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.

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.

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.

Business process reengineering in health-care sector: application for the central sterilization unit

Kybernetes ◽  
2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Mehtap Dursun ◽  
S. Sirin Fındık ◽  
Nazli Goker
Keyword(s):  
Health Care ◽  
Business Process ◽  
Health Care Systems ◽  
Health Care Sector ◽  
Process Reengineering ◽  
Content Type ◽  
Erp System ◽  
New Process ◽  
Care Systems ◽  
Sterilization Process

Purpose In a rapidly changing environment, many health-care systems are forced to survive with rising costs and the need for proper resources utilization. To address the requirements for effective strategic planning, business process reengineering (BPR) is inevitable for health-care systems. This study aims to focus on the reengineering of central sterilization unit’s business processes to obtain performance improvement and efficiency. With the obtained new process design, it is expected to get standardization in all level of the central sterilization unit. Design/methodology/approach This paper presents a BPR method for modeling the system in health-care sector to improve the productivity of the sterilization process of surgical equipment. The case study is conducted in a large hospital in Istanbul, Turkey. First, “as-is” process is modeled and the problems are determined. Then, solution methods are developed and the target system (to-be process) is redesigned and the workflows of each phase are remodeled by using ARIS tool. Enterprise resource planning (ERP)-driven BPR is used to reengineer the current processes and the future processes are operated through the modeled ERP system. Finally, by using a statistical analysis, performance of the new process is compared with the existing process using the first data obtained from the case hospital. Findings In many sterilization services, the control procedures are rarely used. Thus, an ERP solution is developed to automate sterilization tasks and track down the information flow. With the ERP solution, it is possible to track in which dates, where and by whom the items are processed. On the other hand, in the sterilization process, the sets are used efficiently according to the last sterile dates of the items. Also, with the ERP system, it is possible to reduce unnecessary paper usage and this gives the hospitals the opportunity to be more ecological and sustainable. As a result, a centralized sterilization process with an IT support provides efficiency, economy and patient safety. Originality/value This study seeks for the potential benefits of an ERP implementation in health-care sector. As a result of this project, improvements in productivity, cost and quality are expected in sterilization processes because the new process design will bring automation, human-related error reduction and equipment tracking system. For this purpose, a business process management software is developed and implemented to the central sterilization unit so that the information flows more safely and the managers can track the results quickly by charts and reports.

scholarly journals Budgetary bias in the Finnish public hospital system

2019 ◽  
Vol 33 (4) ◽  
pp. 401-418
Author(s):  
Alpo Karila ◽  
Jarmo Vakkuri ◽  
Juhani Lehto
Keyword(s):  
Health Care ◽  
Qualitative Content Analysis ◽  
Health Care Systems ◽  
Public Hospitals ◽  
Research Knowledge ◽  
Hospital System ◽  
Content Type ◽  
Care Systems ◽  
Public Hospital System ◽  
Practical Implications

Purpose The purpose of this paper is to analyze the dynamics of budgetary biasing in the context of public hospitals. Design/methodology/approach The study applies theories of accounting and budgeting behaviors in the specific institutional context of health care systems. Based on the theoretical framework, data from interviews with hospital budget officers were analyzed using qualitative content analysis. Findings A typology of biases is provided. It proved to be useful and highlighted the central empirical assumptions and preliminary results of biasing dynamics. Practical implications Understanding the logic of budgeting actors and the drivers of bias may help explain why bias so often appears in health care budgeting. It further contributes to understanding whether the bias is functional or dysfunctional. Originality/value The concepts of budgetary bias are rarely used in the context of health care budgeting, so the study fills a gap in research knowledge.

A systematic-qualitative research for diffusion of innovation in the primary healthcare centers

2015 ◽  
Vol 10 (1) ◽  
pp. 105-117 ◽  
Author(s):  
Alireza Aslani ◽  
Marja Naaranoja
Keyword(s):  
Health Care ◽  
Qualitative Research ◽  
Primary Health Care ◽  
Diffusion Of Innovation ◽  
Health Care Systems ◽  
Content Type ◽  
Primary Health ◽  
Care Systems ◽  
Primary Health Care Centers ◽  
Health Care Centers

Purpose – This paper aims to discuss a model for diffusion of innovation among the professionals of primary health-care centers in Finland. The authors answer partially to one of the important questions of the policymakers titled “How primary health-care centers can move toward systems that continuously improve their innovation?”. Design/methodology/approach – A systematic-qualitative framework based on an action research is presented to assess dynamics of diffusion of innovation in the primary health-care centers in Finland. Findings – The authors conceptualize the innovation systems of primary health-care systems by three different diagrams: subsystem diagram, policy structure diagram and causal loop diagram. The investigation reviews innovation process of Finnish professionals (staffs, nurses and doctors) in the frame of a systematic-qualitative analysis. The relationships and consequences of decisions and policies are discussed with a new way of thinking in the health-care sector studies. Originality/value – The implemented systematic-qualitative research in this article is an innovative approach in the innovation studies of the health-care systems.

scholarly journals Getting closer by increasing distance: the dynamics of value creation spheres in health care logistics

2020 ◽  
Vol 35 (12) ◽  
pp. 2039-2050
Author(s):  
Timo Pohjosenperä ◽  
Hanna Komulainen
Keyword(s):  
Health Care ◽  
Nursing Staff ◽  
Value Creation ◽  
Service Providers ◽  
Health Care Systems ◽  
Physical Distance ◽  
Content Type ◽  
Logistics Service ◽  
Before And After ◽  
Care Systems

Purpose This paper aims to explore the dynamics of value co-creation in the context of health care logistics by focusing on the change in the value creation spheres of a logistics service provider and its customer organization. Design/methodology/approach The development of value co-creation between the two organizations was researched through a qualitative case study that focuses on a situation wherein the hospital’s central warehouse was moved to a more distant location. Data consist of the interviews and focus group discussions of both nursing staff and logistics managers before and after the change. The empirical results are reflected to service and value co-creation literature as well as to existing knowledge about health care logistics. Findings The new situation compelled the counterparts to plan more structured logistics service procedures, as there was no longer any possibility for nursing staff to pick up urgently needed items from the central warehouse. This strengthened the role of the joint value creation sphere and made it more visible during the change. Research limitations/implications The study contributes to the evolving research on health care logistics and connects it to timely service value discussion. This paper proposes that as the physical distance of service facilities increases, the joint co-creation sphere, interestingly, gets widened during the change. Practical implications Managerially, the study provides implications for how to develop health-care material logistics to provide more value for both the logistics service providers and their customers. Social implications Understanding value co-creation in health care logistics services supports care organizations in developing their processes toward better care for the patients. Thus, health care logistics research facilitates societies and health-care systems to reach their goals in terms of better service and lower costs. Originality/value This study presents an up-to-date example of value co-creation in the scarcely researched context of health care logistics.

Assessing the role of GPs in Nordic health care systems

2016 ◽  
Vol 29 (2) ◽  
pp. 122-135
Author(s):  
Randolph K. Quaye
Keyword(s):  
Health Care ◽  
Health Care Delivery ◽  
Health Care Cost ◽  
Care Delivery ◽  
Health Care Systems ◽  
Delivery Systems ◽  
Content Type ◽  
Care Systems ◽  
Health Care Delivery Systems

Purpose This paper examines the changing role of general practitioners (GPs) in Nordic countries of Sweden, Norway and Denmark. It aims to explore the “gate keeping” role of GPs in the face of current changes in the health care delivery systems in these countries. Design/methodology/approach Data were collected from existing literature, interviews with GPs, hospital specialists and representatives of Danish regions and Norwegian Medical Association. Findings The paper contends that in all these changes, the position of the GPs in the medical division of labor has been strengthened, and patients now have increased and broadened access to choice. Research limitations/implications Health care cost and high cancer mortality rates have forced Nordic countries of Sweden, Norway and Denmark to rethink their health care systems. Several attempts have been made to reduce health care cost through market reform and by strenghtening the position of GPs. The evidence suggests that in Norway and Denmark, right incentives are in place to achieve this goal. Sweden is not far behind. The paper has limitations of a small sample size and an exclusive focus on GPs. Practical implications Anecdotal evidence suggests that physicians are becoming extremely unhappy. Understanding the changing status of primary care physicians will yield valuable information for assessing the effectiveness of Nordic health care delivery systems. Social implications This study has wider implications of how GPs see their role as potential gatekeepers in the Nordic health care systems. The role of GPs is changing as a result of recent health care reforms. Originality/value This paper contends that in Norway and Denmark, right incentives are in place to strengthen the position of GPs.

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.

scholarly journals Creating sustainable health care systems

2019 ◽  
Vol 33 (1) ◽  
pp. 18-34 ◽  
Author(s):  
Peter Littlejohns ◽  
Katharina Kieslich ◽  
Albert Weale ◽  
Emma Tumilty ◽  
Georgina Richardson ◽  
...  
Keyword(s):  
Health Care ◽  
Health Services ◽  
Health Systems ◽  
Public Involvement ◽  
Health Care Systems ◽  
Ethical Challenge ◽  
Content Type ◽  
The Public ◽  
Care Systems ◽  
Sustainable Health

Purpose In order to create sustainable health systems, many countries are introducing ways to prioritise health services underpinned by a process of health technology assessment. While this approach requires technical judgements of clinical effectiveness and cost effectiveness, these are embedded in a wider set of social (societal) value judgements, including fairness, responsiveness to need, non-discrimination and obligations of accountability and transparency. Implementing controversial decisions faces legal, political and public challenge. To help generate acceptance for the need for health prioritisation and the resulting decisions, the purpose of this paper is to develop a novel way of encouraging key stakeholders, especially patients and the public, to become involved in the prioritisation process. Design/methodology/approach Through a multidisciplinary collaboration involving a series of international workshops, ethical and political theory (including accountability for reasonableness) have been applied to develop a practical way forward through the creation of a values framework. The authors have tested this framework in England and in New Zealand using a mixed-methods approach. Findings A social values framework that consists of content and process values has been developed and converted into an online decision-making audit tool. Research limitations/implications The authors have developed an easy to use method to help stakeholders (including the public) to understand the need for prioritisation of health services and to encourage their involvement. It provides a pragmatic way of harmonising different perspectives aimed at maximising health experience. Practical implications All health care systems are facing increasing demands within finite resources. Although many countries are introducing ways to prioritise health services, the decisions often face legal, political, commercial and ethical challenge. The research will help health systems to respond to these challenges. Social implications This study helps in increasing public involvement in complex health challenges. Originality/value No other groups have used this combination of approaches to address this issue.

scholarly journals A view on medical care globalization and medical tourism

2018 ◽  
Vol 32 (1) ◽  
pp. 69-73
Author(s):  
Samlee Plianbangchang
Keyword(s):  
Health Care ◽  
Medical Care ◽  
National Health ◽  
Medical Tourism ◽  
Health Care Systems ◽  
National Level ◽  
Practical Experience ◽  
Content Type ◽  
National Health Care ◽  
Care Systems

Purpose The purpose of this paper is to disseminate among concerned professionals its certain operational aspects, including some possible implications on health and medical care practices. Design/methodology/approach It is written on the basis of the author’s special study of a diverse source of information, as well as on author’s practical experience and observation in this particular area. Findings Special attention is paid to possible public health impacts within a broad social and economic framework, as well as to its impacts on the existing national health care systems in countries, that would possibly lead to certain degree of inequity in health at national level as an important consequence of health development progress. Originality/value Knowledge and understanding gained from this paper might be useful in the efforts to develop and manage national health care systems to ensure a reasonable balance in health status of people of all groups.

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