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Sickness absence is a major concern for healthcare services and their employees with healthcare workers having higher sickness absence rates compared to the general population. The purpose of this paper is to systematically review randomised control trials (RCTs) that aimed to reduce sickness absence among healthcare workers.

A systematic review was conducted that aimed to include RCTs with study participants who were employed in any part of the healthcare sector. This review included any type of intervention with the primary outcome measure being sickness absence.

Seven studies were included in the review and consisted of one exercise-only intervention, three multicomponent intervention programmes, two influenza vaccination interventions and one process consultation. Three studies (exercise-only, one multicomponent intervention programme and one influenza vaccination intervention) were able to demonstrate a reduction in sickness absence compared to control.

Due to the lack of high-quality evidence, this review identified that there are currently no interventions that healthcare organisations are able to use to effectively reduce sickness absence among their employees. This review also highlights the importance of a standardised measure of sickness absence for healthcare staff, such as shifts.

To the authors’ knowledge, this is the first systematic review to synthesise such evidence among healthcare workers.

The purpose of this paper is to examine any unanticipated effects of an educational intervention among newly arrived adult immigrants attending a language school in Denmark.

A qualitative case study was conducted including interviews with nine informants, observations of two complete intervention courses and an analysis of the official intervention documents.

This case study exemplifies how the basic normative assumptions behind an immigrant-oriented intervention and the intrinsic power relations therein may be challenged and negotiated by the participants. In particular, the assumed (power) relations inherent in immigrant-oriented educational health interventions, in which immigrants are in a novice position, are challenged, as the immigrants are experienced adults (and parents) in regard to healthcare. The paper proposes that such unexpected conditions for the implementation – different from the assumed conditions – not only challenge the implementation of the intervention but also potentially produce unanticipated yet valuable effects.

Newly arrived immigrants represent a hugely diverse and heterogeneous group of people with differing values and belief systems regarding health and healthcare. A more detailed study is necessary to fully understand their health seeking behaviours in the Danish context.

Offering newly arrived immigrants a course on health and the healthcare system as part of the mandatory language courses is a new and underexplored means of providing and improving newly arrived immigrants knowledge and use of the Danish healthcare system.

Implementing change in healthcare is difficult to accomplish due to the unpredictability associated with challenging the status quo. Adapting the intervention/practice/program being implemented to better fit the complex context is an important aspect of implementation success. Despite the acknowledged influence of context, the concept continues to receive insufficient attention at the team-level within implementation research. Using two heterogeneous multidisciplinary healthcare teams as implementation case studies, this study evaluates the interplay between context and implementation and highlights the ways in which context influences the introduction of a collective leadership intervention in routine practice.

The multiple case study design adopted, employed a triangulation of qualitative research methods which involved observation (Case A = 16 h, Case B = 15 h) and interview data (Case A = 13 participants, Case B = 12 participants). Using an inductive approach, an in-depth thematic analysis of the data outlined the relationship between team-level contextual factors and implementation success.

Themes are presented under the headings: (1) adapting to the everyday realities, a key determinant for implementation success and (2) implementation stimulating change in context. The findings demonstrate a dynamic relationship between context and implementation. The challenges of engaging busy healthcare professionals emphasised that mapping the contextual complexity of a site and adapting implementation accordingly is essential to enhance the likelihood of successful implementation. However, implementation also altered the surrounding context, stimulating changes within both teams.

By exposing the reciprocal relationship between team-level contextual factors and implementation, this research supports the improved design of implementation strategies through better understanding the interplay and mutual evolution of evidence-based healthcare interventions within different contexts.

The field of implementation science has emerged as a response to the challenges experienced in translating evidence-based practice and research findings to healthcare settings. Whilst the field has grown considerably in recent years, comparatively, there is a conspicuous lack of attention paid to the work of pre-implementation, that is, how we effectively engage with organisations to support the translation of research into practice. Securing the engagement and commitment of healthcare organisations and staff is key in quality improvement and organisational research. In this paper the authors draw attention to the pre-implementation phase, that is, the development of an amenable context to support implementation research.

Drawing from examples across an interdisciplinary group of health systems researchers working across a range of healthcare organisations, the authors present a reflective narrative viewpoint. They identify the principal challenges experienced during the course of their work, describe strategies deployed to effectively mitigate these challenges and offer a series of recommendations to researchers based on their collective experiences of engaging in collaborations with healthcare organisations for research and implementation. This reflective piece will contribute to the narrative evidence base by documenting the challenges, experiences and learning emerging from the authors’ work as university researchers seeking to engage and collaborate with healthcare organisations.

The RELATE model is presented to guide researchers through six key steps and sample strategies in working to secure organisational buy-in and creating a context amenable to implementation and research. The six stages of the RELATE model are: (1) Recognising and navigating the organisation's complexity; (2) Enhancing understanding of organisational priorities and aligning intervention; (3) Leveraging common values and communicating to key individuals the value of implementation research; (4) Aligning and positioning intervention to illustrate synergies with other initiatives; (5) Building and maintaining credibility and trust in the research team; and (6) Evolving the intervention through listening and learning.

The authors hope this guidance will stimulate thinking and planning and indeed that it will encourage other research teams to reflect and share their experiences and strategies for successful engagement of organisations, thus developing a knowledge base to strengthen implementation efforts and increase efficacy in this important enterprise.

Researchers must relate to the world’s everyday reality of the healthcare managers and administrators and enable them to relate to the potential of the research world in enhancing practice if we are to succeed in bringing the evidence to practice in a timely and efficient manner. Climates receptive to implementation must be developed incrementally over time and require actors to navigate messy and potentially unfamiliar organisational contexts. In this paper, the often invisible and lamentably underreported work of how we begin to work with healthcare organisations has been addressed. The authors hope this guidance will stimulate thinking and planning and indeed that it will encourage other research teams to reflect and share their experiences and strategies for successful engagement of organisations, thus developing a knowledge base to strengthen implementation efforts and increase efficacy in this important enterprise.

Measures are important to healthcare outcomes. Outcome changes result from deliberate selective intervention introduction on a measure. If measures can be characterized and categorized, then the resulting schema may be generalized and utilized as a framework for uniquely identifying, packaging and comparing different interventions and probing target systems to facilitate selecting the most appropriate intervention for maximum desired outcomes. Measure characterization was accomplished with multi-axial statistical analysis and measure categorization by logical tabulation. The measure of interest is a key provider productivity index: “patient visits per hour,” while the specific intervention is “patient schedule manipulation by overbooking.” The paper aims to discuss these issues.

For statistical analysis, interrupted time series (ITS), robust-ITS and outlier detection models were applied to an 18-month data set that included patient visits per hour and intervention introduction time. A statistically significant change-point was determined, resulting in pre-intervention, transitional and post-effect segmentation. Linear regression modeling was used to analyze pre-intervention and post-effect mean change while a triangle was used to analyze the transitional state. For categorization, an “intervention moments” table was constructed from the analysis results with: time-to-effect, pre- and post-mean change magnitude and velocity; pre- and post-correlation and variance; and effect decay/doubling time. The table included transitional parameters such as transition velocity and transition footprint visualization represented as a triangle.

The intervention produced a significant change. The pre-intervention and post-effect means for patient visits per hour were statistically different (0.38, p=0.0001). The pre- and post-variance change (0.23, p=0.01) was statistically significant (variance was higher post-intervention, which was undesirable). Post-intervention correlation was higher (desirable). Decay time for the effect was calculated as 11 months post-effect. Time-to-effect was four months; mean change velocity was +0.094 visits per h/month. A transition triangular footprint was produced, yielding 0.35 visits per hr/month transition velocity. Using these results, the intervention was fully profiled and thereby categorized as an intervention moments table.

One limitation is sample size for this time series, 18 monthly cycles’ analysis. However, interventions on measures in healthcare demand short time cycles (hence necessarily yielding fewer data points) for practicality, meaningfulness and usefulness. Despite this shortcoming, the statistical processes applied such as outliers detection, t-test for mean difference, F-test for variances and modeling, all consider the small sample sizes. Seasonality, which usually affects time series, was not detected and even if present, was also considered by modeling.

Obtaining an intervention profile, made possible by multidimensional analysis, allows interventions to be uniquely classified and categorized, enabling informed, comparative and appropriate selective deployment against health measures, thus potentially contributing to outcomes optimization.

The inevitable direction for healthcare is heavy investment in measures outcomes optimization to improve: patient experience; population health; and reduce costs. Interventions are the tools that change outcomes. Creative modeling and applying novel methods for intervention analysis are necessary if healthcare is to achieve this goal. Analytical methods should categorize and rank interventions; probe the measures to improve future selection and adoption; reveal the organic systems’ strengths and shortcomings implementing the interventions for fine-tuning for better performance.

An “intervention moments table” is proposed, created from a multi-axial statistical intervention analysis for organizing, classifying and categorizing interventions. The analysis-set was expanded with additional parameters such as time-to-effect, mean change velocity and effect decay time/doubling time, including transition zone analysis, which produced a unique transitional footprint; and transition velocity. The “intervention moments” should facilitate intervention cross-comparisons, intervention selection and optimal intervention deployment for best outcomes optimization.

The purpose of this study is to identify organisational homeostasis factors in the context of healthcare organisations and to develop a conceptual model for green transformation.

The organisational homeostasis factors were determined by review of literature study and the opinions of healthcare experts. Scheduled interviews and closed-ended questionnaires are employed to collect data for this research. This study employed “TISM methodology” and “MICMAC analysis” to better comprehend how the components interact with one another and prioritise them based on their driving and dependence power.

This study identified 10 factors of organisational homeostasis in healthcare organisation. Recognition of interdependence, hormesis, strategic coalignment, consciousness on dependence of healthcare resources and cybernetic principle of regulations are the driving or key factors of this study.

The study's primary focus was on the organisational homeostasis factors in healthcare organisations. The methodological approach and structural model are used in a healthcare organisation; in the future, these approaches can be applied to other industries as well.

The key drivers of organisational homeostasis and the identified factors will be better comprehended and understood by academic and important stakeholders in healthcare organisations. Prioritizing the factors helps the policymakers to comprehend the organisational homeostasis for green transformation in healthcare.

In this study, the TISM and MICMAC analysis for healthcare is proposed as an innovative approach to address the organisational homeostasis concept in the context of green transformation in healthcare organisations.

At the outbreak of the COVID-19 pandemic, the absence of pharmaceutical agents meant that policy institutions had to intervene by providing nonpharmaceutical interventions (NPIs). To satisfy this need, the World Health Organization (WHO) issued policy guidelines, such as NPIs, and the government of Pakistan released its own policy document that included social distancing (SD) as a containment measure. This study explores the policy actors and their role in implementing SD as an NPI in the context of the COVID-19 pandemic.

The study adopted the constructs of Normalization Process Theory (NPT) to explore the implementation of SD as a complex and novel healthcare intervention under a qualitative study design. Data were collected through document analysis and interviews, and analysed under framework analysis protocols.

The intervention actors (IAs), including healthcare providers, district management agents, and staff from other departments, were active in implementation in the local context. It was observed that healthcare providers integrated SD into their professional lives through a higher level of collective action and reflexive monitoring. However, the results suggest that more coherence and cognitive participation are required for integration.

This novel research offers original and exclusive scenario narratives that satisfy the recent calls of the neo-implementation paradigm, and provides suggestions for managing the implementation impediments during the pandemic. The paper fills the implementation literature gap by exploring the normalisation process and designing a contextual framework for developing countries to implement guidelines for pandemics and healthcare crises.

The purpose of this paper is to report on a process evaluation of a randomised controlled trial (RCT) intervention study that tested the effectiveness of classroom- and simulation-based crew resource management courses, alone and in combination, and identifies organisational barriers and facilitators to implementation of team training programmes in healthcare.

The RCT design consisted of a before and after study with a team training intervention. Quantitative data were gathered on utility and affective reactions to training, and on teamwork knowledge, attitudes, and behaviours of the learners. A sample of participants was interviewed at the conclusion of the study. Interview responses were analysed, alongside qualitative elements of the classroom course critique, to search for evidence, context, and facilitation clues to the implementation process.

The RCT method provided scientifically robust data that supported the benefits of classroom training. Qualitative data identified a number of facilitators to implementation of team training, and shed light on some of the ways that learning was diffused throughout the organisation. Barriers to successful implementation were also identified, including hospital time and resource constraints and poor organisational communication.

Quantitative randomised methods have intermittently been used to evaluate team training interventions in healthcare. Despite two decades of team training trials, however, the authors do not know as well as the authors would like what goes on inside the “black box” of such RCTs. While results are usually centred on outcomes, this study also provides insight into the context and mechanisms associated with those outcomes and identifies barriers and facilitators to successful intervention implementation.

The study aimed to understand the significance of how employee personhood and the act of speaking up is shaped by factors such as employees' professional status, length of employment within their hospital sites, age, gender and their ongoing exposure to unprofessional behaviours.

Responses to a survey by 4,851 staff across seven sites within a hospital network in Australia were analysed to interrogate whether speaking up by hospital employees is influenced by employees' symbolic capital and situated subjecthood (SS). The authors utilised a Bourdieusian lens to interrogate the relationship between the symbolic capital afforded to employees as a function of their professional, personal and psycho-social resources and their self-reported capacity to speak up.

The findings indicate that employee speaking up behaviours appear to be influenced profoundly by whether they feel empowered or disempowered by ongoing and pre-existing personal and interpersonal factors such as their functional roles, work-based peer and supervisory support and ongoing exposure to discriminatory behaviours.

The findings from this interdisciplinary study provide empirical insights around why culture change interventions within healthcare organisations may be successful in certain contexts for certain staff groups and fail within others.

Healthcare delivery faces increasing pressure to move from a provider-centered approach to become more consumer-driven and patient-centered. However, many of the actions taken by clinicians, patients and organizations fail to achieve that aim. This paper aims to take a paradox-based perspective to explore five specific tensions that emerge from this shift and provides implications for patient experience research and practice.

This paper uses a conceptual approach that synthesizes literature in health services and administration, organizational behavior, services marketing and management and service operations to illuminate five patient experience tensions and explore mitigation strategies.

The paper makes three key contributions. First, it identifies five tensions that result from the shift to more patient-centered care: patient focus vs employee focus, provider incentives vs provider motivations, care customization vs standardization, patient workload vs organizational workload and service recovery vs organizational risk. Second, it highlights multiple theories that provide insight into the existence of the tensions and how they may be navigated. Third, specific organizational practices that engage the tensions and associated examples of leading organizations are identified. Relevant measures for research and practice are also suggested.

The authors develop a novel analysis of five persistent tensions facing healthcare organizations as a result of a shift to a more consumer-driven, patient-centered approach to care. The authors detail each tension, discuss an existing theory from organizational behavior or services marketing that helps make sense of the tension, suggest potential solutions for managing or resolving the tension and provide representative case illustrations and useful measures.