scholarly journals Driving digital health transformation in hospitals: a formative qualitative evaluation of the English Global Digital Exemplar programme

2021 ◽  
Vol 28 (1) ◽  
pp. e100429
Author(s):  
Marta Krasuska ◽  
Robin Williams ◽  
Aziz Sheikh ◽  
Bryony Franklin ◽  
Susan Hinder ◽  
...  
Keyword(s):  
Case Studies ◽  
Health Informatics ◽  
Large Scale ◽  
Local Governance ◽  
Digital Health ◽  
National Level ◽  
Qualitative Evaluation ◽  
Digital Transformation ◽  
Sociotechnical Theory ◽  
The Impact

BackgroundThere is currently a strong drive internationally towards creating digitally advanced healthcare systems through coordinated efforts at a national level. The English Global Digital Exemplar (GDE) programme is a large-scale national health information technology change programme aiming to promote digitally-enabled transformation in secondary healthcare provider organisations by supporting relatively digitally mature provider organisations to become international centres of excellence.AimTo qualitatively evaluate the impact of the GDE programme in promoting digital transformation in provider organisations that took part in the programme.MethodsWe conducted a series of in-depth case studies in 12 purposively selected provider organisations and a further 24 wider case studies of the remaining organisations participating in the GDE programme. Data collected included 628 interviews, non-participant observations of 190 meetings and workshops and analysis of 9 documents. We used thematic analysis aided by NVivo software and drew on sociotechnical theory to analyse the data.ResultsWe found the GDE programme accelerated digital transformation within participating provider organisations. This acceleration was triggered by: (1) dedicated funding and the associated requirement for matched internal funding, which in turn helped to prioritise digital transformation locally; (2) governance requirements put in place by the programme that helped strengthen existing local governance and project management structures and supported the emergence of a cadre of clinical health informatics leaders locally; and (3) reputational benefits associated with being recognised as a centre of digital excellence, which facilitated organisational buy-in for digital transformation and increased negotiating power with vendors.ConclusionThe GDE programme has been successful in accelerating digital transformation in participating provider organisations. Large-scale digital transformation programmes in healthcare can stimulate local progress through protected funding, putting in place governance structures and leveraging reputational benefits for participating provider organisations, around a coherent vision of transformation.

HOME VISITS DURING THE FIRST MONTH OF DELIVERY FOR RECENTLY DELIVERED WOMEN IN UTTAR PRADESH, INDIA

2020 ◽  
Vol 6 (5) ◽  
pp. 1183-1189
Author(s):  
Dr. Tridibesh Tripathy ◽  
Dr. Umakant Prusty ◽  
Dr. Chintamani Nayak ◽  
Dr. Rakesh Dwivedi ◽  
Dr. Mohini Gautam
Keyword(s):  
Large Scale ◽  
National Level ◽  
Uttar Pradesh ◽  
Life Time ◽  
Structured Interview ◽  
The Other ◽  
Registration System ◽  
Action Group ◽  
Current Article ◽  
The Impact

The current article of Uttar Pradesh (UP) is about the ASHAs who are the daughters-in-law of a family that resides in the same community that they serve as the grassroots health worker since 2005 when the NRHM was introduced in the Empowered Action Group (EAG) states. UP is one such Empowered Action Group (EAG) state. The current study explores the actual responses of Recently Delivered Women (RDW) on their visits during the first month of their recent delivery. From the catchment area of each of the 250 ASHAs, two RDWs were selected who had a child in the age group of 3 to 6 months during the survey. The response profiles of the RDWs on the post- delivery first month visits are dwelled upon to evolve a picture representing the entire state of UP. The relevance of the study assumes significance as detailed data on the modalities of postnatal visits are available but not exclusively for the first month period of their recent delivery. The details of the post-delivery first month period related visits are not available even in large scale surveys like National Family Health Survey 4 done in 2015-16. The current study gives an insight in to these visits with a five-point approach i.e. type of personnel doing the visit, frequency of the visits, visits done in a particular week from among those four weeks separately for the three visits separately. The current study is basically regarding the summary of this Penta approach for the post- delivery one-month period.     The first month period after each delivery deals with 70% of the time of the postnatal period & the entire neonatal period. Therefore, it does impact the Maternal Mortality Rate & Ratio (MMR) & the Neonatal Mortality Rates (NMR) in India and especially in UP through the unsafe Maternal & Neonatal practices in the first month period after delivery. The current MM Rate of UP is 20.1 & MM Ratio is 216 whereas the MM ratio is 122 in India (SRS, 2019). The Sample Registration System (SRS) report also mentions that the Life Time Risk (LTR) of a woman in pregnancy is 0.7% which is the highest in the nation (SRS, 2019). This means it is very risky to give birth in UP in comparison to other regions in the country (SRS, 2019). This risk is at the peak in the first month period after each delivery. Similarly, the current NMR in India is 23 per 1000 livebirths (UNIGME,2018). As NMR data is not available separately for states, the national level data also hold good for the states and that’s how for the state of UP as well. These mortalities are the impact indicators and such indicators can be reduced through long drawn processes that includes effective and timely visits to RDWs especially in the first month period after delivery. This would help in making their post-natal & neonatal stage safe. This is the area of post-delivery first month visit profile detailing that the current article helps in popping out in relation to the recent delivery of the respondents.   A total of four districts of Uttar Pradesh were selected purposively for the study and the data collection was conducted in the villages of the respective districts with the help of a pre-tested structured interview schedule with both close-ended and open-ended questions.  The current article deals with five close ended questions with options, two for the type of personnel & frequency while the other three are for each of the three visits in the first month after the recent delivery of respondents. In addition, in-depth interviews were also conducted amongst the RDWs and a total 500 respondents had participated in the study.   Among the districts related to this article, the results showed that ASHA was the type of personnel who did the majority of visits in all the four districts. On the other hand, 25-40% of RDWs in all the 4 districts replied that they did not receive any visit within the first month of their recent delivery. Regarding frequency, most of the RDWs in all the 4 districts received 1-2 times visits by ASHAs.   Regarding the first visit, it was found that the ASHAs of Barabanki and Gonda visited less percentage of RDWs in the first week after delivery. Similarly, the second visit revealed that about 1.2% RDWs in Banda district could not recall about the visit. Further on the second visit, the RDWs responded that most of them in 3 districts except Gonda district did receive the second postnatal visit in 7-15 days after their recent delivery. Less than half of RDWs in Barabanki district & just more than half of RDWs in Gonda district received the third visit in 15-21 days period after delivery. For the same period, the majority of RDWs in the rest two districts responded that they had been entertained through a home visit.

scholarly journals Modeling regional impacts and resilience to water service disruptions in urban economies

2021 ◽  
pp. 239980832199870
Author(s):  
Sheree A Pagsuyoin ◽  
Joost R Santos
Keyword(s):  
Case Studies ◽  
Large Scale ◽  
Urban Region ◽  
Economic Losses ◽  
Drought Severity ◽  
Severe Drought ◽  
Time Varying ◽  
National Capital Region ◽  
Economic Sectors ◽  
The Impact

Water is a critical natural resource that sustains the productivity of many economic sectors, whether directly or indirectly. Climate change alongside rapid growth and development are a threat to water sustainability and regional productivity. In this paper, we develop an extension to the economic input-output model to assess the impact of water supply disruptions to regional economies. The model utilizes the inoperability variable, which measures the extent to which an infrastructure system or economic sector is unable to deliver its intended output. While the inoperability concept has been utilized in previous applications, this paper offers extensions that capture the time-varying nature of inoperability as the sectors recover from a disruptive event, such as drought. The model extension is capable of inserting inoperability adjustments within the drought timeline to capture time-varying likelihoods and severities, as well as the dependencies of various economic sectors on water. The model was applied to case studies of severe drought in two regions: (1) the state of Massachusetts (MA) and (2) the US National Capital Region (NCR). These regions were selected to contrast drought resilience between a mixed urban–rural region (MA) and a highly urban region (NCR). These regions also have comparable overall gross domestic products despite significant differences in the distribution and share of the economic sectors comprising each region. The results of the case studies indicate that in both regions, the utility and real estate sectors suffer the largest economic loss; nonetheless, results also identify region-specific sectors that incur significant losses. For the NCR, three sectors in the top 10 ranking of highest economic losses are government-related, whereas in the MA, four sectors in the top 10 are manufacturing sectors. Furthermore, the accommodation sector has also been included in the NCR case intuitively because of the high concentration of museums and famous landmarks. In contrast, the Wholesale Trade sector was among the sectors with the highest economic losses in the MA case study because of its large geographic size conducive for warehouses used as nodes for large-scale supply chain networks. Future modeling extensions could potentially include analysis of water demand and supply management strategies that can enhance regional resilience against droughts. Other regional case studies can also be pursued in future efforts to analyze various categories of drought severity beyond the case studies featured in this paper.

Study of sand wave migration over five years as observed in two windfarm development areas, and the implications for building on moving substrates in the North Sea

2014 ◽  
Vol 105 (4) ◽  
pp. 241-249 ◽  
Author(s):  
Ken P. Games ◽  
David I. Gordon
Keyword(s):  
Case Studies ◽  
Large Scale ◽  
Oil And Gas ◽  
Sand Wave ◽  
Sand Waves ◽  
Migration Rates ◽  
The North ◽  
The North Sea ◽  
Wave Migration ◽  
The Impact

ABSTRACTSand waves are well known indicators of a mobile seabed. What do we expect of these features in terms of migration rates and seabed scour? We discuss these effects on seabed structures, both for the Oil and Gas and the Windfarm Industries, and consider how these impact on turbines and buried cables. Two case studies are presented. The first concerns a windfarm with a five-year gap between the planning survey and a subsequent cable route and environmental assessment survey. This revealed large-scale movements of sand waves, with the displacement of an isolated feature of 155 m in five years. Secondly, another windfarm development involved a re-survey, again over a five-year period, but after the turbines had been installed. This showed movements of sand waves of ∼50 m in five years. Observations of the scour effects on the turbines are discussed. Both sites revealed the presence of barchans. Whilst these have been extensively studied on land, there are few examples of how they behave in the marine environment. The two case studies presented show that mass transport is potentially much greater than expected and that this has implications for choosing turbine locations, the effect of scour, and the impact these sediment movements are likely to have on power cables.

scholarly journals Co-creating a large-scale adolescent health survey integrated with access to digital health interventions

2020 ◽  
Author(s):  
Roshini Peiris-John ◽  
Lovely Dizon ◽  
Kylie Sutcliffe ◽  
Kristy Kang ◽  
Theresa Fleming
Keyword(s):  
Adolescent Health ◽  
Health Survey ◽  
Large Scale ◽  
Service Providers ◽  
Digital Health ◽  
Health Interventions ◽  
Future Research ◽  
Health Providers ◽  
Health And Wellbeing ◽  
The Impact

Aim This paper describes how we engaged with adolescents and health providers to integrate access to digital health interventions as part of a large-scale secondary school health and wellbeing survey in New Zealand. Methods We conducted nine participatory, iterative co-design sessions involving 29 adolescents, and two workshops with young people (n = 11), digital and health service providers (n = 11) and researchers (n = 9) to gain insights into end-user perspectives on the concept and how best to integrate digital interventions in to the survey. Results Students’ perceived integrating access to digital health interventions into a large-scale youth health survey as acceptable and highly beneficial. They did not want personalized/normative feedback, but thought that every student should be offered all the help options. Participants identified key principles: assurance of confidentiality, usability, participant choice and control, and language. They highlighted wording as important for ease and comfort, and emphasised the importance of user control. Participants expressed that it would be useful and acceptable for survey respondents to receive information about digital help options addressing a range of health and wellbeing topics. Conclusion The methodology of adolescent-practitioner-researcher collaboration and partnership was central to this research and provided useful insights for the development and delivery of adolescent health surveys integrated with digital help options. The results from the ongoing study will provide useful data on the impact of digital health interventions integrated in large-scale surveys, as a novel methodology. Future research on engaging with adolescents once interventions are delivered will be useful to explore benefits over time.

Railway fuel and its impact on the forests in colonial India: The case of the Punjab, 1860–1884

2012 ◽  
Vol 47 (4) ◽  
pp. 1283-1309 ◽  
Author(s):  
PALLAVI V. DAS
Keyword(s):  
Environmental Degradation ◽  
Large Scale ◽  
National Level ◽  
Regional Level ◽  
Peak Period ◽  
Colonial State ◽  
Colonial India ◽  
Railway Line ◽  
State Response ◽  
The Impact

AbstractRecent studies have stressed the need for micro-histories of the environment so that important differences and similarities at local, regional and national level might be revealed. This paper analyses the process and patterns of environmental degradation at regional level by taking the case of deforestation in colonial Punjab by studying its implication at the level of empire. More specifically, it examines three aspects of how the operation and expansion of railways from 1869 to 1884, a peak period of railway expansion, affected the forests of the Punjab's plains. First, the paper analyses the reasons for large-scale railway expansion in the Punjab by discussing spatial and temporal expansion. Secondly, the impact of the railway firewood demand on the Punjab's forests between 1860 and 1884 is examined, specifically, the conditions that facilitated the increased dependence of the railways on firewood. Next follows an examination of the temporally varying nature of deforestation, given that railway firewood demand was determined by railway line openings. This section also includes a discussion on the nature of the colonial state response to the deforestation crisis and its role in maintaining the fuel supply to the railways. Finally, in the context of deforestation in the Punjab, the paper discusses how and why railway fuel changed from firewood to coal.

When Participation Wins Votes: Explaining the Emergence of Large-Scale Participatory Democracy

2021 ◽  
Author(s):  
Jared Abbott
Keyword(s):  
Case Studies ◽  
Political Party ◽  
Large Scale ◽  
Participatory Democracy ◽  
National Level ◽  
The Political ◽  
Political Costs ◽  
Participatory Institutions ◽  
Potential Benefits ◽  
Nationwide Implementation

Why are large-scale participatory institutions implemented in some countries but only adopted on paper in others? I argue that nationwide implementation of Binding Participatory Institutions (BPIs)––a critical subtype of participatory institutions––is dependent on the backing of a strong institutional supporter, often a political party. In turn, parties will only implement BPIs if they place a lower value on the political costs than on the potential benefits of implementation. This will be true if: 1) significant societal demand exists for BPI implementation and 2) the party’s political opponents cannot take advantage of BPIs for their own gain. I test this theory through two detailed case studies of Venezuela and Ecuador, drawing on 165 interviews with key national-level actors and grassroots activists.

scholarly journals EXPLORING THE POWER OF COMBINATORIAL HEALTH TECHNOLOGIES TO SUPPORT SELF-MANAGEMENT OF COPD AMONG OLDER PEOPLE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S443-S443
Author(s):  
Sandra Varey ◽  
Mandy Dixon ◽  
Alejandra Hernandez ◽  
Ceu Mateus ◽  
Tom Palmer ◽  
...  
Keyword(s):  
Older People ◽  
Large Scale ◽  
Digital Health ◽  
Self Management ◽  
Chronic Obstructive ◽  
Test Bed ◽  
Long Term Conditions ◽  
Health Technologies ◽  
Healthcare Needs ◽  
The Impact

Abstract Ways to address the increasing healthcare needs of older people are a priority for the National Health Service (NHS) in England. The NHS England Test Bed programme was designed to trial new models of care that are supported by digital health technologies. This paper reports on findings from one Test Bed programme, the Lancashire and Cumbria Innovation Alliance (LCIA) – a partnership between NHS England, industry and Lancaster University, which ran from 2016 to 2018. A key aim of the LCIA Test Bed was to explore the extent to which supported self-care telehealth technology helped older people with long-term conditions to better self-manage their own care, promoting independence and enabling them to remain at home for longer. Each patient received a combination of health technologies over a six-month period. This paper presents results from the qualitative data that formed part of a large-scale mixed-methods evaluation. Specifically it draws on the analysis of 34 observational interviews with 17 participants with chronic obstructive pulmonary disease (COPD) to understand the role of these technologies in the self-management of their care. The data revealed that the majority of participants felt more confident about self-managing COPD as a result of their participation in the programme. These increases in confidence were the result of participants’ increased knowledge and skills in managing their COPD. The paper demonstrates how patients learned to better manage their respiratory condition, the impact of this learning on their daily lives and that of their family carers, and the implications for healthcare practice.

scholarly journals On the Time Evolution of Limited-Area Ensemble Variance: Case Studies with the Convection-Permitting Ensemble COSMO-E

2018 ◽  
Vol 76 (1) ◽  
pp. 11-26 ◽  
Author(s):  
Christina Klasa ◽  
Marco Arpagaus ◽  
André Walser ◽  
Heini Wernli
Keyword(s):  
Case Studies ◽  
Time Evolution ◽  
Large Scale ◽  
Horizontal Wind ◽  
Limited Area ◽  
Convective Activity ◽  
Moist Convection ◽  
Domain Boundaries ◽  
Large Scale Flow ◽  
The Impact

Abstract Dynamical processes determining the time evolution of difference kinetic energy (DKE) in a limited-area domain are investigated with the convection-permitting ensemble model COSMO-E for a forecasting period of 4 days. DKE is quantified by means of ensemble variance of the irrotational and nondivergent horizontal wind. For three case studies characterized by contrasting predictability levels of precipitation, it is shown that DKE of the irrotational wind strongly increases during periods of solar-forced moist convective activity and decreases when the latter ceases. The response of DKE of the nondivergent wind is also clearly related to the convective activity, but delayed by a few hours, pointing to interactions between both wind components. Apart from the impact of moist convection, DKE of the nondivergent wind is primarily governed by large-scale advection, imposed at the lateral domain boundaries of the limited-area ensemble. This forcing may also sustain or increase DKE of the irrotational wind when moist convection is absent. Consequently, the large-scale flow and diurnal solar forcing, associated with higher spatiotemporal predictability, determines the overall evolution of the limited-area ensemble variance of the horizontal wind, which increases in the presence of moist convective activity or strong synoptic-scale forcing, and stagnates or decreases otherwise, rendering forecasts of convection-permitting ensembles valuable beyond the very short forecast range.

Digitization in construction

BUILDER ◽  
2019 ◽  
Vol 266 (9) ◽  
pp. 15-17
Author(s):  
Anna Tryfon-Bojarska ◽  
Ewelina Wińska
Keyword(s):  
Life Cycle ◽  
Project Management ◽  
Case Studies ◽  
Construction Industry ◽  
Industrial Revolution ◽  
Digital Transformation ◽  
Property Development ◽  
Innovative Project ◽  
Fourth Industrial Revolution ◽  
The Impact

The fourth industrial revolution leads to a comprehensive digital transformation of enterprises. Its nine pillars also affect the construction industry. This article presents the impact of digital transformation on innovative projects which are implemented in the construction industry. It describes examples of digital innovations that are used in the life cycle of a property development undertaking, as well as examples and case studies of applied innovative project management models.

scholarly journals US Primary Care in 2029: A Delphi Survey on the Impact of Machine Learning

2020 ◽  
Author(s):  
Charlotte Blease ◽  
Anna Kharko ◽  
Cosima Locher ◽  
Catherine M. DesRoches ◽  
Kenneth D. Mandl
Keyword(s):  
Primary Care ◽  
Health Informatics ◽  
Primary Care Physicians ◽  
Response Rate ◽  
Digital Health ◽  
Training Requirements ◽  
Modified Delphi ◽  
Primary Care Workforce ◽  
The Us ◽  
The Impact

AbstractObjectiveTo solicit leading health informaticians’ predictions about the impact of AI/ML on primary care in the US in 2029.DesignA three-round online modified Delphi poll.ParticipantsTwenty-nine leading health informaticians.MethodsIn September 2019, health informatics experts were selected by the research team, and invited to participate the Delphi poll. Participation in each round was anonymous, and panelists were given between 4-8 weeks to respond to each round. In Round 1 open-ended questions solicited forecasts on the impact of AI/ML on: (1) patient care, (2) access to care, (3) the primary care workforce, (4) technological breakthroughs, and (5) the long-future for primary care physicians. Responses were coded to produce itemized statements. In Round 2, participants were invited to rate their agreement with each item along 7-point Likert scales. Responses were analyzed for consensus which was set at a predetermined interquartile range of ≤ 1. In Round 3 items that did not reach consensus were redistributed.ResultsA total of 16 experts participated in Round 1 (16/29, 55%). Of these experts 13/16 (response rate, 81%), and 13/13 (response rate, 100%), responded to Rounds 2 and 3, respectively. As a result of developments in AI/ML by 2029 experts anticipated workplace changes including incursions into the disintermediation of physician expertise, and increased AI/ML training requirements for medical students. Informaticians also forecast that by 2029 AI/ML will increase diagnostic accuracy especially among those with limited access to experts, minorities and those with rare diseases. Expert panelists also predicted that AI/ML-tools would improve access to expert doctor knowledge.ConclusionsThis study presents timely information on informaticians’ consensus views about the impact of AI/ML on US primary care in 2029. Preparation for the near-future of primary care will require improved levels of digital health literacy among patients and physicians.

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