Factors influencing the use of evidence based practice among physiotherapists and occupational therapists in their clinical work

Background: Evidence-based practice (EBP) is a process through which research is applied in daily clinical practice. Occupational therapists (OTs) and physiotherapists (PTs) are expected to work in line with EBP in order to optimise health care resources. This expectation is too seldom fulfilled. Consequently, research findings may not be implemented in clinical practice in a timely manner, or at all. To remedy this situation, additional knowledge is needed regarding what factors influence the process of EBP among practitioners. The purpose of the present study was to identify factors that influence the use of EBP and the experienced effects of the use of EBP among PTs and OTs in their clinical work. Method: This was a qualitative interview study that consisted of six group interviews involving either OTs or PTs employed by the Jönköping County Council in the South of Sweden. Resulting data were analysed using content analysis. Results: The analysis resulted in the following categories: “definition of evidence and EBP”, “sources of evidence”, “barriers to acquiring evidence and to using evidence in clinical work”, “factors that facilitate the acquisition of evidence and the use of evidence in clinical work”, and “personal experiences of using EBP”. Basing clinical practice on scientific evidence evoked positive experiences, although an ambivalent view towards acting on clinical experience was evident. Participants reported that time for and increased knowledge about searching for, evaluating, and implementing EBP were needed. Conclusion: Because OTs are more oriented towards professional theories and models, and PTs are more focused on randomised controlled trials of interventions, different strategies appear to be needed to increase EBP in these two professions. Management support was considered vital to the implementation of EBP. However, the personal obligation to work in line with EBP must also be emphasised; the participants apparently underestimate its importance.

Challenges to improve inter-professional care and service collaboration for people living with psychiatric disabilities in ordinary housing

The aim of this study was to describe health care- and social service professionals' experiences of a quality-improvement program implemented in the south of Sweden. The focus of the program was to develop inter-professional collaboration to improve care and service to people with psychiatric disabilities in ordinary housing. Focus group interviews and a thematic analysis were used. The result was captured as themes along steps in process. (I) Entering the quality-improvement program: Lack of information about the program, The challenge of getting started, and Approaching the resources reluctantly. (II) Doing the practice-based improvement work: Facing unprepared workplaces, and Doing twice the work. (III) Looking backevaluation over 1 year: Balancing theoretical knowledge with practical training, and Considering profound knowledge as an integral part of work. The improvement process in clinical practice was found to be both time and energy consuming, yet worth the effort. The findings also indicate that collaboration across organizational boundaries was broadened, and the care and service delivery were improved.

Examining Levels of Automation in the Wood Processing Industry - A case study

Companies operating in the wood processing industry need to increase their productivity by implementing automation technologies in their production systems. An increasing global competition and rising raw material prizes challenge their competitiveness. Yet, too extensive automation brings risks such as a deterioration in situation awareness and operator deskilling. The concept of Levels of Automation is generally seen as means to achieve a balanced task allocation between the operators’ skills and competences and the need for automation technology relieving the humans from repetitive or hazardous work activities. The aim of this thesis was to examine to what extent existing methods for assessing Levels of Automation in production processes are applicable in the wood processing industry when focusing on an improved competitiveness of production systems. This was done by answering the following research questions (RQ): RQ1: What method is most appropriate to be applied with measuring Levels of Automation in the wood processing industry? RQ2: How can the measurement of Levels of Automation contribute to an improved competitiveness of the wood processing industry’s production processes? Literature reviews were used to identify the main characteristics of the wood processing industry affecting its automation potential and appropriate assessment methods for Levels of Automation in order to answer RQ1. When selecting the most suitable method, factors like the relevance to the target industry, application complexity or operational level the method is penetrating were important. The DYNAMO++ method, which covers both a rather quantitative technical-physical and a more qualitative social-cognitive dimension, was seen as most appropriate when taking into account these factors. To answer RQ 2, a case study was undertaken at a major Swedish manufacturer of interior wood products to point out paths how the measurement of Levels of Automation contributes to an improved competitiveness of the wood processing industry. The focus was on the task level on shop floor and concrete improvement suggestions were elaborated after applying the measurement method for Levels of Automation. Main aspects considered for generalization were enhancements regarding ergonomics in process design and cognitive support tools for shop-floor personnel through task standardization. Furthermore, difficulties regarding the automation of grading and sorting processes due to the heterogeneous material properties of wood argue for a suitable arrangement of human intervention options in terms of work task allocation.  The application of a modified version of DYNAMO++ reveals its pros and cons during a case study which covers a high operator involvement in the improvement process and the distinct predisposition of DYNAMO++ to be applied in an assembly system.