The role of community engagement in building sustainable health-care delivery interventions for Kenya

2018 ◽  
Vol 42 (1/2) ◽  
pp. 35-47
Author(s):  
Elise Catherine Davis ◽  
Elizabeth T. Arana ◽  
John S. Creel ◽  
Stephanie C. Ibarra ◽  
Jesus Lechuga ◽  
...  
Keyword(s):  
Health Care ◽  
Community Engagement ◽  
Health Care Delivery ◽  
Low Income ◽  
Health Care Quality ◽  
Care Delivery ◽  
Care Quality ◽  
Content Type ◽  
Seek Health Care ◽  
Sustainable Health

Purpose The purpose of this article is to provide a general review of the health-care needs in Kenya which focuses on the role of community engagement in facilitating access and diminishing barriers to quality care services. Health-care concerns throughout Kenya and the culture of Kenyan’s health-care practices care are considered. Design/methodology/approach A comprehensive review covered studies of community engagement from 2000 till present. Studies are collected using Google Scholar, PubMed, EBSCOhost and JSTOR and from government and nongovernment agency websites. The approach focuses on why various populations seek health care and how they seek health care, and on some current health-care delivery models. Findings Suggestions for community engagement, including defining the community, are proposed. A model for improved health-care delivery introduces community health workers (CHWs), mHealth technologies and the use of mobile clinics to engage the community and improve health and quality of care in low-income settings. Practical implications The results emphasize the importance of community engagement in building a sustainable health-care delivery model. This model highlights the importance of defining the community, setting goals for the community and integrating CHWs and mobile clinics to improve health status and decrease long-term health-care costs. The implementation of these strategies contributes to an environment that promotes health and wellness for all. Originality/value This paper evaluates health-care quality and access issues in Kenya and provides sustainable solutions that are linked to effective community engagement. In addition, this paper adds to the limited number of studies that explore health-care quality and access alongside community engagement in low-income settings.

Managed care Medicaid

2017 ◽  
Vol 11 (2) ◽  
pp. 198-210 ◽  
Author(s):  
William Trombetta
Keyword(s):  
Health Care ◽  
Managed Care ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Care Quality ◽  
Market Segment ◽  
Economic Aspects ◽  
Content Type ◽  
The Poor

Purpose Providing health care to the poor is evolving in the new US marketplace. The Affordable Care Act has set goals enhancing access to health care, lowering costs and improving patient outcomes. A key segment in this evolution is the most vulnerable health-care population of all: Medicaid. This paper aims to provide a general review of how providing health care to Medicaid patients is changing including how socio-economic aspects of this vulnerable population affects the quality of the health care provided. Design/methodology/approach The paper is entirely secondary research; no primary research has been conducted. Findings Managed care Medicaid provides a risk-based model to treating a vulnerable health-care market segment. The jury is still out on whether managed care Medicaid (MCM) is improving health-care quality and saving cost, but the provision of health care to the Medicaid segment is definitely shifting from a fee-for-service model to value based payment. Very recent developments of new health-care delivery approaches present a positive outlook for improving quality and containing costs going forward. Research limitations/implications At this stage, whether or not MCM saves money or provides better health-care quality to this vulnerable population is a work in progress. Health-care marketing can impact socio-economic aspects of health care for the poor. There is a need to follow up on the positive results being documented in demonstration health-care delivery models. Practical implications At this point, there has been no long-term study of whether managed care Medicaid offers better quality of health care and cost savings. The research to date suggest that the quality of health-care delivery to the poor is improving at a lower cost to payers. Social implications Medicaid patients are an underserved market segment. Managed care Medicaid offers a new model that has the potential to provide quality care at acceptable cost. Critical to this vulnerable market segment is the need to integrate socio-economic aspects of the population with the delivery of health care. Originality/value There has been very little discussion of Medicaid overall in the marketing literature, much less any discussion of managed care Medicaid.

Incidence of Complicated Appendicitis as a Metric of Health Care Delivery

2020 ◽  
pp. 000313482095376
Author(s):  
Fawaz Araim ◽  
Artem Shmelev ◽  
Gopal C. Kowdley
Keyword(s):  
Health Care ◽  
Acute Appendicitis ◽  
Health Care Delivery ◽  
Health Care Quality ◽  
Care Delivery ◽  
State Level ◽  
Care Quality ◽  
Physician Density ◽  
Multivariable Logistic Regression Model ◽  
Modifiable Factors

Background Complicated acute appendicitis (CAA) has been linked to extremes of age, racial and socioeconomic disparities, public insurance, and remote residency. CAA rate has been used from 2005 to 2018 as a health care quality metric, with the assumption that delay in treatment was a main cause of perforation. We studied factors that could contribute to CAA focusing on modifiable factors which could be altered as part of a health care delivery system. Materials and Methods All primary admissions for acute appendicitis (AA) from the 2010 Nationwide Inpatient Sample were linked to 2010 state-level physician density data. CAA was distinguished by codes for perforation, generalized peritonitis, or intra-abdominal abscess. A multivariable logistic regression model for CAA prediction was built. Results A total of 288 556 patients were admitted with AA and 86 272 (29.9%) had CAA. Independent factors, linked to CAA, included age outside the 10-39 range (odds ratio (OR) = 2.1-2.4 and all P < .001), male gender (OR = 1.2), malnutrition (OR = 6.2), diabetes mellitus (OR = 2.1), chronic anemias (OR = 1.9), nonprivate insurances (OR 1.2-1.5), nonmetropolitan patient’s residence (OR = 1.15), and Midwest region (OR = 1.2). Patient income and physician coverage were not significant factors after adjustment for all other covariates. Highest CAA fraction of 39.6% was noted in rural patients admitted to urban teaching facilities. Discussion Although provider coverage at the state level may seem adequate and not related to increased CAA rates, the distance patients traveled for their definitive surgical care correlated with higher rates of CAA. Adjusting physician distribution into nonurban settings closer to patients could decrease rates of CAA by diminishing time to definitive care.

scholarly journals In patient satisfaction survey- how does it help our health care delivery system (the patient, the health care giver and the organization)?

2017 ◽  
Vol 4 (10) ◽  
pp. 3280
Author(s):  
Priti Prasad Shah
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Health Care Delivery ◽  
Health Care Quality ◽  
Care Delivery ◽  
Healthcare Services ◽  
Care Quality ◽  
Survey Study ◽  
Satisfaction Survey ◽  
Patient Satisfaction Survey

Background: Patient satisfaction is a mean of measuring the effectiveness of health care delivery.    It can suggest proportion to the problem areas and a reference point to take management decisions. It can serve as a mean of holding physician accountable. Patient satisfaction data can be used to document health care quality for accrediting organizations and consumer groups. They can also measure specific initiative or changes in service delivery.  They can increase loyalty of patients by demonstrating you care their perceptions and looking for ways to improve. The purpose of our study is to carry out evaluation of hospital services by getting a patient satisfaction survey. Main aim is to identify potential problems in the services.Methods: A hospital based inpatient satisfaction survey study done on 200 patients. A Predesigned structured questionnaire was based on relevance of questions to healthcare services on various aspects of inpatient care.  The interviewer based questionnaires were filled after obtaining verbal informed consent from all subjects. 200 valid responses were analyzed using MS office excel. Data analysis of study is done using the SPSS (Statistical Package for the Social Science) Version 17 for window.Results: Results of our study is very positive and suggest that patients were satisfied with the attitude of doctors, nurses and paramedical staff and it was appreciated. As in D Y Patil Medical College and Hospital most facilities are free for the patients, so we got better feedback for the facilities and satisfaction for this study. Satisfied patients are more likely to continue using the health care services and maintain their relationship with specific health care providers.Conclusions: Patient satisfaction survey can be a driving force for changes in health care delivery with institutions and individuals. These initiatives can promote improvement in practice and also respond to patient expressed needs.

Assessing health care quality in adolescent clinics, implications for quality improvement

2018 ◽  
Vol 23 (4) ◽  
pp. 269-280 ◽  
Author(s):  
Emmanuel Anongeba Anaba ◽  
Aaron Asibi Abuosi
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Adolescent Health ◽  
Health Care Quality ◽  
Care Quality ◽  
Urban Setting ◽  
Content Type ◽  
Seek Health Care

Purpose Adolescents are more exposed to risky health behaviors. However, many adolescents do not seek health care due to the poor quality of care. The purpose of this paper is to assess health care quality in adolescent clinics in Tema, a suburb of Ghana. Design/methodology/approach Cross-sectional survey design was adopted to collect data from 365 adolescent respondents. Data were analyzed with the aid of Statistical Package for Social Science (version 20) using descriptive statistics and multiple linear regression. Findings The results demonstrate that adolescents perceived quality of care in adolescent clinics to be good. The significant predictors of adolescents’ overall perceptions of quality of care were provider competencies (β=0.311, p<0.01), adolescent’s health literacy (β=0.359, p<0.01), appropriate package of services (β=0.093, p<0.05), and equity and non-discrimination (β=0.162, p<0.01). Research limitations/implications The study was conducted in an urban setting. Therefore, the generalization of findings must be done with caution. Originality/value Adolescent health care quality in Ghana is below expectation. However, it has received little attention from researchers. This study provides empirical evidence for adolescent health care quality improvement in developing countries like Ghana.

scholarly journals Quality of health care in Nigeria: a myth or a reality

2018 ◽  
Vol 6 (9) ◽  
pp. 2875
Author(s):  
Benson Chukwunweike Ephraim-Emmanuel ◽  
Adetutu Adigwe ◽  
Roland Oyeghe ◽  
Daprim S. T. Ogaji
Keyword(s):  
Health Care ◽  
Health Care Delivery ◽  
Health Care Quality ◽  
Care Delivery ◽  
Care Quality ◽  
Quality Systems ◽  
Quality Health Care ◽  
The Poor ◽  
Quality Health

The delivery of high quality health care is crucial to achieving enhanced health benefits, patient safety and a positive patient experience of health care. This article provides insight on the quality of the health care delivery in Nigeria and aim to uncover if quality health care in Nigeria is a reality or a myth. Relevant information was abstracted from included articles and used to provide both descriptive and analytical discourse on the subject. Discussions and reflections were carried out along an established quality framework of treatment effectiveness, acceptability, efficiency, the appropriateness of the means of delivery as well as equity. The slow pace of development of quality systems in health service delivery in Nigeria is evidenced by the poor quality of health services as well as the poor health status of the population. The pace of developing quality systems in health care delivery in Nigeria is unsatisfactory. There is a need to galvanise the efforts of relevant stakeholders including the patient in charting a new agenda for health care quality improvement in Nigeria.

scholarly journals Incorporating digital self-services into integrated mental health care: a physician’s perspective

2018 ◽  
Vol 52 (11) ◽  
pp. 2234-2250 ◽  
Author(s):  
Heini Sisko Maarit Taiminen ◽  
Saila Saraniemi ◽  
Joy Parkinson
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Health Care Delivery ◽  
Value Creation ◽  
Care Delivery ◽  
Service Marketing ◽  
Content Type ◽  
Integrated Mental Health ◽  
Physician’S Perspective

Purpose This paper aims to enhance the current understanding of digital self-services (computerized cognitive behavioral therapy [cCBT]) and how they could be better incorporated into integrated mental health care from the physician’s perspective. Service marketing and information systems literature are combined in the context of mental health-care delivery. Design/methodology/approach An online survey of 412 Finnish physicians was undertaken to understand physicians’ acceptance of cCBT. The study applies thematic analysis and structural equation modeling to answer its research questions. Findings Adopting a service marketing perspective helps understand how digital self-services can be incorporated in health-care delivery. The findings suggest that value creation within this context should be seen as an intertwined process where value co-creation and self-creation should occur seamlessly at different stages. Furthermore, the usefulness of having a value self-creation supervisor was identified. These value creation logic changes should be understood and enabled to incorporate digital self-services into integrated mental health-care delivery. Research limitations/implications Because health-care systems vary across countries, strengthening understanding through exploring different contexts is crucial. Practical implications Assistance should be provided to physicians to enable better understanding of the application and suitability of digital self-service as a treatment option (such as cCBT) within their profession. Additionally, supportive facilitating conditions should be created to incorporate them as part of integrated care chain. Social implications Digital self-services have the potential to serve goals beyond routine activities in a health-care setting. Originality/value This study demonstrates the relevance of service theories within the health-care context and improves understanding of value creation in digital self-services. It also offers a profound depiction of the barriers to acceptance.

The Value of Business Training in the Quest for Sustainable Health Care Delivery in Plastic Surgery

2019 ◽  
Vol 83 (2) ◽  
pp. 121-122
Author(s):  
James Randall Patrinely ◽  
Brian Drolet ◽  
Galen Perdikis ◽  
Antonio Jorge Forte
Keyword(s):  
Health Care ◽  
Plastic Surgery ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Business Training ◽  
Sustainable Health

(Re)descriptions of medical professional work: exploring accounting as a performative device within an emergency unit health-care context

2020 ◽  
Vol 32 (2) ◽  
pp. 159-176 ◽  
Author(s):  
Cemil Eren Fırtın ◽  
Tom S. Karlsson
Keyword(s):  
Health Care ◽  
Health Care Quality ◽  
Treatment Time ◽  
Medical Professional ◽  
Care Quality ◽  
Medical Terminology ◽  
Professional Work ◽  
Content Type ◽  
Emergency Health Care ◽  
Number Of Patients

PurposeThis article addresses issues of calculation and economization in contemporary public organizations. In particular, it investigates how choices of organizing emergency health-care have been affected by accounting as a performative device. Special attention has been paid to how accounting brings about performative consequences in shaping the medical profession and its context.Design/methodology/approachThe article employs qualitative research methods and draws its analysis on empirical data from in-depth interviews at an emergency health-care unit in Sweden.FindingsIt is demonstrated how accounting, in the form of calculations of treatment time and number of patients, enables performative consequences for medical professional work. It is also demonstrated how the use of accounting engages (re)descriptions of practices and roles, creates accounts of patients, and helps to sustain such (re)descriptions. Accounting terms (such as efficiency and control) have been reframed into medical terminology (such as health-care quality and security), ensuring and retaining (re)described medical professional work in terms of practices and emerging roles.Originality/valueThis article contributes to (1) the literature on accounting practices within health-care contexts by demonstrating a case where the accounting ideas and practices of medical professionals are coexistent and interwoven and (2) the increasing body of literature focusing on accountingization by showing how emerging calculative technologies carry performative power over medical professional work through formative (re)descriptions.

Cultural dynamics and tensions when applying design thinking for improving health-care quality

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Jonas Boström ◽  
Helene Hillborg ◽  
Johan Lilja
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Health Care Quality ◽  
Design Thinking ◽  
User Involvement ◽  
Clinical Work ◽  
Care Quality ◽  
Content Type ◽  
Improving Health Care ◽  
Practical Implications

Purpose The purpose of this paper is to contribute knowledge concerning the dynamics and potential cultural tensions that occur when applying user involvement and design thinking (DT) for improving quality in a health-care setting. Design/methodology/approach This paper is based on a case study following a quality improvement (QI) project in a medium-sized Swedish county council in the field of somatic care. The project involved eight health-care professionals, one designer, four patients and two relatives. A multiple data collection method over a period of ten months was used. It included individual interviews, e-mail correspondence and observations of workshops that covered the QI project. Findings The result shows tensions between QI work and the daily clinical work of the participants. These tensions primarily concern the conflict between fast and slow processes, the problem of moving between different fields of knowledge, being a resource for the individual clinic and the system and the participants’ expectations and assumptions about roles and responsibilities in a QI project. Furthermore, these findings could be interpreted as signs of a development culture in the health-care context. Practical implications There are several practical implications. Among others, the insights can inspire how to approach and contextualize the current concepts, roles and methods of DT and user involvement so that they can be more easily understood and integrated into the existing culture and way of working in the health-care sector. Originality/value This study provides a unique insight into a case, trying to uncover what actually is going on and perhaps, why certain things are not happening at all, when user involvement and design practices are applied for improving health-care quality.

Five focus strategies to organize health care delivery

2016 ◽  
Vol 29 (2) ◽  
pp. 177-191 ◽  
Author(s):  
Antti Peltokorpi ◽  
Miika Linna ◽  
Tomi Malmström ◽  
Paulus Torkki ◽  
Paul Martin Lillrank
Keyword(s):  
Health Care ◽  
Health Care Delivery ◽  
Management Practices ◽  
Care Delivery ◽  
System Level ◽  
Content Type ◽  
Requisite Variety ◽  
Care Outcomes ◽  
Definition Of ◽  
Focus Strategies

Purpose – The focused factory is one of the concepts that decision-makers have adopted for improving health care delivery. However, disorganized definitions of focus have led to findings that cannot be utilized systematically. The purpose of this paper is to discuss strategic options to focus health care operations. Design/methodology/approach – First the literature on focus in health care is reviewed revealing conceptual challenges. Second, a definition of focus in terms of demand and requisite variety is defined, and the mechanisms of focus are explicated. A classification of five focus strategies that follow the original idea to reduce variety in products and markets is presented. Finally, the paper examines managerial possibilities linked to the focus strategies. Findings – The paper proposes a framework of five customer-oriented focus strategies which aim at reducing variety in different characteristics of care pathways: population; urgency and severity; illnesses and symptoms; care practices and processes; and care outcomes. Research limitations/implications – Empirical research is needed to evaluate the costs and benefits of the five strategies and about system-level effects of focused units on competition and coordination. Practical implications – Focus is an enabling condition that needs to be exploited using specific demand and supply management practices. It is essential to understand how focus mechanisms differ between strategies, and to select focus that fits with organization’s strategy and key performance indicators. Originality/value – Compared to previous more resource-oriented approaches, this study provides theoretically solid and practically relevant customer-oriented framework for focusing in health care.

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