scholarly journals Early supported hospital discharge for foot disease: a co-design study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rebecca Jessup ◽  
Samantha Hanna ◽  
Jaspreet Kaur ◽  
Iman Bayat ◽  
Cassandra Bramston
Keyword(s):  
Patient Satisfaction ◽  
Focus Groups ◽  
Health System ◽  
Delphi Study ◽  
Response Rate ◽  
Average Length ◽  
Comparative Method ◽  
Health Staff ◽  
Early Supported Discharge ◽  
Foot Disease

Abstract Background There are more than 10,000 admissions each year in Australia for foot disease, with an average length of hospital stay of 26 days. Early supported discharge (ESD) has been shown to improve patient satisfaction and reduce length of stay without increasing the risk of 30-day readmissions. This research aims to gain consensus on an optimal model of early supported discharge for foot disease. Methods Three focus groups were held where preliminary components for an early discharge model, as well as inclusion and exclusion criteria, were identified with a purposefully sampled group of medical, nursing, allied health staff and consumers. Two researchers independently systematically coded focus group transcripts to identify components of an ESD model using an iterative constant comparative method. These components then formed the basis of a three phase Delphi study, with all individuals from the focus groups were invited to act as panellists. Panellists rated components for their importance with consensus established as a rating of either essential or very important by ≥80% of the panel. Results Twenty-nine experts (including 5 consumers) participated across the two study phases. Twenty-three (3 consumers) participated in the focus groups in phase one. Twenty-eight of the twenty-nine experts participated in the phase 2 Delphi. 21/28 completed round 1 of the Delphi (75% response rate), 22/28 completed round 2 (79% response rate), and 16/22 completed round 3 (72% response rate). Consensus was achieved for 17 (29%) of 58 components. These included changes to the way patients are managed on wards (both location and timeliness of care by the multidisciplinary team) and the addition of new workforce roles to improve co-ordination and management of the patients once they are at home. Conclusions A model of early supported discharge that would allow individuals to return home earlier in a way that is safe, acceptable, and feasible may result in improving patient satisfaction while reducing health system burden. Future trial and implementation of the ESD model identified in this study has the potential to make a significant contribution to the experience of care for patients and to the sustainability of the health system.

scholarly journals Early supported hospital discharge for foot disease: a co-design study

2021 ◽  
Author(s):  
Rebecca Jessup ◽  
Samantha Hanna ◽  
Jaspreet Kaur ◽  
Iman Bayat ◽  
Cassandra Bramston
Keyword(s):  
Patient Satisfaction ◽  
Focus Groups ◽  
Health System ◽  
Delphi Study ◽  
Response Rate ◽  
Average Length ◽  
Comparative Method ◽  
Health Staff ◽  
Early Supported Discharge ◽  
Foot Disease

Abstract Background: There are more than 10,000 admissions each year in Australia for foot disease, with an average length of hospital stay of 26 days. Early supported discharge (ESD) has been shown to improve patient satisfaction and reduce length of stay without increasing the risk of 30-day readmissions. This research aims to gain consensus on an optimal model of early supported discharge for foot disease. Methods: Three focus groups were held where preliminary components for an early discharge model, as well as inclusion and exclusion criteria, were identified with a purposefully sampled group of medical, nursing, allied health staff and consumers. Two researchers independently systematically coded focus group transcripts to identify components of an ESD model using an iterative constant comparative method. These components then formed the basis of a three phase Delphi study, with all individuals from the focus groups were invited to act as panellists. Panellists rated components for their importance with consensus established as a rating of either essential or very important by ≥80% of the panel. Results: Twenty-nine experts (including 5 consumers) participated across the two study phases. Twenty-three (3 consumers) participated in the focus groups in phase one. Twenty-eight of the twenty-nine experts participated in the phase 2 Delphi. 21/28 completed round 1 of the Delphi (75% response rate), 22/28 completed round 2 (79% response rate), and 16/22 completed round 3 (72% response rate).Consensus was achieved for 17 (29%) of 58 components. These included changes to the way patients are managed on wards (both location and timeliness of care by the multidisciplinary team) and the addition of new workforce roles to improve co-ordination and management of the patients once they are at home. Conclusions: A model of early supported discharge that would allow individuals to return home earlier in a way that is safe, acceptable, and feasible may result in improving patient satisfaction while reducing health system burden. Future trial and implementation of the ESD model identified in this study has the potential to make a significant contribution to the experience of care for patients and to the sustainability of the health system.

scholarly journals Perceptions of Ecuadorian indigenous healers on their relationship with the formal health care system: barriers and opportunities

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Estefanía Bautista-Valarezo ◽  
Víctor Duque ◽  
Veronique Verhoeven ◽  
Jorge Mejia Chicaiza ◽  
Kristin Hendrickx ◽  
...  
Keyword(s):  
Focus Groups ◽  
Health System ◽  
Ethnic Groups ◽  
Health Beliefs ◽  
Medical Knowledge ◽  
Phenomenological Approach ◽  
Traditional Healers ◽  
Health Staff ◽  
New Paradigm ◽  
Barriers And Opportunities

Abstract Background The new paradigm of intercultural policies focuses on rethinking the common public culture. In Ecuador, the “Buen Vivir” plan seeks to incorporate the ancestral medical knowledge, experience and beliefs of traditional healers into the formal health services. This study explores views on the formal health system from the perspective of the healers belonging to the Kichwa and Shuar ethnicities in the South of Ecuador. Methods A qualitative study with a phenomenological approach was performed. Focus groups were conducted in three locations in Southern Ecuador. Shuar, Kichwa and Mestizo ethnic groups were included in the research. Results Eleven focus groups with a total of 110 participants belonging to the Shuar, Kichwa and Mestizo ethnic groups participated in the study. Six themes were created through analysis: 1) conflicts with health professionals, 2) acceptance of traditional healers, 3) respect, 4) work as a team, 5) environment and patient care, and 6) salary and recognition. Conclusion This study indicated the perceived barriers compromising respectful collaboration between health staff and traditional healers from an indigenous perspective. Power inequalities and a historically unidirectional relationship and, in addition, differences in health beliefs, seem to create misunderstandings regarding each other’s approach when faced with health and disease. However, insight in these barriers can create opportunities towards collaboration, which will have a positive effect on patient confidence in one or both systems and support continuity between traditional healers and the formal health system.

scholarly journals How Public Trust in Health Care Can Shape Patient Overconsumption in Health Systems? The Missing Links

2021 ◽  
Vol 18 (8) ◽  
pp. 3860
Author(s):  
Katarzyna Krot ◽  
Iga Rudawska
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Health System ◽  
Health Systems ◽  
Quantitative Research ◽  
Public Trust ◽  
Complex Problem ◽  
Health Care Consumption ◽  
Mediating Role ◽  
Countries In Transition

Overconsumption of health care is an ever-present and complex problem in health systems. It is especially significant in countries in transition that assign relatively small budgets to health care. In these circumstances, trust in the health system and its institutions is of utmost importance. Many researchers have studied interpersonal trust. Relatively less attention, however, has been paid to public trust in health systems and its impact on overconsumption. Therefore, this paper seeks to identify and examine the link between public trust and the moral hazard experienced by the patient with regard to health care consumption. Moreover, it explores the mediating role of patient satisfaction and patient non-adherence. For these purposes, quantitative research was conducted based on a representative sample of patients in Poland. Interesting findings were made on the issues examined. Patients were shown not to overconsume health care if they trusted the system and were satisfied with their doctor-patient relationship. On the other hand, nonadherence to medical recommendations was shown to increase overuse of medical services. The present study contributes to the existing knowledge by identifying phenomena on the macro (public trust in health care) and micro (patient satisfaction and non-adherence) scales that modify patient behavior with regard to health care consumption. Our results also provide valuable knowledge for health system policymakers. They can be of benefit in developing communication plans at different levels of local government.

scholarly journals Association of shared decision making with inpatient satisfaction: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Huiwen Luo ◽  
Guohua Liu ◽  
Jing Lu ◽  
Di Xue
Keyword(s):  
Patient Satisfaction ◽  
Inpatient Care ◽  
Response Rate ◽  
Positive Response ◽  
Physician Services ◽  
Cross Sectional ◽  
Medical Expenses ◽  
Tertiary Hospitals ◽  
Positive Response Rate ◽  
High Level

Abstract Background We assessed inpatient perceived shared decision making (SDM) and tested the association of SDM with inpatient satisfaction in public tertiary hospitals in Shanghai, China. Methods A cross-sectional survey of 2585 inpatients in 47 public tertiary hospitals in Shanghai in July and August 2018 was conducted. We assessed overall SDM and 4 aspects of SDM and tested the factors influencing SDM and the association of SDM with patient satisfaction (patient satisfaction with physician services, medical expenses, outcomes and overall inpatient care), by adopting linear or two-level regression models. Results The positive response rate (PRR) and high positive response rate (HPRR) to overall SDM among the inpatients of public tertiary hospitals in Shanghai were relatively high (95.30% and 87.86%, respectively), while the HPRR to “My physician informed me of different treatment alternatives” was relatively low (80.09%). In addition, the inpatients who underwent surgery during admission had higher HPRRs and adjusted HPRRs to overall SDM than those who did not undergo surgery. The study showed that the adjusted high satisfaction rates (HSRs) with physician services, medical expenses, outcomes and overall inpatient care among the inpatients with high level of overall SDM were higher (96.50%, 68.44%, 89.50% and 92.60%) than those among the inpatients without a high level of overall SDM (71.77%, 35.19%, 57.30% and 67.49%). The greatest differences in the adjusted HSRs between the inpatients with and without a high level of SDM were found in inpatient satisfaction with medical expenses and informed consent in SDM. Moreover, 46.22% of the variances in the HSRs with overall inpatient care across the hospitals were attributed to the hospital type (general hospitals vs. specialty hospitals). Conclusions Inpatient PRRs and HPRRs to SDM in public tertiary hospitals in Shanghai are relatively high overall but lower to information regarding alternatives. SDM can be affected by the SDM preference of both the patients and physicians and medical condition. Patient satisfaction can be improved through better SDM and should be committed at the hospital level.

American Indian Behavioral Health Treatment Preferences as Perceived by Urban Indian Health Program Providers

2021 ◽  
pp. 104973232110578
Author(s):  
Andrew Pomerville ◽  
Anna Kawennison Fetter ◽  
Joseph P. Gone
Keyword(s):  
Focus Groups ◽  
American Indian ◽  
Behavioral Health ◽  
Cultural Values ◽  
The United States ◽  
Treatment Preferences ◽  
Health Staff ◽  
Indian Health ◽  
Urban Indian ◽  
Therapy Room

Behavioral health services specifically targeted for ethnoracial clients are typically tailored to the specific needs and preferences of these populations; however, little research has been done with American Indian clients specifically. To better understand how clinicians handle provision of treatment to this population, we interviewed 28 behavioral health staff at six Urban Indian Health Programs in the United States and conducted focus groups with 23 staff at five such programs. Thematic analysis of transcripts from these interviews and focus groups suggests that these staff attempt to blend and tailor empirically supported treatments with American Indian cultural values and practices where possible. Simultaneously, staff try to honor the client’s specific preferences and needs and to encourage clients to seek cultural practices and connection outside of the therapy room. In so doing staff members were acutely aware of the limitations of the evidence base and the lack of research with American Indian clients.

scholarly journals Reduction in resource utilization and increase in patient satisfaction two years after implementation of Perioperative Surgical Home

2017 ◽  
Vol 3 (2) ◽  
pp. 18
Author(s):  
Devanand Mangar ◽  
Prachiti H. Dalvi ◽  
Thomas Bernasek ◽  
Enrico Camporesi
Keyword(s):  
Patient Satisfaction ◽  
Joint Replacement ◽  
Average Length ◽  
Preoperative Evaluation ◽  
Preoperative Imaging ◽  
Utilization Review ◽  
Single Shot ◽  
Patient Centered ◽  
Perioperative Surgical Home ◽  
Institutional Review

Introduction: Perioperative Surgical Home (PSH) provides coordinated, team-based care that is patient-centered, designed to guide patients efficiently through the surgical experience. We applied several changes to our anesthesia practice during 2014 and evaluated outcomes for all orthopedic major joint replacement surgeries completed in 2015. Since this was a quality improvement/utilization study, we were granted approval from our institutional review board to retrospectively review these data.Methods: We conducted a utilization review of all 1,356 patients who received total knee, hip, or shoulder joint replacement from 4 major surgical providers in 2015. Preoperative evaluation was limited and focused to each patient’s unique medical conditions. Additionally, we reduced intraoperative fluid use, reduced continuous femoro-sciatic nerve or brachial plexus blocks by increasing the administration of single-shot regional blocks, limited transfusion, and minimized urinary catheter use. We improved pain consult response time and provided timely discharges.Results: We noted 9% reduction in preoperative imaging per case, 22% decrease in average number of tests per case, 87% fewer average units of red blood cell used per case, and a 0.4 day reduction in average length of stay (LOS). Patient satisfaction data showed constant improvement in pain management, and doctor communication.Conclusions: Numerous small modifications to patient care collectively contributed to these progressive observed changes in patient outcomes from quarter to quarter.

Ứng dụng Lean Six Sigma cho quy trình khám chữa bệnh ngoại trú có BHYT tại một số bệnh viện thành phố Hồ Chí Minh

2021 ◽  
Vol 05 (01) ◽  
pp. 84-94
Author(s):  
Van Dat Truong ◽  
◽  
Thi Hong An Hua ◽  
Dang Tu Nguyen Le ◽  
Thi Hai Yen Nguyen
Keyword(s):  
Patient Satisfaction ◽  
Health Insurance ◽  
Six Sigma ◽  
Sigma Model ◽  
Lean Six Sigma ◽  
Health Staff ◽  
Outpatient Services ◽  
Staff Members ◽  
Expected Length ◽  
Screening Procedures

Objects: Evaluate the current state of the quality of insured outpatient services (clinical time, patient satisfaction) and evaluate the effectiveness of the LSS improvement in some steps in the process. Methods: Lean Six Sigma applied research is conducted through five steps: Define-Measure-Analyze-Improve-Control from March 2017 to June 2017 in the outpatient care with health insurance in some Ho Chi Minh city hospitals. A survey on 166 outpatients with health insurance was conducted by direct interviews of pre- and post-admission and in consultation with 10 health staff members. Result: 32 causes of ineffective activities were identified in two screening procedures. Then corrective measures were suggested. The goal of improving survey process timing and patient satisfaction is 20%. After improvements in the Lean Six Sigma model, positive results on the timing of the two procedures were obtained, including the expected length of the registration process (<40 minutes) was improved by 13.8%, the expected length of dosage regimen (<20 minutes) was improved by 22.9%, and the satisfaction level of patients was improved by 11.5%. Conclusion: The Lean Six Sigma model is valued for identifying root causes for non-performance activities in the two above-mentioned screening procedures. It is recommended to apply this model to other procedures and other departments in the hospital, to propose remedies or eliminations from the process based on identified causes. Keyword: Lean, process of outpatients treatment

Patient and Provider Perceptions of a Patient Navigation Program to Improve Postpartum Care Among Publicly Insured Women

2019 ◽  
Author(s):  
Fengling Hu ◽  
Angelina Strohbach ◽  
Noelle G. Martinez ◽  
Melissa A. Simon ◽  
Lynn M. Yee
Keyword(s):  
Patient Satisfaction ◽  
Low Income ◽  
Patient Navigation ◽  
Clinical Care ◽  
Comparative Method ◽  
Interpersonal Relationship ◽  
Program Satisfaction ◽  
Provider Perceptions ◽  
Navigation Program ◽  
Publicly Insured

Abstract Objective This study was aimed to assess patient and provider perceptions of a postpartum patient navigation program. Study Design This was a mixed-method assessment of a postpartum patient navigation program. Navigating New Motherhood (NNM) participants completed a follow-up survey including the Patient Satisfaction with Interpersonal Relationship with Navigator (PSN-I) scale and an open-ended question. PSN-I scores were analyzed descriptively. Eighteen provider stakeholders underwent in-depth interviews to gauge program satisfaction, perceived outcomes, and ideas for improvement. Qualitative data were analyzed by the constant comparative method. Results In this population of low-income, minority women, participants (n = 166) were highly satisfied with NNM. The median PSN-I score was 45 out of 45 (interquartile range [IQR]: 43–45), where a higher score corresponds to higher satisfaction. Patient feedback was also highly positive, though a small number desired more navigator support. Provider stakeholders offered consistently positive program feedback, expressing satisfaction with NNM execution and outcomes. Provider stakeholders noted that navigators avoided inhibiting clinic workflow and eased clinic administrative burden. They perceived NNM improved multiple clinical and satisfaction outcomes. All provider stakeholders believed that NNM should be sustained long-term; suggestions for improvement were offered. Conclusion A postpartum patient navigation program can perceivably improve patient satisfaction, clinical care, and clinic workflow without burden to clinic providers.

scholarly journals Telemedicine Healthcare Service Adoption Barriers in Rural Bangladesh

2020 ◽  
Vol 24 ◽  
Author(s):  
Khondker Mohammad Zobair ◽  
Louis Sanzogni ◽  
Kuldeep Sandhu
Keyword(s):  
Patient Satisfaction ◽  
Information And Communication Technology ◽  
Communication Technology ◽  
Health Staff ◽  
Allocation Of Resources ◽  
Technology Infrastructure ◽  
Rural Bangladesh ◽  
Organisational Effectiveness ◽  
Information And Communication

This article investigates potential barriers to telemedicine adoption in centres hosted by rural public hospitals in Bangladesh. Little is known of the barriers related to telemedicine adoption in this context. Analysis of data collected from rural telemedicine patients identified seven broad categories of barriers: lack of organisational effectiveness, information and communication technology infrastructure, quality of care, allocation of resources, health staff motivation, patient satisfaction and trustworthiness. Their significance is explored. This research is based on the quantitative analysis of a data set of 500 telemedicine patients, from rural areas in Bangladesh. A conceptual model showing the interaction of pre-determined classes of barriers was established and hypotheses set up and tested using partial least squares structural equation modelling. Exemplary barriers to telemedicine adoption were identified and confirmed (p<.01) namely, lack of organisational effectiveness, health staff motivation, patient satisfaction, and trustworthiness collectively explaining 62% of the variance in barriers to adoption and providing for the first-time empirical support of their existence. These barriers offer considerable resistance to the adoption and maintenance of current telemedicine projects in rural Bangladesh. Further, lack of information and communication technology infrastructure, allocation of resources and quality of care are indirect barriers affecting successful deployment of telemedicine in rural settings. These findings illuminate adoption impediments faced by existing telemedicine projects and institutionalise favourable policy guidelines to improve Bangladesh’s and similar emerging economies’ healthcare industries. Policy interventions and recommendations are provided, including current research limitations leading to opportunities for future research.

How neocolonialism and globalization affect the early childhood workforce in Nepal and Kenya

2020 ◽  
Vol 21 (2) ◽  
pp. 111-125
Author(s):  
Lydiah Nganga ◽  
Samara Madrid Akpovo ◽  
Sapna Thapa ◽  
Agnes Muthoni Mwangi
Keyword(s):  
Early Childhood ◽  
Early Childhood Education ◽  
Focus Groups ◽  
Participant Observation ◽  
Comparative Method ◽  
Early Childhood Teachers ◽  
Women's Work ◽  
Work Lives ◽  
Childhood Education ◽  
Women’S Work

Research shows that modern forms of colonization are vested with globalizing discourses which include early childhood education, gender, and curriculum policies and practices that are Euro-western based. In this collaborative qualitative study, four ethnographic researchers—two who conduct research in Nepal and two who conduct research in Kenya—explored the influence of globalization and neocolonialism on the work lives of early childhood teachers. Data was drawn from three long-term, in-depth ethnographic projects over a period of 6 to 13 years. The methods of data collection consisted of participant observation, field notes, class observations, individual interviews, and focus groups. This article reports on the findings from focus groups and uses a constant comparative method to analyze the data. Three common themes emerged from the analysis of the two data sets: Euro-western dominance; gendered positioning; and teacher resilience. The teachers used Euro-western language (i.e. English) as a key indicator of quality. The findings revealed that early childhood teachers experienced pressure from parents to conform to Euro-western standards, especially the use of English, thus alienating local languages. Teaching young children continued to be positioned as “women’s work,” resulting in low pay for early childhood education teachers and a lack of professionalism within the field. Although the themes of Euro-western standards and gendered discourses were frequent within the data, the theme of resilience was also found. The teachers displayed perseverance by using various coping mechanisms to counter the lack of resources and deprecated status of early childhood education as women’s work.

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