scholarly journals Patient and healthcare provider knowledge, attitudes and barriers to handover and healthcare communication during chronic disease inpatient care in India: a qualitative exploratory study

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e028199 ◽  
Author(s):  
Claire Humphries ◽  
Suganthi Jaganathan ◽  
Jeemon Panniyammakal ◽  
Sanjeev K Singh ◽  
Shifalika Goenka ◽  
...  
Keyword(s):  
Healthcare Provider ◽  
Information Exchange ◽  
Inpatient Care ◽  
Medical Information ◽  
Communicable Disease ◽  
Healthcare Management ◽  
Public Hospitals ◽  
Public Healthcare ◽  
Medical Documents ◽  
Healthcare Communication

Objectives1) To investigate patient and healthcare provider (HCP) knowledge, attitudes and barriers to handover and healthcare communication during inpatient care. 2) To explore potential interventions for improving the storage and transfer of healthcare information.DesignQualitative study comprising 41 semi-structured, individual interviews and a thematic analysis using the Framework Method with analyst triangulation.SettingThree public hospitals in Himachal Pradesh and Kerala, India.ParticipantsParticipants included 20 male (n=10) and female (n=10) patients with chronic non-communicable disease (NCD) and 21 male (n=15) and female (n=6) HCPs. Purposive sampling was used to identify patients with chronic NCDs (cardiovascular disease, chronic respiratory disease, diabetes or hypertension) and HCPs.ResultsPatient themes were (1) public healthcare service characteristics, (2) HCP to patient communication and (3) attitudes regarding medical information. HCP themes were (1) system factors, (2) information exchange practices and (3) quality improvement strategies. Both patients and HCPs recognised public healthcare constraints that increased pressure on hospitals and subsequently limited consultation times. Systemic issues reported by HCPs were a lack of formal handover systems, training and accessible hospital-based records. Healthcare management communication during admission was inconsistent and lacked patient-centredness, evidenced by varying reports of patient information received and some dissatisfaction with lifestyle advice. HCPs reported that the duty of writing discharge notes was passed from senior doctors to interns or nurses during busy periods. A nurse reported providing predominantly verbal discharge instructions to patients. Patient-held medical documents facilitated information exchange between HCPs, but doctors reported that they were not always transported. HCPs and patients expressed positive views towards the idea of introducing patient-held booklets to improve the organisation and transfer of medical documents.ConclusionsHandover and healthcare communication during chronic NCD inpatient care is currently suboptimal. Structured information exchange systems and HCP training are required to improve continuity and safety of care during critical transitions such as referral and discharge. Our findings suggest that patient-held booklets may also assist in enhancing handover and patient-centred practices.

scholarly journals The Competency Movement in Public Hospitals: Analysing the Competencies of Hospital Executive Managers

2021 ◽  
pp. 22-43
Author(s):  
Mehtap ÇAKMAK BARSBAY ◽  
Mustafa Kemal ÖKTEM
Keyword(s):  
Assessment Tool ◽  
Management Training ◽  
Healthcare Management ◽  
Public Hospitals ◽  
Public Healthcare ◽  
Healthcare Organizations ◽  
Self Assessment ◽  
Cross Sectional ◽  
Hospital Managers ◽  
Executive Managers

"Our primary aim was to provide a quantitative snapshot relying on a self-assessment tool developed for the local healthcare environment and formal tasks for top-level executive hospital managers of public healthcare organizations. We used a cross-sectional and descriptive mixed study design that targeted the nationwide population of 701 top-level managers in public hospitals in 2015 in Turkey. As the first step, position description content analysis was conducted based on document analysis to explore their legal tasks and statements, and the job requirements for an executive management position in public hospitals. Second, before designing the data-collection instrument, we conducted four meetings and group discussions with several hospital managers – with and without medical backgrounds – and five academics who were part of healthcare management and public administration departments. Lastly, we built upon past efforts and the literature, and constructed a questionnaire. The managers are fully responsible for the healthcare quality, medical, nursing, administrative issues and financial performance of the facility. The participants perceived that they were competent in most of the competencies. The participants’ mean total competency score was 81%, and the competency gap between the required and current competency levels differed from 13% to 22%. This research provides deep insight into the competencies perceived by hospital executive managers in a developing country context. Our results have several practical implications for both healthcare policymakers and new executive hospital managers. There is an urgent need for follow-up self-assessment for competencies and ongoing management training programs."

Building a Public Hospital That Everyone Knows Is Too Small

2021 ◽  
pp. 120-148
Author(s):  
Armando Lara-Millán
Keyword(s):  
Los Angeles ◽  
Federal Government ◽  
Inpatient Care ◽  
Public Hospitals ◽  
Urgent Care ◽  
Public Healthcare ◽  
Hospital System ◽  
Local Residents ◽  
Management Techniques ◽  
Waiting Line

This chapter presents the historical transformation of the Los Angeles County hospital system in order to understand the restriction of medicine in large public hospitals. In contrast to a simple story of underfunding, the chapter details how legal demand and austerity pushed local government to reinvest in public healthcare but downsize inpatient capacity. Officials re-emphasized their patients less as local residents in need of urgent care and more as non-urgent patients, homeless, and immigrants in need of early intervention. Doing so allowed them to draw in funds from the federal government to reconfigure their healthcare systems away from inpatient care. In the process, however, legal and regulatory agencies began threatening public hospitals for dangerous overcrowding. Such pressure led directly to the development of waiting line management techniques—such as policing, closer observation of waiting patients, and opiate medication—that, in practice, worked to restrict care.

AHP framework to assist lean deployment in Abu Dhabi public healthcare delivery system

2016 ◽  
Vol 22 (3) ◽  
pp. 546-565 ◽  
Author(s):  
Matloub Hussain ◽  
Mohsin Malik ◽  
Hamda S. Al Neyadi
Keyword(s):  
Healthcare Delivery ◽  
Healthcare Management ◽  
Public Hospitals ◽  
Waste Reduction ◽  
Abu Dhabi ◽  
Public Healthcare ◽  
Lean Management ◽  
Manufacturing Companies ◽  
Content Type ◽  
Lean Practices

Purpose – The purpose of this paper is to introduce lean concept to the field of healthcare management, expands the conceptualization of lean management beyond the manufacturing companies to consider key waste reduction opportunities which are posited to be requisites to lean practices and implements the proposed framework in the three public hospitals in Abu Dhabi. Design/methodology/approach – This research is designed by decomposing complex and unstructured issue into a set of components organized in a multi-level hierarchical form. To deal with this complexity of multi criteria decision-making process, analytical hierarchical process (AHP) method is used in this research. Findings – AHP framework for this study resulted in a ranking of 21 healthcare wastes based on the evaluations of local situations by experienced healthcare professionals. It has been found that management in healthcare systems of Abu Dhabi is putting more emphasis on the inventory waste. Research limitations/implications – The future directions of the research would be to apply a lean set of tools for the value stream optimization of the prioritized key improvement areas. Practical implications – This is a contribution to the continuing research into lean management, giving practitioners and designers a practical way for measuring and implementing lean practices across health organizations. Originality/value – The contribution of this research, through successive stages of data collection, measurement analysis and refinement, is a set of reliable and valid framework that can be subsequently used in conceptualization, prioritization of the waste reduction strategies in healthcare management.

Diabetes related disease and disorder in a Chinese Q&A website: Comparison on frequency and position (Preprint)

2020 ◽  
Author(s):  
Wei Feng ◽  
Ruocheng Huang ◽  
Shan Lu ◽  
Tao Shan ◽  
Hong Wang ◽  
...  
Keyword(s):  
Kidney Failure ◽  
Medical Information ◽  
Healthcare Management ◽  
Medical Community ◽  
Circulation System ◽  
Age Group ◽  
Disease Category ◽  
Old Patients ◽  
Gender And Age ◽  
Question And Answer

BACKGROUND With the development of the Internet, online medical community can help patient access to medical information and relevant decisions more conveniently, and meet the needs of patients for their own healthcare management. Mining these Q&A (Question and Answer) data, we can help doctors give more targeted feedback which improve the efficiency of question-and-answer, and patient satisfaction. OBJECTIVE This study aimed to (1) analysis frequency and position of diabetes related diseases or symptoms in Q&A website and (2) find out the differences of disease terms in gender and age using in the questions. METHODS We collected 5766 Q&A diabetes related data on the website of Chunyuyisheng from June 2012 to April 2020. In 38176 combined sentences, a vocabulary contains 3 categories of 3851 word and 2094 ICD (International Classification of Diseases) matching terms were obtained by calculating the similarity using word vectors. Proportion of the frequency of words and Mann-Whitney U test on word position were used to quantify the difference in patient’s gender and age group. RESULTS The vocabulary of the disease category accounts for 70%. We analyzed the word frequency and position in questions for different gender and age group. For gender, women participate in question answering more, accounting for 53% of total questions. They pay more attention to pregnancy, sleep and thyroid gland related vocabulary compared to men. Men focus more on circulation system, kidney failure related vocabulary. For different age group, pregnancy, glucose regulation, digestive and respiratory system related vocabulary have a higher proportion for patients under 40 years old. Patients over 40 years old pay more attention on kidney failure, cerebral ischaemia, infectious and circulation system. CONCLUSIONS This study provides a new insight into frequency and position of diabetes related diseases or symptoms in online medical services. It can show patients’ different attention by comparing disease or symptom categories for gender and age with ICD disease codes. The frequency and position of disease category words in patients’ conversation can be used for further risk evaluation for chronic diseases research.

scholarly journals The Problems and Needs of Patients Diagnosed with Cancer and Their Caregivers

2020 ◽  
Vol 18 (1) ◽  
pp. 87
Author(s):  
Anna Lewandowska ◽  
Grzegorz Rudzki ◽  
Tomasz Lewandowski ◽  
Sławomir Rudzki
Keyword(s):  
Cancer Patients ◽  
Medical Information ◽  
Unmet Needs ◽  
Public Healthcare ◽  
Literature Analysis ◽  
The Public ◽  
The Mean ◽  
High Level ◽  
Patients Experience

(1) Background: As the literature analysis shows, cancer patients experience a variety of different needs. Each patient reacts differently to the hardships of the illness. Assessment of needs allows providing more effective support, relevant to every person’s individual experience, and is necessary for setting priorities for resource allocation, for planning and conducting holistic care, i.e., care designed to improve a patient’s quality of life in a significant way. (2) Patients and Methods: A population survey was conducted between 2018 and 2020. Cancer patients, as well as their caregivers, received an invitation to take part in the research, so their problems and needs could be assessed. (3) Results: The study involved 800 patients, 78% women and 22% men. 66% of the subjects were village residents, while 34%—city residents. The mean age of patients was 62 years, SD = 11.8. The patients received proper treatment within the public healthcare. The surveyed group of caregivers was 88% women and 12% men, 36% village residents and 64% city residents. Subjects were averagely 57 years old, SD 7.8. At the time of diagnosis, the subjects most often felt anxiety, despair, depression, feelings of helplessness (46%, 95% CI: 40–48). During illness and treatment, the subjects most often felt fatigued (79%, 95% CI: 70–80). Analysis of needs showed that 93% (95% CI: 89–97) of patients experienced a certain level of need for help in one or more aspects. (4) Conclusions: Patients diagnosed with cancer have a high level of unmet needs, especially in terms of psychological support and medical information. Their caregivers also experience needs and concerns regarding the disease. Caregivers should be made aware of the health consequences of cancer and consider appropriate supportive care for their loved ones.

scholarly journals Analysis of Network Structure and Doctor Behaviors in E-Health Communities from a Social-Capital Perspective

2020 ◽  
Vol 17 (4) ◽  
pp. 1136 ◽  
Author(s):  
Zhigang Li ◽  
Xu Xu
Keyword(s):  
Social Capital ◽  
Information Exchange ◽  
Information Dissemination ◽  
Medical Information ◽  
Service Levels ◽  
Health Community ◽  
Professional Titles ◽  
Health Communities ◽  
Social Capital Perspective ◽  
Doctor Communication

In tandem with internet development and widespread social media use, e-health communities have begun to emerge in recent years. These communities allow doctors to access forums anywhere, anytime, seek or exchange medical information online, find literature, and so on. This is convenient and can solve some problems for doctors while also promoting doctor communication. This study collected and collated 102 doctors in the “Lilac Forum” and used social network tools to quantify the overall network density, centrality, core–periphery structure, and structural hole indicators of doctors’ information exchange from a social-capital perspective. The results showed that the frequency of interaction between doctors differed because of differences in the identities and participation of doctors in the e-health community. The density of the doctors’ information dissemination network (0.228) and network cohesion (0.610) were relatively high. Thus, the doctors were more closely connected, and information was easily spread. At the same time, doctors with higher professional titles had obvious location characteristics, familiarity and trust, and high levels of reciprocity. They could obtain redundant information in the network and were more likely to influence the behavior of other doctors. This study’s findings provide support for improving information exchange among doctors in e-health communities and improving the service levels of the platforms.

Extracting Medical Information from Paper COVID-19 Assessment Forms

2021 ◽  
Vol 12 (01) ◽  
pp. 170-178
Author(s):  
Jacob D. Schultz ◽  
Colin G. White-Dzuro ◽  
Cheng Ye ◽  
Joseph R. Coco ◽  
Janet M. Myers ◽  
...  
Keyword(s):  
User Interface ◽  
Character Recognition ◽  
Optical Character Recognition ◽  
Medical Information ◽  
Medical Center ◽  
Data Validation ◽  
Average Accuracy ◽  
Medical Documents ◽  
Optical Mark Recognition ◽  
The Right

Abstract Objective This study examines the validity of optical mark recognition, a novel user interface, and crowdsourced data validation to rapidly digitize and extract data from paper COVID-19 assessment forms at a large medical center. Methods An optical mark recognition/optical character recognition (OMR/OCR) system was developed to identify fields that were selected on 2,814 paper assessment forms, each with 141 fields which were used to assess potential COVID-19 infections. A novel user interface (UI) displayed mirrored forms showing the scanned assessment forms with OMR results superimposed on the left and an editable web form on the right to improve ease of data validation. Crowdsourced participants validated the results of the OMR system. Overall error rate and time taken to validate were calculated. A subset of forms was validated by multiple participants to calculate agreement between participants. Results The OMR/OCR tools correctly extracted data from scanned forms fields with an average accuracy of 70% and median accuracy of 78% when the OMR/OCR results were compared with the results from crowd validation. Scanned forms were crowd-validated at a mean rate of 157 seconds per document and a volume of approximately 108 documents per day. A randomly selected subset of documents was reviewed by multiple participants, producing an interobserver agreement of 97% for documents when narrative-text fields were included and 98% when only Boolean and multiple-choice fields were considered. Conclusion Due to the COVID-19 pandemic, it may be challenging for health care workers wearing personal protective equipment to interact with electronic health records. The combination of OMR/OCR technology, a novel UI, and crowdsourcing data-validation processes allowed for the efficient extraction of a large volume of paper medical documents produced during the COVID-19 pandemic.

Cancellation on the Day of Surgery in an Ambulatory Setting - A Retrospective Analysis

2021 ◽  
Author(s):  
João Manuel Teixeira Oliveira ◽  
Mariana Ginestal ◽  
Catarina Ferreira ◽  
Ana Povo ◽  
Eurico Castro Alves
Keyword(s):  
Inpatient Care ◽  
Ambulatory Surgery ◽  
Healthcare Management ◽  
Ambulatory Setting ◽  
Day Case ◽  
Chi Square ◽  
Day Case Surgery ◽  
Cancellation Rate ◽  
Case Surgery ◽  
Level Of Significance

Abstract Background: Cancellations on the day of surgery represent an important setback for patients and pose considerable drawbacks for healthcare management. Part of these cancellations are due to patients’ factors. Some studies have addressed this issue in inpatient care, but scarce information is found regarding ambulatory setting. This work intended to analyse the parameters that are important in patient cancellation on the day of surgery for ambulatory surgery, with a closer analysis on those that are patient dependent, specifying those that are significant in order to anticipate which patients will be cancelled beforehand.Methods: This work analysed a total of 19781 patients enrolled for elective day-case surgery in 2018, from which 1253 (6.33%) made a cancellation on their day of surgery. Results: Patients residing closer to the hospital (< 10 Km) had statistically more cancellations than those residing > 10 km away (p<0.05). Also, patients with 65 years of age or more had a higher cancellation rate (p<0.05). Finally, patients without a prior pre operative medical appointment might have a higher likelihood of same day cancellation (5.8% vs 14.01%, p<0.05). T-test and Chi-square tests were used with a level of significance of 0.05.Conclusions: We expect this work can contribute to anticipate the cancellation of a given patient, enabling quicker treatment with optimised resources.

scholarly journals Implementing an Individual-Centric Discharge Process across Singapore Public Hospitals

2021 ◽  
Vol 18 (16) ◽  
pp. 8700
Author(s):  
Reuben Ng ◽  
Kelvin Bryan Tan
Keyword(s):  
Hospital Admissions ◽  
Public Hospitals ◽  
Gradient Boosting ◽  
Care Utilization ◽  
Public Healthcare ◽  
Successful Implementation ◽  
Discharge Process ◽  
Gradient Boosting Machine ◽  
Cumulative Length ◽  
Risk Patients

Singapore is one of the first known countries to implement an individual-centric discharge process across all public hospitals to manage frequent admissions—a perennial challenge for public healthcare, especially in an aging population. Specifically, the process provides daily lists of high-risk patients to all public hospitals for customized discharge procedures within 24 h of admission. We analyzed all public hospital admissions (N = 150,322) in a year. Among four models, the gradient boosting machine performed the best (AUC = 0.79) with a positive predictive value set at 70%. Interestingly, the cumulative length of stay (LOS) in the past 12 months was a stronger predictor than the number of previous admissions, as it is a better proxy for acute care utilization. Another important predictor was the “number of days from previous non-elective admission”, which is different from previous studies that included both elective and non-elective admissions. Of note, the model did not include LOS of the index admission—a key predictor in other models—since our predictive model identified frequent admitters for pre-discharge interventions during the index (current) admission. The scientific ingredients that built the model did not guarantee its successful implementation—an “art” that requires the alignment of processes, culture, human capital, and senior management sponsorship. Change management is paramount, otherwise data-driven health policies, no matter how well-intended, may not be accepted or implemented. Overall, our study demonstrated the viability of using artificial intelligence (AI) to build a near real-time nationwide prediction tool for individual-centric discharge, and the critical factors for successful implementation.

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