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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
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Improving facility-based care: eliciting tacit knowledge to advance intervention design.

Mike English1,2, Jacinta Nzinga3, Jacquie Oliwa4,5

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Summary

Improving healthcare quality requires addressing resource deficits and mobilizing five key forces for change. Engaging staff and patients is crucial for successful interventions and better health outcomes.

Keywords:
Health services researchHealth systems evaluationStudy design

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Area of Science:

  • Healthcare Management
  • Health Systems Research
  • Organizational Behavior in Healthcare

Background:

  • Healthcare quality and safety improvement initiatives aim to reduce preventable mortality and morbidity.
  • Interventions must be tested in supportive health system environments for successful adoption.
  • Behavioral changes required for interventions can have unpredictable consequences.

Purpose of the Study:

  • To address the challenge of implementing healthcare interventions at the meso- and micro-levels.
  • To explore foundational questions regarding resource areas (physical, workforce, relationships) and motive forces for change.
  • To bridge the theory-practice gap in designing effective healthcare interventions.

Main Methods:

  • Drawing on theoretical insights and empirical work.
  • Highlighting the importance of engaging managers, senior and frontline staff, and patients.
  • Examining three core resource areas and five motive forces for change.

Main Results:

  • Successful interventions require addressing deficits in physical resources, workforce capacity/capability, and organizational relationships.
  • Mobilizing five motive forces—goal alignment, leadership, empowerment, planning/procurement, and learning—is essential for overcoming inertia.
  • Engaging diverse stakeholders is critical for eliciting tacit and contextual knowledge.

Conclusions:

  • Addressing resource limitations and mobilizing motive forces are key to successful healthcare interventions.
  • Engaging staff and patients in exploring foundational questions can improve intervention design.
  • This approach contributes to better facility-based care, improved outcomes, and the development of learning health systems.