scholarly journals Keeping up with the codes; accounting for quality in cancer patient pathways (CPPs) in Norway

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
E Håland ◽  
L Melby
Keyword(s):  
Cancer Patient ◽  
Patient Experience ◽  
Health Personnel ◽  
Waiting Times ◽  
Administrative Staff ◽  
Measuring Time ◽  
Clerical Workers ◽  
Patient Pathways ◽  
Coding Manual ◽  
Standardised Patient

Abstract Background Standardised cancer patient pathways (CPPs) were introduced in Norway in 2015. CPPs are national standardised patient pathways which are discipline- and target-based (28 cancer diagnoses), aiming to minimize waiting times and make cancer care more predictable and secure for patients. One important part of the CPPs are different codes aimed at measuring time in the different phases of the pathway. These codes are reported to the Norwegian directorate for health and are made public on a national web site. On the basis of these reports hospitals across the country can be compared regarding compliance to timescales. From a political and bureaucratic level, the codes are seen as signs of quality, and hence very important. Methods In this paper, we present preliminary results from a project which is evaluating the introduction of CPPs. Based on interviews with administrative staff responsible for coding and with other health personnel (physicians, nurses, clerical workers and managers) in different hospitals, we present experiences with and perceptions of coding practices. Results We find that even though the coding manual is presented as a universal tool implying standardised coding practices, there is a multitude of coding practices (which makes comparison between hospitals challenging). The coding represents a massive bureaucratic workload for the dedicated staff, raising concerns if their time is spent on the most important issues. Conclusions The codes are seen as timescales set according to logistics and not according to what is medically safe - and some of the health personnel argue that these timescales have nothing to do with quality. However, they still recognize that keeping the timescales might be important for the patient experience. Key messages Standardised coding are often not standardised, but contains a multitude of practices. These practices need to be explored in order to understand if and how codes can be seen as signs of quality.

scholarly journals Speedy, predictable and secure cancer care? Introducing cancer patient pathways in Norway

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
L Melby ◽  
E Håland
Keyword(s):  
Cancer Patient ◽  
Cancer Care ◽  
Waiting Times ◽  
Hospital Staff ◽  
Cancer Diagnostics ◽  
Cross Sectional ◽  
Clerical Workers ◽  
Time Limits ◽  
Assessment Period ◽  
Patient Pathways

Abstract Norway introduced cancer patient pathways (CPPs) in 2015. CPPs are standardised patient pathways, based on current guidelines for cancer diagnostics and treatment. The aim is to speed up patient assessments and start of treatment and minimise waiting times, in order to make the assessment period as predictable as possible. Each CPP are divided into phases, and each phase should be completed within a defined time period. The aim of this paper is to describe and discuss how healthcare professionals work to realise the objectives of the CPPs and how they reflect upon them as tools for achieving predictable and secure cancer care. The paper departs from an ongoing study (2017-2020) investigating the introduction of CPPs in Norway. The study has a qualitative cross-sectional design and focuses on four CPPs: breast-, prostate, and lung cancer, and malign melanoma. Data are mainly collected through interviews. The study setting is four hospitals, and study participants are hospital staff, including physicians, nurses, clerical workers and managers (N = 60). Preliminary results show that keeping the waiting times has become a major concern, and national statistics are published showing if the hospitals keep the defined time limits. From the perspective of healthcare workers, CPPs may contribute to a predictable assessment period for patients, and thereby creating a more secure experience. However, predictability and security rest on patients being informed about receiving care organised through a CPP. We found that in many instances this was not the case. Our study indicates that most effort in hospitals is directed towards reducing waiting times, and we argue that publishing of statistics may be an incentive for hospitals to reorganise their resources and prioritize cancer patients before other (elective) patients. Further development of the CPPs should encourage informing and supporting patients so they can have the most predictable and secure experience as possible. Key messages Patient pathways is an incentive to reorganise resources to reach defined time limits in cancer diagnostics. Short waiting times are positive for patients, even if survival rate is not necessarily affected.

Cancer Patient Pathways shortens waiting times and accelerates the diagnostic process of suspected sarcoma patients in Denmark

Health Policy ◽  
2013 ◽  
Vol 113 (1-2) ◽  
pp. 110-117 ◽  
Author(s):  
Heidi Buvarp Dyrop ◽  
Akmal Safwat ◽  
Peter Vedsted ◽  
Katja Maretty-Nielsen ◽  
Bjarne Hauge Hansen ◽  
...  
Keyword(s):  
Cancer Patient ◽  
Waiting Times ◽  
Diagnostic Process ◽  
Patient Pathways

scholarly journals Coding for quality? Accountability work in standardised cancer patient pathways (CPPs)

2021 ◽  
pp. 136345932110138
Author(s):  
Erna Håland ◽  
Line Melby
Keyword(s):  
Quality Of Care ◽  
Cancer Patient ◽  
Health Personnel ◽  
Quality Care ◽  
Important Work ◽  
High Quality ◽  
Patient Pathways ◽  
Work Health ◽  
Crucial Part

A vital part of standardised care pathways is the possibility to measure performance through different indicators – for example, codes. In this article, based on interviews with health personnel in a project evaluating the introduction of standardised cancer patient pathways (CPPs) in Norway, we explore the specific types of work involved when health personnel produce codes as (intended) signifiers of quality. All the types of work are dimensions of what we define as accountability work – work health personnel do to make the codes signifiers of quality of care in the CPP. Codes and coding practices raise questions of what quality of care represents and how it could and should be measured. Informants in our study advocate for coding as important work for the patient more than for ‘the system’. This shows how organising for quality becomes a crucial part of professional work, expanding what it means to perform high quality care.

scholarly journals Patient experiences of waiting times in standardised cancer patient pathways in Norway – a qualitative interview study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marit Solbjør ◽  
Kari Sand ◽  
Bente Ervik ◽  
Line Melby
Keyword(s):  
Cancer Patient ◽  
Waiting Times ◽  
Qualitative Interview ◽  
Patient Experiences ◽  
Rapid Diagnosis ◽  
Patient Needs ◽  
Structured Interviews ◽  
Patient Pathways ◽  
Qualitative Interview Study ◽  
Urgent Action

Abstract Objective Standardised cancer patient pathways (CPP) are implemented within cancer care with an aim to ensure standardised waiting times for diagnosis and treatment. This article investigates how patients in Norway experience waiting times within a CPP. Methods Qualitative semi-structured interviews with 19 patients who had been through CPP for breast cancer, prostate cancer or malignant melanoma in Norway. Results Few patients knew about the term CPP but trusted that waiting times were standardised to decrease mortality. Their experiences of waiting depended on their expectations as much as the period they waited. Patients generally felt safe about the timing of treatment, but not all expectations of a rapid response from health services were met. Short waiting times were interpreted as a sign of urgency, and a change of pace between urgent action and prolonged periods of waiting were disturbing. Conclusions Patients are comforted by knowing they are within a structured CPP that ensures rapid diagnosis and start of treatment. CPPs still need to be improved to avoid delays, allow for adaptions to patient needs, and include more information to avoid stress.

scholarly journals P-150 Insights into the gastric and oesophageal cancer patient experience: Results of a pan-European patient survey

2021 ◽  
Vol 32 ◽  
pp. S150
Author(s):  
Z. Maravic ◽  
V. Fotaki ◽  
O. Mesalles Naranjo ◽  
E. Gasenko ◽  
I. Rawicka ◽  
...  
Keyword(s):  
Cancer Patient ◽  
Patient Experience ◽  
Oesophageal Cancer ◽  
Patient Survey

scholarly journals Association of Emergency Department Waiting Times With Patient Experience in Admitted and Discharged Patients

2021 ◽  
Vol 8 ◽  
pp. 237437352110114
Author(s):  
Andrew Nyce ◽  
Snehal Gandhi ◽  
Brian Freeze ◽  
Joshua Bosire ◽  
Terry Ricca ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Patient Experience ◽  
Waiting Times ◽  
Hospital Length ◽  
Short Length ◽  
Hospital Length Of Stay ◽  
Patient’S Experience ◽  
Discharged Patients ◽  
The Impact

Prolonged waiting times are associated with worse patient experience in patients discharged from the emergency department (ED). However, it is unclear which component of the waiting times is most impactful to the patient experience and the impact on hospitalized patients. We performed a retrospective analysis of ED patients between July 2018 and March 30, 2020. In all, 3278 patients were included: 1477 patients were discharged from the ED, and 1680 were admitted. Discharged patients had a longer door-to-first provider and door-to-doctor time, but a shorter doctor-to-disposition, disposition-to-departure, and total ED time when compared to admitted patients. Some, but not all, components of waiting times were significantly higher in patients with suboptimal experience (<100th percentile). Prolonged door-to-doctor time was significantly associated with worse patient experience in discharged patients and in patients with hospital length of stay ≤4 days. Prolonged ED waiting times were significantly associated with worse patient experience in patients who were discharged from the ED and in inpatients with short length of stay. Door-to-doctor time seems to have the highest impact on the patient’s experience of these 2 groups.

scholarly journals Helsepersonells erfaringer med pasientforløp i kommuner i Vest-Norge

2017 ◽  
Vol 13 (2) ◽  
Author(s):  
Torill Aarskog Skorpen ◽  
Marit Kvangarsnes ◽  
Torstein Hole
Keyword(s):  
Health Services ◽  
Health Personnel ◽  
Health Care Services ◽  
User Participation ◽  
Local Health ◽  
Care Services ◽  
Western Norway ◽  
Patient Pathways ◽  
Specialist Health Care ◽  
Group Interviews

Health services in Norway have been described as fragmented with weak coordination between different care levels with respect to patient pathways. The Coordination Reform’s aim was to improve patient pathways and strengthen user participation. The aim of this study was to investigate health personnel ́s experiences with patient pathways in municipalities in Western Norway. A qualitative design was chosen. Six focus group interviews with health personnel working in municipalities in Western Norway were conducted in 2013 and 2014. The interviews revealed that health personnel experienced that local health services gave cohesive patient pathways and strengthened user participation. Cohesive patient pathways and locally adapted pathways were considered important. Coordination and electronic communication between primary and specialist health care services were seen as inadequate. Trust, teamwork, competence and necessary resources were considered vital. Health personnel ́s experiences indicated that the intended aim of cohesive patient pathways near the patient was met. 

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