scholarly journals Clinic managers’ perspectives on the sustainable implementation of a decommissioning programme in Sweden: a qualitative study

2020 ◽  
Author(s):  
Mio Fredriksson ◽  
Inga-Britt Gustafsson ◽  
Ulrika Winblad
Keyword(s):  
Health Systems ◽  
Relationship Building ◽  
Great Effort ◽  
Local Health ◽  
Learning Networks ◽  
Local Conditions ◽  
Positive Effects ◽  
Initial Implementation ◽  
Sustainable Implementation ◽  
Patient Pathways

Abstract Background The sustainability of programmes and interventions is more rarely studied than initial implementation. The aim of this study was to investigate, from a sustainability perspective, the implementation of an extensive decommissioning programme in one of the local health systems in Sweden (a so-called region). Decommissioning may become increasingly relevant because health systems today face many challenges that increase the pressure on existing resources.Methods Interviews were performed with 26 clinic managers 3 years after initial implementation of a decommissioning programme. The analysis was based on a model of potential influences on sustainability by Wiltsey Stirman et al.Results Initial adoption was possible due to the involvement of the clinic managers in developing the programme, which comprised everything from closed and merged units to formalised admission criteria, altered prescription patterns and changed patient pathways. Conditions for sustainability were created by changed and intensified meeting structures that resulted in learning networks and through the clinic managers’ central role balancing the staff’s claims while trying to execute the region leadership’s demands. Factors working against sustainability were, among others, fragmented support from the health system’s central functions for HR and economy, altered local conditions with an escalating staffing crisis, too few follow-ups and a decline in the strategic leadership over the years.Conclusions We conclude that the programme was partly sustained and that the most important influences were intervention fit and modifications (i. innovation characteristics), clinic and health system leadership (ii. context), workforce and champions (iii. capacity) and shared decision-making and relationship building (iv. processes and interactions). Perhaps most important for sustainability was the continuous attention to the health system’s poor economy, visible via a great effort by the clinics to keep their budgets—a change in the culture at the clinics. Furthermore, the study shows that, although unpopular, there are also positive effects of decommissioning from the perspective of the primary implementers, e.g., opportunities to make difficult but necessary changes and increased collegial support when centralising services.

Community and health system partnership.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 190-190
Author(s):  
Madeline G. Harris ◽  
Rebecca M. Di Piazza ◽  
Alia Tunagur ◽  
Susan E. Sellers ◽  
Kristen G. Noles ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Health Systems ◽  
Cancer Survivorship ◽  
Breast Cancer Survivors ◽  
Models Of Care ◽  
Relationship Building ◽  
Local Health ◽  
Breast Cancer Survivorship ◽  
Community Based

190 Background: Breast cancer survivors face physical, psychological, medical, social, cultural and spiritual challenges. Services to address these needs are frequently not available or if available unknown. We sought to determine whether formation of a community-based comprehensive breast cancer survivorship program was feasible. Methods: After months of relationship building, the Women’s Breast Health Fund of the Community Foundation of Greater Birmingham (CFGB), awarded funding to support a systematic assessment of available services in the region. Survivors, their loved ones, providers and other national models of care were surveyed and interviewed. Focus groups including a Lesbian, Bisexual, Gay, Transgender, Queer (LGBTQ) group were held. Aggregated results were presented in monthly meetings to executive level hospital administrators from all health systems in the area, the UAB School of Nursing and CFGB. Results: Survivors seek advice from other survivors more than any other source. Gaps in services exist. Breast cancer survivors were often unaware of existing services. Services were not available to some cultural/ethnic groups or loved ones; staff of some services were not culturally sensitive to the needs of survivors. Some services were available to all, while others require payment. There was no source of authoritative, evidence-based information on breast cancer survivorship except for a few providers. After 12 months the group of executives from all health systems committed to support the formation of a community-based comprehensive breast cancer survivorship program designed to assist breast cancer survivors, their loved ones and institutions by providing reliable information about services. Conclusions: Breast cancer survivors, providers, and local health systems all support the development of a comprehensive breast cancer survivorship program. We feel that it will address unmet needs of breast cancer survivors, allowing each institution to address needs for individual patients. By using the breast cancer survivorship program to assess individual needs and to provide information about services for identified needs, we expect repetitive services will be reduced and quality of life for breast cancer survivors will improve.

scholarly journals Helsepersonells erfaringer med pasientforløp i kommuner i Vest-Norge

2017 ◽  
Vol 13 (2) ◽  
Author(s):  
Torill Aarskog Skorpen ◽  
Marit Kvangarsnes ◽  
Torstein Hole
Keyword(s):  
Health Services ◽  
Health Personnel ◽  
Health Care Services ◽  
User Participation ◽  
Local Health ◽  
Care Services ◽  
Western Norway ◽  
Patient Pathways ◽  
Specialist Health Care ◽  
Group Interviews

Health services in Norway have been described as fragmented with weak coordination between different care levels with respect to patient pathways. The Coordination Reform’s aim was to improve patient pathways and strengthen user participation. The aim of this study was to investigate health personnel ́s experiences with patient pathways in municipalities in Western Norway. A qualitative design was chosen. Six focus group interviews with health personnel working in municipalities in Western Norway were conducted in 2013 and 2014. The interviews revealed that health personnel experienced that local health services gave cohesive patient pathways and strengthened user participation. Cohesive patient pathways and locally adapted pathways were considered important. Coordination and electronic communication between primary and specialist health care services were seen as inadequate. Trust, teamwork, competence and necessary resources were considered vital. Health personnel ́s experiences indicated that the intended aim of cohesive patient pathways near the patient was met. 

scholarly journals Management of Malaria in Children Younger Than 5 Years Old During Coronavirus Disease 2019 Pandemic in Sierra Leone: A Lesson Learned?

2021 ◽  
Vol 8 ◽  
Author(s):  
Danilo Buonsenso ◽  
Francesco Iodice ◽  
Bianca Cinicola ◽  
Francesca Raffaelli ◽  
Solia Sowa ◽  
...  
Keyword(s):  
Sierra Leone ◽  
Health Systems ◽  
Positive Impact ◽  
Local Population ◽  
Malaria Diagnosis ◽  
Peripheral Region ◽  
Local Health ◽  
Significant Drop ◽  
Proactive Approach ◽  
The Impact

Growing evidences are showing the potential indirect effects of the Coronavirus Disease 2019 (COVID-19) on the health systems of low-resource settings, where diseases such as Tuberculosis, Human Immunodeficiency Virus (HIV) and Malaria represent major killers. Therefore, we performed a retrospective study aimed to evaluate the impact of COVID-19 on Malaria programs in a peripheral region of Sierra Leone, previously involved by the Ebola outbreak in 2015, when malaria care have been impaired since local health systems were overwhelmed by Ebola cases. During COVID-19 in Sierra Leone, we did not notice a significant drop in malaria diagnosis in children, suggesting that a proactive approach in the management of malaria in endemic countries during COVID-19 may have had a positive impact. A comprehensive approach that include also educational activities to sensitize the local population, was useful to guarantee successful malaria diagnosis and treatment, and prevents excess of malaria deaths due to potential disruption of the local health systems related to the SARS-CoV-2 pandemic.

scholarly journals Scientific Review Committees as part of institutional review of human participant research: Initial implementation at institutions with Clinical and Translational Science Awards

2020 ◽  
Vol 4 (2) ◽  
pp. 115-124
Author(s):  
Harry P. Selker ◽  
Lisa C. Welch ◽  
Elizabeth Patchen-Fowler ◽  
Janis L. Breeze ◽  
Norma Terrin ◽  
...  
Keyword(s):  
Positive Impact ◽  
Institutional Review Boards ◽  
Scientific Quality ◽  
Translational Science ◽  
Scientific Review ◽  
Positive Effects ◽  
Initial Implementation ◽  
Consensus Group ◽  
Institutional Review ◽  
Group Recommendations

AbstractIntroduction:Scientific quality and feasibility are part of ethics review by Institutional Review Boards (IRBs). Scientific Review Committees (SRCs) were proposed to facilitate this assessment by the Clinical and Translational Science Award (CTSA) SRC Consensus Group. This study assessed SRC feasibility and impact at CTSA-affiliated academic health centers (AHCs).Methods:SRC implementation at 10 AHCs was assessed pre/post-intervention using quantitative and qualitative methods. Pre-intervention, four AHCs had no SRC, and six had at least one SRC needing modifications to better align with Consensus Group recommendations.Results:Facilitators of successful SRC implementation included broad-based communication, an external motivator, senior-level support, and committed SRC reviewers. Barriers included limited resources and staffing, variable local mandates, limited SRC authority, lack of anticipated benefit, and operational challenges. Research protocol quality did not differ significantly between study periods, but respondents suggested positive effects. During intervention, median total review duration did not lengthen for the 40% of protocols approved within 3 weeks. For the 60% under review after 3 weeks, review was lengthened primarily due to longer IRB review for SRC-reviewed protocols. Site interviews recommended designing locally effective SRC processes, building buy-in by communication or by mandate, allowing time for planning and sharing best practices, and connecting SRC and IRB procedures.Conclusions:The CTSA SRC Consensus Group recommendations appear feasible. Although not conclusive in this relatively short initial implementation, sites perceived positive impact by SRCs on study quality. Optimal benefit will require local or federal mandate for implementation, adapting processes to local contexts, and employing SRC stipulations.

scholarly journals Qualitative analysis of the coordination of major system change within the Colombian health system in response to COVID-19: study protocol

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Simon Turner ◽  
Natalia Niño
Keyword(s):  
Health Service ◽  
Health Services ◽  
Health System ◽  
Case Studies ◽  
Health Systems ◽  
National Level ◽  
System Change ◽  
Service Planning ◽  
Local Health ◽  
Health Service Planning

Abstract Background Coronavirus (COVID-19) is posing a major and unprecedented challenge to health service planning and delivery across health systems internationally. This nationally funded study is analysing the response of the Colombian health system to the COVID-19 pandemic, drawing on qualitative case studies of three local health systems within the country. The approach will be informed by the concept of ‘major system change’—or coordinated change among a variety of healthcare organizations and other relevant stakeholders— to identify processes that both enable and inhibit adaptation of health services to the challenges presented by COVID-19. The study will collect information on capacity ‘bottlenecks’ as well as successful practices and forms of innovation that have emerged locally, which have the potential for being ‘scaled up’ across Colombia’s health services. Methods/design This qualitative study will be undertaken in two phases. In the first, up to 30 stakeholder interviews will be conducted to ascertain immediate challenges and opportunities for improvement in response to COVID-19 that can be shared in a timely way with health service leaders to inform health service planning. The stakeholders will include planning, provider and intermediary organizations within the health system at the national level. In the second, up to 60 further interviews will be conducted to develop in-depth case studies of three local health systems at the metropolitan area level within Colombia. The interview data will be supplemented with documentary analysis and, where feasible, non-participant observation of planning meetings. Discussion The study’s findings will aid evaluation of the relevance of the concept of major system change in a context of ‘crisis’ decision-making and contribute to international lessons on improving health systems’ capacity to respond to COVID-19 and future pandemics. Study findings will be shared among various stakeholders in the Colombian healthcare system in a formative and timely way in order to inform healthcare planning in response to COVID-19 and future pandemics. Conducting the study at a time of COVID-19 raises a number of practical issues (including physical distancing and pressure on health services) which have been anticipated in the study design and research team’s ways of working.

scholarly journals A Public Health Learning Collaborative on Climate Change for Urban Health Departments, 2016-2018

2020 ◽  
Vol 135 (2) ◽  
pp. 189-201 ◽  
Author(s):  
Linda Rudolph ◽  
Neil Maizlish ◽  
Savannah North ◽  
Kathy Dervin
Keyword(s):  
Public Health ◽  
Climate Change ◽  
The United States ◽  
Community Partnerships ◽  
Relationship Building ◽  
Local Health ◽  
Health Departments ◽  
Learning Collaborative ◽  
Positive Health ◽  
Vulnerability Assessments

Objectives: The objective of this project was to demonstrate and assess approaches of urban local health departments (LHDs) to simultaneously address climate change, health, and equity; incorporate climate change into program practice; and participate in their jurisdiction’s climate change work. Methods: From January 2016 through March 2018, the Center for Climate Change and Health created learning activities, networking and relationship-building opportunities, communication platforms, and information sharing for 12 urban LHDs in the United States. We used administrative data and conducted interviews with participants and key informants to assess success in meeting learning collaborative goals. Results: LHDs developed diverse projects that incorporated internal capacity building, climate and health vulnerability assessments, surveillance, and community engagement. Projects fostered greater LHD engagement on climate change, broadened community partnerships, and furthered LHD integration into jurisdictions’ climate planning. LHD engagement helped shift the dialogue in the community and jurisdiction about climate change to include public health. Conclusions: LHDs have skills and expertise to rapidly partner with other governmental agencies and community-based organizations and to help communities identify vulnerabilities, take action to reduce the health harms of climate change, and—through Health in All Policies approaches and community partnerships—to ensure that climate policies are optimized for positive health and equity outcomes.

scholarly journals Health surveillance: proposal for a tool to evaluate technological arrangements in local health systems

2008 ◽  
Vol 24 (11) ◽  
pp. 2463-2475 ◽  
Author(s):  
Gerluce Alves Pontes da Silva ◽  
Ligia Maria Vieira-da-Silva
Keyword(s):  
Health Systems ◽  
Surveillance System ◽  
Public Health Surveillance ◽  
Web Of Science ◽  
Health Surveillance ◽  
Epidemiological Surveillance ◽  
Local Health ◽  
Data Collection And Analysis ◽  
Depth Analysis ◽  
Technological Mode

In order to identify the various meanings ascribed to health surveillance, the authors conducted a systematic review of articles published from January 1990 to August 2005 in the following databases: LILACS, SciELO, CAPES, MEDLINE, and Web of Science. A total of 144 abstracts were read and 18 full texts of Brazilian articles were selected for in-depth analysis, leading to the design of a typology for technological arrangements related to the various meanings: (i) traditional epidemiological surveillance, with communicable diseases as the main object; (ii) public health surveillance, as the municipal component of the national health surveillance system; and (iii) health surveillance, a technological mode of organizing health practices in a given territory. The proposed typology can contribute to research on surveillance practices in local health systems. It can also serve as a template for data collection and analysis. The meanings ascribed to the three types are discussed in light of public health's historical development as a field.

scholarly journals Provider Diversity in the English NHS: A Study of Recent Developments in Four Local Health Economies

2012 ◽  
Vol 17 (1_suppl) ◽  
pp. 23-30 ◽  
Author(s):  
Pauline Allen ◽  
Simon Turner ◽  
Will Bartlett ◽  
Virginie Perotin ◽  
Greenwell Matchaya ◽  
...  
Keyword(s):  
Community Involvement ◽  
Economies Of Scale ◽  
Third Sector ◽  
Routine Data ◽  
Care Quality ◽  
Local Health ◽  
Barriers To Entry ◽  
Structured Interviews ◽  
Patient Pathways ◽  
The Impact

Objectives To assess the impact of provider diversity on quality and innovation in the English NHS by mapping the extent of diverse provider activity and identifying the differences in performance between Third Sector Organisations (TSOs), for-profit private enterprises, and incumbent organizations within the NHS, and the factors that affect the entry and growth of new providers. Methods Case studies of four local health economies. Data included: semi-structured interviews with 48 managerial and clinical staff from NHS organizations and providers from the private and third sector; some documentary evidence; a focus group with service users; and routine data from the Care Quality Commission and Companies House. Data collection was mainly between November 2008 and November 2009. Results Involvement of diverse providers in the NHS is limited. Commissioners' local strategies influence degrees of diversity. Barriers to entry for TSOs include lack of economies of scale in the bidding process. Private providers have greater concern to improve patient pathways and patient experience, whereas TSOs deliver quality improvements by using a more holistic approach and a greater degree of community involvement. Entry of new providers drives NHS trusts to respond by making improvements. Information sharing diminishes as competition intensifies. Conclusions There is scope to increase the participation of diverse providers in the NHS but care must be taken not to damage public accountability, overall productivity, equity and NHS providers (especially acute hospitals, which are likely to remain in the NHS) in the process.

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