Editorial

Citation

Bowerman, J. (2013), "Editorial", Leadership in Health Services, Vol. 26 No. 2. https://doi.org/10.1108/lhs.2013.21126baa.001

Editorial

Article Type: Editorial From: Leadership in Health Services, Volume 26, Issue 2

Sometimes leading health initiatives require a number of iterations. –This seems to be the case concerning an initiative here in Edmonton and Calgary, the first of its kind in Canada, to help allow patients to determine which hospital emergency room will have the shortest wait time. The idea is that a would be patient, using a smart phone app and a new website- can determine from the information provided, which emergency department is going to provide them with the quickest service. Given that much of the concern with the Canadian health care system results from wait times – not only for emergency – but also for elective surgeries – its aim is to allow those patients with minor ailments – to make their own decision as to which hospital to go to for medical services. Of course, those patients suffering from severe health emergencies are told to call the emergency number or to simply go to the nearest hospital.

I believe this is an excellent idea for those people who are technologically sophisticated and have a sense about how to make the best decision that suits their circumstances. It likely will not work for the elderly who are not tech savvy, nor the very poor who do not have smart phones or immediate access to a computer; for these, transportation to the nearest hospital will always be the best option. But for the rest of us – especially those with children – the initiative is empowering and allows us to do what is necessary to avoid lengthy waits in hospital waiting rooms.

It may take time however to catch on. According to one news report, the effect has not been dramatic, the number of hits and downloads are not as great as people would have wished. As well, there are fears that patients may decide not to go to a hospital at all because of the anticipated wait time, though the doctors in charge of the project say this has not been the case (Edmonton Journal, June, 2012). Ongoing iterations will necessarily involve building in corrections for how fast any given situation change, and more research into the types of patients and the conditions of those using the system. There are researchers who are exploring the efficacy of the system and how to improve it better – these are researchers whose expertise is queuing theory – and while not necessarily leading to a better health care service over all, certainly their work can build in ongoing improvements to the use of hospital emergency services. According to news reports, Edmonton only met its target of ensuring that 60 per cent of seriously ill patients be admitted and treated within eight hours between 22 and 38 per cent of the time. For less serious cases, the city met its targets between 44 and 65 per cent of the time – though the Minister said that a 17 per cent increase in ER visits has tended to mask improvements.

We are fortunate to live in a province with this kind of service. Technology has much to offer in the way of improvements to health service delivery. From a strictly personal point-of-view, it can be a little disconcerting to know that a visit to the local emergency room can result in huge long wait times – though this has certainly not been my experience. A badly broken wrist was seen to immediately, long before this service was available, although I was anticipating a 12 hour wait based on news headlines. Would I use the service now to select the most appropriate hospital in terms of time under the same circumstances? Likely not. Sometimes it is simply comforting to be in the nearest emergency waiting room, however long the wait may be. But overall, this is a leading initiative and people will make increasing use of it as they become more familiar with the advantages it offers, and as the information becomes more accurate. I am fortunate to be a little familiar with some of the researchers in the system, and wish them luck in building ongoing improvement as the program is revised.

The question of how to leverage models which can positively impact health service delivery is directly considered by Dr Jerry Van Vector in this issue. His paper entitled Leveraging the Patient Centred Medical Home Model as a Health Care Logistics Support Strategy investigates concepts within supply chains that have the potential for cost reduction and more effective supply chain management. He notes that although there are many examples of logistics management outside of health care, there are few within a health care environment Spending related to health care is considered to be quite inefficient, with a great many costs related to potentially unnecessary supply chain expenditures. His paper calls for process improvement in the health care logistics system, collaboration between providers, and an emphasis on the customer to provide ongoing feedback for better results.

Dr Revere’s paper, “Error proofing health care”,provides us with a recommendation or road map as a foundation for understanding more about medical error prevention, and to help in the development of new strategies to help prevent such errors. His paper describes a classification system that ranks error proofing strategies based on information collected by the Agency for Healthcare Research and Quality, so that it is available for health care managers to evaluate and improve their error proofing efforts. Van Vector’s paper above points to the cost of inefficient supply chain logistics; this paper points to the problem with medical errors ranking sixth, ahead of diabetes, Alzheimers, and renal disease in the US, and equally as high in the UK and Europe. As he notes, many error proofing strategies are implemented in individual institutions, isolated from others, and resulting in a hot and miss approach to error prevention. Both of these papers, Revere’s and Van Vector’s remind us of how we need to work with systems if we are to make real advances in reducing health care costs and increasing patient safety.

Our next two papers here concern nursing. One, by Mario Franco, concerns the influence of professional identity on Nurses training and is an empirical study from Portugal. The other, by Carina Furaker from Sweden is about the competencies Registered Nurses require when working with older people at residential facilities. Franco first notes the importance of the nursing profession in the Portugese Health Service and then asks not only how nurses experience their professional identity, but the extent to which training can impact this. His findings indicate the importance of professional training and of socio professional recognition – particularly when working within multi-disciplinary teams. Furaker provides us with an analysis of group interviews conducted in 2009 with Registered Nurses (RNs) working at seven residential facilities. These RNs provide both consultative services and advanced nursing services to patients who are multi-morbid, and suffering from dementia. Furaker notes that the distance situation faced by the RNs because of the job and its context negatively impacts their competence development and working situation. She calls for more evidence based nursing practice as well as more leadership and teaching competency to be able to work more effectively.

Finally John Edmonstone reviews eight evaluations – conducted over a thirteen year period – of leadership and management development programs in parts of the UK National Health Service. His purpose is to identify learning themes which can then be incorporated into an overall evaluation framework focusing on impact within healthcare organisations. His findings are of particular interest to those “organisations delivering healthcare to populations and communities who commission such leadership and management development programmes” rather than the individual leaders and managers who participate in such programs with an eye to career development. In other words, his research points to themes that will assist providers, wherever they are in the system, to be more effective in both designing and evaluating such programmes. With so many training and development programmes out there focusing on leadership and management, Edmonstone’s work provides some very useful evidence-based material so that they can be more focused and useful to the system in which the trainees operate.

We encourage you to continue submitting your research papers to Leadership in Health Services. Increasingly, we are receiving papers from all over the world – which we really appreciate. They point to common themes from which we can all learn. Our journal journey, with your help, is a small reflection of the global nature of this rapidly changing and growing field of health service.

Jennifer Bowerman