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Visser M, ‘t Hart N, de Mul M, Weggelaar‐Jansen AM. The Perspectives of Healthcare Professionals and Managers on Patient Involvement in Care Pathway Development: A Discourse Analysis. Health Expect 2024; 27:e14101. [PMID: 38855873 PMCID: PMC11163266 DOI: 10.1111/hex.14101] [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: 12/22/2023] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND The WHO advocates patient and public involvement as an ethical imperative, due to the value of the lived experience of patients. A deeper understanding of the shared meanings and underlying beliefs of healthcare professionals and managers for and against including patients in care pathway development. OBJECTIVE To explore the considerations of healthcare professionals and managers on the involvement of patients and public in care pathway development. METHODS In a medical rehabilitation centre we conducted a single case study that was part of a 2-year action research programme on blended care pathway development. Following 14 semistructured interviews with healthcare professionals and managers, we analysed their discourses on the value of patient involvement as well as the potential threats and opportunities. RESULTS We identified four discourses. Patient as expert frames involvement as relevant, as adding new perspectives and as required to fully understand the patient's needs. Skills and representation is based on the construct that obtaining valuable insights from patients requires certain skills and competences. Self-protection focusses on personal, interprofessional objections to patient involvement. Professional knows best reveals expertise-related reasons for avoiding or postponing involvement. CONCLUSION These discourses explain why patient and public involvement in care pathway development is sometimes postponed, limited in scope and level of participation, and/or avoided. The following strategies might minimise the paralysing effect of these discourses: strengthen the capabilities of all stakeholders involved; use a mix of complementary techniques to gain involvement in distinct phases of care pathway development; and create/facilitate a safe environment. Put together, these strategies would foster ongoing, reciprocal learning that could enhance patient involvement. PATIENT OR PUBLIC CONTRIBUTION This study belonged to an action research programme on blended care pathway development (developing an integrated, coordinated patient care plan that combines remote, digital telehealth applications, self-management tools and face-to-face care). Multidisciplinary teams took a quality collaborative approach to quality improvement (considering patients as stakeholders) to develop 11 blended care pathways. Although professionals and managers were instructed to invite patients onto their teams and to attend care pathway design workshops, few teams (3/11) actually did. Unravelling why this happened will help improve patient and public involvement in care pathway development.
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Affiliation(s)
- Mildred Visser
- Erasmus School of Health Policy & ManagementErasmus UniversityRotterdamThe Netherlands
| | - Naomi ‘t Hart
- Erasmus School of Health Policy & ManagementErasmus UniversityRotterdamThe Netherlands
| | - Marleen de Mul
- Erasmus School of Health Policy & ManagementErasmus UniversityRotterdamThe Netherlands
| | - Anne Marie Weggelaar‐Jansen
- Erasmus School of Health Policy & ManagementErasmus UniversityRotterdamThe Netherlands
- Clinical InformaticsEindhoven University of TechnologyEindhovenThe Netherlands
- Tranzo, Tilburg School of Social and Behavioural SciencesTilburg UniversityTilburgThe Netherlands
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Øyri SF, Wiig S, Tjomsland O. Influence of external assessment on quality and safety in surgery: a qualitative study of surgeons' perspectives. BMJ Open Qual 2024; 13:e002672. [PMID: 38724111 PMCID: PMC11086481 DOI: 10.1136/bmjoq-2023-002672] [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: 10/31/2023] [Accepted: 04/17/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Transparency about the occurrence of adverse events has been a decades-long governmental priority, defining external feedback to healthcare providers as a key measure to improve the services and reduce the number of adverse events. This study aimed to explore surgeons' experiences of assessment by external bodies, with a focus on its impact on transparency, reporting and learning from serious adverse events. External bodies were defined as external inspection, police internal investigation, systems of patient injury compensation and media. METHODS Based on a qualitative study design, 15 surgeons were recruited from four Norwegian university hospitals and examined with individual semi-structured interviews. Data were analysed by deductive content analysis. RESULTS Four overarching themes were identified, related to influence of external inspection, police investigation, patient injury compensation and media publicity, (re)presented by three categories: (1) sense of criminalisation and reinforcement of guilt, being treated as suspects, (2) lack of knowledge and competence among external bodies causing and reinforcing a sense of clashing cultures between the 'medical and the outside world' with minor influence on quality improvement and (3) involving external bodies could stimulate awareness about internal issues of quality and safety, depending on relevant competence, knowledge and communication skills. CONCLUSIONS AND IMPLICATIONS This study found that external assessment might generate criminalisation and scapegoating, reinforcing the sense of having medical perspectives on one hand and external regulatory perspectives on the other, which might hinder efforts to improve quality and safety. External bodies could, however, inspire useful adjustment of internal routines and procedures. The study implies that the variety and interconnections between external bodies may expose the surgeons to challenging pressure. Further studies are required to investigate these challenges to quality and safety in surgery.
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Affiliation(s)
- Sina Furnes Øyri
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Stavanger University Hospital, Stavanger, Norway
| | - Siri Wiig
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Ole Tjomsland
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Division of Quality and Specialist Areas, South-Eastern Norway Regional Health Authority, Hamar, Norway
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Mboweni SH. Strategies that enabled access to chronic care during the COVID-19 pandemic and beyond in South Africa. Health SA 2024; 29:2412. [PMID: 38628228 PMCID: PMC11019043 DOI: 10.4102/hsag.v29i0.2412] [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: 04/12/2023] [Accepted: 11/27/2023] [Indexed: 04/19/2024] Open
Abstract
Background The COVID-19 epidemic has revealed disturbing information about how chronic diseases are treated globally. Healthcare providers and coronavirus response teams have primarily reported on how individuals with chronic conditions sought care and treatment. However, individuals' experiences of patients are yet unknown. Aim This study aimed to explore those strategies that enabled patients with chronic diseases access to chronic care and treatment during and beyond the COVID-19 pandemic. Setting The study was conducted in the predominantly rural district of the Northwest Province, South Africa. Methods An explorative qualitative research design was followed. Information-rich participants were chosen using a purposive sampling technique. Individual face-to-face interviews were used to gather data. Data saturation was achieved after interviewing n = 28 people in total. The six steps of Braun and Clarke thematic data analysis were used to analyse the data. Results The study revealed three themes, which includes improved healthcare structural systems, shift from traditional chronic care to digital care services and medication refill and buddy system. Conclusion The findings of this study revealed a range of effective and noteworthy approaches that facilitated access to treatment and continuity of care. As a result, enhancing telemedicine as well as structural systems such as appointment scheduling, decanting choices, mobile and medication home delivery can improve access to care and treatment. Contribution The burden of disease and avoidable death will be eventually addressed by maximising the use of telemedicine and sustaining the new norm of ongoing care through digital and remote care and decanting strategies.
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Affiliation(s)
- Sheillah H Mboweni
- Department of Health Studies, Collage of Human Sciences, University of South Africa, Pretoria, South Africa
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Øyri SF, Wiig S, Anderson JE, Bergerød IJ. External inspection approaches and involvement of stakeholders' views in inspection following serious incidents - a qualitative mixed methods study from the perspectives of regulatory inspectors. BMC Health Serv Res 2024; 24:300. [PMID: 38448964 PMCID: PMC10919011 DOI: 10.1186/s12913-024-10714-9] [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: 11/02/2023] [Accepted: 02/13/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVE The objective was to gain knowledge about how external inspections following serious incidents are played out in a Norwegian hospital context from the perspective of the inspectors, and whether stakeholders' views are involved in the inspection. METHODS Based on a qualitative mixed methods design, 10 government bureaucrats and inspectors situated at the National Board of Health Supervision and three County Governors in Norway, were strategically recruited, and individual semi-structured interviews were conducted. Key official government documents were selected, collected, and thematically analyzed along with the interview data. RESULTS Our findings overall demonstrate two overarching themes: Theme (1) Perspectives on different external inspection approaches of responding and involving stakeholders in external inspection following serious incidents, Theme (2) Inspectors' internal work practices versus external expectations. Documents and all participants reported a development towards new approaches in external inspection, with more policies and regulatory attention to sensible involvement of stakeholders. Involvement and interaction with patients and informal caregivers could potentially inform the case complexity and the inspector's decision-making process. However, stakeholder involvement was sometimes complex and challenging due to e.g., difficult communication and interaction with patients and/or informal caregivers, due to resource demands and/or the inspector's lack of experience and/or relevant competence, different perceptions of the principle of sound professional practice, quality, and safety. The inspectors considered balancing the formal objectives and expectations, with the expectations of the public and different stakeholders (i.e. hospitals, patients and/or informal caregivers) a challenging part of their job. This balance was seen as an important part of the continuous development of ensuring public trust and legitimacy in external inspection processes. CONCLUSIONS AND IMPLICATIONS Our study suggests that the regulatory system of external inspection and its available approaches of responding to a serious incident in the Norwegian setting is currently not designed to accommodate the complexity of needs from stakeholders at the levels of hospital organizations, patients, and informal caregivers altogether. Further studies should direct attention to how the wider system of accountability structures may support the internal work practices in the regulatory system, to better algin its formal objectives with expectations of the public.
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Affiliation(s)
- Sina Furnes Øyri
- SHARE - Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
- Stavanger University Hospital, Stavanger, Norway.
| | - Siri Wiig
- SHARE - Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Janet E Anderson
- SHARE - Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Anaesthesiology and Perioperative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Inger Johanne Bergerød
- SHARE - Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Stavanger University Hospital, Stavanger, Norway
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Kleefstra SM, Frederiks BJM, Tingen A, Reulings PGJ. The value of experts by experience in social domain supervision in the Netherlands: results from a 'mystery guests' project. BMC Health Serv Res 2024; 24:187. [PMID: 38336792 PMCID: PMC10858591 DOI: 10.1186/s12913-024-10692-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 02/07/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND User involvement and participation in the supervision of the quality of care is an important topic for many healthcare inspectorates. It offers regulators an additional view on quality, increases the legitimacy and accountability of the inspectorate, empowers users and enhancing the public's trust in the inspectorate. To assess the accessibility of the local governmental social domain services the Joint Inspectorate Social Domain in the Netherlands worked together with people with intellectual disabilities performing as 'mystery guests' in an innovative project. This paper describes the findings of the evaluation of this project. METHODS People with intellectual disabilities living at home on their own may need some help with daily activities such as administrative tasks, raising children, household tasks, managing debts or finding work. In the Netherlands they have to arrange this help at their municipality. The goal of this project was to find out how easily people with intellectual disabilities could get help from their municipality. The participants were equal partners with the JISD inspectors from the beginning: in constructing an inspection framework, in acting as mystery guest with a fictive support request, reported back the results by storytelling. RESULTS The evaluation of the project showed that the JISD succeeded in their key aspect of the project: the goal to involve people with intellectual disabilities in a leading role from the beginning until the end. Their perspectives and preferences were the starting point of supervision. Pain points in accessibility became clear straight away and gave important insights for both inspectors as municipality professionals. Municipalities started to improve their services and evaluated the improvements with the clients. Furthermore, the impact on the participants themselves was also huge: they felt being taken seriously, valued and empowered. CONCLUSION Involving people with intellectual disabilities as participants in all phases of supervision processes contributes to more relevant and useful outcomes, creates mutual understanding of perspectives, as affirmed by both municipalities and inspectors, and creates empowerment of the participants. Furthermore, it fits perfectly within the United Nation Convention on the rights of persons with disabilities and the current development of 'value driven regulation'.
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Affiliation(s)
| | - Brenda J M Frederiks
- Amsterdam UMC, department Ethics, Law and Medical Humanities, Amsterdam, the Netherlands
| | - Adriënne Tingen
- Department of patient care, University Medical Centre Groningen, Groningen, the Netherlands
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Øyri SF, Braithwaite J, Greenfield D, Wiig S. Resilience and regulation-antithesis or a smart combination for future healthcare service improvement? Int J Qual Health Care 2024; 36:mzae002. [PMID: 38252136 DOI: 10.1093/intqhc/mzae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 10/03/2023] [Accepted: 01/17/2024] [Indexed: 01/23/2024] Open
Affiliation(s)
- Sina Furnes Øyri
- SHARE Centre for Resilience in Healthcare, Faculty of Health Sciences, Department of Quality and Health Technology, University of Stavanger, Kjell Arholms gate 41, Stavanger, Rogaland 4021, Norway
| | - Jeffrey Braithwaite
- Faculty of Medicine, Health and Human Sciences, Australian Institute of Health Innovation, Macquarie University, Balaclava Rd, Macquarie Park, Sydney, NSW 2109, Australia
| | - David Greenfield
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Gate 11, Botany Street, Sydney, NSW 2052, Australia
| | - Siri Wiig
- SHARE Centre for Resilience in Healthcare, Faculty of Health Sciences, Department of Quality and Health Technology, University of Stavanger, Kjell Arholms gate 41, Stavanger, Rogaland 4021, Norway
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Palimetaki F, Woutersen K, Pot AM. Correlations between care users' and the healthcare inspectorate's ratings of the quality of care in long-term care homes. BMJ Open Qual 2023; 12:bmjoq-2022-001897. [PMID: 36941009 PMCID: PMC10030658 DOI: 10.1136/bmjoq-2022-001897] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/02/2023] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVES Increasing emphasis is being placed on person-centredness as a quality requirement for long-term care (LTC). Although healthcare inspectorates value the importance of care users' experiences, they struggle to address these experiences in regulatory practice. The aim of this study is to explore the correlations between care users' and the healthcare inspectorate's ratings of the quality of LTC in The Netherlands. DESIGN The correlations between care users' ratings from a public Dutch online patient rating site and the Dutch Health and Youth Care Inspectorate's ratings of the quality of care were examined using Spearman rank correlations. The inspectorate's ratings cover three themes: 'attention to person-centred care', 'working towards sufficient and competent care staff' and 'focusing on quality and safety'. SETTING Ratings of the quality of care were obtained for 200 LTC homes in The Netherlands between January 2017 and March 2019. These LTC homes had 6 to 350 residents (M=89; SD=57) and belonged to organisations with 1-40 LTC homes in total (M=6; SD=6). PARTICIPANTS Publicly available anonymous ratings of the perceived quality of care by care users were extracted from the Dutch patient rating website 'www.zorgkaartnederland.nl'. Care users' ratings were available for the 2 years prior to an assessment by the inspectorate for 200 LTC homes. RESULTS We found a weak, significant correlation between the mean care users' ratings and the inspectorate's aggregated scores for the theme 'person-centred care' (r=0.26, N=200, padj<0.01); no other correlations were significant. CONCLUSIONS This study showed only a weak correlation between care users' ratings and ratings of the Dutch Inspectorate of the quality of 'person-centred care' in LTC homes. Therefore, it may be fruitful to intensify or innovate approaches to involve care users' experiences in regulation to do them justice.
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Affiliation(s)
| | | | - Anne Margriet Pot
- Health and Youth Care Inspectorate, Utrecht, Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
- Optentia, North-West University, Vanderbijlpark, South Africa
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Dimitrova M, Jakab I, Mitkova Z, Kamusheva M, Tachkov K, Nemeth B, Zemplenyi A, Dawoud D, Delnoij DMJ, Houýez F, Kalo Z. Potential Barriers of Patient Involvement in Health Technology Assessment in Central and Eastern European Countries. Front Public Health 2022; 10:922708. [PMID: 35968493 PMCID: PMC9371596 DOI: 10.3389/fpubh.2022.922708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/13/2022] [Indexed: 12/03/2022] Open
Abstract
Patients' perspectives are important to identify preferences, estimate values and appreciate unmet medical needs in the process of research and development and subsequent assessment of new health technologies. Patient and public involvement in health technology assessment (HTA) is essential in understanding and assessing wider implications of coverage and reimbursement decisions for patients, their relatives, caregivers, and the general population. There are two approaches to incorporating the patients' voice in HTA, preferably used in a mix. In the first one, patients, caregivers and/or their representatives directly participate at discussions in different stages of the HTA process, often at the same table with other stakeholders. Secondly, patient involvement activities can be supported by evidence on patient value and experience collected directly from patients, caregivers and/or their representatives often by patient groups Patient involvement practices, however, are limited in Central and Eastern European (CEE) countries without clear methodology or regulatory mechanisms to guide patient involvement in the HTA process. This poses the question of transferability of practices used in other countries, and might call for the development of new CEE-specific guidelines and methods. In this study we aim to map potential barriers of patient involvement in HTA in countries of the CEE region.
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Affiliation(s)
- Maria Dimitrova
- Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
- *Correspondence: Maria Dimitrova
| | - Ivett Jakab
- Syreon Research Institute, Budapest, Hungary
| | - Zornitsa Mitkova
- Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Maria Kamusheva
- Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | | | | | - Antal Zemplenyi
- Syreon Research Institute, Budapest, Hungary
- Center for Health Technology Assessment and Pharmacoeconomics Research, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
| | - Dalia Dawoud
- National Institute for Health and Care Excellence, London, United Kingdom
- Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Diana M. J. Delnoij
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, Netherlands
- National Health Care Institute (Zorginstituut Nederland), Diemen, Netherlands
| | - François Houýez
- EURORDIS: Eurordis, European Organization for Rare Diseases, Paris, France
| | - Zoltan Kalo
- Syreon Research Institute, Budapest, Hungary
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
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Husabø G, Hovlid E. What Might Be Required for Inspections to Be Considered Fair? Comment on "What Lies Behind Successful Regulation? A Qualitative Evaluation of Pilot Implementation of Kenya's Health Facility Inspection Reforms". Int J Health Policy Manag 2022; 12:7296. [PMID: 35942956 PMCID: PMC10125043 DOI: 10.34172/ijhpm.2022.7296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/23/2022] [Indexed: 11/09/2022] Open
Abstract
Tama et al offer us an interesting analysis of a piloted regulatory reform that introduced a Joint Health Inspections (JHIs) system in three Kenyan counties. The study highlights key factors facilitating or hindering the implementation of the reform. In this commentary we reflect on the concept of fairness, which is one of the topics that is discussed in the study. We describe four important dimensions of fairness in the context of inspections: expectation clarity, consistency of assessment, consistency of enforcement, and fairness to patients. We argue that all four dimensions are important in the regulatory design, in order for the inspection to be perceived as fair.
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Affiliation(s)
- Gunnar Husabø
- Department of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Einar Hovlid
- Department of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
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