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de Melo GA, Peixoto MGM, Mendonça MCA, Musetti MA, Serrano ALM, Ferreira LOG. Performance measurement of Brazilian federal university hospitals: an overview of the public health care services through principal component analysis. J Health Organ Manag 2024; ahead-of-print. [PMID: 38773727 DOI: 10.1108/jhom-05-2023-0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
PURPOSE This paper aimed to contextualize the process of public hospital providing services, based on the measurement of the performance of Federal University Hospitals (HUFs) of Brazil, using the technique of multivariate statistics of principal component analysis. DESIGN/METHODOLOGY/APPROACH This research presented a descriptive and quantitative character, as well as exploratory purpose and followed the inductive logic, being empirically structured in two stages, that is, the application of principal component analysis (PCA) in four healthcare performance dimensions; subsequently, the full reapplication of principal component analysis in the most highly correlated variables, in module, with the first three main components (PC1, PC2 and PC3). FINDINGS From the principal component analysis, considering mainly component I, with twice the explanatory power of the second (PC2) and third components (PC3), it was possible to evidence the efficient or inefficient behavior of the HUFs evaluated through the production of medical residency, by specialty area. Finally, it was observed that the formation of two groups composed of seven and eight hospitals, that is, Groups II and IV shows that these groups reflect similarities with respect to the scores and importance of the variables for both hospitals' groups. RESEARCH LIMITATIONS/IMPLICATIONS Among the main limitations it was observed that there was incomplete data for some HUFs, which made it impossible to search for information to explain and better contextualize certain aspects. More specifically, a limited number of hospitals with complete information were dealt with for 60% of SIMEC/REHUF performance indicators. PRACTICAL IMPLICATIONS The use of PCA multivariate technique was of great contribution to the contextualization of the performance and productivity of homogeneous and autonomous units represented by the hospitals. It was possible to generate a large quantity of information in order to contribute with assumptions to complement the decision-making processes in these organizations. SOCIAL IMPLICATIONS Development of public policies with emphasis on hospitals linked to teaching centers represented by university hospitals. This also involved the projection of improvements in the reach of the efficiency of the services of assistance to the public health, from the qualified formation of professionals, both to academy, as to clinical practice. ORIGINALITY/VALUE The originality of this paper for the scenarios of the Brazilian public health sector and academic area involved the application of a consolidated performance analysis technique, that is, PCA, obtaining a rich work in relation to the extensive exploitation of techniques to support decision-making processes. In addition, the sequence and the way in which the content, formed by object of study and techniques, has been organized, generates a particular scenario for the measurement of performance in hospital organizations.
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Affiliation(s)
| | | | | | | | | | - Lucas Oliveira Gomes Ferreira
- Department of Accounting and Actuarial Sciences, Faculty of Economics, Administration, Accounting and Public Policy Management, University of Brasília, Brasilia, Brazil
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Roey T, Hung DY, Rundall TG, Fournier PL, Zhong A, Shortell SM. Lean Performance Indicators and Facilitators of Outcomes in U.S. Public Hospitals. J Healthc Manag 2023; 68:325-341. [PMID: 37678825 DOI: 10.1097/jhm-d-22-00107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
GOAL This study investigated the association between Lean and performance outcomes in U.S. public hospitals. Public hospitals face substantial pressure to deliver high-quality care with limited resources. Lean-based management systems can provide these hospitals with alternative approaches to improve efficiency and effectiveness. Prior research shows that Lean can have positive impacts in hospitals ranging in ownership type, but more study is needed, specifically in publicly owned hospitals. METHODS We performed multivariable regressions using data from the 2017 National Survey of Lean/Transformational Performance Improvement. The data were linked to publicly available hospital performance data from the Agency for Healthcare Research and Quality and the Centers for Medicare & Medicaid Services. We examined 11 outcomes measuring financial performance, quality of care, and patient experience and their associations with Lean adoption. We also explored potential drivers of positive outcomes by examining Lean implementation in each hospital, measured as the number of units using Lean tools and practices; leader commitment to Lean principles; Lean training and education among physicians, nurses, and managers; and use of a daily management system among C-suite leaders and managers. PRINCIPAL FINDINGS Lean adoption and implementation were associated with improved performance in U.S. public hospitals. Compared with hospitals that did not adopt Lean, those that did had significantly lower adjusted inpatient expenses per discharge and higher-than-average national scores on the appropriate use of medical imaging and timeliness of care. The study results also showed marginally significant improvements in patient experience and hospital earnings before interest, taxes, depreciation, and amortization margins. Focusing on these select outcomes, we found that drivers of such improvements involved the extent of Lean implementation, as reflected by leadership commitment, daily management, and training/education while controlling for the number of years using Lean. PRACTICAL APPLICATIONS Lean is a method of continuous improvement centered around a culture of providing high-value care for patients. Our findings provide insight into the potential benefits of Lean in U.S. public hospitals. Notably, they suggest that leader buy-in is key to success. When executives and managers support Lean initiatives and provide proper training for the workforce, improved financial and operational performance can result. This commitment, starting with upper management, may also play a broader role in the effort to reform healthcare while having a positive impact on patient care in U.S. public hospitals.
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Affiliation(s)
| | | | | | | | | | - Stephen M Shortell
- Center for Lean Engagement & Research, Division of Health Policy and Management, University of California, Berkeley, California
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Shortell SM, Toussaint JS, Halvorson GC, Kingsdale JM, Scheffler RM, Schwartz AY, Wadsworth PA, Wilensky G. The Better Care Plan: a blueprint for improving America's healthcare system. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad007. [PMID: 38756832 PMCID: PMC10986211 DOI: 10.1093/haschl/qxad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/30/2023] [Indexed: 05/18/2024]
Abstract
The United States falls far short of its potential for delivering care that is effective, efficient, safe, timely, patient-centered, and equitable. We put forward the Better Care Plan, an overarching blueprint to address the flaws in our current system. The plan calls for continuously improving care, moving all payers to risk-adjusted prospective payment, and creating national entities for collecting, analyzing, and reporting patient safety and quality-of-care outcomes data. A number of recommendations are made to achieve these goals.
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Affiliation(s)
| | - John S Toussaint
- Catalysis, Inc. 3825 East Calumet Street, Suite 400-114, Appleton, WI 54915, United States
| | - George C Halvorson
- The Institute for Intergroup Understanding, 1300 Bracketts Point Road, Wayzata, MN 55391, United States
| | | | | | | | - Peter A Wadsworth
- Amory Associates, 1310 Norwest Drive, Norwood, MA 02062, United States
| | - Gail Wilensky
- Project Hope, 1220 19th Street, Washington, DC 20036, United States
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Charns MP, Lerner B, Yakovchenko V, Urech TH, Shin MH, Kim B, Engle RL, Vashi AA. Achieving transformation to lean management systems in health care. Health Serv Res 2023; 58:343-355. [PMID: 36129687 PMCID: PMC10012231 DOI: 10.1111/1475-6773.14072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To understand what factors and organizational dynamics enable Lean transformation of health care organizations. DATA SOURCES Primary data were collected through two waves of interviews in 2016-2017 with leaders and staff at seven veterans affairs medical centers participating in Lean enterprise transformation. STUDY DESIGN Using an observational study design, for each site we coded and rated seven potential enablers of transformation. The outcome measure was the extent of Lean transformation, constructed by coding and rating 11 markers of depth and spread of transformation. Using multivalue coincidence analysis (CNA), we identified enablers that distinguished among sites having different levels of transformation. We identified representative quotes for the enablers. DATA COLLECTION METHODS We interviewed 121 executive leaders, middle managers, expert consultants, systems redesign staff, frontline supervisors, and staff. PRINCIPAL FINDINGS Two sites achieved high Lean transformation, three medium, and two low. Together leadership support and capability development were sufficient for the three-level Lean transformation outcomes with 100% consistency and 100% coverage. High scores on both corresponded to high Lean transformation; medium on either one corresponded to medium transformation; and low on both corresponded to low transformation. Additionally, low scores in communication and availability of data and very low scores in alignment characterized low-transformation sites. Sites with high leadership support also had a high veteran engagement. CONCLUSIONS This multisite study develops a novel measure of the extent of organization-wide Lean transformation and uses CNA to identify enablers linked to transformation. It provides insights into why and how some organizations are more successful at transformation than others. Findings support the applicability of the organization transformation model that guided the study and highlight the roles of executive leadership and capability development in the dynamics of transformation.
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Affiliation(s)
- Martin P. Charns
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Boston Healthcare SystemBostonMassachusettsUSA
- Department of Health Law, Policy & ManagementBoston University School of Public HealthBostonMassachusettsUSA
| | - Barbara Lerner
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Boston Healthcare SystemBostonMassachusettsUSA
| | - Vera Yakovchenko
- Center for Health Equity and Research Promotion (CHERP)VA Pittsburgh Healthcare SystemPittsburghPennsylvaniaUSA
| | - Tracy H. Urech
- Center for Innovation to Implementation (Ci2i)VA Palo Alto Healthcare SystemMenlo ParkCaliforniaUSA
| | - Marlena H. Shin
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Boston Healthcare SystemBostonMassachusettsUSA
| | - Bo Kim
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Boston Healthcare SystemBostonMassachusettsUSA
- Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
| | - Ryann L. Engle
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Boston Healthcare SystemBostonMassachusettsUSA
| | - Anita A. Vashi
- Center for Innovation to Implementation (Ci2i)VA Palo Alto Healthcare SystemMenlo ParkCaliforniaUSA
- Department of Emergency MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of Emergency Medicine (Affiliated)Stanford UniversityStanfordCaliforniaUSA
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Nicholas J. Lean daily management in healthcare: origins, practices, and associations with lean leadership and lean sustainability. TOTAL QUALITY MANAGEMENT & BUSINESS EXCELLENCE 2023. [DOI: 10.1080/14783363.2023.2182677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Affiliation(s)
- John Nicholas
- Quinlan School of Business, Loyola University of Chicago, Chicago, IL, USA
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Hung DY, Lee J, Rundall TG. Transformational Performance Improvement: Why Is Progress so Slow? Adv Health Care Manag 2022; 21:23-46. [PMID: 36437615 DOI: 10.1108/s1474-823120220000021002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
In this chapter, we identify three distinct transformational performance improvement (TPI) approaches commonly used to redesign work processes in health care organizations. We describe the unique components or tools that each approach uses to improve the delivery of health services. We also summarize what is empirically known about the effectiveness of each TPI approach according to systematic reviews and recent studies published in the peer-reviewed literature. Based on examination of this research, we discuss what knowledge is still needed to strengthen the evidence for whole system transformation. This involves the use of conceptual frameworks to assess and guide implementation efforts, and facilitators and barriers to change as revealed in a recent evaluation of one major initiative, the Lean Enterprise Transformation (LET) at the Veterans Health Administration. The analysis suggests ways in which TPI facilitators can be developed and barriers reduced to improve the effectiveness and sustainability of quality initiatives. Finally, we discuss appropriate study designs to evaluate TPI interventions that may strengthen the evidence for their effectiveness in real world practice settings.
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Affiliation(s)
| | - Justin Lee
- University of California at Berkeley, USA
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Hung DY, Rundall TG, Lee J, Khandel N, Shortell SM. Managing Through a Pandemic: A Daily Management System for COVID-19 Response and Recovery. J Healthc Manag 2022; 67:446-457. [PMID: 36350582 PMCID: PMC9640242 DOI: 10.1097/jhm-d-21-00319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
GOAL This study explored the use of a Lean daily management system (DMS) for COVID-19 response and recovery in U.S. hospitals and health systems. Originally developed in manufacturing, Lean is an evidence-based approach to quality and process improvement in healthcare. Although Lean has been studied in individual hospital units and outpatient practices, it has not been examined as a whole system response to crisis events. METHODS We conducted qualitative interviews with 46 executive leaders, clinical leaders, and frontline staff in four hospitals and health systems across the United States. We developed a semistructured interview guide to understand DMS implementation in these care delivery organizations. As interviews took place 6-8 months following the onset of the pandemic, a subset of our interview questions centered on DMS use to meet the demands of COVID-19. Based on a deductive approach to qualitative analysis, we identified clusters of themes that described how DMS facilitated rapid system response to the public health emergency. PRINCIPAL FINDINGS There were many important ways in which U.S. hospitals and health systems leveraged their DMS to address COVID-19 challenges. These included the use of tiered huddles to facilitate rapid communication, the creation of standard work for redeployed staff, and structured problem-solving to prioritize new areas for improvement. We also discovered ways that the pandemic itself affected DMS implementation in all organizations. COVID-19 universally created greater DMS visibility by opening lines of communication among leadership, strengthening measurement and accountability, and empowering staff to develop solutions at the front lines. Many lessons learned using DMS for crisis management will carry forward into COVID-19 recovery efforts. Lessons include expanding telehealth, reactivating incident command systems as needed, and efficiently coordinating resources amid potential future shortages. PRACTICAL APPLICATIONS Overall, the Lean DMS functioned as a robust property that enabled quick organizational response to unpredictable events. Our findings on the use of DMS are consistent with organizational resilience that emphasizes collective sense-making and awareness of incident status, team decision-making, and frequent interaction and coordination. These features of resilience are supported by DMS practices such as tiered huddles for rapid information dissemination and alignment across organizational hierarchies. When used in conjunction with plan-do-study-act methodology, huddles provide teams with enhanced feedback that strengthens their ability to make changes as needed. Moreover, gaps between work-as-imagined (how work should be done) and work-as-done (how work is actually done) may be exacerbated in the initial chaos of emergency events but can be minimized through the development of standard work protocols. As a facilitator of resilience, the Lean DMS may be used in a variety of challenging situations to ensure high standards of care.
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Affiliation(s)
- Dorothy Y. Hung
- School of Public Health, University of California at Berkeley, Berkeley, California
| | | | - Justin Lee
- School of Public Health, University of California at Berkeley
| | - Negeen Khandel
- School of Public Health, University of California at Berkeley
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A Case Study of a Whole System Approach to Improvement in an Acute Hospital Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031246. [PMID: 35162269 PMCID: PMC8835196 DOI: 10.3390/ijerph19031246] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/16/2022]
Abstract
Changes in healthcare tend to be project-based with whole system change, which acknowledges the interconnectedness of socio-technical factors, not the norm. This paper attempts to address the question of whole system change posed by the special issue and brings together other research presented in this special issue. A case study approach was adopted to understand the deployment of a whole system change in the acute hospital setting along four dimensions of a socio-technical systems framework: culture, system functioning, action, and sense-making. The case study demonstrates evidence of whole system improvement. The approach to change was co-designed by staff and management, projects involving staff from all specialities and levels of seniority were linked to each other and to the strategic objectives of the organisation, and learnings from first-generation projects have been passed to second and third-generation process improvements. The socio-technical systems framework was used retrospectively to assess the system change but could also be used prospectively to help healthcare organisations develop approaches to whole system improvement.
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McDonald N, McKenna L, Vining R, Doyle B, Liang J, Ward ME, Ulfvengren P, Geary U, Guilfoyle J, Shuhaiber A, Hernandez J, Fogarty M, Healy U, Tallon C, Brennan R. Evaluation of an Access-Risk-Knowledge (ARK) Platform for Governance of Risk and Change in Complex Socio-Technical Systems. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312572. [PMID: 34886304 PMCID: PMC8657006 DOI: 10.3390/ijerph182312572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 12/16/2022]
Abstract
Three key challenges to a whole-system approach to process improvement in health systems are the complexity of socio-technical activity, the capacity to change purposefully, and the consequent capacity to proactively manage and govern the system. The literature on healthcare improvement demonstrates the persistence of these problems. In this project, the Access-Risk-Knowledge (ARK) Platform, which supports the implementation of improvement projects, was deployed across three healthcare organisations to address risk management for the prevention and control of healthcare-associated infections (HCAIs). In each organisation, quality and safety experts initiated an ARK project and participated in a follow-up survey and focus group. The platform was then evaluated against a set of fifteen needs related to complex system transformation. While the results highlighted concerns about the platform's usability, feedback was generally positive regarding its effectiveness and potential value in supporting HCAI risk management. The ARK Platform addresses the majority of identified needs for system transformation; other needs were validated in the trial or are undergoing development. This trial provided a starting point for a knowledge-based solution to enhance organisational governance and develop shared knowledge through a Community of Practice that will contribute to sustaining and generalising that change.
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Affiliation(s)
- Nick McDonald
- Centre for Innovative Human Systems, School of Psychology, Trinity College, The University of Dublin, D02 PN40 Dublin, Ireland; (N.M.); (B.D.); (M.E.W.)
| | - Lucy McKenna
- ADAPT Centre, School of Computing, Dublin City University, D09 PX21 Dublin, Ireland; (L.M.); (J.L.); (J.H.); (R.B.)
| | - Rebecca Vining
- Centre for Innovative Human Systems, School of Psychology, Trinity College, The University of Dublin, D02 PN40 Dublin, Ireland; (N.M.); (B.D.); (M.E.W.)
- Correspondence:
| | - Brian Doyle
- Centre for Innovative Human Systems, School of Psychology, Trinity College, The University of Dublin, D02 PN40 Dublin, Ireland; (N.M.); (B.D.); (M.E.W.)
- Health and Safety Unit, Dublin Fire Brigade, D02 RY99 Dublin, Ireland; (J.G.); (C.T.)
| | - Junli Liang
- ADAPT Centre, School of Computing, Dublin City University, D09 PX21 Dublin, Ireland; (L.M.); (J.L.); (J.H.); (R.B.)
| | - Marie E. Ward
- Centre for Innovative Human Systems, School of Psychology, Trinity College, The University of Dublin, D02 PN40 Dublin, Ireland; (N.M.); (B.D.); (M.E.W.)
- Quality and Safety Improvement Directorate, St. James’s Hospital Dublin, D08 NHY1 Dublin, Ireland; (U.G.); (M.F.); (U.H.)
| | - Pernilla Ulfvengren
- KTH Royal Institute of Technology, Industrial Economics and Management, 100 44 Stockholm, Sweden;
| | - Una Geary
- Quality and Safety Improvement Directorate, St. James’s Hospital Dublin, D08 NHY1 Dublin, Ireland; (U.G.); (M.F.); (U.H.)
| | - John Guilfoyle
- Health and Safety Unit, Dublin Fire Brigade, D02 RY99 Dublin, Ireland; (J.G.); (C.T.)
| | - Arwa Shuhaiber
- Beacon Renal, Sandyford Business Park, D18 TH56 Dublin, Ireland;
| | - Julio Hernandez
- ADAPT Centre, School of Computing, Dublin City University, D09 PX21 Dublin, Ireland; (L.M.); (J.L.); (J.H.); (R.B.)
| | - Mary Fogarty
- Quality and Safety Improvement Directorate, St. James’s Hospital Dublin, D08 NHY1 Dublin, Ireland; (U.G.); (M.F.); (U.H.)
| | - Una Healy
- Quality and Safety Improvement Directorate, St. James’s Hospital Dublin, D08 NHY1 Dublin, Ireland; (U.G.); (M.F.); (U.H.)
| | - Christopher Tallon
- Health and Safety Unit, Dublin Fire Brigade, D02 RY99 Dublin, Ireland; (J.G.); (C.T.)
| | - Rob Brennan
- ADAPT Centre, School of Computing, Dublin City University, D09 PX21 Dublin, Ireland; (L.M.); (J.L.); (J.H.); (R.B.)
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Proctor EK, Toker E, Tabak R, McKay VR, Hooley C, Evanoff B. Market viability: a neglected concept in implementation science. Implement Sci 2021; 16:98. [PMID: 34801036 PMCID: PMC8605560 DOI: 10.1186/s13012-021-01168-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 10/26/2021] [Indexed: 11/15/2022] Open
Abstract
This debate paper asserts that implementation science needs to incorporate a key concept from entrepreneurship—market demand—and demonstrates how assessing an innovation’s potential market viability might advance the pace and success of innovation adoption and sustainment. We describe key concepts, language distinctions, and questions that entrepreneurs pose to implementation scientists—many of which implementation scientists appear ill-equipped to answer. The paper concludes with recommendations about how concepts from entrepreneurship, notably market viability assessment, can enhance the translation of research discoveries into real-world adoption, sustained use, and population health benefits. The paper further proposes activities that can advance implementation science’s capacity to draw from the field of entrepreneurship, along with the data foundations required to assess and cultivate market demand.
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Affiliation(s)
- Enola K Proctor
- Brown School, Washington University in St. Louis, One Brookings Drive, Saint Louis, MO, 63130, USA.
| | - Emre Toker
- Washington University Medical School in St. Louis and the University of Arizona, 1110 E. Campus Drive, P.O. Box 210033, Tucson, AZ, USA, 85721-0033
| | - Rachel Tabak
- Brown School, Washington University in St. Louis, One Brookings Drive, Saint Louis, MO, 63130, USA
| | - Virginia R McKay
- Brown School, Washington University in St. Louis, One Brookings Drive, Saint Louis, MO, 63130, USA
| | - Cole Hooley
- School of Social Work, Brigham Young University, 2166 JFSB, Provo, UT, 84602, USA
| | - Bradley Evanoff
- Division of General Medical Sciences, School of Medicine, Washington University in St. Louis, 660 S. Euclid Drive, St. Louis, MO, 63110, USA
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Dillon EC, Kim P, Li M, Huang Q, Colocci N, Cantril C, Hung DY. Breast Cancer Navigation: Using Physician and Patient Surveys to Explore Nurse Navigator Program Experiences. Clin J Oncol Nurs 2021; 25:579-586. [PMID: 34533512 DOI: 10.1188/21.cjon.579-586] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patient navigators can improve patient experiences of care and outcomes, but little is known about how navigation programs may affect physician workflows and experience. OBJECTIVES This study aimed to understand patient and physician experiences with a breast cancer navigation (BCN) program using Lean design principles. METHODS Surveys were developed and distributed from 2019 to 2020 to 255 patients diagnosed with breast cancer and 128 physicians in primary care and cancer-related specialties. Descriptive analyses were conducted. FINDINGS Eighty-three physicians and 94 patients completed the survey. A large majority of physicians reported that the BCN program "made their day easier" and improved flow, care coordination, and patient experience. A large majority of patients reported receiving the right level of support during diagnosis communication and high satisfaction in other domains measured.
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Affiliation(s)
- Ellis C Dillon
- Center for Health Systems Research at Sutter Health and the Palo Alto Medical Foundation Research Institute
| | | | - Martina Li
- Center for Health Systems Research at Sutter Health and Palo Alto Medical Foundation Research Institute
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