Facilitating cultural change in healthcare organisations

The need for cultural change in healthcare organisations is well documented. There is a plethora of evidence to demonstrate the devastating impact of poor workplace culture on staff and patient outcomes. However, balanced against the significant financial pressures and a staffing crisis, cultural change is unlikely to be made a priority, despite the fact that many of the problems faced by organisations are compounded by poor workplace culture. The evidence demonstrates the positive difference cultural change can make, building staff confidence and encouraging innovation which, in turn, will result in greater efficiency and best use of limited funding. This article presents a simple model that may, when combined with other cultural tools, offer organisations a cost-effective and practical way to develop a positive workplace culture.

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Outcome of Acute Peritoneal Dialysis in Northern Tanzania

Peritoneal Dialysis International ◽

10.3747/pdi.2012.00083 ◽

2012 ◽

Vol 32 (3) ◽

pp. 261-266 ◽

Cited By ~ 45

Author(s):

Kajiru Gad Kilonzo ◽

Sudakshina Ghosh ◽

Siya Anaeli Temu ◽

Venance Maro ◽

John Callegari ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Patient Outcomes ◽

Kidney Injury ◽

Cost Effective ◽

High Morbidity ◽

Poor Countries ◽

Resource Limited ◽

Northern Tanzania ◽

Nephrology Care ◽

Technical Simplicity

Data on the burden of acute kidney injury (AKI) in resource-poor countries such as Tanzania are minimal because of a lack of nephrology services and an inability to recognize and diagnose AKI with any certainty. In the few published studies, high morbidity and mortality are reported. Improved nephrology care and dialysis may lower the mortality from AKI in these settings. Hemodialysis is expensive and technically challenging in resource-limited settings. The technical simplicity of peritoneal dialysis and the potential to reduce costs if consumables can be made locally, present an opportunity to establish cost-effective programs for managing AKI. Here, we document patient outcomes in a pilot peritoneal dialysis program established in 2009 at a referral hospital in Northern Tanzania.

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Future of Personalized Medicine in Oncology: A Systems Biology Approach

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.0777 ◽

2010 ◽

Vol 28 (16) ◽

pp. 2777-2783 ◽

Cited By ~ 176

Author(s):

Ana Maria Gonzalez-Angulo ◽

Bryan T.J. Hennessy ◽

Gordon B. Mills

Keyword(s):

Systems Biology ◽

Patient Outcomes ◽

Cost Effective ◽

Molecular Medicine ◽

Multidimensional Data ◽

Data Sets ◽

Therapeutic Modalities ◽

Molecular Tests ◽

Therapeutic Decision Making ◽

The Masses

The development of cost-effective technologies able to comprehensively assess DNA, RNA, protein, and metabolites in patient tumors has fueled efforts to tailor medical care. Indeed validated molecular tests assessing tumor tissue or patient germline DNA already drive therapeutic decision making. However, many theoretical and regulatory challenges must still be overcome before fully realizing the promise of personalized molecular medicine. The masses of data generated by high-throughput technologies are challenging to manage, visualize, and convert to the knowledge required to improve patient outcomes. Systems biology integrates engineering, physics, and mathematical approaches with biologic and medical insights in an iterative process to visualize the interconnected events within a cell that determine how inputs from the environment and the network rewiring that occurs due to the genomic aberrations acquired by patient tumors determines cellular behavior and patient outcomes. A cross-disciplinary systems biology effort will be necessary to convert the information contained in multidimensional data sets into useful biomarkers that can classify patient tumors by prognosis and response to therapeutic modalities and to identify the drivers of tumor behavior that are optimal targets for therapy. An understanding of the effects of targeted therapeutics on signaling networks and homeostatic regulatory loops will be necessary to prevent inadvertent effects as well as to develop rational combinatorial therapies. Systems biology approaches identifying molecular drivers and biomarkers will lead to the implementation of smaller, shorter, cheaper, and individualized clinical trials that will increase the success rate and hasten the implementation of effective therapies into the clinical armamentarium.

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Addressing the Scottish burden of wounds through the Lens of Profound Knowledge

British Journal of Nursing ◽

10.12968/bjon.2021.30.sup20.s34 ◽

2021 ◽

Vol 30 (Sup20) ◽

pp. S34-S40

Author(s):

Jenni MacDonald

Keyword(s):

Patient Outcomes ◽

Wound Care ◽

Cost Effective ◽

Theory Of Knowledge ◽

Care Needs ◽

Profound Knowledge ◽

The Cost ◽

Improve Patient ◽

Growing Population

The prevalence of wounds and the cost of treating them are increasing year on year. Improving the quality of wound care will improve patient outcomes and is a financial necessity. The Lens of Profound Knowledge is a tool that can be used to support quality improvement and identify where action is needed. It allows exploration of an organisation through four aspects—appreciate the system, understanding variation, psychology, and theory of knowledge—and working on all four aspects simultaneously is believed to increase the likelihood of achieving improvement. Improvements at and between all levels—microsystem (such as frontline services), mesosystem (health boards) and macrosystem (NHS Scotland)—would reduce variation in practice and prove to be both clinically and cost-effective. Given the rapidly growing population of people with unhealed wounds, wound care needs to be valued at all system levels and be adequately resourced.

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Pro/Con debate: Are barrier precautions cost-effective in improving patient outcomes in the intensive care unit?

Critical Care ◽

10.1186/cc10532 ◽

2011 ◽

Vol 16 (1) ◽

pp. 202 ◽

Cited By ~ 1

Author(s):

Nisha Thampi ◽

Andrew M Morris

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Patient Outcomes ◽

Cost Effective

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Red Land/Black Land

Advances in Archaeological Practice ◽

10.7183/2326-3768.2.1.38 ◽

2014 ◽

Vol 2 (1) ◽

pp. 39-49 ◽

Cited By ~ 3

Author(s):

Ethan Watrall

Keyword(s):

Cultural Change ◽

Game Design ◽

Digital Games ◽

Cost Effective ◽

Ancient Egypt ◽

Actual Process ◽

Academic Environments ◽

Alternate Reality Games ◽

Alternate Reality ◽

Black Land

AbstractWhile digital games are used for health intervention, language training, and science learning, there are few instances of games being used to teach archaeology. This is a missed opportunity, as narratives of exploration and discovery make archaeology well suited to digital games. This article discusses Red Land/Black Land, a prototype Civilization V mod (modification of an existing game) that allows players to explore both the process of cultural change in ancient Egypt and the construction of archaeological knowledge about ancient Egypt. As a case study of scholarly game design, the article explores the project’s development. Included is a discussion of play mechanics, the merits and process of modding, and the resources required to build games in academic environments. The article also discusses preliminary efforts to test the game in an undergraduate classroom. Ultimately, the article argues that digital games are powerful tools for communicating archaeology. Instead of falling under the glamour of commercial games, however, scholars should adopt cost effective approaches to game design, looking to mobile play, alternate reality games, modding, and browser based games to realize their vision. The article also argues that the actual process of designing a game is an excellent tool to teach archaeology.

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Is Outpatient Thyroid Surgery for Everyone?

Clinical Medicine Insights Ear Nose and Throat ◽

10.1177/1179550617724428 ◽

2017 ◽

Vol 10 ◽

pp. 117955061772442 ◽

Cited By ~ 6

Author(s):

Dale Butler ◽

Sarah Oltmann

Keyword(s):

Patient Outcomes ◽

Postoperative Bleeding ◽

Hospital Setting ◽

Cost Effective ◽

High Volume ◽

Outpatient Setting ◽

Current Trends ◽

Surgeon Experience ◽

Reduced Costs ◽

Inpatient Basis

Thyroidectomy is a common surgical procedure. Traditionally, surgeons have performed thyroidectomy on an inpatient basis. However, consistent with current trends in surgery, some practices are transitioning thyroidectomy to an outpatient setting. Although concerns for hypocalcemia and postoperative bleeding exist regardless of surgeon experience, multiple studies demonstrate that outpatient thyroidectomy is safe in the hands of high-volume surgeons. Indeed, experienced thyroid surgeons who perform thyroidectomy in an outpatient setting experience excellent patient outcomes and reduced costs. However, outpatient thyroidectomy may not be suitable for all surgeons, hospitals, or patients. When evaluating whether to implement an outpatient thyroid program, a practice should consider a number of important factors including the team performing the procedure, the hospital, and the patient. With the appropriate staff education and experience, hospital setting, and patient selection, practices in a multitude of settings can successfully develop a safe, cost-effective outpatient thyroid program.

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Trends in task shifting in HIV treatment in Africa: Effectiveness, challenges and acceptability to the health professions

African Journal of Primary Health Care & Family Medicine ◽

10.4102/phcfm.v7i1.807 ◽

2015 ◽

Vol 7 (1) ◽

Cited By ~ 22

Author(s):

Talitha Crowley ◽

Pat Mayers

Keyword(s):

Human Resources ◽

Human Resource ◽

Patient Outcomes ◽

Resource Constraints ◽

Monitoring And Evaluation ◽

Cost Effective ◽

Health Professions ◽

Task Shifting ◽

Hiv Treatment ◽

Health System Strengthening

Background: Task shifting has been suggested to meet the demand for initiating and managing more patients on antiretroviral therapy. Although the idea of task shifting is not new, it acquires new relevance in the context of current healthcare delivery.Aim: To appraise current trends in task shifting related to HIV treatment programmes in order to evaluate evidence related to the effectiveness of this strategy in addressing human resource constraints and improving patient outcomes, challenges identified in practice and the acceptability of this strategy to the health professions.Method: Electronic databases were searched for studies published in English between January 2009 and December 2014. Keywords such as ‘task shifting’, ‘HIV treatment’, ‘human resources’ and ‘health professions’ were used.Results: Evidence suggests that task shifting is an effective strategy for addressing human resource constraints in healthcare systems in many countries and provides a cost-effective approach without compromising patient outcomes. Challenges include inadequate supervision support and mentoring, absent regulatory frameworks, a lack of general health system strengthening and the need for monitoring and evaluation. The strategy generally seems to be accepted by the health professions although several arguments against task shifting as a long-term approach have been raised.Conclusion: Task shifting occurs in many settings other than HIV treatment programmes and is viewed as a key strategy for governing human resources for healthcare. It may be an opportune time to review current task shifting recommendations to include a wider range of programmes and incorporate initiatives to address current challenges.

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Modeling vaccination strategies in an Excel spreadsheet: Increasing the rate of vaccination is more effective than increasing the vaccination coverage for containing COVID-19

PLoS ONE ◽

10.1371/journal.pone.0254430 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0254430

Author(s):

Mario Moisés Alvarez ◽

Sergio Bravo-González ◽

Grissel Trujillo-de Santiago

Keyword(s):

Simple Model ◽

Vaccination Coverage ◽

Urban Areas ◽

Local Governments ◽

Rational Design ◽

Cost Effective ◽

Excel Spreadsheet ◽

Social Distancing ◽

Vaccination Strategies ◽

Vaccination Campaigns

We have investigated the importance of the rate of vaccination to contain COVID-19 in urban areas. We used an extremely simple epidemiological model that is amenable to implementation in an Excel spreadsheet and includes the demographics of social distancing, efficacy of massive testing and quarantine, and coverage and rate of vaccination as the main parameters to model the progression of COVID-19 pandemics in densely populated urban areas. Our model predicts that effective containment of pandemic progression in densely populated cities would be more effectively achieved by vaccination campaigns that consider the fast distribution and application of vaccines (i.e., 50% coverage in 6 months) while social distancing measures are still in place. Our results suggest that the rate of vaccination is more important than the overall vaccination coverage for containing COVID-19. In addition, our modeling indicates that widespread testing and quarantining of infected subjects would greatly benefit the success of vaccination campaigns. We envision this simple model as a friendly, readily accessible, and cost-effective tool for assisting health officials and local governments in the rational design/planning of vaccination strategies.

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Implementation of the European Water Framework Directive: procedures and a simple model for the identification of the most cost-effective measures in eutrophicated catchments

Water Policy ◽

10.2166/wp.2009.120 ◽

2009 ◽

Vol 12 (3) ◽

pp. 369-380 ◽

Cited By ~ 2

Author(s):

Barbara Zanou ◽

Christodoulos Bellas ◽

Michalis Skourtos

Keyword(s):

Simple Model ◽

Water Framework Directive ◽

Water Quality Management ◽

Cost Effective ◽

European Water Framework Directive ◽

Mathematical Tool ◽

Active Involvement ◽

Additional Information ◽

European Water ◽

The Cost

According to the European Water Framework Directive (WFD), cost-effectiveness analysis (CEA) should be used for measuring the cost and the environmental effectiveness of a measure in water quality management. The purpose of this paper is to argue that, beyond the calculation of the cost efficiency of the measures, additional information related to the cost and the environmental characteristics is required. Such information provides important data for the decision makers to assess the feasibility of measures and renders the application of CEA more reliable. Moreover, considering that the WFD requires the encouragement of the active involvement of the stakeholders in the planning processes, a practical algorithm could be used for a user-friendly presentation and discussion of CEA results. Furthermore, if the evaluated measures are independent of each other, a simple model of integer programming solved by a simple software program is proposed as an alternative mathematical tool for evaluating a combined set of measures which meet a predetermined environmental objective at the lowest cost.

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