Search

PurposeThis paper explores the role of hospital cleaners and their contribution to healthcare safety. Few studies have examined the activities and input of hospital cleaners, rendering them largely invisible in healthcare research. Yet, as coronavirus disease 2019 (COVID-19) has demonstrated, this sizeable workforce carries out tasks critical to healthcare facilities and wider health system functioning.Design/methodology/approachDrawing on the work of Habermas, the authors examine the literature surrounding cleaners and quality and safety in healthcare. The authors theorise cleaners' work as both instrumental and communicative and examine the perceptions of healthcare professionals and managers, as well as cleaners themselves, of healthcare professionals and managers' role and contribution to quality and safety.FindingsCleaners are generally perceived by the literature as performing repetitive – albeit important – tasks in isolation from patients. Cleaners are not considered part of the “healthcare team” and are excluded from decision-making and interprofessional communication. Yet, cleaners can contribute to patient care; ubiquity and proximity of cleaners to patients offer insights and untapped potential for involvement in hospital safety.Originality/valueThis paper brings an overdue focus to this labour force by examining the nature and potential of their work. This paper offers a new application of Habermas' work to this domain, rendering visible how the framing of cleaners' role works to exclude this important workforce from participation in the patient safety agenda.

Genetic referral for Lynch syndrome (LS) exemplifies complex clinical pathways. Identifying target behaviours (TBs) for change and associated barriers requires structured group consultation activities with busy clinicians – consolidating implementation activities whilst retaining rigour is crucial. This study aimed to: i) use process mapping to gain in-depth understandings of site-specific LS testing and referral practices in Australian hospitals and support identification of TBs for change, ii) explore if barriers to identified TBs could be identified through process mapping focus-group data, and iii) demonstrate pandemic-induced transition from in-person to virtual group interactive process mapping methods. LS clinical stakeholders attended interactive in-person or virtual focus groups to develop site-specific “process maps” visually representing referral pathways. Content analysis of transcriptions informed site-specific process maps, then clinical audit data was compared to highlight TBs for change. TBs were reviewed in follow-up focus groups. Secondary thematic analysis explored barriers to identified TBs, coded against the Theoretical Domains Framework (TDF). The transition from in-person to pandemic-induced virtual group interactive process mapping methods was documented. Process mapping highlighted six key areas of clinical practice variation across sites and site-specific TBs for change were identified. Key barriers to identified TBs emerged, categorised to seven TDF domains. Process mapping revealed variations in clinical practices surrounding LS referral between sites. Incorporating qualitative perspectives enhances process mapping by facilitating identification of TBs for change and barriers, providing a pathway to developing targeted interventions. Virtual process mapping activities produced detailed data and enabled comprehensive map development.

This article investigates the finite-time and fixed-time synchronization for memristive neural networks (MNNs) with mixed time-varying delays under the adaptive aperiodically intermittent adjustment strategy. Different from previous works, this article first employs the aperiodically intermittent adjustment feedback control and adaptive control to drive the MNNs to achieve synchronization in finite time and fixed time. First of all, according to the theories of set-valued mappings and differential inclusions, the error MNNs is derived, and its finite-time and fixed-time stability problems are discussed by applying the Lyapunov function method and some LMI techniques. Moreover, by meticulously designing an effective aperiodically intermittent adjustment with adaptive updating law, sufficient conditions that guarantee the finite-time and fixed-time synchronization of the drive-response MNNs are obtained, and the settling time is explicitly estimated. Finally, three numerical examples are provided to illustrate the validity of the obtained theoretical results.

UNSTRUCTURED This is test MS 21 Feb 2023

BACKGROUND To support the rehabilitation of adults with communication difficulty after acquired brain injury (ABI), it is internationally recommended best practice to provide formal (eg, support workers) and informal (eg, friends, family) ‘communication partners’ with communication partner training (CPT). However, ABI affects more than 135 million people globally, surpassing healthcare capacities to provide CPT. ‘interact-ABI-lity’ is a free, 2-hour, self-directed, web-based CPT program that includes education and strategies to support people with cognitive-communication disorders, aphasia, and dysarthria after ABI. It is unknown whether interact-ABI-lity can facilitate the scalability and accessibility of CPT. OBJECTIVE To investigate the implementation and effectiveness of interact-ABI-lity as a web-based service delivery model for CPT after ABI. METHODS This 12-month prospective, mixed methods, hybrid type 2 implementation-effectiveness study is theoretically underpinned by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework. We documented and deployed implementation strategies coproduced with stakeholders and identified by users through formative evaluation. We prospectively observed theoretically-informed implementation outcomes through web analytics, survey data, and individual interviews incorporating think-aloud methods. Qualitative implementation data were deductively analyzed against the NASSS framework, and quantitative implementation data were analyzed descriptively. Effectiveness outcomes were obtained through custom, web-based knowledge and confidence questionnaires which were administered preintervention, postintervention, and at 3 months follow-up. RESULTS interact-ABI-lity received 1069 unique registrations from 29 countries. User feedback surveys (n=325) indicated high satisfaction (92% indicated interact-ABI-lity was “Extremely” or “Very” useful, and 95% rated 8-10 out of 10 likelihood of recommending it to others), with positive qualitative comments. Users also reported high usability (85% indicated interact-ABI-lity was “Very easy” or “Easy” to use). Users who were older, male, informal communication partners, had lower education levels or lower confidence communicating with people with ABI were underrepresented. Effectiveness data indicated significant improvements (p CONCLUSIONS interact-ABI-lity is the first completely self-directed CPT program to support adults with cognitive-communication disorders, aphasia, and dysarthria after ABI. Users reported high satisfaction and usability. Communication knowledge and confidence increased postintervention but were not fully retained after 3 months. Although this may reflect the limitations of a short, self-guided format, this alternate service delivery model was scalable across organizations and internationally, with potential to address unmet community and healthcare needs. Proactive reduction of complexity across a comprehensive range of domains of implementation, particularly a multidimensional value proposition, may have facilitated interact-ABI-lity’s implementation, scalability, and sustainability. Extended implementation research beyond 12 months is required. CLINICALTRIAL Australia and New Zealand Clinical Trials Registry: ACTRN12621001170819, https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621001170819, Universal Trial Number U1111-1266-6628. INTERNATIONAL REGISTERED REPORT RR2-10.2196/31995

We explore a number of key relationships between patient safety and the health status of imprisoned people. This is a conceptual study drawing connections between a number of literatures including the field of patient safety, the work done on health and illness amongst imprisoned people, their social characteristics, and the carceral environment itself. We show that this is an underexplored and under-theorised field of inquiry. It also sets the scene for further investigation of not only individual and systemic factors in the health and illness experienced by such people but the role of the carceral environment. It seems clear that the risk of ill-health rises for many people who are incarcerated. Errors of both omission and commission are common in carceral environments. Risks rise for patients in such environments due to delays in diagnosis, referral and treatment. Understanding the complex and inter-related factors that increase ill-health in individuals, groups and communities provides a starting point for understanding why, when and how imprisoned people need to access and utilise healthcare, how will they are when they do so, and how. It also opens up the question of how these factors might affect their susceptibility to medical errors and adverse events.

Objectives Up to 30% of healthcare spending is considered unnecessary and represents systematic waste. While much attention has been given to low-value clinical tests and treatments, much less has focused on identifying low-value safety practices in healthcare settings. With increasing recognition of the problem of “safety clutter” in organizations, it is important to consider deimplementing safety practices that do not benefit patients, to create the time needed to deliver effective, person-centered, and safe care. This study surveyed healthcare staff to identify safety practices perceived to be of low value. Methods Purposive and snowball sampling was used. Data collection was conducted from April 2018 to November 2019 (United Kingdom) and May 2020 to November 2020 (Australia). Participants completed the survey online or in hard copy to identify practices they perceived to not contribute to safe care. Responses were analyzed using content and thematic analysis. Results A total of 1394 responses from 1041 participants were analyzed. Six hundred sixty-three responses were collected from 526 UK participants and 515 Australian participants contributed 731 responses. Frequently identified categories of practices identified included “paperwork,” “duplication,” and “intentional rounding.” Five cross-cutting themes (e.g., covering ourselves) offered an underpinning rationale for why staff perceived the practices to be of low value. Conclusions Staff identified safety practices that they perceived to be low value. In healthcare systems under strain, removing existing low-value practices should be a priority. Careful evaluation of these identified safety practices is required to determine whether they are appropriate for deimplementation and, if not, to explore how to better support healthcare workers to perform them.

The impact of health service access disparities has significant implications for society. The importance of addressing health and social inequities is never more critical than in the early years of a child’s life. Despite advances in healthcare implementation, there is a lack of an evidence-based framework to specifically guide the adaptation of child and family health (CFH) service models for different community contexts. This paper describes the development of a framework for the adaptation of community-based CFH service models. Drawing on the findings of an integrative review and Delphi study, Participatory Action Research was used to test the framework, resulting in the Framework for Collaborative Adaptation of Service Models for Child and Family Health in Diverse Settings (CASCADES). The Framework uses the analogy of a waterfall to represent the iterative process of collecting information to inform each step. The framework supports a collaborative co-design approach to build a comprehensive understanding of the target community to inform the adaptation and evaluation of evidence-based interventions appropriate to the local context. The ultimate aim is to enable the delivery of services that are contextually relevant for local communities and provide greater access to effective, accessible services to support children and their families.

Inequity in health outcomes is pervasive, with poorer health outcomes identified in rural, regional and remote communities. An international call to action emphasises the need for service models adapted for less well-resourced settings. The aim of this study was to identify key elements of a framework for the adaptation of specialist community-based child and family health (CFH) service models for rural and other under-resourced settings. A modified Delphi study was undertaken with a 12-person expert panel in CFH including Australian and international professionals and parents from rural and remote communities. The study was informed by the WHO Framework for Strengthening Health Service Systems building blocks, the outcomes of an integrative review of literature and a Participatory Action Research study. Experts assessed 107 potential elements for service model development and rated them for importance when adapting service models for different contexts. Round 1 of the Delphi generated considerable consensus with 80 of the 107 potential elements identified as necessary for the service model adaptation framework. A further 17 elements for CFH service models were added in round 2. While multiple varied elements are important for adapting CFH service models for diverse settings, some elements had common themes. Experts highlighted the importance of community engagement and participation; utilising both data and local knowledge to develop a robust understanding of the community context; and the need for a flexible approach to funding and modes of service delivery to address barriers to implementation and access.

Aims This study aimed to describe the demographic characteristics and to measure annual changes in composition of the paediatric population attending a specialist tertiary hospital in Sydney, Australia, between 2015 and 2017. Background Australia has experienced steady growth in the number of people born overseas in the last fifty years thereby building a culturally and linguistically rich country. Such dynamic population changes pose a challenge to the nursing workforce, in particular how the needs of migrant families from non-English-speaking countries are accommodated. Design Retrospective review of medical records. Methods De-identified paediatric inpatient data were imported from a hospital database into Statistical Package for the Social Sciences (version 21) database for cleaning and analysis. Strengthening the reporting of observational studies in epidemiology checklist was completed. Results Paediatric inpatients born in a country other than Australia (8762, 5.7%) emigrated from 155 countries or were "born at Sea" (n = 13, 0.1%) and spoke an array of primary languages (n = 139), other than English. Whilst inpatient health service rates remained constant during the study period, an increased rate of service utilisation was reported for children born in Asia (IRR 1.3, p ≤ 0.001, 95% CI: 1.2-1.4) and in the Middle East (IRR 1.4, p ≤ 0.001, 95% CI: 1.2-1.6). Families who reported that they preferred to speak Chinese Languages, Middle Eastern languages (not Arabic) and languages of India reported increased rates. Conclusion Significant annual changes in composition of the paediatric population were reported. Regular analysis of local inpatient data will inform health care that is responsive to change and addresses the unique needs of diverse families. Relevance to clinical practice Diversity poses a potential challenge to the nursing workforce on a daily basis and more broadly. To meet the changing needs of diverse inpatient populations, nurses will need to plan, implement and evaluate cultural competency, linguistic access, workforce diversity and the quality of care to diverse populations.

Purpose: Dysphagia (swallowing difficulty) impacts physical health, quality of life, and mealtime enjoyment. Staff who provide mealtime assistance to people with dysphagia require adequate training to help ensure that the mealtimes are safe and enjoyable. This systematic review examined literature relating to training in dysphagia (e.g., recognizing signs and symptoms) and mealtime assistance, its components, and benefits for people with dysphagia. Method: In July 2020, five scientific databases were searched for papers meeting the inclusion criteria relating to mealtime assistance training. The quality of the studies was evaluated using the Quality Assessment Tool for Studies of Diverse Design, with scores ranging from 38.1% to 83.3%. We completed a qualitative synthesis using the data extracted from the included studies. Results: Twenty-four studies met the inclusion criteria. Participants in these studies benefited from both group training and one-on-one training. Training programs had many formats including computer-based, face-to-face, individual training, and group training. Each included study demonstrated some level of positive impact to the learners, such as improved knowledge and skills in mealtime management for people with dysphagia. No studies reported negative outcomes. Training duration ranged from 30 min to 5 days. Conclusions: The benefits of different components of mealtime training (e.g., group training, or face-to-face training) for mealtime assistance for people with dysphagia were reviewed. Further research is needed to compare the effectiveness of different training formats, involving not only the assistant but also people with dysphagia as both trainers and trainees, and determine the health outcomes of training programs for people with dysphagia.

Refereed/Peer-reviewed International studies show that telepharmacy service delivery increased to maintain safe pharmaceutical care during the coronavirus disease 2019 (COVID-19) pandemic,1 but little is known about the use of telepharmacy in Australia. We surveyed Australian hospital outpatient pharmacy managers to identify how their services were adapted during the 2020 COVID-19 lockdowns.

BACKGROUND The Social Brain Toolkit, conceived and developed in partnership with stakeholders, is a novel suite of web-based communication interventions for people with brain injury and their communication partners. To support effective implementation, the developers of the Social Brain Toolkit have collaborated with people with brain injury, communication partners, clinicians, and individuals with digital health implementation experience to coproduce new implementation knowledge. In recognition of the equal value of experiential and academic knowledge, both types of knowledge are included in this study protocol, with input from stakeholder coauthors. OBJECTIVE This study aims to collaborate with stakeholders to prioritize theoretically based implementation targets for the Social Brain Toolkit, understand the nature of these priorities, and develop targeted implementation strategies to address these priorities, in order to support the Social Brain Toolkit’s implementation. METHODS Theoretically underpinned by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework of digital health implementation, a maximum variation sample (N=35) of stakeholders coproduced knowledge of the implementation of the Social Brain Toolkit. People with brain injury (n=10), communication partners (n=11), and clinicians (n=5) participated in an initial web-based prioritization survey based on the NASSS framework. Survey completion was facilitated by plain English explanations and accessible captioned videos developed through 3 rounds of piloting. A speech-language pathologist also assisted stakeholders with brain injury to participate in the survey via video teleconference. Participants subsequently elaborated on their identified priorities via 7 web-based focus groups, in which researchers and stakeholders exchanged stakeholder perspectives and research evidence from a concurrent systematic review. Stakeholders were supported to engage in focus groups through the use of visual supports and plain English explanations. Additionally, individuals with experience in digital health implementation (n=9) responded to the prioritization survey questions via individual interview. The results will be deductively analyzed in relation to the NASSS framework in a coauthorship process with people with brain injury, communication partners, and clinicians. RESULTS Ethical approval was received from the University of Technology Sydney Health and Medical Research Ethics Committee (ETH20-5466) on December 15, 2020. Data were collected from April 13 to November 18, 2021. Data analysis is currently underway, with results expected for publication in mid-2022. CONCLUSIONS In this study, researchers supported individuals with living experience of acquired brain injury, of communicating with or clinically supporting someone post injury, and of digital health implementation, to directly access and leverage the latest implementation research evidence and theory. With this support, stakeholders were able to prioritize implementation research targets, develop targeted implementation solutions, and coauthor and publish new implementation findings. The results will be used to optimize the implementation of 3 real-world, evidence-based interventions and thus improve the outcomes of people with brain injury and their communication partners. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/35080

Background The Social Brain Toolkit, conceived and developed in partnership with stakeholders, is a novel suite of web-based communication interventions for people with brain injury and their communication partners. To support effective implementation, the developers of the Social Brain Toolkit have collaborated with people with brain injury, communication partners, clinicians, and individuals with digital health implementation experience to coproduce new implementation knowledge. In recognition of the equal value of experiential and academic knowledge, both types of knowledge are included in this study protocol, with input from stakeholder coauthors. Objective This study aims to collaborate with stakeholders to prioritize theoretically based implementation targets for the Social Brain Toolkit, understand the nature of these priorities, and develop targeted implementation strategies to address these priorities, in order to support the Social Brain Toolkit’s implementation. Methods Theoretically underpinned by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework of digital health implementation, a maximum variation sample (N=35) of stakeholders coproduced knowledge of the implementation of the Social Brain Toolkit. People with brain injury (n=10), communication partners (n=11), and clinicians (n=5) participated in an initial web-based prioritization survey based on the NASSS framework. Survey completion was facilitated by plain English explanations and accessible captioned videos developed through 3 rounds of piloting. A speech-language pathologist also assisted stakeholders with brain injury to participate in the survey via video teleconference. Participants subsequently elaborated on their identified priorities via 7 web-based focus groups, in which researchers and stakeholders exchanged stakeholder perspectives and research evidence from a concurrent systematic review. Stakeholders were supported to engage in focus groups through the use of visual supports and plain English explanations. Additionally, individuals with experience in digital health implementation (n=9) responded to the prioritization survey questions via individual interview. The results will be deductively analyzed in relation to the NASSS framework in a coauthorship process with people with brain injury, communication partners, and clinicians. Results Ethical approval was received from the University of Technology Sydney Health and Medical Research Ethics Committee (ETH20-5466) on December 15, 2020. Data were collected from April 13 to November 18, 2021. Data analysis is currently underway, with results expected for publication in mid-2022. Conclusions In this study, researchers supported individuals with living experience of acquired brain injury, of communicating with or clinically supporting someone post injury, and of digital health implementation, to directly access and leverage the latest implementation research evidence and theory. With this support, stakeholders were able to prioritize implementation research targets, develop targeted implementation solutions, and coauthor and publish new implementation findings. The results will be used to optimize the implementation of 3 real-world, evidence-based interventions and thus improve the outcomes of people with brain injury and their communication partners. International Registered Report Identifier (IRRID) DERR1-10.2196/35080

The aim of this scoping review is to appraise and synthesise the scientific evidence on the use of food shaping interventions aimed at enhancing nutrition in adults. Specifically, the review aims to answer the following questions:1.What food shaping interventions have been examined as a means to increase access to nutrition for adults, across populations and settings?2.What food shaping interventions have been examined as a means to increase access to nutrition for older adults (a) with swallowing difficulty or with conditions with high prevalence of swallowing difficulty, or (b) in aged care settings?

Background Acquired brain injuries (ABIs) commonly cause cognitive-communication disorders, which can have a pervasive psychosocial impact on a person’s life. More than 135 million people worldwide currently live with ABI, and this large and growing burden is increasingly surpassing global rehabilitation service capacity. A web-based service delivery model may offer a scalable solution. The Social Brain Toolkit is an evidence-based suite of 3 web-based communication training interventions for people with ABI and their communication partners. Successful real-world delivery of web-based interventions such as the Social Brain Toolkit requires investigation of intervention implementation in addition to efficacy and effectiveness. Objective The aim of this study is to investigate the implementation and effectiveness of the Social Brain Toolkit as a web-based service delivery model. Methods This is a mixed methods, prospective, hybrid type 2 implementation-effectiveness study, theoretically underpinned by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework of digital health implementation. We will document implementation strategies preemptively deployed to support the launch of the Social Brain Toolkit interventions, as well as implementation strategies identified by end users through formative evaluation of the Social Brain Toolkit. We will prospectively observe implementation outcomes, selected on the basis of the NASSS framework, through quantitative web analytics of intervention use, qualitative and quantitative pre- and postintervention survey data from all users within a specified sample frame, and qualitative interviews with a subset of users of each intervention. Qualitative implementation data will be deductively analyzed against the NASSS framework. Quantitative implementation data will be analyzed descriptively. We will obtain effectiveness outcomes through web-based knowledge tests, custom user questionnaires, and formal clinical tools. Quantitative effectiveness outcomes will be analyzed through descriptive statistics and the Reliable Change Index, with repeated analysis of variance (pretraining, posttraining, and follow-up), to determine whether there is any significant improvement within this participant sample. Results Data collection commenced on July 2, 2021, and is expected to conclude on June 1, 2022, after a 6-month sample frame of analytics for each Social Brain Toolkit intervention. Data analysis will occur concurrently with data collection until mid-2022, with results expected for publication late 2022 and early 2023. Conclusions End-user evaluation of the Social Brain Toolkit’s implementation can guide intervention development and implementation to reach and meet community needs in a feasible, scalable, sustainable, and acceptable manner. End user feedback will be directly incorporated and addressed wherever possible in the next version of the Social Brain Toolkit. Learnings from these findings will benefit the implementation of this and future web-based psychosocial interventions for people with ABI and other populations. Trial Registration Australia and New Zealand Clinical Trials Registry ACTRN12621001170819; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621001170819, Australia and New Zealand Clinical Trials Registry ACTRN12621001177842; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621001177842, Australia and New Zealand Clinical Trials Registry ACTRN12621001180808; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621001180808 International Registered Report Identifier (IRRID) DERR1-10.2196/31995

IntroductionThere is a clear need for improved care quality and quality monitoring in aged care. Aged care providers collect an abundance of data, yet rarely are these data integrated and transformed in real-time into actionable information to support evidence-based care, nor are they shared with older people and informal caregivers. This protocol describes the co-design and testing of a dashboard in residential aged care facilities (nursing or care homes) and community-based aged care settings (formal care provided at home or in the community). The dashboard will comprise integrated data to provide an ‘at-a-glance’ overview of aged care clients, indicators to identify clients at risk of fall-related hospitalisations and poor quality of life, and evidence-based decision support to minimise these risks. Longer term plans for dashboard implementation and evaluation are also outlined.MethodsThis mixed-method study will involve (1) co-designing dashboard features with aged care staff, clients, informal caregivers and general practitioners (GPs), (2) integrating aged care data silos and developing risk models, and (3) testing dashboard prototypes with users. The dashboard features will be informed by direct observations of routine work, interviews, focus groups and co-design groups with users, and a community forum. Multivariable discrete time survival models will be used to develop risk indicators, using predictors from linked historical aged care and hospital data. Dashboard prototype testing will comprise interviews, focus groups and walk-through scenarios using a think-aloud approach with staff members, clients and informal caregivers, and a GP workshop.Ethics and disseminationThis study has received ethical approval from the New South Wales (NSW) Population & Health Services Research Ethics Committee and Macquarie University’s Human Research Ethics Committee. The research findings will be presented to the aged care provider who will share results with staff members, clients, residents and informal caregivers. Findings will be disseminated as peer-reviewed journal articles, policy briefs and conference presentations.

Translating evidence into complex health systems is an ongoing challenge. Building the capacity of healthcare workers in behavioral and implementation science methods may facilitate the use of evidence-based implementation approaches, leading to sustainable and effective translation. The aim was to describe the development, contents and evaluation of a training workshop aimed at upskilling hospital-embedded staff to deliver an evidence-based implementation approach. The Hide and Seek Project (HaSP) is a cluster randomized controlled trial testing two implementation approaches for improving hereditary cancer referral at eight Australian hospitals. Healthcare workers were recruited as “Implementation Leads” and trained via a one-day workshop—TRAining in evideNce-baSed ImpLementATion for hEalth (TRANSLATE). The purpose of TRANSLATE was to upskill Implementation Leads in the delivery of HaSP, as well as implementation science methods more broadly. Implementation Leads participated in semi-structured evaluation interviews, which were analyzed using inductive thematic analysis. Nine Implementation Leads from various professional backgrounds completed the training. Four key themes were identified: (i) training day reactions, (ii) learning, (iii) implementation barriers and facilitators, and (iv) building health system capacity for implementation. Participants reported high levels of satisfaction, and anticipated that the knowledge and skills may be useful in the future. We describe a novel training program focused on the delivery of evidence-based implementation within health systems. Guided by insights from this study, methods to deliver the training on a larger scale and across different contexts are being explored. The prolonged impact of TRANSLATE will be further evaluated at trial completion. Trial registration: ANZCTR, ACTRN12618001072202. Registered on June 27, 2018

BACKGROUND Acquired brain injuries (ABIs) commonly cause cognitive-communication disorders, which can have a pervasive psychosocial impact on a person’s life. More than 135 million people worldwide currently live with ABI, and this large and growing burden is increasingly surpassing global rehabilitation service capacity. A web-based service delivery model may offer a scalable solution. The Social Brain Toolkit is an evidence-based suite of 3 web-based communication training interventions for people with ABI and their communication partners. Successful real-world delivery of web-based interventions such as the Social Brain Toolkit requires investigation of intervention implementation in addition to efficacy and effectiveness. OBJECTIVE The aim of this study is to investigate the implementation and effectiveness of the Social Brain Toolkit as a web-based service delivery model. METHODS This is a mixed methods, prospective, hybrid type 2 implementation-effectiveness study, theoretically underpinned by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework of digital health implementation. We will document implementation strategies preemptively deployed to support the launch of the Social Brain Toolkit interventions, as well as implementation strategies identified by end users through formative evaluation of the Social Brain Toolkit. We will prospectively observe implementation outcomes, selected on the basis of the NASSS framework, through quantitative web analytics of intervention use, qualitative and quantitative pre- and postintervention survey data from all users within a specified sample frame, and qualitative interviews with a subset of users of each intervention. Qualitative implementation data will be deductively analyzed against the NASSS framework. Quantitative implementation data will be analyzed descriptively. We will obtain effectiveness outcomes through web-based knowledge tests, custom user questionnaires, and formal clinical tools. Quantitative effectiveness outcomes will be analyzed through descriptive statistics and the Reliable Change Index, with repeated analysis of variance (pretraining, posttraining, and follow-up), to determine whether there is any significant improvement within this participant sample. RESULTS Data collection commenced on July 2, 2021, and is expected to conclude on June 1, 2022, after a 6-month sample frame of analytics for each Social Brain Toolkit intervention. Data analysis will occur concurrently with data collection until mid-2022, with results expected for publication late 2022 and early 2023. CONCLUSIONS End-user evaluation of the Social Brain Toolkit’s implementation can guide intervention development and implementation to reach and meet community needs in a feasible, scalable, sustainable, and acceptable manner. End user feedback will be directly incorporated and addressed wherever possible in the next version of the Social Brain Toolkit. Learnings from these findings will benefit the implementation of this and future web-based psychosocial interventions for people with ABI and other populations. CLINICALTRIAL Australia and New Zealand Clinical Trials Registry ACTRN12621001170819; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621001170819, Australia and New Zealand Clinical Trials Registry ACTRN12621001177842; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621001177842, Australia and New Zealand Clinical Trials Registry ACTRN12621001180808; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621001180808 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/31995

Aims: Accurate documentation of medication administration time is imperative for many therapeutic decisions, including dosing of intravenous antimicrobials. The objectives were to determine (1) the discrepancy between actual and documented administration times for antimicrobial infusions and (2) whether day of the week, time of day, nurse-to-patient ratio and drug impacted accuracy of documented administration times. Methods: Patient and dosing data were collected (June–August 2019) for 55 in-patients receiving antimicrobial infusions. “Documented” and “actual” administration times (n = 660) extracted from electronic medication management systems and smart infusion pumps, respectively, were compared. Influence of the day (weekday/weekend), time of day (day/evening/night), nurse-to-patient ratio (high 1:1/low 1:5) and drug were examined. Monte Carlo simulation was used to predict the impact on dose adjustments for vancomycin using the observed administration time discrepancies compared to the actual administration time. Results: The median discrepancy between actual and documented administration times was 16 min (range, 2–293 min), with discrepancies greater than 60 minutes in 7.7% of administrations. Overall, discrepancies (median [range]) were similar on weekends (17 [2–293] min) and weekdays (16 [2–188] min), and for high (16 [2–157] min) and low nurse-to-patient ratio wards (16 [2–293] min). Discrepancies were smallest for night administrations (P

This study undertakes a spatial analysis of an Australian aged care setting to explore the role of the built environment in the delivery of a household model of aged care (where residents receive person-centred support in specially-designed, small, homelike environments). Four focus groups with 16 staff were conducted to explore the impact of the built environment in a new residential aged care setting for people living with mental illness. Drawing on Actor-Network Theory and Proxemics, we mapped how the built environment supports improved behaviours and care practices in four key areas: food preparation and dining, sleep and personal self-care, site layout and relationships

Purpose Significant, sustained improvement in patient safety has proved an intractable goal. Attempts to address persistent problems have largely focused on technical solutions to issues conceptualised as clinical, cultural or system based. While communication is at the core of many remediation strategies, the focus has remained largely on communication between clinicians or between clinicians and patients, and on creating centralised guidelines as communicative mechanisms to transmit approved practice. Yet, current attempts at improvement have had limited impact. The purpose of this paper is to highlight vital new ways of conceptualising and exploring the relations and actions that are meant to constitute safety within organisations. Design/methodology/approach Utilising theory from social sciences, the authors reconceptualise trespass and transgression, traditionally positioned as infringements, as acts of resistance: mechanisms for intrusion which intentionally or unintentionally disrupt the territorial claims of professions and organisations to enhance patient safety. Findings Drawing on the literature, research and professional experience, two forms of trespass are discussed: the intrusion of largely invisible and understudied ancillary staff into the world of clinicians; and the use of workarounds by clinicians themselves. In both cases, transgressors intend to increase rather than decrease patient safety and may, upon further examination, prove to do so. Originality/value Trespasses and transgressions considered in this light offer the opportunity to make visible people, relationships and actions which have previously remained hidden in our understanding of, and therefore proposed solutions to, patient safety.

The aim of this study was to investigate the impact of changes to bed configuration and patient mix on nurses' workload in a single ward.Multi-method case study.The study was undertaken in an acute 28-bed ward in a tertiary referral public hospital in Queensland, Australia. Ward-level administrative data were obtained for a 2-year period, 12 months before bed configuration changes in October 2015 and 12 months after. These data included patient activity (bed occupancy, transfers, length of stay and casemix) and nurse staffing (budgeted and actual staffing levels, employment status and skillmix). Semi-structured interviews were conducted with ward nurses (N = 17) to explore the impact of the bed configuration changes on their workload.Administrative data showed that the bed configuration changes resulted in more complex and dependent patients, increased patient transfers and greater variability in casemix. The interview data found these changes to patient complexity and activity intensified workloads, which were further increased by staffing decisions that resulted in greater reliance on temporary staff.Hospitals already possess the data and expert knowledge needed to improve staffing and bed management decisions without the need for additional, costly workload systems.Determining appropriate nurse staffing in light of the complexities and variation of patient needs at the ward level remains a challenge. This study identified increases in patient complexity, dependency, variability and churn that increased workload. Staffing grew but hidden factors associated with temporary staffing and skillmix further intensified nurses' workload. Harnessing existing data and the expertise and experience of nursing unit managers (NUMs) would help staff wards more efficiently and effectively, providing reasonable workloads and appropriate skillmix that can enhance the safety and quality of patient care. To facilitate this, NUMs need access to accurate, timely, data and authority in staffing and bed management decisions.目的: 本研究旨在调查病房内改变床位配置和病人组合对护士工作量的影响。 设计: 多方法案例研究。 方法: 本研究在澳大利亚昆士兰一家三级转诊公立医院的28床急症病房进行。收集病房管理数据的时间长达2年,即2015年10月床位配置改变之前和之后的12个月。数据包括病人活动(床位占用、转移、住院时间延长和病例组合)和护士人员配备(预算和实际人员配备、就业状况和技能组合)。我们还对病房护士进行了半结构式访谈(N = 17),以探讨床位配置变化对其工作量的影响。 结果: 管理性数据显示,床位配置变化导致更多的复杂和依赖的病人、病人转诊增加、病人在casemix的变化更大。访谈数据发现这些变化增加了病人的复杂性和工作量,而工作人员的决定又进一步加重了工作量,导致病人更加依赖临时工作人员。 结论: 医院已经拥有改善住院和病床管理决策所需的数据和专业知识,而不需要额外的昂贵的工作量系统。 影响: 根据病人在病房级的复杂性和多样性需求来决定合适的护士配置仍是一个挑战。研究发现患者的复杂性、依赖性、可变性和搅动性增加了工作量。尽管工作人员增加,但临时职工和技能组合相关的隐性因素也加重了护士的工作量。利用现有的数据和护理部门经理(NUMs)的专业知识和经验能够帮助病房工作人员高效工作,提供合理的工作量和适当的技能组合,从而提高病人护理的安全性和质量。为了促进这一点,护理部门需要在人员配备和床位管理决策方面获得准确、及时的数据和权威。.

© 2018 Paediatrics and Child Health Division (The Royal Australasian College of Physicians) Aim: Youth with both intellectual disability (ID) and mental health (MH) disorders (dual diagnosis) have complex physical and MH needs that can make providing integrated care for this complex group challenging. We conducted a mixed methods needs assessment to identify gaps and challenges in care delivery, identify bridges for these and identify what works well in existing services. Methods: Our research team recruited service providers (n = 126) caring for youth aged 14–24 years with a dual diagnosis in the Illawarra Shoalhaven region of New South Wales, Australia, to participate in focus group interviews. Data were transcribed and analysed thematically. Results: We identified six themes related to caring for youth with dual diagnosis in regional areas: access to services and information about services, communication between service providers and with clients and carers, the divide between MH and ID, early intervention and health promotion, capacity building of service providers and capacity building of clients and carers. Across these themes, service providers highlighted the transition from child to adult services as a particularly challenging time for clients, families and carers. Conclusions: Our data suggest several approaches to break down silos and to facilitate collaboration between current services for youth with a dual diagnosis, including increasing specialised ID/MH services and building the capacity of current disability and MH service providers. Our results provide important information to provide quality and integrated care for youth with complex health needs.

Rationale, aims and objective Accrediting health care organizations against standards is a recognized safety and quality intervention. The credibility of an accreditation programme relies on surveying reliability. We investigated accreditation survey coordinators’ perceptions of reliability issues and their continued relevancy, during a period of national accreditation reform. Method In 2013 and 2014, questionnaire surveys were developed using survey coordinators’ feedback of their experiences and concerns regarding the accreditation process. Each year, a purpose‐designed questionnaire survey was administered during the accrediting agency survey coordinator training days. Results Participants reported that survey reliability was informed by five categories of issues: the management of the accreditation process, including standards and health care organizational issues; surveyor workforce management; survey coordinator role; survey team; and individual surveyors. A new accreditation system and programme did not alter the factors reported to shape survey reliability. However, across the reform period, there was a noted change within each category of the specific issues that were of concern. Furthermore, consensus between coordinators that existed in 2013 appears to have diminished in 2014. Across all categories, in 2014 there was greater diversity of opinion than in 2013. Conclusions The known challenges to the reliability of an accreditation programme retained their potency and relevancy during a period of reform. The diversity of opinion identified across the coordinator workforce could potentially place the credibility and reliability of the new scheme at risk. The study highlights that reliability of an accreditation scheme is an ongoing achievement, not a one‐off attainment.

Summary The study aim was to investigate the understandings and concerns of stakeholders regarding the evolution of health service accreditation programs in Australia. Stakeholder representatives from programs in the primary, acute and aged care sectors participated in semi-structured interviews. Across 2011–12 there were 47 group and individual interviews involving 258 participants. Interviews lasted, on average, 1 h, and were digitally recorded and transcribed. Transcriptions were analysed using textual referencing software. Four significant issues were considered to have directed the evolution of accreditation programs: altering underlying program philosophies; shifting of program content focus and details; different surveying expectations and experiences and the influence of external contextual factors upon accreditation programs. Three accreditation program models were noted by participants: regulatory compliance; continuous quality improvement and a hybrid model, incorporating elements of these two. Respondents noted the compatibility or incommensurability of the first two models. Participation in a program was reportedly experienced as ranging on a survey continuum from “malicious compliance” to “performance audits” to “quality improvement journeys”. Wider contextual factors, in particular, political and community expectations, and associated media reporting, were considered significant influences on the operation and evolution of programs. A hybrid accreditation model was noted to have evolved. The hybrid model promotes minimum standards and continuous quality improvement, through examining the structure and processes of organisations and the outcomes of care. The hybrid model appears to be directing organisational and professional attention to enhance their safety cultures. Copyright © 2015 John Wiley & Sons, Ltd.

Our study examined how accreditation informs the way Australian aged care facility residents manage their healthcare and lifestyle in residential aged care. Residents did not draw direct links between accreditation programmes and their quality of life, yet accreditation standards implicitly underpinned aspects of quality of life that were important to them. There are opportunities for accreditation programmes to more fully utilise resident perspectives to improve their care and quality of life. More overt connections between accreditation standards and issues that are important to residents could promote partnerships with staff, and support enhanced quality of life and a resident-centred focus of care. Furthermore, residents’ perspectives and experiences may contribute to refining accreditation programmes, to ensure they align more with community expectations.