April 2, 2013

Grants & Awards

New articles by Greta Cummings
Part 1: The influence of personal and situational predictors on nurses’ aspirations to management roles: preliminary findings of a national survey of Canadian nurses.
Non UofA Access
Spence Laschinger HK, Wong CA, Macdonald-Rencz S, Burkoski V, Cummings G, D’amour D, et al.
Journal of nursing management 2013 Mar;21(2):217-230

AIM: To examine the influence of personal and situational factors on direct-care nurses’ interests in pursuing nursing management roles. BACKGROUND: Nursing managers are ageing and nurses do not appear to be interested in nursing management roles, raising concerns about a nursing leadership shortage in the next decade. Little research has focused on factors influencing nurses’ career aspirations to nursing management roles. METHODS: A national survey of nurses from nine Canadian provinces was conducted (n = 1241). Multiple regression was used to test a model of personal and situational predictors of nurses’ career aspirations to management roles. RESULTS: Twenty-four per cent of nurses expressed interest in pursuing nursing management roles. Personal and situational factors explained 60.2% of nurses’ aspirations to management roles. Age, educational preparation, feasibility of further education, leadership self-efficacy, career motivation, and opportunity to motivate others were the strongest predictors of aspirations for management roles. CONCLUSIONS: Personal factors were more strongly associated with career aspirations than situational factors. There is a steady decline in interest in management roles with increasing age. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing leadership training to develop leadership self-efficacy (particularly for younger nurses) and organizational support for pursuing advanced education may encourage nurses to pursue nursing management roles. © 2012 Blackwell Publishing Ltd.

Part 2: Nurses’ career aspirations to management roles: qualitative findings from a national study of Canadian nurses.
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Wong CA, Spence Laschinger HK, Macdonald-Rencz S, Burkoski V, Cummings G, D’amour D, et al.
Journal of nursing management 2013 Mar;21(2):231-241

AIM: Our aim was to investigate direct-care nurses’ interests in formal management roles and factors that facilitate their decision-making. BACKGROUND: Based on a projected shortage of nurses by 2022, the profession could be short of 4200 nurse managers in Canada within the next decade. However, no data are currently available that identify nurses’ interests in assuming manager roles. METHODS: Using focus group methodology, we conducted 18 focus groups with 125 staff nurses and managers in four regions across Canada. RESULTS: Major themes and subthemes influencing nurses’ decisions to pursue management roles included personal demographic (education, age, clinical experience and life circumstances), personal disposition (leadership skills, intrinsic rewards and professional commitment) and situation (leadership development opportunities, manager role perceptions and presence of mentors). Although nurses see management roles as positive opportunities, they did not perceive the rewards to be great enough to outweigh their concerns. CONCLUSIONS: Findings suggested that organizations need to provide support, leadership development and succession opportunities and to redesign manager roles for optimum success. IMPLICATIONS FOR NURSING MANAGEMENT: Leaders need to ensure that they convey positive images of manager roles and actively identify and support staff nurses with leadership potential. © 2012 Blackwell Publishing Ltd.

CALL FOR ABSTRACTS: Gerontological Advanced Practice Nurses Association
September 18-21,Chicago, IL
DEADLINE: May 15, 2013

The Research Committee’s goal is to facilitate GAPNA members who wish to present their research or innovative projects at the annual conference. Projects should enrich the advanced practice nurse’s knowledge and/or enhance the care of the older adult. Selected winning abstracts may be published in the GAPNA newsletter or Geriatric Nursing journal.

CALL FOR POSTER ABSTRACTS: Transforming Care through Disruptive Design.
October 26-29, 2013 Washington, DC
DEADLINE: July 15, 2013

Posters will illustrate practice innovations with the Centering model, system change strategies that work, research, and outcomes studies. Posters will be displayed at a reception and presenters are expected to be available for dialogue with conference participants.

Grants & Awards
CIHR: Canadian Consortium on Neurodegeneration in Aging

A series of webinars will be held in April 2013 to assist applicants in understanding the focus and the application process for the Canadian Consortium on Neurodegeneration in Aging.
Research within the CCNA is organized around three Themes that are in line with the overall goals of the Strategy. The three themes are:
Primary Prevention – aimed at preventing the disease from occurring;
Secondary Prevention – focused on delaying the clinical manifestations of the already developing disease; and
Quality of Life – designed for helping individuals, caregivers and the health system to cope with the clinically manifest disease.


Health Care Administration and Organization
Health Care Innovation and Quality Assurance
Research Methodology

An environmental scan of an aged care workplace using the PARiHS model: assessing preparedness for change.
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Gibb H.
Journal of nursing management 2013 Mar;21(2):293-303

Aim  The environmental scan aimed to deepen our understanding of the aged care work culture and to ascertain the readiness of the workers to advance towards team-based quality care provision. Background  The workplace context was a high-care unit within a large residential aged care facility. Methods  We used the Promoting Action on Research Implementation in Health Services (PARiHS) framework to assess workplace readiness via interviews, individual surveys and observation of practice. Results  A profile of current culture emerged as mutually supportive and task focused, but at the same time lacking corporate team features of shared decision-making and feedback for practice improvement. However, latent within the frontline leaders and personal care staff, there was evidence of some embedded knowledge and capacity for corporate team performance. Conclusions  This study has validated an evidence-based method for conducting environmental scanning in aged care, recommended before any major change is introduced. Implications for nursing management  Environmental scanning helps gauge workforce capacity and limitations; this information can enable managers to capitalize on identified cultural strengths to fortify change and avoid pitfalls of personal and collective vulnerabilities. © 2012 Blackwell Publishing Ltd.

What works: a realist evaluation case study of intermediaries in infection control practice.
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Williams L, Burton C, Rycroft-Malone J.
Journal of advanced nursing 2013 Apr;69(4):915-926

AIM: To report a study of an intermediary programme in infection control practice in one hospital in the UK. BACKGROUND: Promoting best evidence in everyday practice is a constant problem in infection control. Intermediaries can influence the transfer and use of evidence in health care, but there remains a lack of evidence and theory about the specific actions and change processes, which can be successful in improving infection control practices. DESIGN: An in-depth mixed methods case study. METHODS: The study was undertaken in 2011. Participants were recruited through purposive sampling and included frontline staff, managers and nurses in intermediary roles in infection control. RESULTS: For frontline staff, intermediary presence triggered a modification in behaviour. Different reactions were noted from the intermediaries’ high level of physical presence in clinical areas, the facilitative approaches they used to give feedback and the specific teaching strategies they employed to meet frontline staff needs. The specific intermediary actions uncovered in this study were contingent on the prevailing systems for performance management, organisational commitment and efforts in clinical areas to foster a collegiate environment. CONCLUSIONS: The study provides theoretical threads of how intermediaries can be successful in promoting evidence use under certain contextual conditions. Further testing of the specific intermediary mechanisms uncovered in this study will contribute to understanding different approaches that work in infection control in embedding evidence in practice. © 2012 Blackwell Publishing Ltd.

Systematic Realist Review of Key Factors Affecting the Successful Implementation and Sustainability of the Liverpool Care Pathway for the Dying Patient.
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McConnell T, O’Halloran P, Porter S, Donnelly M.
Worldviews on evidence-based nursing 2013 Mar 14

BACKGROUND: The Liverpool Care Pathway (LCP) is recommended internationally as a best practice model for the care of patients and their families at the end of life. However, a recent national audit in the United Kingdom highlighted shortcomings; and understanding is lacking regarding the processes and contextual factors that affect implementation. AIM: To identify and investigate factors that help or hinder successful implementation and sustainability of the LCP. METHODS: Electronic databases (Medline, CINAHL, British Nursing Index, Science Direct) and grey literature were searched, supplemented by citation tracking, in order to identify English language papers containing information relevant to the implementation of the LCP. Using a realist review approach, we systematically reviewed all relevant studies that focused on end of life care and integrated care pathway processes and identified theories that explained how the LCP and related programmes worked. RESULTS: Fifty-eight papers were included in the review. Key factors identified were: a dedicated facilitator, education and training, audit and feedback, organisational culture, and adequate resources. DISCUSSION: We discuss how these factors change behaviour by influencing the beliefs, attitudes, motivation and confidence of staff in relation to end of life care, and how contextual factors moderate behaviour change. CONCLUSIONS: The implementation process recommended by the developers of the LCP is necessary but not sufficient to ensure successful implementation and sustainability of the pathway. The key components of the intervention (a dedicated facilitator, education and training, audit and feedback) must be configured to influence the beliefs of staff in relation to end of life care, and increase their motivation and self-efficacy in relation to using the LCP. The support of senior managers is vital to the release of necessary resources, and a dominant culture of cure, which sees every death as a failure, works against effective communication and collaboration in relation to the LCP. © 2013 Sigma Theta Tau International.

Designing a theory-informed, contextually appropriate intervention strategy to improve delivery of paediatric services in Kenyan hospitals.
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English M.
Implementation science : IS 2013 Mar 28;8(1):39

BACKGROUND: District hospital services in Kenya and many low-income countries should deliver proven, effective interventions that could substantially reduce child and newborn mortality. However such services are often of poor quality. Researchers have therefore been challenged to identify intervention strategies that go beyond addressing knowledge, skill, or resource inadequacies to support health systems to deliver better services at scale. An effort to develop a system-oriented intervention tailored to local needs and context and drawing on theory is described. METHODS: An intervention was designed to improve district hospital services for children based on four main strategies: a reflective process to distill root causes for the observed problems with service delivery; developing a set of possible intervention approaches to address these problems; a search of literature for theory that provided the most appropriate basis for intervention design; and repeatedly moving backwards and forwards between identified causes, proposed interventions, identified theory, and knowledge of the existing context to develop an overarching intervention that seemed feasible and likely to be acceptable and potentially sustainable. RESULTS AND DISCUSSION: In addition to human and resource constraints key problems included failures of relevant professionals to take responsibility for or ownership of the challenge of pediatric service delivery; inadequately prepared, poorly supported leaders of service units (mid-level managers) who are often professionally and geographically isolated and an almost complete lack of useful information for routinely monitoring or understanding service delivery practice or outcomes. A system-oriented intervention recognizing the pivotal role of leaders of service units but addressing the outer and inner setting of hospitals was designed to help shape and support an appropriate role for these professionals. It aims to foster a sense of ownership while providing the necessary understanding, knowledge, and skills for mid-level managers to work effectively with senior managers and frontline staff to improve services. The intervention will include development of an information system, feedback mechanisms, and discussion fora that promote positive change. The vehicle for such an intervention is a collaborative network partnering government and national professional associations. This case is presented to promote discussion on approaches to developing context appropriate interventions particularly in international health.

Health Care Administration & Organization
Contingency, Employment Intentions, and Retention of Vulnerable Low-wage Workers: An Examination of Nursing Assistants in Nursing Homes.
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Dill JS, Morgan JC, Marshall VW, Pruchno R.
The Gerontologist 2013 Apr;53(2):222-234

Purpose of the Study: While theories of job turnover generally assume a strong correlation between job satisfaction, intention, and retention, such models may be limited in explaining turnover of low-wage health care workers. Low-wage workers likely have a lower ability to act on their employment intentions or plans due to a lack of resources that serve to cushion higher wage workers. In this study, we examine the relationship between job satisfaction, intention, and retention of nursing assistants in nursing homes and the role that “contingency factors” play in employment intentions and retention. We conceptualize “contingency factors” as resource-related constraints (e.g., being a single mother) that likely influence employment trajectories of individuals but can be independent of job satisfaction or intent. DESIGN AND METHODS: We use survey data from 315 nursing assistants in 18 nursing homes in a U.S. southern state to model employment intentions and retention. RESULTS: We find that job satisfaction and other perceived job characteristics (e.g., workload and perceived quality of care) are significant predictors of an individual’s intent to stay in their job, the occupation of nursing assistant, and the field of long-term care. However, we find that job satisfaction and employment intentions are not significant predictors of retention. Instead, “contingency factors” such as being a primary breadwinner and individual characteristics (e.g., tenure and past health care experience) appear to be stronger factors in the retention of nursing assistants. IMPLICATIONS: Our findings have implications for understanding turnover among low-wage health care workers and the use of proxies such as employment intentions in measuring turnover.

Linking RN workgroup job satisfaction to pressure ulcers among older adults on acute care hospital units.
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Choi J, Bergquist-Beringer S, Staggs VS.
Research in nursing & health 2013 Apr;36(2):181-190

We examined the relationship between registered nurse (RN) workgroup job satisfaction and hospital-acquired pressure ulcers (HAPUs) among older adults on six types of acute care units. Random-intercept logistic regression analyses were performed using 2009 unit-level data from the National Database of Nursing Quality Indicators® (NDNQI®) and the NDNQI RN Survey. Overall, RN workgroup job satisfaction was negatively associated with HAPU rates, although the relationship varied by unit type. RN workgroup satisfaction was significantly associated with HAPU rates on critical care, medical, and rehabilitation units. No significant association was found on step-down, surgical, and medical-surgical units. Findings provide evidence that higher RN workgroup job satisfaction is related to lower HAPU rates among older adult patients in acute care hospitals. Copyright © 2013 Wiley Periodicals, Inc.

The importance of a high-performance work environment in hospitals.
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Weinberg DB, Avgar AC, Sugrue NM, Cooney-Miner D.
Health services research 2013 Feb;48(1):319-332

OBJECTIVE: To examine the benefits of a high-performance work environment (HPWE) for employees, patients, and hospitals. STUDY SETTING: Forty-five adult, medical-surgical units in nine hospitals in upstate New York. STUDY DESIGN: Cross-sectional study. DATA COLLECTION: Surveys were collected from 1,527 unit-based hospital providers (68.5 percent response rate). Hospitals provided unit turnover and patient data (16,459 discharge records and 2,920 patient surveys). PRINCIPAL FINDINGS: HPWE, as perceived by multiple occupational groups on a unit, is significantly associated with desirable work processes, retention indicators, and care quality. CONCLUSION: Our findings underscore the potential benefits for providers, patients, and health care organizations of designing work environments that value and support a broad range of employees as having essential contributions to make to the care process and their organizations. © Health Research and Educational Trust.

CFHI: Strategic Community: An Approach for Developing Interorganizational Collaboration

Improving the accessibility of healthcare services within the Estrie region of Quebec, a region characterized by scarce human and financial resources, was the catalyst for pursuing the “Strategic Community” (SC) approach. The SC approach set out to transform the organization of work among healthcare institutions in the region and has made it possible to:

  • Breakdown the barriers between work silos in various institutions in order to jointly implement simultaneous changes and end the deadlock in situations initially perceived by the partners as unresolvable
  • Significantly improve collaboration between institutions and trust between frontline, second line and third line players, thereby reducing tensions between the partner organizations
  • Take action on concrete things to be changed, as defined by the managers and the caregivers who work with the same clients
  • Transfer lessons learned to other parts of the care continuum

CIHI: Wait times for Priority Procedures in Canada, 2013

In 2004, Canada’s first ministers agreed to reduce wait times in five priority areas: cancer treatment, cardiac care, diagnostic imaging, joint replacement and sight restoration. They also agreed to work towards meeting evidence-based benchmarks–or targets–for medically acceptable waits, which were established in late 2005 for some priority procedures. CIHI was mandated to collect wait times information and monitor provincial progress in meeting benchmarks. Wait times for Priority Procedure in Canada, 2013 is CIHI’s eighth annual report in this series and is accompanied by a new graphic display of wait time data across Canada.

Health Care Innovation and Quality Assurance
Annals of Internal Medicine: Special Issue on Making Health Care Safer

The Top Patient Safety Strategies That Can Be Encouraged for Adoption Now
Shekelle PG, Pronovost PJ, Wachter RM, McDonald KM, Schoelles K, Dy SM, et al.
Promoting a Culture of Safety as a Patient Safety Strategy: A Systematic Review
Weaver SJ, Lubomksi LH, Wilson RF, Pfoh ER, Martinez KA, Dy SM.
Patient Safety Strategies Targeted at Diagnostic Errors: A Systematic Review
McDonald KM, Matesic B, Contopoulos-Ioannidis DG, Lonhart J, Schmidt E, Pineda N, Ioannidis JP
In-Facility Delirium Prevention Programs as a Patient Safety Strategy: A Systematic Review
Reston JT, Schoelles KM
Inpatient Fall Prevention Programs as a Patient Safety Strategy: A Systematic Review
Miake-Lye IM, Hempel S, Ganz DA, Shekelle PG
Medication Reconciliation During Transitions of Care as a Patient Safety Strategy: A Systematic Review
Kwan JL, Lo L, Sampson M, Shojania KG
Nurse–Patient Ratios as a Patient Safety Strategy: A Systematic Review
Shekelle PG
Preventing In-Facility Pressure Ulcers as a Patient Safety Strategy: A Systematic Review
Sullivan N, Schoelles KM
Rapid-Response Systems as a Patient Safety Strategy: A Systematic Review
Winters BD, Weaver SJ, Pfoh ER, Yang T, Pham JC, Dy SM
Simulation Exercises as a Patient Safety Strategy: A Systematic Review
Schmidt E, Goldhaber-Fiebert SN, Ho LA, McDonald KM
Hospital-Initiated Transitional Care Interventions as a Patient Safety Strategy: A Systematic Review
Rennke S, Nguyen OK, Shoeb MH, Magan Y, Wachter RM, Ranji SR

Special Issue of BMJ Quality & Safety: Knowledge for Improvement

Planning and leading a multidisciplinary colloquium to explore the epistemology of improvement
Paul Batalden, Paul Bate, Dale Webb, Vin McLoughlin
Systems of service: reflections on the moral foundations of improvement
Frank Davidoff
Heterogeneity: we can’t live with it, and we can’t live without it
Frank Davidoff
Can evidence-based medicine and clinical quality improvement learn from each other?
Paul Glasziou, Greg Ogrinc, Steve Goodman
Understanding the conditions for improvement: research to discover which context influences affect improvement success
John Øvretveit
The epistemology of quality improvement: it’s all Greek
Rocco J Perla, Gareth J Parry
Reconciling complexity and classification in quality improvement research
Laura Leviton
The contribution of case study research to knowledge of how to improve quality of care
G Ross Baker
The meaning of variation to healthcare managers, clinical and health-services researchers, and individual patients
Duncan Neuhauser, Lloyd Provost, Bo Bergman
Five main processes in healthcare: a citizen perspective
Bo Bergman, Duncan Neuhauser, Lloyd Provost
Beyond evidence: the micropolitics of improvement
Ann Langley, Jean-Louis Denis
Problems and promises of innovation: why healthcare needs to rethink its love/hate relationship with the new
Mary Dixon-Woods, Rene Amalberti, Steve Goodman, Bo Bergman, Paul Glasziou
Clarity and strength of implications for practice in medical journal articles: an exploratory analysis
Joanne Lynn, Allessia P Owens, Jean M Bartunek
Building an integrated methodology of learning that can optimally support improvements in healthcare
Joanne Lynn
Intergroup relationships and quality improvement in healthcare
Jean M Bartunek
Expert patients: learning from HIV
Molly Cooke
Ten tips for incorporating scientific quality improvement into everyday work
Don Goldmann
Multidisciplinary centres for safety and quality improvement: learning from climate change science
Charles Vincent, Paul Batalden, Frank Davidoff
Mainstreaming quality and safety: a reformulation of quality and safety education for health professions students
Molly Cooke, Pamela M Ironside, Gregory S Ogrinc
Creating safety by strengthening clinicians’ capacity for reflexivity
Rick Iedema
Increasing the generalisability of improvement research with an improvement replication programme
John Øvretveit, Laura Leviton, Gareth Parry
Analytical studies: a framework for quality improvement design and analysis
Lloyd P Provost
Confessions of a chagrined trialist
Steven Goodman
So what? Now what? Exploring, understanding and using the epistemologies that inform the improvement of healthcare
Paul Batalden, Frank Davidoff, Martin Marshall, Jo Bibby, Colin Pink

Infection Prevention in Long-Term Care: A Systematic Review of Randomized and Nonrandomized Trials
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Uchida M, Pogorzelska-Maziarz M, Smith PW, Larson E.
Journal of the American Geriatrics Society 2013

The purpose of this systematic review was to critically review and synthesize current evidence and the methodological quality of nonpharmacological infection-prevention interventions in long-term care (LTC) facilities for older adults. Two reviewers searched three electronic databases for studies published over the last decade assessing randomized and nonrandomized trials designed to reduce infections in older adults in which primary outcomes were infection rates and reductions of risk factors related to infections. To establish clarity and standardized reporting of findings, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used. Data extracted included study design, sample size, type and duration of interventions, outcome measures reported, and findings. Two reviewers independently assessed study quality using a validated quality assessment tool. Twenty-four articles met inclusion criteria; the majority were randomized control trials (67%) in which the primary purpose was to reduce pneumonia (66%). Thirteen (54%) studies reported statistically significant results in favor of interventions on at least one of their outcome measures. The methodological clarity of available evidence was limited, placing them at potential risk of bias. Gaps and inconsistencies surrounding interventions in LTC are evident. Future interventional studies need to enhance methodological rigor using clearly defined outcome measures and standardized reporting of findings.

Barriers and Facilitators to Communicating Nursing Errors in Long-term Care Settings.
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Wagner LM, Damianakis T, Pho L, Tourangeau A.
Journal of patient safety 2013 Mar;9(1):1-7

OBJECTIVE: To explore nurses’ perceptions about communicating nursing errors. DESIGN: Cross-sectional, descriptive study. PARTICIPANTS: Approximately 289 nurses working in long-term care facilities in Ontario, Canada. METHODS: A cross-sectional, descriptive study of approximately 289 nurses working in long-term care facilities in Ontario, Canada. Solicited nurses’ perceptions concerning the disclosure of nursing errors and adverse events by including an open-ended item at the conclusion of a 60-item (multiple choice) questionnaire on the same topic. A qualitative content analysis was conducted using a multi-step process. RESULTS: A total of 245 responses were included in the content analysis. The main categories related to error communication that were derived from the analysis were as follows: (1) differences in the definition of terms; (2) the day-to-day working conditions and their impact on defining and reporting errors; (3) organizational factors that both help and hinder the reporting of errors in ensuring both personal and organizational responsibility; (4) communication styles that both help and hinder disclosure and adherence to proper protocols; and (5) external factors such as policies and professional standards and codes of ethics, which can provide clarity of process; and (6) recommendations for implementation of professional standards in long-term care settings to facilitate supportive working conditions. CONCLUSION: Eliminating the barriers to error communication requires moving toward a culture of safety. This involves both top-down and bottom-up approaches that allow nurses to feel comfortable being active participants in the error communication process.

What can we learn from the existing evidence of the business case for investments in nursing care: importance of content, context, and policy environment.
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Yakusheva O, Wholey D, Frick KD.
Medical care 2013 Apr;51 Suppl:S47-52

Decisions of health care institutions to invest in nursing care are often guided by mixed and conflicting evidence of effects of the investments on organizational function and sustainability. This paper uses new evidence generated through Interdisciplinary Nursing Quality Research Initiative (INQRI)-funded research and published in peer-reviewed journals, to illustrate where the business case for nursing investments stands and to discuss factors that may limit the existing evidence and its transferability into clinical practice. We conclude that there are 3 limiting factors: (1) the existing business case for nursing investments is likely understated due to the inability of most studies to capture spillover and long-run dynamic effects, thus causing organizations to forfeit potentially viable nursing investments that may improve long-term financial stability; (2) studies rarely devote sufficient attention to describing the content and the organization-specific contextual factors, thus limiting generalizability; and (3) fragmentation of the current health care delivery and payment systems often leads to the financial benefits of investments in nursing care accruing outside of the organization incurring the costs, thus making potentially quality-improving and cost-saving interventions financially unattractive from the organization’s perspective. The payment reform, with its emphasis on high-quality affordable patient-centered care, is likely to strengthen the business case for investments in nursing care. Methodologically rigorous approaches that focus on broader societal implications of investments in nursing care, combined with a thorough understanding of potential barriers and facilitators of nursing change, should be an integral part of future research and policy efforts.

Health Council of Canada: Which way to quality? Key perspectives on quality improvement in Canadian health care systems
March 2013

While many Canadians believe we have one of the best health care systems in the world, recent international rankings for health care quality place Canada in the middle or at the bottom of the pack. This report calls for the establishment of common and measureable goals to achieve quality improvement in Canada’s health care systems.

CFHI: Knowledge in Action: Healthcare Management and Governance Innovation Lab
March 2013

In order to implement and sustain the changes needed to adapt to evolving needs, decision-makers generally agree that clinical and managerial teams must develop greater ability to carry out improvement or innovation projects in their specific environments. To follow up on their achievements in evidence-informed change, the managers of the Montérégie health and social services region agreed to try out a new form of support for innovation: the Healthcare and Social Services Management and Governance Experiments Project (LEGG).

CFHI: An Innovative Strategy in Organizational Transformation: Creating and Implementing a Transition Support Office Within a University Health Centre
March 2013

The need for information to guide the implementation of change in the healthcare system was revealed by healthcare decision-makers some years ago, and it still exists. In fact, research shows that despite efforts undertaken to improve change management practices, their success rates remain relatively low: around 33%. Given the quite high rate of failure in major transformation projects in healthcare organizations, effective strategies for successfully achieving change are required. These transformations are complex and deep-seated and demand a management approach that pays careful attention to planning and to simultaneously taking charge of the multiple aspects that they entail. Therefore, setting up a Project Office has been proposed as a worthwhile way of achieving success in organizational change.

Conference Board of Canada: Improving Value at Hospitals Through Process Management
March 2013 Report by Vincent Thomson, John Thomson

Using five case studies, the report demonstrates how process management techniques, which have been used successfully in other sectors, can improve health care outcomes and reduce costs in Canada. Document Highlights Health care continues to use an increasing portion of resources in order to provide the level of care that citizens expect. There is currently a great imperative to reduce the cost of health care in Canada. This report demonstrates how hospitals can improve their processes—and ultimately their bottom line—in order to enhance patient outcomes and the patient experience, all while reducing costs. By using process management techniques such as Lean and Six Sigma, which have been used very successfully in the manufacturing, finance, services, and health care sectors, hospitals can deliver better value for money. Using five case studies, the report illustrates how several hospitals in Canada and the United States have improved their processes in order to provide more effective health care and reduce costs. The report emphasizes that process management must become embedded into the health care culture.

CEFAGE: Performance Assessment in Primary Health Care: A Systematic Literature Review

The aim of this research is to carry out a systematic literature review of the studies devoted to the performance assessment of primary health care providers. Focusing on the peculiarities of performance evaluation in the public sector, we analyse the selected empirical papers in terms of the efficacy of the developed measurement schemes. We also examine and classify performance measurement categories, dimensions, and techniques in order to provide a holistic picture of the main developments in the referred domain and to identify directions for future research.

Research Methodology
Enhancing the scoping study methodology: a large, inter-professional team’s experience with Arksey and O’Malley’s framework.
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Daudt HM, van Mossel C, Scott SJ.
BMC medical research methodology 2013 Mar 23;13(1):48

BACKGROUND: Scoping studies are increasingly common for broadly searching the literature on a specific topic, yet researchers lack an agreed-upon definition of and framework for the methodology. In 2005, Arksey and O’Malley offered a methodological framework for conducting scoping studies. In their subsequent work, Levac et al. responded to Arksey and O’Malley’s call for advances to their framework. Our paper builds on this collective work to further enhance the methodology. DISCUSSION: This paper begins with a background on what constitutes a scoping study, followed by a discussion about four primary subjects: (1) the types of questions for which Arksey and O’Malley’s framework is most appropriate, (2) a contribution to the discussion aimed at enhancing the six steps of Arskey and O’Malley’s framework, (3) the strengths and challenges of our experience working with Arksey and O’Malley’s framework as a large, inter-professional team, and (4) lessons learned. Our goal in this paper is to add to the discussion encouraged by Arksey and O’Malley to further enhance this methodology. SUMMARY: Performing a scoping study using Arksey and O’Malley’s framework was a valuable process for our research team even if how it was useful was unexpected. Based on our experience, we recommend researchers be aware of their expectations for how Arksey and O’Malley’s framework might be useful in relation to their research question, and remain flexible to clarify concepts and to revise the research question as the team becomes familiar with the literature. Questions portraying comparisons such as between interventions, programs, or approaches seem to be the most suitable to scoping studies. We also suggest assessing the quality of studies and conducting a trial of the method before fully embarking on the charting process in order to ensure consistency. The benefits of engaging a large, inter-professional team such as ours throughout every stage of Arksey and O’Malley’s framework far exceed the challenges and we recommend researchers consider the value of such a team. The strengths include breadth and depth of knowledge each team member brings to the study and time efficiencies. In our experience, the most significant challenges presented to our team were those related to consensus and resource limitations. Effective communication is key to the success of a large group. We propose that by clarifying the framework, the purposes of scoping studies are attainable and the definition is enriched.

‘Trying to pin down jelly’ – exploring intuitive processes in quality assessment for meta-ethnography.
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Toye F, Seers K, Allcock N, Briggs M, Carr E, Andrews J, et al.
BMC medical research methodology 2013 Mar 21;13(1):46

BACKGROUND: Studies that systematically search for and synthesise qualitative research are becoming more evident in health care, and they can make an important contribution to patient care. However, there is still no agreement as to whether, or how we should appraise studies for inclusion. We aimed to explore the intuitive processes that determined the ‘quality’ of qualitative research for inclusion in qualitative research syntheses. We were particularly interested to explore the way that knowledge was constructed. METHODS: We used qualitative methods to explore the process of quality appraisal within a team of seven qualitative researchers funded to undertake a meta-ethnography of chronic non-malignant musculoskeletal pain. Team discussions took place monthly between October 2010 and June 2012 and were recorded and transcribed. Data was coded and organised using constant comparative method. The development of our conceptual analysis was both iterative and collaborative. The strength of this team approach to quality came from open and honest discussion, where team members felt free to agree, disagree, or change their position within the safety of the group. RESULTS: We suggest two core facets of quality for inclusion in meta-ethnography – (1) Conceptual clarity; how clearly has the author articulated a concept that facilitates theoretical insight. (2) Interpretive rigour; fundamentally, can the interpretation ‘be trusted?’ Our findings showed that three important categories help the reader to judge interpretive rigour: (ii) What is the context of the interpretation? (ii) How inductive is the interpretation? (iii) Has the researcher challenged their interpretation? CONCLUSIONS: We highlight that methods alone do not determine the quality of research for inclusion into a meta-ethnography. The strength of a concept and its capacity to facilitate theoretical insight is integral to meta-ethnography, and arguably to the quality of research. However, we suggest that to be judged ‘good enough’ there also needs to be some assurance that qualitative findings are more than simply anecdotal. Although our conceptual model was developed specifically for meta-ethnography, it may be transferable to other research methodologies.

Applications of functional data analysis: A systematic review.
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Ullah S, Finch CF.
BMC medical research methodology 2013 Mar 19;13(1):43

BACKGROUND: Functional data analysis (FDA) is increasingly being used to better analyze, model and predict time series data. Key aspects of FDA include the choice of smoothing technique, data reduction, adjustment for clustering, functional linear modeling and forecasting methods. METHODS: A systematic review using 11 electronic databases was conducted to identify FDA application studies published in the peer-review literature during 1995–2010. Papers reporting methodological considerations only were excluded, as were non-English articles. RESULTS: In total, 84 FDA application articles were identified; 75.0% of the reviewed articles have been published since 2005. Application of FDA has appeared in a large number of publications across various fields of sciences; the majority is related to biomedicine applications (21.4%). Overall, 72 studies (85.7%) provided information about the type of smoothing techniques used, with B-spline smoothing (29.8%) being the most popular. Functional principal component analysis (FPCA) for extracting information from functional data was reported in 51 (60.7%) studies. One-quarter (25.0%) of the published studies used functional linear models to describe relationships between explanatory and outcome variables and only 8.3% used FDA for forecasting time series data. CONCLUSIONS: Despite its clear benefits for analyzing time series data, full appreciation of the key features and value of FDA have been limited to date, though the applications show its relevance to many public health and biomedical problems. Wider application of FDA to all studies involving correlated measurements should allow better modeling of, and predictions from, such data in the future especially as FDA makes no a priori age and time effects assumptions.

Life With and Without Coding: Two Methods for Early-Stage Data Analysis in Qualitative Research Aiming at Causal Explanations
Gläser J, Laudel G
Forum Qualitative Sozialforschung / Forum: Qualitative Social Research; Vol 14, No 2 (2013)

Qualitative research aimed at “mechanismic” explanations poses specific challenges to qualitative data analysis because it must integrate existing theory with patterns identified in the data. We explore the utilization of two methods—coding and qualitative content analysis—for the first steps in the data analysis process, namely “cleaning” and organizing qualitative data. Both methods produce an information base that is structured by categories and can be used in the subsequent search for patterns in the data and integration of these patterns into a systematic, theoretically embedded explanation. Used as a stand-alone method outside the grounded theory approach, coding leads to an indexed text, i.e. both the original text and the index (the system of codes describing the content of text segments) are subjected to further analysis. Qualitative content analysis extracts the relevant information, i.e. separates it from the original text, and processes only this information. We suggest that qualitative content analysis has advantages compared to coding whenever the research question is embedded in prior theory and can be answered without processing knowledge about the form of statements and their position in the text, which usually is the case in the search for “mechanismic” explanations. Coding outperforms qualitative content analysis in research that needs this information in later stages of the analysis, e.g. the exploration of meaning or the study of the construction of narratives.

Towards Qualitative Data Preservation and Re-Use—Policy Trends and Academic Controversies in UK and Sweden
Slavnic Z
Forum Qualitative Sozialforschung / Forum: Qualitative Social Research; Vol 14, No 2 (2013)

The article considers current policy trends and academic controversies related to qualitative data preservation and re-use. In the first part of the article, the epistemological/methodological, ethical/legal, ideological/political, and practical/technical aspects of the ongoing British debate about data archiving and re-use are presented and commented. In the second part, the Swedish case is briefly described and considered in light of the academic concerns that have been raised by the British debate. The situation in Sweden may be summarized in three points: First, there are many signs that the infrastructure for qualitative data archiving and re-use is being developed without the active participation of sufficient representatives of the qualitative research community; second, there are many signs that developing the infrastructure takes as a point of departure neo-positivistic or foundational epistemology, treating qualitative data in the same way as quantitative data, with all the methodological problems resulting from this; and third there are very few, if any, signs that serious academic debate has started in relation to all the issues that have been raised by the corresponding debate in Britain.

IOM: Sharing Clinical Research Data – Workshop Summary
March 29, 2013

Pharmaceutical companies, academic researchers, and government agencies compile large quantities of clinical research data, which, if shared more widely both within and across sectors, could improve public health, enhance patient safety, and spur drug development. Data sharing also can increase public trust in clinical trials and the conclusions derived from them by lending transparency to the clinical research process. Despite several barriers to data sharing – such as concerns about data mining, erroneous secondary analyses of data, and unwarranted litigation – there is increasing acknowledgement among researchers of the importance and potential benefits to sharing clinical research data at various stages of the research, discovery, and development pipeline. On October 4-5, 2012, four groups within the IOM – the Forum on Drug Discovery, Development, and Translation; the Forum on Neuroscience and Nervous System Disorders; the National Cancer Policy Forum; and the Roundtable on Translating Genomic-Based Research for Health – hosted a workshop to explore the benefits of sharing clinical research data, the barriers to such sharing, and strategies to address these barriers to facilitate the development of safe, effective therapeutics and diagnostics. This document summarizes the workshop.

Environmental Factors Predict the Severity of Delirium Symptoms in Long-Term Care Residents with and without Delirium
Non UofA Access
McCusker J, Cole MG, Voyer P, Vu M, Ciampi A, Monette J, et al.
Journal of the American Geriatrics Society 2013

Objectives To identify potentially modifiable environmental factors (including number of medications) associated with changes over time in the severity of delirium symptoms and to explore the interactions between these factors and resident baseline vulnerability. Design Prospective, observational cohort study. Setting Seven long-term care (LTC) facilities. Participants Two hundred seventy-two LTC residents aged 65 and older with and without delirium. Measurements Weekly assessments (for up to 6 months) of the severity of delirium symptoms using the Delirium Index (DI), environmental risk factors, and number of medications. Baseline vulnerability measures included a diagnosis of dementia and a delirium risk score. Associations between environmental factors, medications, and weekly changes in DI were analyzed using a general linear model with correlated errors. Results Six potentially modifiable environmental factors predicted weekly changes in DI (absence of reading glasses, aids to orientation, family member, and glass of water and presence of bed rails and other restraints) as did the prescription of two or more new medications. Residents with dementia appeared to be more sensitive to the effects of these factors. Conclusion Six environmental factors and prescription of two or more new medications predicted changes in the severity of delirium symptoms. These risk factors are potentially modifiable through improved LTC clinical practices.

When Comorbidity, Aging, and Complexity of Primary Care Meet: Development and Validation of the Geriatric CompleXity of Care Index
Non UofA Access
Min L, Wenger N, Walling AM, Blaum C, Cigolle C, Ganz DA, et al.
Journal of the American Geriatrics Society 2013

Objectives To develop and validate the Geriatric CompleXity of Care Index (GXI), a comorbidity index of medical, geriatric, and psychosocial conditions that addresses disease severity and intensity of ambulatory care for older adults with chronic conditions. Design Development phase: variable selection and rating by clinician panel. Validation phase: medical record review and secondary data analysis. Setting Assessing the Care of Vulnerable Elders-2 study. Participants Six hundred forty-four older (≥75) individuals receiving ambulatory care. Measures Development: 32 conditions categorized according to severity, resulting in 117 GXI variables. A panel of clinicians rated each GXI variable with respect to the added difficulty of providing primary care for an individual with that condition. Validation: Modified versions of previously validated comorbidity measures (simple count, Charlson, Medicare Hierarchical Condition Category), longitudinal clinical outcomes (functional decline, survival), intensity of ambulatory care (primary, specialty care visits, polypharmacy, number of eligible quality indicators (NQI)) over 1 year of care. Results The most-morbid individuals (according to quintiles of GXI) had more visits (7.0 vs 3.7 primary care, 6.2 vs 2.4 specialist), polypharmacy (14.3% vs 0% had ≥14 medications), and greater NQI (33 vs 25) than the least-morbid individuals. Of the four comorbidity measures, the GXI was the strongest predictor of primary care visits, polypharmacy, and NQI (P> .001, controlling for age, sex, function-based vulnerability). Conclusion Older adults with complex care needs, as measured by the GXI, have healthcare needs above what previously employed comorbidity measures captured. Healthcare systems could use the GXI to identify the most complex elderly adults and appropriately reimburse primary providers caring for older adults with the most complex care needs for providing additional visits and coordination of care.

Predicting Functional Decline of Older Men Living in Veteran Homes by Minimum Data Set: Implications for Disability Prevention Programs in Long Term Care Settings
Non UofA Access
Chen L, Liu L, Liu C, Peng L, Lin M, Chen L, et al.
Journal of the American Medical Directors Association 2013 04/01;14(4):309.e9-309.e13

Objective To evaluate the risk and protective factors for functional decline of veteran home residents in Taiwan to develop disability prevention programs in long term care settings. Design A prospective cohort study. Setting Two veteran homes in Taiwan. Participants A total of 1045 residents of veteran homes. Intervention None. Measurements Minimum data set (MDS), resident assessment protocols (RAP), MDS-COGS, Resource Utilization Group-III Activities of Daily Living scale, MDS Social engagement scale, MDS Pain scale. Results A total of 1045 (83.0 ± 5.1 years, all men) residents completed the study, and 11.3% of them developed significant functional decline during the study period. Participants with long-term institutionalization history (odds ratio [OR] 2.966, confidence interval [CI] 1.270–6.927), underlying cerebrovascular disease (OR 4.432, CI 1.994–9.852) and dementia (OR 2.150, CI 1.029–4.504), and higher sum of RAP triggers (OR 1.366, CI 1.230–1.517) were more likely to develop functional decline, whereas those who had better social engagement were significantly protective from functional decline (OR 0.528, CI 0.399–0.697). Conclusions Cerebrovascular disease, dementia, higher sum of RAP triggers, and long-term institutionalization were independent risk factors for functional decline, whereas better social engagement had a protective effect on functional dependence. Further study is needed to develop an integrated disability prevention program based on the discoveries of this study.

Context and research implementation in German Nursing Homes
Presenter: Matthias Hoben
Tue, 9 April, 12:30 – 13:30 ECHA 5-001

This is a KUSP presention. Please join Matthias, a PhD candidate from Heidelberg University and postdoctoral candidate with Dr. Carole Estabrooks, to learn about his research.

Facilitation in the Implementation of Evidence in Nursing Practice: A Multi-Phase Inquiry
Presenter: Elizabeth Dogherty. Queens University, postdoctoral candidate
Thurs, 11 April, 12:00 – 13:00 ECHA 5-001

This is a KUSP presention. Please join Elizabeth, a postdoctoral candidate from Queen’s University, to learn about her research.

Complex budgeting and the dreaded budget justification in operating and programmatic grants
Presenter: Dr. Carole Estabrooks
Wednesday April 10, 2013 12:00-13:00 ECHA 5-140

This is presentation is co-sponsored by Dr. Estabrooks and the Health Systems AOE.

Non UofA
Toward a Canadian Healthcare Strategy
June 13-14, 2013 Toronto ON

Toward a Canadian Healthcare Strategy, explores how a strategy-based approach to governance can help support system integration in the changing context of the Canadian healthcare landscape. The major themes are:

  • How a strategy-based approach to governance can drive healthcare change
  • Change management strategies for an integrated, balanced approach to acute and chronic care
  • Understanding the political dimensions of healthcare transformation

Networks Leadership Symposium 2013
November 12-13, 2013, Royal Roads University, Victoria BC

Should we be re-thinking networks? What do we know about creating and managing networks? How do we sustain or transform networks over time, or wind them down? How do we know if networks are working?
Anyone interested in exploring both the science and practice of inter-organizational networks such as network leaders, practitioners, decision makers, clinicians, researchers, policy makers, students is welcome to attend and participate.

AHRQ: Promoting the Spread of Health Care Innovations
Tuesday, April 9, 2013, 11:00–12:00

How can we speed the uptake of innovations to improve health care quality? Join the Innovations Exchange for a free Web event to hear from health care innovator Linda Wick about the experiences and lessons learned from spreading her innovation both within and outside of her health care organization.
Consider how scaling affects innovations and how to identify core elements for uptake.
Explore staffing considerations and promotional activities that are key to growing and sustaining innovative initiatives.
Business expert Janell Moerer will join the dialogue to stimulate an interactive in-depth discussion of these and other key issues.

John Hopkins: Research Coordinator Training Program

Most of this program is onsite (in Balitimore) but they do have some free webinars being offered on Friday. This Friday (5th) the topic is “You want me to do what?” – The Roles and Responsibilities of Clinical Research Study Team Members.

BBC: Alzheimer’s: A different view

For more than a decade, US sociologist Cathy Greenblat has been travelling the world studying the treatments offered to people with dementia. Her mother and two of her grandparents all developed the disease – and she wanted to understand more about the condition. In her book – Love, Loss and Laughter – she tells positive stories of ageing, dementia and end-of-life treatment, across seven countries. Take a look at some of her touching images here, as she explains what she discovered.

Care Quality Commission: Improving Standards at Swallowcliffe Care Home (Devon)

Swallowcliffe provides accommodation with personal care for up to 30 older people who may also have a physical disability and/or mental disorder or dementia. It is a detached, converted property standing in large well-tended gardens overlooking the sea and approximately half a mile from the centre of Seaton. Bedroom accommodation for service users is in twenty-four single and three double rooms. When it was inspected in November 2011 we found several areas of concern. Follow the link to find out how standars were improved.

Digital Health Data Compendium

This is under construction but looks like it could be interesting and relevant when it’s done.

The findings from the EuroREACH project will feed into a digital compendium of health data initiatives and information systems. The compendium will serve as a toolbox to researchers, policy makers and other stakeholders. Ultimately it aims to improve the quality of comparative health systems analysis and performance measurement. Access to the compendium will be through a Health Data Navigator. It will list national and international data bases relevant for performance assessment with a particular focus on patient-level and disease-oriented data. Each data source is assessed with regards to fixed set of criteria, namely

  • ease of access to the data
  • data coverage (variables, years etc.)
  • data quality
  • possibilities of linkage to other data bases

Facilitation Toolkit: A practical guide for working more effectively with people and groups

This resource is designed for staff in the Department of Environment, Water and Catchment Protection (DEWCP) and the Department of Conservation and Land Management (CALM) who are often called upon to work with groups, yet, may not be professionally trained in facilitation. It is designed to:
• introduce you to group and facilitation processes
• encourage you to practise your facilitation, and
• as you become more confident, delve into understanding even more about groups,adults and yourself


figshare allows researchers to publish all of their research outputs in seconds in an easily citable, sharable and discoverable manner. All file formats can be published, including videos and datasets that are often demoted to the supplemental materials section in current publishing models. By opening up the peer review process, researchers can easily publish null results, avoiding the file drawer effect and helping to make scientific research more efficient. figshare uses creative commons licensing to allow frictionless sharing of research data whilst allowing users to maintain their ownership.

CQC: Infographic on dementia care in the UK

An Impact of Dementia Care (infographic) has been created. It is a visual representation of something, intended to present complex information quickly and clearly – on the impact of dementia care.

Nature: Licence restrictions: A fool’s errand

This commentary discusses different creative commons licenses and what that means for academic authors who want to publish their work in open access formats.

Working with Interpreters in Family Meetings

From the Portal of Geriatric Online Education comes a quick reference tool for any health care professional working with families who require an interpreter or if English is not the first language. Working with Interpreters in Family Meetings is a very brief pocket card, that outlines procedures and tips on how to use an interpreter and how to make the family more at ease with an interpreter present. It also identifies key phrases that can be used with families and interpreters.

Dementia Education and Training Resources for Long-Term Care

The J.W. Crane Memorial Library has just released a selected list of resources on Dementia Education and Training. The type of resources included in the list are books, articles, videos and kits from the Crane Library collection, in addition to a valuable list of web resources. Most of the items should be available through the Scott Health Sciences Library for those not affiliated with University of Manitoba.

Research Associate: Systematic Reviewer
Keele University, UK
DEADLINE: 29 April 2013

We are looking for a highly motivated and experienced systematic reviewer to join our multidisciplinary team of researchers in a newly created post that is central to our research on musculoskeletal conditions. You will work in close collaboration with our systematic reviews team, which includes a Research Information Manager, Epidemiologist and Research Assistant. When developing systematic reviews you will liaise with the team of senior researchers who run the clinical trials and epidemiology programmes in the Centre.

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