scholarly journals Nurses' Viewpoints on the Quality of Care: A Qualitative Study in Timor-Leste

2020 ◽  
Author(s):  
Bernadethe Marheni Luan ◽  
Paulo Lopes ◽  
Domingos Soares
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Health System ◽  
Low Income ◽  
Quality Care ◽  
Low Income Countries ◽  
Small Island ◽  
Skill Mix ◽  
Timor Leste

Abstract Background Research on quality of care revealed nurse-to-patient ratio and skill mix served as key elements in quality of care. However, those studies were done in countries where nursing workforce had reasonable proportion of professional nurses with bachelor degrees. Findings of these researches may overlook challenges in health system as well as the nature of nursing service in small island low-income countries that has a huge proportion of auxiliary nurses. Working in under-sourced places, nurses in Timor-Leste might have different viewpoints on what aspect contribute to quality of care. Methods Focus group discussions (FGDs) were done in 2017, in three districts that included staff nurses and senior nurses from three levels of health care facilities: primary, secondary, and tertiary. Data were analyzed using content analysis method. Results Two themes were emerged from the FGDs data: “patients as the center of the service” and “gaps in providing quality of care”. Aside from attributes of quality care such as equality, efficiency, and patient-centeredness in the delivery of care, the first theme also covered the importance of employing nurses’ value system in order to uphold quality of care. The second theme included quality care milieu amplifying distinctive factors facing health system in under-resources places. Problems related with facility infrastructure, equipment and supplies, financing, management, and staffing were narrated. While an inadequacy or a deficiency of these factors implies the country’s struggles to maintain a functioning health care facility, it incapacitated nurses to improve quality of care. Conclusions Compared to nurses in countries with better skill mix, nurses in under-resources places and small island low-income countries face different challenging situations that go beyond nursing realm, forcing nurses to describe quality care uniquely. Findings from this study provide evidence that it is urgent to develop policies of human resources for health (HRH) within the context of the health policies that contributes to professional management of the largest cadre, thus strengthens their ability to improve patient care service.

scholarly journals Nurses’ Viewpoints on the Quality of Care: A Qualitative Study in Timor-Leste

2020 ◽  
Author(s):  
Bernadethe Marheni Luan ◽  
Paulo Lopes ◽  
Domingos Soares
Keyword(s):  
Quality Of Care ◽  
Health System ◽  
Quality Care ◽  
Small Island ◽  
Nursing Workforce ◽  
Specific Level ◽  
Skill Mix ◽  
Patient Care Service ◽  
Timor Leste

Abstract BackgroundResearch on quality of care revealed nurse-to-patient ratio and skill mix as key elements in quality of care. However, those studies were done in countries where the nursing workforce had a higher proportion of professional nurses with bachelor degrees. The findings of the research studies may have overlooked health system challenges such as the auxiliary nursing services found in lesser developed small island countries with higher proportions of auxiliary nurses. Working in under-resourced places, nurses in Timor-Leste might have differing viewpoints on the aspects that contribute to quality of care perspectives.MethodsFocus group discussions (FGDs) were conducted in 2017, in three districts that included staff and senior nurses from three levels of health care facilities: primary, secondary, and tertiary. Data were analyzed using content analysis method.ResultsTwo themes emerged from the FGDs data: “patients as the center focus of the service” and “gaps in providing quality of care”. Aside from attributes of quality care such as equality, efficiency, and patient-centeredness in the delivery of care, the first theme also identified the importance of identifying nurses’ value system in order to support a specific level of quality of care. The second theme included quality care milieu amplifying distinctive factors facing a health system in under-resourced places. Problems related with structural dimension of quality of care such as facility infrastructure and staffing were described. Nurses were unable to improve the quality of care in healthcare facilities when faced with inadequate and deficient infrastructure, equipment, supplies, financing, management, and staffing support. Conclusions Compared to nurses in countries with a better workforce skill mix, nurses in lesser developed small island countries and nurses working in under-resourced places, face additional challenges that uniquely influence the quality of care. Findings from this study provide evidence that it is important to develop human resources for health (HRH) policies that contribute to professional management of the nursing workforce as the largest health workforce cadre, thus strengthening their ability to improve patient care service.

‘It makes you someone who changes with the times’: health worker and client perspectives on a smartphone-based counselling application deployed in rural Tanzania

2019 ◽  
Vol 34 (4) ◽  
pp. 307-315 ◽  
Author(s):  
Kristy Hackett ◽  
Mina Kazemi ◽  
Curtis Lafleur ◽  
Peter Nyella ◽  
Lawelu Godfrey ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Health System ◽  
Data Management ◽  
Low Income ◽  
Community Intervention ◽  
Health Workers ◽  
Low Income Countries ◽  
Maternal And Newborn Health ◽  
Pregnancy And Childbirth

AbstractMobile health (mHealth) applications have been developed for community health workers (CHW) to help simplify tasks, enhance service delivery and promote healthy behaviours. These strategies hold promise, particularly for support of pregnancy and childbirth in low-income countries (LIC), but their design and implementation must incorporate CHW clients’ perspectives to be effective and sustainable. Few studies examine how mHealth influences client and supervisor perceptions of CHW performance and quality of care in LIC. This study was embedded within a larger cluster-randomized, community intervention trial in Singida, Tanzania. CHW in intervention areas were trained to use a smartphone application designed to improve data management, patient tracking and delivery of health messages during prenatal counselling visits with women clients. Qualitative data collected through focus groups and in-depth interviews illustrated mostly positive perceptions of smartphone-assisted counselling among clients and supervisors including: increased quality of care; and improved communication, efficiency and data management. Clients also associated smartphone-assisted counselling with overall health system improvements even though the functions of the smartphones were not well understood. Smartphones were thought to signify modern, up-to-date biomedical information deemed highly desirable during pregnancy and childbirth in this context. In this rural Tanzanian setting, mHealth tools positively influenced community perceptions of health system services and client expectations of health workers; policymakers and implementers must ensure these expectations are met. Such interventions must be deeply embedded into health systems to have long-term impacts on maternal and newborn health outcomes.

Health system reconstitution syndrome: an often misunderstood phenomenon in global health practice

2019 ◽  
Vol 34 (8) ◽  
pp. 618-624
Author(s):  
Anatole Manzi ◽  
Alyssa Ierardo ◽  
Jean Claude Mugunga ◽  
Cate Oswald ◽  
Patrick Ulysse ◽  
...  
Keyword(s):  
Global Health ◽  
Health System ◽  
Low Income ◽  
Program Implementation ◽  
Quality Care ◽  
Building Blocks ◽  
Health Systems Strengthening ◽  
Low Income Countries ◽  
Global Movement ◽  
Active Implementation

Abstract The beginning of the 21st century was marked by the new definition and framework of health systems strengthening (HSS). The global movement to improve access to high-quality care garnered new resources to design and implement comprehensive HSS programs. In this effort, billions of dollars flowed from novel mechanisms such as The Global Fund to Fight AIDS, Tuberculosis and Malaria; Gavi, the Vaccine Alliance; and several bilateral funders. However, poor health outcomes, particularly in low-income countries, raise questions about the effectiveness of HSS program implementation. While several evaluation projects focus on the ultimate impact of HSS programs, little is known about the short- and mid-term reactions occurring throughout the active implementation of HSS interventions. Using the well-documented WHO framework of six HSS building blocks, we describe the evolution and phases of health system reconstitution syndrome (HSRS), including: (1) quiescent phase, (2) reactive phase, (3) restorative phase and (4) stability phase. We also discuss the implications of HSRS on global health funding, implementation, policy and research. Recognizing signs of HSRS could improve the rigour of HSS program design and minimize premature decisions regarding the progress of HSS interventions.

Neoliberal Reforms in Swedish Primary Health Care: For Whom and for What Purpose?

2008 ◽  
Vol 38 (4) ◽  
pp. 697-715 ◽  
Author(s):  
Göran Dahlgren
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Primary Health Care ◽  
Low Income ◽  
Health Sector ◽  
High Income ◽  
Public Hospitals ◽  
Primary Health ◽  
Access And Quality

The conservative government that came to power in Sweden in 2006 has initiated major market-oriented reforms in the health sector. Its first health care policy bill changed the health legislation to make it possible to sell/transfer public hospitals to commercial providers while maintaining public funding. Far-reaching market-oriented primary health care reforms are also initiated, for example in Stockholm County. They are typically presented as “free choice models” in which “the money follows the patient.” The actual and likely effects of these reforms in terms of access and quality of care are discussed in this article. One main finding is that existing social inequities in geographic access to care not only are reinforced but also become very difficult to change by democratic political decisions. Furthermore, dynamic market forces will gradually reduce the quality of care in low-income areas while both access and quality of care will be even better in high-income areas. Public funds are thus transferred from people living in low-income areas to people living in high-income areas, even though the need for good health services is much greater in the low-income areas. Certain policy options for reversing the inverse law of care are also presented.

International Efforts in Health Care Reform: Systemic Treatment Funding Model Reform in Ontario

2014 ◽  
Vol 10 (3) ◽  
pp. 190-192 ◽  
Author(s):  
Leonard Kaizer ◽  
Vicky Simanovski ◽  
Irene Blais ◽  
Carlin Lalonde ◽  
William K. Evans
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Health System ◽  
Health Care Reform ◽  
Evidence Based Practice ◽  
Systemic Treatment ◽  
Evidence Based ◽  
Clinical Services ◽  
Funding Model

Ontario is undergoing health system funding reform, which will transform the funding of selected clinical services to a patient-based approach anchored in evidence-based practice and quality of care. In support of this approach, a new systemic treatment funding model is being developed, with planned implementation on April 1, 2014.

scholarly journals Can the craze for patient safety hinder a more holistic care of the person in the health care system?

2018 ◽  
Vol 8 (12) ◽  
pp. 9
Author(s):  
Mamane Abdoulaye Samri ◽  
Daphney St-Germain
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Quality Of Care ◽  
Health System ◽  
Continuous Improvement ◽  
Clinical Governance ◽  
Decision Makers ◽  
Holistic Care

Background and objective: Since the publication of a report by the Institute of Medicine on the mortality associated with adverse events in the hospital, patient safety has become one of the essential objectives of the health care system. However, this movement tends to obscure the fundamental link between safety and quality of care in the health system. The study was aimed to demonstrate that the only focus on patient safety concept overshadow the more holistic care of the person and the population in the health care system.Methods: Documentary research in the Pubmed database and the Google Scholar search engine, from 1999 to 2017.Results and conclusion: Highly targeted safety research without addressing quality at first can only be a long-term panacea for current health policies. For cause, a one-way look at patient safety could lead to significant impacts at the population level. In order to get out of this craze, health system decision-makers would benefit from supporting clinical governance advocating humanistic and holistic strategies for interventions, engaging in a process of continuous improvement of the Quality of care more profitable in the long term. In order to overcome this craze, health system decision-makers would benefit from supporting clinical governance that advocates humanistic and holistic strategies for interventions, by engaging in a process of continuous improvement in the quality of care that is most beneficial in the long term. This posture is similar to Caring's well-known nursing model.

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