About SHARE
Background
Components | Structure (Who, What) | Practice (How) |
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1. Governance | ▪ Overseers ▪ Policies for decision-making ▪ Transparency and accountability in all structures ▪ Requirements for addressing conflict of interesta
▪ Requirements for monitoring, evaluation and improvement of systems and processes ▪ Requirements for reporting | ▪ Oversight ▪ Procedures, guidelines, protocols for decision-making ▪ Transparency and accountability in all practices ▪ Methods of addressing conflict of interest ▪ Methods of monitoring, evaluation and improvement of systems and processes ▪ Methods of reporting |
2. Administration | ▪ Administrators ▪ Requirements for administration ▪ Relationships and coordination ▪ Communication | ▪ Methods of administration, coordination, communication and collaboration |
3. Stakeholder engagement | ▪ Clinicians, Managers, Consumers, Technical experts, Funders, other relevant parties ▪ Requirements for stakeholder engagement | ▪ Methods of identification, recruitment and engagement |
4. Resources | ▪ Funding sources ▪ Allocation of staff ▪ Access to experts or ways to gain expertise ▪ Information sources ▪ Requirements for resources | ▪ Provision of appropriate and adequate funding, time, skills/training, information ▪ Utilisation of resources |
5. Decision-making | ▪ Decision-makers – Clinicians – Authorised individuals – Authorised groups ▪ Scope of decisions ▪ Type of decisions ▪ Requirements for decision-making | ▪ Methods of decision-making – Identification of need/application – Decision criteria – Ascertainment and use of evidence – Reminders and prompts to consider disinvestment – Deliberative process – Documentation and dissemination |
6. Implementation | ▪ Purchasers ▪ Requirements for purchasing | ▪ Methods of purchasing |
▪ Policy and guidance developers ▪ Requirements for policies and guidance documents | ▪ Methods of policy and guidance development | |
▪ Implementers ▪ Requirements for implementation | ▪ Methods of project management ▪ Methods of change management | |
7. Evaluation | ▪ Evaluators ▪ Requirements for evaluation ▪ Type and source of data collected | ▪ Methods of evaluation |
8. (Reinvestment) | Requirements for reinvestment/reallocation | Methods of reinvestment/reallocation |
Aims
Research question
Methods
Model for evidence-based change
Literature review
Interviews and workshop
Participants
Data collection and analysis
Development of the model
Concepts
Relationships
Definitions
Drafting and refinement
Analysis and synthesis
Results and discussion
How can consumer and community values and preferences be integrated into organisation-wide decision-making for resource allocation?
Health consumers | |
Consumer representatives | Members of a committee, steering group, working party, panel or similar decision-making group who voices the consumer perspective and takes part in the process on behalf of consumers (adapted from CHF [75]) |
Community | Group of people sharing a common interest including cultural, social, political, health and economic interests and/or a geographic association (adapted from CHF [75]) |
Consumer engagement | Inclusion of consumers and/or community members in a continuum of activities from passive behaviours such as receiving information, through more active participation, to shared decision-making with equal power. These activities include, but are not limited to, provision of information, consultation, development, participation, collaboration and empowerment (adapted from Sarrami-Foroushani et al [31], O’Mara-Eves et al [33]) |
Communication | Consumers and/or community members are engaged through imparting or exchanging information. Information can be verbal, written or provided by other methods. Communication can go both ways between consumers and/or community members and health service staff |
Consultation | Consumers and/or community members are engaged through requests to provide their views, preferences, comments and suggestions to inform the decision-making process, but the consumers and/or community members may not be engaged in subsequent decision-making or action (adapted from PICS [63], CHF [75]) |
Participation | Consumers and/or community members are engaged through meaningful involvement in decision-making processes for health policy and planning, healthcare management and service delivery, care and treatment, and the wellbeing of themselves and the community (adapted from Victorian Department of Human Services [28], CHF [75]) |
Consumer evidence | Consumer opinions, perspectives and preferences found in publications and data sources |
Routine decisions | Decisions made on a recurring basis or scheduled via a timetable eg annual budget setting processes, six-monthly practice audits, monthly Therapeutics Committee meetings, reviews of protocols at specified intervals after their introduction, etc [13]. |
Reactive decisions | Decisions made in response to situations as they arise eg new legislation, product alerts and recalls, applications for new drugs to be included in the formulary, critical incidents, emerging problems, etc [13]. |
Proactive decisions | Decisions driven by information that was actively sought for this purpose eg accessing newly published synthesised research evidence such as Cochrane reviews to compare against current practice, interrogating routinely-collected datasets to ascertain practices with high costs or high rates of adverse events, etc [13]. |
Principles
Scope
Research | Regularly scanning published research evidence such as reviews by the Cochrane Consumer and Communication Group or publications from relevant consumer agencies for applicability to the local context and comparing the findings with current practice to determine whether there is a need for change |
Data | Actively exploring local sources of routinely-collected data such as complaints registers or patient satisfaction surveys for trends or emerging themes that identify opportunities for improvement |
Engagement | (Communication) Establishing mechanisms to encourage, accept and act upon consumer-initiated feedback |
(Consultation) Seeking regular consumer feedback to initiate change in targeted areas, for example: ▪ Topics that are important to patients such as pain management and early discharge ▪ Topics that are important to the health service such as cost containment of high volume or high cost procedures where consumer priorities may inform selection of suitable alternatives ▪ Big problems for patients and health services such as falls and medical mishaps ▪ Patients with high usage of health services such as those on renal dialysis ▪ Patients interacting with areas of the health service undergoing frequent or significant change ▪ Patients with cultural, ethnic or language differences that require additional resources |
Preconditions
Activities
Consumer engagement
Use of consumer evidence
Consumer health journals |
'Health Voices – Journal of the Consumers Health Forum of Australia' is published two times a year to promote debate on health care issues affecting all Australians and of interest to health consumers, government and industry. https://www.chf.org.au/health-voices.php
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'The Australian Health Consumer' was the official journal of the Consumers Health Forum of Australia from 2001 to 2007. It provided a consumer-focused appraisal of the current and ongoing major health issues of the day in the state, national and international health sector. https://www.chf.org.au/australian-health-consumer.php
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'The Patient: Patient-Centered Outcomes Research' is the only journal that aims exclusively to examine the needs, values and role of the patient in an increasingly complex healthcare landscape in which funding and decision-making require ever-greater awareness of the patient’s perspective. The journal deals with the full range of patient-centered studies, reviews and commentary ranging through techniques such as conjoint analysis, patient reported outcomes, studies on compliance and satisfaction through to patient-directed health plans and patient literacy. http://www.springer.com/adis/journal/40271
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'Patient Intelligence' is an international, peer reviewed, open access journal that characterizes and measures the central role of patient behavior and intention in optimizing healthcare management in all areas of disease and complaint types. An improved understanding of patient intelligence coupled with predictive analysis helps an organization contribute more effectively to achieving better outcomes. The journal is characterized by the rapid reporting of reviews, original research, methodologies, analytics, modeling, clinical studies and patient surveys across all disease areas. Specific topics covered in the journal include: Patient and healthcare literacy, Patient information and healthcare professional communication/interaction, Patient behavior, attitude and trends, Behavior management programs, Quantitative and qualitative research, Data collection systems Business performance management, Benchmarking, assessment and reporting systems, Patient preference, satisfaction, convenience, acceptability and adherence, Patient involvement in the design and development of new treatments and management protocols to optimize outcomes, Decision support systems incorporating patient intelligence. |
'Patient Preference and Adherence' is an international, peer reviewed, open access journal that focuses on the growing importance of patient preference and adherence throughout the therapeutic continuum. The journal is characterized by the rapid reporting of reviews, original research, modeling and clinical studies across all therapeutic areas. Patient satisfaction, acceptability, quality of life, compliance, persistence and their role in developing new therapeutic modalities and compounds to optimize clinical outcomes for existing disease states are major areas of interest for the journal. http://www.dovepress.com/aims-and-scope-patient-preference-and-adherence-d16-j20
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'Patient Related Outcome Measures' is an international, peer-reviewed, open access journal focusing on treatment outcomes specifically relevant to patients. All aspects of patient care are addressed within the journal and practitioners from all disciplines are invited to submit their work as well as healthcare researchers and patient support groups. Areas covered will include: Quality of life scores, Patient satisfaction audits, Treatment outcomes that focus on the patient, Research into improving patient outcomes, Hypotheses of interventions to improve outcomes, Short communications that illustrate improved outcomes, Case reports or series that show an improved patient experience, Patient journey descriptions or research. |
Consumer health organisation newsletters |
'Consumers Shaping Health' is a bi-monthly newsletter published by the Consumers Forum of Australia (CHF) for members, consumer representatives and stakeholders in health. It promotes current advocacy work of CHF in its three priority areas: safety and quality in health care; health care for people with chronic conditions; and safe and appropriate use of medicines. |
Cochrane Consumers And Communication Review Group |
The Cochrane Consumers and Communication Review Group is part of the international Cochrane Collaboration. The Group coordinates the preparation and publication of systematic reviews of interventions which affect the way people interact with healthcare professionals, services and researchers. These reviews are published in The Cochrane Library. http://cccrg.cochrane.org/welcome
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Quality of Care Reports |
All Victorian health services are required to publish an annual Quality of Care Report each financial year. The primary audience includes consumers, carers and the health service community. Health services should consult with consumers, carers and community members and/or their Community Advisory Committee about the specific content. Minimum requirements include: ▪ Consumer, carer and community participation ▪ Quality and safety reporting at least four key measures annually (from preventing and controlling healthcare associated infections, medication safety, preventing falls and harm from falls, preventing and managing pressure injuries, clinical indicators for dental services, safe use of blood and blood products) ▪ A review of their local clinical governance policy against the Victorian clinical governance policy framework ▪ A report of the health service’s response to needs of consumers, families or carers and the community across the continuum of care. ▪ Examples or stories that show how these initiatives work in practice. |
Other |
Consumer driven healthcare is designed to help health care organizations respond effectively to the shift in market power, become consumer-centric, and position themselves to become market leaders in the new consumer-driven market. http://go.galegroup.com.ezproxy.lib.monash.edu.au/ps/i.do?action=interpret&v=2.1&u=monash&it=JIourl&issn=1542-0914&p=AONE&sw=w&authCount=1
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Satisfaction surveys |
The Victorian Patient Satisfaction Monitor (VPSM) is a state-wide survey that selects respondents at random; users are sent a unique ID to complete the survey by invitation only. |
The Victorian Healthcare Experience Survey (VHES) is a state-wide survey that allows a wide range of people to provide feedback on their experiences and features specialised questionnaires for adult and child inpatients and emergency department attendees, including parents/guardians, and maternity clients. Surveys are distributed in the month following the admission or attendance. People may respond either online or on paper with a freepost return. Surveys are available in English and a range of community languages. |
Complaints, Compliments, Comments |
Monash Health Complaints, compliments and comments can be made by completing an online form, mailing a printable version of the form, or in person by phone. Complaints are dealt with by the Consumer Liaison Officer on each campus. Details are kept by the Quality Unit. |
The Office of the Health Services Commissioner (OHSC) Complainants can also correspond directly with the OHSC. The OHSC’s role is to receive, investigate and resolve complaints from users of health services, to support healthcare services in providing quality healthcare and to assist them in resolving complaints. The legislation also requires that information gained from complaints be used to improve the standards of healthcare and prevent breaches of these standards. This information was the subject of the first study of its kind in Australia in 2014 leading to recommendations for change. The report is available at http://docs.health.vic.gov.au/docs/doc/Study-of-people-lodging-a-complaint-with-the-Victorian-Health-Services-Commissioner
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Other |
Individual health services and state health departments conduct service reviews, audits and other studies that include patient and consumer information |
Characteristics of the model
Domain | SHARE features |
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Purpose ▪ descriptive, explanatory or predictive | The model is primarily descriptive to enable replication and testing. There are also some explanatory elements addressed in the relationships between components, for example all elements sit within the context of an organisation-wide program; integration of consumer views and preferences is relevant in all of the other components (governance, administration, resources, decision-making, implementation, evaluation and reinvestment). |
Development ▪ deductive or inductive ▪ supporting evidence | Methods used in development were both deductive and inductive. Evidence from the research literature and consultation with health service staff, consumers and community members was used. |
Theoretical underpinning ▪ explicit or implicit | No specific theory was used to underpin the model. |
Conceptual clarity ▪ well-described, coherent language for identification of elements ▪ strengths and weaknesses of theories ▪ potential to stimulate new theoretical developments | The model overlays the three categories of consumer engagement, Communication, Consultation and Participation, onto the components of organisational infrastructure for resource allocation. The relationships between them are captured in the diagram. Details are provided in the text and in tables. No specific theories were used so no comparisons are made. There is potential for new theoretical developments if: ▪ the model is applied for purposes other than resource allocation for TCPs ▪ the model is applied in settings other than local health service networks ▪ the utility and effectiveness of theories and/or interventions for consumer participation in decision-making are investigated in the settings proposed |
Level ▪ individual, team, unit, organisation, policy | The model was developed for organisation-wide implementation in a local health service network for resource allocation decisions. This approach could also be used at a higher (regional, state/provincial, national) or lower (single facility, department or unit) level. It is not designed for application in individual clinical decisions. |
Situation ▪ hypothetical, real | The model represents actual settings and contexts in health service decision-making and implementation of change. However it could also be used for teaching or capacity building through hypothetical classroom discussions or simulation exercises. |
Users ▪ nursing, medical, allied health, policy makers, multidisciplinary | The model can be used by any decision-makers within the health system. While use of the model could be initiated by any group, engagement and involvement of all relevant stakeholders is an underlying principle of application. The model could be used in policy, management, clinical or research contexts. |
Function ▪ barrier analysis ▪ intervention development ▪ selection of outcome measures ▪ process evaluation | The main function is to assist establishment of a consumer engagement program by representing a systematic approach to integration of consumer views and perspectives in organisation-wide decision-making infrastructure and identifying opportunities and methods for consumer engagement in resource allocation decisions. A secondary function is to enable replication and testing. |
Testable ▪ hypothesis generation ▪ supported by empirical data ▪ suitable for different methodologies | The model describes the components of organisational infrastructure for resource allocation and settings and opportunities for consumer engagement in this context. A range of hypotheses could be developed for each of these elements and the relationships between them which could be tested in a number of ways using various methodologies. |