scholarly journals The COVID-19 System Shock Framework: Capturing Health System Innovation During The COVID-19 Pandemic

2021 ◽  
Author(s):  
Michael Hodgins ◽  
Dee van Leeuwen ◽  
Jeffrey Braithwaite ◽  
Johanna Hanefeld ◽  
Ingrid Wolfe ◽  
...  
Keyword(s):  
Health System ◽  
Care Delivery ◽  
Governance Structure ◽  
Models Of Care ◽  
Project Managers ◽  
Delivery Of Care ◽  
Emergency Operations ◽  
Field Researcher ◽  
Hierarchical Governance ◽  
Clinical Directors

Background: COVID-19 has resulted in over 2 million deaths globally. The experience in Australia presents an opportunity to study contrasting responses to the COVID-19 health system shock. We adapted the Hanefeld et al framework for health systems shocks to create the COVID-19 System Shock Framework (CSSF). This framework enabled us to assess innovations and changes created through COVID-19 at the Sydney Children’s Hospitals Network (SCHN), the largest provider of children’s health services in the Southern hemisphere. Methods: We used ethnographic methods, guided by the COVID-19 System Shock Framework, to map innovations and initiatives implemented across SCHN during the pandemic. An embedded field researcher shadowed members of the Emergency Operations Centre (EOC) for nine months. We also reviewed clinic and policy documents pertinent to SCHN’s response to COVID-19 and conducted interviews and focus groups with stakeholders, including clinical directors, project managers, frontline clinicians, and other personnel involved in implementing innovations across SCHN. Results: The CSSF captured SCHN’s complex response to the pandemic. Responses included a COVID-19 assessment clinic, inpatient and infectious disease management services, redeploying and managing a workforce working from home, cohesive communication initiatives, and remote delivery of care, all enabled by a dedicated COVID-19 fund. The health system values that shaped SCHN’s response to the pandemic included principles of equity of health care delivery, holistic and integrated models of care, and supporting workforce wellbeing. SCHN’s resilience was enabled by innovation fostered through a non-hierarchical governance structure and responsiveness to emerging challenges balanced with a singular vision. Conclusion: Using the CSSF, we found that SCHN’s ability to innovate was key to ensuring its resilience during the pandemic.

Achieving a balanced life in the face of chronic illness

2010 ◽  
Vol 16 (1) ◽  
pp. 66 ◽  
Author(s):  
Yun-Hee Jeon ◽  
Tanisha Jowsey ◽  
Laurann Yen ◽  
Nicholas J. Glasgow ◽  
Beverley Essue ◽  
...  
Keyword(s):  
Chronic Illness ◽  
Health Services ◽  
Health System ◽  
Care Delivery ◽  
Models Of Care ◽  
System Reform ◽  
Family Carers ◽  
Co Morbidity ◽  
The Face ◽  
Future Policy

The increasing prevalence of chronic disease is a driver of health system reform in most economically advanced nations. A consistent theme within these reforms is building greater patient-centredness into the health care delivery. This study aims to develop an in-depth understanding of the experience of patients and family carers affected by chronic illness that will be the basis on which to propose policy and health system interventions that are patient-centred. Participants struggled with the ongoing tasks of balancing their lives with the increasing demands and intrusion of chronic illness. Their attempts to achieve a balance were seriously hampered by fragmented services, complexity in navigating health services, relationships with health professionals and others, and co-morbidity. Future policy directions include designing models of care and infrastructure that enable patients and their family carers to balance life and illness, and aligning patient-centred care not only within health services but also with community and social support services.

scholarly journals Clinicians’ Experience of Providing Care: A Rapid Review

2020 ◽  
Author(s):  
Maha Pervaz Iqbal ◽  
Elizabeth Manias ◽  
Laurel Mimmo ◽  
Stephen Mears ◽  
Briony Jack ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Care Delivery ◽  
Grey Literature ◽  
Clinical Work ◽  
Models Of Care ◽  
Rapid Review ◽  
Measurement Tools ◽  
Clinician Experience ◽  
System Sustainability

Abstract BackgroundHealth care services internationally are refocussing care delivery towards patient centred, integrated care that utilises effective, efficient and innovative models of care to optimise patient outcomes and system sustainability. Whilst significant efforts have been made to examine and enhance patient experience, to date little has progressed in relation to provider experience. This review aims to explore this knowledge gap by capturing evidence of clinician experience, and how this experience is defined and measured in the context of health system change and innovation.Methods:A rapid review of published and grey literature review was conducted utilising a rapid evidence assessment methodology. 79 studies retrieved from the literature were included in the review. 14 articles were identified from the grey literature search and one article obtained via hand searching. In total, 94 articles were included in the review. This study was commissioned by and co-designed with the New South Wales, Ministry of Health.Results:Clinician experience of delivering health care is inconsistently defined in the literature, with identified articles lacking clarity regarding distinctions between experience, engagement and work-related outcomes such as job satisfaction. Clinician experience was commonly explored using qualitative research that focused on experiences of discrete health care activities or events in which a change was occurring. Such research enabled exploration of complex experiences. In these contexts, clinician experience was captured in terms of self-reported information that clinicians provided about the health care activity or event, their perceptions of its value, the lived impacts they experienced, and the specific behaviours they displayed in relation to the activity or event. Moreover, clinician’s experience has been identified to have a paucity of measurement tools. Conclusion:Literature to date has not examined clinician experience in a holistic sense. In order to achieve the goals identified in relation to value-based care, further work is needed to conceptualise clinician experience and understand the nature of measurement tools required to assess this. In health system application, a broader ‘clinician pulse’ style assessment may be valuable to understand the experience of clinical work on a continuum rather than in the context of episodes of change/care.

scholarly journals Clinicians’ experience of providing care: a rapid review

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Maha Pervaz Iqbal ◽  
Elizabeth Manias ◽  
Laurel Mimmo ◽  
Stephen Mears ◽  
Briony Jack ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Care Services ◽  
Care Delivery ◽  
Grey Literature ◽  
Clinical Work ◽  
Models Of Care ◽  
Rapid Review ◽  
Measurement Tools ◽  
Clinician Experience

Abstract Background Health care services internationally are refocussing care delivery towards patient centred, integrated care that utilises effective, efficient and innovative models of care to optimise patient outcomes and system sustainability. Whilst significant efforts have been made to examine and enhance patient experience, to date little has progressed in relation to provider experience. This review aims to explore this knowledge gap by capturing evidence of clinician experience, and how this experience is defined and measured in the context of health system change and innovation. Methods A rapid review of published and grey literature review was conducted utilising a rapid evidence assessment methodology. Seventy-nine studies retrieved from the literature were included in the review. Fourteen articles were identified from the grey literature search and one article obtained via hand searching. In total, 94 articles were included in the review. This study was commissioned by and co-designed with the New South Wales, Ministry of Health. Results Clinician experience of delivering health care is inconsistently defined in the literature, with identified articles lacking clarity regarding distinctions between experience, engagement and work-related outcomes such as job satisfaction. Clinician experience was commonly explored using qualitative research that focused on experiences of discrete health care activities or events in which a change was occurring. Such research enabled exploration of complex experiences. In these contexts, clinician experience was captured in terms of self-reported information that clinicians provided about the health care activity or event, their perceptions of its value, the lived impacts they experienced, and the specific behaviours they displayed in relation to the activity or event. Moreover, clinician’s experience has been identified to have a paucity of measurement tools. Conclusion Literature to date has not examined clinician experience in a holistic sense. In order to achieve the goals identified in relation to value-based care, further work is needed to conceptualise clinician experience and understand the nature of measurement tools required to assess this. In health system application, a broader ‘clinician pulse’ style assessment may be valuable to understand the experience of clinical work on a continuum rather than in the context of episodes of change/care.

scholarly journals Clinicians’ Experience of Providing Care: A Rapid Review

2020 ◽  
Author(s):  
Maha Pervaz Iqbal ◽  
Elizabeth Manias ◽  
Laurel Mimmo ◽  
Stephen Mears ◽  
Briony Jack ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Care Services ◽  
Care Delivery ◽  
Grey Literature ◽  
Clinical Work ◽  
Models Of Care ◽  
Rapid Review ◽  
Measurement Tools ◽  
Clinician Experience

Abstract Background Health care services internationally are refocussing care delivery towards patient centred, integrated care that utilises effective, efficient and innovative models of care to optimise patient outcomes and system sustainability. Whilst significant efforts have been made to examine and enhance patient experience, to date little has progressed in relation to provider experience. This review aims to explore this knowledge gap by capturing evidence of clinician experience, and how this experience is defined and measured in the context of health system change and innovation.Methods A rapid review of published and grey literature review was conducted utilising a rapid evidence assessment methodology. 79 studies retrieved from the literature were included in the review. 14 articles were identified from the grey literature search and one article obtained via hand searching. In total, 94 articles were included in the review. This study was commissioned by and co-designed with the New South Wales, Ministry of Health.Results Clinician experience of delivering health care is inconsistently defined in the literature, with identified articles lacking clarity regarding distinctions between experience, engagement and work-related outcomes such as job satisfaction. Clinician experience was commonly explored using qualitative research that focused on experiences of discrete health care activities or events in which a change was occurring. Such research enabled exploration of complex experiences. In these contexts, clinician experience was captured in terms of self-reported information that clinicians provided about the health care activity or event, their perceptions of its value, the lived impacts they experienced, and the specific behaviours they displayed in relation to the activity or event. Moreover, clinician’s experience has been identified to have a paucity of measurement tools. Conclusion Literature to date has not examined clinician experience in a holistic sense. In order to achieve the goals identified in relation to value-based care, further work is needed to conceptualise clinician experience and understand the nature of measurement tools required to assess this. In health system application, a broader ‘clinician pulse’ style assessment may be valuable to understand the experience of clinical work on a continuum rather than in the context of episodes of change/care.

scholarly journals Clinicians’ Experience of Providing Care: A Rapid Review

2020 ◽  
Author(s):  
Maha Pervaz Iqbal ◽  
Elizabeth Manias ◽  
Laurel Mimmo ◽  
Stephen Mears ◽  
Briony Jack ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Care Services ◽  
Care Delivery ◽  
Grey Literature ◽  
Clinical Work ◽  
Models Of Care ◽  
Rapid Review ◽  
Measurement Tools ◽  
Clinician Experience

Abstract Background Health care services internationally are refocussing care delivery towards patient centred, integrated care that utilises effective, efficient and innovative models of care to optimise patient outcomes and system sustainability. Whilst significant efforts have been made to examine and enhance patient experience, to date little has progressed in relation to provider experience. This review aims to explore this knowledge gap by capturing evidence of clinician experience, and how this experience is defined and measured in the context of health system change and innovation. Methods: A rapid review of published and grey literature review was conducted utilising a rapid evidence assessment methodology. 79 studies retrieved from the literature were included in the review. 14 articles were identified from the grey literature search and one article obtained via hand searching. In total, 94 articles were included in the review. This study was commissioned by and co-designed with the New South Wales, Ministry of Health. Results: Clinician experience of delivering health care is inconsistently defined in the literature, with identified articles lacking clarity regarding distinctions between experience, engagement and work-related outcomes such as job satisfaction. Clinician experience was commonly explored using qualitative research that focused on experiences of discrete health care activities or events in which a change was occurring. Such research enabled exploration of complex experiences. In these contexts, clinician experience was captured in terms of self-reported information that clinicians provided about the health care activity or event, their perceptions of its value, the lived impacts they experienced, and the specific behaviours they displayed in relation to the activity or event. Moreover, clinician’s experience has been identified to have a paucity of measurement tools. Conclusion: Literature to date has not examined clinician experience in a holistic sense. In order to achieve the goals identified in relation to value-based care, further work is needed to conceptualise clinician experience and understand the nature of measurement tools required to assess this. In health system application, a broader ‘clinician pulse’ style assessment may be valuable to understand the experience of clinical work on a continuum rather than in the context of episodes of change/care.

scholarly journals Impact of the COVID-19 pandemic: a perspective from industry

2020 ◽  
Vol 22 (Supplement_P) ◽  
pp. P56-P59
Author(s):  
Nick E J West ◽  
Wai-Fung Cheong ◽  
Els Boone ◽  
Neil E Moat
Keyword(s):  
Care Delivery ◽  
Models Of Care ◽  
Medium Term ◽  
Change Models ◽  
New Device ◽  
Supply Chain Logistics ◽  
Cardiovascular Patients ◽  
Medical Crisis ◽  
Device Industry

Abstract The global COVID-19 pandemic has led to unprecedented change throughout society.1 As the articles in this supplement outline, all segments of the broader cardiovascular community have been forced to adapt, to change models of care delivery, and to evolve and innovate in order to deliver optimal management for cardiovascular patients. The medtech/device industry has not been exempt from such change and has been forced to navigate direct and indirect COVID-associated disruption, with effects felt from supply chain logistics to the entire product lifecycle, from the running of clinical trials to new device approvals and managing training, proctoring and congresses in an increasingly-online world. This sea-change in circumstances itself has enforced the industry, in effect, to disrupt its own processes, models and activities. Whilst some of these changes may be temporary, many will endure for some time and some will doubtless become permanent; one thing is for sure: the healthcare ecosystem, including the medical device industry, will never look quite the same again. Although the pandemic has brought a short- to medium-term medical crisis to many countries, its role as a powerful disruptor cannot be underestimated, and may indeed prove to be a force for long-term good, given the accelerated innovation and rapid adaptation that it has cultivated.

scholarly journals Veterans Health Administration’s Whole Health System of Care: Supporting the Health, Well-Being, and Resiliency of Employees

2021 ◽  
Vol 10 ◽  
pp. 216495612110226
Author(s):  
Kavitha P Reddy ◽  
Tamara M Schult ◽  
Alison M Whitehead ◽  
Barbara G Bokhour
Keyword(s):  
Health System ◽  
Care Delivery ◽  
Health Planning ◽  
Well Being ◽  
Employee Health ◽  
Veterans Health ◽  
Health Administration ◽  
Patient Centered ◽  
Foundational Work ◽  
Health And Well Being

The Veterans Health Administration (VHA) is implementing a Whole Health System (WHS) of care that empowers and equips Veterans to take charge of their health and well-being and live their lives to the fullest, and increasingly leaders recognize the need and value in implementing a similar approach to support the health and well-being of employees. The purpose of this paper is to do the following: 1) provide an overview of the WHS of care in VHA and applicability in addressing employee resiliency; 2) provide a brief history of employee well-being efforts in VHA to date; 3) share new priorities from VHA leadership as they relate to Employee Whole Health strategy and implementation; and 4) provide a summary of the impacts of WHS of care delivery on employees. The WHS of care utilizes all therapeutic, evidence-based approaches to support self-care goals and personal health planning. Extending these approaches to employees builds upon 10 years of foundational work supporting employee health and well-being in VHA. In 2017, one facility in each of the 18 Veterans Integrated Service Networks (VISNs) in VHA was selected to participate in piloting the WHS of care with subsequent evaluation by VA’s Center for Evaluating Patient-Centered Care (EPCC). Early outcomes, from an employee perspective, suggest involvement in the delivery of the WHS of care and personal use of the whole health approach have a meaningful impact on the well-being of employees and how they experience the workplace. During the COVID-19 pandemic, VHA has continued to support employees through virtual resources to support well-being and resiliency. VHA's shift to this patient-centered model is supporting not only Veteran care but also employee health and well-being at a time when increased support is needed.

Health system characteristics of quality care delivery: A comparative case study examination of palliative care for cancer patients in four regions in Ontario, Canada

2011 ◽  
Vol 26 (4) ◽  
pp. 322-335 ◽  
Author(s):  
Jonathan Sussman ◽  
Lisa Barbera ◽  
Daryl Bainbridge ◽  
Doris Howell ◽  
Jinghao Yang ◽  
...  
Keyword(s):  
Palliative Care ◽  
Health System ◽  
Acute Care ◽  
Pattern Analysis ◽  
Care Delivery ◽  
Quality Care ◽  
Structural Features ◽  
Comparative Case Study ◽  
Care Utilization

Background: A number of palliative care delivery models have been proposed to address the structural and process gaps in this care. However, the specific elements required to form competent systems are often vaguely described. Aim: The purpose of this study was to explore whether a set of modifiable health system factors could be identified that are associated with population palliative care outcomes, including less acute care use and more home deaths. Design: A comparative case study evaluation was conducted of ‘palliative care’ in four health regions in Ontario, Canada. Regions were selected as exemplars of high and low acute care utilization patterns, representing both urban and rural settings. A theory-based approach to data collection was taken using the System Competency Model, comprised of structural features known to be essential indicators of palliative care system performance. Key informants in each region completed study instruments. Data were summarized using qualitative techniques and an exploratory factor pattern analysis was completed. Results: 43 participants (10+ from each region) were recruited, representing clinical and administrative perspectives. Pattern analysis revealed six factors that discriminated between regions: overall palliative care planning and needs assessment; a common chart; standardized patient assessments; 24/7 palliative care team access; advanced practice nursing presence; and designated roles for the provision of palliative care services. Conclusions: The four palliative care regional ‘systems’ examined using our model were found to be in different stages of development. This research further informs health system planners on important features to incorporate into evolving palliative care systems.

Managing the Digital Disruption Associated with COVID-19-Driven Rapid Digital Transformation in Brisbane, Australia

2021 ◽  
Vol 12 (05) ◽  
pp. 1135-1143
Author(s):  
Amalie Dyda ◽  
Magid Fahim ◽  
Jon Fraser ◽  
Marianne Kirrane ◽  
Ides Wong ◽  
...  
Keyword(s):  
Care Delivery ◽  
Digital Health ◽  
Clinical Care ◽  
Models Of Care ◽  
Digital Transformation ◽  
Lessons Learned ◽  
Digital Data ◽  
Routine Practice ◽  
Action Research Project ◽  
Digital Disruption

Abstract Background The COVID-19 pandemic has forced rapid digital transformation of many health systems. These innovations are now entering the literature, but there is little focus on the resulting disruption. Objective We describe the implementation of digital innovations during the COVID-19 response of Australia's largest health service, Metro North (in Brisbane, Queensland), the challenges of the subsequent digital disruption, how these were managed, and lessons learned. Methods Prior to the COVID-19 pandemic, the Australian state of Queensland created the Queensland Digital Clinical Charter, which provides guidance for the development of digital health programs. The guidelines utilize three horizons: digitizing workflows, leveraging digital data to transform clinical care, and reimagining new and innovative models of care. The technical response to COVID-19 in Metro North is described across these horizons. The rapid digital response caused significant disruption to health care delivery; management of the disruption and the outcomes are detailed. This is a participatory action research project, with members of the research team assisting with leading the implementation project informing the case report content. Results Several digital innovations were introduced across Metro North during the COVID-19 response. This resulted in significant disruption creating digital hypervigilance, digital deceleration, data discordance, and postdigital “depression.” Successful management of the digital disruption minimized the negative effects of rapid digital transformation, and contributed to the effective management of the pandemic in Queensland. Conclusion The rapid digital transformation in Metro North during COVID-19 was successful in several aspects; however, ongoing challenges remain. These include the need to improve data sharing and increase interoperability. Importantly, the innovations need to be evaluated to ensure that Metro North can capitalize on these changes and incorporate them into long-term routine practice. Moving forward, it will be essential to manage not only the pandemic, but increasingly, the resultant digital disruption.

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