Using clinical governance levers to support change in a cancer care reform

2015 ◽  
Vol 29 (4) ◽  
pp. 482-497 ◽  
Author(s):  
Isabelle Brault ◽  
Jean-Louis Denis ◽  
Terrence James Sullivan
Keyword(s):  
Health Care ◽  
Large Scale ◽  
Health Care Systems ◽  
Research Strategy ◽  
Clinical Governance ◽  
Scale Transformation ◽  
Structured Interviews ◽  
Content Type ◽  
Depth Study ◽  
Care Systems

Purpose – Introducing change is a difficult issue facing all health care systems. The use of various clinical governance levers can facilitate change in health care systems. The purpose of this paper is to define clinical governance levers, and to illustrate their use in a large-scale transformation. Design/methodology/approach – The empirical analysis deals with the in-depth study of a specific case, which is the organizational model for Ontario’s cancer sector. The authors used a qualitative research strategy and drew the data from three sources: semi-structured interviews, analysis of documents, and non-participative observations. Findings – From the results, the authors identified three phases and several steps in the reform of cancer services in this province. The authors conclude that a combination of clinical governance levers was used to transform the system. These levers operated at different levels of the system to meet the targeted objectives. Practical implications – To exercise clinical governance, managers need to acquire new competencies. Mobilizing clinical governance levers requires in-depth understanding of the role and scope of clinical governance levers. Originality/value – This study provides a better understanding of clinical governance levers. Clinical governance levers are used to implement an organizational environment that is conducive to developing clinical practice, as well as to act directly on practices to improve quality of care.

The making and sustaining of leaders in health care

2019 ◽  
Vol 33 (2) ◽  
pp. 241-262 ◽  
Author(s):  
Terry J. Boyle ◽  
Kieran Mervyn
Keyword(s):  
Health Care ◽  
Community Health ◽  
Health Care Services ◽  
Health Care Systems ◽  
Structured Interviews ◽  
Healthcare Provision ◽  
Triple Aim ◽  
Content Type ◽  
Care Services ◽  
Care Systems

Purpose Many nations are focussing on health care’s Triple Aim (quality, overall community health and reduced cost) with only moderate success. Traditional leadership learning programmes have been based on a taught curriculum, but the purpose of this paper is to demonstrate more modern approaches through procedures and tools. Design/methodology/approach This study evolved from grounded and activity theory foundations (using semi-structured interviews with ten senior healthcare executives and qualitative analysis) which describe obstructions to progress. The study began with the premise that quality and affordable health care are dependent upon collaborative innovation. The growth of new leaders goes from skills to procedures and tools, and from training to development. Findings This paper makes “frugal innovation” recommendations which while not costly in a financial sense, do have practical and social implications relating to the Triple Aim. The research also revealed largely externally driven health care systems under duress suffering from leadership shortages. Research limitations/implications The study centred primarily on one Canadian community health care services’ organisation. Since healthcare provision is place-based (contextual), the findings may not be universally applicable, maybe not even to an adjacent community. Practical implications The paper dismisses outdated views of the synonymity of leadership and management, while encouraging clinicians to assume leadership roles. Originality/value This paper demonstrates how health care leadership can be developed and sustained.

scholarly journals Data work: A condition for integrations in health care

2019 ◽  
Vol 25 (3) ◽  
pp. 526-535 ◽  
Author(s):  
Camilla Bjørnstad ◽  
Gunnar Ellingsen
Keyword(s):  
Health Care ◽  
Large Scale ◽  
Health Care Systems ◽  
Medication Management ◽  
Articulation Work ◽  
Efficient Treatment ◽  
Daily Work ◽  
Local Actors ◽  
Care Systems ◽  
Information And Communication

Integration and interoperability between different information and communication technology (ICT) systems are crucial for efficient treatment and care in hospitals. In this article, we are particularly interested in the daily local work conducted by health-care personnel to maintain integrations. A principal aim of our article is, therefore, to contribute to a sociotechnical understanding of the “data work” that is embedded in the integration of health-care systems. Theoretically, we draw on the concepts of “information infrastructures” and “articulation work,” and we discuss how social status may influence the invisible articulation work. Furthermore, we show how historical decisions and existing systems both nationally and regionally have impacts on the daily work of local actors. Empirically, we have studied the formative stages of a large-scale electronic medication management system project in the Northern Norway Regional Health Authority.

scholarly journals NGOs, partnerships, and public-private discontent in Nepal’s health care sector

2018 ◽  
Vol 5 (2) ◽  
Author(s):  
Agya Mahat ◽  
David Citrin ◽  
Hima Bista
Keyword(s):  
Health Care ◽  
Global Health ◽  
Health Care Services ◽  
Large Scale ◽  
Health Care Systems ◽  
Nongovernmental Organization ◽  
Care Services ◽  
Care Systems ◽  
Public Sector Health ◽  
Blind Spots

Public-private partnerships (PPPs) have become increasingly popular models of collaboration in the global health arena to deliver, scale, and evaluate health care services. While many of these initiatives are multicountry, large-scale partnerships, smaller NGOs play increasingly central roles in new forms of privatization. This article draws on our collective experiences working in a PPP between the nongovernmental organization Possible and the Ministry of Health in Nepal to ethnographically examine the fragile and contested nature of these arrangements in the Nepali context, amidst an increasingly privatized health care landscape that is resulting in widespread discontent and distrust throughout the country, as well as financial hardship. We discuss the Possible PPP as one approach that simultaneously seeks to strengthen public-sector health care systems, yet still taps into some of the promises, anxieties, and blind spots – such as the broader social determinants of health – inherent in new forms of public-private global health work.

scholarly journals The Role of Health Technology and Informatics in a Global Public Health Emergency: Practices and Implications From the COVID-19 Pandemic

10.2196/19866 ◽  
2020 ◽  
Vol 8 (7) ◽  
pp. e19866 ◽  
Author(s):  
Jiancheng Ye
Keyword(s):  
Health Care ◽  
Large Scale ◽  
Health Care Systems ◽  
Strong Support ◽  
Global Public Health ◽  
Infected People ◽  
Health Technologies ◽  
Care Systems ◽  
Delivery Services ◽  
And Control

At present, the coronavirus disease (COVID-19) is spreading around the world. It is a critical and important task to take thorough efforts to prevent and control the pandemic. Compared with severe acute respiratory syndrome and Middle East Respiratory Syndrome, COVID-19 spreads more rapidly owing to increased globalization, a longer incubation period, and unobvious symptoms. As the coronavirus has the characteristics of strong transmission and weak lethality, and since the large-scale increase of infected people may overwhelm health care systems, efforts are needed to treat critical patients, track and manage the health status of residents, and isolate suspected patients. The application of emerging health technologies and digital practices in health care, such as artificial intelligence, telemedicine or telehealth, mobile health, big data, 5G, and the Internet of Things, have become powerful “weapons” to fight against the pandemic and provide strong support in pandemic prevention and control. Applications and evaluations of all of these technologies, practices, and health delivery services are highlighted in this study.

scholarly journals Status Update on Data Required to Build a Learning Health System

2020 ◽  
Vol 38 (14) ◽  
pp. 1602-1607 ◽  
Author(s):  
Monica M. Bertagnolli ◽  
Brian Anderson ◽  
Kelly Norsworthy ◽  
Steven Piantadosi ◽  
Andre Quina ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Large Scale ◽  
Point Of Care ◽  
Health Care Systems ◽  
Clinical Care ◽  
Real World Data ◽  
Learning Health System ◽  
Care Systems ◽  
Data Elements

Wide adoption of electronic health records (EHRs) has raised the expectation that data obtained during routine clinical care, termed “real-world” data, will be accumulated across health care systems and analyzed on a large scale to produce improvements in patient outcomes and the use of health care resources. To facilitate a learning health system, EHRs must contain clinically meaningful structured data elements that can be readily exchanged, and the data must be of adequate quality to draw valid inferences. At the present time, the majority of EHR content is unstructured and locked into proprietary systems that pose significant challenges to conducting accurate analyses of many clinical outcomes. This article details the current state of data obtained at the point of care and describes the changes necessary to use the EHR to build a learning health system.

scholarly journals Point-Counterpoint: Active Surveillance for Carriers of Toxigenic Clostridium difficile Should Be Performed To Guide Prevention Efforts

2018 ◽  
Vol 56 (8) ◽  
Author(s):  
L. Clifford McDonald ◽  
Daniel J. Diekema
Keyword(s):  
Health Care ◽  
Clostridium Difficile ◽  
Health Care Systems ◽  
Laboratory Diagnosis ◽  
Value Based Purchasing ◽  
University Of Iowa ◽  
Content Type ◽  
Asymptomatic Patients ◽  
Care Systems ◽  
New Guidelines

INTRODUCTION In 2017, the Journal of Clinical Microbiology published a Point-Counterpoint on the laboratory diagnosis of Clostridium difficile infection (CDI). At that time, Ferric C. Fang, Christopher R. Polage, and Mark H. Wilcox discussed the strategies for diagnosing Clostridium difficile colitis in symptomatic patients (J Clin Microbiol 55:670–680, 2017, https://doi.org/10.1128/JCM.02463-16). Since that paper, new guidelines from the Infectious Diseases Society of America and the Society for Health Care Epidemiology have been published (L. C. McDonald, D. N. Gerding, S. Johnson, J. S. Bakken, K. C. Carroll, et al., Clin Infect Dis 66:987–994, 2018, https://doi.org/10.1093/cid/ciy149) and health care systems have begun to explore screening asymptomatic patients for C. difficile colonization. The theory behind screening selected patient populations for C. difficile colonization is that these patients represent a substantial reservoir of the bacteria and can transfer the bacteria to other patients. Hospital administrators are taking note of institutional CDI rates because they are publicly reported. They have become an important metric impacting hospital safety ratings and value-based purchasing, and hospitals may have millions of dollars of reimbursement at risk. In this Point-Counterpoint, Cliff McDonald of the U.S. Centers for Disease Control and Prevention discusses the value of asymptomatic C. difficile screening, while Dan Diekema of the University of Iowa discusses why caution should be used.

scholarly journals Physician perceptions of the types of roles interpreters play in limited English proficient pediatric encounters and how they evaluate the quality of interpretation

2019 ◽  
Vol 20 ◽  
Author(s):  
Rebecca J. Schwei ◽  
Natalie Guerrero ◽  
Alissa L. Small ◽  
Elizabeth A. Jacobs
Keyword(s):  
Health Care ◽  
Limited English Proficient ◽  
Health Care Systems ◽  
Care Staff ◽  
Health Care Staff ◽  
Structured Interviews ◽  
Team Members ◽  
Medical Interpreters ◽  
Care Systems

AbstractPurposeThe purpose of this study is to understand different roles that interpreters play in a pediatric, limited English proficient (LEP) health care encounter and to describe what factors within each role inform physicians’ assessment of the overall quality of interpretation.BackgroundLanguage barriers contribute to lower quality of care in LEP pediatric patients compared to their English-speaking counterparts. Use of professional medical interpreters has been shown to improve communication and decrease medical errors in pediatric LEP patients. In addition, in many pediatric encounters, interpreters take on roles beyond that of a pure language conduit.MethodsWe conducted 11 semi-structured interviews with pediatricians and family medicine physicians in one health system. Transcripts were audio-recorded and transcribed verbatim. We analyzed our data using directed content analysis. Two study team members coded all transcripts, reviewed agreement, and resolved discrepancies.FindingsPhysicians described four different interpreter roles: language conduit, flow manager, relationship builder, and cultural insider. Within each role, physicians described components of quality that informed their assessment of the overall quality of interpretation during a pediatric encounter. We found that for many physicians, a high-quality interpreted encounter involves multiple roles beyond language transmission. It is important for health care systems to understand how health care staff conceptualize these relationships so that they can develop appropriate expectations and trainings for medical interpreters in order to improve health outcomes in pediatric LEP patients.

Users’ involvement in the Italian NHS: the role of associations and self-help groups

2015 ◽  
Vol 29 (5) ◽  
pp. 570-581 ◽  
Author(s):  
Emmanuele Pavolini ◽  
Elena Spina
Keyword(s):  
Health Care ◽  
Collective Action ◽  
Health Care Services ◽  
Health Care Systems ◽  
Qualitative Interviews ◽  
Content Type ◽  
Italian Studies ◽  
Italian Case ◽  
Care Systems ◽  
Self Help Groups

Purpose – The purpose of the paper is to show the importance of considering patients’ and citizens’ associations for understanding users’ involvement in health care systems. Design/methodology/approach – The paper is based on both qualitative and quantitative data on Italy drawn from various sources (national statistics, own survey data, qualitative interviews). Findings – Although the paper avoids an excessively positive view of the success and frequency of collective patients’ participation, it nevertheless shows that the Italian National Health Care System (NHS) is undergoing important changes in this regard. Voice and co-production among patients, health care services and professionals have become more common and important also because of forms of collective action. Professionals themselves often belong to or promote such associations and groups. The Italian case also shows that voice and co-production tend frequently to merge into a single complex strategy where patients’ requests go along with their direct involvement in health care provision. Social implications – The study provides useful information for policy makers considering the implementation of policies that promote collective action in order to increase an active users’ participation in health care. Originality/value – This is one of the limited number of Italian studies which investigates users’ involvement in the NHS and collective action, thus adding knowledge to the limited research in this field.

scholarly journals The Psychosocial Impact of Compounding Humanitarian Crises Caused by War and COVID-19 Informing Future Disaster Response

2021 ◽  
pp. 1-5
Author(s):  
Hakob Harutyunyan ◽  
Artak Mukhaelyan ◽  
Attila J. Hertelendy ◽  
Amalia Voskanyan ◽  
Todd Benham ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Workers ◽  
Disaster Response ◽  
Large Scale ◽  
Health Care Systems ◽  
Influenza Pandemic ◽  
Care Workers ◽  
Care Systems ◽  
The Republic ◽  
1918 Influenza

Abstract The coronavirus disease 2019 (COVID-19) pandemic has caused the greatest global loss of life and economic impact due to a respiratory virus since the 1918 influenza pandemic. While health care systems around the world faced the enormous challenges of managing COVID-19 patients, health care workers in the Republic of Armenia were further tasked with caring for the surge of casualties from a concurrent, large-scale war. These compounding events put a much greater strain on the health care system, creating a complex humanitarian crisis that resulted in significant psychosocial consequences for health care workers in Armenia.

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