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Article
Publication date: 5 June 2017

Peter McGough, Susan Kline and Louise Simpson

As the US health system moves to value-based care and aligns payment with quality, the role of the primary care provider (PCP) is becoming ever more important. The purpose…

Abstract

Purpose

As the US health system moves to value-based care and aligns payment with quality, the role of the primary care provider (PCP) is becoming ever more important. The purpose of this paper is to outline a successful population health and care management strategy depending on accountable teams to standard workflow and agreed upon process and outcome measures in order to achieve the triple aim of improved health, patient experience, and value.

Design/methodology/approach

Two major areas of focus for primary care are ensuring that all patients receive appropriate evidence-based screening and prevention services and coordinating the care of patients with chronic conditions. The former initiative will promote the general health and well-being of patients, while the latter is a key strategy for achieving better outcomes and reducing costs for patients with chronic conditions.

Findings

To achieve these goals while managing a busy practice requires that the authors leverage the PCP by engaging clinical and non-clinical team members in the care of their patient population. It is essential that each team member’s role be clearly defined and ensures they are working at the top of their scope.

Originality/value

This initiative was successful because of the compelling objectives, the buy-in generated by using Lean methodology and engaging the team in the design process, use of multiple feedback mechanisms including stories, dashboards, and patient feedback, and the positive impact on providers, staff, and patients.

Details

International Journal of Health Governance, vol. 22 no. 2
Type: Research Article
ISSN: 2059-4631

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Book part
Publication date: 23 June 2020

Michelle Veyvoda, Thomas J. Van Cleave and Laurette Olson

This chapter draws from the authors’ experiences with service-learning pedagogy in allied health training programs, and illustrates ways in which community-engaged

Abstract

This chapter draws from the authors’ experiences with service-learning pedagogy in allied health training programs, and illustrates ways in which community-engaged teaching and learning can prepare students to become ethical healthcare practitioners. The authors infuse examples from their own courses throughout the chapter, mostly from the clinical fields of speech-language pathology, audiology, and occupational therapy. However, the chapter is applicable and generalizable to faculty from a wide scope of allied health training programs. The chapter introduces considerations for establishing campus–community partnerships in an ethical manner, as well as ways to foster student self-reflection and critical thinking through an ethical lens. Principles from the codes of ethics of various allied health professions are incorporated throughout the chapter along with examples of how each can be applied in community-based clinical experiences. Through a review of relevant literature, analysis of professional codes of ethics, case-based examples, and a step-by-step guide to course development, this chapter provides readers with a mechanism to ground their courses in professional ethics in a way that is relatable and relevant to students.

Details

Civil Society and Social Responsibility in Higher Education: International Perspectives on Curriculum and Teaching Development
Type: Book
ISBN: 978-1-83909-464-4

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Book part
Publication date: 4 January 2013

Tammy Ryan

Purpose – The chapter describes how teacher preparation programs can design effective off-campus clinical programs. Information provided is applicable to clinical

Abstract

Purpose – The chapter describes how teacher preparation programs can design effective off-campus clinical programs. Information provided is applicable to clinical practicums, capstone experiences, and to individual course assignments at the undergraduate and graduate levels.

Methodology/Approach – The author describes the foundational components involved in designing a high-quality off-campus clinical-based program. These components include selecting and building a partnership with an off-campus site, using forms, fees, space, and materials, engaging families, aligning assignments to course content, grading, supervision, and acquiring funding.

Practical implications – In addition to the foundational components involved in designing an effective off-campus clinic, the chapters describes a university-based model that uses two different off-campus clinical-based experiences that support community-based programs and local area schools.

Social implications – The chapter addresses the need for teacher preparation programs to build partnerships with off-campus community-based programs to better prepare teachers to meet the literacy demands of all students, particularly students living and learning in urban communities.

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Article
Publication date: 1 June 2005

Lesley K. Holdsworth, Valerie A. Blair and Jenny Miller

Physiotherapists throughout the UK have a professional obligation to keep up to date and practice effectively. The Scottish Physiotherapists Clinical Effectiveness Network…

Abstract

Purpose

Physiotherapists throughout the UK have a professional obligation to keep up to date and practice effectively. The Scottish Physiotherapists Clinical Effectiveness Network (SPCEN) was established in 1999 with the aim of providing a mechanism through which physiotherapists could share and learn from experiences, avoid duplication of effort and undertake proactive activities. The purpose of this paper is to report on the experience of the SPCEN and provide an evaluation of the impact the network has made on the clinical effectiveness activities of physiotherapists throughout Scotland.

Design/methodology/approach

A questionnaire survey was distributed to 2,118 physiotherapists across Scotland (response rate of 54.5 per cent). It aimed to determine the level of clinical effectiveness activity, the confidence of physiotherapists in engaging in these activities and the extent of involvement with clinical guideline implementation.

Findings

Results were analysed in two groups. Group 1 consisted of those that reported that they did participate in network activities (40 per cent n=330) and Group 2, those who did not (60 per cent n=686). Participants were significantly more engaged in undertaking a range of clinical effectiveness activities than non‐participants (p<0.0001), had greater confidence in their own ability to engage and were involved in the implementation of clinical guidelines to a greater extent (p<0.0001).

Practical implications

Establishing the SPCEN has resulted in more confident physiotherapists who are engaging in greater levels of clinical effectiveness activity throughout Scotland.

Originality/value

This paper provides the reader with an indication of the value networks can achieve.

Details

Clinical Governance: An International Journal, vol. 10 no. 2
Type: Research Article
ISSN: 1477-7274

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Article
Publication date: 20 February 2020

Susanna Doyle

A framework for “negotiating meaning” was applied to a healthcare service to achieve a collaboratively developed suicide prevention clinical pathway.

Abstract

Purpose

A framework for “negotiating meaning” was applied to a healthcare service to achieve a collaboratively developed suicide prevention clinical pathway.

Design/methodology/approach

The framework was originally developed during a previous study that drew on the theory of philosophical hermeneutics to enable a researcher to better understand the experience of older people. This approach was then applied to a healthcare setting and the development of a suicide prevention clinical pathway. Clinical front-line staff engaged effectively and meaningfully with each other, consumers, family members and management to develop a clinical guideline that reflected best practice and improved care provision. An additional outcome involved establishing a supportive culture in which the shared meanings underpinning the experience of working with people expressing suicidality were explored.

Findings

An evidence-based suicide prevention clinical pathway was developed collaboratively with clinicians taking the lead in the process, and leading to the agreement being reached on the final guideline and processes established. The negotiation process brought the perspectives of the different parties together enabling the sharing of underlying meaning inherent in the experience of losing a consumer tragically to suicide. A commitment to taking joint action to reduce the likelihood of further incidents occurring also grew from the shared understanding that developed.

Originality/value

This paper describes the approach that was applied to facilitate engagement processes between clinicians and service management that also challenged the power differentials that usually exist within healthcare and led to positive engagement that supported the safety and quality agenda.

Details

The Journal of Adult Protection, vol. 22 no. 2
Type: Research Article
ISSN: 1466-8203

Keywords

Content available
Article
Publication date: 23 April 2018

Lyn Kathryn Sonnenberg, Lesley Pritchard-Wiart and Jamiu Busari

The purpose of this study was to explore inter-professional clinicians’ perspectives on resident leadership in the context of inter-professional teams and to identify a…

Abstract

Purpose

The purpose of this study was to explore inter-professional clinicians’ perspectives on resident leadership in the context of inter-professional teams and to identify a definition for leadership in the clinical context. In 2015, CanMEDS changed the title of one of the core competencies from manager to leader. The shift in language was perceived by some as returning to traditional hierarchical and physician-dominant structures. The resulting uncertainty has resulted in a call to action to not only determine what physician leadership is but to also determine how to teach and assess it.

Design/methodology/approach

Focus groups and follow-up individual interviews were conducted with 23 inter-professional clinicians from three pediatric clinical service teams at a large, Canadian tertiary-level rehabilitation hospital. Qualitative thematic analysis was used to inductively analyze the data.

Findings

Data analysis resulted in one overarching theme: leadership is collaborative – and three related subthemes: leadership is shared; leadership is summative; and conceptualizations of leadership are shifting.

Research limitations/implications

Not all members of the three inter-professional teams were able to attend the focus group sessions because of scheduling conflicts. Participation of additional clinicians could have, therefore, affected the results of this study. The study was conducted locally at a single rehabilitation hospital, among Canadian pediatric clinicians, which highlights the need to explore conceptualization of leadership across different contexts.

Practical implications

There is an evident need to prepare physicians to be leaders in both their daily clinical and academic practices. Therefore, more concerted efforts are required to develop leadership skills among residents. The authors postulate that continued integration of various inter-professional disciplines during the early phases of training is essential to foster collaborative leadership and trust.

Originality/value

The results of this study suggest that inter-professional clinicians view clinical leadership as collaborative and fluid and determined by the fit between tasks and team member expertise. Mentorship is important for increasing the ability of resident physicians to develop collaborative leadership roles within teams. The authors propose a collaborative definition of clinical leadership based on the results of this study: a shared responsibility that involves facilitation of dialog; the integration of perspectives and expertise; and collaborative planning for the purpose of exceptional patient care.

Details

Leadership in Health Services, vol. 31 no. 2
Type: Research Article
ISSN: 1751-1879

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Book part
Publication date: 25 July 2012

Svante Lifvergren, Ulla Andin, Tony Huzzard and Andreas Hellström

Purpose – This chapter examines the developmental journey toward a sustainable health care system in the West of Skaraborg County in Sweden from 2008 to the present by…

Abstract

Purpose – This chapter examines the developmental journey toward a sustainable health care system in the West of Skaraborg County in Sweden from 2008 to the present by proposing and illustrating the concept of a clinical microsystem to capture the work of a mobile team to care for elderly people with multiple diseases in its embedded context.

Design – An action research approach was adopted that entailed four researchers, one of whom was also a health care practitioner, engaging in iterative dialogues with the mobile team. This aimed at catalyzing joint learning in repeated action-reflection cycles at least three times a year over a period of 3 years. Data from patient databases were also drawn upon as additional resources for reflection.

Findings – The outcome of the initial periods of the team's work in the microsystem dramatically improved the care of these patients, significantly increasing quality of life and stabilizing their medical situation. It has also led to decreased resource utilization, not just by the team, but elsewhere in the wider health system.

Originality/value – We draw on and develop the concept of clinical microsystems to argue that such systems have a team at their core, but their work practices and patient outcomes require us to look beyond the team itself and take into account its interactions with patients and actors in the wider health care system. We also draw on the framework of Christensen, Grossman, and Hwang (2009) to propose that each microsystem has three distinct value configurations, namely shops, a chain, and a network. In terms of design, we suggest that the clinical microsystem can be seen as a parallel learning structure to that of the established health care bureaucracy.

Details

Organizing for Sustainable Health Care
Type: Book
ISBN: 978-1-78190-033-8

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Article
Publication date: 1 June 1997

Dave Buchanan, Simone Jordan, Diane Preston and Alison Smith

Aims to examine medical involvement in hospital management processes, and to consider the implications of current experience for the next generation of clinical directors…

Abstract

Aims to examine medical involvement in hospital management processes, and to consider the implications of current experience for the next generation of clinical directors. Doctors who move into a formal management role often find themselves unprepared for their new responsibilities. Research has thus concentrated on identifying the management competences which doctors lack, and with designing ways to remedy the deficit. Seeks to move beyond this deficit model by adopting a perspective which focuses on the engagement of doctors in the management process. Draws data from in‐depth interviews with six clinical directors and 19 other members of the hospital management team at Leicester General Hospital NHS Trust (LGH). Content analysis of interviews suggests that the engagement of clinical directors in the hospital management process at this site can be described as reluctant, transient, service‐driven, power‐pulled and pressured. This negative portrayal of the role, however, must be set in the context of the “management expectation” held of clinical directors by other hospital managers and staff ‐ an expectation that is not currently fulfilled.

Details

Journal of Management in Medicine, vol. 11 no. 3
Type: Research Article
ISSN: 0268-9235

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Article
Publication date: 16 May 2016

Allan Best, Alex Berland, Carol Herbert, Jennifer Bitz, Marlies W van Dijk, Christina Krause, Douglas Cochrane, Kevin Noel, Julian Marsden, Shari McKeown and John Millar

The British Columbia Ministry of Health’s Clinical Care Management initiative was used as a case study to better understand large-scale change (LSC) within BC’s health…

Abstract

Purpose

The British Columbia Ministry of Health’s Clinical Care Management initiative was used as a case study to better understand large-scale change (LSC) within BC’s health system. Using a complex system framework, the purpose of this paper is to examine mechanisms that enable and constrain the implementation of clinical guidelines across various clinical settings.

Design/methodology/approach

Researchers applied a general model of complex adaptive systems plus two specific conceptual frameworks (realist evaluation and system dynamics mapping) to define and study enablers and constraints. Focus group sessions and interviews with clinicians, executives, managers and board members were validated through an online survey.

Findings

The functional themes for managing large-scale clinical change included: creating a context to prepare clinicians for health system transformation initiatives; promoting shared clinical leadership; strengthening knowledge management, strategic communications and opportunities for networking; and clearing pathways through the complexity of a multilevel, dynamic system.

Research limitations/implications

The action research methodology was designed to guide continuing improvement of implementation. A sample of initiatives was selected; it was not intended to compare and contrast facilitators and barriers across all initiatives and regions. Similarly, evaluating the results or process of guideline implementation was outside the scope; the methods were designed to enable conversations at multiple levels – policy, management and practice – about how to improve implementation. The study is best seen as a case study of LSC, offering a possible model for replication by others and a tool to shape further dialogue.

Practical implications

Recommended action-oriented strategies included engaging local champions; supporting local adaptation for implementation of clinical guidelines; strengthening local teams to guide implementation; reducing change fatigue; ensuring adequate resources; providing consistent communication especially for front-line care providers; and supporting local teams to demonstrate the clinical value of the guidelines to their colleagues.

Originality/value

Bringing a complex systems perspective to clinical guideline implementation resulted in a clear understanding of the challenges involved in LSC.

Details

Journal of Health Organization and Management, vol. 30 no. 3
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 1 April 2014

Luu Trong Tuan and Luu Thi Bich Ngoc

Clinical governance effectiveness is built on the responsibility of clinical members towards other stakeholders inside and outside the hospital. Through the testing of the…

Abstract

Purpose

Clinical governance effectiveness is built on the responsibility of clinical members towards other stakeholders inside and outside the hospital. Through the testing of the hypotheses on the relationships between clinical governance and its antecedents, this paper aims to corroborate that emotional intelligence is the first layer of bricks, ethics and trust the second layer, and corporate social responsibility (CSR) the third layer of the entire architecture of clinical governance.

Design/methodology/approach

A total of 409 responses in completed form returned from self-administered structured questionnaires dispatched to 705 clinical staff members underwent the structural equation modeling (SEM)-based analysis.

Findings

Emotional intelligence among clinicians, as the data reveals, is the lever for ethics of care and knowledge-based or identity-based trust to thrive in hospitals, which in turn activate ethical CSR in clinical activities. Ethical CSR in clinical deeds will heighten clinical governance effectiveness in hospitals.

Originality/value

The journey to test research hypotheses has built layer-by-layer of CSR-based model of clinical governance in which high concentration of emotional intelligence among clinical members in the hospital catalyzes ethics of care and knowledge-based or identity-based trust, without which, CSR initiatives to cultivate ethical values cannot be successfully implemented to optimize clinical governance effectiveness in Vietnam-based hospitals.

Details

International Journal of Pharmaceutical and Healthcare Marketing, vol. 8 no. 1
Type: Research Article
ISSN: 1750-6123

Keywords

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