1
|
Zurynski Y, Herkes-Deane J, Holt J, McPherson E, Lamprell G, Dammery G, Meulenbroeks I, Halim N, Braithwaite J. How can the healthcare system deliver sustainable performance? A scoping review. BMJ Open 2022; 12:e059207. [PMID: 35613812 PMCID: PMC9125771 DOI: 10.1136/bmjopen-2021-059207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Increasing health costs, demand and patient multimorbidity challenge the sustainability of healthcare systems. These challenges persist and have been amplified by the global pandemic. OBJECTIVES We aimed to develop an understanding of how the sustainable performance of healthcare systems (SPHS) has been conceptualised, defined and measured. DESIGN Scoping review of peer-reviewed articles and editorials published from database inception to February 2021. DATA SOURCES PubMed and Ovid Medline, and snowballing techniques. ELIGIBILITY CRITERIA We included articles that discussed key focus concepts of SPHS: (1) definitions, (2) measurement, (3) identified challenges, (4) identified solutions for improvement and (5) scaling successful solutions to maintain SPHS. DATA EXTRACTION AND SYNTHESIS After title/abstract screening, full-text articles were reviewed, and relevant information extracted and synthesised under the five focus concepts. RESULTS Of 142 included articles, 38 (27%) provided a definition of SPHS. Definitions were based mainly on financial sustainability, however, SPHS was also more broadly conceptualised and included acceptability to patients and workforce, resilience through adaptation, and rapid absorption of evidence and innovations. Measures of SPHS were also predominantly financial, but recent articles proposed composite measures that accounted for financial, social and health outcomes. Challenges to achieving SPHS included the increasingly complex patient populations, limited integration because of entrenched fragmented systems and siloed professional groups, and the ongoing translational gaps in evidence-to-practice and policy-to-practice. Improvement strategies for SPHS included developing appropriate workplace cultures, direct community and consumer involvement, and adoption of evidence-based practice and technologies. There was also a strong identified need for long-term monitoring and evaluations to support adaptation of healthcare systems and to anticipate changing needs where possible. CONCLUSIONS To implement lasting change and to respond to new challenges, we need context-relevant definitions and frameworks, and robust, flexible, and feasible measures to support the long-term sustainability and performance of healthcare systems.
Collapse
Affiliation(s)
- Yvonne Zurynski
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, North Ryde, New South Wales, Australia
| | - Jessica Herkes-Deane
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Joanna Holt
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, North Ryde, New South Wales, Australia
| | - Elise McPherson
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gina Lamprell
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Genevieve Dammery
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, North Ryde, New South Wales, Australia
| | - Isabelle Meulenbroeks
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, North Ryde, New South Wales, Australia
| | - Nicole Halim
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, North Ryde, New South Wales, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, North Ryde, New South Wales, Australia
| |
Collapse
|
2
|
Wong E, Mavondo F, Horvat L, McKinlay L, Fisher J. Victorian healthcare experience survey 2016-2018; evaluation of interventions to improve the patient experience. BMC Health Serv Res 2021; 21:316. [PMID: 33827563 PMCID: PMC8028773 DOI: 10.1186/s12913-021-06336-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 03/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient experience is recognised as a quality of care indicator and increasingly health services are working on achieving set targets and improving their performance. Interventions at the point of care targeting communication with patients, patient engagement in care processes and discharge planning are associated with better patient experience. However, their efficacy and application to different contexts are still unclear. The aims were to describe the interventions implemented by health services to improve patient experience, their impact on overall patient experiences and specific experiences in areas of communication, discharge planning, patient education on treatment/tests, the physical environment and access to care. METHODS Secondary data analysis of the Victorian Healthcare Experience inpatient surveys reported in September 2016 and 2018 and content analysis of interventions published in the Victorian Quality Account for 2017 from 59 public health services in Victoria, Australia. The interventions were categorised using an adapted taxonomy of professional interventions by the Cochrane EPOC Review Group. Univariate tests and confirmatory factor analysis were conducted to test measure invariance across the 2016 and 2018 groups and examine the association between each of the intervention categories on overall patient experience measure and specific outcome measures. RESULTS This study found that the overall patient experience was consistent (93%) between 2016 and 2018 samples. In comparing impact, a single intervention rather than none or multiple interventions in communication, respect and dignity and treatment and disease education areas were associated with a higher level of the overall patient experience. Interventions in waiting time, access to service, care continuity and emotional support categories were associated with a decrease in overall patient experience. CONCLUSION This study found that to improve the overall patient experience, more focus is needed on evidence-based interventions in dignity and respect and emotional support. Furthermore, the choice of interventions should be guided by evidence of their efficacy and prioritising implementing one intervention well, provides more gains.
Collapse
Affiliation(s)
- Eunice Wong
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Melbourne, PO Box 8000, Monash University LPO, Clayton, VIC, 3800, Australia.
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Felix Mavondo
- Department of Marketing, Monash University, Melbourne, Australia
| | - Lidia Horvat
- Safer Care Victoria, Department of Health, Victoria, Australia
| | - Louise McKinlay
- Safer Care Victoria, Department of Health, Victoria, Australia
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
3
|
Santana MJ, Manalili K, Zelinsky S, Brien S, Gibbons E, King J, Frank L, Wallström S, Fairie P, Leeb K, Quan H, Sawatzky R. Improving the quality of person-centred healthcare from the patient perspective: development of person-centred quality indicators. BMJ Open 2020; 10:e037323. [PMID: 33122312 PMCID: PMC7597468 DOI: 10.1136/bmjopen-2020-037323] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE International efforts are being made towards a person-centred care (PCC) model, but there are currently no standardised mechanisms to measure and monitor PCC at a healthcare system level. The use of metrics to measure PCC can help to drive the changes needed to improve the quality of healthcare that is person centred. OBJECTIVE To develop and validate person-centred care quality indicators (PC-QIs) measuring PCC at a healthcare system level through a synthesis of the evidence and a person-centred consensus approach to ensure the PC-QIs reflect what matters most to people in their care. METHODS Existing indicators were first identified through a scoping review of the literature and an international environmental scan. Focus group discussions with diverse patients and caregivers and interviews with clinicians and experts in quality improvement allowed us to identify gaps in current measurement of PCC and inform the development of new PC-QIs. A set of identified and newly developed PC-QIs were subsequently refined by Delphi consensus process using a modified RAND/UCLA Appropriateness Method. The international consensus panel consisted of patients, family members, community representatives, clinicians, researchers and healthcare quality experts. RESULTS From an initial 39 unique evidence-based PC-QIs identified and developed, the consensus process yielded 26 final PC-QIs. These included 7 related to structure, 16 related to process, 2 related to outcome and 1 overall global PC-QI. CONCLUSIONS The final 26 evidence-based and person-informed PC-QIs can be used to measure and evaluate quality incorporating patient perspectives, empowering jurisdictions to monitor healthcare system performance and evaluate policy and practice related to PCC.
Collapse
Affiliation(s)
- Maria-Jose Santana
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Alberta Strategy for Patient-oriented Research, Calgary, Alberta, Canada
| | - Kimberly Manalili
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Sandra Zelinsky
- Alberta Strategy for Patient-oriented Research, Calgary, Alberta, Canada
- University of Calgary, Calgary, Alberta, Canada
| | - Susan Brien
- Health Quality Ontario, Toronto, Ontario, Canada
| | | | - Jenny King
- Picker Institute Europe, Oxford, Oxfordshire, UK
| | - Lori Frank
- RAND Corporation, Arlington, Virginia, USA
| | - Sara Wallström
- Center for Person Centered Care, Gothenburg, Sweden
- University of Gothenburg, Gothenburg, Sweden
| | - Paul Fairie
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Kira Leeb
- Victorian Agency for Health Information, Melbourne, Victoria, Australia
| | - Hude Quan
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Richard Sawatzky
- Trinity Western University School of Nursing, Langley, British Columbia, Canada
| |
Collapse
|
4
|
Patient feedback to improve quality of patient-centred care in public hospitals: a systematic review of the evidence. BMC Health Serv Res 2020; 20:530. [PMID: 32527314 PMCID: PMC7291559 DOI: 10.1186/s12913-020-05383-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/01/2020] [Indexed: 11/22/2022] Open
Abstract
Background To review systematically the published literature relating to interventions informed by patient feedback for improvement to quality of care in hospital settings. Methods A systematic search was performed in the CINAHL, EMBASE, PsyInfo, MEDLINE, Cochrane Libraries, SCOPUS and Web of Science databases for English-language publications from January 2008 till October 2018 using a combination of MeSH-terms and keywords related to patient feedback, quality of health care, patient-centred care, program evaluation and public hospitals. The quality appraisal of the studies was conducted with the MMAT and the review protocol was published on PROSPERO. Narrative synthesis was used for evaluation of the effectiveness of the interventions on patient-centred quality of care. Results Twenty papers reporting 20 studies met the inclusion criteria, of these, there was one cluster RCT, three before and after studies, four cross-sectional studies and 12 organisational case studies. In the quality appraisal, 11 studies were rated low, five medium and only two of high methodological quality. Two studies could not be appraised because insufficient information was provided. The papers reported on interventions to improve communication with patients, professional practices in continuity of care and care transitions, responsiveness to patients, patient education, the physical hospital environment, use of patient feedback by staff and on quality improvement projects. However, quantitative outcomes were only provided for interventions in the areas of communication, professional practices in continuity of care and care transitions and responsiveness to patients. Multi-component interventions which targeted both individual and organisational levels were more effective than single interventions. Outcome measures reported in the studies were patient experiences across various diverse dimensions including, communication, responsiveness, coordination of and access to care, or patient satisfaction with waiting times, physical environment and staff courtesy. Conclusion Overall, it was found that there is limited evidence on the effectiveness of interventions, because few have been tested in well-designed trials, very few papers described the theoretical basis on which the intervention had been developed. Further research is needed to understand the choice and mechanism of action of the interventions used to improve patient experience.
Collapse
|
5
|
Santana MJ, Manalili K, Jolley RJ, Zelinsky S, Quan H, Lu M. How to practice person-centred care: A conceptual framework. Health Expect 2018; 21:429-440. [PMID: 29151269 PMCID: PMC5867327 DOI: 10.1111/hex.12640] [Citation(s) in RCA: 407] [Impact Index Per Article: 67.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Globally, health-care systems and organizations are looking to improve health system performance through the implementation of a person-centred care (PCC) model. While numerous conceptual frameworks for PCC exist, a gap remains in practical guidance on PCC implementation. METHODS Based on a narrative review of the PCC literature, a generic conceptual framework was developed in collaboration with a patient partner, which synthesizes evidence, recommendations and best practice from existing frameworks and implementation case studies. The Donabedian model for health-care improvement was used to classify PCC domains into the categories of "Structure," "Process" and "Outcome" for health-care quality improvement. DISCUSSION The framework emphasizes the structural domain, which relates to the health-care system or context in which care is delivered, providing the foundation for PCC, and influencing the processes and outcomes of care. Structural domains identified include: the creation of a PCC culture across the continuum of care; co-designing educational programs, as well as health promotion and prevention programs with patients; providing a supportive and accommodating environment; and developing and integrating structures to support health information technology and to measure and monitor PCC performance. Process domains describe the importance of cultivating communication and respectful and compassionate care; engaging patients in managing their care; and integration of care. Outcome domains identified include: access to care and Patient-Reported Outcomes. CONCLUSION This conceptual framework provides a step-wise roadmap to guide health-care systems and organizations in the provision PCC across various health-care sectors.
Collapse
Affiliation(s)
- Maria J. Santana
- Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Kimberly Manalili
- Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Rachel J. Jolley
- Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Sandra Zelinsky
- Patient PartnerStrategy for Patient‐oriented Research, Methods and Development PlatformAlbertaABCanada
| | - Hude Quan
- Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Mingshan Lu
- Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryABCanada
- Department of EconomicsUniversity of CalgaryCalgaryABCanada
| |
Collapse
|