scholarly journals Orthopedist involvement in the management of clinical activities: a case study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
André Côté ◽  
Kassim Said Abasse ◽  
Maude Laberge ◽  
Marie-Hélène Gilbert ◽  
Mylaine Breton ◽  
...  
Keyword(s):  
Healthcare Delivery ◽  
University Hospital ◽  
Structured Interviews ◽  
Institutional Dynamics ◽  
Level Of Involvement ◽  
Hospital Governance ◽  
Efficiency And Effectiveness ◽  
Data Saturation ◽  
Orthopedic Care ◽  
Four Levels

Abstract Background The rapid shift in hospital governance in the past few years suggests greater orthopedist involvement in management roles, would have wide-reaching benefits for the efficiency and effectiveness of healthcare delivery. This paper analyzes the dynamics of orthopedist involvement in the management of clinical activities for three orthopedic care pathways, by examining orthopedists’ level of involvement, describing the implications of such involvement, and indicating the main responses of other healthcare workers to such orthopedist involvement. Methods We selected four contrasting cases according to their level of governance in a Canadian university hospital center. We documented the institutional dynamics of orthopedist involvement in the management of clinical activities using semi-structured interviews until data saturation was reached at the 37th interview. Results Our findings show four levels (Inactive, Reactive, Contributory and Active) of orthopedist involvement in clinical activities. With the underlying nature of orthopedic surgeries, there are: (i) some activities for which decisions cannot be programmed in advance, and (ii) others for which decisions can be programmed. The management of unforeseen events requires a higher level of orthopedist involvement than the management of events that can be programmed. Conclusions Beyond simply identifying the underlying dynamics of orthopedists’ involvement in clinical activities, this study analyzed how such involvement impacts management activities and the quality-of-care results for patients.

scholarly journals Shifting Care from Hospital to Community, A Strategy to Integrate Care in Singapore: Process Evaluation of Implementation Fidelity

2019 ◽  
Author(s):  
Milawaty Nurjono ◽  
Pami Shrestha ◽  
Ian Yi Han Ang ◽  
Farah Shiraz ◽  
Ke Xin Eh ◽  
...  
Keyword(s):  
Health System ◽  
Functional Integration ◽  
Healthcare Delivery ◽  
Implementation Fidelity ◽  
Realist Evaluation ◽  
University Hospital ◽  
Specialist Care ◽  
Structured Interviews ◽  
National University ◽  
Further Development

Abstract Background: Accessibility to efficient and person-centered healthcare delivery drive healthcare transformation in many countries. In Singapore, specialist outpatient clinics (SOCs) are commonly congested due to increasing demands for chronic care. To improve this situation, the National University Health System (NUHS) Regional Health System (RHS) started an integrated care initiative,the Right-Site Care (RSC) program in 2014. Through collaborations between SOCs at the National University Hospital and primary and community care (PCC) clinics in the western region of the county, the program was designed to facilitate timely discharge and appropriate transition of patients, who no longer required specialist care, to the community. The aim of this study was to evaluate the implementation fidelity of the NUHS RHS RSC program using the modified Conceptual Framework for Implementation Fidelity (CFIF), at three distinct levels; providers, organizational, and system levels to explain outcomes of the program and to inform further development of (similar) programs. Methods: A convergent parallel mixed methods study using the realist evaluation approach was used. Data were collected between 2016-2018 through non-participatory observations, reviews of medical records and program database, together with semi-structured interviews with healthcare providers. Triangulation of data streams was applied guided by the modified CFIF. Results: Our findings showed four out of six program components were implemented with low level of fidelity, and 9,112 suitable patients were referred to the program while 3,032 (33.3%) declined to be enrolled. Moderating factors found to influence fidelity included: (i) complexity of program, (ii) evolving providers’ responsiveness, (iii) facilitation through synergistic partnership, training of PCC providers by specialists and supportive structures: care coordinators, guiding protocols, shared electronic medical record and shared pharmacy, (iv) lack of organization reinforcement, and (v) mismatch between program goals, healthcare financing and providers’ reimbursement. Conclusion: Functional integration alone is insufficient for a successful right-site care program implementation. Improvement in relationships between providers, organizations, and patients are also warranted for further development of the program.

Juggling Multiple Roles amidst Uncertainty: The Asian Father's Perspective of an Infant in Neonatal Intensive Care Unit

2020 ◽  
Author(s):  
Berenice Xueli Lian ◽  
Zubair Amin ◽  
Ramkumar Aishworiya
Keyword(s):  
Intensive Care ◽  
Support Groups ◽  
Neonatal Intensive Care ◽  
Low Birthweight ◽  
Multiple Roles ◽  
University Hospital ◽  
Structured Interviews ◽  
Family Work ◽  
Data Saturation ◽  
Qualitative Descriptive

Objective Parents of preterm, very low birthweight (VLBW) infants in neonatal intensive care units (NICU) undergo emotional turmoil. Studies on parent's experiences typically focus on the maternal perspective. The purpose of the study is to explore the emotional needs and experiences of fathers of VLBW neonates in the NICU and to identify ways to improve their experiences. Study Design This was a qualitative descriptive design study undertaken at the NICU of a tertiary university hospital. Convenience sampling with predefined inclusion and exclusion criteria was used to identify prospective participants. Semi-structured interviews were conducted with 15 fathers of infants until data saturation was reached. The COREQ (Consolidated Criteria for Reporting Qualitative Studies) checklist was used. Results Father's experiences were classified into the topics of concerns, roles, and perspectives. Uncertainty was a predominant theme in each of these. Fathers assume multiple roles toward the child, wife, self, and family. Their concerns were multifaceted involving the child, family, work, and finances; they experienced a myriad of emotions, but these evolved into resilience eventually. Conclusion Fathers have unique concerns pertinent to having an infant in the NICU. They juggle multiple roles and transition to emotions of resilience. It is imperative to acknowledge the uncertainty and diverse roles of fathers, provide them with customized information, and develop more balanced parent-support groups. Key Points

scholarly journals Shifting Care from Hospital to Community, A Strategy to Integrate Care in Singapore: Process Evaluation of Implementation Fidelity

2019 ◽  
Author(s):  
Milawaty Nurjono ◽  
Pami Shrestha ◽  
Ian Yi Han Ang ◽  
Farah Shiraz ◽  
Ke Xin Eh ◽  
...  
Keyword(s):  
Health System ◽  
Functional Integration ◽  
Healthcare Delivery ◽  
Implementation Fidelity ◽  
Realist Evaluation ◽  
University Hospital ◽  
Specialist Care ◽  
Structured Interviews ◽  
National University ◽  
Further Development

Abstract Background: Accessibility to efficient and person-centered healthcare delivery drive healthcare transformation in many countries. In Singapore, specialist outpatient clinics (SOCs) are commonly congested due to increasing demands for chronic care. To improve this situation, the National University Health System (NUHS) Regional Health System (RHS) started an integrated care initiative,the Right-Site Care (RSC) program in 2014. Through collaborations between SOCs at the National University Hospital and primary and community care (PCC) clinics in the western region of the county, the program was designed to facilitate timely discharge and appropriate transition of patients, who no longer required specialist care, to the community. The aim of this study was to evaluate the implementation fidelity of the NUHS RHS RSC program using the modified Conceptual Framework for Implementation Fidelity (CFIF), at three distinct levels; providers, organizational, and system levels to explain outcomes of the program and to inform further development of (similar) programs. Methods: A convergent parallel mixed methods study using the realist evaluation approach was used. Data were collected between 2016-2018 through non-participatory observations, reviews of medical records and program database, together with semi-structured interviews with healthcare providers. Triangulation of data streams was applied guided by the modified CFIF. Results: Our findings showed four out of six program components were implemented with low level of fidelity, and 9,112 suitable patients were referred to the program while 3,032 (33.3%) declined to be enrolled. Moderating factors found to influence fidelity included: (i) complexity of program, (ii) evolving providers’ responsiveness, (iii) facilitation through synergistic partnership, training of PCC providers by specialists and supportive structures: care coordinators, guiding protocols, shared electronic medical record and shared pharmacy, (iv) lack of organization reinforcement, and (v) mismatch between program goals, healthcare financing and providers’ reimbursement. Conclusion: Functional integration alone is insufficient for a successful right-site care program implementation. Improvement in relationships between providers, organizations, and patients are also warranted for further development of the program.

scholarly journals Shifting Care from Hospital to Community, A Strategy to Integrate Care in Singapore: Process Evaluation of Implementation Fidelity

2020 ◽  
Author(s):  
MILAWATY NURJONO ◽  
Pami Shrestha ◽  
Ian Yi Han Ang ◽  
Farah Shiraz ◽  
Ke Xin Eh ◽  
...  
Keyword(s):  
Health System ◽  
Functional Integration ◽  
Healthcare Delivery ◽  
Implementation Fidelity ◽  
Realist Evaluation ◽  
University Hospital ◽  
Specialist Care ◽  
Structured Interviews ◽  
National University ◽  
Further Development

Abstract Background: Accessibility to efficient and person-centered healthcare delivery drives healthcare transformation in many countries. In Singapore, specialist outpatient clinics (SOCs) are commonly congested due to increasing demands for chronic care. To improve this situation, the National University Health System (NUHS) Regional Health System (RHS) started an integrated care initiative, the Right-Site Care (RSC) program in 2014. Through collaborations between SOCs at the National University Hospital and primary and community care (PCC) clinics in the western region of the county, the program was designed to facilitate timely discharge and appropriate transition of patients, who no longer required specialist care, to the community. The aim of this study was to evaluate the implementation fidelity of the NUHS RHS RSC program using the modified Conceptual Framework for Implementation Fidelity (CFIF), at three distinct levels; providers, organizational, and system levels to explain outcomes of the program and to inform further development of (similar) programs. Methods: A convergent parallel mixed methods study using the realist evaluation approach was used. Data were collected between 2016-2018 through non-participatory observations, reviews of medical records and program database, together with semi-structured interviews with healthcare providers. Triangulation of data streams was applied guided by the modified CFIF. Results: Our findings showed four out of six program components were implemented with low level of fidelity, and 9,112 suitable patients were referred to the program while 3,032 (33.3%) declined to be enrolled. Moderating factors found to influence fidelity included: (i) complexity of program, (ii) evolving providers’ responsiveness, (iii) facilitation through synergistic partnership, training of PCC providers by specialists and supportive structures: care coordinators, guiding protocols, shared electronic medical record and shared pharmacy, (iv) lack of organization reinforcement, and (v) mismatch between program goals, healthcare financing and providers’ reimbursement. Conclusion: Functional integration alone is insufficient for a successful right-site care program implementation. Improvement in relationships between providers, organizations, and patients are also warranted for further development of the program.

scholarly journals Chinese NGO-Firm Partnerships and CSR from an Institutional Perspective

2014 ◽  
Vol 43 (4) ◽  
pp. 41-74 ◽  
Author(s):  
Douglas Whitehead
Keyword(s):  
Corporate Social Responsibility ◽  
Social Responsibility ◽  
Institutional Setting ◽  
Chinese Government ◽  
Institutional Perspective ◽  
Institutional Dynamics ◽  
Level Of Involvement ◽  
Government Institutions ◽  
Institutional Settings ◽  
Corporate Social

NGO–firm partnerships have been well studied in the literature on corporate social responsibility (CSR) (Marano and Tashman 2012; Dahan et al. 2010; Oetzel and Doh 2009). However, these studies have generally limited their focus to Western multinationals and Western NGOs and, moreover, not by-and-large examine in depth the institutional settings under which either the firm or the NGO operates Building on recent institutional approaches to CSR (Brammer, Jackson, and Matten 2012; Kang and Moon 2012; Matten and Moon 2008), this paper examines how the institutional dynamics of several partnerships between Chinese firms and NGOs affect the manifestation of CSR (e.g. “implicit” vs. “explicit”). The paper also looks into how CSR and NGO–firm collaboration plays out within a changing state-corporatist framework in Chinese context (Unger and Chan 1995, 2008; Hsu and Hasmath forthcoming). The paper then argues 1) that the involvement of an NGO in the partnership reflects a changing institutional setting in China, and 2) that type and level of involvement of Chinese government institutions affects whether a given firm takes an “implicit” or an “explicit” approach to CSR.

scholarly journals Analysis of the early mother-child relationship in schizophrenic patients

2021 ◽  
pp. 002076402199118
Author(s):  
Marziyeh Khoshgoftar ◽  
Anahita Khodabakhshi-Koolaee ◽  
Mohammad Reza Sheikhi
Keyword(s):  
Cultural Context ◽  
Phenomenological Approach ◽  
Sampling Procedure ◽  
Structured Interviews ◽  
Step Method ◽  
Child Relationship ◽  
New Information ◽  
Data Saturation ◽  
Schizophrenic Patients ◽  
Mother Child Relationship

Background and Aim: The mother as the first caregiver plays a significant role in the formation of the child’s behavior, growth, and communication. The present study aimed to analyze the early mother-child relationship in schizophrenic patients. Materials and Methods: This qualitative study employed a descriptive phenomenological approach. The participants were male patients with schizophrenia who were hospitalized in Qazvin Bahman Psychiatric Hospital from March to September 2020 with an age range of over 18 years. Given the objective of the study, the data were collected using semi-structured interviews. The participants were selected using purposive sampling and the sampling procedure continued until data saturation as the point when no new information is observed in the data. Accordingly, the data were saturated after interviewing 15 participants. The data were analyzed using Colaizzi’s seven-step method. Results: The analysis of the data revealed four main themes including ambivalent attachment to the mother, feelings of constant fear and worry, a sense of constant care for the mother, and a cold and emotionless relationship with the child. Conclusion: The present study suggested that schizophrenia is a disorder that affects the mother-child relationship, and does the term “schizophrenic mothers” need to be reconsidered? However, the result of this research has been done according to the nature and cultural context of Iranian society.

An Integrated Social and Behavioral System Approach to Evaluation of Healthcare Information Technology for Polychronic Conditions

2021 ◽  
pp. 1-14
Author(s):  
Thomas T.H. Wan ◽  
Bing Long Wang
Keyword(s):  
Information Technology ◽  
Healthcare Delivery ◽  
Healthcare Information Technology ◽  
Theoretical Frameworks ◽  
Behavioral Determinants ◽  
The Public ◽  
Behavioral System ◽  
Practical Evaluation ◽  
Efficiency And Effectiveness ◽  
Behavioral System Approach

Healthcare delivery systems are evolving with the advances in health information technology (HIT) development and its applications to coordinated or guided care for polychronic conditions. The design features of artificial intelligence in healthcare reflect the public interest in optimizing care coordination and communication between providers and patients. This article offers a practical evaluation and assessment of the relevance of theoretical frameworks and appropriate methodologies to formalize a multi-criteria optimization of a logic model applicable for achieving the system’s efficiency and effectiveness. In specifying theoretical constructs and evaluation methods for HIT evaluation, a three-fold purpose is to show the relevance of personal and behavioral determinants of HIT use, articulate the need for developing a transdisciplinary framework, and formulate appropriate multilevel modeling and causal analysis of the determinants of HIT use and its impacts on chronic care.

scholarly journals Being parent of a child with congenital heart disease, what does it mean? A qualitative research

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Nahid Dehghan Nayeri ◽  
Zahra Roddehghan ◽  
Farzad Mahmoodi ◽  
Parvin Mahmoodi
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Healthcare Professionals ◽  
Life Experience ◽  
The Body ◽  
Spiritual Needs ◽  
Structured Interviews ◽  
Financial Condition ◽  
Data Saturation

Abstract Background Childbirth is one of the invaluable human experiences and is associated with parental happiness. However, when a child is born with congenital heart disease, it creates emotional and mental distress. As a result, it changes the parents’ response to their child birth. Exploring parenthood experiences add to the body of knowledge and reveal new perspectives. In order to make healthcare professionals able to support these children and their families, they should first understand the meaning of this phenomenon. This study aimed to explore the meaning of parenting a child with Congenital Heart Disease in Iran. Methods A qualitative study was adopted with a conventional content analysis approach and constant comparative analysis. Participants in this study were 17 parents, including parents of children with congenital heart disease who were selected by purposeful sampling method. Semi-structured interviews were used for data collection and continued to data saturation. Data were analyzed via MAXQDA 10 software. Results Four categories and twenty three subcategories emerged as meaning of parenting a child with Congenital Heart Disease. Categories include “Emotional breakdown”, “The catastrophic burden of care”, “Spiritual beliefs of parents” and “The hard road” Conclusions Fully understanding the life experience of these families will allow the implementation of targeted health interventions. Hence, by understanding the meaning of parenting a child with Congenital Heart Disease, healthcare professionals can asses parents emotional statues, information and spiritual needs, financial condition, insurance and marital status using CHD standards so that support is individualized, sensitive and time appropriate.

scholarly journals Couples’ experiences with expanded carrier screening: evaluation of a university hospital screening offer

2021 ◽  
Author(s):  
Ivy van Dijke ◽  
Phillis Lakeman ◽  
Naoual Sabiri ◽  
Hanna Rusticus ◽  
Cecile P. E. Ottenheim ◽  
...  
Keyword(s):  
High Risk ◽  
Medical Center ◽  
Informed Choice ◽  
Carrier Screening ◽  
University Hospital ◽  
Structured Interviews ◽  
Expanded Carrier Screening ◽  
Post Test ◽  
Future Child ◽  
Clinically Significant

AbstractPreconception carrier screening offers couples the possibility to receive information about the risk of having a child with a recessive disorder. Since 2016, an expanded carrier screening (ECS) test for 50 severe autosomal recessive disorders has been available at Amsterdam Medical Center, a Dutch university hospital. This mixed-methods study evaluated the experiences of couples that participated in the carrier screening offer, including high-risk participants, as well as participants with a general population risk. All participants received genetic counselling, and pre- (n = 132) and post-test (n = 86) questionnaires and semi-structured interviews (n = 16) were administered. The most important reason to have ECS was to spare a future child a life with a severe disorder (47%). The majority of survey respondents made an informed decision (86%), as assessed by the Multidimensional Measure of Informed Choice. Among the 86 respondents, 27 individual carriers and no new carrier couples were identified. Turn-around time of the test results was considered too long and costs were perceived as too high. Overall, mean levels of anxiety were not clinically elevated. High-risk respondents (n = 89) and pregnant respondents (n = 13) experienced higher levels of anxiety before testing, which decreased after receiving the test result. Although not clinically significant, distress was on average higher for carriers compared to non-carriers (p < 0.0001). All respondents would opt for the test again, and 80.2% would recommend it to others. The results suggest that ECS should ideally be offered before pregnancy, to minimise anxiety. This study could inform current and future implementation initiatives of preconception ECS.

scholarly journals Preoperative Group Consultation Prior to Surgery for Colorectal Cancer—an Explorative Study of a New Patient Education Method

2021 ◽  
Author(s):  
Sofie Walming ◽  
Eva Angenete ◽  
David Bock ◽  
Mattias Block ◽  
Hanna de la Croix ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Patient Education ◽  
Response Rate ◽  
University Hospital ◽  
Sense Of Control ◽  
Structured Interviews ◽  
Group Setting ◽  
Disease Treatment ◽  
Explorative Study ◽  
Group Consultation

Abstract Patients with colorectal cancer may lack information about the disease and treatment. In 2017, a group consultation before start of surgery was introduced at a university hospital in western Sweden to inform about the disease, treatment, and ongoing scientific studies. The primary aim of this study was to explore the experience of the patients attending the group consultation. Based on semi-structured interviews with patients with colorectal cancer, a questionnaire was constructed and administered to patients, both those attending and those not attending the group consultation. In total, 124 patients were included and the response rate was 86%. A majority of patients attending the group consultation would recommend it to someone else with the same illness. Of the patients attending the group consultation, 81% (30/37) patients agreed, fully or partially, that attending the group consultation had increased their sense of control and 89% (33/37) that the information they received at the group consultation increased their feeling of participation in the treatment. Preoperative group consultation is a feasible modality for informing and discussing the upcoming treatment for colorectal cancer with the patients, and the patients who attended the group setting appreciated it. Attending the group consultation increased the patients’ feeling of active participation in their treatment and their sense of control, which could possibly both improve their experience of their illness and facilitate recovery. ClinicalTrials.gov identifier NCT03888313

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