scholarly journals Leadership assumptions on implementation of patient involvement methods

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kathrine Håland Jeppesen ◽  
Kirsten Frederiksen ◽  
Marianne Johansson Joergensen ◽  
Kirsten Beedholm
Keyword(s):  
Health Care ◽  
Organizational Learning ◽  
Health Care Professionals ◽  
Large Scale ◽  
Patient Involvement ◽  
Hospital Setting ◽  
Implementation Process ◽  
University Hospital ◽  
Structured Interviews ◽  
Implementation Processes

Abstract Background From 2014 to 17, a large-scale project, ‘The User-involving Hospital’, was implemented at a Danish university hospital. Research highlights leadership as crucial for the outcome of change processes in general and for implementation processes in particular. According to the theory on organizational learning by Agyris and Schön, successful change requires organizational learning. Argyris and Schön consider that the assumptions of involved participants play an important role in organizational learning and processes. The purpose was to explore leaders’ assumptions concerning implementation of patient involvement methods in a hospital setting. Methods Qualitative explorative interview study with the six top leaders in the implementation project. The semi-structured interviews were conducted and analyzed in accordance with Kvale and Brinkmanns’ seven stages of interview research. Result The main leadership assumptions on what is needed in the implementation process are in line with the perceived elements in organizational learning according to the theory of Argyris and Schön. Hence, they argued that implementation of patient involvement requires a culture change among health care professionals. Two aspects on how to obtain success in the implementation process were identified based on leadership assumptions: “The health care professionals’ roles in the implementation process” and “The leaders’ own roles in the implementation process”. Conclusion The top leaders considered implementation of patient involvement a change process that necessitates a change in culture with health care professionals as crucial actors. Furthermore, the top leaders considered themselves important facilitators of this implementation process.

scholarly journals A realist evaluation of the implementation of open visiting in an acute care setting for older people

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Helen Hurst ◽  
Jane Griffiths ◽  
Carrie Hunt ◽  
Ellen Martinez
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Qualitative Interviews ◽  
Hospital Setting ◽  
Implementation Process ◽  
Positive Culture ◽  
Routine Data ◽  
Realist Evaluation ◽  
Barriers To Implementation ◽  
The Impact

Abstract Background Open visiting refers to the principle of unrestricted visiting hours in the hospital setting to enable relatives, families and carers to visit at any time. There has been recognition that open visiting supports the principle of patient and family supported care and improves communication. Despite this there has been difficulty in implementing open visiting and barriers identified. The aims of this study were therefore to evaluate the implementation of open visiting, the barriers to implementation, sustainability and the impact of open visiting on communication between health care professionals, families and carers. Methods The study was conducted on two large acute wards for the older person. Realist evaluation methods were used to understand ‘what works well, how, for whom and to what extent.’ Mixed methods were employed including qualitative interviews and descriptive analyses of routine data sets. Following the methodology of realist evaluation, programme theories were identified a long with the context, mechanisms and outcomes of implementation, to better understand the implementation process. Results The results of this study identified some key findings, demonstrating that open visiting does improve communication and can help to build trusting relationships between families/carers and health care professionals (HCP). Barriers to implementation were based on the belief that it would impinge on routines within the ward setting. To achieve the principles of patient and family/carer centred care, the key mechanisms are the confidence and skills of individual nurses and health care assistants to engage with relatives/carers, whilst retaining a sense of control, particularly when care is being delivered to other patients. Conclusion In summary, open visiting creates a positive culture which fosters better relationships between families/carers and HCPs. Involving families/carers as partners in care does not happen automatically in an environment where open visiting is the policy, but requires engagement with staff to encourage and support relatives/carers.

scholarly journals Evaluation of Cancer Patient Satisfaction: A Transversal Study in Radiotherapy Department, Hassan II University Hospital, Fez, Morocco

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Boujemaa EL Marnissi ◽  
Fouad Abbass ◽  
Hafida Charaka ◽  
Nawal Mouhoute ◽  
Abdelaziz Tritha ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Cancer Patient ◽  
Hospital Setting ◽  
Care Quality ◽  
University Hospital ◽  
Structured Interviews ◽  
Radiotherapy Department ◽  
Transversal Study

Patient satisfaction is an important quality outcome indicator of health care in the hospital setting. Patients are nowadays care-partners with caregivers. This relation is practically important for patients presenting chronic diseases, especially cancer. The aim of this study is to evaluate cancer patient satisfaction, treated at the Department of Radiotherapy in Hassan II University Hospital, and to study the different components of this satisfaction. A prospective transversal study was conducted between December 2016 and January 2017. Data was collected by three investigators based on structured interviews, a validated, anonymous and a standardized questionnaire. During this period, we have included 230 patients: 159 women (69.1%), 71 men (30.9%) and the sex ratio (women/men) was 2.23. Half of the investigated patients have never been schooled (52.61%). The majority had urban origin (71.3%) and 90% of patients declared being satisfied with the care at Radiotherapy department. 93.48% of cases recommended Radiotherapy department to other patients and 95.65% will want to continue their treatment at this department. Reception conditions were judged as favorable in 92.14%. Satisfaction rates regarding the availability of medical and paramedics, health-care workers were 86.52% and 83.9%, respectively. The quality of medical and paramedical care was judged as excellent or good in 78% cases. However, 44.34% of patients complained about the complexity of administrative formalities. 60.87% of cases judged that the waiting time was too long, whereas 31.4% of patients claimed that care-quality of their pain was insufficient or bad. The majority of patients declared being very satisfied or at least satisfied with different care services. For items that were judged as less satisfactory, some recommendations will be taken especially at the level of pain’s and palliative care as well as the organization of patients’ circuit inside the department. The satisfaction’s variations can be attributed to personally patients factors as well as systemic ones at the level of the hospital. Assessing and understanding these factors are essential in developing appropriate measures to improve patient satisfaction.

scholarly journals Women, Exercise, and Eating Disorder Recovery: The Normal and the Pathological

2021 ◽  
pp. 104973232199204
Author(s):  
Hester Hockin-Boyers ◽  
Megan Warin
Keyword(s):  
Health Care ◽  
Eating Disorder ◽  
Affect Regulation ◽  
Health Care Professionals ◽  
Value Systems ◽  
Structured Interviews ◽  
Data Set ◽  
The United Kingdom ◽  
Theoretical Frame ◽  
Intensity Of Exercise

The appropriate form, regularity, and intensity of exercise for individuals recovering from eating disorders is not agreed upon among health care professionals or researchers. When exercise is permitted, it is that which is mindful, embodied, and non-competitive that is considered normative. Using Canguilhem’s concepts of “the normal and the pathological” as a theoretical frame, we examine the gendered assumptions that shape medical understandings of “healthy” and “dysfunctional” exercise in the context of recovery. The data set for this article comes from longitudinal semi-structured interviews with 19 women in the United Kingdom who engaged in weightlifting during their eating disorder recovery. We argue that women in recovery navigate multiple and conflicting value systems regarding exercise. Faced with aspects of exercise that are pathologized within the eating disorder literature (such as structure/routine, body transformations, and affect regulation), women re-inscribe positive value to these experiences, thus establishing exercise practices that serve them.

scholarly journals Navigating change – managers’ experience of implementation processes in disability health care: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anette Granberg ◽  
Marie Matérne ◽  
Lars-Olov Lundqvist ◽  
Anna Duberg
Keyword(s):  
Health Care ◽  
Health Care Organizations ◽  
Contextual Factors ◽  
Implementation Process ◽  
Public And Private ◽  
Implementation Processes ◽  
Telephone Interviews ◽  
External Conditions ◽  
The Many ◽  
Dance Intervention

Abstract Background Effective implementation processes play a central role in health care organizations and affect the care of patients. Managers are pivotal in facilitating the use of new practices, but their experience and how it affects the implementation outcome are still largely unknown. In the field of disability health care in particular, managers experiences have scarcely been investigated. Therefore, the aim of this study is to explore managers’ experiences of the implementation process when transferring new practices into disability health care settings. Methods Semi-structured individual telephone interviews were conducted with managers at disability health care organizations in four administrative regions in central Sweden. A total of 23 managers with formal managerial responsibility from both public and private health care were strategically selected to be interviewed. The interviews were analysed using reflexive thematic analysis with an inductive approach. Results The analysis resulted in two themes about factors influencing the implementation process: firstly, Contextual factors set the agenda for what can be achieved, which highlighted aspects that hinder or enable the implementation process, such as internal and external conditions, the workplace culture, the employees and managers’ attitudes and openness to change: secondly, Leadership in the winds of change, which described the challenges of balancing managerial tasks with leading the change, and the importance of a leadership that involves the participation of the employees. Conclusions This study explored how and to what extent managers address and manage the implementation process and the many associated challenges. The findings highlight the importance of leadership support and organizational structure in order to transfer new practices into the work setting, and to encourage an organizational culture for leading change that promotes positive outcomes. We suggest that identifying strategies by focusing on contextual factors and on aspects of leadership will facilitate implementation processes. Trial registration The SWAN (Structured Water Dance Intervention) study was retrospectively registered on April 9, 2019 and is available online at ClinicalTrials.gov (ID: NCT03908801).

Implementation of Wireless “Intelligent” Pump IV Infusion Technology in a Not-for-Profit Academic Hospital Setting

2007 ◽  
Vol 42 (9) ◽  
pp. 832-840 ◽  
Author(s):  
Lor Siv-Lee ◽  
Linda Morgan
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Hospital Setting ◽  
The United States ◽  
Main Campus ◽  
For Profit ◽  
Not For Profit ◽  
Drug Concentrations ◽  
Wireless Infrastructure ◽  
Infusion System

Purpose This paper describes the implementation of wireless “intelligent” pump intravenous (IV) infusion technology in a not-for-profit academic, multicampus hospital system in the United States. Methods The process of implementing a novel infusion system in a multicampus health care institution (main campus plus three satellite campuses) is described. Details are provided regarding the timelines involved, the process for the development of the drug libraries, and the initial implementation within and across campuses. Results In early 2004, with the end of the device purchase contract period nearing, a multidisciplinary committee evaluated potential IV infusion pumps for hospital use. In April 2004, the committee selected the Plum A+ infusion system with Hospira MedNet software and wireless capabilities (Hospira Inc., Lake Forest, IL). Implementation of the single-channel IV infusion system took place July through October 2005 following installation of the wireless infrastructure throughout the multicampus facility. Implementation occurred in July, one campus at a time; the three smaller satellite campuses went “live” before the main campus. Implementation of the triple-channel IV infusion system took place in March 2006 when the wireless infrastructure was completed and fully functional throughout the campuses, software was upgraded, and drug library revisions were completed and uploaded. Conclusion “Intelligent” pump technology provided a framework to standardize drug concentrations used in the intensive care units. Implementation occurred transparently without any compromise of patient care. Many lessons were learned during implementation that explained the initial suboptimal compliance with safety software use. In response, the committee developed strategies to increase software utilization rates, which resulted in improved acceptance by nursing staff and steadily improving compliance rates. Wireless technology has supported remote device management, prospective monitoring, the avoidance of medication error, and the timely education of health care professionals regarding potential medication errors.

Successful Game Development Partnerships between Academics and Physicians

2013 ◽  
Vol 5 (3) ◽  
pp. 97-107 ◽  
Author(s):  
Elena Bertozzi ◽  
Leonard R. Krilov ◽  
Dilys Walker
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Serious Games ◽  
Home Birth ◽  
University Hospital ◽  
Game Development ◽  
Rural Mexico ◽  
Flu Vaccine ◽  
Game Developers ◽  
The University

This paper discusses the creation of two serious games developed by the Engender Games Group with the intention of meeting specific outcomes in the healthcare field. The processes and pitfalls of developing games of this kind are outlined with the intention of demonstrating how game developers and health care professionals can collaborate to produce compelling, fun games that meet specific goals. The Atendiendo el Parto en Casa (Home Birth), game is a collaboration with Drs. Dilys Walker and Carrie Rouse at the University of Washington Medical School to educate traditional midwives working in rural Mexico. The Flu Busters! game is a collaboration with a group of pediatric specialists at Winthrop-University Hospital on Long Island led by Dr. Leonard Krilov which explains how the flu vaccine works and encourages children to get vaccinated.

scholarly journals Surveillance, anticipation and firefighting: Perspectives of patient safety from a New Zealand case study

2020 ◽  
Author(s):  
J Wailling ◽  
Brian Robinson ◽  
M Coombs
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
New Zealand ◽  
Health Care Professionals ◽  
Nuclear Power ◽  
High Reliability ◽  
Health Care Systems ◽  
Tertiary Hospital ◽  
Structured Interviews

© 2018 John Wiley & Sons Ltd Aim: This study explored how doctors, nurses and managers working in a New Zealand tertiary hospital understand patient safety. Background: Despite health care systems implementing proven safety strategies from high reliability organisations, such as aviation and nuclear power, these have not been uniformly adopted by health care professionals with concerns raised about clinician engagement. Design: Instrumental, embedded case study design using qualitative methods. Methods: The study used purposeful sampling, and data was collected using focus groups and semi-structured interviews with doctors (n = 31); registered nurses (n = 19); and senior organisational managers (n = 3) in a New Zealand tertiary hospital. Results: Safety was described as a core organisational value. Clinicians appreciated proactive safety approaches characterized by anticipation and vigilance, where they expertly recognized and adapted to safety risks. Managers trusted evidence-based safety rules and approaches that recorded, categorized and measured safety. Conclusion and Implications for Nursing Management: It is important that nurse managers hold a more refined understanding about safety. Organisations are more likely to support safe patient care if cultural complexity is accounted for. Recognizing how different occupational groups perceive and respond to safety, rather than attempting to reinforce a uniform set of safety actions and responsibilities, is likely to bring together a shared understanding of safety, build trust and nurture safety culture.

scholarly journals Exploring the feasibility of a network of organizations for pain rehabilitation: what are the lessons learned?

2020 ◽  
Author(s):  
Cynthia Lamper ◽  
Ivan PJ Huijnen ◽  
Mariëlle EAL Kroese ◽  
Albère J Köke ◽  
Gijs Brouwer ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Large Scale ◽  
Critical Mass ◽  
Implementation Strategies ◽  
Daily Practice ◽  
Lessons Learned ◽  
Integration Of Care ◽  
Treatment Protocols ◽  
Rehabilitation Care

Abstract Background and aims: Integration of care is lacking for chronic musculoskeletal pain (CMP) patients. Network Pain Rehabilitation Limburg (NPRL), a transmural health care network, has been designed to provide integrated rehabilitation care from a biopsychosocial perspective to improve patients’ levels of functioning. This feasibility study aims to provide insight into barriers and facilitators for the development, implementation, and transferability of NPRL.Methods: This study was conducted with a three-phase iterative and incremental design from October 2017 to October 2018. NPRL comprises two rehabilitation practices, and three local primary care networks, with a general practitioner together with, a mental health practice nurse, and a physiotherapist or exercise therapist. These stakeholders with a random sample of participating patients took part in evaluations, consisting of interviews, focus groups, and observations. Field notes and observations were recorded during meetings. The Consolidated Framework for Implementation Research guided data collection and analysis. Results were used to refine the next phase.Results: According to health care professionals (HCPs), guidelines and treatment protocols facilitate consistency and transparency in collaboration, biopsychosocial language, and treatment. One barrier is stigmatization of CMP in society. Non-participating HCPs’ treatment approaches are often more biomedical than biopsychosocial, causing patients to resist participating in NPRL. The current organization of health care, with cultural, structural, and financial aspects, acts as a barrier, complicating implementation between and within practices. HCPs preferred the iterative, bottom-up strategy. A critical mass of participating organizations is needed for proper implementation.Conclusion: NPRL is feasible in daily practice if barriers are overcome and facilitators of development, implementation, and transferability are promoted. These findings will be used to refine NPRL. A large-scale process and effect evaluation will be performed. Our implementation strategies and results may assist other health care organizations aspiring to implement a transmural network using a similar model.

scholarly journals Understanding Low-value Care and Associated De-implementation Processes: A Qualitative Study of Choosing Wisely Interventions Across Canadian Hospitals

2021 ◽  
Author(s):  
Gillian Parker ◽  
Monika Kastner ◽  
Karen Born ◽  
Nida Shahid ◽  
Whitney Berta
Keyword(s):  
Process Model ◽  
Healthcare Providers ◽  
Implementation Process ◽  
Choosing Wisely ◽  
Structured Interviews ◽  
Team Members ◽  
Implementation Processes ◽  
Healthcare Settings ◽  
National Campaigns ◽  
The Impact

Abstract Background:Choosing Wisely (CW) is an international movement comprised of national campaigns in more than 20 countries to reduce low-value care (LVC). Hospitals and healthcare providers are examining existing practices and putting interventions in place to reduce practices that offer little to no benefit to patients or may cause them harm. De-implementation, the reduction or removal of a healthcare practice is an emerging field of research. Little is known about the factors which (i) sustain LVC; and (ii) the magnitude of the problem of LVC. In addition, little is known about the processes of de-implementation, and if and how these processes differ from implementation endeavours. The objective of this study was to explicate the myriad factors which impact the processes and outcomes of de-implementation initiatives that are designed to address national Choosing Wisely campaign recommendations.Methods:Semi-structured interviews were conducted with individuals implementing Choosing Wisely Canada recommendations in healthcare settings in four provinces. The interview guide was developed using concepts from the literature and the Implementation Process Model (IPM) as a framework. All interviews were conducted virtually, recorded, and transcribed verbatim. Data were analysed using thematic analysis.Results:Seventeen Choosing Wisely team members were interviewed. Participants identified numerous provider factors, most notably habit, which sustain LVC. Contrary to reporting in recent studies, the majority of LVC in the sample was not ‘patient facing’; therefore, patients were not a significant driver for the LVC, nor a barrier to reducing it. Participants detailed aspects of the magnitude of the problems of LVC, specifically the impact of harm and resources. Unique factors influencing the processes of de-implementation reported were: influence of Choosing Wisely campaigns, availability of data, lack of targets and hard-coded interventions.Conclusions: This study explicates factors ranging from those which impact the maintenance of LVC to factors that impact the success of de-implementation interventions intended to reduce them. The findings draw attention to the significance of unintentional factors, highlight the importance of understanding the impact of harm and resources to reduce LVC and illuminate the overstated impact of patients in de-implementation literature. These findings illustrate the complexities of de-implementation.

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