1
|
Improving Youth Sports Safety: Implementing an Emergency Action Plan for Sudden Cardiac Arrest. J Pediatr Nurs 2021; 59:81-88. [PMID: 33549955 DOI: 10.1016/j.pedn.2020.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/20/2020] [Accepted: 10/01/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Children who participate in youth sports are at risk for sudden cardiac arrest (SCA) related to undetected cardiac anomalies or abrupt impact to the chest. Nurse-led interventions may prevent sudden cardiac death by helping leagues implement an emergency action plan to respond to SCA and improve safety. A youth soccer league in the Southeast with participants between the ages of 5-19 years, led by volunteer board members and coaches, did not have reliable access to automated external defibrillators or receive standardized education on SCA and cardiopulmonary resuscitation with a site-specific action plan. METHODS A nurse-led quality improvement pilot project used partnerships to provide league access to automated external defibrillators, institute preseason SCA and cardiopulmonary resuscitation training, and establish an emergency action plan for the league's volunteers. Anonymous pre- and post-training testing was conducted to measure participant knowledge, confidence, and willingness to respond to SCA. A cross-sectional survey, using a convenience sample of board members and coaches, evaluated sustainability of the intervention at midseason. INTERVENTION Training targeted board members (Blue Shirts) to serve as leaders on the field during an SCA event and educated coaches on activating the emergency action plan. RESULTS Blue Shirts and coaches showed significant (p < .05) improvement of knowledge, confidence, and willingness to respond to SCA after receiving the standardized preseason intervention; Blue Shirts' changes were sustained at midseason. CONCLUSION Nurses are ideal for helping youth sports leagues implement a sustainable SCA action plan based on best-practice recommendations for emergency health and safety.
Collapse
|
2
|
Lewinski AA, Rushton S, Van Voorhees E, Boggan JC, Whited JD, Shoup JP, Tabriz AA, Adam S, Fulton J, Gordon AM, Ear B, Williams JW, Goldstein KM, Van Noord MG, Gierisch JM. Implementing remote triage in large health systems: A qualitative evidence synthesis. Res Nurs Health 2020; 44:138-154. [PMID: 33319411 DOI: 10.1002/nur.22093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/20/2020] [Accepted: 11/28/2020] [Indexed: 01/06/2023]
Abstract
Remote triage (RT) allows interprofessional teams (e.g., nurses and physicians) to assess patients and make clinical decisions remotely. RT use has developed widespread interest due to the COVID-19 pandemic, and has future potential to address the needs of a rapidly aging population, improve access to care, facilitate interprofessional team care, and ensure appropriate use of resources. However, despite rapid and increasing interest in implementation of RT, there is little research concerning practices for successful implementation. We conducted a systematic review and qualitative evidence synthesis of practices that impact the implementation of RT for adults seeking clinical care advice. We searched MEDLINE®, EMBASE, and CINAHL from inception through July 2018. We included 32 studies in this review. Our review identified four themes impacting the implementation of RT: characteristics of staff who use RT, influence of RT on staff, considerations in selecting RT tools, and environmental and contextual factors impacting RT. The findings of our systemic review underscore the need for a careful consideration of (a) organizational and stakeholder buy-in before launch, (b) physical and psychological workplace environment, (c) staff training and ongoing support, and (d) optimal metrics to assess the effectiveness and efficiency of implementation. Our findings indicate that preimplementation planning, as well as evaluating RT by collecting data during and after implementation, is essential to ensuring successful implementation and continued adoption of RT in a health care system.
Collapse
Affiliation(s)
- Allison A Lewinski
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.,School of Nursing, Duke University, Durham, North Carolina, USA
| | - Sharron Rushton
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - Elizabeth Van Voorhees
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Joel C Boggan
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.,Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - John D Whited
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.,Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Amir A Tabriz
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy University of North Carolina, Chapel Hill, North Carolina, USA
| | - Soheir Adam
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jessica Fulton
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Adelaide M Gordon
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Belinda Ear
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - John W Williams
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Karen M Goldstein
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.,Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Megan G Van Noord
- Carlson Health Sciences Library, University of California, Davis, California, USA
| | - Jennifer M Gierisch
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.,Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| |
Collapse
|
3
|
Implementing Common Metrics across the NIH Clinical and Translational Science Awards (CTSA) consortium. J Clin Transl Sci 2019; 4:16-21. [PMID: 32257406 PMCID: PMC7103469 DOI: 10.1017/cts.2019.425] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/19/2019] [Accepted: 09/20/2019] [Indexed: 11/12/2022] Open
Abstract
The Clinical and Translational Science Award (CTSA) Consortium and the National Center for Advancing Translational Science (NCATS) undertook a Common Metrics Initiative to improve research processes across the national CTSA Consortium. This was implemented by Tufts Clinical and Translational Science Institute at the 64 CTSA academic medical centers. Three metrics were collaboratively developed by NCATS staff, CTSA Consortium teams, and outside consultants for Institutional Review Board Review Duration, Careers in Clinical and Translational Research, and Pilot Award Publications and Subsequent Funding. The implementation program included training on the metric operational guidelines, data collection, data reporting system, and performance improvement framework. The implementation team provided small-group coaching and technical assistance. Collaborative learning sessions, driver diagrams, and change packages were used to disseminate best and promising practices. After 14 weeks, 84% of hubs had produced a value for one metric and about half had produced an initial improvement plan. Overall, hubs reported that the implementation activities facilitated their Common Metrics performance improvement process. Experiences implementing the first three metrics can inform future directions of the Common Metrics Initiative and other research groups implementing standardized metrics and performance improvement processes, potentially including other National Institutes of Health institutes and centers.
Collapse
|
4
|
Quality and patient safety committee structure and activities in an academic department of anesthesiology: a narrative description. Can J Anaesth 2019; 67:100-108. [PMID: 31520197 DOI: 10.1007/s12630-019-01473-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 01/17/2023] Open
Abstract
Quality and patient safety (QPS) activities continue to attract more attention and are deemed an essential component of care provision by all departments of anesthesiology, but examples of the structure and processes to manage QPS matters at the department level in Canada are not well described in the literature. This narrative article highlights the creation, structure, evolution, and experiences of a QPS committee in a Canadian department of anesthesiology and pain medicine. Specific focus and case examples of the QPS committee's use of a hospital-wide incident reporting system to monitor and respond to perioperative QPS matters are provided.
Collapse
|
5
|
Giannitrapani KF, Rodriguez H, Huynh AK, Hamilton AB, Kim L, Stockdale SE, Needleman J, Yano EM, Rubenstein LV. How middle managers facilitate interdisciplinary primary care team functioning. Healthcare (Basel) 2019; 7:10-15. [DOI: 10.1016/j.hjdsi.2018.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/28/2018] [Accepted: 11/12/2018] [Indexed: 12/01/2022] Open
|
6
|
Harrison MI, Grantham S. Learning from implementation setbacks: Identifying and responding to contextual challenges. Learn Health Syst 2018; 2:e10068. [PMID: 31245592 PMCID: PMC6508762 DOI: 10.1002/lrh2.10068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction We address organizational learning about implementation context during setbacks to primary care redesign in an ambulatory system. The redesign expanded care teams and added a medical assistant assigned administrative and coordination tasks. The redesign was expected to improve care efficiency, prevention, and continuity. In response to setbacks, redesign and system leaders used understanding of context to plan system-wide changes, as well as program adjustments. Doing so enhanced the redesign's prospects and contributed to system learning. Methods We conducted a 33-month, mixed-methods study. Qualitative data included quarterly calls with the redesign leaders and 63 activity log entries. There were three site visits; 73 interviews with practice leaders, providers, and medical assistants. Data analysis used categories from an implementation research framework; these were refined and then expanded inductively using log reports, debriefings with change leaders, and documents. Quantitative analysis used system operational data on chronic care, prevention, efficiency, productivity, and patient access. Results Redesigned teams were not implemented as widely or rapidly as anticipated and did not deliver hoped-for gains in operational metrics. Interviews reported that team redesign was leading to improvements in chronic care and prevention and eased provider burden. Besides making small adjustments to cope with setbacks, redesign and system leaders engaged in more thorough organizational learning. They examined contextual challenges underlying setbacks and posing risks to the delivery system as a whole. Their responses to challenges helped strengthen the redesign's prospects, improved the delivery system's position in its labor market, and helped the system prepare to meet emerging requirements for value-based care and population health. Conclusions This case points to benefits for both health care researchers and change practitioners of paying closer attention to how context affects implementation of organizational change, and to opportunities and conditions for learning from setbacks during change.
Collapse
|
7
|
Harnett PJ. Improvement attributes in healthcare: implications for integrated care. Int J Health Care Qual Assur 2018; 31:214-227. [PMID: 29687756 DOI: 10.1108/ijhcqa-07-2016-0097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Healthcare quality improvement is a key concern for policy makers, regulators, carers and service users. Despite a contemporary consensus among policy makers that integrated care represents a means to substantially improve service outcomes, progress has been slow. Difficulties achieving sustained improvement at scale imply that methods employed are not sufficient and that healthcare improvement attributes may be different when compared to prior reference domains. The purpose of this paper is to examine and synthesise key improvement attributes relevant to a complex healthcare change process, specifically integrated care. Design/methodology/approach This study is based on an integrative literature review on systemic improvement in healthcare. Findings A central theme emerging from the literature review indicates that implementing systemic change needs to address the relationship between vision, methods and participant social dynamics. Practical implications Accommodating personal and professional network dynamics is required for systemic improvement, especially among high autonomy individuals. This reinforces the need to recognise the change process as taking place in a complex adaptive system where personal/professional purpose/meaning is central to the process. Originality/value Shared personal/professional narratives are insufficiently recognised as a powerful change force, under-represented in linear and rational empirical improvement approaches.
Collapse
Affiliation(s)
- Patrick John Harnett
- National Integrated Care Programme, Older Persons, Social Care Division, Health Service Executive, Dublin, Ireland
| |
Collapse
|
8
|
Baxter S, Johnson M, Chambers D, Sutton A, Goyder E, Booth A. Understanding new models of integrated care in developed countries: a systematic review. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06290] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BackgroundThe NHS has been challenged to adopt new integrated models of service delivery that are tailored to local populations. Evidence from the international literature is needed to support the development and implementation of these new models of care.ObjectivesThe study aimed to carry out a systematic review of international evidence to enhance understanding of the mechanisms whereby new models of service delivery have an impact on health-care outcomes.DesignThe study combined rigorous and systematic methods for identification of literature, together with innovative methods for synthesis and presentation of findings.SettingAny setting.ParticipantsPatients receiving a health-care service and/or staff delivering services.InterventionsChanges to service delivery that increase integration and co-ordination of health and health-related services.Main outcome measuresOutcomes related to the delivery of services, including the views and perceptions of patients/service users and staff.Study designEmpirical work of a quantitative or qualitative design.Data sourcesWe searched electronic databases (between October 2016 and March 2017) for research published from 2006 onwards in databases including MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Science Citation Index, Social Science Citation Index and The Cochrane Library. We also searched relevant websites, screened reference lists and citation searched on a previous review.Review methodsThe identified evidence was synthesised in three ways. First, data from included studies were used to develop an evidence-based logic model, and a narrative summary reports the elements of the pathway. Second, we examined the strength of evidence underpinning reported outcomes and impacts using a comparative four-item rating system. Third, we developed an applicability framework to further scrutinise and characterise the evidence.ResultsWe included 267 studies in the review. The findings detail the complex pathway from new models to impacts, with evidence regarding elements of new models of integrated care, targets for change, process change, influencing factors, service-level outcomes and system-wide impacts. A number of positive outcomes were reported in the literature, with stronger evidence of perceived increased patient satisfaction and improved quality of care and access to care. There was stronger UK-only evidence of reduced outpatient appointments and waiting times. Evidence was inconsistent regarding other outcomes and system-wide impacts such as levels of activity and costs. There was an indication that new models have particular potential with patients who have complex needs.LimitationsDefining new models of integrated care is challenging, and there is the potential that our study excluded potentially relevant literature. The review was extensive, with diverse study populations and interventions that precluded the statistical summary of effectiveness.ConclusionsThere is stronger evidence that new models of integrated care may enhance patient satisfaction and perceived quality and increase access; however, the evidence regarding other outcomes is unclear. The study recommends factors to be considered during the implementation of new models.Future workLinks between elements of new models and outcomes require further study, together with research in a wider variety of populations.Study registrationThis study is registered as PROSPERO CRD37725.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Susan Baxter
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Maxine Johnson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Duncan Chambers
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anthea Sutton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| |
Collapse
|
9
|
Zoutman DE, Ford BD. Quality improvement in hospitals: barriers and facilitators. Int J Health Care Qual Assur 2017; 30:16-24. [DOI: 10.1108/ijhcqa-12-2015-0144] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to examine quality improvement (QI) initiatives in acute care hospitals, the factors associated with success, and the impacts on patient care and safety.
Design/methodology/approach
An extensive online survey was completed by senior managers responsible for QI. The survey assessed QI project types, QI methods, staff engagement, and barriers and factors in the success of QI initiatives.
Findings
The response rate was 37 percent, 46 surveys were completed from 125 acute care hospitals. QI initiatives had positive impacts on patient safety and care. Staff in all hospitals reported conducting past or present hand-hygiene QI projects and C. difficile and surgical site infection were the next most frequent foci. Hospital staff not having time and problems with staff prioritizing QI with other duties were identified as important QI barriers. All respondents reported hospital leadership support, data utilization and internal champions as important QI facilitators. Multiple regression models identified nurses’ active involvement and medical staff engagement in QI with improved patient care and physicians’ active involvement and medical staff engagement with greater patient safety.
Practical implications
There is the need to study how best to support and encourage physicians and nurses to become more engaged in QI.
Originality/value
QI initiatives were shown to have positive impacts on patient safety and patient care and barriers and facilitating factors were identified. The results indicated patient care and safety would benefit from increased physician and nurse engagement in QI initiatives.
Collapse
|
10
|
|
11
|
Kim DI, Au H, Fargo R, Garrison RC, Thompson G, Yu M, Loo LK. Code R. Am J Med Qual 2016; 31:429-33. [DOI: 10.1177/1062860615583548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Daniel I. Kim
- University of California, Riverside School of Medicine, Riverside, CA
- Riverside County Regional Medical Center, Moreno Valley, CA
| | - Huy Au
- University of California, Riverside School of Medicine, Riverside, CA
- Riverside County Regional Medical Center, Moreno Valley, CA
| | - Ramiz Fargo
- University of California, Riverside School of Medicine, Riverside, CA
- Riverside County Regional Medical Center, Moreno Valley, CA
| | - Roger C. Garrison
- University of California, Riverside School of Medicine, Riverside, CA
- Riverside County Regional Medical Center, Moreno Valley, CA
| | - Gary Thompson
- Riverside County Regional Medical Center, Moreno Valley, CA
- Loma Linda University School of Medicine, Loma Linda, CA
| | - Minho Yu
- Riverside County Regional Medical Center, Moreno Valley, CA
- Loma Linda University School of Medicine, Loma Linda, CA
| | | |
Collapse
|
12
|
Lauriks S, de Wit MAS, Buster MCA, Arah OA, Klazinga NS. Composing a core set of performance indicators for public mental health care: a modified Delphi procedure. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 41:625-35. [PMID: 23771417 DOI: 10.1007/s10488-013-0506-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Public mental health care (PMHC) systems are responsible for the wellbeing of vulnerable groups that cope with complex psychosocial problems. This article describes the development of a set of performance indicators that are feasible, meaningful, and useful to assess the quality of the PMHC system in Amsterdam, the Netherlands. Performance indicators were selected from an international inventory and presented to stakeholders of the PMHC system in a modified Delphi procedure. Characteristics of indicators were judged individually, before consensus on a core set was reached during a plenary discussion. Involving stakeholders at early stages of development increases support for quality assessment.
Collapse
Affiliation(s)
- Steve Lauriks
- Department of Epidemiology, Documentation and Health Promotion (EDG), Municipal Health Service Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands,
| | | | | | | | | |
Collapse
|
13
|
Pioneering a Nursing Home Quality Improvement Learning Collaborative: A Case Study of Method and Lessons Learned. J Am Med Dir Assoc 2015; 17:136-41. [PMID: 26420494 DOI: 10.1016/j.jamda.2015.08.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/16/2015] [Accepted: 08/17/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To describe the development of a nursing home (NH) quality improvement learning collaborative (QILC) that provides Lean Six Sigma (LSS) training and infrastructure support for quality assurance performance improvement change efforts. DESIGN Case report. SETTING/PARTICIPANTS Twenty-seven NHs located in the Greater Rochester, NY area. INTERVENTION The learning collaborative approach in which interprofessional teams from different NHs work together to improve common clinical and organizational processes by sharing experiences and evidence-based practices to achieve measurable changes in resident outcomes and system efficiencies. MEASUREMENTS NH participation, curriculum design, LSS projects. RESULTS Over 6 years, 27 NHs from urban and rural settings joined the QILC as organizational members and sponsored 47 interprofessional teams to learn LSS techniques and tools, and to implement quality improvement projects. CONCLUSIONS NHs, in both urban and rural settings, can benefit from participation in QILCs and are able to learn and apply LSS tools in their team-based quality improvement efforts.
Collapse
|
14
|
Kent EE, Mitchell SA, Castro KM, DeWalt DA, Kaluzny AD, Hautala JA, Grad O, Ballard RM, McCaskill-Stevens WJ, Kramer BS, Clauser SB. Cancer Care Delivery Research: Building the Evidence Base to Support Practice Change in Community Oncology. J Clin Oncol 2015; 33:2705-11. [PMID: 26195715 PMCID: PMC4559611 DOI: 10.1200/jco.2014.60.6210] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Understanding how health care system structures, processes, and available resources facilitate and/or hinder the delivery of quality cancer care is imperative, especially given the rapidly changing health care landscape. The emerging field of cancer care delivery research (CCDR) focuses on how organizational structures and processes, care delivery models, financing and reimbursement, health technologies, and health care provider and patient knowledge, attitudes, and behaviors influence cancer care quality, cost, and access and ultimately the health outcomes and well-being of patients and survivors. In this article, we describe attributes of CCDR, present examples of studies that illustrate those attributes, and discuss the potential impact of CCDR in addressing disparities in care. We conclude by emphasizing the need for collaborative research that links academic and community-based settings and serves simultaneously to accelerate the translation of CCDR results into practice. The National Cancer Institute recently launched its Community Oncology Research Program, which includes a focus on this area of research.
Collapse
Affiliation(s)
- Erin E Kent
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA
| | - Sandra A Mitchell
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA.
| | - Kathleen M Castro
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA
| | - Darren A DeWalt
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA
| | - Arnold D Kaluzny
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA
| | - Judith A Hautala
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA
| | - Oren Grad
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA
| | - Rachel M Ballard
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA
| | - Worta J McCaskill-Stevens
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA
| | - Barnett S Kramer
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA
| | - Steven B Clauser
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA
| |
Collapse
|
15
|
Frontline experiences of a practice redesign to improve self-management of obesity in safety net clinics. J Ambul Care Manage 2015; 38:153-63. [PMID: 25748264 DOI: 10.1097/jac.0000000000000063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Teamlets of physicians and medical assistants may help improve obesity management in primary care settings. We aimed to understand the barriers and facilitators of implementing a teamlet approach to managing obesity in 3 safety net clinics. Key stakeholder interviews (n = 21) were conducted both during early implementation of practice change and 6 months later. Patient surveys (n = 393) examined obese patient activation and health status. Insufficient program resources and limited patient engagement due to external factors were implementation barriers despite fairly high patient activation. Staff members need time and resources to execute new responsibilities to support obesity management in safety net settings. Because of high turnover, multiple supporters may improve sustainability.
Collapse
|
16
|
Bazos DA, LaFave LRA, Suresh G, Shannon KC, Nuwaha F, Splaine ME. The gas cylinder, the motorcycle and the village health team member: a proof-of-concept study for the use of the Microsystems Quality Improvement Approach to strengthen the routine immunization system in Uganda. Implement Sci 2015; 10:30. [PMID: 25889485 PMCID: PMC4377204 DOI: 10.1186/s13012-015-0215-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 01/27/2015] [Indexed: 11/30/2022] Open
Abstract
Background Although global efforts to support routine immunization (RI) system strengthening have resulted in higher immunization rates, the World Health Organization (WHO) estimates that the proportion of children receiving recommended DPT3 vaccines has stagnated at 80% for the past 3 years (WHO Fact sheet—Immunization coverage 2014, WHO, 2014). Meeting the WHO goal of 90% national DPT3 coverage may require locally based strategies to support conventional approaches. The Africa Routine Immunization Systems Essentials-System Innovation (ARISE-SI) initiative is a proof-of-concept study to assess the application of the Microsystems Quality Improvement Approach for generating local solutions to strengthen RI systems and reach those unreached by current efforts in Masaka District, Uganda. Methods The ARISE-SI intervention had three components: health unit (HU) advance preparations, an action learning collaborative, and coaching of improvement teams. The intervention was informed and assessed using qualitative and quantitative methods. Data collection focused on changes and outcomes of improvement efforts among five HUs and one district-level team during the intervention (June 2011–February 2012) and five follow-up months. Results Workshops and team meetings had a 95% attendance rate. All teams gained RI system knowledge and implemented changes to address locally identified problems. Specific changes included: RI register implementation and expanded use, Child Health Card provision and monitoring, staff cross-training, staffing pattern changes, predictable outreach schedules, and health system leader—community leader meetings. Several RI system barriers prevalent across Masaka District (e.g., lack of backup HU gas cylinders, inadequate outreach transportation, and village health team underutilization) were successfully addressed. Three of five HUs significantly increased the vaccines administered. All improvements were sustained 5 months post-intervention. External evaluation validated the findings of high levels of participant engagement, empowerment to make change, and willingness to sustain improvements. Conclusions The Microsystems Quality Improvement Approach is a comprehensive approach, grounded in systems thinking, and coupled with intensive coaching. It provides a robust framework for engaging teams in the development of unique local solutions that strengthen RI systems in resource poor settings. The sustained improvements in local RI systems from this study provide evidence that this approach may be an effective framework for enhancing the WHO’s Reaching Every District (RED) immunization strategy.
Collapse
Affiliation(s)
- Dorothy A Bazos
- Community Engagement, the Prevention Research Center at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, 35 Centerra Parkway, Lebanon, NH, 03766, USA. .,, 501 South Street, Bow, NH, 03304, USA.
| | - Lea R Ayers LaFave
- JSI Research & Training Institute, Inc., Community Health Institute, 501 South Street, 2nd Floor, Bow, NH, 03304, USA.
| | - Gautham Suresh
- Pediatrics and Community & Family Medicine, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, 1 Rope Ferry Road, Hanover, NH, 03755, USA.
| | - Kevin C Shannon
- SAC Health System, Department of Family Medicine, Loma Linda University School of Medicine, Suite 206-A, Loma, Linda, CA, 92354, USA.
| | - Fred Nuwaha
- Disease Control and Prevention, Makerere University School of Public Health, PO Box 7072, Kampala, Uganda.
| | - Mark E Splaine
- The Dartmouth Institute for Health Policy and Clinical Practice and Community and Family Medicine, Geisel School of Medicine at Dartmouth, 30 Lafayette Street, Lebanon, NH, 03766, USA.
| |
Collapse
|
17
|
Abstract
PURPOSE The purpose of this paper is to investigate the extent to which nursing leadership, perceived by nursing staff, influences nursing quality. DESIGN/METHODOLOGY/APPROACH Data were collected between August and October 2011 in a Portuguese health center via a questionnaire completed by nurses. Our original sample included 283 employees; 184 questionnaires were received (65% response). FINDINGS The theoretical model presents reasonably satisfactory fit indices (values above literature reference). Path analysis between latent constructs clearly suggests that nursing leadership has a direct (beta = 0.724) and statistically significant (p = 0.007) effect on nursing quality. ORIGINALITY/VALUE Results reinforce several ideas propagated throughout the literature, which suggests the relationship's relevance, but lacks empirical support, which this study corrects.
Collapse
|
18
|
Quality improvement processes: drilling down and stepping back*. Crit Care Med 2014; 42:984-5. [PMID: 24633098 DOI: 10.1097/ccm.0000000000000095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
19
|
Abstract
The need to rapidly improve health care value is unquestioned, but the means to accomplish this task is unknown. Improving performance at the level of the health care organization frequently involves multiple interventions, which must be coordinated and sequenced to fit the specific context. Those responsible for achieving large-scale improvements are challenged by the lack of a framework to describe and organize improvement strategies. Drawing from the fields of health services, industrial engineering, and organizational behavior, a simple framework was developed and has been used to guide and evaluate improvement initiatives at an academic health center. The authors anticipate that this framework will be helpful for health system leaders responsible for improving health care quality.
Collapse
Affiliation(s)
- Sally Kraft
- University of Wisconsin School of Medicine and Public Health, Madison, WI UW Health, Quality, Safety and Innovation, Middleton, WI UW Health, Primary Care Academics Transforming Healthcare, Madison, WI
| | | | - Jennifer Weiss
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Nancy Pandhi
- University of Wisconsin School of Medicine and Public Health, Madison, WI UW Health, Primary Care Academics Transforming Healthcare, Madison, WI
| |
Collapse
|
20
|
A multifaceted approach to improve hand hygiene practices in the adult intensive care unit of a tertiary-care center. J Infect Public Health 2014; 7:360-4. [PMID: 24702745 DOI: 10.1016/j.jiph.2014.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 02/09/2014] [Accepted: 02/11/2014] [Indexed: 11/22/2022] Open
Abstract
A multidisciplinary team was formed to improve hand hygiene (HH) practices in a tertiary-care ICU. At baseline, an audit revealed that the overall HH compliance was 64% and was significantly lower at night than during the day shift. After implementing a stepwise multifaceted approach that included education, workplace reminders, active feedback and later universal contact precautions, the HH compliance improved significantly to >80%, and the improvement was sustained over several months. This improvement was noted during the day and night and affected different healthcare workers as well as visitors.
Collapse
|
21
|
Zallman L, Bearse A, Neal N, VanDeusen Lukas C, Hacker K. Strategies for Aligning Physicians to System Redesign Goals at Eight Safety-Net Systems. Jt Comm J Qual Patient Saf 2014; 40:541-3. [PMID: 26111379 DOI: 10.1016/s1553-7250(14)40070-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Facing recent economic and regulatory pressures, safety-net systems (SNSs) are redesigning their organizations to improve care delivery, remain financially viable, and maintain competitive positions. Aligning physicians with redesign goals is a priority, particularly as many SNSs shift toward patient-centered, population health-focused models. No previous work has examined efforts to align physicians to safety net redesign efforts. METHODS This qualitative study, conducted at eight SNSs, examined challenges faced in a changing health care environment, as well as strategies and resources to address them. RESULTS Strategies clustered in two categories: physician role definition and organizational infrastructure. Physician role definition strategies were (1) changing payment and employment arrangements, (2) changing clinical roles, (3) increasing physician involvement in quality improvement, and (4) strengthening physician leadership in clinical and quality roles. Organizational infrastructure strategies were (1) ensuring medical center leadership support and integration, (2) utilizing data to drive physician behavior, and (3) addressing competing allegiances with academia. All sites reported multifaceted approaches but differed in specific strategies employed, facilitators noted, and challenges encountered. DISCUSSION The findings highlight the need to implement multiple strategies to align physicians in redesign efforts. They suggest that all health systems, whether SNSs or not, can capitalize on qualities of physicians and existing infrastructural and leadership elements to achieve physician alignment. However, they must contend with and address challenges of competing allegiance (for example, academic, physician organization, hospital), as well as resistance to changing clinical roles and payment structures.
Collapse
Affiliation(s)
- Leah Zallman
- Institute for Community Health, Cambridge, Massachusetts, USA
| | | | | | | | | |
Collapse
|
22
|
Zayas LE, McMillen JC, Lee MY, Books SJ. Challenges to quality assurance and improvement efforts in behavioral health organizations: a qualitative assessment. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2013; 40:190-8. [PMID: 22160806 DOI: 10.1007/s10488-011-0393-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Behavioral health organizations have been increasingly required to implement plans to monitor and improve service quality. This qualitative study explores challenges that quality assurance and improvement (QA/I) personnel experience in performing their job in those practice settings. Sixteen QA/I personnel from different agencies in St. Louis, Missouri, U.S.A., were interviewed face-to-face using a semi-structured instrument to capture challenges and a questionnaire to capture participant and agency characteristics. Data analysis followed a grounded theory approach. Challenges involved agency resources, agency buy-in, personnel training, competing demands, shifting standards, authority, and research capacity. Further research is needed to assess these challenges given expected outcomes.
Collapse
Affiliation(s)
- Luis E Zayas
- School of Social Work, Arizona State University, 411 N. Central Ave., Suite 800, Phoenix, AZ 85004-0689, USA.
| | | | | | | |
Collapse
|
23
|
Joyner MJ, Warner DO. The syntax of sin taxes: putting it together to improve physical, social, and fiscal health. Mayo Clin Proc 2013; 88:536-9. [PMID: 23726397 DOI: 10.1016/j.mayocp.2013.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 02/01/2013] [Accepted: 02/04/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Michael J Joyner
- Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA.
| | | |
Collapse
|
24
|
McMullen CK, Schneider J, Firemark A, Davis J, Spofford M. Cultivating engaged leadership through a learning collaborative: lessons from primary care renewal in Oregon safety net clinics. Ann Fam Med 2013; 11 Suppl 1:S34-40. [PMID: 23690384 PMCID: PMC3707245 DOI: 10.1370/afm.1489] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The aim of this study was to explore how learning collaboratives cultivate leadership skills that are essential for implementing patient-centered medical homes (PCMHs). METHODS We conducted an ethnographic evaluation of a payor-incentivized PCMH implementation in Oregon safety net clinics, known as Primary Care Renewal. Analyses primarily drew on in-depth interviews with organizational leaders who were involved in the initiative. We solicited perspectives on the history, barriers, facilitators, and other noteworthy factors related to the implementation of PCMH. We reviewed and summarized transcripts and created and applied a coding dictionary to identify emergent leadership themes. We reviewed field notes from clinic site visits and observations of learning collaborative activities for additional information on the role of engaged leadership. RESULTS Interview data suggested that organizations followed a similar, sequential process of Primary Care Renewal implementation having 2 phases-inspiration and implementation-and that leaders needed and learned different leadership skills in each phase. Leaders reported that collaborative learning opportunities were critical for developing engaged leadership skills during the inspiration phase of transformation. Facilitative and modeling aspects of engaged leadership were most important for codesigning a vision and plan for change. Adaptive leadership skills became more important during the implementation phase, when specific operational and management skills were needed to foster standardization and spread of the Primary Care Renewal initiative throughout participating clinics. CONCLUSIONS The PCMH has received much attention as a way to reorganize and potentially improve primary care. Documenting steps and stages for cultivating leaders with the vision and skills to transform their organizations into PCMHs may offer a useful roadmap to other organizations considering a similar transformation.
Collapse
Affiliation(s)
- Carmit K McMullen
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon 97227, USA.
| | | | | | | | | |
Collapse
|
25
|
Vetter TR, Goeddel LA, Boudreaux AM, Hunt TR, Jones KA, Pittet JF. The Perioperative Surgical Home: how can it make the case so everyone wins? BMC Anesthesiol 2013; 13:6. [PMID: 23497277 PMCID: PMC3605191 DOI: 10.1186/1471-2253-13-6] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 03/08/2013] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Varied and fragmented care plans undertaken by different practitioners currently expose surgical patients to lapses in expected care, increase the chance for operational mistakes and accidents, and often result in unnecessary care. The Perioperative Surgical Home has thus been proposed by the American Society of Anesthesiologists and other stakeholders as an innovative, patient-centered, surgical continuity of care model that incorporates shared decision making. Topics central to the debate about an anesthesiology-based Perioperative Surgical Home include: holding the gains made in anesthesia-related patient safety; impacting surgical morbidity and mortality, including failure-to-rescue; achieving healthcare outcome metrics; assimilating comparative effectiveness research into the model; establishing necessary audit and data collection; a comparison with the hospitalist model of perioperative care; the perspective of the surgeon; the benefits of the Perioperative Surgical Home to the specialty of anesthesiology; and its associated healthcare economic advantages. DISCUSSION Improving surgical morbidity and mortality mandates a more comprehensive and integrated approach to the management of surgical patients. In their expanded capacity as the surgical patient's "perioperativist," anesthesiologists can play a key role in compliance with broader set of process measures, thus becoming a more vital and valuable provider from the patient, administrator, and payer perspective. The robust perioperative databases created within the Perioperative Surgical Home present new opportunities for health services and population-level research. The Perioperative Surgical Home is not intended to replace the surgeon's patient care responsibility, but rather leverage the abilities of the entire perioperative care team in the service of the patient. To achieve this goal, it will be necessary to expand the core knowledge, skills, and experience of anesthesiologists. Anesthesiologists will need to view becoming perioperative physicians as an expansion of the specialty, rather than an abdication of their traditional intraoperative role. The Perioperative Surgical Home will need to create strategic added value for a health system and payers. This added value will strengthen the position of anesthesiologists as they navigate and negotiate in the face of finite, if not decreasing fiscal resources. SUMMARY Broadening the anesthesiologist's scope of practice via the Perioperative Surgical Home may promote standardization and improve clinical outcomes and decrease resource utilization by providing greater patient-centered continuity of care throughout the preoperative, intraoperative, and postoperative periods.
Collapse
Affiliation(s)
- Thomas R Vetter
- Department of Anesthesiology, University of Alabama School of Medicine, JT862, 619 19th Street South, Birmingham, AL, 35249-6810, USA
| | - Lee A Goeddel
- Department of Anesthesiology, University of Alabama School of Medicine, 619 19th Street South, JT-920, Birmingham, AL, 35249-6810, USA
| | - Arthur M Boudreaux
- Department of Anesthesiology, University of Alabama School of Medicine, 619 19th Street South, JT-823, Birmingham, AL, 35249-6810, USA
| | - Thomas R Hunt
- Division of Orthopedics, University of Alabama School of Medicine, 1313 13th Street South, OSB Suite 201, Birmingham, AL, 35205, USA
- Department of Surgery, University of Alabama School of Medicine, 1313 13th Street South, OSB Suite 201, Birmingham, AL, 35205, USA
| | - Keith A Jones
- Department of Anesthesiology, University of Alabama School of Medicine, 619 19th Street South, JT-804, Birmingham, AL, 35249-6810, USA
| | - Jean-Francois Pittet
- Department of Anesthesiology, University of Alabama School of Medicine, 619 19th Street South, JT-926, Birmingham, AL, 35249-6810, USA
| |
Collapse
|
26
|
Boudreaux AM, Vetter TR. The creation and impact of a dedicated section on quality and patient safety in a clinical academic department. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2013; 88:173-178. [PMID: 23269289 DOI: 10.1097/acm.0b013e31827b53dd] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Optimizing the effectiveness, efficiency, integration, and satisfaction associated with delivered health care is not only highly principled but also good business practice in an extremely competitive environment. Programs that foster quality improvement and patient safety efforts while also promoting a scholarly focus can generate the incentives and organizational recognition needed to make patient safety and quality improvement bona fide components of the academic mission. The authors describe the development, implementation, and results of a dedicated Section on Quality and Patient Safety (SQPS) within an academic anesthesiology department. Spearheaded by a physician champion and vigorously supported by the departmental chair, this SQPS engaged core leaders from the Department of Anesthesiology. This departmental quality and patient safety management team adopted quality improvement and performance improvement techniques that have been successfully used in other industries. The SQPS has gained support through data-driven results and reiterative promotion. Transparency and accountability have also been powerful motivators for achieving clinician buy-in and changing behavior. Since its inception in 2007, the SQPS has initiated or managed through to completion more than 25 quality and performance improvement projects, including an intraoperative corneal injury reduction program, a wrong-sided regional anesthesia procedure, a drug-eluting coronary stent protocol, and a practice-improvement initiative for resident physicians. The SQPS has not only robustly promoted a departmental culture of quality patient care and safety but also set the standard for other departments and stakeholders within the authors' health system.
Collapse
Affiliation(s)
- Arthur M Boudreaux
- Section on Quality and Patient Safety, Department of Anesthesiology, University of Alabama School of Medicine, Birmingham, USA
| | | |
Collapse
|
27
|
Day TE, Babu AN, Kymes SM, Ravi N. Discrete Event Simulation and Real Time Locating Systems. INTERNATIONAL JOURNAL OF E-ADOPTION 2012. [DOI: 10.4018/jea.2012100102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Veteran’s Health Administration (VHA) is the largest integrated health care system in the United States, forming the arm of the Department of Veterans Affairs (VA) that delivers medical services. From a troubled past, the VHA today is regarded as a model for healthcare transformation. The VA has evaluated and adopted a variety of cutting-edge approaches to foster greater efficiency and effectiveness in healthcare delivery as part of their systems redesign initiative. This paper discusses the integration of two health care analysis platforms: Discrete Event Simulation (DES), and Real Time Locating systems (RTLS) presenting examples of work done at the St. Louis VA Medical Center. Use of RTLS data for generation and validation of DES models is detailed, with prescriptive discussion of methodologies. The authors recommend the careful consideration of these relatively new approaches which show promise in assisting systems redesign initiatives across the health care spectrum.
Collapse
Affiliation(s)
- T. Eugene Day
- Center for Optimization and Semantic Control, St. Louis VA Medical Center & Washington University in St. Louis, St. Louis, MO, USA
| | - Ajit N. Babu
- Center for Advancement of Global Health, Kochi, Kerala, India, & St. Louis VA Medical Center, Saint Louis University, St. Louis, MO, USA
| | - Steven M. Kymes
- Center for Economic Evaluation in Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Nathan Ravi
- St. Louis VA Medical Center, Institute of Public Health, St. Louis University, & Washington University in St. Louis, St. Louis, MO, USA
| |
Collapse
|
28
|
Khoury MJ, Coates RJ, Fennell ML, Glasgow RE, Scheuner MT, Schully SD, Williams MS, Clauser SB. Multilevel research and the challenges of implementing genomic medicine. J Natl Cancer Inst Monogr 2012; 2012:112-20. [PMID: 22623603 DOI: 10.1093/jncimonographs/lgs003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Advances in genomics and related fields promise a new era of personalized medicine in the cancer care continuum. Nevertheless, there are fundamental challenges in integrating genomic medicine into cancer practice. We explore how multilevel research can contribute to implementation of genomic medicine. We first review the rapidly developing scientific discoveries in this field and the paucity of current applications that are ready for implementation in clinical and public health programs. We then define a multidisciplinary translational research agenda for successful integration of genomic medicine into policy and practice and consider challenges for successful implementation. We illustrate the agenda using the example of Lynch syndrome testing in newly diagnosed cases of colorectal cancer and cascade testing in relatives. We synthesize existing information in a framework for future multilevel research for integrating genomic medicine into the cancer care continuum.
Collapse
Affiliation(s)
- Muin J Khoury
- Office of Public Health Genomics, Centers for Disease Control and Prevention, 1600 Clifton Rd, Mailstop E61, Atlanta, GA 30333, USA.
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Sinkowitz-Cochran RL, Garcia-Williams A, Hackbarth AD, Zell B, Baker GR, McCannon CJ, Beltrami EM, Jernigan JA, McDonald LC, Goldmann DA. Evaluation of organizational culture among different levels of healthcare staff participating in the Institute for Healthcare Improvement's 100,000 Lives Campaign. Infect Control Hosp Epidemiol 2011; 33:135-43. [PMID: 22227982 DOI: 10.1086/663712] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Little is known about how hospital organizational and cultural factors associated with implementation of quality initiatives such as the Institute for Healthcare Improvement's (IHI) 100,000 Lives Campaign differ among levels of healthcare staff. DESIGN Evaluation of a mixed qualitative and quantitative methodology ("trilogic evaluation model"). SETTING Six hospitals that joined the campaign before June 2006. PARTICIPANTS Three strata of staff (executive leadership, midlevel, and frontline) at each hospital. RESULTS. Surveys were completed in 2008 by 135 hospital personnel (midlevel, 43.7%; frontline, 38.5%; executive, 17.8%) who also participated in 20 focus groups. Overall, 93% of participants were aware of the IHI campaign in their hospital and perceived that 58% (standard deviation, 22.7%) of improvements in quality at their hospital were a direct result of the campaign. There were significant differences between staff levels on the organizational culture (OC) items, with executive-level staff having higher scores than midlevel and frontline staff. All 20 focus groups perceived that the campaign interventions were sustainable and that data feedback, buy-in, hardwiring (into daily activities), and leadership support were essential to sustainability. CONCLUSIONS The trilogic model demonstrated that the 3 levels of staff had markedly different perceptions regarding the IHI campaign and OC. A framework in which frontline, midlevel, and leadership staff are simultaneously assessed may be a useful tool for future evaluations of OC and quality initiatives such as the IHI campaign.
Collapse
Affiliation(s)
- Ronda L Sinkowitz-Cochran
- Centers for Disease Control and Prevention, Division of Healthcare Quality Promotion, Atlanta, Georgia 30333, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Wilson D, Howell V, Toppozini C, Dong K, Clark M, Hurtado R. Against all odds: diagnosing tuberculosis in South Africa. J Infect Dis 2011; 204 Suppl 4:S1102-9. [PMID: 21996692 DOI: 10.1093/infdis/jir453] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Clinical and logistic systems to support the timely diagnosis of tuberculosis are currently not preventing large numbers of tuberculosis deaths in South Africa. Context-appropriate systems for the diagnosis of tuberculosis are entirely dependent on effective and responsive management of human resources and an uninterrupted supply of clinical materials. Attention to these components of the tuberculosis program is urgently needed before new diagnostic technologies can be expected to impact on tuberculosis mortality in resource constrained settings.
Collapse
Affiliation(s)
- Douglas Wilson
- Department of Medicine, Edendale Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa.
| | | | | | | | | | | |
Collapse
|
31
|
Torrey WC, Bond GR, McHugo GJ, Swain K. Evidence-Based Practice Implementation in Community Mental Health Settings: The Relative Importance of Key Domains of Implementation Activity. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2011; 39:353-64. [DOI: 10.1007/s10488-011-0357-9] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
32
|
Campbell MK, Tessaro I, Gellin M, Valle CG, Golden S, Kaye L, Ganz PA, McCabe MS, Jacobs LA, Syrjala K, Anderson B, Jones AF, Miller K. Adult cancer survivorship care: experiences from the LIVESTRONG centers of excellence network. J Cancer Surviv 2011; 5:271-82. [PMID: 21553353 DOI: 10.1007/s11764-011-0180-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 04/21/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND The objectives of this study were to characterize survivorship models of care across eight LIVESTRONG Survivorship Center of Excellence (COE) Network sites and to identify barriers and facilitators influencing survivorship care. METHODS Using the framework of the Chronic Care Model (CCM), quantitative and qualitative methods of inquiry were conducted with the COEs. Methods included document reviews, key informant telephone interviews with 39 participants, online Assessment of Chronic Illness Care (ACIC) surveys with 40 participants, and three site visits. RESULTS Several overarching themes emerged in qualitative interviews and were substantiated by quantitative methods. Health system factors supporting survivorship care include organization and leadership commitment and program champions at various levels of the health care team. System barriers include reimbursement issues, lack of space, and the need for leadership commitment to support changes in clinical practices as well as having program "champions" among clinical staff. Multiple models of care include separate survivorship clinics and integrated models as well as consultative models. COEs' scores on the ACIC survey showed overall "reasonable support" for survivorship care; however, the clinical information system domain was least developed. Although the ACIC findings indicated "reasonable support" for self-management, the qualitative analysis revealed that self-management support was largely limited to health promotion provided in clinic-based education and counseling sessions, with few COEs providing patients with self-management tools and interventions. CONCLUSIONS The CCM framework captured experiences and challenges of these COEs and provided insight into the current state of survivorship care in the context of National Cancer Institute-designated comprehensive cancer centers. Findings showed that cancer patients and providers could benefit from clinical information systems that would better identify candidates for survivorship care and provide timely information. In addition, a crucial area for development is self-management support outside of clinical care. IMPLICATIONS FOR CANCER SURVIVORS Cancer survivors may benefit from learning about the experience and challenges faced by the eight LIVESTRONG Centers of Excellence in developing programs and models for cancer survivorship care, and these findings may inform patient and caregiver efforts to seek, evaluate, and advocate for quality survivorship programs designed to meet their needs.
Collapse
Affiliation(s)
- Marci K Campbell
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB #7461, 1700 Martin Luther King Blvd, Room 316, Chapel Hill, NC 27599, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Suhonen R, Stolt M, Virtanen H, Leino-Kilpi H. Organizational ethics: A literature review. Nurs Ethics 2011; 18:285-303. [DOI: 10.1177/0969733011401123] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of the study was to report the results of a systematically conducted literature review of empirical studies about healthcare organizations’ ethics and management or leadership issues. Electronic databases MEDLINE and CINAHL yielded 909 citations. After a two stage application of the inclusion and exclusion criteria 56 full-text articles were included in the review. No large research programs were identified. Most of the studies were in acute hospital settings from the 1990s onwards. The studies focused on ethical challenges, dilemmas in practice, employee moral distress and ethical climates or environments. Study samples typically consisted of healthcare practitioners, operational, executive and strategic managers. Data collection was mainly by questionnaires or interviews and most of the studies were descriptive, correlational and cross-sectional. There is need to develop conceptual clarity and a theoretical framework around the subject of organizational ethics and the breadth of the contexts and scope of the research needs to be increased.
Collapse
|
34
|
Glance LG, Neuman M, Martinez EA, Pauker KY, Dutton RP. Performance Measurement at a “Tipping Point”. Anesth Analg 2011; 112:958-66. [DOI: 10.1213/ane.0b013e31820e778d] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
35
|
Dückers ML, Wagner C, Vos L, Groenewegen PP. Understanding organisational development, sustainability, and diffusion of innovations within hospitals participating in a multilevel quality collaborative. Implement Sci 2011; 6:18. [PMID: 21385467 PMCID: PMC3065434 DOI: 10.1186/1748-5908-6-18] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 03/09/2011] [Indexed: 11/26/2022] Open
Abstract
Background Between 2004 and 2008, 24 Dutch hospitals participated in a two-year multilevel quality collaborative (MQC) comprised of (a) a leadership programme for hospital executives, (b) six quality-improvement collaboratives (QICs) for healthcare professionals and other staff, and (c) an internal programme organisation to help senior management monitor and coordinate team progress. The MQC aimed to stimulate the development of quality-management systems and the spread of methods to improve patient safety and logistics. The objective of this study is to describe how the first group of eight MQC hospitals sustained and disseminated improvements made and the quality methods used. Methods The approach followed by the hospitals was described using interview and questionnaire data gathered from eight programme coordinators. Results MQC hospitals followed a systematic strategy of diffusion and sustainability. Hospital quality-management systems are further developed according to a model linking plan-do-study-act cycles at the unit and hospital level. The model involves quality norms based on realised successes, performance agreements with unit heads, organisational support, monitoring, and quarterly accountability reports. Conclusions It is concluded from this study that the MQC contributed to organisational development and dissemination within participating hospitals. Organisational learning effects were demonstrated. System changes affect the context factors in the theory of organisational readiness: organisational culture, policies and procedures, past experience, organisational resources, and organisational structure. Programme coordinator responses indicate that these factors are utilised to manage spread and sustainability. Further research is needed to assess long-term effects.
Collapse
Affiliation(s)
- Michel La Dückers
- NIVEL-Netherlands Institute for Health Services Research, Utrecht, the Netherlands.
| | | | | | | |
Collapse
|
36
|
Schilling L, Chase A, Kehrli S, Liu AY, Matt Stiefel M, Brentari R. Kaiser Permanente’s Performance Improvement System, Part 1: From Benchmarking to Executing on Strategic Priorities. Jt Comm J Qual Patient Saf 2010; 36:484-98. [PMID: 21090018 DOI: 10.1016/s1553-7250(10)36072-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
37
|
Scott I. What are the most effective strategies for improving quality and safety of health care? Intern Med J 2010; 39:389-400. [PMID: 19580618 DOI: 10.1111/j.1445-5994.2008.01798.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
There is now a plethora of different quality improvement strategies (QIS) for optimizing health care, some clinician/patient driven, others manager/policy-maker driven. Which of these are most effective remains unclear despite expressed concerns about potential for QIS-related patient harm and wasting of resources. The objective of this study was to review published literature assessing the relative effectiveness of different QIS. Data sources comprising PubMed Clinical Queries, Cochrane Library and its Effective Practice and Organization of Care database, and HealthStar were searched for studies of QIS between January 1985 and February 2008 using search terms based on an a priori QIS classification suggested by experts. Systematic reviews of controlled trials were selected in determining effect sizes for specific QIS, which were compared as a narrative meta-review. Clinician/patient driven QIS were associated with stronger evidence of efficacy and larger effect sizes than manager/policy-maker driven QIS. The most effective strategies (>10% absolute increase in appropriate care or equivalent measure) included clinician-directed audit and feedback cycles, clinical decision support systems, specialty outreach programmes, chronic disease management programmes, continuing professional education based on interactive small-group case discussions, and patient-mediated clinician reminders. Pay-for-performance schemes directed to clinician groups and organizational process redesign were modestly effective. Other manager/policy-maker driven QIS including continuous quality improvement programmes, risk and safety management systems, public scorecards and performance reports, external accreditation, and clinical governance arrangements have not been adequately evaluated with regard to effectiveness. QIS are heterogeneous and methodological flaws in much of the evaluative literature limit validity and generalizability of results. Based on current best available evidence, clinician/patient driven QIS appear to be more effective than manager/policy-maker driven QIS although the latter have, in many instances, attracted insufficient robust evaluations to accurately determine their comparative effectiveness.
Collapse
Affiliation(s)
- I Scott
- Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
| |
Collapse
|
38
|
Wagg A, Lowe D, Peel P, Potter J. Do self-reported 'integrated' continence services provide high-quality continence care? Age Ageing 2009; 38:730-3. [PMID: 19793925 DOI: 10.1093/ageing/afp177] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION systematic collection of clinical outcome data remains the most difficult task in the measurement of clinical effectiveness. However, the examination of the relationship between organisational and clinical process of care may provide a surrogate measure of quality in care. METHODS data from the 2006 National Audit of Continence Care for Older People were used to examine whether there was an association between organisational structure and standard of continence care for older people. 'Quality' scores were produced and the relationship between scores was examined. RESULTS there were statistically significant correlations between organisational and process scores for continence care. Primary care scored higher than hospitals or care homes in regard to service organisation [median (IQR): 57 (45-68) vs 48 (36-65) vs 50 (38-55), P = 0.001]. Differences were less with clinical process scores for urinary incontinence (UI) [median (IQR): 42 (32-52) vs 40 (29-49) vs 43 (34-52), P = 0.06] and for faecal incontinence (FI) [median: 42 (34-53) vs 45 (36-55) vs 47 (41-53), P = 0.12]. CONCLUSION those with an integrated service provide higher quality care to older people. The provision of high-quality care for continence appears to be dependent upon well-organised services with personnel who have the appropriate training and skills to deliver the care.
Collapse
Affiliation(s)
- Adrian Wagg
- UCL, Geriatric Medicine, University College Hospital, 25 Grafton Way, London WC1E 6AU, UK.
| | | | | | | |
Collapse
|
39
|
Plochg T, Klazinga NS, Starfield B. Transforming medical professionalism to fit changing health needs. BMC Med 2009; 7:64. [PMID: 19857246 PMCID: PMC2773806 DOI: 10.1186/1741-7015-7-64] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Accepted: 10/26/2009] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The professional organization of medical work no longer reflects the changing health needs caused by the growing number of complex and chronically ill patients. Key stakeholders enforce coordination and remove power from the medical professions in order allow for these changes. However, it may also be necessary to initiate basic changes to way in which the medical professionals work in order to adapt to the changing health needs. DISCUSSION Medical leaders, supported by health policy makers, can consciously activate the self-regulatory capacity of medical professionalism in order to transform the medical profession and the related professional processes of care so that it can adapt to the changing health needs. In doing so, they would open up additional routes to the improvement of the health services system and to health improvement. This involves three consecutive steps: (1) defining and categorizing the health needs of the population; (2) reorganizing the specialty domains around the needs of population groups; (3) reorganizing the specialty domains by eliminating work that could be done by less educated personnel or by the patients themselves. We suggest seven strategies that are required in order to achieve this transformation. SUMMARY Changing medical professionalism to fit the changing health needs will not be easy. It will need strong leadership. But, if the medical world does not embark on this endeavour, good doctoring will become merely a bureaucratic and/or marketing exercise that obscures the ultimate goal of medicine which is to optimize the health of both individuals and the entire population.
Collapse
Affiliation(s)
- Thomas Plochg
- Department of Social Medicine, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
| | | | | |
Collapse
|
40
|
Perkins JD. Safety of invasive procedures in end-stage liver disease patients. Liver Transpl 2009; 15:656-7. [PMID: 19479811 DOI: 10.1002/lt.21792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- James D Perkins
- Liver Transplantation Worldwide, University of Washington Medical Center, Seattle, WA, USA
| |
Collapse
|
41
|
Cima RR, Kollengode A, Storsveen AS, Weisbrod CA, Deschamps C, Koch MB, Moore D, Pool SR. A multidisciplinary team approach to retained foreign objects. Jt Comm J Qual Patient Saf 2009; 35:123-32. [PMID: 19326803 DOI: 10.1016/s1553-7250(09)35016-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Retained foreign objects (RFOs) after surgical procedures are an infrequent but potentially devastating medical error. The Mayo Clinic, Rochester (MCR), undertook a quality improvement program to reduce the incidence of surgical RFOs. METHOD A multidisciplinary, multiphase approach was initiated in 2005. The effort, led by surgical, nursing, and administrative institutional leaders, was divided into three phases. The first phase included a defect analysis and policy review. A detailed analysis of all RFOs (both true and near misses) was undertaken to identify patterns of failures unique to our institution and operating room culture. Simultaneously, a review of all relevant institutional policies was performed, with comprehensive revisions focusing on increased clarity and inter- and intrapolicy consistency. The second phase involved increasing awareness and communication among all operating room personnel, including surgeons, residents, nursing, and allied health staff. The education program included all-staff conferences, team training, simulation videos, and daily education reminders and in-room audits. Finally, a monitoring and control phase involved rapid leadership response teams to any events, enhanced staff communication, and policy reviews. RESULTS When the program started, MCR was averaging a surgical RFO every 16 days. After the intervention, the average interval between RFO events increased to 69 days, a level of performance that has been sustained for more than two years. DISCUSSION MCR experienced a significant and sustained reduction in the incidents of RFOs, attributed to the multidisciplinary nature of the initiative, the active engagement of institutional leadership, and use of the principles of enhanced communication between operating room staff members to improve operating room situational awareness.
Collapse
Affiliation(s)
- Robert R Cima
- Department of Surgery, Mayo Clinic, Rochester, MN, USA.
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Ryckman FC, Schoettker PJ, Hays KR, Connelly BL, Blacklidge RL, Bedinghaus CA, Sorter ML, Friend LC, Kotagal UR. Reducing Surgical Site Infections at a Pediatric Academic Medical Center. Jt Comm J Qual Patient Saf 2009; 35:192-8. [DOI: 10.1016/s1553-7250(09)35026-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
43
|
Porzsolt F, Ghosh AK, Kaplan RM. Qualitative assessment of innovations in healthcare provision. BMC Health Serv Res 2009; 9:50. [PMID: 19298658 PMCID: PMC2666677 DOI: 10.1186/1472-6963-9-50] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Accepted: 03/19/2009] [Indexed: 01/05/2023] Open
Abstract
Background The triad of quality, innovation and economic restraint is as important in health care as it is in the business world. There are many proposals for the assessment of quality and of economic restraints in health care but only a few address assessment of innovations. We propose a strategy and new structures to standardize the description of health care innovations and to quantify them. Discussion Strategy and structure are based on the assumption that in the early phase of an innovation only data on the feasibility and possibly on the efficacy or effectiveness of an innovation can be expected. From the patient's perspective, benefit resulting from an innovation can be confirmed only in a later phase of development. Early indicators of patient's benefit will be surrogate parameters which correlate only weakly with the desired endpoints. After the innovation has been in use, there will be more evidence on correlations between surrogate parameters and the desired endpoints to provide evidence of the patient benefit. From an administrative perspective, this evidence can be considered in decisions about public financing. Different criteria are proposed for the assessment of innovations in prevention, diagnosis and therapy. For decisions on public financing a public fund for innovations may be helpful. Depending on the phase of innovation risk sharing models are proposed between manufacturers, private insurers and public funding. Summary Potential for patient benefit is always uncertain during early stages of innovations. This uncertainty decreases with increasing information on the effects of the innovation. Information about an innovation can be quantified, categorized and integrated into rational economic decisions.
Collapse
Affiliation(s)
- Franz Porzsolt
- Clinical Economics, University of Ulm, Frauensteige 6, 89075 Ulm, Germany.
| | | | | |
Collapse
|
44
|
Gross R, Ashkenazi Y, Tabenkin H, Porath A, Aviram A. Implementing QA programs in managed care health plans: factors contributing to success. Int J Health Care Qual Assur 2008; 21:308-24. [PMID: 18578215 DOI: 10.1108/09526860810868247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to identify the factors that contribute to the success or failure of quality assurance programs implemented by Israeli managed care health plans. DESIGN/METHODOLOGY/APPROACH An in-depth study of seven quality assurance programs was conducted, comparing successful with unsuccessful ones using the comparative "case study" method. Employing a semi-structured questionnaire, 42 program directors and professionals in the field were interviewed. FINDINGS A number of factors associated with the programs' success emerged. Those external to the program included: ongoing management support, resource allocation, information system support and perceived financial benefit for the organization. Internal factors included: leadership, perceived problem's importance, laying the groundwork in the field, involving field staff in planning and implementation and staff motivation. ORIGINALITY/VALUE The study provides insights into ways to encourage the implementation of successful quality assurance programs in the special organizational context of managed care health plans. As the implementation relies heavily on data, one important precondition is the development of computerized information systems to facilitate ongoing data collection. It is also necessary from the planning stage to take into account organizational factors that affect success.
Collapse
|
45
|
Abstract
Mental health policy enables the translation of the knowledge base of 'how' to help children and families into the actual 'provision' of help. Amid competing pressures to leave the allocation of services to the market, policy is required to define needs, select priorities, match resources with need, and to measure what has been accomplished. Crafting policy requires balancing contrasting goals and approaches, here spelled out. Public mental health policy can be compared to other forms of continuous quality improvement (CQI).
Collapse
Affiliation(s)
- Gordon Harper
- Child and Adolescent Services, Massachusetts Department of Mental Health, Harvard Medical School, Boston, MA, USA.
| | | |
Collapse
|
46
|
Characteristics of Patient Care Management Problems Identified in Emergency Department Morbidity and Mortality Investigations During 15 Years. Ann Emerg Med 2008; 51:251-61, 261.e1. [DOI: 10.1016/j.annemergmed.2007.06.483] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2006] [Revised: 06/14/2007] [Accepted: 06/25/2007] [Indexed: 11/21/2022]
|
47
|
Harrison MI, Henriksen K, Hughes RG. Improving the health care work environment: a sociotechnical systems approach. Jt Comm J Qual Patient Saf 2008; 33:3-6, 1. [PMID: 18173161 DOI: 10.1016/s1553-7250(07)33108-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This issue examines findings on key elements of the hospital environment, identifies risks to safety and quality, and proposes operational and policy solutions.
Collapse
Affiliation(s)
- Michael I Harrison
- Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Rockville, Maryland, USA.
| | | | | |
Collapse
|
48
|
Abstract
BACKGROUND The Institute of Medicine's 2001 report Crossing the Quality Chasm argued for fundamental redesign of the U.S. health care system. Six years later, many health care organizations have embraced the report's goals, but few have succeeded in making the substantial transformations needed to achieve those aims. PURPOSES This article offers a model for moving organizations from short-term, isolated performance improvements to sustained, reliable, organization-wide, and evidence-based improvements in patient care. METHODOLOGY Longitudinal comparative case studies were conducted in 12 health care systems using a mixed-methods evaluation design based on semistructured interviews and document review. Participating health care systems included seven systems funded through the Robert Wood Johnson Foundation's Pursuing Perfection Program and five systems with long-standing commitments to improvement and high-quality care. FINDINGS Five interactive elements appear critical to successful transformation of patient care: (1) Impetus to transform; (2) Leadership commitment to quality; (3) Improvement initiatives that actively engage staff in meaningful problem solving; (4) Alignment to achieve consistency of organization goals with resource allocation and actions at all levels of the organization; and (5) Integration to bridge traditional intra-organizational boundaries among individual components. These elements drive change by affecting the components of the complex health care organization in which they operate: (1) Mission, vision, and strategies that set its direction and priorities; (2) Culture that reflects its informal values and norms; (3) Operational functions and processes that embody the work done in patient care; and (4) Infrastructure such as information technology and human resources that support the delivery of patient care. Transformation occurs over time with iterative changes being sustained and spread across the organization. PRACTICE IMPLICATIONS The conceptual model holds promise for guiding health care organizations in their efforts to pursue the Institute of Medicine aims of fundamental system redesign to achieve dramatically improved patient care.
Collapse
|
49
|
Harrison MI, Henriksen K, Hughes RG. Improving the Health Care Work Environment: Implications for Research, Practice, and Policy. Jt Comm J Qual Patient Saf 2007; 33:81-4. [DOI: 10.1016/s1553-7250(07)33115-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|