Managing people and performance:An evidence based framework applied to health service organizations

People and their performance are key to an organization's effectiveness. This review describes an evidence-based framework of the links between some key organizational influences and staff performance, health and well-being. This preliminary framework integrates management and psychological approaches, with the aim of assisting future explanation, prediction and organizational change. Health care is taken as the focus of this review, as there are concerns internationally about health care effectiveness. The framework considers empirical evidence for links between the following organizational levels: 1. Context (organizational culture and inter-group relations; resources, including staffing; physical environment) 2. People management (HRM practices and strategies; job design, workload and teamwork; employee involvement and control over work; leadership and support) 3. Psychological consequences for employees (health and stress; satisfaction and commitment; knowledge, skills and motivation) 4. Employee behaviour (absenteeism and turnover; task and contextual performance; errors and near misses) 5. Organizational performance; patient care. This review contributes to an evidence base for policies and practices of people management and performance management. Its usefulness will depend on future empirical research, using appropriate research designs, sufficient study power and measures that are reliable and valid.

Using an evidence-based online module to improve parents’ ability to manage their child with Developmental Coordination Disorder

Background : Developmental coordination disorder (DCD) is a prevalent neurodevelopmental disorder. Best practices include raising parents’ awareness and building capacity but few interventions incorporating these best practices are documented. Objective : To examine whether an evidence-based online module can increase the perceived knowledge and skills of parents of children with DCD, and lead to behavioural changes when managing their child’s health condition. Methods : A mixed-methods, before-after-follow-up design guided by the theory of planned behaviour was employed. Data about the knowledge, skills and behaviours of parents of children with DCD were collected using questionnaires prior to completing the module, immediately after, and three months later. One-way repeated measures ANOVAs and thematic analyses were performed on data as appropriate. Results : Fifty-eight participants completed all questionnaires. There was a significant effect of time on self-reported knowledge [F(2.00,114.00)=16.37, p=0.00] and skills [F(1.81,103.03)=51.37, p=0.00] with higher post- and follow-up scores than pre-intervention scores. Thirty-seven (65%) participants reported an intention to change behaviour postintervention; 29 (50%) participants had tried recommended strategies at follow-up. Three themes emerged to describe parents’ behavioural change: sharing information, trialing strategies and changing attitudes. Factors influencing parents’ ability to implement these behavioural changes included clear recommendations, time, and ‘right’ attitude. Perceived outcomes associated with the parental behavioural changes involved improvement in well-being for the children at school, at home, and for the family as a whole. Conclusions : The online module increased parents’ self-reported knowledge and skills in DCD management. Future research should explore its impacts on children’s outcomes long-term.

Using an evidence-based online module to improve parents’ ability to manage their child with Developmental Coordination Disorder

Background : Developmental coordination disorder (DCD) is a prevalent neurodevelopmental disorder. Best practices include raising parents’ awareness and building capacity but few interventions incorporating these best practices are documented. Objective : To examine whether an evidence-based online module can increase the perceived knowledge and skills of parents of children with DCD, and lead to behavioral changes when managing their child’s health condition. Methods : A mixed-methods, before-after design guided by the theory of planned behavior was employed. Data about the knowledge, skills and behaviors of parents of children with DCD were collected using questionnaires prior to completing the module, immediately after, and three months later. Paired T-tests, sensitivity analyses and thematic analyses were performed on data as appropriate. Results: One hundred-sixteen, 81 and 58 participants respectively completed the three questionnaires. For knowledge and skills, post- and follow-up scores were significantly higher than baseline scores (p<0.01). Fifty-two (64%) participants reported an intention to change behavior post-intervention and 29 (50%) participants had tried recommended strategies at follow-up. Three themes emerged to describe parents’ behavioral change: sharing information, trialing strategies and changing attitudes. Factors influencing parents’ ability to implement these behavioral changes included clear recommendations, time, and ‘right’ attitude. Perceived outcomes associated with the parental behavioral changes involved improvement in well-being for the children at school, at home, and for the family as a whole. Conclusions : The online module increased parents’ self-reported knowledge and skills in DCD management. Future research should explore its impacts on children’s long-term outcomes.

Amblyopia treatment : an evidence-based approach to maximising treatment outcome

The basis of treatment for amblyopia (poor vision due to abnormal visual experience early in life) for 250 years has been patching of the unaffected eye for extended times to ensure a period of use of the affected eye. Over the last decade randomised controlled treatment trials have provided some evidence on how to tailor amblyopia therapy more precisely to achieve the best visual outcome with the least negative impact on the patient and the family. This review highlights the expansion of knowledge regarding treatment for amblyopia and aims to provide optometrists with a summary of research evidence to enable them to better treat amblyopia. Treatment for amblyopia is effective, as it reduces overall prevalence and severity of visual loss in this population. Correction of refractive error alone significantly improves visual acuity, sometimes to the point where further amblyopia treatment is not required. Atropine penalisation and patch occlusion are effective in treating amblyopia. Lesser amounts of occlusion or penalisation have been found to be just as effective as greater amounts. Recent evidence has highlighted that occlusion or penalisation in amblyopia treatment can create negative changes in behaviour in children and impact on family life. These complications should be considere when prescribing treatment because they can negatively affect compliance. Studies investigating the maximum age at which treatment of amblyopia can still be effective and the importance of near activities during occlusion are ongoing.

Evidence-based practice and information literacy

Evidence-based Practice (EBP) has recently emerged as a topic of discussion amongst professionals within the library and information services (LIS) industry. Simply stated, EBP is the process of using formal research skills and methods to assist in decision making and establishing best practice. The emerging interest in EBP within the library context serves to remind the library profession that research skills and methods can help ensure that the library industry remains current and relevant in changing times. The LIS sector faces ongoing challenges in terms of the expectation that financial and human resources will be managed efficiently, particularly if library budgets are reduced and accountability to the principal stakeholders is increased. Library managers are charged with the responsibility to deliver relevant and cost effective services, in an environment characterised by rapidly changing models of information provision, information access and user behaviours. Consequently they are called upon not only to justify the services they provide, or plan to introduce, but also to measure the effectiveness of these services and to evaluate the impact on the communities they serve. The imperative for innovation in and enhancements to library practice is accompanied by the need for a strong understanding of the processes of review, measurement, assessment and evaluation. In 2001 the Centre for Information Research was commissioned by the Chartered Institute of Library and Information Professionals (CILIP) in the UK to conduct an examination into the research landscape for library and information science. The examination concluded that research is “important for the LIS [library and information science] domain in a number of ways” (McNicol & Nankivell, 2001, p.77). At the professional level, research can inform practice, assist in the future planning of the profession, raise the profile of the discipline, and indeed the reputation and standing of the library and information service itself. At the personal level, research can “broaden horizons and offer individuals development opportunities” (McNicol & Nankivell, 2001, p.77). The study recommended that “research should be promoted as a valuable professional activity for practitioners to engage in” (McNicol & Nankivell, 2001, p.82). This chapter will consider the role of EBP within the library profession. A brief review of key literature in the area is provided. The review considers issues of definition and terminology, highlights the importance of research in professional practice and outlines the research approaches that underpin EBP. The chapter concludes with a consideration of the specific application of EBP within the dynamic and evolving field of information literacy (IL).

Are library and information professionals ready for evidence based practice?

Evidence based practice (EBP) is recognised as a way of improving the quality of professional practice in many disciplines however its adoption within library and information sciences (LIS) has been gradual. The term was first introduced into the library and information profession‟s vocabulary a decade ago but an impediment to its uptake is the lack of clear understanding regarding how LIS practitioners understand the concept. Partridge, Thorpe, Edwards and Hallam (2007) identified the need to understand how LIS professionals experience or understand evidence based practice and proposed a model of four categories of experience to describe how LIS professionals experience EBP. This paper extends that framework by refining the different conceptions of evidence based practice and identifying relationships which exist between the categories of experience to provide a rich description of the EBP phenomenon. The paper also argues that the phrase “evidence based librarianship” and its variations be abandoned as practitioners do not see a distinction between EBP as applied to librarianship and information practice and industry specific jargon like “evidence based library and information practice”. This research will help current and future LIS practitioners, leaders and educators engage more actively in the establishment of an evidence based culture to improve library and information practice in Australia and internationally.

Challenges in implementing evidence-based practice into mental health services

This paper highlights challenges in implementing mental health policy at a service delivery level. It describes an attempt to foster greater application of recovery-orientated principles and practices within mental health services. Notwithstanding a highly supportive policy environment, strong support from service administrators, and an enthusiastic staff response to training, application of the training and support tools was weaker than anticipated. This paper evaluates the dissemination trial against key elements to promote sustained adoption of innovations. Organisational and procedural changes are required before mental health policies are systematically implemented in practice.

Evidence-based decision making to strengthen local governance : nutritional health interventions in Bantul and Gunungkidul

Since 2001, district governments have had the main responsibility for providing public health care in Indonesia. One of the main public health challenges facing many district governments is improving nutritional standards, particularly among poorer segments of the population. Developing effective policies and strategies for improving nutrition requires a multi-sectoral approach encompassing agricultural development policy, access to markets, food security (storage) programs, provision of public health facilities, and promotion of public awareness of nutritional health. This implies a strong need for a coordinated approach involving multiple government agencies at the district level. Due to diverse economic, agricultural, and infrastructure conditions across the country, district governments’ ought to be better placed than central government both to identify areas of greatest need for public nutrition interventions, and devise policies that reflect local characteristics. However, in the two districts observed in this study—Bantul and Gunungkidul—it was clear that local government capacity to generate, obtain and integrate evidence about local conditions into the policy-making process was still limited. In both districts, decision-makers tended to rely more on intuition,anecdote, and precedent in formulating policy. The potential for evidence-based decision making was also severely constrained by a lack of coordination and communication between agencies, and current arrangements related to central government fiscal transfers, which compel local governments to allocate funding to centrally determined programs and priorities.

Evidence based decision making to strenghten local governance : nutritional health interventions

Since 2001, district governments have had the main responsibility for providing public health care in Indonesia. One of the main public health challenges facing many district governments is improving nutritional standards, particularly among poorer segments of the population. Developing effective policies and strategies for improving nutrition requires a multi-sectoral approach encompassing agricultural development policy, access to markets, food security (storage) programs, provision of public health facilities, and promotion of public awareness of nutritional health. This implies a strong need for a coordinated approach involving multiple government agencies at the district level. Due to diverse economic, agricultural,and infrastructure conditions across the country, district governments’ ought to be better placed than central government both to identify areas of greatest need for public nutrition interventions, and devise policies that reflect local characteristics. However, in the two districts observed in this study—Bantul and Gunungkidul—it was clear that local government capacity to generate, obtain and integrate evidence about local conditions into the policy-making process was still limited. In both districts, decision-makers tended to rely more on intuition,anecdote, and precedent in formulating policy. The potential for evidence-based decision making was also severely constrained by a lack of coordination and communication between agencies, and current arrangements related to central government fiscal transfers, which compel local governments to allocate funding to centrally determined programs and priorities.

Developing a culture of enquiry to sustain evidence-based practice

Evidence-based practice (EBP) is having a significant effect on the health service environment. It constructs a language that bridges the healthcare disciplines and the clinical and managerial components of health services. Most experienced clinicians in nursing, medicine and allied health now recognise that the contemporary healthcare environment calls for our practice to be justified by sound, credible evidence. There is pressure on all clinicians to accommodate innovation, while at the same time ensuring their practice is effective, safe and efficient (Forbes & Griffiths 2002). Consequently, EBP in healthcare is having a profound effect on nursing and the way we think about nursing. There are many available models for research utilisation that are dependent on organisational strategies for change. This chapter describes the relationship between organisation and culture, and explores the notion of cultural change; that is, developing a culture of inquiry that can sustain evidence-based practice. We begin this chapter with a clear conception of what we mean by EBP and what we mean by ‘culture’.

Evidence-based practice : information professionals' experience of information literacy in the workplace

Evidence-based practice is increasingly being recognised as an important issue in a range of professional contexts including education, nursing, occupational therapy and librarianship. Many of these professions have observed a relationship or interface between evidence-based practice and information literacy. Using a phenomenographic approach this research explores variation in the how library and information professionals are experiencing evidence-based practice as part of their professional work. The findings of the research provide a basis for arguing that evidence-based practice represents the professional's enactment of information literacy in the workplace.