Literature review of digital twin in healthcare

This article aims to make a bibliometric literature review using systematic scientific mapping and content analysis of digital twins in healthcare to know the evolution, domain, keywords, content type, and kind and purpose of digital twin's implementation in healthcare, so a consolidation and future improvement of existing knowledge can be made and gaps for new studies can be identified. The increase in publications of digital twins in healthcare is quite recent and it is still concentrated in the domain of technology sources. The subject is majorly concentrated in patient's digital twin group and in precision medicine and aspects, issues and/or policies subgroups, although the publications keywords mirror it only at the group side. Digital twins in healthcare are probably stepping out of the infancy phase. On the other hand, digital twins in hospital group and the device and facilities management subgroups are more mature with all knowledge gathered from the manufacturing sector. There is an absence of some publication's types in general, device and care subgroup and no whole body or hospital digital twin was reported. Based on the presented arguments, guidelines for future research were presented: advance in the creation of general frameworks, in subgroups not as much explored, and in groups and subgroups already explored, but that need more advancement to achieve the main goals of a whole human or hospital digital twin with the main issues resolved.

How did healthcare professionals define patient engagement in quality management? A survey study

BACKGROUND

Patient and family engagement (PFE) can positively impact the patient experience and care process outcomes. There is no unique type of PFE, and the process is usually defined by the quality management department or professionals responsible for this process in the hospital. The objective of this study is to define PFE in quality management based on the professional's perspective.

METHOD

A survey was carried out with 90 professionals from Brazilian hospitals. There were two questions aimed at understanding the concept. The first was a multiple-choice question to identify synonyms. The second was an open-ended question to develop the definition. A content analysis methodology was employed by applying techniques for thematic and inferential analysis.

RESULTS

Three words were classified as synonyms by more than 60% of respondents: involvement, participation, and centered care. The participants described patient participation at both the individual (related to the treatment) and organizational levels (related to quality improvement). The PFE in the treatment is related to the development, discussion and decision-making about the therapeutic plan, participation in each step of care, and knowledge of the institution's quality and safety processes. At the organizational level, engagement in quality improvement includes the involvement of the P/F in all processes of the institution, from strategic planning to the design or improvement processes, as well as active participation in institutional committees or commissions.

CONCLUSION

The professionals defined engagement in two levels (individual and organizational) and the results suggest that their point of view can influence the practice in the hospitals. Professionals of hospitals that implemented mechanisms of consult defined PFE more in the individual level. On the other hand, professionals of hospitals that implemented mechanisms of involvement considered PFE more focus in the organizational level.

How do hospitals engage patients and family members in quality management? A grounded theory study of hospitals in Brazil

BACKGROUND

Patient and family engagement (PFE) is considered an essential element of the transformation of the healthcare system. However, it is characterised by its complexity and a small number of institutions that have implemented the mechanisms of engagement.

OBJECTIVE

To understand PFE in quality management (QM) in the hospital environment.

DESIGN

A qualitative approach was guided by the grounded theory based in Straussian perspective. Data were gathered using semistructured interviews. The coding was performed by excerpts, using an inductive approach and the constant comparison technique.

SETTING AND PARTICIPANTS

A total of seven Brazilian hospitals were selected based on the theoretical sampling technique.

RESULTS

A total of five categories emerged, namely: patient partner, mechanisms of engagement, internal structure for engagement, maturity of the QM system and openness to change. Externally, three contextual factors can impact the engagement: the local health system, the profile of the community and the change in access to the information. At the centre of the change is the balance in power relations between patients and professionals, the sharing of information from the hospital and a proactive attitude towards improving services.

CONCLUSIONS

The PFE involves a cultural and process change. Cultural change is represented by 'openness', that is, openness to learn, to listen and to consider new perspectives. The change in processes is in turn characterised by the phrase 'test and venture' because the model to be adopted may be different between hospitals. The patient's perspective allows actions to be driven towards what really matters to them, ensuring quality of service and safety, obtaining a new perspective to understand and solve problems, and stimulating a sense of urgency, more empathy and compassion in professionals.

Application of neural network to simulate the behavior of hospitalizations and their costs under the effects of various polluting gases in the city of São Paulo

This work aims to obtain an artificial neural network to simulate hospitalizations for respiratory diseases influenced by pollutant gaseous such as CO, PM₁₀, PM_2.5, NO₂, O₃, and SO₂ emitted from 2011 to 2017, in the city of São Paulo. The hospitalization costs were also be calculated. MLP and RBF neural networks have been tested by varying the number of neurons in the hidden layer and the type of equation of the output function. The following pollutants and its concentration range were collected considering the supervision of Alto Tiete station set, in several neighborhoods in the city of São Paulo, from in the period 2011 to 2017: 28-63 µg/m³ of PM_2.5, 52-110 µg/m³ of PM₁₀, 49-135 µg/m³ of O₃, 0.8-2.6 ppm CO, 41-98 µg/m³ of NO₂, and 3-16 µg/m³ of SO₂. Results showed that a RBF neural network with 6 input neurons, 13 hidden layer neurons, and 1 output neuron, using BFGS algorithm and a Gaussian function to neuronal activation, was the best fitted to the experimental datasets. So, knowing the monthly concentration of gaseous pollutions was possible to predict the hospitalization of 1464 to 3483 ± 510 patients, with costs between 570,447 and 1,357,151 ± 198,171 USD per month. This way, it is possible to use this neural network to predict the costs of hospitalizing patients for respiratory diseases and to contribute to the decision-making of how much the government should spend on health care.

Using patient feedback to drive quality improvement in hospitals: a qualitative study

OBJECTIVES

Although different forms of patient feedback are available, their use in hospital management is still limited. The objective of this study is to explore how patient feedback is currently used in hospitals to improve quality.

DESIGN

This is a qualitative exploratory multiple case study. Data collection included nine interviews, of an average duration of 50 min, conducted between March and June 2019. Additionally, a document and secondary data analysis were performed.

SETTING

This study was conducted in three Brazilian hospitals selected for their solid patient feedback practises.

PARTICIPANTS

Managers from the customer service, quality, nursing, operations, projects and patient experience departments of the three hospitals.

RESULTS

Despite literature suggesting that organisational objectives regarding patient feedback are not clear, data show that there is managerial concern regarding the promotion of an environment capable of changing according to patient feedback. In these instances, organisational processes were structured to focus on patients' feedback and its receipt by the staff, including a non-punitive culture. Several patient feedback forms are available: voluntary events, patient surveys and informal feedback. Instruments to measure patient feedback focused on specific aspects of healthcare, to identify and clarify the problems for addressal by the management. The net promoter score was the main strategic indicator of patient feedback, used to assess the impact of improvement action.

CONCLUSIONS

The hospitals had established objectives that valued the patient's perspective. Involvement of the health team, availability of different channels for feedback and the use of quality tools are considered a good basis for using patient feedback to drive quality improvement.

Preventive risk analysis in the maintenance of patency of the peripherally inserted central catheter

This theoretical and reflexive study analyzed the risks related to the maintenance of patency of the Peripherally Inserted Central Catheter with the use of saline solution in comparison with saline-filled syringes, through the application of the Healthcare Failure Mode and Effect Analysis - HFMEA. The process was mapped, detailing the failure modes of each step. For the calculation of the Risk Priority Number, the severity and probability of the failure modes were analyzed. This analysis gave rise to the severity and probability matrix. Finally, actions to reduce the failure modes in the maintenance of patency were proposed, considering the use of saline-filled syringes in comparison to the use of saline ampoules. It was verified that the use of saline ampoules is associated with a greater risk, since it requires four stages more than saline-filled syringe does not, increasing the risk of contamination and the level of three different risks, which would result in additional hospital costs. The use of the saline-filled syringe would avoid risks that could negatively affect the patient's health, the nursing professional and the health institution.

Evaluating the impact of accreditation on Brazilian healthcare organizations: A quantitative study

Objective

The aim of this study was to evaluate the impact of accreditation programs on Brazilian healthcare organizations.

Design

A web-based questionnaire survey was undertaken between February and May 2016.

Setting

Healthcare organizations from the Federal District and from 18 Brazilian states.

Participants

The quality managers of 141 Brazilian healthcare organizations were the main respondents of the study.

Intervention

The questionnaire was applied to not accredited and accredited organizations.

Main Outcome Measures

The main outcome measures were patient safety activities, quality management activities, planning activities-policies and strategies, patient involvement, involvement of professionals in the quality programs, monitoring of patient safety goals, organizational impact and financial impacts.

Results

The study identified 13 organizational impacts of accreditation. There was evidence of a significant and moderate correlation between the status of accreditation and patient safety activities, quality management activities, planning activities-policies and strategies, and involvement of professionals in the quality programs. The correlation between accreditation status and patient involvement was significant but weak, suggesting that this issue should be treated with a specific policy. The impact of accreditation on the financial results was not confirmed as relevant; however, the need for investment in the planning stage was validated.

Conclusions

The impact of accreditation is mainly related to internal processes, culture, training, institutional image and competitive differentiation.

Gerenciamento de portfólio de projetos no setor público: uma revisão da literatura

Este estudo tem como objetivo investigar o gerenciamento de portfólio de projetos no contexto do setor público. A abordagem metodológica é a de revisão sistemática da literatura, adotando o método de análise de conteúdo. A amostra é composta de artigos selecionados nas bases de dados ISI Web of Science e Scopus. Os resultados permitiram elaborar um quadro teórico síntese da literatura, em que os conteúdos foram divididos em oito temáticas: portfólio e gerenciamento de portfólio, setor público e nova gestão pública, seleção e priorização, controle, riscos, alinhamento estratégico, problemas do gerenciamento de portfólio e performance e sucesso do portfólio.

UNDERSTANDING THE EVOLUTION OF HEALTH SERVICE ACCREDITATION RESEARCH: A LITERATURE REVIEW FROM 2012 TO 2015

The aim of this study is to investigate the core themes of accreditation research. This paper reviews the literature on accreditation in the last four years and compares the findings to a prior research to analyze the evolution of publication over time. The search identified 90 empirical studies examining either the processes or the impacts of accreditation programs. The articles were classified in nine thematic categories, whereas eight were employed by prior studies, one emerged from this review regarding the accreditation program sustainability (n=10). Publications number increased in the last years. The majority of studies were from the United States (n=35) and Australia (n=14). The findings indicate an increasing trend of international collaboration among researches. In the recent literature, the number of studies indicating positive effect of accreditation is higher than prior reviews. The views regarding financial impacts, survey issues and health professionals are less clear.

Envolvimento dos pacientes no gerenciamento da qualidade dos serviços de saúde

Resumo Objetivo: Identificar o estágio de envolvimento dos pacientes nas Instituições de saúde brasileiras, nos programas de melhoria da qualidade e segurança. Métodos: Abordagem quantitativa, através de uma pesquisa de avaliação com 141 Instituições, localizadas em 18 estados e no Distrito Federal, no período de fevereiro a maio de 2016. Para coleta dos dados foi aplicado um questionário pela web, utilizando o software de questionários e pesquisas SurveyMonkeyÓ. No questionário, além das perguntas para caracterização das Instituições e dos respondentes, sete perguntas foram relacionadas às atividades de participação dos pacientes nos processos de gerenciamento da qualidade. Resultados: As atividades realizadas pela maior parte das Instituições foram “pesquisa de satisfação dos pacientes” e “processo formal para comunicação com os pacientes em relação às suas dúvidas, sugestões e reclamações”. A média de atividades realizadas foi de 3,84 de um total de 7 atividades avaliadas. Conclusão: Considerando uma escala de 0 a 3, aproximadamente 70% das Instituições foram classificadas entre os estágios 0 (paciente não é envolvido) e 1 (participação na avaliação das metas de qualidade).

Is there any link between accreditation programs and the models of organizational excellence?

Abstract OBJECTIVE To evaluate whether accredited health organizations perform better management practices than non-accredited ones. METHOD The study was developed in two stages: a literature review, and a study of multiple cases in 12 healthcare organizations in the state of São Paulo, Brazil. It surveyed articles comparing hospital accreditation with the EFQM (European Foundation for Quality Management) model of excellence in management. According to the pertinent literature, the accreditation model and the EFQM model are convergent and supplementary in some aspects. RESULTS With 99% confidence, one can say that there is evidence that accredited organizations scored better in the evaluation based on the EFQM model in comparison to non-accredited organizations. This result was also confirmed in the comparison of results between the categories Facilitators and Results in the EFQM model. CONCLUSION There is convergence between the accreditation model and the EFQM excellence model, suggesting that accreditation helps the healthcare sector to implement the best management practices already used by other business sectors.