scholarly journals Resilience of Cardiac Care through Virtualized Services during COVID-19: A Case Study of a Heart Function Clinic (Preprint)

2020 ◽  
Author(s):  
Amika Shah ◽  
Milena Guessi ◽  
Sahr Wali ◽  
Patrick Ware ◽  
Michael McDonald ◽  
...  
Keyword(s):  
Patient Safety ◽  
Health Systems ◽  
Heart Function ◽  
Single Case ◽  
Lessons Learned ◽  
Barriers And Facilitators ◽  
Cardiac Care ◽  
Semantic Level ◽  
Virtual Care

BACKGROUND Virtual care has historically faced barriers to widespread adoption. However, the COVID-19 pandemic has necessitated the rapid adoption and expansion of virtual care technologies. Although the intense and prolonged nature of the COVID-19 pandemic has renewed interest in health systems resilience, including how services adapt or transform in response to shocks, evidence documenting the role of virtual care technologies in health systems resilience is scarce. OBJECTIVE At Toronto General Hospital in Ontario, Canada, the rapid virtualization of cardiac care began on March 9, 2020 as a response to the pandemic. The objective of this study was to understand the experiences, barriers, and facilitators of the rapid virtualization and expansion of cardiac care due to the pandemic. METHODS A single-case study was conducted with three embedded units of analysis. Patients, clinicians, and staff were recruited purposively from an existing mobile phone-based telemonitoring program at a Heart Function Clinic in Toronto, Canada. Individual semi-structured phone interviews were conducted by two researchers and transcribed verbatim. An inductive thematic analysis at the semantic level was used to analyze transcripts and develop themes. RESULTS A total of 29 participants were interviewed, spanning patients (n=16), clinicians (n=9), and staff (n=4). Five themes were identified: (1) patient safety as a catalyst for virtual care adoption; (2) piecemeal virtual care solutions; (3) confronting new roles and workloads; (4) missing pieces to virtual care; and (5) the inequity paradox. A motivation to protect patient safety and a piecemeal approach to virtual care adoption facilitated absorptive and adaptive resilience of cardiac care during COVID-19, while ad hoc changes to clinic roles and workflows, challenges building relationships virtually, and widened inequities were barriers threatening virtual care sustainment. CONCLUSIONS We contend that sustaining virtual care hinges upon transformative, rather than adaptive actions, to strengthen health systems to face the dynamic and emergent challenges associated with COVID-19 and other shocks. Based on the barriers and facilitators identified, we present lessons learned and recommended transformations to sustain virtual care during and beyond COVID-19.

scholarly journals Scaling virtual health at the epicentre of coronavirus disease 2019: A case study from NYU Langone Health

2020 ◽  
pp. 1357633X2094139
Author(s):  
Jason Sherwin ◽  
Katharine Lawrence ◽  
Veronica Gragnano ◽  
Paul A Testa
Keyword(s):  
Health Care ◽  
At Risk ◽  
Health Systems ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Lessons Learned ◽  
Virtual Care ◽  
Health Enterprise

The coronavirus disease 2019 (COVID-19) pandemic has accelerated the drive of health-care delivery towards virtual-care platforms. While the potential of virtual care is significant, there are challenges to the implementation and scalability of virtual care as a platform, and health-care organisations are at risk of building and deploying non-strategic, costly or unsustainable virtual-health systems. In this article, we share the NYU Langone Health enterprise approach to building and scaling an integrated virtual-health platform prior to and during the COVID-19 pandemic, and offer lessons learned and recommendations for health systems that need to undertake or are currently undertaking the transition to virtual-care delivery.

Appraising clever people: lessons from introducing performance reviews for academics in a UK University

2015 ◽  
Vol 47 (2) ◽  
pp. 81-85 ◽  
Author(s):  
Hedda Bird
Keyword(s):  
Performance Management ◽  
Single Case ◽  
Lessons Learned ◽  
Content Type ◽  
Performance Review ◽  
Highly Educated ◽  
Performance Reviews ◽  
Practical Challenge ◽  
Set Up

Purpose – The purpose of this paper is to build understanding of how to engage a highly educated workforce with the benefits of performance management through sharing the lessons learned from introducing performance reviews (appraisals) into an academic environment. Design/methodology/approach – The paper presents a case study of a four-year programme in a UK higher education establishment. The author was closely involved in the last two years of the programme, and completed a detailed evaluation of the programme for the client. Findings – Performance management creates significant value within a highly educated workforce through bringing together individual capability and expertise to focus on delivering the strategy. Obstacles to success such as routine complaints of “time-wasting” and “pointlessness” can be overcome by wide and deep engagement with employees throughout the design and development of the approach. Research limitations/implications – This is a single case study; however, the author has worked on many similar programmes with highly educated work forces with very similar results. Practical implications – The vast majority of staff positively want a high-quality performance review; the practical challenge is to channel this desire into shared ownership and responsibility for the success of performance review in practice. Originality/value – Literature abounds with analysis of what is wrong with performance review, this paper is a rarer piece in that it develops our understanding of how to set up performance management and review for success.

Application of Lean Six Sigma in conservative dentistry: an action research at an Indian dental college

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Ajay Noronha ◽  
Shreeranga Bhat ◽  
E.V. Gijo ◽  
Jiju Antony ◽  
Suma Bhat
Keyword(s):  
Action Research ◽  
Six Sigma ◽  
Single Case ◽  
Lean Six Sigma ◽  
Lessons Learned ◽  
Healthcare Sector ◽  
Content Type ◽  
Conservative Dentistry ◽  
Tools And Techniques

PurposeThe article evaluates the obstacles, lessons learned and managerial implications of deploying Lean Six Sigma (LSS) in a dental college hospital in India.Design/methodology/approachThe work adopts the action research (AR) methodology to establish a case study, which is carried out using the LSS define–measure–analyze–improve–control (DAMIC) approach in a dental college. It uses LSS tools to enhance the productivity and performance of the Conservative Dentistry Department of a dental college and to unravel the obstacles and success factors in applying it to the education and healthcare sector together.FindingsThe root cause for high turn-around time (TAT) is ascertained using LSS tools and techniques. The effective deployment of the solutions to the root causes of variation assists the dental college to reduce the TAT of the Conservative Dentistry process from an average of 63.9 min–36.5 min (i.e. 42.9% improvement), and the process Standard Deviation (SD) was reduced from 2.63 to 2 min. This, in turn, raises the sigma level from 0.48 to 3.23, a noteworthy successful story for this dental college.Research limitations/implicationsWhile the results and recommendations of this research are focused on a single case study, it is to be noted that the case study is carried out with new users of LSS tools and techniques, especially with the assistance of interns. This indicates the applicability of LSS in dental colleges; thus, the adopted modality can be further refined to fit India's education and hospital sector together.Originality/valueThis article explains the implementation of LSS from an aspiring user viewpoint to assist dental colleges and policymakers in improving competitiveness. In addition, the medical education sector can introduce an LSS course in the existing programme to leverage the potential of this methodology to bring synergy and collaborative research between data-based thinking and the medical field based on the findings of this study. The most important contribution of this article is the illustration of the design of experiments (DOE) in the dental college process.

Implementing the open-source Koha-ILS at the Deutsche Schule Charlotte

2016 ◽  
Vol 32 (4) ◽  
pp. 253-269 ◽  
Author(s):  
Martin D. House
Keyword(s):  
Open Source ◽  
Selection Process ◽  
Single Case ◽  
Good Alternative ◽  
Lessons Learned ◽  
Online Support ◽  
Successful Implementation ◽  
Web Based ◽  
Content Type

Purpose This study aims to present the successful implementation of the Koha-integrated library system (ILS) for libraries that seek an open-source alternative. This study is best suited for small libraries with limited collections and limited funding. The selection process between Koha and Evergreen is described, as is cataloging, patron setup and library workflow changes. Finally, lessons learned are presented. Design/methodology/approach This is a case study which describes the events as they occurred between 2013 and 2014. Findings The Koha-ILS appears to be the open-source system with the most online support, easiest to install and manage. Although the experience of libraries may vary, the Deutsche Schule Charlotte library took the pragmatic approach. Koha was chosen because it could be successfully installed, had an intuitive and web-based interface and could be easily explained to volunteers. Research limitations/implications This is a single case study at a very small library. Practical implications This study broadly demonstrates the requirements for implementing the Koha-ILS and how it can be accomplished even with library volunteers. Social implications The Koha-ILS can be a good alternative, despite limitations, for small libraries who need a robust ILS system with few bells and whistles. Originality/value This study presents a finite view of the implementation and use of the Koha-ILS. The physical setting, availability of capable volunteers and administration’s willingness to experiment with a system may not be reproducible in other locales.

Case Study: Challenges, Successes and Lessons Learned from Implementing Computerized Physician Order Entry (CPOE) at Two Distinct Health Systems: Implications of CPOE on the Pharmacy and the Medication-Use Process

2005 ◽  
Vol 40 (5) ◽  
pp. 420-429 ◽  
Author(s):  
John Manzo ◽  
Mark J. Sinnett ◽  
Frank Sosnowski ◽  
Robert Begliomini ◽  
Jill Green ◽  
...  
Keyword(s):  
Health Systems ◽  
Medical Center ◽  
Medication Management ◽  
Lessons Learned ◽  
Medication Cost ◽  
Computerized Physician Order Entry ◽  
Management Process ◽  
Order Entry ◽  
Physician Order Entry

The purpose of this case study is to provide an understanding of the divergent experiences, challenges, and successes associated with implementing Computerized Physician Order Entry (CPOE) at two distinct health systems utilizing the same software vendor. Pharmacy leaders at Lehigh Valley Hospital and Health Network in Allentown, PA and Montefiore Medical Center in the Bronx, NY describe the various strategies deployed for CPOE planning and implementation, the outcomes and impacts of CPOE implementation, and valuable experience. Improvements and efficiencies in the medication management process and time savings will be described. Additionally, reductions in medication prescribing errors and enhancements in medication cost savings secondary to improved medication utilization are delineated. The authors conclude that while the challenges associated with planning and implementing CPOE for medication management and its impact on the pharmacy are great, pharmacist involvement early in the strategic planning is vital to ensure a successful and safer electronic medication management process.

scholarly journals Resilience of Cardiac Care through Virtualized Services during COVID-19: A Case Study of a Heart Function Clinic (Preprint)

JMIR Cardio ◽  
10.2196/25277 ◽  
2020 ◽  
Author(s):  
Amika Shah ◽  
Milena Guessi ◽  
Sahr Wali ◽  
Patrick Ware ◽  
Michael McDonald ◽  
...  
Keyword(s):  
Heart Function ◽  
Cardiac Care

scholarly journals Challenges and insights in inter-organizational collaborative healthcare networks

2019 ◽  
Vol 27 (4) ◽  
pp. 875-902 ◽  
Author(s):  
Kieran Mervyn ◽  
Nii Amoo ◽  
Rebecca Malby
Keyword(s):  
Health Systems ◽  
Single Case ◽  
Organizational Form ◽  
World Health ◽  
Healthcare Sector ◽  
Single Case Study ◽  
Content Type ◽  
The Public ◽  
The Uk

Purpose Public sectors have responded to grand societal challenges by establishing collaboratives – new inter-organizational partnerships to secure better quality health services. In the UK, a proliferation of collaboration-based healthcare networks exists that could help to enhance the value of investments in quality improvement programs. The nature and organizational form of such improvements is still a subject of debate within the public-sector literature. Place-based collaboration has been proposed as a possible solution. In response, the purpose of this study is to present the results and findings of a place-based collaborative network, highlighting challenges and insights. Design/methodology/approach This study adopted a social constructionist epistemological approach, using a qualitative methodology. A single case study was used and data collected in three different stages over a two-year period. Findings The study finds that leadership, data-enabled learning through system-wide training and development, and the provision of an enabling environment that is facilitated by an academic partner, can go a long way in the managing of healthcare networks for improving quality. Research limitations/implications Regardless of the tensions and challenges with place-based networks, they could still be a solution in maximizing the public value required by government investments in the healthcare sector, as they offer a more innovative structure that can help to address complex issues beyond the remit of hierarchical structures. This study is limited by the use of a single case study. Practical implications Across countries health systems are moving away from markets to collaborative models for healthcare delivery and from individual services to population-based approaches. This study provides insights to inform leaders of collaborative health models in the design and delivery of these new collaborations. Social implications As demand rises (as a result of increasing complexity and demographics) in the western world, health systems are seeking to redefine the boundaries between health service provision and community self-reliance and resilience. This study provides insights into the new partnership between health institutions and communities, providing opportunities for more social- and solidarity-based healthcare models which place patients and the public at the heart of change. Originality/value The city place-based network is the first of such organizational form in healthcare collaboration in the UK.

scholarly journals Accounts Receivable Overdue and Market Dynamics: A Case Study

2018 ◽  
Vol 2 (3) ◽  
pp. 5
Author(s):  
Niek STAM ◽  
Wim WESTERMAN
Keyword(s):  
Default Risk ◽  
Single Case ◽  
Research Strategy ◽  
Lessons Learned ◽  
Market Dynamics ◽  
Relevant Market ◽  
Design Elements ◽  
Accounts Receivable ◽  
The Interest Rate

Aim: This study aims to find out which market dynamics are currently relevant for accounts receivable levels (specifically overdues), and how lessons learned can be used by credit management.Design / Research methods: The unique research strategy is characterised as a single case study with design elements at two country units of a company to be named FEED. The classification and overview of relevant market dynamics provide valuable insights for determinants and intercompany differences in receivables, and whether these arise at the country or market level.Conclusions / findings: The classification and overview of relevant market dynamics provide valuable insights for determinants and intercompany differences in receivables, and whether these arise at the country or market level.Originality / value of the article: The findings suggest adjustments of the literature in that the interest rate is currently not a relevant factor. Moreover, instead of focussing on costs of capital, an emphasis on default risk is more applicable nowadays, and hence researchers should focus on overdue instead of on receivables in general.

scholarly journals Evaluating the Implementation of a Mobile Phone�Based Telemonitoring Program: Longitudinal Study Guided by the Consolidated Framework for Implementation Research (Preprint)

2018 ◽  
Author(s):  
Patrick Ware ◽  
Heather J Ross ◽  
Joseph A Cafazzo ◽  
Audrey Laporte ◽  
Kayleigh Gordon ◽  
...  
Keyword(s):  
Mobile Phone ◽  
Real World ◽  
Implementation Research ◽  
Heart Function ◽  
Single Case ◽  
Barriers And Facilitators ◽  
Relative Advantage ◽  
Implementation Success ◽  
Staff Members ◽  
Intervention Cost

BACKGROUND Telemonitoring has shown promise for alleviating the burden of heart failure on individuals and health systems. However, real-world implementation of sustained programs is rare. OBJECTIVE The objective of this study was to evaluate the implementation of a mobile phone–based telemonitoring program, which has been implemented as part of standard care in a specialty heart function clinic by answering two research questions: (1) To what extent was the telemonitoring program successfully implemented? (2) What were the barriers and facilitators to implementing the telemonitoring program? METHODS We conducted a longitudinal single case study. The implementation success was evaluated using the following four implementation outcomes: adoption, penetration, feasibility, and fidelity. Semistructured interviews based on the Consolidated Framework for Implementation Research (CFIR) were conducted at 0, 4, and 12 months with 12 program staff members to identify the barriers and facilitators of the implementation. RESULTS One year after the implementation, 98 patients and 8 clinicians were enrolled in the program. Despite minor technical issues, the intervention was used as intended. We obtained qualitative data from clinicians (n=8) and implementation staff members (n=4) for 24 CFIR constructs. A total of 12 constructs were facilitators clustered in the CFIR domains of inner setting (culture, tension for change, compatibility, relative priority, learning climate, leadership engagement, and available resources), characteristics of individuals (knowledge and beliefs about the intervention and self-efficacy), and process (engaging and reflecting and evaluating). In addition, we identified other notable facilitators from the characteristics of the intervention domain (relative advantage and adaptability) and the outer setting (patient needs and resources). Four constructs were perceived as minor barriers— the complexity of the intervention, cost, inadequate communication among high-level stakeholders, and the absence of a formal implementation plan. The remaining CFIR constructs had a neutral impact on the overall implementation. CONCLUSIONS This is the first comprehensive evaluation of the implementation of a mobile phone–based telemonitoring program. Although the acceptability of the telemonitoring system was high, the strongest facilitators to the implementation success were related to the implementation context. By identifying what works and what does not in a real-world clinical context using a framework-guided approach, this work will inform the design of telemonitoring services and implementation strategies of similar telemonitoring interventions.

Collaboration and patient safety at an emergency department – a qualitative case study

2018 ◽  
Vol 32 (1) ◽  
pp. 25-38 ◽  
Author(s):  
Anna Helene Meldgaard Pedersen ◽  
Kurt Rasmussen ◽  
Regine Grytnes ◽  
Kent Jacob Nielsen
Keyword(s):  
Emergency Department ◽  
Patient Safety ◽  
Single Case ◽  
Situational Factors ◽  
Working Environment ◽  
Single Case Study ◽  
Potential Threat ◽  
Content Type ◽  
Daily Work

Purpose The purpose of this paper is to examine how conflicts about collaboration between staff at different departments arose during the establishment of a new emergency department and how these conflicts affected the daily work and ultimately patient safety at the emergency department. Design/methodology/approach This qualitative single case study draws on qualitative semi-structured interviews and participant observation. The theoretical concepts “availability” and “receptiveness” as antecedents for collaboration will be applied in the analysis. Findings Close collaboration between departments was an essential precondition for the functioning of the new emergency department. The study shows how a lack of antecedents for collaboration affected the working relation and communication between employees and departments, which spurred negative feelings and reproduced conflicts. This situation was seen as a potential threat for the safety of the emergency patients. Research limitations/implications This study presents a single case study, at a specific point in time, and should be used as an illustrative example of how contextual and situational factors affect the working environment and through that patient safety. Originality/value Few studies provide an in-depth investigation of what actually takes place when collaboration between professional groups goes wrong and escalates, and how problems in collaboration may affect patient safety.

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