scholarly journals A COMBINED MULTI-OBJECTIVE SIMULATION-OPTIMIZATION AND AHP APPROACH: A HEALTHCARE CASE STUDY

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Mohammad Dehghanimohammadabadi ◽  
Nihan Kabadayi
Keyword(s):  
Quality Of Care ◽  
Care Delivery ◽  
Simulation Optimization ◽  
Quality Care ◽  
Health Providers ◽  
Patients Satisfaction ◽  
Combined Simulation ◽  
The Impact

Quality of care is crucial for patients' satisfaction and safety in healthcare centers. The majority of hospitals attempt to implement facility-wide improvements to ensure high-quality care delivery. This study aims to propose a combined Simulation-Optimization and MCDM approach to accurately assess the impact of quality improvement initiatives on different facets of healthcare systems. In this framework, first, the importance (weights) of the different healthcare criteria is determined by health providers’ using an AHP approach. Then, the weights provided by AHP are applied in a simulation-optimization environment to determine the most efficient action with the most desirable quality of care. Simulation provides a platform to examine the effectiveness of different improvement efforts and calculate their impact on the system performance measures.

scholarly journals The relationship between inequitable gender norms and provider attitudes and quality of care in maternal health services in Rwanda: a mixed methods study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kate Doyle ◽  
Shamsi Kazimbaya ◽  
Ruti Levtov ◽  
Joya Banerjee ◽  
Myra Betron ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Care Provider ◽  
Quality Care ◽  
Gender Norms ◽  
Mixed Methods Study ◽  
Gender Attitudes ◽  
Power Dynamics ◽  
Health Providers ◽  
Men’S Involvement

Abstract Background Rwanda has made great progress in improving reproductive, maternal, and newborn health (RMNH) care; however, barriers to ensuring timely and full RMNH service utilization persist, including women’s limited decision-making power and poor-quality care. This study sought to better understand whether and how gender and power dynamics between providers and clients affect their perceptions and experiences of quality care during antenatal care, labor and childbirth. Methods This mixed methods study included a self-administered survey with 151 RMNH providers with questions on attitudes about gender roles, RMNH care, provider-client relations, labor and childbirth, which took place between January to February 2018. Two separate factor analyses were conducted on provider responses to create a Gender Attitudes Scale and an RMNH Quality of Care Scale. Three focus group discussions (FGDs) conducted in February 2019 with RMNH providers, female and male clients, explored attitudes about gender norms, provision and quality of RMNH care, provider-client interactions and power dynamics, and men’s involvement. Data were analyzed thematically. Results Inequitable gender norms and attitudes – among both RMNH care providers and clients – impact the quality of RMNH care. The qualitative results illustrate how gender norms and attitudes influence the provision of care and provider-client interactions, in addition to the impact of men’s involvement on the quality of care. Complementing this finding, the survey found a relationship between health providers’ gender attitudes and their attitudes towards quality RMNH care: gender equitable attitudes were associated with greater support for respectful, quality RMNH care. Conclusions Our findings suggest that gender attitudes and power dynamics between providers and their clients, and between female clients and their partners, can negatively impact the utilization and provision of quality RMNH care. There is a need for capacity building efforts to challenge health providers’ inequitable gender attitudes and practices and equip them to be aware of gender and power dynamics between themselves and their clients. These efforts can be made alongside community interventions to transform harmful gender norms, including those that increase women’s agency and autonomy over their bodies and their health care, promote uptake of health services, and improve couple power dynamics.

scholarly journals Evaluation of a novel approach to community health care delivery in Ifanadiana District, Madagascar

2020 ◽  
Author(s):  
Bénédicte Razafinjato ◽  
Luc Rakotonirina ◽  
Jafeta Benony Andriantahina ◽  
Laura F. Cordier ◽  
Randrianambinina Andriamihaja ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Community Health ◽  
Access To Health Care ◽  
Care Delivery ◽  
Local Level ◽  
Scale Up ◽  
P Value ◽  
The Impact

AbstractDespite the widespread global adoption of community health (CH) systems, there are evidence gaps in how to best deliver community-based care aligned with global best practice in remote settings where access to health care is limited and community health workers (CHWs) may be the only available providers. PIVOT partnered with the Ministry of Public Health to pilot a new two-pronged approach for care delivery in rural Madagascar: one CHW provided care at a stationary CH site while 2-5 additional CHWs provided care via proactive household visits. The pilot included professionalization of the CHW workforce (i.e. recruitment, training, financial incentive) and twice monthly supervision of CHWs. We evaluated the impact of the CH pilot on utilization and quality of integrated community case management (iCCM) in the first six months of implementation (October 2019-March 2020).We compared utilization and proxy measures of quality of care (defined as adherence to the iCCM protocol for diagnosis, classification of disease severity, treatment) in the intervention commune and five comparison communes, using a quasi-experimental study design and relying on routinely collected programmatic data. Average per capita monthly under-five visits were 0.28 in the intervention commune and 0.22 in the comparison communes. In the intervention commune, 40.0% of visits were completed at the household via proactive care. CHWs completed all steps of the iCCM protocol in 77.8% of observed visits in the intervention commune (vs 49.5% in the comparison communes, p-value=<0.001). A two-pronged approach to CH delivery and professionalization of the CHW workforce increased utilization and demonstrated satisfactory quality of care. National stakeholders and program managers should evaluate program re-design at a local level prior to national or district-wide scale-up.

scholarly journals Protocol: Improving Access to Specialist Nephrology Care Among Rural/Remote Dwellers of Alberta: The Role of Electronic Consultation in Improving Care for Patients With Chronic Kidney Disease

2019 ◽  
Vol 6 ◽  
pp. 205435811987871
Author(s):  
Aminu Bello ◽  
Deenaz Zaidi ◽  
Branko Braam ◽  
Mark Courtney ◽  
Jodi Glassford ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Access To Care ◽  
Care Delivery ◽  
Care Quality ◽  
Care Providers ◽  
Practice Facilitation ◽  
Specialist Care ◽  
Nephrology Care ◽  
The Impact

Background: As the burden of chronic kidney disease (CKD) continues to increase, many geographically dispersed Canadians have limited access to specialist nephrology care, which tends to be centralized in major urban areas. As a result, many rural/remote-dwellers in Canada experience poor quality of care and related adverse outcomes. It is imperative to develop alternative care delivery mechanisms to ensure optimal health outcomes for all Canadians. Objective: To investigate the feasibility and effectiveness of electronic consultation (eConsult) as a new model for interactions between specialists and primary care providers (PCPs) to improve access to care for patients with CKD. Design: This is a sequential, mixed methods study that will be conducted in 3 phases. Setting: The study will be conducted across the entire province of Alberta, supported by Alberta Kidney Care (formerly, Northern and Southern Alberta Renal Programs [NARP/SARP]). Patients: Patients suffering from CKD will be included in the study. Measurements: We will assess the barriers and enablers of implementation and adoption of an e-consultation protocol to facilitate access to care for patients with CKD in Alberta with a focus on rural/remote-dwellers with CKD. We will also evaluate the impact of the eConsult system (eg, improved access to specialist care, reduction in care gaps), assess the feasibility of province-wide implementation, and compare eConsult with practice facilitation versus eConsult alone in terms of access to specialist care, quality of care, and related outcomes. Methods: The study will be conducted in 3 phases. In phase 1, we will assess the perceptions of stakeholders (ie, PCPs, nephrologists, patients, policymakers, and other care providers) to improve CKD care delivery, quality, and outcomes in Alberta with focus groups and semistructured interviews. Phase 2 will engage specific family physicians for their input on key factors and logistical issues affecting the feasibility of implementing eConsult for the care of patients with CKD. Phase 3 will provide academic detailing including practice facilitation to clinics in Alberta to assess how eConsult with practice facilitation compares with eConsult alone in terms of access to specialist care, quality of care, and related outcomes. Results: We will assess stakeholder perceptions about potential barriers to and enablers of a new eConsult and decision support system strategy, focusing on elements that are most important for the design of a feasible and implementable intervention. We will develop, pilot test, and assess the impact of the eConsult model in improving access to specialist nephrology care and the feasibility of province-wide implementation. The final phase of the project will address key challenges for optimal care for patients with CKD living in rural, remote, and underserved areas of Alberta, particularly timely referral and disease management as well as the cost-effective benefits of eConsult. Limitations: Lack of high-speed Internet in many rural and remote areas of Alberta may lead to more time spent in completing the eConsult request online versus faxing a referral the traditional way. Allied health care staff (referral coordinators, administrative staff) require training to the eConsult system, and physicians at many remote sites do not have adequate staff to handle eConsult as an added task. Conclusions: Implementation of eConsult can favorably influence referral patterns, access to care, care quality, patient outcomes, and health care costs for people with CKD. Results of this study will inform the optimization of care for rural/remote-dwellers with CKD and will facilitate future partnerships with policymakers and provincial renal programs in Alberta to ensure optimal kidney health for all residents. Trial registration: Not required.

scholarly journals Race, Class, and the Nursing Home Workforce: Experiences of Staff of Color in High-Minority-Proportion Nursing Homes

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 689-689
Author(s):  
Odichinma Akosionu ◽  
Janette Dill ◽  
Manka Nkimbeng ◽  
Tricia Skarphol ◽  
Tetyana Shippee
Keyword(s):  
Nursing Home ◽  
Quality Of Care ◽  
Quality Care ◽  
Structured Interviews ◽  
Culturally Sensitive Care ◽  
Services And Supports ◽  
Staff Wellbeing ◽  
The Impact

Abstract The long-term services and supports workforce is an important part of delivering quality care for nursing home (NH) residents – and increasingly includes staff who are from diverse communities. Our study captured staff (n=61) perspectives on resident quality of care and quality of life through semi-structured interviews, using thematic analysis in six Minnesota high proportion minority NHs. Findings show that although staff of color are valued for the diversity they contribute to the workforce, and the culturally sensitive care they provide, they are also exposed to discriminatory events. In addition, tensions exist between U.S. and non-U.S. born staff of color in NHs. Overall, staff of color who are lower ranked may feel less empowered. Research is needed to explore the impact of negative and discriminatory exposures on staff wellbeing and related outcomes in addition to the direct and indirect impact on the quality of care delivered to NH residents.

A Comprehensive E-prescribing Model to Allow Representing, Comparing, and Analyzing Available Systems

2013 ◽  
Vol 52 (03) ◽  
pp. 199-219 ◽  
Author(s):  
L. Mazzola ◽  
S. Bonacina ◽  
P. Tarquini ◽  
P. Donzelli ◽  
F. Pinciroli ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Care Delivery ◽  
Heterogeneous Systems ◽  
Cost Benefit ◽  
Healthcare Systems ◽  
Cost Evaluation ◽  
The Individual ◽  
Formal Properties ◽  
The Impact

SummaryBackground: Even though ePrescribing systems are now available in many healthcare systems and have been a crucial milestone of the roadmaps towards eHealth in the last years, there is still a large heterogeneity among functionalities and performances of different systems.Objective: In this paper, we propose an updated comprehensive model for the ePre-scribing process able to represent, analyze, and compare current systems and to support the design of new, more general, systems suitable also to sustain the ePrescription process in National Healthcare Systems.Methods: After a preliminary literature review, we identified six main phases of the ePrescribing process, namely Assign, Transmit, Dispense, Administer, Monitor, and Analysis & Decision. Each phase produces a digital object characterized by formal properties that ensure the collection of appropriate data and information and works as input for the next one. The impact, in terms of benefits, of ePrescribing on governance, drug sur -veillance, and quality of care at the individual, territorial, and governmental levels are related to the formal properties of the digital objects created at the end of each phase.Results and Conclusions: The model-based implementation of each phase has an impact on the quality of care, the access to care, and the effectiveness of care delivery. The model does not cover cost evaluation, but the benefits identified can be used as basis for cost-benefit or cost-effectiveness analysis of heterogeneous systems.

Saving Lives following the Expansion of Centralized Remote Telemetry Monitoring

2011 ◽  
Vol 5 (1) ◽  
pp. 64-72 ◽  
Author(s):  
Steven Rubino ◽  
Kathleen Kracht ◽  
Lori Burnell ◽  
Judy Davidson ◽  
Joseph Carney ◽  
...  
Keyword(s):  
Care Delivery ◽  
Quality Care ◽  
Accurate Information ◽  
Care Providers ◽  
Nursing Unit ◽  
Wireless Telemetry ◽  
Patient Status ◽  
Quality Of Patient Care

Continuous monitoring of patients throughout the hospital is a desirable method to ensure the continuity of quality care. Hospitals looking to improve the manner in which they maintain such continuity without compromising efficiency must explore the benefits of implementing monitoring technology to its fullest potential. This case study chronicles the journey of a level-one trauma hospital during the expansion of remote wireless telemetry monitoring and the telemetry technician role. The lives saved as a result of this expansion were primarily attributable to the installation of remote wireless telemetry monitoring in the emergency department. The expansion of the telemetry technician role improved not only the quality of the monitoring signal and recognition, but also the ability to identify changes in trended data. The next step for improving care delivery includes the addition of a patient locator system within the facility, which will provide the most accurate information regarding patient location during transfer. Accurately identifying patient location in addition to alerting staff to changes in patient status will ensure that care providers respond promptly and that the highest quality of patient care is delivered while patients are away from the nursing unit.

scholarly journals Who needs patient satisfaction surveys? Perspectives of Polish doctors, nurses, and patients

2015 ◽  
Vol 125 (2) ◽  
pp. 72-76
Author(s):  
Ludmiła Marcinowicz ◽  
Renata Sierżantowicz ◽  
Agnieszka Dudzik ◽  
Jolanta Sawicka-Powierza ◽  
Zbysław Grajek ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Quality Of Care ◽  
Health Care Providers ◽  
Quality Of Health Care ◽  
Care Delivery ◽  
Care Providers ◽  
The Impact ◽  
Satisfaction Surveys

Abstract Introduction. Patient satisfaction surveys are still popular tools for obtaining feedback on the quality of health care. Nonetheless, there is a paucity of data to indicate whether health care providers even want patients to assess the quality of care delivered. Neither it is certain whether patients are interested in participating in such surveys. Aim. To present and compare the perspectives of doctors, nurses, and patients on the validity of health care customer satisfaction surveys. Material and methods. A cross-sectional survey design was used. The questionnaires were administered to doctors, nurses and patients in three hospitals of different sizes (small, medium, and large), all in the north-east of Poland. Each sample group was given 200 questionnaires; responses were received from 95 doctors (47.5%), 190 nurses (95%), and 182 patients (91%), and included in the final analyses. Results. Most respondents (doctors - 64.2%; nurses - 61.6%; patients - 87.4%) answered ‘Yes’ to the question ‘Do you think that patients should evaluate the quality of health care?’ Analysis of data allowed to identify the following main reasons why patients should evaluate the quality of health care: 1. to enhance the quality of care; 2. to recognise patients as evaluators; 3. to motivate providers to work more efficiently; and 4. to emphasise the impact of evaluation on a core value, i.e. health. Doctors and nurses outlined reasons why they did not advocate conducting patient satisfaction surveys: satisfaction surveys are redundant; negative evaluations; unwillingness to be evaluated by patients; satisfaction surveys hamper effective work with patients; surveys are not objective; survey results are not communicated to providers. Conclusions. Patient satisfaction surveys are desirable tools for evaluating the quality of health care delivery despite the fact that they frequently raise concerns amongst providers and patients. There is, therefore, a definite need for providers to experience the benefits of measuring patient satisfaction. Another important practical implication is that patients need to be convinced that their opinions do matter and contribute to improving the quality of services.

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