scholarly journals Value configurations for balancing standardization and customization in chronic care: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christian Colldén ◽  
Andreas Hellström ◽  
Ida Gremyr
Keyword(s):  
Chronic Care ◽  
Qualitative Data ◽  
Ad Hoc ◽  
Care Pathway ◽  
Care Process ◽  
Healthcare Operations ◽  
Structured Interviews ◽  
Scarce Resources ◽  
Conflicting Demands ◽  
Pathway Data

Abstract Background Demands for both customization and standardization are increasing in healthcare. At the same time, resources are scarce, and healthcare managers are urged to improve efficiency. A framework of three value configurations – shop, chain, and network – has been proposed for how healthcare operations can be designed and organized for efficient value creation. In this paper, use of value configurations for balancing of standardization and customization is explored in the context of care for chronic mental conditions. Methods A typical case is presented to illustrate the manifestations of conflicting demands between customization and standardization, and the potential usefulness of the value configurations framework. Qualitative data were collected from managers and care developers in two focus groups and six semi-structured interviews, completed by a national document describing a care pathway. Data were coded and analysed using an insider-outsider approach. Results Operationalization of the balance between standardization and customization were found to be highly delegated and ad hoc. Also, the conflict between the two demands was often seen as aggravated by scarce resources. Value configurations can be fruitful as a means of discussing and redesigning care operations if applied at a suitable level of abstraction. Applied adequately, all three value configurations were recognized in the care operations for the patient group, with shop as the overarching configuration. Some opportunities for improved efficiency were identified, yet all configurations were seen as vital in the chronic care process. Conclusions The study challenges the earlier proposed organizational separation of care corresponding to different value configurations. Instead, as dual demand for customization and standardization permeates healthcare, parallel but explicated value configurations may be a path to improved quality and efficiency. Combined and intermediate configurations should also be further investigated.

scholarly journals Palliative care after the Liverpool Care Pathway: a study of staff experiences

2019 ◽  
Vol 28 (15) ◽  
pp. 1001-1007
Author(s):  
Heather Collins ◽  
Peter Raby
Keyword(s):  
Palliative Care ◽  
Thematic Analysis ◽  
End Of Life Care ◽  
Care Pathway ◽  
Care Process ◽  
Life Care ◽  
Structured Interviews ◽  
Negative Role ◽  
Nurses Perceptions ◽  
Staff Experiences

The objective of this study was to explore nurses' perceptions of end-of-life care following the withdrawal of the Liverpool Care Pathway (LCP). Thirteen semi-structured interviews were conducted with nurses working in palliative care. Data were analysed using thematic analysis. Three themes emerged: perceptions of the LCP, prevailing issues, and patients' and families' experiences. This study suggested that the removal of the pathway has not remedied the issues attributed to it. Further, the way in which the LCP was removed indicates that the non-expert media can play a negative role in how palliative care is perceived, which inhibits the care process. In this respect it is important that ‘insider’ voices are also heard, in order to educate and also redress disinformation. Similarly, broader, persisting, contextual challenges facing staff need addressing in order to prevent a repeat of the issues leading to the removal of the LCP.

Students' Independent Professional Activity in Pedagogical Practice

2010 ◽  
Vol 12 (2) ◽  
pp. 38-58
Author(s):  
Aina Strode
Keyword(s):  
Higher Education ◽  
Comparative Analysis ◽  
Empirical Study ◽  
Qualitative Data ◽  
Academic Staff ◽  
Professional Activity ◽  
Pedagogical Practice ◽  
Structured Interviews ◽  
Criteria And Indicators ◽  
Study Process

Students' Independent Professional Activity in Pedagogical PracticeThe topicality of the research is determined by the need for changes in higher education concerned with implementing the principles of sustainable education. The article focuses on teacher training, highlighting the teacher's profession as an attractive choice of one's career that permits to ensure the development of general and professional skills and an opportunity for new specialists to align with the labour market. The empirical study of students' understanding of their professional activity and of the conditions for its formation is conducted by applying structured interviews (of practice supervisors, students, academic staff); students and experts' questionnaire. Comparative analysis of quantitative and qualitative data and triangulation were used in case studies. As a result, a framework of pedagogical practice organisation has been created in order to form students' independent professional activity. The criteria and indicators of independent professional activity have been formulated and suggestions for designers of study programmes and organisers of the study process have been provided.

scholarly journals POS0160-HPR THE CARE PROCESS OF HIP AND KNEE OSTEOARTHRITIS: GIVING AN ACCOUNT OF PATIENTS’ EXPERIENCE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 292.2-293
Author(s):  
S. Battista ◽  
M. Manoni ◽  
A. Dell’isola ◽  
M. Englund ◽  
A. Palese ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Health Professionals ◽  
Emotional Experience ◽  
Functional Limitations ◽  
Care Quality ◽  
Care Process ◽  
Exact Science ◽  
Structured Interviews ◽  
Patients Experience

Background:The care process is often a complex and intimate process experienced by patients. Osteoarthritis (OA) care is usually characterised by multimodal interventions that consider the broader array of symptoms and functional limitations and often require a high level of patients’ compliance. Despite efforts to improve the quality of care of patients suffering from OA, and the publication of state-of-the-art clinical practice guidelines [1], the quality of the care process, as experienced by patients, seems to be suboptimal [2]. Hence, it is essential to investigate how patients experience this process to highlight potential elements that can enhance or spoil it to optimise the care quality.Objectives:To explore the patients’ experience of the received OA care process.Methods:Qualitative study, 10 semi-structured interviews were performed. The interview guide was created by a pool of healthcare professionals (physiotherapists, psychologists, nurses) and expert patients. It investigated the emotional experience, beliefs, expectations, perceived barriers and facilitators towards conservative treatments perceived by patients suffering from OA. The interviews lasted approximately one hour, were transcribed verbatim and analysed independently by two authors, who labelled their core parts to find categories and subcategories. A theme-based analysis was performed following an ecological paradigm, naturalistic epistemology, philosophy of phenomenological research.Results:Our analysis revealed 7 main categories with several subcategories (Fig. 1). 1) Uncertainty as some patients perceived treatment choice not to be based on medical evidence “there is an almost religious way of thinking on how to deal with the pathology. It is not an exact science when you choose the physicians you choose the treatment”. 2) Relationship with the self and the others as some patients did not feel understood or even shameful and hopeless about their condition. 3) Patients’ and Health Professionals’ beliefs about the pathology management where common thoughts were the perceived (ab)use of passive therapies, the movement as something dangerous and that OA is “something that you try to resist to, but (surgery) is your destiny”. 4) facilitators and 5) barriers of the adherence to therapeutic exercise that revolve around the cost of the therapy, the time needed and the willingness to change life habits. 6) Patients’ attitudes towards pathology in which the oldest patients perceive OA as “something I have to accept since I am getting old” and the youngest as “Something I have to fight”. 7) Relationship with food in which diet is seen as something that “you force yourself to follow” which is useful only to lose weight and not to preserve a high health status and where overeating is used “to eat your feelings”.Figure 1.Categories and Subcategories stemmed from the analysis of the patients’ interviewsConclusion:Patients suffering from hip and knee OA seem to experience an uncertain care process. The lack of clear explanations and the attitude towards conservative treatment, which is considered as “a pastime while waiting for surgery,” fosters the importance of providing patients with adequate information about the treatment, to shift their beliefs and improve their awareness. This will enhance a patient-centred and shared decision-making treatments.References:[1]Fernandes L, Hagen KB, Bijlsma JWJ, et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann. Rheum. Dis. 2013;72:1125–35.[2]Basedow M, Esterman A. Assessing appropriateness of osteoarthritis care using quality indicators: a systematic review. J Eval Clin Pract 2015;21:782–9.Acknowledgements:This work is part of the project funded by EULAR Health Professionals Research Grant 2020.Disclosure of Interests:None declared

scholarly journals Barriers to the Implementation of Green Practices in the Integrated Resort Sector

SAGE Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 215824402110302
Author(s):  
Jian Ming Luo ◽  
Ka Yin Chau ◽  
Yulan Fan ◽  
Hong Chen
Keyword(s):  
Grounded Theory ◽  
Qualitative Method ◽  
Qualitative Data ◽  
Structured Interviews ◽  
Green Practices

Green practices and integrated resorts are attracting increasing attention from industry practitioners and academics. However, several barriers limit the growth of green practices, especially in the integrated resorts in Macau. The purpose of this study is to identify the major barriers of implementing green practices in integrated resorts in Macau from the managers’ perspective using qualitative method. Semi-structured interviews were conducted with 12 managers from the integrated resort sector in Macau. Grounded theory was adopted along with NVivo 12.0 to analyze the qualitative data collected from the interviews. Results revealed five major barriers to green practices in the integrated resort sector: policies and regulations, management, resources, costs, and awareness. These findings extend existing theoretical explanations for green practices and provide a guideline of implementing green practices in the integrated resort sector for policymakers and practitioners.

scholarly journals What matters to patients? A mixed method study of the importance and consideration of oncology patient demands

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mathias WAELLI ◽  
Etienne Minvielle ◽  
Maria Ximena Acero ◽  
Khouloud Ba ◽  
Benoit Lalloué
Keyword(s):  
Cancer Patients ◽  
Mixed Method ◽  
New Technologies ◽  
Care Pathway ◽  
Scale Up ◽  
Healthcare Delivery ◽  
Delivery Systems ◽  
Breast Cancer Patients ◽  
Structured Interviews ◽  
Oncology Patient

Abstract Background A patient-centred approach is increasingly the mandate for healthcare delivery, especially with the growing emergence of chronic conditions. A relevant but often overlooked obstacle to delivering person-centred care is the identification and consideration of all demands based on individual experience, not only disease-based requirements. Mindful of this approach, there is a need to explore how patient demands are expressed and considered in healthcare delivery systems. This study aims to: (i) understand how different types of demands expressed by patients are taken into account in the current delivery systems operated by Health Care Organisations (HCOs); (ii) explore the often overlooked content of specific non-clinical demands (i.e. demands related to interactions between disease treatments and everyday life). Method We adopted a mixed method in two cancer centres, representing exemplary cases of organisational transformation: (i) circulation of a questionnaire to assess the importance that breast cancer patients attach to every clinical (C) and non-clinical (NC) demand identified in an exploratory inquiry, and the extent to which each demand has been taken into account based on individual experiences; (ii) a qualitative analysis based on semi-structured interviews exploring the content of specific NC demands. Results Further to the way in which the questionnaires were answered (573 answers/680 questionnaires printed) and the semi-structured interviews (36) with cancer patients, results show that NC demands are deemed by patients to be almost as important as C demands (C = 6.53/7 VS. NC = 6.13), but are perceived to be considered to a lesser extent in terms of pathway management (NC = 4.02 VS C = 5.65), with a significant variation depending on the type of non-clinical demands expressed. Five types of NC demands can be identified: demands relating to daily life, alternative medicine, structure of the treatment pathway, administrative and logistic assistance and demands relating to new technologies. Conclusions This study shows that HCOs should be able to consider non-clinical demands in addition to those referring to clinical needs. These demands require revision of the healthcare professionals’ mandate and transition from a supply-orientated system towards a demand-driven approach throughout the care pathway. Other sectors have developed hospitality management, mass customisation and personalisation to scale up approaches that could serve as inspiring examples.

The deputy principal instructional leadership role and professional learning

2017 ◽  
Vol 55 (1) ◽  
pp. 33-48 ◽  
Author(s):  
Ann Leaf ◽  
George Odhiambo
Keyword(s):  
Instructional Leadership ◽  
Professional Learning ◽  
Ad Hoc ◽  
Team Building ◽  
Leadership Role ◽  
Instructional Leaders ◽  
Structured Interviews ◽  
Content Type ◽  
Practical Implications

Purpose The purpose of this paper is to report on a study examining the perceptions of secondary principals, deputies and teachers, of deputy principal (DP) instructional leadership (IL), as well as deputies’ professional learning (PL) needs. Framed within an interpretivist approach, the specific objectives of this study were: to explore the extent to which DPs are perceived as leaders of learning, to examine the actual responsibilities of these DPs and to explore the PL that support DP roles. Design/methodology/approach The researchers used multiple perspective case studies which included semi-structured interviews and key school document analysis. A thematic content analysis facilitated qualitative descriptions and insights from the perspectives of the principals, DPs and teachers of four high-performing secondary schools in Sydney, Australia. Findings The data revealed that deputies performed a huge range of tasks; all the principals were distributing leadership to their deputies to build leadership capacity and supported their PL in a variety of ways. Across three of the case study schools, most deputies were frequently performing as instructional leaders, improving their school’s performance through distributing leadership, team building and goal setting. Deputy PL was largely dependent on principal mentoring and self-initiated but was often ad hoc. Findings add more validity to the importance of principals building the educational leadership of their deputies. Research limitations/implications This study relied upon responses from four case study schools. Further insight into the key issues discussed may require a longitudinal data that describe perceptions from a substantial number of schools in Australia over time. However, studying only four schools allowed for an in-depth investigation. Practical implications The findings from this study have practical implications for system leaders with responsibilities of framing the deputies’ role as emergent educational leaders rather than as administrators and the need for coherent, integrated, consequential and systematic approaches to DP professional development. Further research is required on the effect of deputy IL on school performance. Originality/value There is a dearth of research-based evidence exploring the range of responsibilities of deputies and perceptions of staff about deputies’ IL role and their PL needs. This is the first published New South Wales, Australian DP study and adds to the growing evidence around perceptions of DPs as instructional leaders by providing an Australian perspective on the phenomenon. The paper raises important concerns about the complexity of the DP’s role on the one hand, and on the other hand, the PL that is perceived to be most appropriate for dealing with this complexity.

scholarly journals An evaluation of Cognitive Stimulation Therapy sessions for people with dementia and a concomitant support group for their carers

Dementia ◽  
2016 ◽  
Vol 16 (8) ◽  
pp. 985-1003 ◽  
Author(s):  
Jan Bailey ◽  
Paul Kingston ◽  
Simon Alford ◽  
Louise Taylor ◽  
Edward Tolhurst
Keyword(s):  
Support Groups ◽  
Support Group ◽  
Qualitative Data ◽  
Cognitive Stimulation ◽  
Structured Interviews ◽  
Post Intervention ◽  
Cognitive Stimulation Therapy ◽  
People With Dementia ◽  
Quasi Experimental ◽  
The Impact

This research aimed to ascertain the impact of a pragmatic Cognitive Stimulation Therapy course of 10 sessions on the cognitive function of people living with dementia and whether attending a concomitant carers support group was beneficial to carers. A mixed method quasi-experimental approach was adopted; data were collected pre- and post-intervention. The quantitative arm utilised three validated questionnaires rated by the carers. Qualitative data were collected via semi-structured interviews with carers regarding their perceptions of the impact of Cognitive Stimulation Therapy and the carers support group. Quantitative data analysis found no statistically significant differences within or between groups. The qualitative data demonstrated that carers perceived Cognitive Stimulation Therapy had some benefits for the people living with dementia, especially social benefits. Carers also perceived that attending the carers support group was beneficial for them in terms of gaining a better understanding of dementia, developing coping skills and having peer support. The study was limited in scale and further research with a larger sample, using direct measures of the impact of Cognitive Stimulation Therapy with people living with dementia and supplementary research exploring which characteristic of carers support groups are effective would be worthwhile.

scholarly journals Proposal of a clinical care pathway for quality and safe management of headache patients: a consensus study report

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e037190
Author(s):  
Julio Pascual ◽  
Patricia Pozo-Rosich ◽  
Irene Carrillo ◽  
Sandra Rodríguez-Justo ◽  
Dolores Jiménez-Hernández ◽  
...  
Keyword(s):  
Care Pathway ◽  
Clinical Care ◽  
National Health System ◽  
Diagnostic Errors ◽  
Healthcare Management ◽  
Care Process ◽  
Quality And Safety ◽  
Clinical Safety ◽  
Safety Standards ◽  
Headache Patients

BackgroundHeadache is one of the most prevalent and disabling conditions. Its optimal management requires a coordinated and comprehensive response by health systems, but there is still a wide variability that compromises the quality and safety of the care process.PurposeTo establish the basis for designing a care pathway for headache patients through identifying key subpathways in the care process and setting out quality and clinical safety standards that contribute to providing comprehensive, adequate and safe healthcare.MethodA qualitative research study based on the consensus conference technique. Eleven professionals from the Spanish National Health System participated, seven of them with clinical experience in headache and four specialists in healthcare management and quality. First, identification of the key subpathways in the care process for headache, barriers/limitations for optimal quality of care, and quality and safety standards applied in each subpathway. Second, two consecutive consensus rounds were carried out to assess the content of the subpathway level descriptors, until the expert agreement was reached. Third, findings were assessed by 17 external healthcare professionals to determine their understanding, adequacy and usefulness.ResultsSeven key subpathways were identified: (1) primary care, (2) emergency department, (3) neurology department, (4) specialised headache unit, (5) hospitalisation, (6) outpatients and (7) governance and management. Sixty-seventh barriers were identified, the most frequent being related to diagnostic errors (36,1%), resource deficiency (25%), treatment errors (19,4%), lack of health literacy (13,9%) and inadequate communications with care transitions (5,6%). Fifty-nine quality and 31 safety standards were defined. They were related to evaluation (23.3%), patient safety (21.1%), comprehensive care (12.2%), treatment (12.2%), clinical practice guidelines (7.8%), counselling (6.7%), training (4.4%) and patient satisfaction (3.3%).ConclusionsThis proposal incorporates a set of indicators and standards, which can be used to define a pathway for headache patients and determine the levels of quality.

scholarly journals Community pharmacy as a setting for public health nutrition action: Australian nutritionists’ perspectives

2014 ◽  
Vol 18 (10) ◽  
pp. 1864-1872 ◽  
Author(s):  
Judith H Maher ◽  
John Lowe ◽  
Roger Hughes
Keyword(s):  
Public Health ◽  
Health Care ◽  
Community Pharmacy ◽  
Qualitative Data ◽  
Infant Nutrition ◽  
Public Health Nutrition ◽  
Structured Interviews ◽  
Nutrient Supplementation ◽  
Practice Experience ◽  
In Pregnancy

AbstractObjectiveTo explore public health nutritionists’ perceptions of nutrition and its place in community pharmacy (CP) presently and into the future; and to explore perceived opportunities, feasibility and scope of public health nutrition (PHN) interventions in CP, with a focus on maternal and infant nutrition.DesignQualitative data were gathered through semi-structured interviews and drew on hermeneutics as the theoretical framework for analysis and interpretation.SettingQueensland, Australia.SubjectsPublic health nutritionists, identified through purposive, criterion sampling, were chosen due to (i) their role as potential stakeholders, (ii) their knowledge and emphasis on nutrition and (iii) their practice experience.ResultsOpportunities for PHN action focused primarily on actions relating to early nutrient supplementation in pregnancy and breast-feeding protection and promotion. Opportunities in CP were constrained by practitioners’ perception of (i) conflict between health care and commercial interests in CP, (ii) problematic practices in CP and (iii) values and motivations of practitioners and other stakeholders in the CP sector. Strategies were suggested to improve practices and enhance the setting from a PHN perspective. Participants suggested both collaborative and regulatory approaches to achieve settings-based changes, identifying the need for these to coexist for effective outcomes.ConclusionsPublic health nutritionists suggest that opportunities for PHN action are constrained by perceived conflicted interests and that consumers need to be adequately protected from the influence of commercial interests. PHN action in this setting needs adequate reflection on evidence as well as ethics ensuring that practices are ‘for the good’ of mothers and infants.

Language barriers in healthcare delivery

2021 ◽  
Vol 16 (3) ◽  
Author(s):  
Mercy Akrofi Ansah ◽  
Mercy Adzo Klugah
Keyword(s):  
Ad Hoc ◽  
Healthcare Delivery ◽  
Language Barriers ◽  
Medical Personnel ◽  
Structured Interviews ◽  
Communication Accommodation ◽  
Quality Healthcare ◽  
Communication Accommodation Theory ◽  
Doctor Patient Communication ◽  
Accommodation Theory

The relevance of language for quality healthcare delivery cannot be overemphasised. Within the framework of communication accommodation theory, this paper discusses language barriers in expatriate doctor–patient communication in three state-owned hospitals in Ghana, and the strategies employed by the medical personnel to bridge communication gaps. The study design is qualitative and the data were obtained through semi-structured interviews with 16 expatriate doctors, three nurses and three patients. Furthermore, observation of five patient–doctor interactions was undertaken and notes taken. Both datasets were then analysed using the qualitative conventional content analysis approach. The findings revealed that the expatriate doctors employed convergence strategies such as ad hoc interpreters, gestures, picture charts and electronic dictionaries to deal with language barriers. The study is expected to stimulate further research into innovative ways of dealing with language barriers in expatriate doctor–patient interactions.

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