Zuneera Khurshid

Bio: Zuneera Khurshid is an academic researcher from University College Dublin. The author has contributed to research in topics: Quality management & Thematic analysis. The author has an hindex of 2, co-authored 4 publications receiving 12 citations.

Virtual adaptation of traditional healthcare quality improvement training in response to COVID-19: a rapid narrative review.

Abstract: Information and communication technology are playing a major role in ensuring continuity of healthcare services during the COVID-19 pandemic. The pandemic has also disrupted healthcare quality improvement (QI) training and education for healthcare professionals and there is a need to rethink the way QI training and education is delivered. The purpose of this rapid evidence review is to quickly, but comprehensively collate studies to identify what works and what does not in delivering QI training and education using distance learning modalities. Three healthcare databases were searched along with grey literature sources for studies published between 2015 and 2020. Studies with QI training programmes or courses targeting healthcare professionals and students with at least one component of the programme being delivered online were included. A total of 19 studies were included in the review. Most studies had a mixed methods design and used blended learning methods, combining online and in-person delivery modes. Most of the included studies reported achieving desired outcomes, including improved QI knowledge, skills and attitudes of participants and improved clinical outcomes for patients. Some benefits of online QI training delivery include fewer required resources, reduced need for on-site instructors, increased programme reach, and more control and flexibility over learning time for participants. Some limitations of online delivery modes include limited learning and networking opportunities, functional and technical problems and long lead time for content adaptation and customisation. The review highlights that distance learning approaches to QI help in overcoming barriers to traditional QI training. Some important considerations for those looking to adapt traditional programmes to virtual environments include balancing virtual and non-virtual methods, using suitable technological solutions, customising coaching support, and using multiple criteria for programme evaluation. Virtual QI and training of healthcare professionals and students is a viable, efficient, and effective alternative to traditional QI education that will play a vital role in building their competence and confidence to improve the healthcare system in post-COVID environment.

The Collective Leadership for Safety Culture (Co-Lead) Team Intervention to Promote Teamwork and Patient Safety

Abstract: Traditional hierarchical leadership has been implicated in patient safety failings internationally. Given that healthcare is almost wholly delivered by multidisciplinary teams, there have been calls for a more collective and team-based approach to the sharing of leadership and responsibility for patient safety. Although encouraging a collective approach to accountability can improve the provision of high quality and safe care, there is a lack of knowledge of how to train teams to adopt collective leadership. The Collective Leadership for Safety Cultures (Co-Lead) programme is a co-designed intervention for multidisciplinary healthcare teams. It is an open-source resource that offers teams a systematic approach to the development of collective leadership behaviours to promote effective teamworking and enhance patient safety cultures. This paper provides an overview of the co-design, pilot testing, and refining of this novel intervention prior to its implementation and discusses key early findings from the evaluation. The Co-Lead intervention is grounded in the real-world experiences and identified needs and priorities of frontline healthcare staff and management and was co-designed based on the evidence for collective leadership and teamwork in healthcare. It has proven feasible to implement and effective in supporting teams to lead collectively to enhance safety culture. This intervention overview will be of value to healthcare teams and practitioners seeking to promote safety culture and effective teamworking by supporting teams to lead collectively.

A systematic review exploring the impact of focal leader behaviours on health care team performance.

Abstract: AIM The aim of this study is to understand how the behaviour of focal leaders impacts health care team performance and effectiveness. BACKGROUND Despite recent shifts towards more collectivistic leadership approaches, hierarchical structures that emphasize the role of an individual focal leader (i.e., the formal appointed leader) are still the norm in health care. Our understanding of the effect of focal leader behaviours on health care team performance remains unclear. EVALUATION A systematic review was conducted. Five electronic databases were searched using key terms. One thousand forty-seven records were retrieved. Data extraction, quality appraisal and narrative synthesis were conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. KEY ISSUES Fifty papers met the criteria for inclusion, were reviewed and synthesized under the following categories: task-focused leadership, directive leadership, empowering leadership and relational focused leadership. CONCLUSIONS Categories are discussed in relation to team performance outcomes, safety specific outcomes, individual-level outcomes and outcomes related to interpersonal dynamics. Emerging themes are explored to examine and reflect on how leadership is enacted in health care, to catalogue best practices and to cascade these leadership practices broadly. IMPLICATIONS FOR NURSING MANAGEMENT Empowering and relational leadership styles were associated with positive outcomes for nursing team performance. This underscores the importance of training and encouraging nursing leaders to engage in more collaborative leadership behaviours.

Exploring healthcare staff narratives to understand the role of quality improvement methods in innovative practices during COVID-19

Abstract: Background COVID-19 has impacted the context in which healthcare staff and teams operate and this has implications for quality improvement (QI) work. Contrary to the usual ambivalent relationship staff have with QI work, there have been examples of unprecedented staff engagement in implementing rapid changes during the pandemic indicating a change in important underlying factors that impact staff involvement in QI. The purpose of this study is to explore staff perspectives about how experience and skills of QI methods supported them in implementing innovative practices during COVID-19. Methods This is a qualitative narrative study based on narrative interviews to collect healthcare staff stories of implementing rapid change. The stories were identified through social media (Twitter) and a national health magazine issued by the Irish health service. Twenty staff members participated in the interviews. Interviews were audio recorded, transcribed, and anonymised. A four-step thematic analysis was conducted. Results The analysis revealed the transformational journey of healthcare staff from the initial shock and anxiety caused by COVID-19 to making sense of the situation, implementing rapid changes, and acknowledging COVID as a learning experience. Six themes were evident from the analysis: COVID anxiety and fear, emotional supports and coping mechanisms, person-centric changes, COVID as a 'forcing function' for change, a collective way of working and looking back and thinking ahead. Conclusions While most rapid changes during COVID-19 did not represent a systematic and explicit QI application, QI principles were evident throughout the stories and actions taken, including making small changes, testing changes, learning, reflecting as a team, and improving. Many staff members were able to retrospectively identify the relevance of QI principles. COVID-19 eliminated some traditional barriers to change leading to efficient solutions, thus highlighting a need to sustain these positive changes into routine practice to develop an adaptive healthcare system receptive to QI.

Protocol for an integrated evaluation framework to study training, curricular and contextual factors impacting the success of a measurement for improvement training programme for healthcare staff in Ireland

Abstract: Introduction Measurement for improvement is the process of collecting, analysing and presenting data to demonstrate whether a change has resulted in an improvement. It is also important in demonstrating sustainability of improvements through continuous measurement. This makes measurement for improvement a core element in quality improvement (QI) efforts. However, there is little to no research investigating factors that influence measurement for improvement skills in healthcare staff. This protocol paper presents an integrated evaluation framework to understand the training, curricular and contextual factors that influence the success of measurement for improvement training by using the experiences of trainees, trainers, programme and site coordinators. Methods and analysis This research will adopt a qualitative retrospective case study design based on constructivist-pragmatic philosophy. The Pressure Ulcers to Zero collaborative and the Clinical Microsystems collaborative from the Irish health system which included a measurement for improvement component have been selected for this study. This paper presents an integrated approach proposing a novel application of two pre-existing frameworks: the Model for Understanding Success in Quality framework and the Kirkpatrick Evaluation Model to evaluate an unexplored QI context and programme. A thematic analysis of the qualitative interview data and the documents collected will be conducted. The thematic analysis is based on a four-step coding framework adapted for this research study. The coding process will be conducted using NVivo V.12 software and Microsoft Excel. A cross-case comparison between the two cases will be performed. Ethics and dissemination The study has received an exemption from full ethical review from the Human Research Ethics Committee of University College Dublin, Ireland (LS-E-19-108). Informed consent will be obtained from all participants and the data will be anonymised and stored securely. The results of the study will be disseminated in peer-reviewed journals.

Leadership research in healthcare: a realist review

Abstract: Being largely considered a human right, healthcare needs leaders who are able to make choices and to set directions. Following the recommendations expressed by Gilmartin and D'Aunno's review and roadmap compiled in 2008, today, it is important to acknowledge researchers' contributions to outline this landscape. The realist review of 77 publications answered questions such as "what works, for whom, and in which circumstances" highlighting: the effectiveness and acceptance of transformational and collaborative approaches; professionalism, expertise, and good task delegation within operational teams; distributed leadership, relationships, and social responsibility at a systemic level. The relevancy and need of leadership development programs, framed within a wider strategy, emerged. Nonetheless, gaps still exist and require further investigation: particular needs in public vs. private contexts; professionals' and women's differentiating characters; generational gaps; associations between leadership and recruitment HR practices research; how (and if) leaders (should) influence the organizational culture and values; and developing countries specific challenges. Also, a greater proportion of relevant findings should be drawn by empirical and more rigorous studies. Finally, a major attention could be paid to interactions happening at the team, organizational, and systemic level among different leaders and among leaders, followers and external actors.

Evaluating the Effectiveness of Two Teaching Strategies to Improve Nursing Students Knowledge, Skills, and Attitudes in Quality Improvement and Patient Safety

Abstract: Abstract The purpose of this study was to evaluate two teaching strategies with regard to quality and safety education for nurses content on quality improvement and safety. Two groups (total of 64 students) participated in online learning or online learning in conjunction with a flipped classroom. A pretest/posttest control group design was used. The use of online modules in conjunction with the flipped classroom had a greater effect on increasing nursing students’ knowledge of quality improvement than the use of online modules only. There was no statistically significant difference between the groups for safety.

Nurses' clinical leadership in the hospital setting: A systematic review

Abstract: Abstract Aim This study aims to identify the most effective interventions to facilitate nurses' clinical leadership in the hospital setting. Background There is a gap in the literature on the identification and measurement of effective interventions for leadership skill development among clinical nurses in hospitals. To the best of our knowledge, no systematic review has been performed on this issue. Evaluation A systematic review was conducted. The PubMed, CINAHL, PsycINFO and Cochrane databases were reviewed. Data extraction, quality appraisal and narrative synthesis were conducted in line with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Key issues The evidence reveals that interventions designed to promote nurses' clinical leadership are complex, requiring that cognitive, interpersonal and intrinsic competencies as well as psychological empowerment, emotional intelligence and critical reflexivity skills be addressed. Conclusions The development of multicomponent, theory‐based and mixed‐format programmes may be more suitable to facilitate nurses' clinical leadership in the hospital setting. Implications for Nursing Management Strategies to facilitate nurses' clinical leadership in the hospital setting should address simultaneously the knowledge and ability of bedsides nurses to solve the practical problem collaboratively with a sense of control, competency and autonomy. Hence, it would promote high quality care, satisfaction and retention of bedside nurses.

The regulation of healthcare professions and support workers in international context

Abstract: The objective of this paper is to outline and compare the regulation of paid healthcare professions and associated support workers in international context, bringing out the lessons to be learned as appropriate. Modern neo-liberal societies have sought to enhance healthcare through greater professional regulation, albeit in different ways and at variable pace. This general trend is illustrated with reference to medicine in the UK. However, although such reforms have helpfully cascaded to other health professions, government policy in high-income countries has not yet adequately regulated the interrelated group of non-professionalised health support workers who form the largest and least recognised part of the workforce. Nonetheless, in low- and middle-income (LMIC) countries—aside from the greater need for regulation of health professions—there is even more of an imperative to regulate the disparate, largely invisible support workforce. With reference to existing studies of the medical and wider health professions in the UK and selected other higher income societies, the importance of health professional regulation to the public is underlined in the Global North. The larger gap in the regulation of support workers in modern neo-liberal countries is also emphasised on a similar basis, with an increasingly ageing population and advances in healthcare. It is argued from the very limited patchwork of secondary literature, though, that policy-makers may want to focus even more on enhancing regulation of both the professional and non-professional workforce in LMIC societies centred mainly in the Global South, drawing on lessons from the Global North. Efforts to reform health professional regulatory approaches in more economically developed countries, while needing refinement, are likely to have had a positive effect. However, even in these societies there are still substantial shortfalls in the regulation of health support workers. There are even larger gaps in LMICs where there are fewer health professional staff and a greater dependence on support workers. With higher rates of morbidity and mortality, there is much more scope here for reforming health regulation in the public interest to extend standards and mitigate risk, following the pattern for healthcare professions in the Global North.

Virtual external implementation facilitation: successful methods for remotely engaging groups in quality improvement.

Abstract: BACKGROUND Relatively little guidance exists on how to use virtual implementation facilitation to successfully implement evidence-based practices and innovations into clinical programs. Yet virtual methods are increasingly common. They have potentially wider reach, emergent public health situations necessitate their use, and restrictions on resources can make them more attractive. We therefore outline a set of principles for virtual external implementation facilitation and a series of recommendations based on extensive experience successfully using virtual external implementation facilitation in a national program. MODEL AND RECOMMENDATIONS Success in virtual external implementation facilitation may be achieved by facilitators applying three overarching principles: pilot everything, incorporate a model, and prioritize metacognition. Five practical principles also help: plan in advance, communicate in real time, build relationships, engage participants, and construct a virtual room for participants. We present eight concrete suggestions for enacting the practical principles: (1) assign key facilitation roles to facilitation team members to ensure the program runs smoothly; (2) create small cohorts of participants so they can have meaningful interactions; (3) provide clarity and structure for all participant interactions; (4) structure program content to ensure key points are described, reinforced, and practiced; (5) use visuals to supplement audio content; (6) build activities into the agenda that enable participants to immediately apply knowledge at their own sites, separate from the virtual experience; (7) create backup plans whenever possible; and (8) engage all participants in the program. These principles represent a novel conceptualization of virtual external implementation facilitation, giving structure to a process that has been, to date, inadequately described. The associated actions are demonstrably useful in supporting the principles and offer teams interested in virtual external implementation facilitation concrete methods by which to ensure success. Our examples stem from experiences in healthcare. But the principles can, in theory, be applied to virtual external implementation facilitation regardless of setting, as they and the associated actions are not setting specific.