scholarly journals Inconvenient truths in suicide prevention: Why a Restorative Just Culture should be implemented alongside a Zero Suicide Framework

2020 ◽  
Vol 54 (6) ◽  
pp. 571-581 ◽  
Author(s):  
Kathryn Turner ◽  
Nicolas JC Stapelberg ◽  
Jerneja Sveticic ◽  
Sidney WA Dekker
Keyword(s):  
Health Care ◽  
Suicide Prevention ◽  
Cultural Change ◽  
Successful Implementation ◽  
Just Culture ◽  
Healthcare Settings ◽  
Prevailing Paradigm ◽  
Specialist Services ◽  
Erroneous Belief ◽  
Outcome Biases

Objective: The prevailing paradigm in suicide prevention continues to contribute to the nihilism regarding the ability to prevent suicides in healthcare settings and a sense of blame following adverse incidents. In this paper, these issues are discussed through the lens of clinicians’ experiences as second victims following a loss of a consumer to suicide, and the lens of health care organisations. Method: We discuss challenges related to the fallacy of risk prediction (erroneous belief that risk screening can be used to predict risk or allocate resources), and incident reviews that maintain a retrospective linear focus on errors and are highly influenced by hindsight and outcome biases. Results: An argument that a Restorative Just Culture should be implemented alongside a Zero Suicide Framework is developed. Conclusions: The current use of algorithms to determine culpability following adverse incidents, and a linear approach to learning ignores the complexity of the healthcare settings and can have devastating effects on staff and the broader healthcare community. These issues represent ‘inconvenient truths’ that must be identified, reconciled and integrated into our future pathways towards reducing suicides in health care. The introduction of Zero Suicide Framework can support the much-needed transition from relying on a retrospective focus on errors (Safety I) to a more prospective focus which acknowledges the complexities of healthcare (Safety II), when based on the Restorative Just Culture principles. Restorative Just Culture replaces backward-looking accountability with a focus on the hurts, needs and obligations of all who are affected by the event. In this paper, we argue that the implementation of Zero Suicide Framework may be compromised if not supported by a substantial workplace cultural change. The process of responding to critical incidents implemented at the Gold Coast Mental Health and Specialist Services is provided as an example of a successful implementation of Restorative Just Culture–based principles that has achieved a culture change required to support learning, improving and healing for our consumers, their families, our staff and broader communities.

Impact of a management innovation on professional subcultures – the case of a balanced scorecard implementation in a Chinese hospital

2020 ◽  
Vol 14 (4) ◽  
pp. 857-869
Author(s):  
Tian Gao ◽  
Bruce Gurd
Keyword(s):  
Health Care ◽  
Cultural Change ◽  
Balanced Scorecard ◽  
Research Process ◽  
Successful Implementation ◽  
Management Innovation ◽  
Longitudinal Case Study ◽  
Dominant Group ◽  
Content Type ◽  
Professional Groups

Purpose The balanced scorecard (BSC) has been a popular management innovation in health care. Implementing an innovation like the BSC can change the professional subcultures of a hospital. The purpose of this paper is to measure subcultures to establish the level of change during the implementation of a management innovation in a single Chinese public hospital. Design/methodology/approach Four surveys were administered to the staff of a single hospital, and a 100,000-word research diary was compiled from observation of the research process. A longitudinal case study design was administered from 2006 to 2009. The competing values tool was administered twice to assess organizational cultural change. Findings There was a change in the culture of different professional groups. The group with the strongest dominating culture type, which relies on cohesion, morale and employee participation in decision-making, shows the most positive change in cultural types during the BSC implementation process. Management innovations such as the BSC can create more balance in each professional group. Practical implications The successful implementation of a management innovation in a hospital requires the managers to consider meeting the demand of medical professional groups and achieve desired culture type change, which in turn may help to achieve the expected results. Originality/value This paper provides support to the finding that groups with a dominant group culture are more receptive to change and implementing a management innovation can influence professional group’s culture. It also provides evidence that the implementation of BSC can create more balance in each professional group’s culture. Although these findings come from health care, it may have relevance to other contexts in China.

Integrating eHealth within a transforming healthcare setting: a qualitative study into values, challenges, and prerequisites. (Preprint)

2021 ◽  
Author(s):  
Karin CAG Lorenz-Artz ◽  
Joyce JPA Bierbooms ◽  
Inge MB Bongers
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Healthcare Service ◽  
Healthcare Setting ◽  
Successful Implementation ◽  
Structured Interviews ◽  
Community Based ◽  
Access To Treatment ◽  
Healthcare Settings

BACKGROUND The EU has stated that mental health care services should become more person-centered and community-based. eHealth may contribute to this change by allowing clients to take an active, decision-making role in their healthcare service. In the Netherlands, five organizations currently use the open dialogue (OD) approach, which is an example of a person-centered and community-based healthcare service. OD is a unique approach to organizing care and therapeutic intervention for people who need mental health support. One of these Dutch organizations has integrated the OD approach with eHealth. OBJECTIVE The aim of this study is to help the transition towards person-centered and community-based care models by improving our understanding of eHealth and by showing how eHealth can best be integrated into a transforming healthcare service. The objective is to better understand the value of eHealth within OD practice, and to define the challenges and prerequisites for implementing eHealth within this transforming practice. METHODS This qualitative, practice-oriented field study is part of a pilot project of an ambulatory OD team in a Dutch mental health care institute. In total, 29 semi-structured interviews were held with clients, social network members, and OD professionals between December 2017 and March 2019. We used a thematic coding approach for analyses. RESULTS eHealth was considered mainly beneficial outside the treatment meetings as it improves communication, simplifies planning of treatment meetings, and provides a broader access to treatment. Videoconferencing was considered an acceptable alternative if someone could not attend treatment meetings in person. Several challenges were identified regarding the implementation of eHealth into OD practices: (1) a lack of trust and interest in eHealth, (2) a lack of knowledge about eHealth, (3) the strong conviction that face-to-face contact is needed for effective care, (4) normative pressure to offer eHealth, and (5) introducing eHealth during the start-up of a new OD team. This study has highlighted the multi-level complexity of implementing eHealth and has identified several prerequisites for successful implementation on individual, organization, society, and digital-product levels. CONCLUSIONS The benefits and challenges of eHealth have been identified as well as the prerequisites for its implementation. An important dilemma is to what extent eHealth should be used in healthcare settings when the client is not motivated to use it. We need to find the balance between using eHealth and letting clients refuse to use it. Interviewees emphasized the relevance of a continuous dialogue about eHealth to improve understanding of the possibilities and limitations of eHealth within healthcare settings that are transitioning towards client-centered and network-oriented care, such as OD.

COVID-19: The Importance of Adequate Personal Protective Equipment in Healthcare Medical Staff

2020 ◽  
Author(s):  
Anne Weissenstein
Keyword(s):  
Health Care ◽  
Personal Protective Equipment ◽  
Health Care Services ◽  
Infection Prevention And Control ◽  
Protective Equipment ◽  
Emotional Resilience ◽  
Healthcare Facilities ◽  
Care Services ◽  
Healthcare Settings ◽  
And Control

We present an update on infection prevention and control for COVID-19 in healthcare settings. This update focuses on measures to be applied in settings with increasing community transmission, growing demand for concern about COVID-19 patients, and subsequent staffing issues in the event of shortages of personal protective equipment for healthcare facilities worldwide. The comfort and emotional resilience of health care workers are key components in maintaining essential health care services during the COVID-19 virus (coronavirus) outbreak.

scholarly journals Perceived appropriateness of alcohol screening and brief advice programmes in Colombia, Mexico and Peru and barriers to their implementation in primary health care – a cross-sectional survey

2021 ◽  
Vol 22 ◽  
Author(s):  
Daša Kokole ◽  
Liesbeth Mercken ◽  
Eva Jané-Llopis ◽  
Guillermina Natera Rey ◽  
Miriam Arroyo ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Latin American ◽  
Contextual Factors ◽  
Alcohol Screening ◽  
Successful Implementation ◽  
Implementation Framework ◽  
Effective Measure ◽  
Primary Health ◽  
Brief Advice

Abstract Background: Providing alcohol screening and brief advice (SBA) in primary health care (PHC) can be an effective measure to reduce alcohol consumption. To aid successful implementation in an upper middle-income country context, this study investigates the perceived appropriateness of the programme and the perceived barriers to its implementation in PHC settings in three Latin American countries: Colombia, Mexico and Peru, as part of larger implementation study (SCALA). Methods: An online survey based on the Tailored Implementation for Chronic Diseases (TICD) implementation framework was disseminated in the three countries to key stakeholders with experience in the topic and/or setting (both health professionals and other roles, for example regional health administrators and national experts). In total, 55 respondents participated (66% response rate). For responses to both appropriateness and barriers questions, frequencies were computed, and country comparisons were made using Chi square and Kruskal–Wallis non-parametric tests. Results: Alcohol SBA was seen as an appropriate programme to reduce heavy alcohol use in PHC and a range of providers were considered suitable for its delivery, such as general practitioners, nurses, psychologists and social workers. Contextual factors such as patients’ normalised perception of their heavy drinking, lack of on-going support for providers, difficulty of accessing referral services and lenient alcohol control laws were the highest rated barriers. Country differences were found for two barriers: Peruvian respondents rated SBA guidelines as less clear than Mexican (Mann–Whitney U = −18.10, P = 0.001), and more strongly indicated lack of available screening instruments than Colombian (Mann–Whitney U = −12.82, P = 0.035) and Mexican respondents (Mann–Whitney U = −13.56, P = 0.018). Conclusions: The study shows the need to address contextual factors for successful implementation of SBA in practice. General congruence between the countries suggests that similar approaches can be used to encourage widespread implementation of SBA in all three studied countries, with minor tailoring based on the few country-specific barriers.

scholarly journals 7E.003 Health care providers’ perceptions of the barriers to suicide prevention in Mexico

2021 ◽  
Author(s):  
Lourdes Gómez-García ◽  
Marcela Agudelo-Botero ◽  
Maria de la Luz Arenas-Monreal ◽  
Mario Rojas-Russell ◽  
Rosario Valdez-Santiago
Keyword(s):  
Health Care ◽  
Suicide Prevention ◽  
Health Care Providers ◽  
Care Providers

scholarly journals Optimizing Scarce Resource Allocation During COVID-19: Rapid Creation of a Regional Health-Care Coalition and Triage Teams in San Diego County, California

2020 ◽  
pp. 1-7
Author(s):  
Asha Devereaux ◽  
Holly Yang ◽  
Gilbert Seda ◽  
Viji Sankar ◽  
Ryan C. Maves ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Resource Allocation ◽  
San Diego ◽  
Scarce Resource ◽  
Successful Implementation ◽  
Regional Health ◽  
Incident Command ◽  
Regional Health Care ◽  
Crisis Care

ABSTRACT Successful management of an event where health-care needs exceed regional health-care capacity requires coordinated strategies for scarce resource allocation. Publications for rapid development, training, and coordination of regional hospital triage teams to manage the allocation of scarce resources during coronavirus disease 2019 (COVID-19) are lacking. Over a period of 3 weeks, over 100 clinicians, ethicists, leaders, and public health authorities convened virtually to achieve consensus on how best to save the most lives possible and share resources. This is referred to as population-based crisis management. The rapid regionalization of 22 acute care hospitals across 4500 square miles in the midst of a pandemic with a shifting regulatory landscape was challenging, but overcome by mutual trust, transparency, and confidence in the public health authority. Because many cities are facing COVID-19 surges, we share a process for successful rapid formation of health-care care coalitions, Crisis Standard of Care, and training of Triage Teams. Incorporation of continuous process improvement and methods for communication is essential for successful implementation. Use of our regional health-care coalition communications, incident command system, and the crisis care committee helped mitigate crisis care in the San Diego and Imperial County region as COVID-19 cases surged and scarce resource collaborative decisions were required.

Telemedicine During A Crisis: Challenges, Opportunities & Way Forward At A Tertiary Care Hospital (Preprint)

2021 ◽  
Author(s):  
Sadia Masood ◽  
Zanaib Samad ◽  
Sarah Nadeem ◽  
Unzela Ghulam
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Cost Effective ◽  
Successful Implementation ◽  
Care Hospital ◽  
Quality Health Care ◽  
Cross Sectional ◽  
Innovative Strategy

BACKGROUND Telemedicine is utilized to deliver health care services remotely. Recently, it is well established due to pandemics because it can help the patients get required supportive care while minimizing their hospital exposure. In the future, it will continue to be used as a convenient, cost-effective patient care modality. OBJECTIVE The objectives were to identify physicians' challenges during teleconsultations and recognize the opportunities and strengths of this modality during the pandemic in a lower-income country. METHODS This cross-sectional study was conducted in a tertiary care hospital. The self-made questionnaire was filled through an online medium and responses were recorded on a five-point Likert scale. RESULTS A total of 83 participants were enrolled in this study. Most of them were Associate professors (29.8%), Assistant professors (26.2%), the ratio of the females was (52.4%) greater than males (,47.6%). 46 (54.8%) have laid between the age group 30-40 years. Pediatricians and senior instructors faced more difficulty in using telemedicine. The ones having clinical experience of fewer than 15 years or categorized in the age of 50-60 years faced challenges while using this modality. CONCLUSIONS During the current pandemic, situation telemedicine is the only glimmer of light to provide better quality health care. Telemedicine is an innovative strategy and it is important to understand the perception of physicians about it. Incomplete and inadequate infrastructure and attitude of the physicians is the main obstacle toward successful implementation of telemedicine. Successful installation and deployment of this technology require a complete grasp of the process among physicians.

Creating a Culture of Continuous Improvement in Outpatient Laboratories: Effects on Wait Times, Employee Engagement, and Efficiency

2018 ◽  
Vol 34 (4) ◽  
pp. 389-397
Author(s):  
Joseph Featherall ◽  
Alexander Chaitoff ◽  
Anthony Simonetti ◽  
James Bena ◽  
Daniel Kubiak ◽  
...  
Keyword(s):  
Health Care ◽  
Confidence Interval ◽  
Employee Engagement ◽  
Continuous Improvement ◽  
Cultural Change ◽  
Odds Ratio ◽  
Health Care Quality ◽  
Care Quality ◽  
Wait Times ◽  
Full Time

Transforming health care remains a challenge as many continuous improvement (CI) initiatives fail or are not sustained. Although the literature suggests the importance of culture, few studies provide evidence of cultural change creating sustained CI. This improvement initiative focused on creating cultural change through goal alignment, visual management, and empowering frontline employees. Data included 113 133 encounters. Cochran-Armitage tests and X-bar charting compared wait times during the CI initiative. Odds of waiting <15 minutes increased in both phase 2 (odds ratio = 3.57, 95% confidence interval = [3.43-3.71]) and phase 3 (odds ratio = 5.39, 95% confidence interval = [5.07, 5.74]). At 3 years follow-up, 95% of wait times were <15 minutes. Productivity increased from 519 to 644 patients/full-time equivalent/month; 33/42 Press Ganey employee engagement components significantly improved. This study demonstrates the efficacy of a culture of CI approach to sustain wait time improvement in outpatient laboratory services, and should be considered for application in other areas of health care quality.

scholarly journals Perceptions of Home Telemonitoring Use Among Patients With Chronic Obstructive Pulmonary Disease: Qualitative Study

10.2196/16343 ◽  
2020 ◽  
Vol 8 (6) ◽  
pp. e16343 ◽  
Author(s):  
Sara Lundell ◽  
Mari Modig ◽  
Åsa Holmner ◽  
Karin Wadell
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Health Care ◽  
Pulmonary Disease ◽  
Self Management ◽  
Easy Access ◽  
Chronic Obstructive ◽  
Successful Implementation ◽  
Obstructive Pulmonary Disease ◽  
Major Health Problem ◽  
Home Telemonitoring

Background Chronic obstructive pulmonary disease (COPD) is a major health problem and an economic burden globally. There is growing interest in how electronic health (eHealth) can be used to provide efficient health care. Telemonitoring, where the patient’s health-related data is transmitted to a health care provider, can be used to detect early signs of exacerbations. A successful implementation of telemonitoring systems into clinical practice requires in-depth knowledge of the users’ preferences. Objective The aim of this study was to explore perceptions of the use of a home telemonitoring system among patients with COPD. Methods Semistructured individual interviews were carried out with 8 women and 5 men who were participants in a project aimed at developing and evaluating a telemonitoring system. The web-based telemonitoring system measured pulmonary function, subjective symptoms, and oxygen saturation. Participants were interviewed after having used the system for 2-4 months. Interview transcripts were analyzed with qualitative content analysis. Results The analysis resulted in the theme A transition toward increased control and security and four categories: using with (in)security, affecting technical concern or confidence, providing easy access to health care, and increasing control over the disease. The participants reported various perceptions of using the telemonitoring system. They expressed initial feelings of insecurity, both in terms of operating the system and in terms of their disease. However, the practical management of the telemonitoring system became easier with time; the participants gradually gained confidence and improved their self-management. New technology was perceived as an important complement to existing health care, but the importance of maintaining a human contact in real life or through the telemonitoring system was emphasized. Conclusions This study captured a transition among the participants from being insecure and experiencing technical concerns to acquiring technical confidence and improving disease management. Telemonitoring can be a valuable complement to health care, leading to increased self-knowledge, a sense of security, and improved self-management. Suggestions to improve the further development and implementation of telemonitoring systems include better patient education and the involvement of end users in the technical development process. Additional research is needed, particularly in the design of user-friendly systems, as well as in developing tools to predict which patients are most likely to find the equipment useful, as this may result in increased empowerment, improved quality of life, reduced costs, and a contribution to equity in health.

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