From “Don't Ask, Just Trust” to “Trust Those Who are Accountable”

2014 ◽  
Vol 3 (2) ◽  
pp. 60-73
Author(s):  
Vahé A. Kazandjian

The past three decades have primarily focused on improving performance across health care providing organizations and even individual professionals. While their interest in performance improvement is global, the strategies across health care systems remain variable and the resulting methods of accountability to select audiences continue to be influenced by tradition and expectation. The purpose of this article is to review the key dimensions of the operationalization of performance measurement and the translation of its findings to statements about quality of care. While significant literature exists on the conceptual debates about the nature of quality, the deciding factor in demonstrating that better quality may have been achieved resides in the acceptability of the measurement tools to translate performance measures into profiles of quality. Fundamentally, the use of the tools is seen as only one component of a successful strategy – the education of various audiences as to what the measures mean not only is a necessary requisite for sound project design but also will determine how the accountability model is shaped in each environment based on the generic measurement tools results, local traditions of care and caring, and expectations about outcomes.

2017 ◽  
pp. 924-938
Author(s):  
Vahé A. Kazandjian

The past three decades have primarily focused on improving performance across health care providing organizations and even individual professionals. While their interest in performance improvement is global, the strategies across health care systems remain variable and the resulting methods of accountability to select audiences continue to be influenced by tradition and expectation. The purpose of this article is to review the key dimensions of the operationalization of performance measurement and the translation of its findings to statements about quality of care. While significant literature exists on the conceptual debates about the nature of quality, the deciding factor in demonstrating that better quality may have been achieved resides in the acceptability of the measurement tools to translate performance measures into profiles of quality. Fundamentally, the use of the tools is seen as only one component of a successful strategy – the education of various audiences as to what the measures mean not only is a necessary requisite for sound project design but also will determine how the accountability model is shaped in each environment based on the generic measurement tools results, local traditions of care and caring, and expectations about outcomes.


1975 ◽  
Vol 17 (4) ◽  
pp. 398-410 ◽  
Author(s):  
Virginia Olesen

A somewhat neglected though thoroughly promising area for the analysis of changing women's roles lies in the matter of health and health care systems within any society. This is nowhere more the case than in the instance of contemporary Cuban health care and the part that women in that society play in the health care systems as deflners of health care problems, recipients of care, and as those who deliver care to others. Both women's roles and health care in contemporary Cuba have dramatically altered over the past decade, thus yielding doubly rich insights, which reciprocally illuminate both issues.


Author(s):  
Paul Montgomery ◽  
Nicole Thurston ◽  
Michelle Betts ◽  
C. Scott Smith

The complexities of cancer treatment present a myriad of life-altering impacts for patients. These impacts can be addressed only if health care systems have been designed to detect and address all of these challenges. One significant, but often hidden, challenge is distress. This reaction to the myriad obstacles that cancer presents can impact the quality of life, and influence outcomes, of patients with cancer. Health systems have been slow to address these problems, and a prime example is the implementation of a distress screening and management system. This case study summarizes distress screening in a community oncology clinic compared to a Department of Veterans Affairs (VA) oncology clinic. The community clinic responded to accreditation and grant-driven initiatives, whereas the VA responded to mental health and integrated primary care initiatives. This case study explores the history and the ongoing challenges of distress screening in these community-based health care systems.


10.2196/10477 ◽  
2019 ◽  
Vol 21 (12) ◽  
pp. e10477 ◽  
Author(s):  
Alireza Ahmadvand ◽  
David Kavanagh ◽  
Michele Clark ◽  
Judy Drennan ◽  
Lisa Nissen

Background Digital health has become an advancing phenomenon in the health care systems of modern societies. Over the past two decades, various digital health options, technologies, and innovations have been introduced; many of them are still being investigated and evaluated by researchers all around the globe. However, the actual trends and visibility of peer-reviewed publications using “digital health” as a keyword to reflect the topic, published by major relevant journals, still remain to be quantified. Objective This study aimed to conduct a bibliographic-bibliometric analysis on articles published in JMIR Publications journals that used “digital health” as a keyword. We evaluated the trends, topics, and citations of these research publications to identify the important share and contribution of JMIR Publications journals in publishing articles on digital health. Methods All JMIR Publications journals were searched to find articles in English, published between January 2000 and August 2019, in which the authors focused on, utilized, or discussed digital health in their study and used “digital health” as a keyword. In addition, a bibliographic-bibliometric analysis was conducted using the freely available Profiles Research Networking Software by the Harvard Clinical and Translational Science Center. Results Out of 1797 articles having “digital health” as a keyword, published mostly between 2016 and 2019, 277 articles (32.3%) were published by JMIR Publications journals, mainly in the Journal of Medical Internet Research. The most frequently used keyword for the topic was “mHealth.” The average number of times an article had been cited, including self-citations, was above 2.8. Conclusions The reflection of “digital health” as a keyword in JMIR Publications journals has increased noticeably over the past few years. To maintain this momentum, more regular bibliographic and bibliometric analyses will be needed. This would encourage authors to consider publishing their articles in relevant, high-visibility journals and help these journals expand their supportive publication policies and become more inclusive of digital health.


1997 ◽  
Vol 1 (1) ◽  
pp. 39-43
Author(s):  
Pat Farrell, ◽  
Gary Nuttall,

Over the past five years, we have been privileged to work with 130 leaders, as co-research participants, in discovering new approaches to leadership that will strengthen organizations in this time of shifting world values. For 28 of these leaders, we also have been privileged to study the organizations in which they work, and further, to observe the corporate culture with regard to connections between various employee groups and 1eaders. This paper is about our leadership enhancement process that we have developed for leader (board chairs, presidents, vice-presidents, and executive directors) in all sectors, including health care systems. Our process assists leaders to connect their intrapersonal behaviors to their interpersonal decision making behaviois - a process that influences their caring capacity. We also outline the framework that we have developed inductively, for the assessment of leaders’ intrapersonal and interper sonal decision making.We conclude with some of the outcomes of our process.


2003 ◽  
Vol 33 (2) ◽  
pp. 325-356 ◽  
Author(s):  
Ross Coomber ◽  
Michael Oliver ◽  
Craig Morris

Thirty-three therapeutic cannabis users in England were interviewed about their experiences using an illegal drug for therapeutic purposes. Interviews were semi-structured, and responses highly qualitative. Particular issues included how and why cannabis was used therapeutically; what problems its illegality posed in terms of access, cost, reliability of supply, and quality of the product; the perceived beneficial effects of its use; and unwanted effects (problems in relation to family, friends, partners, the criminal justice system, and the health care system). The study did not seek to prove or disprove the efficacy of cannabis used as a therapeutic agent merely to report the experiences of those who use it in that way. It was found that users perceived cannabis to be highly effective in treating their symptoms, to complement existing medication, and to produce fewer unwanted effects. Smoking was the preferred method of administration, permitting greater control over dose and administration. Problems related to prescribed medication motivated many to use cannabis therapeutically. Few problems were experienced with friends, family, partners, and the criminal justice or health care systems, although other concerns about cannabis's illegality were reported. Although most were relatively unconcerned about the risk involved and were determined to continue use, many resented that they felt they were being forced to break the law. Problems relating to access to the drug (in an illegal context) and managing its administration were reported. A brief discussion of the continued prohibition of cannabis for this group is undertaken, and a harm reduction approach is suggested.


2010 ◽  
Vol 30 (3) ◽  
pp. 263-289 ◽  
Author(s):  
NAONORI KODATE

AbstractOne would expect the common agenda of improving the quality of care in hospital sectors across nations to bring about a convergence of their quality assurance systems. However, one finds great variations in the ways in which such schemes are constructed and communicated to the general public in different countries. This paper examines three universal health care systems (England, Sweden and Japan) and explores the degree to which political institutions and public opinions affect the processes of quality assurance system building within them. It argues that the inputs from governments in response to public concerns are the key to understanding the changes in this seemingly profession-dominated policy domain; therefore policy changes are significantly affected by dynamic interactions between events, public discourses and governance structures within these countries. The findings also demonstrate that public access to information has begun to have a large impact on policy debates in all three countries.


2011 ◽  
Vol 24 (2) ◽  
pp. 135-145 ◽  
Author(s):  
Maria I. Rudis ◽  
Ryan J. Attwood

Emergency medicine (EM) pharmacy practice has existed for over 30 years. In recent years, however, the specialty has grown significantly. A large number of health care systems have either a dedicated EM pharmacist or other clinical pharmacist presence in the Emergency department (ED). Over the past decade, the role of the EM pharmacist as a critical member of the health care team has expanded significantly and many innovative practices have evolved throughout the country. There is also some heterogeneity between different EM pharmacy practice sites. This article reviews the history and general concepts of EM pharmacy practice as well as illustrate some of the established benefits of an EM pharmacist.


Author(s):  
Rebecca J. Schwei ◽  
Natalie Guerrero ◽  
Alissa L. Small ◽  
Elizabeth A. Jacobs

AbstractPurposeThe purpose of this study is to understand different roles that interpreters play in a pediatric, limited English proficient (LEP) health care encounter and to describe what factors within each role inform physicians’ assessment of the overall quality of interpretation.BackgroundLanguage barriers contribute to lower quality of care in LEP pediatric patients compared to their English-speaking counterparts. Use of professional medical interpreters has been shown to improve communication and decrease medical errors in pediatric LEP patients. In addition, in many pediatric encounters, interpreters take on roles beyond that of a pure language conduit.MethodsWe conducted 11 semi-structured interviews with pediatricians and family medicine physicians in one health system. Transcripts were audio-recorded and transcribed verbatim. We analyzed our data using directed content analysis. Two study team members coded all transcripts, reviewed agreement, and resolved discrepancies.FindingsPhysicians described four different interpreter roles: language conduit, flow manager, relationship builder, and cultural insider. Within each role, physicians described components of quality that informed their assessment of the overall quality of interpretation during a pediatric encounter. We found that for many physicians, a high-quality interpreted encounter involves multiple roles beyond language transmission. It is important for health care systems to understand how health care staff conceptualize these relationships so that they can develop appropriate expectations and trainings for medical interpreters in order to improve health outcomes in pediatric LEP patients.


2010 ◽  
Vol 6 (6) ◽  
pp. e11-e16 ◽  
Author(s):  
Simron Singh ◽  
Calvin Law

As providers at a neuroendocrine tumor multidisciplinary reference center, the authors believe these centers have a positive effect on patient and provider experience, and the creation of specialty centers with a focus on improving outcomes and quality of care should be a goal of health care systems.


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