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Article
Publication date: 23 September 2013

Karleen Gwinner and Louise Ward

This paper adds to growing research of psychiatric intensive care units (PICU) by recounting descriptions of psychiatric intensive care settings and discusses the…

Abstract

Purpose

This paper adds to growing research of psychiatric intensive care units (PICU) by recounting descriptions of psychiatric intensive care settings and discusses the perceptions held by nurses of the organisational interfaces, arrangements and provisions of care in these settings.

Design/methodology/approach

Data gathered from focus groups held with nurses from two PICUs was used to establish terminology, defining attributes, related concepts, antecedents, values, processes and concepts related to current practices. A literature search was conducted to permit a review of the conceptual arrangements and contemporary understanding of intensive care for people experiencing acute psychiatric illness based on the perspectives held by the nurses from the focus groups.

Findings

Dissonance between service needs and the needs and management of individual patients overshadow strategies to implement comprehensive recovery-oriented approaches. Three factors are reported in this paper that influence standards and procedural practice in PICU; organisational structures; physical structures; and subtype nomenclature.

Practical implications

Acute inpatient care is an important part of a comprehensive approach to mental health services. Commonly intensive acute care is delivered in specialised wards or units co-located with acute mental health inpatient units mostly known as PICU. Evidence of the most effective treatment and approaches in intensive care settings that support comprehensive recovery for improved outcomes is nascent.

Originality/value

Current descriptions from nurses substantiate wide variations in the provisions, design and classifications of psychiatric intensive care. Idiosyncratic and localised conceptions of psychiatric intensive care are not adequately entailing effective treatment and methods in support of recovery principles for improved and comprehensive outcomes. The authors suggest that more concrete descriptions, guidelines, training and policies for provision of intensive psychiatric health care encompassing the perspective of nursing professionals, would reinforce conceptual construction and thus optimum treatments within a comprehensive, recovery-oriented approach to mental health services.

Details

Mental Health Review Journal, vol. 18 no. 3
Type: Research Article
ISSN: 1361-9322

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Book part
Publication date: 12 June 2017

Jason Rodriquez

This article examines how a profit-centered restructuring of labor relations in an academic medical center undermined team-based care practices in its intensive care unit

Abstract

This article examines how a profit-centered restructuring of labor relations in an academic medical center undermined team-based care practices in its intensive care unit. The Institute of Medicine has promoted team-based care to improve patient outcomes, and the staff in the intensive care unit researched for this paper had established a set of practices they defined as teamwork. After hospital executives rolled out a public relations campaign to promote its culture of teamwork, they restructured its workforce to enhance numerical and functional flexibility in three key ways: implementing a “service line” managerial structure; cutting a range of staff positions while combining others; and doubling the capacity of its profitable and highly regarded intensive care unit. Hospital executives said the restructuring was necessitated by changes to payment models brought forth by the Affordable Care Act. Based on 300 hours of participant-observation and 35 interviews with hospital staff, findings show that the restructuring lowered staff resources and intensified work, which limited their ability to practice care they defined as teamwork and undermined the unit’s collective identity as a team. Findings also show how staff members used teamwork as a sensitizing concept to make sense of what they did at work. The meanings attached to teamwork were anchored to positions in the hospitals’ organizational hierarchy. This paper advances our understanding of he flexible work arrangements in the health care industry and their effects on workers.

Details

Emerging Conceptions of Work, Management and the Labor Market
Type: Book
ISBN: 978-1-78714-459-0

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Article
Publication date: 11 February 2019

Maria Andersson, Bodil Wilde-Larsson and Mona Persenius

The purpose of this paper is to describe and compare nurses’ and healthcare assistants’ oral care quality perceptions, including perceived reality (PR) and subjective…

Abstract

Purpose

The purpose of this paper is to describe and compare nurses’ and healthcare assistants’ oral care quality perceptions, including perceived reality (PR) and subjective importance (SI), to identify improvement areas in intensive care and short-term care, and to explore potential nursing satisfaction predictors regarding oral care.

Design/methodology/approach

Swedish staff, 154 within intensive care and 278 within short-term care responded to a modified quality of care from a patient perspective questionnaire. Descriptive and analytical statistics were used.

Findings

Staff scored oral care quality both high and low in relation to PR and SI. Improvement areas were identified, despite high satisfaction values regarding oral care. Setting, SI and PR explained 51.5 percent of the variance in staff satisfaction regarding oral care quality.

Practical implications

Quality improvements could guide oral care development.

Originality/value

This study describes oral care by comparing nurse perceptions of how important they perceive different oral care aspects and to what extent these oral care aspects are performed.

Details

International Journal of Health Care Quality Assurance, vol. 32 no. 1
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 27 November 2020

Nasr Al-Hinai and Ahm Shamsuzzoha

This study aims to develop a practical methodology to identify possible areas of improvements as well as exploring how to improve the health-care staff flow within a…

Abstract

Purpose

This study aims to develop a practical methodology to identify possible areas of improvements as well as exploring how to improve the health-care staff flow within a selected department in a hospital.

Design/methodology/approach

It focuses on showing how to properly study and analyze the health-care services and processes practiced at a selected department within a hospital. For this, several techniques like non-value-adding activities, time motion study, spaghetti diagram, layout analysis, etc. are used.

Findings

To test the proposed methodology, a neonatal intensive care unit (NICU) of a hospital in Oman was considered as a case study. The study revealed that this unit has several potential improvements capabilities. Further, this study also discussed possible areas of improvements of this case unit and suggested how such improvements can be implemented.

Originality/value

Several possible improvements are suggested and are discussed with the hospital authority, which can be clarified as the re-layout of the NICU rooms, reorganization of the store to improve the staff flow, increase the work efficiency, introduction of Help Us Support Healing policy, etc., which can enhance the entire operational system at the studied NICU.

Details

International Journal of Quality & Reliability Management, vol. 38 no. 6
Type: Research Article
ISSN: 0265-671X

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Article
Publication date: 23 March 2010

Mahi Al Tehewy, Mostafa El Houssinie, Nahla Abou El Ezz, Mohamed Abdelkhalik and Samia El Damaty

Intensive care unit performance evaluation is usually affected by variations in the severity of inpatients' health status. This paper aims, therefore, to standardize two…

Abstract

Purpose

Intensive care unit performance evaluation is usually affected by variations in the severity of inpatients' health status. This paper aims, therefore, to standardize two performance measures: intensive care unit survival and length of stay using the Acute Physiology and Chronic Health Evaluation II (APACHE II) severity of illness score.

Design/methodology/approach

A records study in three Ain Shams University Hospital intensive care units, from January 1‐December 31, 2003 was carried out to examine illness severity effect using APACHE II, length of stay and survival. Retrospective data were used to model length of stay in days and the survival using the APACHE II score as a predictor. This was followed by a prospective study to monitor the standardized measures in two intensive care units for one year.

Findings

APACHE II scores predicted length of stay of those who were discharged and control charts for severity‐adjusted length of stay were drawn up. The APACHE II score predicted survival for those with APACHE II score >16. The model is significant with a specificity of 89.9 percent while sensitivity was 25 percent. Control charts for severity‐adjusted mortality were drawn up to monitor mortality.

Research limitations/implications

Only 60 percent of the files examined in the retrospective part of the study had enough data to calculate APACHE II scores.

Practical implications

Standardized APACHE II severity of illness score can monitor intensive care unit length of stay and mortality.

Originality/value

The paper underlines the need to implement a standardized measurement system to evaluate intensive care patient outcomes.

Details

International Journal of Health Care Quality Assurance, vol. 23 no. 3
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 3 August 2011

Brigitte S. Cypress

This qualitative phenomenological study examined the experiences of patients, their family members, and the nurses in the intensive care unit during critical illness. Five…

Abstract

This qualitative phenomenological study examined the experiences of patients, their family members, and the nurses in the intensive care unit during critical illness. Five participants from each category participated in two interviews over a period of five months. Content analysis of the interview transcripts revealed five integrating common themes, each reflecting concepts from the Roy Adaptation Model (RAM). The ICU experience among all participants is interdependence. Adaptation in the ICU integrated family as a unit, physical care/comfort, physiological care and psychosocial support, resulting in transformation.

Details

Qualitative Research Journal, vol. 11 no. 2
Type: Research Article
ISSN: 1443-9883

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Article
Publication date: 19 June 2009

Patricia Khokher, Ivy Lynn Bourgeault and Ivan Sainsaulieu

This paper sets out to explore health professionals' views and experiences regarding the work culture that exists in their hospital units, and further how patients…

Abstract

Purpose

This paper sets out to explore health professionals' views and experiences regarding the work culture that exists in their hospital units, and further how patients influence these experiences.

Design/methodology/approach

The paper employs a qualitative approach involving individual interviews with 60 health professionals in Canada employed in what is conceptualised as “open” (emergency room and maternity care) and “closed” (intensive care, head and neck surgery) units.

Findings

The paper finds that the influence of the hospital unit outweighs the influence of professional boundaries but for some groups more than for others. Health professionals in more open units tend to be less satisfied with their work, have more difficult relations with patients, and experience tensions with co‐workers and management. Those in closed units tend to be more satisfied with their work, have relatively better relations with patients and co‐workers, and tend to have more cooperative relations with management. The different structural conditions of work in open and closed units are also clearly important.

Research limitations/implications

The sample for the study was self‐selected from one hospital, which may limit the generalisability of some of the findings.

Practical implications

The insights garnered from the study may help professionals and managers to develop unit‐specific policies to create a more positive workplace culture.

Originality/value

There is a growing body of research on professional culture and oganisational culture that often does not clearly delineate how the two exist concurrently. The paper explicitly investigates this issue by examining work culture across various health professional groups and also across hospital units, and further how patients figure in these experiences.

Details

Journal of Health Organization and Management, vol. 23 no. 3
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 23 March 2010

Seetharaman Hariharan and Prasanta Kumar Dey

The purpose of this paper is to develop a comprehensive framework for improving intensive care unit performance.

Abstract

Purpose

The purpose of this paper is to develop a comprehensive framework for improving intensive care unit performance.

Design/methodology/approach

The study introduces a quality management framework by combining cause and effect diagram and logical framework. An intensive care unit was identified for the study on the basis of its performance. The reasons for not achieving the desired performance were identified using a cause and effect diagram with the stakeholder involvement. A logical framework was developed using information from the cause and effect diagram and a detailed project plan was developed. The improvement projects were implemented and evaluated.

Findings

Stakeholders identified various intensive care unit issues. Managerial performance, organizational processes and insufficient staff were considered major issues. A logical framework was developed to plan an improvement project to resolve issues raised by clinicians and patients. Improved infrastructure, state‐of‐the‐art equipment, well maintained facilities, IT‐based communication, motivated doctors, nurses and support staff, improved patient care and improved drug availability were considered the main project outputs for improving performance. The proposed framework is currently being used as a continuous quality improvement tool, providing a planning, implementing, monitoring and evaluating framework for the quality improvement measures on a sustainable basis.

Practical implications

The combined cause and effect diagram and logical framework analysis is a novel and effective approach to improving intensive care performance. Similar approaches could be adopted in any intensive care unit.

Originality/value

The paper focuses on a uniform model that can be applied to most intensive care units.

Details

International Journal of Health Care Quality Assurance, vol. 23 no. 3
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 14 September 2012

Kalle Kraus

This paper aims to explore the effects of the increased influence of accounting on core values and practices within the services providing home care in Sweden – a public…

Abstract

Purpose

This paper aims to explore the effects of the increased influence of accounting on core values and practices within the services providing home care in Sweden – a public sector setting involving inter‐organisational cooperation.

Design/methodology/approach

Case study data were obtained primarily through semi‐structured interviews with managers and front‐line staff involved in home care.

Findings

When accountingisation is extended to include inter‐organisational cooperation, a form of heterogeneous accountingisation occurred in the home care services: an internal domain (with a low level of accountingisation) could be differentiated from an inter‐organisational domain (with a high level of accountingisation). When the accounting‐induced disturbances intensified, there was a redefinition of core values. In the internal domain, core values of pensioner‐oriented focus and flexibility during service delivery persisted. In contrast, in the inter‐organisational domain, core values had the legal boundaries of the organisation as their central foundation, standardisation was emphasised, and inter‐organisational work practices were defined as the other organisation's responsibility. The findings also extend the research on absorption groups by indicating the rise of a new type of absorption process. Absorption was not undertaken by a few individuals, specialist work groups or satellite organisations, as described in the literature; instead, all front‐line welfare professionals were involved in absorbing the accounting‐induced disturbances when performing their tasks.

Research limitations/implications

This case study research is context‐specific and the meaning and consequences of accountingisation may differ within the public sector because of the status and strength of professional groups concerned.

Originality/value

To date, research on accountingisation has primarily employed an intra‐organisational perspective. This paper analyses accountingisation in an inter‐organisational setting.

Details

Accounting, Auditing & Accountability Journal, vol. 25 no. 7
Type: Research Article
ISSN: 0951-3574

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Article
Publication date: 1 June 1997

Jaume Puig Junoy

Presents some examples of the implications derived from imposing the objective of maximizing social welfare, subject to limited resources, on ethical care patients…

Abstract

Presents some examples of the implications derived from imposing the objective of maximizing social welfare, subject to limited resources, on ethical care patients management in respect of quality performance of health services. Conventional knowledge of health economics points out that critically ill patients are responsible for increased use of technological resources and that they receive a high proportion of health care resources. Attempts to answer, from the point of view of microeconomics, the question: how do we measure comparative efficiency in the management of intensive care units? Analyses this question through data from an international empirical study using micro‐economic measures of productive efficiency in public services (data envelopment analysis). Results show a 28.8 per cent level of technical inefficiency processing data from 25 intensive care units in the USA.

Details

International Journal of Health Care Quality Assurance, vol. 10 no. 3
Type: Research Article
ISSN: 0952-6862

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