The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Janet E Hiller - One of the best experts on this subject based on the ideXlab platform.
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citizens perspectives on Disinvestment from publicly funded pathology tests a deliberative forum
Value in Health, 2015Co-Authors: Jackie M Street, Janet E Hiller, Peta Callaghan, Annette J BraunackmayerAbstract:Abstract Background Deliberative forums can be useful tools in policy decision making for balancing citizen voice and community values against dominant interests. Objective To describe the use of a deliberative forum to explore community perspectives on a complex health problem—Disinvestment. Methods A deliberative forum of citizens was convened in Adelaide, South Australia, to develop criteria to support Disinvestment from public funding of ineffective pathology tests. The case study of potential Disinvestment from vitamin B 12 /folate pathology testing was used to shape the debate. The forum was informed by a systematic review of B 12 /folate pathology test effectiveness and expert testimony. Results The citizens identified seven criteria: cost of the test, potential impact on individual health/capacity to benefit, potential cost to society, public good, alternatives to testing, severity of the condition, and accuracy of the test. The participants not only saw these criteria as an interdependent network but also questioned "the authority" of policymakers to make these decisions. Conclusions Coherence between the criteria devised by the forum and those described by an expert group was considerable, the major differences being that the citizens did not consider equity issues and the experts neglected the "cost" of social and emotional impact of Disinvestment on users and the society.
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the astute health study protocol deliberative stakeholder engagements to inform implementation approaches to healthcare Disinvestment
Implementation Science, 2012Co-Authors: Amber M Watt, Janet E Hiller, John R Moss, Katherine Hodgetts, Annette J Braunackmayer, Heather Buchan, Janet Wale, Dagmara Riitano, Jackie M StreetAbstract:Background: Governments and other payers are yet to determine optimal processes by which to review the safety, effectiveness, and cost-effectiveness of technologies and procedures that are in active use within health systems, and rescind funding (partially or fully) from those that display poor profiles against these parameters. To further progress a Disinvestment agenda, a model is required to support payers in implementing Disinvestment in a transparent manner that may withstand challenge from vested interests and concerned citizens. Combining approaches from health technology assessment and deliberative democratic theory, this project seeks to determine if and how wide stakeholder engagement can contribute to improved decision-making processes, wherein the views of both vested and non-vested stakeholders are seen to contribute to informing policy implementation within a Disinvestment context. Methods/design: Systematic reviews pertaining to illustrative case studies were developed and formed the evidence base for discussion. Review findings were presented at a series of deliberative, evidence-informed stakeholder engagements, including partisan (clinicians and consumers) and non-partisan (representative community members) stakeholders. Participants were actively facilitated towards identifying shared and dissenting perspectives regarding public funding policy for each of the case studies and developing their own funding models in response to the evidence presented. Policy advisors will subsequently be invited to evaluate Disinvestment options based on the scientific and colloquial evidence presented to them, and to explore the value of this information to their decision-making processes with reference to Disinvestment. Discussion: Analysis of the varied outputs of the deliberative engagements will contribute to the methodological development around how to best integrate scientific and colloquial evidence for consideration by policy advisors. It may contribute to the legitimization of broad and transparent stakeholder engagement in this context. It is anticipated that decision making will benefit from the knowledge delivered through informed deliberation with engaged stakeholders, and this will be explored through interviews with key decision makers.
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engaging clinicians in evidence based Disinvestment role and perceptions of evidence
International Journal of Technology Assessment in Health Care, 2012Co-Authors: Amber M Watt, Adam G Elshaug, Cameron D Willis, Katherine Hodgetts, Janet E HillerAbstract:Objectives The aim of this study was to determine how evidence from systematic review (SR) is perceived and negotiated by expert stakeholders in considering a technology for potential Disinvestment. Methods An evidence-informed stakeholder engagement examined results from a diagnostic accuracy SR of vitamin B12 and folate tests. Pathologists deliberated around the SR findings to generate an informed contribution to future policy for the funding of B12 and folate tests. Deliberations were transcribed and subject to qualitative analysis. Results Pathologists did not engage with findings from the SR in depth; rather they sought to contest the terms of the problem driving the review and attempted to reframe it. Pathologists questioned the usefulness of SR outcomes given the variable definitions of B12 deficiency and deferred addressing Disinvestment options specifically pertaining to B12 testing. However, folate testing was proffered as a potential Disinvestment candidate, based upon pathologists' definition of "appropriate" evidence beyond the bounds of the SR. Conclusions The value of SR to informing Disinvestment deliberations by expert stakeholders may be a function of timing as well as content. Engagement of stakeholders in co-produced evidence may be required at two levels: (i) Early in the synthesis phase to help shape the SR and harmonize expert views with the available evidence (including gaps); (ii) Collaboration in primary research to fill evidence-gaps thus supporting evidence-based Disinvestment. Without this, information asymmetry between clinically engaged experts and decision makers may preclude the collaborative, informed, and technical discussions required to generate productive policy change.
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news and social media windows into community perspectives on Disinvestment
International Journal of Technology Assessment in Health Care, 2011Co-Authors: Jackie M Street, Amber M Watt, Janet E Hiller, Sophie E Hennessy, Adam G ElshaugAbstract:OBJECTIVES: The aim of this study, in the context of Disinvestment related health technology assessment, is to examine whether analysis of Web 2.0--commercial media output, blogs, and discussion forums--can provide an understanding of media framing, community perspectives, and the sociopolitical aspects of an entrenched technology. METHODS: Thematic analysis of relevant data from fifty-nine media articles, thirty-nine discussion forums, thirteen blogs, and three Facebook pages relating to our case study: public funding for assisted reproductive technology services. Mainstream media and community-based social media responses were compared. RESULTS: Media responses were narrow, primarily describing emotive individual narratives or the political nexus of interests. Community (including patient) responses were broader including discussion of opportunity cost and vested interests but mostly reflected the polar ends of the debate, diverging strongly for or against Disinvestment from public funding. CONCLUSION: Web2.0 and media analysis offers an inexpensive method to capture media portrayal, divergent community responses both to that portrayal and independent of it, and insight into the sociopolitical aspects of an entrenched technology undergoing Disinvestment debate.
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exploring policy makers perspectives on Disinvestment from ineffective healthcare practices
International Journal of Technology Assessment in Health Care, 2008Co-Authors: Adam G Elshaug, Janet E Hiller, John R MossAbstract:Objectives: Many existing healthcare interventions diffused before modern evidence-based standards of clinical- and cost-effectiveness. Disinvestment from ineffective or inappropriately applied practices is growing as a priority for international health policy, both for improved quality of care and sustainability of resource allocation. Australian policy stakeholders were canvassed to assess their perspectives on the challenges and the nature of Disinvestment. Methods: Senior health policy stakeholders from Australia were criterion and snow-ball sampled (to identify opinion leaders). Participants were primed with a potential Disinvestment case study and took part in individual semistructured interviews that focused on mechanisms and challenges within health policy to support Disinvestment. Interviews were taped and transcribed for thematic analysis. Participant comments were de-identified. Results: Ten stakeholders were interviewed before saturation was reached. Three primary themes were identified. (i) The current focus on assessment of new and emerging health technologies/practices and lack of attention toward existing practices is due to resource limitations and methodological complexity. Participants considered a parallel model to that of Australia’s current assessment process for new medical technologies is best-positioned to facilitate Disinvestment. (ii) To advance the Disinvestment agenda requires an explicit focus on the potential for cost-savings coupled with improved quality of care. (iii) Support (financial and collaborative) is needed for research advancement in the methodological underpinnings associated with health technology assessment and for Disinvestment specifically. Conclusions: In this exploratory study, stakeholders support the notion that systematic policy approaches to Disinvestment will improve equity, efficiency, quality, and safety of health care, as well as sustainability of resource allocation.
Jeffrey Winking - One of the best experts on this subject based on the ideXlab platform.
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infidelity jealousy and wife abuse among tsimane forager farmers testing evolutionary hypotheses of marital conflict
Evolution and Human Behavior, 2012Co-Authors: Jonathan Stieglitz, Michael Gurven, Hillard Kaplan, Jeffrey WinkingAbstract:Abstract The role of men's jealousy over a wife's infidelity in precipitating marital conflict and wife abuse is well documented. The role of women's jealousy over a husband's infidelity has received little attention, which is puzzling given high potential costs to women of withdrawal of paternal investment. We address this gap by investigating marital conflict and wife abuse among Tsimane forager–farmers of Bolivia. We test predictions derived from male jealousy and paternal Disinvestment hypotheses, which consider threats and consequences of infidelity by women (male jealousy hypothesis) and men (paternal Disinvestment hypothesis). The paternal Disinvestment hypothesis proposes that wife abuse is employed by husbands to limit wives' mate retention effort and maintain men's opportunities to pursue extrapair sexual relationships. Interviews were conducted among husbands and wives in the same marriages using a combination of open-ended and structured items. Spouses agree that the most frequently reported type of marital argument is women's jealousy over a husband's infidelity ( N =266 arguments). Roughly 60% of abusive events occurred during arguments over men's diversion of household resources ( N =124 abusive events). In multivariate analyses, likelihood of wife abuse is greater in marriages where husbands have affairs, where wives are younger, and where spouses spend more time apart ( N =60 husbands, 71 wives). While we find strong support for both male jealousy and paternal Disinvestment hypotheses, it is men's infidelity, not women's, that precipitates most instances of marital conflict and wife abuse. We conclude that men's aggression towards their wives facilitates men's diversion of family resources for their selfish interests.
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infidelity jealousy and wife abuse among tsimane forager farmers testing evolutionary hypotheses of marital conflict
Evolution and Human Behavior, 2012Co-Authors: Jonathan Stieglitz, Michael Gurven, Hillard Kaplan, Jeffrey WinkingAbstract:The role of men's jealousy over a wife's infidelity in precipitating marital conflict and wife abuse is well documented. The role of women's jealousy over a husband's infidelity has received little attention, which is puzzling given high potential costs to women of withdrawal of paternal investment. We address this gap by investigating marital conflict and wife abuse among Tsimane forager–farmers of Bolivia. We test predictions derived from male jealousy and paternal Disinvestment hypotheses, which consider threats and consequences of infidelity by women (male jealousy hypothesis) and men (paternal Disinvestment hypothesis). The paternal Disinvestment hypothesis proposes that wife abuse is employed by husbands to limit wives' mate retention effort and maintain men's opportunities to pursue extrapair sexual relationships. Interviews were conducted among husbands and wives in the same marriages using a combination of open-ended and structured items. Spouses agree that the most frequently reported type of marital argument is women's jealousy over a husband's infidelity (N=266 arguments). Roughly 60% of abusive events occurred during arguments over men's diversion of household resources (N=124 abusive events). In multivariate analyses, likelihood of wife abuse is greater in marriages where husbands have affairs, where wives are younger, and where spouses spend more time apart (N=60 husbands, 71 wives). While we find strong support for both male jealousy and paternal Disinvestment hypotheses, it is men's infidelity, not women's, that precipitates most instances of marital conflict and wife abuse. We conclude that men's aggression towards their wives facilitates men's diversion of family resources for their selfish interests. Published by Elsevier Inc.
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spousal violence and paternal Disinvestment among tsimane forager horticulturalists
American Journal of Human Biology, 2011Co-Authors: Jonathan Stieglitz, Michael Gurven, Hillard Kaplan, Jeffrey Winking, Basilio Vie TayoAbstract:Objectives: We develop and test a conceptual model of factors influencing the likelihood of physical wife abuse. The paternal Disinvestment model emphasizes that spousal conflict over resource use results from men’s attempts to increase individual fitness at a cost to the family (e.g., through pursuit of extramarital affairs). We propose that men use violence to control women’s responses to the diversion of resources away from the family: to quell women’s objections to male Disinvestment, maintain women’s parental investment, and to dissuade women from pursuing relationships with other men. Methods: Interviews were conducted among men and women to determine rates of violence and demographic and behavioral covariates. Structural equation modeling and generalized estimating equations analyses were used to test predictions derived from the model. We also collected data on frequent complaints in marriage and women’s perceptions of arguments precipitating violence. Results: Over 85% of women experienced physical wife abuse (n 5 49). Indicators of paternal Disinvestment positively covary with indicators of marital strife and with rates of wife abuse. The wife’s age, matrilocal residence, and presence of joint dependent offspring decrease the likelihood of violence through direct and indirect routes. Conclusions: Wife abuse is linked to the importance of paternal investment in human families, and is a means by which men control women’s responses to a dual reproductive strategy of familial investment and pursuit of extramarital sexual relationships. This framework is more general than traditional sociological and evolutionary perspectives empha
Adam G Elshaug - One of the best experts on this subject based on the ideXlab platform.
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sustainability in health care by allocating resources effectively share 10 operationalising Disinvestment in a conceptual framework for resource allocation
BMC Health Services Research, 2017Co-Authors: Claire Harris, Sally Green, Adam G ElshaugAbstract:This is the tenth in a series of papers reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. After more than a decade of research, there is little published evidence of active and successful Disinvestment. The paucity of frameworks, methods and tools is reported to be a factor in the lack of success. However there are clear and consistent messages in the literature that can be used to inform development of a framework for operationalising Disinvestment. This paper, along with the conceptual review of Disinvestment in Paper 9 of this series, aims to integrate the findings of the SHARE Program with the existing Disinvestment literature to address the lack of information regarding systematic organisation-wide approaches to Disinvestment at the local health service level. A framework for Disinvestment in a local healthcare setting is proposed. Definitions for essential terms and key concepts underpinning the framework have been made explicit to address the lack of consistent terminology. Given the negative connotations of the word ‘Disinvestment’ and the problems inherent in considering Disinvestment in isolation, the basis for the proposed framework is ‘resource allocation’ to address the spectrum of decision-making from investment to Disinvestment. The focus is positive: optimising healthcare, improving health outcomes, using resources effectively. The framework is based on three components: a program for decision-making, projects to implement decisions and evaluate outcomes, and research to understand and improve the program and project activities. The program consists of principles for decision-making and settings that provide opportunities to introduce systematic prompts and triggers to initiate Disinvestment. The projects follow the steps in the Disinvestment process. Potential methods and tools are presented, however the framework does not stipulate project design or conduct; allowing application of any theories, methods or tools at each step. Barriers are discussed and examples illustrating constituent elements are provided. The framework can be employed at network, institutional, departmental, ward or committee level. It is proposed as an organisation-wide application, embedded within existing systems and processes, which can be responsive to needs and priorities at the level of implementation. It can be used in policy, management or clinical contexts.
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from talk to action policy stakeholders appropriateness and selective Disinvestment
International Journal of Technology Assessment in Health Care, 2015Co-Authors: Alison P Paprica, Justin Peffer, Adam G Elshaug, Anthony J. Culyer, Guillermo A SandovalAbstract:There is unprecedented interest in decreasing the frequency of unnecessary medical tests and procedures. International examples include the Choosing Wisely campaign (1), the United States Preventative Services Task Force (USPTF) grade C and D recommendations (2), the National Institute for Health and Care Excellence (NICE) “do not do” resources (3), and Australia's federal Quality Management Framework of the Medicare Benefits Schedule (4). In Canada, Health Quality Ontario has an “appropriateness initiative” (5), Choosing Wisely Canada has been launched (6) and appropriateness has been identified as a national priority by Canadian provincial and territorial premiers (7). Notwithstanding the numerous “lists” that identify potential low-value services, prioritizing and implementing Disinvestments from within those lists still pose challenges (8–13). Political and social factors can be barriers to evidence-informed Disinvestment—once a product or service is funded, withdrawing support for it, wholly or in part, is much harder than deciding not to support it in the first place. Expert and professional opinion, political judgment, the interpretation of local values and traditions, and views from stakeholders are all factors that inform and constrain decision making (13–15). Although the literature generally supports stakeholder “ownership” of policy decisions (14–18), few publications detail how policy stakeholders should be involved and what, specifically, they can contribute. Our objective was to explore the involvement of policy stakeholders in the design and implementation of tools and processes related to appropriateness and Disinvestment in Canada, and the province of Ontario in particular, and to assess their effectiveness.
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case studies that illustrate Disinvestment and resource allocation decision making processes in health care a systematic review
International Journal of Technology Assessment in Health Care, 2013Co-Authors: Julie Polisena, Adam G Elshaug, Tammy Clifford, Craig Mitton, Erin Russell, Becky SkidmoreAbstract:Objective Technological change accounts for approximately 25 percent of health expenditure growth. To date, limited research has been published on case studies of Disinvestment and resource allocation decision making in clinical practice. Our research objective is to systematically review and catalogue the application of frameworks and tools for Disinvestment and resource allocation decision making in health care. Methods An electronic literature search was executed for studies on Disinvestment, obsolete and ineffective technologies, and priority healthcare setting, published from January 1990 until January 2012. Databases searched were MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, Embase, The Cochrane Library, PubMed, and HEED. Results Fourteen case studies on the application of frameworks and tools for Disinvestment and resource allocation decisions were included. Most studies described the application of program budgeting and marginal analysis (PBMA), and two reports used health technology assessment (HTA) methods for coverage decisions in a national fee-for-service structure. Numerous healthcare technologies and services were covered across the studies. We describe the multiple criteria considered for decision making, and the strengths and limitations of these frameworks and tools are highlighted. Conclusions Disinvestment and resource allocation decisions require evidence to ensure their transparency and objectivity. PBMA was used to assess resource allocation of health services and technologies in a fixed budget jurisdiction, while HTA reviews focused on specific technologies, principally in fee-for-service structures. Future research can review the data requirements and explore opportunities to increase the quantity of available evidence for Disinvestment and resource allocation decisions.
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engaging clinicians in evidence based Disinvestment role and perceptions of evidence
International Journal of Technology Assessment in Health Care, 2012Co-Authors: Amber M Watt, Adam G Elshaug, Cameron D Willis, Katherine Hodgetts, Janet E HillerAbstract:Objectives The aim of this study was to determine how evidence from systematic review (SR) is perceived and negotiated by expert stakeholders in considering a technology for potential Disinvestment. Methods An evidence-informed stakeholder engagement examined results from a diagnostic accuracy SR of vitamin B12 and folate tests. Pathologists deliberated around the SR findings to generate an informed contribution to future policy for the funding of B12 and folate tests. Deliberations were transcribed and subject to qualitative analysis. Results Pathologists did not engage with findings from the SR in depth; rather they sought to contest the terms of the problem driving the review and attempted to reframe it. Pathologists questioned the usefulness of SR outcomes given the variable definitions of B12 deficiency and deferred addressing Disinvestment options specifically pertaining to B12 testing. However, folate testing was proffered as a potential Disinvestment candidate, based upon pathologists' definition of "appropriate" evidence beyond the bounds of the SR. Conclusions The value of SR to informing Disinvestment deliberations by expert stakeholders may be a function of timing as well as content. Engagement of stakeholders in co-produced evidence may be required at two levels: (i) Early in the synthesis phase to help shape the SR and harmonize expert views with the available evidence (including gaps); (ii) Collaboration in primary research to fill evidence-gaps thus supporting evidence-based Disinvestment. Without this, information asymmetry between clinically engaged experts and decision makers may preclude the collaborative, informed, and technical discussions required to generate productive policy change.
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news and social media windows into community perspectives on Disinvestment
International Journal of Technology Assessment in Health Care, 2011Co-Authors: Jackie M Street, Amber M Watt, Janet E Hiller, Sophie E Hennessy, Adam G ElshaugAbstract:OBJECTIVES: The aim of this study, in the context of Disinvestment related health technology assessment, is to examine whether analysis of Web 2.0--commercial media output, blogs, and discussion forums--can provide an understanding of media framing, community perspectives, and the sociopolitical aspects of an entrenched technology. METHODS: Thematic analysis of relevant data from fifty-nine media articles, thirty-nine discussion forums, thirteen blogs, and three Facebook pages relating to our case study: public funding for assisted reproductive technology services. Mainstream media and community-based social media responses were compared. RESULTS: Media responses were narrow, primarily describing emotive individual narratives or the political nexus of interests. Community (including patient) responses were broader including discussion of opportunity cost and vested interests but mostly reflected the polar ends of the debate, diverging strongly for or against Disinvestment from public funding. CONCLUSION: Web2.0 and media analysis offers an inexpensive method to capture media portrayal, divergent community responses both to that portrayal and independent of it, and insight into the sociopolitical aspects of an entrenched technology undergoing Disinvestment debate.
Terry Haines - One of the best experts on this subject based on the ideXlab platform.
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health care staff responses to Disinvestment a systematic search and qualitative thematic synthesis
Health Care Management Review, 2021Co-Authors: Deb Mitchell, Lisa Obrien, Anne Bardoel, Kellyann Bowles, Terry HainesAbstract:BACKGROUND Health care services must deliver high-quality, evidence-based care that represents sound value. Disinvestment is the process of withdrawing resources from any existing health care practices that deliver low gain for their cost and reallocating these toward practices that are more effective, efficient, and cost-effective, thus benefiting patients and the community. PURPOSE This is the first review to examine the responses of health care staff to Disinvestment and investigate the factors that increase the likelihood of these staff accepting Disinvestment or reallocation of resources from the health services they provide. METHODS We conducted a systematic search of five electronic databases using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) framework. A critical appraisal process of the quality of the included studies was performed by two authors. We undertook a thematic synthesis of the qualitative data to develop an overarching narrative. RESULTS Twelve studies were identified for synthesis and all found that the Disinvestment process was challenging and controversial for those health care staff involved. Negative staff reactions to Disinvestment identified were anxiety, disempowerment, distrust, and feelings of being dismissed and disrespected. Engagement with Disinvestment was observed when staff were invited to participate in a process they considered transparent and in the best interests of the community. PRACTICE RECOMMENDATIONS Health care staff have a strong professional identity associated with autonomy in their decision making in the provision of health care services. Disinvestment from a service that health care staff can usually choose to provide threatens this identity. Engaging clinical champions to lead change, using rigorous patient outcome data, and transparent decision-making processes may assist health care staff to embrace a new identity as innovators and accept Disinvestment in low-value health care.
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moving past the loss a longitudinal qualitative study of health care staff experiences of Disinvestment
Medical Care Research and Review, 2020Co-Authors: Deb Mitchell, Lisa Obrien, Anne Bardoel, Terry HainesAbstract:This longitudinal qualitative study examines staff experience of Disinvestment from a service they are accustomed to providing to their patients. It took place alongside a Disinvestment trial that measured the impact of the removal of weekend allied health services from acute wards at two hospitals. Data were gathered from repeated interviews and focus groups with 450 health care staff. We developed a grounded theory, which explains changes in staff perceptions over time and the key modifying factors. Staff appeared to experience Disinvestment as loss; a key difference to other operational changes. Early staff experiences of Disinvestment were primarily negative, but evolved with time and change-management strategies such as the provision of data, clear and persistent communication approaches, and forums where the big picture context of the Disinvestment was robustly discussed. These allowed the Disinvestment trial to be successfully implemented at two health services, with high compliance with the research protocol.
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understanding health professional responses to service Disinvestment a qualitative study
International journal of health policy and management, 2019Co-Authors: Deb Mitchell, Lisa Obrien, Anne Bardoel, Terry HainesAbstract:Background Disinvestment from inefficient health services may be a potential solution to rising healthcare costs, but there has been poor uptake of Disinvestment recommendations. This Australian study aims to understand how health professionals react when confronted with a plan to disinvest from a health service they previously provided to their patients. Methods This qualitative study took place prior to the Disinvestment phase of a trial which removed weekend allied health services from acute hospital wards, to evaluate the effectiveness and cost effectiveness of the service. Observations and focus groups were used to collect data from 156 participants which was analysed thematically. Results Initial reactions to the Disinvestment were almost universally negative, with staff extremely concerned about the impact on the safety and quality of patient care and planning ways to circumvent the trial. Removal of existing services was perceived as a loss and created a direct threat to some clinicians’ professional identity. With time, discussion, and understanding of the project’s context, some staff moved towards acceptance and perceived the trial as an opportunity, particularly given the service was to be reinstated after the Disinvestment. Conclusion Clinicians and health service managers are protective of the services they deliver and can create barriers to Disinvestment. Even when services are removed to ascertain their value, health professionals may continue to provide services to their patients. Measuring the impact of the Disinvestment may assist staff to accept the removal of a service.
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study protocol for two randomized controlled trials examining the effectiveness and safety of current weekend allied health services and a new stakeholder driven model for acute medical surgical patients versus no weekend allied health services
Trials, 2015Co-Authors: Terry Haines, Deb Mitchell, Lisa Obrien, Kellyann Bowles, Donna Markham, Romi Haas, Samantha Plumb, Timothy Chiu, Kerry May, Kathleen PhilipAbstract:Background Disinvestment from inefficient or ineffective health services is a growing priority for health care systems. Provision of allied health services over the weekend is now commonplace despite a relative paucity of evidence supporting their provision. The relatively high cost of providing this service combined with the paucity of evidence supporting its provision makes this a potential candidate for Disinvestment so that resources consumed can be used in other areas. This study aims to determine the effectiveness, cost-effectiveness and safety of the current model of weekend allied health service and a new stakeholder-driven model of weekend allied health service delivery on acute medical and surgical wards compared to having no weekend allied health service.
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application of a novel Disinvestment research design to the use of weekend allied health services on acute medical and surgical wards randomised trial and economic evaluation protocol
BMC Health Services Research, 2014Co-Authors: Terry Haines, Deb Mitchell, Lisa Obrien, Donna Markham, Elizabeth H Skinner, Samantha Plumb, Kerry May, Kelly Bowles, Timothy Chui, Romi HaasAbstract:Background Some currently provided health services have an absence of evidence for effectiveness, cost-effectiveness and/or safety. These are candidates for Disinvestment. It is possible that such services would prove valuable if trials were to be conducted however, making Disinvestment a clear risk. Provision of these services in the context of usual care is a considerable barrier to conducting a conventional trial of these interventions. Our team has recently developed a novel research approach to conduct a trial in this context [1]. In this paper, we describe the first application of this design. Allied health services include those provided by a range of health professional groups. Weekend allied health services on acute medical or surgical wards are widely provided internationally but are inconsistent in their composition and focus. There is no direct evidence of efficacy for these weekend services, and higher rates of pay on the weekend make their likely cost-effectiveness questionable. This research examines the efficacy, cost-effectiveness and safety of disinvesting from weekend allied health services on acute medical or surgical wards.
Deb Mitchell - One of the best experts on this subject based on the ideXlab platform.
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health care staff responses to Disinvestment a systematic search and qualitative thematic synthesis
Health Care Management Review, 2021Co-Authors: Deb Mitchell, Lisa Obrien, Anne Bardoel, Kellyann Bowles, Terry HainesAbstract:BACKGROUND Health care services must deliver high-quality, evidence-based care that represents sound value. Disinvestment is the process of withdrawing resources from any existing health care practices that deliver low gain for their cost and reallocating these toward practices that are more effective, efficient, and cost-effective, thus benefiting patients and the community. PURPOSE This is the first review to examine the responses of health care staff to Disinvestment and investigate the factors that increase the likelihood of these staff accepting Disinvestment or reallocation of resources from the health services they provide. METHODS We conducted a systematic search of five electronic databases using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) framework. A critical appraisal process of the quality of the included studies was performed by two authors. We undertook a thematic synthesis of the qualitative data to develop an overarching narrative. RESULTS Twelve studies were identified for synthesis and all found that the Disinvestment process was challenging and controversial for those health care staff involved. Negative staff reactions to Disinvestment identified were anxiety, disempowerment, distrust, and feelings of being dismissed and disrespected. Engagement with Disinvestment was observed when staff were invited to participate in a process they considered transparent and in the best interests of the community. PRACTICE RECOMMENDATIONS Health care staff have a strong professional identity associated with autonomy in their decision making in the provision of health care services. Disinvestment from a service that health care staff can usually choose to provide threatens this identity. Engaging clinical champions to lead change, using rigorous patient outcome data, and transparent decision-making processes may assist health care staff to embrace a new identity as innovators and accept Disinvestment in low-value health care.
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moving past the loss a longitudinal qualitative study of health care staff experiences of Disinvestment
Medical Care Research and Review, 2020Co-Authors: Deb Mitchell, Lisa Obrien, Anne Bardoel, Terry HainesAbstract:This longitudinal qualitative study examines staff experience of Disinvestment from a service they are accustomed to providing to their patients. It took place alongside a Disinvestment trial that measured the impact of the removal of weekend allied health services from acute wards at two hospitals. Data were gathered from repeated interviews and focus groups with 450 health care staff. We developed a grounded theory, which explains changes in staff perceptions over time and the key modifying factors. Staff appeared to experience Disinvestment as loss; a key difference to other operational changes. Early staff experiences of Disinvestment were primarily negative, but evolved with time and change-management strategies such as the provision of data, clear and persistent communication approaches, and forums where the big picture context of the Disinvestment was robustly discussed. These allowed the Disinvestment trial to be successfully implemented at two health services, with high compliance with the research protocol.
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understanding health professional responses to service Disinvestment a qualitative study
International journal of health policy and management, 2019Co-Authors: Deb Mitchell, Lisa Obrien, Anne Bardoel, Terry HainesAbstract:Background Disinvestment from inefficient health services may be a potential solution to rising healthcare costs, but there has been poor uptake of Disinvestment recommendations. This Australian study aims to understand how health professionals react when confronted with a plan to disinvest from a health service they previously provided to their patients. Methods This qualitative study took place prior to the Disinvestment phase of a trial which removed weekend allied health services from acute hospital wards, to evaluate the effectiveness and cost effectiveness of the service. Observations and focus groups were used to collect data from 156 participants which was analysed thematically. Results Initial reactions to the Disinvestment were almost universally negative, with staff extremely concerned about the impact on the safety and quality of patient care and planning ways to circumvent the trial. Removal of existing services was perceived as a loss and created a direct threat to some clinicians’ professional identity. With time, discussion, and understanding of the project’s context, some staff moved towards acceptance and perceived the trial as an opportunity, particularly given the service was to be reinstated after the Disinvestment. Conclusion Clinicians and health service managers are protective of the services they deliver and can create barriers to Disinvestment. Even when services are removed to ascertain their value, health professionals may continue to provide services to their patients. Measuring the impact of the Disinvestment may assist staff to accept the removal of a service.
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study protocol for two randomized controlled trials examining the effectiveness and safety of current weekend allied health services and a new stakeholder driven model for acute medical surgical patients versus no weekend allied health services
Trials, 2015Co-Authors: Terry Haines, Deb Mitchell, Lisa Obrien, Kellyann Bowles, Donna Markham, Romi Haas, Samantha Plumb, Timothy Chiu, Kerry May, Kathleen PhilipAbstract:Background Disinvestment from inefficient or ineffective health services is a growing priority for health care systems. Provision of allied health services over the weekend is now commonplace despite a relative paucity of evidence supporting their provision. The relatively high cost of providing this service combined with the paucity of evidence supporting its provision makes this a potential candidate for Disinvestment so that resources consumed can be used in other areas. This study aims to determine the effectiveness, cost-effectiveness and safety of the current model of weekend allied health service and a new stakeholder-driven model of weekend allied health service delivery on acute medical and surgical wards compared to having no weekend allied health service.
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application of a novel Disinvestment research design to the use of weekend allied health services on acute medical and surgical wards randomised trial and economic evaluation protocol
BMC Health Services Research, 2014Co-Authors: Terry Haines, Deb Mitchell, Lisa Obrien, Donna Markham, Elizabeth H Skinner, Samantha Plumb, Kerry May, Kelly Bowles, Timothy Chui, Romi HaasAbstract:Background Some currently provided health services have an absence of evidence for effectiveness, cost-effectiveness and/or safety. These are candidates for Disinvestment. It is possible that such services would prove valuable if trials were to be conducted however, making Disinvestment a clear risk. Provision of these services in the context of usual care is a considerable barrier to conducting a conventional trial of these interventions. Our team has recently developed a novel research approach to conduct a trial in this context [1]. In this paper, we describe the first application of this design. Allied health services include those provided by a range of health professional groups. Weekend allied health services on acute medical or surgical wards are widely provided internationally but are inconsistent in their composition and focus. There is no direct evidence of efficacy for these weekend services, and higher rates of pay on the weekend make their likely cost-effectiveness questionable. This research examines the efficacy, cost-effectiveness and safety of disinvesting from weekend allied health services on acute medical or surgical wards.