Search results

This study intends to improve the quality of venous thromboembolism (VTE) prophylaxis practices including proper VTE risk assessment and the appropriate prophylaxis measures for surgical urology patients.

The authors applied the Six-Sigma define, measure, analyze, improve and control (DMAIC) improvement methodology in a pre–post interventional study that involved all adult patients above 18 years old indicated and scheduled for urology surgical interventions including endoscopic urological surgeries in a urology specialized 60-bed hospital. The pre-intervention sample included all patients meeting the inclusion criteria over a period of six months. Post-intervention sample included all patients meeting the inclusion criteria over a period of six months. The improvement areas included both the VTE risk assessment as well as the VTE prophylaxis prescription.

DMAIC methodology has achieved a substantial sustained improvement in surgical urology VTE prophylaxis practices with an average of 70% on both levels; VTE risk assessment practices and VTE prophylaxis prescribing practices were statistically significant. The post-intervention results also showed a statistically controlled process with no special cause variations. Based on the study results, the Six-Sigma DMAIC methodology can be considered of high value when applied in healthcare clinical practice improvement projects.

The project study includes some pitfalls that can be addressed as follows: 1. The lack of VTE rate incidence tracking. This limitation can be partly refuted when the authors conduct a literature review and explore that the VTE prophylaxis effectiveness had been proven with sufficient evidence to an extent that pushed several scientific societies to develop their own guidelines to support VTE prophylaxis. (Algattas et al., 2018). 2. Another limitation of this study can be that it handled only surgical patients and more specifically surgical urology patients. Of course, VTE prophylaxis is a crucial life-threatening problem not only for the surgical admitted patients but also for all the medical admitted patients either in hospital wards or ICUs. However, the prediction that surgical patients especially surgical urology patients are more prone to VTE development risk as they have -in several cases-two or three main additive risk factors which are age, procedure duration and malignancy in elderly men. (Tikkinen et al., 2014). So, the authors consider the study project to be a prototype that hopefully can be utilized for future study projects that will manage both other surgical specialty patients and medical patients on the national level and can track accurately and effectively report the VTE incidence rates.

Several recommendations can be extracted from the research project that is summarized in the following points: Paying focused attention to continuous healthcare quality improvement initiatives and projects as a main approach for healthcare improvement especially for the public health-related problems. This might be achieved through periodic region-specific or specialty-specific focus groups from which public health problems could be addressed and prioritized to be considered as a part of country healthcare campaigns regarding cost-utility and feasibility studies. The adoption of a system thinking approach in dealing with the improvement strategies; all efforts and resources are to be employed to achieve a common objective. This includes the generation of a national-wide electronic health information system that can aid in healthcare resource allocation and direct the healthcare efforts towards the most important, high-priority public health problems. Electronic national-wide health record is really an effort, and resources consuming activity, but actually, it's worth exerting efforts, and its valuable outcomes may be seen several years later. 3. Development of unified national specialized VTE prophylaxis pathways to standardize the patient-specific VTE prophylaxis plans. Standardization of healthcare pathways enables healthcare professionals to follow an evidence-based practice which will be reflected on the improvement of healthcare quality level, cost-effectiveness enhancement, and timely patient care on all levels especially in high critical areas like ER and ICU. 4. Incorporation of VTE prophylaxis costs in the universal health insurance diagnosis-related group (DRG) insurance packages and service pricing. Universal health insurance is a nationwide strategy that is aiming to cover all Egypt residents by the year 2030. Universal health insurance is being following the DRG reimbursement policy that is thought to control all the healthcare-associated costs so, the VTE prophylaxis costs shall be added as the main cost item to encourage all healthcare facilities to follow an evidence-based VTE prophylaxis pathway taking into consideration the high-risk patient categories who will definitely represent a high-cost burden on the long run if they suffer a VTE event.

DMAIC improvement methodology applications in healthcare are still relatively limited, especially on the clinical level. The study can be considered one of a kind in Egypt dealing with a comprehensive DMAIC methodology application on the clinical level.

The purpose of this paper is to discuss the construction of the theoretic model of systematic knowledge creation in the healthcare process according to professionals' collaboration using clinical‐pathways.

Healthcare is a knowledge‐intensive service conducted by professionals. A clinical‐pathway is an effective tool in the knowledge management aspect of this service. The theoretic model of the medical knowledge management which used the clinical‐pathway from case studies in two hospitals is constructed.

The theoretical model shows the interaction between explicit knowledge and tacit knowledge in the healthcare process using clinical‐pathways. This theoretical model is a knowledge creation model which creates new knowledge continuously. Therefore, the clinical‐pathways are suggested as an effective tool for knowledge management in healthcare.

Promotion of knowledge communication between healthcare professionals by clinical‐pathways activities is important for excellent healthcare management.

This paper will be valuable for sustained improvement of healthcare quality by knowledge management with clinical‐pathways. In this paper, the detailed theoretic model which explains medical knowledge management with clinical‐pathways has been constructed.

Care pathways are becoming increasingly popular within UK healthcare organisations yet very little is known about the tool. Using the results from a survey of healthcare organisations, which are members of the National Pathways Association (NPA), the author suggests that different models of care pathways are being implemented. Four models or different types of care pathways are identified, with different features in each model. The models can be used prospectively by organisations to decide which particular features they may want to include. Alternatively, the models can be used as an assessment tool to identify the type of pathway being developed. This assessment can form the basis for any future evaluations of the effectiveness of the pathways which are developed.

Current performance measurement systems (PMSs) are mainly designed to measure performance at the organizational level. They tend not to assess the value created by the collaboration of multiple organizations and by the involvement of users in the value creation process, such as in healthcare. The purpose of this paper is to investigate the development of PMSs that can assess the population-based value creation process across multiple healthcare organizations while adopting a patient-based perspective.

The paper analyzes the development of a new healthcare PMS according to a constructive approach through the development of a longitudinal case study. The focus is on the re-framing process of the PMS put in place by a large group of Italian regional health systems that have adopted a collaborative assessment framework.

Framing information according to the population served and the patients’ perspective supports PMSs in assessing the value creation process by evaluating the contribution given by the multiple organizations involved. Therefore, it helps prevent each service provider from working in isolation, and avoids dysfunctional behaviors. Re-framing PMSs contributes to re-focusing stakeholders’ perspective toward value creation; legitimizes organizational units specifically aimed at managing transversal communication, cooperation and coordination; supports the alignment of professionals’ and organizations’ goals and behaviors; and fosters shared accountability among providers.

The paper contributes to the scientific debate on PMSs by investigating a case that focuses on value creation by adopting a patient-centered perspective. Although this case comes from the healthcare sector, the underlying user-centered approach may be generalized to assess other environments, processes, or contexts in which value creation stems from the collaboration of multiple providers (integrated co-production).

This article reports an important multi‐centre practice‐based review that identifies good practice and an ideal pathway for the healthcare of frail older people, which, if replicated nationally, could result in improved quality of care and better value for money for the NHS. Data on healthcare resource groups (HRGs) in England were examined as a marker for the management of elderly people through the healthcare system. Care pathways in several different NHS trusts were explored via staff interviews. A high variation in treatment outcomes across centres was found. Principles of best practice were identified and include: comprehensive geriatric assessment; the availability of specialist geriatric teams and wards; and shared assessment and co‐ordination between care agencies.

The article discusses how care programmes and integrated care pathways can be linked, finding ways to improve healthcare process professional and logistical quality from a supply chain and a network point‐of‐view.

The authors argue that owing to cost containment goals and increasing healthcare demand, healthcare services systems are challenged to improve service quality, whilst at the same time finding ways to improve delivery processes. It explores if the combination of two instruments, care programmes and integrated care pathways, can meet both goals. This combination is illustrated by an example from the Institute of Mental Health Care Eindhoven en de Kempen.

Analysis suggests that care programmes can be combined with integrated care pathways, leading to a situation where both quality and process improvement can be reached. These instruments are complementary.

The article is largely conceptual; ideas are presented to stimulate thinking rather than to prove an argument.

Combining care programmes and integrated care pathways has implications for the way we think about and organise healthcare processes.

There have been few publications on instruments combining both a network and a supply chain approach to describe and understand healthcare processes.

The purpose of this paper is to provide wider research evidence for the use of the Short Dynamic Risk Scale (SDRS) in risk management with individuals who have an Intellectual Disability (ID) and reside in a secure psychiatric inpatient setting. The outcomes are supportive of previous research, showing that outcomes on the SDRS are related to maladaptive behaviours recorded for individual with ID.

All participant data taken from the hospital healthcare reporting system were entered into a PASW database. The ratings for each of the SDRS and Short-Term Assessment of Risk and Treatability (START) items were entered and totalled, with a separate total score for the SDRS with the additional three items. In order to capture the behavioural monitoring data, average severities weightings of each of the Overt Aggression Scale-modified for neuro-rehabilitation (OAS-MNR) categories for the three weeks following completion of the individual’s SDRS were calculated and recorded. In addition, average severity weightings reflecting the presence of sexualised behaviour (St Andrew’s Sexual Behaviour Assessment (SASBA) in the subsequent three weeks following SDRS completion was included. Using the most recent START assessment completed allowed for analysis of the predictive ability of the START of the same behavioural data.

A series of Spearman’s correlations were run to determine the relationship between outcomes on the SDRS and engagement in risk behaviours as rated by the OAS-MNR scales. There was a moderate positive correlation between all 11-items of the SDRS and OAS-MNR recordings. A series of Spearman’s correlations were conducted to determine the relationship between outcomes on the START Vulnerability items and engagement in risk behaviours as rated by the OAS-MNR scales. There was a weak negative correlation between all individual START vulnerability item ratings and OAS-MNR recordings.

The current pilot study provides wider research evidence for the use of the SDRS in risk management with individuals who have an ID and reside in a secure psychiatric inpatient setting.

This paper compares outcomes on the START and SDRS in relation to an individual’s risk recordings to support identification of whether either have practical and clinical utility. To the authors’ knowledge, this has not been completed before.

The purpose of this paper is to review the history and current state of provision of homeless medical respite services in the UK, drawing first on the international context. The paper then articulates the need for medical respite services in the UK, and profiles some success stories. The paper then outlines the considerable challenges that currently exist in the UK, considers why some other services have failed and proffers some solutions.

The paper is primarily a literature review, but also offers original analysis of data and interviews, and presents new ideas from the authors. All authors have considerable experience of assessing the need for and delivering homeless medical respite services.

The paper builds on previous published information regarding need, and articulates the human rights argument for commissioning care. The paper also discusses the current complex commissioning arena, and suggests solutions.

The literature review was not a systematic review, but was conducted by authors with considerable experience in the field. Patient data quoted are on two limited cohorts of patients, but broadly relevant. Interviews with stakeholders regarding medical respite challenges have been fairly extensive, but may not be comprehensive.

This paper will support those who are thinking of undertaking a needs assessment for medical respite, or commissioning a new medical respite service, to understand the key issues involved.

This paper challenges the existing status quo regarding the need for a “cost-saving” rationale to set up these services.

This paper aims to be the definitive paper for anyone wishing to get an overview of this topic.

The purpose of this paper is to describe current care pathways for children with autism including enablers and barriers, as experienced by health professionals, education professionals and families in South Wales, UK.

This study is based on a mixed-methods approach using focus group discussions, creative writing workshops and visualisation using rich pictures.

The experiences of the care pathways differed significantly across the three groups. Health professionals described the most rigidly structured pathways, with clear entry points and outcomes. Education professionals and parents described more complex and confusing pathways, with parents assuming the responsibility of coordinating the health and education activity in a bid to link the two independent pathways. All three groups identified enablers, although these differed across the groups. The barriers were more consistent across the groups (e.g. poor communication, missing information, lack of transparency, limited post-diagnosis services and access to services based on diagnosis rather than need).

This research could inform the design of new services which are premised on multi-agency and multi-disciplinary working to ensure children with Autism spectrum disorders (ASD) receive joined up services and support.

Although this study did not represent all professional groups or all experiences of autism, the authors examined three different perspectives of the ASD pathway. In addition, the authors triangulated high-level process maps with rich pictures and creative writing exercises, which allowed the authors to identify specific recommendations to improve integration and reduce duplication and gaps in provision.