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Nikolova-Simons M, Keldermann R, Peters Y, Compagner W, Montenij L, de Jong Y, Bouwman RA. Predictive analytics for cardio-thoracic surgery duration as a stepstone towards data-driven capacity management. NPJ Digit Med 2023; 6:205. [PMID: 37935901 PMCID: PMC10630382 DOI: 10.1038/s41746-023-00938-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/29/2023] [Indexed: 11/09/2023] Open
Abstract
Effective capacity management of operation rooms is key to avoid surgery cancellations and prevent long waiting lists that negatively affect clinical and financial outcomes as well as patient and staff satisfaction. This requires optimal surgery scheduling, leveraging essential parameters like surgery duration, post-operative bed type and hospital length-of-stay. Common clinical practice is to use the surgeon's average procedure time of the last N patients as a planned surgery duration for the next patient. A discrepancy between the actual and planned surgery duration may lead to suboptimal surgery schedule. We used deidentified data from 2294 cardio-thoracic surgeries to first calculate the discrepancy of the current model and second to develop new predictive models based on linear regression, random forest, and extreme gradient boosting. The new ensamble models reduced the RMSE for elective and acute surgeries by 19% (0.99 vs 0.80, p = 0.002) and 52% (1.87 vs 0.89, p < 0.001), respectively. Also, the elective and acute surgeries "behind schedule" were reduced by 28% (60% vs. 32%, p < 0.001) and 9% (37% vs. 28%, p = 0.003), respectively. These improvements were fueled by the patient and surgery features added to the models. Surgery planners can benefit from these predictive models as a patient flow AI decision support tool to optimize OR utilization.
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Affiliation(s)
| | | | - Yvon Peters
- Philips Research, Eindhoven, the Netherlands
| | | | | | | | - R Arthur Bouwman
- Catharina Hospital, Eindhoven, the Netherlands
- Eindhoven University of Technology, Department of Electrical Engineering, Eindhoven, the Netherlands
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van Wijngaarden JDH, Braam A, Buljac-Samardžić M, Hilders CGJM. Towards Process-Oriented Hospital Structures; Drivers behind the Development of Hospital Designs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1993. [PMID: 36767360 PMCID: PMC9916222 DOI: 10.3390/ijerph20031993] [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: 01/09/2023] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
Hospitals have been encouraged to develop more process-oriented designs, structured around patient needs, to better deal with patients suffering from multi-morbidity. However, most hospitals still have traditional designs built around medical specialties. We aimed to understand how hospital designs are currently developing and what the important drivers are. We built a typology to categorize all Dutch general hospitals (61), and we interviewed hospital managers and staff. The inventory showed three types of hospital building blocks: units built around specific medical specialties, clusters housing different medical specialty units, and centers; multi-specialty entities provide the most suitable structure for a process-oriented approach. Only some Dutch hospitals (5) are mainly designed around centers. However, most hospitals are slowly developing towards hybrid designs. Competitive drivers are not important for stimulating these redesigns. Institutional pressures from within the health care sector and institutional 'mimicking' are the main drivers, but the specific path they take is dependent on their 'heritage'. We found that hospital structures are more the result of incremental, path-dependent choices than 'grand-designs'. Although the majority of the Dutch general hospitals still have a general design built around medical specialties, most hospitals are moving towards a more process-oriented design.
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Affiliation(s)
- Jeroen D. H. van Wijngaarden
- Health Services Management & Organisation, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands
| | - Anoek Braam
- Health Services Management & Organisation, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands
| | - Martina Buljac-Samardžić
- Health Services Management & Organisation, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands
| | - Carina G. J. M. Hilders
- Health Services Management & Organisation, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands
- Raad van Bestuur, Reinier de Graaf Gasthuis, 2625 AD Delft, The Netherlands
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Humphreys P, Spratt B, Tariverdi M, Burdett RL, Cook D, Yarlagadda PKDV, Corry P. An Overview of Hospital Capacity Planning and Optimisation. Healthcare (Basel) 2022; 10:healthcare10050826. [PMID: 35627963 PMCID: PMC9140785 DOI: 10.3390/healthcare10050826] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/18/2022] [Accepted: 04/27/2022] [Indexed: 02/04/2023] Open
Abstract
Health care is uncertain, dynamic, and fast growing. With digital technologies set to revolutionise the industry, hospital capacity optimisation and planning have never been more relevant. The purposes of this article are threefold. The first is to identify the current state of the art, to summarise/analyse the key achievements, and to identify gaps in the body of research. The second is to synthesise and evaluate that literature to create a holistic framework for understanding hospital capacity planning and optimisation, in terms of physical elements, process, and governance. Third, avenues for future research are sought to inform researchers and practitioners where they should best concentrate their efforts. In conclusion, we find that prior research has typically focussed on individual parts, but the hospital is one body that is made up of many interdependent parts. It is also evident that past attempts considering entire hospitals fail to incorporate all the detail that is necessary to provide solutions that can be implemented in the real world, across strategic, tactical and operational planning horizons. A holistic approach is needed that includes ancillary services, equipment medicines, utilities, instrument trays, supply chain and inventory considerations.
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Affiliation(s)
- Peter Humphreys
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, QLD 4000, Australia; (B.S.); (R.L.B.); (P.K.D.V.Y.); (P.C.)
- Correspondence: ; Tel.: +61-07-448-963-844
| | - Belinda Spratt
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, QLD 4000, Australia; (B.S.); (R.L.B.); (P.K.D.V.Y.); (P.C.)
| | | | - Robert L. Burdett
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, QLD 4000, Australia; (B.S.); (R.L.B.); (P.K.D.V.Y.); (P.C.)
| | - David Cook
- Princess Alexandra Hospital, Brisbane, QLD 4000, Australia;
| | - Prasad K. D. V. Yarlagadda
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, QLD 4000, Australia; (B.S.); (R.L.B.); (P.K.D.V.Y.); (P.C.)
| | - Paul Corry
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, QLD 4000, Australia; (B.S.); (R.L.B.); (P.K.D.V.Y.); (P.C.)
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Gao N, Xu Y, Tu L, Zhu S, Zhang S. Deep Learning-Based Emergency Care Process Reengineering of Interventional Data for Patients with Emergency Time-Series Events of Myocardial Infarction. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7339930. [PMID: 35251574 PMCID: PMC8890826 DOI: 10.1155/2022/7339930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/12/2021] [Accepted: 01/05/2022] [Indexed: 11/18/2022]
Abstract
This paper proposes a representation learning framework HE-LSTM model for heterogeneous temporal events, which can automatically adapt to the multiscale sampling frequency of multisource heterogeneous data. The proposed model also demonstrates its superiority over other typical approaches on real data sets. A controlled study is performed according to computerized randomization, with 38 patients in each of the two groups. The study group has a higher resuscitation success rate and patient satisfaction than the conventional group (P < 0.05), and the time from the first consultation to the completion of the first ECG, the time from the completion of the ECG to the activation of the path lab, and the time from the emergency admission to the balloon dilation were significantly shorter in the study group than in the conventional group (P < 0.05). The emergency care process reengineering intervention helps patients with acute myocardial infarction to be treated quickly and effectively, thus improving their resuscitation success rate and satisfaction rate, and is worthy to be caused in the clinic and widely applied.
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Affiliation(s)
- Na Gao
- Department of Cardiology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
| | - Yue Xu
- Health Department, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
| | - Lili Tu
- Health Department, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
| | - Siyue Zhu
- Emergency Department, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
| | - Shuhong Zhang
- Department of Cardiology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
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Angel-Garcia D, Martinez-Nicolas I, Salmeri B, Monot A. Quality of Care Indicators for Hospital Physical Therapy Units: A Systematic Review. Phys Ther 2021; 102:6432446. [PMID: 34935986 PMCID: PMC8807027 DOI: 10.1093/ptj/pzab261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 06/10/2021] [Accepted: 10/18/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The purpose of this review was to identify quality indicators described in the literature that may be used as quality measures in hospital physical therapy units. METHODS The following sources were searched for quality indicators or articles: Web of Science, MEDLINE, IBECS, Latin American and Caribbean Health Sciences Literature, Cumulative Index of Nursing and Allied Health, Academic Search Complete, SportDiscus, SciELO, PsychINFO, Consejo Superior de Investigaciones Cientificas, and Scopus databases; the Agency for Healthcare Research and Quality, National Health System Indicator Portal, Joint Commission on Accreditation of Healthcare Organizations, and Organisation for Economic Co-operation and Development websites; and the National Quality Forum's measures inventory tool. Search terms included "quality indicator," "quality measure," "physiotherapy," and "physical therapy." Inclusion criteria were articles written in English, Spanish, French, or Portuguese aimed at measuring the quality of care in hospital physical therapy units. Evidence-based indicators with an explicit formula were extracted by 2 independent reviewers and then classified using the structure-process-outcome model, quality domain, and categories defined by a consensus method. RESULTS Of the 176 articles identified, only 19 met the criteria. From these articles and from the indicator repository searches, 178 clinical care indicators were included in the qualitative synthesis and presented in this paper. Process and outcome measures were prevalent, and 5 out of the 6 quality domains were represented. No efficiency measures were identified. Moreover, structure indicators, equity and accessibility indicators, and indicators in the cardiovascular and circulatory, mental health, pediatrics, and intensive care categories were underrepresented. CONCLUSIONS A broad selection of quality indicators was identified from international resources, which can be used to measure the quality of physical therapy care in hospital units. IMPACT This review identified 178 quality of care indicators that can be used in clinical practice monitoring and quality improvement of hospital physical therapy units. The results highlight a lack of accessibility, equity, and efficiency measures for physical therapy units.
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Affiliation(s)
- Daniel Angel-Garcia
- Department of Physiotherapy, Catholic University of Murcia (UCAM), Guadalupe, Murcia, Spain
| | | | - Bianca Salmeri
- Department of Physiotherapy, Catholic University of Murcia (UCAM), Guadalupe, Murcia, Spain
| | - Alizée Monot
- Department of Physiotherapy, Catholic University of Murcia (UCAM), Guadalupe, Murcia, Spain
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Sogstad MKR, Bergland A. Sårbar sammenheng i helse- og omsorgstjenesten til eldre pasienter. TIDSSKRIFT FOR OMSORGSFORSKNING 2021. [DOI: 10.18261/issn.2387-5984-2021-02-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Sillner AY, Madrigal C, Behrens L. Person-Centered Gerontological Nursing: An Overview Across Care Settings. J Gerontol Nurs 2021; 47:7-12. [PMID: 33497445 DOI: 10.3928/00989134-20210107-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Person-centered care (PCC) is the gold standard in care delivery for all people, including older adults. Key players, such as the National Academies of Sciences, Engineering, and Medicine, the Institute for Healthcare Improvement, and the Centers for Medicare & Medicaid, have highlighted PCC as a means to better meet people's needs and improve their quality of care. Nurses are often a person's primary point of contact throughout their care trajectory, thus essential in planning, coordinating, and delivering PCC. However, limited literature focuses on the application and evaluation of nursing-related PCC for older adults. The current article aims to provide a nursing-focused conceptual review of PCC for older adults across care settings. This review describes PCC from a gerontological nursing perspective and presents setting-specific approaches and person-centered nursing practice outcomes. [Journal of Gerontological Nursing, 47(2), 7-12.].
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Giorgio L, Mascia D, Cicchetti A. Hospital reorganization and its effects on physicians' network churn: The role of past ties. Soc Sci Med 2021; 286:113885. [PMID: 34272101 DOI: 10.1016/j.socscimed.2021.113885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/22/2021] [Accepted: 03/25/2021] [Indexed: 11/28/2022]
Abstract
Hospital reorganizations are difficult and often fail to produce their intended benefits. Prior research has investigated how and under which contingencies changes in organizational structure affect the modification of clinician behaviors, yet we know little about how organizational redesign interventions affect physicians' collaborative networks. This paper explores how hospital reorganizations affect physicians' network churn. We developed hypotheses on the relationship between structural characteristics of networks before reorganization and the formation of cross-unit network ties after reorganization. We tested our hypotheses on a sample of 175 physicians in a large teaching hospital. The hospital had recently adopted a new organizational model aimed at enhancing a process-based approach to care delivery. Our findings revealed that the physicians' propensity to form cross-unit ties after the change was related to the structure of their collaborative networks before the change. In particular, the formation of cross-unit relations was negatively related to the size of advice networks before the reorganization. Furthermore, we found that the diversity of network ties along with the presence of structural holes in the physicians' networks before the change moderated this relationship. We discussed the theoretical and practical implications of our findings. In particular, our results may inform organizational redesign interventions within hospitals.
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Affiliation(s)
- Luca Giorgio
- University of Bologna, Department of Management, Via Capo di Lucca, 34, 40126, Bologna, Italy.
| | - Daniele Mascia
- Luiss University, Department of Business and Management, Viale Romania, 32, 00198, Rome, Italy.
| | - Americo Cicchetti
- Università Cattolica del Sacro Cuore, Faculty of Economics, Largo F. Vito, 1, 00168, Rome, Italy.
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Antonacci G, Lennox L, Barlow J, Evans L, Reed J. Process mapping in healthcare: a systematic review. BMC Health Serv Res 2021; 21:342. [PMID: 33853610 PMCID: PMC8048073 DOI: 10.1186/s12913-021-06254-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 03/08/2021] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Process mapping (PM) supports better understanding of complex systems and adaptation of improvement interventions to their local context. However, there is little research on its use in healthcare. This study (i) proposes a conceptual framework outlining quality criteria to guide the effective implementation, evaluation and reporting of PM in healthcare; (ii) reviews published PM cases to identify context and quality of PM application, and the reported benefits of using PM in healthcare. METHODS We developed the conceptual framework by reviewing methodological guidance on PM and empirical literature on its use in healthcare improvement interventions. We conducted a systematic review of empirical literature using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. Inclusion criteria were: full text empirical study; describing the process through which PM has been applied in a healthcare setting; published in English. Databases searched are: Medline, Embase, HMIC-Health Management Information Consortium, CINAHL-Cumulative Index to Nursing and Allied Health Literature, Scopus. Two independent reviewers extracted and analysed data. Each manuscript underwent line by line coding. The conceptual framework was used to evaluate adherence of empirical studies to the identified PM quality criteria. Context in which PM is used and benefits of using PM were coded using an inductive thematic analysis approach. RESULTS The framework outlines quality criteria for each PM phase: (i) preparation, planning and process identification, (ii) data and information gathering, (iii) process map generation, (iv) analysis, (v) taking it forward. PM is used in a variety of settings and approaches to improvement. None of the reviewed studies (N = 105) met all ten quality criteria; 7% were compliant with 8/10 or 9/10 criteria. 45% of studies reported that PM was generated through multi-professional meetings and 15% reported patient involvement. Studies highlighted the value of PM in navigating the complexity characterising healthcare improvement interventions. CONCLUSION The full potential of PM is inhibited by variance in reporting and poor adherence to underpinning principles. Greater rigour in the application of the method is required. We encourage the use and further development of the proposed framework to support training, application and reporting of PM. TRIAL REGISTRATION Prospero ID: CRD42017082140.
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Affiliation(s)
- Grazia Antonacci
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, London, UK
- Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, London, UK
| | - Laura Lennox
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, London, UK
| | - James Barlow
- Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, London, UK
| | - Liz Evans
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Northwest London, London, UK
| | - Julie Reed
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Northwest London, London, UK
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Interdepartmental Spread of Innovations: A Multicentre Study of the Enhanced Recovery After Surgery Programme. World J Surg 2018; 42:2348-2355. [PMID: 29387957 PMCID: PMC6060819 DOI: 10.1007/s00268-018-4495-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Spread of evidence-based innovations beyond pioneering settings is essential to improve quality of care. This study aimed to evaluate the influence of a national project to implement 'Enhanced Recovery After Surgery' (ERAS) among colorectal teams on the spread of this innovation to gynaecological procedures. METHODS A retrospective observational multicentre study was performed of a consecutive sample of patients who underwent major elective gynaecological surgery in 2012-2013. Ten Dutch hospitals (294 patients) had participated in a colorectal breakthrough project implementing ERAS on a nationwide basis and were assigned to the intervention group. Thirteen hospitals (390 patients) that had not participated in this project acted as controls. Outcome measures were time to functional recovery and total length of postoperative hospital stay. Multilevel models adjusted for clustering and baseline demographics were used for analysis. The uptake of ten selected perioperative care elements was evaluated for each hospital. RESULTS The estimated mean difference (95% confidence interval) between the intervention and control hospitals was -0.3 (-0.9 to 0.3) days in the time to recovery and 0.2 (-0.8 to 1.3) days in the total length of hospital stay. The mean (± standard deviation) absolute rate of implemented perioperative care elements per hospital was 28.9 ± 14.9% in the control, versus 29.3 ± 11.1% in the intervention group (p = 0.934). CONCLUSION Initial implementation effects seem to be restricted to the participating teams and do not automatically spread to other surgical teams in the same hospital.
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Høyem A, Gammon D, Berntsen GR, Steinsbekk A. Policies Make Coherent Care Pathways a Personal Responsibility for Clinicians: A Discourse Analysis of Policy Documents about Coordinators in Hospitals. Int J Integr Care 2018; 18:5. [PMID: 30093843 PMCID: PMC6078125 DOI: 10.5334/ijic.3617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 06/19/2018] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION In response to increase of patients with complex conditions, policies prescribe measures for improving continuity of care. This study investigates policies introducing coordinator roles in Norwegian hospitals that have proven challenging to implement. METHODS This qualitative study of policy documents employed a discourse analysis inspired by Carol Bacchi's 'What's the problem represented to be?'. We analysed six legal documents (2011-2016) and selected parts of four whitepapers presenting the statutory patient care coordinator and contact physician roles in hospitals. RESULTS The 'problem' represented in the policies is lack of coherent pathways and lack of stable responsible professionals. Extended personal responsibility for clinical personnel as coordinators is the prescribed solution. Their duties are described in terms of ideals for coherent pathways across conditions and contexts. System measures to support and orchestrate the individual patient's pathway (e.g. resources, infrastructure) are scarcely addressed. CONCLUSIONS AND DISCUSSION We suggest that the policies' construction of the 'problem' as a responsibility issue, result in that neither diversity of patients' coordination needs, nor heterogeneity of hospital contexts regarding necessary system support for coordinators, is set on the agenda. Adoption of rhetoric from diagnosis-specific standardized pathways obscures unique challenges in creating coherent pathways for patients with complex needs.
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Affiliation(s)
- Audhild Høyem
- Centre for Quality Improvement and Development, University Hospital of North Norway, Box 20, N-9038, Tromsø, NO
| | - Deede Gammon
- Norwegian Centre for E-health Research, University Hospital of North Norway, Box 35, N-9038 Tromsø, NO
- Center for Shared Decision-Making and Collaborative Care Research, Oslo University Hospital HF Division of Medicine, Box 4950 Nydalen, N-0424 Oslo, NO
| | - Gro Rosvold Berntsen
- Norwegian Centre for E-health Research, University Hospital of North Norway, Box 35, N-9038 Tromsø, NO
- Department of primary care, Institute of Community medicine, UiT The Arctic University of Norway, Tromsø, NO
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Box 8905, N-7491 Trondheim, NO
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Abstract
INTRODUCTION Twenty-one new Danish emergency departments (EDs) were established following a 2007 policy reform that included ED autonomy to self-organize. The aim of this study was to describe the organization of the 21 departments and their organizational challenges. PARTICIPANTS AND METHODS We used a qualitative design based on COREQ guidelines. All 21 EDs participated, and 123 semi-structured interviews with hospital and ED leaders, physicians, nurses, and secretaries were performed between 2013 and 2015. We used the framework matrix method to investigate the ED goals, setting, structure, staff, task coordination, and incentive structure. RESULTS We identified three generic models (virtual, hybrid, and independent). All had goals of high quality of care and high efficiency. The virtual model was staffed by junior physicians and tasks were coordinated by other departments. The hybrid model was staffed by junior physicians and senior physicians according to other departments and the ED. The ED coordinated all activities. The independent model was staffed by junior physicians and senior physicians, and activities were coordinated by the ED. Of the EDs, 19 utilized different organizational models at different times during a 24-h period and on weekdays and weekends. The main challenge of the virtual and hybrid models was high dependency on other departments. The main challenge of the independent model was establishing a high level of quality of emergency medicine. DISCUSSION AND CONCLUSION We identified three organizational ED models (virtual, hybrid, and independent). Nineteen EDs used more than one organizational model depending on the time of day or day of the week.
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Høyem A, Gammon D, Berntsen G, Steinsbekk A. Keeping one step ahead: A qualitative study among Norwegian health-care providers in hospitals involved in care coordination for patients with complex needs. INTERNATIONAL JOURNAL OF CARE COORDINATION 2018. [DOI: 10.1177/2053434518764643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Various efforts aim to enhance continuity of care for patients with long-term health-care needs. Since 2012, Norwegian hospitals are mandated to appoint individual care coordinators for patients with complex needs to ensure continuity in the care pathway. New roles must meld with current practice. Implementation has been slow. This study investigates current care coordination across hospital contexts, from the perspective of health-care providers, a scarcely researched area. Methods A qualitative study using semi-structured individual, duo, and group interviews with 16 purposefully selected Norwegian health-care providers from different hospitals, departments, professions and with various roles. A thematic cross-case analysis using systematic text condensation was performed. Results Common for the interviewees’ care coordination experiences was to “keep one step ahead.” The scope of their coordination activities varied from diagnostics and treatment to orchestrating long-term, cross-sectional multidisciplinary care. This work was often performed without designated resources. The interviewees applied experience, knowledge, and sensitivity when defining the patients’ needs and searching for resources to orchestrate coordination work. They strived to balance the needs of patients with the resources available and adjusted the continuity ambitions on behalf of their patients to what they considered doable in the relevant contexts. However, many told of negotiating special solutions for selected patients with particularly complex needs. Discussion Care coordination for patients with complex needs emerged as diverse and context-sensitive. Acknowledgement of coordination activities that go beyond established workflow routines and clinical pathways, together with flexible leadership support and accessible infrastructural resources are needed.
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Affiliation(s)
| | - Deede Gammon
- University Hospital of North Norway, Norway
- Oslo University Hospital, Norway
| | - Gro Berntsen
- University Hospital of North Norway, Norway
- UiT The Arctic University of Norway, Norway
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Fiorio CV, Gorli M, Verzillo S. Evaluating organizational change in health care: the patient-centered hospital model. BMC Health Serv Res 2018; 18:95. [PMID: 29422045 PMCID: PMC5806258 DOI: 10.1186/s12913-018-2877-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 01/23/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND An increasing number of hospitals react to recent demographic, epidemiological and managerial challenges moving from a traditional organizational model to a Patient-Centered (PC) hospital model. Although the theoretical managerial literature on the PC hospital model is vast, quantitative evaluations of the performance of hospitals that moved from the traditional to the PC organizational structure is scarce. However, quantitative analysis of effects of managerial changes is important and can provide additional argument in support of innovation. METHODS We take advantage of a quasi-experimental setting and of a unique administrative data set on the population of hospital discharge charts (HDCs) over a period of 9 years of Lombardy, the richest and one of the most populated region of Italy. During this period three important hospitals switched to the PC model in 2010, whereas all the others remained with the functional organizational model. This allowed us to develop a difference-in-difference analysis of some selected measures of efficiency and effectiveness for PC hospitals focusing on the "between-variability" of the 25 major diagnostic categories (MDCs) in each hospital and estimating a difference-in-difference model. RESULTS We contribute to the literature that addresses the evaluation of healthcare and hospital change by providing a quantitative estimation of efficiency and effectiveness changes following to the implementation of the PC hospital model. Results show that both efficiency and effectiveness have significantly increased in the average MDC of PC hospitals, thus confirming the need for policy makers to invest in new organizational models close to the principles of PC hospital structures. CONCLUSIONS Although an organizational change towards the PC model can be a costly process, implying a rebalancing of responsibilities and power among hospital personnel (e.g. medical and nursing staff), our results suggest that changing towards a PC model can be worthwhile in terms of both efficacy and efficiency. This evidence can be used to inform and sustain hospital managers and policy makers in their hospital design efforts and to communicate the innovation advantages within the hospital organizations, among the personnel and in the public debate.
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Affiliation(s)
- Carlo V. Fiorio
- Irvapp-FBK, Via Santa Croce 77, Trento, 38122 Italy
- Universitá degli Studi di Milano, Via Conservatorio, 7, Milano, 20121 Italy
- Dondena Centre, Bocconi University, Via Rontgen, 1, Milano, 20136 Italy
| | - Mara Gorli
- Universitá Cattolica del Sacro Cuore, Largo Gemelli, 1, Milano, 20123 Italy
- CERISMAS, Centro di Ricerche e Studi in Management Sanitario c/o Universitá Cattolica del Sacro Cuore, Via Necchi 7, Milano, 20123 Italy
| | - Stefano Verzillo
- European Commission, Joint Research Centre**, Via E. Fermi, 2749, Ispra (VA), 21027 Italy
- CRISP - Interuniversity Research Centre on Public Services, Universitá degli Studi di Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, Milano, 20126 Italy
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Poldervaart JM, van Melle MA, Willemse S, de Wit NJ, Zwart DLM. In-hospital prescription changes and documentation in the medical records of the primary care provider: results from a medical record review study. BMC Health Serv Res 2017; 17:792. [PMID: 29187185 PMCID: PMC5707815 DOI: 10.1186/s12913-017-2738-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 11/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An increasing number of transitions due to substitution of care of more complex patients urges
insight in and improvement of transitional medication safety. While lack of documentation of prescription changes and/or lack of information exchange between settings likely cause adverse drug events, frequency of occurrence of these causes is not clear. Therefore, we aimed at determining the frequency of in-hospital patients’ prescription changes that are not or incorrectly documented in their primary care provider’s (PCP) medical record. METHODS A medical record review study was performed in a database linking patients’ medical records of hospital
and PCP. A random sample (n = 600) was drawn from all 1399 patients who were registered at a participating
primary care practice as well as the gastroenterology or cardiology department in 2013 of the University Medical Center Utrecht, the Netherlands. Outcomes were the number of in-hospital prescription changes that was not or incorrectly documented in the medical record of the PCP, and timeliness of documentation. RESULTS Records of 390 patients included one or more primary-secondary care transitions; in total we identified
1511 transitions. During these transitions, 408 in-hospital prescription changes were made, of which 31% was not or incorrectly documented in the medical record of the PCP within the next 3 months. In case changes were documented, the median number of days between hospital visit and documentation was 3 (IQR 0–18). CONCLUSIONS One third of in-hospital prescription changes was not or incorrectly documented in the PCP’s record,
which likely puts patients at risk of adverse drug events after hospital visits. Such flawed reliability of a routine care process is unacceptable and warrants improvement and close monitoring.
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Affiliation(s)
- Judith M Poldervaart
- Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht University, Str. 6.101, PO box 85500, 3508AB, Utrecht, the Netherlands.
| | - Marije A van Melle
- Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht University, Str. 6.101, PO box 85500, 3508AB, Utrecht, the Netherlands
| | - Sanne Willemse
- University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Niek J de Wit
- Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht University, Str. 6.101, PO box 85500, 3508AB, Utrecht, the Netherlands
| | - Dorien L M Zwart
- Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht University, Str. 6.101, PO box 85500, 3508AB, Utrecht, the Netherlands
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Nowak M, Pfaff H, Karbach U. Does Value Stream Mapping affect the structure, process, and outcome quality in care facilities? A systematic review. Syst Rev 2017; 6:170. [PMID: 28838320 PMCID: PMC5571664 DOI: 10.1186/s13643-017-0563-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 08/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quality improvement within health and social care facilities is needed and has to be evidence-based and patient-centered. Value Stream Mapping, a method of Lean management, aims to increase the patients' value and quality of care by a visualization and quantification of the care process. The aim of this research is to examine the effectiveness of Value Stream Mapping on structure, process, and outcome quality in care facilities. METHODS A systematic review is conducted. PubMed, EBSCOhost, including Business Source Complete, Academic Search Complete, PSYCInfo, PSYNDX, SocINDEX with Full Text, Web of Knowledge, and EMBASE ScienceDirect are searched in February 2016. All peer-reviewed papers evaluating Value Stream Mapping and published in English or German from January 2000 are included. For data synthesis, all study results are categorized into Donabedian's model of structure, process, and outcome quality. To assess and interpret the effectiveness of Value Stream Mapping, the frequencies of the results statistically examined are considered. RESULTS Of the 903 articles retrieved, 22 studies fulfill the inclusion criteria. Of these, 11 studies are used to answer the research question. Value Stream Mapping has positive effects on the time dimension of process and outcome quality. It seems to reduce non-value-added time (e.g., waiting time) and length of stay. All study designs are before and after studies without control, and methodologically sophisticated studies are missing. CONCLUSIONS For a final conclusion about Value Stream Mapping's effectiveness, more research with improved methodology is needed. Despite this lack of evidence, Value Stream Mapping has the potential to improve quality of care on the time dimension. The contextual influence has to be investigated to make conclusions about the relationship between different quality domains when applying Value Stream Mapping. However, for using this review's conclusion, the limitation of including heterogeneous and potentially biased results has to be considered.
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Affiliation(s)
- Marina Nowak
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Sciences, Faculty of Medicine, University of Cologne, Eupener Strasse 129, 50933 Cologne, Germany
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Sciences, Faculty of Medicine, University of Cologne, Eupener Strasse 129, 50933 Cologne, Germany
| | - Ute Karbach
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Sciences, Faculty of Medicine, University of Cologne, Eupener Strasse 129, 50933 Cologne, Germany
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Kriegel J, Tuttle-Weidinger L, Schiefer L, Schwarz S. Management of support processes in Austrian hospitals: Integrated network of primary care processes and support processes. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2017. [DOI: 10.1080/20479700.2017.1343759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Johannes Kriegel
- School of Applied Health and Social Sciences, University of Applied Sciences Upper Austria, Linz, Austria
| | - Linda Tuttle-Weidinger
- School of Applied Health and Social Sciences, University of Applied Sciences Upper Austria, Linz, Austria
| | - Lisa Schiefer
- Department of Anesthesiology and Perioperative Medicine, University Hospital Salzburg, Salzburg, Austria
| | - Stefan Schwarz
- School of Applied Health and Social Sciences, University of Applied Sciences Upper Austria, Linz, Austria
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Nilsson K, Sandoff M. Leading processes of patient care and treatment in hierarchical healthcare organizations in Sweden--process managers' experiences. Leadersh Health Serv (Bradf Engl) 2017; 28:135-48. [PMID: 25921318 DOI: 10.1108/lhs-04-2014-0043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study is to gain better understanding of the roles and functions of process managers by describing Swedish process managers' experiences of leading processes involving patient care and treatment when working in a hierarchical health-care organization. DESIGN/METHODOLOGY/APPROACH This study is based on an explorative design. The data were gathered from interviews with 12 process managers at three Swedish hospitals. These data underwent qualitative and interpretative analysis with a modified editing style. FINDINGS The process managers' experiences of leading processes in a hierarchical health-care organization are described under three themes: having or not having a mandate, exposure to conflict situations and leading process development. The results indicate a need for clarity regarding process manager's responsibility and work content, which need to be communicated to all managers and staff involved in the patient care and treatment process, irrespective of department. There also needs to be an emphasis on realistic expectations and orientation of the goals that are an intrinsic part of the task of being a process manager. RESEARCH LIMITATIONS/IMPLICATIONS Generalizations from the results of the qualitative interview studies are limited, but a deeper understanding of the phenomenon was reached, which, in turn, can be transferred to similar settings. ORIGINALITY/VALUE This study contributes qualitative descriptions of leading care and treatment processes in a functional, hierarchical health-care organization from process managers' experiences, a subject that has not been investigated earlier.
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Affiliation(s)
- Kerstin Nilsson
- Institute of Health and Caring Sciences, University of Gothenburg, Gothenburg, Sweden
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Savage C, Parke L, von Knorring M, Mazzocato P. Does lean muddy the quality improvement waters? A qualitative study of how a hospital management team understands lean in the context of quality improvement. BMC Health Serv Res 2016; 16:588. [PMID: 27756348 PMCID: PMC5069852 DOI: 10.1186/s12913-016-1838-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 10/11/2016] [Indexed: 11/10/2022] Open
Abstract
Background Health care has experimented with many different quality improvement (QI) approaches with greater variation in name than content. This has been dubbed pseudoinnovation. However, it could also be that the subtleties and differences are not clearly understood. To explore this further, the purpose of this study was to explore how hospital managers perceive lean in the context of QI. Methods We used a qualitative study design with semi-structured interviews to explore twelve top managers’ perceptions of the relationship between lean and quality improvement (QI) at a university-affiliated hospital. Results Managers described that QI and lean shared the same overall purpose: focus on patient needs and improve efficiency and effectiveness. Employee involvement was emphasized in both strategies, as well as the support offered by managers of staff initiatives. QI was perceived as a strategy that could support structural changes at the organizational level whereas lean was seen as applicable at the operational level. Moreover, lean carried a negative connotation, lacked the credibility of QI, and was perceived as a management fad. Conclusions Aspects of QI and lean were misunderstood. In a context where lean remains an abstract term, and staff associate lean with automotive applications and cost reduction, it may be fruitful for managers to invest time and resources to develop a strategy for continual improvement and utilize vocabulary that resonates with health care staff. This could reduce the risk that improvement efforts are rejected out of hand. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1838-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carl Savage
- Medical Management Centre, Department for Learning, Informatics, Ethics and Management, Karolinska Institutet, Tomtebodavägen 18A, SE-17177, Stockholm, Sweden.
| | - Louise Parke
- Medical Management Centre, Department for Learning, Informatics, Ethics and Management, Karolinska Institutet, Tomtebodavägen 18A, SE-17177, Stockholm, Sweden
| | - Mia von Knorring
- Medical Management Centre, Department for Learning, Informatics, Ethics and Management, Karolinska Institutet, Tomtebodavägen 18A, SE-17177, Stockholm, Sweden
| | - Pamela Mazzocato
- Medical Management Centre, Department for Learning, Informatics, Ethics and Management, Karolinska Institutet, Tomtebodavägen 18A, SE-17177, Stockholm, Sweden
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Barzdins J. Process-oriented knowledge system for health professionals as a tool for transition to hospital process orientation. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2016. [DOI: 10.1080/20479700.2016.1219831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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21
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How to achieve care coordination inside health care organizations: Insights from organization theory on coordination in theory and in action. INTERNATIONAL JOURNAL OF CARE COORDINATION 2016. [DOI: 10.1177/2053434516634115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Understanding how health care organizations can achieve care coordination internally is essential because it is difficult to achieve, but essential for high-quality and efficient health care delivery. This article offers an answer by providing a synthesis of knowledge about coordination from organization theory, where coordination is a central research topic. The article focuses on intra-organizational coordination, which is challenging especially across boundaries such as departments or professions. It provides an overview of the classic coordination mechanisms, e.g., standardization of work processes, but also of recent insights that have identified the conditions that are required to achieve coordination, and how these conditions can be provided by formal mechanisms, such as standardization, but also informally by drawing on features of the emerging situation. Such research highlights the contribution of, e.g., routines like those guided by care pathways or of artifacts like displays. The coordination insights are also discussed as regards inter-organizational care coordination.
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Liberati EG, Gorli M, Scaratti G. Reorganising hospitals to implement a patient-centered model of care. J Health Organ Manag 2015; 29:848-73. [DOI: 10.1108/jhom-07-2014-0129] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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 understand how the introduction of a patient-centered model (PCM) in Italian hospitals affects the pre-existent configuration of clinical work and interacts with established intra/inter-professional relationships.
Design/methodology/approach
– Qualitative multi-phase study based on three main sources: health policy analysis, an exploratory interview study with senior managers of eight Italian hospitals implementing the PCM, and an in-depth case study that involved managerial and clinical staff of one Italian hospital implementing the PCM.
Findings
– The introduction of the PCM challenges clinical work and professional relationships, but such challenges are interpreted differently by the organisational actors involved, thus giving rise to two different “narratives of change”. The “political narrative” (the views conveyed by formal policies and senior managers) focuses on the power shifts and conflict between nurses and doctors, while the “workplace narrative” (the experiences of frontline clinicians) emphasises the problems linked to the disruption of previous discipline-based inter-professional groups.
Practical implications
– Medical disciplines, rather than professional groupings, are the main source of identification of doctors and nurses, and represent a crucial aspect of clinicians’ professional identity. Although the need for collaboration among medical disciplines is acknowledged, creating multi-disciplinary groups in practice requires the sustaining of new aggregators and binding forces.
Originality/value
– This study suggests further acknowledgment of the inherent complexity of the political and workplace narratives of change rather than interpreting them as the signal of irreconcilable perspectives between managers and clinicians. By addressing the specific issues regarding which the political and workplace narratives clash, relationship of trust may be developed through which problems can be identified, mutually acknowledged, articulated, and solved.
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Andersen H, Røvik KA. Lost in translation: a case-study of the travel of lean thinking in a hospital. BMC Health Serv Res 2015; 15:401. [PMID: 26390900 PMCID: PMC4578238 DOI: 10.1186/s12913-015-1081-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 09/18/2015] [Indexed: 11/12/2022] Open
Abstract
Background Lean thinking as a quality improvement approach is introduced in hospitals worldwide, although evidence for its impact is scarce. Lean initiatives are social, complex and context-dependent. This calls for a shift from cause–effect to conditional attributions to understand how lean works. In this study, we bring attention to the transformative power of local translation, which creates different versions of lean in different contexts, and thereby affect the evidence for lean as well as the success of lean initiatives within and among hospitals. Methods We explored the travel of lean within a hospital in Norway by identifying local actors’ perceptions of lean through their images of enablers for successful interventions. These attributions describe the characteristics of lean in use, i.e. the prevailing version of lean. Local actors’ perceptions of enablers for lean interventions were collected through focus group interviews with three groups of stakeholders: managers, internal consultants and staff. A questionnaire was used to reveal the enablers relative importance. Results The enablers known from the literature were retrieved at the case hospital. The only exception was that external expert change agents were not believed to promote lean. In addition, the stakeholders added a number of new and supplementary enablers. Two-thirds of the most important enablers for success were novel, local ones. Among these were a problem, not method focus, a bottom-up approach, the need of internal consultants, credibility, realism and patience. The local actors told different stories about local enablers and had different images of lean depending on their hierarchical level. Discussion By comparing and analyzing the findings from the literature review, the focus groups and the survey, we deduced that the travel of lean within the hospital was affected by three principles of translation: the practical, the pragmatic, and the sceptical. Further, three logics of translation were in play: translation as a funnel, a conscious sell-in, and a wash-out. This resulted in various local versions of lean. Conclusions We conclude that lean, introduced by the management, communicated by the internal consultants, and used by the staff, is transformed more than once within the hospital. Translation is part of the explanation for the lack of evidence for lean, and translation can be decisive for outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-1081-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hege Andersen
- University Hospital of North Norway, Box 100, 9038, Tromsø, Norway. .,Department of Sociology, Political Science, and Community Planning, Faculty of Humanities, Social Sciences, and Education, University of Tromsø, Hansine Hansens v 14, 1919, Tromsø, Norway.
| | - Kjell Arne Røvik
- Department of Sociology, Political Science, and Community Planning, Faculty of Humanities, Social Sciences, and Education, University of Tromsø, Hansine Hansens v 14, 1919, Tromsø, Norway.
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Challenges for inter-departmental cooperation in hospitals: Results from cross-case analysis. HEALTH POLICY AND TECHNOLOGY 2015. [DOI: 10.1016/j.hlpt.2014.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Jacobs M, Boersma L, Dekker A, Hermanns E, Houben R, Govers M, van Merode F, Lambin P. Organizational development trajectory of a large academic radiotherapy department set up similarly to a prospective clinical trial: the MAASTRO experience. Br J Radiol 2015; 88:20140559. [PMID: 25679320 PMCID: PMC4628468 DOI: 10.1259/bjr.20140559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective: To simultaneously improve patient care processes and clinical research activities by starting a hypothesis-driven reorganization trajectory mimicking the rigorous methodology of a prospective clinical trial. Methods: The design of this reorganization trajectory was based on the model of a prospective trial. It consisted of (1) listing problems and analysing their potential causes, (2) defining interventions, (3) defining end points and (4) measuring the effect of the interventions (i.e. at baseline and after 1 and 2 years). The primary end point for patient care was the number of organizational root causes of incidents/near incidents; for clinical research, it was the number of patients in trials. There were several secondary end points. We analysed the data using two sample z-tests, χ2 test, a Mann–Whitney U test and the one-way analysis of variance with Bonferroni correction. Results: The number of organizational root causes was reduced by 27% (p < 0.001). There was no effect on the percentage of patients included in trials. Conclusion: The reorganizational trajectory was successful for the primary end point of patient care and had no effect on clinical research. Some confounding events hampered our ability to draw strong conclusions. Nevertheless, the transparency of this approach can give medical professionals more confidence in moving forward with other organizational changes in the same way. Advances in knowledge: This article is novel because managerial interventions were set up similarly to a prospective clinical trial. This study is the first of its kind in radiotherapy, and this approach can contribute to discussions about the effectiveness of managerial interventions.
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Affiliation(s)
- M Jacobs
- 1 Department of Radiation Oncology (MAASTRO), School for Public Health and Primary Care-Health Services Research, Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
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Andersen H, Røvik KA, Ingebrigtsen T. Lean thinking in hospitals: is there a cure for the absence of evidence? A systematic review of reviews. BMJ Open 2014; 4:e003873. [PMID: 24435890 PMCID: PMC3902334 DOI: 10.1136/bmjopen-2013-003873] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Lean interventions aim to improve quality of healthcare by reducing waste and facilitate flow in work processes. There is conflicting evidence on the outcomes of lean thinking, with quantitative and qualitative studies often contradicting each other. We suggest that reviewing the literature within the approach of a new contextual framework can deepen our understanding of lean as a quality-improvement method. This article theorises the concept of context by establishing a two-dimensional conceptual framework acknowledging lean as complex social interventions, deployed in different organisational dimensions and domains. The specific aim of the study was to identify factors facilitating intended outcomes from lean interventions, and to understand when and how different facilitators contribute. DESIGN A two-dimensional conceptual framework was developed by combining Shortell's Dimensions of capability with Walshes' Domains of an intervention. We then conducted a systematic review of lean review articles concerning hospitals, published in the period 2000-2012. The identified lean facilitators were categorised according to the intervention domains and dimensions of capability provided by the framework. RESULTS We provide a framework emphasising context by relating facilitators to domains and dimensions of capability. 23 factors enabling a successful lean intervention in hospitals were identified in the systematic review, where management and a supportive culture, training, accurate data, physicians and team involvement were most frequent. CONCLUSIONS In the absence of evidence, the two-dimensional framework, incorporating the context, may prove useful for future research on variation in outcomes from lean interventions. Findings from the review suggest that characteristics and local application of lean, in addition to strategic and cultural capability, should be given further attention in healthcare quality improvement.
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Affiliation(s)
- Hege Andersen
- University Hospital of North Norway, Tromsø, Norway
- Department of Sociology, Political Science, and Community Planning, Faculty of Humanities, Social Sciences, and Education, University of Tromsø, Tromsø, Norway
| | - Kjell Arne Røvik
- Department of Sociology, Political Science, and Community Planning, Faculty of Humanities, Social Sciences, and Education, University of Tromsø, Tromsø, Norway
| | - Tor Ingebrigtsen
- University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
- Centre for Clinical Governance research, Australian Institute of Health Innovation, University of New South Wales, Sydney, Australia
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Gonçalves PD, Hagenbeek ML, Vissers JMH. Hospital process orientation from an operations management perspective: development of a measurement tool and practical testing in three ophthalmic practices. BMC Health Serv Res 2013; 13:475. [PMID: 24219362 PMCID: PMC3831252 DOI: 10.1186/1472-6963-13-475] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 11/01/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although research interest in hospital process orientation (HPO) is growing, the development of a measurement tool to assess process orientation (PO) has not been very successful yet. To view a hospital as a series of processes organized around patients with a similar demand seems to be an attractive proposition, but it is hard to operationalize this idea in a measurement tool that can actually measure the level of PO. This research contributes to HPO from an operations management (OM) perspective by addressing the alignment, integration and coordination of activities within patient care processes. The objective of this study was to develop and practically test a new measurement tool for assessing the degree of PO within hospitals using existing tools. METHODS Through a literature search we identified a number of constructs to measure PO in hospital settings. These constructs were further operationalized, using an OM perspective. Based on five dimensions of an existing questionnaire a new HPO-measurement tool was developed to measure the degree of PO within hospitals on the basis of respondents' perception. The HPO-measurement tool was pre-tested in a non-participating hospital and discussed with experts in a focus group. The multicentre exploratory case study was conducted in the ophthalmic practices of three different types of Dutch hospitals. In total 26 employees from three disciplines participated. After filling in the questionnaire an interview was held with each participant to check the validity and the reliability of the measurement tool. RESULTS The application of the HPO-measurement tool, analysis of the scores and interviews with the participants resulted in the possibility to identify differences of PO performance and the areas of improvement--from a PO point of view--within each hospital. The result of refinement of the items of the measurement tool after practical testing is a set of 41 items to assess the degree of PO from an OM perspective within hospitals. CONCLUSIONS The development and practically testing of a new HPO-measurement tool improves the understanding and application of PO in hospitals and the reliability of the measurement tool. The study shows that PO is a complex concept and appears still hard to objectify.
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Affiliation(s)
- Pedro D Gonçalves
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Marie Louise Hagenbeek
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jan M H Vissers
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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