Incorporating the views of obstetric clinicians in implementing evidence‐supported labour and delivery suite ward rounds: a case study

Deshpande, Neelima; Publicover, Mary; Gee, Harry; Khan, Khalid S.

doi:10.1046/j.1471-1842.2003.00422.x

Cited by 21 publications

(18 citation statements)

References 13 publications

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“…For example, while clinicians might have been concerned about whether a particular performance indicator or clinical practice guideline was based on solid and contextually relevant clinical evidence, they did not express much interest in whether indicators or guidelines in general had been demonstrated through research to be effective types of interventions. A few possible exceptions to this were the finding that some clinicians (throughout the health system) believed that there is no clear evidence to suggest that clinical governance contributes to the quality improvement of clinical care ( [52];General) and, more specifically, the finding that some hospital clinicians were skeptical about applying evidence during a ward round in part because of a general lack of faith in the “evidence-based approach” to health care ( [53];EBM).…”

Section: Resultsmentioning

confidence: 99%

“…For example, reflecting on an “evidence-based ward round” on a delivery suite, some hospital clinicians expressed their reservations about conducting a ward round that would allow all members of staff to question decision making by the lead clinician on the labour ward. It was argued that this reluctance might be related to the fear of loss of autonomy by various groups of clinicians on delivery suite ( [53]; EBM).…”

Section: Resultsmentioning

confidence: 99%

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

Lipworth

Taylor

Braithwaite

2013

BMC Health Serv Res

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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.

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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

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“…It is therefore important that teachers of critical literature appraisal and EBM consciously find ways of integrating and incorporating teaching of critical appraisal into routine clinical practice. Where resources and facilities are available, such teaching can form part of a “real time” ward round with the dual purposes of teaching EBM skills and attempting to improve care with best available evidence 28 29. If the provisions for real time teaching are not available, then even traditional teaching settings, such as a journal club,30 can be adapted to be based on real and current clinical problems, thus illustrating that the process is not merely an academic exercise but that it informs care.…”

Section: Discussionmentioning

confidence: 99%

What is the evidence that postgraduate teaching in evidence based medicine changes anything? A systematic review

Coomarasamy

Khan

2004

BMJ

607

495

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Objective To evaluate the effects of standalone versus clinically integrated teaching in evidence based medicine on various outcomes in postgraduates. Design Systematic review of randomised and non-randomised controlled trials and before and after comparison studies. Data sources Medline, Embase, ERIC, Cochrane Library, DARE, HTA database, Best Evidence, BEME, and SCI. Study selection 23 studies: four randomised trials, seven non-randomised controlled studies, and 12 before and after comparison studies. 18 studies (including two randomised trials) evaluated a standalone teaching method, and five studies (including two randomised trials) evaluated a clinically integrated teaching method. Main outcome measures Knowledge, critical appraisal skills, attitudes, and behaviour. Results Standalone teaching improved knowledge but not skills, attitudes, or behaviour. Clinically integrated teaching improved knowledge, skills, attitudes, and behaviour. Conclusion Teaching of evidence based medicine should be moved from classrooms to clinical practice to achieve improvements in substantial outcomes.

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“…Those who endeavour to embark on higher level of EBM teaching methods in our hierarchy will need to study these carefully as part of an implementation plan [44-47]. These methods may be considered similar to an innovation in many settings with the need for various phases for embedding them in practice [48], For example within problem- based learning, there has been discussion about the utility of introducing of interactive approaches to learners who have yet to acquire a baseline level of knowledge.…”

Section: Discussionmentioning

confidence: 99%

“…Where resources and facilities are available, such learning can form part of a real-time ward-round or clinic with the dual purposes of learning EBM skills and attempting to improve patient care with best available evidence [44,52]. If the provisions for a real-time teaching are not available, then even traditional learning settings, such as a journal club [39,46,52-54], can be adapted to be based on real and current clinical problems, thus illustrating the process is not a mere academic exercise, but it informs patient care [52].…”

Section: Discussionmentioning

confidence: 99%

A hierarchy of effective teaching and learning to acquire competence in evidenced-based medicine

2006

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Background: A variety of methods exists for teaching and learning evidence-based medicine (EBM). However, there is much debate about the effectiveness of various EBM teaching and learning activities, resulting in a lack of consensus as to what methods constitute the best educational practice. There is a need for a clear hierarchy of educational activities to effectively impart and acquire competence in EBM skills. This paper develops such a hierarchy based on current empirical and theoretical evidence.

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Incorporating the views of obstetric clinicians in implementing evidence‐supported labour and delivery suite ward rounds: a case study

Abstract: Knowledge of barriers was helpful in developing plans for implementation of evidence-supported ward rounds. The pilot study indicates the feasibility of this approach.

Cited by 21 publications

References 13 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?

What is the evidence that postgraduate teaching in evidence based medicine changes anything? A systematic review

A hierarchy of effective teaching and learning to acquire competence in evidenced-based medicine

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