How systematic reviews can foster evidence-based clinical decisions : part II

In the prior issue, we spoke about what a systematic review is and where a clinician can find this important evidence for decision making (Fineout-Overholt et al. 2008). In this column, we will address what is involved in conducting a systematic review, and how critically appraising a systematic review informs clinicians of the best evidence available to make decisions that impact outcomes.

Thinking about thinking : innovative pedagogy designed to foster thinking skills in junior primary classrooms

This article reports on the collaborative initiative of two primary school teachers who created and implemented innovative pedagogy in order to foster a culture of thinking in their classrooms. The paper outlines teaching strategies that were used with the intent of making students mindful of themselves as learners and thinkers. A 'Toolbox', inspired by 'Habits of Mind' and the Visible Thinking approach to teaching and learning, is described in narrative form by one of the teachers. The Toolbox aims to equip students with the thinking tools to make their thinking visible to themselves, their peers and their teachers.

Capacity building for integrated health care at the local level

Aims & Rationale/Objectives
Taking a capacity building approach to research and evaluation within the context of a federally funded national program challenges the traditional paradigms of both research and evaluation. The objective of this approach was to foster attitudes and behaviours of reflection, critical inquiry and collaborative action amongst participants responsible for health care integration activities.

Methods
A series of workshops focusing on different elements of health care integration was conducted. Each workshop offered skill development in research and evaluation methods relevant to the participants' clinical practise. The workshops were multidisciplinary and cross-sectoral in order to promote discussion about shared patient care issues.

Principal Findings
Participatory action research facilitated by external agents can build the capacity of participants to identify and make changes that improve health care integration at local levels. A capacity building approach to research and evaluation can mediate tensions between top-down initiatives and on-the-ground practitioners.

Discussion
A capacity building approach was crucial to the success of this project particularly as the project proposal was developed at the corporate level. The workshops played an important role in engaging the participants and fostering the development of solutions for locally identified clinical issues. The opportunities for discussion with other health care service providers were both readily embraced and appreciated by the participants. The networks formed during the workshops are likely to be vital in sustaining integration efforts.

Implications
Education sessions such as the workshops held within this project ensure that health care integration remains on the agenda of the relevant organisations. These workshops fostered a continuous quality improvement approach whilst focusing on the skills required and the systemic barriers to achieving health care integration. The success of these workshops is evidence that the need and desire for shared education opportunities exists and the interdisciplinary focus is a powerful tool for developing an appreciation of the cultures within disciplines as well as linkages.

Education and training institutions : building social capital for regional development

Education and training institutions from schools through to universities have a vital role in supporting development in regional Australia. The interaction between these institutions and their rural communities influences the social capital of the community and the extent to which the community is a learning community, willing and able to manage change to the community’s advantage.

There are benefits to be had from a collaborative approach to planning and delivering training. This approach is consistent with theories of social capital that emphasise the crucial part played by networks, values and trust in generating superior outcomes for individuals, communities and regions. Research has found that education and training is most effective in building social capital and learning communities were there is attention to customising or targeting education and training provision to local needs. The key to matching provision with local needs, particularly in the more rural and remote areas, is collaboration and partnerships. Partners can be regional organisations, other educational institutions, businesses and government. The factors that enhance the effectiveness of the collaborations and partnerships are the elements of social capital: networks, shared values and trust, and enabling leadership.

Networks are most effective where there were opportunities and structures for interaction, which can be termed interactional infrastructure, that foster networks within the region, and networks that extended outside the region. Interactional infrastructure includes regional forums, committee structures, consultative processes and opportunities for informal discussion addressing the issues of education, training and employment in a community or region. Better outcomes are evident when there is an interactional infrastructure that is resourced with financial, physical and human resources of sufficient quantity and quality. Collaborations provide access to a greater range of external resources through extended external networks. Effective networks and shared visions, values and trust among the partners in a collaboration, are fostered by enabling leaders. Educational institutions are well placed to supply the ‘human infrastructure’ that makes collaborations and partnerships work, including enabling leadership.

Attention to factors associated with the quality of social capital, especially interactional infrastructure including leadership, shared vision and values and networks within and external to the community, can be expected to improve the effectiveness of education and training outcomes. More importantly, a collaborative approach to planning for education and training in rural regions will build the capacity of regions and their constituent communities to develop and change by building social capital resources. Leadership is an important driver of processes that build community and regional capacity and ultimately produce social and economic benefits through regional development. Educational providers in rural regions are well placed to act as enabling leaders.

Community efficacy and social capital

It has been suggested that the quantity and quality of a community’s social capital has a large impact on that community’s capacity to manage change. Despite many attempts, social capital remains notoriously difficult to measure. There is general consensus that social capital is the ‘property’ of a community or collective, yet in measurement frameworks social capital is normally aggregated up across individuals and different levels. Communities are not homogeneous; we argue that the differential capacity of various groups within the community to participate should be considered. Any measure of community social capital must take account of the diversity of the community and potentially unequal access of groups and individuals to community social capital: the nature and quality of opportunities is not uniform. Further, the validity of social capital depends in fact on its contextualisation – social capital resources that are effective in one context are not necessarily effective in another.

In this paper we present a new way of thinking about the social capital of a community, linked to the community’s capacity to deliver favourable outcomes for its members. We use the term community efficacy for this capacity to manage change and influence the future of the collective and community members. We present a framework that describes the nature and quality of the factors that influence community efficacy and are at the heart of a community’s social capital resources. The framework recognises that social capital resources are used at the point of interaction between community members; hence opportunities for interaction are important. We suggest that the framework can be applied to measure community efficacy in various contexts, and discuss how it can be applied to a rural community’s ability to foster successful transitions to young adulthood for its young people.

Organizational learning orientation - how can it foster alliance relationships?

Purpose – The purpose of this paper is to examine the importance of an organization's learning orientation in developing alliance relationships.

Design/methodology/approach – The paper is based on research conducted on organizations involved in alliances as well as practical evidence.

Findings – The paper finds that alliance managers need to focus on developing learning capabilities within their organizations to achieve superior alliance performance.

Practical implications – The paper has practical implications for managers involved in alliances as it shows the importance of an organization focusing on learning. With the relatively small number of alliance relationships that succeed, it is important that managers harness their organization's learning potential in the context of an alliance.

Originality/value – The paper is unique as it highlights the importance of an organization's learning orientation in an alliance context.

Using intranet technology to foster organizational knowledge creation

Many organizations have embraced intranets with the intent to harness the technology to support knowledge management initiatives. Despite the promise that intranet technology holds in this regard, many of the early research studies indicate rather disappointing results. In this paper we propose a model that organizations can use to conceptualize and reflect on their intranet applications with a view towards more fruitful results, specifically in terms of knowledge creation. We do so by drawing upon Nonaka’s well-known framework of knowledge creation and combining that with a taxonomy of five intranet use modes. For each of Nonaka’s four knowledge creating activities we associate and describe the corresponding primary intranet use mode that we argue can foster the knowledge creation process. We illustrate the arguments with findings from our own empirical intranet field studies and other documented intranet-related knowledge management research. We conclude with some implications of the model and we suggest avenues for further research.

Identifying and developing effective approaches to foster intercultural understanding in schools

This paper provides a systematic review of education literature focused on identifying school-based approaches for developing students’ intercultural understanding. Studies were assessed using selection criteria and then critically appraised for study quality. A key finding from the review is that developing students’ intercultural understanding beyond cultural awareness requires students and teachers to take a critical approach toward cultural diversity, as well as the opportunity for ongoing intercultural and intergroup contact. Studies reported that only building cultural awareness and knowledge is not enough to promote long-term changes in attitudes. There is a need for more rigorously evaluated longitudinal school-based interventions. Finally, studies consistently call for investment in teachers’ professional and personal intercultural capabilities. The paper concludes by calling for school-based interventions that are informed by best practice approaches at a whole school level in order to effectively develop students’ intercultural attitudes and skills.

Can a modelling exercise be developed to aid and foster sustainable planning processes and guide the future growth of a small coastal Australian city?

Over the past few decades coastal cities around the world have grown at an incredible rate. With this growth have come major challenges relating to land use planning, social relationships, economic development, bio diversity and the ecological footprint. Three forces are working to influence the growth rate in coastal cities. They include: -population growth (i.e. the type and quantity of human demand for land), the existing and future properties of the land (i.e. current land status or changes due to nature and human activities), and finally technical changes to a land system (i.e. rezoning or the influence of other external factors). The goal of this research was to determine whether a planning framework could model the three (population growth, the existing and future properties of land and technical changes to a land system) variables in order to assist smaller councils undertaking long term land use planning decisions. The test site for the research was the City of Portland in western Victoria, Australia.

Critical evaluation of a program to foster reflexive antiracism

This paper documents the evaluation of a three-day program entitled “Race, Culture, Indigeneity and the Politics of Disadvantage,” which was delivered in 2010 in Melbourne, Australia with the aim of promoting Reflexive Antiracism (RA), a novel diversity training approach. To assess the impact of the program on its participants, the Reflexive Antiracism Scale- Indigenous (RAS-I) was devised and administered before and after the program both to participants and a matched control group. The program increased Reflexive Antiracism among participants through an enhanced understanding of whiteness, racialisation and White Racial Identity. Future studies are required to advance both the concept of Reflexive Antiracism and its measurement.