scholarly journals Community representation in hospital decision making: a literature review

2015 ◽  
Vol 39 (3) ◽  
pp. 323 ◽  
Author(s):  
Zoë Murray
Keyword(s):  
Decision Making ◽  
Quality Of Care ◽  
Community Engagement ◽  
Good Practice ◽  
Real Life ◽  
Hospital Governance ◽  
Hospital Boards ◽  
Set Up ◽  
Community Representation

Objective Advancing quality in health services requires structures and processes that are informed by consumer input. Although this agenda is well recognised, few researchers have focussed on the establishment and maintenance of customer input throughout the structures and processes used to produce high-quality, safe care. We present an analysis of literature outlining the barriers and enablers involved in community representation in hospital governance. The review aimed to explore how community representation in hospital governance is achieved. Methods Studies spanning 1997–2012 were analysed using Donabedian’s model of quality systems as a guide for categories of interest: structure, in relation to administration of quality; process, which is particularly concerned with cooperation and culture; and outcome, considered, in this case, to be the achievement of effective community representation on quality of care. Results There are limited published studies on community representation in hospital governance in Australia. What can be gleaned from the literature is: 1) quality subcommittees set up to assist Hospital Boards are a key structure for involving community representation in decision making around quality of care, and 2) there are a number of challenges to effectively developing the process of community representation in hospital governance: ambiguity and the potential for escalated indecision; inadequate value and consideration given to it by decision makers resulting in a lack of time and resources needed to support the community engagement strategy (time, facilitation, budgets); poor support and attitude amongst staff; and consumer issues, such as feeling isolated and intimidated by expert opinion. Conclusions The analysis indicates that: quality subcommittees set up to assist boards are a key structure for involving community representation in decision making around quality of care. There are clearly a number of challenges to effectively developing the process of community representation in hospital governance, associated with ambiguity, organisational and consumer issues. For an inclusive agenda to real life, work must be done on understanding the representatives’ role and the decision making process, adequately supporting the representational process, and developing organisational cooperation and culture regarding community representation. What is known about the topic? Partnering community is recognised as a fundamental element of hospital quality improvement strategies and the implementation of the Australian agenda for advancing the quality of health service standards. It is also known that developing collaborative environments and partnerships can be a challenging process, and that it is good practice to consider the factors that will influence their success and develop an approach built on the identification of potential challenges and the incorporation of facilitators. What does this paper add? This paper draws out key obstacles that can challenge the process of involving community representation into hospital governance structures. What are the implications for practitioners? There is little published on the challenges to community engagement in the hospital governance setting. By doing this, this paper encourages the recognition that although partnering with the community is an essential aspect of achieving quality of care, it requires significant effort and support to be an effective aspect. The paper highlights challenges and facilitators that practitioners should consider if planning for successful community representation on hospital committees.

scholarly journals ACO with Intuitionistic Fuzzy Pheromone Updating Applied on Multiple-Constraint Knapsack Problem

Mathematics ◽  
2021 ◽  
Vol 9 (13) ◽  
pp. 1456
Author(s):  
Stefka Fidanova ◽  
Krassimir Todorov Atanassov
Keyword(s):  
Decision Making ◽  
Knapsack Problem ◽  
Propositional Logic ◽  
Optimization Problems ◽  
Real Life ◽  
Combinatorial Optimization Problems ◽  
Intuitionistic Fuzzy ◽  
Life Problems ◽  
Multiple Constraint

Some of industrial and real life problems are difficult to be solved by traditional methods, because they need exponential number of calculations. As an example, we can mention decision-making problems. They can be defined as optimization problems. Ant Colony Optimization (ACO) is between the best methods, that solves combinatorial optimization problems. The method mimics behavior of the ants in the nature, when they look for a food. One of the algorithm parameters is called pheromone, and it is updated every iteration according quality of the achieved solutions. The intuitionistic fuzzy (propositional) logic was introduced as an extension of Zadeh’s fuzzy logic. In it, each proposition is estimated by two values: degree of validity and degree of non-validity. In this paper, we propose two variants of intuitionistic fuzzy pheromone updating. We apply our ideas on Multiple-Constraint Knapsack Problem (MKP) and compare achieved results with traditional ACO.

scholarly journals Exploring the Implementation of a Legal AI Bot for Sustainable Development in Legal Advisory Institutions

2020 ◽  
Vol 12 (15) ◽  
pp. 5991 ◽  
Author(s):  
Juin-Hao Ho ◽  
Gwo-Guang Lee ◽  
Ming-Tsang Lu
Keyword(s):  
Decision Making ◽  
Sustainable Development ◽  
User Behavior ◽  
Real Life ◽  
Implementation Process ◽  
Multicriteria Decision Making ◽  
Life Issues ◽  
Network Process ◽  
Set Up ◽  
Decision Making Model

This study explores the implementation of legal artificial intelligence (AI) robot issues for sustainable development related to legal advisory institutions. While a legal advisory AI Bot using the unique arithmetic method of AI offers rules of convenient legal definitions, it has not been established whether users are ready to use one at legal advisory institutions. This study applies the MCDM (multicriteria decision-making) model DEMATEL (decision-making trial and evaluation laboratory)-based Analytical Network Process (ANP) with a modified VIKOR, to explore user behavior on the implementation of a legal AI bot. We first apply DEMATEL-based ANP, called influence weightings of DANP (DEMATEL-based ANP), to set up the complex adoption strategies via systematics and then to employ an M-VIKOR method to determine how to reduce any performance gaps between the ideal values and the existing situation. Lastly, we conduct an empirical case to show the efficacy and usefulness of this recommended integrated MCDM model. The findings are useful for identifying the priorities to be considered in the implementation of a legal AI bot and the issues related to enhancing its implementation process. Moreover, this research offers an understanding of users’ behaviors and their actual needs regarding a legal AI bot at legal advisory institutions. This research obtains the following results: (1) It effectively assembles a decision network of technical improvements and applications of a legal AI bot at legal advisory institutions and explains the feedbacks and interdependences of aspects/factors in real-life issues. (2) It describes how to vary effective results from the current alternative performances and situations into ideal values in order to fit the existing environments at legal advisory institutions with legal AI bot implementation.

scholarly journals 3200 Balancing Cost and Quality of Care in the US and Denmark: Lessons for Nations Transitioning from Volume-Based to Value-Based Care

2019 ◽  
Vol 3 (s1) ◽  
pp. 140-140
Author(s):  
Negin Fouladi ◽  
Margit Malmmose
Keyword(s):  
Decision Making ◽  
Quality Of Care ◽  
Control Strategies ◽  
Decision Makers ◽  
Sources Of Information ◽  
Healthcare Organizations ◽  
Regulatory Oversight ◽  
Physician Practices ◽  
The Us

OBJECTIVES/SPECIFIC AIMS: Promote knowledge translation and evidence-informed decision-making by assessing barriers and facilitators to balancing cost and quality of care within the US state of Maryland and nation of Denmark. METHODS/STUDY POPULATION: Open-ended and semi-structured key-informant interviews were conducted in 2016 and 2017 among high level decision-makers in Maryland (N=21) and the Danish (N=17) healthcare systems, including hospital, local, regional, and cross-organizational administrators and elected officials. The interviews consisted of questions related to: (1) currently practiced and preferred approaches to resource allocation and development and use of quality performance measures, and (2) preferred sources, formats/styles, modes of information, and decision-making strategies based on a shift from volume to quality-driven care. RESULTS/ANTICIPATED RESULTS: Decision-makers in Maryland expressed the need for collaboration in a changing environment, yet increasingly rely on cost and quality outcomes data to drive decisions and note the struggle to identify credible and useful information. Maryland decision-makers also face challenges in regulating utilization and costs without mandated participation of physician practices within the global budget cap model, which is perceived to be a primary driver of healthcare utilization in the hospital sector. Similarly, decision-makers in Denmark conveyed the importance of quantitative data to aid decisions, however, stress collaboration and dialogue as driving factors and important sources of information. Danish decision-makers also express challenges to wide-spread adoption of a quality-driven approach due to unsustained quality assurance regulatory bodies. DISCUSSION/SIGNIFICANCE OF IMPACT: The findings suggest implementation of value-based healthcare is highly driven and influenced by availability of credible data, which may significantly impact development of policies and innovative cost control strategies, and regulatory oversight to promote adoption of quality measures in decision-making. Furthermore, collaboration within and across healthcare organizations remains a key component to health system improvement as it fosters dialogue and sharing of best practices among stakeholders.

scholarly journals Impacts of common staff on indicators of sanitary evacuation: experience of the gynecology service of Treichville Teaching Hospital

2018 ◽  
Vol 7 (4) ◽  
pp. 1303
Author(s):  
Simplice Anongba ◽  
Jean-Marc Dia ◽  
Ignace Yao ◽  
Edouard N’guessan ◽  
Eric Bohoussou ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Good Practice ◽  
Cross Sectional Study ◽  
Fetal Mortality ◽  
Cross Sectional ◽  
Balance Sheets ◽  
Gynecology And Obstetrics ◽  
The Common ◽  
The Impact

Background: In order to improve the quality of care for patients discharged in our department, since 1996 we have initiated monthly meetings called "common staffs", with the heads of the peripheral maternities who evacuate patients, during which we analyse reference indicators and the SONUs. The objective of this study was to describe the impact of the common staff on the indicators of the reference.Methods: We carried out a retrospective cross-sectional study on the balance sheets of the common staff over the 20 years of practice.Results: In 20 years, 132 meetings were organized, during which 24,337 files were analyzed. In 1996 the indicators of evacuations were at alarming levels: the time taken between the diagnosis and the decision to evacuate was long (more than 1 hour in 83.4%), 73% of the evacuation records were poorly informed, the majority evacuations were by non-medical vehicle (54.8%), pre-discharge management was incorrect in several patients (47%), and maternal and fetal lethality were high (5% and 10%, respectively). Over time, these indicators have improved and have had a favourable impact on maternal and fetal mortality rates, which have gradually decreased. At the same time, the results of the last three years of the evacuees coming from the maternities who do not participate in our staffs, shows that the indicators are still alarming, at levels where we were at the beginning of common staffs.Conclusions: The joint staff proved to be a good practice to promote in the Gynecology and Obstetrics Departments. It helped to improve the quality of care for referred patients.

scholarly journals The use of patient feedback by hospital boards of directors: a qualitative study of two NHS hospitals in England

2017 ◽  
Vol 27 (2) ◽  
pp. 103-109 ◽  
Author(s):  
Robert Lee ◽  
Juan I Baeza ◽  
Naomi J Fulop
Keyword(s):  
Quality Improvement ◽  
Quality Of Care ◽  
Qualitative Study ◽  
Boards Of Directors ◽  
National Health Service Foundation ◽  
Patient Feedback ◽  
Qualitative Feedback ◽  
Hospital Boards ◽  
Foundation Trusts

BackgroundAlthough previous research suggests that different kinds of patient feedback are used in different ways to help improve the quality of hospital care, there have been no studies of the ways in which hospital boards of directors use feedback for this purpose.ObjectivesTo examine whether and how boards of directors of hospitals use feedback from patients to formulate strategy and to assure and improve the quality of care.MethodsWe undertook an in-depth qualitative study in two acute hospital National Health Service foundation trusts in England, purposively selected as contrasting examples of the collection of different kinds of patient feedback. We collected and analysed data from interviews with directors and other managers, from observation of board meetings, and from board papers and other documents.ResultsThe two boards used in-depth qualitative feedback and quantitative feedback from surveys in different ways to help develop strategies, set targets for quality improvement and design specific quality improvement initiatives; but both boards made less subsequent use of any kinds of feedback to monitor their strategies or explicitly to assure the quality of services.Discussion and conclusionsWe have identified limitations in the uses of patient feedback by hospital boards that suggest that boards should review their current practice to ensure that they use the different kinds of patient feedback that are available to them more effectively to improve, monitor and assure the quality of care.

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