Journal of evaluation in clinical practice
-
Evidence suggests that sustainability planning and the use of a collaborative approach to planning result in better sustainability outcomes and more relevant knowledge. Yet, both approaches appear to be underutilized. A detailed description of collaborative sustainability planning may encourage the use of these two impactful strategies. ⋯ Identified strategies may be useful to support (collaborative) sustainment. Future research could investigate the effect of collaborative sustainability planning on sustainability objectives, and the relationship between these objectives.
-
Home care allows patients with functional limitations to receive services at home and prevent health decline. Home care can reduce hospitalization and emergency department (ED) transfers. Integrating primary healthcare nurse practitioners (PHCNPs) in home care increases the supply of services, but little is known about their influence on patients' ability to remain at home. ⋯ PHCNPs in interprofessional home care teams show promise in reducing hospitalizations and ED transfers through planned visits. These findings provide valuable insights that can contribute to enhancing home care services for a population with limited access to healthcare and high healthcare needs. Further research is needed in other jurisdictions.
-
Nursing homes struggle to meet the needs of their residents as they become older and frailer, live with more complex co-morbidity, and are impacted by memory impairment and dementia. Moreover, the nursing home system is overwhelmed with significantly constraining organisational and regulatory demands that stand in the way of achieving resident-focused outcomes. ⋯ The system is beyond the state of 'reform' and requires a fundamental redesign based on first organisational systems understandings: a clearly defined purpose and goal, shared values, and system-wide agreed "simple (or operating) rules". A 'fit-for-purpose' future requires a complex adaptive nursing home system characterised by seamless 'bottom-up and top-down' information flows to ensure that the necessary 'work that needs to be done' is done, and a governance structure that focuses on quality improvement and holds the system accountable for the quality of care that is provided.
-
Many organisations struggle to achieve their true potential. In part it is a problem of organisational design, which is an outcome of a particularly common-command and control-leadership philosophy. ⋯ Systems and complexity thinking provide different ways of understanding organisations and their complex adaptive behaviours. In this paper, we first describe the key characteristics of complex adaptive organisations-their structure and dynamic behaviours-and then propose a three-dimensional visualisation of a complex adaptive organisation that allows its members to clearly see and appreciate its interdependencies.