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Article
Publication date: 4 May 2021

Christine Jorm, Rick Iedema, Donella Piper, Nicholas Goodwin and Andrew Searles

The purpose of this paper is to argue for an improved conceptualisation of health service research, using Stengers' (2018) metaphor of “slow science” as a critical yardstick.

Abstract

Purpose

The purpose of this paper is to argue for an improved conceptualisation of health service research, using Stengers' (2018) metaphor of “slow science” as a critical yardstick.

Design/methodology/approach

The paper is structured in three parts. It first reviews the field of health services research and the approaches that dominate it. It then considers the healthcare research approaches whose principles and methodologies are more aligned with “slow science” before presenting a description of a “slow science” project in which the authors are currently engaged.

Findings

Current approaches to health service research struggle to offer adequate resources for resolving frontline complexity, principally because they set more store by knowledge generalisation, disciplinary continuity and integrity and the consolidation of expertise, than by engaging with frontline complexity on its terms, negotiating issues with frontline staff and patients on their terms and framing findings and solutions in ways that key in to the in situ dynamics and complexities that define health service delivery.

Originality/value

There is a need to engage in a paradigm shift that engages health services as co-researchers, prioritising practical change and local involvement over knowledge production. Economics is a research field where the products are of natural appeal to powerful health service managers. A “slow science” approach adopted by the embedded Economist Program with its emphasis on pre-implementation, knowledge mobilisation and parallel site capacity development sets out how research can be flexibly produced to improve health services.

Details

Journal of Health Organization and Management, vol. 35 no. 6
Type: Research Article
ISSN: 1477-7266

Keywords

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Article
Publication date: 31 October 2008

Rick Iedema, Christine Jorm and Jeffrey Braithwaite

Increased public awareness of clinical failure and rising levels of litigation are spurring health policy makers in industrialized countries to mandate that clinicians…

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2120

Abstract

Purpose

Increased public awareness of clinical failure and rising levels of litigation are spurring health policy makers in industrialized countries to mandate that clinicians report and investigate clinical errors and near misses. This paper seeks to understand the value of root cause analysis (RCA) recommendations for practice improvement purposes. The paper presents an analysis of interviews with nine senior health managers who were asked about their views on RCA as practice improvement method.

Design/methodology/approach

Interview data were collected as part of a multi‐method evaluation consultancy project investigating a local Health Safety Improvement Program. The interview data were discourse analysed and arranged into over‐arching themes.

Findings

The analysis reveals rather negative views of the improvement potential of RCA: RCA is subject to too many constraints to be able to produce valuable recommendations; RCA recommendations: are perceived to be of “variable quality”; generate considerable extra work for senior management to do with vetting RCA recommendations; are experienced as contributing in only a limited way to organizational and practice improvement.

Research limitations/implications

This study focuses on nine interviewees only and presents an analysis of single (not multiple) interviews. However, these nine interviewees fulfil crucial roles in implementing clinical practice improvement initiatives in their respective geographic areas.

Practical implications

The findings suggest that RCA requires much time and negotiation, and that the recommendations produced may not live up to the philosophy of clinical practice improvement's expectations. It may be necessary to reorient the expectations of the power of RCA, or accept that RCA produces communication about clinical processes that would otherwise not have taken place, and whose effects may not be registering for some time to come.

Originality/value

Besides drawing out the implications for RCA as investigative practice, the analysis argues that interviewees' responses harbour indications to suggest that these officials are finding themselves engaged in increasing levels of communicative and emotional labour, in having to manage and compensate for the ambiguities, incommensurabilities and conflicting goals inscribed into “post‐bureaucratic” initiatives such as RCA.

Details

Journal of Health Organization and Management, vol. 22 no. 6
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 9 October 2007

Mary T. Westbrook, Jeffrey Braithwaite, Joanne F. Travaglia, Debbi Long, Christine Jorm and Rick A. Iedema

Patient safety has been addressed since 2002 in the health system of New South Wales, Australia via a Safety Improvement Programme (SIP), which took a system‐wide…

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1293

Abstract

Purpose

Patient safety has been addressed since 2002 in the health system of New South Wales, Australia via a Safety Improvement Programme (SIP), which took a system‐wide approach. The programme involved two‐day courses to educate healthcare professionals to monitor and report incidents and analyse adverse events by conducting root cause analysis (RCA). This paper aims to predict that all professions would favour SIP but that their work and educational histories would result in doctors holding the least and nurses the most positive attitudes. Alternative hypotheses were that doctors' relative power and other professions' team‐working skills would advantage the respective groups when conducting RCAs.

Design/methodology/approach

Responses to a 2005 follow‐up questionnaire survey of doctors (n=53), nurses (209) and allied health staff (59), who had participated in SIP courses, were analysed to compare: their attitudes toward the course; safety skills acquired and applied; perceived benefits of SIP and RCAs; and their experiences conducting RCAs.

Findings

Significant differences existed between professions' responses with nurses being the most and doctors the least affirming. Allied health responses resembled those of nurses more than those of doctors. The professions' experiences conducting RCAs (number conducted, leadership, barriers encountered, findings implemented) were similar.

Research limitations/implications

Observational studies are needed to determine possible professional differences in the conduct of RCAs and any ensuing culture change that this may be eliciting.

Practical implications

There is strong professional support for SIPs but less endorsement from doctors, who tend not to prefer the knowledge content and multidisciplinary teaching environment considered optimal for safety improvement education. This is a dilemma that needs to be addressed.

Originality/value

Few longer‐term SIPs' assessments have been realised and the differences between professional groups have not been well quantified. As a result of this paper, benefits of and barriers to conducting RCAs are now more clearly understood.

Details

International Journal of Health Care Quality Assurance, vol. 20 no. 7
Type: Research Article
ISSN: 0952-6862

Keywords

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Article
Publication date: 9 October 2007

Jeffrey Braithwaite, Mary T. Westbrook, Joanne F. Travaglia, Rick Iedema, Nadine A. Mallock, Debbi Long, Peter Nugus, Rowena Forsyth, Christine Jorm and Marjorie Pawsey

The purpose of this study is to evaluate the effects of a health system‐wide safety improvement program (SIP) three to four years after initial implementation.

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1646

Abstract

Purpose

The purpose of this study is to evaluate the effects of a health system‐wide safety improvement program (SIP) three to four years after initial implementation.

Design/methodology/approach

The study employs multi‐methods studies involving questionnaire surveys, focus groups, in‐depth interviews, observational work, ethnographic studies, documentary analysis and literature reviews with regard to the state of New South Wales, Australia, where 90,000 health professionals, under the auspices of the Health Department, provide healthcare to a seven‐million population. After enrolling many participants from various groups, the measurements included: numbers of staff trained and training quality; support for SIP; clinicians' reports of safety skills acquired, work practices changed and barriers to progress; RCAs undertaken; observation of functioning of teams; committees initiated and staff appointed to deal with adverse events; documentation and computer records of reports; and peak‐level responses to adverse events.

Findings

A cohort of 4 per cent of the state's health professionals has been trained and now applies safety skills and conducts RCAs. These and other senior professionals strongly support SIP, though many think further culture change is required if its benefits are to be more fully achieved and sustained. Improved information‐handling systems have been adopted. Systems for reporting adverse incidents and conducting RCAs have been instituted, which are co‐ordinated by NSW Health. When the appropriate structures, educational activities and systems are made available in the form of an SIP, measurable systems change might be introduced, as suggested by observations of the attitudes and behaviours of health practitioners and the increased reporting of, and action about, adverse events.

Originality/value

Few studies into health systems change employ wide‐ranging research methods and metrics. This study helps to fill this gap.

Details

International Journal of Health Care Quality Assurance, vol. 20 no. 7
Type: Research Article
ISSN: 0952-6862

Keywords

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Article
Publication date: 11 September 2007

Jeffrey Braithwaite, Rick A. Iedema and Christine Jorm

The purpose of the paper is to examine the deep conceptual underpinnings of trust and communication breakdowns via selected health inquiries into things that go wrong…

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2391

Abstract

Purpose

The purpose of the paper is to examine the deep conceptual underpinnings of trust and communication breakdowns via selected health inquiries into things that go wrong using evolutionary psychology.

Design/methodology/approach

This paper explains how this is carried out, and explores some of the adverse consequences for patient care. Evolutionary psychology provides a means of explaining important mental capacities and constructs including theory of mind and the social brain hypothesis. To have a theory of mind is to be able to read others' behaviours, linguistic and non‐verbal cues, and analyse their intentions. To have a social (or Machiavellian) brain means being able to assess, compete with and, where necessary, outwit others. In the tough and complex environment of the contemporary health setting, not too different from the Pleistocene, humans display a well‐developed theory of mind and social brains and, using mental attributes and behavioural repertoires evolved for the deep past in hunter‐gatherer bands, survive and thrive in difficult circumstances.

Findings

The paper finds that, while such behaviours cannot be justified, armed with an evolutionary approach one can predict survival mechanisms such as turf protection, competitive strategies, sending transgressors and whistleblowers to Coventry, self‐interest, and politics and tribal behaviours.

Originality/value

The paper shows that few studies examine contemporary health sector behaviours through an evolutionary psychology lens or via such deep accounts of human nature.

Details

Journal of Health Organization and Management, vol. 21 no. 4/5
Type: Research Article
ISSN: 1477-7266

Keywords

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Article
Publication date: 5 December 2016

David Birnbaum and Michael Decker

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229

Abstract

Details

International Journal of Health Governance, vol. 21 no. 4
Type: Research Article
ISSN: 2059-4631

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Article
Publication date: 19 December 2016

Kathryn Greenwood, Christine Carroll, Lucie Crowter, Kim Jamieson, Laura Ferraresi, Anna-Marie Jones and Rupert Brown

Stigma towards severe mental illness (SMI) is widespread, exacerbating mental health problems, and impacting on help-seeking and social inclusion. Anti-stigma campaigns…

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1193

Abstract

Purpose

Stigma towards severe mental illness (SMI) is widespread, exacerbating mental health problems, and impacting on help-seeking and social inclusion. Anti-stigma campaigns are meeting with success, but results are mixed. Earlier intervention to promote positive mental health literacy rather than challenge stigma, may show promise, but little is known about stigma development or interventions in younger children. The purpose of this paper is to investigate children’s knowledge, attitudes and behaviour towards SMI and whether we can positively influence children’s attitudes before stigma develops.

Design/methodology/approach

A cross-sectional study investigated mental health schema in 7-11 year olds. An experimental intervention investigated whether an indirect contact story-based intervention in 7-8 year olds led to more positive mental health schema.

Findings

Young children’s schema were initially positive, and influenced by knowledge and contact with mental illness and intergroup anxiety, but were more stigmatising in older girls as intergroup anxiety increased. The indirect contact intervention was effective in promoting positive mental health schema, partially mediated by knowledge.

Social implications

Intervening early to shape concepts of mental illness more positively, as they develop in young children, may represent a more effective strategy than attempting to challenge and change mental health stigma once it has formed in adolescents and adults.

Originality/value

This study is the first to investigate an intervention targeted at the prevention of stigma towards SMI, in young children, at the point that stigma is emerging.

Details

Journal of Public Mental Health, vol. 15 no. 4
Type: Research Article
ISSN: 1746-5729

Keywords

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