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Gifford R, van Raak A, Govers M, Westra D. Back to the Future: What Healthcare Organizations Need to Thrive in the Face of Persistent Environmental Uncertainty. Adv Health Care Manag 2024; 22:3-27. [PMID: 38262008 DOI: 10.1108/s1474-823120240000022001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
While uncertainty has always been a feature of the healthcare environment, its pace and scope are rapidly increasing, fueled by myriad factors such as technological advancements, the threat and frequency of disruptive events, global economic developments, and increasing complexity. Contemporary healthcare organizations thus persistently face what is known as "deep uncertainty," which obscures their ability to predict outcomes of strategic action and decision-making, presenting them with novel challenges and threatening their survival. Persistent, deep uncertainty challenges us to revisit and reconsider how we think about uncertainty and the strategic actions needed by organizations to thrive under these circumstances. Simply put, how can healthcare organizations thrive in the face of deeply uncertain environments? We argue that healthcare organizations need to employ both adaptive and creative strategic approaches in order to effectively meet patients' needs and capture value in the long-term future. The chapter concludes by offering two ways organizations can build the dynamic capabilities needed to employ such approaches.
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Kröger C, Molewijk B, Muntinga M, Metselaar S. The Diversity Compass: a clinical ethics support instrument for dialogues on diversity in healthcare organizations. BMC Med Ethics 2024; 25:4. [PMID: 38172942 PMCID: PMC10765795 DOI: 10.1186/s12910-023-00992-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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/01/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Increasing social pluralism adds to the already existing variety of heterogeneous moral perspectives on good care, health, and quality of life. Pluralism in social identities is also connected to health and care disparities for minoritized patient (i.e. care receiver) populations, and to specific diversity-related moral challenges of healthcare professionals and organizations that aim to deliver diversity-responsive care in an inclusive work environment. Clinical ethics support (CES) services and instruments may help with adequately responding to these diversity-related moral challenges. However, although various CES instruments exist to support healthcare professionals with dealing well with morally challenging situations in healthcare, current tools do not address challenges specifically related to moral pluralism and intersectional aspects of diversity and social justice issues. This article describes the content and developmental process of a novel CES instrument called the Diversity Compass. This instrument was designed with and for healthcare professionals to dialogically address and reflect on moral challenges related to intersectional aspects of diversity and social justice issues that they experience in daily practice. METHODS We used a participatory development design to develop the Diversity Compass at a large long-term care organization in a major city in the Netherlands. Over a period of thirteen months, we conducted seven focus groups with healthcare professionals and peer-experts, carried out five expert interviews, and facilitated four meetings with a community of practice consisting of various healthcare professionals who developed and tested preliminary versions of the instrument throughout three cycles of iterative co-creation. RESULTS The Diversity Compass is a practical, dialogical CES instrument that is designed as a small booklet and includes an eight-step deliberation method, as well as a guideline with seven recommendations to support professionals with engaging in dialogue when they are confronted with diversity-related moral challenges. The seven recommendations are key components in working toward creating an inclusive and safe space for dialogue to occur. CONCLUSIONS The Diversity Compass seeks to support healthcare professionals and organizations in their efforts to facilitate awareness, moral learning and joint reflection on moral challenges related to diversity and social justice issues. It is the first dialogical CES instrument that specifically acknowledges the role of social location in shaping moral perspectives or experiences with systemic injustices. However, to make healthcare more just, an instrument like the Diversity Compass is not enough on its own. In addition to the Diversity Compass, a systemic and structural approach to social justice issues in healthcare organizations is needed in order to foster a more inclusive, safe and diversity-responsive care and work environment in health care organizations.
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Affiliation(s)
- Charlotte Kröger
- Department of Ethics, Law and Humanities, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1089a, Amsterdam, The Netherlands.
- Netherlands Defense Academy, Breda, The Netherlands.
| | - Bert Molewijk
- Department of Ethics, Law and Humanities, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1089a, Amsterdam, The Netherlands
- Centre for Medical Ethics, University of Oslo, Oslo, Norway
| | - Maaike Muntinga
- Department of Ethics, Law and Humanities, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1089a, Amsterdam, The Netherlands
| | - Suzanne Metselaar
- Department of Ethics, Law and Humanities, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1089a, Amsterdam, The Netherlands
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Kröger C, Molewijk AC, Metselaar S. Developing Organizational Diversity Statements Through Dialogical Clinical Ethics Support: The Role of the Clinical Ethicist. J Bioeth Inq 2023; 20:379-395. [PMID: 37233964 PMCID: PMC10624755 DOI: 10.1007/s11673-023-10258-3] [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] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/20/2022] [Indexed: 05/27/2023]
Abstract
In pluralist societies, stakeholders in healthcare may have different experiences of and moral perspectives on health, well-being, and good care. Increasing cultural, religious, sexual, and gender diversity among both patients and healthcare professionals requires healthcare organizations to address these differences. Addressing diversity, however, comes with inherent moral challenges; for example, regarding how to deal with healthcare disparities between minoritized and majoritized patients or how to accommodate different healthcare needs and values. Diversity statements are an important strategy for healthcare organizations to define their normative ideas with respect to diversity and to establish a point of departure for concrete diversity approaches. We argue that healthcare organizations ought to develop diversity statements in a participatory and inclusive way in order to promote social justice. Furthermore, we maintain that clinical ethicists can support healthcare organizations in developing diversity statements in a more participatory way by fostering reflective dialogues through clinical ethics support. We will use a case example from our own practice to explore what such a developmental process may look like. We will critically reflect on the procedural strengths and challenges as well as on the role of the clinical ethicist in this example.
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Affiliation(s)
- Charlotte Kröger
- Department of Ethics, Law and Humanities, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1089a, 1081 HV, Amsterdam, Netherlands.
- Faculty of Military Sciences, Netherlands Defence Academy, Breda, The Netherlands.
| | - Albert C Molewijk
- Department of Ethics, Law and Humanities, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1089a, 1081 HV, Amsterdam, Netherlands
- Centre for Medical Ethics, University of Oslo, Oslo, Norway
| | - Suzanne Metselaar
- Department of Ethics, Law and Humanities, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1089a, 1081 HV, Amsterdam, Netherlands
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Williams MS, Myers AK, Finuf KD, Patel VH, Marrast LM, Pekmezaris R, Martinez J. Black Physicians' Experiences with Anti-Black Racism in Healthcare Systems Explored Through An Attraction-Selection-Attrition Lens. J Bus Psychol 2023; 38:75-88. [PMID: 35702386 PMCID: PMC9184355 DOI: 10.1007/s10869-022-09825-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 05/05/2023]
Abstract
Anti-Black racism is a specific form of racism directed at Black people. In healthcare, there are poignant examples of anti-Black racism in the recruitment, selection, and retention stages of the job cycle. Research shows that anti-Black racism is associated with inequitable work outcomes and the under-representation of Black physicians. However, empirical findings are scattered with no organizing framework to consolidate these findings. To add to the literature, in this paper we present the attraction-selection-attrition (ASA) model (Schneider, 1987) as an organizing framework to discuss Black physicians' experiences with anti-Black racism and discrimination throughout their careers. We draw from previous literature to highlight specific experiences of Black physicians at each stage of the job cycle (i.e., attraction, selection, retention), and we offer considerations on how practitioners can mitigate anti-Black racism throughout the job cycle. In the wake of COVID-19 and highly publicized social justice movements, healthcare systems are seeking ways to increase the recruitment, selection, and retention of Black physicians to ensure health equity. We believe this guide will be valuable to practitioners, leaders, researchers, and program directions seeking to advance diversity, equity, and inclusion of Black physicians in their healthcare systems. We conclude by providing practical implications and directions for future research.
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Affiliation(s)
- Myia S. Williams
- Department of Medicine, Northwell Health, Manhasset, NY USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
- Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY USA
- Department of Medicine, Northwell Health, 600 Community Drive 4th Floor, Manhasset, NY 11030 USA
| | - Alyson K. Myers
- Department of Medicine, Northwell Health, Manhasset, NY USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
- Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY USA
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY USA
| | - Kayla D. Finuf
- Department of Medicine, Northwell Health, Manhasset, NY USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
| | - Vidhi H. Patel
- Department of Medicine, Northwell Health, Manhasset, NY USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
| | - Lyndonna M. Marrast
- Department of Medicine, Northwell Health, Manhasset, NY USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
- Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY USA
| | - Renee Pekmezaris
- Department of Medicine, Northwell Health, Manhasset, NY USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
- Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY USA
| | - Johanna Martinez
- Department of Medicine, Northwell Health, Manhasset, NY USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
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Alsaqqa HH. Healthcare Organizations Management: Analyzing Characteristics, Features and Factors, to Identify Gaps "Scoping Review". Health Serv Insights 2023; 16:11786329231168130. [PMID: 37153880 PMCID: PMC10161313 DOI: 10.1177/11786329231168130] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/15/2023] [Indexed: 05/10/2023] Open
Abstract
Background Studying the organizational characteristics, factors and features in healthcare organizations will have its prompt in achieving the desired outcomes of the provided services. Addressing these variables, the subsequent study conducts a scoping review methodology to systematically evaluate existing information while focusing on conclusions and gaps representing organizational variables that have been shown to influence the management of healthcare organizations. Methods A scoping review was performed to shed the light on the healthcare organizations' characteristics, features and factors. Results Fifteen articles were included in the final analysis of this study. Among the relevant studies, 12 were research articles and 8 were quantitative studies. Continuity of care, organizational culture, patient trust, strategic factors and operational factors are among the explored features that have an impact in the management of healthcare organizations. Conclusion This review shows the gaps in the management practice and in the management studies that address healthcare organizations.
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Affiliation(s)
- Hatem H Alsaqqa
- Deanship of Scientific Research, Al-Quds University, Jerusalem, Palestine
- Ministry of Health, Gaza, Palestine
- Hatem H Alsaqqa, Al-Quds University, Palestine, Jerusalem, Abu Dis, P144.
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Kröger C, van Baarle E, Widdershoven G, Bal R, Weenink JW. Combining rules and dialogue: exploring stakeholder perspectives on preventing sexual boundary violations in mental health and disability care organizations. BMC Med Ethics 2022; 23:49. [PMID: 35505331 PMCID: PMC9066979 DOI: 10.1186/s12910-022-00786-9] [Citation(s) in RCA: 2] [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: 12/22/2021] [Accepted: 04/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background Sexual boundary violations (SBV) in healthcare are harmful and exploitative sexual transgressions in the professional–client relationship. Persons with mental health issues or intellectual disabilities, especially those living in residential settings, are especially vulnerable to SBV because they often receive long-term intimate care. Promoting good sexual health and preventing SBV in these care contexts is a moral and practical challenge for healthcare organizations. Methods We carried out a qualitative interview study with 16 Dutch policy advisors, regulators, healthcare professionals and other relevant experts to explore their perspectives on preventing SBV in mental health and disability care organizations. We used inductive thematic analysis to interpret our data. Results We found three main themes on how healthcare organizations can prevent SBV in mental health and disability care: (1) setting rules and regulations, (2) engaging in dialogue about sexuality, and (3) addressing systemic and organizational dimensions. Conclusion Our findings suggest that preventing SBV in mental health and disability care organizations necessitates setting suitable rules and regulations and facilitating dialogue about positive aspects of sexuality and intimacy, as well as about boundaries, and inappropriate behaviors or feelings. Combining both further requires organizational policies and practices that promote transparency and reflection, and focus on creating a safe environment. Our findings will help prevent SBV and promote sexual health in mental health and disability care organizations.
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Affiliation(s)
- Charlotte Kröger
- Department of Ethics, Law and Humanities, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. .,Department of Ethics, Law and Humanities, Amsterdam Public Health Research Institute, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1089a, Amsterdam, The Netherlands.
| | - Eva van Baarle
- Department of Ethics, Law and Humanities, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Netherlands Defense Academy, Breda, The Netherlands
| | - Guy Widdershoven
- Department of Ethics, Law and Humanities, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Roland Bal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jan-Willem Weenink
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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7
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Thomas A, Suresh M. Assessment of COVID-19 prevention and protection measures in hospitals. Clean Eng Technol 2022; 7:100440. [PMID: 35156071 PMCID: PMC8820025 DOI: 10.1016/j.clet.2022.100440] [Citation(s) in RCA: 4] [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] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 01/20/2022] [Accepted: 02/06/2022] [Indexed: 06/14/2023]
Abstract
This paper aims to develop an assessment framework for the Covid-19 prevention and protection measures in hospitals. The conceptual model is developed by using fifty-four attributes, fifteen criteria, and three enablers. The multi-grade fuzzy approach is used to develop the assessment framework, and Importance Performance Analysis (IPA) identifies the weaker attributes in the case organization. The case hospital's preventive and safety measures assessment level is 8.05, which is 'very highly focused on protection measures,' and fourteen weaker attributes were identified. The case hospital management should focus on the guidelines of Covid-19 preventive and protection measures, strict protocols, regular audits, education and training of the staff, and active surveillance. Case hospital managers should also focus on staffing and timings, the formulation of policies, and abiding by those policies without any fail. This proposed assessment model is a new initiative in-hospital assessment in preventive and safety measures in the healthcare sector during the Covid-19 era. This framework will enable hospital managers as a continuous assessment tool to improve their Covid-19 prevention operations.
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Affiliation(s)
- Albi Thomas
- Amrita School of Business, Amrita Vishwa Vidyapeetham, Coimbatore, 641 112, India
| | - M Suresh
- Amrita School of Business, Amrita Vishwa Vidyapeetham, Coimbatore, 641 112, India
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8
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Medlinskiene K, Tomlinson J, Marques I, Richardson S, Stirling K, Petty D. Barriers and facilitators to the uptake of new medicines into clinical practice: a systematic review. BMC Health Serv Res 2021; 21:1198. [PMID: 34740338 PMCID: PMC8570007 DOI: 10.1186/s12913-021-07196-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/19/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Implementation and uptake of novel and cost-effective medicines can improve patient health outcomes and healthcare efficiency. However, the uptake of new medicines into practice faces a wide range of obstacles. Earlier reviews provided insights into determinants for new medicine uptake (such as medicine, prescriber, patient, organization, and external environment factors). However, the methodological approaches used had limitations (e.g., single author, narrative review, narrow search, no quality assessment of reviewed evidence). This systematic review aims to identify barriers and facilitators affecting the uptake of new medicines into clinical practice and identify areas for future research. METHOD A systematic search of literature was undertaken within seven databases: Medline, EMBASE, Web of Science, CINAHL, Cochrane Library, SCOPUS, and PsychINFO. Included in the review were qualitative, quantitative, and mixed-methods studies focused on adult participants (18 years and older) requiring or taking new medicine(s) for any condition, in the context of healthcare organizations and which identified factors affecting the uptake of new medicines. The methodological quality was assessed using QATSDD tool. A narrative synthesis of reported factors was conducted using framework analysis and a conceptual framework was utilised to group them. RESULTS A total of 66 studies were included. Most studies (n = 62) were quantitative and used secondary data (n = 46) from various databases, e.g., insurance databases. The identified factors had a varied impact on the uptake of the different studied new medicines. Differently from earlier reviews, patient factors (patient education, engagement with treatment, therapy preferences), cost of new medicine, reimbursement and formulary conditions, and guidelines were suggested to influence the uptake. Also, the review highlighted that health economics, wider organizational factors, and underlying behaviours of adopters were not or under explored. CONCLUSION This systematic review has identified a broad range of factors affecting the uptake of new medicines within healthcare organizations, which were grouped into patient, prescriber, medicine, organizational, and external environment factors. This systematic review also identifies additional factors affecting new medicine use not reported in earlier reviews, which included patient influence and education level, cost of new medicines, formulary and reimbursement restrictions, and guidelines. REGISTRATION PROSPERO database (CRD42018108536).
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Affiliation(s)
- Kristina Medlinskiene
- Medicine Optimisation Research Group, School of Pharmacy and Medical Sciences, University of Bradford, Richmond Road, Bradford, BD7 1DP UK
- Medicine Management and Pharmacy Services, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Justine Tomlinson
- Medicine Optimisation Research Group, School of Pharmacy and Medical Sciences, University of Bradford, Richmond Road, Bradford, BD7 1DP UK
- Medicine Management and Pharmacy Services, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Iuri Marques
- Medicine Optimisation Research Group, School of Pharmacy and Medical Sciences, University of Bradford, Richmond Road, Bradford, BD7 1DP UK
| | - Sue Richardson
- Department of Management, Huddersfield Business School, University of Huddersfield, Huddersfield, HD1 3DH UK
| | - Katherine Stirling
- Medicine Management and Pharmacy Services, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Duncan Petty
- Medicine Optimisation Research Group, School of Pharmacy and Medical Sciences, University of Bradford, Richmond Road, Bradford, BD7 1DP UK
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9
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Alami H, Lehoux P, Denis JL, Motulsky A, Petitgand C, Savoldelli M, Rouquet R, Gagnon MP, Roy D, Fortin JP. Organizational readiness for artificial intelligence in health care: insights for decision-making and practice. J Health Organ Manag 2021; ahead-of-print. [PMID: 33258359 DOI: 10.1108/jhom-03-2020-0074] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 12/11/2022]
Abstract
PURPOSE Artificial intelligence (AI) raises many expectations regarding its ability to profoundly transform health care delivery. There is an abundant literature on the technical performance of AI applications in many clinical fields (e.g. radiology, ophthalmology). This article aims to bring forward the importance of studying organizational readiness to integrate AI into health care delivery. DESIGN/METHODOLOGY/APPROACH The reflection is based on our experience in digital health technologies, diffusion of innovations and healthcare organizations and systems. It provides insights into why and how organizational readiness should be carefully considered. FINDINGS As an important step to ensure successful integration of AI and avoid unnecessary investments and costly failures, better consideration should be given to: (1) Needs and added-value assessment; (2) Workplace readiness: stakeholder acceptance and engagement; (3) Technology-organization alignment assessment and (4) Business plan: financing and investments. In summary, decision-makers and technology promoters should better address the complexity of AI and understand the systemic challenges raised by its implementation in healthcare organizations and systems. ORIGINALITY/VALUE Few studies have focused on the organizational issues raised by the integration of AI into clinical routine. The current context is marked by a perplexing gap between the willingness of decision-makers and technology promoters to capitalize on AI applications to improve health care delivery and the reality on the ground, where it is difficult to initiate the changes needed to realize their full benefits while avoiding their negative impacts.
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Affiliation(s)
- Hassane Alami
- Center for Public Health Research (CreSP), Université de Montréal, Montreal, Canada.,Department of Health Management, Evaluation and Policy, École de Santé Publique de l'Université de Montréal, Montreal, Canada.,Institute for Excellence in Health and Social Services (INESSS), Montreal, Canada
| | - Pascale Lehoux
- Center for Public Health Research (CreSP), Université de Montréal, Montreal, Canada.,Department of Health Management, Evaluation and Policy, École de Santé Publique de l'Université de Montréal, Montreal, Canada
| | - Jean-Louis Denis
- Department of Health Management, Evaluation and Policy, École de Santé Publique de l'Université de Montréal, Montreal, Canada.,Carrefour de l'innovation et de l'évaluation en santé, Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - Aude Motulsky
- Department of Health Management, Evaluation and Policy, École de Santé Publique de l'Université de Montréal, Montreal, Canada.,Carrefour de l'innovation et de l'évaluation en santé, Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - Cecile Petitgand
- Department of Health Management, Evaluation and Policy, École de Santé Publique de l'Université de Montréal, Montreal, Canada.,Carrefour de l'innovation et de l'évaluation en santé, Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | | | - Ronan Rouquet
- Service SI de Santé
- Direction de la Stratégie et des Territoires, Agence régionale de santé (ARS) Hauts-de-France, Amiens, France
| | - Marie-Pierre Gagnon
- Faculty of Nursing Science, Université Laval, Quebec, Canada.,Research Center on Healthcare and Services in Primary Care, Institute of Health and Social Services in Primary Care, Université Laval, Quebec, Canada
| | - Denis Roy
- Institute for Excellence in Health and Social Services (INESSS), Montreal, Canada
| | - Jean-Paul Fortin
- Research Center on Healthcare and Services in Primary Care, Institute of Health and Social Services in Primary Care, Université Laval, Quebec, Canada.,Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, Canada
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Sousa MJ, Pesqueira AM, Lemos C, Sousa M, Rocha Á. Decision-Making based on Big Data Analytics for People Management in Healthcare Organizations. J Med Syst 2019; 43:290. [PMID: 31332535 DOI: 10.1007/s10916-019-1419-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 07/08/2019] [Indexed: 12/30/2022]
Abstract
Big data analytics enables large-scale data sets integration, supporting people management decisions, and cost-effectiveness evaluation of healthcare organizations. The purpose of this article is to address the decision-making process based on big data analytics in Healthcare organizations, to identify main big data analytics able to support healthcare leaders' decisions and to present some strategies to enhance efficiency along the healthcare value chain. Our research was based on a systematic review. During the literature review, we will be presenting as well the different applications of big data in the healthcare context and a proposal for a predictive model for people management processes. Our research underlines the importance big data analytics can add to the efficiency of the decision-making process, through a predictive model and real-time analytics, assisting in the collection, management, and integration of data in healthcare organizations.
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11
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Dimitropoulos PE. Performance Management in Healthcare Organizations: Concept and Practicum. Adv Exp Med Biol 2017; 989:11-9. [PMID: 28971413 DOI: 10.1007/978-3-319-57348-9_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
Organizational performance can create and sustain competitive advantages for corporations and even improve their sustainability and future prospects. Health care organizations present a sector where performance management is structured by multiple dimensions. The scope of this study is to analyze the issue of performance management in healthcare organizations and specifically the implementation of the Balanced Scorecard (BSC) methodology on organizations providing health services. The study provides a discussion on the BSC development process, the steps that management has to take in order to prepare the implementation of the BSC and finally discusses a practical example of a scorecard with specific strategic goals and performance indicators. Managers of healthcare organizations and specifically those providing services to the elderly and the general population could use the propositions of the study as a roadmap for processing, analyzing, evaluating and implementing the balanced scorecard approach in their organizations' daily operations. BSC methodology can give an advantage in terms of enhanced stakeholder management and preservation within a highly volatile and competitive economic environment.
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12
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Phipps DL, Jones CEL, Parker D, Ashcroft DM. Organizational conditions for engagement in quality and safety improvement: a longitudinal qualitative study of community pharmacies. BMC Health Serv Res 2018; 18:783. [PMID: 30333018 PMCID: PMC6191910 DOI: 10.1186/s12913-018-3607-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 06/14/2018] [Accepted: 10/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background While efforts have been made to bring about quality and safety improvement in healthcare, it remains by no means certain that an improvement project will succeed. This suggests a need to better understand the process and conditions of improvement. The current study addresses this question by examining English community pharmacies attempting to undertake improvement activities. Method The study used a longitudinal qualitative design, involving a sample of ten community pharmacies. Each pharmacy took part in a series of improvement workshops, involving use of the Manchester Patient Safety Framework (MaPSaF), over a twelve-month period. Qualitative data were collected from the workshops, from follow-up focus groups and from field notes. Template analysis was used to identify themes in the data. Results The progress made by pharmacies in improving their practice can be described in terms of a behavioural change framework, consisting of contemplation (resolving to make changes if they are required), planning (deciding how to carry out change) and execution (carrying out and reflecting on change). Organizational conditions supporting change were identified; these included the prioritisation of improvement, a commitment to change, a trusting and collaborative relationship between staff and managers, and knowledge about quality and safety issues to work on. Conclusions Our study suggests a process by which healthcare work units might undergo improvement. In addition to recognising and providing support for this process, it is important to establish an environment that fosters improvement, and for work units to ensure that they are prepared for undergoing improvement activities.
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Affiliation(s)
- Denham L Phipps
- Division of Pharmacy and Optometry, The University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK. .,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Sciences Centre, Oxford Road, Manchester, UK.
| | - Christian E L Jones
- Division of Pharmacy and Optometry, The University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Sciences Centre, Oxford Road, Manchester, UK
| | - Dianne Parker
- Division of Pharmacy and Optometry, The University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Sciences Centre, Oxford Road, Manchester, UK
| | - Darren M Ashcroft
- Division of Pharmacy and Optometry, The University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Sciences Centre, Oxford Road, Manchester, UK
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Wiernik H, Katz G, Coulonjou H, Salagnac A, Kletz F, Thariat J. [The French health care funding system for research and innovation in oncology]. Bull Cancer 2018; 105:581-595. [PMID: 29747854 DOI: 10.1016/j.bulcan.2018.03.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 03/21/2018] [Accepted: 03/29/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION This article provides an overview of the French health system with respect to allocation of public resources to hospitals, to encourage research and innovation, particularly in the field of oncology. It is explained in a historical, economic and scientific perspective. RESULTS Important structural and conceptual reforms (T2A, HPST law, etc.) have been carried out. These have significantly impacted the way public funding is allocated. Funding of innovation and research has been modified into a more incentive logic, aimed at strengthening competitiveness between all health care actors. The funding allocation system has evolved towards a more ubiquitous redistribution, including non-academic and private institutions. The baseline endowment includes indicators relating to scientific publications (60% of the endowment), teaching (25%) and clinical trials (15%). Research funding is then redistributed by regional health agencies, and used in health care institutions at the discretion of the directorates. Other funding sources such as calls for grants, funding for mobile research centers and teams, tumor banks and temporary user licenses are also part of the funding by the French Ministry of health. CONCLUSION Changes in the health research funding system have an incentive purpose. They have significantly modified the global healthcare landscape. Feedback on these changes will be necessary to assess the success of the reinforcement of the dynamics of research and innovation.
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Affiliation(s)
- Harvey Wiernik
- Ministère des Solidarités et de la Santé, direction générale de l'offre de soins, bureau PF4 innovation et recherche clinique, 14, avenue Duquesne, 75007 Paris, France
| | - Gregory Katz
- Université Paris-Descartes, école de médecine, chaire management de l'innovation et performance des soins, 15, rue de l'École de médecine, 75006 Paris, France
| | - Hélène Coulonjou
- Ministère des Solidarités et de la Santé, direction générale de l'offre de soins, sous-direction PF Pilotage de la performance des acteurs de l'offre de soins, 14, avenue Duquesne, 75007 Paris, France
| | - André Salagnac
- CHU de Clermont-Ferrand, 58, rue Montalembert, 63003 Clermont-Ferrand, France; Mines ParisTech, centre de gestion scientifique, 60, boulevard St-Michel, 75006 Paris, France
| | - Frédéric Kletz
- Mines ParisTech, centre de gestion scientifique, 60, boulevard St-Michel, 75006 Paris, France
| | - Juliette Thariat
- Normandie université, centre François-Baclesse-Unicaen, département d'oncologie radiothérapie, 3, avenue Général-Harris, 14000 Caen, France.
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Guo R, Berkshire SD, Fulton LV, Hermanson PM. Use of evidence-based management in healthcare administration decision-making. Leadersh Health Serv (Bradf Engl) 2017; 30:330-342. [PMID: 28693398 DOI: 10.1108/lhs-07-2016-0033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this paper is to examine whether healthcare leaders use evidence-based management (EBMgt) when facing major decisions and what types of evidence healthcare administrators consult during their decision-making. This study also intends to identify any relationship that might exist among adoption of EBMgt in healthcare management, attitudes towards EBMgt, demographic characteristics and organizational characteristics. Design/methodology/approach A cross-sectional study was conducted among US healthcare leaders. Spearman's correlation and logistic regression were performed using the Statistical Package for the Social Sciences (SPSS) 23.0. Findings One hundred and fifty-four healthcare leaders completed the survey. The study results indicated that 90 per cent of the participants self-reported having used an EBMgt approach for decision-making. Professional experiences (87 per cent), organizational data (84 per cent) and stakeholders' values (63 per cent) were the top three types of evidence consulted daily and weekly for decision-making. Case study (75 per cent) and scientific research findings (75 per cent) were the top two types of evidence consulted monthly or less than once a month. An exploratory, stepwise logistic regression model correctly classified 75.3 per cent of all observations for a dichotomous "use of EBMgt" response variable using three independent variables: attitude towards EBMgt, number of employees in the organization and the job position. Spearman's correlation indicated statistically significant relationships between healthcare leaders' use of EBMgt and healthcare organization bed size ( rs = 0.217, n = 152, p < 0.01), attitude towards EBMgt ( rs = 0.517, n = 152, p < 0.01), and the number of organization employees ( rs = 0.195, n = 152, p = 0.016). Originality/value This study generated new research findings on the practice of EBMgt in US healthcare administration decision-making.
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Affiliation(s)
- Ruiling Guo
- Health Care Administration, Kasiska School of Health Professions, Idaho State University , Pocatello, Idaho, USA
| | - Steven D Berkshire
- Department of Health Administration, College of Health Professions, Central Michigan University , Mount Pleasant, Michigan, USA
| | - Lawrence V Fulton
- Department of Health Organization Management, Rawls College of Business, Texas Tech University , Lubbock, Texas, USA
| | - Patrick M Hermanson
- Health Care Administration, Kasiska School of Health Professions, Idaho State University , Pocatello, Idaho, USA
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Gehring ND, McGrath P, Wozney L, Soleimani A, Bennett K, Hartling L, Huguet A, Dyson MP, Newton AS. Pediatric eMental healthcare technologies: a systematic review of implementation foci in research studies, and government and organizational documents. Implement Sci 2017. [PMID: 28637479 PMCID: PMC5479013 DOI: 10.1186/s13012-017-0608-6] [Citation(s) in RCA: 14] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Researchers, healthcare planners, and policymakers convey a sense of urgency in using eMental healthcare technologies to improve pediatric mental healthcare availability and access. Yet, different stakeholders may focus on different aspects of implementation. We conducted a systematic review to identify implementation foci in research studies and government/organizational documents for eMental healthcare technologies for pediatric mental healthcare. Methods A search of eleven electronic databases and grey literature was conducted. We included research studies and documents from organization and government websites if the focus included eMental healthcare technology for children/adolescents (0–18 years), and implementation was studied and reported (research studies) or goals/recommendations regarding implementation were made (documents). We assessed study quality using the Mixed Methods Appraisal Tool and document quality using the Appraisal of Guidelines for Research & Evaluation II. Implementation information was grouped according to Proctor and colleagues’ implementation outcomes—acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability—and grouped separately for studies and documents. Results Twenty research studies and nine government/organizational documents met eligibility criteria. These articles represented implementation of eMental healthcare technologies in the USA (14 studies), United Kingdom (2 documents, 3 studies), Canada (2 documents, 1 study), Australia (4 documents, 1 study), New Zealand (1 study), and the Netherlands (1 document). The quality of research studies was excellent (n = 11), good (n = 6), and poor (n = 1). These eMental health studies focused on the acceptability (70%, n = 14) and appropriateness (50%, n = 10) of eMental healthcare technologies to users and mental healthcare professionals. The quality of government and organizational documents was high (n = 2), medium (n = 6), and low (n = 1). These documents focused on cost (100%, n = 9), penetration (89%, n = 8), feasibility (78%, n = 7), and sustainability (67%, n = 6) of implementing eMental healthcare technology. Conclusion To date, research studies have largely focused on acceptability and appropriateness, while government/organizational documents state goals and recommendations regarding costs, feasibility, and sustainability of eMental healthcare technologies. These differences suggest that the research evidence available for pediatric eMental healthcare technologies does not reflect the focus of governments and organizations. Partnerships between researchers, healthcare planners, and policymakers may help to align implementation research with policy development, decision-making, and funding foci. Electronic supplementary material The online version of this article (doi:10.1186/s13012-017-0608-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicole D Gehring
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Patrick McGrath
- IWK Health Centre, 5850-5980 University Avenue, Halifax, NS, Canada
| | - Lori Wozney
- Centre for Research in Family Health, IWK Health Centre, Halifax, NS, Canada
| | - Amir Soleimani
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Kathryn Bennett
- Department of Health Research Methods, Evidence and Impact (Formally Clinical Epidemiology and Biostatistics), and Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada
| | - Lisa Hartling
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Anna Huguet
- IWK Health Centre, 5850-5980 University Avenue, Halifax, NS, Canada.,Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Michele P Dyson
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Amanda S Newton
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada.
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Carnero MC, Gómez A. A multicriteria decision making approach applied to improving maintenance policies in healthcare organizations. BMC Med Inform Decis Mak 2016; 16:47. [PMID: 27108234 PMCID: PMC4841972 DOI: 10.1186/s12911-016-0282-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 09/03/2015] [Accepted: 04/08/2016] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Healthcare organizations have far greater maintenance needs for their medical equipment than other organization, as many are used directly with patients. However, the literature on asset management in healthcare organizations is very limited. The aim of this research is to provide more rational application of maintenance policies, leading to an increase in quality of care. METHODS This article describes a multicriteria decision-making approach which integrates Markov chains with the multicriteria Measuring Attractiveness by a Categorical Based Evaluation Technique (MACBETH), to facilitate the best choice of combination of maintenance policies by using the judgements of a multi-disciplinary decision group. The proposed approach takes into account the level of acceptance that a given alternative would have among professionals. It also takes into account criteria related to cost, quality of care and impact of care cover. RESULTS This multicriteria approach is applied to four dialysis subsystems: patients infected with hepatitis C, infected with hepatitis B, acute and chronic; in all cases, the maintenance strategy obtained consists of applying corrective and preventive maintenance plus two reserve machines. CONCLUSIONS The added value in decision-making practices from this research comes from: (i) integrating the use of Markov chains to obtain the alternatives to be assessed by a multicriteria methodology; (ii) proposing the use of MACBETH to make rational decisions on asset management in healthcare organizations; (iii) applying the multicriteria approach to select a set or combination of maintenance policies in four dialysis subsystems of a health care organization. In the multicriteria decision making approach proposed, economic criteria have been used, related to the quality of care which is desired for patients (availability), and the acceptance that each alternative would have considering the maintenance and healthcare resources which exist in the organization, with the inclusion of a decision-making group. This approach is better suited to actual health care organization practice and depending on the subsystem analysed, improvements are introduced that are not included in normal maintenance policies; in this way, not only have different maintenance policies been suggested, but also alternatives that, in each case and according to viability, provide a more complete decision tool for the maintenance manager.
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Affiliation(s)
- María Carmen Carnero
- Business Administration Department, University of Castilla-La Mancha, Avda. Camilo José Cela s/n, 13071, Ciudad Real, Spain. .,Centre for Management Studies (CEG-IST), University of Lisbon, Instituto Superior Tecnico, Lisbon, Portugal.
| | - Andrés Gómez
- Business Administration Department, University of Castilla-La Mancha, Avda. Camilo José Cela s/n, 13071, Ciudad Real, Spain.,SESCAM, University General Hospital of Ciudad Real, C/Obispo Rafael Torija s/n, 13005, Ciudad Real, Spain
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Abstract
Patient centered care (PCC) is an essential dimension of healthcare systems' mission worldwide and is recognized as an important condition for ensuring the quality of care. Nonetheless, it is also acknowledged that various care providers perceive patient centeredness differently and that there remain several unanswered questions about the aspects of healthcare delivery that are linked to an actual achievement of PCC. In the paper, we categorize the current research on PCC into two streams ("dyadic" and "organizational") and we discuss the strengths and weaknesses of each. Despite their important contributions to healthcare services research, these approaches to PCC do not fully capture the network of practices and relationships constituting patients and providers' experiences within healthcare contexts. Therefore, we propose an alternative interpretation of PCC that integrates insights from "practice theories" and emphasizes the negotiated and local nature of patient centeredness, which is accomplished through the engagement of providers and patients in everyday care practices. To develop such interpretation, we propose a research approach combining ethnographic and reflexive methods. Ethnography can help achieve more nuanced descriptions of what PCC truly encapsulates in the care process by drawing attention to the social and material reality of healthcare contexts. Reflexivity can help disentangle and bring to surface the tacit knowledge spread in everyday care practices and transform it into actionable knowledge, a type of knowledge that may support services improvement toward PCC. We anticipate that such improvement is far from straightforward: an actual achievement of PCC may challenge the interests of different stakeholders and unsettle consolidated habits, hierarchies and power dynamics. This unsettlement, however, can also serve as a necessary condition for engaging in a participative process of internal development. We discuss the outcomes, limitations and benefits of our approach through a hospital case study.
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Affiliation(s)
- Elisa Giulia Liberati
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20123 Milan, Italy.
| | - Mara Gorli
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20123 Milan, Italy
| | - Lorenzo Moja
- Department of Biomedical Science for Health, Università degli Studi di Milano, Via Carlo Pascal, 36 20133 Milan, Italy; Clinical Epidemiology Unit, IRCCS Galeazzi Orthopedic Institute, Via Riccardo Galeazzi, 4, 20161 Milan, Italy
| | - Laura Galuppo
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20123 Milan, Italy
| | - Silvio Ripamonti
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20123 Milan, Italy
| | - Giuseppe Scaratti
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20123 Milan, Italy
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Denier Y, Gastmans C. Realizing good care within a context of cross-cultural diversity: an ethical guideline for healthcare organizations in Flanders, Belgium. Soc Sci Med 2013; 93:38-46. [PMID: 23906119 DOI: 10.1016/j.socscimed.2013.03.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 12/05/2012] [Accepted: 03/20/2013] [Indexed: 11/23/2022]
Abstract
In our globalizing world, health care professionals and organizations increasingly experience cross-cultural challenges in care relationships, which give rise to ethical questions regarding "the right thing to do" in such situations. For the time being, the international literature lacks examples of elaborated ethical guidelines for cross-cultural healthcare on the organizational level. As such, the ethical responsibility of healthcare organizations in realizing cross-cultural care remains underexposed. This paper aims to fill this gap by offering a case-study that illustrates the bioethical practice on a large-scale organizational level by presenting the ethical guideline developed in the period 2007-2011 by the Ethics Committee of Zorgnet Vlaanderen, a Christian-inspired umbrella organization for over 500 social profit healthcare organizations in Flanders, Belgium. The guideline offers an ethical framework within which fundamental ethical values are being analyzed within the context of cross-cultural care. The case study concludes with implications for healthcare practice on four different levels: (1) the level of the healthcare organization, (2) staff, (3) care receivers, and (4) the level of care supply. The study combines content-based ethics with process-based benchmarks.
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