scholarly journals Improving healthcare performance by focusing on individual productivity of healthcare provider and system thinking: a strategy proposal

2019 ◽  
Vol 5 (2) ◽  
pp. 45-51
Author(s):  
Choni Wangmo

Bhutan’s health system, despite its commendable achievements in past few decades, continues to face shortage of skilled healthcare professionals and quality issues in service delivery. While recruiting more professionals, advocating for population health, better patient experience and safety, healthcare provider wellness has been overlooked. As the recent pay revision receives warm welcome from the health fraternity, a sense of greater professionalism and responsibility will be expected. Yet, aforementioned challenges still remain. Life and aspirations of professionals, brought up and trained in society that provides free healthcare and education, will become more convoluted. Mentorship program for healthcare providers at the beginning of their career and institutionalizing enabling environment for their personal and professional development need to be looked into. Decisions to pursue specialization should be a result of genuine interest and not a presumed exit hallway from professional frustrations, nor a shortcut to hefty pay. A promising and congruous career pathway can improve job satisfaction among health care providers. Endeavors to improve healthcare service delivery are present at every level but lack of coordination hampers favorable outcome. Variation in healthcare is major cause of adverse healthcare outcome and it is also known that every system is perfectly designed to achieve the results it gets. After conceptualizing few desired outcomes, a strategy framework that leads to health system improvement through improved individual productivity and systemic reforms enhancing intra- and inter sectoral coordination, while using evidence-based practice and existing resources, is proposed.

BMJ Open ◽  
2017 ◽  
Vol 7 (5) ◽  
pp. e014719 ◽  
Author(s):  
Mark Harrison ◽  
Katherine Milbers ◽  
Marie Hudson ◽  
Nick Bansback

ObjectivesTo review studies eliciting patient and healthcare provider preferences for healthcare interventions using discrete choice experiments (DCEs) to (1) review the methodology to evaluate similarities, differences, rigour of designs and whether comparisons are made at the aggregate level or account for individual heterogeneity; and (2) quantify the extent to which they demonstrate concordance of patient and healthcare provider preferences.MethodsA systematic review searching Medline, EMBASE, Econlit, PsycINFO and Web of Science for DCEs using patient and healthcare providers. Inclusion criteria: peer-reviewed; complete empiric text in English from 1995 to 31July 2015; discussing a healthcare-related topic; DCE methodology; comparing patients and healthcare providers.DesignSystematic review.ResultsWe identified 38 papers exploring 16 interventions in 26 diseases/indications. Methods to analyse results, determine concordance between patient and physician values, and explore heterogeneity varied considerably between studies. The majority of studies we reviewed found more evidence of mixed concordance and discordance (n=28) or discordance of patient and healthcare provider preferences (n=12) than of concordant preferences (n=4). A synthesis of concordance suggested that healthcare providers rank structure and outcome attributes more highly than patients, while patients rank process attributes more highly than healthcare providers.ConclusionsDiscordant patient and healthcare provider preferences for different attributes of healthcare interventions are common. Concordance varies according to whether attributes are processes, structures or outcomes, and therefore determining preference concordance should consider all aspects jointly and not a binary outcome. DCE studies provide excellent opportunities to assess value concordance between patients and providers, but assessment of concordance was limited by a lack of consistency in the approaches used and consideration of heterogeneity of preferences. Future DCEs assessing concordance should fully report the framing of the questions and investigate the heterogeneity of preferences within groups and how these compare.


Author(s):  
Mohan Tanniru ◽  
Mark Martz

Information technology has enabled tertiary health care providers to improve patient access to preventive and post-discharge care transition services. When such services are supported by facilities that are under the control of the hospital, hospitals can still influence the delivery and overall quality of patient care services. However, for a variety of reasons, many hospitals rely on external care providers who operate relatively independently from the hospital to deliver these services. As such, service delivery intended to create efficiency and value to patients can become complex, challenging to deliver, and resource intensive—especially if the service delivery spans a prolonged time horizon. This chapter discusses one case of an intermediary who helps hospitals address the smoking cessation needs of patients. Using service dominant logic research, the service exchanges among three different ecosystems (healthcare providers, intermediary, and patients) are modeled and intelligence needed to align their goals using blockchain architecture is highlighted.


2016 ◽  
Vol 9 (2) ◽  
pp. 75-85 ◽  
Author(s):  
Abbas Heydari ◽  
Rana Amiri ◽  
Nahid Dehghan Nayeri ◽  
Vedadhir AboAli

Purpose – The purpose of this paper is to explore experiences of Afghan refugees from health service delivery in Mashhad, Iran. Design/methodology/approach – This is a descriptive study with contextual and qualitative design. Semi-structured interview conducted with 19 Afghan refugees and their caregivers and a focus group session were held with Afghan medical science students. Purposive sampling technique was used to select participants. Data were analysed by qualitative content analysis of Graneheim and Lundman. Lincoln and Guba’s criteria were implemented to ensure trustworthiness. Findings – The results with the core concept of “position of immigrants in the health system” were presented at four themes of “perceived discrimination”, “snowed with loneliness”, “feeling inferior”, and “gratitude”. Research limitations/implications – This study has some implications for researchers and practitioners. The present study is the first study that was done on the health of Afghan refugees in Iran, therefore it can be a ground for further research. In addition, it has valuable results regarding the Afghan immigrants’ experience of health care system of Iran. Practical implications – It can be useful for improving the condition of immigrants in Iran and for improving Iran’s health system. In order to improve the health system in Iran, authorities should pay much attention to transcultural caring and needs of minorities. Furthermore, health workers should be trained to appropriately take care of all patients, without prejudice. Originality/value – Overall the study revealed that there is inequity in access to health services among Afghan refugees in Iran. The findings, although not generalized, offer important insights into health care providers in Iran which should be delivering health service without prejudice. The authors recommended that policies of public medical insurance and assistance programme should be implemented for providing affordable health care services for Afghan refugees.


2019 ◽  
Vol 31 (2) ◽  
pp. 131

In Myanmar, the main challenge to provide quality healthcare by Universal Health Care approach is documented as low health services coverage with substantial wealth-based inequality. To achieve the effective health care system, strong medical care system is essential. Understanding on challenges and needs in provision of medical services among patients and health care providers is critical to provide quality care with desirable outcomes. The aim of the study was to explore the patients’ and health care providers’ perceptions on the challenges in provision of medical services at the Mandalay General Hospital. This was a qualitative study conducted at the tertiary level hospital (Mandalay General Hospital). The data was collected by using focus group discussions and in-depth interviews with hospitalized patients or attendants, healthcare providers such as medical doctors, nurses, laboratory scientists and hospital administrators in March 2017. The qualitative data was analyzed using themes by themes matrix analysis. Most patients were satisfied with the care provided by the doctors because they believed that they received quality care. However, some patients complained about long waiting time for elective operation, congested conditions in the ward, burden for investigations outside the hospital for urgent needs and impolite manners of general workers. Healthcare providers reported that they had heavy workload due to limited human and financial resources in the hospital, poor compliances with hospital rules and regulation among patients and attendants, and inefficient referral practices from other health facilities. Other challenges experienced by healthcare providers were lack of ongoing training to improve knowledge and skills, limited health infrastructure and inadequate medicinal supplies. The findings highlighted the areas needed to be improved to provide quality health care at the tertiary level hospital. The challenges and problems encountered in this hospital can be improved by allocating adequate financial and human resources. The systematic referral system and hospital management guidelines are needed to reduce workload of health staff.


2020 ◽  
Author(s):  
Emad Aborajooh ◽  
Mohammed Qussay Al-Sabbagh ◽  
Baraa Mafrachi ◽  
Muhammad Yassin ◽  
Rami Dwairi ◽  
...  

UNSTRUCTURED We aimed to measure levels of knowledge, awareness, and stress about COVID-19 among health care providers (HCP) in Jordan. This was a cross-sectional study on 397 HCPs that utilized an internet-based questionnaire to evaluate knowledge about COVID-19, availability of personal protective equipment (PEE), future perception, and psychological distress. Ordinal logistic regression analysis was used to evaluate factors associated with knowledge and psychological stress. Overall, 24.4% and 21.2% of the participants showed excellent knowledge and poor knowledge, respectively. Social media (61.7%) was the most commonly used source of information. Being female (β= 0.521, 95% CI 0.049 to 0.992), physician (β=1.421, 95% CI 0.849 to 1.992), or using literature to gain knowledge (β= 1.161, 95% CI 0.657 to 1.664) were positive predictors of higher knowledge. While having higher stress (β= -0.854, 95% CI -1.488 to -0.221) and using social media (β= -0.434, 95% CI -0.865 to -0.003) or conventional media (β= -0.884, 95% CI -1.358 to -0.409) for information were negative predictors of knowledge levels. HCPs are advised to use the literature as a source of information about the virus, its transmission, and the best practice. PPEs should be secured for HCPs to the psychological stress associated with treating COVID-19 patients.


2020 ◽  
Vol 32 (S1) ◽  
pp. 123-123
Author(s):  
Ken Schwartz ◽  
Robert Madan ◽  
Anna Berall ◽  
Marsha Natadira ◽  
Anna Santiago

Background:Responsive behaviours in dementia are associated with poor outcomes for the person with dementia (PWD) and caregiver burnout. Family caregivers need a variety of tools to manage responsive behaviours. The Baycrest Quick-Response Caregiver Tool was developed to provide caregivers with a tool that can be used in real time. In this study, the feasibility, impact, and effectiveness of this new tool were studied in family caregivers and health care providers (HCP) using quantitative and qualitative measures.Methods:Family caregivers were recruited and were asked to complete a pre-survey before being sent the link to the educational tool. One month after the telephone survey, caregivers were sent an online post-survey to gather their feedback on the tool and the impact of the tool on caregiver well -being. Healthcare providers were also recruited and reviewed the tool through an online feedback survey. The feasibility, impact, and effectiveness of the tool were assessed using quantitative and qualitative measures.Results:Caregivers had a moderate degree of and reported a high level of competence - these scores were maintained throughout the study. Caregivers reported that tool positively impacted their compassion towards the person with dementia (PWD), and that their interactions with improved. 100% of HCP who completed the feedback survey would recommend the tool to other HCP and to caregivers of PWD. The caregivers and HCP provided specific suggestions for improvement.Conclusions:The Baycrest Quick-Response Caregiver Tool was found to be feasible and helpful. It provides caregivers and HCP with an additional approach for responsive behaviours.


Author(s):  
Ariana Kong ◽  
Michelle Dickson ◽  
Lucie Ramjan ◽  
Mariana S. Sousa ◽  
Joanne Goulding ◽  
...  

The aim of this study was to explore whether oral health was an important consideration for Aboriginal and Torres Strait Islander women during pregnancy, whether oral health could be promoted by Aboriginal health staff, and strategies that would be appropriate to use in a new model of care. A qualitative descriptive methodology underpinned the study. All participants in this study identified as Aboriginal, with no Torres Strait Islander participants, and were from New South Wales, Australia. The interviews were analysed using inductive thematic analysis. From the data, two themes were constructed. The first theme identified that oral health was not always the first priority for participants as poor accessibility alongside other competing commitments were challenges to accessing oral health services. The second theme highlighted how relationships with personal networks and healthcare providers were essential and could be used to support maternal oral health during pregnancy. Effective strategies to promote oral health during pregnancy for Aboriginal and Torres Strait Islander women should involve key stakeholders and health care providers, like Aboriginal Health Workers, to facilitate culturally safe support and tailored oral health advice.


2013 ◽  
Vol 3 (2) ◽  
pp. 154-159
Author(s):  
Janet Perkins ◽  
Aminata Bargo ◽  
Cecilia Capello ◽  
Carlo Santarelli

Assuring the provision of person-centred care is critical in maternal and newborn health (MNH). As a component of the national strategy to improve MNH, Burkina Faso Ministry of Health, supported by Enfants du Monde, La Fondation pour le Développement Communautaire/Burkina Faso and UNFPA, is implementing the World Health Organization’s (WHO) framework for Working with Individuals, Families and Communities (IFC) to improve MNH. As a first step in district implementation, participatory community assessments were conducted. These assessments consistently revealed that poor interactions with healthcare providers posed one important barrier preventing women from seeking MNH services. In order to address this barrier, healthcare providers were trained to improve their interpersonal skills and in counselling women. During 2011-12 a total of 175 personnel were trained over a 5-day course developed using a WHO manual. The course was met with enthusiasm as providers expressed their need and desire for such training. Immediate post-test results revealed an impressive increase in knowledge and anecdotal evidence suggests that training has influenced provider’s behaviours in their interactions with women. In addition, health care providers are taking concrete action to build the capabilities of women to experience pregnancy and birth safely by engaging directly with communities.  While early findings are promising, an evaluation will be necessary to measure how the training has influenced practices, whether this translates into a shift of perceptions at community level and ultimately its contribution toward promoting person-centred care in Burkina Faso.


2021 ◽  
Author(s):  
Siti Balqis Chanmekun ◽  
Maryam Mohd Zulkifli ◽  
Rosediani Muhamad ◽  
Norhasmah Mohd Zain ◽  
Wah Yun Low ◽  
...  

Abstract Purpose: Management of female sexual dysfunction (FSD) is vital for women with breast cancer due to the devastating consequences, which include marital disharmony and reduced quality of life. We explore healthcare providers’ (HCPs) perceptions and experiences in managing FSD for women living with breast cancer using phenomenological approach. Methods: This qualitative study was conducted using a face-to-face interview method to HCPs from two tertiary hospitals in North East Malaysia. The interviews were recorded, transcribed verbatim, and transferred to NVivo ® for data management. The transcriptions were analyzed using thematic analysis. Results: Three key barriers were identified through the thematic analysis: a scarcity of related knowledge; the influence of socio-cultural ideas about sex; and the speciality-centric nature of the healthcare system. Most HCPs interviewed had a very narrow understanding of sexuality, were unfamiliar with the meaning of FSD, and felt their training on sexual health issues to be very limited. They viewed talking about sex to be embarrassing to both parties that is, both to HCPs and patients and was therefore not a priority. They focused more on their specialty hence limited the time to discuss sexual health and FSD with their patients. Conclusion: Therefore, interventions to empower the knowledge, break the sociocultural barriers and improve the clinic settings are crucial for HCPs in managing FSD confidently.


2020 ◽  
Author(s):  
Immaculada Grau-Corral ◽  
Percy Efran Pantoja ◽  
Francisco J. Grajales III ◽  
Belchin Kostov ◽  
Valentí Aragunde ◽  
...  

BACKGROUND The presence of the mobile phone and devices is generating knowledge about the use of applications to support patient care, but there are few recommendations for apps dedicated to healthcare professionals OBJECTIVE To establish a validated scale to assess healthcare mobile applications is the most efficient step for health care providers and systems. The main goal is to create and validate a tool to evaluate health apps destined to be used by health professionals. METHODS A five steps simplified methodology to assess of the scale was followed. The first step consists of building a scale for professionals based on a literature review. Next step would be an expert panel validation by a Delphi method, rating web-based questionnaires to evaluate inclusion and weight of the indicators. It was agreed to carry out, as many iterations as necessary, to reach a consensus of 75%. Finally, a pilot of the score was developed to evaluate the reliability of the scale. For the inter-rater agreement assessment during the pilot, the Cohen Kappa was used. RESULTS After the literature review, a first scale draft was developed. Two rounds of interactions of the local investigation group and the external panel of experts were needed to select final indicators. Seventeen indicators were included in the score. For the pilot test, 280 apps were evaluated and 66 meet the criteria. The interrater agreement was strong (higher than 82% with significant kappa >0.72 per app and item). CONCLUSIONS We have developed, with a reproducible methodology, a tool that allows us to evaluate health applications for clinical, surgical and general medical providers. The ISYScore-PRO scale to be reliable and reproducible. The assessment permitted to consolidate every step of the methodology. We were able to reach consensus on the dimensions and items on the scale with only two rounds. The process of validation included two robust methodologies. The ISYScore-PRO scale is reliable and reproducible.


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