scholarly journals SYSTEMS APPROACHES TO HEALTHCARE SYSTEMS DESIGN AND CARE DELIVERY: AN OVERVIEW OF THE LITERATURE

2021 ◽  
Vol 1 ◽  
pp. 2941-2950
Author(s):  
Alexander Komashie ◽  
Saba Hinrichs-Krapels ◽  
P. John Clarkson
Keyword(s):  
Current Practice ◽  
Systems Approach ◽  
Care Delivery ◽  
Grey Literature ◽  
Systems Design ◽  
Evidence Base ◽  
Healthcare Systems ◽  
Healthcare Sector ◽  
Systems Approaches ◽  
Service Outcomes

AbstractThe healthcare sector is facing significant challenges that require a systems approach, resulting in a rapid growth in the application of systems approaches in healthcare since the beginning of the 21st century. Consequently, healthcare practitioners and policymakers now desire to understand the evidence-base for the approach, but little evidence of the kind desired exists. This paper is a first step in conducting a narrative review of the application of systems approaches in healthcare based on a systematic review of the academic and grey literature. First, the emergence of the approach in healthcare is explored. Second, specific examples of applications of systems approaches in healthcare are examined to identify any missing elements in current practice. Third, fourteen reviews of the approach in healthcare published in the last ten years are analysed. The results suggest that the use of the approach in healthcare will most likely continue to increase, however, significant work remains for the design and systems community to demonstrate the effectiveness of systems approaches, specifically in providing convincing measures of impact on patient and service outcomes.

scholarly journals Systems approach to health service design, delivery and improvement: a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e037667
Author(s):  
Alexander Komashie ◽  
James Ward ◽  
Tom Bashford ◽  
Terry Dickerson ◽  
Gulsum Kubra Kaya ◽  
...  
Keyword(s):  
Systematic Review ◽  
Systems Approach ◽  
Meta Analysis ◽  
Healthcare Setting ◽  
Evidence Base ◽  
Health Improvement ◽  
Healthcare Design ◽  
Systems Approaches ◽  
Service Outcomes ◽  
Before And After

ObjectivesTo systematically review the evidence base for a systems approach to healthcare design, delivery or improvement.DesignSystematic review with meta-analyses.MethodsIncluded were studies in any patients, in any healthcare setting where a systems approach was compared with usual care which reported quantitative results for any outcomes for both groups. We searched Medline, Embase, HMIC, Health Business Elite, Web of Science, Scopus, PsycINFO and CINAHL from inception to 28 May 2019 for relevant studies. These were screened, and data extracted independently and in duplicate. Study outcomes were stratified by study design and whether they reported patient and/or service outcomes. Meta-analysis was conducted with Revman software V.5.3 using ORs—heterogeneity was assessed using I2 statistics.ResultsOf 11 405 records 35 studies were included, of which 28 (80%) were before-and-after design only, five were both before-and-after and concurrent design, and two were randomised controlled trials (RCTs). There was heterogeneity of interventions and wide variation in reported outcome types. Almost all results showed health improvement where systems approaches were used. Study quality varied widely. Exploratory meta-analysis of these suggested favourable effects on both patient outcomes (n=14, OR=0.52 (95% CI 0.38 to 0.71) I2=91%), and service outcomes (n=18, OR=0.40 (95% CI 0.31 to 0.52) I2=97%).ConclusionsThis study suggests that a systems approaches to healthcare design and delivery results in a statistically significant improvement to both patient and service outcomes. However, better quality studies, particularly RCTs are needed.PROSPERO registration numberCRD42017065920.

scholarly journals Exploring Healthcare Systems Design Research and Practice: Outcomes of an International Meeting

2019 ◽  
Vol 1 (1) ◽  
pp. 947-956
Author(s):  
Alexander Komashie ◽  
Guillaume Lame ◽  
Francois Patou ◽  
Nicholas Ciccone ◽  
Anja Maier ◽  
...  
Keyword(s):  
Design Research ◽  
Systems Approach ◽  
Research Work ◽  
Healthcare Delivery ◽  
Systems Design ◽  
Healthcare Systems ◽  
Multiple Perspectives ◽  
Research And Practice ◽  
Wide Range ◽  
Working Together

AbstractCurrent healthcare delivery challenges are multi-faceted, requiring multiple perspectives to be addressed using a systems approach. However, a significant amount of healthcare systems design research work is carried out within single disciplines or at best a few disciplines working together. There appears to be little deliberate attempt to draw together a wide range of disciplines committed to working together to overcome differences and tackle some of the complex challenges in healthcare delivery. In this paper, we report on the initial outcomes of such an international initiative that, in the form of a workshop held at the University of Cambridge, brought together researchers and practitioners from a wide range of disciplines to explore the foundations of a community for Healthcare Systems Design Research and Practice.

scholarly journals A scoping review of patient engagement activities during COVID-19: More consultation, less partnership

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257880
Author(s):  
Lauren Cadel ◽  
Michelle Marcinow ◽  
Jane Sandercock ◽  
Penny Dowedoff ◽  
Sara J. T. Guilcher ◽  
...  
Keyword(s):  
Decision Making ◽  
Patient Engagement ◽  
Care Delivery ◽  
Clinical Care ◽  
Grey Literature ◽  
Community Outreach ◽  
Healthcare Systems ◽  
Barriers And Facilitators ◽  
Organizational Level ◽  
System Quality

Background The COVID-19 pandemic has had a devastating impact on healthcare systems and care delivery, changing the context for patient and family engagement activities. Given the critical contribution of such activities in achieving health system quality goals, we undertook to address the question: What is known about work that has been done on patient engagement activities during the pandemic? Objective To examine peer-reviewed and grey literature to identify the range of patient engagement activities, broadly defined (inclusive of engagement to support clinical care to partnerships in decision-making), occurring within health systems internationally during the first six months of the COVID-19 pandemic, as well as key barriers and facilitators for sustaining patient engagement activities during the pandemic. Methods The following databases were searched: Medline, Embase and LitCOVID; a search for grey literature focused on the websites of professional organizations. Articles were required to be specific to COVID-19, describe patient engagement activities, involve a healthcare organization and be published from March 2020 to September 2020. Data were extracted and managed using Microsoft Excel. A content analysis of findings was conducted. Results Twenty-nine articles were included. Few examples of more genuine partnership with patients were identified (such as co-design and organizational level decision making); most activities related to clinical level interactions (e.g. virtual consultations, remote appointments, family visits using technology and community outreach). Technology was leveraged in almost all reported studies to interact or connect with patients and families. Five main descriptive categories were identified: (1) Engagement through Virtual Care; (2) Engagement through Other Technology; (3) Engagement for Service Improvements/ Recommendations; (4) Factors Impacting Patient Engagement; and (5) Lessons Learned though Patient Engagement. Conclusions Evidence of how healthcare systems and organizations stayed connected to patients and families during the pandemic was identified; the majority of activities involved direct care consultations via technology. Since this review was conducted over the first six months of the pandemic, more work is needed to unpack the spectrum of patient engagement activities, including how they may evolve over time and to explore the barriers and facilitators for sustaining activities during major disruptions like pandemics.

scholarly journals HEALTHCARE SYSTEMS DESIGN: A SANDBOX OF CURRENT RESEARCH THEMES PRESENTED AT AN INTERNATIONAL MEETING

2020 ◽  
Vol 1 ◽  
pp. 1873-1882
Author(s):  
N. Ciccone ◽  
F. Patou ◽  
A. Komashie ◽  
G. Lame ◽  
P. J. Clarkson ◽  
...  
Keyword(s):  
Design Research ◽  
State Of The Art ◽  
Care Delivery ◽  
Systems Design ◽  
Healthcare Systems ◽  
Research Projects ◽  
International Meeting ◽  
Research Themes ◽  
Art Research ◽  
Improve Health

AbstractHealthcare systems are under strain, this creates a challenge for designers to develop solutions for better health and care delivery. This paper presents a sandbox of illustrative design themes used to improve health systems based on state of the art research projects. These were collated from presentations at The Second International Meeting on Healthcare Systems Design Research, held at DTU-Technical University of Denmark. Attending groups were mapped based on their research keywords, target journals and methodologies in order to gain insight on the communities research landscape.

The Karolinska Hospital Information System

1974 ◽  
Vol 13 (03) ◽  
pp. 125-140 ◽  
Author(s):  
Ch. Mellner ◽  
H. Selajstder ◽  
J. Wolodakski
Keyword(s):  
Information System ◽  
Data Processing ◽  
Data Base ◽  
Hospital Information System ◽  
Care Delivery ◽  
Traditional Approach ◽  
Processing System ◽  
Systems Design ◽  
Data Processing System ◽  
Karolinska Hospital

The paper gives a report on the Karolinska Hospital Information System in three parts.In part I, the information problems in health care delivery are discussed and the approach to systems design at the Karolinska Hospital is reported, contrasted, with the traditional approach.In part II, the data base and the data processing system, named T1—J 5, are described.In part III, the applications of the data base and the data processing system are illustrated by a broad description of the contents and rise of the patient data base at the Karolinska Hospital.

COVID 19 and Special Care Dentistry: A Narrative Review

2020 ◽  
Vol 11 (SPL1) ◽  
pp. 1473-1476
Author(s):  
Ashwika Datey ◽  
Soumya Singhai ◽  
Gargi Nimbulkar ◽  
Kumar Gaurav Chhabra ◽  
Amit Reche
Keyword(s):  
Health Care ◽  
Oral Health ◽  
Health Services ◽  
Care Delivery ◽  
Special Care ◽  
World Health ◽  
Healthcare Sector ◽  
Health Care Needs ◽  
Oral Diseases ◽  
Care Needs

The COVID 19 outbreak has been declared a pandemic by the world health organisation. The healthcare sector was overburdened and overstretched with the number of patient increasing and requiring health services. The worst-hit population always are the people with special needs, whether it is children, pregnant females or the geriatric population. The need for the emergency kind of health services was so inflated that the other special population which required them equally as those patients with the COVID 19 suffered a lot. Dentistry was not an exception, and even that is also one of the important components of the health care delivery system and people requiring oral health care needs were also more. Those undergoing dental treatments would not have completed the treatment, and this would have resulted in various complications. In this situation, some dental emergency guidelines have been released by Centres for Disease Control (CDC) for the urgent dental care those requiring special care dentistry during the COVID 19 pandemic. Children with special care needs were considered more vulnerable to oral diseases; hence priority should have been given to them for dental treatments moreover in the future also more aggressive preventive measures should be taken in order to maintain oral hygiene and prevent many oral diseases. Guardians/caregivers should be made aware and motivated to maintain the oral health of children with special health care needs. This review mainly focuses on the prevention and management of oral diseases in children's with special care needs.

scholarly journals Getting It Straight: Accommodating Rectilinear Behavior in Captive Snakes—A Review of Recommendations and Their Evidence Base

Animals ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 1459
Author(s):  
Clifford Warwick ◽  
Rachel Grant ◽  
Catrina Steedman ◽  
Tiffani J. Howell ◽  
Phillip C. Arena ◽  
...  
Keyword(s):  
Scientific Evidence ◽  
Grey Literature ◽  
Evidence Base ◽  
Short Term ◽  
Absolute Minimum ◽  
Scientific Letter ◽  
General Welfare ◽  
Other Information ◽  
Enclosure Size ◽  
Current Guidance

Snakes are sentient animals and should be subject to the accepted general welfare principles of other species. However, they are also the only vertebrates commonly housed in conditions that prevent them from adopting rectilinear behavior (ability to fully stretch out). To assess the evidence bases for historical and current guidance on snake spatial considerations, we conducted a literature search and review regarding recommendations consistent with or specifying ≥1 × and <1 × snake length enclosure size. We identified 65 publications referring to snake enclosure sizes, which were separated into three categories: peer-reviewed literature (article or chapter appearing in a peer-reviewed journal or book, n = 31), grey literature (government or other report or scientific letter, n = 18), and opaque literature (non-scientifically indexed reports, care sheets, articles, husbandry books, website or other information for which originating source is not based on scientific evidence or where scientific evidence was not provided, n = 16). We found that recommendations suggesting enclosure sizes shorter than the snakes were based entirely on decades-old ‘rule of thumb’ practices that were unsupported by scientific evidence. In contrast, recommendations suggesting enclosure sizes that allowed snakes to fully stretch utilized scientific evidence and considerations of animal welfare. Providing snakes with enclosures that enable them to fully stretch does not suggest that so doing allows adequate space for all necessary normal and important considerations. However, such enclosures are vital to allow for a limited number of essential welfare-associated behaviors, of which rectilinear posturing is one, making them absolute minimum facilities even for short-term housing.

scholarly journals A scoping review of registry captured indicators for evaluating quality of critical care in ICU

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Issrah Jawad ◽  
Sumayyah Rashan ◽  
Chathurani Sigera ◽  
Jorge Salluh ◽  
Arjen M. Dondorp ◽  
...  
Keyword(s):  
Critical Care ◽  
Scoping Review ◽  
Health Care Quality ◽  
Grey Literature ◽  
Healthcare Providers ◽  
Evidence Base ◽  
Patient Reported Outcome ◽  
Care Quality ◽  
Patient Reported

Abstract Background Excess morbidity and mortality following critical illness is increasingly attributed to potentially avoidable complications occurring as a result of complex ICU management (Berenholtz et al., J Crit Care 17:1-2, 2002; De Vos et al., J Crit Care 22:267-74, 2007; Zimmerman J Crit Care 1:12-5, 2002). Routine measurement of quality indicators (QIs) through an Electronic Health Record (EHR) or registries are increasingly used to benchmark care and evaluate improvement interventions. However, existing indicators of quality for intensive care are derived almost exclusively from relatively narrow subsets of ICU patients from high-income healthcare systems. The aim of this scoping review is to systematically review the literature on QIs for evaluating critical care, identify QIs, map their definitions, evidence base, and describe the variances in measurement, and both the reported advantages and challenges of implementation. Method We searched MEDLINE, EMBASE, CINAHL, and the Cochrane libraries from the earliest available date through to January 2019. To increase the sensitivity of the search, grey literature and reference lists were reviewed. Minimum inclusion criteria were a description of one or more QIs designed to evaluate care for patients in ICU captured through a registry platform or EHR adapted for quality of care surveillance. Results The search identified 4780 citations. Review of abstracts led to retrieval of 276 full-text articles, of which 123 articles were accepted. Fifty-one unique QIs in ICU were classified using the three components of health care quality proposed by the High Quality Health Systems (HQSS) framework. Adverse events including hospital acquired infections (13.7%), hospital processes (54.9%), and outcomes (31.4%) were the most common QIs identified. Patient reported outcome QIs accounted for less than 6%. Barriers to the implementation of QIs were described in 35.7% of articles and divided into operational barriers (51%) and acceptability barriers (49%). Conclusions Despite the complexity and risk associated with ICU care, there are only a small number of operational indicators used. Future selection of QIs would benefit from a stakeholder-driven approach, whereby the values of patients and communities and the priorities for actionable improvement as perceived by healthcare providers are prioritized and include greater focus on measuring discriminable processes of care.

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