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Bruyneel A, Bouckaert N, Pirson M, Sermeus W, Van den Heede K. Unfinished nursing care in intensive care units and the mediating role of the association between nurse working environment, and quality of care and nurses' wellbeing. Intensive Crit Care Nurs 2024; 81:103596. [PMID: 38043435 DOI: 10.1016/j.iccn.2023.103596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 11/13/2023] [Accepted: 11/17/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES Unfinished care refers to the situation in which nurses are forced to delay or omit necessary nursing care. The objectives was: 1) to measure the prevalence of unfinished nursing care in intensive care units during the COVID-19 pandemic; 2) to examine whether unfinished nursing care has a mediating role in the relationship between nurse working environment and nurse-perceived quality of care and risk of burnout among nurses. DESIGN A national cross-sectional survey. SETTING Seventy-five intensive care units in Belgium (December 2021 to February 2022). MAIN OUTCOME MEASURES The Practice Environment Scale of the Nursing Work Index was used to measure the work environment. The perception of quality and safety of care was evaluated via a Likert-type scale. The risk of burnout was assessed using the Maslach Burnout Inventory scale. RESULTS A total of 2,183 nurse responses were included (response rate of 47.8%). Seventy-six percent of nurses reported at least one unfinished nursing care activity during their last shift. The staffing and resource adequacy subdimension of the Practice Environment Scale of the Nursing Work Index had the strongest correlation with unfinished nursing care. An increase in unfinished nursing care led to significantly lower perceived quality and safety of care and an increase in high risk of burnout. Unfinished nursing care appears to be a mediating factor for the association between staffing and resource adequacy and the quality and safety of care perceived by nurses and risk of burnout. CONCLUSIONS Unfinished nursing care, which is highly related to staffing and resource adequacy, is associated with increased odds of nurses being at risk of burnout and reporting a lower level of perceived quality of care. IMPLICATIONS FOR CLINICAL PRACTICE The monitoring of unfinished nursing care in the intensive care unit is an important early indicator of problems related to adequate staffing levels, the well-being of nurses, and the perceived quality of care.
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Affiliation(s)
- Arnaud Bruyneel
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium.
| | | | - Magali Pirson
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium
| | - Walter Sermeus
- KU Leuven Institute for Healthcare Policy, Leuven, Belgium
| | - Koen Van den Heede
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium; KU Leuven Institute for Healthcare Policy, Leuven, Belgium
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Aiken LH, Sermeus W, McKee M, Lasater KB, Sloane D, Pogue CA, Kohnen D, Dello S, Maier CBB, Drennan J, McHugh MD. Physician and nurse well-being, patient safety and recommendations for interventions: cross-sectional survey in hospitals in six European countries. BMJ Open 2024; 14:e079931. [PMID: 38346890 PMCID: PMC10862305 DOI: 10.1136/bmjopen-2023-079931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/30/2024] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVES To determine the well-being of physicians and nurses in hospital practice in Europe, and to identify interventions that hold promise for reducing adverse clinician outcomes and improving patient safety. DESIGN Baseline cross-sectional survey of 2187 physicians and 6643 nurses practicing in 64 hospitals in six European countries participating in the EU-funded Magnet4Europe intervention to improve clinicians' well-being. SETTING Acute general hospitals with 150 or more beds in six European countries: Belgium, England, Germany, Ireland, Sweden and Norway. PARTICIPANTS Physicians and nurses with direct patient contact working in adult medical and surgical inpatient units, including intensive care and emergency departments. MAIN OUTCOME MEASURES Burnout, job dissatisfaction, physical and mental health, intent to leave job, quality of care and patient safety and interventions clinicians believe would improve their well-being. RESULTS Poor work/life balance (57% physicians, 40% nurses), intent to leave (29% physicians, 33% nurses) and high burnout (25% physicians, 26% nurses) were prevalent. Rates varied by hospitals within countries and between countries. Better work environments and staffing were associated with lower percentages of clinicians reporting unfavourable health indicators, quality of care and patient safety. The effect of a 1 IQR improvement in work environments was associated with 7.2% fewer physicians and 5.3% fewer nurses reporting high burnout, and 14.2% fewer physicians and 8.6% fewer nurses giving their hospital an unfavourable rating of quality of care. Improving nurse staffing levels (79% nurses) and reducing bureaucracy and red tape (44% physicians) were interventions clinicians reported would be most effective in improving their own well-being, whereas individual mental health interventions were less frequently prioritised. CONCLUSIONS Burnout, mental health morbidities, job dissatisfaction and concerns about patient safety and care quality are prevalent among European hospital physicians and nurses. Interventions to improve hospital work environments and staffing are more important to clinicians than mental health interventions to improve personal resilience.
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Affiliation(s)
- Linda H Aiken
- Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Martin McKee
- London School of Hygiene & Tropical Medicine, London, UK
| | - Karen B Lasater
- Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Douglas Sloane
- Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Colleen A Pogue
- Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dorothea Kohnen
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Simon Dello
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | | | - Jonathan Drennan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Matthew D McHugh
- Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Kohnen D, De Witte H, Schaufeli WB, Dello S, Bruyneel L, Sermeus W. Engaging leadership and nurse well-being: the role of the work environment and work motivation-a cross-sectional study. Hum Resour Health 2024; 22:8. [PMID: 38225620 PMCID: PMC10788988 DOI: 10.1186/s12960-023-00886-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/27/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Healthcare literature suggests that leadership behavior has a profound impact on nurse work-related well-being. Yet, more research is needed to better conceptualize, measure, and analyse the concepts of leadership and well-being, and to understand the psychological mechanisms underlying this association. Combining Self-Determination and Job Demands-Resources theory, this study aims to investigate the association between engaging leadership and burnout and work engagement among nurses by focusing on two explanatory mechanisms: perceived job characteristics (job demands and resources) and intrinsic motivation. METHODS A cross-sectional survey of 1117 direct care nurses (response rate = 25%) from 13 general acute care hospitals in Belgium. Validated instruments were used to measure nurses' perceptions of engaging leadership, burnout, work engagement, intrinsic motivation and job demands and job resources. Structural equation modeling was performed to test the hypothesised model which assumed a serial mediation of job characteristics and intrinsic motivation in the relationship of engaging leadership with nurse work-related well-being. RESULTS Confirmatory factor analysis indicated a good fit of the measurement model. The findings offer support for the hypothesized model, indicating that engaging leadership is linked to enhanced well-being, as reflected in increased work engagement, and reduced burnout. The results further showed that this association is mediated by nurses' perceptions of job resources and intrinsic motivation. Notably, while job demands mediated the relationship between EL and nurses' well-being, the relationship became unsignificant when including intrinsic motivation as second mediator. CONCLUSIONS Engaging leaders foster a favourable work environment for nursing staff which is not only beneficial for their work motivation but also for their work-related well-being. Engaging leadership and job resources are modifiable aspects of healthcare organisations. Interventions aimed at developing engaging leadership behaviours among nursing leaders and building job resources will help healthcare organisations to create favourable working conditions for their nurses. TRIAL REGISTRATION The study described herein is funded under the European Union's Horizon 2020 Research and Innovation programme from 2020 to 2023 (Grant Agreement 848031). The protocol of Magnet4Europe is registered in the ISRCTN registry (ISRCTN10196901).
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Affiliation(s)
- Dorothea Kohnen
- Research Group Work, Organizational, and Personnel Psychology, KU Leuven, Leuven, Belgium.
- KU Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.
| | - Hans De Witte
- Research Group Work, Organizational, and Personnel Psychology, KU Leuven, Leuven, Belgium
- Optentia Research Unit, North-West University, Vanderbijlpark, South Africa
| | - Wilmar B Schaufeli
- Research Group Work, Organizational, and Personnel Psychology, KU Leuven, Leuven, Belgium
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Simon Dello
- KU Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Luk Bruyneel
- KU Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Walter Sermeus
- KU Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
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Kohnen D, De Witte H, Schaufeli WB, Dello S, Bruyneel L, Sermeus W. What makes nurses flourish at work? How the perceived clinical work environment relates to nurse motivation and well-being: A cross-sectional study. Int J Nurs Stud 2023; 148:104567. [PMID: 37837704 DOI: 10.1016/j.ijnurstu.2023.104567] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 06/14/2023] [Accepted: 07/17/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Literature shows that the work environment is a main determinant of nurses' well-being and psychological strain; yet, the (psychological) mechanisms underlying this relationship remain understudied. OBJECTIVE This study explored the underlying (psychological) mechanisms (why) and boundary conditions (when) by which characteristics present in the clinical work environment influence nurses' well-being. We investigated the mediating role of intrinsic motivation in the relationship of job demands and job resources with burnout vs. work engagement. In addition, we examined if job resources strengthen the relationship of job demands with intrinsic motivation and burnout. DESIGN A cross-sectional survey study. SETTING(S) General acute care hospitals in Belgium (n = 14). PARTICIPANTS Direct care nurses (n = 1729). METHODS Data were collected by means of online questionnaires between October 2020 and July 2021. Study variables included burnout, work engagement, intrinsic motivation and a set of different job demands (workload, role conflicts, emotional demands, red tape) and job resources (performance feedback, autonomy, skill use, opportunity for growth, and value congruence). All variables were obtained using self-report measures. The central hypotheses were tested using structural equation modeling. RESULTS Job resources appeared to be a crucial factor for nurses' health showing positive associations with work motivation (β = 0.513) and work engagement (β = 0.462) and negative associations with burnout (β = -0.216). Job demands remained an essential factor that harms psychological health and is associated with increased burnout (β = 0.489). Our results confirmed that intrinsic motivation mediated the relationship of job resources with work engagement (β = 0.170) and burnout (β = -0.135). In addition, job resources moderated the relationship of job demands with burnout (β = -0.039). Against our expectations, we found no associations between job demands and intrinsic motivation or a moderation effect of job resources on the respective relationship. CONCLUSIONS A highly demanding work environment can be a source of significant stress which may put nurses' health at severe risk. Nurses who perceive sufficient job resources such as feedback, autonomy and opportunities for growth and development, are likely to feel intrinsically motivated at work. In addition, it will foster their work engagement and prevent them from burning out, particularly when job demands are high. REGISTRATION The study described herein is funded under the European Union's Horizon 2020 Research and Innovation program from 2020 to 2023 (Grant Agreement 848031). The protocol of Magnet4Europe is registered in the ISRCTN registry (ISRCTN10196901). TWEETABLE ABSTRACT Providing nurses with sufficient resources will not only increase their motivation and engagement at work but also reduce their feelings of burnout.
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Affiliation(s)
- Dorothea Kohnen
- Research Group Work, Organizational, and Personnel Psychology, KU Leuven, Leuven, Belgium; KU Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.
| | - Hans De Witte
- Research Group Work, Organizational, and Personnel Psychology, KU Leuven, Leuven, Belgium; Optentia Research Unit, North-West University, South Africa
| | - Wilmar B Schaufeli
- Research Group Work, Organizational, and Personnel Psychology, KU Leuven, Leuven, Belgium; Department of Psychology, Utrecht University, Utrecht, the Netherlands. https://twitter.com/WilmarSchaufeli
| | - Simon Dello
- KU Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Luk Bruyneel
- KU Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Walter Sermeus
- KU Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
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Palese A, Chiappinotto S, Bayram A, Sermeus W, Suhonen R, Papastavrou E. Exploring unfinished nursing care among nursing students: a discussion paper. BMC Nurs 2023; 22:272. [PMID: 37596561 PMCID: PMC10436392 DOI: 10.1186/s12912-023-01445-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/10/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND In line with the impetus traceable among the nursing staff, studies regarding the perception of Unfinished Care among students have increased in recent years as also recommended by some policy documents in the consideration that, as future members of the staff, they are expected to raise concerns about failures in the standards of care. However, no discussion of their methodological requirements has been provided to date. The aim of this study is to debate Unfinished Care explorations among nursing students and developing recommendations. METHODS A Rapid Review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, followed by a scientific discussion based on empirical evidence that emerged from the review combined with expert knowledge. Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases were searched up to May 2022. RESULTS In the last five years, seven studies have been conducted by researchers affiliated at the university level, involving from 18 to 737 undergraduate students across Europe. By critically analysing their key aspects, there are derived some recommendations in conducting investigations in this field as, (a) the hidden meaning of Unfinished Care investigations among students by also deciding which concept is mostly appropriate to investigate; (b) the need of establishing alliances with the clinical settings in order to involve them in such explorations; (c) more complex research methods capable of exploring this issue among students by promoting learning outcomes and not only a simple data collection; and (e) the influences of these explorations on students' wellbeing, as well as on ethical implications and that regarding the relationship between the healthcare services and the universities. CONCLUSION Policymakers consider students to be key informants of the quality of nursing care issues witnessed during their clinical placements. The related emerging line of research is intriguing because of the underlying methodological, ethical and system complexities that need to be addressed according to some considerations.
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Affiliation(s)
- Alvisa Palese
- Department of Medical Science, University of Udine, Udine, Italy.
| | | | - Aysun Bayram
- Faculty of Health Sciences, Karadeniz Technical University, Trabzon, Turkey
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium
| | - Riitta Suhonen
- Department of Nursing Science, University of Turku and Turku University Hospital, Turku, Finland
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Maier CB, Köppen J, Kleine J, McHugh MD, Sermeus W, Aiken LH. Recruiting and retaining bachelor qualified nurses in German hospitals (BSN4Hospital): protocol of a mixed-methods design. BMJ Open 2023; 13:e073879. [PMID: 37562928 PMCID: PMC10423778 DOI: 10.1136/bmjopen-2023-073879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/23/2023] [Indexed: 08/12/2023] Open
Abstract
INTRODUCTION Many countries in Europe are facing a shortage of nurses and seek effective recruitment and retention strategies. The nursing workforce is increasingly diverse in its educational background, ranging from 3-year vocational training (diploma) to bachelor and master educated nurses. This study analyses recruitment and retention strategies for academically educated nurses (minimum bachelor), including intention to leave, job satisfaction and work engagement compared with diploma nurses in innovative German hospitals; it explores recruitment and retention challenges and opportunities, and identifies lessons on recruitment and retention taking an international perspective. METHODS AND ANALYSIS The study will apply a convergent mixed-methods design, including qualitative and quantitative methods. The qualitative study will include semistructured interviews among hospital managers, nurses, students and stakeholders in Germany. In addition, expert interviews will be conducted internationally in countries with a higher proportion of bachelor/master nurses in hospitals. The quantitative, cross-sectional study will consist of a survey among professional nurses (bachelor/master, diploma nurses) in German hospitals. Study settings are hospitals with a higher-than-average proportion of bachelor nurses or relevant recruitment, work environment or retention strategies in place. Analyses will be conducted in several phases, first in parallel, then combined via triangulation: the parallel analysis technique will analyse the qualitative and quantitative data separately via content analyses (interviews) and descriptive, bivariate and multivariate analyses (survey). Subsequently, data sources will be collectively analysed via a triangulation matrix focusing on developing thematic exploratory clusters at three systemic levels: microlevel, mesolevel and macrolevel. The analyses will be relevant for generating lessons for clinical nursing, management and policy in Germany and internationally. ETHICS AND DISSEMINATION Ethics approval was obtained by the Charité Ethics Committee.Several dissemination channels will be used, including publications and presentations, for the scientific community, nursing management, clinical nurses and the wider public in Germany and internationally.
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Affiliation(s)
- Claudia B Maier
- Department of Healthcare Management, Technische Universität Berlin, Berlin, Germany
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Julia Köppen
- Department of Healthcare Management, Technische Universität Berlin, Berlin, Germany
| | - Joan Kleine
- Department of Healthcare Management, Technische Universität Berlin, Berlin, Germany
| | - Matthew D McHugh
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Walter Sermeus
- Institute for Healthcare Policy, KU Leuven, Leuven, Vlaams Brabant, Belgium
| | - Linda H Aiken
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Skela-Savič B, Sermeus W, Dello S, Squires A, Bahun M, Lobe B. How nurses' job characteristics affect their self-assessed work environment in hospitals- Slovenian use of the practice environment scale of the nursing work index. BMC Nurs 2023; 22:100. [PMID: 37024874 PMCID: PMC10077322 DOI: 10.1186/s12912-023-01261-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 03/22/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Nurses' work environment influences nursing practice. Inappropriate working conditions are the result of underdeveloped workplace infrastructure, poor work organisation, inadequate education, and inappropriate staffing norms. The aim of this study was to describe and examine the predictors that affect nurses' work environment using the Practice Environment Scale of the Nursing Work Index (PES-NWI). METHODS The validation of the PES-NWI was made. Nurse-reported job characteristics were used as independent variables. The sample included 1,010 nurses from adult surgical and medical units at 10 Slovenian hospitals. The Nurse Forecasting (RN4CAST) protocol was used. Permission to conduct the study was obtained from the National Medical Ethics Committee. RESULTS The PES-NWI mean (2.64) was low, as were job and career satisfaction at 2.96 and 2.89, respectively. The PES-NWI can be explained in 48% with 'Opportunities for advancement', 'Educational opportunities', 'Satisfaction with current job', 'Professional status', 'Study leave', and 'Level of education'. A three-factor solution of PES-NWI yielded eight distinct variables. CONCLUSIONS The obtained average on the Nursing Work Index was one of the lowest among previously conducted surveys. Nurses should be recognized as equals in the healthcare workforce who need to be empowered to develop the profession and have career development opportunities. Inter-professional relations and equal involvement of nurses in hospital affairs are also very important. TRIAL REGISTRATION This is a non-intervention study - retrospectively registered.
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Affiliation(s)
- Brigita Skela-Savič
- Angela Boškin Faculty of Health Care, Spodnji Plavž 3, Jesenice, 4270, Slovenia.
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, Department of Public Health & Primary Care, Katholieke Universiteit Leuven, Kapucijnenvoer 35/4, Leuven, 3000, Belgium
| | - Simon Dello
- Leuven Institute for Healthcare Policy, Department of Public Health & Primary Care, Katholieke Universiteit Leuven, Kapucijnenvoer 35/4, Leuven, 3000, Belgium
| | - Allison Squires
- Dept. of General Internal Medicine, Grossman School of Medicine, Meyers College of Nursing, New York University, New York, USA
| | - Mateja Bahun
- Angela Boškin Faculty of Health Care, Spodnji Plavž 3, Jesenice, 4270, Slovenia
| | - Bojana Lobe
- Faculty of Social Sciences, University of Ljubljana, Kardeljeva ploščad 5, Ljubljana, 1000, Slovenia
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Van den Heede K, Balcaen K, Bouckaert N, Bruyneel L, Cornelis J, Sermeus W, Van de Voorde C. Improving hospital nurse staffing during the pandemic: Implementation of the 2019 Fund for Health Care Staff in Belgium. Health Policy 2023; 128:69-74. [PMID: 36462953 PMCID: PMC9701585 DOI: 10.1016/j.healthpol.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 10/08/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
Chronic hospital nurse understaffing is a pre-existing condition of the COVID-19 pandemic. With nurses on the frontline against the pandemic, safe nurse staffing in hospitals is high on the political agenda of the responsible ministers of Health. This paper presents a recent Belgian policy reform to improve nurse staffing levels. Although the reform was initiated before the pandemic, its roll-out took place from 2020 onwards. Through a substantial increase of the hospital budget, policy makers envisaged to improve patient-to-nurse ratios. Yet, this ambition was considerably toned down during the implementation. Due to a shortage of nurses in the labour market, hospital associations successfully lobbied to allocate part of the budget to hire non-nursing staff. Moreover, other healthcare settings claimed their share of the pie. Elements of international best-practice examples such as ward managers supernumerary to the team and increasing the transparency on staffing decisions were adopted. Other measures, such as mandated patient-to-nurse ratios, nurse staffing committees, or the monitoring or public reporting of ratios, were not retained. Additional measures were taken to safeguard that bedside staffing levels would improve, such as the requirement to demonstrate a net increase in staff to obtain additional budget, staffing plan's approval by local work councils and recommendation to base staff allocation on patient acuity measures. This policy process makes clear that the engagement of budgets is only a first step towards safe staffing levels, which needs to be embedded in a comprehensive policy plan. Future evaluation of bedside nurse staffing levels and nurse wellbeing is needed to conclude about the effectiveness of these measures and the intended and unintended effects they provoked.
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Affiliation(s)
- Koen Van den Heede
- Belgian Healthcare Knowledge Centre (KCE), Kruidtuinlaan 55, 1000 Brussels, Belgium,Leuven Institute for Healthcare Policy ... Katholieke Universiteit Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium,Corresponding author at: KCE Belgian Health Care Knowledge Centre: Federaal Kenniscentrum voor de Gezondheidszorg, Kruidtuinlaan 55 doorbuilding 9th… 1000 Brussels, Belgium
| | - Koen Balcaen
- University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Nicolas Bouckaert
- Belgian Healthcare Knowledge Centre (KCE), Kruidtuinlaan 55, 1000 Brussels, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy ... Katholieke Universiteit Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium
| | - Justien Cornelis
- Belgian Healthcare Knowledge Centre (KCE), Kruidtuinlaan 55, 1000 Brussels, Belgium
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy ... Katholieke Universiteit Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium
| | - Carine Van de Voorde
- Belgian Healthcare Knowledge Centre (KCE), Kruidtuinlaan 55, 1000 Brussels, Belgium
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Sermeus W, Aiken LH, Ball J, Bridges J, Bruyneel L, Busse R, De Witte H, Dello S, Drennan J, Eriksson LE, Griffiths P, Kohnen D, Köppen J, Lindqvist R, Maier CB, McHugh MD, McKee M, Rafferty AM, Schaufeli WB, Sloane DM, Alenius LS, Smith H. A workplace organisational intervention to improve hospital nurses' and physicians' mental health: study protocol for the Magnet4Europe wait list cluster randomised controlled trial. BMJ Open 2022; 12:e059159. [PMID: 35902190 PMCID: PMC9341186 DOI: 10.1136/bmjopen-2021-059159] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The increasing burden of mental distress reported by healthcare professionals is a matter of serious concern and there is a growing recognition of the role of the workplace in creating this problem. Magnet hospitals, a model shown to attract and retain staff in US research, creates positive work environments that aim to support the well-being of healthcare professionals. METHODS AND ANALYSIS Magnet4Europe is a cluster randomised controlled trial, with wait list controls, designed to evaluate the effects of organisational redesign, based on the Magnet model, on nurses' and physicians' well-being in general acute care hospitals, using a multicomponent implementation strategy. The study will be conducted in more than 60 general acute care hospitals in Belgium, England, Germany, Ireland, Norway and Sweden. The primary outcome is burnout among nurses and physicians, assessed in longitudinal surveys of nurses and physicians at participating hospitals. Additional data will be collected from them on perceived work environments, patient safety and patient quality of care and will be triangulated with data from medical records, including case mix-adjusted in-hospital mortality. The process of implementation will be evaluated using qualitative data from focus group and key informant interviews. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee Research UZ/KU Leuven, Belgium; additionally, ethics approval is obtained in all other participating countries either through a central or decentral authority. Findings will be disseminated at conferences, through peer-reviewed manuscripts and via social media. TRIAL REGISTRATION NUMBER ISRCTN10196901.
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Affiliation(s)
- Walter Sermeus
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
| | - Linda H Aiken
- Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jane Ball
- Faculty of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Jackie Bridges
- Faculty of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Luk Bruyneel
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
| | - Reinhard Busse
- Department of Healthcare Management, Technical University of Berlin, Berlin, Germany
| | - Hans De Witte
- Occupational & Organisational Psychology and Professional Learning, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
- Optentia Research Unit, North-West University, Potchefstroom, South Africa
| | - Simon Dello
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
| | - Jonathan Drennan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Lars E Eriksson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Peter Griffiths
- Faculty of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Dorothea Kohnen
- Occupational & Organisational Psychology and Professional Learning, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
| | - Julia Köppen
- Department of Healthcare Management, Technical University of Berlin, Berlin, Germany
| | - Rikard Lindqvist
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Claudia Bettina Maier
- Department of Healthcare Management, Technical University of Berlin, Berlin, Germany
| | - Matthew D McHugh
- Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Wilmar B Schaufeli
- Occupational & Organisational Psychology and Professional Learning, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Douglas M Sloane
- Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa Smeds Alenius
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Herbert Smith
- Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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10
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Seys D, Coeckelberghs E, Sermeus W, Van Zelm R, Panella M, Babu Payedimarri A, Vanhaecht K. Overview on the target population and methods used in care pathway projects: A narrative review. Int J Clin Pract 2021; 75:e14565. [PMID: 34165865 DOI: 10.1111/ijcp.14565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/23/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND There is evidence that the efficiency and effectiveness of care processes can be improved in all countries. Care pathways (CPs) are proposed as a method to improve the quality of care by reducing variation. During the last decades, CPs have been intensively used in practice. The objective of this study is to examine the study designs for investigating CPs, for which pathologies CPs are used and what the reported indicators to measure the impact of CPs are. METHODS A narrative review of the literature published from 2015 to 2019 was performed. RESULTS We identified 286 studies, of which 207 evaluated the impact of CPs, 33 were review articles, 29 studies described the development of a CP, 12 were study protocols and 5 opinion papers. The most frequently reported study design for studying the impact of a CP is pre-posttest (n = 82), followed by cross-sectional studies (n = 50). Oncology, cardiovascular disease and abdominal surgery are the domains with the highest numbers of studies evaluating the impact of CPs. Financial (n = 86), process (n = 76) and clinical indicators (n = 74) are the most frequently reported indicators while service (n = 12) and team indicators (n = 6) are less reported. CONCLUSIONS Based on the relative low number of identified studies compared with the number of CP projects in organisations, we conclude that the CP knowledge is not only found in the literature. We, therefore, argue that (inter)national scientific societies should not only focus on searching and spreading evidence on the content of care but also enhance their knowledge sharing initiatives on the organisation of care processes.
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Affiliation(s)
- Deborah Seys
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
| | - Ellen Coeckelberghs
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
| | - Ruben Van Zelm
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
| | - Massimiliano Panella
- Department of Translational Medicine, University of Eastern Piedmont Amedeo Avogadro, Novara, Italy
| | - Anil Babu Payedimarri
- Department of Translational Medicine, University of Eastern Piedmont Amedeo Avogadro, Novara, Italy
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
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11
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Plazier M, Raymaekers V, Bruyneel L, Coeckelberghs E, Sermeus W, Vanhaecht K, Duyvendak W. A 15-Year Follow-up Retrospective Study on 959 Spine Surgeries: What Can We Learn From Real-world Data? Clin Spine Surg 2021; 34:E282-E288. [PMID: 33560014 DOI: 10.1097/bsd.0000000000001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 11/07/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective study. OBJECTIVE The aim of this study was to investigate the patient flow and need for additional surgery after first-time lower back surgery. Next, we analyzed the patients who developed chronic low back pain (LBP) and were treated with spinal cord stimulation. SUMMARY OF BACKGROUND DATA LBP has a lifetime prevalence of 84% and imposes a high economic burden. Treatment is focused on preventing chronic pain. Research has shown the efficacy of treatment options. However, less is known about who benefits the most from which therapy and when they should be positioned in the treatment algorithm. METHODS In this retrospective study, data of all patients who underwent first-time surgery from 2000 to 2004 were included. After 10-15 years, patients were contacted about their quality of life (QoL) (EuroQoL-5 Dimension) and life and heath perception (EuroQoL Visual Analogue Scale). RESULTS In all, 959 patients underwent surgery at the lower back area. Follow-up time ranged from 13 to 17 years; 225 patients (23.5%) underwent a second surgery. In total, 20 patients (2.1%) developed chronic neuropathic back pain and received spinal cord stimulation therapy. Ten years postsurgery, 438 (45.7%) patients completed the QoL and LBP questionnaires. The health-related QoL and health situation were significantly lower in patients with multiple surgeries ( P <0.001). CONCLUSIONS The study results indicate that large data sets, with multiple outcome measurements and long-term follow-up are necessary to improve our knowledge and to optimize the therapeutic pathway. In that way, we might learn how to select a patient for the right treatment or treatments at the right moment and shorten the circulation in our health care system.
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Affiliation(s)
- Mark Plazier
- Department of Neurosurgery, Jessa Hospital
- Neurosurgery Study & Training Center Virga Jesse
- Faculty of Medicine and Life Science, Hasselt University, Hasselt
| | | | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | | | - Walter Sermeus
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Wim Duyvendak
- Department of Neurosurgery, Jessa Hospital
- Neurosurgery Study & Training Center Virga Jesse
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12
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Palese A, Papastavrou E, Sermeus W. Challenges and opportunities in health care and nursing management research in times of COVID-19 outbreak. J Nurs Manag 2021; 29:1351-1355. [PMID: 33710710 PMCID: PMC8250042 DOI: 10.1111/jonm.13299] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 12/20/2022]
Abstract
Aim To reflect upon the concrete implications of the COVID‐19 outbreak regarding ongoing health service and nursing management research (NMR) and to identify possible research priorities for the current and post‐pandemic era. Background Health service research and the nursing management research debate have received little attention to date, despite their relevance in responding to the increased demand of care during the COVID‐19 outbreak. Methods A critical analysis on experiences was performed while leading international‐funded studies at different degrees of complexity and targets, involving nurse managers, nurses, care processes and health care services in the last year. Results Ongoing research projects have been profoundly affected by the COVID‐19 outbreak in their aims, methods, management processes, feasibility and outcomes. Conclusions The COVID‐19 outbreak is an unprecedented stress test for the health care sector and for the nursing services. Its onset and persistence have rendered more easily to see what prevails in terms of effectiveness and what fails in our health care services. Implications for Nursing Management Nurse managers have lived and are still living through this crisis, given their omnipresence in the health care systems. Therefore, setting NMR priorities and working together to imagine and design the post‐COVID‐19 era is essential.
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Affiliation(s)
- Alvisa Palese
- Department of Medical Sciences, School of Nursing, Udine University, Udine, Italy
| | | | - Walter Sermeus
- KU Leuven Institute for Healthcare Policy, Leuven, Belgium
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13
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van Zelm R, Coeckelberghs E, Sermeus W, Wolthuis A, Bruyneel L, Panella M, Vanhaecht K. A mixed methods multiple case study to evaluate the implementation of a care pathway for colorectal cancer surgery using extended normalization process theory. BMC Health Serv Res 2021; 21:11. [PMID: 33397382 PMCID: PMC7784254 DOI: 10.1186/s12913-020-06011-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 12/10/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Specific factors that facilitate or prevent the implementation of enhanced recovery protocols for colorectal cancer surgery have been described in previous qualitative studies. This study aims to perform a concurrent qualitative and quantitative evaluation of factors associated with successful implementation of a care pathway (CP) for patients undergoing surgery for colorectal cancer. METHODS This comparative mixed methods multiple case study was based on a sample of 10 hospitals in 4 European countries that implemented a specific CP and performed pre- and post-implementation measurements. In-depth post-implementation interviews were conducted with healthcare professionals who were directly involved. Primary outcomes included protocol adherence and improvement rate. Secondary outcomes included length of stay (LOS) and self-rated protocol adherence. The hospitals were ranked based on these quantitative findings, and those with the highest and lowest scores were included in this study. Qualitative data were summarized on a per-case basis using extended Normalization Process Theory (eNPT) as theoretical framework. The data were then combined and analyzed using joint display methodology. RESULTS Data from 381 patients and 30 healthcare professionals were included. Mean protocol adherence rate increased from 56 to 62% and mean LOS decreased by 2.1 days. Both measures varied greatly between hospitals. The two highest-ranking hospitals and the three lowest-ranking hospitals were included as cases. Factors which could explain the differences in pre- and post-implementation performance included the degree to which the CP was integrated into daily practice, the level of experience and support for CP methodology provided to the improvement team, the intrinsic motivation of the team, shared goals and the degree of management support, alignment of CP development and hospital strategy, and participation of relevant disciplines, most notably, physicians. CONCLUSIONS Overall improvement was achieved but was highly variable among the 5 hospitals evaluated. Specific factors involved in the implementation process that may be contributing to these differences were conceptualized using eNPT. Multidisciplinary teams intending to implement a CP should invest in shared goals and teamwork and focus on integration of the CP into daily processes. Support from hospital management directed specifically at quality improvement including audit may likewise facilitate the implementation process. TRIAL REGISTRATION NCT02965794 . US National Library of Medicine, ClinicalTrials.gov . Registered 4 August 2014.
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Affiliation(s)
- R van Zelm
- Leuven Institute for Healthcare Policy, Katholieke Universiteit Leuven, Leuven, Belgium.
| | - E Coeckelberghs
- Leuven Institute for Healthcare Policy, Katholieke Universiteit Leuven, Leuven, Belgium
| | - W Sermeus
- Depertment of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - A Wolthuis
- Depertment of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - L Bruyneel
- Leuven Institute for Healthcare Policy, Katholieke Universiteit Leuven, Leuven, Belgium
| | - M Panella
- Department of Translational Medicine, University of Eastern Piemonte (UPO), Novarra, Italy
| | - K Vanhaecht
- Leuven Institute for Healthcare Policy, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Quality, Academic Policy Advisor, University Hospital Leuven, Leuven, Belgium
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14
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van Zelm R, Coeckelberghs E, Aeyels D, Sermeus W, Wolthuis A, Panella M, Vanhaecht K. Qualitative Evaluation of the Implementation of a Care Pathway for Colorectal Cancer Surgery. Qual Health Res 2021; 31:241-253. [PMID: 33106115 DOI: 10.1177/1049732320965188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Colorectal cancer care can be standardized by using enhanced recovery protocols. However, adherence to these protocols varies. Using Medical Research Council (MRC) guidance on process evaluations, we examined the experience of health care professionals in the implementation of a care pathway for colorectal surgery, by describing the intervention, context, implementation, mechanisms, and outcomes. Based on data from semi-structured interviews, we divided respondents into two groups: those who perceived positive outcomes of the implementation and those who perceived no effect. Respondents who perceived positive outcomes reported clinical leadership, use of feedback, positive effects of standardization, and teamwork as factors contributing to positive perceived outcomes. Respondents who perceived no effect reported a lack of organizational support, as well as challenging collaboration and standardization as mechanisms potentially explaining the poorer perception of outcomes. Multiple implementation activities were used, focusing on competence, behavior, or workplace. Our findings suggest that feedback is an important implementation activity.
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Affiliation(s)
- Ruben van Zelm
- KU Leuven, Leuven, Belgium
- European Pathway Association, Leuven, Belgium
| | | | | | - Walter Sermeus
- KU Leuven, Leuven, Belgium
- European Pathway Association, Leuven, Belgium
| | - Albert Wolthuis
- KU Leuven, Leuven, Belgium
- University Hospital Leuven, Leuven, Belgium
| | - Massimiliano Panella
- European Pathway Association, Leuven, Belgium
- University of Eastern Piemonte, Novarra, Italy
| | - Kris Vanhaecht
- KU Leuven, Leuven, Belgium
- European Pathway Association, Leuven, Belgium
- University Hospital Leuven, Leuven, Belgium
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15
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Castro EM, Van Regenmortel T, Vanhaecht K, Sermeus W, Kiekens C, Claes K, Bruyneel L. Effect of an intervention on the congruence of nurses' and patients' perceptions of patient-centred care: A pre-test post-test study. J Eval Clin Pract 2020; 26:1648-1656. [PMID: 31919973 DOI: 10.1111/jep.13348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To evaluate measurement invariance of the Individualized Care Scale (ICS) across patients and nurses, and assess the degree of congruence in nurses' and patients' perceptions on patient-centredness and the impact of an intervention there on. METHODS A pre-post intervention study design with an expert by experience intervention was conducted in 2016 to 2017. Nurses (n = 138) and patients (n = 199) of two hospital departments in Belgium were surveyed. Patient-centredness was measured using the ICS (ICS-Nurse and ICS-Patient). Measurement invariance was evaluated by conducting multiple-group confirmatory factor analysis. Unpaired t tests and difference in difference analysis were used to evaluate the degree of congruence in nurses' and patients' perceptions on patient-centredness and assess pre-post changes in nurses' and patients' scores, respectively. SQUIRE guidelines were followed to report the study. RESULTS There was no evidence of measurement non-invariance. Nurses perceived the individuality of care more positively than patients both before and after the implementation of the intervention. Pre-post changes in nurses' and patients' scores were not statistically significant. CONCLUSION There is a significant gap between the perceptions of nurses and patients regarding the support and provision of individual care: nurses consider provided care as more individualized than patients do. To orient nurses' perspectives more towards their patients' perspective, multicomponent interventions are needed. Researchers and hospital managers may use the ICS to evaluate interventions that have the ability to close the gap in nurses' and patients' perceptions of patient-centredness. Embedding experts by experience in the professionals' team has the potential to foster patient-centredness but needs to focus on patients and nurses equally.
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Affiliation(s)
- Eva M Castro
- Faculty of Social Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Tine Van Regenmortel
- Faculty of Social Sciences, KU Leuven-University of Leuven, Leuven, Belgium.,Tilburg School of Social and Behavioral Sciences, Tilburg University, Tranzo, Netherlands
| | - Kris Vanhaecht
- Department of Public Health & Primary Care, Institute for Healthcare Policy, KU Leuven-University of Leuven, Leuven, Belgium.,Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - Walter Sermeus
- Department of Public Health & Primary Care, Institute for Healthcare Policy, KU Leuven-University of Leuven, Leuven, Belgium
| | - Carlotte Kiekens
- Department of Development and Regeneration, KU Leuven-University of Leuven, Leuven, Belgium.,Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Kathleen Claes
- Faculty of Medicine, Laboratory of Nephrology, Department of Microbiology & Immunology, KU Leuven-University of Leuven, Leuven, Belgium.,Department of Nephrology, Dialysis and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Luk Bruyneel
- Department of Public Health & Primary Care, Institute for Healthcare Policy, KU Leuven-University of Leuven, Leuven, Belgium.,Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
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16
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Palese A, Navone E, Danielis M, Vryonides S, Sermeus W, Papastavrou E. Measurement tools used to assess unfinished nursing care: A systematic review of psychometric properties. J Adv Nurs 2020; 77:565-582. [PMID: 33074561 DOI: 10.1111/jan.14603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 08/17/2020] [Accepted: 09/07/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Different tools have been developed and validated to measure unfinished nursing care. However, no systematic review of the psychometric properties has been performed describing the quality of the methods used to estimate their validity. AIMS (a) To identify tools measuring unfinished nursing care that have undergone validation processes; (b) to evaluate critically the quality of the methods used in ascertaining their psychometric properties; and (c) to compare the estimated psychometric properties of these tools. DESIGN A systematic review of the psychometric properties also evaluating their methodological quality was performed by following the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) guideline for systematic reviews. DATA SOURCES The databases Medline, the Cumulative Index to Nursing and Allied Health Literature, PubMed, Google and Google Scholar were searched up to 30 June 2018. REVIEW METHODS Data extraction was performed following the predetermined eligibility criteria. Eight properties and their methodological quality were assessed using the COnsensus-based Standards for the selection of health Measurement INstruments criteria. RESULTS A total of 20 studies reported validation data regarding three family of tools: the Missed Care Survey (MISSCARE), the Basal Extent of Rationing of Nursing Care (BERNCA) and the Task Undone scale (TU-7). The most estimated psychometric properties across studies were internal consistency, followed by structural validity, content validity, and cross-cultural validity. The less evaluated psychometric properties were reliability, hypothesis testing and convergent and criterion validity. CONCLUSION The psychometric properties of the investigated tools showed a more than acceptable quality, as did the methodologies used to estimate these properties. IMPACT The MISSCARE survey is the most widely used tool validated across countries to date. Evaluating the concurrent reliability of the tools available is strongly recommended to assess their effectiveness in measuring the same phenomenon.
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Affiliation(s)
- Alvisa Palese
- Department of Medical Sciences, School of Nursing, Udine University, Udine, Italy
| | - Elena Navone
- Department of Medical Sciences, School of Nursing, Udine University, Udine, Italy
| | - Matteo Danielis
- Department of Medical Sciences, School of Nursing, Udine University, Udine, Italy
| | - Stavros Vryonides
- Department of Nursing, Cyprus University of Technology, Limassol, Cyprus
| | - Walter Sermeus
- KU Leuven Institute for Healthcare Policy, Leuven, Belgium
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17
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Goderis G, Colman E, Irusta LA, Van Hecke A, Pétré B, Devroey D, Van Deun E, Faes K, Charlier N, Verhaeghe N, Remmen R, Anthierens S, Sermeus W, Macq J. Evaluating Large-Scale Integrated Care Projects: The Development of a Protocol for a Mixed Methods Realist Evaluation Study in Belgium. Int J Integr Care 2020; 20:12. [PMID: 33024426 PMCID: PMC7518071 DOI: 10.5334/ijic.5435] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 07/29/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The twelve Integrated Care Program pilot projects (ICPs) created by the government plan 'Integrated Care for Better Health' aim to achieve four outcome types (the Quadruple Aim) for people with chronic diseases in Belgium: improved population health, improved patient and provider experiences and improved cost efficiency. The aim of this article is to present the development of a mixed methods realist evaluation of this large-scale, whole system change programme. METHODS A scientific team was commissioned to co-design and implement an evaluation protocol in close collaboration with the government, the ICPs and several other involved stakeholders. RESULTS A protocol for a mixed methods realist evaluation was developed to gain insights into the mechanisms that foster successful results in ICPs. The qualitative evaluation proposed will be based on the document analysis of yearly ICP progress reports, selected case studies and focus group interviews with stakeholders. Processes and outcomes of all the projects will be monitored using indicators based on administrative data on population health and the quality and costs of care. A yearly survey will be organized to collect data on patient-reported outcomes and experiences and on provider-reported measures of inter-professional collaboration and proper wellbeing. Using both quantitative and qualitative data, we will develop theories about the mechanisms and the associated contextual factors that lead to integrated care and the Quadruple Aim outcomes. DISCUSSION The objective of this study is to deliver policy recommendations on strategies and best practices to improve care integration in Belgium and to implement a sustainable monitoring system that serves both policy makers and the stakeholders within the ICPs. Some challenges due to the large scale of the project and the multiple stakeholders involved may impede the successful implementation of this proposal.
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Affiliation(s)
- Geert Goderis
- Academic Center of General Practice, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer Leuven, BE
| | - Elien Colman
- Department of Primary and Interdisciplinary Care (ELIZA)—Centre for General Practice, Faculty of Medicine and Health Sciences, University of Antwerp, Doornstraat Antwerp, BE
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, BE
- Department of Nursing, Ghent University Hospital, Ghent, BE
| | - Lucia Alvarez Irusta
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos chapelle aux champs Brussels, BE
| | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, BE
- Department of Nursing, Ghent University Hospital, Ghent, BE
| | - Benoit Pétré
- Public Health Department, University of Liege, Quartier Hôpital, Avenue Hippocrate, Liège, BE
| | - Dirk Devroey
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, BE
| | | | - Kristof Faes
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, BE
| | - Nathan Charlier
- Public Health Department, University of Liege, Quartier Hôpital, Avenue Hippocrate, Liège, BE
| | - Nick Verhaeghe
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, BE
- Research Group Social and Economic Policy and Social Inclusion, KU Leuven, Parkstraat, Leuven, BE
| | - Roy Remmen
- Department of Primary and Interdisciplinary Care (ELIZA)—Centre for General Practice, Faculty of Medicine and Health Sciences, University of Antwerp, Doornstraat Antwerp, BE
| | - Sibyl Anthierens
- Department of Primary and Interdisciplinary Care (ELIZA)—Centre for General Practice, Faculty of Medicine and Health Sciences, University of Antwerp, Doornstraat Antwerp, BE
| | | | - Jean Macq
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos chapelle aux champs Brussels, BE
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18
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Bagnasco A, Catania G, Zanini M, Dasso N, Rossi S, Aleo G, Timmins F, Sermeus W, Aiken LH, Sasso L. Are data on missed nursing care useful for nursing leaders? The RN4CAST@IT cross-sectional study. J Nurs Manag 2020; 28:2136-2145. [PMID: 32881131 DOI: 10.1111/jonm.13139] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/04/2020] [Accepted: 08/20/2020] [Indexed: 11/30/2022]
Abstract
AIM To describe nurses' reported missed nursing care activities among hospitalized adult patients medical and surgical wards and explore gaps in service provision. BACKGROUND In 2015, Italy replicated the RN4CAST study, which heralded the exposition of missed care as an international phenomenon. In Italy, nurse-patient workload is high, with high levels of burnout and dissatisfaction reported, all factors associated with missed care. METHODS A cross-sectional study (n = 3,590) was conducted using the 13-item online Task Left Undone Tool aimed at collecting data on missed nursing care. RESULTS The frequency of omission of activities ranged between 7% and 50%. There were significant differences between morning, afternoon and night shifts and the various clinical settings. Oral care was the most frequently missed care activity. CONCLUSIONS This study takes step forward in identifying and reducing missed care on medical and surgical wards, both in Italy and also internationally, which needs to take into account the specific organisational characteristics of each setting. IMPLICATIONS FOR NURSING MANAGEMENT Although more essential activities are missed less frequently, much is known about the relational deficits such as information giving, education, communication and discharge advice, which managers ought to spearhead through local initiatives to improve these practices.
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Affiliation(s)
- Annamaria Bagnasco
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
| | - Gianluca Catania
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
| | - Milko Zanini
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
| | - Nicoletta Dasso
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
| | - Silvia Rossi
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
| | - Giuseppe Aleo
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
| | - Fiona Timmins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Walter Sermeus
- Department of Public Health & Primary Care, KU Leuven, Leuven, Belgium
| | - Linda H Aiken
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Loredana Sasso
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
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19
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Van den Heede K, Cornelis J, Bouckaert N, Bruyneel L, Van de Voorde C, Sermeus W. Safe nurse staffing policies for hospitals in England, Ireland, California, Victoria and Queensland: A discussion paper. Health Policy 2020; 124:1064-1073. [PMID: 32888754 DOI: 10.1016/j.healthpol.2020.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/06/2020] [Accepted: 08/12/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The association between higher registered nurses (RN) staffing (educational level and number) and better patient and nurse outcomes is well-documented. This discussion paper aims to provide an overview of safe staffing policies in various high-income countries to identify reform trends in response to recurring nurse workforce challenges. METHODS Based on a scan of the literature five cases were selected: England (UK), Ireland, California (USA), Victoria and Queensland (Australia). Information was gathered via a review of the grey and peer-reviewed literature. Country experts were consulted for additional information and to review country reports. RESULTS The focus of safe staffing policies varies: increasing transparency about staffing decisions (England), matching actual and required staffing levels based on patient acuity measurement (Ireland), mandated patient-to-nurse ratios at the level of the nurse (California) or the ward (Victoria, Queensland). Calibration of the number of patients by the number of nurses varies across cases. Nevertheless, positive effects on the nursing workforce (increased bedside staffing) and staff well-being (increased job satisfaction) have been consistently documented. The impact on patient outcomes is promising but less well evidenced. CONCLUSION Countries will have to set safe staffing policies to tackle challenges such as the ageing population and workforce shortages. Various approaches may prove effective, but need to be accompanied by a comprehensive policy that enhances bedside nurse staffing in an evidence-based, objective and transparent way.
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Affiliation(s)
- Koen Van den Heede
- Belgian Healthcare Knowledge Centre (KCE), Kruidtuinlaan 55, 1000, Brussels, Belgium; KU Leuven-University of Leuven, Institute for Healthcare Policy, 3000, Leuven, Belgium.
| | - Justien Cornelis
- Belgian Healthcare Knowledge Centre (KCE), Kruidtuinlaan 55, 1000, Brussels, Belgium.
| | - Nicolas Bouckaert
- Belgian Healthcare Knowledge Centre (KCE), Kruidtuinlaan 55, 1000, Brussels, Belgium.
| | - Luk Bruyneel
- KU Leuven-University of Leuven, Institute for Healthcare Policy, 3000, Leuven, Belgium.
| | - Carine Van de Voorde
- Belgian Healthcare Knowledge Centre (KCE), Kruidtuinlaan 55, 1000, Brussels, Belgium.
| | - Walter Sermeus
- KU Leuven-University of Leuven, Institute for Healthcare Policy, 3000, Leuven, Belgium.
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Aeyels D, Bruyneel L, Seys D, Sinnaeve PR, Sermeus W, Panella M, Vanhaecht K. Better hospital context increases success of care pathway implementation on achieving greater teamwork: a multicenter study on STEMI care. Int J Qual Health Care 2020; 31:442-448. [PMID: 30256962 DOI: 10.1093/intqhc/mzy197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 07/16/2018] [Accepted: 09/05/2018] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To evaluate whether hospital context influences the effect of care pathway implementation on teamwork processes and output in STEMI care. DESIGN A multicenter pre-post intervention study. SETTING Eleven acute hospitals. PARTICIPANTS Cardiologists-in-chief, nurse managers, quality staff, quality managers and program managers reported on hospital context. Teamwork was rated by professional groups (medical doctors, nurses, allied health professionals, other) in the following departments: emergency room, catheterization lab, coronary care unit, cardiology ward and rehabilitation. INTERVENTION Care pathway covering in-hospital care from emergency services to rehabilitation. MAIN OUTCOME MEASURES Hospital context was measured by the five dimensions of the Model for Understanding Success in Quality: microsystem, quality improvement team, quality improvement support, high-level organization, external environment. Teamwork process measures reflected teamwork between professional groups within departments and teamwork between departments. Teamwork output was measured through the level of organized care. Two-level regression analysis accounted for clustering of respondents within hospitals and assessed the influence of hospital context on the impact of care pathway implementation on teamwork. RESULTS Care pathway implementation significantly improved teamwork processes both between professional groups (P < 0.001) and between departments (P < 0.001). Teamwork output also improved (P < 0.001). The effect of care pathway implementation on teamwork was more pronounced when the quality improvement team and quality improvement support and capacity were more positively reported on. CONCLUSIONS Hospitals can leverage the effect of quality improvement interventions such as care pathways by evaluating and improving aspects of hospital context.
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Affiliation(s)
- Daan Aeyels
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium.,Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - Deborah Seys
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium
| | | | - Walter Sermeus
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium
| | - Massimiliano Panella
- Department of Clinical and Experimental Medicine, Amedeo Avogadro University of Eastern Piedmont, Vercelli, Italy
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium.,Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
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21
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van Zelm R, Coeckelberghs E, Sermeus W, Wolthuis A, Bruyneel L, Panella M, Vanhaecht K. Effects of implementing a care pathway for colorectal cancer surgery in ten European hospitals: an international multicenter pre-post-test study. Updates Surg 2020; 72:61-71. [PMID: 31993994 DOI: 10.1007/s13304-020-00706-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/15/2020] [Indexed: 01/28/2023]
Abstract
Adherence to evidence-based recommendations is variable and generally low. This is also followed in colorectal surgery, despite the availability of the ERAS® protocol. The aim of the study was to evaluate the effect of implementing a care pathway for perioperative care in colorectal cancer surgery on outcomes and protocol adherence. So, we performed an international pre-test-post-test multicenter study, performed in ten hospitals in four European countries. The measures used included length of stay, morbidity and mortality, and documentation and adherence on intervention and patient level. Unadjusted pre-test-post-test differences were analyzed following an analysis adjusted for patient-mix variables. Importance-performance analysis was used to map the relationship between importance and performance of individual interventions. In total, 381 patients were included. Length of stay decreased from 12.6 to 10.7 days (p = 0.0230). Time to normal diet and walking also decreased significantly. Protocol adherence improved from 56 to 62% (p < 0.00001). Adherence to individual interventions remained highly variable. Importance-performance analysis showed 30 interventions were scored as important, of which 19 had an adherence < 70%, showing priorities for improvement. Across hospitals, change in protocol adherence ranged from a 13% decrease to a 22% increase. Implementing a care pathway for colorectal cancer surgery reduced length of stay, time to normal diet and walking. Documentation and protocol adherence improved after implementing the care pathway. However, not in all participating hospitals protocol adherence improved. Only in 25% of patients, protocol adherence of ≥ 70% was achieved, suggesting a large group is at risk for underuse. Importance-performance analysis showed which interventions are important, but have low adherence, prioritizing improvement efforts.
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Affiliation(s)
- Ruben van Zelm
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35/3, 3000, Louvain, Belgium. .,European Pathway Association, Louvain, Belgium.
| | - Ellen Coeckelberghs
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35/3, 3000, Louvain, Belgium
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35/3, 3000, Louvain, Belgium.,European Pathway Association, Louvain, Belgium
| | - Albert Wolthuis
- Department of Abdominal Surgery, University Hospital Leuven, KU Leuven, Louvain, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35/3, 3000, Louvain, Belgium.,University Hospitals Leuven, Louvain, Belgium
| | - Massimiliano Panella
- European Pathway Association, Louvain, Belgium.,Department of Translational Medicine, University of Eastern Piemonte (UPO), Novarra, Italy
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35/3, 3000, Louvain, Belgium.,European Pathway Association, Louvain, Belgium.,Department of Quality, University Hospital Leuven, Louvain, Belgium
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Abstract
Clinical pathways, also known as care pathways or integrated care pathways, are used worldwide to make care processes transparent and organize care around patient needs. Although this is in international use, it is still unclear why pathways sometimes work and sometimes do not. To better understand how pathways work, there is a growing need for paradigms or organizing concepts. Different quality and health-care management gurus have developed frameworks to better understand how certain processes or methods work. This paper will provide an overview of several frameworks and integrate them into Donabedian's Structure–Process–Outcome configuration. In view of this configuration, the care process organization triangle was developed. In this paper, we will describe the three cornerstones of this triangle by integrating the literature on clinical pathways. The care process organization triangle is only one model, but as Deming described it: ‘Some models can be quite useful’.
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Affiliation(s)
- Kris Vanhaecht
- Center for Health Services and Nursing Research, Catholic University Leuven, Leuven
- Belgian Dutch Clinical Pathway Network, Leuven
- European Pathway Association, Leuven
| | - Karel de Witte
- Belgian Dutch Clinical Pathway Network, Leuven
- Center for Organisation and Personnel Psychology, Catholic University Leuven, Leuven, Belgium
| | - Walter Sermeus
- Center for Health Services and Nursing Research, Catholic University Leuven, Leuven
- Belgian Dutch Clinical Pathway Network, Leuven
- European Pathway Association, Leuven
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Bruyneel L, Lesaffre E, Meuleman B, Sermeus W. Power Distance and Physician–Nurse Collegial Relations Across 14 European Countries: National Culture is Not Merely a Nuisance Factor in International Comparative Research. J Nurs Scholarsh 2019; 51:708-716. [DOI: 10.1111/jnu.12514] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Luk Bruyneel
- Post‐doctoral researcher KU Leuven–University of Leuven, Institute for Healthcare Policy Leuven Belgium
| | - Emmanuel Lesaffre
- Full Professor KU Leuven–University of Leuven, Leuven Biostatistics and Statistical Bioinformatics Centre Leuven Belgium
| | - Bart Meuleman
- Associate Professor KU Leuven–University of Leuven, Centre for Sociological Research Leuven Belgium
| | - Walter Sermeus
- Full Professor KU Leuven–University of Leuven, Institute for Healthcare Policy Leuven Belgium
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24
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Seys D, Deneckere S, Lodewijckx C, Bruyneel L, Sermeus W, Boto P, Panella M, Vanhaecht K. Impact of care pathway implementation on interprofessional teamwork: An international cluster randomized controlled trial. J Interprof Care 2019:1-9. [PMID: 31390223 DOI: 10.1080/13561820.2019.1634016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 01/28/2019] [Accepted: 06/14/2019] [Indexed: 10/26/2022]
Abstract
This study evaluates whether the implementation of an in-hospital care pathway (CP) improves interprofessional teamwork across countries and tests whether improved communications ("relational coordination") is the mechanism of action. A hospital-based cluster randomized controlled trial in Ireland, Belgium, Italy, and Portugal was performed. Fifty-six interprofessional teams caring for patients admitted with an exacerbation of chronic obstructive pulmonary disease or for patients with a proximal femur fracture were included and randomly assigned to an intervention group (31 teams and 567 team members), where a CP was implemented, and a control group (25 teams and 417 team members) representing usual care. Multilevel regression and mediation analysis were applied. First, although no significant effect was found on our primary outcome relational coordination, our CP significantly improved several team inputs, team processes (team climate for innovation) and team output (the level of organized care, level of competence) indicators. Second, our team process indicator of team climate for innovation partially mediated the association between CP implementation and team output indicator of better level of organized care. In conclusion, a CP sets in motion various mechanisms that improve some but not all aspects of interprofessional teamwork. Relational coordination does not appear to be the mechanism by which team outputs are enhanced.
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Affiliation(s)
- Deborah Seys
- a Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven , Leuven , Belgium
| | - Svin Deneckere
- a Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven , Leuven , Belgium
| | - Cathy Lodewijckx
- a Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven , Leuven , Belgium
| | - Luk Bruyneel
- a Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven , Leuven , Belgium
- b Department of Quality Management, University Hospitals Leuven , Leuven , Belgium
| | - Walter Sermeus
- a Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven , Leuven , Belgium
| | - Paulo Boto
- c Department of Health Services Policy and Management, Centro de Investigação em Saúde Pública (CISP), Escola Nacional de Saúde Pública (ENSP), Universidade Nova de Lisboa (UNL) , Lisbon , Portugal
| | - Massimiliano Panella
- a Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven , Leuven , Belgium
- d Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont , Vercilli , Italy
| | - Kris Vanhaecht
- a Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven , Leuven , Belgium
- b Department of Quality Management, University Hospitals Leuven , Leuven , Belgium
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Hardiker NR, Dowding D, Dykes PC, Sermeus W. Reinterpreting the nursing record for an electronic context. Int J Med Inform 2019; 127:120-126. [PMID: 31128823 DOI: 10.1016/j.ijmedinf.2019.04.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 03/15/2019] [Accepted: 04/23/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND This article seeks to facilitate the re-imagining of nursing records purposefully within an electronic context. It questions existing approaches to nursing documentation, critically examines existing nursing record systems and identifies new requirements. METHODS A comprehensive literature review was conducted to identify themes, that might meaningfully contribute to a new approach to nursing record systems development, around four key interrelated areas - standards, decision making, abstraction and summarization, and documenting. Studies were analyzed using narrative synthesis to provide a critical analysis of the current 'state of the art', and recommendations for the future. RESULTS Included studies collectively described aspects of current best practice, both in terms of nursing record systems themselves, and how nurses and other health professionals contribute to and engage with those systems. A number of cross-cutting themes identified more novel approaches taken by nurses to systems development: going back to basics in determining purpose; firming up informatics foundations; nuancing or tailoring to suit different requirements; and engagement, involvement and participation. CONCLUSION There is a paucity of research that specifically focuses on the nature of the electronic nursing record and its impact on patient care processes and outcomes. In addition to further research in these areas, there is a need: to reinterpret nurses as knowledge workers rather than as 'data collectors'; to agree on the application in practice of appropriate standards and terminologies; and to work together with system developers to change the ways in which data are captured and care is documented.
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Affiliation(s)
| | - Dawn Dowding
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, UK.
| | - Patricia C Dykes
- Department of General Internal Medicine and Primary Care, Brigham and Women's Hospital/Harvard Medical School, USA.
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, KU Leuven, Belgium.
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26
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Bagnasco A, Zanini M, Catania G, Aleo G, Sermeus W, Sasso L. Implications of a wide-scale educational intervention to engage nurses in evidence-based practice: The Italian RN4CAST experience. Nurs Forum 2019; 54:183-191. [PMID: 30628738 DOI: 10.1111/nuf.12313] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND In Italy, there are still many barriers to the development of a culture of evidence-based practice (EBP) and nurses' knowledge of EBP is lacking. Additionally, in Italy there are still very few advanced practice registered nurses to significantly contribute to the development of EBP. AIM This aims to identify the implications of a wide-scale nursing education intervention to engage clinical nurses in EBP through the Italian RN4CAST study. METHODS A qualitative study based on a thematic analysis. A total of 800 clinical nurses actively participated in nine training sessions across Italy. At the end of each training session written feedback data were collected and then underwent thematic analysis. RESULTS All participants were strongly motivated to engage in EBP thanks to their involvement in the RN4CAST project. With regard to the implications of EBP, the thematic analysis produced the following themes: Professional identity; Quality of care; Perceptions of patients and nurses; Research impact; and Organization. CONCLUSIONS The involvement of a large number of clinical nurses in a research project raised their awareness about the advantages of engaging in EBP, and how evidence can be used to raise motivation to change current practice policies.
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Affiliation(s)
| | - Milko Zanini
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Gianluca Catania
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Giuseppe Aleo
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Walter Sermeus
- Department of Public Health & Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Loredana Sasso
- Department of Health Sciences, University of Genoa, Genoa, Italy
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Seys D, Panella M, VanZelm R, Sermeus W, Aeyels D, Bruyneel L, Coeckelberghs E, Vanhaecht K. Care pathways are complex interventions in complex systems: New European Pathway Association framework. International Journal of Care Coordination 2019. [DOI: 10.1177/2053434519839195] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Care pathway implementation is characterised by a dual complexity. A care pathway itself represents a complex intervention with multiple interacting and interdependent intervention components and outcomes. The organisations in which care pathways are being implemented represent complex systems that need to be directed at change through an in-depth understanding of their external and internal context in which they are functioning in. This study sets out a new evidence-based and pragmatic framework that unpacks how intervention mechanisms, intervention fidelity and care context are converge and represent interacting processes that determine success or failure of the care pathway. We recommend researchers looking to increase the effectiveness of care pathway implementation and accelerate improvement of desired outcomes to adopt this framework from inception to implementation of the intervention.
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Affiliation(s)
- D Seys
- KU Leuven – University of Leuven, Belgium
| | - M Panella
- KU Leuven – University of Leuven, Belgium
- University of Eastern Piedmont ‘A. Avogadro’, Italy
| | - R VanZelm
- KU Leuven – University of Leuven, Belgium
| | - W Sermeus
- KU Leuven – University of Leuven, Belgium
| | - D Aeyels
- Universitair Ziekenhuis Brussel, Belgium
| | - L Bruyneel
- KU Leuven – University of Leuven, Belgium
- University Hospitals Leuven, Belgium
| | | | - K Vanhaecht
- KU Leuven – University of Leuven, Belgium
- University Hospitals Leuven, Belgium
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Thurn T, Borasio GD, Chiò A, Galvin M, McDermott CJ, Mora G, Sermeus W, Winkler AS, Anneser J. Physicians' attitudes toward end-of-life decisions in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:74-81. [PMID: 30789031 DOI: 10.1080/21678421.2018.1536154] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This study aims (1) to assess physicians' attitudes toward different palliative end-of-life (EOL) practices in amyotrophic lateral sclerosis (ALS) care, including forgoing artificial nutrition and hydration (FANH), continuous sedation until death (CSD), and withdrawing invasive ventilation (WIV), and toward physician-assisted dying (PAD) including physician-assisted suicide and euthanasia and (2) to explore variables influencing these attitudes. METHODS We used two clinical vignettes depicting ALS patients in different stages of their disease progression to assess the influence of suffering (physical/psycho-existential) on attitudes toward WIV and the influence of suffering and prognosis (short-term/long-term) on attitudes toward FANH, CSD, and PAD. RESULTS 50 physicians from European ALS centers and neurological departments completed our survey. Short-term prognosis had a positive impact on attitudes toward offering FANH (p = 0.014) and CSD (p = 0.048) as well as on attitudes toward performing CSD (p = 0.036) and euthanasia (p = 0.023). Predominantly psycho-existential suffering was associated with a more favorable attitude toward WIV but influenced attitudes toward performing CSD negatively. Regression analysis showed that religiosity was associated with more reluctant attitudes toward palliative EOL practices and PAD, whereas training in palliative care was associated with more favorable attitudes toward palliative EOL practices only. CONCLUSION ALS physicians seem to acknowledge psycho-existential suffering as a highly acceptable motive for WIV but not CSD. Physicians appear to be comfortable with responding to the patient's requests, but more reluctant to assume a proactive role in the decision-making process. Palliative care training may support ALS physicians in these challenging situations.
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Affiliation(s)
- Tamara Thurn
- a Palliative Care Team, Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar , Technical University Munich , Munich , Germany
| | - Gian Domenico Borasio
- b Palliative and Supportive Care Service, Centre Hospitalier Universitaire Vaudois (CHUV) , University of Lausanne , Lausanne , Switzerland
| | - Adriano Chiò
- c Department of Neuroscience "Rita Levi Montalcini" , University of Turin , Turin , Italy
| | - Miriam Galvin
- d Academic Unit of Neurology, Trinity Biomedical Sciences Institute , Trinity College Dublin , Dublin , Ireland
| | - Christopher J McDermott
- e Sheffield Institute for Translational Neuroscience , University of Sheffield , Sheffield , United Kingdom
| | | | - Walter Sermeus
- g Leuven Institute for Healthcare Policy , KU Leuven , Leuven , Belgium
| | - Andrea S Winkler
- h Department of Neurology, Klinikum rechts der Isar , Technical University Munich , Munich , Germany.,i Centre for Global Health, Institute of Health and Society , University of Oslo , Oslo , Norway
| | - Johanna Anneser
- a Palliative Care Team, Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar , Technical University Munich , Munich , Germany
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Lankreijer K, D'Hooghe TM, Apers S, Sermeus W, Repping S, Dancet EA. Hormonal medication in medically assisted reproduction: a systematic review of assessments from patients. Reprod Biomed Online 2019; 38:341-363. [PMID: 30770286 DOI: 10.1016/j.rbmo.2018.12.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 12/13/2018] [Accepted: 12/21/2018] [Indexed: 11/19/2022]
Abstract
Several hormonal fertility medications have comparable effectiveness. A literature review was conducted into patients' assessments regarding seven medication characteristics including 'side effects' and 'ease of use'. Medline, CINAHL and PsycINFO were searched for female fertility patients' written assessments of a hormonal medication. The tools used were appraised and common (i.e. ≥10%) unpleasant consequences were distinguished from rare ones. The 35 eligible studies did not rely on valid and reliable tools and did not provide patient assessments regarding all seven medication characteristics for any of the globally used medications. Evidence on medications for oocyte triggering was absent and for induction of pituitary quiescence it was scarce. Regarding medications for ovarian stimulation and luteal support, evidence on general side effects (mostly headache), local side effects (mostly pain), 'interference with home life' and 'impact on psychological wellbeing' was found. Evidence on 'ease of use' and 'required education' was only identified for medication for ovarian stimulation. Evidence on 'interference with work life' and 'compliance worry' was absent. This review calls for randomized controlled trials questioning patients with valid and reliable tools. In the meantime, this review's summary of the best available evidence can be integrated in decision aids facilitating personalized and informed medication choices.
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Affiliation(s)
- Kay Lankreijer
- Centre for Reproductive Medicine, Women's and Children's Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Thomas M D'Hooghe
- University of Leuven, Department of Development and Regeneration, Leuven, Belgium; Adjunct Professor, Department of Obstetrics, Gynecology and Reproductive Sciences Yale School of Medicine, New Haven, CT, USA; Vice-President and Head, Global Medical Affairs Fertility, Research and Development, Merck KGaA, Darmstadt, Germany
| | - Silke Apers
- University of Leuven, Department of Development and Regeneration, Leuven, Belgium; University of Leuven, Department of Public Health and Primary Care, Leuven, Belgium
| | - Walter Sermeus
- University of Leuven, Department of Public Health and Primary Care, Leuven, Belgium
| | - Sjoerd Repping
- Centre for Reproductive Medicine, Women's and Children's Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Eline Af Dancet
- Centre for Reproductive Medicine, Women's and Children's Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands; University of Leuven, Department of Development and Regeneration, Leuven, Belgium; University of Leuven, Department of Public Health and Primary Care, Leuven, Belgium; Research Foundation Flanders, Belgium.
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Kroezen M, Schäfer W, Sermeus W, Hansen J, Batenburg R. Healthcare assistants in EU Member States: an overview. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Kroezen
- Erasmus University Medical Centre, Rotterdam, Netherlands
| | - W Schäfer
- Feinberg School of Medicine, Department of Social Medical Sciences, Northwestern University, Chicago, USA
| | - W Sermeus
- KU Leuven Institute for Healthcare Policy (LIGB), University of Leuven, Leuven, Belgium
| | - J Hansen
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
| | - R Batenburg
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
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31
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Van Zelm R, Coeckelberghs E, Sermeus W, Panella M, Wolthuis A, Vanhaecht K. Variation in perioperative nutrition in colorectal cancer patients – first results of an international quality improvement study. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Aeyels D, Bruyneel L, Sinnaeve PR, Claeys MJ, Gevaert S, Schoors D, Panella M, Sermeus W, Vanhaecht K. Care Pathway Effect on In-Hospital Care for ST-Elevation Myocardial Infarction. Cardiology 2018; 140:163-174. [PMID: 30099470 DOI: 10.1159/000488932] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 04/03/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To study the care pathway effect on the percentage of patients with ST-elevation myocardial infarction -(STEMI) receiving timely coronary reperfusion and the percentage of STEMI patients receiving optimal secondary prevention. METHODS A care pathway was implemented by the Collaborative Model for Achieving Breakthrough Improvement. One pre-intervention and 2 post-intervention audits included all adult STEMI patients admitted within 24 h after onset and eligible for reperfusion. Adjusted (hospital random intercepts and controls for transfer and out-of-office admission) differences in composite outcomes were analyzed by a multilevel logistic regression. RESULTS Significant improvements in intervals between the first medical contact (FMC) to percutaneous coronary intervention (PCI) and between the door to PCI were shown between post-intervention audit II and post-intervention audit I. Secondary prevention significantly deteriorated at post-intervention audit I but improved significantly between both post-intervention audits. Six out of nine outcomes were significantly poorer in the case of transfer. The interval from FMC to PCI was significantly poorer for patients admitted during out-of-office hours. CONCLUSIONS After care pathway implementation, composite outcomes improved for in-hospital STEMI care. Collaborative efforts exploited heterogeneity in performance between hospitals. Iterative and incremental care pathway implementation maximized performance improvement.
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Affiliation(s)
- Daan Aeyels
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium
| | - Peter R Sinnaeve
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Marc J Claeys
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Sofie Gevaert
- Department of Cardiology, University Hospital Ghent, Ghent, Belgium
| | - Danny Schoors
- Department of Cardiology, University Hospitals Brussels, Jette, Belgium
| | - Massimiliano Panella
- Department of Clinical and Experimental Medicine, Amedeo Avogadro University of Eastern Piedmont, Vercelli, Italy
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium.,Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
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Panella M, Seys D, Sermeus W, Bruyneel L, Lodewijckx C, Deneckere S, Sermon A, Nijs S, Boto P, Vanhaecht K. Minimal impact of a care pathway for geriatric hip fracture patients. Injury 2018; 49:1581-1586. [PMID: 29884319 DOI: 10.1016/j.injury.2018.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/23/2018] [Accepted: 06/02/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Adherence to guidelines for patients with proximal femur fracture is suboptimal. OBJECTIVE To evaluate the effect of a care pathway for the in-hospital management of older geriatric hip fracture patients on adherence to guidelines and patient outcomes. DESIGN The European Quality of Care Pathways study is a cluster randomized controlled trial. SETTING 26 hospitals in Belgium, Italy and Portugal. SUBJECTS Older adults with a proximal femur fracture (n = 514 patients) were included. METHODS Hospitals treating older adults (>65) with a proximal femur fracture were randomly assigned to an intervention group, i.e. implementation of a care pathway, or control group, i.e. usual care. Thirteen patient outcomes and 24 process indicators regarding in-hospital management, as well as three not-recommended care activities were measured. Adjusted and unadjusted regression analyses were conducted using intention-to-treat procedures. RESULTS In the intervention group 301 patients in 15 hospitals were included, and in the control group 213 patients in 11 hospitals. Sixty-five percent of the patients were older than 80 years. The implementation of this care pathway had no significant impact on the thirteen patient outcomes. The preoperative management improved significantly. Eighteen of 24 process indicators improved, but only two improved significantly. Only for a few teams a geriatrician was an integral member of the treatment team. DISCUSSION Implementation of a care pathway improved compliance to evidence, but no significant effect on patient outcomes was found. The impact of the collaboration between surgeons and geriatricians on adherence to guidelines and patient outcomes should be studied. TRIAL REGISTRATION ClinicalTrials.gov: NCT00962910.
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Affiliation(s)
- Massimiliano Panella
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium; Department of Translational Medicine, University of Eastern Piedmont "A. Avogadro", Italy
| | - Deborah Seys
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Belgium
| | - Cathy Lodewijckx
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium
| | - Svin Deneckere
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium; Medical Department, Delta Hospitals Roeselare, Belgium
| | - An Sermon
- Department of Development and Regeneration, KU Leuven - University of Leuven, Belgium; Department of Traumatology, University Hospitals Leuven, Belgium
| | - Stefaan Nijs
- Department of Development and Regeneration, KU Leuven - University of Leuven, Belgium; Department of Traumatology, University Hospitals Leuven, Belgium
| | - Paulo Boto
- Department of Health Services Policy and Management, Centro de Investigação em Saúde Pública (CISP), Escola Nacional de Saúde Pública (ENSP), Universidade Nova de Lisboa (UNL), Portugal
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Belgium.
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Najjar S, Baillien E, Vanhaecht K, Hamdan M, Euwema M, Vleugels A, Sermeus W, Schrooten W, Hellings J, Vlayen A. Similarities and differences in the associations between patient safety culture dimensions and self-reported outcomes in two different cultural settings: a national cross-sectional study in Palestinian and Belgian hospitals. BMJ Open 2018; 8:e021504. [PMID: 30061439 PMCID: PMC6067346 DOI: 10.1136/bmjopen-2018-021504] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To investigate the relationships between patient safety culture (PSC) dimensions and PSC self-reported outcomes across different cultures and to gain insights in cultural differences regarding PSC. DESIGN Observational, cross-sectional study. SETTING Ninety Belgian hospitals and 13 Palestinian hospitals. PARTICIPANTS A total of 2836 healthcare professionals matched for profession, tenure and working hours. PRIMARY AND SECONDARY OUTCOME MEASURES The validated versions of the Belgian and Palestinian Hospital Survey on Patient Safety Culture were used. An exploratory factor analysis was conducted. Reliability was tested using Cronbach's alpha (α). In this study, we examined the specific predictive value of the PSC dimensions and its self-reported outcome measures across different cultures and countries. Hierarchical regression and bivariate analyses were performed. RESULTS Eight PSC dimensions and four PSC self-reported outcomes were distinguished in both countries. Cronbach's α was α≥0.60. Significant correlations were found between PSC dimensions and its self-reported outcome (p value range <0.05 to <0.001). Hierarchical regression analyses showed overall perception of safety was highly predicted by hospital management support in Palestine (β=0.16, p<0.001) and staffing in Belgium (β=0.24, p<0.001). The frequency of events was largely predicted by feedback and communication in both countries (Palestine: β=0.24, p<0.001; Belgium: β=0.35, p<0.001). Overall grade for patient safety was predicted by organisational learning in Palestine (β=0.19, p<0.001) and staffing in Belgium (β=0.19, p<0.001). Number of events reported was predicted by staffing in Palestine (β=-0.20, p<0.001) and feedback and communication in Belgium (β=0.11, p<0.01). CONCLUSION To promote patient safety in Palestine and Belgium, staffing and communication regarding errors should be improved in both countries. Initiatives to improve hospital management support and establish constructive learning systems would be especially beneficial for patient safety in Palestine. Future research should address the association between safety culture and hard patient safety measures such as patient outcomes.
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Affiliation(s)
- Shahenaz Najjar
- Population Health Department, Hospital – MNG-HA, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Leuven Institute for Healthcare Policy, School of Public Health & Primary Care, KU Leuven, Leuven, Belgium
| | - Elfi Baillien
- Department of Work and Organisation Studies, KU Leuven, Brussels, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, School of Public Health & Primary Care, Department of Quality Management, UZ Leuven, KU Leuven, Leuven, Belgium
| | - Motasem Hamdan
- Department of Health Policy & Management, Faculty of Public Health, Al-Quds University, Jerusalem, Palestine
| | - Martin Euwema
- OrganizationalPsychology, research group Work, Organizational and PersonnelPsychology, KU Leuven, Leuven, Belgium
| | - Arthur Vleugels
- Leuven Institute for Healthcare Policy, School of Public Health & Primary Care, KU Leuven, Leuven, Belgium
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, School of Public Health & Primary Care, KU Leuven, Leuven, Belgium
| | - Ward Schrooten
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Johan Hellings
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Annemie Vlayen
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
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Castro EM, Malfait S, Van Regenmortel T, Van Hecke A, Sermeus W, Vanhaecht K. Co-design for implementing patient participation in hospital services: A discussion paper. Patient Educ Couns 2018; 101:1302-1305. [PMID: 29602511 DOI: 10.1016/j.pec.2018.03.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/20/2018] [Accepted: 03/21/2018] [Indexed: 06/08/2023]
Affiliation(s)
| | - Simon Malfait
- Faculty of Medicine and Health Sciences, Department of Public Health - University Center for Nursing and Midwifery, Ghent University, Ghent University Hospital, Ghent, Belgium
| | - Tine Van Regenmortel
- Faculty of Social Sciences - HIVA, University of Leuven, Leuven, Belgium; Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo, Tilburg, Netherlands
| | - Ann Van Hecke
- Faculty of Medicine and Health Sciences, Department of Public Health - University Center for Nursing and Midwifery, Ghent University, Ghent University Hospital, Ghent, Belgium
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, Department of Public Health & Primary Care, University of Leuven, Leuven, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, Department of Public Health & Primary Care, University of Leuven, Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
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Kuhlmann E, Batenburg R, Wismar M, Dussault G, Maier CB, Glinos IA, Azzopardi-Muscat N, Bond C, Burau V, Correia T, Groenewegen PP, Hansen J, Hunter DJ, Khan U, Kluge HH, Kroezen M, Leone C, Santric-Milicevic M, Sermeus W, Ungureanu M. A call for action to establish a research agenda for building a future health workforce in Europe. Health Res Policy Syst 2018; 16:52. [PMID: 29925432 PMCID: PMC6011393 DOI: 10.1186/s12961-018-0333-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 06/05/2018] [Indexed: 11/30/2022] Open
Abstract
The importance of a sustainable health workforce is increasingly recognised. However, the building of a future health workforce that is responsive to diverse population needs and demographic and economic change remains insufficiently understood. There is a compelling argument to be made for a comprehensive research agenda to address the questions. With a focus on Europe and taking a health systems approach, we introduce an agenda linked to the 'Health Workforce Research' section of the European Public Health Association. Six major objectives for health workforce policy were identified: (1) to develop frameworks that align health systems/governance and health workforce policy/planning, (2) to explore the effects of changing skill mixes and competencies across sectors and occupational groups, (3) to map how education and health workforce governance can be better integrated, (4) to analyse the impact of health workforce mobility on health systems, (5) to optimise the use of international/EU, national and regional health workforce data and monitoring and (6) to build capacity for policy implementation. This article highlights critical knowledge gaps that currently hamper the opportunities of effectively responding to these challenges and advising policy-makers in different health systems. Closing these knowledge gaps is therefore an important step towards future health workforce governance and policy implementation. There is an urgent need for building health workforce research as an independent, interdisciplinary and multi-professional field. This requires dedicated research funding, new academic education programmes, comparative methodology and knowledge transfer and leadership that can help countries to build a people-centred health workforce.
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Affiliation(s)
- Ellen Kuhlmann
- Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover, OE 5410, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
- Karolinska Institutet, Medical Management Centre, LIME, Tomtebodavagen 18a, 171 77 Stockholm, Sweden
| | - Ronald Batenburg
- Netherlands Institute for Health Services Research, Otterstraat 118-124, 3513 Utrecht, The Netherlands
| | - Matthias Wismar
- European Observatory on Health Systems and Policies, Place Victor Horta/Victor Hortaplein, 40/10, 1060 Brussels, Brussels Belgium
| | - Gilles Dussault
- Global Health and Tropical Medicine & WHO Collaborating Center on Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine-NOVA University of Lisbon, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
| | - Claudia B. Maier
- Department of Healthcare Management, Technische Universität Berlin, Strasse des 17. Juni 135, 10623 Berlin, Germany
| | - Irene A. Glinos
- European Observatory on Health Systems and Policies, Place Victor Horta/Victor Hortaplein, 40/10, 1060 Brussels, Brussels Belgium
| | - Natasha Azzopardi-Muscat
- Department of Health Services Management, Faculty of Health Science & WHO Collaborating Centre for Health Systems and Policy in Small States at the Islands and Small States Institute, University of Malta, Msida, MSD 2080 Malta
- European Public Health Association (EUPHA), Utrecht, Netherlands
| | - Christine Bond
- Christine Bond, Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 ZD United Kingdom
| | - Viola Burau
- Department of Public Health, University of Aarhus, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Tiago Correia
- ISCTE-Instituto Universitário de Lisboa, School of Sociology and Public Policies, Avenida das Forcas Armadas, 1649-026 Lisbon, Portugal
| | - Peter P. Groenewegen
- Netherlands Institute for Health Services Research, Otterstraat 118-124, 3513 Utrecht, The Netherlands
- Department of Sociology, Utrecht University, Heidelberglaan 2, 3584 CS Utrecht, The Netherlands
- Department of Human Geography, Utrecht University, Heidelberglaan 2, 3584 CS Utrecht, The Netherlands
| | - Johan Hansen
- Netherlands Institute for Health Services Research, Otterstraat 118-124, 3513 Utrecht, The Netherlands
| | - David J. Hunter
- Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
| | - Usman Khan
- European Health Management Association (EHMA), Rue Belliard 15-17, 1040 Brussels, Belgium
| | - Hans H. Kluge
- Division of Health Systems and Public Health, WHO Regional Office for Europe, Marmorvej 51, 2100 Copenhagen, Denmark
| | - Marieke Kroezen
- Department of General Practice, Erasmus University Medical Center Rotterdam, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Claudia Leone
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, 57 Waterloo Road, SE1 8WA London, United Kingdom
| | - Milena Santric-Milicevic
- Institute of Social Medicine, Faculty of Medicine University of Belgrade, Dr Subotica, Belgrade, 15 11000 Serbia
| | - Walter Sermeus
- KU Leuven Institute for Healthcare Policy, Kapucijnenvoer 35 blok d – box 7001, 3000 Leuven, Belgium
| | - Marius Ungureanu
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University, 7 Pandurilor Street, 400376 Cluj-Napoca, Romania
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Vanhaecht K, Bollmann M, Bower K, Gallagher C, Gardini A, Guezo J, jansen U, Massoud R, Moody K, Sermeus W, Van Zelm R, Whittle C, Yazbeck AM, Zander K, Panella M. Prevalence and use of clinical pathways in 23 countries – an international survey by the European Pathway Association. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/205343540601000106] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives To give an overview on the use and prevalence of clinical pathways. Design Cross-sectional descriptive study. Study participants European Pathway Association (E-P-A) contact persons in 23 countries. Results Clinical pathways, also known as critical pathways or integrated care pathways, have been used in health care for 20 years. Although clinical pathways are well established, little information exists on their use and dissemination around the world. The E-P-A has performed their first international survey on the use and dissemination of clinical pathways in 23 countries. At present, pathways are used with a minority of patients, mainly in acute hospital trusts. Our survey showed that clinical pathways were predominantly viewed as a multidisciplinary tool to improve the quality and efficiency of evidence-based care. Pathways were also used as a communication tool between professionals to manage and standardize outcome-oriented care. Conclusions There is a future for the use of clinical pathways, but there is a need for international benchmarking and knowledge sharing with regard to their development, implementation and evaluation.
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Affiliation(s)
- Kris Vanhaecht
- Centre for Health Services and Nursing Research, Catholic University Leuven, Leuven, Belgium
- European Pathway Association, Kapucijnenvoer 35, 4th floor, 3000 Leuven, Belgium
| | - Marcus Bollmann
- SANA Kliniken, Munich, Germany
- European Pathway Association, Kapucijnenvoer 35, 4th floor, 3000 Leuven, Belgium
| | - Kathy Bower
- Centre for Case Management, Boston, USA
- European Pathway Association, Kapucijnenvoer 35, 4th floor, 3000 Leuven, Belgium
| | - Clare Gallagher
- Patient Concern & Healthcare Events, London, England, UK
- European Pathway Association, Kapucijnenvoer 35, 4th floor, 3000 Leuven, Belgium
| | - Andrea Gardini
- International Society for Quality in Healthcare, Ancona, Italy
- European Pathway Association, Kapucijnenvoer 35, 4th floor, 3000 Leuven, Belgium
| | - Jen Guezo
- Board of Health, Castel, Guernsey
- European Pathway Association, Kapucijnenvoer 35, 4th floor, 3000 Leuven, Belgium
| | - Uwe jansen
- KISS Project & General practitioners part, County of Sønderjylland, Denmark
- European Pathway Association, Kapucijnenvoer 35, 4th floor, 3000 Leuven, Belgium
| | - Rashad Massoud
- Institute for Healthcare Improvement, Boston, USA
- European Pathway Association, Kapucijnenvoer 35, 4th floor, 3000 Leuven, Belgium
| | - Karen Moody
- Integrated Care Pathway User Group, Glasgow, Scotland, UK
- European Pathway Association, Kapucijnenvoer 35, 4th floor, 3000 Leuven, Belgium
| | - Walter Sermeus
- Centre for Health Services and Nursing Research, Catholic University Leuven, Leuven, Belgium
- European Pathway Association, Kapucijnenvoer 35, 4th floor, 3000 Leuven, Belgium
| | - Ruben Van Zelm
- Institute for Healthcare Improvement CBO, Utrecht, The Netherlands
- European Pathway Association, Kapucijnenvoer 35, 4th floor, 3000 Leuven, Belgium
| | - Claire Whittle
- School of Health Sciences, Birmingham University, Birmingham, England, UK
- European Pathway Association, Kapucijnenvoer 35, 4th floor, 3000 Leuven, Belgium
| | - Anne-Marie Yazbeck
- Ministry of Health, Department for Quality, Ljubljana, Slovenia
- European Pathway Association, Kapucijnenvoer 35, 4th floor, 3000 Leuven, Belgium
| | - Karen Zander
- Centre for Case Management, Boston, USA
- European Pathway Association, Kapucijnenvoer 35, 4th floor, 3000 Leuven, Belgium
| | - Massimiliano Panella
- University of Eastern Piedmont ‘Amedeo Avogadro’, Novara, Italy
- European Pathway Association, Kapucijnenvoer 35, 4th floor, 3000 Leuven, Belgium
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Bruyneel L, Van Houdt S, Coeckelberghs E, Sermeus W, Tambuyzer E, Cosemans P, Peeters G, Van den Broeck K, Weeghmans I, Vanhaecht K. Patient experiences with care across various types of mental health care: Questionnaire development, measurement invariance, and patients' reports. Int J Methods Psychiatr Res 2018; 27:e1592. [PMID: 29027313 PMCID: PMC6877140 DOI: 10.1002/mpr.1592] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 11/12/2022] Open
Abstract
To describe the development, validation, and findings of a patient experience questionnaire across 7 types of residential and ambulatory mental health care services. Thirty-five items were hypothesized to cover information, participation, therapeutic relationship, personalized care, organization and collaboration, safety, patient rights, outcomes of care, and discharge preparation and after-care. Also included were 2 overall rating items (scoring and recommending the organization). This Dutch questionnaire was applied in 79 organizations in Belgium (N patients = 5,168). Exploratory structural equation modelling was conducted on a random split-half sample to examine dimensionality. Confirmatory factor analysis and multiple group confirmatory factor analyses were conducted on the holdout sample to confirm dimensionality and assess measurement invariance across type of service and patient characteristics. Multilevel logistic regression models linking subscale top box scores to overall rating items were used to assess criterion validity. The hypothesized dimensionality was partly confirmed, and configural and scalar invariance were demonstrated across types of organizations and patient characteristics. Subscale scores were significantly associated with overall ratings. Process evaluation showed that participating organizations strongly support continued use of this questionnaire. This validated patient experience questionnaire supports comparison across organizations from different types of services to improve the quality of mental health care.
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Affiliation(s)
- Luk Bruyneel
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium
| | - Sabine Van Houdt
- Flemish Patient Platform, Heverlee, Belgium.,Academic Centre for General Practice, University of Leuven, Leuven, Belgium
| | - Ellen Coeckelberghs
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium
| | | | | | | | - Kris Van den Broeck
- Flemish Association for Psychiatry, Kortenberg, Belgium.,Flemish Agency for Care and Health, Brussels, Belgium
| | | | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium
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Seys D, Bruyneel L, Sermeus W, Lodewijckx C, Decramer M, Deneckere S, Panella M, Vanhaecht K. Teamwork and Adherence to Recommendations Explain the Effect of a Care Pathway on Reduced 30-day Readmission for Patients with a COPD Exacerbation. COPD 2018; 15:157-164. [PMID: 29461135 DOI: 10.1080/15412555.2018.1434137] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study aimed to increase our understanding of processes that underlie the effect of care pathway implementation on reduced 30-day readmission rate. Adherence to evidence-based recommendations, teamwork and burnout have previously been identified as potential mechanisms in this association. We conducted a secondary data analysis of 257 patients admitted with chronic obstructive pulmonary disease exacerbation and 284 team members caring for these patients in 19 Belgian, Italian and Portuguese hospitals. Clinical measures included 30-day readmission and adherence to a specific set of five care activities. Teamwork measures included team climate for innovation, level of organized care and burnout (emotional exhaustion, level of competence and mental detachment). Care pathway implementation was significantly associated with better adherence and reduced 30-day readmission. Better adherence and higher level of competence were also related to reduced 30-day readmission. Only better adherence fully mediated the association between care pathway implementation and reduced 30-day readmission. Better team climate for innovation and level of organized care, although both improved after care pathway implementation, did not show any explanatory mechanisms in the association between care pathway implementation and reduced 30-day readmission. Implementation of a care pathway had an impact on clinical and team indicators. To reduce 30-day readmission rates, in the development and implementation of a care pathway, hospitals should measure adherence to evidence-based recommendations during the whole process, as this can give information regarding the success of implementation.
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Affiliation(s)
- Deborah Seys
- a Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy , KU Leuven - University of Leuven , Leuven , Belgium
| | - Luk Bruyneel
- a Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy , KU Leuven - University of Leuven , Leuven , Belgium.,b Department of Quality Management , University Hospitals Leuven , Leuven , Belgium
| | - Walter Sermeus
- a Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy , KU Leuven - University of Leuven , Leuven , Belgium
| | - Cathy Lodewijckx
- a Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy , KU Leuven - University of Leuven , Leuven , Belgium.,c AZ Sint Maarten , Mechelen , Belgium
| | - Marc Decramer
- d Department of Clinical and Experimental Medicine , KU Leuven - University of Leuven , Leuven , Belgium.,e Chief Executive Officer , University Hospitals Leuven , Leuven , Belgium
| | - Svin Deneckere
- a Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy , KU Leuven - University of Leuven , Leuven , Belgium.,f Delta hospitals Roeselare , Roeselare , Belgium
| | - Massimiliano Panella
- a Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy , KU Leuven - University of Leuven , Leuven , Belgium.,g Department of Translational Medicine , University of Eastern Piedmont , Piedmont , Italy
| | - Kris Vanhaecht
- a Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy , KU Leuven - University of Leuven , Leuven , Belgium.,b Department of Quality Management , University Hospitals Leuven , Leuven , Belgium
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Aeyels D, Seys D, Sinnaeve PR, Claeys MJ, Gevaert S, Schoors D, Sermeus W, Panella M, Bruyneel L, Vanhaecht K. Managing in-hospital quality improvement: An importance-performance analysis to set priorities for ST-elevation myocardial infarction care. Eur J Cardiovasc Nurs 2018; 17:535-542. [PMID: 29448818 DOI: 10.1177/1474515118759065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND A focus on specific priorities increases the success rate of quality improvement efforts for broad and complex-care processes. Importance-performance analysis presents a possible approach to set priorities around which to design and implement effective quality improvement initiatives. Persistent variation in hospital performance makes ST-elevation myocardial infarction care relevant to consider for importance-performance analysis. AIMS The purpose of this study was to identify quality improvement priorities in ST-elevation myocardial infarction care. METHODS Importance and performance levels of ST-elevation myocardial infarction key interventions were combined in an importance-performance analysis. Content validity indexes on 23 ST-elevation myocardial infarction key interventions of a multidisciplinary RAND Delphi Survey defined importance levels. Structured review of 300 patient records in 15 acute hospitals determined performance levels. The significance of between-hospital variation was determined by a Kruskal-Wallis test. A performance heat-map allowed for hospital-specific priority setting. RESULTS Seven key interventions were each rated as an overall improvement priority. Priority key interventions related to risk assessment, timely reperfusion by percutaneous coronary intervention and secondary prevention. Between-hospital performance varied significantly for the majority of key interventions. The type and number of priorities varied strongly across hospitals. CONCLUSIONS Guideline adherence in ST-elevation myocardial infarction care is low and improvement priorities vary between hospitals. Importance-performance analysis helps clinicians and management in demarcation of the nature, number and order of improvement priorities. By offering a tailored improvement focus, this methodology makes improvement efforts more specific and achievable.
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Affiliation(s)
- Daan Aeyels
- 1 Leuven Institute for Healthcare Policy, University of Leuven, Belgium
| | - Deborah Seys
- 1 Leuven Institute for Healthcare Policy, University of Leuven, Belgium
| | - Peter R Sinnaeve
- 2 Department of Cardiology, University Hospitals Leuven, Belgium
| | - Marc J Claeys
- 3 Department of Cardiology, Antwerp University Hospital, Belgium
| | - Sofie Gevaert
- 4 Department of Cardiology, University Hospital Ghent, Belgium
| | - Danny Schoors
- 5 Department of Cardiology, University Hospitals Brussels, Belgium
| | - Walter Sermeus
- 1 Leuven Institute for Healthcare Policy, University of Leuven, Belgium
| | - Massimiliano Panella
- 6 Department of Clinical and Experimental Medicine, Amedeo Avogadro University of Eastern Piedmont, Italy
| | - Luk Bruyneel
- 1 Leuven Institute for Healthcare Policy, University of Leuven, Belgium.,7 Department of Quality Management, University Hospitals Leuven, Belgium
| | - Kris Vanhaecht
- 1 Leuven Institute for Healthcare Policy, University of Leuven, Belgium.,7 Department of Quality Management, University Hospitals Leuven, Belgium
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Braet A, Weltens C, Sermeus W. Effectiveness of discharge interventions from hospital to home on hospital readmissions: a systematic review. ACTA ACUST UNITED AC 2018; 14:106-73. [PMID: 27536797 DOI: 10.11124/jbisrir-2016-2381] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Many discharge interventions are developed to reduce unplanned hospital readmissions, but it is unclear which interventions are more effective. OBJECTIVES The objective of this review was to identify discharge interventions from hospital to home that reduce hospital readmissions within three months and to understand their effect on secondary outcome measures. INCLUSION CRITERIA Participants were adults (18 years or older) discharged from a medical or surgical ward.The included interventions had to be designed to ease the care transition from hospital to home or to prevent problems after hospital discharge.This review considered only randomized controlled trials.The primary outcome measure was hospital readmission within three months after discharge. Secondary outcomes included patient satisfaction, return to emergency departments and mortality. SEARCH STRATEGY Studies in English between January 1990 and July 2014 were considered for inclusion. The databases searched were PubMed, Web of Science, Embase and CINAHL. METHODOLOGICAL QUALITY Methodological validity was assessed by two reviewers prior to inclusion using the standardized critical appraisal instruments from the Joanna Briggs Institute. DATA EXTRACTION Quantitative data were independently extracted by the two reviewers using the standardized data extraction tool from the Joanna Briggs Institute. DATA SYNTHESIS Meta-analysis was performed by using a random effect model; data were pooled using Mantel-Haenszel methods. For subgroups analysis only papers with critical appraisal score of seven or more were selected. RESULTS Meta-analysis was performed on 47 studies. The overall relative risk for hospital readmission was 0.77 [95% CI, 0.70-0.84] (p<0.00001). The relative risk for return to the emergency department was 0.75 [95% CI, 0.55-1.01] (p=0.06) and for mortality 0.70 [95% CI, 0.48-1.01] (p=0.06). Patient satisfaction improved in favor of the intervention group in five out of the six studies evaluating patient satisfaction.Exploratory subgroup analysis found that interventions starting during hospital stay and continuing after discharge were more effective in reducing readmissions compared to interventions starting after discharge (between subgroup difference p=0.01). Multicomponent interventions were not more effective compared to single component interventions (between subgroup difference p=0.54). Interventions oriented towards patient empowerment were more effective compared to all other interventions (between subgroup difference p=0.02). CONCLUSIONS Interventions designed to improve the care transition from hospital to home are effective in reducing hospital readmission. These interventions preferably start in the hospital and continue after discharge rather than starting after discharge. Enhancing patient empowerment is a key factor in reducing hospital readmissions.Interventions to reduce hospital readmissions should start during hospital stay and continue in the community (grade A recommendation). This requires financial systems to support and facilitate collaboration between hospitals and home care.Interventions that support patient empowerment are more effective in reducing hospital readmissions (grade B recommendation). To promote patient empowerment caregivers must be trained to increase patients' capacity to self-care.Future research should focus on interventions that improve patient empowerment and the effects of discharge interventions after more than three months.
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Affiliation(s)
- Anja Braet
- 1. KU Leuven-University of Leuven, Department of Public Health and Primary Care, Leuven, Belgium2. az Sint-Blasius, Dendermonde, Belgium3. Flemish Hospital Network KU Leuven, Leuven, Belgium4. University Hospitals Leuven, Leuven, Belgium5. Belgian Interuniversity Collaboration for Evidence-based Practice (BICEP): an Affiliate Center of The Joanna Briggs Institute
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van Zelm R, Janssen I, Vanhaecht K, de Buck van Overstraeten A, Panella M, Sermeus W, Coeckelberghs E. Development of a model care pathway for adults undergoing colorectal cancer surgery: Evidence-based key interventions and indicators. J Eval Clin Pract 2018; 24:232-239. [PMID: 28145019 DOI: 10.1111/jep.12700] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 12/13/2016] [Accepted: 12/14/2016] [Indexed: 12/16/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES During the last decades, perioperative care for patients with colorectal cancer has shifted towards more standardized care, so-called "enhanced recovery after surgery." Those programs aim to optimize interventions in perioperative care to decrease the rate of postoperative complications, improve patients' recovery, and shorten hospital stay. The purpose of this literature review is to identify, summarize, and operationalize the clinical content of both key interventions and clinical indicators to develop an evidence-based model pathway for surgical patients with colorectal cancer. METHODS A systematic search in 3 databases was conducted to identify key interventions (KIs) and indicators to measure the effect of implementation of care pathways. The KIs from the enhanced recovery after surgery protocol were listed and used as framework to identify and match KIs used in the included studies. The Clinical Pathway Compass was used to categorize the indicators. RESULTS Fifteen studies were included. The number of KI used in the study protocols ranged from 9 to 20. In total, 33 KIs were identified. Little information was available concerning the implementation of and compliance to the protocol. Length of stay and complication rate are the most common used indicators (used in 15/15 and 14/15 of the studies), followed by 21 other measures. All but one of the included studies reported a reduction in length of stay. CONCLUSION There is a considerable variation in both number of KIs and indicators as well as operationalization of key interventions, for surgical patients with colorectal cancer documented in literature. Therefore, we summarized the input from different studies and developed an evidence-based model pathway, which can serve as a basis for a local/regional care pathway team to build their own pathway.
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Affiliation(s)
- Ruben van Zelm
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.,Q-Consult, Utrecht, the Netherlands
| | | | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.,University Hospital Leuven, Leuven, Belgium
| | | | - Massimiliano Panella
- Department of Translational Medicine, University of Eastern Piemonte (UPO), Novarra, Italy
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
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Aeyels D, Sinnaeve PR, Claeys MJ, Gevaert S, Schoors D, Sermeus W, Panella M, Coeckelberghs E, Bruyneel L, Vanhaecht K. Key interventions and quality indicators for quality improvement of STEMI care: a RAND Delphi survey. Acta Cardiol 2017; 73:1-10. [PMID: 29237337 DOI: 10.1080/00015385.2017.1411664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 05/25/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Identification, selection and validation of key interventions and quality indicators for improvement of in hospital quality of care for ST-elevated myocardial infarction (STEMI) patients. METHODS AND RESULTS A structured literature review was followed by a RAND Delphi Survey. A purposively selected multidisciplinary expert panel of cardiologists, nurse managers and quality managers selected and validated key interventions and quality indicators prior for quality improvement for STEMI. First, 34 experts (76% response rate) individually assessed the appropriateness of items to quality improvement on a nine point Likert scale. Twenty-seven key interventions, 16 quality indicators at patient level and 27 quality indicators at STEMI care programme level were selected. Eighteen additional items were suggested. Experts received personal feedback, benchmarking their score with group results (response rate, mean, median and content validity index). Consequently, 32 experts (71% response rate) openly discussed items with an item-content validity index above 75%. By consensus, the expert panel validated a final set of 25 key interventions, 13 quality indicators at patient level and 20 quality indicators at care programme level prior for improvement of in hospital care for STEMI. CONCLUSIONS A structured literature review and multidisciplinary expertise was combined to validate a set of key interventions and quality indicators prior for improvement of care for STEMI. The results allow researchers and hospital staff to evaluate and support quality improvement interventions in a large cohort within the context of a health care system.
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Affiliation(s)
- Daan Aeyels
- a Leuven Institute for Healthcare Policy , Katholieke Universiteit Leuven , Leuven , Belgium
| | - Peter R Sinnaeve
- b Department of Cardiology , University Hospitals Leuven , Leuven , Belgium
| | - Marc J Claeys
- c Department of Cardiology , Antwerp University Hospital , Edegem , Belgium
| | - Sofie Gevaert
- d Department of Cardiology , Ghent University Hospital , Ghent , Belgium
| | - Danny Schoors
- e Department of Cardiology , University Hospitals Brussels , Brussels , Belgium
| | - Walter Sermeus
- f Institute for Healthcare Policy , University of Leuven , Leuven , Belgium
| | - Massimiliano Panella
- g Department of Clinical and Experimental Medicine , Amedeo Avogadro University of Eastern Piedmont , Vercelli , Italy
| | | | - Luk Bruyneel
- f Institute for Healthcare Policy , University of Leuven , Leuven , Belgium
| | - Kris Vanhaecht
- h Department of Quality Management , University Hospitals Leuven , Leuven , Belgium
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van Zelm R, Coeckelberghs E, Sermeus W, De Buck van Overstraeten A, Weimann A, Seys D, Panella M, Vanhaecht K. Variation in care for surgical patients with colorectal cancer: protocol adherence in 12 European hospitals. Int J Colorectal Dis 2017; 32:1471-1478. [PMID: 28717841 DOI: 10.1007/s00384-017-2863-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE Surgical care for patients with colorectal cancer has become increasingly standardized. The Enhanced Recovery After Surgery (ERAS) protocol is a widely accepted structured care method to improve postoperative outcomes of patients after surgery. Despite growing evidence of effectiveness, adherence to the protocol remains challenging in practice. This study was designed to assess the adherence rate in daily practice and examine the relationship between the importance of interventions and adherence rate. METHODS This international observational, cross-sectional multicenter study was performed in 12 hospitals in four European countries. Patients were included from January 1, 2014. Data was retrospectively collected from the patient record by the local study coordinator. RESULTS A total of 230 patients were included in the study. Protocol adherence was analyzed for both the individual interventions and on patient level. The interventions with the highest adherence were antibiotic prophylaxis (95%), thromboprophylaxis (87%), and measuring body weight at admission (87%). Interventions with the lowest adherence were early mobilization-walking and sitting (9 and 6%, respectively). The adherence ranged between 16 and 75%, with an average of 44%. CONCLUSION Our results show that the average protocol adherence in clinical practice is 44%. The variation on patient and hospital level is considerable. Only in one patient the adherence rate was >70%. In total, 30% of patients received 50% or more of the key interventions. A solid implementation strategy seems to be needed to improve the uptake of the ERAS pathway. The importance-performance matrix can help in prioritizing the areas for improvement.
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Affiliation(s)
- Ruben van Zelm
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium. .,European Pathway Association, Leuven, Belgium. .,Q-Consult zorg, Utrecht, The Netherlands.
| | - Ellen Coeckelberghs
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.,European Pathway Association, Leuven, Belgium
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.,European Pathway Association, Leuven, Belgium
| | | | - Arved Weimann
- Department of General, Abdominal, and Oncological Surgery, Klinikum Skt George, Leipzig, Germany
| | - Deborah Seys
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Massimiliano Panella
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.,European Pathway Association, Leuven, Belgium.,Department of Translational Medicine, University of Eastern Piemonte (UPO), Novara, Italy
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.,European Pathway Association, Leuven, Belgium.,Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
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Sasso L, Bagnasco A, Petralia P, Scelsi S, Zanini M, Catania G, Aleo G, Dasso N, Rossi S, Watson R, Sermeus W, Icardi G, Aiken LH. RN4CAST@IT-Ped: Nurse staffing and children's safety. J Adv Nurs 2017; 74:1223-1225. [PMID: 28960392 DOI: 10.1111/jan.13462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Loredana Sasso
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - Paolo Petralia
- General Directorate, Gaslini Children's Hospital, Genoa, Italy
| | - Silvia Scelsi
- General Directorate, Gaslini Children's Hospital, Genoa, Italy
| | - Milko Zanini
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Gianluca Catania
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Giuseppe Aleo
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Nicoletta Dasso
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Silvia Rossi
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Roger Watson
- School of Health & Social Work, University of Hull, Hull, UK
| | - Walter Sermeus
- Department of Public Health & Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Giancarlo Icardi
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Linda H Aiken
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
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Ball JE, Bruyneel L, Aiken LH, Sermeus W, Sloane DM, Rafferty AM, Lindqvist R, Tishelman C, Griffiths P. Post-operative mortality, missed care and nurse staffing in nine countries: A cross-sectional study. Int J Nurs Stud 2017; 78:10-15. [PMID: 28844649 PMCID: PMC5826775 DOI: 10.1016/j.ijnurstu.2017.08.004] [Citation(s) in RCA: 265] [Impact Index Per Article: 37.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 08/04/2017] [Accepted: 08/08/2017] [Indexed: 12/12/2022]
Abstract
Background Variation in post-operative mortality rates has been associated with differences in registered nurse staffing levels. When nurse staffing levels are lower there is also a higher incidence of necessary but missed nursing care. Missed nursing care may be a significant predictor of patient mortality following surgery. Aim Examine if missed nursing care mediates the observed association between nurse staffing levels and mortality. Method Data from the RN4CAST study (2009–2011) combined routinely collected data on 422,730 surgical patients from 300 general acute hospitals in 9 countries, with survey data from 26,516 registered nurses, to examine associations between nurses’ staffing, missed care and 30-day in-patient mortality. Staffing and missed care measures were derived from the nurse survey. A generalized estimation approach was used to examine the relationship between first staffing, and then missed care, on mortality. Bayesian methods were used to test for mediation. Results Nurse staffing and missed nursing care were significantly associated with 30-day case-mix adjusted mortality. An increase in a nurse’s workload by one patient and a 10% increase in the percent of missed nursing care were associated with a 7% (OR 1.068, 95% CI 1.031–1.106) and 16% (OR 1.159 95% CI 1.039–1.294) increase in the odds of a patient dying within 30 days of admission respectively. Mediation analysis shows an association between nurse staffing and missed care and a subsequent association between missed care and mortality. Conclusion Missed nursing care, which is highly related to nurse staffing, is associated with increased odds of patients dying in hospital following common surgical procedures. The analyses support the hypothesis that missed nursing care mediates the relationship between registered nurse staffing and risk of patient mortality. Measuring missed care may provide an ‘early warning’ indicator of higher risk for poor patient outcomes.
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Affiliation(s)
- Jane E Ball
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet (KI), Stockholm, Sweden; University of Southampton & National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex, Southampton, United Kingdom.
| | - Luk Bruyneel
- KU Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium
| | - Linda H Aiken
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA 19104, USA
| | - Walter Sermeus
- KU Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium
| | - Douglas M Sloane
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA 19104, USA
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, England, United Kingdom
| | | | - Carol Tishelman
- LIME Karolinska Institutet & Innovation Centre, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Griffiths
- Chair of Health Services Research, University of Southampton, & National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex, Southampton, United Kingdom
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Seys D, Bruyneel L, Deneckere S, Kul S, Van der Veken L, van Zelm R, Sermeus W, Panella M, Vanhaecht K. Better organized care via care pathways: A multicenter study. PLoS One 2017; 12:e0180398. [PMID: 28672030 PMCID: PMC5495424 DOI: 10.1371/journal.pone.0180398] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 06/15/2017] [Indexed: 11/18/2022] Open
Abstract
An increased need for efficiency and effectiveness in today’s healthcare system urges professionals to improve the organization of care. Care pathways are an important tool to achieve this. The overall aim of this study was to analyze if care pathways lead to better organization of care processes. For this, the Care Process Self-Evaluation tool (CPSET) was used to evaluate how healthcare professionals perceive the organization of care processes. Based on information from 2692 health care professionals gathered between November 2007 and October 2011 we audited 261 care processes in 108 organizations. Multilevel analysis was used to compare care processes without and with care pathways and analyze if care pathways led to better organization of care processes. A significant difference between care processes with and without care pathways was found. A care pathway in use led to significant better scores on the overall CPSET scale (p<0.001) and its subscales, “coordination of care” (p<0.001) and “follow-up of care” (p<0.001). Physicians had the highest score on the overall CPSET scale and the five subscales. Care processes organized by care pathways had a 2.6 times higher probability that the care process was well-organized. In around 75% of the cases a care pathway led to better organized care processes. Care processes supported by care pathways were better organized, but not all care pathways were well-organized. Managers can use care pathways to make healthcare professionals more aware of their role in the organization of the care process.
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Affiliation(s)
- Deborah Seys
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Quality Management, UZ Leuven, Leuven, Belgium
| | - Svin Deneckere
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
- Medical Department, Delta Hospitals Roeselare, Roeselare, Belgium
| | - Seval Kul
- Department of Biostatistics, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| | - Liz Van der Veken
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
| | - Ruben van Zelm
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
- Q Consult, Utrecht, The Netherlands
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
| | - Massimiliano Panella
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Clinical and Experimental Medicine, University of Eastern Piedmont 'A. Avogadro', Novara, Italy
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Quality Management, UZ Leuven, Leuven, Belgium
- * E-mail:
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Nagle LM, Sermeus W, Junger A. Evolving Role of the Nursing Informatics Specialist. Stud Health Technol Inform 2017; 232:212-221. [PMID: 28106600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The scope of nursing informatics practice has been evolving over the course of the last 5 decades, expanding to address the needs of health care organizations and in response to the evolution of technology. In parallel, the educational preparation of nursing informatics specialists has become more formalized and shaped by the requisite competencies of the role. In this chapter, the authors describe the evolution of nursing informatics roles, scope and focus of practice, and anticipated role responsibilities and opportunities for the future. Further, implications and considerations for the future are presented.
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Affiliation(s)
- Lynn M Nagle
- Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, University of Leuven, Belgium
| | - Alain Junger
- University Hospital of Lausanne, Lausanne, Switzerland
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Seys D, Bruyneel L, Decramer M, Lodewijckx C, Panella M, Sermeus W, Boto P, Vanhaecht K. An International Study of Adherence to Guidelines for Patients Hospitalised with a COPD Exacerbation. COPD 2016; 14:156-163. [PMID: 27997254 DOI: 10.1080/15412555.2016.1257599] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Guideline adherence rates for the treatment of chronic obstructive pulmonary disease (COPD) exacerbation are low. The aim of this study is to perform an importance-performance analysis as an approach for prioritisation of interventions by linking guidelines adherence rates to expert consensus rates for the in-hospital management of COPD exacerbation. We illustrate the relevance of such approach by describing variation in guideline adherence across indicators and hospitals. A secondary data analysis of patients with an acute COPD exacerbation admitted to Belgian, Italian and Portuguese hospitals was performed. Twenty-one process indicators were used to describe adherence to guidelines from patient record reviews. Expert consensus on the importance for follow-up of these 21 indicators was derived from a previous Delphi study. Three of the twenty-one indicators had high level of expert consensus and a high level of adherence. Eleven of the twenty-one indicators had high level of expert consensus but a low level of adherence. For none of the 378 patients included in this study were all process indicators adhered to, patients received 41.0% of the recommended care on average, and only 34.1% of the patients received 50% or more of the care they should receive. There was also a large variation within and between hospitals regarding the care received. This study confirms the findings of previous studies, indicating that COPD exacerbations are largely undertreated. Importance-performance analysis provides a decision-making tool for prioritising indicators. All hospitals in this study would benefit from having in place a quality framework for systematic follow-up of these indicators.
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Affiliation(s)
- Deborah Seys
- a Department of Public Health and Primary Care , Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven , Leuven , Belgium
| | - Luk Bruyneel
- a Department of Public Health and Primary Care , Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven , Leuven , Belgium.,b Department of Quality Management , University Hospitals Leuven , Leuven , Belgium
| | - Marc Decramer
- c Department of Clinical and Experimental Medicine , KU Leuven-University of Leuven , Leuven , Belgium.,d Chief Executive Officer, University Hospitals Leuven , Leuven , Belgium
| | - Cathy Lodewijckx
- a Department of Public Health and Primary Care , Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven , Leuven , Belgium
| | - Massimiliano Panella
- a Department of Public Health and Primary Care , Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven , Leuven , Belgium.,e Department of Translational Medicine , University of Eastern Piedmont , Vercelli , Italy
| | - Walter Sermeus
- a Department of Public Health and Primary Care , Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven , Leuven , Belgium
| | - Paulo Boto
- f Department of Health Services Policy and Management Centro de Investigação em Saúde Pública (CISP), Escola Nacional de Saúde Pública (ENSP), Universidade Nova de Lisboa (UNL) , Lisbon , Portugal
| | - Kris Vanhaecht
- a Department of Public Health and Primary Care , Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven , Leuven , Belgium.,b Department of Quality Management , University Hospitals Leuven , Leuven , Belgium
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Sermeus W, Cullum N, Balzer K, Schröder R, Junghans A, Stahl U, Träder JM, Köpke S, Dichter MN, Palm R, Halek M, Bartholomeyczik S, Meyer G, Holle D, Graf R, Rosier U, Reuther S, Roes M, Halek M, Gouveia BR, Jardim HG, Martins MM, Freitas DL, Maia JA, Rose DJ, Gouveia ÉR, Bruyneel L, Lesaffre E, Sermeus W, Ball JE, Bruyneel L, Aiken L, Tishelman C, Sermeus W, Griffiths P, Papastavrou E, Andreou P, Sasso L, Bagnasco A, Zanini MP, Catania G, Aleo G, Spandonaro F, Icardi G, Watson R, Sermeus W, Fleischer S, Burckhardt M, Meyer G, Berg A, Van Hecke A, Malfait S, Van Daele J, Eeckloo K, Deschodt M, Van Grootven B, Milisen K, Flamaing J, Rahn AC, Köpke S, Backhus I, Kasper J, Krützelmann A, Kleiter I, Mühlhauser I, Heesen C. European Academy of Nursing Science 2016 Summer Conference. BMC Nurs 2016. [PMCID: PMC5260782 DOI: 10.1186/s12912-016-0186-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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