinical quality interventions.ConclusionsThe TDF can be usefully applied to a wide range of clinical quality interventions. Because all 14 of the domains emerged as relevant, and we did not identify any obvious differences between different kinds of clinical quality interventions, our findings support an initially broad approach to identifying barriers and facilitators, followed by a “drilling down” to what is most contextually salient. In future, it may be possible to establish a model of clinical quality policy implementation using the TDF.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Can the theoretical domains framework account for the implementation of clinical quality interventions?

Lipworth

Taylor

Braithwaite

2013

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…Their power is in many ways constrained however by norms and ethics that underpin their profession such as equity, patient care, confidentiality and trustworthiness (Moline, 1986;Freeman et al, 2009). These constraints are also embodied in rules and practices instilled in their professional identity during training and education (Perrow, 1979) and by the continued and active development of clinical protocols and standards that categorise diagnoses and treatments and thus also restrict professionals' decision making.…”

Section: Changes In Healthcare Professional Work Afforded By Technologymentioning

confidence: 99%

Changes in healthcare professional work afforded by technology: The introduction of a national electronic patient record in an English hospital

2014

View full text Add to dashboard Cite

This article considers changes in healthcare professional work afforded by technology. It uses the sociology of professionals' literature together with a theory of affordances to examine how and when technology allows change in healthcare professional work. The study draws from research into the introduction of a national electronic patient record in an English hospital. We argue that electronic patient record affords changes through its materiality as it interacts with healthcare professional practice. Its affordances entail some level of standardisation of healthcare professional conduct and practice, curtailment of professional autonomy, enlargement of nurses' roles and redistribution of clinical work within and across professional boundaries. The article makes a contribution to the growing literature advocating a cultural approach to the study of technological affordances in organisations and to studies that explore healthcare professional practice in conjunction with the materiality of technology. Two main lines of argument are developed here. First, that technological affordances do not solely lie with the materiality of technology nor with individual perceptions, but are cultivated and nurtured within a broader cultural-institutional context, in our case a professional context of use. Second, that technological affordance of change is realised when healthcare professionals' (individual and collective) perceptions of technology (and of its materiality) fit with their sense of (professional) self. In this respect, the article shows the extent to which the materiality of technology plays out with professional identity and frames

show abstract

“…Studies have revealed the impact on health professionals of different aspects of the institutional dimension, for example, waiting lists (organisational aspect), institutional goals (administrative aspect) and ethical obligations (regulatory aspect). These significant impacts include: (1) pressure and ethical tensions affecting decision-making42 43; (2) fatigue and cognitive overload44 leading to interventions of suboptimal quality and increased risk of errors and (3) choice of interventions (CR) diverging from formal professional theories with a potential impact on quality 45. Importantly, although several studies have been conducted with respect to the institutional dimension and other aspects influencing health professionals’ CR, no clear integration of their results is yet available.…”

Section: Introductionmentioning

confidence: 99%

Influence of societal and practice contexts on health professionals’ clinical reasoning: a scoping study protocol

et al. 2013

View full text Add to dashboard Cite

IntroductionIn a context of constrained resources, the efficacy of interventions is a pivotal aim of healthcare systems worldwide. Efficacy of healthcare interventions is highly compromised if clinical reasoning (CR), the process that practitioners use to plan, direct, perform and reflect on client care, is not optimal. The CR process of health professionals is influenced by the institutional dimension (ie, legal, regulatory, administrative and organisational aspects) of their societal and practice contexts. Although several studies have been conducted with respect to the institutional dimension influencing health professionals’ CR, no clear integration of their results is yet available. The aim of this study is to synthesise and disseminate current knowledge on the influence of the institutional dimension of contexts on health professionals’ CR.Methods and analysisA scoping study of the scientific literature from January 1980 to March 2013 will be undertaken to summarise and disseminate research findings about the influence of the institutional dimension on CR. Numerous databases (n=18) from three relevant fields (healthcare, health law and politics and management) will be searched. Extended search strategies will include the manual search of bibliographies, health-related websites, public registries and journals of interest. Data will be collected and analysed using a thematic chart and content analysis. A systematic multidisciplinary team approach will allow optimal identification of relevant studies, as well as effective and valid content analysis and dissemination of the results.DiscussionThis scoping study will provide a rigorous, accurate and up-to-date synthesis of existing knowledge regarding: (1) those aspects of the institutional dimension of health professionals’ societal and practice contexts that impact their CR and (2) how these aspects influence health professionals’ CR. Through the synergy of a multidisciplinary research team from a wide range of expertise, clinical pertinence and an exhaustive dissemination of results to knowledge-users will be ensured.

show abstract

Health professionals' enactment of their accountability obligations: Doing the best they can

Cited by 31 publications

References 27 publications

Can the theoretical domains framework account for the implementation of clinical quality interventions?

Can the theoretical domains framework account for the implementation of clinical quality interventions?

Changes in healthcare professional work afforded by technology: The introduction of a national electronic patient record in an English hospital

Influence of societal and practice contexts on health professionals’ clinical reasoning: a scoping study protocol

Contact Info

Product

Resources

About