Search results

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.

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.

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.

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.

This paper proposes the adoption of Industry 4.0 (I4) technologies and lean techniques for improving operational performance in the healthcare sector.

The research adopted a systematic literature review and feedback of healthcare professionals to identify the inefficiencies in the current healthcare system. A questionnaire was used to get feedback from the patients and the hospital staff about the current practices and issues, and the expected impact of technology on existing practices. Data were analysed using descriptive statistics, correlation analysis and multiple regression analysis.

The results indicate that I4 technologies lead to the improvement of the operational performance, and the perceptions about I4 technologies are made through the pre-medical diagnosis. However, a weak correlation between lean practices and healthcare operational performance compared to that of I4 technologies and operational performance indicate that lean practices are not fully implemented in the Sri Lankan healthcare sector to their full potential.

This study is limited to two government hospitals, with insights from only the doctors and nurses in Sri Lanka. Furthermore, the study is limited to only selected aspects of I4 technologies (big data, cloud computing and IoT) and lean concepts (value stream mapping and 5S). Therefore, recommendations on the adoption of I4 technologies in the healthcare sector need to be made within the scope of the study investigation.

The implementation of I4 technologies needs careful consideration of process improvement as part of the overall plan for achieving the maximum benefits of technology adoption.

The findings of the research can be used as a benchmark/guide for other hospitals to explore the adoption of I4 technologies, and how process improvement from lean concepts could influence the overall operational performance.

The purpose of this paper is to provide a comprehensive description, justification and modus operandi for implementation of cellular operations within healthcare delivery supply chains. The methodology outlined has a sound theoretical basis, has been proven in a wide range of market sectors (including hospitals) and hence qualifies for consideration as a contribution to “new management theory”.

Approach is based on the well established management‐by‐projects (MBP) methodology for analysis, design and effective implementation of change. There is detailed coverage of the five‐step MBP programme with specific applications in healthcare. The importance of “people involvement” as a core requirement is demonstrated via the set‐up of task forces to design and operate such cells. These groups integrate cognate activities so as to provide seamless patient flow within the healthcare delivery process. MBP is derived from a systems perspective. This in turn is concerned with maintaining quality, reducing uncertainty, smooth transference, synchronisation, schedule adherence, and minimisation of throughput times.

The outputs from case studies executed in a large UK teaching hospital confirm the substantial benefits accruing from cellular operation. In both materials supplies and urology admission processes significant improvements result form adoption of the MBP change methodology. This includes substantive 50 per cent reduction in patient throughput times, plus 25 per cent increase in bed utilisation. Measurable cost benefits are achieved in materials supply, especially via simplification of ordering systems.

The healthcare applications demonstrate the applicability of MBP within this specialised scenario. However, the solutions depend on the innovatory capability of the relevant task forces who execute the projects. Since these necessarily include participation by coal‐face “players”, i.e. doctors, nurses, support staff, etc. advised by internal “change experts” the solutions adopted are shaped to be the best and most appropriate “local” schema.

It is essential that task forces be properly constituted, well trained, well advised, and actively practice the plan‐do‐check‐act cyclic route of well‐tested improvement. “Train‐Do” is the key. However, in healthcare especially, the “Elephant Must Be Eaten in Bite Sized Chunks”. In other words the organisation needs visible progressive change, unit‐by‐unit, thus avoiding saturation of scarce resources.

Brings together the MBP methodology and cellular organisational concepts into an integrated, sustainable, systems based approach to the analysis, design and implementation of effective change.

The concept of value is becoming increasingly fashionable in healthcare and various improvement approaches (IAs) have been introduced with the aim of increasing value. The purpose of this paper is to construct a taxonomy that supports the management of parallel IAs in healthcare.

Based on previous research, this paper proposes a taxonomy that includes the dimensions of view on value and organizational focus; three contemporary IAs – lean, value-based healthcare, and patient-centered care – are related to the taxonomy. An illustrative qualitative case study in the context of psychiatric (psychosis) care is then presented that contains data from 23 interviews and focuses on the value concept, IAs, and the proposed taxonomy.

Respondents recognized the dimensions of the proposed taxonomy and indicated its usefulness as support for choosing and combining different IAs into a coherent management model, and for facilitating dialog about IAs. The findings also suggested that the view of value as “health outcomes” is widespread, but healthcare professionals are less likely than managers to also view value as a process.

The conceptual contribution of this paper is to delineate some important characteristics of IAs in relation to the emerging “value era”. It also highlights the coexistence of different IAs in healthcare management practice. A taxonomy is proposed that can help managers choose, adapt, and combine IAs in local management models.

This paper evaluates the non‐healthcare organisational literature on conceptualisations of trust. The aim of the paper is to review this diverse literature, and to reflect on the potential insights it might offer healthcare researchers, policy makers and managers.

A number of the key concepts that contribute to contrasting definitions of trust in the organisational literature are identified.

The paper highlights the heterogeneity of trust as an organisational concept. Aspects of trust that relate more specifically to non‐healthcare settings are shown to have some potential relevance for healthcare. Five aspects of trust, considered to have particular significance to the changing face of the NHS, appear to offer scope for further exploration in healthcare settings.

The NHS continues to face changes to its organisational structures, both planned and unplanned. Healthcare providers will need to be alert to intra‐ and inter‐organisational relationships, of which trust issues will form an inevitable part. Whilst it might be argued that the lessons offered by conceptualisations of trust within wider organisational settings have limitations, the paper demonstrates sufficient areas of overlap to encourage cross‐fertilisation of ideas.

The paper draws together previous research on a topic of increasing relevance to healthcare researchers, which has exercised management researchers for at least three decades. The paper acts as a guide to future research and practice.

Research findings provide the professional community with knowledge that enables to better understand healthcare interventions. Many authors point out that whilst these findings are valued, the findings are not always translated into healthcare practise. The purpose of the paper is to assess the applicability of the essential elements of an integrated palliative care system (IPCS) found in research into the practise of Osona Palliative Care System (OPCS).

The study used a qualitative methodology with a case study design. In total, 24 health professionals were interviewed in Osona for the research, and the results were analysed using deductive content analysis.

The study concludes that research findings can better be translated into specific contexts by incorporating the needs and characteristics of the system. The process could be a strategy for bridging the research–practise gap.

Combining the findings from the study and the findings found in the literature reviewed led to the creation of the IPCS-elements-blended model of research and practise. Such a kind of mixed model could be used in other studies seeking to overcome the research and practice gap.

As a model of integrated care (IC), deliberate team-based care (DTBC) can help address workforce shortages facing rural communities by improving the health and wellbeing of healthcare providers. This study focuses on a GP practice implementing DTBC in rural Australia. The aim of this research was to understand the perspectives of the healthcare workers involved and to ascertain factors impacting on the day to day running of the model, patient care and clinician work-life. The authors conducted a qualitative study on the experiences of the DTBC workers.

Team members were invited to participate in semi-structured interviews (n = 9). Interviews were analysed using an iterative thematic analysis, summarised, collated and explored for emergent themes.

Key themes included: creating change from old ways of doing things, development and implementation processes outlining how the model evolved and how it ran from day to day, model outcomes for patients and clinicians, as well as practical considerations like funding, technology and time.

Building DTBC from the ground up has produced a high functioning team who demonstrate trust and equality, share information freely and all have a voice which is heard and respected. By acting as a champion and a leader, the GP has created a psychologically safe environment allowing the team to share knowledge, collaborate in problem solving and provide effective patient care which is holistic and community grounded. This work environment holds promise for creating improved work-life for rural clinicians and potential for workforce retention.

The purpose of this paper is to assess the future of healthcare and quality.

The paper describes six future healthcare systems based on four archetypes.

Instead of dealing with process oriented practice, management participation, financial incentives and capacity management, the emphasis should be on communication, education, shared decisions and quality of life.

The paper makes it clear that quality improvement efforts should be centred on the needs and wishes of patients, recognising patients' expertise, values and preferences.

Under the impact of Coronavirus disease 2019 (COVID-19), this paper contributes in the deployment of the Artificial Intelligence of Things (AIoT)-based system, namely AIoT-based Domestic Care Service Matching System (AIDCS), to the existing electronic health (eHealth) system so as to enhance the delivery of elderly-oriented domestic care services.

The proposed AIDCS integrates IoT and Artificial Intelligence (AI) technologies to (1) capture real-time health data of the elderly at home and (2) provide the knowledge support for decision making in the domestic care appointment service in the community.

A case study was conducted in a local domestic care centre which provided elderly oriented healthcare services to the elderly. By integrating IoT and AI into the service matching process of the mobile apps platform provided by the local domestic care centre, the results proved that customer satisfaction and the quality of the service delivery were improved by observing the key performance indicators of the transactions after the implementation of the AIDCS.

Following the outbreak of COVID-19, this is a new attempt to overcome the limited research done on the integration of IoT and AI techniques in the domestic care service. This study not only inherits the ability of the existing eHealth system to automatically capture and monitor the health status of the elderly in real-time but also improves the overall quality of domestic care services in term of responsiveness, effectiveness and efficiency.

The purpose of this paper is to examine the relational consequences of electronic patient records based on co-produced data from pregnant women’s IT supported self-reporting. The analysis unfolds how the clinical encounter between patient and professional is reconfigured in the digitized society.

The paper provides a grounded theory analysis based on observations and interviews in an antenatal care unit. The study draws on empirical material generated through observations of the clinical encounters between pregnant women and midwifes, interviews with managers and midwifes, field notes and policy documents.

The author argues that the use of technology and co-produced data displace tasks and relations between healthcare professional and patient. The analysis shows that four modes of organizational patient involvement are enacted: involvement in administrative tasks, involvement in professional resistance, individualized involvement, and homogenized involvement of patients that tends to categorize the pregnancy roughly as either “normal” or “abnormal.”

This study contributes to qualitative research in digitization and patient involvement in health organization studies by showing how digital technology distributes the midwife’s autonomy, tasks and knowledge about the patient with both intended and unintended consequences. The argument goes beyond the prevalent prescriptive approaches to e-government and co-production, instead providing a critical analytical perspective on the promises of delivering efficient and patient-centered healthcare.