Shelly McMaster

Bio: Shelly McMaster is an academic researcher from Stormont Vail Health. The author has contributed to research in topics: Workaround & Safety culture. The author has an hindex of 1, co-authored 1 publications receiving 13 citations.

Systems approach to health service design, delivery and improvement: a systematic review and meta-analysis.

Abstract: Objectives To systematically review the evidence base for a systems approach to healthcare design, delivery or improvement. Design Systematic review with meta-analyses. Methods Included were studies in any patients, in any healthcare setting where a systems approach was compared with usual care which reported quantitative results for any outcomes for both groups. We searched Medline, Embase, HMIC, Health Business Elite, Web of Science, Scopus, PsycINFO and CINAHL from inception to 28 May 2019 for relevant studies. These were screened, and data extracted independently and in duplicate. Study outcomes were stratified by study design and whether they reported patient and/or service outcomes. Meta-analysis was conducted with Revman software V.5.3 using ORs—heterogeneity was assessed using I2 statistics. Results Of 11 405 records 35 studies were included, of which 28 (80%) were before-and-after design only, five were both before-and-after and concurrent design, and two were randomised controlled trials (RCTs). There was heterogeneity of interventions and wide variation in reported outcome types. Almost all results showed health improvement where systems approaches were used. Study quality varied widely. Exploratory meta-analysis of these suggested favourable effects on both patient outcomes (n=14, OR=0.52 (95% CI 0.38 to 0.71) I2=91%), and service outcomes (n=18, OR=0.40 (95% CI 0.31 to 0.52) I2=97%). Conclusions This study suggests that a systems approaches to healthcare design and delivery results in a statistically significant improvement to both patient and service outcomes. However, better quality studies, particularly RCTs are needed. PROSPERO registration number CRD42017065920.

Systems thinking and CMM for continuous improvement in the construction industry

Abstract: The purpose of this paper is to present a capability maturity model (CMM) developed to implement continuous improvement in small and medium scale construction companies (SMSCC) in Nigeria.,A multi-strategy approach involving qualitative studies of SMSCC in Nigeria was conducted. Semi-structured interviews were conducted with purposively selected construction experts in Nigeria to identify variables essential for continuous improvement in SMSCC. Data collected were thematically analysed using NVIVO. Subsequently, a system thinking approach is employed to design and develop the CMM for implementing continuous improvement SMSCC, by exploring possible relationships between the variables established.,CMM provided a five-level approach for the inclusion of investigated variables such as team performance; culture; structure; post-project reviews, financial risk management, waste management policy and cost control. These variables are factors leading to continuous improvement in SMSCC, implementable within a six to seven and a half years’ timeline.,The system thinking model revealed cogent archetypes in the form of reinforcing loops that can be applied in developing the performance of SMSCC. Continuous improvement is feasible. However, it takes time to implement. Further longitudinal studies on the cost of implementing continuous improvement through CMM a knowledge transfer project can be initiated.,A methodical strategy for enhancing the effectiveness and operations of SMSCC in developing countries can be extracted from the causal loop diagram and the CMM.

Huddles and their effectiveness at the frontlines of clinical care: a scoping review.

Abstract: Brief, stand-up meetings known as huddles may improve clinical care, but knowledge about huddle implementation and effectiveness at the frontlines is fragmented and setting specific. This work provides a comprehensive overview of huddles used in diverse health care settings, examines the empirical support for huddle effectiveness, and identifies knowledge gaps and opportunities for future research. A scoping review was completed by searching the databases PubMed, EBSCOhost, ProQuest, and OvidSP for studies published in English from inception to May 31, 2019. Eligible studies described huddles that (1) took place in a clinical or medical setting providing health care patient services, (2) included frontline staff members, (3) were used to improve care quality, and (4) were studied empirically. Two reviewers independently screened abstracts and full texts; seven reviewers independently abstracted data from full texts. Of 2,185 identified studies, 158 met inclusion criteria. The majority (67.7%) of studies described huddles used to improve team communication, collaboration, and/or coordination. Huddles positively impacted team process outcomes in 67.7% of studies, including improvements in efficiency, process-based functioning, and communication across clinical roles (64.4%); situational awareness and staff perceptions of safety and safety climate (44.6%); and staff satisfaction and engagement (29.7%). Almost half of studies (44.3%) reported huddles positively impacting clinical care outcomes such as patients receiving timely and/or evidence-based assessments and care (31.4%); decreased medical errors and adverse drug events (24.3%); and decreased rates of other negative outcomes (20.0%). Huddles involving frontline staff are an increasingly prevalent practice across diverse health care settings. Huddles are generally interdisciplinary and aimed at improving team communication, collaboration, and/or coordination. Data from the scoping review point to the effectiveness of huddles at improving work and team process outcomes and indicate the positive impact of huddles can extend beyond processes to include improvements in clinical outcomes. This scoping review was registered with the Open Science Framework on 18 January 2019 ( https://osf.io/bdj2x/ ).

Systems Analysis of Vulnerability to Hydrometeorological Threats: An Exploratory Study of Vulnerability Drivers in Northern Zimbabwe

Abstract: Disasters result from complex interactions of hazards and vulnerability conditions. Reducing human exposure and sensitivity to threats can reduce disaster impact. Prior knowledge about community vulnerability levels is crucial to minimizing potential losses from future threats. Most vulnerability studies focus on high-impact disasters and their temporal and spatial analyses. Yet high-frequency, low-impact disasters have a cumulative potential to severely disrupt or damage socioeconomic systems. There is limited knowledge especially in the global south about the creation of vulnerability to hydrometeorological threats. Using a systems approach, this study explores ways in which communities in the northern semiarid tropics of Zimbabwe are vulnerable to hydrometeorological threats. This predominantly qualitative study used literature review, interviews, transect walks, and focus groups to gather data from selected samples involving smallholder farmers with in-depth knowledge about community vulnerability. The results show that the communities are vulnerable to multiple hydrometeorological threats due to multiple interacting factors including rainfed and flood-based farming, land tenure, topography, climate, and other socioeconomic conditions such as inadequate income sources and high poverty. In order to reduce vulnerability, this study provides five policy options for government and nongovernmental organization interventions, including the need to transform rural economies beyond the traditional rainfed and flood-based farming systems.

Development and Validation of the Systems Thinking Scale

Abstract: Systems thinking is the ability to recognize and synthesize patterns, interactions, and interdependencies in a set of activities and is a key component in quality and safety. A measure of systems thinking is needed to advance our understanding of the mechanisms that contribute to improvement efforts. The purpose of this study was to develop and conduct psychometric testing of a systems thinking scale (STS). The development of the STS included obtaining national quality and safety experts’ conceptual domains of systems thinking and the generation of a provisional set of items. Further psychometric analyses were conducted with interprofessional healthcare faculty (N = 342) and students (N = 224) engaged in quality improvement initiatives and education. Of the 26 items identified in the development phase, factor analyses indicated three factors: (1) system thinking (20 items), (2) personal effort (2 items), and (3) reliance on authority (4 items). The six items from factors 2 and 3 were omitted due to low factor loadings. Test-retest reliability of the 20-item STS was performed on 36 healthcare professionals and a correlation of 0.74 was found. Internal consistency testing on a sample of 342 healthcare professionals using Cronbach’s alpha showed a coefficient of 0.89. Discriminant validity was confirmed with three groups of healthcare professions students (N = 102) who received high, low, or no dose levels of systems thinking education in the context of process improvement. The 20-item STS is a valid and reliable instrument that is easy to administer and takes less than 10 min to complete. Further research using the STS has the potential to advance the science and education of quality improvement in two main ways: (1) increase understanding of a critical mechanism by which quality improvement processes achieve results, and (2) evaluate the effectiveness of our education to improve systems thinking.