A review of primary health-care organization

Factors associated with patients bypassing primary healthcare centres in Qassim Region, KSA

Objective

This study investigates the reasons for bypassing local primary healthcare centres (PHCs) by patients with minor illnesses in Qassim Region, KSA.

Methods

A cross-sectional study was performed on 266 patients that visited emergency departments in public hospitals in Qassim Region. The patients were randomly selected and categorised as level five patients (LFPs) using the Canadian Triage and Acuity Scale (CTAS) for patient characterisation.

Results

Of the 266 patients, 85.7% had previous experience of visiting PHC facilities. The majority of these patients were not satisfied with their treatment in PHCs. Approximately 52.9% of the patients reported that the working hours at PHCs were not sufficient, 38.1% mentioned a lack of experienced staff, and 31.7% believed that PHCs were insufficient for diagnostic tests. Another 13.8% of the patients reported the unavailability of prescribed medicines. Interestingly, 17.7% of the patients reported that they never bypassed PHCs. In general, the data demonstrate that patients’ gender, employment, and marital status have no significant role in their decision to skip PHCs in favor of emergency departments of public hospitals (p > 0.05).

Conclusions

Patients bypassing PHCs without a referral form is a serious concern that have a deleterious effect on the healthcare system, particularly emergency departments. If bypassing continues, it will increase the burden on emergency departments, particularly on healthcare services for the general population.

Communication and teamworking in healthcare

The development of teamworking and multidisciplinary communication across organizational settings, and particularly in healthcare, reflects a growing awareness of the benefits to be derived from this way of working. These benefits, in the form of improved healthcare delivery and better member well-being, are described by reference to research evidence. However, it is pointed out that the greatest barrier to effective teamwork and communication is the organisational context, and the appropriate supports and integration systems to achieve this are identified. The importance of effective team processes and, above all, the team's capacity for reflexivity (reflecting on and adapting objectives, strategies, processes and context) is emphasized.

Nursing unit design and communication patterns: what is "real" work?

While considerable attention has been paid to how the design of nursing units can help reduce nurse fatigue, improve safety, and reduce nosocomial infection rates, much less attention has been paid to how nursing unit design influences informal communication patterns, on-the-job learning, and job stress and satisfaction. Yet the literature consistently cites communication among diverse caregivers as a critical component for improving quality of care. This paper reviews relevant literature related to nursing unit design and communication patterns, and suggests an evidence-based design research agenda grounded in the concept of "organizational ecology" for increasing our understanding of how hospital design can contribute to improved quality of care.Key Words Evidence-based design, physical design, communication, job stress, nurses.

Effects of nursing unit spatial layout on nursing team communication patterns, quality of care, and patient safety

Studies investigating factors contributing to improved quality of care have found that effective team member communication is among the most critical and influential aspects in the delivery of quality care. Relatively little research has examined the role of the physical design of nursing units on communication patterns among care providers. Although the concept of decentralized unit design is intended to increase patient safety, reduce nurse fatigue, and control the noisy, chaotic, and crowded space associated with centralized nursing stations, until recently little attention has been paid to how such nursing unit designs affected communication patterns or other medical and organizational outcomes. Using a pre/post research design comparing more centralized or decentralized unit designs with a new multi-hub design, the aim of this study was to describe the relationship between the clinical spatial environment and its effect on communication patterns, nurse satisfaction, distance walked, organizational outcomes, patient safety, and patient satisfaction. Hospital institutional data indicated that patient satisfaction increased substantially. Few significant changes were found in communication patterns; no significant changes were found in nurse job satisfaction, patient falls, pressure ulcers, or organizational outcomes such as average length of stay or patient census.

In the front line: the impact of specialist training for hospital physicians in children at risk on their collaboration with social workers

Until recently, dealing with children at risk in Israeli hospitals was almost exclusively the domain of medical social workers. Suspected cases of abuse or neglect must be identified in real-time, during the child's short stay in the hospital, and the decision of whether or not to report the case, and to whom (law enforcement or welfare authorities), must be made. The recognition that effective treatment also demands the involvement of physicians led to the development of an intensive training program for hospital-pediatricians. The current study, based on in-depth interviews with the doctors who participated in the program and the social workers who work with them at 14 hospitals in Israel, examined the impact of the training on cooperation between the two groups, seeking to determine whether the doctors' increased familiarity with the social work profession enhanced team-work. Phenomenological analysis of the interviews revealed several themes, indicating greater collaboration between the doctors and social workers. However, the participants also noted increased friction between the two groups. Possible explanations and practical recommendations for enhancing the potential effectiveness of such collaborations are offered. The study has implications for designing similar training programs as well as for improving the dynamics between the two professions.

Organizational (role structuring) and personal (organizational commitment and job involvement) factors: Do they predict interprofessional team effectiveness?

Teamwork in community clinics was examined to propose and test a model that views the different kinds of commitment (job involvement and organizational commitment) and the potential conflict between them, as mediators between personal and organizational factors (mechanistic structuring and organic structuring) and the effectiveness of interprofessional teamwork. Differences among the professional groups became evident with regard to their views of the goals of teamwork and the ways to achieve them. As for mechanistic structuring, although the clinic members saw their mechanistic structuring in a more bureaucratic sense, the combination of mechanistic structuring and organic structuring led to effective teamwork. In terms of commitment, while staff members were committed primarily to their job and not the organization, commitment to the organization produced effective teamwork in the clinics.

Improving nursing unit teamwork

A lack of teamwork among nursing staff affects care delivery and unit operations. Barriers present in the structure of a typical patient care unit that make it extremely difficult to achieve a high level of teamwork include large team size, lack of familiarity, instability of the work force and assignments, the absence of a common purpose and destiny, and an inhibiting physical environment. The authors discuss strategies to overcome these obstacles to teamwork.

Interdisciplinary Team Processes Within an In-Home Service Delivery Organization

Interdisciplinary teamwork is particularly difficult to achieve in the community context where geographical separateness and solo practices impede face to face contact and collaborative practice. Understanding the processes that occur within interdisciplinary teams is imperative, since client outcomes are influenced by interdisciplinary teamwork. The purpose of this exploratory study was to describe the processes that occur within interdisciplinary teams that deliver in-home care. Applying grounded theory methodology, the researcher conducted unstructured in-depth interviews with a purposeful sample of healthcare providers and used constant comparative analysis to elicit the findings. Findings revealed three key team processes: networking, navigating, and aligning. The descriptions afford several insights that are applicable to in-home healthcare agencies attempting to achieve effective interdisciplinary team functioning.

Breast cancer teams: the impact of constitution, new cancer workload, and methods of operation on their effectiveness

National guidance and clinical guidelines recommended multidisciplinary teams (MDTs) for cancer services in order to bring specialists in relevant disciplines together, ensure clinical decisions are fully informed, and to coordinate care effectively. However, the effectiveness of cancer teams was not previously evaluated systematically. A random sample of 72 breast cancer teams in England was studied (548 members in six core disciplines), stratified by region and caseload. Information about team constitution, processes, effectiveness, clinical performance, and members' mental well-being was gathered using appropriate instruments. Two input variables, team workload (P=0.009) and the proportion of breast care nurses (P=0.003), positively predicted overall clinical performance in multivariate analysis using a two-stage regression model. There were significant correlations between individual team inputs, team composition variables, and clinical performance. Some disciplines consistently perceived their team's effectiveness differently from the mean. Teams with shared leadership of their clinical decision-making were most effective. The mental well-being of team members appeared significantly better than in previous studies of cancer clinicians, the NHS, and the general population. This study established that team composition, working methods, and workloads are related to measures of effectiveness, including the quality of clinical care.

The future of community nursing in the United Kingdom: district nursing, health visiting and school nursing

This paper examines the future of community nursing, within the wider framework of a rapidly changing National Health Service. The research was commissioned by the Community Performance Review Network, as part of a series of comparative studies between community healthcare NHS trusts. Three questionnaires were sent to 24 trusts, covering three of the community nursing services; district nursing, health visiting and school nursing. Of the 24 trusts involved in the network, 22 responded to some or all of the questionnaires. A wide range of management structures and working practices were found between trusts, but several common themes and issues of concern emerged. For district nurses, these included the shift from secondary to primary care and the changing demands of the client population served, with increasing numbers of elderly and chronically disabled patients. This led to anxiety over the communication between different providers of care, such as community, acute and social services, and the skills mix and training requirements for nurses. Health visitors and school nurses were concerned about being marginalized in the move towards integrated primary health care teams. As the emphasis changes from treating illness to health promotion, concern was expressed about how performance could be measured on the less quantifiable outcomes of preventative care, and hence how jobs could be justified to purchasers of health care. A central theme was the potential role of the nurse practitioner in provision of primary care, and this formed a focus for other anxieties concerning both the current situation and future of community nursing services.