Search

Over the past several decades, the paradigm of risk has become increasingly salient for understanding how health care is provided. In more recent years, we have seen an expanding body of literature...

BackgroundHealth policy and management decisions rarely reflect research evidence. In response, it is important to determine how to improve evidence-informed decision-making. As part of a broader study exploring implementation science strategies we examined how allied health managers respond to two distinct recommendations and the evidence that supports them. MethodsAllied health managers across Australia and New Zealand who were responsible for weekend allied health resource allocation decisions towards the provision of inpatient service to acute general medical and surgical wards, and sub-acute rehabilitation wards were eligible for inclusion. Consenting participants were randomised to: (1) control group or; (2) Implementation Group 1: received an evidence-based policy recommendation document guiding weekend allied health resource allocation decisions, or (3) Implementation Group 2: received the same policy recommendation document guiding weekend allied health resource allocation decisions with support from a knowledge broker. Serial focus groups were conducted with a sample of over 80 allied health managers recruited to Implementation Group 2 only. Out of 6 waves of recruitment, up to four focus groups were conducted with each wave during the 12 months study period. In total 17 health services participated in serial focus groups according to their allocated wave, over a 12-month study period. Data were analysed using an inductive thematic approach with constant comparison. Thematic saturation was achieved.ResultsResults provide insights into resource allocation and decision-making, including the interplay between barriers and facilitators concerning implementation of recommendations outlined in evidence-based policy recommendation document. Five key themes emerged: (1) Local data trumps, or is more influential; (2) How good is the evidence and does it apply to us; (3) It is difficult to change things; (4) Historically that’s how we have done things; and (5) What if we get complaints?ConclusionsThis study explored implementation of strategies to bridge gaps in evidence-informed decision-making. Results provide insight into barriers, which prevent the implementation of evidence base practice from fully, and successfully occurring such as attitudes towards evidence, limited skills in critical appraisal, and lack of authority to promote change. In addition, strategies are needed to manage the risk of confirmation biases in decision-making processes.

Risk assessment and management are considered core elements of healthcare practice. However, a brief examination of the theoretical literature on risk demonstrates that it is not a fixed concept. This chapter will critically analyze the impact that focusing on risk has on healthcare practice. The authors will join many others in pointing out the many potential negative impacts of viewing healthcare through the lens of risk. One risk type, suicide risk, will be examined closely. It will be shown that health professionals often fear liability when risk is a factor. In order to dissuade these fears, the legal elements of liability will be outlined, and relevant common law judgements will be discussed. Finally, future directions will be discussed.

The aim of this chapter is to contribute to addressing the gap between policy and practice for the development and implementation of accessible health and wellbeing organizations and practices from a culturally safe, trauma-informed approach. The objective is to increase use of services early on by Aboriginal people and ultimately to improve health and wellbeing outcomes. A targeted literature search identifies the main features of cultural safety and trauma-informed approaches followed by the presentation of a culturally safe, trauma-informed framework, and implementation plan. The literature on organizations is predominantly from Australia with the work of Michael Yellow Bird in the United States relied upon for the discussion of decolonization. For improved health and wellbeing outcomes with Aboriginal people, historical and contemporary political, economic, and social contextual factors relating to colonization must be acknowledged, and in the Australian context, particular attention must be given to the stolen generations.

Background It is widely acknowledged that health policy and practice do not always reflect current research evidence. Whether knowledge transfer from research to practice is more successful when specific implementation approaches are used remains unclear. A model to assist engagement of allied health managers and clinicians with research implementation could involve disseminating evidence-based policy recommendations, along with the use of knowledge brokers. We developed such a model to aid decision-making for the provision of weekend allied health services. This protocol outlines the design and methods for a multi-centre cluster randomised controlled trial to evaluate the success of research implementation strategies to promote evidence-informed weekend allied health resource allocation decisions, especially in hospital managers. Methods This multi-centre study will be a three-group parallel cluster randomised controlled trial. Allied health managers from Australian and New Zealand hospitals will be randomised to receive either (1) an evidence-based policy recommendation document to guide weekend allied health resource allocation decisions, (2) the same policy recommendation document with support from a knowledge broker to help implement weekend allied health policy recommendations, or (3) a usual practice control group. The primary outcome will be alignment of weekend allied health service provision with policy recommendations. This will be measured by the number of allied health service events (occasions of service) occurring on weekends as a proportion of total allied health service events for the relevant hospital wards at baseline and 12-month follow-up. Discussion Evidence-based policy recommendation documents communicate key research findings in an accessible format. This comparatively low-cost research implementation strategy could be combined with using a knowledge broker to work collaboratively with decision-makers to promote knowledge transfer. The results will assist managers to make decisions on resource allocation, based on evidence. More generally, the findings will inform the development of an allied health model for translating research into practice. Trial registration This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12618000029291). Universal Trial Number (UTN): U1111-1205-2621. Electronic supplementary material The online version of this article (10.1186/s13012-018-0752-7) contains supplementary material, which is available to authorized users.

The use of compulsion has become one of the most contentious issues in psychiatry. This special edition, guest edited by Professor Steve Kisely and Professor Lisa Brophy, brings together a range of perspectives on Community Treatment Orders or outpatient commitment.

Access to drinkable water is essential to human life. The consequence of unsafe drinking water can be damaging to communities and catastrophic to human health. Today, one in five First Nation communities in Canada is on a boil water advisory, with some advisories lasting over 10 years. Factors contributing to this problem stretch back to colonial structures and institutional arrangement that reproduce woefully inadequate community drinking water systems. Notwithstanding these challenges, First Nation communities remain diligent, adaptive, and innovative in their efforts to provide drinkable water to their community members. One example is through the practice of source water protection planning. Source water is untreated water from groundwater or surface water that supplies drinking water for human consumption. Source water protection is operationalized through land and water planning activities aimed at reducing the risk of contamination from entering a public drinking water supply. Here, we introduce a source water protection planning process at Muskowekwan First Nation, Treaty 4, Saskatchewan. The planning process followed a community-based participatory approach guided by trust, respect, and reciprocity between community members and university researchers. Community members identified threats to the drinking water source followed by restorative land management actions to reduce those threats. The result of this process produced much more than a planning document but engaged multiple community members in a process of empowerment and self-determination. The process of plan-making produced many unintended results including human&ndash, land connectivity, reconnection with the water spirit, as well as the reclaiming of indigenous planning. Source water protection planning may not correct all the current water system inadequacies that exist on many First Nations, but it will empower communities to take action to protect their drinking water sources for future generations as a pathway to local water security.

Speech and language impairment in the context of children who have experienced abuse and neglect is not well documented, with only a handful of controlled studies and research reviews on the relationships between maltreatment and children's communication development. More prevalent in the literature are reports on the deleterious effects of child abuse and neglect on overall childhood development, purporting effects on cognitive, affective, social and neurological development. However, the growth of communication skills is integral to a child's early development and is closely related to cognitive and social-emotional development. The experience of abuse and/or neglect has profound implications for a child's developing communication, supporting the inclusion of speech pathology in approaches to working with children and families in abusive and neglectful environments. This article reviews the literature on the relationship between communication development and childhood abuse and neglect. Data collected during the course of speech pathology intervention for abused and neglected children attending the Abused Child Trust's (Queensland) counselling service is also presented in order to highlight the need for the inclusion of this therapeutic modality in managing the developmental needs of this population of children.