This final webinar will emphasise the importance of understanding the problem before brainstorming solutions to better ensure a match between barriers and the solutions.
MORE INFO: http://bit.ly/2KctiLH
At the end of the session patient/family champions as well as health authorities will understand different approaches to patient engagement in patient safety and quality committees (e.g. dealing with incident reporting, root cause analysis, developing policies and procedures) and how patient engagement impacted patient safety and quality outcomes. The participants and presenters are invited to present examples, tools, and leading practices so the participants will leave with at least one practical idea to implement.
Canadian healthcare organizations are taking patient and family engagement to new heights and the best of the best want to share the secrets of their success with you!
As part two of the Human Factors Call Series, CPSI is pleased to invite you to attend When being present isn't enough – Improving patient safety through situational awareness!
How the CIHI – CPSI collaborative on hospital harm can support patient safety initiatives in your organization
Most patients in Canadian hospitals experience safe care, but when harm happens there is a significant impact on patients, families, the healthcare team, and the health system in general. Until now, there hasn't been a standard approach to measuring and monitoring harm experienced by patients in hospital.
Think Human factors doesn't have an impact on clinical outcomes like infection rates? Guess again! According to the World Health Organization (2017), infections acquired in healthcare settings represent the most frequent adverse event occurring in the delivery of healthcare and no institution or country has solved the problem yet.
Full Details: https://goo.gl/Z7Mhuy
As patients and families impacted by harm, we imagine progressive approaches in responding to patient safety incidents – focused on restoring health and repairing trust.
We can change how we respond to healthcare harm by shifting the focus away from what happened, towards who has been affected and in what way. This is your opportunity to hear about innovative approaches in Canada, New Zealand, and the United States that appreciate these human impacts.
This interactive webinar is hosted by Patients for Patient Safety Canada, the patient-led program of the Canadian Patient Safety Institute and the Canadian arm of the World Health Organization Patients for Patient Safety Global Network.
This document outlines the development of a pressure ulcer prevention program at a 134 bed rehabilitation and complex care facility. The program aimed to decrease the skin incidence rate from over 30% to under 5%. Key strategies included forming a multidisciplinary committee, designating wound care champions, implementing standardized skin care products and therapeutic surfaces, and conducting staff education and regular skin audits. Through these efforts, the facility achieved the goal of reducing the skin incidence rate by 2013. Challenges included gaining staff buy-in and connecting prevention strategies to risk assessment scores. Lessons learned were that change takes time and a team effort, and measuring outcomes provides motivation.
Have you ever wanted to learn more about human factors in health care and it’s impact on patient safety? Well now is the time. Join us on Oct. 4th at noon ET as Dr. Kathy Momtahan and Dr. Gianni D’Egidio explore the work of the Canadian Human Factors in Healthcare Network and recent human factors evaluations of hospital external defibrillators.
Objectives:
By the end of this call, you will be able to:
•Describe the processes of Root-Cause Analysis (RCA) and Multi-Incident Analysis (MIA) and their role in quality improvement
•Compare and contrast the different approaches to collecting hospital-acquired VTE data
•Identify an approach suitable for improving patient safety at your institution
This document summarizes a webinar about using hospital harm data and resources to inform quality improvement plans. It includes an agenda with presentations on the patient perspective, an organization's experience in Fraser Health, and tips for using the Hospital Harm Improvement Resource. It discusses why reducing hospital harms is important to patients, and Fraser Health's journey to reduce common harms like UTIs, pneumonia, and sepsis. It promotes engaging patients and provides links to resources on including the patient experience and engaging patients as partners in safety. Attendees are invited to learn more about the Hospital Harm project through listed websites and contacts.
This document discusses engaging patients and families in recognizing deteriorating patient conditions. It provides an overview of a webinar on the topic, which includes a patient and family perspective on experiences, a provider perspective from a professor, and a case study example. The webinar aims to understand deteriorating conditions and what to do if they occur. It also discusses a track-and-trigger early warning system called HEWS (Hamilton Early Warning Score) that monitors vital signs and triggers escalating care. Lessons learned from implementing HEWS include recognizing high-risk patients earlier and reducing critical events. The webinar discusses challenges and resources for improving partnership with families in patient safety.
Patient & Family Advisory Councils: the Business Case for Starting a PFAC & P...EngagingPatients
This webinar was presented on March 12, 2015 by Barbara Lewis. It looks at the prevalence and roles that Patient & Family Advisory Councils (PFACs) are playing in U.S. hospitals today, and builds a business case for their implementation:
1) Getting research into practice is challenging due to barriers like information overload, specialty silos, and increasing patient safety issues.
2) Tools that can help include surveys, knowledge management strategies, and establishing an information team.
3) Key success factors include dedicating resources, ensuring relevance, and fostering collaboration between stakeholders.
4) Implementing research takes time and a multifaceted approach, as changing clinical behavior is complex.
PFCC Methodology and Practice: Deliver Ideal Care Experiences and Outcomes…By...EngagingPatients
The document describes the Patient and Family Centered Care (PFCC) methodology used at UPMC, a large integrated health system. The six-step PFCC methodology involves: 1) defining the care experience, 2) forming a guiding council, 3) observing the current state through shadowing, 4) identifying touchpoints through a working group, 5) creating a shared vision for an ideal experience, and 6) implementing improvement projects. The methodology aims to improve outcomes and experiences by engaging patients and families in co-designing care and breaking down silos between care providers. Examples of successful PFCC projects that improved discharge processes and communication through bedside rounding are provided.
Digital engagement of discharged ED patients through asynchronous surveys is important for several reasons:
1) Contacting patients after discharge through digital means rather than phone calls improves patient safety and satisfaction while reducing costs. Automating the process allows clinicians to efficiently address patient wellbeing issues.
2) Surveys that check on patient status and experience provide opportunities to identify care gaps, prevent return visits, and improve care quality over time based on patient feedback.
3) Hospitals are increasingly focused on patient experience metrics that link to value-based reimbursement and consumer loyalty. Digital surveys can enhance hospitals' understanding of the patient perspective in a low-cost, consistent manner.
This document summarizes a webinar for selecting topics for a national ICU collaborative initiative in 2016-17. It discusses the results of a survey where pain, agitation, and delirium (PAD) and end-of-life care were the top choices. Potential Topic 1 provides an overview of how end-of-life care could be improved across the ICU continuum. Potential Topic 2 reviews evidence that consistent pain assessment and management paired with sedation protocols can reduce length of stay and complications. The webinar participants then decided to focus on improving PAD management in 2016-17.
Iu Ahrq Hai Assessment Ctr Presentation Feb 22 2010 FinalBrad Doebbeling
75. Healthcare Associated Infections: Assessment Center Findings , Invited Talk, NCQIP, Agency for Healthcare Research and Quality, Bethesda, MD, February 22, 2010.
The third interactive webinar in the series builds on the second session by focusing on the question: once we have evidence to justify implementing a new patient safety initiative, what next?
The fifth webinar continues the momentum of the series as it focuses on providing concrete approaches for identifying barriers and enablers, emphasising behaviour change approaches.
READ MORE: http://bit.ly/2LOwbj0
This document discusses factors to consider when developing and implementing clinical protocols for older adult patients. It outlines a 4-step process: 1) recognizing areas for improvement, 2) selecting evidence-based protocols, 3) implementing protocols through strategies like education and hardwiring into documentation, and 4) measuring performance through reliable tools. Interprofessional collaboration and support from administrators are also emphasized as key to successful protocol adoption.
This document discusses factors to consider when developing and implementing clinical protocols for older adult patients. It outlines a 4-step process: 1) recognizing areas for improvement, 2) selecting evidence-based protocols, 3) implementing protocols through strategies like education and hardwiring into documentation, and 4) measuring performance through reliable tools. Interprofessional collaboration and support from administrators are also emphasized as key to successful protocol adoption.
Achieving behaviour change for patient safety, Judith Dyson, Lecturer, Mental Health - University of Hull
Presentation from the Patient Safety Collaborative launch event held in London on 14 October 2014
More information at http://www.nhsiq.nhs.uk/improvement-programmes/patient-safety/patient-safety-collaboratives.aspx
This document summarizes a presentation on using multicriteria decision analysis (MCDA) to address ethical dilemmas in healthcare decision making. It discusses how MCDA could support a natural decision process that integrates evidence and values. Specifically, it proposes that MCDA could provide a framework to structure criteria based on the common goal of health and its underlying ethical aspects, allow for interpretation of distinct concepts like effectiveness and costs, and support qualitative reasoning and judgment in decision making. The EVIDEM collaboration aims to develop an open source MCDA framework based on these principles to help make fair and legitimate healthcare decisions.
This document provides an overview of implementation research. It defines implementation research as using strategies to introduce or change evidence-based health interventions in real world contexts. Implementation research is a multidisciplinary field that seeks to understand and close the gap between evidence and practice. The document discusses conceptual frameworks, methods, outcomes and evidence used in implementation research. It describes both qualitative and quantitative research designs that can be used, including descriptive, analytic, experimental and mixed methods approaches.
Ovretveit implementation science research course 1day sept 11john
1. The document discusses a workshop on implementation science and research, which aims to explain what implementation science is, describe elements of an implementation program, explain strengths and limitations of implementation research studies, and plan an implementation study.
2. Implementation research mostly describes, evaluates and explains an implementation in different real-life settings. It involves assessing elements like content, structure, strategy, and methods using tools like CESSiM and REAIM.
3. Effective implementation is important for improving health outcomes and depends more on how interventions are implemented than just the intervention itself. Factors like context affect implementation success.
This document outlines the process of clinical audit, which involves comparing aspects of patient care against explicit criteria to improve outcomes. It discusses establishing structure, measuring processes, and evaluating outcomes. The document also describes the audit cycle of preparing, selecting criteria, measuring performance, making improvements, and sustaining them over time. Clinical audit is presented as a way for healthcare professionals and organizations to critically examine practices and ensure patients receive optimal care.
An Introduction to Implementation Research_Emily Peca_4.22.13CORE Group
There are often challenges in ensuring all relevant stakeholders are meaningfully engaged throughout the implementation research process. Effective partnerships require ongoing communication and finding the right roles for all parties.
1. Rate yourself according to your confidence level performing theSantosConleyha
1. Rate yourself according to your confidence level performing the skills identified in the Clinical Skills Self-Assessment Form.
2. Based on your ratings, summarize your strengths and opportunities for improvement.
3. Based on your self-assessment and theory of nursing practice, develop four (4) measurable goals and objectives for a practicum experience.
4. Include them on the designated area of the form.
Self-Assessment Form
Desired Clinical Skills for Students to Achieve
Confident (Can complete independently)
Mostly confident (Can complete with supervision)
Beginning (Have performed with supervision or needs supervision to feel confident)
New (Have never performed or does not apply)
Comprehensive psychiatric evaluation skills in:
Recognizing clinical signs and symptoms of psychiatric illness across the lifespan
X
Differentiating between pathophysiological and psychopathological conditions
X
Performing and interpreting a comprehensive and/or interval history and physical examination (including laboratory and diagnostic studies)
X
Performing and interpreting a mental status examination
X
Performing and interpreting a psychosocial assessment and family psychiatric history
X
Performing and interpreting a functional assessment (activities of daily living, occupational, social, leisure, educational).
X
Diagnostic reasoning skill in:
Developing and prioritizing a differential diagnoses list
X
Formulating diagnoses according to DSM 5 based on assessment data
X
Differentiating between normal/abnormal age-related physiological and psychological symptoms/changes
X
Pharmacotherapeutic skills in:
Selecting appropriate evidence based clinical practice guidelines for medication plan (e.g., risk/benefit, patient preference, developmental considerations, financial, the process of informed consent, symptom management)
X
Evaluating patient response and modify plan as necessary
X
Documenting (e.g., adverse reaction, the patient response, changes to the plan of care)
X
Psychotherapeutic Treatment Planning:
Recognizes concepts of therapeutic modalities across the lifespan
X
Selecting appropriate evidence based clinical practice guidelines for psychotherapeutic plan (e.g., risk/benefit, patient preference, developmental considerations, financial, the process of informed consent, symptom management, modality appropriate for situation)
X
Applies age appropriate psychotherapeutic counseling techniques with individuals and/or any caregivers
X
Develop an age appropriate individualized plan of care
X
Provide psychoeducation to individuals and/or any caregivers
X
Promote health and disease prevention techniques
X
Self-assessment skill:
Develop SMART goals for practicum experiences
X
Evaluating outcomes of practicum goals and modify plan as necessary
X
Documenting and reflecting on learning experiences
X
Professional skills:
Maintains professional boundaries and thera ...
1. Rate yourself according to your confidence level performing theAbbyWhyte974
1. Rate yourself according to your confidence level performing the skills identified in the Clinical Skills Self-Assessment Form.
2. Based on your ratings, summarize your strengths and opportunities for improvement.
3. Based on your self-assessment and theory of nursing practice, develop four (4) measurable goals and objectives for a practicum experience.
4. Include them on the designated area of the form.
Self-Assessment Form
Desired Clinical Skills for Students to Achieve
Confident (Can complete independently)
Mostly confident (Can complete with supervision)
Beginning (Have performed with supervision or needs supervision to feel confident)
New (Have never performed or does not apply)
Comprehensive psychiatric evaluation skills in:
Recognizing clinical signs and symptoms of psychiatric illness across the lifespan
X
Differentiating between pathophysiological and psychopathological conditions
X
Performing and interpreting a comprehensive and/or interval history and physical examination (including laboratory and diagnostic studies)
X
Performing and interpreting a mental status examination
X
Performing and interpreting a psychosocial assessment and family psychiatric history
X
Performing and interpreting a functional assessment (activities of daily living, occupational, social, leisure, educational).
X
Diagnostic reasoning skill in:
Developing and prioritizing a differential diagnoses list
X
Formulating diagnoses according to DSM 5 based on assessment data
X
Differentiating between normal/abnormal age-related physiological and psychological symptoms/changes
X
Pharmacotherapeutic skills in:
Selecting appropriate evidence based clinical practice guidelines for medication plan (e.g., risk/benefit, patient preference, developmental considerations, financial, the process of informed consent, symptom management)
X
Evaluating patient response and modify plan as necessary
X
Documenting (e.g., adverse reaction, the patient response, changes to the plan of care)
X
Psychotherapeutic Treatment Planning:
Recognizes concepts of therapeutic modalities across the lifespan
X
Selecting appropriate evidence based clinical practice guidelines for psychotherapeutic plan (e.g., risk/benefit, patient preference, developmental considerations, financial, the process of informed consent, symptom management, modality appropriate for situation)
X
Applies age appropriate psychotherapeutic counseling techniques with individuals and/or any caregivers
X
Develop an age appropriate individualized plan of care
X
Provide psychoeducation to individuals and/or any caregivers
X
Promote health and disease prevention techniques
X
Self-assessment skill:
Develop SMART goals for practicum experiences
X
Evaluating outcomes of practicum goals and modify plan as necessary
X
Documenting and reflecting on learning experiences
X
Professional skills:
Maintains professional boundaries and thera ...
Strategy, Policy and Change Workshop May 2014 Brett Gardiner
This document discusses strategies to improve hand hygiene compliance among doctors. It begins by establishing that hand hygiene and hospital-acquired infections are important issues. Goals for improving doctor hand hygiene rates are discussed, including making the goal specific, measurable, achievable, realistic and time-bound. Kotter's 8-step model for change management is covered. The document emphasizes that change requires leadership and influencing behavior. A variety of strategies are proposed, including education, establishing champions, displaying compliance rates, and using sensors or undercover observers.
My Health Record & change management webinar katrina otto 230616Katrina Otto
The document discusses change management strategies for implementing digital health records like My Health Record. It provides tips for leading change in a healthcare practice, finding motivators for staff, preparing for the future of digital health, and learning lessons from other implementations. The presentation aims to help practices successfully adopt digital health technologies and improve data quality through change management.
Understanding Why, When, and What it Will Take to do Operations and/or Implem...CORE Group
Here are some issues with the objectives and research questions:
- The objectives are not specific enough and focus more on methods rather than the purpose of the research.
- The questions make assumptions that community beliefs are "wrong" rather than trying to understand perspectives.
- Questions 1.1 and 1.2 for the formative research objective are too leading and specific rather than open-ended to understand barriers.
- Objective 2 aims to "prove" effectiveness rather than objectively measure impact, and the questions only measure outcomes rather than factors influencing them.
The objectives and questions should be more open-ended, focus on understanding rather than proving assumptions, and aim to inform program improvement rather than prove effectiveness.
This document discusses quality and safety issues in primary care. It notes that 30-50% of complaints relate to safety, and 3-11% of GP prescriptions contain errors. Risk areas for patient safety include prescription errors, drug monitoring, communication, delayed or missed diagnoses, and results management. Ensuring quality and safety is a responsibility for all NHS staff. Tools like the Plan-Do-Study-Act cycle, safety walkarounds, and trigger tools can help proactively identify risks to improve safety. A systems approach is needed to address errors by examining multiple contributing factors rather than blaming individuals.
Evaluating the impact of HTA and ‘better decision-making’ on health outcomescheweb1
This document outlines a conceptual framework for assessing the impact of health technology assessments (HTA). It begins by discussing what is already known about evaluating HTA, including the limited literature on long-term effects and barriers to implementation. The document then presents two case studies and proposes a theory-driven, realist approach to impact assessment using configurations of context, mechanism, and outcomes. Interviews and primary data collection are suggested to test an initial program theory regarding how and why HTA influences policy and practice. The goal is to produce guidance on effective implementation by understanding what works, for whom, and in what contexts.
Implementation Strategies & Outcomes: Advancing the ScienceHopkinsCFAR
This document discusses implementation science and strategies to advance the field. It begins with definitions of implementation and dissemination research. The document then discusses quality gaps in mental healthcare that implementation research aims to address. It reviews evidence-based interventions and conceptual models for measuring implementation outcomes. The rest of the document outlines theories that guide implementation strategies and provides a compilation of 68 strategies grouped into key processes like plan, educate, finance, restructure, quality management, and policy. It concludes by noting that passive dissemination is ineffective, while training is one of the most commonly used strategies.
This interactive webinar is part of the world tour series designed by the World Health Organization's Patients for Patient Safety (PFPS) Global Network and hosted by Patients for Patient Safety Canada, the patient-led program of the Canadian Patient Safety Institute, a WHO Collaborating Centre on Patient Safety and Patient Engagement.
The goal of this virtual discussion is to explore practical solutions for keeping seniors safe. The ideas are drawn from real life experiences noting how COVID-19 impacted seniors, their loved ones as well as healthcare workers and leaders.
The focus of the discussion is on identifying safety risks together with practical solutions for seniors who live at home, in residences and long-term care facilities.
After hearing the perspectives of patients, providers and leaders from Indigenous communities on how they perceive safety and what solutions are/ can be implemented, we will leave the session with at least one practical idea for engaging all patients, families and/or the public in improving patient safety.
Healthcare providers and leaders will address three types of silences in healthcare: organizational silence, patient-related silence, and provider to provider silence.
Read More: www.conquersilence.ca
This document discusses teamwork in healthcare and its importance for patient safety. It describes how teamwork skills are often taught through simulations but clinical experience is limited for undergraduates. The intervention described uses a film about a patient falling through the cracks followed by workshops using scenarios to practice and debrief teamwork skills. Key concepts emphasized include shared understanding of goals and plans, involving patients as part of the team, and skills like adaptation, trust, and psychological safety. The overall goal is to apply teamwork knowledge to improve patient outcomes and safety.
Enhanced Recovery After Surgery (ERAS®) is the Enhanced Recovery After Surgery (ERAS®) is the implementation of patient-focused, standardized, evidencefocused, standardized, evidencefocused, standardized, evidencefocused, standardized, evidencefocused, standardized, evidencefocused, standardized, evidence-based, interdisciplinary perioperative guidelines.
Learn more about Enhanced Recovery Canada:
http://ow.ly/hR3j30jsnjR
Dr. Dee Mangin, Professor of Family Medicine and the Associate Chair and Director, Research, at McMaster University, will join practicing pharmacist, and Vice President, Pharmacy Affairs, Sandra Hanna of the Neighbourhood Pharmacy Association of Canada to discuss medication risks, deprescribing and the dangers of polypharmacy in this one hour webinar. Learn more at www.asklistentalk.ca
Joshua Myers, Terry Brock - Fraser Health (BC) - We Want to Hear from You: Fraser Health Real-Time Experience Survey
Leading organizations in Canada invite, listen and act on feedback from patients in their care to improve the safety and quality of care. Explore the three award-winning practices linked below then join us in a conversation to learn more about each approach and reflect on how you may apply it in your organization. This webinar promises practical ideas to help you engage patients in making care safer.
Leading organizations in Canada invite, listen and act on feedback from patients in their care to improve the safety and quality of care. Explore the three award-winning practices linked below then join us in a conversation to learn more about each approach and reflect on how you may apply it in your organization. This webinar promises practical ideas to help you engage patients in making care safer.
Cathy Masuda, Leslie Louie - BC Children's Hospital, an Agency of the Provincial Health Services Authority -Patient's View: Engaging Patients and Families in Patient Safety Incident Reporting
Leading organizations in Canada invite, listen and act on feedback from patients in their care to improve the safety and quality of care. Explore the three award-winning practices linked below then join us in a conversation to learn more about each approach and reflect on how you may apply it in your organization. This webinar promises practical ideas to help you engage patients in making care safer.
Alberta Health Services: Family Volunteers or Advisors Gathering Real-time Patient Experiences
Leading organizations in Canada invite, listen and act on feedback from patients in their care to improve the safety and quality of care. Explore the three award-winning practices linked below then join us in a conversation to learn more about each approach and reflect on how you may apply it in your organization. This webinar promises practical ideas to help you engage patients in making care safer.
Please join CPSI as we conclude our Human Factors webinar series with our final presentation Collaborative "Spaces" and Health Information Technology Design
Professor Benedetta Allegranzi,World Health Organisation
Dr. Benedetta Allegranzi is a specialist in infectious diseases, tropical medicine, infection prevention and control and hospital epidemiology. She currently works at the World Health Organization HQ (Service Delivery and Safety department), leading the "Clean Care is Safer Care" programme. Since 2013, Dr Allegranzi has gathered the title of professor of infectious diseases in the official Italian professorship list and is adjunct professor attached to the Institute of Global Health at the Faculty of Medicine, University of Geneva, Switzerland. She closely collaborates with the team at the IPC and WHO Collaborating Center on Patient Safety, University of Geneva Hospitals (Geneva, Switzerland), as well as with the Armstrong Institute for Patient Safety and Quality, John Hopkins University, (Baltimore, USA) for clinical research projects. She is currently involved in the leadership on the WHO Ebola Response in the field of IPC and supervises IPC activities in Sierra Leone and Guinea. She has experience in clinical management of infectious diseases and tropical medicine, and clinical research in healthcare settings in both developing and developed countries. She has thorough skills and experience in training and education.
She is also the author or coauthor of more than 150 scientific publications, including articles published in high-profile medical journal such as the Lancet, Lancet Infectious Diseases, New England Journal of Medicine and the WHO Bulletin, and six book chapters.
Lori Moore joined GOJO Industries in 2013 as a Clinical Application Specialist. In this position, she provided leadership and support to healthcare organizations as they implemented electronic compliance monitoring (ECM) to more accurately measure hand hygiene performance. She has been a trusted partner to hospital key stakeholders in the development, design and implementation of hand hygiene improvement efforts. Areas of expertise include root cause analysis with targeted solutions, just-in-time coaching and ECM software data analytics. In January 2017, she transitioned to the position of Clinical Educator for Healthcare.
She began her professional career in healthcare in 2010 as a registered nurse in the medical intensive care unit at the Cleveland Clinic Foundation (where she continues to work on the weekends). Her passion for patient safety and quality of care sparked her interest in infection prevention, and she worked as an infection preventionist prior to joining GOJO.
Lori has a well-rounded academic background which includes a Bachelor’s of Arts in Management from Malone College, a Bachelor’s of Science in Nursing from the University of Akron, and a Master’s degree in Public Health from the University of Akron. She is a member of the Association for Professionals in Infection Control and Epidemiology, American Society of Professionals in Patient Safety, and the American Medical Writers Association. She has also earned the credential of Certified Health Education Specialist (CHES) and Certified Professional in Patient Safety (CPPS).
This second interactive webinar in the series will draw upon Dr. Ian Graham's Knowledge to Action cycle and focus specifically on the central role of developing and synthesising evidence of what to implement and which knowledge translation and implementation strategies are most effective for promoting implementation, and developing the knowledge infrastructure to make best use of evidence.
With the introduction of new technologies, there are opportunities to introduce new types of medical errors (i.e. technology-induced errors). Technology-induced errors arise from interactions between citizens, patients and health professionals and the technologies they use to provide health information and health care (Borycki & Kushniruk, 2008).
Evidence demonstrates that communication is one of the leading contributors to adverse events. Transitions of care epitomize this challenge.
WATCH ON DEMAND: https://goo.gl/M1ovsS
Unsafe medication is a leading cause of harm, most of it preventable, in health care systems across the world. Medication incidents occur when weak medication systems and/or human factors such as fatigue, poor environmental conditions or staff shortages affect prescribing, transcribing, dispensing, administration and monitoring practices, which can then result in severe harm, disability and even death.
Full Details: https://goo.gl/gCQ64V
Healthcare information technology (IT) procurement is critical for healthcare organizations, as procurement decisions on medical devices and IT infrastructure will impact safety, efficiency, staff and patient experiences – impact that could last decades.
Full details: https://goo.gl/HgtYHQ
Etiologies of Bipolar disorders. Power Point Presentation ptxseri bangash
www.seribangash.com
Bipolar disorder, formerly known as manic-depressive illness, is a complex psychiatric condition characterized by extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). The etiology of bipolar disorder involves a combination of genetic, biological, and environmental factors. Here's a breakdown of these etiologies:
Genetic Factors:
Family History: Bipolar disorder tends to run in families, suggesting a genetic component. Studies indicate that having a close relative with bipolar disorder increases the risk.
Genetic Studies: Research has identified specific genetic variations associated with bipolar disorder. These include genes involved in neurotransmitter signaling, ion channel function, and circadian rhythms.
Neurobiological Factors:
Neurotransmitter Imbalance: Imbalances in neurotransmitters such as dopamine, serotonin, and norepinephrine are implicated in bipolar disorder. For example, elevated dopamine levels during manic episodes and decreased levels during depressive episodes.
Neuroendocrine Factors: Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and abnormal cortisol levels have been observed in individuals with bipolar disorder.
Neuroanatomical Factors:
Brain Structure and Function: Structural and functional abnormalities in certain brain regions are linked to bipolar disorder. These include the prefrontal cortex, amygdala, and hippocampus, which are involved in emotional regulation and cognition.
Environmental Factors:
Stress: Stressful life events, such as trauma, loss, or significant life changes, can trigger or exacerbate episodes of bipolar disorder.
Substance Abuse: Substance use, particularly stimulants or drugs that affect neurotransmitter systems, can precipitate manic episodes or worsen the course of the disorder.
Developmental Factors:
Early Life Experiences: Adverse childhood experiences, including abuse, neglect, or chronic stress, may increase susceptibility to developing bipolar disorder later in life.
Trajectories: Some individuals may have a prodromal phase marked by subthreshold symptoms or other behavioral indicators before full-blown episodes manifest.
30 – Hours Yogic Sukshma Vyayama Teacher Training Course
What is Sukshma Yoga?
Dhirendra Brahmachari formulated this system and wrote books to clearly formulate the ancient yogic science. This practice simple yet powerful series of specific exercises that improve health and enhance the strength of different organs and systems in the body, from top of head to toes.
Suksma means subtle prana, mind, and intellect: Vyayama means exercise. Suksma Vyayama is meant for the Subtle Body (Suksma Sarira), it is not meant for the Sthula Sarira (Gross Physical Body).
Need of Suksma Vyayama
In yoga, it is said that most pranic blockages start in our joints. Ayurveda says that ‘ama’ or the toxic and undigested waste material tends to settle in the empty spaces of our body, the joints. To remove these impurities we practice Suksma Vyayama, to release any such impurities in our subtle pranic body.
Three dimension of suksma Vyayama:
1.Breathing (slow or fast: Bhastrika/Bellows)
2.Point of concentration (mental concentration on Chakras)
3.Exercise (using Bandhas and Mudras)
Sukshma yoga purifies and recharges the body, mind, energy, and emotion. It prepares the well foundation for further means of Yoga practice. It includes Sukshma Vyayama (Subtle Exercise), and Vishram (Rest & Relaxation). It is itself complete package that fulfills the basic need of human being.
Sukshma Vyayama is one of the major parts for physical activity and the regulation of entire physiologies. Sukshma Vyayama is also known as a kind of warm up exercise or basic exercise or clinically anti-rheumatic group of exercise and also called body scan. The system of the physical and breathing exercise which help to sequentially work out all joints of a body, to warm it up. This system has a strong purifying effect on energy body of a human.
1.1. History of Sukshma Vyayama
We will observe visible Parampara of Sukshma Vyayama. Literal meaning of Parampara is the continuous chain of succession by Master to followers. In Parampara system, the knowledge is passed on without changes from generation to generation). Unfortunately because of the absence of enough information we are not able to find sources of this tradition.
System of Sukshma Vyayama knowledge which was unknown in the west before that was extended by one of outstanding yoga masters, Dhirendra Brahmachari (1925-1994). He received Initiation into Sukshma Vyayama techniques from Maharshi Kartikeya, the prophet and sacred great yogi who was his Master. In the preface to the book “Yogic Sukshma Vyayama” Dhirendra Brahmachari wrote about his precious Guru. Deep knowledge made him the unique expert of human characters, of their abilities and possibilities. From Maharshi Kartikeya, Dhirendra Brahmachari received a precept to spread knowledge about Sukshma Vyayama. The invaluable merit of Dhirendra Brahmachari is that he managed to accumulate knowledge in the convenient form, to make it open and understandable for the audience everywhere. The b
BLOOD DONATION ppt For medical students..pptxdarshitam0310
Mention safety measures and potential side effects. Provide tips on how to prepare for donations such as staying hydrated and eating well.This concise format covers the essential aspects of blood donation.
Revolutionize Pain Management with Almagia’s PEMF Devices Shop Now.pptxALMAGIA INTERNATIONAL
In this blog, we will dig into some scientific studies that highlight the effectiveness of Almagia’s PEMF devices for sale and how they have transformed the landscape of pain management.
Online Live Personal Yoga Training at Home
Home Yoga
Change is Possible!
I am ready to help you, to improve your health, reduce stress and moving towards perfect peace, happiness and joy!
Show you the difference between intentional self-care and unintentional numbing out, so that you can be fully awake for all of your life
Restore your natural physical alignment, because it is critical to your health and well-being
Help you develop a practice of intentional surrender because it brings relief from stress and will improve every aspect of your life
Show you how to take care of yourself because that is the first step toward the connection you are craving with others
Restore your mind-body connection, because decision-making is so much easier when you can hear your own intuition
Home yoga course contents
The private yoga lesson consists of Power Yoga, Dynamic Yoga, Yoga Therapy for different ailments, Yoga for stress management, yoga posture (asana), yogic breathing (pranayama), guided meditation and relaxation. Sometimes the cleansing practices like Vamana Dhouti (vomiting), Jala & Sutra Neti (nasal cleaning), Laghu Sankhaprakshalana (intestine cleansing), vyutkarma & sheetkarma kapalabhati (nasal cleansing), Trataka (eye cleansing) and MSRT (immune system enhancement) are also included depending on the requirement of the participant
If you are looking for a secluded, silent, one-on-one yoga practice with personal care and attention and without any outside disturbances, private yoga lessons are perfect for you. In private yoga lessons, you save your time and energy from traveling to a distance yoga studio and practice yoga from the comfort of your home in a personal ambiance. In private yoga lessons, you learn properly with one-on-one attention from the yoga trainer. The yoga trainer also gets enough time to understand your requirements and customizes the yoga practices accordingly for your maximum health benefit.
If you are suffering from any specific health problems, private yoga lessons are ideal for you. Yoga therapy practices cannot be done in a group, it has to be done always one-on-one basis. Because your problem is different from others. In a group yoga class, the yoga practices are not addressed according to your body conditions & requirements, some of the practices in the group might be harmful to you. Moreover, if the group yoga trainer is not a qualified yoga therapist but only a yoga instructor, he may not know the yoga practices that are useful and harmful to you. Therefore, if you are suffering from any specific health conditions, you require private yoga lessons with one-on-one attention from an experienced yoga therapist for your recovery.
How many people can join in private yoga lessons?
We allow one or, maximum of two people at a time in a private yoga lesson.
Private yoga course contents
The private yoga lesson consists of Power Yoga, Dynamic Yoga, Yoga Therapy for different ailments, Yoga for stress management, yoga post
Holistic nursing Primacy of nature in the healing process.pptxraima10
HOLISTIC NURSING
Holistic nursing is a way of treating and taking care the patient as a whole body which involves physical, social environment, psychological, cultural and religious beliefs.
Yoga Nidra Retreat in Bangalore
Yoga Nidra Retreat in Bangalore
A restful night is key to a healthy lifestyle. The reason behind many health issues that most people have from the modern way of living is nothing but lack of proper sleep. Well, it’s not like they don’t want to sleep, lack of time, an after-effect of day-long stress, and long-term anxiety trigger sleeplessness and thus respective disorders as well.
As per the recent survey, the insomnia percentage in India is above 33%, and the people who are most likely to be impacted with sleep deprivation hover around 52%. These numbers are higher compared to other countries.
Are you one of those populations suffering from sleeplessness and health issues due to lack of proper sleep? If Yes, then you must know that Yoga is the only way to get out of your situation to ensure restful nights after daylong stress and busy working schedules throughout the week.
Besides, even scientific studies prove that frequent consumption of stress-relieving, depression, or sleeping pills is not at all good for health and the brain. In such a scenario, Yoga is the only effective and probably most reliable way to get your sleep on track. Karuna Yoga Vidya Peetham will be on your side as a reliable Weekend Yoga Nidra Retreat in Bangalore.
Yoga Nidra aims at activating the relaxation response and improving the nervous and endocrine system functioning to ensure peaceful nights and active working hours.
Benefits:
An emphasis on some of the more Eastern practices (like yoga nidra, including pranayama, kriyas, mantras).
A peaceful location – the perfect setting for a Yoga Nidra Retreat.
Deepen your yoga practice and take it to the next level.
Retreat Curriculum Details
Practice Relaxation & Preparation for Yogic Sleep
Introduction to the concept and practices of relaxation
Relaxation in daily life
Sequence of relaxation practices
Tension & relaxation exercises
Systematic relaxation exercises
Preparations for Yoga Nidra
Mantra chanting
Introduction to mantra science
Morning prayers & Evening prayers
Surya-namaskar 12 mantras along with bija mantras
Pranayama Practices
Establishment of diaphragmatic breath
Different practices of pranayama
Yoga Nidra philosophy, Lifestyle, & Yoga Ethics
What is Yoga Nidra?
Philosophy of Yoga Nidra
Yoga Ethics
What Makes This Retreat Special
The practice of Yoga Nidra has been secret and imparted to those few yogis who have mastered their sleep. In Indian Mythology, there occurs a unique concept of sleep. We often find even the trinity of the universe Lord Brahma, Vishnu, and Shiva under the domination of sleep.
The course will explore the concept of Yoga Nidra details at theoretical and practical levels. This is designed to assist students of yoga to understand and experience the deeper layers of their personalities.
Type: Yoga Nidra Retreat
Date: 11th Sep 2021
Duration: 2 days
Location: Bangalore outskirt, India.
Food: Vegetarian
Accommodation
Shared Dormitory
Room
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Yoga for Hypertension and Heart Diseases
Yoga Hypertension and Heart Diseases Certificate Course
Prevention and healing have been always the main purpose of yoga therapy practice. Yoga therapy is the process of empowering every individual to progress toward better health and optimal well-being through the application of the teachings and practices of Yoga therapy class. With the support of the Yoga trainer, implements a personalized and evolving Yoga therapy techniques that not only addresses the illness in a multi-dimensional manner, Pancha Kosa (Five Sheaths): Annamaya Kosha (Physical Body), Pranamaya Kosha (Energy Field), Manomaya Kosha (Mental Dimension), Vignanamaya Kosha (Psychic level of experience), Anandamaya Kosha (Bliss and Beatitude). It helps to reduce patient suffering in a progressive, non-invasive and complementary manner.
Why to study yoga Hypertension and Heart Diseases course?
Consequently, the demand for yoga therapist with specialized knowledge in yoga as a therapeutic tool, in different fields such as: health management organizations, hospitals and alcohol rehabilitation centers have grown rapidly. Studying yoga therapy as a tool to overcome and ease the symptoms of common illnesses has become extremely popular recently, due to the great therapeutic effects yoga practitioners experience in their body, mind and soul.
What you will learn from this course?
You may offer special seminars for people with similar diseases/conditions.
You will learn how to use yoga to assist in healing ailments and managing conditions?
You aim to be part of a positive change regarding health and lifestyle habits.
You want to teach people how to prevent diseases.
In group classes, you can teach your students how to become healthy.
You will feel more self-confident when approached by students that come to yoga seeking for support in their healing process.
Therapeutic applications of posture, movement and breathing.
Pre-Requisites:
This course is open to all students who wish to deepen their knowledge and application of some of the highest teachings of
Participants do not need to be yoga
Mastery of any yoga practice is not
Only yours sincere desire for knowledge and your commitment to personal
Love for Yoga is the most important eligibility factor for learning this course.
Students who want to know Yoga in totality and move beyond Asana and Pranayama, Mudra & Bandha.
Assessment and Certification
The students are continuously assessed throughout the course at all levels. There will be a written exam at the end of the course to evaluate the understanding of the philosophy of Yoga and skills of the students. Participants should pass all different aspects of the course to be eligible for the course diploma.
What do I need for the online course?
Yoga mat
Computer / Smartphone with camera
Internet connection
Yoga Blocks
Pillow or Bolster or Cushion
Strap
Notebook and Pen
Zoom
Recommended Texts
Asana Pranayama Mudra Bandha by Swami
Attitude and Readiness towards Artificial Intelligence and its Utilisation: A...ShravBanerjee
AI is a hot topic in recent days... We students of IPGME&R, Kolkata, India have done a study on Attitude, Readiness and Utilization of AI by medical students.
Artificial Intelligence (AI): The theory and development of computer systems able to perform tasks normally requiring human intelligence, such as visual perception, speech recognition, decision-making, and translation between languages.
Our study showed that:
1. Nearly half of the study participants showed a favorable attitude towards role of AI in healthcare
2. Around three-fifth of the participants could define basic concepts of data sciences and AI and were ready to choose AI based applications for healthcare; they were willing to accept AI usage despite feeling a lack of cognitive skills
3. Most of them used AI-based applications for studying (ChatGPT), however, some of them faced difficulties in using them
Thank you!
"NeuroActiv6: Revitalize Your Mind with Youthful Energy and Clarity"Ajay Agnihotri
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NeuroActiv6 works by providing your brain with the essential nutrients it needs to function at its best. The combination of these powerful ingredients helps reduce brain fog, improve focus and concentration, and increase energy levels. By supporting brain health and enhancing cognitive function, NeuroActiv6 allows you to tackle your day with renewed vigor and mental clarity.
This presentation tells about health education for hand wash to children. Every child should know that how to keep hand clean. And maintain the good hand washing practices. Nowadays disease are easily spread through uncleaned hands.germs are habitat in their hands and then it causes different types of diseases.so, we must give the health education for hand washing to every children. And make them practice.
5 Must-Have’s in ePCR Software for a More PROFITABLE and EFFICIENT EMS, NEM...Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS & NEMT organization, not just certain groups of people or certain departments.
It should benefit EMS crews – making it convenient to enter data and have the tools to increase document accuracy.
It should benefit the back-office by streamlining documentation and billing processes internally and with health facilities.
It should benefit the entire organization by improving workflow efficiency, comply with regulations, reduce costs, and contribute to generating data-driven reports.
To achieve those benefits, ePCR software must have these 5 functions.
5 Must-Have’s in ePCR Software for a More PROFITABLE and EFFICIENT EMS, NEM...
Webinar 6: Selecting strategies and techniques best suited to address barriers measurement and evaluation
1. www.ohri.ca | Affiliated with • Affilié à
CPSI National Webinar Series
Knowledge Translation and Implementation Science Education Series
Webinar 6: Selecting strategies and techniques best suited to
address barriers and enablers
Centre for Implementation Research
Justin Presseau
Scientist, OHRI
Assistant Professor, uOttawa
@JPresseau
jpresseau@ohri.ca
Jeremy Grimshaw
Senior Scientist, OHRI
Full Professor, uOttawa
@GrimshawJeremy
jgrimshaw@ohri.ca
2. Webinar 6 overview
▶ Situating our progress in the webinar series
▶ Tools for selecting strategies
▶ Mapping barriers/enablers to strategies
▶ Tools for reporting intervention descriptions
3. A behavioural perspective to KT and IS
▶ Successful implementation of patient safety programs needs key
actors (patients, healthcare providers, managers and policy makers)
to change their behaviours and/or decisions whilst working in the
complex (ordered chaos) of health care environments
▶ There is a substantial evidence base in behavioural sciences that
can support the development of patient safety programs and
increase the likelihood of success
4. The webinar series – overview
▶ Webinar 1: Introduction to KT and Implementation Science
▶ Webinar 2: Knowledge creation and synthesis
▶ Webinar 3: Who needs to do what, differently, to promote implementation?
▶ Webinar 4: Identifying barriers and enablers, and determinants, in theory
▶ Webinar 5: Identifying barriers and enablers, and determinants, in practice
▶ Webinar 6: Selecting and evaluating strategies to address barriers and
enablers
Aim: build capacity in the basic principles and practice of Knowledge
Translation and Implementation Science to inform your own patient safety
initiatives
5. Situating ourselves in the webinar series
Knowledge to Action
Framework
Graham et al (2006)
Webinar 2: Focus on
the Knowledge
Creation funnel
Knowledge creation
funnel produces:
- Systematic reviews
(e.g. Cochrane)
- Clinical practice
guidelines
- Decision Aids
- Policy briefs
but… producing and
disseminating these
products does not
guarantee change
6. Situating ourselves in the webinar series
Knowledge to Action
Framework
Graham et al (2006)
Webinar 3: Focus on
identifying the
problem
• Identified gaps between
what evidence suggests
and current performance
• Specified: who needs to do
what, differently
• Used TACT-A to specify
each actors’ behaviour
... but selecting and tailoring
interventions depends on
knowing what to tailor on so
that solutions designed are fit
for purpose
7. Knowledge to Action
Framework
Graham et al (2006)
Webinar 4: What helps
and hinders
implementation?
• Theoretical frameworks
provide a strong, replicable
basis for identifying
barriers and enablers to
implementing a patient
safety-related behaviour
• Gives leg-up on factors
to consider
• Prevents “re-inventing
the wheel”
• Helps to generalize
across settings
Situating ourselves in the webinar series
8. Today’s webinar
Knowledge to Action
Framework
Graham et al (2006)
Webinar 5: What helps
and hinders
implementation?
A practical approach
• Result: theory-linked
barriers and enablers that
can then be used to
identify strategies best
suited to address identified
barriers
9. Today’s webinar
Knowledge to Action
Framework
Graham et al (2006)
Webinar 6: Selecting
strategies that are fit-
for-purpose
10. ▶Healthcare-associated infections are one of the top 10 causes
of hospital deaths worldwide
• Affects 10% of all patients in acute-care hospitals
▶Physician hand hygiene compliance is an international
problem
• Average reported compliance rate: 49-57%
▶Reasons for poor compliance not well understood
▶Our case study: assume we want to develop a patient safety
initiative to improve physician hand hygiene
Our Case Study to inform our overview:
Physician hand hygiene
11. Step 1: Who needs to do what, differently?
Whose behaviour need to change, and which behaviours? What is the evidence supporting this?
Step 2: What factors determine whether or not they do it?
What are the barriers and enablers?
Step 3: Which strategies can be effectively used to target
those factors?
Which behaviour change techniques are best suited to specifically target the identified
barriers and enablers
Step 4: How can we robustly measure the outcome?
1
2
3
4
11
(French et al., 2012)
Key Process model: The French Model
12. TACT-A:
Atool for specifying
behaviours Use alcohol-based hand gel
Staff physicians, nurses and residents
Patients receiving care at the hospital
Patient rooms and hallways
Before and after touching a patient
Example 1: a ‘do more’
behavior
Hand hygiene
13. Step 1: Who needs to do what, differently?
Whose behaviour need to change, and which behaviours? What is the evidence supporting this?
Step 2: What factors determine whether or not they do it?
What are the barriers and enablers?
Step 3: Which strategies can be effectively used to target
those factors?
Which behaviour change techniques are best suited to specifically target the identified
barriers and enablers
Step 4: How can we robustly measure the outcome?
1
2
3
4
13
(French et al., 2012)
Key Process model: The French Model
14. Theoretical Domains Framework: barriers and enablers
TDF Domains
Knowledge
Skills
Beliefs about capabilities
Memory, attention & decision processes
Behavioural regulation
Environmental context & resources
Social Influences
Intention
Goals
Social/professional role & identity
Beliefs about consequences
Reinforcement
Emotion
Optimism
“I am (not) aware of hand hygiene
guidelines and have (not) heard of the 4
moments of hand hygiene”
“I am (not) aware of evidence linking hand
hygiene to health care associated
infections”
“Education about hand hygiene ensures
that I practice it consistently”
Squires et al 2014
15. Theoretical Domains Framework: barriers and enablers
TDF Domains
Knowledge
Skills
Beliefs about capabilities
Memory, attention & decision processes
Behavioural regulation
Environmental context & resources
Social Influences
Intention
Goals
Social/professional role & identity
Beliefs about consequences
Reinforcement
Emotion
Optimism
”Hand hygiene is easy to practice”
“I am not confident that I am following hand
hygiene guidelines when practicing hand
hygiene”
Squires et al 2014
16. Theoretical Domains Framework: barriers and enablers
TDF Domains
Knowledge
Skills
Beliefs about capabilities
Memory, attention & decision processes
Behavioural regulation
Environmental context & resources
Social Influences
Intention
Goals
Social/professional role & identity
Beliefs about consequences
Reinforcement
Emotion
Optimism
Observations made while on a Surgery
and Medicine Unit confirmed what was
said in the physician interviews:
• Alcohol dispensers are
sometimes empty
• Alcohol dispensers blend in with
the wall
• Beside alcohol bottle baskets are
empty
Squires et al 2014
17. Theoretical Domains Framework: barriers and enablers
TDF Domains
Knowledge
Skills
Beliefs about capabilities
Memory, attention & decision processes
Behavioural regulation
Environmental context & resources
Social Influences
Intention
Goals
Social/professional role & identity
Beliefs about consequences
Reinforcement
Emotion
Optimism
“Practicing hand hygiene reduces the
transmission of infection”
“While improper hand hygiene can
contribute to infection, it is not the only
factor that can do so”
“Practicing hand hygiene gives patients
confidence in their physician” Squires et al 2014
18. Step 1: Who needs to do what, differently?
Whose behaviour need to change, and which behaviours? What is the evidence supporting this?
Step 2: What factors determine whether or not they do it?
What are the barriers and enablers?
Step 3: Which strategies can be effectively used to target
those factors?
Which behaviour change techniques are best suited to specifically target the identified
barriers and enablers
Step 4: How can we robustly measure the outcome?
1
2
3
4
18
(French et al., 2012)
Key Process model: The French Model
19. Affiliated with • Affilié à
▶Choice of improvement program, should be
based upon:
• ‘Diagnostic’ assessment of barriers
• Understanding of mechanism of action of
interventions
• Empirical evidence about effects of interventions
• Available resources
• Practicalities & logistics
DESIGNING IMPROVEMENT PROGRAMS
20. CHOOSING THE RIGHT INGREDIENTS
▶There is no ‘right’ strategy for all barriers and enablers
▶Faced with specific barriers and enablers identified,
best to select strategies and techniques best suited to
address such barriers
Cooking Analogy
To cook a rack of lamb, any number of possible herbs and spices could be used.
• Some make it delicious (rosemary + thyme)
• Some, not so much
Would we mix as many possible ingredients as we could in hopes more = better?
Probably not.
Implementation Interventions:
select ‘ingredients’ best suited for addressing key barriers
21. Selecting and reporting strategies
Taxonomies
• EPOC taxonomy
• ERIC taxonomy
• BCT taxonomy
• TIDIER checklist
22. Step 1
Who needs to do
what, differently?
Step 2
What factors
determine whether
or not they do it?
Step 3
Which strategies
can be effectively
used to target
those factors?
Step 4
How can we robustly
measure the
outcome?
(French et al., 2012)
Once determinants/barriers identified, which strategies to select?
✓ Principle: no magic bullets
✓ Select strategies that work best for specific
barriers/enablers
✓ Be explicit to ensure clarity and replication
✓ Distinguish ‘what’ you deliver from ‘how’ it is delivered
22
23. DESIGNING IMPROVEMENT PROGRAMS
▶We have found it useful to distinguish:
• What we are trying to change
• Why are we trying to change it? (constructs:
barriers and enablers)
• How are we going to change it, including
- Behaviour change technique
- Method of delivery: eg group meeting, DVD
- Content: how the technique will be
operationalised
24. Describing the content of KT interventions
• Need better description and reporting of KT strategies1
• Need shared language to describe content
1Proctor et al 2013
Often presented at high level of description
• Well recognized in KT literature; helps communication
• Combine content with method of delivery, recipient, and/or deliverer
• Unclear ‘active ingredients’ + mechanisms of action
• Synthesis, replication and optimization = challenging
Van Woerkum (1990)
RURU taxonomy (2003)
ERIC (2015)
Behaviour change wheel (2012)
EPOC taxonomy (2002; 2015)
Many lists of KT strategies
25. Cochrane Effective Practice and Organization of Care (EPOC) taxonomy
Cochrane Effective Practice and Organisation of Care
(EPOC) group undertakes systematic reviews of
interventions to improve health care systems and
health care delivery including:
• Professional interventions (e.g. continuing
medical education, audit and feedback)
• Financial interventions (e.g. professional
incentives)
• Organisational interventions (e.g. the
expanded role of pharmacists)
• Regulatory interventions
26. Cochrane Effective Practice and Organization of Care (EPOC) taxonomy
Healthcare worker-focused
• Audit and Feedback
• Clinical incident reporting
• Monitoring performance of care
delivery
• Communities of practice
• Continuous quality improvement
• Educational games
• Educational materials
• Educational meetings
• Educational outreach visits/
• Clinical practice guidelines
• Inter-professional education
• Local consensus processes
• Local opinion leaders
• Managerial supervision
• Patient-mediated interventions
• Public release of performance data
• Reminders
• Patient-reported outcome
measures
• Tailored interventions
Organization-focused
• Organizational culture
Who provides health care
• Role expansion or task
shifting
• Self-management
• Length of consultation
• Staffing models
• Exit interviews
• Movement of health
workers between public
or private
• Pre-licensure education
• Recruitment and
retention strategies
Coordination of care
• Care pathways
• Case management
• Communication between
providers
• Continuity of care
• Discharge planning
• Disease management
• Integration
• Packages of care
• Patient-initiated appointment
systems
• Procurement
• Referral systems
• Shared care
• Shared decision-making
• Teams
• Transition of care
Information and
communication
technology
• Health information
systems
• Smart home
technologies
• Telemedicine
http://epoc.cochrane.org/epoc-taxonomy
27. Expert Recommendations for Implementing Change (ERIC)
taxonomy
• Recognises the issues of conceptual clarity (or lack
thereof) in describing implementation strategies:
- Idiosyncratic use of terms
- Homonymy (same term with multiple meanings)
- Synonymy (different terms with same meaning)
- Instability (term meaning shift)
• Recognises that other ‘lists’ were never necessarily
intended to be comprehensive or used by a range of
knowledge users and stakeholders
• ERIC involved panel of 71 experts used Delphi study to
refine and define list of implementation strategies
• Produced list of 73 discrete implementation strategies
Powell et al 2015
28. Expert Recommendations for Implementing Change (ERIC) taxonomy
1. Access new funding
2. Alter incentive/allowance structures
3. Alter patient/consumer fees
4. Assess for readiness and identify barriers and
facilitators
5. Audit and provide feedback
6. Build a coalition
7. Capture and share local knowledge
8. Centralize technical assistance
9. Change accreditation or membership requirements
10. Change liability laws
11. Change physical structure and equipment
12. Change record systems
13. Change service sites
14. Conduct cyclical small tests of change
15. Conduct educational meetings
16. Conduct educational outreach visits
17. Conduct local consensus discussions
18. Conduct local needs assessment
19. Conduct ongoing training
20. Create a learning collaborative
21. Create new clinical teams
22. Create or change credentialing and/or licensure
standards
23. Develop a formal implementation blueprint
24. Develop academic partnerships
25. Develop an implementation glossary
26. Develop and implement tools for quality monitoring
27. Develop and organize quality monitoring systems
28. Develop disincentives
29. Develop educational materials
30. Develop resource sharing agreements
31. Distribute educational materials
32. Facilitate relay of clinical data to providers
38. Inform local opinion leaders
39. Intervene with patients/consumers to enhance
uptake and adherence
40. Involve executive boards
41. Involve patients/consumers and family members
42. Make billing easier
43. Make training dynamic
44. Mandate change
45. Model and simulate change
46. Obtain and use patients/consumers and family
feedback
47. Obtain formal commitments
48. Organize clinician implementation team meetings
49. Place innovation on fee for service lists/formularies
50. Prepare patients/consumers to be active participants
51. Promote adaptability
52. Promote network weaving
53. Provide clinical supervision
54. Provide local technical assistance
55. Provide ongoing consultation
56. Purposely reexamine the implementation
57. Recruit, designate, and train for leadership
58. Remind clinicians
59. Revise professional roles
60. Shadow other experts
61. Stage implementation scale up
62. Start a dissemination organization
63. Tailor strategies
64. Use advisory boards and workgroups
65. Use an implementation advisor
66. Use capitated payments
67. Use data experts
68. Use data warehousing techniques
69. Use mass media
Powell et al 2015
29. Using a behaviour change techniques taxonomy
• BCTTv1: 93 techniques within 16 categories focusing on
behaviour change
30. Goals and Planning
Goal setting (behavior) OR Goal setting (outcome)
Problem solving
Action planning
Review behavior goal(s) OR Review outcome goal(s)
Discrepancy between current behavior and goal
Behavioral contract
Commitment
Feedback and monitoring
Monitoring of behaviour by others without feedback
Feedback on behaviour/outcomes of behaviour
Feedback on outcomes of behaviour
Self-monitoring of behaviour
Self-monitoring of outcomes of behaviour
Monitoring of outcome(s) of behaviour without
feedback
Biofeedback
Social Support
Social support (unspecified)
Social support (practical)
Social support (emotional)
Shaping Knowledge
Instruction on how to perform behaviour
Information about Antecedents
Re-attribution
Behavioural experiments
Natural Consequences
Info about health consequences
Info about emotional consequences
Info re social and environment
consequences
Salience of consequences
Monitoring of emotional consequences
Anticipated regret
Comparison of behaviour
Demonstration of the behaviour
Social comparison
Information about others’ approval
Associations
Prompts/cues
Cue signalling reward
Reduce prompts/cues
Remove access to the reward
Remove aversive stimulus
Satiation
Exposure
Associative learning
Repetition and substitution
Behavioural practice/rehearsal
Behaviour substitution
Habit formation
Habit reversal
Overcorrection
Generalisation of target behaviour
Graded tasks
Comparison of outcomes
Credible source
Pros and cons
Comparative imagining of future
outcomes
Reward and threat
Incentive (outcome
Material incentive (behaviour)
Social incentive
Non-specific incentive
Self-incentive
Self-reward
Reward (outcome)
Material reward (behaviour)
Non-specific reward
Social reward
Future punishment
Regulation
Conserving mental resources
Pharmacological support
Reduce negative emotions
Paradoxical instructions
Antecedents
Adding objects to the environment
Restructuring the physical
environment
Restructuring the social environment
Avoidance/reducing exposure to cues
Distraction
Body changes
Identity
Identification of self as role model
Framing/reframing
Incompatible beliefs
Valued self-identify
Identity linked with changed behaviour
Scheduled consequences
Behaviour cost
Punishment
Remove reward
Reward approximation
Rewarding completion
Situation-specific reward
Reward incompatible behaviour
Reward alternative behaviour
Reduce reward frequency
Remove punishment
Self-belief
Verbal persuasion about capability
Mental rehearsal of successful perform
Focus on past success
Self-talk
Covert learning
Imaginary punishment
Imaginary reward
Vicarious consequences
Behaviour change techniques taxonomy v1 (Michie et al 2013)
32. TIDieR items
Brief name
Why
What materials
What procedures
Who provided
How
Where
When and how
much
Tailoring
Modifications
How well (planned)
How well (actual)
TIDieR1: Template for Intervention Description and
Replication checklist and guide
1 Hoffman et al (2014). Better reporting of interventions: template for intervention description and replication (TIDieR)
checklist and guide. BMJ.
• Most intervention descriptions are poor and either
under-report or conflate aspects of the intervention
• To ensure implementation, replication and
advancement, KT interventions must be clearly
described in detail
• International panel of experts produced the 12 item
TIDieR
• Extension of CONSORT 2010 (item 5) and SPIRIT
2013 (item 11)
Consider using TIDieR at the KT intervention
development stage
33. Summary: taxonomies
Taxonomies provide a shared language for describing KT
interventions that may help:
• Promote clarity, which helps fidelity, replication, and optimization
• Design and describe novel interventions (new ideas)
BUT: taxonomy approaches in themselves do not necessarily
clarify how to tailor to specific barriers/enablers
Taxonomies provide a toolkit but no indication of which tool is
best suited for a particular job
35. What do we know from Cochrane reviews?
▶Cochrane Effective Practice and Organization of Care (EPOC)
undertakes systematic reviews to improve healthcare systems
and healthcare delivery
▶Currently 200+ reviews/protocols
• We know quite a bit!
• Many reviews of randomised and cluster randomized trials
http://epoc.cochrane.org/ 35
36. What do we know from Cochrane reviews?
Implementation intervention
strategy
# of
trials
Median improved
performance
Interquartile
range
Automatically-generated reminders
on paper (Arditi 2012)
32 Reminders alone: 11%
Reminders +: 4%
7-20%
3-6%
Printed educational materials
(Giguere 2012)
7 2% 0-11%
On-screen point of care reminders
(Shojania 2009)
28 4% 1-19%
Audit and Feedback (Ivers 2012) 140 4% 1-16%
Meetings and workshops (Forsetlund
2009)
81 6% 2-16%
Educational outreach visits (O’Brien
2007)
69 6% 3-9%
• Small effects at population level may be important
• Wide variability of effect; What explains variability?
• Categories are largely methods of delivery rather than techniques; need to unpack
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• Cochrane 2012 review – 140 trials of audit and
feedback, median absolute improvement +4%,
interquartile range +1% to +16%
• Larger effects were seen if:
- baseline compliance was low.
- the source was a supervisor or colleague
- it was provided more than once
- it was delivered in both verbal and written formats
- it included both explicit targets and an action plan
Ivers (2012) Cochrane Library
EMPIRICAL SUPPORT
38. 38
• Be provided multiple times
• Present feedback as soon as
possible
• Provide individual rather than
general data
• Include clear comparators that
reinforce desired behaviour
change
• Support an action perceived to
be a priority for recipients
• Recommend actions that can
improve and are under control of
the recipient
• Recommend a specific action
• Tailor feedback interventions
based on situation-specific
barriers
• Closely link visual display and
summary message
• Be presented in multiple ways
• Minimize cognitive load
• Address barriers that prevent
use of the feedback
• Provide short, actionable
messages followed by more
detail
• Address credibility of the
information
• Increase motivation to change
practice
• Encourage social construction
of feedback rather than passive
delivery
THEORETICAL
SUPPORT
39. Summary: systematic reviews
• Systematic reviews a good source of
identifying strategies shown to be effective
across settings
• MAY be effective for your intervention… but
depends on whether fit for purpose
(depends on barriers/enablers)
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▶Important TDF domains were prioritized with team input,
and mapped to known effective behaviour change
techniques
▶Intervention focused on five prioritized domains, considering
feasibility in our environment, and acceptability to the
“actors”
• Knowledge; skills; beliefs about consequences; memory,
attention and decision processes; social influences
▶Intervention delivery differed for medicine and surgery
INTERVENTION MAPPING AND DESIGN
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▶Choice of implementation intervention should be based
upon:
• ‘Diagnostic’ assessment of barriers
• Understanding of mechanism of action of interventions
• Empirical evidence about effects of interventions
• Available resources
• Practicalities, logistics etc
▶ Hand hygiene seen as low priority for physicians
▶ Limited contact options - educational sessions unlikely to be attended
INTERVENTION MAPPING AND DESIGN
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1.Initial sensitisation (to: residents)
Intervention content:
• Refresher on 4 moments of hand hygiene
- Domain: knowledge; Technique: instruction on how to perform the behaviour
• Refresher on what is the patient environment
- Domain: knowledge; Technique: information about health consequences
• TOH hand hygiene compliance and infection rates
- Domain: beliefs about consequences, Technique: information about health consequences
- Domain: social influences; Technique: (credible source and information about others’
approval priority for chief resident and hospital))
Proposed delivery for Medicine:
• When: During Resident Orientation -1st day of block
• What: 1-2 slides on hand hygiene to be developed by team and given to Chief Resident
• Who will deliver: Chief Resident at the beginning of the block
INTERVENTION MAPPING AND DESIGN
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2. Re-emphasis (to: residents, attending physicians)
Intervention Content:
• Information about: Infection rates, the 4 moments, the patient environment (exact
content to be developed and will be clinically relevant)
- Domain: knowledge; Technique: information about health consequences, instruction on how
to perform the behaviour
• Add Glo Germ demonstration in one of these sessions to illustrate technique (booth
after session for all to try if interested)
- Domain: skills; Technique: Demonstration of the behaviour
- Domain: knowledge; Technique: Salience of consequences and Self-monitoring of outcome
of behaviour
Proposed delivery for Medicine:
• When: During Antibiotic Stewardship Rounds – a weekly pause of rounds that lasts a
few minutes (already in practice) (social influence)
• What: A hand hygiene curriculum delivered weekly (~2min/session) X 4 (for one block)
• Who will deliver: Local experts/opinion leaders
INTERVENTION MAPPING AND DESIGN
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3. Address environmental barriers (unit staff)
Intervention Content:
• Ensure that hand hygiene resources are easily accessible and
noticeable (including systems to ensure hand hygiene resources
are routinely replaced)
- domain: environmental context and resources; Technique:
Restructuring the physical environment
Proposed delivery for Medicine:
• How: Will walk through the chosen unit(s)
• Who will deliver: Members of the study team
• Accountability – unit
INTERVENTION MAPPING AND DESIGN
51. WEBINAR 6 – TAKE HOME MESSAGES
▶ Use taxonomies:
• Promotes shared language and operationalization
• Provide novel ideas for intervention
▶ Distinguish and clarify ‘what’ you deliver (intervention strategies)
from ‘how’ you deliver it (method of delivery)
▶ Use systematic review evidence of effectiveness of strategies
where possible
▶ When selecting strategies and interventions, tailor to identified
barriers and enablers
• Use tools that link barriers/enablers to fit-for-purpose
strategies
52. OVERALL TAKE HOME MESSAGES
▶ Patient safety remains major concern in healthcare systems
▶ Implementation Science is the scientific study of the determinants,
processes and outcomes of implementation
▶ Successful implementation of patient safety change programs
requires actors to change their behaviour(s)
▶ Don’t jump straight to solutions: Developing solutions before
understanding the problem risks developing elegant solutions to
non-problems
▶ No magic bullets: no strategy works in all instances
▶ Insights from behavioural science can help optimise change
programs and increase their likelihood of success
▶ Drawing upon IS approaches can avoid the pitfalls of ISLAGIATT
approaches and promote a shared understanding of what works to
improve patient safety
53. www.ohri.ca | Affiliated with • Affilié à
Centre for Implementation Research
Thank you
Justin Presseau
Scientist, OHRI
Assistant Professor, uOttawa
@JPresseau
jpresseau@ohri.ca
Jeremy Grimshaw
Senior Scientist, OHRI
Full Professor, uOttawa
@GrimshawJeremy
jgrimshaw@ohri.ca