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"Gardner, Heidi"
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Smart collaboration : how professionals and their firms succeed by breaking down silos
Many professional service firms today face a serious dilemma. Clients are demanding more sophisticated service for complex problems that can only be delivered by interdisciplinary teams of experts. No one consultant or lawyer--or even one functional group--can guide a client through today's challenges, which often span technological, regulatory, economic, and environmental issues on an increasingly global scale. The problem is, most firms have narrowly defined practice areas and partners with specialized expertise. These siloed experts are often \"stars\" who have built their reputations and client rosters independently, not by working with peers. What's more, most firms have grown so large and so fast that their members can't even know--let alone trust--their colleagues around the world. In Smart Collaboration, Heidi Gardner shows that a much more profitable--albeit difficult--path is to push the firm toward cross-partner collaboration. Gardner, a former McKinsey consultant and Harvard Business School professor, now a fellow at Harvard Law School, has spent over a decade conducting an in-depth study of more than a dozen global professional service firms. In a research tour de force, she brings together time sheet records, financial information, and personnel records--literally millions of data points--to uncover the effect of interdisciplinary teamwork in the professional services field. The result: conclusive proof that collaboration pays, both for employees and for their firms. Moving group by group through the ranks of a typical firm, she offers powerful prescriptions for how leaders can foster collaboration, move to higher-end and higher-margin work, increase client satisfaction, attract and retain top-caliber talent, and improve their bottom line.-- Provided by publisher.
Book
Performance Pressure as a Double-edged Sword: Enhancing Team Motivation but Undermining the Use of Team Knowledge
In this paper, I develop and empirically test the proposition that performance pressure acts as a double-edged sword for teams, providing positive effects by enhancing the team's motivation to achieve good results while simultaneously triggering process losses. I conducted a multimethod field study of 78 audit and consulting teams from two global professional firms, revealing an irony of team life: even though motivated to perform well on a high-stakes project, pressured teams are more likely to engage in performance-detracting behaviors. Survey results show that, as performance pressure increases, team members begin to overly rely on general expertise while discounting domain-specific expertise, leading to suboptimal performance. I then use longitudinal qualitative case studies of six project teams across two firms to explore the underlying behavioral mechanisms that generate this outcome. Results reveal four limiting team processes: (1) a drive toward consensus, (2) a focus on common knowledge, (3) a shift from learning to project completion, and (4) increased conformity to the status hierarchy. Results also show that only domain-specific expertise—the kind that teams underuse when facing higher pressure—increases client-rated team performance. I thus find, paradoxically, that when teams need domain-specific expertise the most, they tend to use it the least, despite evidence suggesting they are highly motivated to do well on their task.
Journal Article
Lovely beasts : the surprising truth
The author lists several animals that many people would consider scary (sharks), ugly (bats), or creepy (spiders) then explains how they benefit their biological niche, and humans!
Book
Using evidence when planning for trial recruitment: An international perspective from time-poor trialists
Recruiting participants to trials is challenging. To date, research has focussed on improving recruitment once the trial is underway, rather than planning strategies to support it, e.g. developing trial information leaflets together with people like those to be recruited. We explored whether people involved with participant recruitment have explicit planning strategies; if so, how these are developed, and if not, what prevents effective planning.
Design: Individual qualitative semi-structured interviews. Data were analysed using a Framework approach, and themes linked through comparison of data within and across stakeholder groups. Participants: 23 international trialists (UK, Canada, South Africa, Italy, the Netherlands); 11 self-identifying as 'Designers'; those who design recruitment methods, and 12 self-identifying as 'Recruiters'; those who recruit participants. Interviewees' had recruitment experience spanning diverse interventions and clinical areas. Setting: Primary, secondary and tertiary-care sites involved in trials, academic institutions, and contract research organisations supporting pharmaceutical companies.
To varying degrees, respondents had prospective strategies for recruitment. These were seldom based on rigorous evidence. When describing their recruitment planning experiences, interviewees identified a range of influences that they believe impacted success: The timing of recruitment strategy development relative to the trial start date, and who is responsible for recruitment planning.The methods used to develop trialists' recruitment strategy design and implementation skills, and when these skills are gained (i.e. before the trial or throughout).The perceived barriers and facilitators to successful recruitment planning; and how trialists modify practice when recruitment is poor.
Respondents from all countries considered limited time and disproportionate approvals processes as major challenges to recruitment planning. Poor planning is a mistake that trialists live with throughout the trial. The experiences of our participants suggest that effective recruitment requires strategies to increase the time for trial planning, as well as access to easily implementable evidence-based strategies.
Journal Article
Developing the INCLUDE Ethnicity Framework—a tool to help trialists design trials that better reflect the communities they serve
Background
Ensuring that a trial is designed so that its participants reflect those who might benefit from the results, or be spared harms, is key to the potential benefits of the trial reaching all they should. This paper describes the process, facilitated by Trial Forge, that was used between July 2019 and October 2020 to develop the INCLUDE Ethnicity Framework, part of the wider INCLUDE initiative from the National Institute for Health Research to improve inclusion of under-served groups in clinical research studies.
Methods
Development of the Framework was done in seven phases: (1) outline, (2) initial draft, (3) stakeholder meeting, (4) modify draft, (5) Stakeholder feedback, (6) applying the Framework and (7) packaging. Phases 2 and 3 were face-to-face meetings. Consultation with stakeholders was iterative, especially phases 4 to 6. Movement to the next phase was done once all or most stakeholders were comfortable with the results of the current phase. When there was a version of the Framework that could be considered final, the Framework was applied to six trials to create a set of examples (phase 6). Finally, the Framework, guidance and examples were packaged ready for dissemination (phase 7).
Results
A total of 40 people from stakeholder groups including patient and public partners, clinicians, funders, academics working with various ethnic groups, trial managers and methodologists contributed to the seven phases of development. The Framework comprises two parts. The first part is a list of four key questions:
Who should my trial apply to?
Are the groups identified likely to respond in different ways?
Will my study intervention make it harder for some groups to engage?
Will the way I have designed the study make it harder for some groups to engage?
The second part is a set of worksheets to help trial teams address these questions. The Framework can be used for any stage of trial, for a healthcare intervention in any disease area. The Framework was launched on 1st October 2020 and is available open access at the Trial Forge website:
https://www.trialforge.org/trial-forge-centre/include/
.
Conclusion
Thinking about the number of people in our trials is not enough: we need to start thinking more carefully about
who
our participants are.
Journal Article
Trial Forge Guidance 1: what is a Study Within A Trial (SWAT)?
Randomised trials are a central component of all evidence-informed health care systems and the evidence coming from them helps to support health care users, health professionals and others to make more informed decisions about treatment. The evidence available to trialists to support decisions on design, conduct and reporting of randomised trials is, however, sparse. Trial Forge is an initiative that aims to increase the evidence base for trial decision-making and in doing so, to improve trial efficiency.
One way to fill gaps in evidence is to run Studies Within A Trial, or SWATs. This guidance document provides a brief definition of SWATs, an explanation of why they are important and some practical ‘top tips’ that come from existing experience of doing SWATs. We hope the guidance will be useful to trialists, methodologists, funders, approvals agencies and others in making clear what a SWAT is, as well as what is involved in doing one.
Journal Article
Identifying trial recruitment uncertainties using a James Lind Alliance Priority Setting Partnership – the PRioRiTy (Prioritising Recruitment in Randomised Trials) study
Background
Despite the problem of inadequate recruitment to randomised trials, there is little evidence to guide researchers on decisions about how people are effectively recruited to take part in trials. The PRioRiTy study aimed to identify and prioritise important unanswered trial recruitment questions for research. The PRioRiTy study - Priority Setting Partnership (PSP) included members of the public approached to take part in a randomised trial or who have represented participants on randomised trial steering committees, health professionals and research staff with experience of recruiting to randomised trials, people who have designed, conducted, analysed or reported on randomised trials and people with experience of randomised trials methodology.
Methods
This partnership was aided by the James Lind Alliance and involved eight stages: (i) identifying a unique, relevant prioritisation area within trial methodology; (ii) establishing a steering group (iii) identifying and engaging with partners and stakeholders; (iv) formulating an initial list of uncertainties; (v) collating the uncertainties into research questions; (vi) confirming that the questions for research are a current recruitment challenge; (vii) shortlisting questions and (viii) final prioritisation through a face-to-face workshop.
Results
A total of 790 survey respondents yielded 1693 open-text answers to 6 questions, from which 1880 potential questions for research were identified. After merging duplicates, the number of questions was reduced to 496. Questions were combined further, and those that were submitted by fewer than 15 people and/or fewer than 6 of the 7 stakeholder groups were excluded from the next round of prioritisation resulting in 31 unique questions for research. All 31 questions were confirmed as being unanswered after checking relevant, up-to-date research evidence. The 10 highest priority questions were ranked at a face-to-face workshop. The number 1 ranked question was “How can randomised trials become part of routine care and best utilise current clinical care pathways?” The top 10 research questions can be viewed at
www.priorityresearch.ie
.
Conclusion
The prioritised questions call for a collective focus on normalising trials as part of clinical care, enhancing communication, addressing barriers, enablers and motivators around participation and exploring greater public involvement in the research process.
Journal Article
Trial Forge Guidance 3: randomised trials and how to recruit and retain individuals from ethnic minority groups—practical guidance to support better practice
Randomised trials, especially those intended to directly inform clinical practice and policy, should be designed to reflect all those who could benefit from the intervention under test should it prove effective. This does not always happen. The UK National Institute for Health and Care Research (NIHR) INCLUDE project identified many groups in the UK that are under-served by trials, including ethnic minorities.
This guidance document presents four key recommendations for designing and running trials that include the ethnic groups needed by the trial. These are (1) ensure eligibility criteria and recruitment pathway do not limit participation in ways you do not intend, (2) ensure your trial materials are developed with inclusion in mind, (3) ensure staff are culturally competent and (4) build trusting partnerships with community organisations that work with ethnic minority groups. Each recommendation comes with best practice advice, public contributor testimonials, examples of the inclusion problem tackled by the recommendation, or strategies to mitigate the problem, as well as a collection of resources to support implementation of the recommendations.
We encourage trial teams to follow the recommendations and, where possible, evaluate the strategies they use to implement them. Finally, while our primary audience is those designing, running and reporting trials, we hope funders, grant reviewers and approvals agencies may also find our guidance useful.
Journal Article
Routinely collected data for randomized trials: promises, barriers, and implications
Background
Routinely collected health data (RCD) are increasingly used for randomized controlled trials (RCTs). This can provide three major benefits: increasing value through better feasibility (reducing costs, time, and resources), expanding the research agenda (performing trials for research questions otherwise not amenable to trials), and offering novel design and data collection options (e.g., point-of-care trials and other designs directly embedded in routine care). However, numerous hurdles and barriers must be considered pertaining to regulatory, ethical, and data aspects, as well as the costs of setting up the RCD infrastructure. Methodological considerations may be different from those in traditional RCTs: RCD are often collected by individuals not involved in the study and who are therefore blinded to the allocation of trial participants. Another consideration is that RCD trials may lead to greater misclassification biases or dilution effects, although these may be offset by randomization and larger sample sizes. Finally, valuable insights into external validity may be provided when using RCD because it allows pragmatic trials to be performed.
Methods
We provide an overview of the promises, challenges, and potential barriers, methodological implications, and research needs regarding RCD for RCTs.
Results
RCD have substantial potential for improving the conduct and reducing the costs of RCTs, but a multidisciplinary approach is essential to address emerging practical barriers and methodological implications.
Conclusions
Future research should be directed toward such issues and specifically focus on data quality validation, alternative research designs and how they affect outcome assessment, and aspects of reporting and transparency.
Journal Article
A good use of time? Providing evidence for how effort is invested in primary and secondary outcome data collection in trials
Background
Data collection is a substantial part of trial workload for participants and staff alike. How these hours of work are spent is important because stakeholders are more interested in some outcomes than others. The ORINOCO study compared the time spent collecting primary outcome data to the time spent collecting secondary outcome data in a cohort of trials.
Methods
We searched PubMed for phase III trials indexed between 2015 and 2019. From these, we randomly selected 120 trials evaluating a therapeutic intervention plus an additional random selection of 20 trials evaluating a public health intervention. We also added eligible trials from a cohort of 189 trials in rheumatology that had used the same core outcome set.
We then obtained the time taken to collect primary and secondary outcomes in each trial. We used a hierarchy of methods that included data in trial reports, contacting the trial team and approaching individuals with experience of using the identified outcome measures. We calculated the primary to secondary data collection time ratio and notional data collection cost for each included trial.
Results
We included 161 trials (120 phase III; 21 core outcome set; 20 public health), which together collected 230 primary and 688 secondary outcomes. Full primary and secondary timing data were obtained for 134 trials (100 phase III; 17 core outcome set; 17 public health). The median time spent on primaries was 56.1 h (range: 0.0–10,746.7, IQR: 226.89) and the median time spent on secondaries was 190.7 hours (range: 0.0–1,356,832.9, IQR: 617.6). The median primary to secondary data collection time ratio was 1.0:3.0 (i.e. for every minute spent on primary outcomes, 3.0 were spent on secondaries). The ratio varied by trial type: phase III trials were 1.0:3.1, core outcome set 1.0:3.4 and public health trials 1.0:2.2. The median notional overall data collection cost was £8015.73 (range: £52.90–£31,899,140.70, IQR: £20,096.64).
Conclusions
Depending on trial type, between two and three times as much time is spent collecting secondary outcome data than collecting primary outcome data. Trial teams should explicitly consider how long it will take to collect the data for an outcome and decide whether that time is worth it given importance of the outcome to the trial.
Journal Article