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Mandhana DM, Jacome CS, Ballard DI, Tesfai Y, Johnson SB, Gionfriddo MR, Espinoza Suarez NR, Perneth SA, Su L, Montori VM. Developing and validating the Unhurried Conversations Assessment Tool (UCAT). PATIENT EDUCATION AND COUNSELING 2024; 123:108237. [PMID: 38461793 DOI: 10.1016/j.pec.2024.108237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/29/2024] [Accepted: 02/29/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE Given the importance of unhurried conversations for providing careful and kind care, we sought to create, test, and validate the Unhurried Conversations Assessment Tool (UCAT) for assessing the unhurriedness of patient-clinician consultations. METHODS In the first two phases, the unhurried conversation dimensions were identified and transformed into an assessment tool. In the third phase, two independent raters used UCAT to evaluate the unhurriedness of 100 randomly selected consultations from 184 videos recorded for a large research trial. UCAT's psychometric properties were evaluated using this data. RESULTS UCAT demonstrates content validity based on the literature and expert review. EFA and reliability analyses confirm its construct validity and internal consistency. The seven formative dimensions account for 89.93% of the variance in unhurriedness, each displaying excellent internal consistency (α > 0.90). Inter-rater agreement for the overall assessment item was fair (ICC = 0.59), with individual dimension ICCs ranging from 0.26 (poor) to 0.95 (excellent). CONCLUSION UCAT components comprehensively assess the unhurriedness of consultations. The tool exhibits content and construct validity and can be used reliably. PRACTICE IMPLICATIONS UCAT's design and psychometric properties make it a practical and efficient tool. Clinicians can use it for self-evaluations and training to foster unhurried conversations.
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Affiliation(s)
- Dron M Mandhana
- Department of Communication, Villanova University, Villanova, PA, USA; Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA
| | - Cristian Soto Jacome
- Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Norwalk Hospital, Department of Internal Medicine, Nuvance Health, Norwalk, CT, USA
| | - Dawna I Ballard
- Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Department of Communication Studies, The University of Texas at Austin, Austin, TX, USA
| | - Yohanna Tesfai
- Department of Communication Studies, The University of Texas at Austin, Austin, TX, USA
| | - Sarah B Johnson
- Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA
| | - Michael R Gionfriddo
- Division of Pharmaceutical, Administrative, and Social Sciences, School of Pharmacy, Duquesne University, Pittsburgh, PA, USA
| | - Nataly R Espinoza Suarez
- Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; VITAM - Centre for Sustainable Health Research, Integrated University Health and Social Services Center of Capitale-Nationale, Quebec City, QC, Canada; Faculty of Nursing, Laval University, Quebec City, QC, Canada
| | - Sandra Algarin Perneth
- Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Lillian Su
- Division of Cardiovascular Intensive Care Medicine, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Victor M Montori
- Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA.
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Klaber R, Mountford J, Allwood D. Kindness in healthcare: why it matters and why BMJ Leader will focus on it. BMJ LEADER 2024; 8:1-2. [PMID: 38365439 DOI: 10.1136/leader-2024-000991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 02/07/2024] [Indexed: 02/18/2024]
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Feo R, Young JA, Urry K, Lawless M, Hunter SC, Kitson A, Conroy T. 'I wasn't made to feel like a nut case after all': A qualitative story completion study exploring healthcare recipient and carer perceptions of good professional caregiving relationships. Health Expect 2024; 27:e13871. [PMID: 37858980 PMCID: PMC10726062 DOI: 10.1111/hex.13871] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Professional caregiving relationships are central to quality healthcare but are not always developed to a consistently high standard in clinical practice. Existing literature on what constitutes high-quality relationships and how they should be developed is plagued by dyadic conceptualisations; discipline, context and condition-specific research; and the absence of healthcare recipient and informal carer voices. This study aimed to address these issues by exploring how healthcare recipients and carers conceptualise good professional caregiving relationships regardless of discipline, care setting and clinical condition. DESIGN A qualitative story completion approach was used. Participants completed a story in response to a hypothetical stem that described a healthcare recipient (and, in some instances, carer) developing a good relationship with a new healthcare provider. Stories were analysed using reflexive thematic analysis. PARTICIPANTS Participants were 35 healthcare recipients and 37 carers (n = 72 total). RESULTS Participants' stories were shaped by an overarching discourse that seeking help from new providers can elicit a range of unwanted emotions for both recipients and carers (e.g., anxiety, fear, dread). These unwanted emotions were experienced in relation to recipients' presenting health problems as well as their anticipated interactions with providers. Specifically, recipient and carer characters were fearful that providers would dismiss their concerns and judge them for deciding to seek help. Good relationships were seen to develop when healthcare providers worked to relieve or minimise these unwanted emotions, ensuring healthcare recipients and carers felt comfortable and at ease with the provider and the encounter. Participants positioned healthcare providers as primarily responsible for relieving recipients' and carers' unwanted emotions, which was achieved via four approaches: (1) easing into the encounter, (2) demonstrating interest in and understanding of recipients' presenting problems, (3) validating recipients' presenting problems and (4) enabling and respecting recipient choice. Participants' stories also routinely oriented to temporality, positioning relationships within recipients' and carers' wider care networks and biographical and temporal contexts. CONCLUSION The findings expand our understanding of professional caregiving relationships beyond dyadic, static conceptualisations. Specifically, the findings suggest that high-quality relationships might be achieved via a set of core healthcare provider behaviours that can be employed across disciplinary, context and condition-specific boundaries. In turn, this provides a basis to support interprofessional education and multidisciplinary healthcare delivery, enabling different healthcare disciplines, specialties, and teams to work from the same understanding of what is required to develop high-quality relationships. PATIENT OR PUBLIC CONTRIBUTION The findings are based on stories from 72 healthcare recipient and carer participants, providing rich insight into their conceptualisations of high-quality professional caregiving relationships.
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Affiliation(s)
- Rebecca Feo
- College of Nursing and Health SciencesFlinders UniversityAdelaideSouth AustraliaAustralia
- Caring Futures InstituteFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Jessica A. Young
- College of Nursing and Health SciencesFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Kristi Urry
- College of Nursing and Health SciencesFlinders UniversityAdelaideSouth AustraliaAustralia
- School of PsychologyUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Michael Lawless
- College of Nursing and Health SciencesFlinders UniversityAdelaideSouth AustraliaAustralia
- Caring Futures InstituteFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Sarah C. Hunter
- College of Nursing and Health SciencesFlinders UniversityAdelaideSouth AustraliaAustralia
- Caring Futures InstituteFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Alison Kitson
- College of Nursing and Health SciencesFlinders UniversityAdelaideSouth AustraliaAustralia
- Caring Futures InstituteFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Tiffany Conroy
- College of Nursing and Health SciencesFlinders UniversityAdelaideSouth AustraliaAustralia
- Caring Futures InstituteFlinders UniversityAdelaideSouth AustraliaAustralia
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Khatri RB, Wolka E, Nigatu F, Zewdie A, Erku D, Endalamaw A, Assefa Y. People-centred primary health care: a scoping review. BMC PRIMARY CARE 2023; 24:236. [PMID: 37946115 PMCID: PMC10633931 DOI: 10.1186/s12875-023-02194-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Integrated people-centred health services (IPCHS) are vital for ensuring comprehensive care towards achieving universal health coverage (UHC). The World Health Organisation (WHO) envisions IPCHS in delivery and access to health services. This scoping review aimed to synthesize available evidence on people-centred primary health care (PHC) and primary care. METHODS We conducted a scoping review of published literature on people-centred PHC. We searched eight databases (PubMed, Scopus, Embase, CINAHL, Cochrane, PsycINFO, Web of Science, and Google Scholar) using search terms related to people-centred and integrated PHC/primary care services. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist to select studies. We analyzed data and generated themes using Gale's framework thematic analysis method. Themes were explained under five components of the WHO IPCHS framework. RESULTS A total of fifty-two studies were included in the review; most were from high-income countries (HICs), primarily focusing on patient-centred primary care. Themes under each component of the framework included: engaging and empowering people and communities (engagement of community, empowerment and empathy); strengthening governance and accountability (organizational leadership, and mutual accountability); reorienting the model of care (residential care, care for multimorbidity, participatory care); coordinating services within and across sectors (partnership with stakeholders and sectors, and coordination of care); creating an enabling environment and funding support (flexible management for change; and enabling environment). CONCLUSIONS Several people-centred PHC and primary care approaches are implemented in HICs but have little priority in low-income countries. Potential strategies for people-centred PHC could be engaging end users in delivering integrated care, ensuring accountability, and implementing a residential model of care in coordination with communities. Flexible management options could create an enabling environment for strengthening health systems to deliver people-centred PHC services.
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Affiliation(s)
- Resham B Khatri
- School of Public Health, Faculty of Medicine, the University of Queensland, Brisbane, QLD, Australia.
- Health Social Science and Development Research Institute, Kathmandu, Nepal.
| | - Eskinder Wolka
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Frehiwot Nigatu
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Anteneh Zewdie
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Daniel Erku
- Centre for Applied Health Economics, School of Medicine, Griffith University, Southport, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - Aklilu Endalamaw
- School of Public Health, Faculty of Medicine, the University of Queensland, Brisbane, QLD, Australia
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, Faculty of Medicine, the University of Queensland, Brisbane, QLD, Australia
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León-García M, Wieringa TH, Espinoza Suárez NR, Hernández-Leal MJ, Villanueva G, Singh Ospina N, Hidalgo J, Prokop LJ, Rocha Calderón C, LeBlanc A, Zeballos-Palacios C, Brito JP, Montori VM. Does the duration of ambulatory consultations affect the quality of healthcare? A systematic review. BMJ Open Qual 2023; 12:e002311. [PMID: 37875307 PMCID: PMC10603464 DOI: 10.1136/bmjoq-2023-002311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/23/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND The objective is to examine and synthesise the best available experimental evidence about the effect of ambulatory consultation duration on quality of healthcare. METHODS We included experimental studies manipulating the length of outpatient clinical encounters between adult patients and clinicians (ie, therapists, pharmacists, nurses, physicians) to determine their effect on quality of care (ie, effectiveness, efficiency, timeliness, safety, equity, patient-centredness and patient satisfaction). INFORMATION SOURCES Using controlled vocabulary and keywords, without restriction by language or year of publication, we searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews and Scopus from inception until 15 May 2023. RISK OF BIAS Cochrane Risk of Bias instrument. DATA SYNTHESIS Narrative synthesis. RESULTS 11 publications of 10 studies explored the relationship between encounter duration and quality. Most took place in the UK's general practice over two decades ago. Study findings based on very sparse and outdated evidence-which suggested that longer consultations improved indicators of patient-centred care, education about prevention and clinical referrals; and that consultation duration was inconsistently related to patient satisfaction and clinical outcomes-warrant low confidence due to limited protections against bias and indirect applicability to current practice. CONCLUSION Experimental evidence for a minimal or optimal duration of an outpatient consultation is sparse and outdated. To develop evidence-based policies and practices about encounter length, randomised trials of different consultation lengths-in person and virtually, and with electronic health records-are needed. TRIAL REGISTRATION NUMBER OSF Registration DOI:10.17605/OSF.IO/EUDK8.
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Affiliation(s)
- Montserrat León-García
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Catalunya, Spain
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Pediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Thomas H Wieringa
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University, Leiden, Netherlands
| | - Nataly R Espinoza Suárez
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- VITAM Research Center for Sustainable Health, Quebec Integrated University Health and Social Services; Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - María José Hernández-Leal
- Department of Economics. Research Centre on Economics and Sustainability (ECO-SOS). Research Group on Statistics, Economic Evaluation and Health (GRAEES), Faculty of Business and Economics. Rovira i Virgili University, Reus, Spain
| | - Gemma Villanueva
- Department of Pediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
- Cochrane Response, London, UK
| | - Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Jessica Hidalgo
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Larry J Prokop
- Mayo Clinic Libraries, Mayo Clinic, Mayo Clinic, Rochester, Minnesota, USA
| | - Claudio Rocha Calderón
- Department of Preventive Medicine, University Hospital of Bellvitge, IDIBELL, Barcelona, Catalunya, Spain
| | - Annie LeBlanc
- VITAM Research Center for Sustainable Health, Quebec Integrated University Health and Social Services; Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Claudia Zeballos-Palacios
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Juan Pablo Brito
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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6
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Bornman J, Louw B. Leadership Development Strategies in Interprofessional Healthcare Collaboration: A Rapid Review. J Healthc Leadersh 2023; 15:175-192. [PMID: 37641632 PMCID: PMC10460600 DOI: 10.2147/jhl.s405983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/19/2023] [Indexed: 08/31/2023] Open
Abstract
Background Contemporary healthcare practitioners require leadership skills for a variety of professional roles related to improved patient/client outcomes, heightened personal and professional development, as well as strengthened interprofessional collaboration and teamwork. Objective/Aim The aim of this study is to systematically catalogue literature on leadership in healthcare practice and education to highlight the leadership characteristics and skills required by healthcare practitioners for collaborative interprofessional service delivery and the leadership development strategies found to be effective. Methods/Design A rapid review was conducted. The Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) diagram shows that the 11 databases, yielded 465 records. A total of 147 records were removed during the initial screening phase. The remaining 318 records were uploaded onto Rayyan, an online collaborative review platform. Following abstract level screening, a further 236 records were removed with 82 records meeting the eligibility criteria at full text level, of which 42 were included in the data extraction. The Mixed Methods Appraisal Tool (MMAT) was used for quality appraisal. Results Results showed variability in methodologies used, representing various healthcare disciplines with a range in population size (n = 6 to n = 537). Almost half of the results reported on new programs, with interprofessional collaboration and teamwork being the most frequently mentioned strategies. The training content, strategies used as well as the length of training varied. There were five outcomes which showed positive change, namely skills, knowledge, confidence, attitudes, and satisfaction. Conclusion This rapid review provided an evidence-base, highlighted by qualitative, quantitative, and mixed methods research, which presents distinct opportunities for curriculum development by focusing on both content and the methods needed for leadership programs. Anchoring this evidence-base within a systematic search of the extant literature provides increased precision for curriculum development.
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Affiliation(s)
- Juan Bornman
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, Gauteng, South Africa
| | - Brenda Louw
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, Gauteng, South Africa
- Department Audiology and Speech-Language Pathology, East Tennessee State University, Johnson City, TN, USA
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Montori VM, Ruissen MM, Hargraves IG, Brito JP, Kunneman M. Shared decision-making as a method of care. BMJ Evid Based Med 2023; 28:213-217. [PMID: 36460328 PMCID: PMC10423463 DOI: 10.1136/bmjebm-2022-112068] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 12/04/2022]
Affiliation(s)
- Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Merel M Ruissen
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
- Department of Biomedical Data Sciences, Section of Medical Decision Making, Leiden University Medical Center, Leiden, Netherlands
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
| | - Ian G Hargraves
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Marleen Kunneman
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
- Department of Biomedical Data Sciences, Section of Medical Decision Making, Leiden University Medical Center, Leiden, Netherlands
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Bailey S, Allwood D, Macklin N, Montori V, Bisognano M, Klaber B. Healthcare education needs radical reform to emphasise careful and kind care. BMJ 2023; 382:p1505. [PMID: 37402510 DOI: 10.1136/bmj.p1505] [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: 07/06/2023]
Affiliation(s)
| | - Dominique Allwood
- Imperial College Healthcare NHS Trust, UK
- Imperial College London, UK
| | - Nicki Macklin
- Faculty of Medicine and Health Sciences, University of Auckland, New Zealand
| | | | | | - Bob Klaber
- Imperial College Healthcare NHS Trust, UK
- Imperial College London, UK
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Shickh S, Leventakos K, Lewis MA, Bombard Y, Montori VM. Shared Decision Making in the Care of Patients With Cancer. Am Soc Clin Oncol Educ Book 2023; 43:e389516. [PMID: 37339391 DOI: 10.1200/edbk_389516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
Shared decision making (SDM) is a method of care that is suitable for the care of patients with cancer. It involves a collaborative conversation seeking to respond sensibly to the problematic situation of the patient, cocreating a plan of care that makes sense intellectually, practically, and emotionally. Genetic testing to identify whether a patient has a hereditary cancer syndrome represents a prime example of the importance for SDM in oncology. SDM is important for genetic testing because not only results affect current cancer treatment, cancer surveillance, and care of relatives but also these tests generate both complex results and psychological concerns. SDM conversations should take place without interruptions, disruptions, or hurry and be supported, where available, by tools that assist in conveying the relevant evidence and in supporting plan development. Examples of these tools include treatment SDM encounter aids and the Genetics Adviser. Patients are expected to play a key role in making decisions and implementing plans of care, but several evolving challenges related to the unfettered access to information and expertise of varying trustworthiness and complexity in between interactions with clinicians can both support and complicate this role. SDM should result in a plan of care that is maximally responsive to the biology and biography of each patient, maximally supportive of each patient's goals and priorities, and minimally disruptive of their lives and loves.
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Affiliation(s)
- Salma Shickh
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Konstantinos Leventakos
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
- Department of Medical Oncology, Mayo Clinic, Rochester, MN
| | - Mark A Lewis
- Division of Gastrointestinal Oncology, Intermountain Healthcare, Salt Lake City, UT
| | - Yvonne Bombard
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
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Louiset M, Allwood D, Bailey S, Klaber R, Bisognano M. Let's reconnect healthcare with its mission and purpose by bringing humanity to the point of care. BMJ LEADER 2023:leader-2023-000747. [PMID: 37192120 DOI: 10.1136/leader-2023-000747] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/31/2023] [Indexed: 05/18/2023]
Affiliation(s)
- Mathieu Louiset
- Plateforme pour l'Amélioration continue de la Qualité des soins et de la Sécurité des patients, Bruxelles, Belgium
- Faculté de santé publique, UCLouvain, Bruxelles, Belgium
| | - Dominique Allwood
- Medical Directors Office, Imperial College Healthcare NHS Trust, London, UK
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Cribb A, Pullin G. Aesthetics for everyday quality: one way to enrich healthcare improvement debates. MEDICAL HUMANITIES 2022; 48:480-488. [PMID: 35210355 PMCID: PMC9691827 DOI: 10.1136/medhum-2021-012330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
In this paper we seek to illuminate the importance of aesthetics for healthcare quality and encourage more explicit discussion of aesthetics in healthcare improvement scholarship and practice. We hope to contribute to and help develop the hinterland between arts-based initiatives in healthcare and the 'normal business' of healthcare quality improvement. Our broad contention is: (1) That aesthetic considerations should be seen as of universal relevance across quality debates (2) That they never be assumed to have a marginal or even secondary status; and (3) That taking aesthetic considerations seriously calls for explicit discussion of associated uncertainties and dilemmas and a readiness to welcome aesthetics expertise into improvement debates.
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Affiliation(s)
- Alan Cribb
- Centre for Public Policy Research, King's College London, London, UK
| | - Graham Pullin
- Duncan of Jordanstone College of Art and Design, University of Dundee, Dundee, UK
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14
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Montori V. A movement for common care. BMJ 2021; 375:n2886. [PMID: 34815240 DOI: 10.1136/bmj.n2886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Orrow G. Designing an ecological approach to health. BMJ 2021; 375:n2827. [PMID: 34789452 DOI: 10.1136/bmj.n2827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Caneiras C, Jácome C, Oliveira D, Moreira E, Dias CC, Mendonça L, Mayoralas-Alises S, Fonseca JA, Diaz-Lobato S, Escarrabill J, Winck JC. The Portuguese Model of Home Respiratory Care: Healthcare Professionals' Perspective. Healthcare (Basel) 2021; 9:1523. [PMID: 34828569 PMCID: PMC8623333 DOI: 10.3390/healthcare9111523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
Patients' and carers' views regarding the Portuguese model of home respiratory care were recently described, yet the complementary perspective of healthcare professionals (HCPs) is still to be investigated. Thus, this study explored HCPs experience in the management of patients needing home respiratory therapies (HRT), and their perspective about the Portuguese model. A phenomenological descriptive study, using focus groups, was carried out with 28 HCPs (median 42 y, 68% female) with distinct backgrounds (57% pulmonologists, 29% clinical physiologists, 7% physiotherapists, 7% nurses). Three focus groups were conducted in three regions of Portugal. Thematic analysis was performed by two independent researchers. HCPs have in general a positive view about the organization of the Portuguese model of home respiratory care, which was revealed in four major topics: Prescription (number of references, n = 171), Implementation and maintenance (n = 162), Carer involvement (n = 65) and Quality of healthcare (n = 247). Improvements needed were related to patients' late referral, HRT prescription (usability of the medical electronic prescription system and renewals burden), patients' education, access to hospital care team, lack of multidisciplinary work and articulation between hospital, primary and home care teams. This study describes the perspective of HCPs about the Portuguese model of home respiratory care and identifies specific points where improvements and reflections are needed. This knowledge may be useful to decision makers improve the current healthcare model.
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Affiliation(s)
- Cátia Caneiras
- Microbiology Research Laboratory on Environmental Health (EnviHealthMicro Lab), Institute of Environmental Health (ISAMB), Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal
- Institute for Preventive Medicine and Public Health, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal
- Healthcare Department, Nippon Gases Portugal, 2600-242 Vila Franca de Xira, Portugal
| | - Cristina Jácome
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (C.J.); (D.O.); (E.M.); (C.C.D.); (L.M.); (J.A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Daniela Oliveira
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (C.J.); (D.O.); (E.M.); (C.C.D.); (L.M.); (J.A.F.)
- Department of Medicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- Rheumatology Department, Centro Hospitalar Universitário São João (CHUSJ), 4200-319 Porto, Portugal
| | - Emília Moreira
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (C.J.); (D.O.); (E.M.); (C.C.D.); (L.M.); (J.A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Cláudia Camila Dias
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (C.J.); (D.O.); (E.M.); (C.C.D.); (L.M.); (J.A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Liliane Mendonça
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (C.J.); (D.O.); (E.M.); (C.C.D.); (L.M.); (J.A.F.)
| | | | - João Almeida Fonseca
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (C.J.); (D.O.); (E.M.); (C.C.D.); (L.M.); (J.A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- Allergy Unit, Instituto and Hospital CUF Porto, 4460-188 Matosinhos, Portugal
| | - Salvador Diaz-Lobato
- Healthcare Department, Nippon Gases Spain, 28020 Madrid, Spain;
- Service of Pneumology, Hospital Universitario Moncloa, 28008 Madrid, Spain
| | - Joan Escarrabill
- Programa de Atención a la Cronicidad, Hospital Clínic de Barcelona, 08036 Barcelona, Spain;
- Master Plan for Respiratory Diseases (Ministry of Health) & Observatory of Home Respiratory Therapies (FORES), 08028 Barcelona, Spain
- REDISSEC Health Services Research on Chronic Patients Network, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - João Carlos Winck
- Department of Medicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
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O'Brien N, Durkin M, Lachman P. Lessons post-COVID from national and international approaches to safety and quality in healthcare. Future Healthc J 2021; 8:e602-e608. [PMID: 34888449 PMCID: PMC8651324 DOI: 10.7861/fhj.2021-0158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The COVID-19 pandemic has been a challenge as well as an opportunity for healthcare. The pandemic has exposed the inherent weaknesses in health systems globally while, at the same time, revealing strengths on which post-pandemic health systems can be built. We propose lessons on improving quality and safety post-pandemic from a global perspective based on recent policy publications and our global experience. Nine possible lessons are discussed. These lessons can ensure that healthcare does not return to the old normal, but rather builds on what we have learnt as we deliver on the Sustainable Development Goals and universal health coverage. Quality and safety are an essential component of healthcare strategy. Post-pandemic systems require a transparent compassionate culture, with integration of care at its core. The workforce must be trained in the skills to improve care, and patient and healthcare worker protection (both physically and psychologically) needs to be a given. Any development of systems will best be co-produced with the people who receive and deliver care in an equal partnership. Finally, the new systems need to be conscious of emerging threats (such as the challenge of climate change), building sustainable health systems that also address the structural inequities that currently exist.
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Affiliation(s)
- Niki O'Brien
- Institute of Global Health Innovation, London, UK and Imperial College London, London, UK
| | - Mike Durkin
- and academic lead, Global Patient Safety Collaborative, London, UK
| | - Peter Lachman
- Royal College of Physicians of Ireland, Dublin, Ireland
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