Building a learning health system using clinical registers: a non-technical introduction

2016 ◽  
Vol 30 (7) ◽  
pp. 1105-1118 ◽  
Author(s):  
John Ovretveit ◽  
Eugene Nelson ◽  
Brent James
Keyword(s):  
Health Systems ◽  
Computer Literacy ◽  
Patient Empowerment ◽  
Healthcare Services ◽  
Healthcare Systems ◽  
Digital Data ◽  
Content Type ◽  
Daily Work ◽  
Effective Use ◽  
Unpublished Research

Purpose The purpose of this paper is to describe how clinical registers were designed and used to serve multiple purposes in three health systems, in order to contribute practical experience for building learning healthcare systems. Design/methodology/approach Case description and comparison of the development and use of clinical registries, drawing on participants’ experience and published and unpublished research. Findings Clinical registers and new software systems enable fact-based decisions by patients, clinicians, and managers about better care, as well as new and more economical research. Designing systems to present the data for users’ daily work appears to be the key to effective use of the potential afforded by digital data. Research limitations/implications The case descriptions draw on the experience of the authors who were involved in the development of the registers, as well as on published and unpublished research. There is limited data about outcomes for patients or cost-effectiveness. Practical implications The cases show the significant investments which are needed to make effective use of clinical register data. There are limited skills to design and apply the digital systems to make the best use of the systems and to reduce their disadvantages. More use can be made of digital data for quality improvement, patient empowerment and support, and for research. Social implications Patients can use their data combined with other data to self-manage their chronic conditions. There are challenges in designing and using systems so that those with lower health and computer literacy and incomes also benefit from these systems, otherwise the digital revolution may increase health inequalities. Originality/value The paper shows three real examples of clinical registers which have been developed as part of their host health systems’ strategies to develop learning healthcare systems. The paper gives a simple non-technical introduction and overview for clinicians, managers, policy-advisors and improvers of what is possible and the challenges, and highlights the need to shape the design and implementation of digital infrastructures in healthcare services to serve users.

scholarly journals Benchmarking management practices in Australian public healthcare

2016 ◽  
Vol 30 (1) ◽  
pp. 31-56 ◽  
Author(s):  
Renu Agarwal ◽  
Roy Green ◽  
Neeru Agarwal ◽  
Krithika Randhawa
Keyword(s):  
Health Systems ◽  
Operations Management ◽  
Performance Monitoring ◽  
Management Practices ◽  
Healthcare Systems ◽  
The State ◽  
Public Hospitals ◽  
Public Healthcare ◽  
Content Type

Purpose – The purpose of this paper is to investigate the quality of management practices of public hospitals in the Australian healthcare system, specifically those in the state-managed health systems of Queensland and New South Wales (NSW). Further, the authors assess the management practices of Queensland and NSW public hospitals jointly and globally benchmark against those in the health systems of seven other countries, namely, USA, UK, Sweden, France, Germany, Italy and Canada. Design/methodology/approach – In this study, the authors adapt the unique and globally deployed Bloom et al. (2009) survey instrument that uses a “double blind, double scored” methodology and an interview-based scoring grid to measure and internationally benchmark the management practices in Queensland and NSW public hospitals based on 21 management dimensions across four broad areas of management – operations, performance monitoring, targets and people management. Findings – The findings reveal the areas of strength and potential areas of improvement in the Queensland and NSW Health hospital management practices when compared with public hospitals in seven countries, namely, USA, UK, Sweden, France, Germany, Italy and Canada. Together, Queensland and NSW Health hospitals perform best in operations management followed by performance monitoring. While target management presents scope for improvement, people management is the sphere where these Australian hospitals lag the most. Practical implications – This paper is of interest to both hospital administrators and health care policy-makers aiming to lift management quality at the hospital level as well as at the institutional level, as a vehicle to consistently deliver sustainable high-quality health services. Originality/value – This study provides the first internationally comparable robust measure of management capability in Australian public hospitals, where hospitals are run independently by the state-run healthcare systems. Additionally, this research study contributes to the empirical evidence base on the quality of management practices in the Australian public healthcare systems of Queensland and NSW.

scholarly journals Merging Data Diversity of Clinical Medical Records to Improve Effectiveness

2019 ◽  
Vol 16 (5) ◽  
pp. 769 ◽  
Author(s):  
Berit I. Helgheim ◽  
Rui Maia ◽  
Joao C. Ferreira ◽  
Ana Lucia Martins
Keyword(s):  
Language Processing ◽  
Medical Records ◽  
Healthcare Services ◽  
Data Sources ◽  
Digital Data ◽  
External Data ◽  
Knowledge Area ◽  
Effective Use ◽  
Technical Solutions

Medicine is a knowledge area continuously experiencing changes. Every day, discoveries and procedures are tested with the goal of providing improved service and quality of life to patients. With the evolution of computer science, multiple areas experienced an increase in productivity with the implementation of new technical solutions. Medicine is no exception. Providing healthcare services in the future will involve the storage and manipulation of large volumes of data (big data) from medical records, requiring the integration of different data sources, for a multitude of purposes, such as prediction, prevention, personalization, participation, and becoming digital. Data integration and data sharing will be essential to achieve these goals. Our work focuses on the development of a framework process for the integration of data from different sources to increase its usability potential. We integrated data from an internal hospital database, external data, and also structured data resulting from natural language processing (NPL) applied to electronic medical records. An extract-transform and load (ETL) process was used to merge different data sources into a single one, allowing more effective use of these data and, eventually, contributing to more efficient use of the available resources.

India’s rural healthcare systems: structural modeling

2018 ◽  
Vol 31 (7) ◽  
pp. 757-774 ◽  
Author(s):  
Dinesh Kumar
Keyword(s):  
Structural Model ◽  
Healthcare Services ◽  
Healthcare Systems ◽  
Climatic Conditions ◽  
Healthcare Management ◽  
Driving Factors ◽  
Rural Healthcare ◽  
Content Type ◽  
Rural Health Center ◽  
Interpretive Structural Model

Purpose The purpose of this paper is to identify factors related to rural healthcare services and establish a hierarchical model for the effective rural healthcare management in India. Design/methodology/approach A questionnaire survey identified and correlated numerous factors related to the Uttarakhand rural healthcare systems. Experts opinion were translated into a reachability matrix and an interpretive structural model. A fuzzy matriced impacts croises-multiplication applique and classment (FMICMAC) analysis arranged the factors as hierarchical stages using their driving power. Findings The interpretive structural and FMICMAC hierarchical models suggest four key driving factors: diseases, climatic conditions, population growth and political pressure. Practical implications Despite numerous issues, rural healthcare services can be improved by considering key driving factors that could be used as a prediction tool for policy makers. Originality/value Results demonstrate that population control, coordinating services with local bodies and rural health center annual maintenance can be game changers toward better healthcare services.

scholarly journals Exploring how teachers suggest informing designs for learning

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Stefan Hrastinski
Keyword(s):  
Student Perceptions ◽  
Lessons Learned ◽  
Learning Theories ◽  
Limited Attention ◽  
Content Type ◽  
Daily Work ◽  
Use Of Resources ◽  
Design For Learning ◽  
Effective Use ◽  
Practical Implications

PurposeAn issue that has received limited attention is how teachers make informed decisions when designing learning activities, which makes effective use of resources and technologies. The aim of this paper is to explore how teachers suggest informing their designs for learning.Design/methodology/approachThe study is based on documentation from workshops where adult education teachers were encouraged to suggest how a design for learning can draw on what is known, how the design can be evaluated and how the design and lessons learned can be shared. The data was analyzed using thematic analysis.FindingsMost teachers did not explicitly suggest how to inform their designs for learning, although some suggested to draw on learning theories. The teachers were able to provide many examples of how their designs for learning could be evaluated based on student perceptions and assessment. They primarily suggested to discuss and share their designs and lessons learned at the school.Practical implicationsThe workshop format could be adapted and used in practice.Originality/valueRelatively little attention has been paid to how teachers inform their designs for learning. A key challenge for teachers is to understand design for learning as an informed practice, which could be integrated as part of their daily work.

scholarly journals Improving immunization practices in United States hospitals and health systems

2017 ◽  
Vol 22 (3) ◽  
pp. 199-211
Author(s):  
Wesley D. Kufel ◽  
Dennis M. Williams ◽  
David Jay Weber
Keyword(s):  
Health System ◽  
Health Systems ◽  
Healthcare Services ◽  
Healthcare Personnel ◽  
Fee For Service ◽  
Content Type ◽  
Vaccination Rates ◽  
Immunization Rates ◽  
The Usa ◽  
Mandatory Vaccination

Purpose Payment for healthcare services in the USA has shifted from fee for service to compensation based on value and quality. The indicators used for payments are a variety of clinical measures, including administration of vaccines to patients. The purpose of this paper is to describe the implementation of programs in health systems to improve vaccination rates and patient outcomes. Design/methodology/approach A search of the literature was conducted to find examples of vaccine programs in US health systems, and also to identify policies to improve immunization rates. Findings Successful programs for improving vaccination rates require advocacy and support of leadership, a systematic and multidisciplinary approach, and an evaluation of local resources and capacity. Numerous examples exist of medical, nursing, and pharmacy led programs that improve vaccination rates. The department in charge has relied on the support of other groups to ensure the success. Social implications Mandatory vaccination of healthcare personnel (HCP) in the health system has been a growing trend in the USA. Although there has been some resistance to mandatory vaccinations for HCP, the standards and requirements have resulted in improved rates in health systems, which ultimately improve efficiency and protects patients. Originality/value This review describes considerations for implementing a successful vaccination program in a health system and provides examples of specific strategies. An overview of mandatory vaccinations for HCP is also described.

Healthcare under pressure: modelling COVID-19 fatalities with multiscale geographically weighted regressions

Kybernetes ◽  
2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Zizi Goschin ◽  
Gina Cristina Dimian
Keyword(s):  
Local Level ◽  
Age Distribution ◽  
Case Fatality ◽  
Healthcare Services ◽  
Healthcare Systems ◽  
Content Type ◽  
Case Fatality Ratio ◽  
Factors Of Influence ◽  
The Impact ◽  
Local Healthcare

PurposeThe paper aims to disentangle the factors behind territorial disparities in the coronavirus disease 2019 (COVID-19) case fatality ratio, focusing on the pressure put by the pandemic on healthcare services and adopting a spatial perspective.Design/methodology/approachMultiscale geographically weighted regression (MGWR) models have been used for uncovering the spatial variability in the impact of healthcare services on COVID-19 case fatality ratio, allowing authors to better capture the real spatial patterns at local level. The authors proved that this approach yields better results, and the MGWR model outperforms traditional regression methods. The selected case studies are two of the biggest UE countries, among the first affected by a high incidence of COVID-19 cases, namely Italy and Germany.FindingsThe authors found sizeable regional differences in COVID-19 mortality rates within each of the analysed countries, and the stress borne by local healthcare systems seems to be the most powerful factor in explaining them. In line with other studies, the authors found additional factors of influence, such as age distribution, gender ratio, population density and regional development.Originality/valueThis research clearly indicated that COVID-19 related deaths are strongly associated with the degree of resilience of the local healthcare systems. The authors supply localized results on the factors of influence, useful for assisting the decision-makers in prioritizing limited healthcare resources. The authors provide a scientific argument in favour of the decentralization of the pandemic management towards local authorities not neglecting, however, the necessary regional or national coordination.

COVID-19 stretches weak Latin American health systems

2020 ◽  
Keyword(s):  
Latin America ◽  
Economic Impact ◽  
Health Systems ◽  
Latin American ◽  
Mortality Rates ◽  
Healthcare Systems ◽  
Content Type ◽  
Containment Measures ◽  
The Impact ◽  
Deep Recession

Subject Preparedness for COVID-19. Significance In two months since the first confirmed case in Latin America, COVID-19 has spread throughout the region and cases are rising rapidly. With a few exceptions, governments have responded with severe measures to contain the spread, including lockdowns and border closures. However, containing the impact of the disease will also depend critically on bolstering the region’s underprepared healthcare systems. Impacts Governments such as Brazil and Mexico could face a backlash if mortality rates dramatically exceed those of other countries. The economic impact of containment measures will be severe, and the region faces a deep recession. China’s geopolitical position in Latin America will benefit from the extensive assistance that it is providing.

The excellence of patient-centered healthcare

2018 ◽  
Vol 30 (2) ◽  
pp. 153-167 ◽  
Author(s):  
Andrea Moretta Tartaglione ◽  
Ylenia Cavacece ◽  
Fabio Cassia ◽  
Giuseppe Russo
Keyword(s):  
Patient Satisfaction ◽  
Structural Equation ◽  
Patient Empowerment ◽  
Chronically Ill ◽  
Healthcare Services ◽  
Healthcare Management ◽  
Equation Modeling ◽  
Patient Centered ◽  
Cross Sectional ◽  
Content Type

Purpose Nowadays, international healthcare agendas are focused on patient centeredness. Policies are aimed at improving patient’s satisfaction by enhancing patient empowerment and value co-creation. However, a comprehensive model addressing the relationships between these constructs has not so far been developed. The purpose of this paper is to develop and test a model which explains the effects of patient empowerment and value co-creation on patients’ satisfaction with the quality of the services they experience. Design/methodology/approach The links between patient satisfaction, empowerment and value co-creation are theoretically outlined via an in-depth literature review. The resulting model is tested through a survey administered to 186 chronically ill patients. The results are analyzed through covariance-based structural equation modeling. Findings The results show that patient empowerment positively influences value co-creation which, in turn, is positively related to patient satisfaction. In addition, the analysis reveals that patient empowerment has no direct effects on satisfaction. Research limitations/implications Although the cross-sectional design made it possible to clearly estimate the relationships among variables, it overlooked the longitudinal dimensions of co-creation processes. Practical implications The study provides practitioners with suggestions to design patient-centered healthcare services by leveraging on patient knowledge, participation, responsibility in care and involvement in the value-creation process. Originality/value Over the last decade, healthcare management literature has shifted its focus from healthcare organizations to patients. The number of contributions about patient satisfaction, empowerment and value co-creation exponentially increased. However, these dimensions are often studied separately. This work advances available knowledge by clarifying and testing the relationships between these three constructs.

scholarly journals The role of organizational factors in how efficiency-thoroughness trade-offs potentially affect clinical quality dimensions – a review of the literature

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Malin Knutsen Glette ◽  
Siri Wiig
Keyword(s):  
Health Personnel ◽  
Organizational Factors ◽  
Healthcare Services ◽  
Patient Centeredness ◽  
Clinical Quality ◽  
Content Type ◽  
Daily Work ◽  
Trade Offs ◽  
Quality Dimensions ◽  
Balancing Efficiency

PurposeThe purpose of this paper is to increase knowledge of the role organizational factors have in how health personnel make efficiency-thoroughness trade-offs, and how these trade-offs potentially affect clinical quality dimensions.Design/methodology/approachThe paper is a thematic synthesis of the literature concerning health personnel working in clinical, somatic healthcare services, organizational factors and clinical quality.FindingsIdentified organizational factors imposing trade-offs were high workload, time limits, inappropriate staffing and limited resources. The trade-offs done by health personnel were often trade-offs weighing thoroughness (e.g. providing extra handovers or working additional hours) in an environment weighing efficiency (e.g. ward routines of having one single handover and work-hour regulations limiting physicians' work hours). In this context, the health personnel functioned as regulators, balancing efficiency and thoroughness and ensuring patient safety and patient centeredness. However, sometimes organizational factors limited health personnel's flexibility in weighing these aspects, leading to breached medication rules, skipped opportunities for safety debriefings and patients being excluded from medication reviews.Originality/valueBalancing resources and healthcare demands while maintaining healthcare quality is a large part of health personnel's daily work, and organizational factors are suspected to affect this balancing act. Yet, there is limited research on this subject. With the expected aging of the population and the subsequent pressure on healthcare services' resources, the balancing between efficiency and thoroughness will become crucial in handling increased healthcare demands, while maintaining high-quality care.

Trust building in a Norwegian municipal acute ward

2020 ◽  
Vol 34 (6) ◽  
pp. 673-685
Author(s):  
Brita Gjerstad ◽  
Svein Ingve Nødland ◽  
Inger Lise Teig
Keyword(s):  
Health Care ◽  
Healthcare Workers ◽  
Care Service ◽  
Health Care Service ◽  
Healthcare Services ◽  
Trust Building ◽  
Content Type ◽  
Daily Work ◽  
Systemic Factors

PurposeTrust plays an important role in the organisation of healthcare services. In Norway, the establishment of mandatory municipal acute wards with 24 h inpatient services introduces a new unit into the healthcare system. This article discusses how this new health care service succeeds in building trust with patients and among healthcare workers.Design/methodology/approachThe article is an in-depth case study of a single, exemplary inter-municipal acute ward. The study draws on interviews with COPD patients, the leader and doctors at the ward. The study also includes observations of daily work at the municipal acute ward. Moreover, administrators and healthcare workers at related healthcare institutions have been interviewed. Data were analysed using a qualitative method.FindingsThe study reveals that trust is built in complex relations and that it has both individual and systemic factors. The practices employed in the daily treatment and care of patients and in encounters between health care personnel and patients are important trust-building processes; however, these processes depend on structures and routines that promote efficient and adequate inter-organisational communication and patient-oriented procedures.Practical implicationsThe study provides insight into how trust dynamics work on multiple organisational levels and how they depend on both individual and systemic factors. Additionally, the study may provide a picture of the importance of trust in organising healthcare services in the future.Originality/valueLessons regarding trust building inspired by data from a case-study care institution can be applied in different care settings and countries.

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