scholarly journals Hospital resilience after the 2015 earthquake in Nepal: a qualitative study with hospital staff

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Moitinho de Almeida ◽  
J van Loenhout ◽  
R Singh ◽  
D P Mahara ◽  
D Guha-Sapir ◽  
...  
Keyword(s):  
Thematic Analysis ◽  
Health Workers ◽  
Early Stage ◽  
Community Support ◽  
Hospital Staff ◽  
Task Shifting ◽  
Structured Interviews ◽  
Basic Care ◽  
Individual Resilience ◽  
Life Saving

Abstract Background Research on hospital resilience is scarce and favours top-down approaches, and evidence from the field and operational levels is lacking. The aim of our study was to understand the mechanisms of hospital and individual resilience experienced by staff from a tertiary hospital in Kathmandu, Nepal, after the 2015 Earthquake. Methods We conducted semi-structured interviews with different professionals in May 2018; undertook a deductive thematic analysis of hospital resilience using the framework proposed by Bruneau et al; and used an inductive thematic analysis for individual resilience. Results The earthquake caused different types of burden to the hospital and individuals. Redundancy was mostly influenced by linkages with lower levels of care. Resourcefulness consisted mostly of spontaneous adaptations, with task shifting the most important for human resources. External provision of resources enabled the transfer of part of the burden but precipitated accountability-related challenges. The hospital's robustness depended not only on its physical resistance, but also on the functional capacity to provide life saving care, although routine services were interrupted and quality decreased. The hospital ensured rapidity in providing life saving care to the victims and re-start of routine activities, but recovery to a sense of normality was more conflicting and dependent on the individual. Individual resilience was dictated by safety, a sense of meaningfulness, self and external appreciation, and community support. Conclusions Our study shows the importance of staff experiences to improve hospital resilience. Disaster plans should acknowledge the role of task shifting, and basic care should be taught to all, not just those with clinical functions. Health workers are extremely overwhelmed during disaster response, and disaster plans should engage staff at an early stage to ensure they feel safe and sufficiently supported. Key messages Our work is one of the first to study hospital resilience with field data from qualitative interviews with hospital staff. Hospital resilience strategies should also address individual resilience of hospital staff.

scholarly journals Improving the experience of facility-based delivery for vulnerable women through obstetric care navigation: a qualitative evaluation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kirsten Austad ◽  
Michel Juarez ◽  
Hannah Shryer ◽  
Patricia L. Hibberd ◽  
Mari-Lynn Drainoni ◽  
...  
Keyword(s):  
Health Workers ◽  
Positive Impact ◽  
Qualitative Evaluation ◽  
Obstetric Care ◽  
Hospital Staff ◽  
Public Hospitals ◽  
Future Research ◽  
Care Seeking ◽  
Structured Interviews ◽  
The Impact

Abstract Background Global disparities in maternal mortality could be reduced by universal facility delivery. Yet, deficiencies in the quality of care prevent some mothers from seeking facility-based obstetric care. Obstetric care navigators (OCNs) are a new form of lay health workers that combine elements of continuous labor support and care navigation to promote obstetric referrals. Here we report qualitative results from the pilot OCN project implemented in Indigenous villages in the Guatemalan central highlands. Methods We conducted semi-structured interviews with 17 mothers who received OCN accompaniment and 13 staff—namely physicians, nurses, and social workers—of the main public hospital in the pilot’s catchment area (Chimaltenango). Interviews queried OCN’s impact on patient and hospital staff experience and understanding of intended OCN roles. Audiorecorded interviews were transcribed, coded, and underwent content analysis. Results Maternal fear of surgical intervention, disrespectful and abusive treatment, and linguistic barriers were principal deterrents of care seeking. Physicians and nurses reported cultural barriers, opposition from family, and inadequate hospital resources as challenges to providing care to Indigenous mothers. Patient and hospital staff identified four valuable services offered by OCNs: emotional support, patient advocacy, facilitation of patient-provider communication, and care coordination. While patients and most physicians felt that OCNs had an overwhelmingly positive impact, nurses felt their effort would be better directed toward traditional nursing tasks. Conclusions Many barriers to maternity care exist for Indigenous mothers in Guatemala. OCNs can improve mothers’ experiences in public hospitals and reduce limitations faced by providers. However, broader buy-in from hospital staff—especially nurses—appears critical to program success. Future research should focus on measuring the impact of obstetric care navigation on key clinical outcomes (cesarean delivery) and mothers’ future care seeking behavior.

scholarly journals Organisational change in hospitals: a qualitative case-study of staff perspectives

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Chiara Pomare ◽  
Kate Churruca ◽  
Janet C. Long ◽  
Louise A. Ellis ◽  
Jeffrey Braithwaite
Keyword(s):  
Health Systems ◽  
Early Stage ◽  
Organisational Change ◽  
Hospital Staff ◽  
Hospital Environment ◽  
Structured Interviews ◽  
Metropolitan Hospital ◽  
The Face ◽  
Negative Expectations

Abstract Background Organisational change in health systems is common. Success is often tied to the actors involved, including their awareness of the change, personal engagement and ownership of it. In many health systems, one of the most common changes we are witnessing is the redevelopment of long-standing hospitals. However, we know little about how hospital staff understand and experience such potentially far-reaching organisational change. The purpose of this study is to explore the understanding and experiences of hospital staff in the early stages of organisational change, using a hospital redevelopment in Sydney, Australia as a case study. Methods Semi-structured interviews were conducted with 46 clinical and non-clinical staff working at a large metropolitan hospital. Hospital staff were moving into a new building, not moving, or had moved into a different building two years prior. Questions asked staff about their level of awareness of the upcoming redevelopment and their experiences in the early stage of this change. Qualitative data were analysed using thematic analysis. Results Some staff expressed apprehension and held negative expectations regarding the organisational change. Concerns included inadequate staffing and potential for collaboration breakdown due to new layout of workspaces. These fears were compounded by current experiences of feeling uninformed about the change, as well as feelings of being fatigued and under-staffed in the constantly changing hospital environment. Nevertheless, balancing this, many staff reported positive expectations regarding the benefits to patients of the change and the potential for staff to adapt in the face of this change. Conclusions The results of this study suggest that it is important to understand prospectively how actors involved make sense of organisational change, in order to potentially assuage concerns and alleviate negative expectations. Throughout the processes of organisational change, such as a hospital redevelopment, staff need to be engaged, adequately informed, trained, and to feel supported by management. The use of champions of varying professions and lead departments, may be useful to address concerns, adequately inform, and promote a sense of engagement among staff.

scholarly journals The Relationship between Staff Compliance with Implementing Discharge Planning Guidelines, and Stroke Patients’ Experiences Post-Discharge

2009 ◽  
Author(s):  
Julie Luker ◽  
Karen Grimmer-Somers
Keyword(s):  
Acute Stroke ◽  
Hospital Discharge ◽  
Clinical Guideline ◽  
Discharge Planning ◽  
Community Support ◽  
Hospital Staff ◽  
Structured Interviews ◽  
Stroke Patients ◽  
Post Discharge ◽  
Planning Methods

Purpose: To investigate staff compliance with discharge planning clinical guideline recommendations in an acute stroke unit, and its relationship with post-discharge experiences of stroke patients and their carers. Subjects: Fifty acute stroke patients were systematically recruited for a retrospective patient record audit of staff compliance with clinical guideline recommendations related to discharge planning. Methods: Semi-structured interviews were conducted over six months post-discharge on patients’ actual community support needs and experiences. Audit and patient experience data were integrated to seek evidence of 1) characteristics of patients receiving guideline-compliant care, 2) relationships between staff compliance with discharge planning recommendations and patient’s post-discharge experiences, and 3) whether patient’s post-discharge experiences of shortfalls in support related to hospital discharge planning. Results: Not all patients received guideline-based care. There was a trend that patients with more complex strokes received guideline-compliant care than other patients. Compliance with providing an occupational therapy (OT) home assessment was significantly related to discharge directly home from hospital. There was a shortfall with 40% of patients between community supports predicted by hospital staff and actual post-discharge support requirements. Community support requirements increased over time for 32% of patients, whose six-month post-discharge needs were actually greater than their needs at six weeks. Conclusions: Staff compliance with discharge planning recommendations was variable and did not always relate to improved post-discharge patient experiences. The post-discharge experiences of many stroke patients could not have been predicted whilst they were in hospital. Discharge planning and support systems thus need to be flexible and responsive to short and long-term needs.

scholarly journals Early Adopters’ Philosophies, Practices and Perspectives on Eco-Tourism and Eco-Certification: The Case of Ecotourism in Jamaica

2021 ◽  
Vol 14 (1) ◽  
pp. 120-136
Author(s):  
Natalya R. Brown ◽  
Anahit Armenakyan ◽  
Linda A. Piper
Keyword(s):  
Thematic Analysis ◽  
Strong Evidence ◽  
Community Support ◽  
Economic Sustainability ◽  
Cultural Environment ◽  
Structured Interviews ◽  
Sustainable Practices ◽  
Early Adopters

This paper examines business philosophies, sustainable practices, and attitudes towards eco-certification of pio-neering tourism operators engaged in ecotourism in the mature ‘sun and beach’ destination of Jamaica. We conducted a thematic analysis of the data collected from semi-structured interviews with managers and owners, and observations from on-site visits with establishments identified as ecotourism operators in Jamaica. We identified five distinct busi-ness philosophies that guided our participants' operations: presenting Jamaica in a holistic way, preserving the natural and cultural environment, community support, economic sustainability and incentivized preservation, and operational independence. The tourism operations in our study primarily engage in sustainable practices as a means of attaining operational independence. Meanwhile, participants held mixed attitudes towards eco-certification. There was signifi-cant overlap between our findings and the existing conceptual UNWTO framework for ecotourism. We found strong evidence for the role of education as the defining characteristic of ecotourism. Varying attitudes towards and awareness of sustainability and conservation of the country’s cultural and natural assets limit the amount of community consulta-tion in planning and development of these enterprises.

scholarly journals Hospital resilience after the 2015 earthquake in Nepal: results from semi-structured interviews with hospital staff

2020 ◽  
Author(s):  
Maria Moitinho de Almeida ◽  
Joris Adriaan Frank van Loenhout ◽  
Sunil Singh Thapa ◽  
KC Kumar ◽  
Deepak Prakash Mahara ◽  
...  
Keyword(s):  
Real Life ◽  
Hospital Staff ◽  
University Teaching ◽  
Standards Of Care ◽  
Structured Interviews ◽  
Healthcare Provision ◽  
Disaster Plan ◽  
Individual Resilience ◽  
Hospital Systems

Abstract Background “Safe and resilient hospitals” are increasingly recognized as a cornerstone of disaster reduction in global policies such as the Sendai Framework for Action. However, current hospital resilience frameworks emerged from pre-disaster conceptualizations, and have not been verified in real-life disaster contexts nor in the frontlines. Our aim was to study a tertiary hospital’s resilience after the 2015 earthquake in Nepal, as experienced by its staff. Methods We undertook a qualitative study in the Tribhuvan University Teaching Hospital (TUTH), where we conducted 18 semi-structured interviews with hospital staff. We inductively created themes to describe the earthquake burden to the hospital, and to analyze individual resilience of hospital staff. In addition, we deductively documented the resilience of the hospital as a system, according to the system resilience dimensions: means of resilience (redundancy and resourcefulness), and ends of resilience (robustness and rapidity).Results TUTH faced material challenges, as well as challenges to healthcare provision, to management and coordination, and to hospital staff. In terms of robustness, TUTH increased its capacity for earthquake victims as elective activities were temporarily interrupted and quality of care was not a priority. Three stages of rapidity were identified: critical rapidity to address immediate needs, stabilizing rapidity until the hospital re-started routine activities, and recovery rapidity. In addition to the disaster plan, emerging adaptations played a major role in redundancy and resourcefulness. We found that individual resilience depended on three determinants: safety, meaningfulness, and sense of belonging.Conclusions Hospital resilience results from a complexity of emerging and planned adaptations, as well as from interdependencies with individual resilience. Ensuring workforce safety and sense of meaning directly contributes to hospital systems-level resilience. Hospitals should establish and test disaster plans and strategies to alter standards of care, while being flexible to emerging adaptations.

scholarly journals ADVANCED NASOPHARYNGEAL CARCINOMA WITH NASAL POLYP: A MISDIAGNOSED CASE

2019 ◽  
Vol 1 (03) ◽  
pp. 86-89
Author(s):  
Oke Kadarullah
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Nasal Cavity ◽  
Health Workers ◽  
Early Stage ◽  
Stage Iv ◽  
Hospital Staff ◽  
Neck Mass ◽  
Type I ◽  
Anatomic Site ◽  
Nasopharyngeal Mass

Introduction: Nasopharyngeal carcinoma (NPC) commonly misdiagnosed in early stage, because of it’s multiple nonspesific sign and symptoms also because of the difficult anatomic site. Especially if there is a comorbid in the area around the nasopharynx, most likely will end up with missdiagnosis. So the mortality rate are still high due to advanced stage incidence. Case report: Reported a 58 years male with history of recurrent nasal bleeding since 6 months ago accompanied by hearing problem and also ear fullnes since 11 months ago. There also a severe headache since 4 months ago and a left neck mass arised within 2 months approximately 6 cm in dimension. In nasopharyngocopy found a gelatinous mass at right nasal cavity and nasopharyngeal mass extend to both nasal cavity. The biopsy results are polip nasi Hellquist Type I and Nonkeratinizing Carcinoma Undifferentiated type. CT showed the nasopharyngeal mass has extend intracranially. Patient’s management were planned to polypectomy and chemoiiradiation. Despite of the tumor was radiosensitive, the prognosis and the survival rate are low because the patient came at stage IV.   Conclusion: Educating the society, health workers and hospital staff is a critical step for controlling NPC at early stage

scholarly journals Thought, Attitude and Action

2020 ◽  
Vol 10 (S3) ◽  
pp. 75-90
Author(s):  
Lara Fridani ◽  
Ulfa Elfiah ◽  
Selfi Handayani ◽  
Aschawir Ali
Keyword(s):  
Young Child ◽  
Thematic Analysis ◽  
Qualitative Data ◽  
Community Support ◽  
Pivotal Role ◽  
Structured Interviews ◽  
Narrative Study ◽  
Academic Time ◽  
And Coping

The purpose of this narrative study was to explore how an international PhD student-mother, who has a young child, negotiated and coped with the challenges to complete her studies during the COVID-19 pandemic. Multiple semi-structured interviews were adopted to collect narrative data. Anchored in a thematic analysis, qualitative data showed that the participant encountered such challenges as the skills of managing academic time and activities, difficulty in focusing on studying, worries about family conditions in Indonesia and financial needs. We concluded that physical, mental and spiritual strengths of an individual derived from family and community support play a pivotal role in thinking of, managing, and coping with various challenges during the COVID-19 pandemic.

Does Inter-Border Conflict Influence the Views of Task Sharing Among Community Health Volunteers in Nigeria? a Qualitative Study

2021 ◽  
Author(s):  
Luret Albert Lar ◽  
Martyn Stewart ◽  
Sunday Isiyaku ◽  
Laura Dean ◽  
Kim Ozano ◽  
...  
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Human Resources For Health ◽  
Community Support ◽  
World Health ◽  
Task Sharing ◽  
Structured Interviews ◽  
Factors Affecting ◽  
Allocation Process

Abstract Background: Volunteer community health workers are increasingly being engaged in Nigeria, through the World Health Organization’s task sharing strategy. This strategy aims to address gaps in human resources for health, including inequitable distribution of health workers. Recent conflicts in rural and fragile border communities in northcentral Nigeria create challenges for volunteer community health workers to meet their communities increasing health needs. This study aimed to explore the perception of volunteers involved in task sharing to understand factors affecting performance and delivery in such contexts.Methods: Eighteen audio recorded, semi-structured interviews with volunteers and supervisors were conducted. Their perceptions on on how task sharing and allocation affect performance and delivery were elucidated. The transactional social framework was applied during the thematic analysis process to generate an explanatory account of the research data.Results: Promotive and preventive tasks were shared among the predominantly agrarian respondents. There was a structured task allocation process that linked the community with the health system and mainly cordial relationships were in place. However, there were barriers related to ethnoreligious crises and current conflict, timing of task allocations, gender inequities in volunteerism, shortage of commodities, inadequate incentives, dwindling community support and negative attitudes of some volunteers.Conclusion: The perception of task sharing was mainly positive, despite the challenges, especially the current conflict. In this fragile context, reconsideration of non-seasonal task allocations within improved community-driven selection and security systems should be encouraged. Supportive supervision and providing adequate and timely renumerations will also be beneficial in this fragile setting.

scholarly journals Hospital Resilience After the 2015 Earthquake in Nepal: Results From Semi-structured Interviews With Hospital Staff

2021 ◽  
Vol 9 ◽  
Author(s):  
Maria Moitinho de Almeida ◽  
Joris Adriaan Frank van Loenhout ◽  
Sunil Singh Thapa ◽  
K. C. Kumar ◽  
Deepak Prakash Mahara ◽  
...  
Keyword(s):  
Disaster Response ◽  
Real Life ◽  
Well Being ◽  
Hospital Staff ◽  
University Teaching ◽  
Structured Interviews ◽  
Disaster Plan ◽  
Individual Resilience ◽  
Improve Hospital

Background: Resilient hospitals are increasingly recognized as a cornerstone of disaster reduction in global policies such as the Sendai Framework for Action. However, current hospital resilience frameworks emerged from pre-disaster conceptualizations, and have not been verified in real-life disaster contexts nor in the frontlines. Our aim was to study a tertiary hospital's resilience after the 2015 earthquake in Nepal, as experienced by its staff.Methods: We undertook a qualitative study in the Tribhuvan University Teaching Hospital (TUTH), where we conducted 18 semi-structured interviews with hospital staff. We inductively created themes to describe the earthquake burden to the hospital, and to analyze individual resilience of hospital staff. In addition, we deductively documented the resilience of the hospital as a system, according to the system resilience dimensions: means of resilience (redundancy and resourcefulness), and ends of resilience (robustness and rapidity).Results: In terms of robustness, TUTH increased its capacity for earthquake victims as elective activities were temporarily interrupted and quality of care was not a priority. Three stages of rapidity were identified: critical rapidity to address immediate needs, stabilizing rapidity until the hospital re-started routine activities, and recovery rapidity. In addition to the disaster plan, emerging adaptations played a major role in redundancy and resourcefulness. We found that individual resilience depended on three determinants: safety, meaningfulness, and sense of belonging.Conclusions: Hospital resilience results from a complexity of emerging and planned adaptations, as well as from interdependencies with individual resilience. Frameworks and plans to improve hospital resilience must reflect flexibility of response, and a concern for well-being of hospital staff is central for sustainable disaster response and improved resilience.

A design contribution to the entrepreneurial experience

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Juan David ROLDAN ACEVEDO ◽  
Ida TELALBASIC
Keyword(s):  
Product Development ◽  
Qualitative Analysis ◽  
Design Research ◽  
Recent Literature ◽  
Early Stage ◽  
Entrepreneurial Activity ◽  
Value Proposition ◽  
Structured Interviews ◽  
User Centric ◽  
Constant Growth

In recent history, different design approaches have been entering fields like management and strategy to improve product development and service delivery. Specifically, entrepreneurship has adopted a user-centric mindset in methodologies like the business canvas model and the value proposition canvas which increases the awareness of the users’ needs when developing solutions. What happens when a service design approach is used to understand the entrepreneurs’ experience through the creation of their startups? Recent literature suggests that entrepreneurial activity and success is conditioned by their local entrepreneurship ecosystem. This study investigates the Entrepreneurship Ecosystem of Medellín, Colombia - an ecosystem in constant growth but that lacks qualitative analysis. The sample consists of 12 entrepreneurs in early-stage phase. The data was gathered with two design research methods: Cultural Probes and Semi-structured interviews. The analysis of the information collected facilitated the development of 4 insights about the entrepreneurs and an experience map to visualise and interpret their journey to create a startup. The results of this study reflected the implications of the ecosystem, the explanation of the users’ perceptions and awareness and propose a set of ideas to the local government to improve the experience of undertaking a startup in Medellín.

Sign in / Sign up

Export Citation Format

Share Document