1
|
Watson JL. A New Paradigm for Nurse Leader Decision-Making Within Complex Adaptive Systems. Nurs Adm Q 2024; 48:209-217. [PMID: 38848482 DOI: 10.1097/naq.0000000000000650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Health care is a complex and ever-changing environment for nurse leaders and other health care industry decision-makers. The prevailing leadership and decision-making models, rooted in Industrial Age principles, often struggle to adapt to the complexities of modern health care. This article explores the foundations of complexity science and its application to health care decision-making, highlighting the importance of understanding systems dynamics and embracing complexity. Drawing from systems knowledge, the Cynefin Sensemaking Framework, and understanding how to develop enabling constraints, nurse leaders can navigate the complexities of health care by identifying the nature of the problem and applying appropriate decision-making strategies, fostering agility and innovation. By embracing complexity and adopting adaptive leadership approaches, nurse leaders can pragmatically navigate the complexities of modern health care and drive transformative change. This manuscript provides methods for nurse leaders to enhance decision-making within the dynamic landscape of health care as a complex adaptive system.
Collapse
Affiliation(s)
- Joni L Watson
- The Creating Collective, LLC, Rockwall, Texas; and Duke University School of Nursing, Durham, North Carolina
| |
Collapse
|
2
|
Carroll E, Tan C, Hayes S, Mordang S, Rizzo G, Zaia V, Montagna E, Könings KD, Wiese A, O'Tuathaigh C. Implementing high-value, cost-conscious care: experiences of Irish doctors and the role of education in facilitating this approach. BMC MEDICAL EDUCATION 2024; 24:684. [PMID: 38907222 PMCID: PMC11191173 DOI: 10.1186/s12909-024-05666-x] [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: 11/12/2023] [Accepted: 06/14/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Adopting high-value, cost-conscious care (HVCCC) principles into medical education is growing in importance due to soaring global healthcare costs and the recognition that efficient care can enhance patient outcomes and control costs. Understanding the current opportunities and challenges doctors face concerning HVCCC in healthcare systems is crucial to tailor education to doctors' needs. Hence, this study aimed to explore medical students, junior doctors, and senior doctors' experiences with HVCCC, and to seek senior doctors' viewpoints on how education can foster HVCCC in clinical environments. METHODS Using a mixed-methods design, our study involved a cross-sectional survey using the Maastricht HVCCC-Attitude Questionnaire (MHAQ), with a subset of consultants engaging in semi-structured interviews. Descriptive analysis provided insights into both categorical and non-categorical variables, with differences examined across roles (students, interns, junior doctors, senior doctors) via Kruskal-Wallis tests, supplemented by two-group analyses using Mann-Whitney U testing. We correlated experience with MHAQ scores using Spearman's rho, tested MHAQ's internal consistency with Cronbach's alpha, and employed thematic analysis for the qualitative data. RESULTS We received 416 responses to the survey, and 12 senior doctors participated in the semi-structured interviews. Overall, all groups demonstrated moderately positive attitudes towards HVCCC, with more experienced doctors exhibiting more favourable views, especially about integrating costs into daily practice. In the interviews, participants agreed on the importance of instilling HVCCC values during undergraduate teaching and supplementing it with a formal curriculum in postgraduate training. This, coupled with practical knowledge gained on-the-job, was seen as a beneficial strategy for training doctors. CONCLUSIONS This sample of medical students and hospital-based doctors display generally positive attitudes towards HVCCC, high-value care provision, and the integration of healthcare costs, suggesting receptiveness to future HVCCC training among students and doctors. Experience is a key factor in HVCCC, so early exposure to these concepts can potentially enhance practice within existing healthcare budgets.
Collapse
Affiliation(s)
- Evan Carroll
- School of Medicine, University College Cork, Cork, Ireland
| | - Crisann Tan
- School of Medicine, University College Cork, Cork, Ireland
| | - Samantha Hayes
- School of Medicine, University College Cork, Cork, Ireland
| | - Serge Mordang
- Educational Development and Research, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Maastricht University Office, Maastricht University , Maastricht, Netherlands
| | - Gabriella Rizzo
- Department of Medicine, Cork University Hospital, Cork, Ireland
| | - Victor Zaia
- Faculdade de Medicina do ABC, Centro Universitário FMABC, Santo André, SP, Brazil
| | - Erik Montagna
- Faculdade de Medicina do ABC, Centro Universitário FMABC, Santo André, SP, Brazil
| | - Karen D Könings
- Educational Development and Research, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Anél Wiese
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | - Colm O'Tuathaigh
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland.
| |
Collapse
|
3
|
Hellstrand Tang U, Smith F, Karilampi UL, Gremyr A. Exploring the Role of Complexity in Health Care Technology Bottom-Up Innovations: Multiple-Case Study Using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability Complexity Assessment Tool. JMIR Hum Factors 2024; 11:e50889. [PMID: 38669076 PMCID: PMC11087855 DOI: 10.2196/50889] [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: 07/18/2023] [Revised: 02/24/2024] [Accepted: 03/02/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND New digital technology presents new challenges to health care on multiple levels. There are calls for further research that considers the complex factors related to digital innovations in complex health care settings to bridge the gap when moving from linear, logistic research to embracing and testing the concept of complexity. The nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework was developed to help study complexity in digital innovations. OBJECTIVE This study aims to investigate the role of complexity in the development and deployment of innovations by retrospectively assessing challenges to 4 digital health care innovations initiated from the bottom up. METHODS A multicase retrospective, deductive, and explorative analysis using the NASSS complexity assessment tool LONG was conducted. In total, 4 bottom-up innovations developed in Region Västra Götaland in Sweden were explored and compared to identify unique and shared complexity-related challenges. RESULTS The analysis resulted in joint insights and individual learning. Overall, the complexity was mostly found outside the actual innovation; more specifically, it related to the organization's readiness to integrate new innovations, how to manage and maintain innovations, and how to finance them. The NASSS framework sheds light on various perspectives that can either facilitate or hinder the adoption, scale-up, and spread of technological innovations. In the domain of condition or diagnosis, a well-informed understanding of the complexity related to the condition or illness (diabetes, cancer, bipolar disorders, and schizophrenia disorders) is of great importance for the innovation. The value proposition needs to be clearly described early to enable an understanding of costs and outcomes. The questions in the NASSS complexity assessment tool LONG were sometimes difficult to comprehend, not only from a language perspective but also due to a lack of understanding of the surrounding organization's system and its setting. CONCLUSIONS Even when bottom-up innovations arise within the same support organization, the complexity can vary based on the developmental phase and the unique characteristics of each project. Identifying, defining, and understanding complexity may not solve the issues but substantially improves the prospects for successful deployment. Successful innovation within complex organizations necessitates an adaptive leadership and structures to surmount cultural resistance and organizational impediments. A rigid, linear, and stepwise approach risks disregarding interconnected variables and dependencies, leading to suboptimal outcomes. Success lies in embracing the complexity with its uncertainty, nurturing creativity, and adopting a nonlinear methodology that accommodates the iterative nature of innovation processes within complex organizations.
Collapse
Affiliation(s)
- Ulla Hellstrand Tang
- Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Frida Smith
- Regional Cancer Centre West, Gothenburg, Sweden
- Department of Technology Management and Economics, Collaborative Plattform for Healthcare Improvement, Chalmers University of Technology, Gothenburg, Sweden
| | - Ulla Leyla Karilampi
- Department of Schizophrenia Spectrum Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Gremyr
- Department of Schizophrenia Spectrum Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| |
Collapse
|
4
|
Tyack Z, Carter H, Allen M, Senanayake S, Warhurst K, Naicker S, Abell B, McPhail SM. Multicomponent processes to identify and prioritise low-value care in hospital settings: a scoping review. BMJ Open 2024; 14:e078761. [PMID: 38604625 PMCID: PMC11015208 DOI: 10.1136/bmjopen-2023-078761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/15/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVES This scoping review mapped and synthesised original research that identified low-value care in hospital settings as part of multicomponent processes. DESIGN Scoping review. DATA SOURCES Electronic databases (EMBASE, PubMed, CINAHL, PsycINFO and Cochrane CENTRAL) and grey literature were last searched 11 July and 3 June 2022, respectively, with no language or date restrictions. ELIGIBILITY CRITERIA We included original research targeting the identification and prioritisation of low-value care as part of a multicomponent process in hospital settings. DATA EXTRACTION AND SYNTHESIS Screening was conducted in duplicate. Data were extracted by one of six authors and checked by another author. A framework synthesis was conducted using seven areas of focus for the review and an overuse framework. RESULTS Twenty-seven records were included (21 original studies, 4 abstracts and 2 reviews), originating from high-income countries. Benefit or value (11 records), risk or harm (10 records) were common concepts referred to in records that explicitly defined low-value care (25 records). Evidence of contextualisation including barriers and enablers of low-value care identification processes were identified (25 records). Common components of these processes included initial consensus, consultation, ranking exercise or list development (16 records), and reviews of evidence (16 records). Two records involved engagement of patients and three evaluated the outcomes of multicomponent processes. Five records referenced a theory, model or framework. CONCLUSIONS Gaps identified included applying systematic efforts to contextualise the identification of low-value care, involving people with lived experience of hospital care and initiatives in resource poor contexts. Insights were obtained regarding the theories, models and frameworks used to guide initiatives and ways in which the concept 'low-value care' had been used and reported. A priority for further research is evaluating the effect of initiatives that identify low-value care using contextualisation as part of multicomponent processes.
Collapse
Affiliation(s)
- Zephanie Tyack
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Hannah Carter
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Michelle Allen
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Sameera Senanayake
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Kym Warhurst
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Mater Misericordiae Ltd, South Brisbane, Queensland, Australia
| | - Sundresan Naicker
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bridget Abell
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Metro South Health, Brisbane, Queensland, Australia
| |
Collapse
|
5
|
Stoffel M, Beal SG, Ibrahim KA, Rummel M, Greene DN. Optimizing the data in direct access testing: information technology to support an emerging care model. Crit Rev Clin Lab Sci 2024; 61:127-139. [PMID: 37800865 DOI: 10.1080/10408363.2023.2258973] [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: 04/17/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023]
Abstract
Direct access testing (DAT) is an emerging care model that provides on-demand laboratory services for certain preventative, diagnostic, and monitoring indications. Unlike conventional testing models where health care providers order tests and where sample collection is performed onsite at the clinic or laboratory, most interactions between DAT consumers and the laboratory are virtual. Tests are ordered and results delivered online, and specimens are frequently self-collected at home with virtual support. Thus, DAT depends on high-quality information technology (IT) tools and optimized data utilization to a greater degree than conventional laboratory testing. This review critically discusses the United States DAT landscape in relation to IT to highlight digital challenges and opportunities for consumers, health care systems, providers, and laboratories. DAT offers consumers increased autonomy over the testing experience, cost, and data sharing, but the current capacity to integrate DAT as a care option into the conventional patient-provider model is lacking and will require innovative approaches to accommodate. Likewise, both consumers and health care providers need transparent information about the quality of DAT laboratories and clinical decision support to optimize appropriate use of DAT as a part of comprehensive care. Interoperability barriers will require intentional approaches to integrating DAT-derived data into the electronic health records of health systems nationally. This includes ensuring the laboratory results are appropriately captured for downstream data analytic pipelines that are used to satisfy population health and research needs. Despite the data- and IT-related challenges for widespread incorporation of DAT into routine health care, DAT has the potential to improve health equity by providing versatile, discreet, and affordable testing options for patients who have been marginalized by the current limitations of health care delivery in the United States.
Collapse
Affiliation(s)
- Michelle Stoffel
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
- M Health Fairview Laboratory Medicine and Pathology, Minneapolis, MN, USA
| | - Stacy G Beal
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
- LetsGetChecked, Monrovia, CA, USA
| | - Khalda A Ibrahim
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Dina N Greene
- LetsGetChecked, Monrovia, CA, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| |
Collapse
|
6
|
Pradhan M, Waghmare KT, Alghabshi R, Almahdouri F, Al Sawafi KM, M I, Alhadhramy AM, AlYaqoubi ER. Exploring the Economic Aspects of Hospitals: A Comprehensive Examination of Relevant Factors. Cureus 2024; 16:e54867. [PMID: 38533171 PMCID: PMC10964728 DOI: 10.7759/cureus.54867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2024] [Indexed: 03/28/2024] Open
Abstract
Financial limitations in the hospital industry have the potential to exacerbate healthcare disparities, impede investments in cutting-edge medical treatments, as well as impair patient outcomes. The interdependent connection between a hospital economy and the general well-being of the community highlights the necessity of careful financial oversight and inventive healthcare policies. Effective collaboration among policymakers, healthcare administrators, and stakeholders is imperative in the development of sustainable economic models that give equal weight to fiscal prudence and optimal patient outcomes. This article aims to underscore the pivotal importance of strategic fund allocation guided by hospital administrators, accentuating several key initiatives capable of revolutionizing healthcare delivery and elevating the institution's stature within the medical community. The other important aspects discussed here are fund allocation in hospitals, the boom of online consultations, and emphasis on the use of sustainable and cost-effective modalities of energy.
Collapse
Affiliation(s)
- Madhur Pradhan
- Obstetrics and Gynaecology, Khoula Hospital, Muscat, OMN
| | | | | | | | | | - Iman M
- Obstetrics and Gynaecology, Khoula Hospital, Muscat, OMN
| | | | | |
Collapse
|
7
|
Cakmak MF, Horoz L. The Examination of the Benefits of the Usage of Barbed, Knotless Suture in Capsule Repair During Total Knee Arthroplasty: A Prospective, Double-Blind, Randomized Controlled Study. Indian J Orthop 2023; 57:1881-1890. [PMID: 37881278 PMCID: PMC10593675 DOI: 10.1007/s43465-023-00976-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 08/11/2023] [Indexed: 10/27/2023]
Abstract
Introduction In today's world, high-cost procedures are being examined, and alternative procedures are being developed. In this context, one frequently examined procedure is total knee replacement. Purpose This study aims to examine the three different closure techniques used in total knee replacement. Methods This study is a prospective randomized controlled study. Two hundred participants who underwent total knee replacement surgery, were included in the study. Participants were randomly divided into three groups. Arthrotomy was performed using a medial parapatellar approach with a midline incision. Standard femoral and tibial cuts were followed by the implantation of a Smith and Nephew genesis II implant for all participants. Complications, joint range of motion, pain scores, certain movement degrees, and functional scores were investigated. Results Pre-op and post-op range of motion, knee society score, oxford knee score, certain movement degree values have shown no significant difference. Visual analogue scale values were different significantly between the groups. There is a statistical difference between the range of motion, knee society score, oxford knee score, certain movement degree and visual analogue scale values in repeated measurements. The most common complication was a hematoma. This was observed most frequently in the continuous vicryl suture group. The closure time in the Barbed group was significantly lower than in the other groups. Discussion Treatment for total knee replacement is a heavy economic burden. Health systems and hospitals are under pressure. The results obtained in our study show that there is no superiority of one closure technique over the other.
Collapse
Affiliation(s)
- Mehmet Fevzi Cakmak
- Department of Orthopedics and Traumatology, Kirsehir Ahi Evran University, Kirsehir, Turkey
| | - Levent Horoz
- Department of Orthopedics and Traumatology, Kirsehir Ahi Evran University, Kirsehir, Turkey
| |
Collapse
|
8
|
Tiwari RR, Pandey B, Chaudhari KS. Image-Based Communication for Strengthening Patient Health Education in Rural and Underserved Settings. Cureus 2023; 15:e41279. [PMID: 37533623 PMCID: PMC10391694 DOI: 10.7759/cureus.41279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 08/04/2023] Open
Abstract
Effective communication is the cornerstone of efficient patient care. It is vital to obtain a thorough history, build the patient's trust, and ensure compliance to treatment. Image-based communication (IBC) using comic-like strips is better than the conventional verbal and written modes, as it is inexpensive, less human resource dependent, and diversity agnostic. Strips based on local and socioculturally relevant issues and characters grab readers' attention, are relatable and entertaining, and utilize a storyline that invigorates thinking. The medical advice delivered by an ideal IBC strip is easy to comprehend, has a better recall, and promotes patient adherence. With an idea that IBC strips can serve as a vital supportive tool in underserved and overburdened clinics, we have described the nuances of adapting them into the existing physician-patient experience. We utilize a prototype IBC of an elderly woman helping a family whose child developed acute fever, possibly malaria. Various elements of an IBC strip, namely, panels, gutters, background, characters, bubbles, captions, and visual effects, are illustrated, and their variations are described later. Once designed, an IBC strip must be critically evaluated for the accuracy of the educational message, and errors, if any, must be corrected. The images are then subjected to a series of local field tests to ensure that they serve their purpose and have the desired cultural competence. Once ready, IBC strips can be posted in public spaces and outside clinics or distributed to healthcare workers or patients. Here, they serve as educational and health literacy tools. The strips can significantly reduce caregiver-patient interaction time and improve the quality of communication, especially when patients are illiterate or understand a different language. It is easier to develop rapport and partnership with a patient when the communication is presented through a pictorial tool. An IBC strip can be used to train grassroot workers, who subsequently train patients, thereby serving a dual purpose. To obtain tangible clinical and epidemiologic benefits from IBC strips, rigorous evidence building and standardization are a crucial long-term goal.
Collapse
Affiliation(s)
- Rakesh R Tiwari
- Department of Ayurved Basic Principles (Department of Ayurveda Samhita Siddhanta), Dr. D.Y. Patil College of Ayurved & Research Centre, Dr. D.Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
- Department of Ayurved Basic Principles (Department of Ayurveda Samhita Siddhanta), K.G. Mittal Ayurved College, Mumbai, IND
| | - Bhrigupati Pandey
- Department of Ayurved Basic Principles (Department of Ayurveda Samhita Siddhanta), Dr. D.Y. Patil College of Ayurved & Research Centre, Dr. D.Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Kaustubh S Chaudhari
- Department of Internal Medicine, Dr. Vaishampayan Memorial Government Medical College, Solapur, IND
| |
Collapse
|
9
|
Ponholzer F, Ng C, Maier H, Lucciarini P, Öfner D, Augustin F. Risk factors, complications and costs of prolonged air leak after video-assisted thoracoscopic surgery for primary lung cancer. J Thorac Dis 2023; 15:866-877. [PMID: 36910082 PMCID: PMC9992586 DOI: 10.21037/jtd-21-2011] [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: 12/29/2021] [Accepted: 06/10/2022] [Indexed: 11/06/2022]
Abstract
Background Prolonged air leak (PAL) represents a common complication after lung resection. This study aims to analyze the risk factors for the development of a PAL, its impact on the postoperative outcome and to estimate additional treatment costs. Methods A single center database was queried for all patients scheduled for video-assisted thoracoscopic surgery for primary lung cancer. In total, 957 patients between 2009 and 2021 were analyzed. Exclusion criteria was pneumonectomy. Collected data included demographics and perioperative data (e.g., duration of surgery, postoperative infections, air leak duration etc.). PAL was defined as an air leak lasting for 5 days or longer. The PAL cohort included 103 patients, the non-PAL included 854 patients. Univariate analysis and binomial logistic regression were performed. Cost calculation was performed using available data from prior publications to estimate treatment costs. Results Male sex, chronic obstructive pulmonary disease (COPD) and low body mass index (BMI) showed to be risk factors for the development of postoperative PAL (P<0.001). Using these risk factors, a risk prediction score for PAL has been established. A subgroup analysis showed a significantly higher rate of sarcopenia in patients with PAL (P<0.001). The mean duration until removal of chest drains and length of stay (LOS) was significantly longer in the PAL cohort (14.2 vs. 4.4 days, P<0.001; 19.8 vs. 9.3 days, P<0.001). Also, the duration of the operation was longer in PAL patients (179.1 vs. 161.2 minutes, P=0.001). Patients with PAL had an elevated risk for postoperative infections [odds ratio (OR) 3.211, 31.1% vs. 12.3%, P<0.001]. As a result of a prolonged LOS, estimated treatment costs were significantly higher for PAL, ranging from 2,888.2 to 12,342.8 € depending on available cost bases compared to the non-PAL cohort, which ranged from 1,370.5 to 5,856.8 € (P<0.001). Conclusions PAL is a frequent complication that prolongs the LOS after thoracic surgery and, according to the literature, results in elevated readmission rates, leading to excess health care costs. Risk factors for PAL are well established. Preoperative treatment of sarcopenia and dismal nutritional status might alter the risk. As measures to prevent PAL are otherwise limited, guidelines for effective management of PAL need to be established.
Collapse
Affiliation(s)
- Florian Ponholzer
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Caecilia Ng
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Herbert Maier
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Paolo Lucciarini
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Dietmar Öfner
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Florian Augustin
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
10
|
Beogo I, Bationo NJC, Sia D, Collin S, Kinkumba Ramazani B, Létourneau AA, Ramdé J, Gagnon MP, Tchouaket EN. COVID-19 pandemic or chaos time management: first-line worker shortage - a qualitative study in three Canadian Provinces. BMC Geriatr 2022; 22:727. [PMID: 36057549 PMCID: PMC9440325 DOI: 10.1186/s12877-022-03419-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 08/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background Over the successive waves of the COVID-19 pandemic, front-line care workers (FLCWs) —in this case, at long-term care facilities (LTCFs)— have been the backbone of the fight. The COVID-19 pandemic has disproportionately affected LTCFs in terms of the number of cases, deaths, and other morbidities, requiring managers to make rapid and profound shifts. The purpose of this study is to describe the effects of the pandemic on LTCF services offered and LTCFs staff dedicated to linguistic minorities in three Canadian provinces. Methods This qualitative descriptive study involved eleven managers and fourteen FLCWs, from six LTCFs of three Canadian provinces (New-Brunswick, Manitoba and Quebec). A qualitative content analysis was performed to identify key themes describing the effects of the COVID-19 pandemic on the services offered and the management of LTCFs staff. Results Based on participants’ experiences, we identified three main categories of themes. These macro-themes are as follows: (i) organization and management of staff, (ii) communication and decision-making method, and (iii) staff support. Conclusion The study highlighted the tremendous impact of COVID-19 on direct care staff in terms of the high risks associated with caring for LTCFs residents, which are exacerbated by absences and resignations (sometimes up to 50% of staff), resulting in higher resident to FLCWs ratios. Team members had to support each other, they also received accolades and appreciation from the residents.. Finally, the pandemic led to the rethinking of management procedures centred on a coordinated, inclusive and more hands-on management approach.
Collapse
Affiliation(s)
- Idrissa Beogo
- École des sciences infirmières, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada. .,College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | | | - Drissa Sia
- Département des sciences infirmières, Université du Québec en Outaouais, Saint-Jérôme, Gatineau, Québec, Canada.,Département de médecine sociale et préventive, École de santé publique Université de Montréal, Montréal, Québec, Canada
| | - Stephanie Collin
- École des hautes études publiques (HEP), Université de Moncton, New Brunswick, Moncton, Canada
| | | | - Aurée-Anne Létourneau
- English Language and Cultural Communities Planning, Programming and Research Officer, Jeffery Hale - Saint Brigid's, CIUSSSCN, Québec, Canada
| | - Jean Ramdé
- Faculté des sciences de l'éducation, Université Laval, Québec, Québec, Canada
| | | | - Eric Nguemeleu Tchouaket
- Département des sciences infirmières, Université du Québec en Outaouais, Saint-Jérôme, Gatineau, Québec, Canada.,Département de Gestion, d'évaluation Et de Politique de Santé, École de santé publique, Université de Montréal, Montréal, Québec, Canada
| |
Collapse
|
11
|
Maeda A. The complexity of achieving UHC through PHC: How do we connect the competing narratives? J Eval Clin Pract 2022; 28:335-337. [PMID: 34846090 DOI: 10.1111/jep.13637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 11/03/2021] [Indexed: 12/01/2022]
|
12
|
Christou CD, Athanasiadou EC, Tooulias AI, Tzamalis A, Tsoulfas G. The process of estimating the cost of surgery: Providing a practical framework for surgeons. Int J Health Plann Manage 2022; 37:1926-1940. [PMID: 35191067 DOI: 10.1002/hpm.3431] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/25/2021] [Accepted: 01/21/2022] [Indexed: 02/05/2023] Open
Abstract
Over the last decades, health care costs have been increasing at an alarming, exponential rate which is considered unsustainable. Surgical care utilizes one-third of health care costs. Estimating, evaluating, and understanding the cost of surgery is a vital step towards cost management and reduction. Current cost estimation studies and cost-effectiveness studies have vast disparities in their methodology, with published costs of Operating Room varying from as low as $7 and as high as $113 per minute. Costs in surgery are distinguished as direct and indirect. Allocation of direct costs involves identification, measurement, and valuation processes. Allocation of indirect costs involves the allocation of capital and overhead costs and of indirect department costs. Annualised capital costs and overhead hospital costs are then allocated to surgery by either the cost-centre allocation or the activity-based allocation frameworks. Indirect department costs are allocated to a specific surgery by weighted service allocation or hourly rate allocation or inpatient day allocation, or marginal markup allocation. The growing societal, financial and political pressure for cost reduction has brought cost analysis to the forefront of healthcare discussions. Thus, we believe that almost every single surgeon will eventually enter the field of healthcare economics by necessity. This review aims to provide surgeons with a practical framework for engaging in cost estimation studies.
Collapse
Affiliation(s)
- Chrysanthos D Christou
- Organ Transplant Unit, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni C Athanasiadou
- Surgical Oncology Department, Theageneio Anticancer Hospital of Thessaloniki, Thessaloniki, Greece
| | - Andreas I Tooulias
- First General Surgery Department, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Argyrios Tzamalis
- Second Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Tsoulfas
- Organ Transplant Unit, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
13
|
Clervoy P, Chauvin A, Gil-Jardiné C, Claret PG, Lefort H. [Plea for a collegial practice of emergency psychiatric care]. Soins Psychiatr 2021; 42:44-46. [PMID: 34763768 DOI: 10.1016/j.spsy.2021.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The care of patients, especially in the field of agitation or psychiatry, requires close coordination between different actors. Interdisciplinarity makes it possible to analyse and harmonise the links between various disciplines with the common aim of solving complex problems. This interdisciplinarity must now become a fundamental in the teaching of health sciences and a prerequisite for the functioning of hospital services, in particular in the formalisation of acute care pathways.
Collapse
Affiliation(s)
| | - Anthony Chauvin
- Structure des urgences, centre hospitalier universitaire Lariboisière, 2 rue Ambroise-Paré, 75010 Paris, France
| | - Cédric Gil-Jardiné
- Service des urgences adultes, hôpital Pellegrin, centre hospitalo-universitaire de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France; Bordeaux Population Health, Inserm U1219, université de Bordeaux, Case 11, 146 rue Léo-Saignat, 33076 Bordeaux cedex, France
| | - Pierre-Géraud Claret
- Structure des urgences, centre hospitalo-universitaire de Nîmes, rue du Professeur-Robert-Debré, 30900 Nîmes, France
| | - Hugues Lefort
- Structure des urgences, hôpital d'instruction des armées Laveran, 4 boulevard Laveran, 13384 Marseille, France.
| |
Collapse
|
14
|
Saulnier DD, Blanchet K, Canila C, Cobos Muñoz D, Dal Zennaro L, de Savigny D, Durski KN, Garcia F, Grimm PY, Kwamie A, Maceira D, Marten R, Peytremann-Bridevaux I, Poroes C, Ridde V, Seematter L, Stern B, Suarez P, Teddy G, Wernli D, Wyss K, Tediosi F. A health systems resilience research agenda: moving from concept to practice. BMJ Glob Health 2021; 6:e006779. [PMID: 34353820 PMCID: PMC8344286 DOI: 10.1136/bmjgh-2021-006779] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022] Open
Abstract
Health system resilience, known as the ability for health systems to absorb, adapt or transform to maintain essential functions when stressed or shocked, has quickly gained popularity following shocks like COVID-19. The concept is relatively new in health policy and systems research and the existing research remains mostly theoretical. Research to date has viewed resilience as an outcome that can be measured through performance outcomes, as an ability of complex adaptive systems that is derived from dynamic behaviour and interactions, or as both. However, there is little congruence on the theory and the existing frameworks have not been widely used, which as diluted the research applications for health system resilience. A global group of health system researchers were convened in March 2021 to discuss and identify priorities for health system resilience research and implementation based on lessons from COVID-19 and other health emergencies. Five research priority areas were identified: (1) measuring and managing systems dynamic performance, (2) the linkages between societal resilience and health system resilience, (3) the effect of governance on the capacity for resilience, (4) creating legitimacy and (5) the influence of the private sector on health system resilience. A key to filling these research gaps will be longitudinal and comparative case studies that use cocreation and coproduction approaches that go beyond researchers to include policy-makers, practitioners and the public.
Collapse
Affiliation(s)
- Dell D Saulnier
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, Faculty of Medicine, University of Geneva and Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - Carmelita Canila
- Department of Health Policy and Administration, University of the Philippines Manila, Manila, Philippines
| | - Daniel Cobos Muñoz
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Livia Dal Zennaro
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Don de Savigny
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kara N Durski
- World Health Organization, Geneva, Switzerland
- Center for Emerging Infectious Diseases Policy and Research, Boston University, Boston, Massachusetts, USA
| | - Fernando Garcia
- Department of Health Policy and Administration, University of the Philippines Manila, Manila, Philippines
| | | | - Aku Kwamie
- Alliance For Health Policy and System Research, Geneva, Switzerland
| | - Daniel Maceira
- Department of Economics, University of Buenos Aires, Buenos Aires, Argentina
- Center for the Study of State and Society (CEDES), Buenos Aires, Argentina
| | - Robert Marten
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | | | - Camille Poroes
- Unisanté, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Valery Ridde
- CEPED, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM SAGESUD, Paris, France
| | - Laurence Seematter
- Unisanté, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Barbara Stern
- Center for the Study of State and Society (CEDES), Buenos Aires, Argentina
| | - Patricia Suarez
- Center for the Study of State and Society (CEDES), Buenos Aires, Argentina
| | - Gina Teddy
- Centre for Health Systems and Policy Research, Ghana Institute of Management and Public Administration, Accra, Ghana
| | - Didier Wernli
- Global Studies Institute, University of Geneva, Geneva, Switzerland
| | - Kaspar Wyss
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| |
Collapse
|
15
|
Ordak M, Nasierowski T, Muszynska E, Bujalska-Zadrozny M. Increasing the Effectiveness of Pharmacotherapy in Psychiatry by Using a Pharmacological Interaction Database. J Clin Med 2021; 10:jcm10102185. [PMID: 34070064 PMCID: PMC8158110 DOI: 10.3390/jcm10102185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/11/2021] [Accepted: 05/17/2021] [Indexed: 12/27/2022] Open
Abstract
Recent studies have shown that the knowledge of pharmacological interaction databases in global psychiatry is negligible. The frequency of hospitalizations in the case of patients taking new psychoactive substances along with other drugs continues to increase, very often resulting in the need for polypharmacotherapy. The aim of our research was to make members of the worldwide psychiatric community aware of the need to use a pharmacological interaction database in their daily work. The study involved 2146 psychiatrists from around the world. Participants were primarily contacted through the LinkedIn Recruiter website. The surveyed psychiatrists answered 5 questions concerning case reports of patients taking new psychoactive substances along with other drugs. The questions were answered twice, i.e., before and after using the Medscape drug interaction database. The mean percentage of correct answers given by the group of psychiatrists who were studied separately in six individual continents turned out to be statistically significantly higher after using the pharmacological interaction database (p < 0.001). This also applies to providing correct answers separately, i.e., to each of the five questions asked concerning individual case reports (p < 0.001). Before using the drug interaction database, only 14.1% of psychiatrists stated that they knew and used this type of database (p < 0.001). In the second stage of the study, a statistically significant majority of subjects stated that they were interested in using the pharmacological interaction database from that moment on (p < 0.001) and expressed the opinion that it could be effective in everyday work (p < 0.001). Using a pharmacological interaction database in psychiatry can contribute to the effectiveness of pharmacotherapy.
Collapse
Affiliation(s)
- Michal Ordak
- Department of Pharmacodynamics, Centre for Preclinical Research and Technology (CePT), Medical University of Warsaw, 02-091 Warsaw, Poland;
- Correspondence:
| | - Tadeusz Nasierowski
- Department of Psychiatry, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Elzbieta Muszynska
- Department of Medical Biology, Medical University of Bialystok, 15-089 Bialystok, Poland;
| | - Magdalena Bujalska-Zadrozny
- Department of Pharmacodynamics, Centre for Preclinical Research and Technology (CePT), Medical University of Warsaw, 02-091 Warsaw, Poland;
| |
Collapse
|
16
|
Sharif Z, Peiravian F, Salamzadeh J, Mohammadi NK, Jalalimanesh A. Irrational use of antibiotics in Iran from the perspective of complex adaptive systems: redefining the challenge. BMC Public Health 2021; 21:778. [PMID: 33892681 PMCID: PMC8063475 DOI: 10.1186/s12889-021-10619-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 03/14/2021] [Indexed: 11/12/2022] Open
Abstract
Background Irrational use of antibiotics is proving to be a major concern to the health systems globally. This results in antibiotics resistance and increases health care costs. In Iran, despite many years of research, appreciable efforts, and policymaking to avoid irrational use of antibiotics, yet indicators show suboptimal use of antibiotics, pointing to an urgent need for adopting alternative approaches to further understand the problem and to offer new solutions. Applying the Complex Adaptive Systems (CAS) theory, to explore and research health systems and their challenges has become popular. Therefore, this study aimed to better understand the complexity of the irrational use of antibiotics in Iran and to propose potential solutions. Method This research utilized a CAS observatory tool to qualitatively collect and analyse data. Twenty interviews and two Focus Group discussions were conducted. The data was enriched with policy document reviews to fully understand the system. MAXQDA software was used to organize and analyze the data. Result We could identify several diverse and heterogeneous, yet highly interdependent agents operating at different levels in the antibiotics use system in Iran. The network structure and its adaptive emergent behavior, information flow, governing rules, feedback and values of the system, and the way they interact were identified. The findings described antibiotics use as emergent behavior that is formed by an interplay of many factors and agents over time. According to this study, insufficient and ineffective interaction and information flow regarding antibiotics between agents are among key causes of irrational antibiotics use in Iran. Results showed that effective rules to minimize irrational use of antibiotics are missing or can be easily disobeyed. The gaps and weaknesses of the system which need redesigning or modification were recognized as well. Conclusion The study suggests re-engineering the system by implementing several system-level changes including establishing strong, timely, and effective interactions between identified stakeholders, which facilitate information flow and provision of on-time feedback, and create win-win rules in a participatory manner with stakeholders and the distributed control system.
Collapse
Affiliation(s)
- Zahra Sharif
- School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Peiravian
- School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jamshid Salamzadeh
- School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nastaran Keshavarz Mohammadi
- Health Promotion School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,Scientific Committee of UNESCO global Chair on Health and Education Associate Editor, Health Promotion International, UZH, Zurich, Switzerland.
| | - Ammar Jalalimanesh
- Iranian Research Institute for Information Science and Technology (IRANDOC), Tehran, Iran
| |
Collapse
|
17
|
Bircher J. Meikirch model: new definition of health as hypothesis to fundamentally improve healthcare delivery. INTEGRATED HEALTHCARE JOURNAL 2020. [DOI: 10.1136/ihj-2020-000046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The unrelenting rise in healthcare costs over the past 50 years has caused policymakers to respond. Their reactions have led to a gradual economic transformation of medicine. As a result, detailed billing, quality controls, financial incentives, savings targets and digitalisation are now putting increasing pressures on the nursing and medical staff. In addition, the humanity of care of the patient–doctor and/or patient–nurse interactions has been cast aside to a great extent. Therefore, the immaterial side of care has been neglected or even removed from these relationships. These changes are now perceived as intolerable by most health workers and patients. Yet healthcare costs are still rising. This paper presents a hypothesis that should enable healthcare systems to respond more effectively. It proposes the introduction of the Meikirch model, a new comprehensive definition of health. The Meikirch model takes human nature fully into account, including health and disease. The inclusion of the individual potentials, the social surroundings and the natural environment leads to the concept of health as a complex adaptive system (CAS). Care for such a definition of health requires medical organisations to change from top–down management to bottom–up leadership. Such innovations are now mature and ready for implementation. They require a long-term investment, a comprehensive approach to patient care and new qualifications for leadership. The Meikirch model reads: ‘To be healthy a human individual must be able to satisfy the demands of life. For this purpose, each person disposes of a biologically given and a personally acquired potential, both of which are closely related to the social surroundings and the natural environment. The resulting CAS enables the individual to unfold a personal identity and to develop it further until death. Healthcare has the purpose to empower each individual to fully realize optimal health’.This hypothesis postulates that the new definition of health will further develop healthcare systems in such a way that better health results at lower costs.
Collapse
|
18
|
Lefort H, Psiuk T, Nonin D, Voirgard C, Epifanie S. [Crisis management in the face of SARS-CoV-2: management and leadership in health care]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2020; 65:12-17. [PMID: 33357611 DOI: 10.1016/s0038-0814(20)30237-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The coronavirus SARS-CoV-2 pandemic has forced frontline health care teams to make radical and rapid adjustments. Aside from the danger of catalysing and integrating, the crisis provides an opportunity to rediscover the very essence of the art of caring: an ability to be present for oneself, for others and for the world. This pandemic is shattering everyone's comfort zones, on the social, professional, psychological and ethical level. It is reviving our profound humanity, imposing with humility coordinated actions, while allowing a degree of subsidiarity in the adjustments.
Collapse
Affiliation(s)
- Hugues Lefort
- Hôpital d'instruction des armées Legouest, 27 avenue de Plantières, BP 90001, 57077 Metz cedex 3, France.
| | | | - Danielle Nonin
- Hôpital d'instruction des armées Legouest, 27 avenue de Plantières, BP 90001, 57077 Metz cedex 3, France
| | - Carole Voirgard
- Hôpital d'instruction des armées Legouest, 27 avenue de Plantières, BP 90001, 57077 Metz cedex 3, France
| | - Sandie Epifanie
- Hôpital d'instruction des armées Legouest, 27 avenue de Plantières, BP 90001, 57077 Metz cedex 3, France
| |
Collapse
|