Implementation outcome assessment instruments used in physical healthcare settings and their measurement properties:a systematic review protocol

INTRODUCTION: Over the past 10 years, research into methods that promote the uptake, implementation and sustainability of evidence-based interventions has gathered pace. However, implementation outcomes are defined in different ways and assessed by different measures; the extent to which these measures are valid and reliable is unknown. The aim of this systematic review is to identify and appraise studies that assess the measurement properties of quantitative implementation outcome instruments used in physical healthcare settings, to advance the use of precise and accurate measures.  METHODS AND ANALYSIS: The following databases will be searched from inception to March 2017: MEDLINE, EMBASE, PsycINFO, CINAHL and the Cochrane Library. Grey literature will be sought via HMIC, OpenGrey, ProQuest for theses and Web of Science Conference Proceedings Citation Index-Science. Reference lists of included studies and relevant reviews will be hand searched. Three search strings will be combined to identify eligible studies: (1) implementation literature, (2) implementation outcomes and (3) measurement properties. Screening of titles, abstracts and full papers will be assessed for eligibility by two reviewers independently and any discrepancies resolved via consensus with the wider team. The methodological quality of the studies will be assessed using the COnsensus-based Standards for the selection of health Measurement INstruments checklist. A set of bespoke criteria to determine the quality of the instruments will be used, and the relationship between instrument usability and quality will be explored.  ETHICS AND DISSEMINATION: Ethical approval is not necessary for systematic review protocols. Researchers and healthcare professionals can use the findings of this systematic review to guide the selection of implementation outcomes instruments, based on their psychometric quality, to assess the impact of their implementation efforts. The findings will also provide a useful guide for reviewers of papers and grants to determine the psychometric quality of the measures used in implementation research.  TRIAL REGISTRATION NUMBER: International Prospective Register of Systematic Reviews (PROSPERO): CRD42017065348

Implementation science: a reappraisal of our journal mission and scope.

The implementation of research findings into healthcare practice has become increasingly recognised as a major priority for researchers, service providers, research funders and policymakers over the past decade. Nine years after its establishment, Implementation Science, an international online open access journal, currently publishes over 150 articles each year. This is fewer than 30% of those submitted for publication. The majority of manuscript rejections occur at the point of initial editorial screening, frequently because we judge them to fall outside of journal scope. There are a number of common reasons as to why manuscripts are rejected on grounds of scope. Furthermore, as the field of implementation research has evolved and our journal submissions have risen, we have, out of necessity, had to become more selective in what we publish. We have also expanded our scope, particularly around patient-mediated and population health interventions, and will monitor the impact of such changes. We hope this editorial on our evolving priorities and common reasons for rejection without peer review will help authors to better judge the relevance of their papers to Implementation Science

Obstacles to research on the effects of interruptions in healthcare

The authors of The Institute of Medicine report ‘To Err is Human’ concluded that interruptions can contribute to medical errors. Given this risk, healthcare researchers have generally, and often solely, viewed interruptions as obstacles to work—as factors that thwart progress, create stress, increase workload, interfere with memory for current and future tasks and harm efficiency, productivity and safety. For example, researchers reported a positive association between interruptions and errors. A contrasting view is to see interruptions as promoting safety and high-quality patient care. From this view, interruptions function as interventions,6–8 such as a call to cease or change work if the interruptee is potentially committing an error.9 Other industries encourage interruptions for that reason. Many researchers investigating interruptions in healthcare cite the sterile cockpit principle as a rationale for reducing interruptions—but it is less often noted that copilots are trained to speak up with safety concerns even if it means interrupting a senior pilot's work. These different views on studying interruptions have made it difficult to draw conclusions from the research. Granted, diverse perspectives and methods can generate a greater variety of ideas and solutions than single perspectives and methods. However, such diversity also makes it more difficult to compile and compare research results or identify critical research questions. The present paper draws attention to three obstacles to research on the effects of interruptions that arise from differing views and methods: definitions, processes and data collection. We discuss possible solutions that may lead us to a better understanding of the effects of interruptions and to a multidisciplinary view on the effects of interruptions in healthcare

\u201cGive, but Give until It Hurts\u201d: The Modulatory Role of Trait Emotional Intelligence on the Motivation to Help

Two studies investigated the effect of trait Emotional Intelligence (trait EI) on people\u2019s moti- vation to help. In Study 1, we developed a new computer-based paradigm that tested partic- ipants\u2019 motivation to help by measuring their performance on a task in which they could gain a hypothetical amount of money to help children in need. Crucially, we manipulated partici- pants\u2019 perceived efficacy by informing them that they had been either able to save the chil- dren (positive feedback) or unable to save the children (negative feedback). We measured trait EI using the Trait Emotional Intelligence Questionnaire\u2013Short Form (TEIQue-SF) and assessed participants\u2019 affective reactions during the experiment using the PANAS-X. Results showed that high and low trait EI participants performed differently after the presen- tation of feedback on their ineffectiveness in helping others in need. Both groups showed increasing negative affective states during the experiment when the feedback was negative; however, high trait EI participants better managed their affective reactions, modulating the impact of their emotions on performance and maintaining a high level of motivation to help. In Study 2, we used a similar computerized task and tested a control situation to explore the effect of trait EI on participants\u2019 behavior when facing failure or success in a scenario unre- lated to helping others in need. No effect of feedback emerged on participants\u2019 emotional states in the second study. Taken together our results show that trait EI influences the impact of success and failure on behavior only in affect-rich situation like those in which people are asked to help others in need

Paper 2: Conceptualizing the transition from advanced to consultant practitioner: role clarity, self-perception, and adjustment

Background Interest in the influence of emotions on behaviour, decision making, and leadership has accelerated over the last decade. Despite this, the influence of emotions on career advancement and behaviour within radiography and radiotherapy has largely been ignored. The ease of transition from one work role to another within an individual's career may be influenced by previous experience, personal characteristics, organizational environment, culture, and the nature of the role itself. Consequently, the transition from the often well-defined role of advanced or specialist practitioner to the more fluid role of consultant practitioner is associated with changing emotions as reported in the first part of this two-part series. What remains unexplored are the emotional triggers that pre-empt each stage in the transition cycle and how our understanding of these might support the successful implementation of consultant practitioner roles. Objectives To explore the emotional triggers that pre-empted each stage in the transitional journey of trainee consultant radiographers as they moved from advanced to consultant practitioner within a locally devised consultant development program. Design Longitudinal qualitative enquiry. Methods and Settings Five trainee consultant radiographers were recruited to a locally devised consultant practice development program within a single UK hospital trust. Semistructured interviews were undertaken at 1, 6, and 12 months with the trainees. Results Although all trainee consultant radiographers experienced the emotional events described in the first part of this two-part series in a predictable order (ie, elation, denial, doubt, crisis, and recovery), the timing of the events was not consistent. Importantly, four emotional triggers were identified, and the dominance of these and the reaction of individuals to them determined the emotional well-being of the individual over time. Conclusions This study provides a unique and hitherto unexplored insight into the transition journey from advanced or specialist practitioner. Importantly, the findings suggest that commonly adopted supportive change interventions may, in fact, trigger the negative emotions they are intended to alleviate and disable rather than enable role transition

A novel conceptual approach to lean: value, psychological conditions for engagement with work and perceived organizational support in hospital care

Background: Lean thinking (LT) has emerged as a promising approach for reducing waste and improving efficiency. However, its applicability to and effectiveness within healthcare, particularly within hospital-based care, remains clouded by uncertainty. This paper attempts to answer the question 'how lean thinking can best be applied to hospital-based care'. Methods: Narrative review and conceptual synthesis. Results: We first review the principles of LT and how some of them are challenging to apply within hospital-based care. We then highlight that lean is an approach that was always meant as a combination of technical expertise and a focus on people-supported by a suite of human resource management supportive practices. We proceed to introduce evidence stemming from the literature studies on perceived organizational support and the psychological conditions for successful staff engagement with their work (namely, psychological meaningfulness, availability and safety as experienced by staff) and review how they may apply to hospital-based health workers. We finally advance a set of hypotheses regarding how different facets of value in a hospital care pathway may be correlated and these relationships mediated/moderated by perceived organizational support and the psychological conditions for engagement with work. Conclusion: We conclude with a discussion of the limitations of our work and the aspiration that the conceptual analysis we have offered is a useful and actionable framework for hospital management to explore how best to support their staff-in a manner that ultimately achieves better quality and patient experience of care

Communication in the operating theatre: A systematic literature review of observational research

Background: Communication is extremely important to ensure safe and effective clinical practice. A systematic literature review of observational studies addressing communication in the operating theatre was conducted. The focus was on observational studies alone in order to gain an understanding of actual communication practices, rather than what was reported through recollections and interviews. Methods: A systematic review of the literature for accessible published and grey literature was performed in July 2012. The following information was extracted: year, country, objectives, methods, study design, sample size, healthcare professional focus and main findings. Quality appraisal was conducted using the Critical Appraisal Skills Programme. A meta-ethnographic approach was used to categorize further the main findings under key concepts. Results: Some 1174 citations were retrieved through an electronic database search, reference lists and known literature. Of these, 26 were included for review after application of full-text inclusion and exclusion criteria. The overall quality of the studies was rated as average to good, with 77 per cent of the methodological quality assessment criteria being met. Six key concepts were identified: signs of effective communication, signs of communication problems, effects on teamwork, conditions for communication, effects on patient safety and understanding collaborative work. Conclusion: Communication was shown to affect operating theatre practices in all of the studies reviewed. Further detailed observational research is needed to gain a better understanding of how to improve the working environment and patient safety in theatre

Beyond clinical engagement:a pragmatic model for quality improvement interventions, aligning clinical and managerial priorities

Despite taking advantage of established learning from other industries, quality improvement initiatives in healthcare may struggle to outperform secular trends. The reasons for this are rarely explored in detail, and are often attributed merely to difficulties in engaging clinicians in quality improvement work. In a narrative review of the literature, we argue that this focus on clinicians, at the relative expense of managerial staff, has proven counterproductive. Clinical engagement is not a universal challenge; moreover, there is evidence that managers-particularly middle managers-also have a role to play in quality improvement. Yet managerial participation in quality improvement interventions is often assumed, rather than proven. We identify specific factors that influence the coordination of front-line staff and managers in quality improvement, and integrate these factors into a novel model: the model of alignment. We use this model to explore the implementation of an interdisciplinary intervention in a recent trial, describing different participation incentives and barriers for different staff groups. The extent to which clinical and managerial interests align may be an important determinant of the ultimate success of quality improvement interventions.</p

Individual differences in athletes' perception of expressive body movements

© 2016 Elsevier Ltd.Objectives: Understanding others' actions depends on the observer's individual characteristics and sensorimotor experience. Motor performance domains, such as sports and the performing arts, provide optimal situations to investigate the determinants of action perception. We investigated athletes' perceptual identification of expression intensity in body movements. Design: A within-subjects design was used. Method: Participants watched point-light displays (1000 ms long) depicting expressive and inexpressive dance movements. The task was to identify the dancer's intended expression intensity. Results: The results indicate that expressive body movements can be reliably identified, with judgement accuracy correlating with self-report empathy indices, intuitive/deliberate decision-making preferences, and indices of sports training. Only years of sports training could predict perceptual identification accuracy. Conclusions: We discuss the findings in relation to motor and cognitive-emotional contributions to action simulation. The potential of cross-domain transfer of motor expertise for boosting perceptual judgements and a hierarchical role of factors eliciting action simulation are also outlined