scholarly journals Involving clinicians in management: assessing views of doctors and nurses on hybrid professionalism in clinical directorates

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anna Prenestini ◽  
Marco Sartirana ◽  
Federico Lega
Keyword(s):  
Management Practices ◽  
Healthcare Professionals ◽  
Clinical Work ◽  
Local Health Authority ◽  
Local Health ◽  
Policy Makers ◽  
Polarity Index ◽  
Validated Questionnaire ◽  
Clinical Directorates ◽  
Doctors And Nurses

Abstract Background Hybrid professionalism is one of the most effective ways to involve clinicians in management practices and responsibilities. With this study we investigated the perceptions of doctors and nurses on hybridization in clinical directorates (CDs) in hospitals. Methods We investigated the attitudes of healthcare professionals (doctors and nurses) towards eight hospital CDs in the Local Health Authority (LHA) of Bologna (Emilia Romagna, Italy) 6 years after their implementation. We used a validated questionnaire by Braithwaite and Westbrook (2004). Drawing on Palmer et al. (2007), we added a section about the characteristics of department heads. In all, 123 healthcare professionals in managerial roles completed and returned the questionnaire. The return rate was 47.4% for doctors and 31.6% for nurses. Results Doctors reported an increase in clinical governance, interdisciplinarity collaboration, and standardization of clinical work. Hybridization of practices was noted to have taken place. While doctors did not see these changes as a threat to professional values, they felt that hospital managers had taken greater control. There was a large overlap of attitudes between doctors and nurses: inter-professional integration in CDs fostered alignment of values and aims. The polarity index was higher for responses from the doctors than from the nurses. Conclusion The study findings have implications for policy makers and managers: mission and strategic mandate of CDs; governance of CDs, leadership issues; opportunities for engaging healthcare professionals; changes in managerial involvement during the COVID-19 pandemic. We also discuss the limitations of the present study and future areas for research into hybrid structures.

scholarly journals Il coaching nel wound care. L'infermiere specialista in wound care, facilitatore nella gestione delle ferite cutanee tra ospedale e territorio nell'Azienda AUSL di Bologna: una proposta progettuale/Coaching in wound care. The wound care specialist nurse, facilitator for the management of skin lesions between hospital and territory in the Bologna Local Health Authority: a research project

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Rossana Quatrini
Keyword(s):  
Healthcare Professionals ◽  
Wound Care ◽  
Care Home ◽  
Skin Lesions ◽  
Local Health Authority ◽  
Local Health ◽  
Specialist Nurse ◽  
Long Duration ◽  
Care Specialist ◽  
Operational Processes

Questo progetto nasce con l’idea di elaborare una strategia organizzativa/professionale che possa favorire un’omogeneizzazione dei comportamenti dei professionisti sanitari, determinando una riduzione dei costi in termini di risparmio di risorse umane ed economiche, ma soprattutto favorire un miglioramento della qualità di vita dei soggetti portatori di lesioni cutanee. Le lesioni cutanee, ma soprattutto le ferite di difficile guarigione, si caratterizzano per una lunga durata e un’elevata incidenza di complicanze, che spesso si traducono in un considerevole onere economico. L’infermiere Specialista Wound Care, collaborando attivamente con i professionisti sanitari attraverso attività di consulenza, formazione on work, supervisione dei processi operativi, si pone come un’importante figura di riferimento in termini di miglioramento degli obiettivi di cura, nonché degli esiti di cura. Il progetto, di dimensioni Aziendali, si sviluppa in setting assistenziali specifici Ospedale-Territorio e lo Specialista Wound Care opera in collaborazione con gli infermieri di quei setting attraverso una metodologia di Coaching. The aim of this is project is the development of an organizational/professional strategy that can help the homogenization of the behavior of healthcare professionals, determining a reduction of human resources and costs, but above all promoting an improvement of the quality of life of people with skin lesions. Some skin wounds are characterized by a long duration and a high incidence of complications, which often result in considerable economic expenses. The Wound Care Specialist Nurse, in collaboration with healthcare professionals by consultancy, training and supervision of operational processes, is an important reference for the improvement of the care and the treatment goals and outcomes. The project involves Hospital/Health Care Home and the Wound Care Specialist that works in collaboration with the nurses of the area.

scholarly journals Improving chronic diseases management using Learning from Excellence (LfE) model

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
A Borghini ◽  
F Vola ◽  
F Pennucci ◽  
C Seghieri ◽  
S Nuti
Keyword(s):  
Quality Improvement ◽  
Chronic Diseases ◽  
Healthcare Professionals ◽  
National Level ◽  
Healthcare Providers ◽  
Local Health Authority ◽  
Local Health ◽  
Integration Of Care ◽  
Italian Regions ◽  
Shared Goals

Abstract Background Learning from excellence (LfE) model demonstrated to be an effective method in the promotion of quality improvement in healthcare and in the reduction of patient’s harm. We applied LfE to identify the best models that could represent the excellence in the management of chronic heart failure (CHF) patients among the models adopted among 98 healthcare providers across 10 Italian Regions. Methods The research consisted of 2 phases: 1) the creation of a 9 indicators set to map CHF pathways and the analysis of these indicators through a quantitative approach using a modified positive deviance model which identified the best performers among our sample of hospitals and local health authorities (H/LHA) grouped in geographical Areas. We transformed 3 indicators (“tracking” indicators) into a 0-5 scale to assure direct comparison. 2) The H/LHA best performers were asked to share their organizational and clinical model during a workshop where every stakeholder involved could take part. Results Among the 10 investigated Italian Regions, 42 Areas were ranked and ranged 1,83-3,91. The three best performing areas that ranked above the 3rd quartile and were interested in taking part in this new approach were selected. The results arising from the qualitative analysis of these areas showed that communication, trust and shared goals among healthcare professionals resulted to play a key role among the best performing H/LHA. Indeed, the same role is played by all the policies and practices that enabled Interactions among healthcare workforce and patients, thus representing the ‘integration of care’. Conclusions The identification-celebration of best performers LfE implementation model holds the potential to promote quality improvement of processes among healthcare providers. This potential also unlocks in the chronic disease management field, making the sharing of best performers’ experience possible at a Regional and National level. Key messages Learning from excellence model demonstrated to be an effective method in the promotion of best models in the management of chronic diseases. Communication, trust and shared goals among healthcare professionals resulted to play a key role among the best performing hospital and local health authority.

scholarly journals An individual care plan for a high risk elderly population in the Local Health Authority of Bologna

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
E Ciotti ◽  
F Catalani ◽  
F Martino ◽  
I Camplone ◽  
C Valisella ◽  
...  
Keyword(s):  
Nursing Care ◽  
Health Authority ◽  
Healthcare Professionals ◽  
Early Recognition ◽  
Care Plan ◽  
Local Health Authority ◽  
Local Health ◽  
Individualized Care ◽  
Professional Management ◽  
Very High

Abstract Issue Fragility is a major challenge that demand a comprehensive public health response, since a high rate of population is aging and becoming vulnerable. Description of the Problem The Local Health Authority of Bologna, about 850,000 inhabitants, has implemented a new qualitative and quantitative Project on fragile patients. Frailty was measured by the “Risk Profile of the Emilia-Romagna region,”, an algorithm that provides a risk index, based on patients'record, which divide population in risk categories (high/very high, moderate and low risk) of hospitalization. The 585 General Practitioners (GPs) have enrolled their fragile patients with high and very high risk (about 6% of the population). GPs and other healthcare professionals are asked to define an Individualized Care Plan (ICP) according to an integrated and multi-professional management perspective. Patients' and healthcare professionals' subjective experience was collected throughout a structured interview. Results From October 2018 to April 2019, 260 patients were included in the project and they received a ICP which included different interventions such as: integrated nursing care (105), nursing care in chronic ambulatory (55), community hospital care (9), social assistance (92), physiotherapy (88), specialist activities (114). Qualitative data highlighted high level of satisfaction both in patients and clinicians. The strengths of the Project are: 1) an integrated management (with a multi- professional team) of frailty population, 2) proactive and individualized treatment plan. Limitations are: 1) different approaches among clinicians in the Local Health Authority of Bologna with possible inequalities of accessibility to the treatment; 2) difficulties in the relationships among clinicians. The early recognition and the specialistic management of the fragile population have to be considered a priority in health practice in order to provide effective medical intervention. Key messages Individualized Care Plan (ICP) and integrated and multi-professional management. Importance of fragility early recognition.

scholarly journals Subsequent attendance in a breast cancer screening program after a false-positive result in the Local Health Authority of Bologna (Italy)

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Lorena Squillace ◽  
Lorenzo Pizzi ◽  
Flavia Rallo ◽  
Carmen Bazzani ◽  
Gianni Saguatti ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Positive Result ◽  
Breast Cancer Screening ◽  
Health Authority ◽  
False Positive ◽  
Screening Program ◽  
Local Health Authority ◽  
Local Health ◽  
False Positive Result

AbstractWe conducted a cross-sectional study to assess the likelihood of returning for routine breast cancer screening among women who have experienced a false-positive result (FPR) and to describe the possible individual and organizational factors that could influence subsequent attendance to the screening program. Several information were collected on demographic and clinical characteristics data. Electronic data from 2014 to 2016 related to breast screening program of the Local Health Authority (LHA) of Bologna (Italy) of women between 45 and 74 years old were reviewed. A total of 4847 women experienced an FPR during mammographic screening and were recalled to subsequent round; 80.2% adhered to the screening. Mean age was 54.2 ± 8.4 years old. Women resulted to be less likely to adhere to screening if they were not-Italian (p = 0.001), if they lived in the Bologna district (p < 0.001), if they had to wait more than 5 days from II level test to end of diagnostic procedures (p = 0.001), if the diagnostic tests were performed in a hospital with the less volume of activity and higher recall rate (RR) (p < 0.001) and if they had no previous participation to screening tests (p < 0.001). Our results are consistent with previous studies, and encourages the implementation and innovation of the organizational characteristics for breast cancer screening. The success of screening programs requires an efficient indicators monitoring strategy to develop and evaluate continuous improvement processes.

scholarly journals Patients perspectives on drug shortages in six European hospital settings – a cross sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Darija Kuruc Poje ◽  
Domagoj Kifer ◽  
Isabelle Huys ◽  
Joao Miranda ◽  
Helena Jenzer ◽  
...  
Keyword(s):  
Management Practices ◽  
Healthcare Professionals ◽  
Demographic Data ◽  
General Information ◽  
Basic Knowledge ◽  
Drug Shortage ◽  
Cross Sectional ◽  
Drug Shortages ◽  
Good Communication ◽  
Information Preferences

Abstract Background It is known that drug shortages represent a major challenge for all stakeholders involved in the process, but there is little evidence regarding insights into patients′ awareness and perspectives. This study aimed to investigate the patients-perceived drug shortages experience and their view on outcomes in different European hospital settings. Furthermore, we wanted to explore information preferences on drug shortages. Methods A retrospective, cross sectional, a mixed method study was conducted in six European hospital settings. One hospital (H) from each of this country agreed to participate: Bosnia and Herzegovina (H-BiH), Croatia (H-CR), Germany (H-GE), Greece (H-GR), Serbia (H-SE) and Poland (H-PO). Recruitment and data collection was conducted over 27 months from November 2017 until January 2020. Overall, we surveyed 607 patients which completed paper-based questionnaire. Questions related to: general information (demographic data), basic knowledge on drug shortages, drug shortages experienced during hospitalization and information preferences on drug shortage. Differences between hospital settings were analyzed using Chi-squared test or Fisher’s exact test. For more complex contingency tables, Monte Carlo simulations (N = 2000) were applied for Fisher’s test. Post-hoc hospital-wise analyses were performed using Fisher’s exact tests. False discovery rate was controlled using the Bonferroni method. Analyses were performed using R: a language and environment for statistical computing (v 3.6.3). Results 6 % of patients reported experiences with drug shortages while hospitalized which led to a deterioration of their health. The majority of affected patients were hospitalized at hematology and/or oncology wards in H-BiH, H-PO and H-GE. H-BiH had the highest number of affected patients (18.1 %, N = 19/105, p < 0.001) while the fewest patients were in H-SE (1 %, N = 1/100, p = 0.001). In addition, 82.5 %, (N = 501/607) of respondents wanted to be informed of alternative treatment options if there was a drug shortage without a generic substitute available. Majority of these patients (66.4 %, N = 386/501) prefer to be informed by a healthcare professional. Conclusions Although drug shortages led to serious medical consequences, our findings show that most of the patients did not perceive shortages as a problem. One possible interpretation is that good hospital management practices by healthcare professionals helped to mitigate the perceived impact of shortages. Our study highlights the importance of a good communication especially between patients and healthcare professionals in whom our patients have the greatest trust.

scholarly journals The use of text mining to detect key shifts in Japanese first-year medical student professional identity formation through early exposure to non-healthcare hospital staff

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yayoi Shikama ◽  
Yasuko Chiba ◽  
Megumi Yasuda ◽  
Maham Stanyon ◽  
Koji Otani
Keyword(s):  
Text Mining ◽  
Professional Identity ◽  
Identity Formation ◽  
Role Models ◽  
Healthcare Professionals ◽  
Clinical Work ◽  
Working Environment ◽  
First Year ◽  
Professional Identity Formation ◽  
The Impact

Abstract Background Professional identity formation is nurtured through socialization, driven by interaction with role models, and supported through early clinical exposure (ECE) programmes. Non-healthcare professionals form part of the hospital community but are external to the culture of medicine, with their potential as role models unexplored. We employed text mining of student reflective assignments to explore the impact of socialization with non-healthcare professionals during ECE. Methods Assignments from 259 first-year medical students at Fukushima Medical University, Japan, underwent hierarchical cluster analysis. Interrelationships between the most-frequently-occurring words were analysed to create coding rules, which were applied to elucidate underlying themes. Results A shift in terms describing professional characteristics was detected, from “knowledge/skill” towards “pride [in one’s work]” and “responsibility”. Seven themes emerged: contribution of non-healthcare professionals, diversity of occupation, pride, responsibility, teamwork, patient care and gratitude. Students mentioning ‘contribution of non-healthcare professionals’ spoke of altruistic dedication and strong sense of purpose. These students expressed gratitude towards non-healthcare professionals for supporting clinical work, from a doctor’s perspective. Conclusion Socialization with non-healthcare professionals provides important insights into the hospital working environment and cultural working norms. Through role modelling altruism and responsibility, non-healthcare professionals positively influenced student professional identity formation, promoting self-conceptualisation as a doctor.

Peri-operative elective path optimization through algorithms in the Local Health Authority of Bologna

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Leonessi ◽  
P Tubertini ◽  
A Longanesi ◽  
E Malaguti ◽  
S Guicciardi ◽  
...  
Keyword(s):  
Mathematical Models ◽  
Health Authority ◽  
Surgical Planning ◽  
Waiting Times ◽  
Local Health Authority ◽  
Local Health ◽  
Surgical Interventions ◽  
Patient Preparation ◽  
Surgical Teams ◽  
Available Resources

Abstract Background High costs of healthcare and population ageing force the health system to constantly improve its efficiency in order to provide patients the best possible care with the available resources. In this perspective, the Local Health Authority and the University of Bologna started an experimentation to re-organize, manage and control the peri-operative elective path of general surgery, a discipline that works in a multiplatform environment according to a Hub & Spoke logic. Methods The experimentation is built on two mathematical programming models. The first one defines patient preparation appointments (i.e. diagnostic and anesthesiologic visits), harmonizing patient preparation with available resources, and planning migration from Hub to Spoke platforms, in order to optimize waiting time and facilities utilization. The second model defines weekly optimal admission plans. Both models consider the availability of resources in terms of surgical teams, operating room slots and number of beds for each operating unit. The proposed approach works on a four-week time horizon following a rolling horizon framework (weekly update) in order to effectively manage high priority patients. Results Both models have been tested on real-world instances over a six-month observation period. Overall, it was possible to increase the efficiency of surgical programming by reducing the waiting times for surgical interventions in over 20% of cases of high priority patiets in four local departments. Conclusions The proposed model represents one of the few cases in Italy of surgical programming developed through mathematical models. It will be necessary to evaluate the evolution of its effectiveness to optimize the system's ability to respond to the growing health needs of the population. Key messages Mathematical models are needed to optimize surgical planning. Efficiency of surgical planning may reduce waiting times for high priority procedures.

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