How to build effective teams in primary care

 

Teamworking is fundamental to the future of general practice. Practices are coming together at scale in primary care networks and new roles are being introduced, creating multidisciplinary and multi-agency teams. Making these teams function effectively is a complex task. King’s Fund published a guide with insights from research, policy analysis and leadership practice.

What are the fundamentals of effective teams?

• A small number of meaningful objectives
• Clear roles and responsibilities among team members
• Reflect on how the team is working together
• Introduce new roles into the teams
• Create a multidisciplinary team
• Ensure good communication within your teams.
• Effective information-sharing systems
• Re-design the physical space into shaered working spaces
• Clinical supervision
• Gather feedback from colleagues and patients
• Access to learning and development
• Give space for team members to talk about their experiences

Access Publication: Effective teams in General Practice (january 2020)

Merry christmas and happy new year 2021. Stay safe.

photo: Children’s Christmas play, 1958. (Nina Leen / The LIFE Picture Collection) ______________________________________________________________________

false optimism not to be at risk of COVID-19

 

 

 

 

 

Koula Asimakopoulou et al. from King’s College London investigated comparative optimism for infection and recovery from COVID-19, and the implications this may have on the second wave and the possible lockdown. The study found that during the first lockdown period, most respondents believed that compared to others, they were unlikely to be at risk of COVID-19.

Data were collected through an international survey (N = 6485) exploring people’s thoughts and psychosocial behaviours relating to COVID‐19. The paper reports UK data.

They found the belief that negative events surrounding risk and recovery from COVID‐19 are perceived as more likely to happen to others rather than to oneself. Researchers believe that comparative optimism may have brought out the anecdotally observed, lack of compliance with lockdown guidelines in the UK. People who believe COVID‐19 is less likely to happen to them than to others may infer that their actual risk is much smaller than that communicated in the media, and thus the strict adherence to lockdown restrictions is unnecessary in their case.

The results showed how participants overwhelmingly believed that as compared to people of their age and gender, they were somewhat or extremely unlikely to have accidentally infected people with COVID‐19 in the past and to infect others or get infected themselves in the next month. They were also comparatively optimistic, but to a lesser extent, about their likelihood of getting hospitalized due to COVID‐19, finding themselves in an ICU, being ventilated, and making a full recovery.

In contrast, participants showed comparative pessimism about COVID‐19 infections in the more distant future. As compared to the average person of their age and gender they felt likely to get infected by COVID‐19 in the next year and to develop COVID‐19‐related symptoms. The authors argued that this finding supports earlier research that shows that people who have experienced some ill health tend to unduly exaggerate their future risk of experiencing further ill health. One important difference between COVID‐19 and other risks is that controlling the pandemic was very much placed in the hands of individuals restricting their lives in the UK—as seen in the slogan urging people to ‘Stay at home’. It is reasonable that participants would reason that in the long term, staying at home would be less possible, plausible or practical. Feeling that compliance with social distancing rules cannot be maintained indefinitely may thus explain these perceptions, in line with research showing that high prevalence negative events may engender comparative pessimism.

The implication for a second lockdown is that where people's experience so far may be that they have not been ill with COVID, they are likely to be even more comparatively optimistic than they were in March. Thinking that COVID has not happened to you so far so it is unlikely to happen to you now, can be even more dangerous than it was earlier in the spring. Both comparative optimism and comparative pessimism may have important consequences for people’s psychological well‐being and their likelihood of engaging in risk behaviours or responding to further lockdown measures.

Acces article (pdf free) Comparative optimism about infection and recovery from COVID‐19; Implications for adherence with lockdown advice

photo: Càpsules de confinament. Museu Can Framis Fundació Vilacasas. 2020 

Obra 'Sense títol' d'Eulàlia Valldosera, (Vertical)

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Why is independent evaluation so important? The simple answer is trust.

 

 

 

 

 

 

 

Evaluation is an assessment, as systematic and impartial as possible, of an activity, project, programme, strategy, policy, topic, theme, sector, operational area, or institutional performance. It analyses the level of achievement of both expected and unexpected results by examining the results chain, processes, contextual factors and causality using appropriate criteria such as relevance, effectiveness, efficiency, impact and sustainability. This definition of evaluation further states that evaluation “should provide credible, useful evidence-based information that enables the timely incorporation of its findings, recommendations and lessons into the decision-making processes of the organizations and stakeholders”

The best way to ensure an evaluation is credible, reliable and useful is to ensure that it meets high quality and professional standards. The main principles of good evaluation practice are:

• Independent and impartial: evaluation processes need to be separated from policymaking, implementation and management of the intervention. It has to be without undue influence by any party. Independent evaluation assesses, as objectively as humanly possible, the success and failure of policies and interventions, and reports critical findings without fear of repercussion. Why is independence so important? The simple answer is trust. Independence is necessary for credibility, influences the ways in which an evaluation is used and allows evaluators to be impartial and free from undue pressure throughout the evaluation process.

• Independent evaluation team: Evaluators must have the full freedom to conduct their evaluative work impartially, without the risk of negative effects on their career development, and must be able to freely express their assessment.  How and independent evaluation team should be:

1. External of the organization being evaluated and with no conflicts of interest
   
2. Geographically diverse: professionals around the world outside of the country where the institution is being evaluated.
   
3. Gender balanced
4. Half members with extensive expertise in evaluation and the other half with expertise in the substantive topic to be evaluated.
5. Recruited on a competitive and transparent basis 

• Transparent, participatory and inclusive: evaluations need to be conducted in an open, respectful and consultative manner creating spaces for all relevant stakeholders, including those in a more disadvantaged position, to engage directly in the evaluation and take ownership of the evaluation process. 
• Robust in methodological approach: evaluations need to be conducted in a systematic manner, using sound approaches and methods.
• Utilization focused: there needs to be clear intent about the purpose and use of findings to improve the organization’s work.
• Ethically conducted: evaluations need to be carried out according to professional and ethical guidelines and codes of conduct
  

Usefull resources:
Evaluation Handbook of UNODC 2017
CIDA evaluation guide 2004

 

photo: William Klein
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Alert: health care professionals and stress impact during the COVID-19

Healthcare professionals (HCPs) on the front lines against COVID-19 may face increased workload, and stress. Understanding HCPs’ risk for burnout is critical to supporting HCPs and maintaining the quality of healthcare during the pandemic.

Large numbers of healthcare professionals (HCPs) on the frontlines against COVID-19 face high adversity, workloads, and stress, making them vulnerable to burnout.

• Burnout: Defined as emotional exhaustion, depersonalization, and low personal achievement, is known to detract from optimal working capacities, It has been found to be driven by high job stress, high time pressure and workload, and poor organizational support.

We present a preprint article: Factors Contributing to Healthcare Professional Burnout During the COVID-19 Pandemic: A Rapid Turnaround Global Survey (2020)

Method: To assess exposure, perceptions, workload, and possible burnout of HCPs during the COVID-19 pandemic the authors conducted a cross-sectional survey.

The main outcomes and measures were HCPs’ self-assessment of burnout and other experiences and attitudes associated with working during the COVID-19 pandemic.

Results: Burnout was associated with:

• Work impacting household activities
• Feeling pushed beyond training
• Exposure to COVID-19 patients
• Making life prioritizing decisions
• Lack of adequate personal protective equipment (PPE)
• Limited organizatins support

Implications: Athough the results have multiple limitations including a non-validated questionnaire, minimal demographic data collection, and sampling method using social media the institutions should put the emphasis in support these individuals as they face enormous stress that can negatively impact their emotional and physical well-being.

Some actions that proactively instituions should do:

• Develop a resilience training: resilience refers to an individual’s ability to handle stress and recover quickly from the effects of adversity
• Cut drastically the belief of  HCP feeling that their organization doesn’t value their well-being.
• HCPs should feel secure knowing that management care about them and the management are doing as much as possible to handle with the adverse situation
  
• Support for HCPs’ families,
  
• Provide PPE,
  
• Provide mental health resources

Acces to the preprint article (pdf available)

Final article

photo: Life

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Florence Nightingale bicentenary 2020

Florence Nightingale "the Lady of the Lamp" was born on May 12, 1820, in Florence. This 2020 the worldwide celebrates of Florence Nightingale’s bicentenary. In her honour The World Health Organisation have named 2020 the Year of the Nurse and Midwife.

Despite family pressures to marry and live as a conventional wealthy woman, she considered her dedication to nursing to be a response to the call of God to care for the sick. Her success in radically lowering the death rate of wounded soldiers in the Crimean War led to society’s acceptance of her proposals for better sanitation and nutrition, accurate medical knowledge, and professionally trained nurses.

While Nightingale is best known worldwide for revolutionising nursing and healthcare through her campaigning for health reform, her far-reaching recommendations were based on impressive statistical work and popularised through pioneering data visualisation and her evidence-based approach to healthcare.

Florence Nigthtingale was the first female fellow in 1858 from Royal Statistical Society. The Significance magazine from Royal Statistical Society and American Statistical Association has published a special issue: Significance magazine, 2020, Volume 17, Issue 2: Florence Nightingale

More information:
Celebrating Nightingale 2020 Bicentenary
Mujeres con ciencia: Florence Nightingale (in spanish)
Florence Nightingale foundation
Guys and St Thomas Hospital

picture: Helping the wounded. Shutterstock/Everett Historical
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stay at home

 

Image: Milo Manara 2020
https://www.milomanara.it/?lang=en 
Milo Manara is an Italian comic book writer and artist.
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stay at home

photo: Sabadell (AHS, 1936...)
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What Works to Prevent Violence Against Women and Girls (VAWG)

Violence against women and girls (VAWG) is preventable.

Over the last two decades, the global community has come to recognise the profound impact of violence on the lives of women and girls. This fundamentally undermines their health and well-being, and stands as a barrier to women’s full participation in global development and the economic and civic life of their communities.

What works to prevent violence published last january 2020 a brief where evaluated the design and implementation of diferent interventions designed to reduce VAWG. The interventions were included in four different groups:

• Community activism approaches to shift harmful gender attitudes, roles and social norms
• Combined gender transformation and economic empowerment interventions
• Couples’ interventions and special populations
• Prevention of violence among and against children

The brief show many examples of well-designed, well-implemented interventions of different modalities. Ten core elements of the design and implementations have contributed to their success.

Eight elements related to the design of the interventions:

1. Rigorously planned, with a robust theory of change, rooted in knowledge of local context.
2. Address multiple drivers of VAW, such as gender inequity, poverty, poor communication and marital conflict
3. Especially in highly patriarchal contexts, work with women and men, and where relevant, families.
4. Based on theories of gender and social empowerment that view behaviour change as a collective rather than solely individual process, and foster positive interpersonal relations and gender equity
5. Use group-based participatory learning methods, for adults and children, that emphasise empowerment, critical reflection, communication and conflict resolution skills building.
6. Age-appropriate design for children with a longer time for learning and an engaging pedagogy such as sport and play
7. Carefully designed, user-friendly manuals and materials supporting all intervention components to accomplish their goals.
8. Integrate support for survivors of violence.

Two elements related to the implementation of the interventions:

1. Optimal intensity: duration and frequency of sessions and overall programme length enables time for reflection and experiential learning
2. Staff and volunteers are selected for their gender equitable attitudes and non-violence behaviour, and are thoroughly trained, supervised and supported.

What Works to Prevent Violence Against Women and Girls is an innovative global programme working in 13 countries across the world building the evidence base on What Works to prevent violence in low-middle income settings.

Access article (pdf) 2020 What works brief

photo: Vivian Maier (1980)
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clinical practice guidelines and the voice of patients

Clinical practice guidelines (CPG) are the user manuals of modern medicine. If the human body can suffer it, chances are there's a guideline for treating it, from burns and breaks to cancers and strokes. At their best, they provide gold-standard guidance to doctors: how to diagnose and treat a condition, what symptoms to watch for, what tests to order. But that's not always the reality. Clinicians are experts, but the patients with the disease are also experts. They're the ones living with it on a daily basis.

Guideline development could be unsatisfactory and unreliable. Because it so often fails to engage any patients or caregivers. Usually guidelines are developed without any input from the people who would actually experience them. Also, there is no consensus on what exactly patients and their representatives should be asked to do during CPG development. For example, should they be active members of guideline groups, or should patient input and preferences be shared only with clinicians in guideline groups. Moreover, there is little clarity about how guidelines should reflect patient-based evidence, or information generated by patients about different aspects of care, patient preferences, and care experience.

Rand (2019) in an interdisciplinary team of researchers, patient representatives from the Parent Project Muscular Dystrophy (PPMD) and clinicians developed the RAND/PPMD Patient-Centeredness Method (RPM) - a version of a Delphi method- with a online approach to engaging patients and their representatives in Clinicial Practice Guildelines.

The authors said that Duchenne was a good test case, because the disease is so rare, so complex, and the balance between treatment and quality of life is so precarious. but this method should be formally validated and tested in the context of other clinical conditions and compared to other ways of engaging patients in CPG development.

Open access article

photo: Moda ald carrer 1971. Joana Biarnés (1935-2018)
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