scholarly journals Making the invisible visible: a place for utilizing activity theory within in situ simulation to drive healthcare organizational development?

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Gerard J. Gormley ◽  
Anu Kajamaa ◽  
Richard L. Conn ◽  
Sarah O’Hare
Keyword(s):  
Organizational Development ◽  
Activity Theory ◽  
Health Care Systems ◽  
System Level ◽  
Main Body ◽  
Healthcare Provision ◽  
In Situ Simulation ◽  
Healthcare Needs ◽  
Care Systems

Abstract Background The healthcare needs of our societies are continual changing and evolving. In order to meet these needs, healthcare provision has to be dynamic and reactive to provide the highest standards of safe care. Therefore, there is a continual need to generate new evidence and implement it within healthcare contexts. In recent times, in situ simulation has proven to have been an important educational modality to accelerate individuals’ and teams’ skills and adaptability to deliver care in local contexts. However, due to the increasing complexity of healthcare, including in community settings, an expanded theoretical informed view of in situ simulation is needed as a form of education that can drive organizational as well as individual learning. Main body Cultural-historical activity theory (CHAT) provides us with analytical tools to recognize and analyse complex health care systems. Making visible the key elements of an in situ simulation process and their interconnections, CHAT facilitates development of a system-level view of needs of change. Conclusion In this paper, we theorize how CHAT could help guide in situ simulation processes—to generate greater insights beyond the specific simulation context and bring about meaningful transformation of an organizational activity.

The making and sustaining of leaders in health care

2019 ◽  
Vol 33 (2) ◽  
pp. 241-262 ◽  
Author(s):  
Terry J. Boyle ◽  
Kieran Mervyn
Keyword(s):  
Health Care ◽  
Community Health ◽  
Health Care Services ◽  
Health Care Systems ◽  
Structured Interviews ◽  
Healthcare Provision ◽  
Triple Aim ◽  
Content Type ◽  
Care Services ◽  
Care Systems

Purpose Many nations are focussing on health care’s Triple Aim (quality, overall community health and reduced cost) with only moderate success. Traditional leadership learning programmes have been based on a taught curriculum, but the purpose of this paper is to demonstrate more modern approaches through procedures and tools. Design/methodology/approach This study evolved from grounded and activity theory foundations (using semi-structured interviews with ten senior healthcare executives and qualitative analysis) which describe obstructions to progress. The study began with the premise that quality and affordable health care are dependent upon collaborative innovation. The growth of new leaders goes from skills to procedures and tools, and from training to development. Findings This paper makes “frugal innovation” recommendations which while not costly in a financial sense, do have practical and social implications relating to the Triple Aim. The research also revealed largely externally driven health care systems under duress suffering from leadership shortages. Research limitations/implications The study centred primarily on one Canadian community health care services’ organisation. Since healthcare provision is place-based (contextual), the findings may not be universally applicable, maybe not even to an adjacent community. Practical implications The paper dismisses outdated views of the synonymity of leadership and management, while encouraging clinicians to assume leadership roles. Originality/value This paper demonstrates how health care leadership can be developed and sustained.

scholarly journals Seroprevalence of SARS-CoV-2 IgG Specific Antibodies among Healthcare Workers in the Northern Metropolitan Area of Barcelona, Spain, after the first pandemic wave

2020 ◽  
Author(s):  
J Barallat ◽  
G Fernández-Rivas ◽  
B Quirant-Sánchez ◽  
V González ◽  
M Doladé ◽  
...  
Keyword(s):  
Metropolitan Area ◽  
Healthcare Workers ◽  
Health Care Systems ◽  
Geographical Area ◽  
Risk Groups ◽  
Serum Samples ◽  
Healthcare Needs ◽  
Strategic Role ◽  
Reference Hospital ◽  
Care Systems

ABSTRACTBackgroundThe rapid spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) around the world has caused a global pandemic, infecting millions of individuals worldwide, with an unprecedented impact in health care systems worldwide. Healthcare workers are one of the risk groups that need to be well characterized due to their strategic role in the management of patients, presently and in prevention of healthcare needs for future outbreaks. This study presents the results of the first SARS-CoV-2 seroprevalence study in the Northern Metropolitan Area of Barcelona, Spain.MethodsIgG SARS-CoV2 antibodies were analyzed in serum samples from 7563 healthcare workers of the Northern Metropolitan Area of Barcelona taken during the pandemia (from May 4th to May 22nd, 2020) by chemiluminescence assays.ResultsA total of 779 of 7563 (10.3%) healthcare workers had detectable anti-SARS-CoV-2 IgG (specific for either S1/S2 or N antigens). No significant differences were observed between those working at primary care or at the reference hospital.Interestingly, in 29 (8.53%) of the previously confirmed positive reverse-transcriptase polymerase chain reaction (rRT-PCR) patients SARS-CoV-2 IgG (S1/S2 or recombinant N antigen) were negative.ConclusionSeroprevalence of anti-SARS-CoV-2 IgG in the healthcare workers of the Nord Metropolitan Area of Barcelona was significantly increased in comparison with the general population in the same geographical area. These results give us an important insight for a better understanding of SARS-CoV-2 epidemiology, in a collective that is essential for the response against this pandemic.

Ten (+1) lessons from conducting a mass casualty in situ simulation exercise in a Canadian academic hospital setting

2021 ◽  
Vol 19 (3) ◽  
pp. 253-265
Author(s):  
Jeffrey T. Tochkin, MA, CEM ◽  
Hung Tan, MSc ◽  
Caroline Nolan ◽  
Harrison Carmichael, MD ◽  
Andrew Willmore, MD ◽  
...  
Keyword(s):  
Disaster Preparedness ◽  
Hospital Setting ◽  
Mass Casualty ◽  
First Century ◽  
System Level ◽  
In Situ Simulation ◽  
Hospital Administrators ◽  
Simulation Based ◽  
Disaster Exercise

Providing care in a twenty-first century urban emergency department (ED) and trauma center is a complex high-pressure practice environment. The pressure is intensified during patient surge scenarios commonly seen during mass casualty incidents, such that response must be practiced regularly. Beyond clinical mastery of individual patient trauma care, a coordinated system-level response is essential to optimize patient care during these relatively infrequent events. This paper highlights the need to perform exercises in hospitals while providing practical advice on how to utilize in situ simulation for mass casualty testing. Eleven lessons are presented to assist other emergency management professionals, hospital administrators, or clinical staff to achieve success with in situ simulation. Based upon our experience designing and executing an in situ mass casualty simulation within an ED, we offer lessons applicable to any type of disaster exercise. Simulation offers a powerful tool for the conduct of disaster preparedness exercises for staff across multiple hospital departments and professions.

In Situ Simulation to Assess Pediatric Tracheostomy Care Safety: A Novel Multicenter Quality Improvement Program

2020 ◽  
Vol 163 (2) ◽  
pp. 250-258
Author(s):  
Sharan J. Shah ◽  
Cristen Cusumano ◽  
Sadia Ahmed ◽  
Anthony Ma ◽  
Farrukh N. Jafri ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Assessment Tool ◽  
Clinical Care ◽  
System Level ◽  
Clinical Environment ◽  
Improvement Program ◽  
In Situ Simulation ◽  
Simulation Performance ◽  
Tracheostomy Tubes

Objectives Our objectives were (1) to use in situ simulation to assess the clinical environment and identify latent safety threats (LSTs) related to the management of pediatric tracheostomy patients and (2) to analyze the effects of systems interventions and team factors on LSTs and simulation performance. Methods A multicenter, prospective study to assess LSTs related to pediatric tracheostomy care management was conducted in emergency departments (EDs) and intensive care units (ICUs). LSTs were identified through equipment checklists and in situ simulations via structured debriefs and blinded ratings of team performance. The research team and unit champions developed action plans with interventions to address each LST. Reassessment by equipment checklists and in situ simulations was repeated after 6 to 9 months. Results Forty-one LSTs were identified over 21 simulations, 24 in the preintervention group and 17 in the postintervention group. These included LSTs in access to equipment (ie, availability of suction catheters, lack of awareness of the location of tracheostomy tubes) and clinical knowledge gaps. Mean equipment checklist scores improved from 76% to 87%. Twenty-one unique teams (65 participants) participated in the simulations. The average simulation score was 6.19 out of 16 points. Discussion In situ simulation is feasible and effective as an assessment tool to identify latent safety threats and thus measure the system-level performance of a clinical care environment. Implications for Practice In situ simulation can be used to identify and reassess latent safety threats related to pediatric tracheostomy management and thereby support quality improvement and educational initiatives.

scholarly journals A universal outcome measure for headache treatments, care-delivery systems and economic analysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Timothy J Steiner ◽  
Mattias Linde ◽  
Petra Schnell-Inderst
Keyword(s):  
Health Care ◽  
Outcome Measure ◽  
Care Delivery ◽  
Health Care Systems ◽  
Population Level ◽  
Disability Weight ◽  
Delivery Systems ◽  
System Level ◽  
Care Plans ◽  
Care Systems

Abstract Background The first manuscript in this series delineated a model of structured headache services, potentially cost-effective but requiring formal cost-effectiveness analysis (CEA). We envisaged a need for a new outcome measure for this purpose, applicable to all forms of treatment, care and care-delivery systems as opposed to comparisons of single-modality treatments. Conception and delineation A literature review confirmed the lack of any suitable established measure. We prioritised construct validity, simplicity, comprehensiveness and expression in intuitive units. We noted that pain was the key burdensome symptom of migraine and episodic tension-type headache (TTH), that pain above a certain level was disabling, that it was difficult to put economic value to pain but relatively easy to do this for time, a casualty of headache leading to lost productivity. Alleviation of pain to a non-disabling level would be expected to bring restoration of function. We therefore based the measure on time spent in the ictal state (TIS) of migraine or TTH, either as total TIS or proportion of all time. We expressed impact on health, in units of time, as TIS*DW, where DW was the disability weight for the ictal state supplied by the Global Burden of Disease (GBD) studies. If the time unit was hours, TIS*DW yielded hours lived with (or lost to) disability (HLDs), in analogy with GBD’s years lived with disability (YLDs). Utility assessment Acute treatments would reduce TIS by shortening attack duration, preventative treatments by reducing attack frequency; health-care systems such as structured headache services would have these effects by delivering these treatments. These benefits were all measurable as HLDs-averted. Population-level estimates would be derived by factoring in prevalence, but also taking treatment coverage and adherence into account. For health-care systems, additional gains from provider-training (promoting adherence to guidelines and, therefore, enhancing coverage) and consumer-education (improving adherence to care plans), increasing numbers within populations gaining the benefits of treatments, would be measurable by the same metric. Conclusions The new outcome measure expressed in intuitive units of time is applicable to treatments of all modalities and to system-level interventions for multiple headache types, with utility for CEA and for informing health policy.

scholarly journals COVID-19 pandemic as a watershed moment: A call for systematic psychological health care for frontline medical staff

2020 ◽  
Vol 25 (7) ◽  
pp. 883-887 ◽  
Author(s):  
Agustina Zaka ◽  
Soraya E Shamloo ◽  
Pasquale Fiorente ◽  
Alessandro Tafuri
Keyword(s):  
Health Care ◽  
Psychological Health ◽  
Medical Staff ◽  
Psychological Intervention ◽  
Health Care Systems ◽  
Mental Healthcare ◽  
Sudden Onset ◽  
Psychological Services ◽  
Healthcare Needs ◽  
Care Systems

The COVID-19 pandemic is producing a huge health care burden with millions of cases and thousands of deaths. The coronavirus’ high virulence and contagiousness and the frequent sudden onset of illness is overwhelming critical care and frontline healthcare staff. Frontline professionals are exposed to unprecedented levels of intensive existential threat requiring systematic, specialized psychological intervention and support. New psychological services need to be urgently implemented to manage the mental healthcare needs of frontline medical staff working with patients with COVID-19. The COVID-19 pandemic is a watershed moment: health care systems universally require a step-change to improve our preparedness for future pandemics.

Learning Health Systems Can Promote and Sustain High-Value Occupational Therapy

2021 ◽  
Vol 76 (1) ◽  
Author(s):  
Adam R. Kinney ◽  
Beth Fields ◽  
Lisa Juckett ◽  
Halley Read ◽  
M. Nicole Martino ◽  
...  
Keyword(s):  
Occupational Therapy ◽  
Health Systems ◽  
Health Care Systems ◽  
Quality Care ◽  
System Level ◽  
Learning Health System ◽  
Care Systems ◽  
Concrete Action ◽  
Therapy Services ◽  
Professional Contexts

In the current policy context, the occupational therapy profession must act to promote and sustain high-value care. Stakeholders have delineated efforts, such as defining and measuring high-quality care processes or promoting the adoption of evidence into practice, that can enhance the value of occupational therapy services. There is a growing recognition, however, that low-value care is the product of deficiencies within health care systems and is therefore most amenable to system-level solutions. To date, the specific nature of system-level changes capable of identifying and rectifying low-value occupational therapy has yet to be elucidated. In this “The Issue Is. . .” column, we introduce occupational therapy to the Learning Health System concept and its essential functions. Moreover, we discuss action steps for occupational therapy stakeholders to lay the foundation for Learning Health Systems in their own professional contexts. What This Article Adds: This article is the first to outline concrete action steps needed to transform occupational therapy practice contexts into Learning Health Systems. Such a transformation would represent a system-level change capable of fostering the delivery of high-value occupational therapy services to clients in a variety of practice settings.

scholarly journals HER2 status in breast cancer–an example of pharmacogenetic testing

2007 ◽  
Vol 100 (7) ◽  
pp. 326-329 ◽  
Author(s):  
Mark Kroese ◽  
Ron L Zimmern ◽  
Sarah E Pinder
Keyword(s):  
Breast Cancer ◽  
Health Care Systems ◽  
New Drugs ◽  
Her2 Status ◽  
Timely Manner ◽  
Her2 Testing ◽  
Laboratory Techniques ◽  
Care Systems ◽  
The Uk

The development of new drugs and associated pharmacogenetic tests will provide an increasing number of challenges to health care systems. In particular, how to evaluate their benefits, prioritize for commissioning purposes and implement a service to provide them in a timely manner. This paper presents an overview of HER2 testing for trastuzumab (Herceptin) treatment in breast cancer cases. Immunohistochemistry and fluorescence in situ hybridization laboratory techniques are described and their HER2 testing performances are compared. Future options for the national provision of HER2 testing by the National Health Service in the UK are also discussed.

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