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This paper aims to report on research undertaken in an National Health Service (NHS) emergency department in the north of England, UK, to identify which patients, with which clinical conditions are returning to the emergency department with an unscheduled return visit (URV) within seven days. This paper analyses the data in relation to the newly introduced Integrated Care Boards (ICBs). The continued upward increase in demand for emergency care services requires a new type of “upstreamist”, health system leader from the emergency department, who can report on URV data to influence the development of integrated care services to reduce further demand on the emergency department.

Patients were identified through the emergency department symphony data base and included patients with at least one return visit to emergency department (ED) within seven days. A sample of 1,000 index visits between 1 January 2019–31 October 2019 was chosen by simple random sampling technique through Excel. Out of 1,000, only 761 entries had complete data in all variables. A statistical analysis was undertaken using Poisson regression using NCSS statistical software. A review of the literature on integrated health care and its relationship with health systems leadership was undertaken to conceptualise a new type of “upstreamist” system leadership to advance the integration of health care.

Out of all 83 variables regressed with statistical analysis, only 12 variables were statistically significant on multi-variable regression. The most statistically important factor were patients presenting with gynaecological disorders, whose relative rate ratio (RR) for early-URV was 43% holding the other variables constant. Eye problems were also statistically highly significant (RR = 41%) however, clinically both accounted for just 1% and 2% of the URV, respectively. The URV data combined with “upstreamist” system leadership from the ED is required as a critical mechanism to identify gaps and inform a rationale for integrated care models to lessen further demand on emergency services in the ED.

At a time of significant pressure for emergency departments, there needs to be a move towards more collaborative health system leadership with support from statistical analyses of the URV rate, which will continue to provide critical information to influence the development of integrated health and care services. This study identifies areas for further research, particularly for mixed methods studies to ascertain why patients with specific complaints return to the emergency department and if alternative pathways could be developed. The success of the Esther model in Sweden gives hope that patient-centred service development could create meaningful integrated health and care services.

This research was a large-scale quantitative study drawing upon data from one hospital in the UK to identify risk factors for URV. This quality metric can generate important data to inform the development of integrated health and care services. Further research is required to review URV data for the whole of the NHS and with the new Integrated Health and Care Boards, there is a new impetus to push for this metric to provide robust data to prioritise the need to develop integrated services where there are gaps.

To the best of the authors’ knowledge, this is the first large-scale study of its kind to generate whole hospital data on risk factors for URVs to the emergency department. The URV is an important global quality metric and will continue to generate important data on those patients with specific complaints who return back to the emergency department. This is a critical time for the NHS and at the same time an important opportunity to develop “Esther” patient-centred approaches in the design of integrated health and care services.

The purpose of this study was to determine the relationship between the leadership orientations of nurses and their clinical decision-making skills.

This descriptive study was conducted between June and December 2018 on nurses working at three hospitals in Turkey. This study was completed with 1,100 nurses. The Personal Information Form, Leadership Orientation Scale and Clinical Decision-Making Scale in Nursing were used for data collection.

A significant correlation was found between the leadership orientations of nurses and age, sex, institution where they were employed, time spent in the profession, being in a management position and satisfaction with the current unit of employment (p < 0.05), and a significant correlation was found between clinical decision-making skills of nurses and age, sex and occupational status (p < 0.05). Furthermore, a significant correlation was found between the mean scores of the Leadership Orientation Scale and Clinical Decision-Making in Nursing Scale (p < 0.05).

The development of leadership orientations of nurses positively affects their clinical decision-making skills. In this respect, it is important to instill effective leadership orientations in nurses and to incorporate novel training methods in nursing education to develop accurate and timely clinical decision-making skills.

The Covid-19 pandemic generated significant changes in the operating methods of hospital logistics departments. The objective of this research is to understand how these changes took place, what collaboration mechanisms were developed with clinical authorities and, to what extent, logistics and clinical care activities should be decoupled to maximize each area's contribution?

The case study is selected to investigate practices implemented during the COVID-19 pandemic in hospitals in Canada. The pandemic presented an opportunity to contrast practices implemented in response to this crisis with those historically used in this environment.

The strategy of decoupling logistical tasks of an operational nature from clinical activities is well-founded and helps free clinical staff from tasks for which they are not trained. However, the decoupling of operational tasks should be combined with an integration of the clinical information flow to the logistics hub players. With this clinical information, the logistics hub can generate its full potential enabling better inventory management decisions to be made.

The concept of decoupling is studied to identify configurations that offer the best benefits for clinical staff.

As part of a national plan to govern professional and organizational development in Norwegian specialist healthcare, the country’s hospital clinics are tasked with constructing development plans. Using the development plan as a case, the paper analyzes how managers navigate and legitimize the planning process among central actors and deals with the contingency of decisions in such strategy work.

This study applies a qualitative research design using a case study method. The material consists of public documents, observations and single interviews, covering the process of constructing a development plan at the clinical level.

The findings suggest that the development plan was shaped through a multilevel translation process consisting of different contending rationalities. At the clinical level, the management had difficulties in legitimizing the process. The underlying tension between top-down and bottom-up steering challenged involvement and made it difficult to manage the contingency of decisions.

The findings are relevant to public sector managers working on strategy documents and policymakers identifying challenges that might hinder the fulfillment of political intentions.

This paper draws on a case from Norway; however, the findings are of general interest. The study contributes to the academic discussion on how to consider both the health authorities’ perspective and the organizational perspective to understand the manager’s role in handling the contingency of decisions and managing paradoxes in the decision-making process.

Healthcare tribalism refers to the phenomenon through which different groups in a healthcare setting strictly adhere to their profession-based silo, within which they exhibit stereotypical behaviours. In turn, this can lead to deleterious downstream effects upon productivity and care delivered to patients. This study highlights a clinician-led governance model, implemented at a National Health Service (NHS) trust, to investigate whether it successfully overcame tribalism and helped drive innovation.

This was a convergent mixed-methods study including qualitative and quantitative data collected in parallel. Qualitative data included 27 semi-structured interviews with representatives from four professional groups. Quantitative data were collected through a verbally administered survey and scored on a 10-point scale.

The trust arranged its services under five autonomous business units, with a clinician and a manager sharing the leadership role at each unit. According to interviewees replies, this equivalent authority was cascaded down and enabled breaking down professional siloes, which in turn aided in the adoption of an innovative clinical model restructure.

This study contributes to the literature by characterizing a real-world example in which healthcare tribalism was mitigated while reflecting on the advantages yielded as a result.

Previous studies from all over the world identified major differences in the perspectives of different healthcare professional groups. In the United Kingdom, clinicians largely felt cut off from decision-making and dissatisfied with their managerial role. The study findings explain a governance model that allowed harmony and inclusion of different professions. Given the long-standing strains on healthcare systems worldwide, stakeholders can leverage the study findings for guidance in developing and implementing innovative managerial approaches.

This study aims to analyze a conspicuous corpus of literature related to the field of technology-based intensive care research and to develop an architecture model of the future smart intensive care unit (ICU).

Papers related to the topics of electronic health record (EHR), big data, data flow and clinical decision support in ICUs were investigated. These concepts have been analyzed in combination with secondary use of data, prediction models, data standardization and interoperability challenges. Based on the findings, an architecture model evaluated using MIMIC III is proposed.

Research identified issues regarding implementation of systems, data sources, interoperability, management of big data and free text produced in ICUs and lack of accuracy of prediction models. ICU should be treated as part of a greater system, able to intercommunicate with other entities.

The research examines the current needs of ICUs in interoperability and data management. As environment changes dynamically, continuous assessment and evaluation of the model with other ICU databases is required.

The proposed model improves ICUs interoperability in national health system, ICU staff intercommunication, remote access and decision support. Its modular approach ensures that ICUs can have their own particularities and specialisms while ICU functions provide ongoing expertise and training to upgrade its staff.

There are no existing tools to capture resources needed to support people with intellectual disability in an inpatient setting on an individual patient basis. The purpose of this paper is to describe the development of a new tool called Universal Needs Based Resource Assessment (UNBRA).

Using the Delphi method, focus groups were used to generate factors determining resource use. From these, themes were identified, a scoring system was created and the UNBRA tool was developed. This was piloted in two NHS inpatient units and modified following feedback.

The UNBRA tool holistically assesses resource requirements of an individual with intellectual disability supported in an inpatient setting. It considers ten factors grouped into the six themes of staffing, indirect work, clinical/ multi-disciplinary work, incidents, carer link activity and discharge process. UNBRA scores allow intra- and interpersonal comparison as well as comparison between units and can support resource allocation and operational decision-making.

To the best of the authors’ knowledge, there is no suitable existing tool to capture individual resource requirements of patients in intellectual inpatient settings. The development of the UNBRA tool fills this gap.

Diffusion of innovations, defined as the adoption and implementation of new ideas, processes, products, or services in health care, is both particularly important and especially challenging. One known problem with adoption and implementation of new technologies is that, while organizations often make innovations immediately available, organizational actors are more wary about adopting new technologies because these may impact not only patients and practices but also reimbursement. As a result, innovations may remain underutilized, and organizations may miss opportunities to improve and advance. As innovation adoption is vital to achieving success and remaining competitive, it is important to measure and understand factors that impact innovation diffusion. Building on a survey of a national sample of 654 clinicians, our study measures the extent of diffusion of value-enhancing care delivery innovations (i.e., technologies that not only improve quality of care but has potential to reduce care cost by diminishing waste, Faems et al., 2010) for 13 clinical specialties and identifies healthcare-specific individual characteristics such as: professional purview, supervisory responsibility, financial incentive, and clinical tenure associated with innovation diffusion. We also examine the association of innovation diffusion with perceived value of one type of care delivery innovation – artificial intelligence (AI) – for assisting clinicians in their clinical work. Responses indicate that less than two-thirds of clinicians were knowledgeable about and aware of relevant value-enhancing care delivery innovations. Clinicians with broader professional purview, more supervisory responsibility, and stronger financial incentives had higher innovation diffusion scores, indicating greater knowledge and awareness of value-enhancing, care delivery innovations. Higher levels of knowledge of the innovations and awareness of their implementation were associated with higher perceptions of the value of AI-based technology. Our study contributes to our knowledge of diffusion of innovation in healthcare delivery and highlights potential mechanisms for speeding innovation diffusion.

The primary objective of this paper is to show a systematic and methodological approach for the digitalization of critical clinical pathways (CPs) within the healthcare domain.

The methodology entails the integration of service design (SD) and action research (AR) methodologies, characterized by iterative phases that systematically alternate between action and reflective processes, fostering cycles of change and learning. Within this framework, stakeholders are engaged through semi-structured interviews, while the existing and envisioned processes are delineated and represented using BPMN 2.0. These methodological steps emphasize the development of an autonomous, patient-centric web application alongside the implementation of an adaptable and patient-oriented scheduling system. Also, business processes simulation is employed to measure key performance indicators of processes and test for potential improvements. This method is implemented in the context of the CP addressing transient loss of consciousness (TLOC), within a publicly funded hospital setting.

The methodology integrating SD and AR enables the detection of pivotal bottlenecks within diagnostic CPs and proposes optimal corrective measures to ensure uninterrupted patient care, all the while advancing the digitalization of diagnostic CP management. This study contributes to theoretical discussions by emphasizing the criticality of process optimization, the transformative potential of digitalization in healthcare and the paramount importance of user-centric design principles, and offers valuable insights into healthcare management implications.

The study’s relevance lies in its ability to enhance healthcare practices without necessitating disruptive and resource-intensive process overhauls. This pragmatic approach aligns with the imperative for healthcare organizations to improve their operations efficiently and cost-effectively, making the study’s findings relevant.

The purpose of this study is to describe participation in decision-making among service users with severe mental illness.

Service users want to participate in decision-making and in the planning of their care. There are widely known methods, such as shared decision-making, that could be used to facilitate service user participation. Three focus group interviews were conducted with the participation of 14 persons with mental illness and/or substance abuse who were service users at two Swedish Homes for Care and Residence (HVB). Data were analyzed by qualitative content analysis.

Two themes emerged: service users’ involvement in decisions is hampered by the professionals’ approach and adequate information and experience of participation means greater empowerment.

Although it is known that service users would like to have more influence, and that methods like shared decision-making are recommended to empower service users and improve the decision process, research on these matters is limited.

This study reveals that there is a need of more systematic decisional support, such as shared decision-making, so that service users can be seen as important persons not only in guidelines and policy documents but also in clinical practice.

The findings indicate that service users do not participate in decisions systematically, although policies, guidelines and laws providing that service users should be offered an active part in decision-making with regard to their care and treatment.

Although it is known that service users would like to have more influence, and that methods like shared decision-making are recommended to empower service users and improve their decision process, research on these matters is limited. The findings indicate that service users do not participate in decisions systematically, even though policies, guidelines and laws are in place stipulating that service users should be offered an active part in decision-making with regard to their own care and treatment. The results of this project bring improvement opportunities to light.