Yes / Healthcare systems worldwide devote significant resources towards collecting data to support care quality assurance and improvement. In the United Kingdom, National Clinical Audits are intended to contribute to these objectives by providing public reports of data on healthcare treatment and outcomes, but their potential for quality improvement in particular is not realized fully among healthcare providers. Here, we aim to explore this outcome from the perspective of hospital boards and their quality committees: an under-studied area, given the emphasis in previous research on the audits' use by clinical teams. Methods: We carried out semi-structured, qualitative interviews with 54 staff in different clinical and management settings in five English National Health Service hospitals about their use of NCA data, and the circumstances that supported or constrained such use. We used Framework Analysis to identify themes within their responses. Results: We found that members and officers of hospitals' governing bodies perceived an imbalance between the benefits to their institutions from National Clinical Audits and the substantial resources consumed by participating in them. This led some to question the audits' legitimacy, which could limit scope for improvements based on audit data, proposed by clinical teams. Conclusions: Measures to enhance the audits' perceived legitimacy could help address these limitations. These include audit suppliers moving from an emphasis on cumulative, retrospective reports to real-time reporting, clearly presenting the “headline” outcomes important to institutional bodies and staff. Measures may also include further negotiation between hospitals, suppliers and their commissioners about the nature and volume of data the latter are expected to collect; wider use by hospitals of routine clinical data to populate audit data fields; and further development of interactive digital technologies to help staff explore and report audit data in meaningful ways. / Health Services and Delivery Research Programme, Grant/Award Number: 16/04/06

<p>The purpose of this study was to explore and describe the experiences of academic and decision-maker researchers participating in a public health integrated knowledge translation (IKT) and exchange program of research in Ontario and British Columbia. This research sought to identify structures and processes that acted as enablers or barriers for all partners on a research team as they engaged in collaborative research. The researcher answered the following research questions: <em>What are the experiences of academics and decision-makers participating in the first two years of an integrated knowledge translation program of research?</em> <em>What structures and processes positively and negatively influence the engagement of partners on the collaborative research team?</em> Through answering these two questions the research contributes relatively new knowledge in the form of strategies for engaging academics and decision-makers engaging in collaborative public health systems and services research.</p> <p>A qualitative descriptive approach was used to gain a contextual understanding of experiences of participants in the IKT research program. Twelve semi-structured, one-on-one interviews were conducted with academic and decision-maker researchers working in British Columbia universities and Health Authorities. Qualitative content analysis of transcripts was used to explore and identify concepts emerging from the data.</p> <p>Data analysis identified IKT processes and concepts that encompass and underlie a collaborative research team. An overarching systems approach is used to examine the evolution of the collaborative team. Themes are presented in relation to IKT engagement concepts identified from the literature as well as those that emerged from analysis including: establishing and maintaining relationships, communication, capacity building, multidirectional knowledge sharing, and multidisciplinary capacity.</p> <p>By examining experiences of research partners representing both academia and decision and policy-making, this research contributes new knowledge about strategies to support collaborative health services research which can subsequently strengthen the Canadian public health systems and services research agenda.</p> / Master of Science in Nursing (MSN)

<p><strong>Introduction</strong></p> <p>Despite increasing global interest in regional palliative care networks (PCN) to integrate care, little explicit direction exists to guide their evaluation. The first step of this research was to develop a comprehensive conceptual framework using a systems approach for evaluating integrated palliative care. This framework was then used to guide a rigorous examination of a selected PCN.</p> <p><strong>Methods</strong></p> <p>The conceptual framework was derived from the empirical literature, incorporating principal features of network integration. A case study methodology was used to assess structure (administration) and process (provider) levels in the framework through document review, a PCN executive interview, and surveys with organizational administrators and health professionals who provide palliative care in the community catchment of the PCN.</p> <p><strong>Results</strong></p> <p>Key features to efficient palliative care delivery are currently lacking across this PCN area. Still, the 20 responding administrators (90% response rate) largely viewed Network accomplishments positively and the resulting partnerships as beneficial and collaborative. Additional efforts were seen as required in ensuring palliative care patient identification, reducing silos between organizations, and greater by-in from regional authorities. Relative to processes, the 86 health care providers (85% response rate) reported valuing collaboration and reflected positively on many of the framework elements measured. Insufficiencies were perceived in support for case conferencing and evaluative activities, as well as in informational access.</p> <p><strong> </strong></p> <p><strong>Conclusion</strong></p> <p>This study enabled us to test both the utility of the framework and the capacity of the selected PCN for providing quality, integrated palliative care. This study represents an important initial attempt at examining network-integrated palliative care.</p> / Doctor of Philosophy (PhD)

<p>Objectives: (1) to assess whether computer simulation modeling or process modeling have improved medication management systems, including informing the design of e-prescribing systems for Canada, and (2) to build and validate a workflow diagram of the handwritten medication management process in the community setting for Canada and use it to obtain feedback from stakeholders.</p> <p>Methods: A systematic review was conducted to assess whether the modeling techniques have improved medication management systems. A workflow diagram was developed and used to obtain feedback from stakeholders as to where problems exist in the current paper-based process and where information technology might be of help. Analyses were descriptive and qualitative.</p> <p>Results: The systematic review identified 13,376 citations, 8 of which were included in the full data extraction. The review revealed that simulation models of e-prescribing systems have been developed, but their accuracy and usefulness has not been established. One process model had been used to analyze a Canadian medication management system, but no evidence was found that process models had any positive impact on e-prescribing development in Canada.</p> <p>Fifteen stakeholders, including 5 physicians, 5 pharmacists, and 5 members of the public provided feedback using the workflow diagram. All stakeholders agreed that the diagram was a realistic representation of the actual handwritten medication management process, suggesting face validity. The majority of stakeholders identified the most problematic processes as generating the prescription by the physician (9/15 (60.0%)) and drug checking by the physician (6/15 (40.0%)).</p> <p>Conclusions: There is a lack of published evidence on simulation models and process models, and the studies that exist do not suggest any benefit in informing e-prescribing design. We developed and established face validity for a workflow diagram of the paper-based medication management cascade. Stakeholders believed that generating the prescription and drug checking by the physician could be improved by e-prescribing.</p> / Master of Science (MSc)

<p><strong>Introduction:</strong> Client-Centred Care (CCC) is emerging as a best practice in health care organizations around the world. Partnerships between patient, family, and health professionals in planning and delivery of health care services are known to improve outcomes and satisfaction with care. Studies report lack of understanding of the elements involved in creating this partnership, and identify the need for valid and reliable measures of client-centredness for adults</p> <p><strong>Objectives:</strong> 1) To explore the historical evolution and current state of CCC as these were used in adult health care settings; 2) to evaluate the performance of the adapted MPOC for Adults (MPOC-A) and MPOC-SP (A) as measures of client-centredness from the perspectives of adult clients and their HCPs, respectively; and 3) to develop an in-depth understanding of health professionals’ and clients’ experiences of engaging in CCC.</p> <p><strong>Methods: </strong>A narrative review was completed to explore the development and conceptualization of CCC. Two validation studies looked at psychometric properties of the Measure of Processes of Care for Adults (MPOC-A) in orthopedic surgery and in-patient neurological rehabilitation settings, and the Measure of Processes of Care for Service Providers working with Adults (MPOC-SP (A)) in in-patient neurological rehabilitation programs. A qualitative study using Grounded Theory methodology explored experiences of CCC, barriers, and supports to developing successful partnerships from patients’, families’, and health care professionals’ perspectives.</p> <p><strong>Results: </strong>The narrative review presented theoretical conceptualizations and definitions of CCC and identified areas that needed further development, e.g., clinical implementation of CCC principles into adult health care, development of valid and reliable outcome measures for adult clients, etc. In the validation studies, good to excellent internal consistency and moderate to good correlations between domains supported internal reliability of the tools. Results of confirmatory factor analysis of MPOC-SP (A) supported the original multi-dimensional structure of the tool.</p> <p>Being on common ground was the main category identified by both clients and HCPs in the qualitative study. All participants repeatedly highlighted the importance of good communication and information flow among all the parties.</p> <p><strong>Conclusions: </strong>The MPOC-A and MPOC-SP (A) will be useful in assisting with program evaluation and quality control. The qualitative components of this study will help to improve our understanding of attributes of programs and health professionals that clients consider important for good quality care, and will provide some practical recommendations for clinicians on implementation of CCC into practice.</p> / Doctor of Rehabilitation (RhD)

<p>Lengthy waiting times have been a problem in Swedish health services for many years. In 1992, Sweden implemented a national maximum waiting-time guarantee (MWG) through an agreement between the Swedish Government and the Federation of Swedish County Councils. The “guarantee” assured patients that the waiting time between the decision-to-treat and the treatment itself would not exceed three months. The national MWG covered twelve different treatments/interventions and remained in force for five years. This dissertation describes the genesis of the MWG, its implementation, and its effects.</p><p>Four papers serve as a foundation for the dissertation. Paper I describes how the guarantee was implemented during the first two years. Paper II studies the impact that the MWG had on cataract surgery. Paper III uses the results of two questionnaire surveys of department heads to explain why the MWG, although successfully launched, became increasingly difficult to maintain. Paper IV analyses data from the national cataract register to determine how production and waiting times in cataract surgery were affected by termination of the MWG.</p><p>This dissertation confirms that waiting time for health care is a complex phenomenon resulting from multiple causes. “Guarantees” are of particular interest because they define what constitutes too long in reference to waiting times. Beyond that, they are only a framework for developing a plan of action. The positive effects of the MWG were transient and based on rationalisation, introduction of new technology, and stricter prioritisation. The MWG contributed towards empowering patients and slowing the expansion of treatment indications, but it was unsuccessful in levelling out the wide regional variations in surgical rates.</p>

Lengthy waiting times have been a problem in Swedish health services for many years. In 1992, Sweden implemented a national maximum waiting-time guarantee (MWG) through an agreement between the Swedish Government and the Federation of Swedish County Councils. The “guarantee” assured patients that the waiting time between the decision-to-treat and the treatment itself would not exceed three months. The national MWG covered twelve different treatments/interventions and remained in force for five years. This dissertation describes the genesis of the MWG, its implementation, and its effects. Four papers serve as a foundation for the dissertation. Paper I describes how the guarantee was implemented during the first two years. Paper II studies the impact that the MWG had on cataract surgery. Paper III uses the results of two questionnaire surveys of department heads to explain why the MWG, although successfully launched, became increasingly difficult to maintain. Paper IV analyses data from the national cataract register to determine how production and waiting times in cataract surgery were affected by termination of the MWG. This dissertation confirms that waiting time for health care is a complex phenomenon resulting from multiple causes. “Guarantees” are of particular interest because they define what constitutes too long in reference to waiting times. Beyond that, they are only a framework for developing a plan of action. The positive effects of the MWG were transient and based on rationalisation, introduction of new technology, and stricter prioritisation. The MWG contributed towards empowering patients and slowing the expansion of treatment indications, but it was unsuccessful in levelling out the wide regional variations in surgical rates.

M.Cur. / With the changes in health care occuring in South Africa, new concepts and functions concerning the community health nurse are being presented. The role of the community health nurse is altering, and with his/her grassroot involvement with the community, the researcher was concerned about what contribution he/she should make on health committees. The goal of the study was to explore and describe the role of the community health nurse on health committees. The objectives were to: - explore and describe the role the community health nurse should play on health committees; explore and describe the role the community health nurse is playing on health committees and - to develop guidelines to describe the role of the community health nurse on health committees. The study was conducted in three phases: PHASE 1: After conducting a literature study, six categories were identified as the role of the community health nurse on health committees. Thereafter a questionnaire was presented to community health nurses to find out what their perceptions were about the role of the community health nurse on health committees. The results of Phase One were used to develop a central question. Individual categories relevant to the role of the community health nurse on health committees were identified and an interview schedule was drafted for presentation to selected members of health committees. ii PHASE 2: Personal interviews based on the results of Phase One were conducted with selected health committee members to find out their perceptions of the same. PHASE 3: ' Guidelines describing the role of the community health nurse on health committees were developed based on the findings of the study. It was found that the literature, the community health nurses and the health committee members all concured as to what the community health nurse should be doing on health committees. This study stresses the importance of the community health nurse's involvement on health committees. It should lead to the implementation of community health nurses being allowed to accept their rightful role on health

M.A. / A diagnosis with cancer causes certain fears in a patient, as well as, their family. It activates intense emotional responses in everybody concerned. Reach for Recovery play a huge role in mastectomy patients and their family's lives. It is there to support the patient and to understand what the patient is experiencing. Reach for Recovery is a selfhelp group, functioning under the name of the Cancer Association of South Africa. The group was started in 1952 in the USA, at a time when there was a tendency to discourage patients from discussing their operations with other patients. Therese Lasser, a mastectomy patient, realized that not enough was being done for women whose life had changed dramatically in the span of a few hours. The goal of the study was to do training for Reach for Recovery volunteers. To assess if the Reach for Recovery volunteer is fulfilling in the need of the mastectomy patient. A qualitative approach, using an inductive strategy, was followed to achieve the aim of the study. Focus groups are being used to gather information about the functioning of the Reach for Recovery groups at present. Focus groups were held in the Far East Rand and the West Rand with the Reach for Recovery support groups. The purpose of the focus group was to identify the needs of the mastectomy patients, to enable the researcher to identify guidelines for the Reach for Recovery programme. A literature control was done after the central themes were identified. After having compared the results of the focus group with the relevant literature certain conclusions were drawn and recommendations made. In conclusion to this study, guidelines were designed to be used in the Reach for Recovery programme when the training is done.

<p>Increasingly, informal caregivers are providing hospice palliative care and support to dying friends and family members. These individuals must often negotiate multiple roles and responsibilities as a result of being caregivers and members of the paid labour force. Canada’s federal government has recognized the burden placed on informal caregivers, and legislated the Compassionate Care Benefit (CCB) in 2004. The CCB allows informal caregivers providing hospice palliative care six paid weeks off work to alleviate some of the role strain in the provision of care. Evaluations of the CCB have recognized that the low program uptake has been primarily the result of a lack of awareness. As such, knowledge translation campaigns about the CCB are needed. Stakeholders interviewed, including family caregivers, front-line palliative providers, and employers, have suggested that Canadian social workers are the primary group in need of a targeted knowledge campaign. This research presents the results of the development of a two-stage knowledge translation intervention for social workers. First, the development of appropriate interventions are explored through a qualitative messaging survey (<em>n</em>=16), a focus group (<em>n</em>=8) and key informant interviews (<em>n</em>=3). Preferred intervention formats and messages are identified, and draft knowledge tools are created. Secondly, draft knowledge tools are piloted in workplaces by social workers (<em>n</em>=8), the results of which are captured through participant interviews. The refinement period suggested some of the constraints of space and time on knowledge translation about the CCB and tool use. Hägerstrand’s time geography is explored in relation to tool use and knowledge translation. The research presented herein is relevant to policy makers, program planners, clinicians and researchers working with the fields of hospice palliative care, social work and knowledge translation. This research makes contributions to the knowledge translation and intervention development literatures through the presentation of novel methodologies and the application of time geography.</p> / Master of Arts (MA)