Making Changes (making + change)

Distribution by Scientific Domains


Selected Abstracts


Translating Research into Clinical Practice: Making Change Happen

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2004
Elizabeth H. Bradley PhD
Objectives: To describe the process of adoption of an evidence-based, multifaceted, innovative program into the hospital setting, with particular attention to issues that promoted or impeded its implementation. This study examined common challenges faced by hospitals implementing the Hospital Elder Life Program (HELP) and strategies used to address these challenges. Design: Qualitative study design based on in-depth, open-ended telephone interviews. Setting: Nine hospitals implementing HELP throughout the United States. Participants: Thirty-two key staff members (physician, nursing, volunteer, and administrative staff) who were directly involved with the HELP implementation. Measurements: Staff experiences implementing the program, including challenges and strategies they viewed as successful in overcoming challenges of implementation. Results: Six common challenges faced hospital staff: (1) gaining internal support for the program despite differing requirements and goals of administration and clinical staff, (2) ensuring effective clinician leadership, (3) integrating with existing geriatric programs, (4) balancing program fidelity with hospital-specific circumstances, (5) documenting positive outcomes of the program despite limited resources for data collection and analysis, and (6) maintaining the momentum of implementation in the face of unrealistic time frames and limited resources. Strategies perceived to be successful in addressing each challenge are described. Conclusion: Translating research into clinical practice is challenging for staff across disciplines. Developing strategies to address common challenges identified in this study may facilitate the adoption of innovative programs within healthcare organizations. [source]


On the way to the future: The knowledge-based enterprise

HUMAN FACTORS AND ERGONOMICS IN MANUFACTURING & SERVICE INDUSTRIES, Issue 1 2005
Irena K. Hejduk
The knowledge employees, who constitute intellectual capital of contemporary organizations, are the essence of 21st century enterprises. Utilization of such intellectual capital requires making changes in the enterprise's organizational culture to implement efficient and effective knowledge management processes. The concept of knowledge management as a business tool is discussed, and definitions and classification of contemporary knowledge management strategies and techniques are provided herein. © 2005 Wiley Periodicals, Inc. Hum Factors Man 15: 5,14, 2005. [source]


The feasibility of a GP led screening intervention for depression among nursing home residents

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 11 2006
Sandra Davidson
Abstract Aim To examine the feasibility of a brief intervention training general practitioners (GPs) in the administration of a depression screening instrument for use among nursing home residents. Intervention GPs attended a single education session on late-life depression and were trained in the use of the Cornell Scale for Depression in Dementia. Following the intervention GPs reviewed their patients for depression. Outcome measures Diagnosis of depression pre and post intervention; changes in antidepressant medications post intervention. Results Ten GPs and 38 patients completed all components of the study. GPs identified that 24% of their patients had Cornell Scores indicative of probable major depression that was either unrecognised or inadequately treated. 88% of these patients had been previously diagnosed with depression. A further 32% of patients exhibited depression symptoms, half (50%) of whom had a previous diagnosis of depression. Reviewing patients had an effect on antidepressant prescribing for patients with probable major depression, with GPs making changes to the antidepressant medication of 29% of patients. Conclusions The high rate of residents presenting with probable major depression despite being prescribed antidepressants indicate that depression symptoms are inadequately recognised and treated in nursing homes. This study demonstrated that a single education session on late-life depression was feasible and was associated with an improvement in GPs' recognition of depression among nursing home patients. Copyright © 2006 John Wiley & Sons, Ltd. [source]


Challenges in multisource feedback: intended and unintended outcomes

MEDICAL EDUCATION, Issue 6 2007
Joan Sargeant
Context, Multisource feedback (MSF) is a type of formative assessment intended to guide learning and performance change. However, in earlier research, some doctors questioned its validity and did not use it for improvement, raising questions about its consequential validity (i.e. its ability to produce intended outcomes related to learning and change). The purpose of this qualitative study was to increase understanding of the consequential validity of MSF by exploring how doctors used their feedback and the conditions influencing this use. Methods, We used interviews with open-ended questions. We purposefully recruited volunteer participants from 2 groups of family doctors who participated in a pilot assessment of MSF: those who received high (n = 25) and those who received average/lower (n = 44) scores. Results, Respondents included 12 in the higher- and 16 in the average/lower-scoring groups. Fifteen interpreted their feedback as positive (i.e. confirming current practice) and did not make changes. Thirteen interpreted feedback as negative in 1 or more domains (i.e. not confirming their practice and indicating need for change). Seven reported making changes. The most common changes were in patient and team communication; the least common were in clinical competence. Positive influences upon change included receiving specific feedback consistent with other sources of feedback from credible reviewers who were able to observe the subjects. These reviewers were most frequently patients. Discussion, Findings suggest circumstances that may contribute to low consequential validity of MSF for doctors. Implications for practice include enhancing procedural credibility by ensuring reviewers' ability to observe respective behaviours, enhancing feedback usefulness by increasing its specificity, and considering the use of more objective measures of clinical competence. [source]


Standardizing evaluation of on-line continuing medical education: Physician knowledge, attitudes, and reflection on practice

THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 2 2004
Associate Director, Dr. Linda Casebeer PhD Associate Professor
Abstract Introduction: Physicians increasingly earn continuing medical education (CME) credits through on-line courses, but there have been few rigorous evaluations to determine their effects. The present study explores the feasibility of implementing standardized evaluation templates and tests them to evaluate 30 on-line CME courses. Methods: A time series design was used to compare the knowledge, attitudes, and reported changes in practice of physician participants who completed any of 30 on-line CME courses that were hosted on an academic CME Web site and a CME Web portal during the period from August 1, 2002, through March 31, 2003. Data were collected at baseline, at course completion, and 4 weeks later. Paired t tests were used to compare the means of responses across time. Results: U.S. physicians completed 720 post-tests. Quality of content was the characteristic of most importance to participants; too little interaction was the largest source of dissatis-faction. Overall mean knowledge scores increased from 58.1% to 75.6% at post-test and then decreased to 68.2% at 4 weeks following the course. Effect sizes of increased knowledge immediately following the course were larger for case-based than for text-based courses. Nearly all physicians reported making changes in practice following course completion, although reported changes differed from expected changes. Conclusions: Increases in physician knowledge and knowledge retention were demonstrated following participation in on-line CME courses. The implementation of standardized evaluation tests proved to be feasible and allowed longitudinal evaluation analyses across CME providers and content areas. [source]