scholarly journals Assessing the Integrative Framework for the Implementation of Change in Nursing Practice: Comparative Case Studies in French Hospitals

2021 ◽  
Author(s):  
Israa SALMA ◽  
Mathias WAELLI
Keyword(s):  
Case Studies ◽  
Routine Practice ◽  
Leadership Roles ◽  
Structured Interviews ◽  
Implementation Processes ◽  
Integrative Framework ◽  
Effective Implementation ◽  
Certification Procedure ◽  
Definition Of ◽  
The Impact

Abstract Background Quality improvement initiatives in healthcare often require change in nursing practices. Implementing such change into routine practice is challenging, often with unpredictable outcomes. Extensive research in this area has documented effective implementation change in clinical practice and identified barriers and facilitators at strategic levels, e.g. leadership, culture, and technical factors, which are common across most organizations. However, other research avenues have investigated different perspectives, e.g., the impact of local work contexts on implementation processes and the overlap of local social and material factors in appropriation processes. Therefore, considering both perspectives is essential for effective implementation. However, strategic and socio-material factors have only been investigated as distinct perspectives. In previous work, we developed an Integrative Framework for Implementation of change in Nursing Practices (IFINP) based on certification procedure implementation at a French hospital. In this current study, we assess the generalizability of our framework in other organizational settings and explore links between strategic and socio-material factors during implementation. Methods We used comparative qualitative case studies at three French hospitals to assess the implementation of certification procedures. Data were collected from 33 semi-structured interviews with managers and nurses. Narratives reflecting actions and interactions were extracted and deductively analyzed using IFINP components. Results The framework was flexible and captured all the different aspects of implementation actions and interactions at the three hospitals. Strong interferences were identified between mobilization mechanisms and strategic elements. Interference was observed mostly between ‘reflexive monitoring and work articulation’, and ‘reflexive monitoring and sense-making’ mechanisms. Leadership was integrated into the different mechanisms, especially the ‘translation’ mechanism. Conclusion The IFINP facilitated a greater understanding of strategic elements and associated relationships with social and material factors during implementation. Our results support the non-linearity aspect of implementation processes and highlight the importance of leadership roles in translating change in practice. This provides a clear definition of the managers’ role when implementing new nurse practices. Therefore, we advocate the IFINP as a practical managerial framework supporting implementation initiatives in nursing.

scholarly journals Understanding Low-value Care and Associated De-implementation Processes: A Qualitative Study of Choosing Wisely Interventions Across Canadian Hospitals

2021 ◽  
Author(s):  
Gillian Parker ◽  
Monika Kastner ◽  
Karen Born ◽  
Nida Shahid ◽  
Whitney Berta
Keyword(s):  
Process Model ◽  
Healthcare Providers ◽  
Implementation Process ◽  
Choosing Wisely ◽  
Structured Interviews ◽  
Team Members ◽  
Implementation Processes ◽  
Healthcare Settings ◽  
National Campaigns ◽  
The Impact

Abstract Background:Choosing Wisely (CW) is an international movement comprised of national campaigns in more than 20 countries to reduce low-value care (LVC). Hospitals and healthcare providers are examining existing practices and putting interventions in place to reduce practices that offer little to no benefit to patients or may cause them harm. De-implementation, the reduction or removal of a healthcare practice is an emerging field of research. Little is known about the factors which (i) sustain LVC; and (ii) the magnitude of the problem of LVC. In addition, little is known about the processes of de-implementation, and if and how these processes differ from implementation endeavours. The objective of this study was to explicate the myriad factors which impact the processes and outcomes of de-implementation initiatives that are designed to address national Choosing Wisely campaign recommendations.Methods:Semi-structured interviews were conducted with individuals implementing Choosing Wisely Canada recommendations in healthcare settings in four provinces. The interview guide was developed using concepts from the literature and the Implementation Process Model (IPM) as a framework. All interviews were conducted virtually, recorded, and transcribed verbatim. Data were analysed using thematic analysis.Results:Seventeen Choosing Wisely team members were interviewed. Participants identified numerous provider factors, most notably habit, which sustain LVC. Contrary to reporting in recent studies, the majority of LVC in the sample was not ‘patient facing’; therefore, patients were not a significant driver for the LVC, nor a barrier to reducing it. Participants detailed aspects of the magnitude of the problems of LVC, specifically the impact of harm and resources. Unique factors influencing the processes of de-implementation reported were: influence of Choosing Wisely campaigns, availability of data, lack of targets and hard-coded interventions.Conclusions: This study explicates factors ranging from those which impact the maintenance of LVC to factors that impact the success of de-implementation interventions intended to reduce them. The findings draw attention to the significance of unintentional factors, highlight the importance of understanding the impact of harm and resources to reduce LVC and illuminate the overstated impact of patients in de-implementation literature. These findings illustrate the complexities of de-implementation.

E pluribus unum? Language diversity and the harmonization of company law in the European Union

2019 ◽  
Vol 26 (5) ◽  
pp. 669-690
Author(s):  
Federico M Mucciarelli
Keyword(s):  
European Union ◽  
Case Studies ◽  
Company Law ◽  
Language Diversity ◽  
The European Union ◽  
Freedom Of Establishment ◽  
First Case ◽  
Definition Of ◽  
The Impact

This work addresses the impact of language diversity and nation-specific doctrinal structures on harmonized company law in the EU. With this aim, two emblematic case studies will be analysed. The first case study is related to the definition of ‘merger’ adopted in the Company Law Directive 2017/1132 (originally in the Third Company Law Directive and the Cross-Border Merger Directive); by relying on the example of the SEVIC case decided by the Court of Justice of the European Union (CJEU), it will be shown that scholars’ and courts’ conception of the definition of ‘merger’ varies according to own domestic doctrinal structures. The second case study is related to the notion of ‘registered office’, which is key for establishing the scope of several harmonizing provisions and the freedom of establishment; this paper analyses terminological fluctuations across language versions of EU legislation and the impact of domestic taxonomies and legal debates upon the interpretation of these notions. These case studies show that company law concepts, despite their highly technical nature, are influenced by discourse constructions conducted within national interpretative communities, and by the language used to draft statutory instruments and discuss legal issues. The task of the CJEU is to counterbalance these local tendencies, and yet it is unlikely that doctrinal structures, rooted in national languages and legal cultures, will disappear.

Sense of place in the changing process of house form: Case studies from Ankara, Turkey

2017 ◽  
Vol 45 (4) ◽  
pp. 772-796 ◽  
Author(s):  
Duygu Gokce ◽  
Fei Chen
Keyword(s):  
Case Studies ◽  
Sense Of Place ◽  
Morphological Characters ◽  
Structured Interviews ◽  
Housing Developments ◽  
Planning And Design ◽  
Different Types ◽  
Physical Changes ◽  
Changes Over Time ◽  
The Impact

This paper aims to investigate the impact of typomorphological changes of residential environments on residents’ sense of place’. Seven housing developments representing different types introduced in Ankara, Turkey since the late 19th-century are selected as case studies. Their morphological characters at the building, street and neighbourhood scales are examined, and typological transformations among the cases in terms of the degrees of continuity are identified. The paper proposes a conceptual model consisting of ten indicators to assess sense of place at the building, street and neighbourhood scales of the residents of the seven cases. The scores of sense of place are generated through structured interviews with the residents and analysed in SPSS. The results show that sense of place is negatively affected by typomorphological changes over time, particularly when mutational changes occur. Continuity in typomorphological transformation helps to maintain sense of place at a desirable level. Furthermore, physical changes at the street and neighbourhood scales have larger impact on sense of place than that at the building scale. The research thus suggests that planning and design should be responsive to traditional types in residential development, particularly at the street and neighbourhood scales to maintain residents’ sense of place.

scholarly journals Implementing Radical Cure Diagnostics for Malaria: User Perspectives on G6PD Testing in Bangladesh

2020 ◽  
Author(s):  
Nora Engel ◽  
Cristian Ghergu ◽  
Mohammad Abdul Matin ◽  
Mohammad Golam Kibria ◽  
Kamala Thriemer ◽  
...  
Keyword(s):  
Health Care Providers ◽  
G6pd Deficiency ◽  
New Technologies ◽  
Routine Practice ◽  
Radical Cure ◽  
Care Providers ◽  
Structured Interviews ◽  
Drug Induced ◽  
User Perspectives ◽  
The Impact

Abstract Background: The radical cure of Plasmodium vivax requires treatment with an 8-aminoquinoline drug, such as primaquine and tafenoquine, to clear the liver of parasites which can reactivate to cause relapsing infections. Safe treatment regimens require prior screening of patients for glucose-6-phosphate dehydrogenase (G6PD) deficiency to avoid potential life-threatening drug induced hemolysis. Testing is rarely available in malaria endemic countries, but will be needed to support routine use of radical cure. This study investigates end-user perspectives in Bangladesh on the introduction of a quantitative G6PD test (SD Biosensor STANDARD™ G6PD analyser) to support malaria elimination.Methods: The perspectives of users on the SD Biosensor test were analysed using semi-structured interviews and focus group discussions with health care providers and malaria programme officers in Bangladesh. Key emerging themes regarding the feasibility of introducing this test into routine practice, including perceived barriers, were analysed.Results: In total 63 participants were interviewed. Participants emphasized the life-saving potential of the biosensor, but raised concerns including the impact of limited staff time, high workload and some technical aspects of the device. Participants highlighted that there are both too few and too many P. vivax patients to implement G6PD testing owing to challenges of funding, workload and complex testing infrastructure. Implementing the biosensor would require flexibility and improvisation to deal with remote sites, overcoming a low index of suspicion and mutual interplay of declining patient numbers and reluctance to test. This approach would generate new forms of evidence to justify introduction in policy and carefully consider questions of deployment given declining patient numbers. Conclusions: The results of the study show that, in an elimination context, the importance of malaria needs to be maintained for both policy makers and the affected communities, in this case by ensuring P. vivax, PQ treatment, and G6PD deficiency remain visible. Availability of new technologies, such as the biosensor, will fuel ongoing debates about priorities for allocating resources that must be adapted to a constantly evolving target. Technical and logistical concerns regarding the biosensor should be addressed by future product designs, adequate training, strengthened supply chains, and careful planning of communication, advocacy and staff interactions at all health system levels.

scholarly journals An Assessment of the Impact and Benefits of Total Productive Maintenance (TPM) On Manufacturing Profitability: A Case Study of a Food Processing Industry in Nigeria

2020 ◽  
Vol 9 (09) ◽  
pp. 25175-25188
Author(s):  
Kalwang, M. M. ◽  
Kulla D. M. ◽  
Agontu J. A. ◽  
Mafai, G. S
Keyword(s):  
Raw Materials ◽  
Business Environment ◽  
Spare Parts ◽  
Structured Interviews ◽  
Total Productive Maintenance ◽  
Effective Implementation ◽  
Maintenance System ◽  
Direct Observations ◽  
World Class ◽  
The Impact

This study was carried out to assess the impact and benefits of Total Productive Maintenance on manufacturing profitability awareness for Grand Cereals Ltd., Jos-Nigeria). The research objective is to assess the impact and benefits of TPM on manufacturing profitability of the company. Data relevant to the study were collected using designed questionnaire, structured interviews, direct observations and company records. The Statistical Package for Social Sciences (SPSS) and Microsoft Excel were used in analysing the data obtained. The results show that the frequency of machine and equipment breakdowns is 58% often and 42% rarely. The research also reviewed that 84% of machine operators were not involved in maintenance activities with only 16% involvement. As regards to the effectiveness of the maintenance technique(s) used, 76% was rated good while 24% was rated fair. Cereal Mill Overall Plant Effectiveness (OPE) was obtained at 38% which was below the world class standard by almost 50%. Equipment downtime was a major cause of plant underutilization with 91% caused by shortage of critical spare parts and 9% shortage of raw materials. On TPM awareness, 80% of the employees have been aware of the TPM concept while 98% indicated the concept of TPM would help improve the current maintenance system and 2% were not sure.20% of the employees were not aware of TPM while 80% of employees indicated that the company does not implement TPM, with 20% not sure that the TPM concept can help improve the current maintenance system. Based on these results, knowledge and information sharing, operator involvement, engagement of all employees from top management to lower level and training should be considered. The effective implementation of TPM model could increase the competition of the company in the dynamic business environment. Thus, adoption and effective implementation of TPM is recommended for the company towards achieving improvement in its manufacturing profitability.  

Managing stressors in a detention facility: the need for supporting and safeguarding staff

2020 ◽  
Vol 22 (3) ◽  
pp. 153-163
Author(s):  
David N. Eades
Keyword(s):  
Case Studies ◽  
Subjective Experience ◽  
Negative Impact ◽  
Coping Mechanisms ◽  
Stress Disorders ◽  
Structured Interviews ◽  
Research Attention ◽  
Content Type ◽  
Detention Facility ◽  
The Impact

Purpose This paper aims to explore the impact of stressors and the strategies staff use to cope with these at a detention facility. It documents through case studies some of the triggers of trauma, possible coping mechanisms that might assist in navigating the associated stressors in a workplace and recommendations as to what might assist staff. Design/methodology/approach A naturalist approach was used in this research, using an ethnographic qualitative methodology. Grounded theory assisted in the analysis of the data to capture naturalistically the subjective experience of the participants of the study. Conversations occurred with staff who had worked in a detention facility using face to face semi-structured interviews. The structure was open-ended to allow the staff to discuss and share their experiences freely. Findings Stressors that impacted staff working in a detention facility resulted from areas such as heightened reactions from detainees because of the length of their detainment, detainee self-harm, dealing with the effects of an increase of substance abuse through detainees obtaining contraband and the associated violent reactions that can occur as a result. Adverse symptoms noted within the lives of staff included acute anxiety, sleeplessness, depression and tension within impersonal relationships, including family. What compounded the issue was staffs’ reluctance to talk about work stressors. Research limitations/implications The research used nine participants for case studies of staff who had formerly experienced various adverse impacts of stressors. This is not a comprehensive study, however, of the broader experiences of staff at an Australian detention facility. It does provide, however, a snapshot of the experiences of a small group who had significantly been impacted by the stressors of the workplace. Practical implications This paper provides fresh perspectives or initiatives that are needed to assist staff to navigate the changing environment of working in a detention facility. In particular, some support mechanisms and protective factors that could be put in place to curb the negative impact of stressors in the workplace and to mitigate against long term stress disorders developing in the personal lives of staff. Social implications Many staff are not getting the help they need to cope with the emotional distress they experience in their workplace. However, there are practical interventions to support staff in managing the stressors they face. These will be outlined in this article. Originality/value This study was carried out with the goal of giving staff a voice and to capture their former experiences in their vocational responsibilities in a venue that has had very limited research attention. This study has presented the challenges staff faced in a unique venue of working in a detention facility. It has documented some of the common stressors staff faced, the impact of such and some coping mechanisms used to handle them.

The influence of fatalistic beliefs on health beliefs among diabetics in Khartoum, Sudan: a comparison between Coptic Christians and Sunni Muslims

2017 ◽  
Vol 26 (3) ◽  
pp. 15-22 ◽  
Author(s):  
Dana Hag Hamed ◽  
Marguerite Daniel
Keyword(s):  
Free Will ◽  
Health Beliefs ◽  
Phenomenological Study ◽  
Health Condition ◽  
Structured Interviews ◽  
Concept Of God ◽  
Health Responsibility ◽  
Definition Of ◽  
And Coping ◽  
The Impact

Although there are many studies assessing the influence of religious beliefs on health they do not agree on whether the impact is positive or negative. More so, there is no consensus in the available literature on the definition of fatalism and what it means to individuals. In this phenomenological study we attempt to define what religious fatalism means to people living with diabetes in Khartoum, and how it affects their health beliefs, and how those beliefs affect their sense of coherence and generalized resistance resources, since salutogenesis is the guiding theory in this study. Three Copts and five Sunnis living with diabetes were interviewed, as well as a Coptic clergyman and a Sunni scholar. The semi-structured interviews were recorded and transcribed verbatim for analysis. Thematic network analysis was used to code salient concepts into basic themes, organizing themes and global themes. The empirical findings are thus structured as the three global themes: (1) fatalism and free will; (2) health responsibility; (3) acceptance and coping. Fatalism was defined as events beyond an individual’s control where it is then the individual’s free will to seek healthy behavior. Thus health responsibility was stressed upon by the participants in this study as well as the clergyman and scholar. There is also the concept of ‘God doesn’t give one what one cannot handle’ that the participants relate to coping and acceptance. This study finds that the meaning of religious fatalism held by participants and religious clergy is not disempowering. The participants believe that they are responsible for their health. The meaning derived from fatalism is related to how they can accept what is beyond their control and cope with their health condition. Religious fatalism contributed to comprehensibility, manageability and meaningfulness in our participants’ response to diabetes.

The duality of the Brazilian jeitinho

2018 ◽  
Vol 14 (4) ◽  
pp. 404-425 ◽  
Author(s):  
Camila Lee Park ◽  
Mauro Fracarolli Nunes ◽  
Maral Muratbekova-Touron ◽  
Valérie Moatti
Keyword(s):  
Business Environment ◽  
Global Supply Chains ◽  
Structured Interviews ◽  
Supplier Relationships ◽  
Content Type ◽  
Personal Benefit ◽  
Local Practices ◽  
Definition Of ◽  
The Impact ◽  
Practical Implications

Purpose This paper aims to deepen the understanding of the impact of cultural and national idiosyncrasies on businesses. The authors concentrate on the cultural particularity of the Brazilian jeitinho to assess the ethicality of the concept in buyer–supplier relationships. Design/methodology/approach Semi-structured interviews were conducted with 28 Brazilian professionals working for both national and international companies, allowing for the analysis of the context in which the Brazilian jeitinho is perceived either as positive or negative in terms of ethics. Findings The authors propose five distinct dimensions (harm to third parties, seriousness of the issue, formality of relationships, personal benefit and assessed pertinence of rules and laws) to the assessment of Brazilian jeitinho as creativity, corruption or more nuanced classifications between them and offer a reviewed definition of the practice. Practical implications The results of the study may offer new insights into the Brazilian business environment. Deeper comprehension of the contexts in which jeitinho is used and its different connotations may optimise the relations between foreign and Brazilian companies and between foreign and Brazilian professionals and employees. Originality/value Within the context of intensified international trade, global supply chains and geographically spread operations, an understanding of cultural and national idiosyncrasies may provide managers with a powerful tool to conduct their business more effectively. With the economic emergence of countries such as China, Russia and Brazil, local practices are also gaining increased importance as they seem to have a direct influence on management in these places and beyond.

scholarly journals The Impact of Industry 4.0 on Employees—Insights from Australia

2021 ◽  
Vol 13 (6) ◽  
pp. 3095 ◽  
Author(s):  
Krzysztof Ejsmont
Keyword(s):  
Industry 4.0 ◽  
Industrial Revolution ◽  
Structured Interviews ◽  
Social Challenges ◽  
Industrial Enterprises ◽  
Current State ◽  
State Of Research ◽  
Definition Of ◽  
Development And Validation ◽  
The Impact

Currently, Industry 4.0 (I4.0) is the most popular concept relating to changes in the functioning of industrial enterprises. Industry 4.0 has been discussed in the actual literature mainly from a technological perspective, overlooking social challenges regarding this fourth industrial revolution. The objective of this article is to diagnose the impact of I4.0 on employees. This aim will be achieved by (1) a literature review of existing research efforts, (2) conducting structured interviews, and (3) summarizing the current state of knowledge and providing a definition of further work. Scopus, Web of Science, and a set of specific keywords were used to select peer-reviewed articles showing evidence of the impact of I4.0 on employees/jobs in given countries or industries. After determining the current state of research in this area, it was decided to conduct structured interviews questionnaire in the country (Australia) and industry (horticulture), which had not been covered by the research in this topic so far. The main contribution of the article was the development and validation of a comprehensive research agenda on the impact of I4.0 on employees. The obtained results suggest that the impact of I4.0 on employees is significant, and the changes occur in many different categories related to human work. The impact of I4.0 was identified both at the macro (labor market) and micro (jobs) level.

scholarly journals Implementing radical cure diagnostics for malaria: user perspectives on G6PD testing in Bangladesh

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Nora Engel ◽  
Cristian Ghergu ◽  
Mohammad Abdul Matin ◽  
Mohammad Golam Kibria ◽  
Kamala Thriemer ◽  
...  
Keyword(s):  
Health Care Providers ◽  
G6pd Deficiency ◽  
New Technologies ◽  
Routine Practice ◽  
Radical Cure ◽  
Care Providers ◽  
Structured Interviews ◽  
Drug Induced ◽  
User Perspectives ◽  
The Impact

Abstract Background The radical cure of Plasmodium vivax requires treatment with an 8-aminoquinoline drug, such as primaquine and tafenoquine, to eradicate liver hypnozoite stages, which can reactivate to cause relapsing infections. Safe treatment regimens require prior screening of patients for glucose-6-phosphate dehydrogenase (G6PD) deficiency to avoid potential life-threatening drug induced haemolysis. Testing is rarely available in malaria endemic countries, but will be needed to support routine use of radical cure. This study investigates end-user perspectives in Bangladesh on the introduction of a quantitative G6PD test (SD Biosensor STANDARD™ G6PD analyser) to support malaria elimination. Methods The perspectives of users on the SD Biosensor test were analysed using semi-structured interviews and focus group discussions with health care providers and malaria programme officers in Bangladesh. Key emerging themes regarding the feasibility of introducing this test into routine practice, including perceived barriers, were analysed. Results In total 63 participants were interviewed. Participants emphasized the life-saving potential of the biosensor, but raised concerns including the impact of limited staff time, high workload and some technical aspects of the device. Participants highlighted that there are both too few and too many P. vivax patients to implement G6PD testing owing to challenges of funding, workload and complex testing infrastructure. Implementing the biosensor would require flexibility and improvisation to deal with remote sites, overcoming a low index of suspicion and mutual interplay of declining patient numbers and reluctance to test. This approach would generate new forms of evidence to justify introduction in policy and carefully consider questions of deployment given declining patient numbers. Conclusions The results of the study show that, in an elimination context, the importance of malaria needs to be maintained for both policy makers and the affected communities, in this case by ensuring P. vivax, PQ treatment, and G6PD deficiency remain visible. Availability of new technologies, such as the biosensor, will fuel ongoing debates about priorities for allocating resources that must be adapted to a constantly evolving target. Technical and logistical concerns regarding the biosensor should be addressed by future product designs, adequate training, strengthened supply chains, and careful planning of communication, advocacy and staff interactions at all health system levels.

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