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Article
Publication date: 21 September 2015

Angelina Taylor and Oliver Groene

The spotlight has recently been placed on managers’ responsibility for patient-centred care as a result of Mid Staffordshire NHS Foundation Trust failings. In previous…

Abstract

Purpose

The spotlight has recently been placed on managers’ responsibility for patient-centred care as a result of Mid Staffordshire NHS Foundation Trust failings. In previous research, clinicians reported that managers do not have an adequate structured plan for implementing patient-centred care. The purpose of this paper is to assess the perceptions of European hospital management with respect to factors affecting the implementation of a patient-centred approach.

Design/methodology/approach

In total, 15 semi-structured interviews were conducted with hospital managers (n=10), expert country informants (n=2), patient organisations (n=2) and a user representative (n=1) from around Europe. Participants were purposively and snowball sampled. Interviews were analysed using framework analysis.

Findings

Most participants felt that current levels of patient-centred care are inadequate, but accounted that there were a number of macro, meso and micro challenges they faced in implementing this approach. These included budget constraints, political and historical factors, the resistance of clinicians and other frontline staff. Organisational culture emerged as a central theme, shaped by these multi-level factors and influencing the way in which patient-centred care was borne out in the hospital. Participants proposed that the needs of patients might be better met through increasing advocacy by patient organisations and greater staff contact with patients.

Originality/value

This study is the first of its kind to obtain management views from around Europe. It offers an insight into different models of how patient-centred care is realised by management. It indicates that managers see the value of a patient-centred approach but that they feel restricted by a number of factors at multiple levels.

Details

Journal of Health Organization and Management, vol. 29 no. 6
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 11 November 2014

Laura Lord and Nicola Gale

Patient-centred care and patient involvement are increasingly central concepts in health policy in the UK and elsewhere. However, there is little consensus regarding their…

Abstract

Purpose

Patient-centred care and patient involvement are increasingly central concepts in health policy in the UK and elsewhere. However, there is little consensus regarding their definition or how to achieve “patient-centredcare in everyday practice or how to involve patients in service redesign initiatives. The purpose of this paper is to explore these issues from the perspective of key stakeholders within National Health Service (NHS) hospitals in the UK.

Design/methodology/approach

Semi-structured interviews, covering a range of topics related to service redesign, were conducted with 77 key stakeholders across three NHS Trusts in the West Midlands. In total, 20 of these stakeholders were re-interviewed 18 months later. Data were managed and analysed using the Framework Method.

Findings

While patient-centred care and patient involvement were regularly cited as important to the stakeholders, a gap persisted between values and reported practice. This gap is explained through close examination of the ways in which the concepts were used by stakeholders, and identifying the way in which they were adapted to fit other organisational priorities. The value placed on positive subjective experience changed to concerns about objective measurement of the patients as they move through the system.

Research limitations/implications

Increased awareness and reflection on the conceptual tensions between objective processes and subjective experiences could highlight reasons why patient-centred values fail to translate into improved practice.

Originality/value

The paper describes and explains a previously unarticulated tension in health organisations between values and practice in patient centred care and patient involvement in service redesign.

Details

Journal of Health Organization and Management, vol. 28 no. 6
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 11 December 2009

Stephen Abbott, Julie Attenborough, Annie Cushing, Mary Hanrahan and Ania Korszun

Medical and nursing students are often anxious about communicating with patients with mental health problems, even when they have received general communication skills…

Abstract

Medical and nursing students are often anxious about communicating with patients with mental health problems, even when they have received general communication skills training. Communication is particularly challenging when patients are compulsorily admitted to hospital. The study reported here sought to explore medical and nursing students' attitudes to this challenge, stimulated by watching a DVD illustrating professional‐patient communications in this situation. Facilitated discussions of the DVD were recorded and the transcripts were thematically analysed. A strong commitment to three underlying principles of patient‐centred care emerged.1. A preference for egalitarian over authoritarian relationships between patients and professionals.2. A preference for empathetic over bureaucratic approaches to patients.3. Respect for patients as autonomous beings.Students seemed less aware of the need for clear and effective communication of information, and some appear confused about patient‐professional boundaries.

Details

The Journal of Mental Health Training, Education and Practice, vol. 4 no. 4
Type: Research Article
ISSN: 1755-6228

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Article
Publication date: 1 June 2010

Anu Kajamaa

This study seeks to challenge the notions of the standardized care pathway and patient‐centred care, both of which provide only a partial view of care as a complex system…

Abstract

Purpose

This study seeks to challenge the notions of the standardized care pathway and patient‐centred care, both of which provide only a partial view of care as a complex system. In exploring and contrasting the care pathway protocol and an actual care pathway, the study aims to analyze the conceptualizations of care that actors involved in the actual care pathway have. The study makes suggestions on how to expand care pathways and thereby improve patient care.

Design/methodology/approach

A care pathway protocol is contrasted with the actual care pathway of a patient at a university hospital in Finland. Observational ethnography is combined with a narrative approach and activity‐theoretical ideas.

Findings

The study depicts the gap between the care pathway protocol and an actual care pathway. The actual care pathway, rather than being a clear‐cut process, is ruptured and unpredictable. The conceptualizations of care (i.e. care‐objects) held by the doctors, nurses and the patient were fragmented and clashed in their practical work activity. The main message to hospital management is that in order to expand care pathways, the multiple care‐objects need to be placed in constructive interplay.

Research limitations/implications

A single actual care pathway is presented and the results are interpreted accordingly.

Originality/value

The study explores the idea of a care pathway and patient‐centred care in the analysis of care‐objects. A new discursive model is introduced that places different care‐objects into interplay and opens up the possibilities for the expansion of care pathways.

Details

International Journal of Public Sector Management, vol. 23 no. 4
Type: Research Article
ISSN: 0951-3558

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Article
Publication date: 1 February 2000

Kerry‐Ann Gilmore and Owen Hargie

Watson and Gallois have argued that “at the very core of health communication is the interaction between health professionals and their patients”, and thus effective and…

Abstract

Watson and Gallois have argued that “at the very core of health communication is the interaction between health professionals and their patients”, and thus effective and quality communication between doctor and patient is imperative.

Details

International Journal of Health Care Quality Assurance, vol. 13 no. 1
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 5 February 2020

Agnieszka Sobolewska, Amy-Louise Byrne, Clare Lynette Harvey, Eileen Willis, Adele Baldwin, Sandy McLellan and David Heard

The purpose of the paper is to explore how the national, state and organisational health policies in Australia support the implementation of person-centred care in…

Abstract

Purpose

The purpose of the paper is to explore how the national, state and organisational health policies in Australia support the implementation of person-centred care in managing chronic care conditions.

Design/methodology/approach

A qualitative content analysis was performed regarding the national, state and organisational Queensland Health policies using Elo and Kyngas' (2008) framework.

Findings

Although the person-centred care as an approach is well articulated in health policies, there is still no definitive measure or approach to embedding it into operational services. Complex funding structures and competing priorities of the governments and the health organisations carry the risk that person-centred care as an approach gets lost in translation. Three themes emerged: the patient versus the government; health care delivery versus the political agenda; and health care organisational processes versus the patient.

Research limitations/implications

Given that person-centred care is the recommended approach for responding to chronic health conditions, further empirical research is required to evaluate how programs designed to deliver person-centred care achieve that objective in practice.

Practical implications

This research highlights the complex environment in which the person-centred approach is implemented. Short-term programmes created specifically to focus on person-centred care require the right organisational infrastructure, support and direction. This review demonstrates the need for alignment of policies related to chronic disease management at the broader organisational level.

Originality/value

Given the introduction of the nurse navigator program to take up a person-centred care approach, the review of the recent policies was undertaken to understand how they support this initiative.

Details

Journal of Health Organization and Management, vol. 34 no. 2
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 25 May 2020

Adam Capon, Lien McGowan and Julia Bowman

Patient-centred care is a key approach used in Australia for the delivery of quality health care, and understanding experiences and perceptions is a key part to this. This…

Abstract

Purpose

Patient-centred care is a key approach used in Australia for the delivery of quality health care, and understanding experiences and perceptions is a key part to this. This paper aims to explore prisoners’ experiences and perceptions of health-care service provision in New South Wales, Australia.

Design/methodology/approach

In February and March 2017, 24 focus groups, consisting of 128 participants, were undertaken using semi-structured interviews that explored experiences of health care in prison.

Findings

A conceptualisation of the prisoners’ health-care experience around the core category of access to health care emerged from the data. Enablers or barriers to this access were driven by three categories: a prison construct – how the prisoners “see” the prison system influencing access to health care; a health-care system construct – how the prisoners “see” the prison health-care system and the pathways to navigate it; and personal factors. Communication was the category with the greatest number of relational connections.

Research limitations/implications

This study takes a pragmatic approach to the analysis of data, the findings forming the basis for a future quantitative study. The findings identify communication as a key issue for access to health care.

Originality/value

This study provides first-hand accounts of enablers and barriers to accessing health-care services in the prison environment. To the best of the authors’ knowledge, this study is the first of its kind to identify access to health care as a core category and is of value to health workers and researchers that work with the prison population.

Details

International Journal of Prisoner Health, vol. 16 no. 3
Type: Research Article
ISSN: 1744-9200

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Article
Publication date: 31 December 2020

Risha Fayyaz, Fasih Ali Ahmed, Adeel Abid, Afshan Akhtar, Rabail Jarwar, Anila Jasmine, Sameer Ahmad Khan, Shahira Shahid, Iraj Khan, Aneeq Muhammad Yousuf and Imtiaz Jehan

This study aims to assess the quality of care among adult oncology patients in tertiary care hospitals in Karachi by using an international standard of quality of care and…

Abstract

Purpose

This study aims to assess the quality of care among adult oncology patients in tertiary care hospitals in Karachi by using an international standard of quality of care and to identify domains where improvement is needed.

Design/methodology/approach

This is a cross-sectional study carried out at two tertiary care hospitals of Karachi, Pakistan, belonging to private and public sector, respectively, between February and April 2018. Face-to-face interviews were conducted using a modified questionnaire having five-point Likert scale questions regarding satisfaction of patients with doctors, nursing staff, information provided and the hospital standards. SPSS 20 was used for statistical analysis, and the results were expressed using mean, frequencies, percentages and p-values.

Findings

The authors approached 415 patients, out of which 389 patients agreed to participate in the study. For both hospitals, the lowest mean scores were for sections pertaining to satisfaction with psychosocial support and information provided. The mean satisfaction score of patients from the private hospital were found to be significantly higher as compared to patients from the public hospital for all domains of patient care (p-value < 0.01 using t-test for two independent samples). The data showed an increasing trend of “satisfied” responses as the household income increased.

Research limitations/implications

A comparative study should be conducted with the aim of pinpointing the differences in areas in which there is a significant difference in positive satisfaction levels between private and public sectors. Similar research could also be expanded adding other variables that affect quality of care such as doctor's approach to their patients, time given during each consultation and patient's understanding of doctor's knowledge. Further studies can be done to bridge the gaps between what a doctor views as standard care and what the patient knows will help them receive a more holistic approach to care.

Practical implications

Assessing the quality of care helps determine gaps in care and allocating health resources accordingly. In clinical practice, emphasis needs to be given on increased duration and improved quality of patient counselling to improve the low satisfaction levels of patients regarding the psychosocial support. Addressing patients' concerns should be made part of clinical teaching from an undergraduate level. As far as patient access to doctors of the specific speciality is concerned, hospital managements should adopt systems to ensure continuum of care and come up with mechanisms to bridge the discrepancy between a patient's needs and doctor availability.

Social implications

After being identified as a major deficiency, training doctors in the sensitivities of the population and demographics, especially with respect to socio-economic statuses, can aid in enhancing patient satisfaction to the treatment. Implementation of patient-centred care leads to greater satisfaction with care, which, in turn, increases a patient's self efficacy in managing important aspects of their care and improves health care-related quality of life.

Originality/value

Cancer patients have long-term exposure to the hospital environment. A patient's satisfaction with the quality of care is an important determinant in patient compliance to the treatment protocol and required hospital visits. There is a dearth of research on the outpatient quality of care in the oncology departments in Karachi. This study provides an overview of the quality of care available to cancer patients in Karachi both in public and private sectors. The results of our study identify the gaps in the quality of care being provided to the patients in a developing country like Pakistan, which can be used to improve the quality of care, leading to better patient outcomes.

Details

International Journal of Health Care Quality Assurance, vol. 34 no. 1
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 12 March 2018

Loretta M. Isaac, Elaine Buggy, Anita Sharma, Athena Karberis, Kim M. Maddock and Kathryn M. Weston

The patient-centred management of people with cognitive impairment admitted to acute health care facilities can be challenging. The TOP5 intervention utilises carers…

Abstract

Purpose

The patient-centred management of people with cognitive impairment admitted to acute health care facilities can be challenging. The TOP5 intervention utilises carers’ expert biographical and social knowledge of the patient to facilitate personalised care. The purpose of this paper is to explore whether involvement of carers in the TOP5 initiative could improve patient care and healthcare delivery.

Design/methodology/approach

A small-scale longitudinal study was undertaken in two wards of one acute teaching hospital. The wards admitted patients with cognitive impairment, aged 70 years and over, under geriatrician care. Data for patient falls, allocation of one-on-one nurses (“specials”), and length-of-stay (LOS) over 38 months, including baseline, pilot, and establishment phases, were analysed. Surveys of carers and nursing staff were undertaken.

Findings

There was a significant reduction in number of falls and number of patients allocated “specials” over the study period, but no statistically significant reduction in LOS. A downward trend in complaints related to communication issues was identified. All carers (n=43) completing the feedback survey were satisfied or very satisfied that staff supported their role as information provider. Most carers (90 per cent) felt that the initiative had a positive impact and 80 per cent felt that their loved one benefitted. Six months after implementation of the initiative, 80 per cent of nurses agreed or strongly agreed that it was now easier to relate to carers of patients with cognitive impairment. At nine-ten months, this increased to 100 per cent.

Originality/value

Actively engaging carers in management of people with cognitive impairment may improve the patient, staff, and carer journeys, and may improve outcomes for patient care and service delivery.

Details

International Journal of Health Care Quality Assurance, vol. 31 no. 2
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 12 November 2018

Shelagh Ferguson

This paper aims to elucidate health-related transformations experienced by an individual. Building from personal experience offers an understanding of the relational…

Abstract

Purpose

This paper aims to elucidate health-related transformations experienced by an individual. Building from personal experience offers an understanding of the relational dynamics at play within health transformations, which makes a contribution to realising and facilitating the agency of the patient in systems of integrated care.

Design/methodology/approach

Introspection can be used as a methodology to elucidate messy and personal affective experiences. The author’s introspection is an 18-month catalogue and analysis from diagnosis of breast cancer through significant stages of rehabilitation. Reflexive introspection has gained traction in health research due to its cathartic benefits, whilst this approach offers much; a key challenge for integrated care is translating deeply personal and subjective introspections into strategic-level application.

Findings

Using Turner’s (1969) concept of liminality, this research explicates key relational dynamics of health-related transformations experienced by an individual. By recognising changes in affective being as a pivotal point in rehabilitation, this work links embodied transformation as a critical antecedent to a patient’s willingness to engage his/her agency in their rehabilitation.

Originality/value

Whilst recognising that integrated care is patient-centred and seeks to incorporate the patient’s voice, this research gives insight into how the author, as a patient, engaged her agency in her rehabilitation through building her own transformed personal ontologies of health.

Details

European Journal of Marketing, vol. 52 no. 11
Type: Research Article
ISSN: 0309-0566

Keywords

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