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  • 1
    Online Resource
    Online Resource
    Mapping continuous learning using social network research: a social network study of Australian Genomics as a Learning Health System
    BMJ ; 2022
    In:  BMJ Open Vol. 12, No. 10 ( 2022-10), p. e064663-
    Details
    In: BMJ Open, BMJ, Vol. 12, No. 10 ( 2022-10), p. e064663-
    Abstract: To explore a macrolevel Learning Health System (LHS) and examine if an intentionally designed network can foster a collaborative learning community over time. The secondary aim was to demonstrate the application of social network research to the field of LHS. Design Two longitudinal online questionnaires of the Australian Genomics learning community considering relationships between network members at three time points: 2016, 2018, 2019. The questionnaire included closed Likert response questions on collaborative learning patterns and open-response questions to capture general perceptions of the community. Social network data were analysed and visually constructed using Gephi V.0.9.2 software, Likert questions were analysed using SPSS, and open responses were analysed thematically using NVivo. Setting Australian Genomic Health Alliance. Participants Clinicians, scientists, researchers and community representatives. Results Australian Genomics members highlighted the collaborative benefits of the network as a learning community to foster continuous learning in the ever-evolving field of clinical genomics. The learning community grew from 186 members (2016), to 384 (2018), to 439 (2019). Network density increased (2016=0.023, 2018=0.043), then decreased (2019=0.036). Key players remained consistent with potential for new members to achieve focal positions in the network. Informal learning was identified as the most influential learning method for genomic practice. Conclusions This study shows that intentionally building a network provides a platform for continuous learning—a fundamental component for establishing an LHS. The Australian Genomics learning community shows evidence of maturity and sustainability in supporting the continuous learning culture of clinical genomics. The network provides a practical means to spread new knowledge and best practice across the entire field. We show that intentionally designed networks provide the opportunity and means for interdisciplinary learning between diverse agents over time and demonstrate the application of social network research to the LHS field.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    URL: Article
    DOI: 10.1136/bmjopen-2022-064663
    DOI: 10.1136/bmjopen-2022-064663.supp1
    Language: English
    Publisher: BMJ
    Publication Date: 2022
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  • 2
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    Comprehensive Researcher Achievement Model (CRAM): a framework for measuring researcher achievement, impact and influence derived from a systematic literature review of metrics and models
    BMJ ; 2019
    In:  BMJ Open Vol. 9, No. 3 ( 2019-03), p. e025320-
    Details
    In: BMJ Open, BMJ, Vol. 9, No. 3 ( 2019-03), p. e025320-
    Abstract: Effective researcher assessment is key to decisions about funding allocations, promotion and tenure. We aimed to identify what is known about methods for assessing researcher achievements, leading to a new composite assessment model. Design We systematically reviewed the literature via the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols framework. Data sources All Web of Science databases (including Core Collection, MEDLINE and BIOSIS Citation Index) to the end of 2017. Eligibility criteria (1) English language, (2) published in the last 10 years (2007–2017), (3) full text was available and (4) the article discussed an approach to the assessment of an individual researcher’s achievements. Data extraction and synthesis Articles were allocated among four pairs of reviewers for screening, with each pair randomly assigned 5% of their allocation to review concurrently against inclusion criteria. Inter-rater reliability was assessed using Cohen’s Kappa (ĸ). The ĸ statistic showed agreement ranging from moderate to almost perfect (0.4848–0.9039). Following screening, selected articles underwent full-text review and bias was assessed. Results Four hundred and seventy-eight articles were included in the final review. Established approaches developed prior to our inclusion period (eg, citations and outputs, h-index and journal impact factor) remained dominant in the literature and in practice. New bibliometric methods and models emerged in the last 10 years including: measures based on PageRank algorithms or ‘altmetric’ data, methods to apply peer judgement and techniques to assign values to publication quantity and quality. Each assessment method tended to prioritise certain aspects of achievement over others. Conclusions All metrics and models focus on an element or elements at the expense of others. A new composite design, the Comprehensive Researcher Achievement Model (CRAM), is presented, which supersedes past anachronistic models. The CRAM is modifiable to a range of applications.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2018-025320
    Language: English
    Publisher: BMJ
    Publication Date: 2019
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  • 3
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    Exploring the ripple effects of an Australian hospital redevelopment: a protocol for a longitudinal, mixed-methods study
    BMJ ; 2019
    In:  BMJ Open Vol. 9, No. 7 ( 2019-07), p. e027186-
    Details
    In: BMJ Open, BMJ, Vol. 9, No. 7 ( 2019-07), p. e027186-
    Abstract: Hospital redevelopment projects typically intend to improve hospital functioning and modernise the delivery of care. There is research support for the proposition that redevelopment along evidence-based design principles can lead to improved quality and safety. However, it is not clear how redevelopment influences the wider context of the hospital and its functioning. That is, beyond a limited examination of intended outcomes (eg, improved patient satisfaction), are there additional consequences (positive, negative or unintended) occurring within the hospital after the physical environment is changed? Is new always better? The primary purpose of this study is to explore the ripple effects of how hospital redevelopment may influence the organisation, staff and patients in both intended and unintended ways. Methods and analysis We propose to conduct a longitudinal, mixed-methods, case study of a large metropolitan hospital in Australia. The study design consists of a series of measurements over time that are interrupted by the natural intervention of a hospital redevelopment. How hospital redevelopment influences the wider context of the hospital will be assessed in six domains: expectations and reflections of hospital redevelopment, organisational culture, staff interactions, staff well-being, efficiency of care delivery and patient experience. Methods of data collection include a hospital-wide staff survey, semistructured interviews, a network survey, a patient experience survey, analysis of routinely collected hospital data and observations. In addition to a hospital-level analysis, a total of four wards will be examined in-depth, with two acting as controls. Data will be analysed using thematic, statistical and network analyses, respectively, for the qualitative, quantitative and relational data. Ethics and dissemination The study has been reviewed and approved by the relevant Ethics Committee in New South Wales, Australia. The results will be actively disseminated through peer-reviewed journals, conference presentations and in report format to the stakeholders.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2018-027186
    Language: English
    Publisher: BMJ
    Publication Date: 2019
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  • 4
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    Predictors of response rates of safety culture questionnaires in healthcare: a systematic review and analysis
    BMJ ; 2022
    In:  BMJ Open Vol. 12, No. 9 ( 2022-09), p. e065320-
    Details
    In: BMJ Open, BMJ, Vol. 12, No. 9 ( 2022-09), p. e065320-
    Abstract: Safety culture questionnaires are widely used in healthcare to understand how staff feel at work, their attitudes and views, and the influence this has on safe and high-quality patient care. A known challenge of safety culture questionnaires is achieving high response rates to enhance reliability and validity. This review examines predictors of response rates, explores reasons provided for low response rates and identifies strategies to improve those rates. Methods Four bibliometric databases were searched for studies assessing safety culture in hospitals from January 2008 to May 2022. Data were extracted from 893 studies that included a safety culture questionnaire conducted in the hospital setting. Regression was used to predict response rate based on recruitment and data collection methods (incentives, reminders, method of survey administration) and country income classification. Reasons for low response were thematically analysed and used to identify strategies to improve response rates. Results Of the 893 studies that used a questionnaire to assess safety culture in hospitals, 75.6% reported a response rate. Response rates varied from 4.2% to 100%, with a mean response rate of 66.5% (SD=21.0). Regression analyses showed that safety culture questionnaires conducted in low-income and middle-income countries were significantly more likely to yield a higher response rate compared with high-income countries. Mode of administration, questionnaire length and timing of administration were identified as key factors. Remote methods of questionnaire data collection (electronic and by post) were significantly less likely to result in a higher response rate. Reasons provided for low response included: survey fatigue, time constraints, and lack of resources. Conclusion This review presents strategies for researchers and hospital staff to implement when conducting safety culture questionnaires: principally, distribute questionnaires in-person, during meetings or team training sessions; use a local champion; and consider the appropriate time of distribution to manage survey fatigue.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.1136/bmjopen-2022-065320
    DOI: 10.1136/bmjopen-2022-065320.supp1
    DOI: 10.1136/bmjopen-2022-065320.supp2
    Language: English
    Publisher: BMJ
    Publication Date: 2022
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  • 5
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    Dimensions of safety culture: a systematic review of quantitative, qualitative and mixed methods for assessing safety culture in hospitals
    BMJ ; 2021
    In:  BMJ Open Vol. 11, No. 7 ( 2021-07), p. e043982-
    Details
    In: BMJ Open, BMJ, Vol. 11, No. 7 ( 2021-07), p. e043982-
    Abstract: The study of safety culture and its relationship to patient care have been challenged by variation in definition, dimensionality and methods of assessment. This systematic review aimed to map methods to assess safety culture in hospitals, analyse the prevalence of these methods in the published research literature and examine the dimensions of safety culture captured through these processes. Methods We included studies reporting on quantitative, qualitative and mixed methods to assess safety culture in hospitals. The review was conducted using four academic databases (PubMed, CINAHL, Scopus and Web of Science) with studies from January 2008 to May 2020. A formal quality appraisal was not conducted. Study purpose, type of method and safety culture dimensions were extracted from all studies, coded thematically, and summarised narratively and using descriptive statistics where appropriate. Results A total of 694 studies were included. A third (n=244, 35.2%) had a descriptive or exploratory purpose, 225 (32.4%) tested relationships among variables, 129 (18.6%) evaluated an intervention, while 13.8% (n=96) had a methodological focus. Most studies exclusively used surveys (n=663; 95.5%), with 88 different surveys identified. Only 31 studies (4.5%) used qualitative or mixed methods. Thematic analysis identified 11 themes related to safety culture dimensions across the methods, with ‘Leadership’ being the most common. Qualitative and mixed methods approaches were more likely to identify additional dimensions of safety culture not covered by the 11 themes, including improvisation and contextual pressures. Discussion We assessed the extent to which safety culture dimensions mapped to specific quantitative and qualitative tools and methods of assessing safety culture. No single method or tool appeared to measure all 11 themes of safety culture. Risk of publication bias was high in this review. Future attempts to assess safety culture in hospitals should consider incorporating qualitative methods into survey studies to evaluate this multi-faceted construct.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2020-043982
    Language: English
    Publisher: BMJ
    Publication Date: 2021
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  • 6
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    Innovative models of healthcare delivery: an umbrella review of reviews
    BMJ ; 2023
    In:  BMJ Open Vol. 13, No. 2 ( 2023-02), p. e066270-
    Details
    In: BMJ Open, BMJ, Vol. 13, No. 2 ( 2023-02), p. e066270-
    Abstract: To undertake a synthesis of evidence-based research for seven innovative models of care to inform the development of new hospitals. Design Umbrella review. Setting Interventions delivered inside and outside of acute care settings. Participants Children and adults with one or more identified acute or chronic health conditions. Data sources PsycINFO, Ovid MEDLINE and CINAHL. Primary and secondary outcome measures Clinical indicators and mortality, healthcare utilisation, quality of life, self-management and self-care and patient knowledge. Results A total of 66 reviews were included, synthesising evidence from 1272 primary studies across the 7 models of care. Virtual care was the most common model studied, addressed by 47 (73%) of the reviews. Common outcomes evaluated across reviews were clinical indicators and mortality, healthcare utilisation, self-care and self-management, patient knowledge, quality of life and cost-effectiveness. The findings indicate that the innovative models of healthcare we identified in this review may be effective in managing patients with a range of acute and chronic conditions. Most of the included reviews reported evidence of comparable or improved care. Conclusions A consideration of local infrastructure and individual patient characteristics, such as health literacy, may be critical in determining the suitability of models of care for patients and their implementation in local health systems. Trial registration number 10.17605/OSF.IO/PS6ZU.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.1136/bmjopen-2022-066270
    DOI: 10.1136/bmjopen-2022-066270.supp1
    DOI: 10.1136/bmjopen-2022-066270.supp2
    DOI: 10.1136/bmjopen-2022-066270.supp4
    DOI: 10.1136/bmjopen-2022-066270.supp3
    Language: English
    Publisher: BMJ
    Publication Date: 2023
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  • 7
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    Implementation of consensus-based perioperative care pathways to reduce clinical variation for elective surgery in an Australian private hospital: a mixed-methods pre–post study protocol
    BMJ ; 2023
    In:  BMJ Open Vol. 13, No. 7 ( 2023-07), p. e075008-
    Details
    In: BMJ Open, BMJ, Vol. 13, No. 7 ( 2023-07), p. e075008-
    Abstract: Addressing clinical variation in elective surgery is challenging. A key issue is how to gain consensus between largely autonomous clinicians. Understanding how the consensus process works to develop and implement perioperative pathways and the impact of these pathways on reducing clinical variation can provide important insights into the effectiveness of the consensus process. The primary objective of this study is to understand the implementation of an organisationally supported, consensus approach to implement perioperative care pathways in a private healthcare facility and to determine its impact. Methods A mixed-methods Effectiveness-Implementation Hybrid (type III) pre–post study will be conducted in one Australian private hospital. Five new consensus-based perioperative care pathways will be developed and implemented for specific patient cohorts: spinal surgery, radical prostatectomy, cardiac surgery, bariatric surgery and total hip and knee replacement. The individual components of these pathways will be confirmed as part of a consensus-building approach and will follow a four-stage implementation process using the Exploration, Preparation, Implementation and Sustainment framework. The process of implementation, as well as barriers and facilitators, will be evaluated through semistructured interviews and focus groups with key clinical and non-clinical staff, and participant observation. We anticipate completing 30 interviews and 15–20 meeting observations. Administrative and clinical end-points for at least 152 participants will be analysed to assess the effectiveness of the pathways. Ethics and dissemination This study received ethical approval from Macquarie University Human Research Ethics Medical Sciences Committee (Reference No: 520221219542374). The findings of this study will be disseminated through peer-reviewed publications, conference presentations and reports for key stakeholders.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.1136/bmjopen-2023-075008
    DOI: 10.1136/bmjopen-2023-075008.supp1
    DOI: 10.1136/bmjopen-2023-075008.supp2
    DOI: 10.1136/bmjopen-2023-075008.supp3
    DOI: 10.1136/bmjopen-2023-075008.supp4
    Language: English
    Publisher: BMJ
    Publication Date: 2023
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  • 8
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    Assessing the appropriateness of the management of upper respiratory tract infection in Australian children: a population-based sample survey
    BMJ ; 2019
    In:  BMJ Open Vol. 9, No. 5 ( 2019-05), p. e026915-
    Details
    In: BMJ Open, BMJ, Vol. 9, No. 5 ( 2019-05), p. e026915-
    Abstract: To assess the proportion of Australian children aged 0–15 years that received care in line with clinical practice guidelines (CPGs) for upper respiratory tract infections (URTIs). Design Retrospective medical record review using a multistage sampling strategy. Setting General practices, hospital emergency departments and hospital inpatient service providers in three Australian states. Participants Children aged up to 15 years who received care for URTI in 2012 and 2013. Primary and secondary outcome measures The primary assessment was estimated adherence with 14 indicators of appropriate care as documented in medical records. Indicators were extracted from national and international CPGs and ratified by experts. Secondary assessment was adherence to two bundles of indicators (diagnostic symptoms and medical history taking), where all indicators must be adherent for the bundle to be scored as adherent. Results There were 1653 children with one or more assessments of URTI care to CPG adherence. Over half of the children were under 3 years of age, with roughly equal numbers of males and females. Three indicators had fewer than 25 visits so were not reported. Overall adherence ranged from 0.5% for ‘documented advice around antibiotics’ to 88.3% for ‘documentation of medical history’. Adherence with Bundle A (documentation of all three definitive symptoms) was 43.1% (95% CI 32.8% to 54.0%) and Bundle B (documentation of all four indicators of medical history) was 30.2% (95% CI 20.9% to 40.9%). Conclusions URTIs in children are common, usually self-limiting, conditions that are allocated considerable resources. The results suggest that there may be a need for more thorough holistic assessment of the patient and improved documentation. Since inappropriate prescription of antibiotics for URTIs is still a known problem in Australia, there is a need for consistent, clear communication around antibiotics’ lack of impact on symptoms and a high association with undesirable side effects.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2018-026915
    Language: English
    Publisher: BMJ
    Publication Date: 2019
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  • 9
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    A cross-sectional study investigating the associations of person-organisation and person-group fit with staff outcomes in mental healthcare
    BMJ ; 2019
    In:  BMJ Open Vol. 9, No. 9 ( 2019-09), p. e030669-
    Details
    In: BMJ Open, BMJ, Vol. 9, No. 9 ( 2019-09), p. e030669-
    Abstract: Organisational and workplace cultures are fundamental determinants of health systems performance; through better understanding of the dimensions of culture there is the potential to influence them, and subsequently improve safety and quality of care, as well as the experiences of both patients and staff. One promising conceptual framework for studying culture in healthcare is person-environment (P-E) fit. Comprising person-organisational (P-O) and person-group (P-G) components, P-E fit is defined as the extent to which individuals are compatible with their work environment. The aim of this study was to examine the associations of P-O and P-G fit with staff outcomes in mental healthcare. Setting and participants Participants (n=213) were staff and volunteers at 31 primary mental health facilities across six states of Australia. Primary and secondary outcome measures Staff outcomes, comprising burnout (depersonalisation and emotional exhaustion), job satisfaction and work stress. Design A multidimensional survey tool was used to measure P-O and P-G fit, and staff outcomes. Multiple regression analyses were used to test the associations between fit and outcome measures. Results The regression analyses indicated that, based on a Bonferroni adjusted alpha value of α=00417, P-O fit accounted for 36.6% of the variability in satisfaction (F=8.951, p≤0.001); 27.7% in emotional exhaustion (F=6.766, p≤0.001); 32.8% in depersonalisation (F=8.646, p≤0.001); and 23.5% in work stress (F=5.439, p≤0.001). The P-G fit results were less conclusive, with P-G fit accounting for 15.8% of the variability in satisfaction (F=4.184, p≤0.001); 10.0% in emotional exhaustion (F=2.488, p=0.014); 28.6% in depersonalisation (F=8.945, p≤0.001); and 10.4% in work stress (F=2.590, p=0.032). There was no statistically significant increase in the variability accounted for when the interaction term of P-O and P-G fit was added to the regression. Conclusions The findings highlight that staff’s perception of their workplace and organisational culture can have implications for staff well-being.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    URL: Article
    DOI: 10.1136/bmjopen-2019-030669
    DOI: 10.1136/bmjopen-2019-030669.supp1
    Language: English
    Publisher: BMJ
    Publication Date: 2019
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  • 10
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    Engagement with healthcare providers and healthcare system navigation among Australians with chronic conditions: a descriptive survey study
    BMJ ; 2022
    In:  BMJ Open Vol. 12, No. 12 ( 2022-12), p. e061623-
    Details
    In: BMJ Open, BMJ, Vol. 12, No. 12 ( 2022-12), p. e061623-
    Abstract: With the rate of chronic conditions increasing globally, it is important to understand whether people with chronic conditions have the capacity to find the right care and to effectively engage with healthcare providers to optimise health outcomes. We aimed to examine associations between care navigation, engagement with health providers and having a chronic health condition among Australian adults. Design and Setting This is a cross-sectional, 39-item online survey including the navigation and engagement subscales of the Health Literacy Questionnaire, completed in December 2018, in Australia. Binary variables (low/high health literacy) were created for each item and navigation and engagement subscale scores. Logistic regression analyses (estimating ORs) determined the associations between having a chronic condition and the navigation and engagement scores, while controlling for age, gender, level of education and income. Participants 1024 Australians aged 18–88 years (mean=46.6 years; 51% female) recruited from the general population. Results Over half (n=605, 59.0%) of the respondents had a chronic condition, mostly back pain, mental disorders, arthritis and asthma. A greater proportion of respondents with chronic conditions had difficulty ensuring that healthcare providers understood their problems (32.2% vs 23.8%, p=0.003), having good discussions with their doctors (29.1% vs 23.5%, p=0.05), discussing things with healthcare providers until they understand all they needed (30.5% vs 24.5%, p=0.04), accessing needed healthcare providers (35.7% vs 29.7%, p=0.05), finding the right place to get healthcare services (36.3% vs 29.2%, p=0.02) and services they were entitled to (48.3% vs 40.6%, p=0.02), and working out what is the best healthcare for themselves (34.2% vs 27.7%, p=0.03). Participants with chronic conditions were 1.5 times more likely to have low scores on the engagement (adjusted OR=1.48, p=0.03, 95% CI 1.05 to 2.08) and navigation (adjusted OR=1.43, p=0.026, 95% CI 1.043 to 1.970) subscales after adjusting for age, gender, income and education. Conclusion Upskilling in engagement and communication for healthcare providers and people with chronic conditions is needed. Codesigned, clearly articulated and accessible information about service entitlements and pathways through care should be made available to people with chronic conditions. Greater integration across health services, accessible shared health records and access to care coordinators may improve navigation and engagement.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    URL: Article
    DOI: 10.1136/bmjopen-2022-061623
    DOI: 10.1136/bmjopen-2022-061623.supp1
    Language: English
    Publisher: BMJ
    Publication Date: 2022
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