scholarly journals From a View of the Hospital as a System to a View of the Suffering Patient

2022 ◽  
Vol 9 ◽  
Author(s):  
Gillie Gabay ◽  
Smadar Ben Asher
Keyword(s):  
Patient Centered Care ◽  
Public Hospitals ◽  
Three Dimensions ◽  
System Level ◽  
Patient Centered ◽  
Patient Level ◽  
Narrative Interview ◽  
Patient’S Experience ◽  
Centered Care ◽  
Systemic View

Purpose: Hospitals aspire to provide patient-centered care but are far from achieving it. This qualitative mixed methods study explored the capacity of hospital directors to shift from a hospital systemic-view to a suffering patient-view applying the Salutogenic theory.Methods: Following IRB, we conducted in-depth narrative interviews with six directors of the six Israeli academic tertiary public hospitals, focusing on their managerial role. In a second meeting we conducted vignette interviews in which we presented each director with a narrative of a suffering young patient who died at 33 due to medical misconduct, allowing self-introspection. Provisional coding was performed for data analysis to identify categories and themes by the three dimensions of the sense-of-coherence, an anchor of Salutogenics: comprehensibility, manageability, and meaningfulness.Results: While at the system level, directors reported high comprehensibility and manageability in coping with complexity, at the patient level, when confronted with the vignette, directors acknowledged their poor comprehensibility of patients' needs and patient's experience during hospitalizations. They acknowledged their poor capacity to provide patient-centered care. Meaningfulness in the narrative interview focused on the system while meaningfulness in the vignette interview focused on providing patient care.Conclusions: The evident gaps between the system level and the patient level create lack of coherence, hindering the ability to cope with complexity, and are barriers to providing patient-centered care. To improve the delivery of patient-centered care, we suggest ways to consolidate the views, enabling the shift from a systemic-view to a patient-view.

scholarly journals A Nurse-Led Conceptual Model to Inform Patient-Centered Type 2 Diabetes Management in Public Clinical Settings

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 576-577
Author(s):  
Stella Bosun-Arije ◽  
Candidus Nwakasi
Keyword(s):  
Type 2 Diabetes ◽  
Conceptual Model ◽  
Diabetes Management ◽  
Patient Centered Care ◽  
Public Hospitals ◽  
Clinical Settings ◽  
Clinical Practices ◽  
Patient Centered ◽  
Centered Care

Abstract Globally, there is an increased need to provide patient-centered care for people diagnosed with Type 2 diabetes mellitus (T2DM). In Nigeria, a poorly financed health system worsens the difficulties associated with managing T2DM in clinical settings, resulting in a detrimental effect on patient-centered care. We aimed to develop a conceptual model to promote patient-centered T2DM care in clinical settings. We explored nurses' contextual perceptions of clinical practices and operations that are relevant to T2DM management across public hospitals in Lagos, Nigeria. Identifying a nurse-led intervention is critical to care optimization for people diagnosed with T2DM. Using a qualitative research, we used semi-structured questions and the Constant Comparison Method to interview 17 practice (registered) nurses with over 1-year experience working in public hospitals across Lagos, Nigeria. The Framework Method was used for data analysis. The nurses provided insight into four areas of patient-centered T2DM management in clinical settings. They are: empowering collaboration, empowering flexibility, empowering approach, and empowering practice. The nurses discussed an empowering pathway through which health settings could provide patient-centered care to individuals diagnosed with T2DM. The pathway includes the integration of macro, meso, and micro levels for patient management. Their views informed the development of a conceptual model for the optimization of patient care. The model developed from this research sits within the Patient-Centered Care model of healthcare delivery. The model has the potential to inform patient-centered care in countries with poorly financed healthcare systems, and developed countries with comparatively better healthcare.

scholarly journals The Impact of Job Role on Health-Care Workers’ Definitions of Patient-Centered Care

2020 ◽  
Vol 7 (6) ◽  
pp. 1634-1641
Author(s):  
Jessica L Moreau ◽  
Alison B Hamilton ◽  
Elizabeth M Yano ◽  
Lisa V Rubenstein ◽  
Susan E Stockdale
Keyword(s):  
Health Care ◽  
Health Care Workers ◽  
Patient Centered Care ◽  
Care Quality ◽  
System Level ◽  
Patient Contact ◽  
Patient Centered ◽  
Care Workers ◽  
Centered Care ◽  
The Impact

While patient-centered care (PCC) is a widely accepted aspect of health-care quality, its definition is still the subject of debate. We investigated health-care workers’ definitions of PCC by level of patient contact in job roles. Our qualitative study involved semi-structured interviews with key stakeholder employees (n = 66) at 6 Veterans’ Affairs health-care locations in Southern California. Interviews were recorded, transcribed, coded for definitions of PCC, and analyzed by participants’ self-described level of patient contact. Stakeholders whose role primarily involved patient contact tended to define PCC through: patient as a person, patient preferences, and shared decision-making. Stakeholders whose role did not primarily involve patient contact tended to define PCC through: patient-centered redesign, customer service, and access to services. Stakeholders with more patient contact emphasized patient-level and interpersonal concepts, while those with less patient contact emphasized system-level and business-oriented concepts. The focus on PCC-as-access may reflect influence of changing institutional climate on definitions of PCC for some stakeholders. To facilitate successful PCC efforts, health-care systems may need to leverage differing but complementary definitions of PCC within its workforce.

scholarly journals The Impact of Applying Quality Management Practices on Patient Centeredness in Jordanian Public Hospitals: Results of Predictive Modeling

2018 ◽  
Vol 55 ◽  
pp. 004695801875473 ◽  
Author(s):  
Heba H. Hijazi ◽  
Heather L. Harvey ◽  
Mohammad S. Alyahya ◽  
Hussam A. Alshraideh ◽  
Rabah M. Al abdi ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Management Practices ◽  
Patient Centered Care ◽  
Accreditation Process ◽  
Public Hospitals ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Centered Care ◽  
The Impact

Targeting the patient’s needs and preferences has become an important contributor for improving care delivery, enhancing patient satisfaction, and achieving better clinical outcomes. This study aimed to examine the impact of applying quality management practices on patient centeredness within the context of health care accreditation and to explore the differences in the views of various health care workers regarding the attributes affecting patient-centered care. Our study followed a cross-sectional survey design wherein 4 Jordanian public hospitals were investigated several months after accreditation was obtained. Total 829 clinical/nonclinical hospital staff members consented for study participation. This sample was divided into 3 main occupational categories to represent the administrators, nurses, as well as doctors and other health professionals. Using a structural equation modeling, our results indicated that the predictors of patient-centered care for both administrators and those providing clinical care were participation in the accreditation process, leadership commitment to quality improvement, and measurement of quality improvement outcomes. In particular, perceiving the importance of the hospital’s engagement in the accreditation process was shown to be relevant to the administrators (gamma = 0.96), nurses (gamma = 0.80), as well as to doctors and other health professionals (gamma = 0.71). However, the administrator staff (gamma = 0.31) was less likely to perceive the influence of measuring the quality improvement outcomes on the delivery of patient-centered care than nurses (gamma = 0.59) as well as doctors and other health care providers (gamma = 0.55). From the nurses’ perspectives only, patient centeredness was found to be driven by building an institutional framework that supports quality assurance in hospital settings (gamma = 0.36). In conclusion, accreditation is a leading factor for delivering patient-centered care and should be on a hospital’s agenda as a strategy for continuous quality improvement.

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