Browsing by Author "White, Deborah Elizabeth"

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    An Ethnographic Study of Interprofessional Collaboration in Palliative Care
    (2024-01-09) Forsyth, Erin Christine; Raffin Bouchal, Donna Shelley; Sinclair, Shane Aaron; White, Deborah Elizabeth; Mather, Charles Maurice
    Background: The concept of the modern palliative care movement was initially developed by Cecily Saunders. She believed that the complex emotional, physical, and spiritual needs of dying patients and their families were best met by a team of professionals working together rather than a sole practitioner. Today local, national, and international definitions of palliative care remain grounded in the philosophy established by Saunders, where care is most effectively delivered by an interprofessional team working in a collaborative manner to support patient and family centred goals. Research Aim: The purpose of this study was to better understand the differences in interprofessional collaboration between palliative care teams in different clinical settings. The research questions were: 1) Do palliative care providers believe interprofessional collaboration is important? and 2) What are the contextual factors that act as either facilitators or barriers to the implementation of interprofessional collaboration in practice? Methods: A qualitative ethnographic methodology was used to understand the factors impacting interprofessional collaboration in three separate teams providing palliative care in different settings in a city in Western Canada. Data were collected and analyzed using Carspecken’s five step process for ethnographic research. Participant observation and focus groups were conducted with interprofessional team members responsible for providing direct care for palliative care patients/families. Findings: Five themes emerged from the data: Interprofessional Collaboration: A Central Tenet of Palliative Care; Interprofessional Communication: The Single Most Important Ingredient for Effective Interprofessional Collaboration; Professional Hierarchy Impacts Interprofessional Collaboration; Role Understanding and Valuing Others; and Facilitators and Barriers to Team Function. Discussion: Findings from this study can be used to better understand how individual, professional, and organizational culture impacts teamwork in the delivery of palliative care and supports opportunities for understanding and mitigating the barriers to interprofessional collaboration in palliative care settings. The structure and values of the team impact interprofessional collaboration: how communication is enacted; how the hierarchy of the team influences who is viewed as having the ultimate authority over care; and how role understanding and valuing others drives interactions with other members of the team.
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    Consequence Delimiting: A Grounded Theory of Healthcare Leader Decision Making in the Context of Adverse Events
    (2018-05-22) McRae, Leonard Glenn; White, Deborah Elizabeth; Estefan, Andrew; Raffin Bouchal, Shelley; Reilly, Sandra Muir; Sheps, Samuel Barry
    Adverse events (AEs) remain a central focus of North American healthcare leaders (HLs) since the release of the Institute of Medicine’s (IOM) report: “To Err is Human” in 1999 (Institute of Medicine, 1999). The IOM reported that as many as 98,000 people died from preventable deaths every year in the United States as a result of errors in the delivery of healthcare. Studies in other healthcare systems report comparable rates of harm (Baker et al., 2004; Thomas et al., 2000; Vincent, Neale, & Woloshynowych, 2001). The high incidence of AEs coupled with healthcare leaders’ fiduciary and regulatory responsibilities to manage these events result in its central import for healthcare leaders. The aim of this study was to discover a general substantive theory on how HLs approach accountability in the context of adverse events (AEs). The research findings were that the main concern of HLs was determining how to respond to each AE. Consequence Delimiting emerged as the core category of this classic grounded theory (CGT). The theory was conceptualized as a stage theory where multiple phases proceed sequentially and each produces a product that is built upon by subsequent stages to ultimately produce an outcome. Consequence Delimiting begins at the time that the HL accountable for managing the AE; the accountable leader (AL) becomes aware of the AE and proceeds through the interrelated categories of apprehending, story constructing, expectation navigating and truth promoting to an event disposition. The emergent theory takes particular cognizance of the role that context and discretion play in determining the disposition of an AE. It highlights the influence of organizational and leadership culture, constraints and the role of pathways in influencing the disposition. Consequence Delimiting has implications for regulators and healthcare leaders interested in better understanding and improving patient safety in their organizations.
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    Optimizing Advance Care Planning in the Acute Cardiac Care Setting: A combined quality improvement and knowledge translation approach.
    (2019-03-17) Shaw, Marta; Holroyd-Leduc, Jayna M.; Simon, Jessica E.; White, Deborah Elizabeth; Flemons, William Ward; Grant, Jeff Andrew
    Advance care planning (ACP) is a process by which patients are able to prepare for future in-the-moment medical decision-making and share their values, wishes and preferences. ACP is important as patients are often not well informed about life-sustaining treatments, they can endure more invasive care at end of life than they would want, and they spend more time in hospital than they prefer. Despite known benefits of ACP and recognition of its importance, its integration into regular clinical workflow remains limited. We conducted three studies to examine and address the problem of integrating ACP process into clinical workflow. The first study utilized qualitative methods to characterize ACP process across clinical contexts. In the second study, we utilized an integrated knowledge translation approach to design and implement a multifaceted intervention to routinize ACP process in one hospital unit. We assessed outcomes using an interrupted time series design, and collected data for thirty-two weeks; before, during and after the intervention period. In our third study, we utilized multiple methods to conduct a process evaluation to better understand the effectiveness of our ACP intervention implementation procedure. From our first study, we found that there was significant variability of ACP process both across and within clinical contexts. Segmented regression analysis from our ACP intervention, showed an increase in the proportion of patients to be discharged with a prepared green sleeve, containing their ACP documentation. No significant change was measured for the remaining process and outcome measures. The process evaluation indicated that limitations in the engagement of physicians may have constrained the impact of the intervention. Future opportunities have already begun to address implementation challenges of this work and are using tailored and targeted approaches to improve the reach of intervention components. This program of study comprised of an effort to improve the integration of ACP process into clinical workflow using an iKT approach. Process evaluation helped to provide a deeper understanding of the implementation process. Future research can help to address implementation challenges of this study by focusing on tailored engagement of knowledge users and a strengthening of skill and team building.
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    A Value Driven, Co-designed Framework for Sustained Patient Engagement
    (2019-04-22) McCarron, Tamara L.; Marlett, Nancy J.; Noseworthy, Tom W.; Hassay, Derek N.; White, Deborah Elizabeth; Lorenzetti, Diane L.; Bryan, Stirling; McCaughey, Deirdre
    Patient involvement in various aspects of healthcare, from improving healthcare quality to promoting patient safety, has emerged as a critical priority, but understanding how best to engage patients is not well-understood. This knowledge gap results in frustrating barriers for decision-makers looking to draw transferable lessons to inform the design of patient engagement programs and processes. Coupled with challenges to the sustainability of health care and the need for innovative solutions, patient engagement has become central to improving both quality and delivery of services. This thesis is comprised of three independent studies that form an overarching program of research. The first study reports the results of a scoping review to understand how health systems are investing in building the capacity and ability of patients. In the second study, we build on the findings from the scoping review and a series of qualitative interviews to inform a provincial survey tool to understand the motivations of individuals who chose to give their time and talents to health organizations. In the third study, we co-designed a framework for patient engagement, grounded in market choice behaviour theory and informed by the literature, a province-wide survey and four provincial stakeholder workshops. While significant research exists that highlights the motivations of the public who choose to participate in decision-making, a limited number of studies have explored these concepts within healthcare. As the roles of patient and family members in the context of healthcare decision-making continue to evolve, the importance of effective and sustainable engagement programs will become increasingly important. A deeper knowledge of patient motivations will not only create meaningful engagement opportunities for patients but will also enable health organizations to gain from the experience of these individuals. While further research is needed to support the engagement of diverse groups of stakeholders, the findings from this study have developed an understanding of how patients are motivated to make engagement decisions. This knowledge will help focus patient engagement efforts, thereby improving the efficiency and cost effectiveness of these programs, ensuring their relative sustainability.