Understanding staff views and experiences of a clinical practice change to reduce stillbirth in South Asian women: A cross-sectional survey

Davies‐Tuck, Miranda; Ruzic, Mikayla; Davey, Mary‐Ann; Hodges, Ryan; Nowotny, Benjamin M.; Flenady, Vicki; Andrews, Christina M.; Wallace, Euan

doi:10.1016/j.wombi.2020.07.010

Cited by 5 publications

(3 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Indeed, the next steps will be to target interventions directly towards women at increased risk, itself achieved by understanding the maternal characteristics that are now more important predictors of stillbirth risk. One recent example of this in Victoria has been the implementation of a clinical guideline for the care of South Asian women at term gestations, 31 after an audit revealed their rates of stillbirth were significantly higher than those of other women 32 . Until better markers of fetal compromise are found, accelerating reductions in stillbirth will be achieved by identifying women at increased risk and targeting care towards them.…”

Section: Discussionmentioning

confidence: 99%

Stillbirth: are we making more progress than we think? A retrospective cohort study

Selvaratnam

Rolnik

et al. 2021

BJOG

View full text Add to dashboard Cite

Objective To quantify how the changing stillbirth risk profile of women is affecting the interpretation of the stillbirth rate. Design A retrospective, population‐based cohort study from 1983 to 2018. Setting Victoria, Australia. Population A total of 2 419 923 births at ≥28 weeks of gestation. Methods Changes in maternal characteristics over time were assessed. A multivariable logistic regression model was developed for stillbirth, based on maternal characteristics in 1983–1987, and used to calculate individual predictive probabilities of stillbirth from the regression equation. The number of expected stillbirths per year as a result of the change in maternal demographics was then calculated, assuming no changes in care and in the associations between maternal characteristics and stillbirth over time. Main outcome measure Stillbirth. Results Compared with 1983–1987, there were more women in older age groups giving birth, more nulliparous women, more indigenous women and women born in Oceania, Asia and Africa, more multiple pregnancies and more women with pre‐existing diabetes in 2014–2018. Despite this, the rate of stillbirth fell from 5.42 per 1000 births in 1983 to 1.72 per 1000 births in 2018 (P < 0.001). Applying the multivariable logistic regression equation, derived from the 1983–87 data, to each year, had there been no changes in care or in the associations between maternal characteristics and stillbirth, the rate of stillbirth would have increased by 12%, from 4.94 per 1000 in 1983 to 5.54 per 1000 in 2018, as a result of the change in maternal characteristics. Conclusions Population rates of stillbirth are falling faster than is generally appreciated. Tweetable abstract Population reductions in stillbirth have been underestimated as a result of changing maternal characteristics.

show abstract

Section: Discussionmentioning

confidence: 99%

Stillbirth: are we making more progress than we think? A retrospective cohort study

Selvaratnam

Rolnik

et al. 2021

BJOG

View full text Add to dashboard Cite

show abstract

“…[2][3][4][5][6] Clinical practice changes often transform work ows, communication networks, staff responsibilities, and ultimately how healthcare is delivered. [7][8][9][10] Adopting new clinical practices disturbs the status quo and requires staff to learn and unlearn behaviors. 11,12 These multiple implementation challenges are exacerbated by the additional barriers of limited resources, structural obstacles, and differing staff values and beliefs.…”

Section: Introductionmentioning

confidence: 99%

Defining the transition from new to normal: a qualitative investigation of the clinical change process

Silver,

Jones,

Hook

et al. 2024

Preprint

View full text Add to dashboard Cite

Background Understanding how and when a new evidence-based clinical intervention becomes standard practice is crucial to ensure that healthcare is delivered in alignment with the most up-to-date knowledge. However, rigorous methods are needed to determine when a new clinical practice becomes normalized to the standard of care. To address this gap, this study qualitatively explores how, when, and why a clinical practice change becomes normalized within healthcare organizations.Methods We used purposive sampling to recruit clinical leaders who worked in implementation science across diverse health contexts. Enrolled participants completed semi-structured interviews. Qualitative data analysis was guided by a modified version of the Normalization Process Theory (NPT) framework to identify salient themes. Identified normalization strategies were mapped to the Expert Recommendations for Implementation Change (ERIC) project.Results A total of 17 individuals were interviewed. Participants described four key signals for identifying when a novel clinical practice becomes the new normal: 1) integration into existing workflows; 2) scaling across the entire organizational unit; 3) staff buy-in and ownership; and 4) sustainment without ongoing monitoring. Participants identified salient strategies to normalize new clinical interventions: 1) taking a patient approach; 2) gaining staff buy-in and ownership; and 3) conducting ongoing measurement of progress towards normalization.Conclusions The results offer valuable insight into the indicators that signify when a novel clinical practice becomes normalized, and the strategies employed to facilitate this transition. These findings can inform future research to develop instruments that implementation leaders can use to systematically measure the clinical change process.

show abstract

“…(80) In a cross-sectional survey of clinical staff following the implementation of a new clinical practice guideline to reduce the rates of term stillbirth in women of South Asian background in the Australian state of Victoria, Davies-Tuck and team found that staff reported an increase in workload following the implementation of the guideline (72%, n=86) and that almost 60% of respondents (n=67) thought that additional education was needed. (106) Cost pressures coupled with overly simplistic thinking by some practitioners, researchers, and agencies around complex health problems that require systems-level approaches and solutions are some of the biggest challenges to effective implementation and change in health systems. (107) A critique levelled at many of the models in the health dissemination and implementation literature is that they fail to consider larger systems and infrastructure "needed to carry out dissemination and implementation functions" in their approaches.…”

Section: Implementation Processesmentioning

confidence: 99%

Moving Beyond Dusty Guidelines: Developing a National Clinical Practice Guidelines Dissemination and Implementation Model for Aotearoa New Zealand's Maternity System

McNally

View full text Add to dashboard Cite

<p><strong>Clinical practice guidelines bridge cutting-edge research and the best evidence-based practice in maternity care. They are critical tools to address provider factors contributing to preventable maternal morbidity and mortality. This mixed methods comparative ethnographic research study utilised three districts health boards (DHBs) of varying sizes (Capital and Coast, Hutt Valley and Hauora Tairāwhiti) to address the study’s primary research question: How can Aotearoa New Zealand's maternity system disseminate and implement the national clinical practice guideline on hypertension and preeclampsia to integrate best clinical practices into standard care? The research identified barriers and facilitators to disseminating and implementing national maternity clinical practice guidelines and developed a new maternity clinical practice guideline dissemination and implementation model. The methodology comprised an electronic clinicians survey, semi-structured key informant interviews, field notes, an analysis of relevant policy documents and reports and selected published media. The sample involved 34 key informants (national and local maternity stakeholders) and 91 maternity clinician survey respondents. Significant barriers to integrating maternity clinical practice guidelines included understaffing, limited funding, technology gaps, a hierarchical organisational culture, embedded inequities, and no maternity clinical practice guideline dissemination and implementation plan. These barriers informed a ten-step maternity clinical practice guideline dissemination and implementation model and a series of maternity quality and safety recommendations that the Aotearoa New Zealand Ministry of Health/Manatū Hauora and the maternity system could use to improve clinical care.(1-3) The recommendations include a more proactive and collaborative role for the Ministry of Health/Manatū Hauora, leveraging existing staffing and systems of care to strengthen maternity quality and safety, fostering Māori and Pasifika leadership in maternity quality and safety, educating consumers on maternity clinical practice guideline recommendations, bridging technology gaps to implement guidelines better, identifying and sharing local best practices that promote quality and safety, and ensuring adequate funding for maternity quality and safety. There has been ongoing dialogue with the Ministry of Health/Manatū Hauora and other stakeholders throughout this research, increasing the likelihood of its translational impact. Although specific to Aotearoa New Zealand, these results are likely applicable in other countries as maternity clinical practice guidelines are used extensively to improve and standardise provider practice.</strong></p>

show abstract

Understanding staff views and experiences of a clinical practice change to reduce stillbirth in South Asian women: A cross-sectional survey

Cited by 5 publications

References 20 publications

Stillbirth: are we making more progress than we think? A retrospective cohort study

Stillbirth: are we making more progress than we think? A retrospective cohort study

Defining the transition from new to normal: a qualitative investigation of the clinical change process

Moving Beyond Dusty Guidelines: Developing a National Clinical Practice Guidelines Dissemination and Implementation Model for Aotearoa New Zealand's Maternity System

Contact Info

Product

Resources

About