Systematic Review of Morbidity and Mortality Meeting Standardization: Does It Lead to Improved Professional Development, System Improvements, Clinician Engagement, and Enhanced Patient Safety Culture?

OBJECTIVES: This systematic review sought to better understand the effect of standardized Morbidity and Mortality meetings (M&Ms) on learning, system improvement, clinician engagement, and patient safety culture. METHODS: Three electronic databases were searched using a range of text words, synonyms, and subject headings to identify the major concepts of M&M meetings. Articles published between October 2012 (the end date of an earlier review) and February 2021 were assessed against the inclusion criteria, and thematic synthesis was conducted on the included studies. RESULTS: After abstract and full-text review in Covidence, from 824 studies identified, 16 met the eligibility criteria. Studies were mostly surveys (n = 13) and evaluated effectiveness primarily from the perspectives of M&M chairs and participants, rather than assessment of objective improvement in patient outcomes. The most prevalent themes relating to the standardization of M&M processes were case selection (n = 15) and administration (n = 12). The objectives of quality improvement and education were equally prevalent (12 studies each), but several studies reported that these 2 objectives as conflicting rather than complementary. Clinician engagement, patient safety culture, and organizational governance and leadership were identified as facilitators of effective M&Ms. CONCLUSIONS: There is insufficient evidence to guide best practice in M&Ms, but standardized structures and processes implemented with organizational leadership and administrative support are associated with M&Ms that address objectives related to learning and system improvement. Standardization of the structures and processes of M&Ms is perceived differently depending on participants' role and discipline, and clinician engagement is critical to support a culture of safety and quality improvement.

Content analysis to locate assistive technology in Queensland's motor injury insurance rehabilitation legislation and guidelines.

INTRODUCTION: Reforms to Australia's disability and rehabilitation sectors have espoused the potential of assistive technology as an enabler. As new insurance systems are being developed it is timely to examine the structure of existing systems. This exploratory study examined the policies guiding assistive technology provision in the motor accident insurance sector of one Australian state. METHODS: Policy documents were analyzed iteratively with a set of qualitative questions to understand the intent and interpretation of policies guiding assistive technology provision. Content analysis identified relevant sections and meaningful terminology, and context analysis explored the dominant perspectives informing policy. RESULTS AND DISCUSSION: The concepts and language of assistive technology are not part of the policy frameworks guiding rehabilitation practice in Queensland's motor accident insurance sector. The definition of rehabilitation in the legislation is consistent with contemporary international interpretations that focus on optimizing functioning in interaction with the environment. However, the supporting documents are focused on recovery from injuries where decisions are guided by clinical need and affordability. CONCLUSION: The policies frame rehabilitation in a medical model that separates assistive technology provision from the rehabilitation plan. The legislative framework provides opportunities to develop and improve assistive technology provision as part of an integrated approach to rehabilitation.

Currency and Competence of Occupational Therapists and Consumers with Rapidly Changing Technology.

Assistive technology was once a specialised field of practice, involving products designed for populations with specific impairments or functional goals. In Australia, occupational therapists have, at times, functioned as gatekeepers to public funding, prescribing products from a predefined list. An expanding range of accessible mainstream products available via international and online markets has changed the meaning and application of assistive technology for many people with disability. In the policy context of consumer choice and cost-effectiveness, have occupational therapists been left behind? This paper describes the change in context for access to assistive technology resulting in expanded possibilities for participation and inclusion. A case study of environmental control systems is used to explore the overlap of mainstream and assistive products and the funding and services to support their uptake. The analysis describes a future policy and practice context in which assistive technology includes a spectrum of products decoupled from access to independent advice and support services. A broader scope of occupational therapy practice has potential to enhance the occupational rights of people with disability and the efficiency and effectiveness of assistive technology provision.

Drafting standards on cognitive accessibility: a global collaboration.

PURPOSE: The International Organization for Standardization (ISO) is working on accessibility of products to support people with cognitive impairment. Working Group 10, within the technical committee 173 (assistive products for persons with disability) was formed in 2014 to draft standards for assistive products that support people with cognitive impairment. METHOD: This article explains the scope and purpose of the working group and the context for its formation, and describes the plans and process for drafting and publishing new international standards. RESULTS: The proposed suite of standards is presented, with examples from a draft standard on daily time management. It draws on international research evidence for the effectiveness of assistive products designed to support time management in people with cognitive impairment. Examples of assistive products and their key features are provided based on domains of time as defined in the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY). CONCLUSIONS: The proposed standards will provide design recommendations for features and functions that increase the accessibility of products used by people with cognitive impairment. They are intended to be used by designers, manufactures, educators and services providers, to facilitate their commitment to inclusion and demonstrate their willingness to work with accessibility regulation. Implications for Rehabilitation New standards based on universal design (UD) principles can guide the design of more user-friendly assistive products for people with cognitive impairment. Greater usability of assistive products, whether mainstream or specially-designed, will make it easier for practitioners to find and introduce assistive solutions to individuals with cognitive impairment. Greater usability of assistive products for daily time management can decrease the need for user training and support and enable participation.

Assistive Technology in Australia: Integrating theory and evidence into action.

BACKGROUND: Occupational therapists use a range of strategies to influence the relationship between person, environment and occupation and facilitate people's participation and inclusion in society. Technology is a fundamental environmental factor capable of enabling inclusion, and occupational therapy models articulate a role for assistive technology (AT) devices and services, but there is a gap between theory, research and practice. The context of AT provision in Australia presents systemic barriers that prevent optimal application of AT devices and services for societal health promotion and in individualised solutions. METHODS: The Integrating Theory, Evidence and Action method (ITEA) was used to answer the question 'How can occupational therapy support AT provision to enable older people and people with disability?' A wide range of sources were systematically analysed to explore the complexities of AT provision in Australia. RESULTS: The International Classification of Functioning, Disability and Health (ICF) and IMPACT2 model are used as frameworks to reconstruct evidence into statements that summarise the theory, process and outcomes of AT provision. Analysis of the influence of the global disability rights and local policies and AT provision systems is used to highlight important aspects for occupational therapists to consider in research and practice. Pragmatic recommendations are provided to enable practitioners to translate theory and evidence into action. CONCLUSION: AT provision can be improved by focusing on evidence for and congruence between theory, process and outcomes, rather than isolated interventions. Occupational therapists should consider the influence of contextual factors on practice, and work with consumers to improve access and equity in AT provision systems.

Challenges of user-centred assistive technology provision in Australia: shopping without a prescription.

PURPOSE: People with disability have a right to assistive technology devices and services, to support their inclusion and participation in society. User-centred approaches aim to address consumer dissatisfaction and sub-optimal outcomes from assistive technology (AT) provision, but make assumptions of consumer literacy and empowerment. Policy discourses about consumer choice prompt careful reflection, and this paper aims to provide a critical perspective on user involvement in assistive technology provision. METHODS: User-centred approaches are considered, using literature to critically reflect on what user involvement means in AT provision. Challenges at the level of interactions between practitioners and consumers, and also the level of markets and policies are discussed, using examples from Australia. RESULTS: There is no unanimous conceptual framework for user-centred practice. Power imbalances and differing perspectives between practitioners and consumers make it difficult for consumers to feel empowered. Online access to information and international suppliers has not surmounted information asymmetries for consumers or lifted the regulation of publicly funded AT devices. CONCLUSIONS: Ensuring access and equity in the public provision of AT is challenging in an expanding market with diverse stakeholders. Consumers require personalised information and support to facilitate their involvement and choice in AT provision. Implications for Rehabilitation Variations in approaches informing AT provision practices have a profound impact on equity of access and outcomes for consumers. An internationalised and online market for AT devices is increasing the need for effective information provision strategies and services. Power imbalances between practitioners and consumers present barriers to the realisation of user-centred practice.

"An Environment Built to Include Rather than Exclude Me": Creating Inclusive Environments for Human Well-Being.

Contemporary discourses which challenge the notion of health as the "absence of disease" are prompting changes in health policy and practice. People with disability have been influential in progressing our understanding of the impact of contextual factors in individual and population health, highlighting the impact of environmental factors on functioning and inclusion. The World Health Organization's (WHO) more holistic definition of health as "wellbeing" is now applied in frameworks and legislation, and has long been understood in occupational therapy theory. In practice, however, occupational therapists and other professionals often address only local and individual environmental factors to promote wellbeing, within systems and societies that limit equity in population health and restrict inclusion in communities. This paper presents an in-depth analysis of the supports and accommodations identified by a cohort of individuals (n-100) living with disability. A range of environmental facilitators and barriers were identified in peoples' experience of "inclusive community environs" and found to influence inclusion and wellbeing. The roles and responsibilities of individuals, professionals, and society to enact change in environments are discussed in light of these findings. Recommendations include a focus on the subjective experience of environments, and application of theory from human rights and inclusive economics to address the multiple dimensions and levels of environments in working towards inclusion and wellbeing.

The role of the International Classification of Functioning, Disability, and Health and quality criteria for improving assistive technology service delivery in Europe.

OBJECTIVE: People with disabilities are entitled to access assistive technology (AT) to facilitate their full and effective participation in society and may reasonably expect to be central to the decision-making processes of services that provide these technologies. European projects have improved the knowledge and resources available for AT service delivery in many countries, but the outputs are not consistently implemented or published in scientific literature. This article examines European developments in AT service delivery and the barriers to its effective provision. Specifically, it analyzes the role of the International Classification of Functioning, Disability, and Health in service delivery improvement. DESIGN: Published scientific papers, as well as reports from and descriptions of European projects related to AT service delivery, were reviewed. The publications were analyzed in relation to six criteria for AT service delivery described in an earlier, major European project. The findings and recommendations from the publications are synthesized in this article to identify advances and gaps in AT service delivery and to assess the current status and direction of AT service delivery improvement in Europe. RESULTS: Multicountry projects have brought together AT researchers from across Europe to work together and produced promising results that are contextually relevant. Access to AT information and training of practitioners has improved, and efforts are being made to facilitate user involvement. CONCLUSIONS: More effort should be put into integrating research and resources from European projects into practice. Use of the International Classification of Functioning, Disability, and Health model and terminology may support coordination of service delivery systems. The AT research and practice communities in Europe may be able to learn from developments in North America, while continuing to work together, sharing resources and strategies, and communicating results internationally.