Assessing organisational readiness for change:Use of diagnostic analysis prior to the implementation of a multidisciplinary assessment for acute stroke care

BACKGROUND: Achieving evidence-based practice in health care is integral to the drive for quality improvement in the National Health Service in the UK. Encapsulated within this policy agenda are challenges inherent in leading and managing organisational change. Not least of these is the need to change the behaviours of individuals and groups in order to embed new practices. Such changes are set within a context of organisational culture that can present a number of barriers and facilitators to change. Diagnostic analysis has been recommended as a precursor to the implementation of change to enable such barriers and facilitators to be identified and a targeted implementation strategy developed. Although diagnostic analysis is recommended, there is a paucity of advice on appropriate methods to use. This paper addresses the paucity and builds on previous work by recommending a mixed method approach to diagnostic analysis comprising both quantitative and qualitative data. METHODS: Twenty staff members with strategic accountability for stroke care were purposively sampled to take part in semi-structured interviews. Six recently discharged patients were also interviewed. Focus groups were conducted with one group of registered ward-based nurses (n = 5) and three specialist registrars (n = 3) purposively selected for their interest in stroke care. All professional staff on the study wards were sent the Team Climate Inventory questionnaire (n = 206). This elicited a response rate of 72% (n = 148). RESULTS: A number of facilitators for change were identified, including stakeholder support, organisational commitment to education, strong team climate in some teams, exemplars of past successful organisational change, and positive working environments. A number of barriers were also identified, including: unidisciplinary assessment/recording practices, varying in structure and evidence-base; weak team climate in some teams; negative exemplars of organisational change; and uncertainty created by impending organisational merger. CONCLUSION: This study built on previous research by proposing a mixed method approach for diagnostic analysis. The combination of qualitative and quantitative data were able to capture multiple perspectives on barriers and facilitators to change. These data informed the tailoring of the implementation strategy to the specific needs of the Trust

Theoretical and philosophical framework for individualised care

Individuality plays a central role in human existence. Its realisation varies greatly in different historical times and places. In modern societies it can often be under threat, under the influence of mass media and mass production, but its importance is recognised, and there have been constant efforts to enhance it. In health services, holistic care for individual patients has become a milestone goal. Individualised care can improve patient outcomes in an ethical and respectful way. Despite the difficulties posed by modern health-care delivery, an increasing number of studies ascertain the importance of individualised care. Based on the existing evidence, various health-care organisations recognise the need to enhance individualised care and implement various initiatives to do so. However, various economic constraints do not allow for wide implementation of individualised health interventions. Technological progress provides more opportunities than ever for individualised care, but limited health resources set a series of obstacles for its delivery. Further research in this field shall help towards embodying the best affordable individualised care in modern health delivery

Missing in action: Species competition is a neglected predictor variable in species distribution modelling

The central role of species competition in shaping community structure in ecosystems is well appreciated amongst ecologists. However species competition is a consistently missing variable in Species Distribution Modelling (SDM). This study presents results of our attempt to incorporate species competition in SDMs. We used a suit of predictor variables including Soil Adjusted Vegetation Index (SAVI), as well as distance from roads, settlements and water, fire frequency and distance from the nearest herbivore sighting (of selected herbivores) to model individual habitat preferences of five grazer species (buffalo, warthog, waterbuck, wildebeest and zebra) with the Ensemble SDM algorithm for Gonarezhou National Park, Zimbabwe. Our results showed that distance from the nearest animal sighting (a proxy for competition among grazers) was the best predictor of the potential distribution of buffalo, wildebeest and zebra but the second best predictor for warthog and waterbuck. Our findings provide evidence to that competition is an important predictor of grazer species' potential distribution. These findings suggest that species distribution modelling that neglects species competition may be inadequate in explaining the potential distribution of species. Therefore our findings encourage the inclusion of competition in SDM as well as potentially igniting discussions that may lead to improving the predictive power of future SDM efforts