Charmaine McPherson

Rural interprofessional primary health care team development and sustainability: establishing a research agenda

Primary health care (PHC) plays a pivotal role in health system reform locally and globally. The use of well functioning interprofessional primary health care (IPHC) teams is recognized as a key strategy in widespread health system reform across global, national, and provincial jurisdictions. IPHC teams contribute to the improvement of the health and well being of the population. These teams engage in issues that are a priority for citizens, such as: providing good evidence-based care; supporting the efforts of individuals, families, and communities in leading healthy lives; actively and deliberatively involving citizens in decisions affecting their health and health care system; and addressing the systemic social, economic, and political causes of health disparities, such as poverty, violence, and rural isolation. Many jurisdictions have begun to experiment with and implement major changes in the delivery of PHC. This has required that health care managers and practitioners reconsider the ways in which they have traditionally worked. However, although many innovative PHC services were developed, the notion of how to best develop and sustain the service delivery team itself and within what contexts could have used more deliberate attention. There are no documented best practices for rural IPHC team development and sustainability in the scholarly literature. This paper presents the results of a literature review, including the empirical and conceptual evidence regarding team development, team sustainability, and the role of rural context in IPHC team development. An argument for advancing PHC research that focuses on rural IPHC team development and sustainability is posited.

Ontario primary care reform and quality improvement activities: an environmental scan

BackgroundQuality improvement is attracting the attention of the primary health care system as a means by which to achieve higher quality patient care. Ontario, Canada has demonstrated leadership in terms of its improvement in healthcare, but the province lacks a structured framework by which it can consistently evaluate its quality improvement initiatives specific to the primary healthcare system. The intent of this research was to complete an environmental scan and capacity map of quality improvement activities being built in and by the primary healthcare sector (QI-PHC) in Ontario as a first step to developing a coordinated and sustainable framework of primary healthcare for the province.MethodsData were collected between January and July 2011 in collaboration with an advisory group of stakeholder representatives and quality improvement leaders in primary health care. Twenty participants were interviewed by telephone, followed by review of relevant websites and documents identified in the interviews. Data were systematically examined using Framework Analysis augmented by Prior’s approach to document analysis in an iterative process.ResultsThe environmental scan identified many activities (n = 43) designed to strategically build QI-PHC capacity, identify promising QI-PHC practices and outcomes, scale up quality improvement-informed primary healthcare practice changes, and make quality improvement a core organizational strategy in health care delivery, which were grouped into clusters. Cluster 1 was composed of initiatives in the form of on-going programs that deliberately incorporated long-term quality improvement capacity building through province-wide reach. Cluster 2 represented activities that were time-limited (research, pilot, or demonstration projects) with the primary aim of research production. The activities of most primary health care practitioners, managers, stakeholder organizations and researchers involved in this scan demonstrated a shared vision of QI-PHC in Ontario. However, this vision was not necessarily collaboratively developed nor were activities necessarily strategically linked.ConclusionsWithin the scope of this research, the scan affirmed that there is currently no province-wide, integrated, and measured quality improvement program for the primary healthcare sector in Ontario. This could be improved by the development of a coordinated plan, an accompanying accountability framework, and an appropriate sustainable funding envelope for QI-PHC at the provincial level.

Swimming against the tide: A Canadian qualitative study examining the implementation of a province-wide public health initiative to address health equity.

BackgroundEffectively addressing the social determinants of health and health equity are critical yet still-emerging areas of public health practice. This is significant for contemporary practice as the egregious impacts of health inequities on health outcomes continue to be revealed. More public health organizations seek to augment internal organizational capacity to address health equity while the evidence base to inform such leadership is in its infancy. The purpose of this paper is to report on findings of a study examining key factors influencing the development and implementation of the social determinants of health public health nurse (SDH-PHN) role in Ontario, Canada.MethodsA descriptive qualitative case study approach examined the first Canadian province-wide initiative to add SDH-PHNs to each public health unit. Data sources were documents and staff from public health units (i.e., SDH-PHNs, Managers, Directors, Chief Nursing Officers, Medical Officers of Health) as well as external stakeholders. Data were collected through 42 individual interviews and 226 documents. Interview data were analyzed using framework analysis methods; Prior’s approach guided document analysis.ResultsThree themes related to the SDH-PHN role implementation were identified: (1) ‘Swimming against the tide’ to lead change as staff navigated ideological tensions, competency development, and novel collaborations; (2) Shifting organizational practice environments impacted by initial role placement and action to structurally embed health equity priorities; and (3) Bridging policy implementation gaps related to local-provincial implementation and reporting expectations.ConclusionsThis study extends our understanding of the dynamic interplay among leadership, change management, ideological tensions, and local-provincial public health policy impacting health equity agendas. Given that the social determinants of health lie outside public health, collaboration with communities, health partners and non-health partners is essential to public health practice for health equity. The study findings have implications for increasing our knowledge and capacity for effective system-wide intervention towards health equity as a critical strategic priority for public health and for broader public policy and community engagement. Appropriate and effective public health leadership at multiple levels and by multiple actors is tantamount to adequately making inroads for health equity.

A catalyst for system change: a case study of child health network formation, evolution and sustainability in Canada

BackgroundThe purpose of this study was to examine key processes and supportive and inhibiting factors involved in the development, evolution, and sustainability of a child health network in rural Canada. This study contributes to a relatively new research agenda aimed at understanding inter-organizational and cross-sectoral health networks. These networks encourage collaboration focusing on complex issues impacting health – issues that individual agencies cannot effectively address alone. This paper presents an overview of the study findings.MethodsAn explanatory qualitative case study approach examined the Networks 13-year lifespan. Data sources were documents and Network members, including regional and 71 provincial senior managers from 11 child and youth service sectors. Data were collected through 34 individual interviews and a review of 127 documents. Interview data were analyzed using framework analysis methods; Priors approach guided document analysis.ResultsThree themes related to network development, evolution and sustainability were identified: (a) Network relationships as system triggers, (b) Network-mediated system responsiveness, and (c) Network practice as political.ConclusionsStudy findings have important implications for network organizational development, collaborative practice, interprofessional education, public policy, and public system responsiveness research. Findings suggest it is important to explicitly focus on relationships and multi-level socio-political contexts, such as supportive policy environments, in understanding health networks. The dynamic interplay among the Network members; central supportive and inhibiting factors; and micro-, meso-, and macro-organizational contexts was identified.

A multiple case study of intersectoral public health networks: experiences and benefits of using research

BackgroundNetwork partnerships between public health and third sector organisations are being used to address the complexities of population level social determinants of health and health equity. An understanding of how these networks use research and knowledge is crucial to effective network design and outcome evaluation. There is, however, a gap in the literature regarding how public health networks use research and knowledge. The purpose of this paper is to report on the qualitative findings from a larger study that explored (1) the experiences of public health networks with using research and knowledge, and (2) the perceived benefits of using research and knowledge.MethodsA multiple case study approach framed this study. Focus group data were collected from participants through a purposive sample of four public health networks. Data were analyzed using Framework Analysis and Nvivo™ software supported data management. Each network had the opportunity to participate in data interpretation.ResultsAll networks used published research studies and other types of knowledge to accomplish their work, although in each network research and knowledge played different but complementary roles. Neither research nor other types of knowledge were privileged, and an approach that blended varied knowledge types was typically used. Network experiences with research and knowledge produced individual and collective benefits. A novel finding was that research and knowledge were both important in shaping network function.ConclusionsThis study shifts the focus in the current literature from public health departments to the community setting where public health collaborates with a broader spectrum of actors to ameliorate health inequities. Both formal research and informal knowledge were found to be important for collaborative public health networks. Examining the benefits of research and knowledge use within public health networks may help us to better understand the relationships among process (the collaborative use of research and knowledge), structure (networks) and outcomes (benefits).

Examination of the British Columbia influenza prevention policy for healthcare workers: Phase 1 qualitative case study

ABSTRACT In August 2012, British Columbia became the first Canadian province to implement a province-wide Influenza Prevention Policy requiring all healthcare workers (HCWs) in residential and acute care facilities to either be immunized against influenza, or wear masks in patient care areas during the influenza season. This qualitative case study sought to understand the key facilitators and barriers involved in developing and implementing British Columbias Influenza Prevention Policy. An explanatory qualitative case study approach was selected for this project. Data were collected through the review of 110 documents (policy and planning documents, implementation tools, press releases, communication materials, etc.), and through 7 focus groups with policy implementation team members (n = 48). Focus group interview transcripts were analyzed using Framework Analysis methods, and Priors approach guided document analysis. Four themes were identified: (1) Clashing paradigms, (2) Policy implementation gaps, (3) Pathways of power, and (4) Personal impacts. Issues embedded in macro-, meso-, and micro-level contexts, and planning across the province, were identified as critical to policy implementation. A province-wide approach with senior-level engagement and dedicated resources is critical in a province-wide influenza prevention policy for HCW. Recommendations to improve large-scale implementation of condition-of-service influenza policies include: engaging stakeholders early, considering the complexity of political contexts, allotting time to plan appropriately, developing ‘enforcement’ plans, and providing education and skills to frontline providers.

Blending Simulation-Based Learning and Interpretative Pedagogy for Undergraduate Leadership Competency Development.

BACKGROUND Effective leadership is an essential component guiding nursing activity and influencing health systems, health workers, and patient outcomes. Despite this evidence, undergraduate nursing programs may not be adequately preparing graduates to effectively engage in leadership practice. METHOD This article describes an educational innovation designed to support prelicensure leadership competency development. The authors blended simulation-based learning (SBL) with an interpretative pedagogical frame in a senior nursing leadership course at a primarily undergraduate university. RESULTS The innovation involves a break from traditional nursing educational pedagogy by bringing SBL into the leadership classroom. Using interpretative pedagogy to purposefully create different relationships in the learning space supported deeper personal and professional transformation for the students. CONCLUSION Nurse educators must purposefully design leadership curricula using active educational strategies that adequately prepare nurses for complex health systems. Integrating SBL within an interpretative pedagogy for leadership development moves students from merely knowing theory to informed and effective action. [J Nurs Educ. 2017;56(1):49-54.].