Quality Innovation in Healthcare – The Challenge of the Third Era

2020 ◽  
Vol 3 (2) ◽  
pp. 29
Author(s):  
Pieter Kievit ◽  
Marianne Schoorl ◽  
Jeannette Oomes
Keyword(s):  
Health Care ◽  
Design Thinking ◽  
Social Systems ◽  
Core Values ◽  
Medical Professional ◽  
Change Readiness ◽  
Successful Implementation ◽  
Feasibility Assessment ◽  
Health Delivery ◽  
The Third

In the third era of quality assurance in health care, innovation is no longer the exclusive focus area of the individual medical professional dedicated to optimizing patient care nor is it achieved by design thinking by the health delivery organization aiming for economic sustainability. Change platform in the third era is the community of professionals, committed to providing the best possible care within the limits of organizational logic. We aim to clarify the conditions for sustainable quality improvement in health delivery organizations and in doing so to provide a means of improving initial feasibility assessment by identifying critical factors in the cooperation between different parties. We designed a model representing the sources of influence on the process of decision making regarding the selection of innovations and choosing the most effective implementation strategy. These sources are: aspects of legitimacy, core values and change readiness. We tested this model on a project, aimed at improving the efficiency of the OR in a Dutch University Clinic. The example project failed to deliver the projected outcome because of non-disclosed conflicting interpretations of core values and an implicit controversial status shift between medical professionals and OR management. This confirms the explaining power of our model. Successful implementation of quality innovation in health care depends (among other things) on addressing the challenges of differing concepts of legitimacy, conflicting core values and varying change readiness between social systems in complex organizations. Installing a QIC as such does not meet these challenges.

Keynote

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Jeanne LIEDTKA
Keyword(s):  
Organizational Performance ◽  
Design Thinking ◽  
Social Systems ◽  
Field Research ◽  
Higher Order ◽  
Lens Design ◽  
Social Sector ◽  
Extensive Field ◽  
Innovative Solutions ◽  
The Impact

The value delivered by design thinking is almost always seen to be improvements in the creativity and usefulness of the solutions produced. This paper takes a broader view of the potential power of design thinking, highlighting its role as a social technology for enhancing the productivity of conversations for change across difference. Examined through this lens, design thinking can be observed to aid diverse sets of stakeholders’ abilities to work together to both produce higher order, more innovative solutions and to implement them more successfully. In this way, it acts as a facilitator of the processes of collectives, by enhancing their ability to learn, align and change together. This paper draws on both the author’s extensive field research on the use of design thinking in social sector organizations, as well as on the literature of complex social systems, to discuss implications for both practitioners and scholars interested in assessing the impact of design thinking on organizational performance.

Integration of Ayurvedic Medicine in Public Health Delivery System at primary level for UHC - An Evidence Based Study.

2017 ◽  
Vol 2 (1) ◽  
Author(s):  
Rayeesa Zainab ◽  
Karthika P. ◽  
Irfanahemad A. S. ◽  
Gulappa M.D.
Keyword(s):  
Health Care ◽  
Economic Status ◽  
Ayurvedic Medicine ◽  
Evidence Based ◽  
Primary Level ◽  
Health Delivery ◽  
Ayurvedic Drugs ◽  
Choice Of Treatment ◽  
Health Delivery System ◽  
National Programs

Background: In developing country like India it is very difficult for people of low socio-economic status to get access to healthcare and in case they seek healthcare, cost of medicines becomes major reason for out of pocket expenditure, as all the medicines are not available in PHC. Objective: To collate Ayurvedic medicine with Allopathic medicine to provide choice of treatment to patient in view of UHC. Methods: A literature review on Ayurvedic drugs (single drug and formulations) was done after prioritizing the diseases for our study based on National programs and other frequently seen diseases in Primary healthcare (PHC). Evidence was collected in two ways, first by pure Ayurvedic evidence based on Samhitas and second was based on modern techniques and then tabulated. Results: Ayurvedic drug list for Primary Health Care was formulated based on available modern as well as Classical evidence and tabulated in the form of a table. Conclusion: Ayurvedic drugs can be integrated in PHC to provide universal health care at primary level.

Quality Assessment of Ethics in Health Care: The Accountability Revolution

1994 ◽  
Vol 20 (1-2) ◽  
pp. 105-128
Author(s):  
Susan M. Wolf
Keyword(s):  
Health Care ◽  
World War Ii ◽  
Quality Assessment ◽  
Central Place ◽  
World War ◽  
New Era ◽  
The Third ◽  
Cost Cutting ◽  
Global Budgeting

Writing in 1988, Arnold Relman heralded the dawning of the “third revolution“ in medical care. The first revolution, at the end of World War II, had inaugurated an Era of Expansion, with an explosion of hospitals, physicians, and research. Medicare and Medicaid were passed, and medicine experienced a golden age of growth. Inevitably, according to Relman, this yielded to an Era of Cost Containment starting in the 1970s. The federal government and private employers revolted against soaring costs, brandishing the weapons of prospective payment, managed care, and global budgeting. Yet these blunt instruments of cost-cutting eventually produced concern over how to evaluate the quality of health care, to promote the good while trimming the bad. Thus Relman announced the arrival of the Era of Assessment and Accountability.This chronology helps explain the current importance of quality. Quality assessment and more recently, quality improvement techniques, occupy a central place in this new era.

scholarly journals Perceived appropriateness of alcohol screening and brief advice programmes in Colombia, Mexico and Peru and barriers to their implementation in primary health care – a cross-sectional survey

2021 ◽  
Vol 22 ◽  
Author(s):  
Daša Kokole ◽  
Liesbeth Mercken ◽  
Eva Jané-Llopis ◽  
Guillermina Natera Rey ◽  
Miriam Arroyo ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Latin American ◽  
Contextual Factors ◽  
Alcohol Screening ◽  
Successful Implementation ◽  
Implementation Framework ◽  
Effective Measure ◽  
Primary Health ◽  
Brief Advice

Abstract Background: Providing alcohol screening and brief advice (SBA) in primary health care (PHC) can be an effective measure to reduce alcohol consumption. To aid successful implementation in an upper middle-income country context, this study investigates the perceived appropriateness of the programme and the perceived barriers to its implementation in PHC settings in three Latin American countries: Colombia, Mexico and Peru, as part of larger implementation study (SCALA). Methods: An online survey based on the Tailored Implementation for Chronic Diseases (TICD) implementation framework was disseminated in the three countries to key stakeholders with experience in the topic and/or setting (both health professionals and other roles, for example regional health administrators and national experts). In total, 55 respondents participated (66% response rate). For responses to both appropriateness and barriers questions, frequencies were computed, and country comparisons were made using Chi square and Kruskal–Wallis non-parametric tests. Results: Alcohol SBA was seen as an appropriate programme to reduce heavy alcohol use in PHC and a range of providers were considered suitable for its delivery, such as general practitioners, nurses, psychologists and social workers. Contextual factors such as patients’ normalised perception of their heavy drinking, lack of on-going support for providers, difficulty of accessing referral services and lenient alcohol control laws were the highest rated barriers. Country differences were found for two barriers: Peruvian respondents rated SBA guidelines as less clear than Mexican (Mann–Whitney U = −18.10, P = 0.001), and more strongly indicated lack of available screening instruments than Colombian (Mann–Whitney U = −12.82, P = 0.035) and Mexican respondents (Mann–Whitney U = −13.56, P = 0.018). Conclusions: The study shows the need to address contextual factors for successful implementation of SBA in practice. General congruence between the countries suggests that similar approaches can be used to encourage widespread implementation of SBA in all three studied countries, with minor tailoring based on the few country-specific barriers.

scholarly journals Optimizing Scarce Resource Allocation During COVID-19: Rapid Creation of a Regional Health-Care Coalition and Triage Teams in San Diego County, California

2020 ◽  
pp. 1-7
Author(s):  
Asha Devereaux ◽  
Holly Yang ◽  
Gilbert Seda ◽  
Viji Sankar ◽  
Ryan C. Maves ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Resource Allocation ◽  
San Diego ◽  
Scarce Resource ◽  
Successful Implementation ◽  
Regional Health ◽  
Incident Command ◽  
Regional Health Care ◽  
Crisis Care

ABSTRACT Successful management of an event where health-care needs exceed regional health-care capacity requires coordinated strategies for scarce resource allocation. Publications for rapid development, training, and coordination of regional hospital triage teams to manage the allocation of scarce resources during coronavirus disease 2019 (COVID-19) are lacking. Over a period of 3 weeks, over 100 clinicians, ethicists, leaders, and public health authorities convened virtually to achieve consensus on how best to save the most lives possible and share resources. This is referred to as population-based crisis management. The rapid regionalization of 22 acute care hospitals across 4500 square miles in the midst of a pandemic with a shifting regulatory landscape was challenging, but overcome by mutual trust, transparency, and confidence in the public health authority. Because many cities are facing COVID-19 surges, we share a process for successful rapid formation of health-care care coalitions, Crisis Standard of Care, and training of Triage Teams. Incorporation of continuous process improvement and methods for communication is essential for successful implementation. Use of our regional health-care coalition communications, incident command system, and the crisis care committee helped mitigate crisis care in the San Diego and Imperial County region as COVID-19 cases surged and scarce resource collaborative decisions were required.

HEALTH CARE AND HEALTH DELIVERY

Ergonomics ◽  
1976 ◽  
Vol 19 (3) ◽  
pp. 343-396
Author(s):  
F. H. Bonjer
Keyword(s):  
Health Care ◽  
Health Delivery

Telemedicine During A Crisis: Challenges, Opportunities & Way Forward At A Tertiary Care Hospital (Preprint)

2021 ◽  
Author(s):  
Sadia Masood ◽  
Zanaib Samad ◽  
Sarah Nadeem ◽  
Unzela Ghulam
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Cost Effective ◽  
Successful Implementation ◽  
Care Hospital ◽  
Quality Health Care ◽  
Cross Sectional ◽  
Innovative Strategy

BACKGROUND Telemedicine is utilized to deliver health care services remotely. Recently, it is well established due to pandemics because it can help the patients get required supportive care while minimizing their hospital exposure. In the future, it will continue to be used as a convenient, cost-effective patient care modality. OBJECTIVE The objectives were to identify physicians' challenges during teleconsultations and recognize the opportunities and strengths of this modality during the pandemic in a lower-income country. METHODS This cross-sectional study was conducted in a tertiary care hospital. The self-made questionnaire was filled through an online medium and responses were recorded on a five-point Likert scale. RESULTS A total of 83 participants were enrolled in this study. Most of them were Associate professors (29.8%), Assistant professors (26.2%), the ratio of the females was (52.4%) greater than males (,47.6%). 46 (54.8%) have laid between the age group 30-40 years. Pediatricians and senior instructors faced more difficulty in using telemedicine. The ones having clinical experience of fewer than 15 years or categorized in the age of 50-60 years faced challenges while using this modality. CONCLUSIONS During the current pandemic, situation telemedicine is the only glimmer of light to provide better quality health care. Telemedicine is an innovative strategy and it is important to understand the perception of physicians about it. Incomplete and inadequate infrastructure and attitude of the physicians is the main obstacle toward successful implementation of telemedicine. Successful installation and deployment of this technology require a complete grasp of the process among physicians.

The U.S. Health Delivery System: Inefficient and Unfair to Children

1997 ◽  
Vol 23 (2-3) ◽  
pp. 319-337
Author(s):  
Loretta M. Kopelman ◽  
Michael G. Palumbo
Keyword(s):  
United States ◽  
Health Care ◽  
Universal Access ◽  
The United States ◽  
Industrialized Countries ◽  
Health Care Resources ◽  
Health Delivery ◽  
Hip Replacements ◽  
The Many ◽  
Older Citizens

What proportion of health care resources should go to programs likely to benefit older citizens, such as treatments for Alzheimer’s disease and hip replacements, and what share should be given to programs likely to benefit the young, such as prenatal and neonatal care? What portion should go to rare but severe diseases that plague the few, or to common, easily correctable illnesses that afflict the many? What percentage of funds should go to research, rehabilitation or to intensive care? Many nations have made such hard choices about how to use their limited funds for health care by explicitly setting priorities based on their social commitments. In the United States, however, allocation of health care resources has largely been left to personal choice and market forces. Although the United States spends around 14% of its gross national product (GNP) on health care, the United States and South Africa are the only two industrialized countries that fail to provide citizens with universal access.

An Introduction to Global Health Delivery

2021 ◽  
Author(s):  
Joia Mukherjee ◽  
Paul Farmer
Keyword(s):  
Health Care ◽  
Global Health ◽  
Access To Health Care ◽  
Right To Health ◽  
Treatment Access ◽  
The Road ◽  
Health Delivery ◽  
Positive Side ◽  
Access To Health ◽  
The Right

What has called so many young people to the field of global health is the passion to be a force for change, to work on the positive side of globalization, and to be part of a movement for human rights. This passion stems from the knowledge that the world is not OK. Impoverished people are suffering and dying from treatable diseases, while the wealthy live well into their 80s and 90s. These disparities exist between and within countries. COVID-19 has further demonstrated the need for global equity and our mutual interdependence. Yet the road to health equity is long. People living in countries and communities marred by slavery, colonialism, resource extraction, and neoliberal market policies have markedly less access to health care than the wealthy. Developing equitable health systems requires understanding the history and political economy of communities and countries and working to adequately resource health delivery. Equitable health care also requires strong advocacy for the right to health. In fact, the current era in global health was sparked by advocacy—the activist movement for AIDS treatment access, for the universality of the right to health and to a share of scientific advancement. The same advocacy is needed now as vaccines and treatments are developed for COVID-19. This book centers global health in principles of equity and social justice and positions global health as a field to fulfill the universal right to health.

The NHS — is Scotland Different? a Case Study of the Management of Health Care in the Hospital Service in the West of Scotland 1947 – 1987

2000 ◽  
Vol 45 (5) ◽  
pp. 155-158 ◽  
Author(s):  
D. McTavish
Keyword(s):  
Health Care ◽  
Health Service ◽  
Private Practice ◽  
Central Government ◽  
Medical Professional ◽  
Hospital Service ◽  
The West ◽  
New Managerialism ◽  
Hospital Boards

Management of the health service in Scotland and England, has since its creation, shown both divergence and congruence. In the initial decades in Scotland the executive hospital boards (which contained strong medical professional membership) and central government had a clearer relationship than in England. The health service-civil service machinery in Scotland was without doubt more to the forefront with higher status in the Scottish ‘polity’ than was the case in England. The 1970s reforms also indicated difference: despite the pro managerialist tones of the Farquarson Lang report in Scotland, a managerial emphasis was more apparent in the English reforms. By the 1980s, the government's clear intention that their ‘radical’ agenda should apply in Scotland and England was implemented in many instances: aspects of the new managerialism were applied as vigorously in the case examined than anywhere in England: the attempt to draw clinicians into resource management (as advocated in the Griffiths report) appeared to have advanced further in Scotland until well into the 1990s. Yet in other aspects, Scotland diverged from parts of England in the implementation of the 1980's agenda most notably in the growth of private practice though the case indicated significant Scottish developments here too. The article concludes by speculating on some Scottish differences in the coming years.

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