Challenges and potential improvements in hospital patient flow: the contribution of frontline, top and middle management professionals

2020 ◽  
Vol 34 (8) ◽  
pp. 829-848
Author(s):  
Raffaella Gualandi ◽  
Cristina Masella ◽  
Daniela Viglione ◽  
Daniela Tartaglini
Keyword(s):  
Healthcare Professionals ◽  
Patient Flow ◽  
A Priori ◽  
Qualitative Studies ◽  
Hospital Patient ◽  
Hospital Data ◽  
Content Type ◽  
Qualitative Interview Study ◽  
Potential Improvement ◽  
Efficient Hospital

PurposeThis study aims to describe and understand the contributions of frontline, middle and top management healthcare professionals in detecting areas of potential improvement in hospital patient flow and proposing solutions.Design/methodology/approachThis is a qualitative interview study. Semistructured interviews were conducted with 22 professionals in the orthopedic department of a 250-bed academic teaching hospital. Data were analyzed through a thematic framework analytical approach by using an a priori framework. The Consolidated Criteria for Reporting Qualitative (COREQ) checklist for qualitative studies was followed.FindingsWhen dealing with a hospital-wide process, the involvement of all professionals, including nonhealth professionals, can reveal priority areas for improvement and for services integration. The improvements identified by the professionals largely focus on covering major gaps detected in the technical and administrative quality.Research limitations/implicationsThis study focused on the professional viewpoint and the connections between services and further studies should explore the role of patient involvement. The study design could limit the generalizability of findings.Practical implicationsImproving high-quality, efficient hospital patient flow cannot be accomplished without learning the perspective of the healthcare professionals on the process of service delivery.Originality/valueFew qualitative studies explore professionals' perspectives on patient needs in hospital flow management. This study provides insights into what produces value for the patient within a complex process by analyzing the contribution of professionals from their particular role in the organization.

scholarly journals Improving hospital patient flow: a systematic review

2019 ◽  
Vol 26 (6) ◽  
pp. 1541-1575
Author(s):  
Raffaella Gualandi ◽  
Cristina Masella ◽  
Daniela Tartaglini
Keyword(s):  
Performance Indicator ◽  
Patient Flow ◽  
Quality Criteria ◽  
Process Efficiency ◽  
Cochrane Library ◽  
Hospital Patient ◽  
Content Type ◽  
Wide Range ◽  
Top Management Commitment ◽  
Policy Priority

Purpose Improving hospital patient flow has become a policy priority, to effectively balance the increasing demands of an unknown and variable volume of patients with limited available hospital resources. A systematic literature review was conducted in order to identify actions, actors involved and enablers in improving hospital patient flow. The paper aims to discuss this issue. Design/methodology/approach Searches were conducted in Scopus, Web of Science, MEDLINE and The Cochrane Library for quantitative and qualitative empirical primary studies with patients (adults) receiving inpatient acute hospital care. The study protocol was based on PRISMA-P guidance. A critical appraisal of included studies was performed by using the Quality Improvement Minimum Quality Criteria Set. Findings In total, 38 key papers were identified. A wide range of actions are reported, but most studies focus on one or a few departments instead of a whole hospital. Process efficiency is most often used as a performance indicator, clinical outcomes are poorly analyzed, and patients’ expectations and experience are rarely considered. Top-management commitment and front-line staff involvement are considered key factors for the success of implementations. Patient involvement in the process improvement is rarely mentioned. Originality/value Achieving improvements in hospital patient flow requires the design and implementation of complex, multifaceted and coordinated interventions. This study may be of value to healthcare managers, helping them to act effectively in their context, and to researchers of future studies including the different variables and the patient’s perspective.

scholarly journals Experiences of a National Early Warning Score (NEWS) intervention in care homes during the COVID-19 pandemic: a qualitative interview study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e045469
Author(s):  
Rachel Stocker ◽  
Siân Russell ◽  
Jennifer Liddle ◽  
Robert O Barker ◽  
Adam Remmer ◽  
...  
Keyword(s):  
Early Warning ◽  
Healthcare Professionals ◽  
Care Home ◽  
Qualitative Interview ◽  
Interview Study ◽  
Care Homes ◽  
Early Warning Score ◽  
Service Utilisation ◽  
Qualitative Interview Study ◽  
National Early Warning Score

BackgroundThe COVID-19 pandemic has taken a heavy toll on the care home sector, with residents accounting for up to half of all deaths in Europe. The response to acute illness in care homes plays a particularly important role in the care of residents during a pandemic. Digital recording of a National Early Warning Score (NEWS), which involves the measurement of physical observations, started in care homes in one area of England in 2016. Implementation of a NEWS intervention (including equipment, training and support) was accelerated early in the pandemic, despite limited evidence for its use in the care home setting.ObjectivesTo understand how a NEWS intervention has been used in care homes in one area of North-East England during the COVID-19 pandemic, and how it has influenced resident care, from the perspective of stakeholders involved in care delivery and commissioning.MethodsA qualitative interview study with care home (n=10) and National Health Service (n=7) staff. Data were analysed using thematic analysis.ResultsUse of the NEWS intervention in care homes in this area accelerated during the COVID-19 pandemic. Stakeholders felt that NEWS, and its associated education and support package, improved the response of care homes and healthcare professionals to deterioration in residents’ health during the pandemic. Healthcare professionals valued the ability to remotely monitor resident observations, which facilitated triage and treatment decisions. Care home staff felt empowered by NEWS, providing a common clinical language to communicate concerns with external services, acting as an adjunct to staff intuition of resident deterioration.ConclusionsThe NEWS intervention formed an important part of the care home response to COVID-19 in the study area. Positive staff perceptions now need to be supplemented with data on the impact on resident health and well-being, workload, and service utilisation, during the pandemic and beyond.

scholarly journals The role of research in improving responsiveness of palliative care to migrants and other underserved populations in the Netherlands: a qualitative interview study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
M. Torensma ◽  
B. D. Onwuteaka-Philipsen ◽  
X. de Voogd ◽  
D. L. Willems ◽  
J. L. Suurmond
Keyword(s):  
Palliative Care ◽  
Healthcare Professionals ◽  
Underserved Populations ◽  
Ethnic Disparities ◽  
Migration Background ◽  
Structured Interviews ◽  
Migrant Populations ◽  
Funding Agencies ◽  
Qualitative Interview Study ◽  
Palliative Patient

Abstract Background The aging of migrant populations across Europe challenges researchers in palliative care to produce knowledge that can be used to respond to the needs of the growing group of patients with a migration background and address ethnic disparities in palliative care. The aim of this study was to identify what factors influence researchers’ efforts to address responsiveness of palliative care to patients with a migration background and other underserved populations in their projects. Methods We conducted semi-structured interviews with 11 researchers involved in seven projects under the Dutch national program for palliative care innovation. Results Researchers’ efforts to address responsiveness of palliative care in their projects were influenced by individual factors, i.e. awareness of the need for responsiveness to patients with a migration background; experience with responsiveness; and, differences in perceptions on responsiveness in palliative care. Researchers’ efforts were furthermore influenced by institutional factors, i.e. the interaction with healthcare institutions and healthcare professionals as they rely on their ability to identify the palliative patient with a migration background, address the topic of palliative care, and enrol these patients in research; scientific standards that limit the flexibility needed for responsive research; and, the responsiveness requirements set by funding agencies. Conclusion Researchers play a key role in ensuring research addresses responsiveness to patients with a migration background. Such responsiveness may also benefit other underserved populations. However, at times researchers lack the knowledge and experience needed for responsive research. To address this we recommend training in responsiveness for researchers in the field of palliative care. We also recommend training for healthcare professionals involved in research projects to increase enrolment of patients with a migration background and other underrepresented populations. Lastly, we encourage researchers as well as research institutions and funding agencies to allow flexibility in research practices and set a standard for responsive research practice.

Examination of customer-centric measures among different types of customers in the context of major Canadian ski resort

2018 ◽  
Vol 30 (2) ◽  
pp. 438-459
Author(s):  
Matti J. Haverila ◽  
Kai Christian Haverila
Keyword(s):  
Customer Satisfaction ◽  
Structural Equation ◽  
A Priori ◽  
Equation Modeling ◽  
Marketing Practice ◽  
Content Type ◽  
Ski Resort ◽  
Different Types ◽  
Managerial Implications ◽  
Satisfaction Model

Purpose Customer-centric measures such as customer satisfaction and repurchase intent are important indicators of performance. The purpose of this paper is to examine what is the strength and significance of the path coefficients in a customer satisfaction model consisting of various customer-centric measures for different types of ski resort customer (i.e. day, weekend and ski holiday visitors as well as season pass holders) in a ski resort in Canada. Design/methodology/approach The results were analyzed using the partial least squares structural equation modeling approach for the four different types ski resort visitors. Findings There appeared to differences in the strength and significance in the customer satisfaction model relationships for the four types of ski resort visitors indicating that the a priori managerial classification of the ski resort visitors is warranted. Originality/value The research pinpoints differences in the strength and significance in the relationships between customer-centric measures for four different types ski resort visitors, i.e. day, weekend and ski holiday visitors as well as season pass holders, which have significant managerial implications for the marketing practice of the ski resort.

Assessing emphasis gaps among MBA alumni: a model framework

2016 ◽  
Vol 9 (1) ◽  
pp. 31-51
Author(s):  
Stuart Van Auken ◽  
Earl Chrysler ◽  
Ludmilla Gricenko Wells
Keyword(s):  
Methodological Approach ◽  
A Priori ◽  
Dimensional Structure ◽  
Assessment Procedure ◽  
Model Framework ◽  
Mba Programs ◽  
Content Type ◽  
Program Delivery ◽  
Mba Program ◽  
One Year

Purpose This paper aims to focus on Master of Business Administration (MBA) alumni and their ability to provide institution-specific insights into MBA program delivery. Given desired MBA positioning dimensions, a case exemplar is used to reveal gaps between “should have” program emphases and “actual” emphases. Departures from expectations are used to reveal either under- or over-emphases which require repair. Design/methodology/approach The study develops a gap assessment procedure and the theory of gaps, and it presents insights into the prioritization of gaps for closing through the revelation of gap themes of varying magnitude. It also reveals the benefits and the limitations of emphasis-based gap assessments. Additionally, the study addresses the complexity of creating the dimensional structure for MBA program gap revelation. Findings This paper reports on the issues of framing dimensions, including the possibility of dimensional omissions, with a particular emphasis on the utilization of an emphasis-based gap model within an a priori identified structure. Practical implications The methodological approach provides a blueprint for additional program review, and it produces a strong structural base for MBA program positioning. It is also is particularly important in evaluating newly created one-year MBA programs. Originality/value The work reveals the potential for the revelation of both under- and over-emphases in MBA program delivery and the possible issue of sub-optimization in gap closing (i.e. the closing of one gap while opening another).

Changes in the contents of corporate codes of ethics: an institutional interpretation

2015 ◽  
Vol 27 (4) ◽  
pp. 369-388 ◽  
Author(s):  
Jang B. Singh
Keyword(s):  
Design Methodology ◽  
Management Practices ◽  
A Priori ◽  
Codes Of Ethics ◽  
Legal Authority ◽  
Valuable Contribution ◽  
Content Type ◽  
Innovative Management ◽  
Study Population ◽  
Over Time

Purpose – The purpose of this paper was to examine changes in the contents of Canadian corporate codes of ethics over a period of two decades from an institutionalization perspective. Design/methodology/approach – The paper tracks changes in the contents of the codes of large Canadian corporations longitudinally by analyzing their contents at two points over two decades, in 1992 and 2012. In particular, the paper tests three hypotheses related to the institutionalization of codes. Findings – It was found that the codes have become more prescriptive, they are more concerned with social responsibility and are more likely to identify their moral and legal authority. Overall, the findings support an institutional interpretation of the observed changes. Research limitations/implications – While large corporations are critical in establishing new and innovative management practices, their selection as the study population limits the generalizabilty of the findings. Another limitation of this paper is that it used an a priori determined set of items to analyze the contents of the codes and while this was needed to facilitate the comparison across time, it also meant that some important items were not clearly identified. Originality/value – Codes of ethics are the foundation of ethics programs in corporations and their contents could be critical in the development of a culture of ethics in corporations. This paper makes a valuable contribution to research on business ethics by analyzing the codes of ethics of the largest corporations in Canada at two points over two decades. The need to track changes in corporate codes of ethics over time has been advocated by several researchers, but longitudinal studies in this area are rare.

Iron loss simulation using a local material model

2019 ◽  
Vol 38 (4) ◽  
pp. 1224-1234
Author(s):  
Benedikt Groschup ◽  
Silas Elfgen ◽  
Kay Hameyer
Keyword(s):  
A Priori ◽  
Material Model ◽  
Edge Length ◽  
Iron Loss ◽  
Local Magnetization ◽  
Content Type ◽  
Local Loss ◽  
Cut Edge ◽  
Iron Losses ◽  
Local Material

Purpose The cutting process of the electric machine laminations causes residual mechanical stress in the soft magnetic material. A local magnetic deterioration can be observed and the resulting local and global iron losses increase. A continuous local material model for the consideration of the changing magnetization properties has been introduced in a previous work as well as an a priori assessment of iron losses. A local iron loss calculation considering both a local magnetization and local loss parameters misses yet. The purpose of this study is to introduce a local iron loss calculation model considering both a local magnetization and local loss parameters. Design/methodology/approach In this paper, an approach for local iron loss simulation is developed and a comparison to the cut-edge length-dependent loss model is given. The comparison includes local loss distribution in the lamination as well as the impact on the overall motor efficiency and vehicle range in an electric vehicle driving cycle. Findings For an analysis of the resulting local iron loss components, both the local magnetization and iron loss parameters must be considered using physically based models. Consistently, a local iron loss model is presented in the work. The developed model can be used to gain detailed information of the local loss distribution inside the machine. The comparability of this local iron loss with the cut-edge length approach for overall system characteristics, e.g. efficiency or driving range, is shown. Originality/value A local iron loss simulation approach is a physical accurate model to describe the influence of cutting techniques on electric machine characteristics. A comparison with the less complicated a priori assessment gives detailed information about the necessity of the local model under consideration of the given problem.

Convergence of management practices in India’s IT sector with ana priorivalidation

2018 ◽  
Vol 12 (4) ◽  
pp. 402-421
Author(s):  
Jayashree Mahesh ◽  
Anil K. Bhat
Keyword(s):  
Cluster Analysis ◽  
Operations Management ◽  
Management Practices ◽  
Qualitative Interviews ◽  
A Priori ◽  
Statistical Testing ◽  
Content Type ◽  
Empirical Survey ◽  
Different Types ◽  
Group A

PurposeThe purpose of this paper is to document similarities and differences between management practices of different types of organizations in India’s IT sector through an empirical survey. The authors expected these differences to be significant enough for us to be able to groupa priorithis set of companies meaningfully through cluster analysis on the basis of the similarity of their management practices alone.Design/methodology/approachUsing a mixed-methods approach, 73 senior-level executives of companies working in India’s IT sector were approached with a pretested questionnaire to find out differences on eighteen management practices in the areas of operations management, monitoring management, targets management and talent management. The different types of organizations surveyed were small and amp; medium global multinationals, large global multinationals, small and medium Indian multinationals, large Indian multinationals and small and medium local Indian companies. The differences and similarities found through statistical testing were further validateda priorithrough cluster analysis and qualitative interviews with senior-level executives.FindingsThe management practices of multinationals in India are moving toward Western management practices, indicating that management practices converge as the organizations grow in size. Though the practices of large Indian multinationals were not significantly different from those of global multinationals, the surprising finding was that large Indian multinationals scored better than global multinationals on a few practices. The practices of small and medium Indian companies differed significantly from those of other types of organizations and hence they formed a cluster.Practical implicationsThe finding that large Indian IT multinationals have an edge over global multinationals in certain people management practices is a confirmation of the role of human resource practices in their current success and their continuing competitive advantage.Originality/valueThis is perhaps the first study of its kind to document state of specific management practices across different types of organizations in India’s IT sector and then use measures on these practices to group a priori these organizations for validation.

Novel method for hyperspectral unmixing: fuzzy c-means unmixing

Sensor Review ◽  
2016 ◽  
Vol 36 (2) ◽  
pp. 184-192
Author(s):  
Mingyu Nie ◽  
Zhi Liu ◽  
Xiaomei Li ◽  
Qiang Wu ◽  
Bo Tang ◽  
...  
Keyword(s):  
Design Methodology ◽  
Hyperspectral Image ◽  
A Priori ◽  
Image Sensors ◽  
Spectral Unmixing ◽  
Content Type ◽  
Hyperspectral Unmixing ◽  
Fuzzy C Means ◽  
Novel Method ◽  
Iteration Analysis

Purpose This paper aims to effectively achieve endmembers and relative abundances simultaneously in hyperspectral image unmixing yield. Hyperspectral unmixing, which is an important step before image classification and recognition, is a challenging issue because of the limited resolution of image sensors and the complex diversity of nature. Unmixing can be performed using different methods, such as blind source separation and semi-supervised spectral unmixing. However, these methods have disadvantages such as inaccurate results or the need for the spectral library to be known a priori. Design/methodology/approach This paper proposes a novel method for hyperspectral unmixing called fuzzy c-means unmixing, which achieves endmembers and relative abundance through repeated iteration analysis at the same time. Findings Experimental results demonstrate that the proposed method can effectively implement hyperspectral unmixing with high accuracy. Originality/value The proposed method present an effective framework for the challenging field of hyperspectral image unmixing.

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