The Patient’s Perspective on Institutional Logics in Russian Maternity Care

The interplay between different institutional logics is a vital topic in contemporary institutional analyses of healthcare. In this paper, we consider relations between professional, bureaucratic, market, and informal logics in the volatile and ever-transforming context of post-Soviet maternity care. We approach this issue from an unconventional angle and study how various logics are interpreted, enacted and manipulated by women-patients. Neo-institutional scholars commonly enlist patients as institutional actors that are involved both in maintaining and changing the institutional order. However, current research neglects the patients’ perspective instead focusing on the practices of healthcare providers. In order to fill this gap, we investigate how expectant mothers make sense of and navigate the complex institutional environment of Russian maternity care. In our analysis we rely on empirical data from fifty-nine qualitative interviews with recent mothers conducted in St. Petersburg in 2015–2017. This data allows us to conclude that the institutional dynamics of maternity care are powered mostly by the rivalry of two logics – one bureaucratic, the other market-driven. The professional logic, meanwhile, remains underrepresented and dominated by the other two. Unlike healthcare practitioners, women perceive the bureaucratic logic as chaotic and unpredictable, while wealthy clients employ a repertoire of actions offered by the market logic to exercise more control of their hospital routine. Different institutional logics compete for dominance, leaving areas of uncertainty in regard to institutional rules. In some cases, patients use informality to manage such ambivalence and challenge the formal order of healthcare facilities. The common character of this strategy prompts us to suggest that informality forms a distinctive fourth logic that frames some actions and interactions within Russian maternity care.

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Youth-Centered Maternity Care: A Binational Qualitative Comparison of the Experiences and Perspectives of Latina Adolescents and Healthcare Providers

10.21203/rs.3.rs-108766/v1 ◽

2020 ◽

Author(s):

Martha J. Decker ◽

Noelle Pineda ◽

Abigail Gutmann-Gonzalez ◽

Claire D. Brindis

Keyword(s):

Decision Making ◽

Maternity Care ◽

Quality Care ◽

Qualitative Interviews ◽

Healthcare Providers ◽

Qualitative Comparison ◽

Latina Adolescents ◽

Provider Perspectives ◽

Centered Care ◽

Delivery Options

Abstract Background Although there is growing recognition of the importance of person-centered maternity care, the needs and perspectives of pregnant adolescents are rarely considered. The purpose of this study was to compare the maternity care experiences of Mexican-origin adolescents in Guanajuato, Mexico and Fresno, California from both youth and healthcare provider perspectives. Methods Qualitative interviews and focus groups were conducted with a total of 89 respondents, including pregnant and parenting adolescents as well as providers between December 2016 and July 2017. Adolescents also completed a short demographic survey prior to participation. Transcripts in English and Spanish were coded and thematically analyzed using Dedoose software. Results were compared by location and between youth and providers. Results Four themes emerged regarding patient-provider interactions: the need for communication and clear explanations, respectful versus judgmental providers, engaging youth in decision-making, and a focus on the age of the youth and their partners. While youth had similar perspectives and priorities in both locations, youth in Mexico reported more negative healthcare experiences than youth in California. Perspectives varied between the youth and providers, with providers in both California and Mexico identifying several structural challenges in providing quality care to adolescents. In California, challenges to supporting immigrant Latina adolescents and their families included language and translation issues as well as barriers to care due to immigration status and documentation. In both locations, providers also mentioned high patient caseloads and their own concerns about the youth’s life choices. Conclusion Youth-centered care requires more effective and respectful patient-provider communication, where adolescents are engaged in their healthcare decision-making and delivery options. Changes in patient-provider interactions can help improve the maternity care experiences and outcomes of Latina adolescents. Healthcare systems and providers need to reconfigure their approaches to focus on the needs and priorities of adolescents.

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Youth-centered maternity care: a binational qualitative comparison of the experiences and perspectives of Latina adolescents and healthcare providers

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03831-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Martha J. Decker ◽

Noelle Pineda ◽

Abigail Gutmann-Gonzalez ◽

Claire D. Brindis

Keyword(s):

Decision Making ◽

Maternity Care ◽

Quality Care ◽

Qualitative Interviews ◽

Healthcare Providers ◽

Qualitative Comparison ◽

Latina Adolescents ◽

Provider Perspectives ◽

Centered Care ◽

Delivery Options

Abstract Background Although there is growing recognition of the importance of person-centered maternity care, the needs and perspectives of pregnant adolescents are rarely considered. The purpose of this study was to compare the maternity care experiences of Mexican-origin adolescents in Guanajuato, Mexico and Fresno, California from both youth and healthcare provider perspectives. Methods Qualitative interviews and focus groups were conducted with a total of 89 respondents, including 74 pregnant and parenting adolescents as well as 15 providers between December 2016 and July 2017. Adolescents also completed a short demographic survey prior to participation. Transcripts in English and Spanish were coded and thematically analyzed using Dedoose software. Results were compared by location and between youth and providers. Results Four themes emerged regarding patient-provider interactions: the need for communication and clear explanations, respectful versus judgmental providers, engaging youth in decision-making, and a focus on the age of the youth and their partners. While youth had similar perspectives and priorities in both locations, youth in Mexico reported more negative healthcare experiences than youth in California. Perspectives varied between the youth and providers, with providers in both California and Mexico identifying several structural challenges in providing quality care to adolescents. In California, challenges to supporting immigrant Latina adolescents and their families included language and translation issues as well as barriers to care due to immigration status and documentation. In both locations, providers also mentioned high patient caseloads and their own concerns about the youth’s life choices. Conclusion Youth-centered care requires more effective and respectful patient-provider communication, where adolescents are engaged in their healthcare decision-making and delivery options. Changes in patient-provider interactions can help improve the maternity care experiences and outcomes of Latina adolescents. Healthcare systems and providers need to reconfigure their approaches to focus on the needs and priorities of adolescents.

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Youth-Centered Maternity Care: A Binational Qualitative Comparison of the Experiences and Perspectives of Latina Adolescents and Healthcare Providers

10.21203/rs.3.rs-85024/v1 ◽

2020 ◽

Author(s):

Martha J. Decker ◽

Noelle Pineda ◽

Abigail Gutmann-Gonzalez ◽

Claire D. Brindis

Keyword(s):

Decision Making ◽

Maternity Care ◽

Quality Care ◽

Qualitative Interviews ◽

Healthcare Providers ◽

Qualitative Comparison ◽

Latina Adolescents ◽

Provider Perspectives ◽

Centered Care ◽

Delivery Options

Abstract Background: Although there is growing recognition of the importance of person-centered maternity care, the needs and perspectives of pregnant adolescents are rarely considered. The purpose of this study was to compare the maternity care experiences of Mexican-origin adolescents in Guanajuato, Mexico and Fresno, California from both youth and healthcare provider perspectives. Methods: Qualitative interviews and focus groups were conducted with a total of 89 respondents, including pregnant and parenting adolescents as well as providers between December 2016 and July 2017. Transcripts in English and Spanish were coded and analyzed using Dedoose software. Results were compared by location and between youth and providers. Results: Four themes emerged regarding patient-provider interactions: the need for communication and clear explanations, respectful versus judgmental providers, engaging youth in decision-making, and a focus on the age of the youth and their partners. While youth had similar perspectives and priorities in both locations, youth in Mexico reported more negative healthcare experiences than youth in California. Perspectives varied between the youth and providers, with providers in both California and Mexico identifying several structural challenges in providing quality care to adolescents. In California, challenges to supporting immigrant Latina adolescents and their families included language and translation issues as well as barriers to care due to immigration status and documentation. In both locations, providers also mentioned high patient caseloads and their own concerns about the youth’s life choices. Conclusion: Youth-centered care requires more effective and respectful patient-provider communication, where adolescents are engaged in their healthcare decision-making and delivery options. Changes in patient-provider interactions can help improve the maternity care experiences and outcomes of Latina adolescents. Healthcare systems and providers need to reconfigure their approaches to focus on the needs and priorities of adolescents.

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Compliance with smoke-free policy at tuberculosis facilities in Armenia: a mixed-methods study

European Journal of Public Health ◽

10.1093/eurpub/ckz186.378 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

Z Grigoryan ◽

V Hayrumyan ◽

Z h Sargsyan ◽

A Harutyunyan

Keyword(s):

Mixed Methods ◽

Policy Implementation ◽

Qualitative Interviews ◽

Healthcare Providers ◽

Mixed Methods Study ◽

Healthcare Facilities ◽

Smoke Free Policy ◽

Sequential Mixed Methods ◽

Free Environment ◽

Indoor Smoking

Abstract Background Smoke-free environments in tuberculosis (TB) facilities promote a tobacco-free lifestyle among patients and healthcare providers and advance their healthy image. Though the national law of Armenia prohibits indoor smoking in healthcare facilities, enforcement of the law is still insufficient. This study aimed to explore compliance with the smoke-free policy in TB facilities in Armenia. Methods An exploratory sequential mixed-methods study was conducted. Overall 21 TB physicians and five key informants in the field of TB and tobacco control participated in qualitative interviews. To further quantify and validate the findings, structured observations of smoke-free policy implementation were conducted in 36 facilities. Results All physicians expressed a positive attitude towards the smoke-free environment and were satisfied with the level of implementation of a smoke-free policy in their TB facilities. According to the respondents, they already have smoke-free environments established in their facilities. “No smoking” signs, warnings about health consequences and financial penalties, and pictures of damaged lungs were the most common measures against indoor smoking. However, only in 17.1% (n = 6) and 8.6% (n = 3) of observed TB facilities there were posted “No smoking” signs and financial penalties, respectively. In 5.7% (n = 2) of facilities, the research team found ashtrays inside the building, and in 20.0% (n = 7) of facilities, there were smoking patients, physicians, and visitors. Conclusions While the qualitative study indicated good compliance, the quantitative findings were controversial with this regard. In fact, in most of the facilities, the smoke-free policy was not properly implemented and enforced. Additional efforts are needed to harmonize the current practices with national policies and recommendations. Key messages There was a discrepancy between practices reported by physicians and the actual observed compliance. Further interventions are needed to ensure 100% compliance with smoke-free policy in TB healthcare facilities.

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RESEARCH: Dry Heat Processing of Single-Use Respirators and Surgical Masks

Biomedical Instrumentation & Technology ◽

10.2345/0899-8205-54.6.410 ◽

2020 ◽

Vol 54 (6) ◽

pp. 410-416

Author(s):

Joyce M. Hansen ◽

Scott Weiss ◽

Terra A. Kremer ◽

Myrelis Aguilar ◽

Gerald McDonnell

Keyword(s):

Microbial Contamination ◽

Healthcare Providers ◽

High Volume ◽

Airborne Particles ◽

Heat Processing ◽

Protective Equipment ◽

Healthcare Facilities ◽

Dry Heat ◽

Surgical Masks ◽

Single Use

The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2, has challenged healthcare providers in maintaining the supply of critical personal protective equipment, including single-use respirators and surgical masks. Single-use respirators and surgical masks can reduce risks from the inhalation of airborne particles and microbial contamination. The recent high-volume demand for single-use respirators and surgical masks has resulted in many healthcare facilities considering processing to address critical shortages. The dry heat process of 80°C (176°F) for two hours (120 min) has been confirmed to be an appropriate method for single-use respirator and surgical mask processing.

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Når styringens ambitioner udfordres af praksis. Om at analysere rummet imellem styringens intentioner og situationel praksis

Dansk Sociologi ◽

10.22439/dansoc.v27i1.5127 ◽

2016 ◽

Vol 27 (1) ◽

pp. 15-34 ◽

Cited By ~ 1

Author(s):

Mathias Herup Nielsen ◽

Niklas Andreas Andersen

Keyword(s):

Michel Foucault ◽

Qualitative Interviews ◽

The Other ◽

Empirical Reality ◽

Men I ◽

Unemployment Policy ◽

The Relationship ◽

Point Of Departure ◽

Local Employment

Studier, der analyserer det sociale med inspiration fra Foucaults tanker om governmentality, kritiseres i stigende omfang for at afskære sig fra at analysere de praktiske relationer, som politisk styring konkret indlejres i. I artiklen tager vi afsæt i denne kritik og viser, med et studie af forholdet mellem et kommunalt jobcenter og et lokalt beskæftigelsesråd, hvordan governmental magtanalyse kan indfange styringens uforudsigelige, mangefacetterede og immanente karakter ved at fokusere på styringsintentionernes møde med den praktiske virkelighed, der søges styret. Formelt er rådet nedsat til at overvåge og kontrollere jobcentret, men i den praktiske relation er det snarere jobcentret, som overvåger og kontrollerer rådet. Artiklen viser, hvordan dette er muligt ved at analysere jobcentrets arbejde med rådet ved hjælp af en række centrale begreber fra Foucaults forfatterskab. Empirisk trækker studiet foruden formelle myndighedsdokumenter, der beskriver rådets tiltænkte rolle, på praksisinformerende empiri i form af kvalitative interviews og mødereferater over en fire-årig periode. ENGELSK ABSTRACT: Mathias Herup Nielsen and Niklas Andreas Andersen: When Praxis Challenges the Ambitions of Governing. Analyzing the Space between the Intentions of Governing and Situational Praxis Studies working with the Foucauldian concept of ”governmentality” are frequently criticized for their apparent disregard of empirical reality. This article takes this critique as its point of departure and demonstrates the application of the concept of governmentality in a concrete empirical case study in order to grasp the unpredictable and multifaceted nature of modern day power. The case investigated here is the relationship between a Danish Jobcentre and a so-called local employment council (LBR). The latter was created to ”control” and ”monitor” the former organization. However, in practice, it is rather the other way around – the Jobcentre is controlling and monitoring the members of the LBR. This article draws on a number of well-known Foucauldian concepts to show how this relation of power is practically structured. Empirically the article draws on documents from central authorities as well as on a number of qualitative interviews with the actors involved – hence, the article attempts to meet with the dominant overall critique of the governmentality perspective for disregarding empirical reality. Keywords: governmentality, Michel Foucault, unemployment policy, jobcentre.

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Preparedness and response to an emerging health threat—Lessons learned from Candida auris outbreaks in the United States

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.12 ◽

2021 ◽

pp. 1-6

Author(s):

Diane Meyer ◽

Elena K. Martin ◽

Syra Madad ◽

Priya Dhagat ◽

Jennifer B. Nuzzo

Keyword(s):

United States ◽

New York ◽

Qualitative Interviews ◽

The United States ◽

Lessons Learned ◽

Infection Prevention And Control ◽

Healthcare Organizations ◽

Candida Auris ◽

Term Care ◽

Healthcare Facilities

Abstract Objective: Candida auris infections continue to occur across the United States and abroad, and healthcare facilities that care for vulnerable populations must improve their readiness to respond to this emerging organism. We aimed to identify and better understand challenges faced and lessons learned by those healthcare facilities who have experienced C. auris cases and outbreaks to better prepare those who have yet to experience or respond to this pathogen. Design: Semi-structured qualitative interviews. Setting: Health departments, long-term care facilities, acute-care hospitals, and healthcare organizations in New York, Illinois, and California. Participants: Infectious disease physicians and nurses, clinical and environmental services, hospital leadership, hospital epidemiology, infection preventionists, emergency management, and laboratory scientists who had experiences either preparing for or responding to C. auris cases or outbreaks. Methods: In total, 25 interviews were conducted with 84 participants. Interviews were coded using NVivo qualitative coding software by 2 separate researchers. Emergent themes were then iteratively discussed among the research team. Results: Key themes included surveillance and laboratory capacity, inter- and intrafacility communication, infection prevention and control, environmental cleaning and disinfection, clinical management of cases, and media concerns and stigma. Conclusions: Many of the operational challenges noted in this research are not unique to C. auris, and the ways in which we address future outbreaks should be informed by previous experiences and lessons learned, including the recent outbreaks of C. auris in the United States.

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An innovative intervention to improve respectful maternity care in three Districts in Ethiopia

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03934-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Birkety Mengistu ◽

Haregeweyni Alemu ◽

Munir Kassa ◽

Meseret Zelalem ◽

Mehiret Abate ◽

...

Keyword(s):

Quality Improvement ◽

Maternity Care ◽

Regression Coefficient ◽

Interrupted Time Series ◽

The Other ◽

Respectful Maternity Care ◽

Experience Of Care ◽

National Initiative ◽

Care Training

Abstract Background Mistreatment of women during facility-based childbirth is a major violation of human rights and often deters women from attending skilled birth. In Ethiopia, mistreatment occurs in up to 49.4% of mothers giving birth in health facilities. This study describes the development, implementation and results of interventions to improve respectful maternity care. As part of a national initiative to reduce maternal and perinatal mortality in Ethiopia, we developed respectful maternity care training module with three core components: testimonial videos developed from key themes identified by staff as experiences of mothers, skills-building sessions on communication and onsite coaching. Respectful maternity care training was conducted in February 2017 in three districts within three regions. Methods Facility level solutions applied to enhance the experience of care were documented. Safe Childbirth Checklist data measuring privacy and birth companion offered during labor and childbirth were collected over 27 months from 17 health centers and three hospitals. Interrupted time series and regression analysis were conducted to assess significance of improvement using secondary routinely collected programmatic data. Results Significant improvement in the percentage of births with two elements of respectful maternal care—privacy and birth companionship offered— was noted in one district (with short and long-term regression coefficient of 18 and 27% respectively), while in the other two districts, results were mixed. The short-term regression coefficient in one of the districts was 26% which was not sustained in the long-term while in the other district the long-term coefficient was 77%. Testimonial videos helped providers to see their care from their clients’ perspectives, while quality improvement training and coaching helped them reflect on potential root causes for this type of treatment and develop effective solutions. This includes organizing tour to the birthing ward and allowing cultural celebrations. Conclusion This study demonstrated effective way of improving respectful maternity care. Use of a multipronged approach, where the respectful maternity care intervention was embedded in quality improvement approach helped in enhancing respectful maternity care in a comprehensive manner.

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Registration of Blood Exposure Accidents in the Netherlands by a Nationally Operating Call Center

Infection Control and Hospital Epidemiology ◽

10.1086/667728 ◽

2012 ◽

Vol 33 (10) ◽

pp. 1017-1023

Author(s):

Peter M. Schneeberger ◽

Annemarie E. Meiberg ◽

Janet Warmelts ◽

Sander C. A. P. Leenders ◽

Paul T. L. van Wijk

Keyword(s):

The Netherlands ◽

Call Center ◽

Preventive Measures ◽

Healthcare Providers ◽

Mental Healthcare ◽

Incidence Rates ◽

Hepatitis B Vaccination ◽

Occupational Health Services ◽

Healthcare Facilities ◽

Call Center Employees

Objective.Healthcare providers and other employees, especially those who do not work in a hospital, may not easily find help after the occurrence of a blood exposure accident. In 2006, a national call center was established in the Netherlands to fill this gap.Methods.All occupational blood exposure accidents reported to the 24-hours-per-day, 7-days-per-week call center from 2007, 2008, and 2009 were analyzed retrospectively for incidence rates, risk assessment, handling, and preventive measures taken.Results.A total of 2,927 accidents were reported. The highest incidence rates were reported for private clinics and hospitals (68.5 and 54.3 accidents per 1,000 person-years, respectively). Dental practices started reporting incidents frequently after the arrangement of a collective financial agreement with the call center. Employees of ambulance services, midwife practices, and private clinics reported mostly high-risk accidents, whereas penitentiaries frequently reported low-risk accidents. Employees in mental healthcare facilities, private clinics, and midwife practices reported accidents relatively late. The extent of hepatitis B vaccination in mental healthcare facilities, penitentiaries, occupational health services, and cleaning services was low (<70%).Conclusions.The national call center successfully organized the national registration and handling of blood exposure accidents. The risk of blood exposure accidents could be estimated on the basis of this information for several occupational branches. Targeted preventive measures for healthcare providers and other employees at risk can next be developed.Infect Control Hosp Epidemiol 2012;33(10):1017-1023

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Community health worker models in South Africa: a qualitative study on policy implementation of the 2018/19 revised framework

Health Policy and Planning ◽

10.1093/heapol/czaa172 ◽

2020 ◽

Author(s):

Joshua P Murphy ◽

Aneesa Moolla ◽

Sharon Kgowedi ◽

Constance Mongwenyana ◽

Sithabile Mngadi ◽

...

Keyword(s):

South Africa ◽

Qualitative Study ◽

Policy Implementation ◽

Community Health ◽

Resource Constraints ◽

Health Workers ◽

Healthcare Providers ◽

Successful Implementation ◽

Programme Implementation ◽

Healthcare Facilities

Abstract South Africa has a long history of community health workers (CHWs). It has been a journey that has required balancing constrained resources and competing priorities. CHWs form a bridge between communities and healthcare service provision within health facilities and act as the cornerstone of South Africa’s Ward-Based Primary Healthcare Outreach Teams. This study aimed to document the CHW policy implementation landscape across six provinces in South Africa and explore the reasons for local adaptation of CHW models and to identify potential barriers and facilitators to implementation of the revised framework to help guide and inform future planning. We conducted a qualitative study among a sample of Department of Health Managers at the National, Provincial and District level, healthcare providers, implementing partners [including non-governmental organizations (NGOs) who worked with CHWs] and CHWs themselves. Data were collected between April 2018 and December 2018. We conducted 65 in-depth interviews (IDIs) with healthcare providers, managers and experts familiar with CHW work and nine focus group discussions (FGDs) with 101 CHWs. We present (i) current models of CHW policy implementation across South Africa, (ii) facilitators, (iii) barriers to CHW programme implementation and (iv) respondents’ recommendations on how the CHW programme can be improved. We chronicled the differences in NGO involvement, the common facilitators of purpose and passion in the CHWs’ work and the multitude of barriers and resource limitations CHWs must work under. We found that models of implementation vary greatly and that adaptability is an important aspect of successful implementation under resource constraints. Our findings largely aligned to existing research but included an evaluation of districts/provinces that had not previously been explored together. CHWs continue to promote health and link their communities to healthcare facilities, in spite of lack of permanent employment, limited resources, such as uniforms, and low wages.

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