Karen Day

Supporting information technology across health boards in New Zealand: the role of learning in adapting to complex change.

This article describes a study of a major change management project involving the establishment of a shared services organization to align the information services functions for two district health boards in New Zealand. The research uncovered a capability crisis that many people experienced when they realized the magnitude of the task they were involved in. Not everyone experienced the crisis and it seems that learning, especially in a complex healthcare environment, plays an important role in reducing the negative impact of change.

Supporting information technology across health boards in New Zealand: themes emerging from the development of a shared services organization.

Shared services organizations are ascribed with adding value to business in several ways but especially by sharing resources and leading to economies of scale. However, these gains are not automatic and in some instances, particularly healthcare, they are difficult to achieve. This article describes a project to develop a shared services information technology infrastructure across two district health boards in New Zealand. The study reveals valuable insight into the crisis issues that accompany change management and identifies emergent themes that can be used to reduce negative impact.

Unleashing the power of human genetic variation knowledge: New Zealand stakeholder perspectives

Purpose: This study aimed to characterize the challenges in using genetic information in health care and to identify opportunities for improvement.Methods: Taking a grounded theory approach, semistructured interviews were conducted with 48 participants to collect multiple stakeholder perspectives on genetic services in New Zealand.Results: Three themes emerged from the data: (1) four service delivery models were identified in operation, including both those expected models involving genetic counselors and variations that do not route through the formal genetic service program; (2) multiple barriers to sharing and using genetic information were perceived, including technological, organizational, institutional, legal, ethical, and social issues; and (3) impediments to wider use of genetic testing technology, including variable understanding of genetic test utilities among clinicians and the limited capacity of clinical genetic services. Targeting these problems, information technologies and knowledge management tools have the potential to support key tasks in genetic services delivery, improve knowledge processes, and enhance knowledge networks.Conclusion: Because of the effect of issues in genetic information and knowledge management, the potential of human genetic variation knowledge to enhance health care delivery has been put on a “leash.”

Should we embed randomized controlled trials within action research: arguing from a case study of telemonitoring.

BackgroundAction research (AR) and randomized controlled trials (RCTs) are usually considered to be theoretically and practically incompatible. However, we argue that their respective strengths and weaknesses can be complementary. We illustrate our argument from a recent study assessing the effect of telemonitoring on health-related quality of life, self-care, hospital use, costs and the experiences of patients, informal carers and health care professionals in two urban hospital services and one remote rural primary care service in New Zealand.MethodsData came from authors’ observations and field notes of discussions with three groups: the healthcare providers and healthcare consumers who participated in the research, and a group of 17 researchers and collaborators. The consumers had heart failure (Site A, urban), airways disease (Site B, urban), and diabetes (Site C, rural). The research ran from 2008 (project inception) until 2012 (project close-off). Researchers came from a wide range of disciplines. Both RCT and AR methods were recognised from early in the process but often worked in parallel rather than together. In retrospect, we have mapped our observed research processes to the AR cycle characteristics (creation of communicative space, democracy and participation, iterative learning and improvement, emergence, and accommodation of different ways of knowing).ResultsWe describe the context, conduct and outcomes of the telemonitoring trial, framing the overall process in the language of AR. Although not fully articulated at the time, AR processes made the RCT sensitive to important context, e.g. clinical processes. They resulted in substantive changes to the design and conduct of the RCT, and to interpretation and uptake of findings, e.g. a simpler technology procurement process emerged. Creating a communicative space enabled co-design between the researcher group and collaborators from the provider participant group, and a stronger RCT design.ConclusionsIt appears possible to enhance the utility of RCTs by explicitly embedding them in an AR framework to shape stronger RCT design. The AR process and characteristics may enable researchers to evaluate telehealth while enhancing rather than compromising the quality of an RCT, where research results are returned to practice as part of the research process.Trial registrationAustralian New Zealand Clinical Trials Registry, reference ACTRN12610000269033.

Attitudes and concerns of doctors and nurses about using a translation application for in-hospital brief interactions with Korean patients

Background New Zealand is becoming more ethnically diverse, with a rising number of people with limited English language proficiency. Consequently, hospital interactions are increasing where patients have insufficient English to communicate adequately with doctors or nurses for appropriate, effective and safe care. Translation technology is rapidly evolving, but evidence is limited regarding its usefulness to clinicians. Objective To examine the acceptability to doctors and nurses of a translation application (app) used on a tablet, in brief interactions with Korean patients. Method An app was developed to facilitate brief conversations between patients and clinicians as part of clinical care. We used the Technology Acceptance Model 2 to develop semi-structured interview questions for 15 junior and senior doctors and nurses in an urban hospital. Participants used the app to interact with the interviewer as part of a scenario. The interviews were analysed thematically. Results The app was easy to use, learn to use and to memorise for future use. It was considered useful for everyday brief interactions and urgent situations where there is no time to call an interpreter and, after hours, to augment the work of interpreters. Subject to perceived usefulness, there appears to be little need for social normalisation of a translation app, other than management support for the costs, maintenance and implementation of the app for everyday use. Conclusion Guidelines are required for the use of a translation app by doctors and nurses to augment the interpreter role. A larger study and future research on the patient’s perspective are required.

Technology Informatics Guiding Education Reform – TIGER

Summary Background: While health informatics recommendations on competencies and education serve as highly desirable corridors for designing curricula and courses, they cannot show how the content should be situated in a specific and local context. Therefore, global and local perspectives need to be reconciled in a common framework. Objectives: The primary aim of this study is therefore to empirically define and validate a framework of globally accepted core competency areas in health informatics and to enrich this framework with exemplar information derived from local educational settings. Methods: To this end, (i) a survey was deployed and yielded insights from 43 nursing experts from 21 countries worldwide to measure the relevance of the core competency areas, (ii) a workshop at the International Nursing Informatics Conference (NI2016) held in June 2016 to provide information about the validation and clustering of these areas and (iii) exemplar case studies were compiled to match these findings with the practice. The survey was designed based on a comprehensive compilation of competencies from the international literature in medical and health informatics. Results: The resulting recommendation framework consists of 24 core competency areas in health informatics defined for five major nursing roles. These areas were clustered in the domains “data, information, knowledge”, “information exchange and information sharing”, “ethical and legal issues”, “systems life cycle management”, “management” and “biostatistics and medical technology”, all of which showed high reliability values. The core competency areas were ranked by relevance and validated by a different group of experts. Exemplar case studies from Brazil, Germany, New Zealand, Taiwan/China, United Kingdom (Scotland) and the United States of America expanded on the competencies described in the core competency areas. Conclusions: This international recommendation framework for competencies in health informatics directed at nurses provides a grid of knowledge for teachers and learner alike that is instantiated with knowledge about informatics competencies, professional roles, priorities and practical, local experience. It also provides a methodology for developing frameworks for other professions/disciplines. Finally, this framework lays the foundation of cross-country learning in health informatics education for nurses and other health professionals.

Citizens' Access to Their Digital Health Data in Eleven Countries - A Comparative Study

Governments around the world are actively promoting citizens electronic access to their health data as one of a number of ways to respond to the challenges of health care delivery in the 21st century. While numerous approaches have been utilized it is evident from cross-country comparisons that there are different conceptualizations of: both the expected and desired roles for citizens in the management of their own health; the benefits that will be delivered by citizen access and how these benefits should be measured and benchmarked over-time. This paper presents comparative analyses of the methods by which citizens are provided with access to their own health data across 11 countries. The paper aims to stimulate debate on electronic citizen access to health data and the challenges of measuring benefit as well as reflection on capacity of different citizens to engage with e-health.

How Nurses Use Telehealth to Support Health Transitions of Older Adults.

When people with long term health issues transition from illness to health, or move from hospital to home after an exacerbation they feel vulnerable, unsafe, uncertain, lost, and unsupported. Transitions are life experiences that result in change. Telehealth gives easier access to care and increases patient involvement and self-awareness for self-care and improved outcomes. The purpose of our research was to explore how telehealth tools and processes lend themselves to nursing of patients through transitions. METHODS A multimethod study with before and after questionnaires consisting of validated questionnaires. These were triangulated with nurse field notes, nurse assessment of each participant, exit interviews with participants, and questionnaire for referring clinicians about their experience of the service. Twenty patients, their five doctors, and two telehealth nurses, participated. RESULTS PACIC questions revealed that participants felt more involved in decision making, self-care planning, referrals to other services, and understood more clearly their health issues. The Quality of Life questions showed improvement, and their health issues bothered them less after telehealth. The Perceived Health Competence questions showed an improvement in how they rated their health, and their ability to influence their health. Clinicians indicated that the service worked well, was appropriate and useful, and should continue. The interviews revealed that participants learned how to do self-care with insight, made the transition from hospital to home and from illness to a new way of being well, and referred the service to others like them. DISCUSSION AND CONCLUSION We conclude that our experienced nurses used the tools of telehealth (monitoring of self-care and videoconferencing) to coach, supervise, guide, and accompany patients through an organizational transition for half our participants (from hospital to home) and all the participants through an illness to a new way of being well.