Empowering Patients to Co-Create a Sustainable Healthcare Value

Using the Non-Adoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) Framework to Identify Barriers and Facilitators for the Implementation of Digital Twins in Cardiovascular Medicine

A digital twin is a computer-based "virtual" representation of a complex system, updated using data from the "real" twin. Digital twins are established in product manufacturing, aviation, and infrastructure and are attracting significant attention in medicine. In medicine, digital twins hold great promise to improve prevention of cardiovascular diseases and enable personalised health care through a range of Internet of Things (IoT) devices which collect patient data in real-time. However, the promise of such new technology is often met with many technical, scientific, social, and ethical challenges that need to be overcome-if these challenges are not met, the technology is therefore less likely on balance to be adopted by stakeholders. The purpose of this work is to identify the facilitators and barriers to the implementation of digital twins in cardiovascular medicine. Using, the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework, we conducted a document analysis of policy reports, industry websites, online magazines, and academic publications on digital twins in cardiovascular medicine, identifying potential facilitators and barriers to adoption. Our results show key facilitating factors for implementation: preventing cardiovascular disease, in silico simulation and experimentation, and personalised care. Key barriers to implementation included: establishing real-time data exchange, perceived specialist skills required, high demand for patient data, and ethical risks related to privacy and surveillance. Furthermore, the lack of empirical research on the attributes of digital twins by different research groups, the characteristics and behaviour of adopters, and the nature and extent of social, regulatory, economic, and political contexts in the planning and development process of these technologies is perceived as a major hindering factor to future implementation.

Exploring the factors that affect user experience in mobile-health applications: A text-mining and machine-learning approach

Recent years have witnessed an increased demand for mobile health (mHealth) platforms owing to the COVID-19 pandemic and preference for doorstep delivery. However, factors impacting user experiences and satisfaction levels across these platforms, using customer reviews, are still largely unexplored in academic research. The empirical framework we proposed in this paper addressed this research gap by analysing unmonitored user comments for some popular mHealth platforms. Using topic-modelling techniques, we identified the impacting factors (predictors) and categorised them into two major dimensions based on strategic adoption and motivational association. Findings from our study suggest that time and money, convenience, responsiveness, and availability emerge as significant predictors for delivering a positive user experience on m-health platforms. Next, we identified substantial moderating effects of review polarity on the predictors related to brand association and hedonic motivation, such as online booking and video consultation. Further, we also identified the top predictors for successful user experience across these platforms. Recommendations from our study will benefit business managers by offering an improved service design leading to higher user satisfaction across these m-health platforms.

Towards Green and Sustainable Healthcare: A Literature Review and Research Agenda for Green Leadership in the Healthcare Sector

The health sector is one of the keys to sustainable development. Although it is directly related to only one Sustainable Development Goal (Goal 3, "Ensuring a healthy life and promoting well-being at all ages"), the sector itself, which aims to protect health, is paradoxically at the same time the main emitter of environmental pollutants that have a negative impact on health itself. Therefore, sustainability has become a key priority for health sector organizations, and leadership in this area is essential at all levels. Scientific research plays a particular role here, helping to more clearly define the links between environmental sustainability and the health effects of a polluted environment and climate change as well as indicating the direction of actions needed and disseminating good practices that can help accelerate the adoption of efforts towards climate neutrality and sustainable development of health sector organizations. The aim of this article is to present the current state of the art and future research scenarios in the field of green and sustainable healthcare through a literature review by using the Preferred Reporting Items for Systematic Reviews Meta-Analyses (PRISMA) method to perform a bibliometric analysis of papers published in 2012-2022. The Web of Science Core Collection (WoSCC) database is used for this purpose. A total of 144 papers are included for analysis, categorized based on eight fields: author(s), title, year of publication, country, journal, scientific category, and number of citations. Based on the results, themes for future research on green leadership in the healthcare sector are identified and recommended.

Creating person‐centred health care value together

In this article we ask: to what extent is person‐centred care truly embedded in our system, and are we making the most of the policy levers that could help?

We describe person‐centred care, shine a light on deficits in the health system, and point to some policy enablers to support person‐centred care.

Cultural change and a commitment to value‐based health care are required. We highlight the merit in adopting and acting on patient‐reported measures as an indicator of what matters to the patient, the need for integrated data systems, and the role of a co‐creation approach. Most importantly, we underscore the importance of funding reform and consumer leadership.

Where are we in shared decision-making in Italy? A brief updated review

The aim of this paper is to provide an overview of the current state of the art concerning patient-centred care (PCC), shared decision-making (SDM), and patient involvement in health care in Italy, by updating the previous versions of the review. In the past 5 years some progress has been made towards a higher involvement of patients in their health care and patient-centredness into the national health care system. The updated scoping literature search focused on articles reporting primary data collected in Italy and showed a great increase in the number of publications. Nonetheless, the research efforts are still relatively sporadic compared to other countries especially as for evaluations of interventions and, most notably, they are not driven by a consistent effort to promote SDM and PCC in clinical practice.

Value Cocreation in Health Care: Systematic Review

Background

Value cocreation in health care (VCCH), mainly based on service-dominant logic, emphasizes that participants, including both patients and physicians, can effectively enroll in the health care value creation process. Effective VCCH is of great significance for realizing value-based health care and improving doctor-patient relationships. Therefore, a comprehensive understanding of VCCH is critical. However, the current literature on VCCH is fragmented and not well studied.

Objective

The goal of the research is to investigate the antecedents, consequences, and dimensions of VCCH by systematically searching, selecting, summarizing, and evaluating relevant literature.

Methods

English-language articles on VCCH in the Web of Science, PubMed, and Scopus databases published from January 2008 to December 2019 were identified. The articles were screened using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol, and the quality of studies included were appraised using the Mixed Methods Appraisal Tool.

Results

Out of the 181 publications initially identified through the bibliographic searches, 28 publications met the inclusion criteria. This review summarizes antecedents, consequences, and dimensions of VCCH, as well as possible associations among them. An integrative framework is also proposed for mapping the literature of VCCH grounded on social cognitive theory to reveal the whole process of VCCH.

Conclusions

The findings of this systematic review provide implications for continued development of VCCH and contribute to inspire more research in the future.

The COVID-19 emergency as an opportunity to co-produce an innovative approach to health services provision: the women's antenatal classes move on the web

The COVID-19 pandemic has strongly affected healthcare organizations, leading to the need for reorganizing also maternal care services during pregnancy. The Regional Health Authorities in Tuscany (Italy) promoted the creation of online antenatal classes (ACs). This study illustrates the innovative approach to deliver ACs online and discusses how the collaborative approach in co-producing this innovative solution co-creates value in healthcare. The action research design was based, on one hand, on the indirect involvement of users by analyzing qualitative data collected through a continuous survey to pregnant women and, on the other one, on the direct involvement of managers and health professionals in meetings and workshops. The authors encompassed all necessary changes in organizational practices and facilitated the collaborative process implementation and analysis. The main findings are that moving ACs online has been a relevant choice, since the need of pregnant women to share information and receive emotional support increased in times of crisis. Additionally, in the perspective of health professionals, the new online ACs model emerged as a valuable solution not only for the contingent situation, but also in a long-term perspective to reach more women during pregnancy and to early support them throughout the maternal care pathway. This study shows that the collaborative approach to co-innovate healthcare services provision, such as with ACs online, facilitates the creation of, long-lasting, and integrated solutions in healthcare, to be used also after pandemic period. Finally, despite this action-research is context-specific, the findings presented in this paper may help other healthcare organizations innovate their own strategies in ACs’ provision.

Smart health via mHealth? Potentials of mobile health apps for improving prevention and adherence of breast cancer patients

Objective

Today there are several health and medical apps (mHealth) in app stores. Germany is the world's first country that introduced apps paid by the regular health insurance service. Even though breast cancer is the most common cancer in women, mHealth for breast cancer has been largely unexplored.

Methods

A total of 33 apps from two major mobile application marketplaces (Google Play Store/Android; App Store/iOS) have been selected for analysis.

Results

The app analysis shows that there are currently only 10 mHealth apps in German, which are specifically dedicated to breast cancer patients. The features of these apps fall into two categories: improvement of health literacy and indirect intervention. These apps can be used for all phases of the patient journey starting with the diagnosis.

Conclusions

mHealth apps have the potential to support the adherence of breast cancer patients. In order to exploit this future potential, the app quality, as well as the information about the available apps, must be urgently improved. Currently, it is very difficult both for laypersons and for doctors/other therapists to identify high-quality apps. Guidance from independent or governmental institutions would be helpful to further the digitalization in health care.

Patient organizations supporting health care and co-creating value: insights from a simulation model

Purpose

Patient organizations (POs) belong to the non-profit world and carry on several activities alongside health care. However, literature devotes scarce attention to POs’ management specificities in the interaction with health-care delivery. This paper aims to describe the contribution of POs to health care from an operational point of view; investigate the effect of POs’ managerial choices on health-care performance; and provide useful insights for patient organizations and health-care management.

Design/methodology/approach

The paper combines qualitative case study research and system dynamics (SD). After a literature review about patient organizations’ role, modeling steps are described. In first place, the analyses of institutional documents, interviews and observations are condensed in a stock-and-flow diagram. The latter is translated into a set of differential equations to simulate the effect of alternative resource allocations.

Findings

The case study emphasizes PO’s educational and administrative role in supporting health-care delivery. Simulated policy scenarios, while confirming the positive contribution of patient co-created health, disclose potential divergencies in public and private/third sector decision-making, to be read considering key feedback mechanisms within the system.

Originality/value

This study proposes a holistic view of patient organizations’ engagement in health care. The findings highlight synergies and trade-offs of alternative managerial decisions involving POs and health-care providers, disclosing the benefits of joint resource planning.

Understanding and Being Understood: Information and Care Needs of 2113 Patients With Confirmed or Suspected COVID-19

To become a proactive and informed partner in postacute coronavirus disease 2019 (COVID-19) management, patients need to have the knowledge, skills, and confidence to self-manage COVID-19-related health challenges. Due to several restrictions and consequently social isolation, online platforms and forums where people can share information and experiences became more popular and influential. Therefore, this study aimed to identify perceived information needs and care needs of members of 2 Facebook groups for patients with COVID-19 and persistent complaints in the Netherlands and Belgium and patients with COVID-19 who registered at a website of the Lung Foundation Netherlands. Besides demographics and clinical characteristics, the degree of satisfaction with care during and after the infection as well as satisfaction with available information were assessed. Open text fields revealed specific information needs which were summarized. Patients with confirmed or suspected COVID-19 perceive various unmet needs varying from specific information needs (eg, information about permanent lung damage) to general needs (eg, being heard and understood). These data lead to several recommendations to improve care for patients with COVID-19 and justify further development of online platforms specifically addressing these unmet needs.

A qualitative exploration of value and waste in a Trinidadian emergency department patient flow process: perspectives of patients and clinicians

PURPOSE

A process that does not include the customer's value may not be effective in providing care. This study aimed to identify value and waste in an emergency department (ED) patient flow process from a patient and clinician perspective.

DESIGN/METHODOLOGY/APPROACH

A qualitative case study was conducted in an ED in Trinidad and Tobago. Observations and informal conversational interviews with clinicians (n = 33) and patients (n = 50) explored patient flow, value and waste. Thematic analysis was used to create a framework on valuable and wasteful aspects in the ED patient flow process.

FINDINGS

Valuable aspects led to direct improvements in the patient's health or an exchange of information in the process. Wasteful aspects were those with no patient activity, no direct ED clinical involvement, or resulted in a perceived inappropriate use of ED resources. However, there was a disparity in responses between clinicians and patients with clinicians identifying more features in the process.

RESEARCH LIMITATIONS/IMPLICATIONS

The single case study design limits the generalizability of findings to other settings. This study did not specifically explore the influence of age and gender on what mattered to patients in ED services. Future studies would benefit from exploring whether there are any age and gender differences in patient perspectives of value and waste. Further research is needed to validate the usefulness of the framework in a wider range of settings and consider demographic factors such as age and gender.

PRACTICAL IMPLICATIONS

The study has produced a framework which may be used to improve patient flow in a way that maximized value to its users. A collaborative approach, with active patient involvement, is needed to develop a process that is valuable to all. The single case study design limits the generalizability of findings to other settings.

ORIGINALITY/VALUE

Qualitative methods were used to explicitly explore both value and waste in emergency department patient flow, incorporating the patient perspective. This paper provides an approach that decision makers may use to refine the ED patient flow process into one that flows well, improves quality and maximizes value to its users.

Core Values that Influence the Patient-Healthcare Professional Power Dynamic: Steering Interaction towards Partnership

Healthcare has long been marked by the authoritative-physician–passive-patient interaction, with patients seeking help and physicians seeking to restore patients back to health. However, globalisation, social movements, and technological advancements are transforming the nature of this relationship. We aim to identify core values that influence the power dynamic between patients and healthcare professionals, and determine how to steer these interactions towards partnership, a more suitable approach to current healthcare needs. Patients with chronic diseases (10 men, 18 women) and healthcare professionals (11 men, 12 women) were interviewed, sessions transcribed, and the framework method used to thematically analyse the data. Validation was done through analyst triangulation and member check recheck. Core values identified as influencing the patient-healthcare professional power dynamic include: (A) values that empower patients (acceptance of diagnosis and autonomy); (B) values unique to healthcare professionals (HCPs) (acknowledging patients experiential knowledge and including patients in the therapeutic process); and (C) shared capitals related to their interactions (communication, information sharing and exchange, collaboration, and mutual commitment). These interdependent core values can be considered prerequisites to the implementation of the patient-as-partner approach in healthcare. Partnership would imply a paradigm shift such that stakeholders systematically examine each other’s perspective, motivations, capabilities, and goals, and then adapt their interactions in this accord, for optimal outcome.

Improving the Theoretical Understanding Toward Patient-Driven Health Care Innovation Through Online Value Cocreation: Systematic Review

Background

Patient participation in the health care domain has surged dramatically through the availability of digital health platforms and online health communities (OHCs). Such patient-driven service innovation has both potential and challenges for health care organizations. Over the last 5 years, articles have surfaced that focus on value cocreation in health care services and the importance of engaging patients and other actors in service delivery. However, a theoretical understanding of how to use OHCs for this purpose is still underdeveloped within the health care service ecosystem.

Objective

This paper aimed to introduce a theoretical discussion for better understanding of the potential of OHCs for health care organizations, in particular, for patient empowerment.

Methods

This literature review study involved a comprehensive search using 12 electronic databases (EMBASE, PsycINFO, Web of Science, Scopus, ScienceDirect, Medical Literature Analysis and Retrieval System Online, PubMed, Elton B Stephens Co [academic], Cumulative Index of Nursing and Allied Health Literature, Accelerated Information Sharing for Law Enforcement, Association for Computing Machinery, and Google Scholar) from 2013 to 2019. A total of 1388 studies were identified from the database search. After removing duplicates and applying inclusion criteria, we thematically analyzed 56 articles using the Braun and Clarke thematic analysis approach.

Results

We identified a list of 5 salient themes: communication extension, improved health literacy for patients and health care organizations, communication transparency with patients, informational and social support for patients, and patient empowerment in self-management. The most frequent theme was communication extension, which covers 39% (22/56) of the literature. This theme reported that an extension of communication between patients, caregivers, and physicians and organizations led to new opportunities to create value with minimal time and cost restrictions. Improved health literacy and communication transparency with patients were the second and third most frequent themes, respectively, covering 26% (15/56) and 25% (14/56) of the literature, respectively. The frequency of these themes indicated that the use of OHCs to generate new knowledge from patients’ interactions helped health care organizations to customize treatment plans and establish transparent and effective communication between health care organizations and patients. Furthermore, of the 56 studies, 13 (23%) and 10 (17%) studies contended the opportunity of using OHCs in terms of informational and emotional support and empowering patients in their self-management of diseases.

Conclusions

This review enables better understanding of the current state of the art of the online value cocreation and its potential for health care organizations. This study found that the opportunities for health care organizations through enhancement of patient participation and their cocreation of value in digital health platforms have been rapidly increasing. The identified gaps and opportunities in this study would identify avenues for future directions in modernized and more effective value-oriented health care informatics research.

The personalised discharge letter: the experience of patients and parents from the Filadelfia Epilepsy Hospital

OBJECTIVE

To examine the experience of a discharge letter received by patients suffering from epilepsy and parents with children who suffer from epilepsy.

DESIGN

Qualitative research inspired by a phenomenological methodology approach.

SETTING

Face-to-face interviews with patients and parents of epileptic children in their own homes.

SAMPLE

Participants (total n = 11).

METHODS

In-depth interviews were recorded verbatim, transcribed and analysed.

RESULTS

Two themes were identified: (i) it was written about me and (ii) a sense of feeling secure. By being discharged with a personalised letter, the participants felt seen and heard. The discharge letter enabled them to contact their doctor and the Filadelfia hospital more efficiently if needed. Parents indicated that the discharge letter bridged the uncertainty that they often experienced when dealing with the child's school or authorities in general.

CONCLUSIONS

The discharge letter enables the participants to make the transition into everyday life with the best and most up-to-date information about themselves and their current condition as an epilepsy patient. The discharge letter empowers the patient or parents to face everyday life. The discharge becomes a kind of passport to the outside world when encountering the general practitioner, the school or other circumstances where the patient engages. The discharge letter becomes a patient-centred tool proving that enhanced communication and understanding between healthcare professionals, patients and parents succeeds. This example could be transferable to other hospitals to heighten the patient's self-efficacy and quality of life after being discharged from the hospital.

On-line Crowdsourcing: Motives of Customers to Participate in Online Collaborative Innovation Processes

The large-scale adoption of the Internet and social media make transactions and interactions between businesses and customers easy, inexpensive, and highly efficient. Online crowdsourcing and co-creation with customers are developments increasingly seen as attractive alternatives to traditional forms of innovation management. Online customers are willing to spend time and effort on collaborative innovation trajectories and so have a say in the development of new products and services. Identifying and recruiting capable and innovation-minded co-creation partners online is one of the main challenges of such collaborative innovation-focused processes; understanding the attitudes and motives of innovation-minded customers are the first steps in enticing and recruit these as innovation partners. In this study, we identify and classify customer motives for participating in online co-creation processes in two European countries: Spain and The Netherlands. More than a quarter of online customers are active co-creators and two co-creator profiles were identified in both countries, based the levels of motivation predisposition; Spanish online customers are more involved and enthusiastic co-creators than Dutch customers. The study confirms that financial motives are not the main reason for co-creation; highly motivated customers are motivated by product-related benefits, while hedonic benefits are the most important triggers for less motivated co-creators.