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Article
Publication date: 3 July 2017

Gaetano R. Lotrecchiano, Mary Kane, Mark S. Zocchi, Jessica Gosa, Danielle Lazar and Jesse M. Pines

The purpose of this paper is to describe the use of group concept mapping (GCM) as a tool for developing a conceptual model of an episode of acute, unscheduled care from…

Abstract

Purpose

The purpose of this paper is to describe the use of group concept mapping (GCM) as a tool for developing a conceptual model of an episode of acute, unscheduled care from illness or injury to outcomes such as recovery, death and chronic illness.

Design/methodology/approach

After generating a literature review drafting an initial conceptual model, GCM software (CS Global MAXTM) is used to organize and identify strengths and directionality between concepts generated through feedback about the model from several stakeholder groups: acute care and non-acute care providers, patients, payers and policymakers. Through online and in-person population-specific focus groups, the GCM approach seeks feedback, assigned relationships and articulated priorities from participants to produce an output map that described overarching concepts and relationships within and across subsamples.

Findings

A clustered concept map made up of relational data points that produced a taxonomy of feedback was used to update the model for use in soliciting additional feedback from two technical expert panels (TEPs), and finally, a public comment exercise was performed. The results were a stakeholder-informed improved model for an acute care episode, identified factors that influence process and outcomes, and policy recommendations, which were delivered to the Department of Health and Human Services’s (DHHS) Assistant Secretary for Preparedness and Response.

Practical implications

This study provides an example of the value of cross-population multi-stakeholder input to increase voice in shared problem health stakeholder groups.

Originality/value

This paper provides GCM results and a visual analysis of the relational characteristics both within and across sub-populations involved in the study. It also provides an assessment of observational key factors supporting how different stakeholder voices can be integrated to inform model development and policy recommendations.

Details

Leadership in Health Services, vol. 30 no. 3
Type: Research Article
ISSN: 1751-1879

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Article
Publication date: 5 September 2018

Silvia Bruzzi, Paolo Landa, Elena Tànfani and Angela Testi

The ageing of the world’s population is causing an increase in the number of frail patients admitted to hospitals. In the absence of appropriate management and…

Abstract

Purpose

The ageing of the world’s population is causing an increase in the number of frail patients admitted to hospitals. In the absence of appropriate management and organisation, these patients risk an excessive length of stay and poor outcomes. To deal with this problem, the purpose of this paper is to propose a conceptual model to facilitate the pathway of frail elderly patients across acute care hospitals, focussed on avoiding improper wait times and treatment during the process.

Design/methodology/approach

The conceptual model is developed to enrich the standard flowchart of a clinical pathway in the hospital. The modified flowchart encompasses new organisational units and activities carried out by new dedicated professional roles. The proposed variant aims to provide a correct assessment of frailty at the entrance, a better management of the patient’s stay during different clinical stages and an early discharge, sending the patient home or to other facilities, avoiding a delayed discharge. The model is completed by a set of indicators aimed at measuring performance improvements and creating a strong database of evidence on the managing of frail elderly’s pathways, providing proper information that can validate the model when applied in current practice.

Findings

The paper proposes a design of the clinical path of frail patients in acute care hospitals, combining elements that, according to an evidence-based management approach, have proved to be effective in terms of outcomes, costs and organisational issues. The authors can, therefore, expect an improvement in the treatment of frail patients in hospital, avoiding their functional decline and worsening frailty conditions, as often happens in current practice following the standard path of other patients.

Research limitations/implications

The framework proposed is a conceptual model to manage frail elderly patients in acute care wards. The research approach lacks application to real data and proof of effectiveness. Further work will be devoted to implementing a simulation model for a specific case study and verifying the impact of the conceptual model in real care settings.

Practical implications

The paper includes suggestions for re-engineering the management of frail elderly patients in hospitals, when a reduction of lengths of stay and the improvement of clinical outcomes is required.

Originality/value

This paper fulfils an identified need to study and provide solutions for the management of frail elderly patients in acute care hospitals, and generally to produce value in a patient-centred model.

Details

Management Decision, vol. 56 no. 10
Type: Research Article
ISSN: 0025-1747

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Article
Publication date: 14 May 2018

Desley Harvey, Michele Foster, Rachel Quigley and Edward Strivens

The purpose of the paper is to examine the care transitions of older people who transfer between home, acute and sub-acute care to determine if there were common…

Abstract

Purpose

The purpose of the paper is to examine the care transitions of older people who transfer between home, acute and sub-acute care to determine if there were common transition types and areas for improvements.

Design/methodology/approach

A longitudinal case study design was used to examine care transitions of 19 older people and their carers as a series of transitions and a whole-of-system experience. Case study accounts synthesising semi-structured interviews with function and service use data from medical records were compared.

Findings

Three types of care transitions were derived from the analysis: manageable, unstable and disrupted. Each type had distinguishing characteristics and older people could experience elements of all types across the system. Transition types varied according to personal and systemic factors.

Originality/value

This study identifies types of care transition experiences across acute, sub-acute and primary care from the perspective of older people and their carers. Understanding transition types and their features can assist health professionals to better target strategies within and across the system and improve patient experiences as a whole.

Details

Journal of Integrated Care, vol. 26 no. 3
Type: Research Article
ISSN: 1476-9018

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Article
Publication date: 5 October 2010

Marie Boltz, Elizabeth Capezuti and Nina Shabbat

The purpose of this mixed methods study is to define the core components of a system‐wide, acute care program designed to meet the needs of older adults.

Abstract

Purpose

The purpose of this mixed methods study is to define the core components of a system‐wide, acute care program designed to meet the needs of older adults.

Design/methodology/approach

Concept mapping methodology (multidimensional scaling and cluster analysis) was used to obtain data describing the core components of a geriatric acute care model. The input of 306 “stakeholders” (clinicians, administrators, consumers, educators, and researchers) was obtained through a world wide web interface, supplemented with consumer interviews.

Findings

The findings yielded eight clusters describing components of a geriatric acute care program: guiding principles, leadership, organizational structures, physical environment, patient‐ and family‐centered approaches, aging‐sensitive practices, geriatric staff competence, and interdisciplinary resources and processes. A total of 113 items that describe dimensions of quality were identified with these clusters.

Practical implications

The clusters and dimensions provide a framework for a hospital to use to plan, implement, and evaluate an acute care model for older adults.

Originality/value

There is not a common understanding of what constitutes a comprehensive set of resources, programs, and activities to address the needs of hospitalized older adults and their families and the staff who serve them. Concept mapping was an effective method of engaging the perspectives of various stakeholders in creating a framework to address these needs, as well as useful in illuminating areas for future research.

Details

Leadership in Health Services, vol. 23 no. 4
Type: Research Article
ISSN: 1751-1879

Keywords

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Article
Publication date: 3 October 2018

Peter Nugus, Geetha Ranmuthugala, Josianne Lamothe, David Greenfield, Joanne Travaglia, Kendall Kolne, Julia Kryluk and Jeffrey Braithwaite

Health service effectiveness continues to be limited by misaligned objectives between policy makers and frontline clinicians. While capturing the discretion workers…

Abstract

Purpose

Health service effectiveness continues to be limited by misaligned objectives between policy makers and frontline clinicians. While capturing the discretion workers inevitably exercise, the concept of “street-level bureaucracy” has tended to artificially separate policy makers and workers. The purpose of this paper is to understand the role of social-organizational context in aligning policy with practice.

Design/methodology/approach

This mixed-method participatory study focuses on a locally developed tool to implement an Australia-wide strategy to engage and respond to mental health services for parents with mental illness. Researchers: completed 69 client file audits; administered 64 staff surveys; conducted 24 interviews and focus groups (64 participants) with staff and a consumer representative; and observed eight staff meetings, in an acute and sub-acute mental health unit. Data were analyzed using content analysis, thematic analysis and descriptive statistics.

Findings

Based on successes and shortcomings of the implementation (assessment completed for only 30 percent of clients), a model of integration is presented, distinguishing “assimilist” from “externalist” positions. These depend on the degree to which, and how, the work environment affords clinicians the setting to coordinate efforts to take account of clients’ personal and social needs. This was particularly so for allied health clinicians and nurses undertaking sub-acute rehabilitative-transitional work.

Originality/value

A new conceptualization of street-level bureaucracy is offered. Rather than as disconnected, it is a process of mutual influence among interdependent actors. This positioning can serve as a framework to evaluate how and under what circumstances discretion is appropriate, and to be supported by managers and policy makers to optimize client-defined needs.

Details

Journal of Health Organization and Management, vol. 32 no. 6
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 1 March 2003

Penny West

Abstract

Details

Mental Health Review Journal, vol. 8 no. 1
Type: Research Article
ISSN: 1361-9322

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Article
Publication date: 17 June 2011

Jonathan Webster

This paper seeks to demonstrate the role of person‐centred assessment in improving the standard of care for people with dementia in acute hospitals.

Abstract

Purpose

This paper seeks to demonstrate the role of person‐centred assessment in improving the standard of care for people with dementia in acute hospitals.

Design/methodology/approach

The paper offers a review of recent research and literature on person centred care highlighting its role in acute hospital settings. Case studies are also used by way of illustration.

Findings

Acute hospitals are inherently complex environments which pose particular challenges for the care and management of people with dementia. Evidence drawn from the literature and recent research suggests that person‐centred assessment has the capacity to enhance the quality of care for people with dementia and improve outcomes. Patients who are understood, listened to, and responded to tend to display lower levels of challenging behaviour, are calmer, more receptive to accepting treatment and have higher levels of well being. Although experienced nurses working in acute wards often have in‐depth knowledge of older peoples' health‐related needs, a reliance on inflexible “assessment frameworks” can distract them from focusing on the individual. The routinised nature of many ward environments, shift patterns, high staff turnover and weak clinical leadership also act as barriers. Person‐centred assessment can be employed to identify the needs of people with dementia based upon their life history and patterns of daily living; it can also underpin the design and delivery of person‐centred care and treatment throughout their hospital stay.

Originality/value

The capacity of person‐centred care to improve care suggests that it needs to be embedded in gerontological nursing practice in acute hospital settings as a clinical and managerial priority.

Details

Quality in Ageing and Older Adults, vol. 12 no. 2
Type: Research Article
ISSN: 1471-7794

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Article
Publication date: 1 November 2018

Rebecca Feo, Frank Donnelly, Åsa Muntlin Athlin and Eva Jangland

Globally, acute abdominal pain (AAP) is one of the most common reasons for emergency admissions, yet little is known about how this patient group experiences the delivery…

Abstract

Purpose

Globally, acute abdominal pain (AAP) is one of the most common reasons for emergency admissions, yet little is known about how this patient group experiences the delivery of fundamental care across the acute care delivery chain. The purpose of this paper is to describe how patients with AAP experienced fundamental care across their acute care presentation, and to explicate the health professional behaviours, reported by patients, that contributed to their positive experiences.

Design/methodology/approach

A qualitative descriptive study, using repeated reflective interviews, was analysed thematically (n=10 patients).

Findings

Two themes were identified: developing genuine, caring relationships with health professionals and being informed about one’s care. Patients reported that health professionals established genuine professional–patient relationships despite the busy care environment but perceived this environment as impeding information-provision. Patients were typically accepting of a lack of information, whereas poor professional–patient relationships were seen as inexcusable.

Practical implications

To provide positive fundamental care experiences for patients with AAP, health professionals should establish caring relationships with patients, such as by using humour, being attentive, and acknowledging patients’ physical pain and emotional distress; and should inform patients about their care, including allowing patients to ask questions and taking time to answer those questions.

Originality/value

This is the first Australian study to explore the experiences of patients with AAP across the acute care delivery chain, using a novel method of repeated interviews, and to demonstrate how fundamental care can be delivered, in clinical practice, to ensure positive patient experiences.

Details

Journal of Health Organization and Management, vol. 33 no. 1
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 9 March 2015

Olle Olsson and Håkan Aronsson

– This paper aims to explore if actions used at a hospital to manage a variable acute patient flow can be categorised using the concepts of lean, agile and leagile.

Abstract

Purpose

This paper aims to explore if actions used at a hospital to manage a variable acute patient flow can be categorised using the concepts of lean, agile and leagile.

Design/methodology/approach

Empirical evidence from a university hospital was gathered by interviews, internal documents, shadowing and participation in meetings. Identified actions used at both hospital level and departmental level are categorised as lean or agile, while combinations of actions are compared with different leagile approaches.

Findings

Actions from every lean and agile category derived from literature are used at the hospital, however in varying extent. Many agile actions are reactive, indicating a lack of proactive measures. Actions that directly manage external variation are also few in numbers. Leagile approaches of all three combinations derived from literature are also used at the hospital.

Research limitations/implications

As a single-case study is used, empirical generalisation to other hospitals cannot be deduced. Future research assessing the appropriateness of different actions for managing a variable acute patient flow is encouraged.

Practical implications

The use of actions within both lean and agile categories indicate the possibility of combining these process strategies in hospitals, and not only focusing on implementing lean. By cleverly combining lean and agile actions, leagile approaches can be formed.

Originality/value

The use of lean in health care has been a topic of research, while the use of agile has been sparsely researched, as well as the combination of the two.

Details

Supply Chain Management: An International Journal, vol. 20 no. 2
Type: Research Article
ISSN: 1359-8546

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Article
Publication date: 17 February 2012

Elizabeth Hughes, Yvette Brown and Robert Tummey

The focus of this paper is to consider the findings of a survey, which aims to identify the types of training that acute mental health staff could access, in relation to…

Abstract

Purpose

The focus of this paper is to consider the findings of a survey, which aims to identify the types of training that acute mental health staff could access, in relation to workforce development and substance misuse issues in acute mental health care.

Design/methodology/approach

An electronic survey was developed and distributed using work email lists to all clinicians who worked in acute mental health services across a region in England. Not all NHS organisations agreed to participate.

Findings

A total of 89 clinicians responded to the survey, some failed to indicate their consent, therefore the results of the 77 that did are presented. The main finding was that most acute care staff had only accessed mandatory training such as risk assessment. Many staff had not been trained in the use of psychosocial approaches. Drug and alcohol specific activities were performed on the whole only “sometimes”.

Research limitations/implications

It was not possible to determine the total number of potentially eligible staff who were sent the survey, therefore, response rates cannot be calculated. It is possible that the findings may not be generalisable to other services. There may be bias in those who choose to respond to an electronic email, in terms of those who had access to a computer or who were more IT literate. In addition, the survey did not specifically set out to examine substance misuse issues as its main focus.

Practical implications

Acute care staff work with service users with increasingly complex needs. Creative and cost effective ways of facilitating access to training and support must be found as a priority to ensure that staff have the competencies to identify and manage substance users effectively in acute mental health settings.

Originality/value

The findings reinforce previous studies highlighting the deficit in access to psychosocial interventions training for acute care staff.

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