Measuring and describing perceived quality on physiotherapy practice management software

INTRODUCTION

Despite the growing trend in the use of digital technologies in physiotherapy, the overall adoption and satisfaction of both, practice management software (PMS) and electronic health records in physiotherapy clinics has been low and slow over time. Satisfaction of expectations or perceived quality (PQ) is an abstract construct based on the discrepancy between expectations and perceptions, to measure the satisfaction of physiotherapists on PMS. This study aims to develop and validate an instrument to measure PQ on PMS, and to describe the PQ of the currently available physiotherapy PMS.

METHODS

Instrument development study with validity and reliability testing. The development of this questionnaire was conducted in 3 phases: identification of attributes to be explored; development of the item pairs and pretesting; pilot study for item reduction, and psychometric testing. The questionnaire was distributed to chartered physiotherapists. A total of 144 participants completed the questionnaire.

RESULTS

A series of analyses were conducted to assess item reduction, factor structure of the questionnaire and metric properties of multi-item scales. From the initial 43 attributes, the final version of the Quality Questionnaire on Physiotherapy Practice Management Software consisted of 24 items of PQ on PMS, structured in 3 areas (clinical care, administrative activities, and accounting), which included 11, 9, and 4 items grouped into 4, 3, and 2 scales respectively. The questionnaire proved to be reliable and valid. In multitrait scaling analysis, all scores had strong item-scale correlations, excellent item scaling success, and good internal consistency (Cronbach alpha coefficients of >0.7).

CONCLUSIONS

Our study provides a valuable PQ questionnaire on PMS attributes for clinical care, administrative activities, and accounting. The attributes related to clinical care and control stock supplies showed a worse PQ. This suggests that those functions related to clinical care should be improved to facilitate greater satisfaction with physiotherapy PMS.

Educational models, participant experience and outcomes of a diploma course in practice management for Aboriginal Medical Services: a qualitative study

BACKGROUND

Practice managers and other administrative and management staff in Aboriginal Medical Services operate in a highly specialised cultural, social and administrative environment requiring a unique skill set. The TAFE NSW Diploma in Practice Management for Aboriginal Medical Services (DPMAMS) addresses the need for training in these skills. This study sought to explore DPMAMS graduates' experiences of having undertaken the diploma course, and the effects on their subsequent work practice and career.

METHODS

A qualitative study utilising individual, semi-structured interviews conducted via videoconference and employing a thematic analysis approach was performed.

RESULTS

Ten DPMAMS alumni participated. At the time of DPMAMS completion, two participants were Aboriginal Medical Services practice managers, two were reception staff, five were in non-practice manager administrative or management roles and one was in a clinical role. Principal themes in the study findings were related to (1) the rich and singular learning environment with emphasis on peer-to-peer learning (which also facilitated 'communities of practice' extending the collaborative learning model to post-DMAMS peer learning and support); (2) knowledge and subsequent professional and personal confidence (leading to taking on increased workplace responsibility including post-DPMAMS mentoring roles); (3) translational effects on personal work and professional performance; (4) translational effects on work processes at the participants' Aboriginal Medical Services; and (5) the permeating influence of Aboriginal culture and commitment to Aboriginal communities.

CONCLUSIONS

The DPMAMS is an education/training program of perceived high value and fitness for purpose. The findings of utility of education that is empowered by culture, values and peer support may be applicable in wider settings.

Strategies for spine surgeons to enhance a clinical practice and research program: stepping stones for practice management

In this review, the value of patient-reported outcome measures, immersive technology, and patient review systems is discussed, and these strategies are presented as ways to enhance both the research and clinical aspects of a practice. The value of a research team and open access research databases is also discussed. Establishing a research program does not need elaborate resources to sustain efforts. The aforementioned simple yet effective strategies can enhance the clinical and research experience for surgeons in both academic and private practice settings.

Vaccination after spleen embolization: A practice management guideline from the Eastern Association for the Surgery of Trauma

BACKGROUND

Angioembolization is an important adjunct in the non-operative management of adult trauma patients with splenic injury. Multiple studies have shown that angioembolization may increase the non-operative splenic salvage rate for patients with high-grade splenic injuries. We performed a systematic review and developed evidence-based recommendations regarding the need for post-splenectomy vaccinations after splenic embolization in trauma patients.

METHODS

A systematic review and meta-analysis of currently available evidence were performed utilizing the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.

RESULTS

Nine studies were identified and analyzed. A total of 240 embolization patients were compared to 443 control patients who neither underwent splenectomy nor were embolized. There was no statistical difference between the splenic immune function of embolized and control patients. In addition, a total of 3974 splenectomy patients was compared with 686 embolization patients. Embolization patients had fewer infectious complications and a greater degree of preserved splenic immune function.

CONCLUSION

In adult trauma patients who have undergone splenic angioembolization, we conditionally recommend against routine post-splenectomy vaccinations.

STUDY TYPE

systematic review/meta-analysis Level of evidence: level III.

Gaps in Practice Management Skills After Training: A Qualitative Needs Assessment of Early Career Surgeons

PURPOSE

Shifts in American healthcare delivery mechanisms pose significant hurdles to new physicians. Surgeons are particularly susceptible to these changes, but surgical residency educational efforts primarily focus on technical and clinical training to the exclusion of business and management practices. This study conducted a needs assessment of perceived gaps in practice management skills among early career surgeons to guide future training curricula.

METHODS

This study was an exploratory qualitative study following the Consolidated Criteria for Reporting Qualitative Research. Purposive sampling was used to identify early career (<5 years following fellowship completion) surgeons across the United States. A semi-structured interview guide was created from interviews with surgical administrators and physician administrative curricula. Transcripts were de-identified and analyzed using a constructivist grounded theory approach.

RESULTS

Ten surgeons from 6 specialties and 6 institutions were interviewed along with 3 surgeon administrators. Three major domains of need were identified: (1) fundamentals of procedural coding, clinical billing, & compliance, (2) finding/building a practice, and (3) navigating organizational challenges. First, surgeons thought trainees would benefit from a better understanding of reimbursement schema and the basics of health policy. They also thought that more exposure to malpractice litigation, especially for handling case review or expert witness requests, would be helpful for discerning how to handle such issues early in their career. In addition, early career surgeons expressed a desire to have dedicated mentorship time, a primer on evaluating job offers with simulated contract negotiation, and guidance regarding administrative roles. Finally, surgeons requested training in change management techniques, care pathway construction, and the basics of staffing decisions.

CONCLUSIONS

There are significant practice management gaps in surgical training which may be amenable to targeted educational efforts during a residency or fellowship program. Future research will test the generalizability of these findings as well as build curricula that adequately meet these needs.

Management of the open abdomen: A systematic review with meta-analysis and practice management guideline from the Eastern Association for the Surgery of Trauma

BACKGROUND

Multiple techniques describe the management of the open abdomen (OA) and restoration of abdominal wall integrity after damage-control laparotomy (DCL). It is unclear which operative technique provides the best method of achieving primary myofascial closure at the index hospitalization.

METHODS

A writing group from the Eastern Association for the Surgery of Trauma performed a systematic review and meta-analysis of the current literature regarding OA management strategies in the adult population after DCL. The group sought to understand if fascial traction techniques or techniques to reduce visceral edema improved the outcomes in these patients. The Grading of Recommendations Assessment, Development and Evaluation methodology was utilized, meta-analyses were performed, and an evidence profile was generated.

RESULTS

Nineteen studies met inclusion criteria. Overall, the use of fascial traction techniques was associated with improved primary myofascial closure during the index admission (relative risk, 0.32) and fewer hernias (relative risk, 0.11.) The use of fascial traction techniques did not increase the risk of enterocutaneous fistula formation nor mortality. Techniques to reduce visceral edema may improve the rate of closure; however, these studies were very limited and suffered significant heterogeneity.

CONCLUSION

We conditionally recommend the use of a fascial traction system over routine care when treating a patient with an OA after DCL. This recommendation is based on the benefit of improved primary myofascial closure without worsening mortality or enterocutaneous fistula formation. We are unable to make any recommendations regarding techniques to reduce visceral edema.

LEVEL OF EVIDENCE

Systematic Review and Meta-Analysis; Level IV.

Update to the Canadian clinical practice guideline for best-practice management of breast cancer-related lymphedema: study protocol

BACKGROUND

One of the more frequent complications following treatment for breast cancer, lymphedema is a substantial swelling of the arm, breast and chest wall that occurs on the side where lymph nodes were removed. The aim of this work is to update recommendations on the prevention, diagnosis and management of lymphedema related to breast cancer.

METHODS

We present the protocol for an update of the 2001 clinical practice guideline on lymphedema from the Steering Committee for Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. We will use a patient-oriented research approach with a focus on self-management and the positive health model to inform the updated guideline development. The methods proposed will be undertaken with consideration of the standards outlined in the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. The literature will be appraised by evaluating existing guidelines from other countries, the evidence from systematic reviews and meta-analyses and direct evidence from clinical studies. We will manage competing interests according to Guidelines International Network principles. Recommendations will be presented using an actionable statement format and will be linked to the level of evidence along with any relevant considerations used in formulation. A draft of the guideline will be produced by the steering committee then sent out to international experts and stakeholder groups for feedback.

INTERPRETATION

The primary benefit of this clinical guideline will be to improve the quality of care of women with breast cancer-related lymphedema. Findings will be disseminated at national and international conferences and through webinars and educational videos hosted on the websites of the supporting organizations.

Spinal Cord Stimulation for Chronic Pain Syndromes: A Review of Considerations in Practice Management

BACKGROUND

Chronic pain syndromes are clinically challenging to treat, and management with opioid medications is increasingly shown to be inappropriate and ineffective. Spinal cord stimulation (SCS) has been demonstrated across numerous high-quality and well-designed studies to be effective in treating various refractory chronic pain. The efficacy and overall success of SCS is highly dependent on compliance to and consideration of various practice patterns.

OBJECTIVE

This manuscript is intended to compile and present comprehensive recommendations for key SCS management principles including: a) patient selection criteria, b) efficacy of SCS for various conditions, c) discussion of SCS waveforms, d) trial and permanent implantation considerations, e) periprocedural management, and f) complications and adverse events.

STUDY DESIGN

An evidence-based narrative review.

METHODS

PubMed, Medline, Cochrane Library, prior systematic reviews, and reference lists were screened by 2 separate authors for all randomized trials, meta-analyses, and observational studies relevant to each of the aforementioned management principles and considered for study inclusion.

RESULTS

All high-level evidence studies that explored the various facets of SCS practice management were included for review.

LIMITATIONS

Both continued investigation into, and practice implementation of, the various facets of SCS management are necessary to optimize patient outcomes.

CONCLUSION

Implementation of and adherence to the evidenced-based recommendations delineated in this publication may help optimize efficacy outcomes and maintain safety profiles for persons treated with SCS interventions.

Intrathecal Drug Delivery for Chronic Pain Syndromes: A Review of Considerations in Practice Management

BACKGROUND

Chronic pain syndromes are poorly understood and challenging to treat. However, intrathecal drug delivery systems (IDDS) have been shown to have good efficacy in treating various pain subtypes and patient populations. The success of IDDS interventions is largely dependent on consideration of and adherence to varying practice patterns.

OBJECTIVES

We aimed to review and report on the evidence basis for various considerations in IDDS practice management including: (1) patient selection and periprocedural criteria, (2) efficacy of IDDS for various conditions, (3) intrathecal medications, (4) drug delivery systems, (5) trial and implantation, (6) complications and adverse events, and (7) chronic follow-up.

STUDY DESIGN

We conducted an evidence-based narrative review.

METHODS

PubMed, Medline, Cochrane Library, prior systematic reviews, and reference lists were screened by 2 separate authors for all randomized trials, meta-analyses, and observational studies relevant to each of the aforementioned management principles and were considered for study inclusion.

RESULTS

All high-level evidence studies that explored the various facets for IDDS practice management were included for review.

LIMITATIONS

Despite existing evidence basis for practice considerations, current practice patterns are highly practitioner dependent. More and continued high-level evidence is necessary to support, affirm, and dictate principles in practice considerations.

CONCLUSIONS

Incorporation of the principles found in this evidence-based narrative, which is comprised of the highest level of evidence supportive of various facets of IDDS practice management, is essential to optimize outcomes, treatment efficacy, and safety profiles.

Facilitators and barriers to safer care in Scottish general practice: a qualitative study of the implementation of the trigger review method using normalisation process theory

OBJECTIVES

Patient safety is a key concern of modern health systems, with numerous approaches to support safety. One, the trigger review method (TRM), is promoted nationally in Scotland as an approach to improve the safety of care in general medical practice. However, it remains unclear which factors are facilitating or hindering its implementation. The aim of this study was to identify the important factors that facilitate or hinder the implementation of the TRM in this setting.

DESIGN

Qualitative study employing semi-structured interviews. Data analysis was theoretically informed using normalisation process theory (NPT).

SETTING

Scottish general practice.

PARTICIPANTS

We conducted 28 semistructured interviews with general practitioners (n=12), practice nurses (n=11) and practice managers (n=5) in Scotland.

RESULTS

We identified four important factors that facilitated or hindered implementation: (1) the amount of time and allocated resources; (2) integration of the TRM into existing initiatives and frameworks facilitated implementation and justified participants' involvement; (3) the characteristics of the reviewers-implementation was facilitated by experienced, reflective clinicians with leadership roles in their teams; (4) the degree to which participants perceived the TRM as acceptable, feasible and useful.

CONCLUSIONS

This study is the first known attempt to investigate how the TRM is implemented and perceived by general practice clinicians and staff. The four main factors that facilitated TRM implementation are comparable with the wider implementation science literature, suggesting that a small number of specific factors determine the success of most, if not all, complex healthcare interventions. These factors can be identified, described and understood through theoretical frameworks such as NPT and are amenable to intervention. Researchers and policymakers should proactively identify and address these factors.

A Comparison of Approaches to Student Pharmacist Business Planning in Pharmacy Practice Management

Objective. To compare second-year student pharmacists' perspectives on two approaches for completing a pharmacy practice management business planning project. Methods. A mixed-methods approach was used to compare two options (traditional and experimental) for completing business plan projects that were offered to teams of second-year student pharmacists as part of a required pharmacy management course. Teams who chose the traditional project were required to develop a unique, pharmacy-related business plan while those who chose the experimental concept were paired with a pharmacy-focused firm within Tennessee and tasked with designing a potential service for the firm's consideration. At semester's end, all students were asked to complete a brief survey to provide insight on their experiences with either of the group projects. Students and firm stakeholders were also asked to participate in a group and individual interview, respectively. Results. Student group comparisons indicated that the experimental project provided a more real-world, business planning experience. Additionally, groups that did the experimental project were more likely to report seeing how business and pharmacy practice were connected, indicate a better understanding of the principles of pharmacy management, and be perceived as more marketable for a future pharmacy career. Firm representatives indicated that insight provided by the students was valuable and that they had plans to implement what was proposed. Conclusion. Connecting student pharmacists with a pharmacy-focused firm provided a real-world management experience that better complemented the course's principles, and created a mutually beneficial innovation-focused partnership.

Education on the Business of Plastic Surgery During Training: A Survey of Plastic Surgery Residents

BACKGROUND

Entrepreneurial skills are important for physicians, especially plastic surgeons. Nevertheless, these skills are not typically emphasized during residency training.

OBJECTIVE

Evaluate the extent of business training at plastic surgery residency programs as well as means of enhancing business training.

METHODS

A 6-question online survey was sent to plastic surgery program directors for distribution to plastic surgery residents. Responses from residents at the PGY2 level and above were included for analysis. Tables were prepared to present survey results.

RESULTS

Hundred and sixty-six residents including 147 PGY2 and above residents responded to our survey. Only 43.5% reported inclusion of business training in their plastic surgery residency. A majority of residents reported they do not expect on graduation to be prepared for the business aspects of plastic surgery. Additionally, a majority of residents feel establishment of a formal lecture series on the business of plastic surgery would be beneficial.

CONCLUSIONS

Results from our survey indicate limited training at plastic surgery programs in necessary business skills. Plastic surgery residency programs should consider incorporating or enhancing elements of business training in their curriculum.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Layout and flow of dermatology clinics: principles from operations management

Dermatology is a medical specialty that experiences high patient demand and long patient wait times. Dermatology clinics should look for ways to improve efficiency through the incorporation of principles from operations management. Addressing the layout and flow of a clinic can lead to operational efficiency. An ideal layout may lead to increased patient volume, satisfaction, and retention.

Alternatives to the face-to-face consultation in general practice: focused ethnographic case study

BACKGROUND

NHS policy encourages general practices to introduce alternatives to the face-to-face consultation, such as telephone, email, e-consultation systems, or internet video. Most have been slow to adopt these, citing concerns about workload. This project builds on previous research by focusing on the experiences of patients and practitioners who have used one or more of these alternatives.

AIM

To understand how, under what conditions, for which patients, and in what ways, alternatives to face-to-face consultations present benefits and challenges to patients and practitioners in general practice.

DESIGN AND SETTING

Focused ethnographic case studies took place in eight UK general practices between June 2015 and March 2016.

METHOD

Non-participant observation, informal conversations with staff, and semi-structured interviews with staff and patients were conducted. Practice documents and protocols were reviewed. Data were analysed through charting and the 'one sheet of paper' mind-map method to identify the line of argument in each thematic report.

RESULTS

Case study practices had different rationales for offering alternatives to the face-to-face consultation. Beliefs varied about which patients and health issues were suitable. Co-workers were often unaware of each other's practice; for example, practice policies for use of e-consultations systems with patients were not known about or followed. Patients reported benefits including convenience and access. Staff and some patients regarded the face-to-face consultation as the ideal.

CONCLUSION

Experience of implementing alternatives to the face-to-face consultation suggests that changes in patient access and staff workload may be both modest and gradual. Practices planning to implement them should consider carefully their reasons for doing so and involve the whole practice team.

Understanding Business Models in Pharmacy Schools

The objectives of this article are to define business models, contrast the business models in pharmacy schools, and discuss issues that can arise from misunderstandings about whom pharmacy schools serve and how they do so.

A Framework for Integrating Biosimilars Into the Didactic Core Requirements of a Doctor of Pharmacy Curriculum

Biologic drugs approved via the abbreviated United States biosimilar approval pathway are anticipated to improve access to medications by addressing increasing health care expenditures. Surveys of health care practitioners indicate that there is inadequate knowledge and understanding about biosimilars; this must be addressed to ensure safe and effective use of this new category of products. Concepts of biosimilar development, manufacturing, regulation, naming, formulary, and inventory considerations, as well as patient and provider education should be included within the doctor of pharmacy (PharmD) curriculum as preparation for clinical practice. Based on these considerations, we propose that PharmD graduates be required to have knowledge in the following domains regarding biologics and biosimilars: legal definition, development and regulation, state pharmacy practice laws, and pharmacy practice management. We link these general biosimilar concepts to the Accreditation Council for Pharmacy Education (ACPE) Standards 2016 and Center for the Advancement of Pharmacy Education (CAPE) Outcomes 2013, and provide example classroom learning objectives, in-class activities, and assessments to guide implementation.

Clinical Decision Support in GPIT Certified Practice Management Systems

This research has focused on identifying the current level of Clinical Decision Support Systems (CDSSs) within the current five certified Practice Management Systems (PMSs) that are provided to General practitioners (GPs) in Ireland. In this research, we also have conducted a survey questionnaire to explore the familiarity, perceptions and attitudes of GPs towards the current level of CDSSs functions within the five certified PMSs. From the current research results and in the light of its findings, a conclusion and proposed recommendations are provided.

Achieving Human Service Outcomes Through Competency-Based Training

During the past three decades, empirically supported strategies have been demonstrated for the training of competencies—highly specific skills and behaviors that are needed to complete a critical job task. The present article reviews several examples of competency-based training in human service programs and provides guidelines for the implementation of competency-based training by managers. Four methods for delineating a competency model are described, with recommendations for using them in combination. A sample direct support worker competency is described, and a guideline is provided for conducting competency-based training on the job based on the findings of research on performance-based feedback. This guide may offer some assistance to managers of human service programs.

The Only Safe SMS Texting Is No SMS Texting

Many physicians and practice staff use short messaging service (SMS) text messaging to communicate with patients. But SMS text messaging is unencrypted, insecure, and does not meet HIPAA requirements. In addition, the short and abbreviated nature of text messages creates opportunities for misinterpretation, and can negatively impact patient safety and care. Until recently, asking patients to sign a statement that they understand and accept these risks--as well as having policies, device encryption, and cyber insurance in place--would have been enough to mitigate the risk of using SMS text in a medical practice. But new trends and policies have made SMS text messaging unsafe under any circumstance. This article explains these trends and policies, as well as why only secure texting or secure messaging should be used for physician-patient communication.

Managing Pessimistic, Gloomy, and Cynical Employees: Twenty-Five Do's and Don'ts

Every medical practice manager has to deal with a certain amount of employee pessimism at times. But one overly pessimistic employee can spread his or her negativity to the entire medical practice team if the manager doesn't intervene. This article suggests practical strategies managers can use to deal effectively with a pessimistic, defeatist, gloomy, or cynical employee. It describes two kinds of pessimism medical practice managers may encounter and offers 25 specific management do's and don'ts for managing a pessimist. This article also offers managers guidance for firing a pessimistic employee, including sample language they can use. It provides 10 self-care strategies for practice managers so they can keep themselves from succumbing to an employee's negativity. It also suggests eight ways that pessimism can hurt the medical practice team and describes five kinds of negative thinking managers may encounter. Finally, this article explores defensive pessimism theory and the surprising benefits for managers of some pessimistic thinking.

Payroll: A Headache You Can Cure!

Payroll is not only an expense for your practice; it can be a headache for you or your practice manager. Payroll is also a major scope of audit procedures. Don't rely on the word of anyone else that your taxes were processed and remitted. Demand to see proof. By outsourcing your human resources and payroll functions to one company, you can free up valuable time to concentrate on your area of expertise, leaving the administrative hassles to the staffing firm.

Sun Tzu and The Art of War: Implications for the Healthcare Professional

Nearly 2500 years ago, Sun Tzu wrote The Art of War, a book that provided emperors and military leaders with methods to achieve success on the battlefield. Those same strategies and tactics will also work on the battlefield of the healthcare war that is going to take place in the very near future. Perhaps we can go back in time and learn the valuable lessons that were used so successfully and apply them to modern healthcare to help us through the quagmire of the healthcare crisis. This article was inspired by the book Sun Tzu and the Art of Business, by Mark McNeilly (Oxford University Press, 2011).

The Purpose of an Operations Manual

In the healthcare practice, proper systems are needed. As employees are hired, it is necessary to obtain and provide applications, resumes, job descriptions, daily office procedures, operating hours, and other such information. A proper workflow must be implemented to ensure that all work points to the purpose of patient retention and acquisition. One of the factors to ensure that all employees work from the same perspective is having a written formula of policies and procedures. Often called an operations manual, the document provides the framework upon which employees all base their approach to greeting patients, scheduling them, and billing them, and often to obtain referrals. This article reviews the components of a strong operations manual.