Frequent presentations to emergency departments and the collaborative community and emergency response

2018 ◽  
Vol 26 (4) ◽  
pp. 267-276
Author(s):  
Debra Irene Harcourt ◽  
Clancy Jack McDonald ◽  
Leonie Cartlidge-Gann ◽  
Nathan J. Brown ◽  
Kim Rayner
Keyword(s):  
Health Care ◽  
Case Studies ◽  
Patient Characteristics ◽  
Management Plan ◽  
Management Approach ◽  
Community Case Management ◽  
Content Type ◽  
Complex Needs ◽  
Number Of Patients ◽  
Previous Trauma

Purpose Patient dependence on an emergency department (ED) for ongoing, non-urgent health care is a complex issue related to poor mental and physical health, disability, previous trauma, social disadvantage and lack of social supports. Working Together to Connect Care is an innovative program that provides an assertive community case management approach coupled with an ED management plan to support people who frequently attend the Royal Brisbane and Women’s Hospital ED. The program, which is yet to be fully evaluated, currently helps to manage a large number of patients with a wide variety of complex needs. To demonstrate the scope and capabilities of the program, the purpose of this paper is to present a series of case studies of patients who frequently attended the ED and subsequently became program participants. Design/methodology/approach A series of five case studies is used to illustrate the variety of patient characteristics and available management pathways. Outcomes, including rates of ED attendance, at five months after program commencement are also described. Findings The variety of characteristics and experiences of the patients in the case studies is representative of the program cohort as a whole. Program participation has resulted in improved patient outcomes as demonstrated by crisis resolution, housing stability, engagement with primary health care and reduced frequency of ED presentations. Originality/value A personalized, integrated-care management approach is both flexible and effective in responding to the complex needs of five patients who frequently attend EDs.

The workplace culture in addiction psychiatry in Finland as described by healthcare personnel

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Eeva Lyyra ◽  
Mervi Roos ◽  
Tarja Suominen
Keyword(s):  
Job Satisfaction ◽  
Health Care ◽  
Dual Diagnosis ◽  
Workplace Culture ◽  
Service Development ◽  
Practice Environment ◽  
Addiction Psychiatry ◽  
Content Type ◽  
Substance Addiction ◽  
Number Of Patients

Purpose The purpose of this study is to describe the workplace culture and factors associated with it from the viewpoint of the personnel providing care to patients with dual diagnosis. Design/methodology/approach Data were collected from six organizations using an electronic survey in 2019. The respondents (n = 75) worked in addiction psychiatry in specialized health care and provided care to patients. The data were statistically analyzed. Findings Workplace culture was evaluated as positive. Stress was experienced occasionally (Md = 2.58, Q1 = 1.96, Q3 = 3.03), job satisfaction levels were moderate (Md = 4.83, Q1 = 4.28, Q3 = 5.44) and the practice environment was evaluated as neutral (Md = 4.46, Q1 = 4.00, Q3 = 5.04). Gender, age in years, employment relationship, work time, staffing, number of patients and the participants’ experience in health care and experience in their current workplace had statistically significant associations with workplace culture. Originality/value In Finland, there have been attempts to reform service structures that also influence mental health and substance addiction services. Workplace culture is one approach to promote service development. Yet, there has been no research on workplace culture in the context of the care of patients with dual diagnosis. The results of this study bring knowledge about how health-care personnel perceives stress, job satisfaction and their practice environment in addiction psychiatry, which can be used to further develop services and workplace culture.

scholarly journals Lean management in health care: a review of reviews of socio-technical components for effective impact

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Marta Marsilio ◽  
Martina Pisarra
Keyword(s):  
Health Care ◽  
Implementation Process ◽  
Management Approach ◽  
Lean Management ◽  
Impact Measurement ◽  
Content Type ◽  
Four Dimensions ◽  
Support Organization ◽  
Review Of Reviews

PurposeThe aims of the implementation of lean management in health care are to improve quality of care, to eliminate waste and to increase efficiency. The purpose of this study is to contribute to the advancement of knowledge by investigating which main socio-technical factors are considered to be effective for the implementation and management of lean initiatives.Design/methodology/approachA systematic review of literature reviews on lean management in health care was conducted. The components of the socio-technical system are identified by moving from the socio-technical drivers that support organization-wide quality improvement practices and the lean implementation process in health care. The impacts of lean management are classified using the internal processes, patient, learning and financial dimensions.FindingsThe 28 reviews retrieved confirm the current and increasing interest in lean management. While more than 60% of them call for a system-wide approach, system-wide implementations have rarely been observed, and, instead, adoption in isolated units or departments, or the use of single techniques and tools, prevails. The most commonly investigated socio-technical components are organizational structure, techniques and tools and organizational culture and strategic management. Significant impacts are reported for all the four dimensions. Nonetheless, the review reveals that there is still a lack of evidence on the sustainability of lean results and a need for a standardized impact measurement system.Originality/valueThis work stands out as the first review of reviews of how the socio-technical components of the lean management approach obtain positive impacts within the patient, internal processes, learning and financial dimensions.

scholarly journals Promoting Self-Care Management Among Persons With Serious Mental Illness and HIV

2011 ◽  
Vol 23 (6) ◽  
pp. 421-427 ◽  
Author(s):  
Nancy P. Hanrahan ◽  
Donna Rolin-Kenny ◽  
June Roman ◽  
Aparna Kumar ◽  
Linda Aiken ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Mental Illness ◽  
Nursing Students ◽  
Case Studies ◽  
Serious Mental Illness ◽  
Care Management ◽  
Self Care ◽  
Public Health Nurses ◽  
Management Approach

People with a serious mental illness (SMI) along with HIV have complex health conditions. This population also has high rates of poverty, difficulty in sustaining regular housing, and limited supportive networks. Typically, the combination of psychotropic and HIV medication regimens is complicated, changes frequently, and requires coordination among multiple providers. Furthermore, fragmented and divided primary health care and mental health care systems present substantial barriers for these individuals and for the public health nurses who care for them. In this article, we present “real world” case studies of individuals with SMI and HIV and the self-care management strategies used by nurses to address medication and treatment management, build interpersonal skills, and develop sustainable health networks. The case studies can be used for quality improvement discussions among practicing public health nurses and for instructing nursing students in a self-care management approach.

(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.

Analyzing perceived healthcare service quality on patient related outcomes

2016 ◽  
Vol 8 (4) ◽  
pp. 478-497 ◽  
Author(s):  
Aygül Turan ◽  
Tuba Bozaykut-Bük
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Service Quality ◽  
Health Care Service ◽  
Management Approach ◽  
Total Quality ◽  
Reliability Factor ◽  
Content Type ◽  
Perceived Service Quality ◽  
Children's Diseases

Purpose Through the lens of a total quality management approach, this paper aims to examine the effects of health-care service quality on patient satisfaction, repatronage intention (RI) and positive word-of mouth (PWOM) at a public hospital specialized in women and children’s diseases. The contribution is to measure and compare patient expectations and perceptions related to the public health service quality. Design/methodology/approach A structured questionnaire was distributed to in-patients who stayed at a public training and research hospital for at least three days. To analyze the relationship between variables, multiple regression analysis was used. To test the difference between expected and perceived service quality, the paired-sample t-test was used. Findings The findings provided empirical evidence that perceived service quality significantly influenced patient satisfaction, RI and PWOM. The “responsiveness and reliability” factor was found to be the most influential on patient RI and PWOM. The “tangibility” dimension had the strongest influence on patient satisfaction. Practical implications The results reveal that a reliable and responsive service, empathic personnel behaviors and appropriate tangibles are the outstanding factors for high levels of patient satisfaction, RI and PWOM. Originality/value Although the concepts of perceived service quality, patient satisfaction, RI and PWOM are explored frequently in service literature, there are few researches that focus on specialized health services for women and children’s diseases. By evaluating the service quality, it is hoped to provide an insight to health-care managers about the service quality dimensions and their relationship with patient satisfaction, RI and PWOM, specifically based on women patients.

The supplier perspective: forging strong partnerships with buyers

2015 ◽  
Vol 36 (1) ◽  
pp. 25-32 ◽  
Author(s):  
Julia Roloff ◽  
Michael S. Aßländer ◽  
Dilek Zamantili Nayir
Keyword(s):  
Case Studies ◽  
Corporate Social Performance ◽  
Social Performance ◽  
Clothing Industry ◽  
Management Approach ◽  
Open Communication ◽  
Content Type ◽  
Problems And Solutions ◽  
Supplier Partnerships ◽  
Corporate Social

Purpose – The purpose of this paper is to identify three commonly observed mistakes made when managing suppliers and describe factors that contribute to successful buyer–supplier partnerships. Design/methodology/approach – Five extensive case studies in the automotive and clothing industry, as well as cases discussed in the literature, are analysed. Findings – Barriers to successful partnerships are a too strong emphasis on cost cutting and a too controlling management approach on the part of the buyer, and the abuse of insider knowledge for faking performances on the side of the supplier. Open communication, willingness to engage in mutual learning and encouraging innovations are observed in successful partnerships. Research limitations/implications – A limited number of case studies in the German automotive industry and the Turkish clothing industry are used. Both industries are subject to significant change which means that generalisations should be made with caution. Therefore, we discuss only problems and solutions that have also been identified in studies conducted in other industries and/or countries. Practical implications – Managers learn how to best manage partnerships with suppliers and what mistakes to avoid. Social implications – Partnerships aiming at improving working conditions are discussed. Findings and recommendations help managers improve their corporate social performance in the supply chain. Originality/value – Partnerships are approached from the perspective of the supplier to identify commonly made mistakes and successful practices of buyers.

scholarly journals 63 Quality Improvement Project: Should We be Doing More or Less Ct Head Scans in the Health Care of Older People Department?

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i18-i20
Author(s):  
M Munir ◽  
T Shouter ◽  
H S Tay
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Older People ◽  
Management Plan ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Number Of Patients ◽  
New Findings ◽  
New Finding ◽  
Ct Head

Abstract Introduction Older people are likely to have more CT head scans given their multiple co- morbidities, being on anticoagulants, and increased falls. The aims of this quality improvement project (QIP) were to identify the number of patients who had CT head scan, the reason/indication of it, the number of patients who had new finding/s on it, actions taken on new findings, and whether the management plan was altered because of the CT scan. Methods Medical notes and CT head scan reports of all patients admitted to the Health Care of Older People department from April to September 2018 were reviewed to evaluate the indications of CT head scans, new findings, and management plans following the findings. Results 461 (10.7%) out of the 4323 patients discharged from the healthcare of older people department during April to September 2018 had CT head scans during admission. Frequent indications for CT head scans included delirium, falls and head injury. Only 46 (9.9%) patients had new finding/s on the CT head scan, and action was taken on 26 (56.5%) of these patients. The CT head scan changed the management plan of only 17 (3.6%) patients. Please see Table for more details. Conclusions By using our clinical judgement, following NICE guidelines on head injuries, educating our colleagues on the criteria for requesting a CT head scan, taking collateral histories about patients’ cognition and ascertaining the mechanism of fall, we can lessen the financial burden on the NHS and minimise the radiation exposure to our patients.

Dysphagia

2014 ◽  
Vol 44 (5) ◽  
pp. 407-413
Author(s):  
Charles C. Broz ◽  
Rhonda K. Hammond
Keyword(s):  
Health Care ◽  
Career Choice ◽  
Sample Size ◽  
Small Sample ◽  
Term Care ◽  
Content Type ◽  
Number Of Patients ◽  
The Us ◽  
The Usa ◽  
And Training

Purpose – The purpose of this study was to survey current culinary, hospitality and nutrition students to determine their level of knowledge about dysphagia, or swallowing impairment, and the dysphagia diet. In addition, the study provided a means by which to gauge current students’ awareness of health-care foodservice as a career option. Design/methodology/approach – A pilot study conducted in 2009 indicated that health-care foodservice workers were unaware of many of the risks associated with the dysphagia diet. A second study was conducted in 2012 to obtain an idea of the perceptions and knowledge levels of culinary, hospitality and nutrition students about dysphagia. Subjects included students across the three disciplines at two large universities in the Midwestern USA, and a private culinary school on the east coast of the USA. The instrument consisted of a traditional paper survey containing 18 questions. A total sample size of n = 139 surveys was collected and analyzed. Findings – Results of the survey suggests that current university students are lacking in some areas of knowledge concerning dysphagia patients and their dietary needs. Education and training are indicated, as the number of patients suffering from some degree of dysphagia is only going to increase as the US population ages. Findings also indicate that many introductory-level students are unaware of health-care foodservice as a viable career choice in industry. Research limitations/implications – The primary limitations to this research were the relatively small sample size, and the fact that most students surveyed were not interested or aware of health-care foodservice as a viable industry career choice. This study would be greatly enhanced by contacting professors/instructors at several universities representing the Northeast, Midwest, and east and west coasts of the USA. Educating future foodservice professionals at the introductory level would allow industry leaders to make students aware of this large and necessary sector of the foodservice industry. Likewise, there is no doubt that food preparers, food deliverers and foodservice managers in health care will come in contact with a patient with some level of dysphagia as our population ages. More research to strengthen this body of data is indicated, as are similar studies across broader ranges of the population. Practical implications – The occurrence of dysphagia is growing as the US population ages. That fairly little research has been done is somewhat alarming. There is a need for standardization of recipe formulas, benchmarking viscosities of dietary liquids and solids and training of food preparers. The symptom is found in very large populations in the USA, as well as in Europe. Also, the fact that dysphagia has so many potential causes makes the symptom that much more of a health issue. More research is certainly called for to better prepare potential institutional foodservice employees for the next 20 years. Originality/value – Millions of Americans currently suffer from at least some degree of dysphagia. This number is expected to increase as the Baby Boomer generation reaches retirement age. The USA will be populated by more elderly people than ever before, and will thus host more individuals suffering from swallowing impairment. Health-care foodservice, including hospital and long-term care foodservice will certainly become a viable career choice for current students of culinary arts, nutrition and hospitality.

scholarly journals Implementing HBIM on conservation heritage projects

2019 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Alexa Woodward ◽  
David Heesom
Keyword(s):  
Case Studies ◽  
Asset Management ◽  
Laser Scanning ◽  
Management Plan ◽  
Actual Process ◽  
Content Type ◽  
Digital Representations ◽  
Building Information ◽  
Conservation Projects ◽  
The Uk

Purpose Heritage or historic building information modelling (BIM), often referred to as HBIM, is becoming an established feature in both research and practice. The advancement of data capture technologies such as laser scanning and improved photogrammetry, along with the continued power of BIM authoring tools, has provided the ability to generate more accurate digital representations of heritage buildings which can then be used during renovation and refurbishment projects. Very often these representations of HBIM are developed to support the design process. What appears to be often overlooked is the issue of conservation and how this can be linked to the BIM process to support the conservation management plan for the building once it is given a new lease of life following the refurbishment process. The paper aims to discuss these issues. Design/methodology/approach The paper presents a review of the context of conservation and HBIM, and then subsequently presents two case studies of how HBIM was applied to high-profile renovation and conservation projects in the UK. In presenting the case studies, a range of issues is identified which support findings from the literature noting that HBIM is predominantly a tool for the geometric modelling of historic fabric with less regard for the actual process of renovation and conservation in historic buildings. Findings Lessons learnt from the case studies and from existing literature are distilled to develop a framework for the implementation of HBIM on heritage renovation projects to support the ongoing conservation of the building as an integral part of a BIM-based asset management strategy. Five key areas are identified in the framework including value, significance, recording, data management and asset management. Building on this framework, a conceptual overlay is proposed to the current Level 2 BIM process to support conservation heritage projects. Originality/value This paper addresses the issue of HBIM application to conservation heritage projects. Whilst previous work in the field has identified conservation as a key area, there is very little work focusing on the process of conservation in the HBIM context. This work provides a framework and overlay which could be used by practitioners and researchers to ensure that HBIM is fully exploited and a more standardised method is employed which could be used on conservation heritage renovation projects.

Reducing carbon footprint of facilities using a facility management approach

Facilities ◽  
2016 ◽  
Vol 34 (3/4) ◽  
pp. 247-259 ◽  
Author(s):  
Manish K. Dixit ◽  
Charles H. Culp ◽  
Jose L. Fernandez-Solis ◽  
Sarel Lavy
Keyword(s):  
Life Cycle ◽  
Case Studies ◽  
Carbon Footprint ◽  
Management Practices ◽  
Facility Management ◽  
Embodied Energy ◽  
Management Approach ◽  
Facilities Management ◽  
Life Cycle Approach ◽  
Content Type

Purpose The purpose of this paper is to emphasize the importance of a life cycle approach in facilities management practices to reduce the carbon footprint of built facilities. A model to holistic life cycle energy and carbon reduction is also proposed. Design/methodology/approach A literature-based discovery approach was applied to collect, analyze and synthesize the results of published case studies from around the globe. The energy use results of 95 published case studies were analyzed to derive conclusions. Findings A comparison of energy-efficient and conventional facilities revealed that decreasing operating energy may increase the embodied energy components. Additionally, the analysis of 95 commercial buildings indicated that nearly 10 per cent of the total US carbon emissions was influenced by facilities management practices. Research limitations/implications The results were derived from case studies that belonged to various locations across the globe and included facilities constructed with a variety of materials. Practical implications The proposed approach to holistic carbon footprint reduction can guide facility management research and practice to make meaningful contributions to the efforts for creating a sustainable built environment. Originality/value This paper quantifies the extent to which a facilities management professional can contribute to the global efforts of reducing carbon emission.

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