scholarly journals The Use of Telerehabilitation Technologies for Cardiac Patients to Improve Rehabilitation Activities and Unify Organizations: Qualitative Study (Preprint)

2018 ◽  
Author(s):  
Birthe Dinesen ◽  
Helle Spindler
Keyword(s):  
Health Care ◽  
Community Of Practice ◽  
Health Care Professionals ◽  
Large Scale ◽  
Qualitative Interviews ◽  
Cardiac Patients ◽  
Long Term Effects ◽  
Interorganizational Cooperation ◽  
Health Care Centers

BACKGROUND Cardiovascular disease is a leading cause of death globally causing 31% of all deaths worldwide. The Danish health care system is characterized by fragmented delivery of services and rehabilitation activities. The Teledialog Telerehabilitation Program for cardiac patients was developed and tested to rectify fragmentation and improve the quality of care. The Teledialog program was based on the assumption that a common communication platform shared by health care professionals, patients, and relatives could reduce or eliminate the fragmentation in the rehabilitation process and improve cooperation between the health professionals. OBJECTIVE This study aimed to assess the interorganizational cooperation between health care professionals across sectors (hospitals, municipal health care centers) in a cardiac telerehabilitation program. METHODS Theories of networks between organizations, the sociology of professions, and the “community of practice” approach were used in a case study of a cardiac telerehabilitation program. A triangulation of data collection techniques were used including documents, participant observation (n=76 hours), and qualitative interviews with healthcare professionals (n=37). Data were analyzed using NVivo 11.0. RESULTS The case study of cooperation in an interorganizational context of cardiac telerehabilitation program is characterized by the following key themes and patterns: (1) integrated workflows via a shared digital rehabilitation plan that help integrate workflow between health care professions and organizations, (2) joint clinical practice showed as a community of practice in telerehabilitation developed across professions and organizations, and (3) unifying the organizations as cooperation has advanced via a joint telerehabilitation program across municipalities and hospitals. CONCLUSIONS The Teledialog Telerehabilitation Program was a new innovative cardiac program tested on a large scale across hospitals, health care centers, and municipalities. Assessments showed that the Teledialog program and its associated technologies helped improve interorganizational cooperation and reduce fragmentation. The program helped integrate the organizations and led to the creation of a community of practice. Further research is needed to explore long-term effects of implementation of telerehabilitation technologies and programs. CLINICALTRIAL ClinicalTrials.gov NCT01752192; http://clinicaltrials.gov/ct2/show/NCT01752192 (Archived by WebCite at http://www.webcitation.org/6yR3tdEpb)

scholarly journals Leadership assumptions on implementation of patient involvement methods

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kathrine Håland Jeppesen ◽  
Kirsten Frederiksen ◽  
Marianne Johansson Joergensen ◽  
Kirsten Beedholm
Keyword(s):  
Health Care ◽  
Organizational Learning ◽  
Health Care Professionals ◽  
Large Scale ◽  
Patient Involvement ◽  
Hospital Setting ◽  
Implementation Process ◽  
University Hospital ◽  
Structured Interviews ◽  
Implementation Processes

Abstract Background From 2014 to 17, a large-scale project, ‘The User-involving Hospital’, was implemented at a Danish university hospital. Research highlights leadership as crucial for the outcome of change processes in general and for implementation processes in particular. According to the theory on organizational learning by Agyris and Schön, successful change requires organizational learning. Argyris and Schön consider that the assumptions of involved participants play an important role in organizational learning and processes. The purpose was to explore leaders’ assumptions concerning implementation of patient involvement methods in a hospital setting. Methods Qualitative explorative interview study with the six top leaders in the implementation project. The semi-structured interviews were conducted and analyzed in accordance with Kvale and Brinkmanns’ seven stages of interview research. Result The main leadership assumptions on what is needed in the implementation process are in line with the perceived elements in organizational learning according to the theory of Argyris and Schön. Hence, they argued that implementation of patient involvement requires a culture change among health care professionals. Two aspects on how to obtain success in the implementation process were identified based on leadership assumptions: “The health care professionals’ roles in the implementation process” and “The leaders’ own roles in the implementation process”. Conclusion The top leaders considered implementation of patient involvement a change process that necessitates a change in culture with health care professionals as crucial actors. Furthermore, the top leaders considered themselves important facilitators of this implementation process.

scholarly journals Surveillance, anticipation and firefighting: Perspectives of patient safety from a New Zealand case study

2020 ◽  
Author(s):  
J Wailling ◽  
Brian Robinson ◽  
M Coombs
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
New Zealand ◽  
Health Care Professionals ◽  
Nuclear Power ◽  
High Reliability ◽  
Health Care Systems ◽  
Tertiary Hospital ◽  
Structured Interviews

© 2018 John Wiley & Sons Ltd Aim: This study explored how doctors, nurses and managers working in a New Zealand tertiary hospital understand patient safety. Background: Despite health care systems implementing proven safety strategies from high reliability organisations, such as aviation and nuclear power, these have not been uniformly adopted by health care professionals with concerns raised about clinician engagement. Design: Instrumental, embedded case study design using qualitative methods. Methods: The study used purposeful sampling, and data was collected using focus groups and semi-structured interviews with doctors (n = 31); registered nurses (n = 19); and senior organisational managers (n = 3) in a New Zealand tertiary hospital. Results: Safety was described as a core organisational value. Clinicians appreciated proactive safety approaches characterized by anticipation and vigilance, where they expertly recognized and adapted to safety risks. Managers trusted evidence-based safety rules and approaches that recorded, categorized and measured safety. Conclusion and Implications for Nursing Management: It is important that nurse managers hold a more refined understanding about safety. Organisations are more likely to support safe patient care if cultural complexity is accounted for. Recognizing how different occupational groups perceive and respond to safety, rather than attempting to reinforce a uniform set of safety actions and responsibilities, is likely to bring together a shared understanding of safety, build trust and nurture safety culture.

scholarly journals Exploring the feasibility of a network of organizations for pain rehabilitation: what are the lessons learned?

2020 ◽  
Author(s):  
Cynthia Lamper ◽  
Ivan PJ Huijnen ◽  
Mariëlle EAL Kroese ◽  
Albère J Köke ◽  
Gijs Brouwer ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Large Scale ◽  
Critical Mass ◽  
Implementation Strategies ◽  
Daily Practice ◽  
Lessons Learned ◽  
Integration Of Care ◽  
Treatment Protocols ◽  
Rehabilitation Care

Abstract Background and aims: Integration of care is lacking for chronic musculoskeletal pain (CMP) patients. Network Pain Rehabilitation Limburg (NPRL), a transmural health care network, has been designed to provide integrated rehabilitation care from a biopsychosocial perspective to improve patients’ levels of functioning. This feasibility study aims to provide insight into barriers and facilitators for the development, implementation, and transferability of NPRL.Methods: This study was conducted with a three-phase iterative and incremental design from October 2017 to October 2018. NPRL comprises two rehabilitation practices, and three local primary care networks, with a general practitioner together with, a mental health practice nurse, and a physiotherapist or exercise therapist. These stakeholders with a random sample of participating patients took part in evaluations, consisting of interviews, focus groups, and observations. Field notes and observations were recorded during meetings. The Consolidated Framework for Implementation Research guided data collection and analysis. Results were used to refine the next phase.Results: According to health care professionals (HCPs), guidelines and treatment protocols facilitate consistency and transparency in collaboration, biopsychosocial language, and treatment. One barrier is stigmatization of CMP in society. Non-participating HCPs’ treatment approaches are often more biomedical than biopsychosocial, causing patients to resist participating in NPRL. The current organization of health care, with cultural, structural, and financial aspects, acts as a barrier, complicating implementation between and within practices. HCPs preferred the iterative, bottom-up strategy. A critical mass of participating organizations is needed for proper implementation.Conclusion: NPRL is feasible in daily practice if barriers are overcome and facilitators of development, implementation, and transferability are promoted. These findings will be used to refine NPRL. A large-scale process and effect evaluation will be performed. Our implementation strategies and results may assist other health care organizations aspiring to implement a transmural network using a similar model.

scholarly journals Conceptualization and Implementation of the Central Information Portal on Rare Diseases: Protocol for a Qualitative Study (Preprint)

2017 ◽  
Author(s):  
Svenja Litzkendorf ◽  
Tobias Hartz ◽  
Jens Göbel ◽  
Holger Storf ◽  
Frédéric Pauer ◽  
...  
Keyword(s):  
Health Care ◽  
Rare Diseases ◽  
Health Care Professionals ◽  
Information Needs ◽  
Qualitative Interviews ◽  
Quality Criteria ◽  
Quality Information ◽  
High Quality ◽  
Information Portal ◽  
High Quality Information

BACKGROUND Recently, public and political interest has focused on people living with rare diseases and their health concerns. Due to the large number of different types of rare diseases and the sizable number of patients, taking action to improve the life of those affected is gaining importance. In 2013, the federal government of Germany adopted a national action plan for rare diseases, including the call to establish a central information portal on rare diseases (Zentrales Informationsportal über seltene Erkrankungen, ZIPSE). OBJECTIVE The objective of this study, therefore, was to conduct scientific research on how such a portal must be designed to meet the needs of patients, their families, and medical professionals, and to provide high-quality information for information seekers. METHODS We chose a 3-step procedure to develop a needs-based prototype of a central information portal. In the first step, we determined the information needs of patients with rare diseases, their relatives, and health care professionals by means of qualitative interviews and their content-analytical evaluation. On the basis of this, we developed the basic structure of the portal. In the second step, we identified quality criteria for websites on rare diseases to ensure that the information linked with ZIPSE meets the quality demands. Therefore, we gathered existing criteria catalogs and discussed them in an expert workshop. In the third step, we implemented and tested the developed prototypical information portal. RESULTS A portal page was configured and made accessible on the Web. The structure of ZIPSE was based on the findings from 108 qualitative interviews with patients, their relatives, and health care professionals, through which numerous information needs were identified. We placed particularly important areas of information, such as symptoms, therapy, research, and advisory services, on the start page. Moreover, we defined 13 quality criteria, referring to factors such as author information, creation date, and privacy, enabling links with high-quality information. Moreover, 19 users tested all the developed routines based on usability and comprehensibility. Subsequently, we improved the visual presentation of search results and other important search functions. CONCLUSIONS The implemented information portal, ZIPSE, provides high-quality information on rare diseases from a central point of access. By integrating the targeted groups as well as different experts on medical information during the construction, the website can assure an improved search for information for users. ZIPSE can also serve as a model for other Web-based information systems in the field of rare diseases. REGISTERED REPORT IDENTIFIER RR1-10.2196/7425

scholarly journals Co-designing tools for workplace learning

2020 ◽  
Vol 121 (3/4) ◽  
pp. 175-205
Author(s):  
Sebastian Maximilian Dennerlein ◽  
Vladimir Tomberg ◽  
Tamsin Treasure-Jones ◽  
Dieter Theiler ◽  
Stefanie Lindstaedt ◽  
...  
Keyword(s):  
Health Care ◽  
Informal Learning ◽  
Health Care Professionals ◽  
Technology Enhanced Learning ◽  
Cognitive Tools ◽  
Formal Learning ◽  
Learning Context ◽  
Design Decisions ◽  
Content Type

Purpose Introducing technology at work presents a special challenge as learning is tightly integrated with workplace practices. Current design-based research (DBR) methods are focused on formal learning context and often questioned for a lack of yielding traceable research insights. This paper aims to propose a method that extends DBR by understanding tools as sociocultural artefacts, co-designing affordances and systematically studying their adoption in practice. Design/methodology/approach The iterative practice-centred method allows the co-design of cognitive tools in DBR, makes assumptions and design decisions traceable and builds convergent evidence by consistently analysing how affordances are appropriated. This is demonstrated in the context of health-care professionals’ informal learning, and how they make sense of their experiences. The authors report an 18-month DBR case study of using various prototypes and testing the designs with practitioners through various data collection means. Findings By considering the cognitive level in the analysis of appropriation, the authors came to an understanding of how professionals cope with pressure in the health-care domain (domain insight); a prototype with concrete design decisions (design insight); and an understanding of how memory and sensemaking processes interact when cognitive tools are used to elaborate representations of informal learning needs (theory insight). Research limitations/implications The method is validated in one long-term and in-depth case study. While this was necessary to gain an understanding of stakeholder concerns, build trust and apply methods over several iterations, it also potentially limits this. Originality/value Besides generating traceable research insights, the proposed DBR method allows to design technology-enhanced learning support for working domains and practices. The method is applicable in other domains and in formal learning.

scholarly journals “Repeated Hierarchies”: Uneven Participation in Research of Ethical Spaces in Hospitals

2019 ◽  
Vol 14 (5) ◽  
pp. 493-495
Author(s):  
Brenda Bogaert ◽  
Catherine Dekeuwer ◽  
Nadja Eggert ◽  
Claire Harpet
Keyword(s):  
Health Care ◽  
Focus Group ◽  
Health Care Professionals ◽  
Group Discussion ◽  
Ethical Reflection ◽  
Full Participation ◽  
The Status ◽  
Study Process ◽  
Participation In Research

We present a case study of uneven participation in a focus group discussion with health care professionals involved in local ethical committees. We conclude that the status of the different participants did not give adequate space for full participation of the members involved. Two commentators were invited to comment on the case study to enable further reflection on the methodology used for the target group. The first reviewer investigated whether research should address power relations and hierarchies of knowledge encountered in the study process. She also discussed whether researchers should be held ethically and politically responsible for the consequences of producing relations and hierarchies. The second reviewer looked at what focus groups say about professional practices in hospitals, what participants are willing (or unwilling) to invest, and what are the conditions for setting up ethical reflection.

scholarly journals Geographical Access of the Elderly to Health Care Centers During a 20-Year Period (1996–2016): a Case Study of Kermanshah, Iran

2020 ◽  
Author(s):  
Ali Almasi ◽  
Shahram Saeidi ◽  
Alireza Zangeneh ◽  
Mehdi Khezeli ◽  
Yahya Salimi ◽  
...  
Keyword(s):  
Health Care ◽  
The Elderly ◽  
Geographical Access ◽  
Health Care Centers

scholarly journals Smoking control: challenges and achievements

2016 ◽  
Vol 42 (4) ◽  
pp. 290-298 ◽  
Author(s):  
Luiz Carlos Corrêa da Silva ◽  
Alberto José de Araújo ◽  
Ângela Maria Dias de Queiroz ◽  
Maria da Penha Uchoa Sales ◽  
Maria Vera Cruz de Oliveira Castellano
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Large Scale ◽  
Scale Production ◽  
Large Scale Production ◽  
Care Policies ◽  
Promising Area ◽  
Health Care Policies ◽  
Smoking Control

ABSTRACT Smoking is the most preventable and controllable health risk. Therefore, all health care professionals should give their utmost attention to and be more focused on the problem of smoking. Tobacco is a highly profitable product, because of its large-scale production and great number of consumers. Smoking control policies and treatment resources for smoking cessation have advanced in recent years, showing highly satisfactory results, particularly in Brazil. However, there is yet a long way to go before smoking can be considered a controlled disease from a public health standpoint. We can already perceive that the behavior of our society regarding smoking is changing, albeit slowly. Therefore, pulmonologists have a very promising area in which to work with their patients and the general population. We must act with greater impetus in support of health care policies and social living standards that directly contribute to improving health and quality of life. In this respect, pulmonologists can play a greater role as they get more involved in treating smokers, strengthening anti-smoking laws, and demanding health care policies related to lung diseases.

scholarly journals Recommendations to reduce inequalities for LGBT people facing advanced illness: ACCESSCare national qualitative interview study

2017 ◽  
Vol 32 (1) ◽  
pp. 23-35 ◽  
Author(s):  
Katherine Bristowe ◽  
Matthew Hodson ◽  
Bee Wee ◽  
Kathryn Almack ◽  
Katherine Johnson ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Qualitative Interviews ◽  
Historical Context ◽  
Service Level ◽  
National Study ◽  
Care Needs ◽  
Advanced Illness ◽  
Qualitative Interview Study ◽  
Lgbt People

Background: Lesbian, gay, bisexual and/or trans (LGBT) people have higher risk of certain life-limiting illnesses and unmet needs in advanced illness and bereavement. ACCESSCare is the first national study to examine in depth the experiences of LGBT people facing advanced illness. Aim: To explore health-care experiences of LGBT people facing advanced illness to elicit views regarding sharing identity (sexual orientation/gender history), accessing services, discrimination/exclusion and best-practice examples. Design: Semi-structured in-depth qualitative interviews analysed using thematic analysis. Setting/participants: In total, 40 LGBT people from across the United Kingdom facing advanced illness: cancer ( n = 21), non-cancer ( n = 16) and both a cancer and a non-cancer conditions ( n = 3). Results: In total, five main themes emerged: (1) person-centred care needs that may require additional/different consideration for LGBT people (including different social support structures and additional legal concerns), (2) service level or interactional (created in the consultation) barriers/stressors (including heteronormative assumptions and homophobic/transphobic behaviours), (3) invisible barriers/stressors (including the historical context of pathology/criminalisation, fears and experiences of discrimination) and (4) service level or interactional facilitators (including acknowledging and including partners in critical discussions). These all shape (5) individuals’ preferences for disclosing identity. Prior experiences of discrimination or violence, in response to disclosure, were carried into future care interactions and heightened with the frailty of advanced illness. Conclusion: Despite recent legislative change, experiences of discrimination and exclusion in health care persist for LGBT people. Ten recommendations, for health-care professionals and services/institutions, are made from the data. These are simple, low cost and offer potential gains in access to, and outcomes of, care for LGBT people.

scholarly journals The evaluation of knowledge and activities of primary health care professionals in promoting breast-feeding

Medicina ◽  
2009 ◽  
Vol 45 (3) ◽  
pp. 238 ◽  
Author(s):  
Giedra Levinienė ◽  
Aušra Petrauskienė ◽  
Eglė Tamulevičienė ◽  
Jolanta Kudzytė ◽  
Liutauras Labanauskas
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
General Practitioners ◽  
Breast Feeding ◽  
Health Professionals ◽  
Health Care Professionals ◽  
Primary Health ◽  
Breast Feed ◽  
Primary Health Care Centers ◽  
Health Care Centers

The objective of this study was to evaluate the knowledge and activities of Kaunas primary health care center professionals in promoting breast-feeding. Material and methods. A total of 84 general practitioners and 52 nurses participated in the survey, which was carried out in Kaunas primary health care centers in 2006. Data were gathered from the anonymous questionnaire. Results. Less than half of general practitioners (45.1%) and 65% of nurses were convinced that baby must be exclusively breast-fed until the age of 6 months, but only 21.6% of general practitioners and 27.5% of nurses knew that breast-feeding with complementary feeding should be continued until the age of 2 years and longer. Still 15.7% of general practitioners and 25% of nurses recommended pacifiers; 7.8% of general practitioners advised to breast-feed according to hours. Half of the health professionals recommended additional drinks between meals; onethird of them – to give complementary food for the babies before the age of 6 months. One-third (29.6%) of the health professionals surveyed recommended mothers to feed their babies more frequently in case the amount of breast milk decreased. Conclusions. The survey showed that knowledge of medical personnel in primary health care centers about the advantages of breast-feeding, prophylaxis of hypogalactia, and duration of breast-feeding was still insufficient.

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