51
|
Organisational networks, organisational learning, organisational adaptability and role clarity among humanitarian organisations during relief delivery. JOURNAL OF HUMANITARIAN LOGISTICS AND SUPPLY CHAIN MANAGEMENT 2021. [DOI: 10.1108/jhlscm-04-2021-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Organisations involved in relief delivery tend to have cross-boundary mandates, which cause ambiguity of roles during delivery of relief services to the targeted victims. Having no clear role, specialisation affects service timeliness and increases resource duplication among the relief organisations. The objective of this study is to understand how organisational networks and organisational learning as complex adaptive system metaphors improve both organisational adaptability and role clarity in humanitarian logistics.
Design/methodology/approach
Using ordinary partial least squares regression through SmartPLS version 3.3.3, the authors tested the study hypotheses basing on survey data collected from 315 respondents who were selected randomly to complete a self-administered questionnaire from 101 humanitarian organisations. Common method bias (CMB) associated with surveys was minimised by implementing both procedural and post statistics methods.
Findings
The results indicate that organisational networks and organisational learning have a significant influence on organisational adaptability and role clarity. The results also show that organisational adaptability partially mediates in the relationship between organisational networks, organisational learning and role clarity.
Research limitations/implications
The major limitation of the study is that the authors have used cross-sectional data to test this research hypotheses. However, this was minimised following Guide and Ketokivi's (2015) recommendation on how to address the limitations of cross-sectional data or the use of longitudinal data that can address CMB and endogeneity problems.
Practical implications
Managers in humanitarian organisations can use the authors’ framework to understand, first, how complex adaptive system competence can be used to create organisational adaptability and, second, how organisational adaptability can help organisational networks and organisational learning in improving role clarity among humanitarian organisations by collaboratively working together.
Originality/value
This research contributes to the existing body of knowledge in humanitarian logistics and supply chain management by empirically testing the anecdotal and conceptual evidence. The findings may be useful to managers who are contemplating the use of organisational networks, organisational learning and organisational adaptability to improve role clarity in disaster relief-related activities.
Collapse
|
52
|
Lopes A, Roque F, Morgado S, Dinis C, Herdeiro MT, Morgado M. Behavioral Sciences in the Optimization of Pharmacological and Non-Pharmacological Therapy for Type 2 Diabetes. Behav Sci (Basel) 2021; 11:bs11110153. [PMID: 34821614 PMCID: PMC8614941 DOI: 10.3390/bs11110153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 11/21/2022] Open
Abstract
Type 2 diabetes mellitus is one of the main chronic diseases worldwide, with a significant impact on public health. Behavioral changes are an important step in disease prevention and management, so the way in which individuals adapt their lifestyle to new circumstances will undoubtedly be a predictor of the success of the treatments instituted, contributing to a reduction in the morbidity and mortality that may be associated with them. It is essential to prepare and educate all diabetic patients on the importance of changing behavioral patterns in relation to the disease, with health professionals assuming an extremely important role in this area, both from a pharmacological and non-pharmacological point of view, and also ensuring the monitoring of the progress of these measures. Diabetes is a chronic disease that requires a high self-management capacity on the part of patients in order to achieve success in treating the disease, and non-adherence to therapy or non-compliance with the previously defined plan, together with an erratic lifestyle, will contribute to failure in controlling the disease. The lower adherence to pharmacological and non-pharmacological treatment in diabetes is mainly correlated to socio-economic aspects, lower health literacy, the side effects associated with the use of antidiabetic therapy or even the concomitant use of several drugs. This article consists of a narrative review that aims to synthesize the findings published in the literature, retrieved by searching databases, manuals, previously published scientific articles and official texts, following the methodology of the Scale for Assessment of Narrative Review Articles (SANRA). We aim to address the importance of behavioral sciences in the treatment of diabetes, in order to assess behavior factors and barriers for behavior changes that have an impact on the therapeutic and non-therapeutic optimization in patients with type 2 diabetes mellitus control.
Collapse
Affiliation(s)
- António Lopes
- Pharmaceutical Services of Unity Local of Health of Guarda (ULS da Guarda), 6300-035 Guarda, Portugal; (A.L.); (C.D.)
- Health Sciences Faculty, University of Beira Interior (FCS-UBI), 6200-506 Covilhã, Portugal;
| | - Fátima Roque
- Research Unit for Inland Development, Polytechnic Institute of Guarda (UDI-IPG), 6300-559 Guarda, Portugal
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal
- Correspondence:
| | - Sandra Morgado
- Pharmaceutical Services of University Hospital Center of Cova da Beira, 6200-251 Covilhã, Portugal;
| | - Cristina Dinis
- Pharmaceutical Services of Unity Local of Health of Guarda (ULS da Guarda), 6300-035 Guarda, Portugal; (A.L.); (C.D.)
| | - Maria Teresa Herdeiro
- Institute of Biomedicine, Department of Medical Sciences (iBiMED-UA), University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Manuel Morgado
- Health Sciences Faculty, University of Beira Interior (FCS-UBI), 6200-506 Covilhã, Portugal;
- Research Unit for Inland Development, Polytechnic Institute of Guarda (UDI-IPG), 6300-559 Guarda, Portugal
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal
- Pharmaceutical Services of University Hospital Center of Cova da Beira, 6200-251 Covilhã, Portugal;
| |
Collapse
|
53
|
The Role of the Physical Environment in Shaping Interruptions and Disruptions in Complex Health Care Settings: A Scoping Review. Am J Med Qual 2021; 36:449-458. [PMID: 34714780 DOI: 10.1097/jmq.0000000000000005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Interruptions and disruptions in complex healthcare environments, such as trauma rooms, can lead to compromised workflow and safety issues due to the physical environment's characteristics. This scoping review investigated the impact of the physical environment on interruptions and disruptions and the associated outcomes in complex environments, as they relate to the components of the Systems Engineering Initiative for Patient Safety. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to conduct the scoping review. CINAHL, Web of Science, and PubMed databases were searched. After removing duplicates and eligibility screening, quality assessment was conducted using the Mixed Methods Appraisal Tool (MMAT). Of 1,158 articles found, 20 were selected. Poor layout configurations, tripping hazards, and technology integration were common examples. More research must be conducted to unveil the impact of the physical environment on interruptions and disruptions.
Collapse
|
54
|
Jones BL, Cheng C, Foglia LM, Ricciotti H, El-Amin WW. Promoting Culture Change Within Organizations. Pediatrics 2021; 148:e2021051440F. [PMID: 34470881 DOI: 10.1542/peds.2021-051440f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 01/13/2023] Open
Affiliation(s)
- Bridgette L Jones
- Department of Pediatrics, School of Medicine, University of Missouri-Kansas City and Children's Mercy, Kansas City, Missouri
| | - Catherine Cheng
- Department of Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lisa M Foglia
- Department of Graduate Medical Education, Womack Army Medical Center, Fayetteville, North Carolina
| | - Hope Ricciotti
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University
| | - Wendi Willis El-Amin
- Department of Family Medicine and Medical Education, Southern Illinois University School of Medicine, Springfield, Illinois
| |
Collapse
|
55
|
Safi-Keykaleh M, Khorasani-Zavareh D, Ghomian Z, Nateghinia S, Safarpour H, Mohammadi R. Barriers and requirements in the off-line emergency medical protocols implementation in Iranian Pre-hospital system: A qualitative study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:312. [PMID: 34667812 PMCID: PMC8459878 DOI: 10.4103/jehp.jehp_1566_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/04/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND To avoid making decisions based on the unproven opinions of emergency medical technicians (EMTs), many emergency medical service (EMS) systems rely on emergency medical protocols. As protocol-based on-scene decision-making is influenced by many challenges, identifying these challenges can result in providing appropriate conditions for EMTs' decision-making. Therefore, this study aimed to identify the barriers and requirements in the off-line emergency medical protocols implementation m in the prehospital emergency medical system. MATERIALS AND METHODS To conduct this study, qualitative content analysis using 10 field observations, 22 interviews, and 2 rounds of focus group discussions was applied. The duration of interviews lasted from October 2019 to January 2020. The Graneheim and Lundman approach was used to analyze the data. RESULTS Seven categories (15 subcategories) including education and awareness (professional training and education and community-based education); attitudes (professional attitude and community attitude); interactions and coordination (interpersonal interactions, organizational interferences, and community's interactions); rules and instructions (instructions and supportive rules); control system (monitoring and evaluation and motivational system); accessibility (recourses and communication); and organization (structure and process) were obtained as the obstacles and challenges in the offline emergency medical protocol implementation in the prehospital system. CONCLUSIONS There are many challenges in implementing offline emergency medical protocols in the prehospital emergency system. To achieve the effectiveness and efficiency of offline prehospital emergency protocols, it is necessary to facilitate these challenges and improve the EMTs' knowledge, attitude, and performance through cooperative and skill-based education. The findings of this study can be useful for EMS systems from national to local levels.
Collapse
Affiliation(s)
- Meysam Safi-Keykaleh
- Department of Nursing, Nahavand School of Allied Medical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Davoud Khorasani-Zavareh
- Professor in Workplace Health Promotion Research Center (WHPRC), Department of Health in Emergencies and Disasters, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zohreh Ghomian
- Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeideh Nateghinia
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Safarpour
- Department of Nursing, School of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran
| | - Reza Mohammadi
- Department of Neurobiology, Care Sciences and Society (NVS), H1, Division of Family Medicine and Primary Care, Huddinge, Sweden
| |
Collapse
|
56
|
Bierman AS, Wang J, O'Malley PG, Moss DK. Transforming care for people with multiple chronic conditions: Agency for Healthcare Research and Quality's research agenda. Health Serv Res 2021; 56 Suppl 1:973-979. [PMID: 34378192 PMCID: PMC8515222 DOI: 10.1111/1475-6773.13863] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Arlene S Bierman
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland, USA
| | - Jing Wang
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland, USA.,Florida State University College of Nursing, Tallahassee, Florida, USA.,Health and Aging Policy Fellows Program, Columbia University, New York, New York, USA
| | - Patrick G O'Malley
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland, USA
| | - Dina K Moss
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland, USA
| |
Collapse
|
57
|
Reigada C, Centeno C, Gonçalves E, Arantzamendi M. Palliative Care Professionals' Message to Others: An Ethnographic Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105348. [PMID: 34067892 PMCID: PMC8156736 DOI: 10.3390/ijerph18105348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/14/2021] [Accepted: 05/16/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Palliative care continues to be misunderstood within the world of healthcare. Palliative care professionals are key agents for promoting a greater understanding of their field. This study aims to examine the messages, both implicit and explicit, that palliative care professionals transmit about themselves and their work within their teams and to other health professionals. METHODS Focused ethnographic secondary analysis, exploring the interactions of palliative care professionals as it happens at everyday work. An inductive thematic analysis was developed from 242 h of observation of the daily work practices of palliative care professionals, focusing on their interactions with others. The data was coded without predefined categories, and the analysis was performed independently by two researchers. RESULTS Palliative professionals communicate that they are part of an active team working in an organized manner. They value and feel proud of their work. Despite the intensity of their work, these professionals are always available to others, to whom they demonstrate a clear professional identity. They convey their expertise in alleviating suffering, respectful behavior and collaborative ability. CONCLUSION Professionals, in their daily work, communicate through their messages the essence of palliative care. It is essential that palliative care professionals perceive themselves as potential influencers and explicitly transmit the reasons for their intervention. Otherwise, others will perpetuate the myths, misunderstandings, and lack of a positive reputation for palliative care.
Collapse
Affiliation(s)
- Carla Reigada
- ATLANTES Research Group, Institute for Culture and Society, University of Navarra, 31009 Pamplona, Spain; (C.C.); (M.A.)
- Health Research Institute of Navarra (IdiSNA), 31009 Pamplona, Spain
- Correspondence:
| | - Carlos Centeno
- ATLANTES Research Group, Institute for Culture and Society, University of Navarra, 31009 Pamplona, Spain; (C.C.); (M.A.)
- Health Research Institute of Navarra (IdiSNA), 31009 Pamplona, Spain
- Palliative Medicine Department, Clínica Universidad de Navarra, 31009 Pamplona, Spain
| | - Edna Gonçalves
- Palliative Care Service, Centro Hospitalar Universitário de São João, E.P.E., 4200-319 Porto, Portugal;
| | - Maria Arantzamendi
- ATLANTES Research Group, Institute for Culture and Society, University of Navarra, 31009 Pamplona, Spain; (C.C.); (M.A.)
- Health Research Institute of Navarra (IdiSNA), 31009 Pamplona, Spain
| |
Collapse
|
58
|
Austin EJ, Blacker A, Kalia I. "Watching the tsunami come": A case study of female healthcare provider experiences during the COVID-19 pandemic. Appl Psychol Health Well Being 2021; 13:781-797. [PMID: 33929103 PMCID: PMC8239839 DOI: 10.1111/aphw.12269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/14/2021] [Indexed: 11/30/2022]
Abstract
As health systems rapidly respond to COVID‐19, it is unclear how these changes influence the experiences and well‐being of female healthcare providers (FHCPs), including the potential for FHCPs to develop compassion fatigue and secondary traumatic stress. We conducted qualitative interviews (n = 15) with FHCPs at three locations (Washington, California, and New York). Interviews explored FHCP's perspectives on how care delivery changed, processes of information delivery and decision‐making, gender inclusion, and approaches to managing stress and well‐being. An inductive coding process was used to generate themes. FHCPs described significant changes to the way they delivered care, and their work environments, during the COVID‐19 pandemic. Five themes emerged that characterized the experiences of FHCPs during COVID‐19, including conflicting feelings while providing care, managing information and decisions, balancing roles, coping and well‐being, and considerations for moving forward. FHCPs experienced many impacts to their professional and personal lives during COVID‐19 that further complicated their ability to manage stress and well‐being. The themes identified through this work offer important lessons about how to support the well‐being of FHCPs and signify the widespread potential for compassion fatigue among FHCPs as a result of COVID‐19.
Collapse
Affiliation(s)
| | | | - Isha Kalia
- Department of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| |
Collapse
|
59
|
Sampaio JRF, Vidal SA, de Goes PSA, Bandeira PFR, Cabral Filho JE. Sociodemographic, Behavioral and Oral Health Factors in Maternal and Child Health: An Interventional and Associative Study from the Network Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083895. [PMID: 33917677 PMCID: PMC8067955 DOI: 10.3390/ijerph18083895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/04/2021] [Accepted: 04/05/2021] [Indexed: 01/10/2023]
Abstract
Oral healthcare during pregnancy needs to be part of the assistance routine given to pregnant women by health professionals as a way to encourage self-care and strengthen the general health of the mother and the baby. The aim of this study was to evaluate the effectiveness of an integrated oral healthcare intervention for pregnant women and to analyze the association of sociodemographic, behavioral, oral health and general maternal and child health factors in prenatal care at usual risk in primary care in a city in the northeast of Brazil, in 2018–2019. A controlled, randomized, single-blinded community trial was conducted. The intervention group (IG) received dental assistance and collective health education actions in conversation circles, while the control group (CG) received the usual assistance. All pregnant women (146 in total, 58 from IG and 88 from CG) that took part in the trial answered a questionnaire and underwent a dental examination at the beginning of prenatal care and at the puerperal visit. To assess the effect of the intervention, a network analysis was used. The results have shown that being in the control group was associated with neonatal complications (0.89) and prematurity (0.54); the use of tobacco and alcohol are associated with high risk in initial and final oral health; lower educational level of the pregnant women implicates high risk for initial oral health (−0.19), final oral health (−0.26), pregnancy complications (−0.13), low birth weight (−0.23), prematurity (−0.19) and complications in the newborn (−0.14). Having a low family income (≤261.36 USD) has shown a high risk for initial oral health (−0.14), final oral health (−0.20) and prematurity (−0.15). The intervention based on integrated oral healthcare for pregnant women indicated that socioeconomic and behavioral factors must be considered as determinants for the quality of women and children’s health and that multi-professional performance during prenatal care contributes to the positive outcomes of pregnancy.
Collapse
Affiliation(s)
| | - Suely Arruda Vidal
- Study Group on Health Management and Evaluation at IMIP/Pernambuco, Institute of Integral Medicine Fernando Figueira—IMIP, Recife, PE 50070-550, Brazil;
- Post-Graduation Stricto Sensu, Institute of Integral Medicine Professor Fernan-do Figueira—IMIP, Recife, PE 50070-550, Brazil;
| | - Paulo Savio Angeiras de Goes
- Child and Adolescent Health Program, Department of Clinic and Preventive Dentistry, Federal University of Pernambuco—UFPE, Recife, PE 50670-901, Brazil;
| | - Paulo Felipe R. Bandeira
- Center for Biological and Health Sciences, Regional University of Cariri-URCA/Ceará, Northeastern Family Health Training Network—RENASF, Crato, CE 63105-000, Brazil;
| | - José Eulálio Cabral Filho
- Post-Graduation Stricto Sensu, Institute of Integral Medicine Professor Fernan-do Figueira—IMIP, Recife, PE 50070-550, Brazil;
- Brazilian Journal of Maternal and Child Health of IMIP, Recife, PE 50070-550, Brazil
| |
Collapse
|
60
|
Lucrezia S, Noether J, Sochet AA. Standardized Work Rounds Enhance Teaming, Comprehensiveness, Shared Mental Model Development, and Achievement Rate of End-of-Shift Goals. Pediatr Crit Care Med 2021; 22:354-364. [PMID: 33258573 DOI: 10.1097/pcc.0000000000002609] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine the impact of standardized PICU work rounds on the frequency of ideal teaming behaviors, rounds comprehensiveness, shared mental model index development, and rate of completed end-of-shift goals. DESIGN A single-center, pre-post, prospective cohort study. SETTING A 259-bed, quaternary, pediatric referral center. PATIENTS Children 0-18 years old from November 2018 to January 2020. INTERVENTIONS Standardized, bedside, nurse-led PICU work rounds, emphasizing ideal teaming behaviors using a collaboratively developed rounding script and quality/safety checklist. MEASUREMENTS AND MAIN RESULTS Study data were collected by direct observation and immediate postrounds participant questionnaire data. Primary outcomes were frequency of observed ideal teaming behaviors, rounds comprehensiveness, efficiency (rounds content divided by duration), shared mental model index (congruence among rounds participants regarding key healthcare data and planning), rounds face validity, and achievement rate of rounds-established, end-of-shift goals. During study, 154 encounters were observed (50 preintervention, 52 after Plan-Do-Study-Act cycle 1, and 52 after Plan-Do-Study-Act cycle 2). We observed improvements in overall shared mental model index (24-87%), rounds comprehensiveness (72-98%), and ideal teaming behaviors (including closed-loop communication: 82-100%; responsibility delegation: 74-100%; interdependence behaviors: 26-98%, all p < 0.01) by the end of study. Nursing presentations accounted for 3.6 ± 1.5 minutes of rounds and rounds duration was unchanged postintervention (11 ± 5 min preintervention and 11 ± 4 min after Plan-Do-Study-Act cycle 2, p > 0.99). Face validity, assessed using questionnaire data from 953 participants, revealed positive attitudes regarding efficiency, clarity, and participant self-value. Greatest enhancements in self-value were noted among advanced practice providers and respiratory therapists. On exploratory modeling, we noted associations between ideal teaming behaviors, rounds comprehensiveness, and shared mental model index. Similarly, we noted a positive association between the shared mental model index and the rate of achieved rounds-established, end-of-shift goals (odds ratio, 8.9; 95% CI, 1.7-46; p < 0.01). CONCLUSIONS Standardization of PICU work rounds may encourage ideal teaming behaviors, enhance rounds comprehensiveness, strengthen the congruence of participant shared mental model, and affect the rate of achieved goals established during rounds without compromising workplace efficiency.
Collapse
Affiliation(s)
- Samantha Lucrezia
- Department of Graduate Medical Education, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Julia Noether
- Division of Pediatric Critical Care Medicine, Department of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Anthony A Sochet
- Division of Pediatric Critical Care Medicine, Department of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
61
|
Grant M, de Graaf E, Teunissen S. A systematic review of classifications systems to determine complexity of patient care needs in palliative care. Palliat Med 2021; 35:636-650. [PMID: 33706600 PMCID: PMC8022082 DOI: 10.1177/0269216321996983] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Providing the right care for each individual patient is a key element of quality palliative care. Complexity is a relatively new concept, defined as the nature of patients' situations and the extent of resulting needs. Classifying patients according to the complexity of their care needs can guide integration of services, anticipatory discussions, health service planning, resource management and determination of needs for specialist or general palliative care. However, there is no consistent approach to interpreting and classifying complexity of patient needs. AIM The aim of this article is to identify and describe classification systems for complexity of patient care needs in palliative care. DESIGN Narrative systematic review (PROSPERO registration number CRD42020182102). DATA SOURCES MEDLINE, Embase, CINAHL and PsychINFO databases were searched without time limitations. Articles were included that described classification systems for complexity of care requirements in populations with palliative care needs. RESULTS In total, 4301 records were screened, with nine articles identified reporting the use of patient classification systems in populations with palliative care needs. These articles included the use of six classification systems: HexCom, Perroca Scale, AN-SNAP, Hui Major Criteria, IDC-Pal and PALCOM. These systems were heterogenous in the manner they determined complexity of care needs. The HexCom and IDC-Pal systems contained items that covered all domains of complexity as described by Hodiamont; personal, social support, health care team and environment. CONCLUSION Although six classification systems have been developed, they access differing aspects of care needs and their application has been limited. The HexCOM and IDC-Pal systems offer the broadest determinations of complexity from an individual perspective. Further research is needed to apply these systems to populations external to those in which they were developed, and to appreciate how they may integrate with, and impact, clinical care.
Collapse
Affiliation(s)
- Matthew Grant
- Centre of Expertise Palliative Care Utrecht, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, the Netherlands.,Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, VIC, Australia
| | - Everlien de Graaf
- Centre of Expertise Palliative Care Utrecht, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, the Netherlands
| | - Saskia Teunissen
- Centre of Expertise Palliative Care Utrecht, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, the Netherlands
| |
Collapse
|
62
|
Byerly LK, Floren LC, Yukawa M, O'Brien BC. Getting outside the box: exploring role fluidity in interprofessional student groups through the lens of activity theory. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:253-275. [PMID: 32705403 DOI: 10.1007/s10459-020-09983-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 07/13/2020] [Indexed: 05/15/2023]
Abstract
Health professionals' roles and scopes often overlap, creating a need for role clarity in interprofessional teamwork. Yet, such clarity does not mean roles are fixed within teams and some literature suggests role flexibility can enhance team functioning. Interprofessional practice competencies and learning activities often emphasize knowledge and definition of roles, but rarely attend to the dynamic nature of roles and influential contextual factors. This study explores role fluidity in interprofessional student groups using an activity theory framework. Using a collective instrumental case study approach, the authors examine the fluidity of one physical therapy (PT) student's role within 3 different interprofessional (medical, pharmacy, PT) student groups completing nursing home patient care plans. Field notes, group debriefing interviews, and care plans were collected and coded from all care planning sessions. Codes mapped to group-specific activity systems that compared role-influencing interactions and tensions. The PT student's role fluidity varied in each group's activity system, influenced primarily by system tensions from implicit rules (e.g., encouraging questions), division of labor (e.g., rigid profession-based task assignment), and tool use (e.g., computers). Attention to modifiable system elements, such as tool use and explicit rules of inclusivity, could foster role fluidity and improve interprofessional teamwork and learning environments.
Collapse
Affiliation(s)
- Laura K Byerly
- Division of General Internal Medicine and Geriatrics, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L-475, Portland, OR, 97239, USA.
| | - Leslie C Floren
- School of Pharmacy, University of California San Francisco, San Francisco, CA, USA
| | - Michi Yukawa
- Division of Geriatrics, University of California San Francisco, San Francisco, CA, USA
| | - Bridget C O'Brien
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
63
|
Achieving Clostridioides difficile infection Health and Human Services 2020 goals: Using agile implementation to bring evidence to the bedside. Infect Control Hosp Epidemiol 2021; 41:237-239. [PMID: 31801642 DOI: 10.1017/ice.2019.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
64
|
Suresh M, Roobaswathiny A, Lakshmi Priyadarsini S. A study on the factors that influence the agility of COVID-19 hospitals. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2021. [DOI: 10.1080/20479700.2020.1870355] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- M. Suresh
- Amrita School of Business, Amrita Vishwa Vidyapeetham, Coimbatore, India
| | - A. Roobaswathiny
- Amrita School of Business, Amrita Vishwa Vidyapeetham, Coimbatore, India
| | - S. Lakshmi Priyadarsini
- Department of Zoology, Government Victoria College, Palakkad, University of Calicut, Palakkad, India
| |
Collapse
|
65
|
Noce LGDA, Oliveira TSD, Melo LC, Silva KFB, Parreira BDM, Goulart BF. Interprofessional relationships of a patient assistance team in critical care. Rev Bras Enferm 2020; 73:e20190420. [PMID: 32609179 DOI: 10.1590/0034-7167-2019-0420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/16/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to identify perceptions of teamwork according to the professionals of an Adult Intensive Care Unit. METHODS descriptive research with qualitative approach. The methodological framework was thematic content analysis. The theoretical framework of the work process was used to guide the interpretation of the data. Data collection: A semi-structured interview was conducted with 38 professionals in a public teaching hospital in the state of Minas Gerais. Results: three thematic categories emerged from the interviews: Work Organization, which is related to work performed through tasks/routines, with or without coordinated actions; Non-material Work Instruments, which reveal that teamwork is based on communication/collaboration; Insufficient Material Resources, which indicate that lack of material creates conflicts between professionals. CONCLUSIONS Teamwork requires effective communication and collaboration, integrated work and appropriate professional training. On the other hand, fragmentation and rigidity at work, poor collaboration/communication and lack of material make teamwork difficult. We emphasize the need to revise the curriculum of health courses, with a view to including and/or improving discussions about teamwork in order to train professionals for a more integrated and perhaps even sympathetic health practice.
Collapse
|
66
|
Reigada C, Arantzamendi M, Centeno C. Palliative care in its own discourse: a focused ethnography of professional messaging in palliative care. BMC Palliat Care 2020; 19:88. [PMID: 32571288 PMCID: PMC7310281 DOI: 10.1186/s12904-020-00582-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 05/20/2020] [Indexed: 11/19/2022] Open
Abstract
Background Despite 50 years of modern palliative care (PC), a misunderstanding of its purpose persists. The original message that PC is focused on total care, helping to live until the person dies, is being replaced and linked to feelings of fear, anxiety and death, instead of compassion, support or appropriate care. Society is still afraid to speak its name, and specialized units are identified as “places of death” as opposed to “places of life” meant to treat suffering. This issue is prohibitive to the implementation and development of PC policies worldwide. It is imperative to identify what message PC professionals are relaying to patients and other health care specialists and how that message may condition understandings of the right to access PC. Methods A qualitative study, employing focused ethnography and participant observation (PO) of the daily interaction of PC professionals with patients and family members in three different PC services. Two researchers independently conducted a thematic analysis, followed by member checking with participants. Results A total of 242 h of participant observation revealed the following messages sent by PC professionals in their daily interaction with patients and families: i) We are focused on your wellbeing; ii) You matter: we want to get to know you; iii) Your family is important to us. Conclusion The complexity of PC discourses contributes to the difficulty of identifying a clear universal message between PC professionals, patients and families. The PC professionals observed transmit a simple message focused on their actions rather than their identity, which may perpetuate some social/cultural misunderstandings of PC. It seems there is a common culture, based on the same values and attitudes, within the messages that PC professionals transmit to patients and their families. PC teams are characterised by their availability.
Collapse
Affiliation(s)
- Carla Reigada
- ATLANTES Research Group; Institute for Culture and Society, University of Navarra, Campus Universitario, 31009, Pamplona, Spain. .,Health Research Intitute of Navarra (IdiSNA), Pamplona, Spain.
| | - Maria Arantzamendi
- ATLANTES Research Group; Institute for Culture and Society, University of Navarra, Campus Universitario, 31009, Pamplona, Spain.,Health Research Intitute of Navarra (IdiSNA), Pamplona, Spain
| | - Carlos Centeno
- ATLANTES Research Group; Institute for Culture and Society, University of Navarra, Campus Universitario, 31009, Pamplona, Spain.,Health Research Intitute of Navarra (IdiSNA), Pamplona, Spain.,Palliative Medicine Department, Clinica Universidad de Navarra, Pamplona, Spain
| |
Collapse
|
67
|
Glover WJ, Nissinboim N, Naveh E. Examining innovation in hospital units: a complex adaptive systems approach. BMC Health Serv Res 2020; 20:554. [PMID: 32552869 PMCID: PMC7302354 DOI: 10.1186/s12913-020-05403-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We are in an innovation age for healthcare delivery. Some note that the complexity of healthcare delivery may make innovation in this setting more difficult and may require more adaptive solutions. The aim of this study is to examine the relationship between unit complexity and innovation, using a complex adaptive systems approach in a hospital setting. METHODS We conducted a quantitative study of 31 hospital units within one hospital and use complex adaptive systems (CAS) theory to examine how two CAS factors, autonomy and performance orientation, moderate the relationship between unit complexity and innovation. RESULTS We find that unit complexity is associated with higher innovation performance when autonomy is low rather than high. We also find that unit complexity is associated with higher innovation performance when performance orientation is high rather than low. Our findings make three distinct contributions: we quantify the influence of complexity on innovation success in the health care sector, we examine the impact of autonomy on innovation in health care, and we are the first to examine performance orientation on innovation in health care. CONCLUSIONS This study tackles the long debate about the influence of complexity on healthcare delivery, particularly innovation. Instead of being subject to the influence of complexity with no means of making progress or gaining control, hospitals looking to implement innovation programs should provide guidance to teams and departments regarding the type of innovation sought and provide support in terms of time and management commitment. Hospitals should also find ways to promote and make successful pilot implementations of such innovations visible in the organization. A close connection between the targeted innovation and the overall success and performance of the hospital unit is ideal.
Collapse
Affiliation(s)
- Wiljeana Jackson Glover
- Technology, Operations, and Information Management Division, Babson College, Babson Park, Wellesley, MA, 02457, USA.
| | - Noa Nissinboim
- Industrial Engineering and Management, Technion - Israel Institute of Technology, Haifa, Israel
| | - Eitan Naveh
- Industrial Engineering and Management, Technion - Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
68
|
Burrows KE, Abelson J, Miller PA, Levine M, Vanstone M. Understanding health professional role integration in complex adaptive systems: a multiple-case study of physician assistants in Ontario, Canada. BMC Health Serv Res 2020; 20:365. [PMID: 32349738 PMCID: PMC7189743 DOI: 10.1186/s12913-020-05087-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 03/09/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To meet the complex needs of healthcare delivery, the Ministry of Health and Long Term Care (MOHLTC) introduced Physician Assistants (PAs) into the Ontario health care system in 2006 with the goal of helping to increase access to care, decrease wait times, improve continuity of care and provide a flexible addition to the healthcare workforce. The characterization of healthcare organizations as complex adaptive systems (CAS) may offer insight into the relationships and interactions that optimize and restrict successful PA integration. The aim of this study is to explore the integration of PAs across multiple case settings and to understand the role of PAs within complex adaptive systems. METHODS An exploratory, multiple-case study was used to examine PA role integration in four settings: family medicine, emergency medicine, general surgery, and inpatient medicine. Interviews were conducted with 46 healthcare providers and administrators across 13 hospitals and 6 family medicine clinics in Ontario, Canada. Analysis was conducted in three phases including an inductive thematic analysis within each of the four cases, a cross-case thematic analysis, and a broader, deductive exploration of cross-case patterns pertaining to specific complexity theory principles of interest. RESULTS Forty-six health care providers were interviewed across 19 different healthcare sites. Support for PA contributions across various health care settings, the importance of role awareness, supervisory relationship attributes, and role vulnerability are interconnected and dynamic. Findings represent the experiences of PAs and other healthcare providers, and demonstrate how the PAs willingness to work and ability to build relationships allows for the establishment of interprofessional, collaborative, and person-centered care. As a self-organizing agent in complex adaptive systems (i.e., health organizations), PA role exploration revealed patterns of team behavior, non-linear interconnections, open relationships, dynamic systems, and the legacy of role implementation as defined by complexity theory. CONCLUSIONS By exploring the role of PAs across multiple sites, the complexity theory lens concurrently fosters an awareness of emerging patterns, relationships and non-linear interactions within the defined context of the Ontario healthcare system. By establishing collaborative, interprofessional care models in hospital and community settings, PAs are making a significant contribution to Ontario healthcare settings.
Collapse
Affiliation(s)
- Kristen E Burrows
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
- Michael G. DeGroote School of Medicine, Physician Assistant Education Program, McMaster University, Hamilton, Ontario, Canada.
| | - Julia Abelson
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Patricia A Miller
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Mitchell Levine
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
69
|
Olsson A, Thunborg C, Björkman A, Blom A, Sjöberg F, Salzmann-Erikson M. A scoping review of complexity science in nursing. J Adv Nurs 2020. [PMID: 32281684 DOI: 10.1111/jan.14382] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/03/2020] [Accepted: 03/25/2020] [Indexed: 11/26/2022]
Abstract
AIM To describe how complexity science has been integrated into nursing. DESIGN A scoping review. DATA SOURCE/REVIEW METHOD Academic Search Elite, Scopus, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, PubMed and Web of Science were searched November 2016, updated in October 2017 and January 2020. The working process included: problem identification, literature search, data evaluation, synthesizing and presentation. RESULTS Four categories were found in the included 89 articles: (a) how complexity science is integrated into the nursing literature in relation to nursing education and teaching; (b) patients' symptoms, illness outcome and safety as characteristics of complexity science in nursing; (c) that leaders and managers should see organizations as complex and adaptive systems, rather than as linear machines; and (d) the need for a novel approach to studying complex phenomena such as healthcare organizations. Lastly, the literature explains how complexity science has been incorporated into the discourse in nursing and its development. CONCLUSION The review provided strong support for use in complexity science in the contemporary nursing literature. Complexity science is also highly applicable and relevant to clinical nursing practice and nursing management from an organizational perspective. The application of complexity science as a tool in the analysis of complex nursing systems could improve our understanding of effective interactions among patients, families, physicians and hospital and skilled nursing facility staff as well as of education. IMPACT Understanding complexity science in relation to the key role of nurses in the healthcare environment can improve nursing work and nursing theory development. The use of complexity science provides nurses with a language that liberates them from the reductionist view on nursing education, practice and management.
Collapse
Affiliation(s)
- Annakarin Olsson
- Faculty of Health and Occupational Studies, Department of Caring Science, University of Gävle, Gävle, Sweden
| | - Charlotta Thunborg
- Department of Neurobiology, Care Sciences and Society, Division of Clinical geriatrics, Karolinska Institutet, Stockholm, Sweden.,School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Annica Björkman
- Faculty of Health and Occupational Studies, Department of Caring Science, University of Gävle, Gävle, Sweden.,Health Services Research, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Anneli Blom
- Centre for Clinical Research, Västmanland County Hospital, Västerås, Sweden
| | - Fredric Sjöberg
- Unit of Anaesthesiology and Intensive Care, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Martin Salzmann-Erikson
- Faculty of Health and Occupational Studies, Department of Caring Science, University of Gävle, Gävle, Sweden
| |
Collapse
|
70
|
Silverio SA, Cope LC, Bracken L, Bellis J, Peak M, Kaehne A. The implementation of a Technician Enhanced Administration of Medications [TEAM] model: An evaluative study of impact on working practices in a children's hospital. Res Social Adm Pharm 2020; 16:1768-1774. [PMID: 32035869 DOI: 10.1016/j.sapharm.2020.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/20/2020] [Accepted: 01/26/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Children are frequently prescribed unlicensed and off-label medicines meaning dosing and administration of medicines to children is often based on poor quality guidance. In UK hospitals, nursing staff are often responsible for administering medications. Medication Errors [MEs] are problematic for health services, though are poorly reported and therefore difficult to quantify with confidence. In the UK, children's medicines require administration by at least two members of ward staff, known as a 'second check' system, thought to reduce Medication Administration Errors [MAEs]. OBJECTIVES To assess the impact on working practices of the introduction of a new way of working, using Technician Enhanced Administration of Medications [TEAM] on two specialist wards within a children's' hospital. To evidence any potential impact of a TEAM ward-based pharmacy technician [PhT] on the reporting of MEs. METHODS A TEAM PhT was employed on two wards within the children's hospital and trained in medicines administration. Firstly, an observational pre-and-post cohort design was used to identify the effect of TEAM on MEs. We analysed the hospital's official reporting system for incidents and 'near misses', as well as the personal incident log of the TEAM PhT. Secondly, after implementation, we interviewed staff about their perceptions of TEAM and its impact on working practices. RESULTS We affirm MEs are considerably under-reported in hospital settings, but TEAM PhTs can readily identify them. Further, placing TEAM PhTs on wards may create opportunities for inter-professional knowledge exchange and increase nurses' awareness of potential MAEs, although this requires facilitation. CONCLUSIONS TEAM PhT roles may be beneficial for pharmacy technicians' motivation, job satisfaction, and career development. Hospitals will need to consider the balance between resources invested in TEAM PhTs and the level of impact on reporting MEs. Health economic analyses could provide evidence to fully endorse integration of TEAM PhTs for all hospital settings.
Collapse
Affiliation(s)
- Sergio A Silverio
- Department of Women & Children's Health, King's College London, London, UK; Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK; Department of Psychological Sciences, University of Liverpool, Liverpool, UK.
| | - Louise C Cope
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK
| | - Louise Bracken
- Paediatric Medicines Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Jennifer Bellis
- Pharmacy Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Matthew Peak
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK; Paediatric Medicines Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Axel Kaehne
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK
| |
Collapse
|
71
|
|
72
|
Sarli L, D'Apice C, Rossi S, Artioli G. Interprofessionalism and interprofessional research: a challenge still to be won in Italy. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:5-7. [PMID: 31714495 PMCID: PMC7233633 DOI: 10.23750/abm.v90i11-s.8947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 10/17/2019] [Indexed: 11/23/2022]
Abstract
Public health and pedagogical institutions have long been calling for collaborative models of assistance and training that provide inter-professional synergy and there is a broad international consensus on the importance of inter-professionalism in the field of assessment and healthcare provision (1-10). [...].
Collapse
|
73
|
Cristancho SM, Taylor T. The agility of ants: lessons for grappling with complexity in health care teamwork. MEDICAL EDUCATION 2019; 53:855-857. [PMID: 31414517 DOI: 10.1111/medu.13937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Sayra M Cristancho
- Faculty of Education, Department of Surgery, Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Taryn Taylor
- Department of Obstetrics and Gynecology, Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| |
Collapse
|
74
|
Opsomer S, Pype P, Lauwerier E, De Lepeleire J. Resilience in middle-aged partners of patients diagnosed with incurable cancer: A thematic analysis. PLoS One 2019; 14:e0221096. [PMID: 31412074 PMCID: PMC6693771 DOI: 10.1371/journal.pone.0221096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 07/30/2019] [Indexed: 01/04/2023] Open
Abstract
Background Providing care for patients with advanced cancer is often the responsibility of the partner. Being confronted with an incurable cancer diagnosis can be highly disruptive for the patient’s partner and can be considered a potentially traumatic event. However, most caregivers seem to adapt well during the process of providing care. This finding is in line with the concept of resilience in literature: a dynamic process of adapting well, resulting from the interplay between intrinsic and extrinsic resources and risks. Resilience is age-related, with the elderly population being higher in resilience as compared to the younger generation. However, resilience has been understudied in middle-aged caregivers. Aim To explore what intrinsic and extrinsic resources facilitate or hamper resilience in the middle-aged partner of a patient with incurable cancer. Methods Nine middle-aged partners of patients who died at home of cancer were selected and interviewed in depth within the first year following the death of their partner. A thematic analysis utilizing an inductive approach was conducted. Findings Resilience was challenged by the partner’s diagnosis of incurable cancer. All participants made use of a set of interacting, caregiver-specific and context-related resources, facilitating a resilient process and leading to positive feelings and even personal growth. The partners demonstrated individual competences: adaptive flexibility, positivism, a sense of self-initiative and adaptive dependency. Furthermore, they relied on their context: cancer-related professionals and relatives. Context and situation interact continuously. The resulting dynamics were based on the context-availability, meaningful relationships and the patient’s role. Conclusion A resilient trajectory results from an interplay between individual and contextual resources. To build resilience in middle-aged partners of patients with incurable cancer, health care professionals should address all available resources. Moreover, they should be aware of being part of the caregiver’s context, a complex adaptive system that can be either resilience-supporting or -threatening.
Collapse
Affiliation(s)
- Sophie Opsomer
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Department of Public Health and Primary Care, UGent, Gent, Belgium
- * E-mail:
| | - Peter Pype
- Department of Public Health and Primary Care, UGent, Gent, Belgium
- End-of-life Care Research Group, VUB & UGent, Gent, Belgium
| | - Emelien Lauwerier
- Department of Public Health and Primary Care, UGent, Gent, Belgium
- Department of Experimental-Clinical and Health Psychology, UGent, Gent, Belgium
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| |
Collapse
|
75
|
O’Leary N, Boland P. Organization and system theories in interprofessional research: a scoping review. J Interprof Care 2019; 34:11-19. [DOI: 10.1080/13561820.2019.1632815] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Noreen O’Leary
- School of Allied Health, Faculty of Education & Health Sciences, University of Limerick, Limerick, Ireland
| | - Pauline Boland
- School of Allied Health, Faculty of Education & Health Sciences, University of Limerick, Limerick, Ireland
| |
Collapse
|
76
|
Van Houtven CH, Hastings SN, Colón-Emeric C. A Path To High-Quality Team-Based Care For People With Serious Illness. Health Aff (Millwood) 2019; 38:934-940. [DOI: 10.1377/hlthaff.2018.05486] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Courtney H. Van Houtven
- Courtney H. Van Houtven is a research scientist in the Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs (VA) Health Care System, and a professor in the Department of Population Health Sciences at the Duke University School of Medicine, in Durham, North Carolina
| | - S. Nicole Hastings
- S. Nicole Hastings is center director and a research scientist in the Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, and an associate professor of medicine and population health sciences and a senior fellow in the Center for the Study of Aging and Human Development at the Duke University School of Medicine
| | - Cathleen Colón-Emeric
- Cathleen Colón-Emeric is a research scientist in the Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, and in the Durham VA Geriatrics Research, Education, and Clinical Center; a professor of medicine and chief of the Division of Geriatrics in the Department of Medicine, Duke University; and a senior fellow in the Center for the Study of Aging and Human Development, Duke University School of Medicine
| |
Collapse
|
77
|
Hodiamont F, Jünger S, Leidl R, Maier BO, Schildmann E, Bausewein C. Understanding complexity - the palliative care situation as a complex adaptive system. BMC Health Serv Res 2019; 19:157. [PMID: 30866912 PMCID: PMC6417077 DOI: 10.1186/s12913-019-3961-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 02/20/2019] [Indexed: 12/30/2022] Open
Abstract
Background The concept of complexity is used in palliative care (PC) to describe the nature of patients’ situations and the extent of resulting needs and care demands. However, the term or concept is not clearly defined and operationalised with respect to its particular application in PC. As a complex problem, a care situation in PC is characterized by reciprocal, nonlinear relations and uncertainties. Dealing with complex problems necessitates problem-solving methods tailored to specific situations. The theory of complex adaptive systems (CAS) provides a framework for locating problems and solutions. This study aims to describe criteria contributing to complexity of PC situations from the professionals’ view and to develop a conceptual framework to improve understanding of the concept of “complexity” and related elements of a PC situation by locating the complex problem “PC situation” in a CAS. Methods Qualitative interview study with 42 semi-structured expert (clinical/economical/political) interviews. Data was analysed using the framework method. The thematic framework was developed inductively. Categories were reviewed, subsumed and connected considering CAS theory. Results The CAS of a PC situation consists of three subsystems: patient, social system, and team. Agents in the "system patient" are allocated to further subsystems on patient level: physical, psycho-spiritual, and socio-cultural. The "social system" and the "system team" are composed of social agents, who affect the CAS as carriers of characteristics, roles, and relationships. Environmental factors interact with the care situation from outside the system. Agents within subsystems and subsystems themselves interact on all hierarchical system levels and shape the system behaviour of a PC situation. Conclusions This paper provides a conceptual framework and comprehensive understanding of complexity in PC. The systemic view can help to understand and shape situations and dynamics of individual care situations; on higher hierarchical level, it can support an understanding and framework for the development of care structures and concepts. The framework provides a foundation for the development of a model to differentiate PC situations by complexity of patients and care needs. To enable an operationalisation and classification of complexity, relevant outcome measures mirroring the identified system elements should be identified and implemented in clinical practice. Electronic supplementary material The online version of this article (10.1186/s12913-019-3961-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Farina Hodiamont
- Department of Palliative Medicine, Munich University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Saskia Jünger
- Research Unit Ethics, University Hospital Cologne, Cologne, Germany.,Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health, University of Cologne, Cologne, Germany
| | - Reiner Leidl
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Munich, Germany.,Ludwig-Maximilians-Universitaet Munich, Munich School of Management, Institute of Health Economics and Health Care Management & Munich Centre of Health Sciences, Munich, Germany
| | - Bernd Oliver Maier
- St. Josephs-Hospital, Department of Palliative Medicine and Interdisciplinary Oncology, Wiesbaden, Germany
| | - Eva Schildmann
- Department of Palliative Medicine, Munich University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, Munich University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| |
Collapse
|
78
|
Brooke-Sumner C, Petersen-Williams P, Kruger J, Mahomed H, Myers B. 'Doing more with less': a qualitative investigation of perceptions of South African health service managers on implementation of health innovations. Health Policy Plan 2019; 34:132-140. [PMID: 30863845 PMCID: PMC6481285 DOI: 10.1093/heapol/czz017] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2019] [Indexed: 11/12/2022] Open
Abstract
Building resilience in health systems is an imperative for low- and middle- income countries. Health service managers' ability to implement health innovations may be a key aspect of resilience in primary healthcare facilities, promoting adaptability and functionality. This study investigated health service managers' perceptions and experiences of adopting health innovations. We aimed to identify perceptions of constraints to adoption and emergent behaviours in response to these constraints. A convenience sample of 34 facility, clinical service and sub-district level managers was invited to participate. Six did not respond and were not contactable. In-depth individual interviews in a private space at participants' place of work were conducted with 28 participants. Interviews were audio recorded and transcribed verbatim. NVivo 11 was used to store data and facilitate framework analysis. Study participants described constraints to innovation adoption including: staff lack of understanding of potential benefits; staff personalities, attitudes and behaviours which lead to resistance to change; high workload related to resource constraints and frequent policy changes inducing resistance to change; and suboptimal communication through health system structures. Managers reported employing various strategies to mitigate these constraints. These comprised (1) technical skills including participatory management skills, communication skills, community engagement skills and programme monitoring and evaluation skills, and (2) non-technical skills including role modelling positive attitudes, understanding staff personalities, influencing perceptions of innovations, influencing organizational climate and building trusting relationships. Managers have a vital role in the embedding of service innovations into routine practice. We present a framework of technical and non-technical skills that managers need to facilitate the adoption of health innovations. Future efforts to build managers' capacity to implement health innovations should target these competencies.
Collapse
Affiliation(s)
- Carrie Brooke-Sumner
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie Van Zijl Drive, Parow Valley, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - Petal Petersen-Williams
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie Van Zijl Drive, Parow Valley, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - James Kruger
- Western Cape Government: Health, Norton Rose House, 8 Riebeeck Street, Cape Town, South Africa and
| | - Hassan Mahomed
- Western Cape Government: Health, Norton Rose House, 8 Riebeeck Street, Cape Town, South Africa and
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, South Africa
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie Van Zijl Drive, Parow Valley, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| |
Collapse
|