scholarly journals Facilitating knowledge exchange between health-care sectors, organisations and professions: a longitudinal mixed-methods study of boundary-spanning processes and their impact on health-care quality

2013 ◽  
Vol 1 (7) ◽  
pp. 1-170 ◽  
Author(s):  
L Nasir ◽  
G Robert ◽  
M Fischer ◽  
I Norman ◽  
T Murrells ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Mixed Methods ◽  
Health Services ◽  
Knowledge Exchange ◽  
Boundary Spanning ◽  
Data Sources ◽  
Integration Of Services ◽  
General Practices

BackgroundRelatively little is known about how people and groups who function in boundary-spanning positions between different sectors, organisations and professions contribute to improved quality of health care and clinical outcomes.ObjectivesTo explore whether or not boundary-spanning processes stimulate the creation and exchange of knowledge between sectors, organisations and professions and whether or not this leads, through better integration of services, to improvements in the quality of care.DesignA 2-year longitudinal nested case study design using mixed methods.SettingAn inner-city area in England (‘Coxford’) comprising 26 general practices in ‘Westpark’ and a comparative sample of 57 practices.ParticipantsHealth-care and non-health-care practitioners representing the range of staff participating in the Westpark Initiative (WI) and patients.InterventionsThe WI sought to improve services through facilitating knowledge exchange and collaboration between general practitioners, community services, voluntary groups and acute specialists during the period late 2009 to early 2012. We investigated the impact of the four WI boundary-spanning teams on services and the processes through which they produced their effects.Main outcome measures(1) Quality-of-care indicators during the period 2008–11; (2) diabetes admissions data from April 2006 to December 2011, adjusted for deprivation scores; and (3) referrals to psychological therapies from January 2010 to March 2012.Data sourcesData sources included 42 semistructured staff interviews, 361 hours of non-participant observation, 36 online diaries, 103 respondents to a staff survey, two patient focus groups and a secondary analyses of local and national data sets.ResultsThe four teams varied in their ability to, first, exchange knowledge across boundaries and, second, implement changes to improve the integration of services. The study setting experienced conditions of flux and uncertainty in which known horizontal and vertical structures underwent considerable change and the WI did not run its course as originally planned. Although knowledge exchanges did occur across sectoral, organisational and professional boundaries, in the case of child and family health services, early efforts to improve the integration of services were not sustained. In the case of dementia, team leadership and membership were undermined by external reorganisations. The anxiety and depression in black and minority ethnic populations team succeeded in reaching its self-defined goal of increasing referrals from Westpark practices to the local well-being service. From October to December 2010 onwards, referrals have been generally higher in the six practices with a link worker than in those without, but the performance of Westpark and Coxford practices did not differ significantly on three national quality indicators. General practices in a WI diabetes ‘cluster’ performed better on three of 17 Quality and Outcomes Framework (QOF) indicators than practices in the remainder of Westpark and in the wider Coxford primary care trust. Surprisingly, practices in Westpark, but not in the diabetes cluster, performed better on one indicator. No statistically significant differences were found on the remaining 13 QOF indicators. The time profiles differed significantly between the three groups for elective and emergency admissions and bed-days.ConclusionsBoundary spanning is a potential solution to the challenge of integrating health-care services and we explored how such processes perform in an ‘extreme case’ context of uncertainty. Although the WI may have been a necessary intervention to enable knowledge exchange across a range of boundaries, it was not alone sufficient. Even in the face of substantial challenges, one of the four teams was able to adapt and build resilience. Implications for future boundary-spanning interventions are identified. Future research should evaluate the direct, measurable and sustained impact of boundary-spanning processes on patient care outcomes (and experiences), as well as further empirically based critiques and reconceptualisations of the socialisation → externalisation → combination → internalisation (SECI) model, so that the implications can be translated into practical ideas developed in partnership with NHS managers.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Guidelines for Adapting Mindfulness-Based School Interventions with Underserved Youth

2021 ◽  
Author(s):  
Mary Lynd Phan ◽  
Tyler L Renshaw
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Health Disparities ◽  
Quality Of Care ◽  
Health Services ◽  
Social Emotional ◽  
Emotional Competencies ◽  
Underserved Youth ◽  
Diverse Youth

Low-income and ethnically diverse youth in the United States have unmet needs for mental health services; however, these same youth are unlikely to be connected with high-quality mental health care. Promoting social-emotional competencies through school-based service delivery is one potential solution for improving the accessibility and quality of care for diverse youth facing mental health disparities. Mindfulness, conceived as a set of practices to cultivate social-emotional competencies, can therefore be useful for improving the accessibility and quality of care for diverse youth facing mental health disparities. Given the growing interest in MBSIs and the need to enhance equity in youth mental health services more generally, we provide guidelines to help practicing clinicians successfully adapt and implement MBSIs with underserved youth. First, we offer recommendations for clinicians to enhance underserved youths’ engagement with MBSIs. Next, we overview implementation approaches that clinicians could use for increasing access to MBIs in school settings. Following, we discuss strategies clinicians might employ when working with teachers to effectively implement MBSIs with underserved youth in their classrooms. Ultimately, we hope the guidelines offered in this paper might help inform better practice—as well as motivate further, better research—that advances equitable mental health care in schools with underserved youth.

scholarly journals Effectiveness of Essential Health Care Services Delivery in Nepal

1970 ◽  
Vol 6 (2) ◽  
pp. 74-83 ◽  
Author(s):  
B Devkota
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Health Services ◽  
Health Facility ◽  
Health Care Services ◽  
Health Facilities ◽  
Care Services ◽  
Services Delivery ◽  
Equity And Efficiency

Background: Ensuring delivery of quality health services in a sustainable and equitable manner is a challenge in Nepal. A host of factors may have impeded the access, quality and utilization of the health services particularly by the marginalized and disadvantaged sections of the population. Review essential health care services (EHCS) provided by the public health facilities, level of progress, effectiveness, sustainability, equity and efficiency, quality of care and inclusion of marginalized and disadvantaged populations in health care servicesMethods: A total of 40 VDCs from 10 districts representing five regions and three eco-zones were covered. Altogether 800 mothers with under two year children, 40 health service providers, 145 key informants and 40 exit clients were interviewed. Forty focused group discussions were also conducted. From each district, health records of one hospital, PHCC, HP, SHP and Ayurvedic health facility each were collected.Results: More than two-third (68.2%) of the mothers received antenatal checks, highest in hills (85%) followed by terai (64.5%) and mountain districts (52.8%).Tetanus vaccine coverage (80.7%) seems higher compared to Nepal Demographic Health Survey 2001 (45%). FP use rate in mountain, hill and terai are 57.6%, 54.1% and 49.7%, higher than in DoHS 2003/2004 statistics, which were 26.8%, 36.4% and 45.3% respectively. Nine out of ten patients visiting the health facilities were outpatients. The coverage of DPT 3, Polio 3, BCG and measles are 92.8%, 93.4%, 95.2% and 90.7% respectively. From the service utilization perspective, disparities in terms of gender, ecological regions, season of the year and health facility were revealed.Conclusion: Health sector services are yet to be made responsive to the ecological and district specific health problems, and be made more inclusive linking with doable safety nets.  Key words: Essential health care services; Effectiveness; Sustainability; Equity and efficiency; Quality of care and inclusion  doi: 10.3126/jnhrc.v6i2.2188Journal of Nepal Health Research Council Vol. 6 No. 2 Issue 13 Oct 2008 Page: 74-83 

Quality development in mental health care in Europe. Recent contributions by WHO

1997 ◽  
Vol 6 (S1) ◽  
pp. 211-215
Author(s):  
José G. Sampaio Faria
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Quality Of Care ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Health Care ◽  
European Region ◽  
Quality Development

In 1984 all Member States of the European Region agreed on a Pan European Health Policy, popularly known as Targets for Health for All (Health for all targets, 1991).Among the 38 targets agreed, Target 31 states (table I).More recently the first meeting of national directors/officials of mental health services in the European Member States stated that “there should be greater concern about the quality of mental health care in each Member State, and mechanisms must be established to guarantee a quality service. These include: a.encouraging mental health care professionals to develop systems to monitor the quality of care;b.independent inspection of services;c.the participation of consumers and relatives;d.improving the basic and continuing training of mental health professionals as well as their working conditions;Special attention should be paid to the quality of care provided to those with severe long-term mental disorder, the elderly, children and adolescents. Barriers to care should be avoided, particularly for people with long-term mental disabilities.”The need for quality development and evaluation differ quite significantly across the European Region as a result of the existing differences in the pattern of mental health services and priority policies to be implemented.

scholarly journals Understanding quality of care and analyzing different strategies to assure and improve it

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
R Busse ◽  
D Panteli ◽  
W Quentin
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Health Services ◽  
Health System ◽  
System Performance ◽  
Health System Performance ◽  
Patient Centeredness ◽  
Definition Of ◽  
Comprehensive Framework

Abstract Assessing and improving quality of care presupposes an understanding of what it does and does not entail. Different definitions often specify relatively long lists of various attributes that they recognize as part of quality. Effectiveness, patient safety, and responsiveness/patient-centeredness seem to have become universally accepted as core dimensions of quality of care. The inclusion of a list of additional elements is confusing and often blurs the line between quality of care and overall health system performance. This presentation provides an in-depth look at this interplay, recognizing that the definition of quality changes depending on the level at which it is assessed. At the level of health services, there seems to be an emerging consensus that quality of care is the degree to which health services for individuals and populations are effective, safe, and people-centered. On the other hand, a health care system as a whole is of high quality when it achieves the overall goals of improved health, responsiveness, financial protection, and efficiency; here, there seems to be an international trend towards using the term health system performance. The workshop looks at different strategies to assure or improve the quality of health care. To understand, analyze, compare and ultimately prioritize or align different quality strategies, this presentation will introduce a comprehensive framework, which includes the following lenses: i) the three core dimensions of quality: safety, effectiveness, and patient-centeredness; ii) the four functions of health care: primary prevention, acute care, chronic care, and palliative care; iii) the three main activities of quality strategies: setting standards, monitoring, and assuring improvements; iv) Donabedian’s triad: structures, processes, and outcomes; v) the five main targets of quality strategies: health professionals, technologies, provider organizations, patients, and payers.

scholarly journals Quality of care in public sector family planning services in KwaZulu-Natal, South Africa: a qualitative evaluation from community and health care provider perspectives

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yolandie Kriel ◽  
Cecilia Milford ◽  
Joanna Paula Cordero ◽  
Fatima Suleman ◽  
Petrus S. Steyn ◽  
...  
Keyword(s):  
South Africa ◽  
Health Care ◽  
Quality Of Care ◽  
Family Planning ◽  
Health Care Providers ◽  
Contraceptive Use ◽  
Care Providers ◽  
Contraceptive Methods ◽  
Integration Of Services

Abstract Background Quality of care is a multidimensional concept that forms an integral part of the uptake and use of modern contraceptive methods. Satisfaction with services is a significant factor in the continued use of services. While much is known about quality of care in the general public health care service, little is known about family planning specific quality of care in South Africa. This paper aims to fill the gap in the research by using the Bruce-Jain family planning quality of care framework. Methods This formative qualitative study was conducted in South Africa, Zambia, and Kenya to explore the uptake of family planning and contraception. The results presented in this paper are from the South African data. Fourteen focus group discussions, twelve with community members and two with health care providers, were conducted along with eight in-depth interviews with key informants. Thematic content analysis using the Bruce-Jain Quality of Care framework was conducted to analyse this data using NVIVO 10. Results Family planning quality of care was defined by participants as the quality of contraceptive methods, attitudes of health care providers, and outcomes of contraceptive use. The data showed that women have limited autonomy in their choice to either use contraception or the method that they might prefer. Important elements that relate to quality of care were identified and described by participants and grouped according to the structural or process components of the framework. Structure-related sub-themes identified included the lack of technically trained providers; integration of services that contributed to long waiting times and mixing of a variety of clients; and poor infrastructure. Sub-themes raised under the process category included poor interpersonal relations; lack of counselling/information exchange, fear; and time constraints. Neither providers nor users discussed follow up mechanisms which is a key aspect to ensure continuity of contraceptive use. Conclusion Using a qualitative methodology and applying the Bruce-Jain Quality of Care framework provided key insights into perceptions and challenges about family planning quality of care. Identifying which components are specific to family planning is important for improving contraceptive outcomes. In particular, autonomy in user choice of contraceptive method, integration of services, and the acceptability of overall family planning care was raised as areas of concern.

Guidelines for Adapting Mindfulness-Based School Interventions with Underserved Youth

2021 ◽  
Author(s):  
Mary Lynd Phan ◽  
Tyler L Renshaw
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Health Disparities ◽  
Quality Of Care ◽  
Health Services ◽  
Social Emotional ◽  
Emotional Competencies ◽  
Underserved Youth ◽  
Diverse Youth

Low-income and ethnically diverse youth in the United States have unmet needs for mental health services; however, these same youth are unlikely to be connected with high-quality mental health care. Promoting social-emotional competencies through school-based service delivery is one potential solution for improving the accessibility and quality of care for diverse youth facing mental health disparities. Mindfulness, conceived as a set of practices to cultivate social-emotional competencies, can therefore be useful for improving the accessibility and quality of care for diverse youth facing mental health disparities. Given the growing interest in MBSIs and the need to enhance equity in youth mental health services more generally, we provide guidelines to help practicing clinicians successfully adapt and implement MBSIs with underserved youth. First, we offer recommendations for clinicians to enhance underserved youths’ engagement with MBSIs. Next, we overview implementation approaches that clinicians could use for increasing access to MBIs in school settings. Following, we discuss strategies clinicians might employ when working with teachers to effectively implement MBSIs with underserved youth in their classrooms. Ultimately, we hope the guidelines offered in this paper might help inform better practice—as well as motivate further, better research—that advances equitable mental health care in schools with underserved youth.

Problems of pathology related to the dermatovenerology field in the emergency hospital

2020 ◽  
pp. 45-52
Author(s):  
I. Barsukova ◽  
I. Bagretsova
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Emergency Care ◽  
Diagnostic Process ◽  
Emergency Hospital ◽  
New Models ◽  
Hospital Development

Development of a system for the delivery of emergency care in a hospital inevitably raises questions of its availability and quality. And, if the leading pathological syndrome which is a reason for hospitalization and posing a threat to the patient's life deserves priority attention, then the accompanying pathology often stays in the background. At the same time the accompanying pathology related to the field of dermatovenerology poses epidemiological threat. The aim of the study was to improve the organization of health care for patients with concomitant pathology related to dermatovenerology in an emergency hospital. Development of new models and principles of the organization of medical and diagnostic process, introduction of methods of express diagnostics is required; importance of a dermatovenerologist becomes obvious, it will increase the availability and quality of care for patients with dermatovenereological pathology in an emergency hospital.

Problems in the Health Care of Dying Old Men: Complaints by their Widows

1995 ◽  
Vol 31 (2) ◽  
pp. 121-141 ◽  
Author(s):  
Maria M. Talbott
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Medical Care ◽  
Health Care Professionals ◽  
Lack Of Control ◽  
Old Men

Complaints of older widows regarding their husbands' health care are investigated in this study. Sixty-four older widows were interviewed several years after their husbands' deaths. The deaths occurred in the early 1980s. Forty-six percent reported problems in the health care their husbands had received. Widows whose husbands had not known in advance that they were going to die were more likely to complain about their husbands' medical care than widows whose husbands had known in advance. Complaints were also related to the frequency of several symptoms of grief. The widows' complaints about their husbands' care focus on quality of care, perceived insensitivity on the part of health care professionals, lack of control over the death, and the organization of services.

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