Deference to Expertise: Making Care Safer

2017 ◽  
Vol 23 (1) ◽  
pp. 7-12 ◽  
Author(s):  
Gwendolyn Cherese Godlock ◽  
Rebecca Suzie Miltner ◽  
Dori Taylor Sullivan
Keyword(s):  
Health Care ◽  
Care Delivery ◽  
High Reliability ◽  
Health Care Team ◽  
Institute Of Medicine ◽  
Structural Elements ◽  
Speaking Up ◽  
Quality Of Patient Care ◽  
Speak Up

Since the seminal report by the Institute of Medicine, To Err Is Human, was issued in 1999, significant efforts across the health care industry have been launched to improve the safety and quality of patient care. Recent advances in the safety of health care delivery have included commitment to creating high-reliability organizations (HROs) to enhance existing quality improvement activities. This article will explore key elements of the HRO concept of deference to expertise, describe the structural elements that support nurses and other personnel in speaking up, and provide examples of practical, evidence-based tools to help organizations support and encourage all members of the health care team to speak up.

Patient Response Toward a Change in the System of Health Care Delivery

PEDIATRICS ◽  
1973 ◽  
Vol 52 (2) ◽  
pp. 289-293
Author(s):  
Kathleen J. Motil ◽  
W. John Siar
Keyword(s):  
Health Care ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Poor Quality ◽  
Emergency Rooms ◽  
Patient Response ◽  
Number Of Patients ◽  
Comprehensive Health ◽  
Crisis Care

With the emphasis being placed on comprehensive health care, outpatient clinics in major city hospitals have found it necessary to reevaluate their methods of health care delivery. An increasing number of patients who fail to schedule or keep medical appointments appear for crisis care, resulting in a higher cost of hospital operation due to unnecessary utilization of emergency rooms and the wasting of time of clerical and professional personnel, as well as poor quality of health care due to See the Table in PDF File sporadic clinic attendance. When comparing behavior patterns and attitudes of clinic patients under different methods of health care delivery, patient preferences become apparent.

scholarly journals The impact of the use of health information and communication technology on health care delivery in Manitoba, Canada

2014 ◽  
Vol 3 (6) ◽  
pp. 8 ◽  
Author(s):  
Israel R Kabashiki ◽  
Ngozi I Moneke
Keyword(s):  
Health Care ◽  
Health Information ◽  
Information And Communication Technology ◽  
Health Care Delivery ◽  
Communication Technology ◽  
Quality Of Health Care ◽  
Care Delivery ◽  
Wait Times ◽  
Information And Communication

Background: Health Information and Communication Technology (HICT) has the potential to reduce patient wait time and improves patient satisfaction. The Long wait times for patients to receive medical services are a big issue in Canada. The Canadian government has invested in Information and Communication Technology (ICT) to shorten patient referral wait times for medical services. Little was known about the association between ICT investments and the quality of health care delivery, and particularly between the use of ICT and referral wait times in the Manitoba Health System (MHS). Methods: The purpose of this quantitative correlational study was to determine if a relationship existed between the use of HICT and the quality of health care delivery in the MHS. The quality of health care delivery was measured in terms of referral wait time, health information sharing effectiveness, physicians’ satisfaction, and patients’ satisfaction. Conclusion: Findings indicated the absence of a significant association between HICT use and referral wait times. Significant correlations were found to exist between (1) HICT use and health information sharing effectiveness, (2) HICT use and physician’s satisfaction, and (3) HICT use and patient’s satisfaction. Four recommendations emerged from this study: First, patient satisfaction should be used as an indicator of the quality of health care delivery. Second, health knowledge repository and expert systems should be integrated into health ICT systems to minimize unnecessary referrals. Third, a mixed health system should be implemented to shorten wait times. Fourth, the portability of the Canadian Medicare should be enhanced to allow Manitobans in particular and Canadians in general to seek medical services abroad. This study was intended to contribute to the existing body of knowledge associated with ICT investments’ outcomes and health care delivery in the MHS.  

scholarly journals Female insertion in neurosurgery: Evolution of a stigma break

2021 ◽  
Vol 12 ◽  
pp. 76
Author(s):  
Luiz Severo Bem Junior ◽  
Nilson Batista Lemos ◽  
Júlia de Araújo Vianna ◽  
Juliana Garcia Silva ◽  
Luana Moury Fernandes Sanchez ◽  
...  
Keyword(s):  
Health Care ◽  
Gender Differences ◽  
Literature Review ◽  
Gender Inequality ◽  
Care Delivery ◽  
Electronic Library ◽  
Participation Of Women ◽  
The World ◽  
The Usa

Background: Utilizing the Brazilian Medical Demography analysis and a literature review, we evaluated how women choose to become neurosurgeons in Brazil and around the world, specifically citing the Europe, the USA, India, and Japan. Methods: We utilized the Brazilian Medical Demography prepared by the Federal Council of Medicine and the Regional Council of Medicine of the State of São Paulo (2011, 2013, 2015, and 2018). We also included an evaluation of 20 articles from PubMed, the Scientific Electronic Library Online, and National Health Library databases (e.g., using descriptors “Women in neurosurgery” and “Career”). Results: In Brazil in 2017, women comprised 45.6% of active doctors, but only 8.6% of all neurosurgeons. Of 20 articles identified in the literature, 50% analyzed the factors that influenced how women choose neurosurgery, 40% dealt with gender differences, while just 10% included an analysis of what it is like to be a female neurosurgeon in different countries/continents. Conclusion: The participation of women in neurosurgery has increased in recent years despite the persistence of gender inequality and prejudice. More women need to be enabled to become neurosurgeons as their capabilities, manual dexterity, and judgment should be valued to improve the quality of neurosurgical health-care delivery.

scholarly journals The Art of Surgery: Balancing Compassionate With Virtual Care (Preprint)

2020 ◽  
Author(s):  
Elisheva Tamar Anne Nemetz ◽  
David Robert Urbach ◽  
Karen Michelle Devon
Keyword(s):  
Health Care ◽  
Physical Examination ◽  
Health Care Team ◽  
Body Language ◽  
Surgical Practice ◽  
Good Communication ◽  
Academic Literature ◽  
Virtual Care ◽  
Patient Groups

UNSTRUCTURED The recent drive to include virtual care in surgical practice has been accelerated due to the COVID-19 pandemic. Many physicians feel that communicating via telehealth is unlike traditional methods of providing health care, and thus guidance on maintaining excellence in communication is necessary, especially as academic literature on virtual care in surgery is nonexistent. Challenges faced in transitioning to virtual care include the inability to utilize body language, barriers to traditional physical examination, exacerbation of existing vulnerabilities and inequities in patient groups, the declining quality of medical education, and the fragmentation of the multidisciplinary health care team. This paper seeks to resolve these challenges by focusing on the pillars of good communication, including preparation, professionalism, empathy, respect, and the virtual physical examination.

scholarly journals DENTAL HYGIENISTS AS ESSENTIAL MEMBERS OF THE HEALTH CARE TEAM

2018 ◽  
Vol 1 (2) ◽  
pp. 73
Author(s):  
Jacqueline Juhl
Keyword(s):  
Health Care ◽  
Oral Health ◽  
Care Delivery ◽  
Cost Effective ◽  
Economic Loss ◽  
The United States ◽  
Health Care Team ◽  
Care Team ◽  
Oral Disease ◽  
Dental Hygienists

Despite the advances in dental sciences, innovative oral health programs, and efforts dedicated by oral health professionals,globally, unmet oral disease, and the economic loss it causes, is growing. In the present, oral health care delivery systemsurgently need improvement. The introduction of dental hygienists as essential members of the health care team can contributeto improved and cost-effective health care outcomes. This paper provides definitions of dental hygienists from both, aninternational and the United States (U.S.) and describes their education, functions, and contributions to the health care team.

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.

Managed care Medicaid

2017 ◽  
Vol 11 (2) ◽  
pp. 198-210 ◽  
Author(s):  
William Trombetta
Keyword(s):  
Health Care ◽  
Managed Care ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Care Quality ◽  
Market Segment ◽  
Economic Aspects ◽  
Content Type ◽  
The Poor

Purpose Providing health care to the poor is evolving in the new US marketplace. The Affordable Care Act has set goals enhancing access to health care, lowering costs and improving patient outcomes. A key segment in this evolution is the most vulnerable health-care population of all: Medicaid. This paper aims to provide a general review of how providing health care to Medicaid patients is changing including how socio-economic aspects of this vulnerable population affects the quality of the health care provided. Design/methodology/approach The paper is entirely secondary research; no primary research has been conducted. Findings Managed care Medicaid provides a risk-based model to treating a vulnerable health-care market segment. The jury is still out on whether managed care Medicaid (MCM) is improving health-care quality and saving cost, but the provision of health care to the Medicaid segment is definitely shifting from a fee-for-service model to value based payment. Very recent developments of new health-care delivery approaches present a positive outlook for improving quality and containing costs going forward. Research limitations/implications At this stage, whether or not MCM saves money or provides better health-care quality to this vulnerable population is a work in progress. Health-care marketing can impact socio-economic aspects of health care for the poor. There is a need to follow up on the positive results being documented in demonstration health-care delivery models. Practical implications At this point, there has been no long-term study of whether managed care Medicaid offers better quality of health care and cost savings. The research to date suggest that the quality of health-care delivery to the poor is improving at a lower cost to payers. Social implications Medicaid patients are an underserved market segment. Managed care Medicaid offers a new model that has the potential to provide quality care at acceptable cost. Critical to this vulnerable market segment is the need to integrate socio-economic aspects of the population with the delivery of health care. Originality/value There has been very little discussion of Medicaid overall in the marketing literature, much less any discussion of managed care Medicaid.

Quality of Care: Performance Measurement and Quality Improvement in Clinical Practice

2017 ◽  
Author(s):  
Sonali P. Desai ◽  
Allen Kachalia
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Performance Measurement ◽  
Financial Incentives ◽  
Clinical Performance ◽  
Care Delivery ◽  
The United States ◽  
Technological Advancement

Attention to the quality of care within the United States health care system has grown tremendously over the past decade. We have witnessed a significant change in how quality improvement and clinical performance measurement are approached. The current focus on quality and safety stems in part from the increasingly clear realization that more services and technological advancement are not automatically equivalent to high-quality care. Much of the discussion about cost and quality in health care is shifting towards the concept of value. Value is defined as health outcomes achieved per dollar spent (in other words, an assessment of the quality of care per cost). This chapter reviews the current state of quality improvement in health care and, because improvement cannot be determined without measurement, reviews several aspects of effective clinical performance measurement. Since many measures are already in place, the chapter describes some of the organizations involved in quality measurement and improvement, as well the approaches they utilize. It looks at the multiple strategies in place to improve quality, from process management to collaboration, from financial incentives to transparency, and reviews newer models of care delivery that may materialize in the near future. Tables list types of quality measures, characteristics to consider when developing a quality measure, and organizations involved in quality improvement and performance measurement. A figure shows strategies used by the federal government to spur performance measurement and quality improvement. This chapter contains 56 references.

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