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1 – 10 of 445Marthe E. Ribbink, Catharina C. Roozendaal, Janet L. MacNeil-Vroomen, Remco Franssen and Bianca M. Buurman
The acute geriatric community hospital (AGCH) in an intermediate care facility is an alternative to conventional hospitalization. A comprehensive geriatric assessment and…
Abstract
Purpose
The acute geriatric community hospital (AGCH) in an intermediate care facility is an alternative to conventional hospitalization. A comprehensive geriatric assessment and rehabilitation are integrated into acute medical care for older patients. This study aims to evaluate patient experience and satisfaction with the AGCH.
Design/methodology/approach
This is a mixed method observational study including a satisfaction questionnaire and qualitative interviews with AGCH patients or informal caregivers.
Findings
A total of 152 participants filled in the questionnaire, and thirteen semi-structured interviews were conducted. Twelve categories and four overarching themes emerged in the analysis. In general, study participants experience the admission to the AGCH as positive and are satisfied with the care they received; there were also suggestions for improvement.
Research limitations/implications
Limitations of this study include possible participation bias. The results show that patients value this type of care indicating that it should be implemented elsewhere. Further research will focus on health outcomes, readmission rates and cost effectiveness of the AGCH.
Originality/value
This is the first study to evaluate care satisfaction with the AGCH. It shows that hospitalized older adults positively value the AGCH as an alternative to hospitalization.
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Tony Smith, Sally Fowler-Davis, Susan Nancarrow, Steven Mark Brian Ariss and Pam Enderby
The purpose of this study is to review evidence on the nature of effective leadership in interprofessional health and social care teams.
Abstract
Purpose
The purpose of this study is to review evidence on the nature of effective leadership in interprofessional health and social care teams.
Design/methodology/approach
A critical review and thematic synthesis of research literature conducted using systematic methods to identify and construct a framework to explain the available evidence about leadership in interprofessional health and social care teams.
Findings
Twenty-eight papers were reviewed and contributed to the framework for interprofessional leadership. Twelve themes emerged from the literature, the themes were: facilitate shared leadership; transformation and change; personal qualities; goal alignment; creativity and innovation; communication; team-building; leadership clarity; direction setting; external liaison; skill mix and diversity; clinical and contextual expertise. The discussion includes some comparative analysis with theories and themes in team management and team leadership.
Originality/value
This research identifies some of the characteristics of effective leadership of interprofessional health and social care teams. By capturing and synthesising the literature, it is clear that effective interprofessional health and social care team leadership requires a unique blend of knowledge and skills that support innovation and improvement. Further research is required to deepen the understanding of the degree to which team leadership results in better outcomes for both patients and teams.
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Felix Gradinger, Julian Elston, Sheena Asthana, Chloe Myers, Sue Wroe and Richard Byng
This integrated care study seeks to highlight how voluntary sector “wellbeing co-ordinators” co-located in a horizontally and vertically integrated, multidisciplinary community…
Abstract
Purpose
This integrated care study seeks to highlight how voluntary sector “wellbeing co-ordinators” co-located in a horizontally and vertically integrated, multidisciplinary community hub within one locality of an Integrated Care Organisation contribute to complex, person-centred, co-ordinated care.
Design/methodology/approach
This is a naturalistic, mixed method and mixed data study. It is complementing a before-and-after study with a sub-group analysis of people receiving input from the wider hub (including Wellbeing Co-ordination and Enhanced Intermediate Care), qualitative case studies, interviews, and observations co-produced with embedded researchers-in-residence.
Findings
The cross-case analysis uses trajectories and outcome patterns across six client groups to illustrate the bio-psycho-social complexity of each group across the life course, corresponding with the range of inputs offered by the hub.
Research limitations/implications
To consider the effectiveness and mechanisms of complex system-wide interventions operating at horizontal and vertical interfaces and researching this applying co-produced, embedded, naturalistic and mixed methods approaches.
Practical implications
How a bio-psycho-social approach by a wellbeing co-ordinator can contribute to improved person reported outcomes from a range of preventive, rehabilitation, palliative care and bereavement services in the community.
Social implications
To combine knowledge about individuals held in the community to align the respective inputs, and expectations about outcomes while considering networked pathways based on functional status, above diagnostic pathways, and along a life-continuum.
Originality/value
The hub as a whole seems to (1) Enhance engagement through relationship, trust and activation, (2) Exchanging knowledge to co-create a shared bio-psycho-social understanding of each individual’s situation and goals, (3) Personalising care planning by utilising the range of available resources to ensure needs are met, and (4) Enhancing co-ordination and ongoing care through multi-disciplinary working between practitioners, across teams and sectors.
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Emili Vela, Aina Plaza, Gerard Carot-Sans, Joan Carles Contel, Mercè Salvat-Plana, Marta Fabà, Andrea Giralt, Aida Ribera, Sebastià Santaeugènia and Jordi Piera-Jiménez
To assess the effectiveness of an integrated care program for post-acute care of stroke patients, the return home program (RHP program), deployed in Barcelona (North-East Spain…
Abstract
Purpose
To assess the effectiveness of an integrated care program for post-acute care of stroke patients, the return home program (RHP program), deployed in Barcelona (North-East Spain) between 2016 and 2017 in a context of health and social care information systems integration.
Design/methodology/approach
The RHP program was built around an electronic record that integrated health and social care information (with an agreement for coordinated access by all stakeholders) and an operational re-design of the care pathways, which started upon hospital admission instead of discharge. The health outcomes and resource use of the RHP program participants were compared with a population-based matched control group built from central healthcare records of routine care data.
Findings
The study included 92 stroke patients attended within the RHP program and the patients' matched controls. Patients in the intervention group received domiciliary care service, home rehabilitation, and telecare significantly earlier than the matched controls. Within the first two years after the stroke episode, recipients of the RHP program were less frequently institutionalized in a long-term care facility (5 vs 15%). The use of primary care services, non-emergency transport, and telecare services were more frequent in the RHP group.
Originality/value
The authors' analysis shows that an integrated care program can effectively promote and accelerate delivery of key domiciliary care services, reducing institutionalization of stroke patients in the mid-term. The integration of health and social care information allows not only a better coordination among professionals (thus avoiding redundant assessments) but also to monitor health and resource use outcomes of care delivery.
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Sonia Bussu and Martin Marshall
Organisational Development (OD), with its focus on partnership working and distributed leadership, is increasingly advocated as an effective approach to driving change. Our…
Abstract
Purpose
Organisational Development (OD), with its focus on partnership working and distributed leadership, is increasingly advocated as an effective approach to driving change. Our evaluation of the impact of OD on delivery of integrated care in three London boroughs sheds light on how OD is being understood and implemented within health services, and what impact it is having on delivery of care.
Design/methodology/approach
The findings presented here are based on a qualitative and participatory evaluation. The authors looked at how health and social care professionals communicated and coordinated delivery of care and evaluated the impact of current OD activities on the ground to evidence whether and to which degree they are enabling frontline staff to change their working routines towards greater coordination.
Findings
Our findings highlight the limited reach and scope of a top-down approach to OD based on ad hoc coaching and staff engagement events, often delivered by external consultancies, and mostly focused at the senior management level. This approach fell short of enabling the creation of sustainable, integrated and collaborative organisations. Instead, some of the professionals that participated in our study tried to develop spaces that facilitated ongoing dialogue and mutual support among professionals on the ground.
Practical implications
Initiatives of bottom-up OD such as those described in this paper have greater potential to change working routines as they enable staff to move towards more collaborative and coordinated work.
Originality/value
These findings contribute to the literature on OD in public services and highlight the benefits of a context-sensitive, pragmatic, and long-term approach to OD to help create sustainable collaborative organisations.
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Maria Goddard, Panagiotis Kasteridis, Rowena Jacobs, Rita Santos and Anne Mason
The purpose of this paper is to explore the link between one aspect of primary care in England – the annual review by general practitioners for dementia patients – and length of…
Abstract
Purpose
The purpose of this paper is to explore the link between one aspect of primary care in England – the annual review by general practitioners for dementia patients – and length of hospital stay (LoS). The annual review should identify the needs of both patients and carers and co-ordinate services across health and social care to address those needs. If this is done well, timely discharge from hospital may be facilitated.
Design/methodology/approach
The study uses linked national data from 2006/2007 to 2010/2011 on over 36,000 patients, employing sophisticated statistical techniques to isolate the effect of the annual dementia review on LoS.
Findings
Hospital patients discharged to the community have significantly shorter stays if they are cared for by practices that reviewed a higher percentage of their patients with dementia. However, this effect is small and is not evident for patients discharged to care homes or who died in hospital. Longer LoS is associated with a range of co-morbidities, markers of low availability of social care and with intensive provision of informal care.
Practical implications
Although the dementia review has only a modest effect on LoS, the components of the review could improve the health and well-being of those with dementia and their carers.
Originality/value
The study is the first to employ a robust methodology to investigate the impact of the annual dementia review on hospital LoS, an important aspect of the interface between primary and secondary care. There are implications for clinical and financial aspects of health and social care policy.
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Mariona Espaulella-Ferrer, Felix Jorge Morel-Corona, Mireia Zarco-Martinez, Alba Marty-Perez, Raquel Sola-Palacios, Maria Eugenia Campollo-Duquela, Maricelis Cruz-Grullon, Emma Puigoriol-Juvanteny, Marta Otero-Viñas and Joan Espaulella-Panicot
Older people living in nursing homes have complex care needs and frequently need specialists’ advice and support that can be challenging to deliver in a rural setting. The aim of…
Abstract
Purpose
Older people living in nursing homes have complex care needs and frequently need specialists’ advice and support that can be challenging to deliver in a rural setting. The aim of this paper is to describe a model of integrated care in a rural area supported by a nurse case manager.
Design/methodology/approach
A real-world evidence study of people living in Ribes de Freser nursing home, was conducted between specific timeframes in 2019 and 2022, comparing the casemix and outcomes of a traditional care model with the integrated interdisciplinary model.
Findings
The integrated care model led to a significant reduction in transfers to the emergency department, hospitalisations, outpatient medical visits and a reduction in the number of medicines. In addition, the number of residents receiving end-of-life care at the nursing home showed a substantial increase.
Originality/value
This case study contributes valuable evidence supporting the implementation of an integrated model of nurse case manager support in nursing homes, particularly in the rural contexts, where access to specialist medical staff may be limited. The findings highlight the potential benefits of person-centred integrated care for older adults, addressing their complex needs and improving end-of-life care in nursing home settings.
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David de Kam, Marianne van Bochove and Roland Bal
Despite the continuation of hospital mergers in many western countries, it is uncertain if and how hospital mergers impact the quality of care. This poses challenges for the…
Abstract
Purpose
Despite the continuation of hospital mergers in many western countries, it is uncertain if and how hospital mergers impact the quality of care. This poses challenges for the regulation of mergers. The purpose of this paper is to understand: how regulators and hospitals frame the impact of merging on the quality and safety of care and how hospital mergers might be regulated, given their uncertain impact on quality and safety of care.
Design/methodology/approach
This paper studies the regulation of hospital mergers in The Netherlands. In a qualitative study design, it draws on 30 semi-structured interviews with inspectors from the Dutch Health and Youth Care Inspectorate (Inspectorate) and respondents from three hospitals that merged between 2013 and 2015. This paper draws from literature on process-based regulation to understand how regulators can monitor hospital mergers.
Findings
This paper finds that inspectors and hospital respondents frame the process of merging as potentially disruptive to daily care practices. While inspectors emphasise the dangers of merging, hospital respondents report how merging stimulated them to reflect on their care practices and how it afforded learning between hospitals. Although the Inspectorate considers mergers a risk to quality of care, their regulatory practices are hesitant.
Originality/value
This qualitative study sheds light on how merging might affect key hospital processes and daily care practices. It offers opportunities for the regulation of hospital mergers that acknowledges rather than aims to dispel the uncertain and potentially ambiguous impact of mergers on quality and safety of care.
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Claire O’Brien, Laura Hogan, Peter Ward, William Howard, Rebecca Mooney, Paul Bernard and Grace Corcoran
Emergency Department (ED) presentations in older people are associated with a wide range of adverse events, which increase the risk of lengthy hospitalisation and poor outcomes…
Abstract
Purpose
Emergency Department (ED) presentations in older people are associated with a wide range of adverse events, which increase the risk of lengthy hospitalisation and poor outcomes. Pathfinder is an inter-organisational initiative delivered in partnership between Beaumont Hospital Occupational Therapy and Physiotherapy departments and the National Ambulance Service. Pathfinder responds to non-serious and non-life-threatening emergency medical service (EMS) calls. This study aims to demonstrate how Pathfinder can safely treat a proportion of older people at home by using alternative care pathways (ACPs), therefore avoiding unnecessary ED presentations. Once a decision has been reached to treat the person at home, the Pathfinder follow-up team delivers functional rehabilitation and case management in the persons’ home over the subsequent days.
Design/methodology/approach
This paper outlines the Pathfinder assessment, management and interventions in one clinical case example. Outcome measures include the level of patient satisfaction obtained via routine telephone feedback questionnaire and re-presentation to Beaumont Hospital within 30 days.
Findings
This paper illustrates through a case example the benefit of a collaborative multi-disciplinary rapid response team for non-serious and non-life-threatening EMS calls in older adults. The patient in this case example had no further EMS calls or ED presentations for 30 days after Pathfinder intervention and reported a high level of satisfaction with the service.
Research limitations/implications
ED presentation was avoided through comprehensive multi-disciplinary assessment, including immediate access to intensive follow-up support in the person’s own home.
Practical implications
The Pathfinder service is improving access to ACPs for older people in the Beaumont Hospital catchment area. Pathfinder will now be spread nationally, with local adaptation, so that older people in other parts of Ireland will also benefit from this integrated model of care.
Originality/value
Patient feedback surveys confirm older adults want access to alternative care pathways.
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Gavin David Brown, Ann Largey, Caroline McMullan, Gráinne O'Shea and Niamh Reilly
This study explored the experiences of Irish emergency medical services (EMS) first responders during the first nationwide restrictions to curb the spread of COVID-19.
Abstract
Purpose
This study explored the experiences of Irish emergency medical services (EMS) first responders during the first nationwide restrictions to curb the spread of COVID-19.
Design/methodology/approach
A systematic literature review (SLR) of research into healthcare workers' and first responders' experiences during the COVID-19 and 2003 SARS pandemics was performed. The SLR informed the content of an online questionnaire distributed via the Irish Pre-Hospital Emergency Care Council to 2,092 first responders on its live register. Data analysis used both descriptive and content analysis.
Findings
EMS first responders faced many challenges including PPE quality, training on its use, issues with decontamination facilities, and organisational effectiveness. Emotional challenges included the anxiety experienced, the impact on families, and ethical dilemmas confronted related to patient care. Positive findings also emerged, such as first responders' dedication to working through the pandemic, collegiality, and the community goodwill displayed.
Originality/value
While investigations of the impact of the COVID-19 pandemic on healthcare workers have been undertaken globally, studies focussing exclusively on the experiences of EMS first responders have been rare. This study addressed this knowledge gap, providing an insight into the challenges and successes experienced by first responders and identifying opportunities for learning that can be applied to future public health emergencies.
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