Basics of qualitative research: Grounded theory procedures and techniques

* Starting from Need* Evolution of the Toyota Production System* Further Development* Genealogy of the Toyota Production System* The True Intention of the Ford System* Surviving the Low-Growth Period

Toyota production system : beyond large-scale production

Implementation science is growing in importance among funders, researchers, and practitioners as an approach to bridging the gap between science and practice. We addressed three goals to contribute to the understanding of the complex and dynamic nature of implementation. Our first goal was to provide a conceptual overview of the process of implementation by synthesizing information from 25 implementation frameworks. The synthesis extends prior work by focusing on specific actions (i.e., the “how to”) that can be employed to foster high quality implementation. The synthesis identified 14 critical steps that were used to construct the Quality Implementation Framework (QIF). These steps comprise four QIF phases: Initial Considerations Regarding the Host Setting, Creating a Structure for Implementation, Ongoing Structure Once Implementation Begins, and Improving Future Applications. Our second goal was to summarize research support for each of the 14 QIF steps and to offer suggestions to direct future research efforts. Our third goal was to outline practical implications of our findings for improving future implementation efforts in the world of practice. The QIF’s critical steps can serve as a useful blueprint for future research and practice. Applying the collective guidance synthesized by the QIF to the Interactive Systems Framework for Dissemination and Implementation (ISF) emphasizes that accountability for quality implementation does not rest with the practitioner Delivery System alone. Instead, all three ISF systems are mutually accountable for quality implementation.

http://nrepp.samhsa.gov/Docs/The%20Quality%20Implementation%20Framework_%20A%20Synthesis%20of%20Critical%20Steps%20in%20the%20Implementation%20Process%20.pdf

The Quality Implementation Framework: A Synthesis of Critical Steps in the Implementation Process

For some time now councils with social services responsibilities (CSSRs) have been required to conduct surveys of user’s experience of social services. These have taken place nationally in three-yearly cycles. In 2002/03 the survey was for older people, in 2003/04 it was for younger adults with physical and sensory impairments, and in 2004/05 it was for children. 2005/06 marked the beginning of the second wave of the cycle. The mandate for conducting surveys of user’s experiences and satisfaction with services was first given in the white paper Modern Local Government: in Touch with the People (Department for the Environment, Trade and the Regions, 1998). In 2002 the Office of National Statistics (ONS) and SPRU developed a set of questionnaires for this purpose (Qureshi and Rowlands, 2004). Subsequent national surveys have drawn on this work to identify a set of compulsory questions for each round. User experience surveys (UESs) are regarded as an important part of the overall performance framework for social care and, providing councils with information about how they might improve services locally. Local authorities are required to submit their results to government bodies so that the relative performance of the CSSRs can be judged. This report is composed of five sections. The aims and objectives of the report are outlined in the second section and the method used to gather the data is outlined in section 3. In section 4 we report on the findings from the fieldwork and draw some conclusions and recommendations for the national survey in section 5. The topic guides for the focus groups and interviews are included in the appendices along with a brief discussion of the findings from the focus groups and a copy of the final extended questionnaire.

Younger Adults' Understanding of Questions for a Service User Experience Survey. Funded/commissioned by: The Health and Social Care Information Centre

Sesquiterpenoids, and specifically sesquiterpene lactones from Asteraceae, may play a highly significant role in human health, both as part of a balanced diet and as pharmaceutical agents, due to their potential for the treatment of cardiovascular disease and cancer. This review highlights the role of sesquiterpene lactones endogenously in the plants that produce them, and explores mechanisms by which they interact in animal and human consumers of these plants. Several mechanisms are proposed for the reduction of inflammation and tumorigenesis at potentially achievable levels in humans. Plants can be classified by their specific array of produced sesquiterpene lactones, showing high levels of translational control. Studies of folk medicines implicate sesquiterpene lactones as the active ingredient in many treatments for other ailments such as diarrhea, burns, influenza, and neurodegradation. In addition to the anti-inflammatory response, sesquiterpene lactones have been found to sensitize tumor cells to conventional drug treatments. This review explores the varied ecological roles of sesquiterpenes in the plant producer, depending upon the plant and the compound. These include allelopathy with other plants, insects, and microbes, thereby causing behavioural or developmental modification to these secondary organisms to the benefit of the sesquiterpenoid producer. Some sesquiterpenoid lactones are antimicrobial, disrupting the cell wall of fungi and invasive bacteria, whereas others protect the plant from environmental stresses that would otherwise cause oxidative damage. Many of the compounds are effective due to their bitter flavor, which has obvious implications for human consumers. The implications of sesquiterpenoid lactone qualities for future crop production are discussed.

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Sesquiterpenoids Lactones: Benefits to Plants and People

BackgroundIn 2006, the National Institute of Health and Clinical Excellence (NICE) published guidelines for the prevention and management of overweight and obesity. To tailor the implementation of guidelines, information is needed about the prevailing barriers and enablers, and practical methods for identifying barriers and enablers. Aim To uncover and describe barriers and enablers to implementing NICE’s recommendations on the management of obesity in adults in general practice, using practical qualitative methods. MethodsA qualitative study involving semi-structured interviews with seven general practitioners, seven practice nurses and nine overweight or obese patients, exploring their views and experiences on the implementation of NICE guidelines on obesity. The interviews were undertaken and analysed by a health professional with support of a health service researcher; they were recorded and transcribed verbatim and analysed using a thematic framework approach. The analysis described the reported barriers and enablers. Results Barriers included: stigma, cost of private sector services, previous patient experience, practitioners not wanting to take responsibility for obesity management, lack of consistency in care, limited practitioner skills, perceived lack of NHS services and constraints imposed by commissioners. Trust between practitioners and patients, practitioners with the skills and confidence to raise the issue of obesity, practice-based procedures and weight management services being available were perceived as enablers to implementation. ConclusionThis pragmatic study found that there are many barriers to the implementation of NICE guidance on obesity, involving patients, practitioners and support services for primary care.

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Barriers and enablers to managing obesity in general practice: a practical approach for use in implementation activities

Background: Medication-related admissions are an important cause of hospital admissions in older people. The scope for prevention is less clear. Objectives: To characterize medication-related hospital admissions in older people and assess their preventability. Methods: This was a cross-sectional, observational study conducted over 3 months. A pharmacist based in the medical admissions ward of a north London hospital screened all patients aged ≥65 years. A specialist physician assembled additional information, which was presented to a multi-professional panel to confirm attribution and preventability. A total of 409 patients were screened, of whom 14% (95% CI 10.6, 17.4) had medication-related problems, 6.4% (95% CI 4.0, 8.8) were admitted because of medication-related problems and 3.9% (95% CI 2.0, 5.8) were considered to have preventable medication-related problems. Medicines to prevent or treat cardiovascular disease were implicated in 69% (18/26) of the medication-related admissions and 69% (11/16) of preventable medication-related admissions. Amongst hospitalized patients, admission attributed to adverse drug reaction was more likely as the number of medications being taken increased, and admission attributed to undertreatment was more likely as the number of pre-existing conditions increased. Conclusion: Medication-related admissions are common in older people and over half are preventable. Morbidity associated with medicines used for cardiovascular disease is important. There is a difficult balance to be struck between avoiding iatrogenic illness in older people and ensuring they benefit from medications for pre-existing conditions. Opportunities exist for improving the delivery of care to reduce adverse outcomes.

Medication-related admissions in older people: a cross-sectional, observational study.

From 2004 to 2009 there was almost a 12% rise in emergency admissions in England. This can be explained partly by an aging population and other socio-demographic characteristics, but much cannot be explained by these factors. We explored aspects of care, in addition to known demographic characteristics in general practice, that are associated with emergency admissions. A cross-sectional design employing hospital admission data from 76 general practices in Northamptonshire, England for 2006–08, including demographic data, quality and outcomes framework points and GP patient survey outcomes. There were statistically significant associations between emergency admissions and age, gender, distance from hospital and proportion classified as white. There was also a statistically significant relationship between emergency admissions and being able to book an appointment with a preferred doctor; this relationship was stronger in less deprived communities. Enabling patients to book with a preferred doctor, particularly those in less deprived communities could have an impact on reducing emergency admissions. It is possible that being able to consult a preferred GP gives patient’s confidence to avoid an emergency admission or it facilitates consistent clinical management that helps prevent the need for admission. However the findings only explained some of the variation.

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What aspects of primary care predict emergency admission rates? A cross sectional study

In October 2008, the National Institute for Health Research launched nine new research projects to develop and investigate methods of translating research evidence into practice. Given the title Collaborations for Leadership in Applied Health Research and Care (CLAHRC), all involve collaboration between one or more universities and the local health service, but they are adopting different approaches to achieve translation. The translation and implementation programme of this CLAHRC has been built around a pragmatic framework for undertaking research to address live concerns in the delivery of care, in partnership with the managers, practitioners, and patients of the provider organisations of the CLAHRC. Focused on long-term conditions, the constituent research themes are prevention, early detection, self-management, rehabilitation, and implementation. Individual studies have various designs, and include both randomised trials of new ways to deliver care and qualitative studies of, for example, means of identifying barriers to research translation. A mix of methods will be used to evaluate the CLAHRC as a whole, including use of public health indicators, social research methods, and health economics. This paper describes one of the nine collaborations, that of Leicestershire, Northamptonshire, and Rutland. Drawing a distinction between translation as an organising principle for healthcare providers and implementation as a discrete activity, this collaboration is built on a substantial programme of applied research intended to create both research generation and research use capacity in provider organisations. The collaboration in Leicestershire, Northamptonshire, and Rutland has potential to provide evidence on how partnerships between practitioners, patients, and researchers can improve the transfer of evidence into practice.

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The National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Leicestershire, Northamptonshire and Rutland (LNR): a programme protocol

Objective Using a nationally representative sample, to identify groups among British children aged 1 1 / 2 ― 4 1 / 2 years who report similar patterns of diet. Design: Nationally representative dietary survey, using 4 d weighed dietary records, of girls and boys aged 1 1 / 2 ― 4 1 / 2 years living in private households in Great Britain in 1992―1993. Cluster analysis was used to aggregate individuals into diet groups. Setting: Great Britain. Participants: Eight hundred and forty-eight boys and 827 girls. Results: Three clusters were identified for girls and three for boys. Among boys the most prevalent cluster was 'Healthy Diet' (52·3%), the second was 'Convenience Diet' (38·3%) and the third was 'Traditional Diet' (9·3%). Among girls, the most prevalent dietary cluster was 'Healthy Diet' (58·7%), followed by a 'Convenience Diet' (36·6%) and 'Traditional Diet' (4·3%). There were important differences in nutrient profile, sociodemographic and behavioural characteristics between clusters. Conclusions: Cluster analysis identified three groups among both girls and boys which differed not only in terms of reported dietary intake, but also with respect to nutrient intake, social and behavioural characteristics. The groups identified could provide a useful basis for the development, monitoring and targeting of public health nutrition policy for pre-school children in the UK. Further research is needed on the consequences for chronic disease in the future for these children.

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Stephen Rogers

Papers

Barriers and enablers to managing obesity in general practice: a practical approach for use in implementation activities

Medication-related admissions in older people: a cross-sectional, observational study.

What aspects of primary care predict emergency admission rates? A cross sectional study

The National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Leicestershire, Northamptonshire and Rutland (LNR): a programme protocol

Dietary patterns among a national sample of British children aged 1 1/2-4 1/2 years.