- Professor Greenfield is the Director of the Australian Institute of Health Service Management (AIHSM), University of ... moreProfessor Greenfield is the Director of the Australian Institute of Health Service Management (AIHSM), University of Tasmania, Australia. The AIHSM, based in Sydney, is dedicated to improving the quality and efficiency of healthcare by: educating professionals to lead, manage, and innovate in increasingly complex organisational and clinical environments; and conducting collaborative research projects.
Professor David Greenfield research is at the intersection of improvement and implementation sciences. He is researching healthcare complex adaptive systems, health services and the organisation and delivery of clinical practice. Within and across these spheres Professor Greenfield investigates what impacts on quality improvement and mechanisms to integrate research findings and evidence into healthcare policy and practice. This includes, for example, the formal or informal regulation of the organisation and delivery of care, via accreditation programs or interprofessional collaboration strategies. The purpose of this research is to derive evidence to improve organisational functioning, service delivery mechanisms and patient outcomes.
Professor Greenfield is a Fellow of the Australasian Association for Quality in Health Care, a Fellowof the International Society for Quality in Health Care (ISQua), and recognised as an ISQua Expert.edit
Background: Recognition of a need for patient-centred care is not new, however making patient-centred care a reality remains a challenge to organisations. We need empirical studies to extend current understandings, create new... more
Background: Recognition of a need for patient-centred care is not new, however making patient-centred care a reality remains a challenge to organisations. We need empirical studies to extend current understandings, create new representations of the complexity of patient-centred care, and guide collective action toward patient-centred health care. To achieve these ends, the research aim was to empirically determine what organisational actions are required for patient-centred care to be achieved. Methods: We used an established participatory concept mapping methodology. Cross-sector stakeholders contributed to the development of statements for patient-centred care requirements, sorting statements into groupings according to similarity, and rating each statement according to importance, feasibility, and achievement. The resultant data were analysed to produce a visual concept map representing participants' conceptualisation of patient-centred care requirements. Analysis included the development of a similarity matrix, multidimensional scaling, hierarchical cluster analysis, selection of the number of clusters and their labels, identifying overarching domains and quantitative representation of rating data.
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Why has so little evidence of the efficacy of accreditation programmes been published in the peer-reviewed literature? Since its introduction in the 1970s accreditation has spread across the world to become an established part of... more
Why has so little evidence of the efficacy of accreditation programmes been published in the peer-reviewed literature? Since its introduction in the 1970s accreditation has spread across the world to become an established part of healthcare systems in over 70 countries and ...
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Patients with amyotrophic lateral sclerosis (ALS) are required to make decisions concerning quality of life and symptom management over the course of their disease. Clinicians perceive that... more
Patients with amyotrophic lateral sclerosis (ALS) are required to make decisions concerning quality of life and symptom management over the course of their disease. Clinicians perceive that patients' ability to engage in timely decision-making is extremely challenging. However, we lack patient perspectives on this issue. This study aimed to explore patient experiences of ALS, and to identify factors influencing their decision-making in the specialized multidisciplinary care of ALS. An exploratory study was conducted. Fourteen patients from two specialized ALS multidisciplinary clinics participated in semistructured interviews that were audio recorded and transcribed. Data were analyzed for emergent themes. Decision-making was influenced by three levels of factors, ie, structural, interactional, and personal. The structural factor was the decision-making environment of specialized multidisciplinary ALS clinics, which supported decision-making by providing patients with disease-specific information and specialized care planning. Interactional factors were the patient experiences of ALS, including patients' reaction to the diagnosis, response to deterioration, and engagement with the multidisciplinary ALS team. Personal factors were patients' personal philosophies, including their outlook on life, perceptions of control, and planning for the future. Patient approaches to decision-making reflected a focus on the present, rather than anticipating future progression of the disease and potential care needs. Decision-making for symptom management and quality of life in ALS care is enhanced when the patient's personal philosophy is supported by collaborative relationships between the patient and the multidisciplinary ALS team. Patients valued the support provided by the multidisciplinary team; however, their focus on living in the present diverged from the efforts of health professionals to prepare patients and their carers for the future. The challenge facing health professionals is how best to engage each patient in decision-making for their future needs, to bridge this gap.
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The effective incorporation of interprofessional education (IPE) within health professional curricula requires the synchronised and systematic collaboration between and within the various stakeholders. Higher education institutions, as... more
The effective incorporation of interprofessional education (IPE) within health professional curricula requires the synchronised and systematic collaboration between and within the various stakeholders. Higher education institutions, as primary health education providers, have the capacity to advocate and facilitate this collaboration. However, due to the diversity of stakeholders, facilitating the pedagogical change can be challenging and complex, and brings a degree of uncertainty and resistance. This review, through an analysis of the barriers and enablers investigates the involvement of stakeholders in higher education IPE through three primary stakeholder levels: Government and Professional, Institutional and Individual. A review of eight primary databases using 21 search terms resulted in 40 papers for review. While the barriers to IPE are widely reported within the higher education IPE literature, little is documented about the enablers of IPE. Similarly, the specific identification and importance of enablers for IPE sustainability and the dual nature of some barriers and enablers have not been previously reported. An analysis of the barriers and enablers of IPE across the different stakeholder levels reveals five key "fundamental elements" critical to achieving sustainable IPE in higher education curricula.
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Inquiries into healthcare organisations have highlighted organisational or system failure, attributed to poor responses to early warning signs. One response, and challenge, is for professionals and academics to build capacity for quality... more
Inquiries into healthcare organisations have highlighted organisational or system failure, attributed to poor responses to early warning signs. One response, and challenge, is for professionals and academics to build capacity for quality and safety research to provide evidence for improved systems. However, such collaborations and capacity building do not occur easily as there are many stakeholders. Leadership is necessary to unite differences into a common goal. The lessons learned and principles arising from the experience of providing distributed leadership to mobilise capacity for quality and safety research when researching health care accreditation in Australia are presented. A case study structured by temporal bracketing that presents a narrative account of multi-stakeholder perspectives. Data are collected using in-depth informal interviews with key informants and ethno-document analysis. Distributed leadership enabled a collaborative research partnership to be realised. The leadership harnessed the relative strengths of partners and accounted for, and balanced, the interests of stakeholder participants involved. Across three phases, leadership and the research partnership was enacted: identifying partnerships, bottom-up engagement and enacting the research collaboration. Two principles to maximise opportunities to mobilise capacity for quality and safety research have been identified. First, successful collaborations, particularly multi-faceted inter-related partnerships, require distributed leadership. Second, the leadership-stakeholder enactment can promote reciprocity so that the collaboration becomes mutually reinforcing and beneficial to partners. The paper addresses the need to understand the practice and challenges of distributed leadership and how to replicate positive practices to implement patient safety research.
Research Interests: Leadership, Patient Safety, Health Care, Australia, Quality of Mental Health Care, and 20 moreAccreditation, Qualitative Research, Health, Health Services Research, Capacity Building, Stakeholder participation, Collaborative Research, Early Warning, Humans, Document Analysis, Health Services, Hospital administration, Case Study, Design Methodology, Safety Management, Lessons Learned, Patient Care, Interdisciplinary Communication, Bottom Up, and Cooperative Behavior
Evidence suggests that Crew Resource Management (CRM), a form of team training, is beneficial. In CRM training, participants learn individual portable team skills such as communication and decision making through group discussion and... more
Evidence suggests that Crew Resource Management (CRM), a form of team training, is beneficial. In CRM training, participants learn individual portable team skills such as communication and decision making through group discussion and activities. However, the usual 1-day course format is not always compatible with health care organizational routines. A modular training format, while theoretically sound, is untested for interprofessional team training. The aim of this study was to explore the potential for modularized CRM training to be delivered to a group of interprofessional learners. Modularized CRM training, consisting of two 2-hour workshops, was delivered to health care workers in an Australian tertiary hospital. Kirkpatrick's evaluation model provided a framework for the study. Baseline attitude surveys were conducted prior to each workshop. Participants completed a written questionnaire at the end of each workshop that examined their motivations, reactions to the training, and learner demographics. An additional survey, administered 6 weeks post training, captured self-assessed behavior data. Twenty-three individuals from a range of professions and clinical streams participated. One in 5 participants (22%) reported that they translated teamwork skills to the workplace. While positive about the workshop format and content, many respondents identified personal, team, and organizational barriers to the application of the workshop techniques. CRM training when delivered in a modular format has positive outcomes. Following the training, some respondents overcame workplace barriers to attempt to change negative workplace behavior. This progress provides cautious optimism for the potential for modular CRM training to benefit groups of interprofessional health staff.
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This paper aims to explore how surveying benefits accreditation surveyors and the organisations in which they are regularly employed. The purpose is to examine from the perspective of senior executives who pursue this form of secondary... more
This paper aims to explore how surveying benefits accreditation surveyors and the organisations in which they are regularly employed. The purpose is to examine from the perspective of senior executives who pursue this form of secondary professional activity, what they seek from being surveyors and what they believe they gain from the experience. The data were collected from recorded interviews with three senior area health executives who also serve as accreditation surveyors for the Australian Council on Healthcare Standards. The interviews comprised a series of open-ended, semi-structured questions. One hour was allocated for each interview. The questions were designed to explore why senior executive health professionals seek secondary professional activity as surveyors and their perceptions of the benefits they gain from surveying. The benefits derived from surveying as a secondary professional activity fall into four categories. First, it exposes the surveyor to new methods and innovations. Second, it provides a unique form of ongoing learning. Third, it serves as a resource for acquiring expertise to enhance quality within the institutions in which the participants were regularly employed and, finally, it provides opportunities to contribute to the process of quality improvement and enhance public health beyond the organisations in which the participants were regularly employed. This research identifies a key aspect of the accreditation process that has not been the focus of previous research. It provides a reference point for understanding the value of surveying to the surveyor and to the institutions in which they are regularly employed. The paucity of existing literature on the role of the surveyor-both pre and post accreditation-makes this topic timely and significant. This study is important because almost all accreditation programs world wide rely on external surveyors, and yet we know little about them.
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This paper aims to investigate how health care accreditation surveyors enact their role with a view to identifying a surveyor styles typology. This study was conducted in two phases. First, observational research was used to examine the... more
This paper aims to investigate how health care accreditation surveyors enact their role with a view to identifying a surveyor styles typology. This study was conducted in two phases. First, observational research was used to examine the conduct of a small survey team during the 2005 accreditation survey of a rural health service in Australia. The survey team was from the Australian Council on Healthcare Standards (ACHS), the major health care accreditation agency in Australia. Second, the emerging typology was reviewed by an expert panel of ACHS surveyors. A typology comprising three unique surveyor styles is identified--interrogator; explorer; and discusser. Additionally, a further style, the questioner, is hypothesised. RESEARCH LIMITATION/IMPLICATIONS: The typology has application for development by accreditation agencies to be used with surveyors as a self-reflection tool to improve learning and development. The knowledge gained about surveyors' styles can be used to match more effectively survey teams to organisations seeking accreditation. Further research is necessary to confirm these styles and examine whether other styles are apparent. This study is an important step in examining the conduct of surveyors and opening up health care accreditation surveyor inter-rater reliability for further investigation.
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To investigate whether an accreditation program facilitates healthcare organizations (HCOs) to evolve and maintain high-performance human resource management (HRM) systems. Cross-sectional multimethod study. Healthcare organizations... more
To investigate whether an accreditation program facilitates healthcare organizations (HCOs) to evolve and maintain high-performance human resource management (HRM) systems. Cross-sectional multimethod study. Healthcare organizations participating in the Australian Council on Healthcare Standards Evaluation and Quality Improvement Program (EQuIP 4) between 2007 and 2011. Ratings across the EQuIP 4 HRM criteria, a clinical performance measure, surveyor reports (HRM information) and interview data (opinions and experiences regarding HRM and accreditation). Healthcare organizations identified as high performing on accreditation HRM criteria seek excellence primarily because of internal motivations linked to best practice. Participation in an accreditation program is a secondary and less significant influence. Notwithstanding, the accreditation program provides the HCO opportunity for internal and external review and assessment of their performance; the accreditation activities are reflective learning and feedback events. This study reveals that HCOs that pursue highly performing HRM systems use participation in an accreditation program as an opportunity. Their organizational mindset is to use the program as a tool by which to reflect and obtain feedback on their performance so to maintain or improve their management of staff and delivery of care.
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The purpose of this study was to identify and analyze research into accreditation and accreditation processes. A multi-method, systematic review of the accreditation literature was conducted from March to May 2007. The search identified... more
The purpose of this study was to identify and analyze research into accreditation and accreditation processes. A multi-method, systematic review of the accreditation literature was conducted from March to May 2007. The search identified articles researching accreditation. Discussion or commentary pieces were excluded. From the initial identification of over 3000 abstracts, 66 studies that met the search criteria by empirically examining accreditation were selected. DATA EXTRACTION AND RESULTS OF DATA SYNTHESIS: The 66 studies were retrieved and analyzed. The results, examining the impact or effectiveness of accreditation, were classified into 10 categories: professions' attitudes to accreditation, promote change, organizational impact, financial impact, quality measures, program assessment, consumer views or patient satisfaction, public disclosure, professional development and surveyor issues. The analysis reveals a complex picture. In two categories consistent findings were recorded: promote change and professional development. Inconsistent findings were identified in five categories: professions' attitudes to accreditation, organizational impact, financial impact, quality measures and program assessment. The remaining three categories-consumer views or patient satisfaction, public disclosure and surveyor issues-did not have sufficient studies to draw any conclusion. The search identified a number of national health care accreditation organizations engaged in research activities. The health care accreditation industry appears to be purposefully moving towards constructing the evidence to ground our understanding of accreditation.
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Networks in health care typically involve services delivered by a defined set of organizations. However, networked associations between the healthcare system and consumers or consumer organizations tend to be open, fragmented and are... more
Networks in health care typically involve services delivered by a defined set of organizations. However, networked associations between the healthcare system and consumers or consumer organizations tend to be open, fragmented and are fraught with difficulties. Understanding the role and activities of consumers and consumer groups in a formally initiated inter-organizational health network, and the impacts of the network, is a timely endeavour. This study addresses this aim in three ways. First, the Unbounded Network Inter-organizational Collaborative Impact Model, a purpose-designed framework developed from existing literature, is used to investigate the process and products of inter-organizational network development. Second, the impact of a network artefact is explored. Third, the lessons learned in inter-organizational network development are considered. Data collection methods were: 16 h of ethnographic observation; 10 h of document analysis; six interviews with key informants and a survey (n = 60). Findings suggested that in developing the network, members used common aims, inter-professional collaboration, the power and trust engendered by their participation, and their leadership and management structures in a positive manner. These elements and activities underpinned the inter-organizational network to collaboratively produce the Health Expo network artefact. This event brought together healthcare providers, community groups and consumers to share information. The Health Expo demonstrated and reinforced inter-organizational working and community outreach, providing consumers with community-based information and linkages. Support and resources need to be offered for developing community inter-organizational networks, thereby building consumer capacity for self-management in the community.
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... It focuses on the existing quality movement within health care and on the specific ... Chapter 5 discusses issues of meeting customer satisfaction re-quirements together with methods and ... care environment and the requirement that,... more
... It focuses on the existing quality movement within health care and on the specific ... Chapter 5 discusses issues of meeting customer satisfaction re-quirements together with methods and ... care environment and the requirement that, for CQI to meet its expectations, managers and ...
Research Interests: Nursing and Health Care
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Page 1. Strategies for accreditation surveyor professional development Dr David Greenfield, Dr Marjorie Pawsey, Dr Justine Naylor, Ms Jo Travaglia and Prof Jeffrey Braithwaite ISQua 2009 - Designing for Quality 11 14 October 2009,... more
Page 1. Strategies for accreditation surveyor professional development Dr David Greenfield, Dr Marjorie Pawsey, Dr Justine Naylor, Ms Jo Travaglia and Prof Jeffrey Braithwaite ISQua 2009 - Designing for Quality 11 14 October 2009, Dublin, Ireland Page 2. Outline ...
... 2007; Patterson et al. 2006; McAlearney et al. 2007; Vogelsmeier et al. ... Brooks, N., Adger, WN and Kelly, PM, (2005), 'The determinants of vulnerability and adaptive capacity at the... more
... 2007; Patterson et al. 2006; McAlearney et al. 2007; Vogelsmeier et al. ... Brooks, N., Adger, WN and Kelly, PM, (2005), 'The determinants of vulnerability and adaptive capacity at the national level and the implications for adaptation', Global Environmental Change, 15, 151-163. ...
Methods: We reviewed evidence drawn from the social networks,1 inter-professional learning (IPL)2 and communities of practice3 literatures by interrogating the Medline, CINAHL and Embase bibliographical databases. The resulting references... more
Methods: We reviewed evidence drawn from the social networks,1 inter-professional learning (IPL)2 and communities of practice3 literatures by interrogating the Medline, CINAHL and Embase bibliographical databases. The resulting references were assessed in two ways. They were subjected to automated data mining identifying underlying concepts in the literature. We then extracted the key empirical references and analysed them in detail using grounded theory.4 These were applied to three case studies of relevance to policymakers, managers, practitioners and ...
The healthcare context is characterized with new developments, technologies, ideas and expectations that are continually reshaping the frontline of care delivery. Mannion and Exworthy identify two key factors driving this complexity,... more
The healthcare context is characterized with new developments, technologies, ideas and expectations that are continually reshaping the frontline of care delivery. Mannion and Exworthy identify two key factors driving this complexity, 'standardization' and 'customization, ' and their apparent resulting paradox to be negotiated by healthcare professionals, managers and policy makers. However, while they present a compelling argument an alternative viewpoint exists. An analysis is presented that shows instead of being 'competing' logics in healthcare, standardization and customization are long standing 'colluding' logics. Mannion and Exworthy's call for further sustained work to understand this complex, contested space is endorsed, noting that it is critical to inform future debates and service decisions.