There is a gap in the literature regarding what takes place between the announcement of a regulatory intervention, such as an external inspection of a health care organisation, and the inspecting ...body's site visit. This study aimed to explore inspecting bodies' expectations of how inspected organisations should prepare before an external inspection and to elucidate how inspected health care organisations prepare before site visits.
This qualitative study was based on data from 17 group interviews with a total of 75 participants representing inspection teams, organisation leaders and clinicians in inspected health care organisations. The data were analysed using a qualitative content analysis method.
We identified two approaches to how the inspection teams expected that the inspected organisations should prepare before site visits. In the first approach the inspection teams did not expect any improvement activities to be initiated during this period and focused on identifying inadequacies that the inspected organisations should subsequently improve. In the second approach the inspection teams expected organisations to review their own practices and begin improvement activities if necessary. The inspected organisations responded in different ways to an upcoming site visit, and the organisations' leaders were important in determining which activities would be initiated. Organisations in which leaders involved clinicians in assessing care delivery tended to initiate action to improve and expected inspection teams to assess their ongoing improvement work and provide guidance on further improvements. Leaders who did not involve clinicians in assessing the quality of care tended to perceive the current quality of care as adequate on the basis of reviewing written guidelines. They did not initiate action to improve care delivery apart from updating written guidelines describing how care should be delivered, and they expected the inspection team to confirm that their current practices were in line with the guidelines and external standards.
To promote anticipatory effects in inspected organisations, inspecting bodies should stress the importance of assessing clinical practice and involving frontline clinical staff and leaders in the assessment and in improvement work before the site visit.
I denne artikkelen analyserer vi en spesifikk kommunal akutt døgnenhet (KAD) som ble etablert i 2013. Vi undersøker hvordan etableringen og organiseringen av enheten utfolder seg i praksis, og ...hvordan denne etableringen og organiseringen kan forstås som ulike former for «samstyring». Studien er basert på 28 kvalitative intervjuer med ledere og helsepersonell ved enheten, i kommunene og på sykehuset. Studien viser hvordan samstyring kan nyanseres i flere former for styring der «egenaktiv styring», «interaktiv styring» og «transaktiv styring» viser til ulike grader av autonomi og handlingsrom i styringsrelasjonene. Studien utvider vår forståelse av begrepet samstyring.
Research proactively and deliberately aims to bring about specific changes to how societies function and individual lives fare. However, in the ever-expanding field of ethical regulations and ...guidance for researchers, one ethical consideration seems to have passed under the radar: How should researchers act when pursuing actual, societal changes based on their academic work?
When researchers engage in the process of bringing about societal impact to tackle local or global challenges important concerns arise: cultural, social and political values and institutions can be put at risk, transformed or even hampered if researchers lack awareness of how their 'acting to impact' influences the social world. With today's strong focus on research impacts, addressing such ethical challenges has become urgent within in all fields of research involved in finding solutions to the challenges societies are facing. Due to the overall goal of doing something good that is often inherent in ethical approaches, boundaries to researchers' impact of something good is neither obvious, nor easy to detect. We suggest that it is time for the field of bioethics to explore normative boundaries for researchers' pursuit of impact and to consider, in detail, the ethical obligations that ought to shape this process, and we provide a four-step framework of fair conditions for such an approach. Our suggested approach within this field can be useful for other fields of research as well.
With this paper, we draw attention to how the transition from pursuing impact within the Academy to trying to initiate and achieve impact beyond the Academy ought to be configured, and the ethical challenges inherent in this transition. We suggest a stepwise strategy to identify, discuss and constitute consensus-based boundaries to this academic activity. This strategy calls for efforts from a multi-disciplinary team of researchers, advisors from the humanities and social sciences, as well as discussants from funding institutions, ethical committees, politics and the society in general. Such efforts should be able to offer new and useful assistance to researchers, as well as research funding agencies, in choosing ethically acceptable, impact-pursuing projects.
From January to June 2020, 22 FUS kindergartens across Norway implemented Tuning in to Kids for Kindergarten Teachers (TIK-KT) as part of a randomized control trial (RCT). Between the evaluation of ...an intervention and use of it in daily practice, a research-to-practice gap can often occur. The theory of planned behavior constituted the theoretical basis for the qualitative interviews that were administered to explore these gaps. This study aimed to explore motivation among kindergarten staff regarding the implementation of TIK-KT.
Participants from the FUS kindergartens RCT were part of the current study. A stepwise deductive inductive strategy was used in the thematic content analysis. The data were from eleven semi-structured telephone interviews with kindergarten leaders and teachers. Codes from interviews before and after implementation were grouped based on thematic connections, and code groups were further combined into themes. The Consolidated criteria for reporting qualitative research were used as a reporting standard.
The interviews resulted in four main themes: (1) understanding the rationale of implementation, (2) "aha"-experiences, (3) the research-to-practice gap and (4) the main motivation. Kindergarten leaders and teachers expressed positive attitudes toward the intervention ideas and motivation to practice emotion coaching skills and toward implementing TIK-KT both before and after implementation.
Kindergarten leaders' and teachers' motivation for implementation came from having a good understanding of the ideas of Tuning in to Kids for Kindergarten Teachers (TIK-KT), experiencing moments of "aha" regarding the intervention, not being held back by practical issues, and working toward their ultimate goal, the wellbeing of the children. These findings have implications for future implementation of TIK-KT and other mental health-promoting interventions and guide further areas of research to examine implementation mechanisms.
The study was registered with the Clinical Trials Registry (NCT03985124), June 13th, 2019.
ObjectiveInspections and other forms of external assessment may contribute to positive changes in the health services, but the mechanisms of such change remain unclear. We did a study to explore how ...external inspections may foster clinical improvement in hospitals.DesignFocus group study.SettingStatutory inspections of sepsis treatment in hospital emergency departments in Norway.ParticipantsClinicians, managers and inspection teams involved with the inspections of sepsis treatment in emergency departments at four different hospitals. Twelve focus group interviews were carried out, with a total of 47 participants.ResultsThree themes emerged as central for understanding how the inspections could contribute to clinical improvement in the emergency departments: (1) increasing awareness about the need to improve the quality of care by providing data on clinical performance, (2) building acceptance for improvement through professional credibility and focus on clinical practice, and (3) fostering leadership commitment.ConclusionOur findings suggest that the inspections have the potential to enhance hospital management and staff’s understanding of complicated care processes and help strengthen the organisational commitment to bring about systemic quality improvements.
This chapter describes how profession based hierarchies (stratified social orders between professions) may appear in a teaching context of interprofessionality involving a variety of health ...professions presenting challenges to learning and offers suggestions on how these challenges can be overcome.
External inspections constitute a key element of healthcare regulation. Improved quality of care is one of the important goals of inspections but the mechanisms of how inspections might contribute to ...quality improvement are poorly understood. Drawing on interviews with healthcare professionals and managers and health record data from inspected organizations, we used a realist evaluation approach to explore how twelve inspections of healthcare providers in x= Norway influenced quality improvement. We found that for inspections to contribute to quality improvement, there must be contextual structures present supporting accountability and engaging staff in improvement work. When such structures are present, inspections can contribute to improvement by creating awareness of gaps between desired and current practices, which leads to readiness for change and stimulates intra-organizational reasoning around quality improvement. We discuss our findings using the theory of de- and recoupling, noting how regulators can identify decoupling between intended goals, management systems, practices, and patient outcomes. We further argue that regulators can contribute to a recoupling between these levels by having the capacity to track the providers' clinical performance over time. This will hold the organization accountable for implementing improvement measures and evaluate the effects of the measures on quality of care.
•A realist evaluation of the impact of external inspections on quality of care.•Impact on quality improvement depends on the inspectee's institutional structures.•Inspections that succeed do so through creating awareness of quality problems.•Inspections should include capacity to assess quality as experienced by patients.•Regulators should promote the creation of systems for monitoring performance.
PurposeUnequal social conditions that provide people with unequal opportunities to live healthy lives are considered unjust and associated with “health inequity”. Governing power is impacting ...people's lives through laws, policies and professional decisions, and can be used intentionally to combat health inequity by addressing and changing people's living- and working conditions. Little attention is paid to how these ways of exercising governing power unintentionally can structure further conditions for health inequity. In this paper, the authors coin the term “governance determinants of health” (GDHs). The authors' discussion of GDHs potential impact on health inequity can help avoid the implementation of governing strategies with an adverse impact on health equality. This paper aims to discuss the aforementioned objective.Design/methodology/approachThe authors identify Governance Determinants of Health, the GDHs. GDHs refer to governance strategies that structurally impact healthcare systems and health equality. The authors focus on the unintended, blind sides of GDHs that maintain or reinforce the effects of socioeconomic inequality on health.FindingsThe power to organize healthcare is manifested in distinct structural approaches such as juridification, politicalization, bureaucratization and medical standardization. The authors explore the links between different forms of governance and health inequalities.Research limitations/implicationsThe authors' discussion in this article is innovative as it seeks to develop a framework that targets power dynamics inherent in GHDs to help identify and avoid GDHs that may promote unequal access to healthcare and prompt health inequity. However, this framework has limitations as the real-world, blurred and intertwined aspects of governing instruments are simplified for analytical purposes. As such, it risks overestimating the boundaries between the separate instruments and reducing the complexity of how the GDHs work in practice. Consequently, this kind of theory-driven framework does not do justice to the myriad of peoples' complex empirical practices where GDHs may overlap and intertwine with each other. Nevertheless, this framework can still help assist governing authorities in imagining a direction for the impacts of GDHs on health equity, so they can take precautionary steps to avoid adverse impacts.Originality/valueThe authors develop and explore – and demonstrate – the relevance of a framework that can assist governing authorities in anticipating the impacts of GDHs on health inequity.
This article examines how unitary management as a discourse of general management is able to permeate a psychiatric hospital through the management training program. The argument is that the ...management training program was a pervasive vehicle in reconstituting the "subjectivities" of those involved to the extent that it made the managers see themselves as the driving agents of the structural changes. The training program stressed the unitary managers' freedom as they assumed responsibility without being ordered to, were expected to evaluate their actions, and were told to continue improving their managerial practices. The individual manager was put in the fore and given the power to drive the changes in their professional-managerial role. The central focus is how senior managers' "managementhood" was constructed through training session meetings. Disagreements or oppositions to the program were refigured into administrative dilemmas by rephrasing disagreements as communication problems and by the interpellation to create "managementhood": "What will you do then?" The training program meetings are analyzed as technologies that operate within a "dispositif" in the sense that the meetings shape the range of possible actions and outcomes of the organization and they also serve to disseminate the key organizing metaphors through which the organization and its participants are to plan and implement their activities. Actual meetings get agents to commit themselves to the employment of the organizing metaphors of the general management discourse.
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