Contextualizing learning to improve care using collaborative communities of practices.

Contextualizing learning to improve care using collaborative communities of practices.

BMC Health Serv Res. 2016;16(1):464

Authors: Jeffs L, McShane J, Flintoft V, White P, Indar A, Maione M, Lopez AJ, Bookey-Bassett S, Scavuzzo L

Abstract
BACKGROUND: The use of interorganizational, collaborative approaches to build capacity in quality improvement (QI) in health care is showing promise as a useful model for scaling up and accelerating the implementation of interventions that bridge the "know-do" gap to improve clinical care and provider outcomes. Fundamental to a collaborative approach is interorganizational learning whereby organizations acquire, share, and combine knowledge with other organizations and have the opportunity to learn from their respective successes and challenges in improvement areas. This learning approach aims to create the conditions for collaborative, reflective, and innovative experiential systems that enable collective discussions regarding daily practice issues and finding solutions for improvement.
METHODS: The concepts associated with interorganizational learning and deliberate learning activities within a collaborative 'Communities-of-practice'(CoP) approach formed the foundation of the of an interactive QI knowledge translation initiative entitled PERFORM KT. Nine teams participated including seven teams from two acute care hospitals, one from a long term care center, and one from a mental health sciences center. Six monthly CoP learning sessions were held and teams, with the support of an assigned mentor, implemented a QI project and monitored their results which were presented at an end of project symposium. 47 individuals participated in either a focus group or a personal interview. Interviews were transcribed and analyzed using an iterative content analysis.
RESULTS: Four key themes emerged from the narrative dataset around experiences and perceptions associated with the PERFORM KT initiative: 1) being successful and taking it to other levels by being systematic, structured, and mentored; 2) taking it outside the comfort zone by being exposed to new concepts and learning together; 3) hearing feedback, exchanging stories, and getting new ideas; and 4) having a pragmatic and accommodating approach to apply new learnings in local contexts.
CONCLUSIONS: Study findings offer insights into collaborative, inter-organizational CoP learning approaches to build QI capabilities amongst clinicians, staff, and managers. In particular, our study delineates the need to contextualize QI learning by using deliberate learning activities to balance systematic and structured approaches alongside pragmatic and accommodating approaches with expert mentors.

PMID: 27590455 [PubMed - as supplied by publisher]

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Contextualizing learning to improve care using collaborative communities of practices.

Contextualizing learning to improve care using collaborative communities of practices.

BMC Health Serv Res. 2016;16(1):464

Authors: Jeffs L, McShane J, Flintoft V, White P, Indar A, Maione M, Lopez AJ, Bookey-Bassett S, Scavuzzo L

Abstract
BACKGROUND: The use of interorganizational, collaborative approaches to build capacity in quality improvement (QI) in health care is showing promise as a useful model for scaling up and accelerating the implementation of interventions that bridge the "know-do" gap to improve clinical care and provider outcomes. Fundamental to a collaborative approach is interorganizational learning whereby organizations acquire, share, and combine knowledge with other organizations and have the opportunity to learn from their respective successes and challenges in improvement areas. This learning approach aims to create the conditions for collaborative, reflective, and innovative experiential systems that enable collective discussions regarding daily practice issues and finding solutions for improvement.
METHODS: The concepts associated with interorganizational learning and deliberate learning activities within a collaborative 'Communities-of-practice'(CoP) approach formed the foundation of the of an interactive QI knowledge translation initiative entitled PERFORM KT. Nine teams participated including seven teams from two acute care hospitals, one from a long term care center, and one from a mental health sciences center. Six monthly CoP learning sessions were held and teams, with the support of an assigned mentor, implemented a QI project and monitored their results which were presented at an end of project symposium. 47 individuals participated in either a focus group or a personal interview. Interviews were transcribed and analyzed using an iterative content analysis.
RESULTS: Four key themes emerged from the narrative dataset around experiences and perceptions associated with the PERFORM KT initiative: 1) being successful and taking it to other levels by being systematic, structured, and mentored; 2) taking it outside the comfort zone by being exposed to new concepts and learning together; 3) hearing feedback, exchanging stories, and getting new ideas; and 4) having a pragmatic and accommodating approach to apply new learnings in local contexts.
CONCLUSIONS: Study findings offer insights into collaborative, inter-organizational CoP learning approaches to build QI capabilities amongst clinicians, staff, and managers. In particular, our study delineates the need to contextualize QI learning by using deliberate learning activities to balance systematic and structured approaches alongside pragmatic and accommodating approaches with expert mentors.

PMID: 27590455 [PubMed - as supplied by publisher]

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Speech perception adjusts to stable spectrotemporal properties of the listening environment

Publication date: Available online 3 September 2016
Source:Hearing Research
Author(s): Christian E. Stilp, Paul W. Anderson, Ashley A. Assgari, Gregory M. Ellis, Pavel Zahorik
When perceiving speech, listeners compensate for reverberation and stable spectral peaks in the speech signal. Despite natural listening conditions usually adding both reverberation and spectral coloration, these processes have only been studied separately. Reverberation smears spectral peaks across time, which is predicted to increase listeners’ compensation for these peaks. This prediction was tested using sentences presented with or without a simulated reverberant sound field. All sentences had a stable spectral peak (added by amplifying frequencies matching the second formant frequency [F2] in the target vowel) before a test vowel varying from/i/to/u/in F2 and spectral envelope (tilt). In Experiment 1, listeners demonstrated increased compensation (larger decrease in F2 weights and larger increase in spectral tilt weights for identifying the target vowel) in reverberant speech than in nonreverberant speech. In Experiment 2, increased compensation was shown not to be due to reverberation tails. In Experiment 3, adding a pure tone to nonreverberant speech at the target vowel’s F2 frequency increased compensation, revealing that these effects are not specific to reverberation. Results suggest that perceptual adjustment to stable spectral peaks in the listening environment is not affected by their source or cause.



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Speech perception adjusts to stable spectrotemporal properties of the listening environment

Publication date: Available online 3 September 2016
Source:Hearing Research
Author(s): Christian E. Stilp, Paul W. Anderson, Ashley A. Assgari, Gregory M. Ellis, Pavel Zahorik
When perceiving speech, listeners compensate for reverberation and stable spectral peaks in the speech signal. Despite natural listening conditions usually adding both reverberation and spectral coloration, these processes have only been studied separately. Reverberation smears spectral peaks across time, which is predicted to increase listeners’ compensation for these peaks. This prediction was tested using sentences presented with or without a simulated reverberant sound field. All sentences had a stable spectral peak (added by amplifying frequencies matching the second formant frequency [F2] in the target vowel) before a test vowel varying from/i/to/u/in F2 and spectral envelope (tilt). In Experiment 1, listeners demonstrated increased compensation (larger decrease in F2 weights and larger increase in spectral tilt weights for identifying the target vowel) in reverberant speech than in nonreverberant speech. In Experiment 2, increased compensation was shown not to be due to reverberation tails. In Experiment 3, adding a pure tone to nonreverberant speech at the target vowel’s F2 frequency increased compensation, revealing that these effects are not specific to reverberation. Results suggest that perceptual adjustment to stable spectral peaks in the listening environment is not affected by their source or cause.



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Speech perception adjusts to stable spectrotemporal properties of the listening environment

Publication date: Available online 3 September 2016
Source:Hearing Research
Author(s): Christian E. Stilp, Paul W. Anderson, Ashley A. Assgari, Gregory M. Ellis, Pavel Zahorik
When perceiving speech, listeners compensate for reverberation and stable spectral peaks in the speech signal. Despite natural listening conditions usually adding both reverberation and spectral coloration, these processes have only been studied separately. Reverberation smears spectral peaks across time, which is predicted to increase listeners’ compensation for these peaks. This prediction was tested using sentences presented with or without a simulated reverberant sound field. All sentences had a stable spectral peak (added by amplifying frequencies matching the second formant frequency [F2] in the target vowel) before a test vowel varying from/i/to/u/in F2 and spectral envelope (tilt). In Experiment 1, listeners demonstrated increased compensation (larger decrease in F2 weights and larger increase in spectral tilt weights for identifying the target vowel) in reverberant speech than in nonreverberant speech. In Experiment 2, increased compensation was shown not to be due to reverberation tails. In Experiment 3, adding a pure tone to nonreverberant speech at the target vowel’s F2 frequency increased compensation, revealing that these effects are not specific to reverberation. Results suggest that perceptual adjustment to stable spectral peaks in the listening environment is not affected by their source or cause.



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A functional synergistic model to explain postural control during precise visual tasks

Publication date: October 2016
Source:Gait & Posture, Volume 50
Author(s): Cédrick T. Bonnet, Stéphane Baudry
In everyday life, individuals sometimes have to perform precise, or challenging, visual tasks in upright standing. Upright, one problem to perform precise saccades and fixations is that the body oscillates continuously in a mainly unpredictable way. Current cognitive models assume that the central nervous system should divide its attention to perform these ‘dual tasks’ because of limited attentional resources (keeping balance and performing the precise visual task). The problem with the concept of duality is that individuals (need to) succeed in precise visual tasks upright and should not be more unstable and inefficient – because of a division of attention – in these tasks. In our opinion, the central nervous system should work adaptively in a way that enables success in these tasks. Hence, instead of assuming ‘duality’ in cognitive processes, we suggest that i) a ‘synergy’ – or unification – between visual and postural processes may be required to succeed in precise visual tasks. Success in precise visual tasks upright would also require ii) the synergy to be based on two feedforward processes with the visual process being the leader; iii) individuals to reduce their postural sway to facilitate successful synergies; iiii) additional cognitive resources to link visual and postural processes. We discuss some literature findings consistent with these assumptions and summarize a recent validation of the synergistic model. In summary, both models of duality and synergy could be complementary and the present manuscript shows how they could be included in a higher-order, two directional, cognitive model of postural control.



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A validation of neural co-activation as a measure of attentional focus in a postural task

Publication date: Available online 3 September 2016
Source:Gait & Posture
Author(s): Toby J. Ellmers, Guilherme Machado, Thomson Wai-Lung Wong, Frank Zhu, A. Mark Williams, William R. Young
Postural threat can induce conscious involvement in movement control. This internal focus has been implicated in compromising attentional processing efficiency during postural control, leading to behavioral adaptations that might increase the risk of falling in the elderly. It is suggested that electroencephalography (EEG) coherence, or ‘communication’, between T3 (verbal-analytical) and Fz (motor-planning) regions may provide an objective measure of internal focus in learned movement skills. However, it is currently unknown whether this experimental technique can be applied to the control of gait and posture; skills which develop early in life, without the use of declarative knowledge/explicit verbal cues to guide performance. We validate the utility of the EEG T3-Fz coherence analysis in a postural task. A total of 24 young adults produced small voluntary swaying movements in medial-lateral or anterior-posterior direction under conditions that directed their attentional focus either internally or externally. Although EEG coherence was sensitive to voluntary changes in attentional focus, the lack of observed between-group (High/Low-trait-reinvestment) difference in coherence may suggest that younger adults cannot be assumed to utilize explicit verbal cues to control voluntary postural sway unless explicitly instructed to do so. As a result, while these results indicate that EEG T3-Fz is a valid technique for assessing attentional focus in postural tasks, our data do not support the clinical application of this method of analysis in providing an objective indication of trait-reinvestment in tasks involving voluntary postural sway.



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