scholarly journals Implementation of patient-centred care: which system-level determinants matter from a decision maker’s perspective? Results from a qualitative interview study across various health and social care organisations

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e050054
Author(s):  
Carmen Leidner ◽  
Vera Vennedey ◽  
Hendrik Hillen ◽  
Lena Ansmann ◽  
Stephanie Stock ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Healthcare System ◽  
Information Exchange ◽  
Social Care ◽  
Qualitative Content Analysis ◽  
Decision Makers ◽  
System Level ◽  
Patient Centred Care ◽  
Qualitative Interview Study ◽  
Health And Social Care

ObjectivesThe healthcare system is characterised by a high degree of complexity and involves various actors at different institutional levels and in different care contexts. To implement patient-centred care (PCC) successfully, a multidimensional consideration of influencing factors is required. Our qualitative study aims to identify system-level determinants of PCC implementation from the perspective of different health and social care organisations (HSCOs).DesignA qualitative study using n=20 semistructured face-to-face interviews with n=24 participants was carried out between August 2017 and May 2018. Interview data were analysed based on concepts of qualitative content analysis using an inductive and deductive approach.Setting and participantsInterviews were conducted with clinical and managerial decision makers from multiple HSCOs in the model region of Cologne, Germany. Participants were recruited via networks of practice partners and cold calling.ResultsThis study identified various determinants on the system level that are associated with PCC implementation. Decision makers described external regulations as generating an economically controlled alignment of the healthcare system. The availability and qualification of staff resources and patient-related incentives of financial resources were identified as an eminent requirement for providers to deliver PCC. Participants considered the strict separation of financing and delivery of healthcare into inpatient and outpatient sectors to be a barrier to PCC. Interorganisational collaboration and information exchange were identified as facilitators of PCC, as they enable continuous patient care cycles.ConclusionThe results showed the necessity of enforcing paradigm changes at the system level from disease-centredness to patient-centredness while aligning policy and reimbursement decisions directly with patient needs and values. A systematic, long-term planned strategy that extends across all organisations is lacking, rather each organisation seeks its own possibilities to implement PCC activities under external restrictions.Trial registration numberDRKS00011925

scholarly journals Implementation of patient-centred care: which organisational determinants matter from decision maker’s perspective? Results from a qualitative interview study across various health and social care organisations

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e027591 ◽  
Author(s):  
Kira Isabel Hower ◽  
Vera Vennedey ◽  
Hendrik Ansgar Hillen ◽  
Ludwig Kuntz ◽  
Stephanie Stock ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Social Care ◽  
Qualitative Content Analysis ◽  
Qualitative Interviews ◽  
Sampling Strategy ◽  
Well Being ◽  
Decision Makers ◽  
Patient Centred Care ◽  
Qualitative Interview Study ◽  
Health And Social Care

ObjectivesHealth and social care systems, organisations and providers are under pressure to organise care around patients’ needs with constrained resources. To implement patient-centred care (PCC) successfully, barriers must be addressed. Up to now, there has been a lack of comprehensive investigations on possible determinants of PCC across various health and social care organisations (HSCOs). Our qualitative study examines determinants of PCC implementation from decision makers’ perspectives across diverse HSCOs.DesignQualitative study of n=24 participants in n=20 semistructured face-to-face interviews conducted from August 2017 to May 2018.Setting and participantsDecision makers were recruited from multiple HSCOs in the region of the city of Cologne, Germany, based on a maximum variation sampling strategy varying by HSCOs types.OutcomesThe qualitative interviews were analysed using an inductive and deductive approach according to qualitative content analysis. The Consolidated Framework for Implementation Research was used to conceptualise determinants of PCC.ResultsDecision makers identified similar determinants facilitating or obstructing the implementation of PCC in their organisational contexts. Several determinants at the HSCO’s inner setting and the individual level (eg, communication among staff and well-being of employees) were identified as crucial to overcome constrained financial, human and material resources in order to deliver PCC.ConclusionsThe results can help to foster the implementation of PCC in various HSCOs contexts. We identified possible starting points for initiating the tailoring of interventions and implementation strategies and the redesign of HSCOs towards more patient-centredness.

scholarly journals How to Implement Digital Services in a Way That They Integrate Into Routine Work: Qualitative Interview Study Among Health and Social Care Professionals

10.2196/31668 ◽  
2021 ◽  
Vol 23 (12) ◽  
pp. e31668
Author(s):  
Janna Nadav ◽  
Anu-Marja Kaihlanen ◽  
Sari Kujala ◽  
Elina Laukka ◽  
Pirjo Hilama ◽  
...  
Keyword(s):  
Social Care ◽  
Service Providers ◽  
Qualitative Content Analysis ◽  
Implementation Process ◽  
Digital Services ◽  
Routine Work ◽  
Qualitative Interview Study ◽  
Health And Social Care ◽  
Work Tasks ◽  
The Impact

Background Although the COVID-19 pandemic has significantly boosted the implementation of digital services worldwide, it has become increasingly important to understand how these solutions are integrated into professionals’ routine work. Professionals who are using the services are key influencers in the success of implementations. To ensure successful implementations, it is important to understand the multiprofessional perspective, especially because implementations are likely to increase even more. Objective The aim of this study is to examine health and social care professionals’ experiences of digital service implementations and to identify factors that support successful implementations and should be considered in the future to ensure that the services are integrated into professionals’ routine work. Methods A qualitative approach was used, in which 8 focus group interviews were conducted with 30 health and social care professionals from 4 different health centers in Finland. Data were analyzed using qualitative content analysis. The resulting categories were organized under the components of normalization process theory. Results Our results suggested 14 practices that should be considered when implementing new digital services into routine work. To get professionals to understand and make sense of the new service, (1) the communication related to the implementation should be comprehensive and continuous and (2) the implementation process should be consistent. (3) A justification for the service being implemented should also be given. The best way to engage the professionals with the service is (4) to give them opportunities to influence and (5) to make sure that they have a positive attitude toward the service. To enact the new service into professionals’ routine work, it is important that (6) the organization take a supportive approach by providing support from several easy and efficient sources. The professionals should also have (7) enough time to become familiar with the service, and they should have (8) enough know-how about the service. The training should be (9) targeted individually according to skills and work tasks, and (10) it should be diverse. The impact of the implementation on the professionals’ work should be evaluated. The service (11) should be easy to use, and (12) usage monitoring should happen. An opportunity (13) to give feedback on the service should also be offered. Moreover, (14) the service should support professionals’ work tasks. Conclusions We introduce 14 practices for organizations and service providers on how to ensure sustainable implementation of new digital services and the smooth integration into routine work. It is important to pay more attention to comprehensive and continuing communication. Organizations should conduct a competence assessment before training in order to ensure proper alignment. Follow-ups to the implementation process should be performed to guarantee sustainability of the service. Our findings from a forerunner country of digitalization can be useful for countries that are beginning their service digitalization or further developing their digital services.

scholarly journals How to Implement Digital Services in a Way That They Integrate Into Routine Work: Qualitative Interview Study Among Health and Social Care Professionals (Preprint)

2021 ◽  
Author(s):  
Janna Nadav ◽  
Anu-Marja Kaihlanen ◽  
Sari Kujala ◽  
Elina Laukka ◽  
Pirjo Hilama ◽  
...  
Keyword(s):  
Social Care ◽  
Service Providers ◽  
Qualitative Content Analysis ◽  
Implementation Process ◽  
Digital Services ◽  
Routine Work ◽  
Qualitative Interview Study ◽  
Health And Social Care ◽  
Work Tasks ◽  
The Impact

BACKGROUND Although the COVID-19 pandemic has significantly boosted the implementation of digital services worldwide, it has become increasingly important to understand how these solutions are integrated into professionals’ routine work. Professionals who are using the services are key influencers in the success of implementations. To ensure successful implementations, it is important to understand the multiprofessional perspective, especially because implementations are likely to increase even more. OBJECTIVE The aim of this study is to examine health and social care professionals’ experiences of digital service implementations and to identify factors that support successful implementations and should be considered in the future to ensure that the services are integrated into professionals’ routine work. METHODS A qualitative approach was used, in which 8 focus group interviews were conducted with 30 health and social care professionals from 4 different health centers in Finland. Data were analyzed using qualitative content analysis. The resulting categories were organized under the components of normalization process theory. RESULTS Our results suggested 14 practices that should be considered when implementing new digital services into routine work. To get professionals to understand and make sense of the new service, (1) the communication related to the implementation should be comprehensive and continuous and (2) the implementation process should be consistent. (3) A justification for the service being implemented should also be given. The best way to engage the professionals with the service is (4) to give them opportunities to influence and (5) to make sure that they have a positive attitude toward the service. To enact the new service into professionals’ routine work, it is important that (6) the organization take a supportive approach by providing support from several easy and efficient sources. The professionals should also have (7) enough time to become familiar with the service, and they should have (8) enough know-how about the service. The training should be (9) targeted individually according to skills and work tasks, and (10) it should be diverse. The impact of the implementation on the professionals’ work should be evaluated. The service (11) should be easy to use, and (12) usage monitoring should happen. An opportunity (13) to give feedback on the service should also be offered. Moreover, (14) the service should support professionals’ work tasks. CONCLUSIONS We introduce 14 practices for organizations and service providers on how to ensure sustainable implementation of new digital services and the smooth integration into routine work. It is important to pay more attention to comprehensive and continuing communication. Organizations should conduct a competence assessment before training in order to ensure proper alignment. Follow-ups to the implementation process should be performed to guarantee sustainability of the service. Our findings from a forerunner country of digitalization can be useful for countries that are beginning their service digitalization or further developing their digital services.

scholarly journals 138 The Role of Health and Social Care Professional Teams in the Emergency Department: A Qualitative Study of Key Stakeholders’ Views

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
Marica Cassarino ◽  
Katie Robinson ◽  
Rosie Quinn ◽  
Fiona Boland ◽  
Marie E Ward ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Qualitative Study ◽  
Social Care ◽  
Care Delivery ◽  
System Level ◽  
Social Care Professional ◽  
Health And Social Care ◽  
Wide Range

Abstract Background Introducing Health and Social Care Professional (HSCP) teams to the emergency department (ED) has increasingly demonstrated benefits for ED patient and process outcomes. However, there is a dearth of research exploring the views of key ED stakeholders on the role of HSCP teams in care delivery the ED. This qualitative study investigated the perspectives of a wide range of ED stakeholders about HSCPs teams working in the ED. Methods A total of 65 participants including older adults who had recently attended the ED and their carers/relatives, ED doctors and nurses, HSCPs and pre-hospital staff participated in four World Café style focus groups and individual interviews across two Irish hospital sites. Written and audio-recorded data were transcribed and thematically analysed. Results Overall, participants expressed positive views on HSCPs working in teams in the ED, with benefits for patients, staff members and the hospital (Theme 1). Having an ED-based HSCP team was described as promoting effective and timely decision-making and a more integrated approach to patient care, particularly for frail older adults with complex needs (Theme 2). Barriers and enablers for effective implementation were identified at multiple levels (Theme 3) including the ED physical environment, (e.g., space and equipment), operational factors (e.g., working hours), and relations (e.g., patient-staff or staff-staff communication); factors at system level included availability of community resources and financial pressures. Conclusion Our study indicates overall acceptability of HSCPs working in teams in the ED and positive views on their contribution to enhance the quality care of older adults. However, a number of operational and relational factors need to be considered to ensure feasibility and effectiveness. This information is crucial to inform implementation.

scholarly journals Psychosocial impact on frontline health and social care professionals in the UK during the COVID-19 pandemic: a qualitative interview study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e047353
Author(s):  
Henry Aughterson ◽  
Alison R McKinlay ◽  
Daisy Fancourt ◽  
Alexandra Burton
Keyword(s):  
Personal Growth ◽  
Social Care ◽  
Well Being ◽  
Work Conditions ◽  
Individual Interviews ◽  
Work Related ◽  
Qualitative Interview Study ◽  
Health And Social Care ◽  
Communication Challenges ◽  
The Uk

ObjectivesTo explore the psychosocial well-being of health and social care professionals working during the COVID-19 pandemic.DesignThis was a qualitative study deploying in-depth, individual interviews, which were audio-recorded and transcribed verbatim. Thematic analysis was used for coding.ParticipantsThis study involved 25 participants from a range of frontline professions in health and social care.SettingInterviews were conducted over the phone or video call, depending on participant preference.ResultsFrom the analysis, we identified 5 overarching themes: communication challenges, work-related stressors, support structures, personal growth and individual resilience. The participants expressed difficulties such as communication challenges and changing work conditions, but also positive factors such as increased team unity at work, and a greater reflection on what matters in life.ConclusionsThis study provides evidence on the support needs of health and social care professionals amid continued and future disruptions caused by the pandemic. It also elucidates some of the successful strategies (such as mindfulness, hobbies, restricting news intake, virtual socialising activities) deployed by health and social care professionals that can support their resilience and well-being and be used to guide future interventions.

scholarly journals Occupational therapists’ experiences of enabling people to participate in sport

2020 ◽  
pp. 030802262097394
Author(s):  
Deborah Bullen ◽  
Channine Clarke
Keyword(s):  
Qualitative Study ◽  
Occupational Therapy ◽  
Thematic Analysis ◽  
Social Care ◽  
Occupational Therapists ◽  
Phenomenological Approach ◽  
Scope Of Practice ◽  
Local Populations ◽  
Care Services ◽  
Health And Social Care

Introduction In response to growing demands on health and social care services there is an emphasis on communities addressing the needs of local populations to improve lives and reduce inequalities. Occupational therapists are responding to these demands by expanding their scope of practice into innovative settings, such as working with refugees, the homeless and residents of nursing homes, and within sport and leisure environments. The benefits of sport are widely acknowledged, and this paper argues that occupational therapists could play a pivotal role in enabling people to participate. Method This qualitative study drew on a phenomenological approach and used interviews and thematic analysis to explore five occupational therapists’ experiences of enabling people to participate in sport. Findings Findings revealed that participants demonstrated the uniqueness of occupational therapy when enabling people to participate in sport and practised according to their professional philosophy. There were opportunities to reach wider communities and promote the value of occupational therapy by collaborating with organisations, but there were also challenges when working outside of traditional settings. Conclusion The study emphasises the unique skills occupational therapists can bring to this setting. It highlights opportunities to expand their practice, to forge new partnerships in sports and leisure environments, and to address the national inactivity crisis.

scholarly journals Facilitating integrated delivery of services across organisational boundaries: Essential enablers to integration

2017 ◽  
Vol 80 (5) ◽  
pp. 302-309
Author(s):  
Stephanie Best
Keyword(s):  
United Kingdom ◽  
Qualitative Study ◽  
Service Provision ◽  
Social Care ◽  
Occupational Therapists ◽  
Leadership Communication ◽  
The United Kingdom ◽  
Health And Social Care ◽  
Integration Of Services ◽  
Integrated Delivery

Introduction Integrating services is a key tenet to developing services across the United Kingdom. While many aspects of integration have been explored, how to facilitate integration of services remains unclear. Method An exploratory qualitative study was undertaken in 2015 to explore occupational therapists’ perceptions on integrating service provision across health and social care organisational boundaries. The views of practitioners who had experienced integration were sought on a range of aspects of integrating services. This paper focuses on the facilitators for delivering integration and the essential enablers are identified. Findings Numerous factors were noted to facilitate integration and three essential enablers were highlighted. Leadership, communication and joint education were recognised as playing a central role in integrating services across organisational boundaries; without these three essential enablers, integration is liable to fail. Conclusion Integration is a process rather than an event; continued emphasis will be required on leadership, communication and joint education to progress integration achievements made to date.

scholarly journals Exploring the role of the Care and Health Information Exchange (CHIE) in clinical decision-making: a realist evaluation

2020 ◽  
Author(s):  
Philip Scott ◽  
Elisavet Andrikopoulou ◽  
Haythem Nakkas ◽  
Paul Roderick
Keyword(s):  
Decision Making ◽  
Health Information ◽  
Information Exchange ◽  
Healthcare Professionals ◽  
Clinical Decision Making ◽  
Social Care ◽  
Health Information Exchange ◽  
Clinical Decision ◽  
Health And Social Care ◽  
The Impact

Background: The overall evidence for the impact of electronic information systems on cost, quality and safety of healthcare remains contested. Whilst it seems intuitively obvious that having more data about a patient will improve care, the mechanisms by which information availability is translated into better decision-making are not well understood. Furthermore, there is the risk of data overload creating a negative outcome. There are situations where a key information summary can be more useful than a rich record. The Care and Health Information Exchange (CHIE) is a shared electronic health record for Hampshire and the Isle of Wight that combines key information from hospital, general practice, community care and social services. Its purpose is to provide clinical and care professionals with complete, accurate and up-to-date information when caring for patients. CHIE is used by GP out-of-hours services, acute hospital doctors, ambulance service, GPs and others in caring for patients. Research questions: The fundamental question was How does awareness of CHIE or usage of CHIE affect clinical decision-making? The secondary questions were What are the latent benefits of CHIE in frontline NHS operations? and What is the potential of CHIE to have an impact on major NHS cost pressures? The NHS funders decided to focus on acute medical inpatient admissions as the initial scope, given the high costs associated with hospital stays and the patient complexities (and therefore information requirements) often associated with unscheduled admissions. Methods: Semi-structured interviews with healthcare professionals to explore their experience about the utility of CHIE in their clinical scenario, whether and how it has affected their decision-making practices and the barriers and facilitators for their use of CHIE. The Framework Method was used for qualitative analysis, supported by the software tool Atlas.ti. Results: 21 healthcare professionals were interviewed. Three main functions were identified as useful: extensive medication prescribing history, information sharing between primary, secondary and social care and access to laboratory test results. We inferred two positive cognitive mechanisms: knowledge confidence and collaboration assurance, and three negative ones: consent anxiety, search anxiety and data mistrust. Conclusions: CHIE gives clinicians the bigger picture to understand the patient's health and social care history and circumstances so as to make confident and informed decisions. CHIE is very beneficial for medicines reconciliation on admission, especially for patients that are unable to speak or act for themselves or who cannot remember their precise medication or allergies. We found no clear evidence that CHIE has a significant impact on admission or discharge decisions. We propose the use of recommender systems to help clinicians navigate such large volumes of patient data, which will only grow as additional data is collected.

Sign in / Sign up

Export Citation Format

Share Document