The Role of Frontline Leaders in Building Health Professional Support for a New Patient Portal: Survey Study

Evaluating barriers and facilitators to healthcare providers' use of an emergency department electronic referral portal for high-risk children with asthma using the Theoretical Domains Framework

OBJECTIVE

Urban children with asthma are at risk for frequent emergency department (ED) visits and suboptimal asthma management. ED visits provide an opportunity for referrals to community-based asthma management services. Electronic medical record-based referral portals have been shown to improve quality of care but use of these portals by healthcare providers (HCPs) is variable. The purpose of the study was to investigate facilitators, barriers, and recommendations to improve the use of an electronic referral portal to connect children presenting with asthma exacerbations in an urban pediatric ED to community-based education and case management services.

METHODS

The study was grounded in the Theoretical Domains Framework, an implementation provided the theoretical basis of the study. All ED HCPs were invited to complete qualitative interviews; twenty-three HCPs participated. Interviews were coded using directed content analysis.

RESULTS

Facilitators to portal use included its relative ease of use and HCP beliefs regarding the importance of such referrals for preventive asthma care. Barriers included insufficient time to make referrals, lack of information regarding the community agency and challenges communicating the value of the referral to patients and/or their caregivers.

CONCLUSIONS

Successfully engaging HCPs working in ED settings to use electronic portals to refer children with asthma to community agencies for health services may involve helping providers increase their comfort and knowledge of the external provider agency, ensuring organizational leaders support the need for preventive asthma care and provision of feedback to HCPs on the success of such referrals in meeting the needs of those families served.

Does transformational leadership and psychological empowerment improve nurses' innovative behaviour during COVID-19 outbreak? A cross-sectional study

AIMS

To investigate the relationships between transformational leadership, psychological empowerment and innovative behaviour among nurses in China.

BACKGROUND

The innovative behaviour of nurses is important to adapt to the changing medical environment. However, there is currently a limited understanding of the relationship between nurses' innovative behaviour and transformational leadership and psychological empowerment during the pandemic.

METHODS

Convenience sampling was used to conduct an investigation involving 1317 nurses from 10 hospitals in China from January 2022 to April 2022. Data analysis was performed using correlation analysis, univariate analysis and multiple regression analysis. The STROBE checklist was followed when writing this manuscript.

RESULTS

High transformational leadership and high psychological empowerment were associated with high innovative behaviour. The results of the multiple linear regression analysis showed that physical condition, whether or not you have attended academic conferences or whether or not you have participated in fund research projects, transformational leadership and psychological empowerment were the main factors on nurses' innovative behaviour, together explaining 64.5% of the total variance.

CONCLUSION

Promotion of transformational leadership and psychological empowerment is vital for nurses to promote innovation, thereby meeting the urgent demand for innovative nurses and the rapid development of nursing disciplines.

IMPLICATIONS FOR NURSING MANAGEMENT

This study highlights the importance of transformational leadership in developing nurses' innovative behaviours. Understanding the role of psychological empowerment can help nurse managers formulate relevant intervention strategies and cultivate nurses' innovative behaviour.

Leadership in the Context of Digital Health Services: A Concept Analysis

AIM

To define and clarify the concept of leadership in the context of digital health services using Walker's and Avant's concept analysis model.

BACKGROUND

Conceptualizing leadership in the context of digital health services is needed to deliver higher quality services and advance research.

METHOD

Searches were conducted of MEDLINE (Ovid), Scopus, CINAHL (EBSCO), and ProQuest (ABI/INFORM). Empirical articles were included if they reported attributes, antecedents, or consequences of leadership in the study context. A total of 4,037 references were identified; 23 were included.

RESULTS

Leadership attributes concerned leaders' behavior, roles, and qualities. Antecedents concerned informatics skills and competence, information and tools, understanding care systems and their complexity, and education. Consequences related to organization, professionals, and patient and care.

CONCLUSION

Based on our results, the term 'e-leadership' should be more widely utilized in nursing practice and research.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse leaders need to be strong leaders; they need to be visionary and use strategic thinking to develop existing and new digital solutions. By becoming e-leaders, nurse leaders may increase the successful development and implementation of eHealth, and benefit clinicians and patients.

Health Care Professionals' Experiences of Web-Based Symptom Checkers for Triage: Cross-sectional Survey Study

Background

Web-based symptom checkers are promising tools that provide help to patients seeking guidance on health problems. Many health organizations have started using them to enhance triage. Patients use the symptom checker to report their symptoms online and submit the report to the health care center through the system. Health care professionals (registered nurse, practical nurse, general physician, physiotherapist, etc) receive patient inquiries with urgency rating, decide on actions to be taken, and communicate these to the patients. The success of the adoption, however, depends on whether the tools can efficiently support health care professionals’ workflow and achieve their support.

Objective

This study explores the factors influencing health care professionals’ support for a web-based symptom checker for triage.

Methods

Data were collected through a web-based survey of 639 health care professionals using either of the two most used web-based symptom checkers in the Finnish public primary care. Linear regression models were fitted to study the associations between the study variables and health care professionals’ support for the symptom checkers. In addition, the health care professionals’ comments collected via survey were qualitatively analyzed to elicit additional insights about the benefits and challenges of the clinical use of symptom checkers.

Results

Results show that the perceived beneficial influence of the symptom checkers on health care professionals’ work and the perceived usability of the tools were positively associated with professionals’ support. The perceived benefits to patients and organizational support for use were positively associated, and threat to professionals’ autonomy was negatively associated with health care professionals’ support. These associations were, however, not independent of other factors included in the models. The influences on professionals’ work were both positive and negative; the tools streamlined work by providing preliminary information on patients and reduced the number of phone calls, but they also created extra work as the professionals needed to call patients and ask clarifying questions. Managing time between the use of symptom checkers and other tasks was also challenging. Meanwhile, according to health care professionals’ experience, the symptom checkers benefited patients as they received help quickly with a lower threshold for care.

Conclusions

The efficient use of symptom checkers for triage requires usable solutions that support health care professionals’ work. High-quality information about the patients’ conditions and an efficient way of communicating with patients are needed. Using a new eHealth tool also requires that health organizations and teams reorganize their workflows and work distributions to support clinical processes.

Leaders' support for using online symptom checkers in Finnish primary care: Survey study

Online symptom checkers (SCs) are eHealth solutions that offer healthcare organizations the possibility to empower their patients to independently assess their symptoms. The successful implementation of eHealth solutions, such as SCs, requires a supportive organizational culture and leadership. However, there is limited knowledge about the factors associated with leaders' support for the use of SCs. The aim of the study was to identify the factors associated to primary care leaders' support for SCs in triage and their experiences of the benefits and challenges related to the use of SCs. An online survey was used to collect data from 84 Finnish primary care leaders. The data were analyzed using statistical analysis methods and content analysis. Vision clarity, perceiving efficiency improvements, and considering the service to be beneficial for patients were associated with leaders' support for the service (β ranging from 0.41 to 0.44, p < 0.001). Leaders' support for the service was also associated with how well the leaders provided information about the service to their subordinates (β =0.22, p < 0.048). SCs present slightly more challenges than benefits regarding health professionals' work. The developers of SCs should focus more on features that decrease health professionals' workload as well as how the solution can benefit patients.

Building Primary Health Care Personnel's Support for a Patient Portal While Alleviating eHealth-Related Stress: Survey Study

Background

Health care personnel’s (HCP) engagement in patient portal implementation is necessary in embedding the use of the portal in everyday practices of a health care organization. While portal implementation may raise personnel’s positive expectations of the benefits in patient care, it is often also stressful for them due to increased workloads and disruptions in clinical workflows. An understanding of social and technical factors that build personnel’s support for patient portal implementation and alleviate their eHealth-related stress is therefore needed to realize the full potential of portals.

Objective

The aim of this study was to explore the influence of managerial implementation practices, information technology (IT) usability, and personnel’s eHealth competences on support for patient portal implementation and eHealth-related stress among primary HCP.

Methods

The data were collected through a survey of 919 members at 2 health organizations in Finland. Linear and logistic regression models were fitted to study the associations between the variables.

Results

Professionals’ eHealth competence (β=.15, P<.001), usability (β=.11, P<.001), and implementation practices (β=.07, P<.001) were positively associated with professionals’ support and negatively associated with professionals eHealth-related stress (β=−.07, P=.010; β=−.27, P<.001; and β=−.14, P<.001, respectively). Professionals’ support was associated with their promotion of the portal to the patients (odds ratio 1.22, 95% CI 1.07-1.40).

Conclusions

The adoption of appropriate implementation practices and the usability of the technology can build personnel’s support for a patient portal and alleviate their stress related to eHealth. Personnel’s support is manifested in their promotion of the portal to patients. Health care managers are encouraged to consider the usability of the technology and the good implementation practices, such as proper informing, engagement of the personnel in planning the services, and allocation of resources to improve eHealth competence, as prerequisites for meaningful and sustainable use of patient portals.

Leadership in Digital Health Services: Protocol for a Concept Analysis

Background

Due to the rapid digitalization of health care, leadership is becoming more complex. Leadership in digital health services is a term that has been used in the literature with various meanings. Conceptualization of leadership in digital health services is needed to deliver higher quality digital health services, update existing leadership practices, and advance research.

Objective

The aim of this study is to outline a concept analysis that aims to clarify and define the concept of leadership in digital health services.

Methods

The concept analysis will be performed using the Walker and Avant model, which involves eight steps: concept selection, determination of aims, identification of uses, determination of defining attributes, construction of a model case, construction of additional cases, identification of antecedents and consequences, and definition of empirical referents. A scoping literature search will be performed following the search protocol for scoping reviews by the Joanna Briggs Institute to identify all relevant literature on leadership in digital health services. Searches will be conducted in 6 scientific databases (CINAHL, MEDLINE, Scopus, ProQuest, Web of Science, and the Finnish database Medic), and unpublished studies and gray literature will be searched using Google Scholar, EBSCO Open Dissertations, and MedNar.

Results

An initial limited search of MEDLINE was undertaken on October 19, 2020, resulting in 883 records. The results of the concept analysis will be submitted for publication by July 2021.

Conclusions

A robust conceptualization of leadership in digital health services is needed to support research, leadership, and education. The concept analysis model of Walker and Avant will be used to meet this need. As leadership in digital health services appears to be an interprofessional and intersectoral collaboration, defining this concept may also facilitate collaboration between professionals and sectors. The concept analysis to be conducted will also expand our understanding of leadership in digital health services.

International Registered Report Identifier (IRRID)

PRR1-10.2196/25495

What Do Patients and Caregivers Want? A Systematic Review of User Suggestions to Improve Patient Portals

Significant investments have been made in patient portals in order to provide patients with greater access to their medical records, as well as to other services such as secure electronic communication with their healthcare provider(s). Unfortunately, overall, patient adoption and use of patient portals has been lower than expected. According to the user-centered design philosophy, including end-user voices in all stages of the design process is critical to a technology's success. Thus, as a part of a larger systematic review, we examined the patient portal literature and identified 42 studies that reported patient's or their caregiver's suggestions to improve patient portals. The results suggest that patients and caregivers want patient portals to (i) support human connection (e.g., virtual patient-provider interactions), (ii) give patients more control (e.g., over their medical record) and be designedfor the variation in patient and caregiver experiences, and (iii) be innovative (e.g., provide contextualized medical advice).

Implementing a digital patient feedback system: an analysis using normalisation process theory

BACKGROUND

Patient feedback in the English NHS is now widespread and digital methods are increasingly used. Adoption of digital methods depends on socio-technical and contextual factors, alongside human agency and lived experience. Moreover, the introduction of these methods may be perceived as disruptive of organisational and clinical routines. The focus of this paper is on the implementation of a particular digital feedback intervention that was co-designed with health professionals and patients (the DEPEND study).

METHODS

The digital feedback intervention was conceptualised as a complex intervention and thus the study focused on the contexts within which it operated, and how the different participants made sense of the intervention and engaged with it (or not). Four health care sites were studied: an acute setting, a mental health setting, and two general practices. Qualitative data was collected through interviews and focus groups with professionals, patients and carers. In total 51 staff, 24 patients and 8 carers were included. Forty-two observations of the use of the digital feedback system were carried out in the four settings. Data analysis was based on modified grounded theory and Normalisation Process Theory (NPT) formed the conceptual framework.

RESULTS

Digital feedback made sense to health care staff as it was seen as attractive, fast to complete and easier to analyse. Patients had a range of views depending on their familiarity with the digital world. Patients mentioned barriers such as kiosk not being visible, privacy, lack of digital know-how, technical hitches with the touchscreen. Collective action in maintaining participation again differed between sites because of workload pressure, perceptions of roles and responsibilities; and in the mental health site major organisational change was taking place. For mental health service users, their relationship with staff and their own health status determined their digital use.

CONCLUSION

The potential of digital feedback was recognised but implementation should take local contexts, different patient groups and organisational leadership into account. Patient involvement in change and adaptation of the intervention was important in enhancing the embedding of digital methods in routine feedback. NPT allowed for a in-depth understanding of actions and interactions of both staff and patients.

Identifying the Roles of Healthcare Leaders in HIT Implementation: A Scoping Review of the Quantitative and Qualitative Evidence

Despite major investment, health information technology (HIT) implementation often tends to fail. One of the reasons for HIT implementation failure is poor leadership in healthcare organisations, and thus, more research is needed on leaders' roles in HIT implementation. The aim of the review was to identify the role of healthcare leaders in HIT implementation. A scoping review with content analysis was conducted using a five-step framework defined by Arksey and O'Malley. Database searches were performed using CINAHL, Business Source Complete, ProQuest, Scopus and Web of Science. The included studies were written either in English or Finnish, published between 2000 and 2019, focused on HIT implementation and contained leadership insight given by various informants. In total, 16 studies were included. The roles of healthcare leaders were identified as supporter, change manager, advocate, project manager, manager, facilitator and champion. Identifying healthcare leaders' roles in HIT implementation may allow us to take a step closer to successful HIT implementation. Yet, it seems that healthcare leaders cannot fully realise these identified roles and their understanding of HIT needs enforcement. Also, healthcare leaders seem to need more support when actively participating in HIT implementation.