Leveraging Quality Improvement and Change-Management Tools to Change the Scope of Practice
Bibliographic record
Abstract
In October of 2019 the College of Midwives of Ontario amended the Standard on Prescribing andAdministering Drugs to remove the limitation that restricted midwives from administering oxytocin in the intrapartum period on their own authority. Trillium Health Partners uses ADKAR, a standardized change management tool for large scale change. As part of the implementation plan related to this change in scope of practice, the Midwifery Division at Trillium Health Partners, used ADKAR and a quality improvement framework to review outcomes pre and post implementation, to ensure the quality of care midwifery clients received remained consistent through the change of practice. Outcome, process and balancing measuresremained consistent in the post implementation phase and the results were reported out to the whole Women’s Health team. This article is a reflection on the value of using a quality improvement framework as part of the change management process, as a helpful tool in the expansion of scope of practice. RÉSUMÉEn octobre 2019, l’Ordre des sages-femmes de l’Ontario a modifié la norme sur la prescription etl’administration de médicaments pour enlever la limite qui empêchait les sages-femmes d’administrer de l’ocytocine de leur propre chef durant la période intrapartum. Trillium Health Partners recourt à ADKAR, un outil de changement normalisé pour les modifications de grande envergure. Dans le cadre du plan de mise en oeuvre de ce changement du champ d’activité, la Division de la pratique sage-femme de Trillium Health Partners a utilisé ADKAR et un cadre d’amélioration de la qualité afin d’examiner les issues avant et après l’instauration de la nouvelle approche pour assurer le maintien de la qualité des soins offerts à la clientèleà la suite de la modification de la pratique. Les données fournies par les indicateurs relatifs aux issues et au processus et par les indicateurs de pondération sont demeurées constantes après la mise en oeuvre. Les résultats ont été communiqués à toute l’équipe des services de santé des femmes. Le présent article témoigne de l’utilité de l’emploi d’un cadre d’amélioration de la qualité dans le contexte du processus de gestion du changement comme outil d’élargissement du champ de pratique.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.180 | 0.152 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.010 | 0.006 |
| Science and technology studies | 0.005 | 0.012 |
| Scholarly communication | 0.017 | 0.013 |
| Open science | 0.004 | 0.013 |
| Research integrity | 0.003 | 0.008 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".