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This article aims to review the available literature on how clinicians meet the daily challenge of translating medical information into clinical EBM. It also seeks to describe the procedures involved in a local initiative in the UK to develop software applications for implementation of national clinical guidelines to enhance EBM in routine clinical practice.

It was hypothesised that improved access to these guidelines in routine clinical practice could be achieved through integrated local procedures, thereby enhancing the quality of care provided to children and adolescents with asthma or UTI. A literature search was performed using databases. To explore the preferences of the doctors and other healthcare professionals on how they accessed clinical guidelines, feedback was obtained. Stepwise implementation of the clinical guidelines was instituted over a period of three years in different primary care and hospital settings.

The professionals actively engaged with all the different stages in the implementation of the clinical guidelines. The majority preferred the interactive computerized system based on its ease of use, better aesthetic features, familiarity with the software and limited dependence on the technical skills of the users.

The limitations of this study include lack of systematic data to assess the clinical effectiveness of the guidelines' implementation. Another apparent limitation of the study is the small size of participants within the paediatric unit of each organisation where the study was conducted.

There is a need for further comparative studies between the local intervention strategies described in this study and other implementation strategies, to identify the most effective implementation methods for electronic guideline‐based systems.

Reliable high quality guidelines from reputable professional bodies could be successfully implemented at the primary or hospital‐based levels through a series of coordinated multidisciplinary interactive processes. This study has positive implications for improving the quality of care provided to children and adolescents, enhancing the role of clinical governance, provision of useful information to patients/carers and other healthcare providers.

This study highlights a potentially effective way of implementing and integrating an electronic guideline‐based computer system into local practice.

This study aims to use a narrative-based simulation approach to explore potential implications of including or excluding a dayroom in the design of an internal medicine ward.

The approach involved: collecting data in facilities using field observations and experts’ interviews; modeling representative behavior patterns in the form of rule-based narratives that direct collaborative behaviors of virtual occupants; simulating the behavior patterns in two alternative design options, one of which includes a dayroom; and analyzing the simulation results with respect to selected key performance indicators of day-to-day operations and spatial occupancy, including occupant density in corridors, number and locations of staff-visitor interactions and duration of a doctors’ round procedure.

Simulation results suggest that the presence of a dayroom reduces visitors’ density in corridors and diminishes the number of staff–visitor interactions that can delay the performing of scheduled medical procedures.

A high level of uncertainty is intrinsic to the simulation of future human behavior. Additional work is required to systematically collect large volumes of occupancy data in existing facilities, model additional narratives and develop validation protocols to assess the degree of uncertainty of the proposed model.

A limited number of studies explore how simulation can be used to study the impact of building design on operations. This study uses a narrative-based approach to address some of the limitations of existing methods, including discrete-event simulations. Preliminary results suggest that the lack of appropriate spaces for patients and visitors to socialize may cause potential disruptions to hospital operations.

The purpose of this paper is to illustrate the design, development, delivery and evaluation of a customised team building project on a paediatric unit.

The project content was tailored to meet the developmental needs of the staff working within the units, incorporating both soft and hard leadership approaches. A personal self development approach was used, and how this could enhance team working. Theory was embedded using innovative approaches that enabled practical application facilitating both surface and deep learning.

All staff participated and found themselves to have significantly developed both as individuals and as a team. They also identified the support required from management in order to fulfil their potential and to work effectively as a team. The teams have since completion of the project been more cohesive, are working more effectively and patient care has improved.

The project demonstrated how externally developed team building projects can be an effective approach to team building and leadership skill set acquisition, which can then be utilised in the practice arena.

Utilisation of a person centred approach to team building enables the individual to develop both as an individual and as a team – allowing them to contribute at a higher level.

Preventing burnout and promoting psychological well-being in nurses are of great importance. In this study the effect of an online, stand-alone individualized preventive program for nurse burnout based on cognitive behavioral therapy (CBT) is described and explained.

A mixed method study with an explanatory sequential design was applied. Quantitative data were collected from September 2015 to March 2016 during an intervention study with a pretest-posttest wait-list control group design within a population of hospital nurses in the Dutch speaking part of Belgium. Consecutively, 13 nurses from the intervention group who fully completed the program were interviewed.

All interviewed participants experienced some sort of effect due to working with the program. Emotional exhaustion remained stable in the intervention group and increased in the control group. However, this difference was not significant. Personal accomplishment decreased significantly within the intervention group when compared to the control group. This might be explained by the self-awareness that was created through the program, which confronted participants with their weaknesses and problems.

This study adds to the understanding of online individual burnout prevention. The results suggest the feasibility of an online program to prevent nurse burnout. This could be optimized by complementing it with organizational interventions, introducing refresher courses, reminders and follow-up. Furthermore, additional attention should be devoted to preparing the implementation in order to minimize attrition rates.

Positive sexual growth is a key developmental challenge for all children and adolescents. An acquired brain injury (ABI) can create major hurdles to achieving this goal. A conceptual model will be outlined that suggests sexual growth is achieved by progress across six domains, namely: social competence versus social isolation; identity formation, individuation and independence versus dependence and lack of individual identity; physical development versus physical challenge; sexually informed and educated versus sexually ignorant and uneducated; sexually experienced versus sexually inexperienced; and sexually appropriate behaviour versus sexually inappropriate behaviour. The ability to form successful peer relationships is a key mediating factor in the developmental process. Drawing on this model, a number of strategies will be outlined that support the positive sexual development of children and adolescents after ABI.

The purpose of this paper is to contribute to knowledge about dissemination strategies for Lean thinking throughout multiple healthcare organisations.

The Östergötland county council, Sweden (CCÖ) was chosen as a case study for an healthcare Lean-thinking dissemination strategies. Document analysis and interviews were used and results were compared with similar strategies employed by staff at the National Health Service Institute for Innovation (NHSI) and improvement in Great Britain and the Odense University Hospital in Denmark.

The Lean improvement programme was introduced to tackle challenges such as an ageing society, rising care expectations and budgetary and economic constraints. It was designed as a long-term programme to create added value for patients and employee involvement. The dissemination strategy was: forming clear visions and objectives; piloting; training potential adopters; and formal dissemination. The CCÖ strategy was focused primarily on managers and was not meant to involve all staff until the implementation stage. Staff at the NHSI attempted to address nurses’ needs during dissemination, which questioned whether the CCÖ managers’ dissemination strategy is sustainable.

This paper inspires healthcare managers and decision makers who aim to disseminate Lean production in their organisations.

There are many case studies describing Lean implementation in single healthcare organisations, but little is known about effective dissemination and implementation strategies in large healthcare systems. The authors, therefore, suggest activities for developing and implementing dissemination strategies in multiple healthcare organisations.

The purpose of this paper is to explore how leadership is practiced across four different hospital units.

The study is a comparative case study of four hospital units, based on detailed observations of the everyday work practices, interactions and interviews with ten interdisciplinary clinical managers.

Comparing leadership as configurations of practices across four different clinical settings, the author shows how flexible and often shared leadership practices were embedded in and central to the core clinical work in all units studied here, especially in more unpredictable work settings. Practices of symbolic work and emotional support to staff were particularly important when patients were severely ill.

Based on a study conducted with qualitative methods, these results cannot be expected to apply in all clinical settings. Future research is invited to extend the findings presented here by exploring leadership practices from a micro-level perspective in additional health care contexts: particularly the embedded and emergent nature of such practices.

This paper shows leadership practices to be primarily embedded in the clinical work and often shared across organizational or professional boundaries.

This paper demonstrated how leadership practices are embedded in the everyday work in hospital units. Moreover, the analysis shows how configurations of leadership practices varied in four different clinical settings, thus contributing with contextual accounts of leadership as practice, and suggested “configurations of practice” as a way to carve out similarities and differences in leadership practices across settings.

In Canada, integrated care pilot projects are often implemented as a local reform strategy to improve the quality of patient care and system efficiencies. In the qualitative study reported here, the authors explored the experiences of healthcare professionals when first implementing integrated care pilot projects, bringing together physical and mental health services, in a community hospital setting.

Engaging a qualitative descriptive study design, semi-structured interviews were conducted with 24 healthcare professionals who discussed their experiences with implementing three integrated care pilot projects one year following project launch. The thematic analysis captured early implementation issues and was informed by an institutional logics framework.

Three themes highlight disruptions to established logics reported by healthcare professionals during the early implementation phase: (1) integrated care practices increased workload and impacted clinical workflows; (2) integrating mental and physical health services altered patient and healthcare provider relationships; and (3) the introduction of integrated care practices disrupted healthcare team relations.

Study findings highlight the importance of considering existing logics in healthcare settings when planning integrated care initiatives. While integrated care pilot projects can contribute to organizational, team and individual practice changes, the priorities of healthcare stakeholders, relational work required and limited project resources can create significant implementation barriers.

Several audits of clinical practice have confirmed that there is insignificant yield from screening of prolonged jaundice babies with a wide range of tests including thyroid function test (TFT) and full blood count (FBC). This paper aims to audit local practice based on a newly adopted rationalised protocol of selective screening with split bilirubin supplemented with other investigations based on clinical risk assessment.

The paper uses a retrospective audit of 50 babies referred for prolonged jaundice to a large district hospital in South West England. The authors also designed an easy‐to‐use, user‐friendly software application as a quick aid for implementation of the prolonged jaundice protocol.

The overall annual incidence of prolonged jaundice was 2.2 per cent of all live births. 32 patients (64 per cent) had only split biliburin test according to the protocol. In total 16 patients (32 per cent) had 18 tests requested unnecessarily including seven liver function test (LFT), eight FBC, one each of glucose, TFT and serum electrolytes. No patient with any serious liver disease was missed.

Appropriate recommendations for optimising the implementation of the current protocol based on the available scientific evidence were introduced.

After two years of implementation of the protocol, it has been found to be cost‐effective and safe. The electronic software provides a useful prompt in guiding the investigation of prolonged jaundice.

The nutritionist must be aware of genetic principles, biological variations and the complex genetic and environmental factors which have a direct bearing on the science of nutrition