The roles, activities and impacts of middle managers who function as knowledge brokers to improve care delivery and outcomes in healthcare organizations: a critical interpretive synthesis

Background Middle Managers (MMs) are thought to play a pivotal role as knowledge brokers (KBs) in healthcare organizations. However, the role of MMs who function as KBs (MM KBs) in health care is under-studied. Research is needed that contributes to our understanding of how MMs broker knowledge in health care and what factors influence their KB efforts. Methods We used a critical interpretive synthesis (CIS) approach to review both qualitative and quantitative studies to develop an organizing framework of how MMs enact the KB role in health care. We used compass questions to create a search strategy and electronic searches were conducted in MEDLINE, CINAHL, Social Sciences Abstracts, ABI/INFORM, EMBASE, PubMed, PsycINFO, ERIC and the Cochrane Library. Searching, sampling, and data analysis was an iterative process, using constant comparison, to synthesize the results. Results We included 41 articles (38 empirical studies and 3 conceptual papers) that met the eligibility criteria. No existing review was found on this topic. A synthesis of the studies revealed 12 MM KB roles and 63 associated activities beyond existing roles hypothesized by extant theory, and we elaborate on two MM KB roles: 1) convincing others of the need for, and benefit of an innovation or evidence-based practice; and 2) functioning as a strategic influencer. We identified organizational and individual factors that may influence the efforts of MM KBs in healthcare organizations. Additionally, we found that the MM KB role was associated with enhanced provider knowledge, and skills, as well as improved organizational outcomes. Conclusion Our findings suggest that MMs do enact KB roles in healthcare settings to implement innovations and practice change. Our organizing framework offers a novel conceptualization of MM KBs that advances understanding of the emerging KB role that MMs play in healthcare organizations. In addition to roles, this study contributes to the extant literature by revealing factors that may influence the efforts and impacts of MM KBs in healthcare organizations. Future studies are required to refine and strengthen this framework. Trial registration A protocol for this review was not registered.

Agen Ganda dan Perubahan Praktik Pertanian

This article aims to explain the role of dual agents in bringing about changes in agricultural practices. Starting from the phenomenon of changing plant species that occurred in Parbotihan Village, Onan Ganjang District, Humbang Hasundutan Regency. Changes in these types of crops often occur in a short period of time and are followed by most farmers. These changes sometimes occur without considering the adequacy of land, cultivation knowledge, and capital capacity. So, often the changes that occur are not profitable for them. On the other hand, these changes also change the cultivation pattern which requires farmers to learn from the beginning as a consequence of changing the types of plants. This research was conducted during the research period of my thesis by collecting data through observation and interviews. The selected informants are farmers who are involved in changing practices. The author found that the role of multiple agents such as relatives, friends, skippers, and group leaders with different capacities had a role in influencing farmers' actions. Multiple agents act as initiators, motivators, introductors, educators, and interventors. This research also shows that the social arena as public space becomes an effective arena in exchanging information and influences that encourage practice change.

Evaluation of feedback modalities and preferences regarding feedback on decision-making in a pediatric emergency department

Objectives To compare pediatric emergency clinicians’ attitudes toward three feedback modalities and assess clinicians’ case-based feedback preferences. Methods Electronic survey sent to pediatric emergency medicine (PEM) physicians and fellows; general pediatricians; and advanced practice providers (APPs) with nine questions exploring effectiveness and emotional impact of three feedback modalities: case-based feedback, bounce-back notifications, and biannual performance reports. Additional questions used a four-point ordinal agreement response scale and assessed clinicians’ attitudes toward case review notification, case-based feedback preferences, and emotional support. Survey responses were compared by feedback modality using Pearson’s chi-squared. Results Of 165 eligible providers, 93 (56%) responded. Respondents agreed that case-based feedback was timely (81%), actionable (75%), prompted reflection on decision-making (92%), prompted research on current clinical practice (53%), and encouraged practice change (58%). Pediatric Emergency Care Applied Research Network (PECARN) performance reports scored the lowest on all metrics except positive feedback. No more than 40% of providers indicated that any feedback modality provided emotional support. Regarding case-based feedback, 88% of respondents desired email notification before case review and 88% desired feedback after case review. Clinicians prefer receiving feedback from someone with similar or more experience/training. Clinicians receiving feedback desire succinctness, supporting evidence, consistency, and sensitive delivery. Conclusions Case-based feedback scored highest of the three modalities and is perceived to be the most likely to improve decision-making and promote practice change. Most providers did not perceive emotional support from any feedback modality. Emotional safety warrants purposeful attention in feedback delivery. Critical components of case-based feedback include succinctness, supporting evidence, consistency, and sensitive delivery.

Safety and Outcome of Intracranial Pressure Monitor Placement Performed by Trauma Critical Care Surgeons

Introduction The Brain Trauma Foundation advises intracranial pressure monitor placement (ICPM) following traumatic brain injury (TBI) with a Glasgow Coma Scale (GCS) score ≤8 and an abnormal head computed tomographic scan (CT) finding. Prior studies demonstrated that ICPMs could be placed by non-neurosurgeons. We hypothesized that ICPM placement by trauma critical care surgeons (TCCS) would increase appropriate utilization (AU), decrease time to placement (TTP), and have equivalent complications to those placed by neurosurgeons. Methods We retrospectively reviewed medical records of adult trauma patients admitted with a TBI in a historical control group (HCG) and practice change group (PCG). Demographics, Injury Severity Score (ISS), outcomes, ICPM placement by provider type, and time to placement were identified. Complications and appropriate utilization were recorded. Results 70 patients in the HCG and 84 patients in the PCG met criteria for inclusion. Demographics, arrival GCS, ICU GCS, ISS, and admission APACHE II scores were not statistically significant. AU was 7/70 for HCG vs 19/84 in the PCG ( P = .04036). Median TTP was 6.5 hours for HCG vs 5.25 for PCG ( P = .9308). Interquartile range showed the data clustered around an earlier placement time, 2.3-14.0 hours, in the PCG. Complications between the 2 groups were not statistically significant, 0/7 for HCG vs 5/19 for PCG ( P = .2782). Discussion This study confirms that ICPMs can be safely placed by TCCS. Our results demonstrate that placement of ICPMs by TCCS improves AU and possibly improves TTP.

Early Collaboration Measures Among a Cross-Sector Stakeholder Group in a Statewide GWEP

The AgingME Geriatrics Workforce Enhancement Program (GWEP) uses collaboration across institutions of higher education, community-based organizations, and healthcare entities to imbed transformational healthcare practice change across Maine, a primarily rural state. To explore the factors that influence cross-sector collaboration among a diverse array of partners, a baseline anonymous electronic survey was distributed to the newly formed project steering committee. The survey consisted of the Wilder Collaborative Factors Inventory, an established measure of 22 research-based collaboration factors along with four open response questions on process-level challenges and opportunities for improvement. A total of eleven responses (N = 11) were received out of 20 Steering Committee members (55% response). Collaboration strengths noted in the assessment include unique purpose of statewide GWEP efforts (M = 4.41 out of 5 points), mutual trust among members (M = 4.32), favorable social and political environment (M = 4.27), and a history of collaboration among partners (M = 4.27). Lower scores were received on the multiple layers of participation (M = 3.45 out of 5 points), and ability to compromise factors (M = 3.45). Qualitative responses reinforced the need for a common understanding of the project’s goals and outcomes early on in the collaboration. Barriers to collaboration included scheduling considerations and limited time and energy among partners due to heightened COVID-19 response efforts. Results elucidate: 1) Early collaboration strengths and needs of a newly formed statewide education collaborative; and 2) Strategic action steps and focal points informing early partnershipping among organizations engaged in interprofessional health education efforts.

Assessing the quality of deliberative stakeholder consultations involving allied health professionals in pediatric palliative care and hematology/oncology in Canada

Background In this paper we assess the quality of six deliberative stakeholder consultations regarding the implementation of a precision diagnostic for life-threatening pediatric brain tumors. Decision makers who base policy recommendations on the outputs of consultative exercises can presuppose that all deliberants are well informed of the policy issue, that participation in the deliberative process was fair, and that overcoming implementation barriers will necessarily result in practice change. Additional evidence is therefore needed to substantiate the informational quality of the deliberation, measure the equality of participation and study the effects on stakeholder reasoning to appropriately guide uptake of proposed recommendation(s). Methods Using the DeVries framework for assessing the deliberative quality, we analyzed data from 44 post-consultation evaluation surveys completed by pediatric oncology and palliative care teams at two tertiary pediatric healthcare centers in Canada. We also conducted turn-taking and word-contribution analyses from the text transcriptions of each deliberation to assess equality of participation using descriptive statistics. Results Deliberants agreed the quality of the deliberative process was fair (median ratings ranging from 9–10 out of 10) and the opportunities to receive expert information and discuss with others about the implementation of a new LDT were helpful (9.5 out of 10). While the session improved understanding of the implementation barriers and opportunities, it had marginal effects on deliberants’ reasoning about whether LDTs would change their own clinical practice (3–10 out of 10). Participation was proportionate in at least four of the six deliberations, where no deliberant took more than 20% of total turns and contributed equal to, or less than 20% of total words. Conclusion The quality assessment we performed demonstrates high informational value and perceived fairness of two deliberative stakeholder consultations involving pediatric palliative care and oncology teams in Canada. Quality assessments can reveal how the process of deliberation unfolds, whether deliberative outputs are the result of equitable participation among deliberants and what, if any, stakeholder voices may be missing. Such assessments should be routinely reported as a condition of methodological rigor and trustworthiness of deliberative stakeholder engagement research.