scholarly journals An integrative approach to improving patient care pathways

2018 ◽  
Vol 31 (7) ◽  
pp. 810-821 ◽  
Author(s):  
Sharon Williams ◽  
Zoe Radnor
Keyword(s):  
Patient Care ◽  
Conceptual Framework ◽  
Care Pathway ◽  
Healthcare Delivery ◽  
Integrative Approach ◽  
Care Pathways ◽  
Content Type ◽  
Integrated Care Pathways ◽  
Improving Patient Care ◽  
First Time

Purpose Globally, healthcare managers continue to struggle with increasing demands for their services being delivered with limited or shrinking resources. It is, therefore, clear that systems, processes and practices need to change to meet these challenges. The purpose of this paper is to assess how integrating two improvement technologies, Lean and integrated care pathways (ICP) might help. Design/methodology/approach Lean and ICP in healthcare provide a platform to develop conceptual frameworks for integrating two approaches. Findings A conceptual integrated framework is provided to assist care pathway designers and implementers to consider the synergistic benefits of combining approaches to improvement. Research limitations/implications The authors provide a conceptual framework that requires empirically testing. Practical implications This research provides a conceptual framework to aid practitioners to improve healthcare design and delivery. Originality/value For the first time, the authors bring together two approaches to improving patient care pathway design and consider how these are linked in relation to improving healthcare delivery.

scholarly journals Understanding and improving the care pathway for children with autism

2019 ◽  
Vol 32 (1) ◽  
pp. 208-223 ◽  
Author(s):  
Lisa Hurt ◽  
Kate Langley ◽  
Kate North ◽  
Alex Southern ◽  
Lauren Copeland ◽  
...  
Keyword(s):  
Creative Writing ◽  
Health Professionals ◽  
Care Pathway ◽  
Children With Autism ◽  
Autism Spectrum ◽  
Care Pathways ◽  
Content Type ◽  
Education Professionals ◽  
Entry Points ◽  
High Level

Purpose The purpose of this paper is to describe current care pathways for children with autism including enablers and barriers, as experienced by health professionals, education professionals and families in South Wales, UK. Design/methodology/approach This study is based on a mixed-methods approach using focus group discussions, creative writing workshops and visualisation using rich pictures. Findings The experiences of the care pathways differed significantly across the three groups. Health professionals described the most rigidly structured pathways, with clear entry points and outcomes. Education professionals and parents described more complex and confusing pathways, with parents assuming the responsibility of coordinating the health and education activity in a bid to link the two independent pathways. All three groups identified enablers, although these differed across the groups. The barriers were more consistent across the groups (e.g. poor communication, missing information, lack of transparency, limited post-diagnosis services and access to services based on diagnosis rather than need). Practical implications This research could inform the design of new services which are premised on multi-agency and multi-disciplinary working to ensure children with Autism spectrum disorders (ASD) receive joined up services and support. Originality/value Although this study did not represent all professional groups or all experiences of autism, the authors examined three different perspectives of the ASD pathway. In addition, the authors triangulated high-level process maps with rich pictures and creative writing exercises, which allowed the authors to identify specific recommendations to improve integration and reduce duplication and gaps in provision.

Technological innovation and socioemotional wealth in family firm research

2018 ◽  
Vol 16 (3) ◽  
pp. 270-301 ◽  
Author(s):  
Rubén Martínez-Alonso ◽  
María J. Martínez-Romero ◽  
Alfonso A. Rojo-Ramírez
Keyword(s):  
Conceptual Framework ◽  
Technological Innovation ◽  
Family Business ◽  
Family Firms ◽  
Current Knowledge ◽  
Integrative Approach ◽  
Socioemotional Wealth ◽  
Content Type ◽  
The Family ◽  
New Research

Purpose There are currently two issues that generate growing interest among specialized scholars within the family business field: technological innovation (TI) and socioemotional wealth (SEW). While it is true that both topics are highly popular among researchers, the joint study of both perspectives is scarce. Thus, the purpose of this paper is to analyse the interrelationships between TI and SEW in the context of family firms. Design/methodology/approach This literature review systematically analyses the findings of 25 journal articles focusing on TI and SEW, published between 2012 and 2018. Findings The findings reveal an integrative approach, identifying different variables that relate TI and SEW. A conceptual framework is built in which these variables are incorporated into four categories (SEW, TI, moderating effects and performance). New lines of research emerge with the development of a conceptual model and the formulation of six propositions. Practical implications The conceptual framework can be useful as integrative summary of the factors that family business managers and directors should take into account to be successful in implementing innovative projects and strategies. Originality/value The study of TI from the SEW approach has emerged as a fruitful field of research in recent years, but the current knowledge of the role that SEW plays in family firms’ TI is still scarce. This paper contributes to the family business literature by offering a conceptual framework of the SEW–TI relationship and new research avenues that will provide a better comprehension for scholars and specialists for future investigations in the field.

scholarly journals Quality in practice: applying the patient inventory method at a Danish psychiatric hospital

2020 ◽  
Vol 32 (7) ◽  
pp. 477-479
Author(s):  
Sabina Bay Hermansen ◽  
Jens Holmskov ◽  
Søren Paaske Johnsen ◽  
Jan Mainz ◽  
Søren Valgreen Knudsen
Keyword(s):  
Patient Care ◽  
Care Pathway ◽  
Lessons Learned ◽  
Clinical Staff ◽  
Initial Assessment ◽  
Psychiatric Ward ◽  
Care Pathways ◽  
The Right ◽  
To Receive ◽  
Inventory Method

Abstract Quality problem Patient care pathways should be organized according to the needs of the patients. This requires methods to assess whether the specific pathways ensure the right care for the right person at the right time and in the right setting. Initial assessment Previous investigations indicate that ~25% of the patients in Danish hospitals experience inappropriate elements in their care pathways. Choice of solution This study applied the Patient Inventory method to identify inappropriate elements in care pathways in 15 psychiatric in-patient wards in Denmark. Implementation The pathway for 201 patients was systematically evaluated by the clinical staff to identify whether the admission of the patient was avoidable, the hospitalization was unnecessarily prolonged or if the patient could receive more relevant treatment elsewhere. A subsequent meeting between the clinical staff and management qualified the assessment and identified possible solutions to problems. Evaluation A total of 54 (26.9%) of the included patients were assessed to have inappropriate elements in their care pathways, some with more than one type, resulting in a total of 65 episodes. Eight of these episodes (13.1%) were admissions considered to be avoidable, 26 (42.2%) were unnecessary prolongation of admissions, and 31 (58.1%) were patients assessed to be able to receive more relevant care elsewhere. Lessons learned One out of four assessed patients admitted to a psychiatric ward was exposed to an inappropriate element in their care pathway. The Patient Inventory tool can assist in a structured dialogue between clinical staff and management to identify focus areas for improvement efforts.

scholarly journals Integrated care pathways on dementia in Italy: a survey testing the compliance with a national guidance

2019 ◽  
Vol 41 (4) ◽  
pp. 917-924
Author(s):  
Giuseppe Gervasi ◽  
Guido Bellomo ◽  
Flavia Mayer ◽  
Valerio Zaccaria ◽  
Ilaria Bacigalupo ◽  
...  
Keyword(s):  
Integrated Care ◽  
Care Pathway ◽  
Care Pathways ◽  
Local Health ◽  
Health Authorities ◽  
People With Dementia ◽  
Specific Objective ◽  
Item Checklist ◽  
Integrated Care Pathways ◽  
Integrated Care Pathway

AbstractDementias are chronic, degenerative neurological disorders with a complex management that require the cooperation of different healthcare professionals. The Italian Ministry of Health produced the document “Guidance on Integrated Care pathway for People with Dementia” (GICPD) with the specific objective of providing a standardized framework for the definition, development, and implementation of integrated care pathways (ICP) dedicated to people with dementia. We searched all available Italian territorial ICPs. Two raters assessed the retrieved ICPs with a 2-point scale on a 43-item checklist based on the GICPD. Only 5 out of 21 regions and 5 out of 101 local health authorities had an ICP, with most ICPs having a moderate compliance to the GICPD, in particular for the items referring to the development and implementation of the care pathways. A low to moderate inter-rater agreement was observed, mainly due to a lack of standardized models to describe ICPs for dementias. Results suggest that policy- and decision-makers should pay more attention to the GICPD when producing ICPs. The direct communication with clinicians, and the implementation of more precise and appropriate clinical outcomes, could increase the involvement of clinicians, whose participation is crucial to guarantee that ICPs meet needs of patients and their carers.

Enhancing hospital care of patients with cognitive impairment

2018 ◽  
Vol 31 (2) ◽  
pp. 173-186 ◽  
Author(s):  
Loretta M. Isaac ◽  
Elaine Buggy ◽  
Anita Sharma ◽  
Athena Karberis ◽  
Kim M. Maddock ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Patient Care ◽  
Positive Impact ◽  
Healthcare Delivery ◽  
Improve Patient Care ◽  
Health Care Facilities ◽  
Small Scale ◽  
Content Type ◽  
Loved One ◽  
Number Of Patients

Purpose The patient-centred management of people with cognitive impairment admitted to acute health care facilities can be challenging. The TOP5 intervention utilises carers’ expert biographical and social knowledge of the patient to facilitate personalised care. The purpose of this paper is to explore whether involvement of carers in the TOP5 initiative could improve patient care and healthcare delivery. Design/methodology/approach A small-scale longitudinal study was undertaken in two wards of one acute teaching hospital. The wards admitted patients with cognitive impairment, aged 70 years and over, under geriatrician care. Data for patient falls, allocation of one-on-one nurses (“specials”), and length-of-stay (LOS) over 38 months, including baseline, pilot, and establishment phases, were analysed. Surveys of carers and nursing staff were undertaken. Findings There was a significant reduction in number of falls and number of patients allocated “specials” over the study period, but no statistically significant reduction in LOS. A downward trend in complaints related to communication issues was identified. All carers (n=43) completing the feedback survey were satisfied or very satisfied that staff supported their role as information provider. Most carers (90 per cent) felt that the initiative had a positive impact and 80 per cent felt that their loved one benefitted. Six months after implementation of the initiative, 80 per cent of nurses agreed or strongly agreed that it was now easier to relate to carers of patients with cognitive impairment. At nine-ten months, this increased to 100 per cent. Originality/value Actively engaging carers in management of people with cognitive impairment may improve the patient, staff, and carer journeys, and may improve outcomes for patient care and service delivery.

Developing an eating disorder pathway: a case study

2014 ◽  
Vol 9 (4) ◽  
pp. 244-260
Author(s):  
Joanna Blackburn ◽  
Virginia Minogue
Keyword(s):  
Eating Disorders ◽  
Eating Disorder ◽  
Care Pathway ◽  
Meta Analysis ◽  
Local Area ◽  
Care Pathways ◽  
Service Users ◽  
Treatment Pathways ◽  
Content Type ◽  
True Incidence

Purpose – The purpose of this paper is to describe the development of an eating disorder care pathway for adults with eating disorders, in a northern borough town. It arose out of a need to reduce and address inconsistent access to services and treatment pathways. Design/methodology/approach – The development involved a mapping exercise of current service delivery, a review of the literature on eating disorder care pathways, consultation workshops, the engagement of service users and carers, and the development of draft pathways for patients and carers. Findings – Significant emphasis was on raising awareness, prevention, identification and assessment, treatment and recovery. Two pathways were proposed, one for service users focusing on awareness raising/prevention, identification and assessment, treatment, stabilisation and relapse prevention and one for carers/families focusing on carers being identifiable in their own right to receive support for caring for someone with an eating disorder. Research limitations/implications – A limitation of the care pathway under development was the difficulty obtaining an accurate figure of the true number of cases of eating disorders in the local area. This, together with the lack of any form of systematic review or meta-analysis of care pathways made identifying the number of people suffering from eating disorders and developing an effective model difficult. Originality/value – The proposed pathway places significant emphasis on increasing knowledge, incorporating the patient perspective, and enhancing the recognition and understanding of eating disorders in the community. A model was created that could be implemented successfully and identify patients suffering from eating disorders, when the true incidence of eating disorders remains hidden.

scholarly journals Escalating complexity and fragmentation of mental health service systems: the role of recovery as a form of moral communication

Kybernetes ◽  
2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Nicholas Weaver
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Meaning Making ◽  
Healthcare Delivery ◽  
Mental Healthcare ◽  
Magic Bullet ◽  
Care Pathways ◽  
Content Type ◽  
Moral Communication

PurposeTheoretical generalisation provides the basis for tackling problems of service complexity, fragmentation and disrupted care pathways.Design/methodology/approachRecent mental health service transformation in Wales, United Kingdom, has been stimulated by a policy programme underpinned by person-centred recovery values. This paper offers analysis informed by the perspectives of Niklas Luhmann and other noted theorists to examine escalating service system complexity related to this transformation. Analysis builds upon the findings of a qualitative study employing thematic discourse analysis of talk of people with mental illness and associated workers.FindingsIn total, three themes were constructed in participants' talk: “Competing versions of recovery”, “Misaligned service expectations” and “Disrupted care pathways.” Recovery may be understood as a form of moral communication and autopoietic meaning-making activity, according to Luhmann's radical constructionist epistemology. This has the potential to generate competing versions of recovery, a key contributor to escalating complexity.Research limitations/implicationsFindings could be developed further by continued investigation of the relationship between recovery implementation and service fragmentation.Social implicationsA more judicious, balanced policy-implementation may cultivate optimal conditions for recovery pluralism by avoiding polarisation towards either top-down, policy-based recovery implementation or a proliferation of approaches at the grassroots level. Findings have implications for healthcare settings beyond the scope of mental healthcare, given the prevalence of person-centred care internationally.Originality/valueA simplistic view of recovery implementation should be challenged. Recovery should not be considered a “magic bullet” for mental healthcare delivery. Haphazard recovery-implementation may have detrimental effects of escalating complexity, service fragmentation and disrupted care pathways.

scholarly journals ARIA 2019: Um Percurso Assistencial Integrado para a Rinite Alérgica em Portugal

2020 ◽  
Vol 33 (13) ◽  
Author(s):  
João Fonseca ◽  
Tiago Taveira-Gomes ◽  
Ana Margarida Pereira ◽  
Manuel Branco-Ferreira ◽  
Pedro Carreiro-Martins ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Integrated Care ◽  
Allergen Immunotherapy ◽  
Care Pathway ◽  
Response Monitoring ◽  
Care Pathways ◽  
The European Union ◽  
Levels Of Care ◽  
Integrated Care Pathways ◽  
Grade Methodology

The Allergic Rhinitis and Its Impact on Asthma (ARIA) initiative started more than 20 years ago and has developed and disseminated evidence-based guidelines and projects in the field of allergic rhinitis. This initiative is currently focused on providing patient-centred guidelines that contribute to an integrated care pathway between the various levels of care and take advantage of digital solutions, and the introduction of integrated care pathways in clinical practice has been recommended. In this article we describe the adaptation for Portugal of the ARIA Integrated Care Pathways document. After a brief review of the epidemiology and impact of allergic rhinitis in Portugal and the activities carried out in Portugal within the ARIA initiative, we describe the broad knowledge base used for the development of recommendations for the pharmacological treatment of allergic rhinitis, and these recommendations are based on the GRADE methodology, real world evidence acquired by mobile technology (mHealth) and resulting from allergenic exposure chamber studies. What follows is a summary of integrated care pathways for allergen immunotherapy produced in 2019. Allergen immunotherapy is considered an example of precision medicine where the use of mHealth technologies will improve stratification for patient selection and response monitoring. These recommendations were considered as best practices of integrated patient-centred care supported by digital systems from Directorate General for Health and Food Safety of the European Union (DG Santé) and represent the ARIA Phase4 Change Management strategy.

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