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Wilson KL, Garney WR, Garcia KM, Esquivel CH, Ajayi KV, Flores SA, Curran L. The Development of a Systems-Level Approach to Address Adolescent Access to Health Care: A Novel Confidentiality Policy Intervention. FAMILY & COMMUNITY HEALTH 2023; 46:S66-S73. [PMID: 37696017 DOI: 10.1097/fch.0000000000000380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Most evidence-based interventions in adolescent sexual and reproductive health and mental health remain largely aimed at individual-level outcomes and do not conceptualize adolescent health within a social-ecological model. Interventions to affect policy, systems, and environmental change offer potential for sustained population impact. The current initiative used an innovation framework to develop a novel systems-level approach to address adolescent access to health care. The Framework for Public Health Innovation provided an approach to develop a novel intervention. Confident Teen is a systems-level intervention that creates the opportunity, through organizational policy change, to increase adolescents' access to confidential sexual and reproductive health services through organizational policies. Gaps in adolescents' access to health care services allowed for a systems-level approach to be designed through an adolescent pregnancy prevention innovation initiative. Confidentiality is a right and critical component to their health care; therefore, a policy and conversation between provider and patient is a prioritized component of the novel intervention.
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Affiliation(s)
- Kelly L Wilson
- School of Public Health, Texas A&M University, College Station (Drs Garney, Esquivel, and Ajayi and Mss Garcia, Flores, and Curran); and School of Nursing, Texas A&M University, Bryan (Dr Wilson)
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Usher S, Denis JL. Exploring expectations and assumptions in the public and patient engagement literature: A meta-narrative review. PATIENT EDUCATION AND COUNSELING 2022; 105:2683-2692. [PMID: 35459528 DOI: 10.1016/j.pec.2022.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Public and patient engagement (PPE) is increasingly recognized in policy statements as essential to achieving transformation towards patient-centred, value-based, integrated care. Despite extensive research over two decades, important gaps and questions remain around how the efforts invested in engagement drive the changes needed to meet these objectives. METHODS We conducted a meta-narrative review of systematic and scoping reviews to understand persistent difficulties and uncertainties in this research domain. Thirty-eight reviews looking at studies of PPE in care, healthcare organizations and systems were appraised. We synthesized the expectations of PPE that prompted each review, the guiding ideas about how PPE comes about, main findings and the questions and gaps they raise. RESULTS Four storylines are found in reviews: 1. Terminology is inconsistent and concepts are weak; 2. Outcomes of care can be improved 3. Influence on healthcare delivery and design is uncertain; 4. Characteristics of engagement efforts are consequential. DISCUSSION AND PRACTICE IMPLICATIONS Three assumptions underlie these storylines and appear as barriers to practice and research; alternative approaches based on collaborative governance and theories of change are proposed to understand and support engagement with transformative potential.
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Affiliation(s)
- Susan Usher
- École Nationale D'administration Publique, 4750 Henri Julien, Montréal, Québec H2T 2C8, Canada.
| | - Jean-Louis Denis
- École de Santé Publique, Université de Montréal, 7101 ave du Parc, Montréal, Québec H3N 1X9, Canada
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Shaw J, Gutberg J, Wankah P, Kadu M, Gray CS, McKillop A, Baker GR, Breton M, Wodchis WP. Shifting paradigms: Developmental milestones for integrated care. Soc Sci Med 2022; 301:114975. [PMID: 35461081 DOI: 10.1016/j.socscimed.2022.114975] [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: 01/11/2022] [Revised: 03/21/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
Abstract
Frameworks for understanding integrated care risk underemphasizing the complexities of the development of integrated care in a local context. The objectives of this article are to (1) present a novel strategy for conceptualizing integrated care as developing through a series of milestones at the organizational level, and (2) present a typology of milestones empirically generated through the analysis of four cases of integrated community-based primary health care (ICBPHC) in Canada and New Zealand. Our paper reports on an analysis of 4 specific organizational case studies within a large dataset generated for an international multiple case study project of exemplar models of ICBPHC. Drawing on earlier analyses of 359 qualitative interviews with patients, caregivers, health care providers, managers, and policymakers, in this article we present a detailed analysis of 28 interviews with managers and leaders of local models of integrated care. We generated a detailed timeline of the development of integrated care as expressed by each participant, and synthesized themes across timelines within each case to identify specific milestone events. We then synthesized across cases to generate the broader milestone categories to which each event belongs. We generated 5 milestone categories containing 12 more specific milestone events. The milestone categories include (1) strategic relational, (2) strategic process change, (3) internal structural, (4) inter-organizational structural, and (5) external milestones. We propose a comprehensive framework of developmental milestones for integrated care. Milestones represent a compelling strategy for conceptualizing the development of integrated care. Practically, policymakers and health care leaders can support the implementation of integrated care by examining the history and context of a given model of care and identifying strategies to achieve milestones that will accelerate integrated care. Further research should document additional milestone events and advance the development of dynamic frameworks for integrated care.
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Affiliation(s)
- James Shaw
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, 160-500 University Avenue, Toronto, Ontario, M5G 1V7, Canada.
| | - Jennifer Gutberg
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Paul Wankah
- Department of Community Health, University of Sherbrooke, Canada
| | - Mudathira Kadu
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Canada
| | - Ann McKillop
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - G Ross Baker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Mylaine Breton
- Department of Community Health, University of Sherbrooke, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada; Research Chair Implementation and Evaluation Science, Institute for Better Health, Trillium Health Partners, Canada
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Côté-Boileau É, Breton M, Rouleau L, Denis JL. Appropriating integrated performance management tools in healthcare: a sociomaterial work story. J Health Organ Manag 2021; ahead-of-print. [PMID: 34873898 DOI: 10.1108/jhom-01-2021-0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to explore the appropriation of control rooms based on value-based integrated performance management tools implemented in all publicly funded health organizations in Quebec (Canada) as a form of legitimate sociomaterial work. DESIGN/METHODOLOGY/APPROACH Multi-site organizational ethnographic case studies in two Integrated health and social services centers, with narrative process analysis of triangulated qualitative data collected through non-participant observation (163 h), individual semi-structured interviews (N = 34), and document review (N = 143). FINDINGS Three types of legitimate sociomaterial work are accomplished when actors appropriate control rooms: 1) reformulating performance management work; 2) disrupting accountability work and; 3) effecting value-based integrated performance management. Each actor (tools, institutions and people) follows recurrent institutional work-paths: tools consistently engage in disruptive work; institutions consistently engage in maintaining work, and people consistently engage in creation work. The study reveals the potential of performance management tools as "effective integrators" of the technological, managerial, policy and delivery levels of data-driven health system performance and improvement. PRACTICAL IMPLICATIONS This paper draws on theoretically informed empirical insights to develop actionable knowledge around how to better design, implement and adapt tool-driven health system change: 1) Packaging the three agents of data-driven system change in health care: tools, institutions, people; 2) Redefining the search for performance in health care in the context of value creation, and; 3) Strengthening clinical and managerial relevance in health performance management practice. ORIGINALITY/VALUE The authors aim to stimulate new and original scholarship around the under-theorized concept of sociomaterial work, challenging theoretical, ontological and practical conceptions of work in healthcare organizations and beyond.
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Affiliation(s)
- Élizabeth Côté-Boileau
- Health Sciences Research, Faculty of Medicine and Health Sciences, University of Sherbrooke, Fonds de recherche du Québec - Santé, Montreal, Canada
| | - Mylaine Breton
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Charles-Le Moyne Hospital Research Center, University of Sherbrooke, Longueuil, Canada
| | - Linda Rouleau
- Department of Management, HEC Montreal, Montreal, Canada
| | - Jean-Louis Denis
- Department of Management, Evaluation and Health Policy, School of Public Health, University of Montreal Hospital Research Center, University of Montreal, Montreal, Canada
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Clavel N, Pomey MP, Ghadiri DPS. Partnering with patients in quality improvement: towards renewed practices for healthcare organization managers? BMC Health Serv Res 2019; 19:815. [PMID: 31703678 PMCID: PMC6839263 DOI: 10.1186/s12913-019-4618-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 10/04/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Around the world, many healthcare organizations engage patients as a quality improvement strategy. In Canada, the University of Montreal has developed a model which consists in partnering with patient advisors, providers, and managers in quality improvement. This model was introduced through its Partners in Care Programs tested with several quality improvement teams in Quebec, Canada. Partnering with patients in quality improvement brings about new challenges for healthcare managers. This model is recent, and little is known about how managers contribute to implementing and sustaining it using key practices. METHODS In-depth multi-level case studies were conducted within two healthcare organizations which have implemented a Partners in Care Program in quality improvement. The longitudinal design of this research enabled us to monitor the implementation of patient partnership initiatives from 2015 to 2017. In total, 38 interviews were carried out with managers at different levels (top-level, mid-level, and front-line) involved in the implementation of Partners in Care Programs. Additionally, seven focus groups were conducted with patients and providers. RESULTS Our findings show that managers are engaged in four main types of practices: 1-designing the patient partnership approach so that it makes sense to the entire organization; 2-structuring patient partnership to support its deployment and sustainability; 3-managing patient advisor integration in quality improvement to avoid tokenistic involvement; 4-evaluating patient advisor integration to support continuous improvement. Designing and structuring patient partnership are based on typical management practices used to implement change initiatives in healthcare organizations, whereas managing and evaluating patient advisor integration require new daily practices from managers. Our results reveal that managers at all levels, from top to front-line, are concerned with the implementation of patient partnership in quality improvement. CONCLUSION This research adds empirical support to the evidence regarding daily managerial practices used for implementing patient partnership initiatives in quality improvement and contributes to guiding healthcare organizations and managers when integrating such approaches.
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Affiliation(s)
- Nathalie Clavel
- Department of Health Policy, Management and Evaluation, School of Public Health, University of Montreal, Montreal, Canada.
| | - Marie-Pascale Pomey
- Department of Health Policy, Management and Evaluation, School of Public Health, University of Montreal, Montreal, Canada
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Côté-Boileau É, Denis JL, Callery B, Sabean M. The unpredictable journeys of spreading, sustaining and scaling healthcare innovations: a scoping review. Health Res Policy Syst 2019; 17:84. [PMID: 31519185 PMCID: PMC6744644 DOI: 10.1186/s12961-019-0482-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/01/2019] [Indexed: 11/20/2022] Open
Abstract
Innovation has the potential to improve the quality of care and health service delivery, but maximising the reach and impact of innovation to achieve large-scale health system transformation remains understudied. Interest is growing in three processes of the innovation journey within health systems, namely the spread, sustainability and scale-up (3S) of innovation. Recent reviews examine what we know about these processes. However, there is little research on how to support and operationalise the 3S. This study aims to improve our understanding of the 3S of healthcare innovations. We focus specifically on the definitions of the 3S, the mechanisms that underpin them, and the conditions that either enable or limit their potential. We conducted a scoping review, systematically investigating six bibliographic databases to search, screen and select relevant literature on the 3S of healthcare innovations. We screened 641 papers, then completed a full-text review of 112 identified as relevant based on title and abstract. A total of 24 papers were retained for analysis. Data were extracted and synthesised through descriptive and inductive thematic analysis. From this, we develop a framework of actionable guidance for health system actors aiming to leverage the 3S of innovation across five key areas of focus, as follows: (1) focus on the why, (2) focus on perceived-value and feasibility, (3) focus on what people do, rather than what they should be doing, (4) focus on creating a dialogue between policy and delivery, and (5) focus on inclusivity and capacity building. While there is no standardised approach to foster the 3S of healthcare innovations, a variety of practical frameworks and tools exist to support stakeholders along this journey.
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Affiliation(s)
- Élizabeth Côté-Boileau
- Health Sciences Research, Faculty of Medicine and Health Sciences, University of Sherbrooke, Quebec, Canada. .,Charles-Le Moyne - Saguenay-Lac-Saint-Jean Research Center on Health Innovations, Quebec, Canada. .,Doctoral Award Fellow from Quebec's Fonds de recherche du Québec - Santé (FRQS), Quebec, Canada. .,Health Standards Organization, Ottawa, Canada.
| | - Jean-Louis Denis
- Health Administration Department, School of Public Health, University of Montreal, Quebec, Canada.,University of Montreal Hospital Research Center, Quebec, Canada.,Canada Research Chair (Tier I) holder on Health system design and adaptation (Canadian Institutes of Health Research), Montreal, Canada
| | - Bill Callery
- Canadian Foundation for Healthcare Improvement, Corporate Strategy and Program Development, Ottawa, Canada
| | - Meghan Sabean
- Canadian Foundation for Healthcare Improvement, Corporate Strategy and Program Development, Ottawa, Canada
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Miedaner F, Kuntz L, Enke C, Roth B, Nitzsche A. Exploring the differential impact of individual and organizational factors on organizational commitment of physicians and nurses. BMC Health Serv Res 2018; 18:180. [PMID: 29544478 PMCID: PMC5856378 DOI: 10.1186/s12913-018-2977-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 02/28/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Physician and nursing shortages in acute and critical care settings require research on factors which might drive their commitment, an important predictor of absenteeism and turnover. However, the degree to which the commitment of a physician or a nurse is driven by individual or organizational characteristics in hospitals remains unclear. In addition, there is a need for a greater understanding of how antecedent-commitment relationships differ between both occupational groups. Based on recent findings in the literature and the results of a pilot study, we investigate the degree to which selected individual and organizational characteristics might enhance an employee's affective commitment working in the field of neonatal intensive care. Moreover, our aim is to examine the different antecedent-commitment relationships across the occupational groups of nurses and physicians. METHODS Information about individual factors affecting organizational commitment was derived from self-administered staff questionnaires, while additional information about organizational structures was taken from hospital quality reports and a self-administered survey completed by hospital department heads. Overall, 1486 nurses and 540 physicians from 66 Neonatal Intensive Care Units participated in the study. We used multilevel modeling to account for different levels of analysis. RESULTS Although organizational characteristics can explain differences in an employee's commitment, the differences can be largely explained by his or her individual characteristics and work experiences. Regarding occupational differences, individual support by leaders and colleagues was shown to influence organizational commitment more strongly in the physicians' group. In contrast, the degree of autonomy in the units and perceived quality of care had a larger impact on the nurses' organizational commitment. CONCLUSIONS With the growing number of hospitals facing an acute shortage of highly-skilled labor, effective strategies on the individual and organizational levels have to be considered to enhance an employee's commitment to his or her organization. Regarding occupational differences in antecedent-commitment relationships, more specific management actions should be undertaken to correspond to different needs and aspirations of nurses and physicians. TRIAL REGISTRATION German Clinical Trials Register ( DRKS00004589 , date of trial registration: 15.05.2013).
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Affiliation(s)
- Felix Miedaner
- Department of Business Administration and Health Care Management, University of Cologne, Universitätsstraße 91, 50931 Cologne, Germany
| | - Ludwig Kuntz
- Department of Business Administration and Health Care Management, University of Cologne, Universitätsstraße 91, 50931 Cologne, Germany
| | - Christian Enke
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres) and Research Unit Ethics, Medical Faculty, University Clinic Cologne, Cologne, Germany
| | - Bernhard Roth
- Department of Neonatology and Paediatric Intensive Care, Children’s Hospital, University of Cologne, Cologne, Germany
| | - Anika Nitzsche
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
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Health System Creation and Integration at a Health Sciences University: A Five-Year Follow-up. J Healthc Manag 2017; 62:386-402. [PMID: 29135763 DOI: 10.1097/jhm-d-16-00007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
EXECUTIVE SUMMARY Shifting healthcare market forces and regulation have exerted near-constant pressure on U.S. academic health centers (AHCs) attempting to successfully execute their traditional tripartite mission. A governance structure and organizational alignment that works well under one set of conditions is rarely optimal when conditions change. Thus, the degree and type of alignment of an AHC's clinical, educational, and faculty practice organizations have changed regularly within the sector, typically landing near one end or the other on a continuum from fully aligned with centralized governance to largely independent with separate governance. The authors examine the case of Georgia Regents University and Health System in this context. In step with industry trends, the institution's governance structure swung from fully aligned/centralized governance in the early 1990s to essentially separate and decentralized by 2000. In 2010, the Georgia Regents University organizations achieved rapid realignment by creating a governance structure of sufficient strength and flexibility to absorb and adjust to continuing external upheaval. The hospitals, clinics, and physician-faculty practice group were combined into one integrated health system, then aligned with the university to form the state's only public AHC under aligned, but distinct, corporate and management structures. The years since reorganization have seen significant growth in patient volumes and complexity, improved service quality, and enhanced faculty physician satisfaction, while also significantly increasing economic contributions from the health system to the academic mission. This case study offers observations and lessons learned that may be useful to other higher education institutions considering reorganization.
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Therrien MC, Normandin JM, Denis JL. Bridging complexity theory and resilience to develop surge capacity in health systems. J Health Organ Manag 2017; 31:96-109. [PMID: 28260411 DOI: 10.1108/jhom-04-2016-0067] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Health systems are periodically confronted by crises - think of Severe Acute Respiratory Syndrome, H1N1, and Ebola - during which they are called upon to manage exceptional situations without interrupting essential services to the population. The ability to accomplish this dual mandate is at the heart of resilience strategies, which in healthcare systems involve developing surge capacity to manage a sudden influx of patients. The paper aims to discuss these issues. Design/methodology/approach This paper relates insights from resilience research to the four "S" of surge capacity (staff, stuff, structures and systems) and proposes a framework based on complexity theory to better understand and assess resilience factors that enable the development of surge capacity in complex health systems. Findings Detailed and dynamic complexities manifest in different challenges during a crisis. Resilience factors are classified according to these types of complexity and along their temporal dimensions: proactive factors that improve preparedness to confront both usual and exceptional requirements, and passive factors that enable response to unexpected demands as they arise during a crisis. The framework is completed by further categorizing resilience factors according to their stabilizing or destabilizing impact, drawing on feedback processes described in complexity theory. Favorable order resilience factors create consistency and act as stabilizing forces in systems, while favorable disorder factors such as diversity and complementarity act as destabilizing forces. Originality/value The framework suggests a balanced and innovative process to integrate these factors in a pragmatic approach built around the fours "S" of surge capacity to increase health system resilience.
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Affiliation(s)
| | | | - Jean-Louis Denis
- Department of Public Health, Ecole nationale d'administration publique a Montreal, Montreal, Canada
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Denis JL, Usher S. Governance Must Dive Into Organizations to Make a Real Difference Comment on "Governance, Government, and the Search for New Provider Models". Int J Health Policy Manag 2017; 6:49-51. [PMID: 28005542 PMCID: PMC5193506 DOI: 10.15171/ijhpm.2016.89] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 06/28/2016] [Indexed: 11/09/2022] Open
Abstract
In their 2016 article, Saltman and Duran provide a thoughtful examination of the governance challenges involved in different care delivery models adopted in primary care and hospitals in two European countries. This commentary examines the limited potential of structural changes to achieve real reform and considers that, unless governance arrangements actually succeed in penetrating organizations, they are unlikely to improve care. It proposes three sets of levers influenced by governance that have potential to influence what happens at the point of care: harnessing the autonomy and expertise of professionals at a collective level to work towards better safety and quality; creating enabling contexts for cross-fertilization of clinical and organizational expertise, notably through teamwork; and patient and public engagement to achieve greater agreement on improvement priorities and overcome provider/manager tensions. Good governance provides guidance at a distance but also goes deep enough to influence clinical habits.
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Affiliation(s)
- Jean-Louis Denis
- Canada Research Chair in Governance and Transformation of Health Organizations and Systems, École nationale d'administration publique, Montréal, QC, Canada
| | - Susan Usher
- Health Innovation Forum, Montréal, QC, Canada.,Institute for Strategic Analysis and Innovation, McGill University Health Centre, Montréal, QC, Canada.,École nationale d'administration publique, Montréal, QC, Canada
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Busari JO, Duits AJ. The strategic role of competency based medical education in health care reform: a case report from a small scale, resource limited, Caribbean setting. BMC Res Notes 2015; 8:13. [PMID: 25605271 PMCID: PMC4305231 DOI: 10.1186/s13104-014-0963-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 12/29/2014] [Indexed: 11/20/2022] Open
Abstract
Background Curaçao is a Dutch Caribbean island with a relatively high aging population, a high prevalence of chronic diseases and a health care system that is driven by cost-containment. In 2009 the development of a new value-based health care (VBHC) system was initiated on the island, and a key role was identified for the St. Elisabeth Hospital as a (model) platform for implementing this initiative. We therefore decided to investigate for the requirements needed to build a health care environment that is conducive for change and capable of facilitating the smooth migration of existent services into an effective and sustainable VBHC system. Findings Our findings revealed that our chosen approach was well accepted by the stakeholders. We discovered that in order to achieve a new value based health care system based on a reliable and well-organized system, the competencies of health care providers and the quality of the health care system needs to be assured. For this, extra focus needs to be given to improving service and manpower development both during and after formal training. Conclusions In order to achieve a VBHC system in a resource-limited environment, the standard of physicians’ competencies and of the health care system need to be guaranteed. The quality of the educational process needs to be maintained and safeguarded within an integrated health care delivery system that offers support to all care delivery and teaching institutions within the community. Finally, collaborative efforts with international medical institutions are recommended.
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Affiliation(s)
- Jamiu O Busari
- Department of Pediatrics, Atrium Medical Center, Henri Dunantstraat 5, 6401 CX, Heerlen, Netherlands. .,Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, the Netherlands.
| | - Ashley J Duits
- Department of Medical Education, St. Elisabeth Hospital, Willemstad, Curaçao. .,Institute for Medical Education, University Medical Center Groningen, Groningen, the Netherlands. .,Red Cross Blood bank Foundation, Willemstad, Curaçao.
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Légaré F, Witteman HO. Shared decision making: examining key elements and barriers to adoption into routine clinical practice. Health Aff (Millwood) 2013; 32:276-84. [PMID: 23381520 DOI: 10.1377/hlthaff.2012.1078] [Citation(s) in RCA: 516] [Impact Index Per Article: 46.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
For many patients, the time spent meeting with their physician-the clinical encounter-is the most opportune moment for them to become engaged in their own health through the process of shared decision making. In the United States shared decision making is being promoted for its potential to improve the health of populations and individual patients, while also helping control care costs. In this overview we describe the three essential elements of shared decision making: recognizing and acknowledging that a decision is required; knowing and understanding the best available evidence; and incorporating the patient's values and preferences into the decision. To achieve the promise of shared decision making, more physicians need training in the approach, and more practices need to be reorganized around the principles of patient engagement. Additional research is also needed to identify the interventions that are most effective.
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Affiliation(s)
- France Légaré
- Department of Family and Emergency Medicine at Université Laval, Quebec City, Quebec.
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Brown R. A health care system in transformation: making the case for chiropractic. Chiropr Man Therap 2012; 20:37. [PMID: 23216921 PMCID: PMC3552679 DOI: 10.1186/2045-709x-20-37] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 11/14/2012] [Indexed: 02/03/2023] Open
Abstract
There are a number of factors that have conspired to create a crisis in healthcare. In part, the successes of medical science and technologies have been to blame, for they have led to survival where lives would previously have been cut short. An informed public, aware of these technological advances, is demanding access to the best that healthcare has to offer. At the same time the burden of chronic disease in an increasing elderly population has created a marked growth in the need for long term care. Current estimates for expenditure predict a rapid escalation of healthcare costs as a proportion of the GDP of developed nations, yet at the same time a global economic crisis has necessitated dramatic cuts in health budgets. This unsustainable position has led to calls for an urgent transformation in healthcare systems.This commentary explores the present day healthcare crisis and looks at the opportunities for chiropractors as pressure intensifies on politicians and leaders in healthcare to seek innovative solutions to a failing model. Amidst these opportunities, it questions whether the chiropractic profession is ready to accept the challenges that integration into mainstream healthcare will bring and identifies both pathways and potential obstacles to acceptance.
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Affiliation(s)
- Richard Brown
- The Lansdown Clinic, 1, High Street, Stroud, Gloucestershire, GL5 1AU, United Kingdom.
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