Papers by Martin McNamara
Journal of Clinical Nursing, Feb 1, 2018
To inform and guide the development of a future model of specialist and advanced nursing and midw... more To inform and guide the development of a future model of specialist and advanced nursing and midwifery practice.
International Journal of Environmental Research and Public Health, Nov 6, 2021
Healthcare staff are required to undertake mandatory training programs to ensure they maintain ke... more Healthcare staff are required to undertake mandatory training programs to ensure they maintain key clinical competencies. This study was conducted in a private hospital in Ireland, where the processes for accessing mandatory training were found to be highly complex and nonuser friendly, resulting in missed training opportunities, specific training license expiration, and underutilized training slots which resulted in lost time for both the trainers and trainees. A pilot study was undertaken to review the process for accessing mandatory training with a focus on the mandatory training program of Basic Life Support (BLS). This was chosen due to its importance in patient resuscitation and its requirement in the hospital achieving Joint Commission International (JCI) accreditation. A pre-and post-team-based intervention design was used with Lean Six Sigma (LSS) methodology employed to redesign the process of booking, scheduling, and delivery of BLS training leading to staff individual BLS certification for a period of two years. The redesign of the BLS training program resulted in a new blended delivery method, and the initiation of a pilot project led to a 50% increase in the volume of BLS classes and a time saving of 154 h 30 min for staff and 48 h 14 min for BLS instructors. The success of the BLS process access pilot has functioned as a platform for the redesign of other mandatory education programs and will be of interest to hospitals with mandatory training requirements that are already facing healthcare challenges and demands on staff time.
International Journal of Environmental Research and Public Health, Nov 13, 2021
The Health Service Executive Ireland model of care for elective surgery supports the delivery of ... more The Health Service Executive Ireland model of care for elective surgery supports the delivery of elective surgical care in achieving both process and clinical outcomes. This project was conducted in the Orthopaedic Department. Following an outpatient consultation with an orthopaedic surgeon, patients who required surgical intervention were scheduled for their intervention by the administrative team. Prior to commencing this project, the average time from patient consultation to being scheduled for surgery on the hospital system was 62 h/2.58 days. A pre-and post-team-based intervention design employing Lean Six Sigma methodology was applied to redesign the process for scheduling elective orthopaedic surgery. The project was informed by collaborative, inclusive, and participatory stakeholder engagement. The goal was to streamline the scheduling process for elective orthopaedic surgery, with a target that 90% of surgeries are scheduled "right first time" within 48 h/two working days of the outpatient consultant appointment. The main outcome measures showed that 100% of orthopaedic surgeries were scheduled successfully within 2 days of outpatient appointment. Duplication in work between patient services and scheduling teams was eliminated and facilitated a reduction in unnecessary staff workload. This project highlights the importance of collaborative interdisciplinary stakeholder engagement in the redesigning of processes to achieve sustainable outcomes, and the findings have informed further improvements across the hospital's surgical scheduling system.
International Journal of Environmental Research and Public Health, Nov 21, 2021
Clinical documentation is a key safety and quality risk, particularly at transitions of care wher... more Clinical documentation is a key safety and quality risk, particularly at transitions of care where there is a higher risk of information being miscommunicated or lost. A surgical operation note (ON) is an essential medicolegal document to ensure continuity of patient care between the surgical operating team and other colleagues, which should be completed immediately following surgery. Incomplete operating surgeon documentation of the ON, in a legible and timely manner, impacts the quality of information available to nurses to deliver post-operative care. In the project site, a private hospital in Dublin, Ireland, the accuracy of completion of the ON across all surgical specialties was 20%. This project sought to improve the accuracy, legibility, and completeness of the ON in the Operating Room. A multidisciplinary team of staff utilised the Lean Six Sigma (LSS) methodology, specifically the Define/Measure/Analyse/Design/Verify (DMADV) framework, to design a new digital process application for documenting the ON. Post-introduction of the new design, 100% of the ONs were completed digitally with a corresponding cost saving of EUR 10,000 annually. The time to complete the ON was reduced by 30% due to the designed digital platform and mandatory fields, ensuring 100% of the document is legible. As a result, this project significantly improved the quality and timely production of the ON within a digital solution. The success of the newly designed ON process demonstrates the effectiveness of the DMADV in establishing a co-designed, value-adding process for post-operative surgical notes.
International Journal of Environmental Research and Public Health, Jan 22, 2022
Changes in healthcare tend to be project-based with whole system change, which acknowledges the i... more Changes in healthcare tend to be project-based with whole system change, which acknowledges the interconnectedness of socio-technical factors, not the norm. This paper attempts to address the question of whole system change posed by the special issue and brings together other research presented in this special issue. A case study approach was adopted to understand the deployment of a whole system change in the acute hospital setting along four dimensions of a socio-technical systems framework: culture, system functioning, action, and sense-making. The case study demonstrates evidence of whole system improvement. The approach to change was co-designed by staff and management, projects involving staff from all specialities and levels of seniority were linked to each other and to the strategic objectives of the organisation, and learnings from first-generation projects have been passed to second and third-generation process improvements. The socio-technical systems framework was used retrospectively to assess the system change but could also be used prospectively to help healthcare organisations develop approaches to whole system improvement.
International Journal of Environmental Research and Public Health, Jan 30, 2022
The purpose of this study was to reduce the length of stay of anterior cruciate ligament reconstr... more The purpose of this study was to reduce the length of stay of anterior cruciate ligament reconstruction patients within a private hospital in Ireland, reducing any non-value-added activity in the patient pathway, with the goal of increasing patient flow, bed capacity, and revenue generation within the hospital system, while maintaining patient satisfaction. Methods: We used a pre-/post-intervention design and Lean Six Sigma methods and tools to assess and improve the current process. Results: A reduction in inpatient length of stay by 57%, and a reduction in identified non-value-added activity by 88%, resulted in a new day-case surgery pathway for anterior cruciate ligament reconstruction patients. The pathway evidenced no re-admissions and demonstrated patient satisfaction. Conclusion: Six months post-project commencement, we had successfully achieved our goals of reducing our anterior cruciate ligament reconstruction patient's length of stay. This study contributes to the growing body of published evidence which shows that adopting a Lean Six Sigma approach can be successfully employed to optimise care and surgical pathways in healthcare.
Interdisciplinary Journal of Partnership Studies, 2015
Partnering in research across disciplines and across countries can be challenging due to differin... more Partnering in research across disciplines and across countries can be challenging due to differing contexts of practice and culture. This study sought to demonstrate how central constructs that have application across disciplines and countries can be studied while concurrently considering context. Groups of nurses from Botswana, Ireland, Israel, New Zealand, and Spain partnered to identify how to measure the constructs of caring for self, burnout, and compassion fatigue, replicating a study by Johnson (2012), who found that caring for self had a moderately strong negative relationship with both compassion fatigue and burnout. While these constructs were of interest to all five groups, the conversation of contextual influences varied. All five groups used the same instruments to measure the central constructs. Levels of burnout and compassion fatigue varied by country but were moderated by caring for self. Partnering across countries made it possible to understand that caring for sel...
Journal of Advanced Nursing, 2019
Results 68 papers were included. There exists empirical support for six key domains which require... more Results 68 papers were included. There exists empirical support for six key domains which require to be addressed in the policymaking and analysis process: 1) Context 2) Process 3) Content 4) Stakeholder Consultation 5) Implementation 6) Evaluation. Failure to contextualise and integrate these six domains in problem identification, policy analysis, strategy and policy development, policy enactment and policy implementation is problematic. Conclusion There is a need to test and refine the constructs linked to the policymaking cycle taking cognisance of the context where these are developed, implemented and evaluated. Impact This review makes a novel contribution to the synthesis of evidence to inform the policymaking and analysis process. Findings illuminate the complexity of policymaking, the competing pressures involved and the importance of the local, national and international context. These findings have international relevance and provide empirical support for key criteria to guide those involved in context specific policymaking and/or the analysis of existing policy.
Journal of Nursing Management, 2019
Aim: To develop a tool for the analysis of nursing, midwifery and health-related policy and profe... more Aim: To develop a tool for the analysis of nursing, midwifery and health-related policy and professional guidance documents. Background: Analysis tools can aid both policy evaluation and policy development. However, no framework for analysing the content of professional regulation and guidance documents among healthcare professionals currently exists. Method: This study used an action research, cooperative inquiry design. Data were generated from two integrative literature reviews and discussions held during the cooperative inquiry meetings. Results: A set of key themes to be considered in the development or evaluation of health policy or professional regulation and guidance documents were identified. These themes formed the basis of the six domains considered by the Health-related Policy Analysis Tool (HrPAT): Context, Process, Content, Stakeholder Consultation, Implementation, and Evaluation. Conclusion: Use of the HrPAT can assist in policy development, evaluation and implementation, as well as providing some retrospective analytical insights into existing health policies. Implication for Nursing Management: Professional regulation documents, guidelines and policy reports should be capable of being scrutinised for their content, quality, and developmental process. The HrPAT can assist relevant stakeholders in the development , analysis and evaluation of such documents, including local, servicelevel policies and guidelines.
6.3.2 Evolving roles of nurses and midwives and negotiating role boundaries 6.3.3 Impacts on care... more 6.3.2 Evolving roles of nurses and midwives and negotiating role boundaries 6.3.3 Impacts on care delivery 6.4 Theme 2: Scope of practice, understanding and use 6.4.1 Understanding my scope of practice 6.4.2 Use of scope of practice Framework 6.4.3 Aspects of scope 6.5 Theme 3: Expanding scope of practice 6.5.1 Expanded scope 6.5.2 Barriers to expanded scope 6.5.3 Enablers of expanded scope 6.6 Theme 4: Professional competence 6.6.1 What is competence? 6.6.2 Gaining and maintaining competence 6.6.3 Competence and the practitioner 6.7 Theme 5: Practice setting and context 6.7.1 Legislation, policies, guidelines and regulation 6.7.2 Practice concerns 6.8 Theme 6: Reflections on the current Framework 6.8.1 General thoughts on the current Framework 6.8.2 Comments on individual sections of the Framework 6.9 Summary of findings 6.10 Case examples of expanded practice 6.10.1 Case example of midwifery practice 6.10.2 Case example of advanced practice: Reflective tool 7 DISCUSSION 7.1 Introduction 7.2 Self-reported scope of practice 7.3 Expanding practice: Enablers and barriers 7.4 Scope of practice and role boundaries 7.5 Perspectives on the Framework 7.6 Strengths and limitations of the study design 8 CONCLUSIONS AND RECOMMENDATIONS
HRB Open Research, 2020
Background: In 2018, the Office of the Nursing and Midwifery Services Director (ONMSD) completed ... more Background: In 2018, the Office of the Nursing and Midwifery Services Director (ONMSD) completed phase one of work which culminated in the development and launch of seven research reports with defined suites of quality care process metrics (QC-Ms) and respective indicators for the practice areas – acute care, midwifery, children’s, public health nursing, older persons, mental health and intellectual disability nursing in Ireland. This paper presents a rapid realist review protocol that will systematically review the literature that examines QC-M in practice; what worked, or did not work for whom, in what contexts, to what extent, how and why? Methods: The review will explore if there are benefits of using the QC-Ms and what are the contexts in which these mechanisms are triggered. The essence of this rapid realist review is to ascertain how a change in context generates a particular mechanism that produces specific outcomes. A number of steps will occur including locating existing t...
International Journal of Environmental Research and Public Health
The eighteen papers in this Special Issue, ‘Whole-Systems Approaches to Process Improvement in He... more The eighteen papers in this Special Issue, ‘Whole-Systems Approaches to Process Improvement in Health Systems’, address an enduring challenge in healthcare: to improve efficiency with existing or reduced resources, while maintaining safe and effective care [...]
International Journal for Quality in Health Care, 2019
This paper discusses the development of a Lean Six Sigma (LSS) postgraduate education programme t... more This paper discusses the development of a Lean Six Sigma (LSS) postgraduate education programme that has enabled the delivery of over 90 quality improvement projects led by its graduates across 50 healthcare organizations in Ireland. A key success factor in embedding and sustaining LSS in these organizations was the accreditation by a major, national, research-intensive university of the LSS education programme from which the students graduated. To ensure the programme’s approval by the university it was necessary to contextualize LSS within established conceptual frameworks. This helped counter misconceptions that what was proposed was technical training in tools and techniques to provide quick fixes for routine healthcare process issues. Two related conceptual frameworks were selected to frame the curriculum: Senge’s Fifth Discipline and Deming’s System of Profound Knowledge. This paper focuses on how a central element of both frameworks, systems thinking or appreciation for a sys...
International Journal of Environmental Research and Public Health
Quality measurement initiatives promote quality improvement in healthcare but can be challenging ... more Quality measurement initiatives promote quality improvement in healthcare but can be challenging to implement effectively. This paper presents a Rapid Realist Review (RRR) of published literature on Quality Care-Process Metrics (QCP-M) implementation in nursing and midwifery practice. An RRR informed by RAMESES II standards was conducted as an efficient means to synthesize evidence using an expert panel. The review involved research question development, quality appraisal, data extraction, and evidence synthesis. Six program theories summarised below identify the key characteristics that promote positive outcomes in QCP-M implementation. Program Theory 1: Focuses on the evidence base and accessibility of the QCP-M and their ease of use by nurses and midwives working in busy and complex care environments. Program Theory 2: Examines the influence of external factors on QCP-M implementation. Program Theory 3: Relates to existing cultures and systems within clinical sites. Program Theor...
International Journal of Environmental Research and Public Health, 2022
The unexpected advent of the COVID-19 pandemic led to a sudden disruption of routine medical care... more The unexpected advent of the COVID-19 pandemic led to a sudden disruption of routine medical care, with a subsequent reorganization of hospital structures and of care. Case studies are becoming available in the literature referring to the logistical difficulties involved in a hospital resuming normal activity following the first COVID-19 lockdown period. This paper details the experience of a study site, a private hospital in Dublin, Ireland, in the redesign of service delivery in compliance with new COVID-19 prevention regulations to facilitate the resumption of routine hospital activity following the first wave of COVID-19. The aim was to resume routine activity and optimize patient activity, whilst remaining compliant with COVID-19 guidelines. We employed a pre-/post-intervention design using Lean methodology and utilised a rapid improvement event (RIE) approach underpinned by person-centred principles. This was a system-wide improvement including all hospital staff, facilitated ...
International Journal of Environmental Research and Public Health, 2022
Background: The purpose of this study was to reduce the length of stay of anterior cruciate ligam... more Background: The purpose of this study was to reduce the length of stay of anterior cruciate ligament reconstruction patients within a private hospital in Ireland, reducing any non-value-added activity in the patient pathway, with the goal of increasing patient flow, bed capacity, and revenue generation within the hospital system, while maintaining patient satisfaction. Methods: We used a pre-/post-intervention design and Lean Six Sigma methods and tools to assess and improve the current process. Results: A reduction in inpatient length of stay by 57%, and a reduction in identified non-value-added activity by 88%, resulted in a new day-case surgery pathway for anterior cruciate ligament reconstruction patients. The pathway evidenced no re-admissions and demonstrated patient satisfaction. Conclusion: Six months post-project commencement, we had successfully achieved our goals of reducing our anterior cruciate ligament reconstruction patient’s length of stay. This study contributes to ...
What Lies Beneath ?T He Underlying Principles Structuring the Field of Academic Nursing
This article reports the findings of a structural analysis of the field of academic nursing in Ir... more This article reports the findings of a structural analysis of the field of academic nursing in Ireland and considers the implications of the field's current structure for its present status and future trajectory in the academy. Six years after preregistration nursing education transferred to the higher education sector, tensions continue to exist concerning the status and legitimacy of academic nursing and of those who profess to profess it. The languages of legitimation of senior nursing academics and national nursing leaders (n = 16) were elicited and subjected to a critical discourse analysis. Respondents' languages were analyzed in terms of the settings of four underlying structuring legitimation principles: autonomy, density, specialization, and temporality. Academic nursing in Ireland was found to be structured by low autonomy, high density, and weak specialization. I conclude that academic and professional leaders in Irish nursing need to urgently consider how academi...
International Journal of Environmental Research and Public Health, 2021
Clinical documentation is a key safety and quality risk, particularly at transitions of care wher... more Clinical documentation is a key safety and quality risk, particularly at transitions of care where there is a higher risk of information being miscommunicated or lost. A surgical operation note (ON) is an essential medicolegal document to ensure continuity of patient care between the surgical operating team and other colleagues, which should be completed immediately following surgery. Incomplete operating surgeon documentation of the ON, in a legible and timely manner, impacts the quality of information available to nurses to deliver post-operative care. In the project site, a private hospital in Dublin, Ireland, the accuracy of completion of the ON across all surgical specialties was 20%. This project sought to improve the accuracy, legibility, and completeness of the ON in the Operating Room. A multidisciplinary team of staff utilised the Lean Six Sigma (LSS) methodology, specifically the Define/Measure/Analyse/Design/Verify (DMADV) framework, to design a new digital process appli...
International Journal of Environmental Research and Public Health, 2021
Healthcare systems internationally are working under increasing demand to use finite resources wi... more Healthcare systems internationally are working under increasing demand to use finite resources with greater efficiency. The drive for efficiency utilises process improvement methodologies such as Lean Six Sigma. This study outlines a pilot Lean Six Sigma intervention designed to release nursing time to care within a peri-operative environment; this was achieved by collaborating with stakeholders to redesign the process for laparoscopic hernia surgical case preparation (set up) material. Across 128 laparoscopic hernia surgical cases, the pilot resulted in a 55% decrease in overall nursing time spent in gathering and preparing materials for laparoscopic hernia surgical cases, with a corresponding reduction in packaging waste. The major impact of releasing nursing time to care within busy Operating Room environments enabled nurses to focus on continuing to deliver high-quality care to their patients and reduce pressure expressed by the Operating Room nurses. The results have led to an ...
International Journal of Environmental Research and Public Health, 2021
The Health Service Executive Ireland model of care for elective surgery supports the delivery of ... more The Health Service Executive Ireland model of care for elective surgery supports the delivery of elective surgical care in achieving both process and clinical outcomes. This project was conducted in the Orthopaedic Department. Following an outpatient consultation with an orthopaedic surgeon, patients who required surgical intervention were scheduled for their intervention by the administrative team. Prior to commencing this project, the average time from patient consultation to being scheduled for surgery on the hospital system was 62 h/2.58 days. A pre- and post-team-based intervention design employing Lean Six Sigma methodology was applied to redesign the process for scheduling elective orthopaedic surgery. The project was informed by collaborative, inclusive, and participatory stakeholder engagement. The goal was to streamline the scheduling process for elective orthopaedic surgery, with a target that 90% of surgeries are scheduled “right first time” within 48 h/two working days ...
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Papers by Martin McNamara