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Many countries have developed hospital-at-home (HAH) models to bring hospital services closer to home. Although some countries already have a long tradition of HAH for adults, paediatric HAH has been developed more recently. Specificities of paediatric care make it difficult to directly extend an adult HAH model to the paediatric population. The objective of this study is to compare the organisation of paediatric HAH in four countries: France, Australia (states of Victoria and New South Wales), the Netherlands and Belgium. Ultimately, lessons can be drawn for further development in the countries analysed and/or for implementation in other countries.

Legal documents and other grey literature were analysed to describe the legal context for the provision of paediatric HAH in the selected countries. In addition, semi-structured in-depth interviews were conducted with key informants from paediatric HAH organisations in these countries, addressing the following topics: historical background, legal framework, functioning of HAH models, workforce, number of services, profile of children, type of care activities, funding, coordination with other providers and quality of care. Results were reviewed by a content expert from the respective country.

Organisational differences were highlighted in terms of coordinating actor (hospital or home nursing care services), decision-making process, range of clinical conditions treated, territorial organisation, qualifications and expertise of the team members, medical expertise, financing, responsibilities, etc.

There is no single preferred model for the provision of HAH care for children. There is a large variety in almost all aspects of organisation. There are, however, also some common characteristics across the different models. Notably, paediatric expertise of nurses within the HAH team was considered indispensable in all programmes.

Previous studies of general practitioner views of paediatric home care have presented a rather negative view of such services. This study examines GPs’, nurses’ and managers’ views of a new, acute paediatric hospital‐at‐home nursing service in Rugby. Methods used are qualitative and quantitative questionnaires and interviews, including Likert‐type scales and open questions. Contrary to the mixed and somewhat negative findings of previous studies, this study reports positive views on the impact of hospital‐at‐home in Rugby, in terms of acceptability and impact on the roles and responsibilities of GPs.

The aim of this study is to undertake a systemic literature review (SLR) of horticultural therapy and to explore whether its inclusion in a healthcare programme can enhance hospitalised children's well-being.

An empirical study was developed using a mixed methods approach to monitor stakeholders' perceptions of horticultural therapy. Specifically, hospitalised children (N = 31) and their families (N = 21), as well as medical and nursing staff (N = 3), were engaged in the empirical study. Qualitative and quantitative surveys were developed, involving two paediatric units in an Italian hospital.

The authors’ findings show a significant improvement of children's mood and psycho-physical well-being following horticultural therapy. The authors found positive effects of interactive horticultural therapy on hospitalised paediatric patients and their parents. Parents perceived a positive influence on their mood and found the therapy very beneficial for their children. Qualitative analyses of children's and parents' comments (and related rankings) revealed the helpful support role of horticultural therapy in dealing with the hospitalisation period. There is a very limited number of studies that have inspected co-therapy implementation in paediatric hospitals, and to the best of the authors' knowledge, no study has yet examined the effect of horticultural therapy in such a context. The practice of horticultural therapy with children in health settings has been documented in some Italian hospitals, but its effectiveness has not yet been well established in the literature.

The authors’ findings could provide useful insights to clinicians, health managers and directors in creating and sustaining a successful group co-therapy programme under the managed healthcare system.

The purpose of this paper is to provide an “inside” account of efforts to enhance the quality of care in a paediatric hospital department in Malawi.

The authors describe the problems they face as health workers in an overcrowded, under-resourced emergency departments in a low-income setting. Where it is helpful, the authors combine reports of their experience with reference to reports emanating from other African countries.

There is increased awareness of the need for a good health system to be able to provide quality care. The authors emphasise the importance of teamwork and the need for cross cutting activities that are not disease-centred or vertically driven. Task sharing and multi-tasking have helped fill the gaps left by inadequate staffing but specialists in emergency medicine are needed to advocate for the specialty and be role models in departments.

This paper is aimed at a broad audience of fellow clinicians, funders and policy makers, and those who have an interest in clinical governance in support of quality improvement in developing countries.

This is a firsthand account of efforts to enhance the quality of emergency care from a paediatric hospital department in Malawi.

Health care professionals (HCPs) face numerous barriers in providing services to limited English proficient (LEP) patients and their families. The purpose of this paper is to explore and expand on the limited scholarship concerning HCPs’ experiences using children as informal interpreters in pediatric consultations.

Ten HCPs from five different fields participated in this study. They were interviewed over the phone and replied to follow-up correspondence about their knowledge on policies for communicating with LEP patients and/or their families when providing medical care.

Using a thematic analysis five themes emerged across all cases: cultural awareness, communication quality, live interpreters as a solution, use of child language brokers (CLBs), and the norm of child language brokering. Through the development of the aforementioned themes, HCPs’ limited awareness of implications when using CLBs and of the established policies related to this phenomenon were apparent.

This lack of knowledge, acknowledged by HCPs, provides a platform from which to create awareness of the need for further education about the potential risks CLBs face when interpreting medical information and of the negative impact this process can have on the overall medical outcome of a patient. Furthermore, it allows the authors to address the ignorance within the health care system that has allowed vulnerabilities to LEP individuals being treated in health care facilities.

This study aimed to determine mothers' knowledge of children with congenital heart disease (CHD) and to examine the relationship between types of CHD, the duration of treatments, the perception of the severity of illness and the mothers' knowledge.

A correlation study was conducted among 84 mothers of children (from infancy to six years old) with CHD who had attended pediatric cardiology clinics and pediatric units in three tertiary hospitals in Bangkok, Thailand. The two questionnaires aimed to evaluate the mothers' knowledge and perceptions of the severity of illness. Descriptive statistics, Spearman's rank-order correlation and Fisher's exact test were used to analyze the data.

Knowledge levels of mothers of children with CHD were at a high level with a mean score of 34.79 (SD = 8.23), but the knowledge domain of preventing complications was at a low level with a mean score of 14.95 (SD = 5.28). The types of CHD and the perceptions of illness were not correlated with the mothers' knowledge, but the duration of treatments was significantly correlated (r = 0.271, p < 0.05).

Healthcare professionals, especially nurses, should emphasize proper health education on complication prevention and the duration of treatments for children. Moreover, mothers should be supported to nurture children with CHD to reduce possible complications and prepare for cardiac surgery where needed.

The subject area is entrepreneurship.

Graduate and executive education level in leadership, entrepreneurship and strategic management are used to discuss leadership, entrepreneurship and strategy in health services.

This case talks about the passionate journey of a pediatrician practicing in the Mumbai city of India, who as an individual private practitioner is contributing to the fulfilment of the global health agenda and the fourth Millennium Development Goal (MDG) – “reduce child mortality”. His vision is to make quality and affordable expert pediatric care accessible to all the individuals, right from pre-birth to adulthood. Surya Mother and Child Care Hospital (SMCH) is being strengthened as a nation-wide network of mother and child hospital offering patient/consumer-centric integrated collaborative quality care, and it needs to be seen how this model can be made sustainable as it enlarges in scale for the future.

The case is structured to achieve the following learning outcomes: to understand about effectuation as a logic for entrepreneurial success through the lens of Dr Avasthi and his venture SMCH; To understand and apply Porter’s Principles of value transformation that essentially focus on outcome-driven cost-efficient work practices in a collaborative integrative fashion, where transformation must come from within (some practices suggested can be applied to the Indian Healthcare Services Delivery systems); to critically analyze the overall strategic position of SMCH as an organization and its competitive environment; to discuss the factors influencing health-care delivery capacity build up, given the MDGs 2015, Every Newborn Action Plan and Indian Newborn Action Plan framework, as applicable to India; and to discuss and analyze mechanisms for future sustainable service delivery options for SMCH. Although each of these principles is important, possibly, the instructor could emphasize and encourage more discussions on potential models of shared partnerships that can help quality health-care services reach the unreached and the incorporation of technology in achieving this. The learning process can also facilitate discussions about leadership qualities in the creation of health-care entrepreneurs, for the “Change That They Would Want To See”.

Teaching notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes.

CSS:3 Entrepreneurship.

The purpose of this paper is to describe an international survey of hospital executives and administrators’ perspectives on the contributions of their affiliation with a Ronald McDonald House (RMH) as an example of accommodation in family-centered care to the hospital’s mission, operations and patient experience.

RMHs worldwide provided the names and e-mail addresses of the people holding key leadership positions in their main hospital partner, who in turn were invited to complete an internet-based survey (530 participants; response rate of 54.5 percent).

Hospital leaders reported very positive opinions about the contributions of their RMHs affiliation to their ability to serve seriously ill children and their families. This included such important outcomes as increasing family integrity and family participation in care decisions; and decreasing psychosocial stress and hospital social work resource burdens associated with lodging, food, transportation and sibling support. Hospital chief executive offices (CEOs) and medical directors reported very strong and positive opinions regarding the value-added of their RMHs affiliation in many areas, including enhanced marketing of hospital specialty services and reduced length of stay.

Survey response bias is a limitation, although the results are still useful in terms of identifying multiple ways in which RMHs are perceived as contributing to hospitals’ operations and provision of family-centered care.

Overall, the results suggest that, internationally, hospital leaders believe that RMHs play a key and valued role in their provision of family-centered care to seriously ill children and their families.

Family accommodation is more than the simple provision of lodging and plays an integral role how hospitals approach family-centered care.

This international study contributes to the general literature on the role of family accommodation in hospitals’ provision of family-centered care and the specific and very sparse literature on RMHs in particular.

In January 2005 Dr. Mean Chhi Vun, director of the Cambodian National Center for HIV/AIDS, Dermatology and STDs (NCHADS), needed to decide how to control the spread of HIV/AIDS and save the lives of thousands of Cambodians who were dying from it each year. In the seven years since Dr. Vun had been appointed director, NCHADS had built an organization that was transparent and efficient, had implemented a nationwide 100 percent Condom Use Program, had established a system that allowed individuals to voluntarily seek confidential counseling and testing, and had instituted a set of guidelines and procedures for staff at health facilities to refer HIV-positive patients to treatment clinics and link them with NGOs providing financial and psychosocial support. Now, however, Dr. Vun faced decisions about three initiatives that were critical to expanding care and treatment programs in his country. First, he needed to decide how to quickly and cost-effectively improve the national HIV/AIDS laboratory support infrastructure. Second, Dr. Vun needed to improve logistics and supply management in order to get the best prices and ensure patients had access to life-saving medicines. Finally, he needed to figure out how to provide sustainable care and treatment to the thousands of Cambodian children living with HIV/AIDS.

Create innovative solutions for large-scale, socially relevant challenges. Understand how to start, scale, and lead cross-sector public health initiatives, or any initiative requiring behavior change by a range of players on a large scale over the long term. Discover and implement operating models that balance the needs of for-profit, non-profit, and government organizations. More effectively manage situations where required resources are not under one's direct control.

The purpose of this paper is to describe the structure and impact of a Queensland Research Support Network (RSN) in emergency medicine (EM).

This paper presents a descriptive summary of EM networks, network evaluations and the structure and development of the Emergency Medicine Foundation’s (EMF) RSN in Queensland, including an observational pre- and post-study of research metrics.

In two years, the RSN supported 33 Queensland emergency departments (EDs), of which 14 developed research strategies. There was an increase in research active clinicians, from 23 in 2015 to 181 in 2017. Collaborator engagement increased from 9 in 2015 to 276 in 2017 as did the number of research presentations, from 6 in 2015 to 61 in 2017. EMF experienced a growth in new researchers, with new investigators submitting approximately 60 per cent of grant applications in 2016 and 2017. EMF also received new applications from a further three HHS (taking EMF-funded research activity from 8 to 11 HHS).

This paper describes changes in KPIs and research metrics, which the authors attribute to the establishment of the RSN. However, it is possible that attribution bias plays a role in the KPI improvements.

This network has actively boosted and expanded EM research capacity and capability in Queensland. It provides services, in the form of on-the-ground managers, to develop novice clinician-researchers, new projects and engage entire EDs. This model may be replicated nationwide but requires funding commitment.

The RSN improves front-line clinician research capacity and capability and increases research activity and collaborations with clear community outcomes. Collaborations were extended to community, primary health networks, non-government organisations, national and international researchers and academic institutions. Evaluating and measuring a network’s benefits are difficult, but it is likely that evaluations will help networks obtain funding.