Interprofessional Healthcare Collaboration on the Front Lines: A Qualitative Exploration of the Facilitators and Barriers to Effective Collaboration in Qatar.

Background:

Healthcare in Qatar is undergoing a period of major reform, driven by a strong economy and vision for a world-class healthcare system. One area identified as a potential contributor to developing a world-class healthcare system is interprofessional education (IPE), with the goal of facilitating healthcare workers to work together collaboratively. Several key steps have been taken towards developing IPE in Qatar, such as the formation of the Qatar Interprofessional Health Council (QIHC), the development of an IPE program for undergraduate healthcare students, the development of a set of shared core competencies, the receipt of substantial buy-in from leaders across the healthcare system, and recent approval of funding to develop a post-licensure healthcare IPE program. In order to improve IPE in Qatar, it is important to better understand the facilitators and barriers to interprofessional collaboration in Qatar. This study seeks to do so by qualitatively exploring facilitators and barriers to interprofessional collaboration for healthcare professional in Qatar from the perspective of health care professionals. By better understanding how health care workers give meaning to interprofessional education and collaboration, this research can assist in improving interprofessional activities in healthcare in Qatar.

Objectives

The purpose of this paper-presentation is to report on finding from a qualitative study that explored different facilitators and barriers of interprofessional practice in Qatar.

Method:

Ten healthcare professionals who work in Qatar were interviewed using semi-structured, open-ended interviews. Interview questions were organized by phenomenological (e.g. exploring the lived-experiences of healthcare workers) and ethnographic interviewing techniques (e.g. focusing on what people do). The questions explored the barriers, facilitators, and what is working well in terms of interprofessional practice for health care professional in Qatar.

Findings and Implications:

Different factors associated with interprofessional collaborations will be discussed. In doing so, this research adds to the literature on IPE by shedding light on interprofessional collaboration and education in the Middle East. Furthermore, this study identifies barriers for health care workers to work collaboratively in health care settings in Qatar. Addressing such barriers, and building off of what is working well, will facilitate Qatar in reaching one of the Vision 2030 goals of improving Qatar’s health and wellness.

What counts and what is being counted – The social organization of knowledge on the front lines of emergency medical services.

Paramedics are trained to use specialized medical knowledge and a variety of medical procedures and pharmaceutical interventions to “save patients and prevent further damage” in emergency situations, both as members of “health-care teams” in hospital emergency departments (Swanson, 2005: 96) and on the streets – unstandardized contexts “rife with chaotic, dangerous, and often uncontrollable elements” (Campeau, 2008: 3). The paramedic’s unique skill-set and ability to function in diverse situations have resulted in the occupation becoming ever more important to health care systems (Alberta Health and Wellness, 2008: 12).
Today, prehospital emergency services, while varying, exist in every major city and many rural areas throughout North America (Paramedics Association of Canada, 2008) and other countries around the world (Roudsari et al., 2007). Services in North America, for instance, treat and/or transport 2 million Canadians (over 250,000 in Alberta alone ) and between 25 and 30 million Americans annually (Emergency Medical Services Chiefs of Canada, 2006; National EMS Research Agenda, 2001). In Canada, paramedics make up one of the largest groups of health care professionals, with numbers exceeding 20,000 (Pike and Gibbons, 2008; Paramedics Association of Canada, 2008). However, there is little known about the work practices of paramedics, especially in light of recent changes to how their work is organized, making the profession “rich with unexplored opportunities for research on the full range of paramedic work” (Campeau, 2008: 2).

This presentation reports on findings from an institutional ethnography that explored the work of paramedics and different technologies of knowledge and governance that intersect with and organize their work practices. More specifically, my tentative focus of this presentation is on discussing some of the ruling discourses central to many of the technologies used on the front lines of EMS in Alberta and the consequences of such governance practices for both the front line workers and their patients. In doing so, I will demonstrate how IE can be used to answer Rankin and Campbell’s (2006) call for additional research into “the social organization of information in health care and attention to the (often unintended) ways ‘such textual products may accomplish…ruling purposes but otherwise fail people and, moreover, obscure that failure’ (p. 182)” (cited in McCoy, 2008: 709).

Technologies of Knowledge and Governance on the Front Lines of Emergency Services.

Using institutional ethnography, a sociology and critical method of inquiry used primarily in North America, this presentation discusses new forms and technologies of knowledge and governance – “forms of language, technologies of representation and communication, and text-based, objectified modes of knowledge through which local particularities are interpreted or rendered actionable in abstract, translocal terms” (McCoy, 2008: 701) on the front line of emergency medical services. I focus specifically on technologies central to health reforms that attempt to reshape how health care is delivered, experienced, and made accountable (Anantharaman, 2004; Ball, 2005; Alberta Health Services, 2008). In additional to exemplifying how institutional ethnography can be used to answer Rankin and Campbell’s (2006) call for additional research into “the social organization of information in health care and attention to the (often unintended) ways ‘such textual products may accomplish…ruling purposes but otherwise fail people and, moreover, obscure that failure’ (p. 182)” (cited in McCoy, 2008: 709), this presentation will introduce the audience to a critical approach to social inquiry that explores how knowledge is socially organized.

Assessment Work of Paramedics on the Front lines of Emergency Health Services

This article draws on an institutional ethnographic inquiry into the work of paramedics and the institutional setting that organizes and coordinates their work processes. Drawing on over 200 hours of observations and over 100 interviews with paramedics (average length of 18 minutes) and other emergency medical personnel, this article explores the standard and not so standard work of paramedics as they assess and care for their patients on the front lines of emergency health services. More specifically, I focus on the multiplicity of interfacing social, demographic, locational, situational, and institutional factors that shape and organize the work of paramedics. In doing so, this article provides insights into how paramedics orient to the social context in which their work occurs and contrasts this actual work with how their work is institutionally reported and made visible; what gets counted institutionally is not necessarily the same as what counts for the paramedics. This article problematizes this demarcation between what is known institutionally and “systematic practices of ‘not knowing’” (DeVault, 2008, p. 290).

Street Medicine – Assessment Work Strategies of Paramedics on the Front lines of Emergency Health Services

This article is based on an institutional ethnographic inquiry into the work of paramedics and the institutional setting that organizes and coordinates their work processes in a major City in Canada. Drawing on over 200 hours of observations and over 100 interviews with paramedics (average length of 18 minutes) and other emergency medical personnel, this article explores the standard and not so standard work of paramedics as they assess and care for their patients on the front lines of emergency health services. The multiplicity of interfacing social, demographic, locational, and situational factors that shape and organize the work of paramedics are analyzed. In doing so, this article provides insights into the complex work of an understudied yet ever-important profession in healthcare.

Characterization and modelling of software defined radio front-ends

O presente trabalho tem por objectivo estudar a caracterização e modelação de arquitecturas de rádio frequência para aplicações em rádios definidos por software e rádios cognitivos. O constante aparecimento no mercado de novos padrões e tecnologias para comunicações sem fios têm levantado algumas limitações à implementação de transceptores rádio de banda larga. Para além disso, o uso de sistemas reconfiguráveis e adaptáveis baseados no conceito de rádio definido por software e rádio cognitivo assegurará a evolução para a próxima geração de comunicações sem fios. A ideia base desta tese passa por resolver alguns problemas em aberto e propor avanços relevantes, tirando para isso partido das capacidades providenciadas pelos processadores digitais de sinal de forma a melhorar o desempenho global dos sistemas propostos. Inicialmente, serão abordadas várias estratégias para a implementação e projecto de transceptores rádio, concentrando-se sempre na aplicabilidade específica a sistemas de rádio definido por software e rádio cognitivo. Serão também discutidas soluções actuais de instrumentação capaz de caracterizar um dispositivo que opere simultaneamente nos domínios analógico e digital, bem como, os próximos passos nesta área de caracterização e modelação. Além disso, iremos apresentar novos formatos de modelos comportamentais construídos especificamente para a descrição e caracterização não-linear de receptores de amostragem passa-banda, bem como, para sistemas nãolineares que utilizem sinais multi-portadora. Será apresentada uma nova arquitectura suportada na avaliação estatística dos sinais rádio que permite aumentar a gama dinâmica do receptor em situações de multi-portadora. Da mesma forma, será apresentada uma técnica de maximização da largura de banda de recepção baseada na utilização do receptor de amostragem passa-banda no formato complexo. Finalmente, importa referir que todas as arquitecturas propostas serão acompanhadas por uma introdução teórica e simulações, sempre que possível, sendo após isto validadas experimentalmente por protótipos laboratoriais.

Adaptive digital receivers for analog front-end mismatch correction

Phase and gain mismatches between the I and Q analog signal processing paths of a quadrature receiver are responsible for the generation of image signals which limit the dynamic range of a practical receiver. In this paper we analyse the effects these mismatches and propose a low-complexity blind adaptive algorithm to minimize this problem. The proposed solution is based on two, 2-tap adaptive filters, arranged in Adaptive Noise Canceller (ANC) set-up. The algorithm lends itself to efficient real-time implementation with minimal increase in modulator complexity.

Adaptive compensation of analog front-end I/Q mismatches in digital receivers

I and Q Channel phase and gain misniatches are of great concern in communications receiver design. In this paper we analyse the effects of I and Q channel mismatches and propose a low-complexity blind adaptive algorithm to minimize this problem. The proposed solution consists of two, 2-tap adaptive filters, arranged in Adaptive Noise Canceller (ANC) set-up, with the output of one cross-fed to the input of the other. The system works as a de-correlator eliminating I and Q mismatch errors.

Old conflicts, new rivals? Airline competition in the European market

Christoph Franz of Lufthansa recently identified Ryanair, easyJet, Air Berlin and Emirates as the company’s main competitors – gone are the days when it could benchmark itself against BA or Air France-KLM! This paper probes behind the headlines to assess the extent to which different airlines are in competition, using evidence from the UK and mainland European markets. The issue of route versus network competition is addressed. Many regulators have put an emphasis on the former whereas the latter, although less obvious, can be more relevant. For example, BA and American will cease to compete between London and Dallas Fort Worth if their alliance obtains anti-trust immunity but 80% of the passengers on this route are connecting at one or both ends and hence arguably belong to different markets (e.g. London-San Francisco, Zurich-Dallas, Edinburgh-New Orleans) which may be highly contested. The remaining 20% of local traffic is actually insufficient to support a single point to point service in its own right. Estimates are made of the seat capacity major airlines are offering to the local market as distinct from feeding other routes. On a sector such as Manchester–Amsterdam, 60% of KLM’s passengers are transferring at Schiphol as against only 1% of bmibaby’s. Thus although KLM operates 5 flights and 630 seats per day against bmibaby’s 2 flights and 298 seats, in the point to point market bmibaby offers more seats than KLM. The growth of the Low Cost Carriers (LCCs) means that competition increasingly needs to be viewed on city pair markets (e.g. London-Rome) rather than airport pair markets (e.g. Heathrow-Fiumicino). As the stronger LCCs drive out weaker rivals and mainline carriers retrench to their major hubs, some markets now have fewer direct options than existed prior to the low cost boom. Timings and frequencies are considered, in particular the extent to which services are a true alternative especially for business travellers. LCCs typically offer lower frequencies and more unsociable timings (e.g. late evening arrivals at remote airports) as they are more focused on providing the cheapest service rather than the most convenient schedule. Interesting findings on ‘monopoly’ services are presented (including alliances) - certain airlines have many more of these than others. Lufthansa has a significant number of sectors to itself whereas at the other extreme British Airways has direct competition on almost every route in its network. Ryanair and flybe have a higher proportion of monopoly routes than easyJet or Air Berlin. In the domestic US market it has become apparent since deregulation that better financial returns can come from dominating a large number of smaller markets rather than being heavily exposed in the major markets - which are hotly fought over. Regional niches that appear too thin for Ryanair to serve (with its all 189 seat 737-800 fleet) are identified. Fare comparisons in contrasting markets provide some insights to marketing and pricing strategies. Data sources used include OAG (schedules and capacity), AEA (traditional European airlines traffic by region), the UK CAA (airport, airline and route traffic plus survey information of passenger types) and ICAO (international route traffic and capacity by carrier). It is concluded that airlines often have different competitors depending on the context but in surprisingly many cases there are actually few or no direct substitutes. The competitive process set in train by deregulation of European air services in the 1990s is leading back to one of natural monopolies and oblique alternatives. It is the names of the main participants that have changed however!

Dual-tracking multi-constellation GNSS front-end for high-performance receiver applications

This paper presents the design and implementation of a dual–tracking Radio Frequency (RF) front–end for a multi–constellation Global Navigation Satellite Systems (GNSS) receiver. The RF frond–end is based on the direct RF conversion architecture, which employs sub–Nyquist sampling (also known as subsampling) at RF. The dual–tracking RF front–end is composed of a few RF components that are duplicated to form the two RF channels. Employing a dual–channel Analogue–to–Digital Converter (ADC) enables synchronisation of the RF channels and minimises the errors resulting from the differences in the satellite clocks and the propagation delay between the two RF channels. The digitised GNSS signals are processed by two separate acquisition and tracking engines that are driven by the front–end’s master clock. This setup provides two synchronised receivers that are integrated onto one piece of hardware. The hardware is intended to be used for research applications such as multipath mitigation, scintillation assessment, and advanced satellite clock and spatial frame transformation modelling.