Gerd Flodgren

The effectiveness of strategies to change organisational culture to improve healthcare performance: a systematic review

BackgroundOrganisational culture is an anthropological metaphor used to inform research and consultancy and to explain organisational environments. In recent years, increasing emphasis has been placed on the need to change organisational culture in order to improve healthcare performance. However, the precise function of organisational culture in healthcare policy often remains underspecified and the desirability and feasibility of strategies to be adopted have been called into question. The objective of this review was to determine the effectiveness of strategies to change organisational culture in order to improve healthcare performance.MethodsWe searched the following electronic databases: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, Sociological Abstracts, Web of Knowledge, PsycINFO, Business and Management, EThOS, Index to Theses, Intute, HMIC, SIGLE, and Scopus until October 2009. The Database of Abstracts of Reviews of Effectiveness (DARE) was searched for related reviews. We also searched the reference lists of all papers and relevant reviews identified, and we contacted experts in the field for advice on further potential studies. We considered randomised controlled trials (RCTs) or well designed quasi-experimental studies (controlled clinical trials (CCTs), controlled before and after studies (CBAs), and interrupted time series (ITS) analyses). Studies could be set in any type of healthcare organisation in which strategies to change organisational culture in order to improve healthcare performance were applied. Our main outcomes were objective measures of professional performance and patient outcome.ResultsThe search strategy yielded 4,239 records. After the full text assessment, two CBA studies were included in the review. They both assessed the impact of interventions aimed at changing organisational culture, but one evaluated the impact on work-related and personal outcomes while the other measured clinical outcomes. Both were at high risk of bias. Both reported positive results.ConclusionsCurrent available evidence does not identify any effective, generalisable strategies to change organisational culture. Healthcare organisations considering implementing interventions aimed at changing culture should seriously consider conducting an evaluation (using a robust design, e.g., ITS) to strengthen the evidence about this topic.

Glutamate and prostaglandin E2 in the trapezius muscle of female subjects with chronic muscle pain and controls determined by microdialysis

Much is still unknown concerning the mechanisms underlying the development of chronic muscle pain. The presence and magnitude of inflammatory substances and neurotransmitters in chronic painful conditions is not clear. The aims of the present study were to determine, with the use of microdialysis, the interstitial concentrations and the equilibration times for PGE2 and glutamate in the trapezius muscles of nine female subjects with chronic muscle pain, and nine pain‐free age‐matched controls. A microdialysis probe was implanted in the upper part of the trapezius muscle and perfused with Ringer‐acetate solution at a flow rate of 0.3 μL/min. Samples were obtained every 30 min, during a 4‐h rest period. At equilibration, the mean concentrations (−SE) of PGE2 were 0.71 (−0.11) ng/mL for the pain‐group and 0.97 (−0.35) ng/mL for the controls. For glutamate the mean concentrations for the pain‐group were 66.3 (−13.3) μmol/L and 60.6 (−22.9) μmol/L for the controls. For the pain group and the control group, respectively, equilibration for PGE2 was reached at 180 and 150 min, and for glutamate at 150 and 120 min. The present study showed no differences between groups in the concentrations of PGE2 and glutamate in the trapezius muscle. Further, it revealed that when using the slow‐flow method, a period of at least 2.0‐2.5 h is needed, after probe insertion, to reach steady state for glutamate and PGE2.

Combining microdialysis and near-infrared spectroscopy for studying effects of low-load repetitive work on the intramuscular chemistry in trapezius myalgia.

Epidemiological research provides strong evidence for a link between repetitive work (RW) and the development of chronic trapezius myalgia (TM). The aims were to further elucidate if an accumulation of sensitising substances or impaired oxygenation is evident in painful muscles during RW. Females with TM (n = 14) were studied during rest, 30 minutes RW and 60 minutes recovery. Microdialysate samples were obtained to determine changes in intramuscular microdialysate (IMMD) [glutamate], [PGE2], [lactate], and [pyruvate] (i.e., [concentration]) relative to work. Muscle oxygenation (%StO2) was assessed using near-infrared spectroscopy. During work, all investigated substances, except PGE2, increased significantly: [glutamate] (54%, P < .0001), [lactate] (26%, P < .005), [pyruvate] (19%, P < .0001), while the %StO2 decreased (P < .05). During recovery [PGE2] decreased (P < .005), [lactate] remained increased (P < .001), [pyruvate] increased progressively (P < .0001), and %StO2 had returned to baseline. Changes in substance concentrations and oxygenation in response to work indicate normal increase in metabolism but no ongoing inflammation in subjects with TM.

The champion for improved delivery of care to older people in long‐term care settings: effects on professional practice, quality of care and resident outcomes

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effectiveness of the champion on professional practice, quality of care and resident outcomes in long-term care for older people.

Interstitial PGE2 and Glutamate Levels in the Trapezius Muscle of Females - Determined by Microdialysis

Interstitial PGE2 and glutamate levels in the trapezius muscle of females - determined by microdialysis (poster)