Éidín Ní Shé

Undertaking a Collaborative Rapid Realist Review to Investigate What Works in the Successful Implementation of a Frail Older Person’s Pathway

We addressed the research question “what factors enable the successful development and implementation of a frail older person’s pathway within the acute setting”. A rapid realist review (RRR) was conducted by adopting the RAMESES standards. We began with a sample of 232 articles via database searches supplemented with 94 additional records including inputs from a twitter chat and a hospital site visit. Our final sample consisted of 18 documents. Following review and consensus by an expert panel we identified a conceptual model of context-mechanism-(resources)-outcomes. There was overall agreement frailty should be identified at the front door of the acute hospital. Significant challenges identified related to organisational boundaries both within the acute setting and externally, the need to shift outcomes to patient orientated ones, to support staff to sustain the pathway by providing ongoing education and by providing role clarity. RRRs can support research such as the systematic approach to improving care for frail older adults (SAFE) study by producing accounts of what works based on a wide range of sources and innovative engagement with stakeholders. It is evident from our provisional model that numerous factors need to combine and interact to enable and sustain a successful frail older person’s pathway.

Imbuing Medical Professionalism in Relation to Safety: A study protocol for a mixed-methods intervention focused on trialling an embedded learning approach that centres on the use of a custom designed board game

Introduction Healthcare organisations have a responsibility for ensuring that the governance of workplace settings creates a culture that supports good professional practice. Encouraging such a culture needs to start from an understanding of the factors that make it difficult for health professionals to raise issues of concern in relation to patient safety. The focus of this study is to determine whether a customised education intervention, developed as part of the study, with interns and senior house officers (SHOs) can imbue a culture of medical professionalism in relation to patient safety and support junior doctors to raise issues of concern, while shaping a culture of responsiveness and learning. Methods and analysis We will use quantitative and qualitative methods to collect data. The sample size will be approximately 200 interns and SHOs across the two hospital sites. Two surveys will be included with one measuring leadership inclusiveness and psychological safety and a second capturing information on safety concerns that participants may have witnessed in their places of work. The PlayDecide embedded learning intervention will be developed with key stakeholders. This will be trialled in the middle stage of data collection for both interns and SHOs. A detailed content analysis will be conducted on the surveys to assess any changes in reporting following the PlayDecide intervention. This will be compared with the incident reporting levels and the results of the preintervention and postintervention leadership inclusiveness and psychological safety survey. Statistical analysis will be conducted using SPSS. Differences will be considered statistically significant at p<0.05. Semistructured interviews using a critical incident technique will be used for the ongoing analysis and evaluation of the project. These will be transcribed, de-identified and coded into themes. Ethics and dissemination The study has been granted ethics approval from University College Dublin (Ref. LS-15–19-Ward-McAuliffe: Imbuing Medical Professionalism in Relation to Safety). The study results will be disseminated through peer-reviewed publications.

Scoping of models to support population-based regional health planning and management: comparison with the regional operating model in Victoria, Australia

Objective The aim of the present study was to try to understand the breadth and comprehensiveness of a regional operating model (ROM) developed within the Victorian Department of Healths North West Metropolitan Region office in Melbourne, Australia. Methods A published literature search was conducted, with additional website scanning, snowballing technique and expert consultation, to identify existing operating models. An analytical grid was developed covering 16 components to evaluate the models and assess the exhaustiveness of the ROM. Results From the 34 documents scoped, 10 models were identified to act as a direct comparator to the ROM. These concerned models from Australia (n=5) and other comparable countries (Canada, UK). The ROM was among the most exhaustive models, covering 13 of 16 components. It was one of the few models that included intersectoral actions and levers of influence. However, some models identified more precisely the planning tools, prioritisation criteria and steps, and the allocation mechanisms. Conclusions The review finds that the ROM appears to provide a wide coverage of aspects of planning and integrates into a single model some of the distinctive elements of the other models scoped. What is known about the topic? Various jurisdictions are moving towards a population-based approach to manage public services with regard to the provision of individual medical and social care. Various models have been proposed to guide the planning of services from a population health perspective. What does this paper add? This paper assesses the coverage of attributes of operating models supporting a population health planning approach to the management of services at the regional or local level. It provides a scoping of current models proposed to organise activities to ensure an integrated approach to the provision of services and compares the scoped models to a model recently implemented in Victoria, Australia. What are the implications for practitioners? This paper highlights the relative paucity of operating models describing in concrete terms how to manage medical and social services from a population perspective and encourages organisations that are accountable for securing population health to clearly articulate their own operating model. It outlines strengths and potential gaps in current models.

Men of Business ‘ Pay it Forward ’ Program: A Model for Building Social Capital in Disenfranchised Youth in High Schools

The Men of Business (MOB) ‘Pay it Forward’ programme was established on the Gold Coast, Queensland, Australia, in 2009, by a group of local business owners with the aim of introducing a healthy lifestyle and attitude to marginalised male youth aged 13–17 years. For eight weeks, high school student participants attended weekly one-hour physical workouts, followed by a one-hour mentoring session. Each week, a different MOB mentor volunteered his time to share his story with the MOB boys. This chapter focuses on the lived experiences of the MOB programme from the boys’ and mentors’ perspectives, respectively. The qualitative research findings informed the development of an MOB operating model across five output areas—outcomes relevant to the MOB boys, MOB mentors, school, community and public policy—each with their corresponding social impacts. A logic model for introducing the MOB programme to new schools is also provided. Understanding the full social impacts of the MOB programme requires longer-term tracking of the change process relevant to key stakeholders, specifically the MOB boys and MOB mentors.

Stewarding Change? A Discussion About the METRO Care Model in Regional Australia

METRO Care is a Toowoomba-based not-for-profit organisation and is the community care expression of METRO Church Toowoomba which is in south-west Queensland in Australia. METRO Care partners with the local community offering innovative and targeted outreach programme that complement existing services. This chapter presents a discussion on the METRO Care partnership model highlighting the innovative projects METRO Care has initiated in the community. The METRO Care Street Crews program, a harm minimisation, peer-support street outreach program, operating every Thursday, Friday and Saturday night in the Toowoomba central business district is showcased in this chapter. These programme aim to (a) provide an on-the-ground support network helping young people find effective solutions and support in accessing vital services and (b) reduce alcohol-related behaviours and maintain a safer night precinct. This chapter presents a discussion held by the authors on the focus and work of METRO Care in developing innovative sustainable partnerships in the Toowoomba community and suggests that their programme offer a model for stewarding change in the non-government organisation sector.

The Health Systems Workforce in an Era of Globalised Superdiversity—Exploring the Global Care Chain Landscape in Ireland

Globally, in advanced economies, there has been an increase in “superdiversity” which is associated with person’s immigration status and associated rights and entitlements. There is a relative paucity of the literature on the internal impacts of globalisation on core welfare services such as education and health. On review, you can clearly see the internal impacts of globalisation and superdiversity within a central component of the welfare state such as the health system. This chapter explores these impacts by reflecting on the global workforce within the Irish health system workforce via the lens of a global care chain framework. The chapter argues for new thinking to retain health workers and notes that the lessons being learned slowly in Ireland can assist other international health workforce planners.

Enabling States, Capitalising Enterprise and Confronting the Social: Issues and Implications in Researching Contemporary Social Capital and Enterprise

A key feature of late capitalism continues to be a complex reworking of previous approaches to the relationship between the state and business. This significant shift in the interplay between the public and private sectors has generated such developments as the privatisation of many services formerly provided by government and the growth of not-for-profit organisations seeking to fill gaps in service provision. These changes are highly significant for every citizen and community member and for all stakeholders. This first chapter in this book encapsulates these complex developments in terms of debates about the enabling imperatives of the contemporary state, the character of the intersection between capital and enterprise, and a timely confrontation of what is understood by “the social” in current discourses, policies and strategies. In presenting this distillation, the authors introduce the subsequent chapters in the book in terms of how each chapter, including this one, contributes new insights to the broader project of eliciting the issues and implications attendant on researching contemporary social capital and social enterprise. This project is crucial if we are to understand the ways in which social capital and social enterprise can work sustainably and transformatively with variously marginalised and vulnerable groups in our societies. It is vital also for understanding the ways that such work is constrained and limited in its effectiveness.

The systematic approach to improving care for Frail Older Patients (SAFE) study: A protocol for co-designing a frail older person’s pathway

Background: Frailty is the age-accelerated decline across multiple organ systems which leads to vulnerability to poor resolution of homeostasis after a stressor event. This loss of reserve means that a minor illness can result in a disproportionate loss of functional ability. Improving acute care for frail older patients is now a national priority and an important aspect of the National Programme for Older People in Ireland. Evidence suggests that an interdisciplinary approach incorporating rapid comprehensive geriatric assessment and early intervention by an interdisciplinary team can reduces susceptibility to hospitalisation related functional decline. The aim of the Systematic Approach to Improving Care for Frail Older Patients (SAFE) is to develop and explore the process of implementing a model of excellence in the delivery of patient-centred integrated care within the context of frail older people’s acute admissions. Methods: The SAFE study will employ a mixed methodology approach, including a rapid realist review of the current literature alongside a review of baseline data for older people attending the emergency department. Semi-structured interviews will be undertaken to document the current pathway. The intervention processes and outcomes will be jointly co-designed by a patient and public involvement (PPI) group together with the interdisciplinary healthcare professionals from hospital, community and rehabilitation settings. Successive rounds of Plan-Do-Study-Act cycles will then be undertaken to test and refine the pathway for full implementation. Discussion: This research project will result in a plan for implementing an integrated, patient-centred pathway for acute care of the frail older people which has been tested in the Irish setting. During the process of development, each element of the new pathway will be tested in turn to ensure that patient centred outcomes are being realised. This will ensure the resulting model of care is ready for implementation in the context of the Irish health service.

Moving regional health services planning and management to a population-based approach: implementation of the Regional Operating Model (ROM) in Victoria, Australia

Various jurisdictions are moving towards population-based approaches to plan and manage healthcare services. The evidence on the implementation of these models remains limited. The aim of this study is to evaluate the effect of a regional operating model (ROM) on internal functioning and stakeholder engagement of a regional office. Semi-structured interviews and focus groups with staff members and stakeholders of the North West Metropolitan Regional office in Victoria, Australia, were conducted. Overall, the ROM was perceived as relevant to staff and stakeholders. However, creating shared objectives and priorities across a range of organisations remained a challenge. Area-based planning and management is seen as simplifying management of contracts; however, reservations were expressed about moving from specialist to more generalist approaches. A clearer articulation of the knowledge, skills and competencies required by staff would further support the implementation of the model. The ROM provides a platform for public services and stakeholders to discuss, negotiate and deliver on shared outcomes at the regional level. It provides an integrated managerial platform to improve service delivery and avoid narrow programmatic approaches.