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O'Dowd E, Lydon S, Ward ME, Kane M, Geary U, Rudland C, O'Connor P. The impact of the COVID-19 pandemic on patient complaints within one Irish teaching hospital. Ir J Med Sci 2023; 192:2563-2571. [PMID: 36787028 PMCID: PMC9926407 DOI: 10.1007/s11845-023-03282-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 01/12/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic dramatically impacted the delivery of hospital care in terms of quality and safety. OBJECTIVES To examine complaints from two time points, quarter 4 (Q4) 2019 (pre-pandemic) and Q4 2020 (second wave), and explore whether there was a difference in the frequency and/or content of complaints. METHODS A retrospective analysis of complaints from one Irish hospital was conducted using the Healthcare Complaints Analysis Tool (HCAT). Within each complaint, the content, severity, harm reported by the patient, and stage of care were categorised. The complaints were analysed using descriptive statistics and chi-square tests of independence. RESULTS There were 146 complaints received in Q4 2019 and 114 in Q4 2020. Complaint severity was significantly higher in Q4 2019 as compared to Q4 2020. However, there were no other significant differences. Institutional processes (e.g. staffing, resources) were the most common reason for complaints (30% in Q4 2019 and 36% in Q4 2020). The majority of complaints were concerned with care on the ward (23% in Q4 2019 and 31% in Q4 2020). CONCLUSIONS The severity of complaints was significantly higher in Q4 2019 than in Q4 2020, which requires further exploration as the reasons for this are unclear. The lack of a difference in the frequency and content of complaints during the two time periods was unexpected. However, this may be linked to a number of factors, including public support for the healthcare system, existing system-level issues in the hospital, or indeed increased staff collaboration in the context of the COVID-19 crisis.
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Affiliation(s)
- Emily O'Dowd
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland.
- Irish Centre for Applied Patient Safety and Simulation, School of Medicine, National University of Ireland Galway, Galway, Ireland.
- Department of Surgical Affairs, RCSI, Dublin, Ireland.
| | - Sinéad Lydon
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, School of Medicine, National University of Ireland Galway, Galway, Ireland
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Marie E Ward
- Quality and Safety Improvement Directorate, St James's Hospital, Dublin, Ireland
- University of Dublin, Dublin, Ireland
| | - Maria Kane
- Quality and Safety Improvement Directorate, St James's Hospital, Dublin, Ireland
| | - Una Geary
- Quality and Safety Improvement Directorate, St James's Hospital, Dublin, Ireland
| | - Chris Rudland
- National Complaints Governance and Learning Team, Health Service Executive, Catherine Street, Limerick, Ireland
| | - Paul O'Connor
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, School of Medicine, National University of Ireland Galway, Galway, Ireland
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2
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Davis J, Sinni S, Maloney S, Walker L. Strategies Australian Hospitals Utilize to Incorporate Patient Feedback in the Delivery and Measurement of Person-Centered Care: A Scoping Review. Clin Nurs Res 2021; 31:782-794. [PMID: 34293956 DOI: 10.1177/10547738211033098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients are central to healthcare clinicians and organizations but often subsidiary to clinical expertise, knowledge, workplace processes, and culture. Shifting societal values, technology, and regulations have remoulded the patient-clinician relationship, augmenting the patient's voice within the healthcare construct. Scaffolding this restructure is the global imperative to deliver person-centered care (PCC). The aim of the scoping review was to explore and map the intersection between patient feedback and strategies to improve the provision of PCC within acute hospitals in Australia. Database searches yielded 493 articles, with 16 studies meeting inclusion criteria. Integration of patient feedback varied from strategy design, through to multi-staged input throughout the initiative and beyond. Initiatives actioning patient feedback fell broadly into four categories: clinical practice, educational strategies, governance, and measurement. How clinicians can invite feedback and support patients to engage equally remains unclear, requiring further exploration of strategies to propel clinician-patient partnerships, scaffolded by hospital governance structures.
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Affiliation(s)
- Joy Davis
- Monash University, Frankston, VIC, Australia.,Peninsula Health, Frankston, VIC, Australia
| | - Sue Sinni
- Monash University, Frankston, VIC, Australia.,Peninsula Health, Frankston, VIC, Australia
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3
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Khan G, Kagwanja N, Whyle E, Gilson L, Molyneux S, Schaay N, Tsofa B, Barasa E, Olivier J. Health system responsiveness: a systematic evidence mapping review of the global literature. Int J Equity Health 2021; 20:112. [PMID: 33933078 PMCID: PMC8088654 DOI: 10.1186/s12939-021-01447-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organisation framed responsiveness, fair financing and equity as intrinsic goals of health systems. However, of the three, responsiveness received significantly less attention. Responsiveness is essential to strengthen systems' functioning; provide equitable and accountable services; and to protect the rights of citizens. There is an urgency to make systems more responsive, but our understanding of responsiveness is limited. We therefore sought to map existing evidence on health system responsiveness. METHODS A mixed method systemized evidence mapping review was conducted. We searched PubMed, EbscoHost, and Google Scholar. Published and grey literature; conceptual and empirical publications; published between 2000 and 2020 and English language texts were included. We screened titles and abstracts of 1119 publications and 870 full texts. RESULTS Six hundred twenty-one publications were included in the review. Evidence mapping shows substantially more publications between 2011 and 2020 (n = 462/621) than earlier periods. Most of the publications were from Europe (n = 139), with more publications relating to High Income Countries (n = 241) than Low-to-Middle Income Countries (n = 217). Most were empirical studies (n = 424/621) utilized quantitative methodologies (n = 232), while qualitative (n = 127) and mixed methods (n = 63) were more rare. Thematic analysis revealed eight primary conceptualizations of 'health system responsiveness', which can be fitted into three dominant categorizations: 1) unidirectional user-service interface; 2) responsiveness as feedback loops between users and the health system; and 3) responsiveness as accountability between public and the system. CONCLUSIONS This evidence map shows a substantial body of available literature on health system responsiveness, but also reveals evidential gaps requiring further development, including: a clear definition and body of theory of responsiveness; the implementation and effectiveness of feedback loops; the systems responses to this feedback; context-specific mechanism-implementation experiences, particularly, of LMIC and fragile-and conflict affected states; and responsiveness as it relates to health equity, minority and vulnerable populations. Theoretical development is required, we suggest separating ideas of services and systems responsiveness, applying a stronger systems lens in future work. Further agenda-setting and resourcing of bridging work on health system responsiveness is suggested.
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Affiliation(s)
- Gadija Khan
- School of Public Health and Family Medicine, Health Policy and Systems Division, University of Cape Town, Cape Town, South Africa
| | - Nancy Kagwanja
- Kenya Medical Research Institute (KEMRI)-Wellcome-Trust Research Programme, Kilifi, Kenya
| | - Eleanor Whyle
- School of Public Health and Family Medicine, Health Policy and Systems Division, University of Cape Town, Cape Town, South Africa
| | - Lucy Gilson
- School of Public Health and Family Medicine, Health Policy and Systems Division, University of Cape Town, Cape Town, South Africa
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Sassy Molyneux
- Kenya Medical Research Institute (KEMRI)-Wellcome-Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, Center for Tropical medicine and Global Health, University of Oxford, Oxford, UK
| | - Nikki Schaay
- University of the Western Cape, School of Public Health, Cape Town, South Africa
| | - Benjamin Tsofa
- Kenya Medical Research Institute (KEMRI)-Wellcome-Trust Research Programme, Kilifi, Kenya
| | - Edwine Barasa
- Kenya Medical Research Institute (KEMRI)-Wellcome-Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, Center for Tropical medicine and Global Health, University of Oxford, Oxford, UK
| | - Jill Olivier
- School of Public Health and Family Medicine, Health Policy and Systems Division, University of Cape Town, Cape Town, South Africa
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Abstract
OBJECTIVES Although different forms of patient feedback are available, their use in hospital management is still limited. The objective of this study is to explore how patient feedback is currently used in hospitals to improve quality. DESIGN This is a qualitative exploratory multiple case study. Data collection included nine interviews, of an average duration of 50 min, conducted between March and June 2019. Additionally, a document and secondary data analysis were performed. SETTING This study was conducted in three Brazilian hospitals selected for their solid patient feedback practises. PARTICIPANTS Managers from the customer service, quality, nursing, operations, projects and patient experience departments of the three hospitals. RESULTS Despite literature suggesting that organisational objectives regarding patient feedback are not clear, data show that there is managerial concern regarding the promotion of an environment capable of changing according to patient feedback. In these instances, organisational processes were structured to focus on patients' feedback and its receipt by the staff, including a non-punitive culture. Several patient feedback forms are available: voluntary events, patient surveys and informal feedback. Instruments to measure patient feedback focused on specific aspects of healthcare, to identify and clarify the problems for addressal by the management. The net promoter score was the main strategic indicator of patient feedback, used to assess the impact of improvement action. CONCLUSIONS The hospitals had established objectives that valued the patient's perspective. Involvement of the health team, availability of different channels for feedback and the use of quality tools are considered a good basis for using patient feedback to drive quality improvement.
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Affiliation(s)
- Simone Berger
- Department of Production Engineering, University of São Paulo, Sao Paulo, Brazil
| | - Ana Maria Saut
- Department of Production Engineering, University of São Paulo, Sao Paulo, Brazil
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Chia YYP, Ekladious A. Australian public hospital inpatient satisfaction related to early patient involvement and shared decision-making in discharge planning. Intern Med J 2020; 51:891-895. [PMID: 32358924 PMCID: PMC8362186 DOI: 10.1111/imj.14872] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 11/29/2022]
Abstract
Background Surveys of hospital inpatient satisfaction may help develop actionable plans for quality improvement, and patients have preferred to give feedback during admission at the point of service compared to after discharge. However, patient satisfaction measurement has often been done by questionnaires post‐discharge, and without focussing on an Australian general internal medicine setting. Aims To understand patients' perceptions of their admission experiences in an Australian public teaching hospital's general internal medicine unit, and to understand the opportunities for quality improvement. Methods A prospective study of 50 inpatients of a general internal medicine unit at an Australian public teaching hospital was carried out using a patient satisfaction questionnaire given to patients on the day of discharge. Results Patients perceived deficits in early communication about discharge destination planning, and provision of written discharge instructions. Responses highlighted the importance of checking with patients to elicit further information that was not previously captured during initial history‐taking, patient‐centred communication to enable informed consent and decision making, use of language readily understandable to laypersons, and checking for patients' understanding of messages as communicated by the treating clinician. Conclusions In an Australian general internal medicine service, early involvement and shared decision‐making in discharge planning are valued by patients. Incorporating checking of patients' understanding of diagnoses, management, discharge instructions, and follow‐up plans into ward round routines may benefit patient satisfaction. This study stimulates further research into the use of a proforma to capture and check patients' understanding of discharge diagnoses and plans.
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Affiliation(s)
- Yong Yau Paul Chia
- Department of General Internal Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia.,Tasmanian School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Adel Ekladious
- Department of Medicine, Bunbury Hospital, Bunbury, Western Australia, Australia
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6
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Melin J, Fornazar R, Spångfors M, Pendrill L. Rasch analysis of the Patient Participation in Rehabilitation Questionnaire (PPRQ). J Eval Clin Pract 2020; 26:248-255. [PMID: 30968514 PMCID: PMC7004110 DOI: 10.1111/jep.13134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 03/01/2019] [Accepted: 03/01/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the Patient Participation in Rehabilitation Questionnaire (PPRQ) according to Rasch measurement theory. METHOD Five hundred twenty-two post-discharge patients from a neurological rehabilitation unit were included. The PPRQ questionnaire comprises 20 items rated by a cohort of 522 patients about their experiences of participating in rehabilitation. The measurement properties of the PPRQ were evaluated by Rasch analysis of the responses. RESULTS The Rasch analysis of 20 items showed some major misfits, particularly three items addressing the involvement of family members. After removing those items, the model fit improved and no significant DIF remained. Despite improvements, person values (-2.96 to 4.86 logits) were not fully matched by the item values (-0.61 to 0.77 logits). Neither did the t test for unidimensionality meet the criterion of 5%, and local dependency was present. The unidimensionality and local dependency could, however, be accommodated for by four testlets. CONCLUSION The PPRQ-17 showed that a ruler with a reasonable and clinical hierarchy can be constructed, although the expectations of dimensionality and local dependency need to be evaluated further. Despite room for further development, PPRQ-17 nevertheless shows improved measurement precision in terms of patient leniency compared with previous evaluations with classical test theory. In turn, this can play a crucial role when comparing different rehabilitation programs and planning tailored care development activities.
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Affiliation(s)
- Jeanette Melin
- Metrology, RISE Research Institutes of Sweden, Gothenburg, Sweden
| | - Robin Fornazar
- Section for Epidemiology and Social Medicine (EPSO), The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Martin Spångfors
- Department of Clinical Sciences Lund, Anaesthesiology and Intensive Care Medicine, Lund University, Lund, Sweden.,Department of Anaesthesiology and Intensive Care, Kristianstad Hospital, Kristianstad, Sweden
| | - Leslie Pendrill
- Metrology, RISE Research Institutes of Sweden, Gothenburg, Sweden
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7
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Goodridge D, McDonald M, New L, Scharf M, Harrison E, Rotter T, Watson E, Henry C, Penz ED. Building patient capacity to participate in care during hospitalisation: a scoping review. BMJ Open 2019; 9:e026551. [PMID: 31272973 PMCID: PMC6615828 DOI: 10.1136/bmjopen-2018-026551] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 06/07/2019] [Accepted: 06/13/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To map the existing literature and describe interventions aimed at building the capacity of patients to participate in care during hospitalisation by: (1) describing and categorising the aspects of care targeted by these interventions and (2) identifying the behaviour change techniques (BCTs) used in these interventions. A patient representative participated in all aspects of this project. DESIGN Scoping review. DATA SOURCES MEDLINE, Embase and CINAHL (Inception -2017). STUDY SELECTION Studies reporting primary research studies on building the capacity of hospitalised adult patients to participate in care which described or included one or more structured or systematic interventions and described the outcomes for at least the key stakeholder group were included. DATA EXTRACTION Title and abstract screening and full text screening were conducted by pairs of trained reviewers. One reviewer extracted data, which were verified by a second reviewer. Interventions were classified according to seven aspects of care relevant to hospital settings. BCTs identified in the articles were assigned through consensus of three reviewers. RESULTS Database searches yielded a total 9899 articles, resulting in 87 articles that met the inclusion criteria. Interventions directed at building patient capacity to participate in care while hospitalised were categorised as those related to improving: patient safety (20.9%); care coordination (5.7%); effective treatment (5.7%) and/or patient-centred care using: bedside nursing handovers (5.7%); communication (29.1%); care planning (14%) or the care environment (19.8%). The majority of studies reported one or more positive outcomes from the defined intervention. Adding new elements (objects) to the environment and restructuring the social and/or physical environment were the most frequently identified BCTs. CONCLUSIONS The majority of studies to build capacity for participation in care report one or more positive outcomes, although a more comprehensive analysis is warranted.
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Affiliation(s)
- Donna Goodridge
- Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Meghan McDonald
- School of Nursing, Saskatchewan Polytechnic, Saskatoon, Saskatchewan, Canada
| | - Lucia New
- School of Nursing, Saskatchewan Polytechnic, Saskatoon, Saskatchewan, Canada
| | - Murray Scharf
- College of Education, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Elizabeth Harrison
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Thomas Rotter
- Healthcare Quality Programs, Queen’s University, Kingston, Ontario, Canada
| | - Erin Watson
- Leslie and Irene Dube Health Sciences Library, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Chrysanthus Henry
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Erika D Penz
- Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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8
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Watterson D, Walter K, O'Brien L, Terrill D, Philip K, Swan I, Somerville L. Trans-disciplinary advanced allied health practitioners for acute hospital inpatients: a feasibility study. Int J Qual Health Care 2019; 31:103-109. [PMID: 29912467 DOI: 10.1093/intqhc/mzy127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 01/16/2018] [Accepted: 05/23/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To explore cost-efficiency, safety and acceptability of trans-disciplinary advanced allied health (AH) practitioners for acute adult general medicine inpatients. DESIGN Quasi-experimental feasibility study. SETTING Three acute general medical units in an Australian urban hospital. PARTICIPANTS Two hundred and fifty-six acute hospital inpatients. MAIN OUTCOME MEASURES Cost-efficiency measures included AH service utilization and length of stay (LOS). Patient outcomes were functional independence, discharge destination, adverse events, unplanned admissions within 28 days, patient satisfaction and quality of life data on admission, and 30 days post-discharge. Ward staff were surveyed regarding satisfaction with the service model, and advanced health practitioners (AHPs) rated their confidence in their own ability to meet the performance standards of the role. RESULTS Patients allocated to AHPs (n = 172) received 0.91 less hours of AH intervention (adjusted for LOS) (95% confidence intervals (CI): -1.68 to -0.14; P = 0.02) and had 1.76 days shorter LOS relative to expected (95%CI: 0.18-3.34; P = 0.03) compared with patients receiving standard AH (n = 84). There were no differences in patient outcomes or satisfaction. AHPs demonstrated growth in job satisfaction and skill confidence. CONCLUSIONS Trans-disciplinary advanced AH roles may be feasible and cost-efficient compared with traditional roles for acute general medical inpatients. Further development of competency frameworks is recommended.
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Affiliation(s)
| | | | - Lisa O'Brien
- Department of Occupational Therapy, Monash University, Melbourne, Australia
| | - Desiree Terrill
- Department of Health and Human Services, Victoria, Australia
| | - Kathleen Philip
- Department of Health and Human Services, Victoria, Australia
| | - Indi Swan
- Allied Health, Alfred Health, Melbourne, Australia
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9
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Wisniewski JM, Diana ML, Yeager VA, Hotchkiss DR. Comparison of objective measures and patients' perceptions of quality of services in government health facilities in the Democratic Republic of Congo. Int J Qual Health Care 2018; 30:472-479. [PMID: 29617833 PMCID: PMC6047449 DOI: 10.1093/intqhc/mzy052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 03/14/2018] [Indexed: 12/18/2022] Open
Abstract
Objective Examine the relationship between patients’ perceptions of quality and the objective level of quality at government health facilities, and determine whether the pre-existing attitudes and beliefs of patients regarding health services interfere with their ability to accurately assess quality of care. Design Cross-sectional, visit-level analysis. Setting Three regions (Nord-Ubangi, Kasai/Kasai-Central and Maniema/Tshopo) of the Democratic Republic of Congo. Participants Data related to the inpatient and outpatient visits to government health facilities made by all household members who were included in the survey was used for the analysis. Data were collected from patients and the facilities they visited. Main Outcome Measures Patients’ perceptions of the level of quality related to availability of drugs and equipment; patient-centeredness and safety serve compared with objective measures of quality. Results Objective measures and patient perceptions of the drug supply were positively associated (β = 0.16, 95% CI = 0.03, 0.28) and of safety were negatively associated (β = −0.12, 95% CI = −0.23, −0.01). Several environmental factors including facility type, region and rural/peri-urban setting were found to be significantly associated with respondents’ perceptions of quality across multiple outcomes. Conclusions Overall, patients are not particularly accurate in their assessments of quality because their perceptions are impacted by their expectations and prior experience. Future research should examine whether improving patients’ knowledge of what they should expect from health services, and the transparency of the facility’s quality data can be a strategy for improving the accuracy of patients’ assessments of the quality of the health services, particularly in low-resourced settings.
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Affiliation(s)
- Janna M Wisniewski
- Department of Global Health Management and Policy, Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Mark L Diana
- Department of Global Health Management and Policy, Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Valerie A Yeager
- Department of Health Management and Policy, Indiana University, Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - David R Hotchkiss
- Department of Global Community Health and Behavioral Sciences, Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA
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10
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Dunsford J, Reimer LE. Relationship-centered health care as a Lean intervention. Int J Qual Health Care 2017; 29:1020-1024. [PMID: 29190380 DOI: 10.1093/intqhc/mzx156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 11/08/2017] [Indexed: 11/13/2022] Open
Abstract
Continuous improvement efforts, recognized in much literature as Lean management techniques have been used in efforts to improve efficiency in democratic health care contexts for some time to varying degrees of success. The complexity of the health care system is magnified by the sheer number of processes and sub processes required to deliver value within a bureaucratic environment, while maintaining some level of compassionate and personalized care. There is inherent tension between what is required to be efficient and what is required to be caring and this conflict presses against Lean practice at the level of delivery.Administration and care intersect at the point of the patient's experience. In order to achieve the dual goals of improved value and lower costs, the application of Lean thinking for meaningful health care reform must acknowledge the fundamental dichotomy between the impersonal tasks required to provide health services, and human interactions. Meaningful health care reform requires an acknowledgement of this distinction, currently not recognized in literature. While administrative process improvements are necessary, they are insufficient to achieve a sustainable and caring health care system. Lean thinking must be applied differently for administrative processes and patient care encounters, because these are fundamentally different processes. In this way, Lean principles will effectively contribute to sustainable health system improvements.
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Affiliation(s)
- Jennifer Dunsford
- Joint Master of Public Administration Program, University of Winnipeg, 515 Portage Ave, Winnipeg, MB, Canada R3B 2E9
| | - Laura E Reimer
- Joint Master of Public Administration Program, University of Winnipeg, 515 Portage Ave, Winnipeg, MB, Canada R3B 2E9
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