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Objectives Effective communication amongst healthcare workers simultaneously promotes optimal patient outcomes when present and is deleterious to outcomes when absent. The advent of electronic health record (EHR)-embedded secure instantaneous messaging systems has provided a new conduit for provider communication. This manuscript describes the experience of one academic medical center with deployment of one such system (Secure Chat). Methods Data were collected on Secure Chat message volume from June 2017 to April 2023. Significant perideployment events were reviewed chronologically. Results After the first coronavirus disease 2019 lockdown in March 2020, messaging use increased by over 25 000 messages per month, with 1.2 million messages sent monthly by April 2023. Comparative features of current communication modalities in healthcare were summarized, highlighting the many advantages of Secure Chat. Conclusions While EHR-embedded secure instantaneous messaging systems represent a novel and potentially valuable communication medium in healthcare, generally agreed-upon best practices for their implementation are, as of yet, undetermined. [ABSTRACT FROM AUTHOR]

Rationale, Aimsand Objectives: Healthcare systems are confronted with a rising number of patients with chronic conditions and complex care needs, requiring the development of new models of coordinated, patient‐centred care. In this study, we aimed to describe and compare a range of new models of care recently implemented in primary care in Switzerland, as well as to gain insight into the type of coordination or integration implemented, the strengths and weaknesses of each model and the challenges they face. Method: We used an embedded multiple case study design to describe in‐depth a series of current Swiss initiatives that specifically aim to improve care coordination in primary care. For each model, documents were collected, a questionnaire was administered and semistructured interviews with key actors were conducted. A within‐case analysis followed by a cross‐case analysis were performed. Based on the Rainbow Model of Integrated Care framework, similarities and differences between the models were highlighted. Results: Eight integrated care initiatives were included in the analysis, representing three types of models: independent multiprofessional GP practices, multiprofessional GP practices/health centres that are part of larger groups and regional integrated delivery systems. Recognized effective activities and tools to improve care coordination, such as multidisciplinary teams, case manager involvement, use of electronic medical records, patient education and use of care plans, were implemented by at least six of the eight initiatives studied. The main obstacles to the implementation of integrated care models were the inadequate Swiss reimbursement policies and payment mechanisms and the desire of some healthcare professionals to protect their territory in a context where new roles are emerging. Conclusion: The integrated care models implemented in Switzerland are promising; nevertheless, financial and legal reforms must be introduced to promote integrated care in practice. [ABSTRACT FROM AUTHOR]

Research suggests that feedback in Emergency Medical Services (EMS) positively affects quality of care and professional development. However, the mechanisms by which feedback achieves its effects still need to be better understood across healthcare settings. This study aimed to understand how United Kingdom (UK) ambulance services provide feedback for EMS professionals and develop a programme theory of how feedback works within EMS, using a mixed-methods, realist evaluation framework. A national cross-sectional survey was conducted to identify feedback initiatives in UK ambulance services, followed by four in-depth case studies involving qualitative interviews and documentary analysis. We used qualitative content analysis and descriptive statistics to analyse survey responses from 40 prehospital feedback initiatives, alongside retroductive analysis of 17 interviews and six documents from case study sites. Feedback initiatives mainly provided individual patient outcome feedback through "pull" initiatives triggered by staff requests. Challenges related to information governance were identified. Our programme theory of feedback to EMS professionals encompassed context (healthcare professional and organisational characteristics), mechanisms (feedback and implementation characteristics, psychological reasoning) and outcomes (implementation, staff and service outcomes). This study suggests that most UK ambulance services use a range of feedback initiatives and provides 24 empirically based testable hypotheses for future research. [ABSTRACT FROM AUTHOR]

Research suggests that feedback in Emergency Medical Services (EMS) positively affects quality of care and professional development. However, the mechanisms by which feedback achieves its effects still need to be better understood across healthcare settings. This study aimed to understand how United Kingdom (UK) ambulance services provide feedback for EMS professionals and develop a programme theory of how feedback works within EMS, using a mixed-methods, realist evaluation framework. A national cross-sectional survey was conducted to identify feedback initiatives in UK ambulance services, followed by four in-depth case studies involving qualitative interviews and documentary analysis. We used qualitative content analysis and descriptive statistics to analyse survey responses from 40 prehospital feedback initiatives, alongside retroductive analysis of 17 interviews and six documents from case study sites. Feedback initiatives mainly provided individual patient outcome feedback through “pull” initiatives triggered by staff requests. Challenges related to information governance were identified. Our programme theory of feedback to EMS professionals encompassed context (healthcare professional and organisational characteristics), mechanisms (feedback and implementation characteristics, psychological reasoning) and outcomes (implementation, staff and service outcomes). This study suggests that most UK ambulance services use a range of feedback initiatives and provides 24 empirically based testable hypotheses for future research.

Simple Summary: In this article, we report on action research in the Canadian province of Alberta, based on forging alliances with officers who enforce federal, provincial, and municipal legislation involving animals. Some of these officers worked in rural areas, and others worked in urban areas. Some mainly enforced Alberta's Animal Protection Act, while a few specialized in enforcing Canada's Criminal Code. For the most part, however, participating officers had a mandate to enforce animal-related local bylaws. Such ordinances or rulebooks exist because Alberta's Municipal Government Act allows local councils to enact legislation regarding domestic and wild animals, particularly as regards people's health, property, safety, and welfare. Many professionals refer to policies such as these, which are deeply rooted in the western legal tradition, such as "animal control." Our findings illuminate how animal-control policies and personnel can help to protect domesticated animals, not just people. Even so, our research highlights that animal-control policies as well as animal-protection policies routinely fail to protect officers who enforce legislation involving animals. Furthermore, whenever officers who enforce legislation involving animals work in unsafe conditions, this endangers human as well as non-human lives. Across Canada and internationally, laws exist to protect animals and to stop them from becoming public nuisances and threats. The work of officers who enforce local bylaws protects both domestic animals and humans. Despite the importance of this work, research in this area is emergent, but growing. We conducted research with officers mandated to enforce legislation involving animals, with a focus on local bylaw enforcement in the province of Alberta, Canada, which includes the city of Calgary. Some experts regard Calgary as a "model city" for inter-agency collaboration. Based on partnerships with front-line officers, managers, and professional associations in a qualitative multiple-case study, this action-research project evolved towards advocacy for occupational health and safety. Participating officers spoke about the societal benefits of their work with pride, and they presented multiple examples to illustrate how local bylaw enforcement contributes to public safety and community wellbeing. Alarmingly, however, these officers consistently reported resource inadequacies, communication and information gaps, and a culture of normalized disrespect. These findings connect to the concept of "medico-legal borderlands," which became central to this study. As this project unfolded, we seized upon opportunities to improve the officers' working conditions, including the potential of relational coordination to promote the best practices. [ABSTRACT FROM AUTHOR]

Background: Heart failure patients often present with frailty and/or multi-morbidity, complicating care and service delivery. The Chronic Care Model (CCM) is a useful framework for designing care for complex patients. It assumes responsibility of several actors, including frontline providers and health-care administrators, in creating conditions for optimal chronic care management. This qualitative case study examines perceptions of care among providers and administrators in a large, urban health system in Canada, and how the CCM might inform redesign of care to improve health system functioning. Methods: Sixteen semi-structured interviews were conducted between August 2014 and January 2016. Interpretive analysis was conducted to identify how informants perceive care among this population and the extent to which the design of heart failure care aligns with elements of the CCM. Results: Current care approaches could better align with CCM elements. Key changes to improve health system functioning for complex heart failure patients that align with the CCM include closing knowledge gaps, standardizing treatment, improving interdisciplinary communication and improving patient care pathways following hospital discharge. Conclusions: The CCM can be used to guide health system design and interventions for frail and multi-morbid heart failure patients. Addressing care- and service-delivery barriers has important clinical, administrative and economic implications. [ABSTRACT FROM AUTHOR]

Viral hepatitis is a leading cause of morbidity and mortality worldwide, but has long been neglected by national and international policymakers. Recent modelling studies suggest that investing in the global elimination of viral hepatitis is feasible and cost‐effective. In 2016, all 194 member states of the World Health Organization endorsed the goal to eliminate viral hepatitis as a public health threat by 2030, but complex systemic and social realities hamper implementation efforts. This paper presents eight case studies from a diverse range of countries that have invested in responses to viral hepatitis and adopted innovative approaches to tackle their respective epidemics. Based on an investment framework developed to build a global investment case for the elimination of viral hepatitis by 2030, national activities and key enablers are highlighted that showcase the feasibility and impact of concerted hepatitis responses across a range of settings, with different levels of available resources and infrastructural development. These case studies demonstrate the utility of taking a multipronged, public health approach to: (a) evidence‐gathering and planning; (b) implementation; and (c) integration of viral hepatitis services into the Agenda for Sustainable Development. They provide models for planning, investment and implementation strategies for other countries facing similar challenges and resource constraints. [ABSTRACT FROM AUTHOR]

This paper explores a counter-weight to anti-democratic trends suggested by civil society theory: mediating structures (also known as ‘intermediate’ or ‘intermediary’ organizations). We look briefly at the range of ways in which the concept has been used in social science and then focus on literature which employs the concept specifically in the context of debates about sustainable democracy We discern from the theoretical literature four distinct functions said to be performed in democracies by mediating structures and we offer case examples of organizations which perform those functions in the contemporary real world. We conclude by providing pointers to how mediating structures might be identified, supported and sustained in the face of anti-democratic trends today.

Aim: Carry out a descriptive and organizational analysis of the Oral Health warehouse of the Municipal Health Department in a city in the South of Brazil in order to assist in its management. Methods: This case study is a descriptive and organizational analysis of the Oral Health warehouse of the Municipal Health Department. The Always Better Control (ABC) curve, and Vital Essential Desirable (VED) analysis and ABC-VED matrix was performed, in order to assist the warehouse’s management. The first stage was a descriptive situational analysis. In the second stage, the supplies were classified by the ABC curve and the VED analysis. Subsequently, the ABC-VED matrix was carried out. Results: Changes were made together with the local manager, such as organizing the products, labeling the items in the proper places and, carrying out the inventory more frequently (monthly). Furthermore, the method the first in, first out (FIFO) was applied. Of the 120 inputs, 13% corresponded to 65% of the expenditures (class A). In class B, close to 26% of the items accounted for 25% of the expenditures. Class C accounted for 10% of the costs and 61% of total materials. In the VED analysis, 19.2% of the items were classified as vital, and 62% and 19% as essential and desirable, respectively. In ABC-VED matrix, 23.3% (72%) belonged to category I, while 63% (25.6%) and 13% (2%) were classified in categories II and III, respectively. Conclusion: The use of inventory control tools granted a better storage of products and made it easier to find the items. The ABC curve, VED analysis and ABC-VED analysis allowed greater control, considering both cost and importance of supplies.

Aim: Carry out a descriptive and organizational analysis of the Oral Health warehouse of the Municipal Health Department in a city in the South of Brazil in order to assist in its management. Methods: This case study is a descriptive and organizational analysis of the Oral Health warehouse of the Municipal Health Department. The Always Better Control (ABC) curve, and Vital Essential Desirable (VED) analysis and ABC-VED matrix was performed, in order to assist the warehouse's management. The first stage was a descriptive situational analysis. In the second stage, the supplies were classified by the ABC curve and the VED analysis. Subsequently, the ABC-VED matrix was carried out. Results: Changes were made together with the local manager, such as organizing the products, labeling the items in the proper places and, carrying out the inventory more frequently (monthly). Furthermore, the method the first in, first out (FIFO) was applied. Of the 120 inputs, 13% corresponded to 65% of the expenditures (class A). In class B, close to 26% of the items accounted for 25% of the expenditures. Class C accounted for 10% of the costs and 61% of total materials. In the VED analysis, 19.2% of the items were classified as vital, and 62% and 19% as essential and desirable, respectively. In ABC-VED matrix, 23.3% (72%) belonged to category I, while 63% (25.6%) and 13% (2%) were classified in categories II and III, respectively. Conclusion: The use of inventory control tools granted a better storage of products and made it easier to find the items. The ABC curve, VED analysis and ABC-VED analysis allowed greater control, considering both cost and importance of supplies. [ABSTRACT FROM AUTHOR]

Background: Transition care programs (TCPs) are designed to optimise functional recovery and independence in older adults post-hospitalisation. These programs are under high demand, and understanding inefficiencies in patient flow are a key step towards service improvement.Aims: To identify service improvement opportunities in an Australian community TCP service.Methods: An in-depth retrospective study of 113 community TCP clients.Results: TCP occupancy was high (94%) and client functional level improved across the program. Inefficiencies experienced included: admission delays to the program; low completion rates (61%) predominantly due to re-hospitalisation; variable response times by Allied Health services (5-20 days); and discharge delays—the latter attributed to waiting for services such as Home Care Packages through Non-Government Organisations.Discussion: This study identified several opportunities for service improvement in a community TCP service. Health practitioners should be regularly provided with up-to-date information on efficiency of TCP services. [ABSTRACT FROM AUTHOR]

Objective Non-progressive cerebral palsy (CP) is due to abnormal development of brain and or brain damages before, during, or after birth. The reason of cerebral palsy is brain damage or its abnormal development. Most of these problems happen when the child is in mother’s womb, but the chance is high that it happens in the first 2 years of life, when the brain develops. One of the commonest and most important debilitating signs of cerebral palsy is damage to higher functions, in such a way that the control of moves in grasping and leaving get damaged and in the end, the strength of hand for planning of movement decreases. Several studies have examined the effect of resistance training on muscle strength of patients with CP, while none of them has examined the effect of progressive resistance and balance training in children with CP. This study aimed to investigate the effects of progressive resistance and balance training on upper trunk muscle strength of children with CP. Materials & Methods Three boys with cerebral palsy (two patients who were 7 years old and one who was 6) participated in this research. In this study, single subject research method with A-B-A plan was used. Progressive resistance and balance training were administered for 3 days per week for 8 weeks. Wrist and elbow flexor muscles strength was measured by PowerTrack Õ dynamometer (manufactured by JTECK with 4.4 N threshold). Results According to visual analysis of data diagrams and based on descriptive statistical indexes and visual analyses, the results showed that resistance and balance training in intervention situation compared to baseline increased the strength of elbow flexor (percentages of non-overlapping data for the first and second participants were 75% and for the third participant, 100%). The strength of upper trunk muscles after intervention hve improved compared to baseline; however, one month after intervention, the trend was pretty stabilized. Conclusion The results of this study showed that 8 weeks of progressive resistance and balance training (in combination) has increased muscle strength in children with cerebral palsy. The present research showed that resistance and balanced trainings have significant effects on muscle strength of children with CP. It seems that these practices have been effective, especially for the wrist flexor and elbow flexor muscles. It can be said that the increase in the muscles of children with CP was due to practice principle along with increase in neuronal compatibility. One of the important points in the effectiveness of resistance training is the intensity of training. The results showed that resistance and balanced trainings increase the muscle strength of children with CP. This power could be partly due to increase in muscle volume and partly due to anabolic hormones.

Objective: Few evaluations have assessed the factors triggering an adequate health care response to intimate partner violence. This article aimed to: 1) describe a realist evaluation carried out in Spain to ascertain why, how and under what circumstances primary health care teams respond to intimate partner violence, and 2) discuss the strengths and challenges of its application. Methods: We carried out a series of case studies in four steps. First, we developed an initial programme theory (PT1), based on interviews with managers. Second, we refined PT1 into PT2 by testing it in a primary healthcare team that was actively responding to violence. Third, we tested the refined PT2 by incorporating three other cases located in the same region. Qualitative and quantitative data were collected and thick descriptions were produced and analysed using a retroduction approach. Fourth, we analysed a total of 15 cases, and identified combinations of contextual factors and mechanisms that triggered an adequate response to violence by using qualitative comparative analysis. Results: There were several key mechanisms —the teams’ self-efficacy, perceived preparation, women-centred care—, and contextual factors —an enabling team environment and managerial style, the presence of motivated professionals, the use of the protocol and accumulated experience in primary health care— that should be considered to develop adequate primary health-care responses to violence. Conclusion: The full application of this realist evaluation was demanding, but also well suited to explore a complex intervention reflecting the situation in natural settings.

Objectives: Chiropractic care may have value in improving patient outcomes and decreasing opioid use, but little is known about the impetus for or process of incorporating these services into conventional medical settings. The purpose of this qualitative study was to describe organizational structures, care processes, and perceived value of chiropractic integration within U.S. private sector medical facilities. Design: Multisite, comparative organizational case study. Settings: Nine U.S. private sector medical facilities with on-site chiropractic care, including five hospitals and four clinics. Participants: One hundred and thirty-five key facility stakeholders including doctors of chiropractic (DCs), non-DC clinicians, support staff, administrators, and patients. Methods: Researchers conducted 2-day site visits to all settings. Qualitative data were collected from audio-recorded, semi-structured, role-specified, individual interviews; standardized organizational data tables; and archival document review. A three-member, interdisciplinary team conducted thematic content analysis of verbatim transcripts using an existing conceptual framework and emergent codes. Results: These nine medical facilities had unique organizational structures and reasons for initiating chiropractic care in their settings. Across sites, DCs were sought to take an evidence-based approach to patient care, work collaboratively within a multidisciplinary team, engage in interprofessional case management, and adopt organizational mission and values. Chiropractic clinics were implemented within existing human resources, physical plant, information technology, and administrative support systems, and often expanded over time to address patient demand. DCs usually were co-located with medical providers and integrated into the collaborative management of patients with musculoskeletal and co-morbid conditions. Delivery of chiropractic services was perceived to have high value among patients, medical providers, and administration. Patient clinical outcomes, patient satisfaction, provider productivity, and cost offset were identified as markers of clinic success. Conclusion: A diverse group of U.S. private sector medical facilities have implemented chiropractic clinics, and a wide variety of facility stakeholders report high satisfaction with the care provided. [ABSTRACT FROM AUTHOR]

Se presenta la experiencia de introducción de acciones de mejora de la calidad en una organización de salud pública. Tras la acreditación ISO 17025 del laboratorio de control oficial obtenida por requisito legal, la dirección acordó en 2003 extender la política de calidad, poniendo en marcha un repertorio de acciones mediante el análisis de procesos y la formulación de acciones de mejora, la mayor formalización de procedimientos, el conocimiento de la opinión de los clientes, la creación de grupos de mejora, y la auditoría o certificación externa. La organización respondió de forma diversa a estas iniciativas. Someter los servicios a auditoría o certificación externa parece el motor más poderoso para el cambio. El estudio de costes de la actividad permite valorar que, en 2010, el 75% del gasto total se realiza en servicios de salud pública sujetos a auditoría/certificación externa.This article describes the introduction of quality improvement actions in a public health organization. After ISO 17025 accreditation, which was legally mandated, was granted to the official control laboratory, the management decided to expand a quality policy in 2003, through a series of actions based on process analysis and proposals for improvement, further definition of standard operating procedures, exploration of users' opinions, the creation of improvement groups, and external audits or certification. The organizational response to these initiatives was diverse. External audit or certification of services seems to be the most powerful tool for change. Costing studies showed that up to 75% of the total expenditure of the agency in 2010 was spent on public health services subject to external audit or certification.

OBJETIVO: Analisar a organização do trabalho em centros de atenção psicossocial a partir da lógica da área de gestão de serviços. MÉTODOS: Foi realizada uma análise organizacional por meio de estudo de caso em um serviço de atenção psicossocial em São Paulo (SP), entre 2006 e 2007. Foram analisadas cinco fontes de informação: documentos do Ministério da Saúde, relatórios de pesquisa realizada no serviço estudado, registros do serviço, entrevistas com trabalhadores do CAPS e gestores de saúde e observação simples. As entrevistas versaram sobre objetivos, resultados e avaliação do processo de trabalho. Cada fonte recebeu tratamento diferenciado de acordo com sua finalidade. Posteriormente um diálogo dos resultados obtidos visou a construção de uma cadeia de observações sobre a qual se fundamentou o estudo do caso. RESULTADOS: O CAPS se propõe a entregar resultado altamente intangível, que contempla o usuário no seu contexto social. A mudança almejada nas condições do usuário foi descrita como "a pessoa vivendo melhor". Tal condição possui difícil definição e compreensão acerca dos detalhes e limites dessa mudança, sendo, portanto, difícil medir os resultados. Aliado a isso, o processo de trabalho envolve atividades não rotineiras, não previstas e algumas vezes simultâneas, de tal forma que a equipe encontra dificuldade de reconhecer e legitimar os esforços para fazer o trabalho acontecer, fato descrito pelos trabalhadores como invisibilidade do trabalho. CONCLUSÕES: O processo de avaliação mostrou-se um aspecto complexo dessa intangibilidade aliado à inadequação e a insuficiência da estrutura administrativa do sistema de saúde municipal para acolher um serviço dessa natureza. Os resultados permitiram compreender melhor um campo de trabalho em que a subjetividade de trabalhadores e de usuários é inerente ao processo de gestão de serviços.OBJETIVO: Analizar la organización del trabajo en centros de atención psicosocial a partir de la lógica del área de gestión de servicios. MÉTODOS: Fue realizado un análisis organizacional por medio del estudio de caso en un servicio de atención psicosocial en Sao Paulo (Sureste de Brasil), entre 2006 y 2007. Fueron analizadas cinco fuentes de información: documentos del Ministerio de la Salud, informes de investigación realizado en el servicio estudiado, registros de servicio, entrevistas con trabajadores de CAPS y gestores de salud y observación simple. Las entrevistas trataron sobre objetivos, resultados y evaluación del proceso de trabajo. Cada fuente recibió tratamiento diferenciado de acuerdo con su finalidad. Posteriormente un diálogo de los resultados obtenidos visó la construcción de una cadena de observaciones sobre la cual se fundamentó el estudio del caso. RESULTADOS: El CAPS se propone a entregar resultado altamente intangible, que contempla el usuario en su contexto social. El cambio basado en las condiciones del usuario fue descrito como "la persona viviendo mejor". Tal condición posee difícil definición y comprensión acerca de los detalles y límites de ese cambio, siendo, por tanto, difícil medir los resultados. Aunado a eso, el proceso de trabajo envuelve actividades no rutinarias, no previstas y algunas veces simultáneas, de tal forma que el equipo encuentra dificultades de reconocer y legitimar los esfuerzos para hacer el trabajo acontecer, hecho descrito por los trabajadores como invisibilidad del trabajo. CONCLUSIONES: El proceso de evaluación mostró un aspecto complejo de esa intangibilidad aunado a la inadecuación y la insuficiencia de la estructura administrativa del sistema de salud municipal para acoger un servicio de esa naturaleza. Los resultados permitieron comprender mejor un campo de trabajo en que la subjetividad de trabajadores y de usuarios es inherente al proceso de gestión de servicios.OBJECTIVE: To analyze work organization in psychosocial healthcare services from the logic of the service management field. METHODS: Organizational analysis was performed, using a case study in a psychosocial healthcare service located in the city of São Paulo, Southeastern Brazil, between 2006 and 2007. A total of five sources of information were analyzed: Ministério da Saúde (Brazilian Ministry of Health) documents, research reports made in the service studied, service records, interviews with healthcare workers and managers and simple observation. Interviews dealt with objectives, results and assessment of work process. Each source was treated differently, according to its purpose. A subsequent dialogue about the results obtained aimed to make a set of observations on which the case study was founded. RESULTS: The service proposes to deliver a very intangible result, which views the user in their social context. The intended change in the user's conditions was described as "the person living better". Such condition is difficult to be defined and understood in terms of the details and limits of this change, thus hindering measurement of results. In addition, the work process involves activities which are not routinary, not predictable and sometimes simultaneous, so that the team finds it difficult to recognize and legitimize efforts made to perform work, a fact described as "work invisibility" by workers. CONCLUSIONS: The assessment process was found to be a complex aspect of this intangibility, associated with inadequacy and insufficiency of the municipal health system's management structure to include a service of this nature. Results enabled better understanding of a field of work where workers' and users' subjectivity is inherent in the service management process.

A AIDS foi um evento marcante tanto por sua capacidade devastadora como pela forma como estimulou a solidariedade e a mobilização da sociedade na defesa dos direitos de pessoas vivendo e convivendo com HIV/AIDS. De iniciativas para dar dignidade na morte, as ONG/AIDS passaram por mudanças estruturais para responder às demandas da epidemia. Este estudo descreve a trajetória da ONG/AIDS Casa de Assistência Filadélfia com relação à evolução da epidemia de AIDS ressaltando o desenvolvimento organizacional. Utilizou-se uma metodologia qualitativa com estudo de caso, sendo os dados colhidos por meio de análise documental e entrevistas semi-estruturadas com informantes-chave referidos pela organização. A análise dos dados baseou-se nas proposições teóricas de desenvolvimento organizacional e mostra como a organização saiu da fase pioneira marcada pela improvisação, se expandiu, indo para uma fase de regulamentação até chegar à fase de flexibilização e inovação com a diversificação dos projetos. O estudo aponta para a importância do desenvolvimento organizacional como elemento essencial na formação de organizações saudáveis e ágeis na resposta às suas demandas.AIDS has been a unique event due not only to its devastating effects, but also to the ways in which it has stimulated solidarity and mobilization of society in the defense of the rights of persons living with HIV/AIDS and their families, friends, and contacts. Beginning as initiatives to ensure dignity in death, AIDS NGOs have undergone structural changes to respond to the demands raised by the epidemic. The current study describes the history of the Brazilian AIDS NGO "Casa de Assistência Filadélfia" in relation to the evolution of the AIDS epidemic, highlighting the issue of organizational development. A qualitative case study methodology was used, and the data were collected from document analysis and semi-structured interviews with key informants identified by the organization. Data analysis was based on the theoretical premises of organizational development and shows how the organization made the transition from the pioneering phase marked by improvisation and expanded to a phase of regulation until reaching flexibility and innovation by diversifying its projects. The study highlights the importance of organizational development as an essential element in building healthy, agile organizations in the response to their demands.

Este artigo trata dos questionamentos em relação à baixa capacidade dos governos para a formulação e implementação de políticas públicas, considerando particularmente alguns casos de gestão governamental em secretarias estaduais de saúde, sob a ótica de seus dirigentes. Trata-se de um estudo de casos múltiplos, 12 secretarias estaduais de Saúde, com níveis de análise imbricados. O método adotado foi a "análise de conteúdo" de discursos proferidos por dirigentes governamentais do setor saúde, acerca de seus modos e práticas de gestão, destacando os processos de formulação de políticas, tomada de decisões e implementação de programas. As evidências referem-se às características dos gestores e da gestão no âmbito estadual de governo, denotando-se algumas dificuldades e lacunas nos processos de formulação de políticas, no uso de tecnologias de planejamento e programação, na conformação dos sistemas de direção estratégica e na implementação das políticas governamentais de saúde, além de investimentos para a qualificação das práticas de gestão setorial, com gradual incremento na capacidade dos governos estaduais para a condução e implementação de suas políticas.This article deals with issues concerning the poor capability of governments in planning and implementing public policies and considers particularly some cases of government management inside state departments of health, according to their own managers. It is also an organizational case study of 12 state departments of health with intricate levels of analysis. The study adopted the 'content analysis' method, considering statements of public managers of the healthcare sector in which they pointed out their managerial ways and practices, as well as their policy-making, decision-making, and program implementation processes. The main subjects highlighted by the reports refer to the characteristics of both managers and management within the state government. They also indicate some difficulties and gaps in policy-making processes, in the use of planning and programming technologies, in the configuration of strategic management systems, and in the implementation of public healthcare policies. On the other hand there have been investments to improve management qualification, as well as a gradual increase in the capability of state governments in carrying out and implementing their policies.

This paper describes a developing partnership between a church-based service learning center and a university initiative to build a field station in a low-income community in the anthracite coal region of Pennsylvania. It is a case study of how secular and religious institutions have been collaborating to achieve the shared goal of improving social conditions in specific communities. The theoretical focus of the paper is on how a change from a "glass is half empty" to a "glass is half full" perception of the community opens new possibilities for change. This paper concentrates on the story of one partnership as a case study demonstrating current trends in service learning both within universities and within the Catholic Church in America. Analysis centers on the basic question of why the project had symbolic power for both partners and on the institutional processes within both organizations that helped the partnership grow. We use the framework of Assets-Based Community Development (ABCD), also known as the "strengths perspective", to conceptualize the contrast. [ABSTRACT FROM AUTHOR]

Sociotechnical approaches are grounded in theory and evidence-based. They are useful for evaluations involving health information technologies. This contribution begins with an overview of sociotechnical theory and ethnography. These theories concern interactions between technology, its use, people who use or are affected by it, and their organizational and societal situations. Then the contribution discusses planning and designing evaluations, including frameworks and models to focus an evaluation, and methodological considerations for conducting it. Next, ethical issues and further challenges and opportunities are taken up. Concluding case examples, referenced throughout, illustrate how good evaluations provide useful results to help design, implement, and use health information technologies effectively. [ABSTRACT FROM AUTHOR]

Visual management (VM) tools such as whiteboards, often employed in Lean thinking applications, are intended to be helpful in improving work processes in different industries including health care. It remains unclear, however, how VM is actually applied in health care Lean interventions and how it might influence the clinical staff. We therefore examined how Lean-inspired VM using whiteboards for continuous improvement efforts related to the hospital staff's work and collaboration. Within a case study design, we combined semistructured interviews, nonparticipant observations, and photography on 2 cardiology wards. The fate of VM differed between the 2 wards; in one, it was well received by the staff and enhanced continuous improvement efforts, whereas in the other ward, it was not perceived to fit in the work flow or to make enough sense in order to be sustained. Visual management may enable the staff and managers to allow communication across time and facilitate teamwork by enabling the inclusion of team members who are not present simultaneously; however, its adoption and value seem contingent on finding a good fit with the local context. A combination of continuous improvement and VM may be helpful in keeping the staff engaged in the change process in the long run. [ABSTRACT FROM AUTHOR]

Background: Medication Review (MRev) has been implemented in many hospitals to improve patient safety and well-being. However, it seems sometimes difficult to implement, maintain and systematize this process, especially when key-elements are absent. This study focuses on the analysis of a MRev process implemented in an Acute Geriatric Unit (AGU) which, at the time of the study, had no Computerized Physician Order Entry (CPOE) and no sufficient staff to - normally - support the process. Objective: This study describes the MRev process as existing in the AGU with a particular focus on the preparatory MRev meeting phase and presents our recommendations to maintain and optimize it. Methods: Human Factor experts have collected and analyzed data during MRev process by interviews, shadowing observations and video recording from April to October 2014 at Lille University Hospital. Results: MRev process consists of three phases (meeting preparation, MRev meeting and patient discharge) and includes seven main tasks for which actors, documented supports, outcomes and difficulties are identified. Although allocating a fulltime pharmacist for the AGU would solve several problems, the main realistic recommendations concern training for junior and senior actors according to their roles and the improvement of some tasks processes. Conclusion: Despite less than optimal conditions as compared to those recommended by the literature, the observed AGU performs an efficient review based on well designed tools and processes. [ABSTRACT FROM AUTHOR]

Background As patient’s length of stay in waiting lists increases, governments are looking for strategies to control the problem. Agreements were created with private providers to diminish the workload in the public sector. However, the growth of the private sector is not following the demand for care. Given this context, new management strategies have to be considered in order to minimize patient length of stay in waiting lists while reducing the costs and increasing (or at least maintaining) the quality of care. Method Appointment scheduling systems are today known to be proficient in the optimization of health care services. Their utilization is focused on increasing the usage of human resources, medical equipment and reducing the patient waiting times. In this paper, a simulation-based optimization approach to the Patient Admission Scheduling Problem is presented. Modeling tools and simulation techniques are used in the optimization of a diagnostic imaging department. Results The proposed techniques have demonstrated to be effective in the evaluation of diagnostic imaging workflows. A simulated annealing algorithm was used to optimize the patient admission sequence towards minimizing the total completion and total waiting of patients. The obtained results showed average reductions of 5% on the total completion and 38% on the patients’ total waiting time. [ABSTRACT FROM AUTHOR]

This paper describes a developing partnership between a church-based service learning center and a university initiative to build a field station in a low-income community in the anthracite coal region of Pennsylvania. It is a case study of how secular and religious institutions have been collaborating to achieve the shared goal of improving social conditions in specific communities. The theoretical focus of the paper is on how a change from a “glass is half empty” to a “glass is half full” perception of the community opens new possibilities for change. This paper concentrates on the story of one partnership as a case study demonstrating current trends in service learning both within universities and within the Catholic Church in America. Analysis centers on the basic question of why the project had symbolic power for both partners and on the institutional processes within both organizations that helped the partnership grow. We use the framework of Assets-Based Community Development (ABCD), also known as the “strengths perspective”, to conceptualize the contrast.

Background Substance abuse continues to exact a significant toll, despite promising advancements in treatment, and American Indian and Alaska Native (AI/AN) communities remain disproportionately impacted. Understanding the challenges in providing quality substance abuse treatment to AI/AN communities could ultimately result in more effective treatment interventions, but no multi-site studies have examined this important issue. Methods This qualitative study examined the challenges of providing substance abuse treatment services for American Indian and Alaska Native (AI/AN) communities. We conducted key informant interviews and focus groups at 18 substance abuse treatment programs serving AI/AN communities. Seventy-six service participants (21 individuals in clinical administrative positions and 55 front-line clinicians) participated in the project. Interview transcripts were coded to identify key themes. Results We found that the challenges of bringing effective substance abuse treatment to AI/AN communities fell into three broad categories: challenges associated with providing clinical services, those associated with the infrastructure of treatment settings, and those associated with the greater service/treatment system. These sets of challenges interact to form a highly complex set of conditions for the delivery of these services. Conclusions Our findings suggest that substance abuse treatment services for AI/AN communities require more integrated, individualized, comprehensive, and longer-term approaches to care. Our three categories of challenges provide a useful framework for eliciting challenges to providing quality substance abuse treatment in other substance abuse treatment settings. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Although the adoption rates for Electronic Health Records (EHRs) are growing, significant opportunities for further advances in EHR system design remain. The goal of this study was to identify issues that should be considered in the design process for the successful development of future systems by analyzing end users’ service requests gathered during a recent three-year period after a comprehensive EHR system was implemented at Seoul National University''s Bundang Hospital in South Korea. Methods: Data on 11,400 service requests from end users of the EHR system made from 2008 through 2010 were used in this study. The requests were categorized as program modification/development, data request, insurance-fee identification/generation, patient-record merging, or other. The authors further subcategorized the requests for program modification/development into the following nine areas of concern: (1) indicators and statistics, (2) patient safety and quality of care, (3) special task-oriented functionalities, (4) ease of use and user interface, (5) system speed, (6) interoperability and integration, (7) privacy and security, (8) customer service, and (9) miscellaneous. The system users were divided into four groups—direct care, care support, administrative/insurance, and general management—to identify each group''s needs and concerns. Results: The service requests for program modification/development, data request, insurance-fee identification/generation, patient-record merging, and other issues constituted approximately 49.2%, 33.9%, 11.4%, 4.0%, and 1.5% of the total data set, respectively. The number of data-request service requests grew over the three years studied. Different groups of users were found to have different concerns according to their activities and tasks. Within the program-modification/development category, end users were most frequently concerned with ease of use and user interface (38.1% of the total) and special task-oriented functionalities (29.3% of the total) in their use of the EHR system, with increasing numbers of requests in both categories over the three years. Users in the direct-care group differed from the other groups in that they most frequently submitted requests related to ease of use and user interface, followed by special functionalities, patient safety and quality care, and customer service, while users in other groups submitted requests concerning ease of use and user interface and special functionalities with a similarly high frequency. Conclusions: Users have continued to make suggestions about their needs and requirements, and the EHR system has evolved to optimize ease of use and special functionalities for particular groups of users and particular subspecialties. Based on our experiences and the lessons we have learned in the course of maintaining full-EHR systems, we suggest that the key goals to be considered for future EHR systems include innovative new user-interface technologies; special extended functions for each user group''s specific task-oriented requirements; powerful, easy-to-use functions to support research; new flexible system architecture; and patient-directed functions. [Copyright &y& Elsevier]

The article presents a case study involving the medical group's motivation for seeking recognition from the U.S. National Committee for Quality Assurance (NCQA) as a patient-centered medical home (PCMH). It indicates that PCMH principles were consistent with the culture and mission of the organization. It reveals that some PCMH components were viewed as part of the patient-centered culture of the organization, whereas others helped the practice compete in its local market.

Background: The implementation of evidence-based infection control practices is essential, yet challenging for healthcare institutions worldwide. Although acknowledged that implementation success varies with contextual factors, little is known regarding the most critical specific conditions within the complex cultural milieu of varying economic, political, and healthcare systems. Given the increasing reliance on unified global schemes to improve patient safety and healthcare effectiveness, research on this topic is needed and timely. The 'InDepth' work package of the European FP7 Prevention of Hospital Infections by Intervention and Training (PROHIBIT) consortium aims to assess barriers and facilitators to the successful implementation of catheter-related bloodstream infection (CRBSI) prevention in intensive care units (ICU) across several European countries. Methods: We use a qualitative case study approach in the ICUs of six purposefully selected acute care hospitals among the 15 participants in the PROHIBIT CRBSI intervention study. For sensitizing schemes we apply the theory of diffusion of innovation, published implementation frameworks, sensemaking, and new institutionalism. We conduct interviews with hospital health providers/agents at different organizational levels and ethnographic observations, and conduct rich artifact collection, and photography during two rounds of on-site visits, once before and once one year into the intervention. Data analysis is based on grounded theory. Given the challenge of different languages and cultures, we enlist the help of local interpreters, allot two days for site visits, and perform triangulation across multiple data sources. Qualitative measures of implementation success will consider the longitudinal interaction between the initiative and the institutional context. Quantitative outcomes on catheter-related bloodstream infections and performance indicators from another work package of the consortium will produce a final mixed-methods report. Conclusion: A mixed-methods study of this scale with longitudinal follow-up is unique in the field of infection control. It highlights the 'Why' and 'How' of best practice implementation, revealing key factors that determine success of a uniform intervention in the context of several varying cultural, economic, political, and medical systems across Europe. These new insights will guide future implementation of more tailored and hence more successful infection control programs. [ABSTRACT FROM AUTHOR]

Abstract: It is argued that with the introduction of electronic medical record (EMR) systems into the primary care sector, data collected can be used for secondary purposes which extend beyond individual patient care (e.g., for chronic disease management, prevention and clinical performance evaluation). However, EMR systems are primarily designed to support clinical tasks, and data entry practices of clinicians focus on the treatment of individual patients. Hence data collected through EMRs is not always useful in meeting these ends. Purpose: In this paper we follow a community health centre (CHC), and document the changes in work practices of the personnel that were necessary in order to make EMR data useful for secondary purposes. Methods: This project followed an action research approach, in which ethnographic data were collected mainly by participant observations, by a researcher who also acted as an IT support person for the clinic''s secondary usage of EMR data. Additionally, interviews were carried out with the clinical and administrative personnel of the CHC. Results: The case study demonstrates that meaningful use of secondary data occurs only after a long process, aimed at creating the pre-conditions for meaningful use of secondary data, has taken place. Preconditions: Specific areas of focus have to be chosen for secondary data use, and initiatives have to be continuously evaluated and adapted to the workflow through a team approach. Collaboration between IT support and physicians is necessary to tailor the software to allow for the collection of clinically relevant data. Data entry procedures may have to be changed to encourage the usage of an agreed-upon coding scheme, required for meaningful use of secondary data. And finally resources in terms of additional personnel or dedicated time are necessary to keep up with data collection and other tasks required as a pre-condition to secondary use of data, communication of the results to the clinic, and eventual re-evaluation. Consequences: Changes in the work practices observed in this case which were required to support secondary data use from the EMR included completion of additional tasks by clinical and administrative personnel related to the organization of follow-up tasks. Among physicians increased awareness of specific initiatives and guideline compliance in terms of chronic disease management and prevention was noticed. Finally, the clinic was able to evaluate their own practice and present the results to varied stakeholders. Conclusions: The case describes the secondary usage of data by a clinic aimed at improving management of the clinic''s patients. It illustrates that creating the pre-conditions for secondary use of data from EMRs is a complex process which can be seen as a shift in paradigms from a focus on individual patient care to chronic disease management and performance measurement. More research is needed about how to best support clinics in the process of change management necessitated by emerging clinical management goals. [Copyright &y& Elsevier]

Background: A number of palliative care delivery models have been proposed to address the structural and process gaps in this care. However, the specific elements required to form competent systems are often vaguely described.Aim: The purpose of this study was to explore whether a set of modifiable health system factors could be identified that are associated with population palliative care outcomes, including less acute care use and more home deaths.Design: A comparative case study evaluation was conducted of ‘palliative care’ in four health regions in Ontario, Canada. Regions were selected as exemplars of high and low acute care utilization patterns, representing both urban and rural settings. A theory-based approach to data collection was taken using the System Competency Model, comprised of structural features known to be essential indicators of palliative care system performance. Key informants in each region completed study instruments. Data were summarized using qualitative techniques and an exploratory factor pattern analysis was completed.Results: 43 participants (10+ from each region) were recruited, representing clinical and administrative perspectives. Pattern analysis revealed six factors that discriminated between regions: overall palliative care planning and needs assessment; a common chart; standardized patient assessments; 24/7 palliative care team access; advanced practice nursing presence; and designated roles for the provision of palliative care services.Conclusions: The four palliative care regional ‘systems’ examined using our model were found to be in different stages of development. This research further informs health system planners on important features to incorporate into evolving palliative care systems. [ABSTRACT FROM PUBLISHER]

Introduction To bring people with complex medical, social and vocational needs back to the labour market, interorganizational cooperation is often needed. Yet, studies of processes and strategies for achieving sustainable interorganizational cooperation are sparse. The aim of this study was to analyse the implementation processes of Swedish legislation on financial coordination, with specific focus on different strategies for and perspectives on implementing interorganizational cooperation. Methods A multiple-case study was used, where two local associations for financial coordination were studied in order to elucidate and compare the development of cooperative work in two settings. The material, collected during a 3-year period, consisted of documents, individual interviews with managers, and focus groups with officials. Results Two different implementation strategies were identified. In case 1, a linear strategy was used to implement cooperative projects, which led to difficulties in maintaining cooperative work forms due to a fragmented and time-limited implementation process. In case 2, an interactive strategy was used, where managers and politicians were continuously involved in developing a central cooperation team that became a central part of a developing structure for interorganizational cooperation. An interactive cooperation strategy with long-term joint financing was here shown to be successful in overcoming organizational barriers to cooperation. Conclusions It is suggested that a strategy based on adaptation to local conditions, flexibility and constant evaluation is preferred for developing sustainable interorganizational cooperation when implementing policies or legislation affecting interorganizational relationships. [ABSTRACT FROM AUTHOR]

The article discusses a study which examined the costs and benefits of joining a nascent health information exchange (HIE) from the perspective of potential provider organization participants. Topics covered include the concerns about HIE increasing the risk of data security breaches, the need for state and federal governments to consider subsidies to sustain HIE and the importance of coordinating HIE policies with those of founding organizations.

Background: Complex, incrementally changing, context dependent and variable palliative care services are difficult to evaluate. Case study research strategies may have potential to contribute to evaluating such complex interventions, and to develop this field of evaluation research.Aim: This paper explores definitions of case study (as a unit of study, a process, and a product) and examines the features of case study research strategies which are thought to confer benefits for the evaluation of complex interventions in palliative care settings.Results: Ten features of case study that are thought to be beneficial in evaluating complex interventions in palliative care are discussed, drawing from exemplars of research in this field. Important features are related to a longitudinal approach, triangulation, purposive instance selection, comprehensive approach, multiple data sources, flexibility, concurrent data collection and analysis, search for proving-disproving evidence, pattern matching techniques and an engaging narrative. The limitations of case study approaches are discussed including the potential for subjectivity and their complex, time consuming and potentially expensive nature.Conclusions: Case study research strategies have great potential in evaluating complex interventions in palliative care settings. Three key features need to be exploited to develop this field: case selection, longitudinal designs, and the use of rival hypotheses. In particular, case study should be used in situations where there is interplay and interdependency between the intervention and its context, such that it is difficult to define or find relevant comparisons. [ABSTRACT FROM PUBLISHER]

There is much debate around the use of evidence in health promotion practice. This article aims to sharpen our understanding of this matter by reviewing and analyzing the 26 case studies presented in this special issue. These case studies suggest that health promotion practitioners are using a wide range of research evidence in interventions for high-risk individuals, entire populations, and vulnerable groups according to all five strategies for action described in the Ottawa Charter for Health Promotion. In nearly every case, practitioners had to mediate and adapt research evidence for their case. Eight key levers helped practitioners embed research evidence into practice: local and cultural relevance of the evidence, community capacity-building, sustained dialogue from the outset with all stakeholders, established academic-supported partnerships, communication that responds to organizational and political readiness, acknowledgement and awareness of gaps between evidence and practice, advocacy, and adequate earmarked resources. These case studies provide some evidence that there is an evidence-based health promotion, that this evidence base is broad, and that practitioners use different strategies to adapt it for their case. [ABSTRACT FROM PUBLISHER]

For the health education profession in the United States, role delineation research has been ongoing to identify valid professional competencies as the basis for workforce development. During 1998—2004, a multi-phase national research study, the National Health Educator Competencies Update Project (CUP), was designed to re-verify the role of the entry-level health educator, and further define and verify the role of advanced level health educators. The CUP findings are the evidence that has influenced the professional preparation, credentialing, and professional development of health educators. The lessons learned include the importance of employing role delineation research with a discipline-specific representative sample to appropriately affect workforce development and sustainability through an empirically-based model. [ABSTRACT FROM PUBLISHER]

This study compares the use of evidence in two 18-month Canadian projects with a similar goal: improved prevention of type II diabetes in women from ethno-cultural communities with a gestational diabetes diagnosis. Evidence used for both projects included epidemiological data and research literature, needs assessments with the target population, and project evaluations. Contexts for the use of evidence differed between the two projects in terms of the innovation and its level of complexity; organizational context and system readiness for change; and partnership characteristics. This study showed that while evidence played some role in determining project success, it was but one factor in deciding how project activities were (or were not) sustained. [ABSTRACT FROM PUBLISHER]

This article presents a health promotion initiative in French school settings. This initiative aims to promote children’s social, emotional and physical health. The main strategy is the development of teachers’ health-promoting practices and schools’ health-promoting environment. The initiative was implemented in 115 primary schools in six French regions. Three types of evidence were used to develop the initiative: scientific, professional contextual, and critical evidence. The evidence was translated into the programme through a training and support process. According to their position, the actors used the evidence differently. The importance of the local context and actors’ involvement is further explored. [ABSTRACT FROM PUBLISHER]

A social marketing campaign promoting hand-washing with soap was implemented to reduce the high burden of infection experienced by Australian Aboriginal children living in remote communities. Epidemiological evidence of effect and other evidence were used to identify the hygiene intervention and health promotion approach for the project. We drew on the findings of: (i) a systematic literature review to identify the intervention for which there is strong effect in similar populations and contexts; and (ii) a narrative literature review to determine our health promotion approach. This process provided practitioners with confidence and understanding so they could address a complex problem in a politically and otherwise sensitive context. [ABSTRACT FROM PUBLISHER]

The United States (US) Centers for Disease Control and Prevention (CDC), and key partners conducted a systematic review of the effectiveness of 0.08% blood alcohol concentration (BAC) laws on alcohol-related traffic mortality. Review findings of strong evidence of effectiveness were presented by partners during US Congressional hearings contributing to the passage of a bill requiring states to lower the legal BAC limit to 0.08% (80 mg of alcohol/100 ml of blood) or lose a portion of their federal highway funds. The bill was signed into law, making 0.08 the new national standard. Extensive and targeted dissemination of the evidence and recommendations to key stakeholders and partners built support for policy change at the state level. [ABSTRACT FROM PUBLISHER]

The Refuah Shlema programme was established to reduce health disparities, promote health literacy and health indicators of the Ethiopian immigrant community in Israel, and included: (i) integrating Ethiopian immigrant liaisons in primary care as inter-cultural mediators; (ii) in-service training of clinical staff to increase cultural awareness and sensitivity; and (iii) health education community activities. Qualitative and quantitative evidence showed improvements in: (i) clinic staff—patient relations; (ii) availability and accessibility of health services, and health system navigation without increasing service expenditure; (iii) perception of general well-being; and (iv) self-care practice with regards to chronic conditions. Evidence significantly contributed to sustaining the programme for over 13 years. [ABSTRACT FROM AUTHOR]

This project aimed at transforming a rural District Hospital in the Limpopo Province of South Africa into a Health Promoting Hospital according to standards developed by WHO-Europe. The intervention used a diagnostic approach and baseline needs assessment of hospital staff, patients, and their relatives to identify health education and promotion needs. Activities included empowerment training and skills development, implementation of health education and promotion activities, and the integration of health-promoting standards and values in the hospital structure and culture. The project indicated applicability of the model in a resource-limited setting, based on staff empowerment, local leadership, and stakeholder engagement. [ABSTRACT FROM AUTHOR]

The Battle River Project (BRP) is a school division-level intervention in rural Alberta, Canada, built upon the health-promoting schools approach to health promotion. Using self-reported school and student-level data from administrators and students, the central aim of the BRP is to examine: ‘How can the school environment and health behaviours (healthy eating, physical activity and mental wellness) of children and youth be improved when a health-promoting schools model, the Ever Active Schools program, is implemented with school division support?’ Evidence used to inform school level changes included students’ demographic, behavioral, and psychosocial variables linked to school environment data, comprised of school demographics and administrator-assessed quality of policies, facilities, and programs related to physical activity. Each participating school and the division were provided with a tailored report of their schools’ results to reflect, plan and implement for positive health behavior change. The main lesson learned was that sharing school-specific evidence can operate as a catalyst for embedding health promoting policy and practices within the school and division culture. (Global Health Promotion, 2011; 18(1): pp. 39—42) [ABSTRACT FROM AUTHOR]

The Centers for Disease Control and Prevention’s (CDC) Racial and Ethnic Approaches to Community Health (REACH) program funded 40 communities in the United States during 1999—2007. Three of these communities implemented interventions to increase physical activity among African Americans. This case study looks at these interventions and the evidence-based recommendations from the CDC’s Community Guide for Preventive Services. These recommendations address creating or improving access to physical activity and the dissemination of information via media campaigns. Findings suggest that although the evidence could not be applied in every respect, culturallytailored change strategies can meet unique characteristics of African Americans with or at risk for heart disease and may contribute to increased physical activity. (Global Health Promotion, 2011; 18(1): pp. 43—46) [ABSTRACT FROM AUTHOR]

Neighbors Connected is a community-based intervention in the Netherlands. It helps the active older people to organize social activities for their less active older neighbors, facilitated by practical and financial support from the Community Health Service. The intervention is the outcome of a combination of semi-structured interviews with the older people, with organizations for older people and with local policy-makers, epidemiological data and interactive discussions, all of which support the notion that engaging in social activities is a way to enhance healthy ageing within the community. The use of different sources of evidence resulted in a comprehensive picture and actionable local knowledge. [ABSTRACT FROM AUTHOR]

St. Jamestown is the most densely populated vertical immigrant-receiving urban neighbourhood in Canada. The Photovoice project engaged and empowered immigrant residents of St. Jamestown to influence public policy and secure improved local services for promoting health and well-being. Twenty-seven residents used photography and storytelling to record neighbourhood characteristics and their implications on residents’ health and well-being. Eight participants presented recommendations actionable at neighbourhood level to the councillor and worked with the city to carry out the recommendations made that were recognized as important for neighbourhood residents’ health and well-being. The results indicate Photovoice can be used to generate dialogue on community concerns and priorities and promote community action. (Global Health Promotion, 2011; 18(1): pp. 16—19) [ABSTRACT FROM AUTHOR]

This case study has two aims. First, it describes intervention strategies from two school-based programs designed to prevent tobacco use among adolescents in India. Second, it explains how evidence from randomized controlled trials of these intervention programs was used by a local non-governmental organization in Delhi to advocate for scaling up the Government of India’s tobacco control efforts to include school health interventions as one of the components of India’s National Tobacco Control Program. This case study illustrates the need for developing countries to conduct rigorous evaluation in order to provide context-relevant evidence prior to scaling up interventions. [ABSTRACT FROM AUTHOR]

The article discusses the growing need for behavioral safety programs in Indian multinational organizations. It provides the practical steps for implementing a behavior-based safety (BBS) developed from observations made in BBS training interventions. A national action research survey was conducted on 1,650 executives and 713 workers from 57 Indian multinational organizations in diverse industries such as petroleum, steel and cement. It concludes that BBS provides better accident prevention practices and instills workforce stewardship of safety systems.

Abstract: Objectives: This study aims to explore the issues and challenges involved in designing and organizing pilot implementations of health information systems (HIS). Pilot implementations are a widely used approach for identifying design flaws and implementation issues before full-scale deployment of new HIS. However, it is not uncommon for pilot implementations to fail in the sense that little can be learned from them. Method: We employed an interpretive case study approach in attempting to throw light on the reasons why pilot implementations sometimes fail. We studied the (failed) pilot implementation of an electronic Pregnancy Record (ePR) in Denmark. Our primary data collection methods comprised participant observations, semi-structured interviews and document analyses. Results: Based on a comprehensive evaluation of the implementation process, we identify three major challenges that complicated the pilot project and eventually led to its failure, namely difficulties in (1) defining an appropriate scope for the pilot implementation, (2) coping with unanticipated technical and practical problems, and (3) ensuring commitment from test users and their managers. Conclusion: Pilot implementations are a very useful technique for developing HIS, but also one that is very difficult to do successfully. It is sometimes assumed that pilot implementations are less complicated and risky than regular, full-scale implementations. However, pilot implementations are not just small-scale versions of conventional implementations; they are fundamentally different and they have their own complications and issues to deal with that make them hard to design and manage. [ABSTRACT FROM AUTHOR]

Abstract: Reducing racial and ethnic disparities in health care has become an important policy goal in the United States and other countries, but evidence to inform interventions to address disparities is limited. The objective of this study was to identify important dimensions of interventions to reduce health care disparities. We used qualitative research methods to examine interventions aimed at improving diabetes and/or cardiovascular care for patients from racial and ethnic minority groups within five health care organizations. We interviewed 36 key informants and conducted a thematic analysis to identify important features of these interventions. Key elements of interventions included two contextual factors (external accountability and alignment of incentives to reduce disparities) and four factors related to the organization or intervention itself (organizational commitment, population health focus, use of data to inform solutions, and a comprehensive approach to quality). Consideration of these elements could improve the design, implementation, and evaluation of future interventions to address racial and ethnic disparities in health care. [Copyright &y& Elsevier]