Sharon-Marie Weldon

Communication in the operating theatre.

Communication is extremely important to ensure safe and effective clinical practice. A systematic literature review of observational studies addressing communication in the operating theatre was conducted. The focus was on observational studies alone in order to gain an understanding of actual communication practices, rather than what was reported through recollections and interviews.

Communication in the operating theatre: A systematic literature review of observational research

Communication is extremely important to ensure safe and effective clinical practice. A systematic literature review of observational studies addressing communication in the operating theatre was conducted. The focus was on observational studies alone in order to gain an understanding of actual communication practices, rather than what was reported through recollections and interviews.

Sequential simulation of a patient journey

To develop an intervention for educating pharmacists (community and hospital) about integrated care and their role in implementing it.

Engaging patients and clinicians through simulation: rebalancing the dynamics of care

This paper proposes simulation-based enactment of care as an innovative and fruitful means of engaging patients and clinicians to create collaborative solutions to healthcare issues. This use of simulation is a radical departure from traditional transmission models of education and training. Instead, we frame simulation as co-development, through which professionals, patients and publics share their equally (though differently) expert perspectives. The paper argues that a process of participatory design can bring about new insights and that simulation offers understandings that cannot easily be expressed in words. Drawing on more than a decade of our group’s research on simulation and engagement, the paper summarises findings from studies relating to clinician-patient collaboration and proposes a novel approach to address the current need. The paper outlines a mechanism whereby pathways of care are jointly created, shaped, tested and refined by professionals, patients, carers and others who are affected and concerned by clinical care.

Microanalysis of video from the operating room: an underused approach to patient safety research

Video recording technologies offer a powerful way to document what happens in clinical areas.1 Cameras, and to a lesser extent, microphones, can be found in a growing number of modern operating rooms in the USA, UK and other parts of the world. While they could be used to create a detailed record of what happens in and around the operating table, this is still rarely being done; the vast majority of operations are still only documented in written operation notes. When operations are being recorded, it is primarily for educational purposes: for instance, to broadcast a live feed of a surgical demonstration to a remote audience; to provide an ‘adjunct’ to live observation;2 to collect authentic footage for edited, instructional videos on a surgical technique or procedure; to facilitate video enhanced debriefing and coaching; or to formally assess surgical skills. Recently, Makary et al 1 ,3 have proposed that video equipment in the operating room could be used as an auditing tool. They also argue that making video recording a routine occurrence would improve performance and make surgical care more transparent. They propose that a video archive of operations could prove useful for surgeons preparing to operate on a patient who had been operated on before—to check the anatomy and density of adhesions for example. It has also been suggested that when used routinely, video could be used to investigate adverse events.4–6 What has gone relatively unnoticed in these recent discussions about the potential of video in the operating room is the possibilities it opens up for empirical research . While videos can only provide a partial representation of what happened and are always open to interpretation, they do provide a relatively objective, shareable point of reference. Using video, clinical events can be looked at from …

Sequential simulation (SqS) of clinical pathways: a tool for public and patient engagement in point-of-care diagnostics

Objectives Public and patient engagement (PPE) is fundamental to healthcare research. To facilitate effective engagement in novel point-of-care tests (POCTs), the test and downstream consequences of the result need to be considered. Sequential simulation (SqS) is a tool to represent patient journeys and the effects of intervention at each and subsequent stages. This case study presents a process evaluation of SqS as a tool for PPE in the development of a volatile organic compound-based breath test POCT for the diagnosis of oesophagogastric (OG) cancer. Setting Three 3-hour workshops in central London. Participants 38 members of public attended a workshop, 26 (68%) had no prior experience of the OG cancer diagnostic pathway. Interventions Clinical pathway SqS was developed from a storyboard of a patient, played by an actor, noticing symptoms of oesophageal cancer and following a typical diagnostic pathway. The proposed breath testing strategy was then introduced and incorporated into a second SqS to demonstrate pathway impact. Facilitated group discussions followed each SqS. Primary and secondary outcome measures Evaluation was conducted through pre-event and postevent questionnaires, field notes and analysis of audiovisual recordings. Results 38 participants attended a workshop. All participants agreed they were able to contribute to discussions and like the idea of an OG cancer breath test. Five themes emerged related to the proposed new breath test including awareness of OG cancer, barriers to testing and diagnosis, design of new test device, new clinical pathway and placement of test device. 3 themes emerged related to the use of SqS: participatory engagement, simulation and empathetic engagement, and why participants attended. Conclusions SqS facilitated a shared immersive experience for participants and researchers that led to the coconstruction of knowledge that will guide future research activities and be of value to stakeholders concerned with the invention and adoption of POCT.

Collaborative healthcare remodelling through sequential simulation: a patient and front-line staff perspective

Background The Department of health funded an initiative to pioneer new approaches that would create a more integrated form of care. Local problem In order to receive funding, local Clinical Commissioning Groups were required to engage a range of stakeholders in a practical approach that generated the development of an integrated model of care. Intervention Two sequential simulation (SqS) workshops comprising 65 and 93 participants, respectively, were designed using real patient scenarios from the locality, covering areas of general practice, community health and adult social care. Workshops were attended by a diverse group of stakeholders. The first workshop addressed current care pathways and the second modelled ideal care pathways generated from the data obtained at the first workshop. Methods Discussions were captured through video recording, field-notes and pre and post questionnaires. Data was collated, transcribed and analysed through a combination of descriptive statistics and thematic analysis. Results The questionnaires revealed that attendees strongly agreed that they had had an opportunity to contribute to all discussions and raise questions, concerns and ideas (100%). Pre and post knowledge of current and new models of care was vastly improved. The opportunity to share information and to network was valued, with the SqS approach seen as breaking professional barriers (100%). Conclusions Simulation can be used as a tool to engage stakeholders in designing integrated models of care. The systematic data collection from the diverse ideas generated also allows for a much-needed ‘ear’ to those providing the solutions, as well as a legitimate and balanced perspective.

Sequential simulation used as a novel educational tool aimed at healthcare managers: a patient-centred approach

Background A new challenge for healthcare managers is to improve the patient experience. Simulation is often used for clinical assessment and rarely for those operating outside of direct clinical care. Sequential simulation (SqS) is a form of simulation that re-creates care pathways, widening its potential use. Local problem Numbers, outcome measures and system profiling are used to inform healthcare decisions. However, none of these captures the personal subtleties of a patient’s experience. Intervention 56 students attended a teaching module using SqS and facilitated workshops as part of their induction week on an MSc International Health Management course. The workshop was voluntary and was offered as an opportunity for the students to gain an insight into the UK health system through the medium of simulation. Methods An evaluation survey incorporating quantitative and qualitative student feedback was conducted. Descriptive statistics were generated from the quantitative data, and thematic analysis was undertaken for the qualitative data. Results There was strong agreement for the acceptability of the workshop approach in relation to the aims and objectives. Likert scale (1–-5) mean total=4.49. Participants responded enthusiastically (revealed through the qualitative data) with ideas related to perspectives sharing, understanding healthcare management and processes and the consideration of feasibility and practicalities. They also suggested other applications that SqS could be used for. Conclusion The SqS approach has demonstrated that simulation has a wider potential than for clinical assessment alone. Further studies are required to determine its potential uses and affordances beyond its current format.

Using a variety of research methods and angles to understand a new approach that explores health-care services

Simulation is traditionally used for health-care professional training and assessment; however, its remit is much wider and new studies are emerging that highlight the breadth of opportunities it affords. We used simulation to engage professionals and patients in National Health Service (NHS) maternity services across a London borough. Six services were identified due to recognized disparities in care. A form of simulation termed Sequential Simulation was used to recreate an expectant mother’s 9-month care pathway, in order to engage staff and patients across sites in discussing strengths and challenges of their services. Due to this innovative approach to sharing learning in maternity care, several areas of research interest were identified. These included the engagement of health-care professionals and patients, the design of the simulation pathway, the perceived benefit of the simulation approach, the discussions generated in relation to the objectives of the project, the project process, sociocultural insights, and the educational opportunities that emerged. A range of methods and theories were used to investigate each angle including the mixing of methods where appropriate. This article discusses the array of research approaches used to understand this innovative form of engagement and quality improvement and generates a holistic understanding of sequential simulation’s use in this setting. It argues the importance of a broad conceptualization when researching a complex intervention and illustrates how this can illuminate a complex area to best ensure benefit to others working in the field.Abstracts, Oral Presentations for Qualitative Health Research Conference, 2017s, Oral Presentations for Qualitative Health Research Conference, 2017 Qualitative Health Research Conference October 17–19, 2017 Quebec City Quebec Canada Implementation and Maintenance Evaluation of the School Oral Health Program in Kuwait Aishah Alsumait, University of Alberta Maryam Amin, University of Alberta Kim Raine, University of Alberta Rebecca Rgokiert, University of Alberta Objectives: The purpose of this study was to (a) explore the factors affecting the implementation of Kuwait School Oral Health Program (SOHP) procedures and (b) identify factors influencing program maintenance over the past three decades. Methods: A qualitative focused ethnography approach was employed. An interview guide inspired by the ecological health framework and RE-AIM evaluation model directed our data collection through in-depth and focus group interviews with dental care providers, key informants in the Kuwait Capital Education Area, and decision policy makers in the SOHP. The interviews were recorded and transcribed verbatim. Thematic analysis of data was performed. Findings: Thirty participants contributed to this study. There were 13 dental care providers, four team leaders, nine key informants, and four policy makers in four in-depth and four focus group interviews. Data analysis revealed two main categories influencing successful program implementation: (a) SOHP structure and characteristics including prevention protocol and resources and (b) school environment characteristics including schools’ engagement, however, at a policy level, maintenance dimension. Three main categories emerged related to chronological phases of the program journey: (a) initiation, (b) expansion, and (c) sustainability. At the initiation phase, the role of gatekeepers, advocate leadership, and employing evidence-based dentistry was the main facilitators for establishing the program. At the expansion phase, proactive organizational change led to developing a solid infrastructure. This led to the sustainability phase, which was characterized by awareness by the policy makers of population dental care need and sustained public funding. These elements were the main facilitators to successful program maintenance. Yet, some program constructs showed weak sustainability. For example, the expansion of school-based fixed clinics was implemented due to a serious oral health-care need among schoolchildren as a reactive organizational change due to the Second Gulf War. However, numbers of school-based fixed clinics declined dramatically and were replaced by mobile prevention dental clinics due to unsupported environment, power dynamics, and cost–benefit reasons. Conclusions: Kuwait SOHP succeeded in implementing and maintaining school-based prevention procedures over 30 years, yet many program constructs showed poor sustainability. Revisiting program vision, theory, and recognition of elements related to successful implementation and maintenance will allow decision and policy makers to focus on pursuing means to improve capacity for more efficient and successful implementation of the program. This study provides insights that can be shared with wider national and international settings. International Journal of Qualitative Methods Volume 17: 1–59 a The Author(s) 2018 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1609406917748701 journals.sagepub.com/home/ijq Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). Engaging People Living With HIV and Health-Care Providers in the Design and Pilot of a User-Centered Strategy to Improve ART Adherence Among MSM Living With HIV in Mexico Zafiro Del Carmen Andrade-Romo, National Institute of Public Health of Mexico Laura Chavira-Razo, National Institute of Public Health of Mexico Luis Fernando Barraza-Araiza, National Institute of Public Health of Mexico Sergio Bautista-Arredondo, UC Berkeley School of Public Health High adherence to antiretroviral therapy (ART) is essential to improve survival rates among people living with HIV and reduce HIV transmission. Unfortunately, studies show that adherence levels to ART are not optimal. In Mexico, men who have sex with men (MSM) are one of the most affected populations by HIV; nevertheless, few studies have focused on understanding the barriers and facilitators influencing their adherence. This project’s first-stage objective was to develop a user-centered strategy to improve ART adherence among MSM starting ART in Mexico. To enhance participants’ involvement and translate their perspectives into a strategy, we combined qualitative methods with ‘‘design thinking,’’ a marketing approach used to develop user-centered products. In 2016, 37 MSM living with HIV participated in six focus groups discussions, and nine semistructured interviews were conducted with health-care providers. A team discourse analysis approach was used to identify main themes. Design thinking was then used to identify patients’ journey after being diagnosed, their profiles according to their experience while taking ART, and the best elements to design the strategy. We found that MSM’s barriers and facilitators to adherence are not static and might undergo changes throughout different stages of adjustment to ART. Based on these results, we designed a strategy that focuses on habit formation, with multiple levels of support mechanisms including experienced MSM living with HIV as support peers. Results from this stage were crucial to understand the motivations that will engage both newly and previously diagnosed MSM in the strategy’s pilot stage. Adapting the Group Antenatal Care (G-ANC) Model to the Mexican Context Zafiro del Carmen Andrade-Romo, National Institute of Public Health of Mexico Evelyn Fuentes-Rivera, National Institute of Public Health of Mexico Jacqueline Elizabeth Alcalde-Rabanal, National Institute of Public Health of Mexico Blair G. Darney, Oregon Health & Science University Group antenatal care (G-ANC) is a model of antenatal health care where all clinical, educational, and support care happen in a group context with multiple health-care professionals as facilitators. G-ANC is a midwife-led model focused on supporting women to learn from each other’s experiences in a supportive environment. To date, studies in diverse U.S. populations have demonstrated improvements in self-efficacy for birth, high levels of satisfaction, and reductions in caesarean deliveries and preterm births. It is not known whether the G-ANC model will be feasible or acceptable in other settings. The aim of this study was to adapt G-ANC to the context of the Mexican health system and assess feasibility and acceptability by women and health-care personnel. We first worked with local health professionals to adapt the model, with attention to national clinical guidelines and cultural acceptability. We have trained 29 health professionals and implemented our model Consulta Prenatal en Grupo in four clinics and have enrolled 78 of the 140 women to date. Our feasibility study relies on qualitative (6 focus groups and 17 in-depth semistructured interviews) and quantitative (measures of self-efficacy and satisfaction) data with women and providers. Preliminary results suggest a high level of satisfaction with the model among women. Women with their first pregnancies mention feeling less stress for birth due to having heard other women’s birth experiences in group. Findings from the project (anticipated Spring 2018) will be used to inform decisions about expanding the G-ANC model in Mexico. Narratives of Living With Chronic Obstructive Pulmonary Disease (COPD): Engaging the Voices of People Experiencing Social Isolation Marcy G. Antonio, University of Victoria Laurene Sheilds, University of Victoria Anne Bruce, University of Victoria To have successful public engagement requires citizens who are willing to share their experiences. However, people living with the greatest burdens of illness may also be the most difficult to locate and engage. Chronic obstructive pulmonary disease (COPD) is an illness that exemplifies unique challenges for public engagement. According to the literature, COPD is underdiagnosed and, compared to other fatal conditions, has fewer dedicated research, community, and palliative care resources. With smoking viewed as the most common risk factor for COPD, the resulting shame and victim blaming may further discourage self-identification and sharing of illness experiences and compound social isolation. Within the context of a large narrative study, this presentation will focus on how social isolation is experienced by people living with COPD and their family members. Twenty-two participants were interviewed up to 3 times over 18 months, six of which were dyads. Shared narratives revealed a shrinking physical world and limited connections to friends, families, advocates, and other individuals living with COPD. Participants described the signage that warned visitors on entry and the visibility and vulnerability of being ‘‘out in community’’ with their oxygen support. People often lived alone and spoke of the physical fatigue related to 2 International Journal of Qualitative Methods

O53 A multi-discpilnary training programme for end-of-life care: a sequential simulation

Background/Context/Aims Sequential Simulation,1 a longitudinal form of simulation, was identified as an effective training approach for multi-disciplinary teams in identifying and caring for patients in their last year of life in a hospital setting. Sequential Simulation is a physical simulation of a pathway of care rather than isolated components of the trajectory. End-of-life care for patients in hospital has been reported as inadequate in the UK.2 The need for this training was identified through the literature and an in-house training needs analysis in conjunction with patients and their families. Methodology /Education Programme or Project Description The Sequential Simulation was designed based on the outcomes of the Training Needs Analysis and in conjunction with clinical staff. The pathway was separated into segments of time (day two and day six), following a patient (speciality specific scenario) over a six-day period (from admission). Seven Sequential Simulations training sessions were conducted over a three-month period. A mixed-methods study was conducted through pre and post questionnaires and video-recordings of the simulation and subsequent debrief. Confidence levels were measured to assess any changes pre and post training programme and open-ended questions allowed for further exploration of the results. Evaluation of the training was also conducted. Results/Outcomes 14 multi-disciplinary teams consisting of 57 participants in total attended the training: Doctors 45% (Consultants 26%, registrars 19%), nurses 30% and therapists 25%. Preliminary results revealed that confidence levels were improved across all professional cohorts. 89% of participants felt the course met their expectations. 87% would consider recommending the course to colleagues and 80% felt that the course had an impact on their approach to end of life care. Conclusions and Recommendations Sequential Simulation is a unique approach to end of life care training that takes into account the longitudinal element of a patient‘s end of life journey. Post-training revealed an increase in healthcare professional’s confidence in end of life care. The healthcare professional’s evaluation of the course was highly positive. Further studies to assess if this innovative form of end of life simulation training has an effect on actual clinical care are needed. References . Weldon S-M, Ralhan S, Paice E, Kneebone R, Bello F. Sequential simulation of a patient pathway. The Clinical Teacher 2016. doi:10.1111/tct.12549 . Office for National Statistics. National Survey of Bereaved People (VOICES) 2015. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/bulletins/nationalsurveyofbereavedpeoplevoices/england2015