scholarly journals From Good to Great – insights, learnings and a change of perspective on patient involvement at Karolinska University Hospital (KUH)

2021 ◽  
Vol 21 (S1) ◽  
pp. 49
Author(s):  
Anna Blommengren
Keyword(s):  
Patient Involvement ◽  
University Hospital ◽  
Good To Great ◽  
Change Of Perspective

scholarly journals Leadership assumptions on implementation of patient involvement methods

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kathrine Håland Jeppesen ◽  
Kirsten Frederiksen ◽  
Marianne Johansson Joergensen ◽  
Kirsten Beedholm
Keyword(s):  
Health Care ◽  
Organizational Learning ◽  
Health Care Professionals ◽  
Large Scale ◽  
Patient Involvement ◽  
Hospital Setting ◽  
Implementation Process ◽  
University Hospital ◽  
Structured Interviews ◽  
Implementation Processes

Abstract Background From 2014 to 17, a large-scale project, ‘The User-involving Hospital’, was implemented at a Danish university hospital. Research highlights leadership as crucial for the outcome of change processes in general and for implementation processes in particular. According to the theory on organizational learning by Agyris and Schön, successful change requires organizational learning. Argyris and Schön consider that the assumptions of involved participants play an important role in organizational learning and processes. The purpose was to explore leaders’ assumptions concerning implementation of patient involvement methods in a hospital setting. Methods Qualitative explorative interview study with the six top leaders in the implementation project. The semi-structured interviews were conducted and analyzed in accordance with Kvale and Brinkmanns’ seven stages of interview research. Result The main leadership assumptions on what is needed in the implementation process are in line with the perceived elements in organizational learning according to the theory of Argyris and Schön. Hence, they argued that implementation of patient involvement requires a culture change among health care professionals. Two aspects on how to obtain success in the implementation process were identified based on leadership assumptions: “The health care professionals’ roles in the implementation process” and “The leaders’ own roles in the implementation process”. Conclusion The top leaders considered implementation of patient involvement a change process that necessitates a change in culture with health care professionals as crucial actors. Furthermore, the top leaders considered themselves important facilitators of this implementation process.

Deciding on treatment duration for unprovoked venous thromboembolism: what is important to patients?

2021 ◽  
Author(s):  
Anouk van de Brug ◽  
Maria De Winter ◽  
Marije ten Wolde ◽  
Karin Kaasjager ◽  
Mathilde Nijkeuter
Keyword(s):  
Venous Thromboembolism ◽  
Treatment Duration ◽  
Patient Involvement ◽  
University Hospital ◽  
Sufficient Information ◽  
Structured Interviews ◽  
Risks And Benefits ◽  
Conventional Content Analysis ◽  
The Impact ◽  
Treatment Education

Background After 3 months of anticoagulation for unprovoked venous thromboembolism (VTE), a decision must be made to stop or continue indefinitely by weighing risks of recurrence and bleeding through shared decision-making (SDM). Despite the importance of patient involvement, patients’ perspectives on treatment duration are understudied. Aim To describe knowledge of VTE and anticoagulation, need for education, perception of risks and benefits of extended treatment and factors influencing patient’s preference to stop or continue treatment after unprovoked VTE. Methods: Semi-structured interviews were conducted between May 2019 and August 2020 with adults with unprovoked VTE in one university hospital and one general hospital. Interviews were audio-recorded and transcribed verbatim. Data were analyzed using conventional content analysis. Results 18 patients were interviewed (median age 64, range 32-83 years). Three major themes were identified: diagnosis and initial treatment, SDM and perception of treatment. Education, knowledge, coping and attitude towards healthcare suffused the major themes. The impact of VTE on daily life varied between individuals, as did the preferred extent of SDM. Overall, patients who felt involved and informed were more satisfied with received care, more aware of risks and benefits of treatment and more likely to be treatment adherent. Generally, patients were more concerned with risk of recurrent VTE than risk of bleeding during anticoagulation. We identified a multitude of aspects important to patients when deciding to stop or continue anticoagulation. Conclusion Sufficient information and an individualized extent of SDM are of crucial importance for patients when deciding on treatment duration after unprovoked VTE.

Use of patient-reported outcomes in outpatient settings as a means of patient involvement and self-management support – a qualitative study of the patient perspective

2016 ◽  
Vol 4 (2) ◽  
pp. 359 ◽  
Author(s):  
Caroline Trillingsgaard ◽  
Berit Kjærside Nielsen ◽  
Niels Henrik Hjøllund ◽  
Kirsten Lomborg
Keyword(s):  
Clinical Practice ◽  
Outpatient Clinic ◽  
Patient Reported Outcomes ◽  
Patient Involvement ◽  
Disease Patient ◽  
Psychosocial Problems ◽  
Well Being ◽  
University Hospital ◽  
Self Management ◽  
Patient Reported

Rationale, aims and objectives Patient-reported outcomes (PRO) is being implemented in clinical practice across different healthcare settings with various purposes. Involving the patients in reporting outcomes may increase their attention to symptoms and thereby support their self-management. The aim of the present study was to describe patients’ experiences with a web-based PRO system where patients fill in a PRO questionnaire at home or in the outpatient clinic prior to a consultation. Moreover, the study aimed to explore how PRO influenced the interaction between patients and clinicians during the consultation.Methods Through participant observations of nine consultations and 12 semi-structured interviews with patients after the consultation this interpretive description study explored patients’ experiences with the PRO system. The PRO included self-assessment on health-related quality of life, symptoms, and well-being. Patients who visited the outpatient clinic at Department of Renal Medicine at Aarhus University Hospital in the Central Denmark Region in February and March 2014 and in March and August 2015 were invited to participate. We used a convenience sampling approach to recruit patients who had completed at least two PRO questionnaires.Results The analysis revealed rudiments of PRO in clinical practice leading to an increased understanding of their chronic disease, patient-centred communication and an additional focus on psychosocial problems. However, the very application of PRO in the outpatient clinic and the patient attitudes were substantial and crucial barriers for PRO as a method to achieve patient involvement and self-management.Conclusion The use of PRO in outpatient consultations may support patients' self-management by a) impelling patient-centred communication in the consultation, b) legitimising talk about psychosocial problems, and c) increasing the patients' understanding of their disease. Yet, applying PRO into clinical practice does not automatically involve the patients and support their self-management. We suggest supplementary clinical initiatives to strengthen the patient involving benefits of PRO.

scholarly journals How does a new patient education programme for renal recipients become situated and adapted when implemented in the daily teaching practice in a university hospital? An ethnographic observation study

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e023005 ◽  
Author(s):  
Ida Lillehagen ◽  
Marit Helen Andersen ◽  
Kristin Hjorthaug Urstad ◽  
Astrid Wahl ◽  
Eivind Engebretsen
Keyword(s):  
Patient Education ◽  
Patient Involvement ◽  
Teaching Practice ◽  
Education Programme ◽  
University Hospital ◽  
Observation Study ◽  
Knowledge Based ◽  
Ethnographic Observation ◽  
The Individual ◽  
Patient Education Programme

ObjectiveTo understand how a new patient education programme for renal recipients becomes situated and adapted when implemented in daily hospital teaching practice. The analysis focuses in particular on how principles of individual tailoring and patient involvement are adapted.DesignEthnographic observation study. 19 teaching sessions were observed, resulting in 35 pages of data written observation notes.SettingA Norwegian University hospital. The study included the transplantation (TX) post, the medical post and the outpatient clinic.Participants10 newly transplanted patients receiving the education programme, and 13 nurses trained in the new programme participated in the study.ResultsWe observed that the nurses attempted to implement the programme’s core principles of individual tailoring and patient involvement as intended, but that patients found it difficult to formulate their knowledge needs and interest. Patients and nurses developed an approach to individual tailoring and patient involvement, which used knowledge about the patients’ life and experiences as basis for translating generalised knowledge into knowledge that is individualised and meaningful for the patient. The individual tailoring was however also limited, as the nurses balanced between responsibilities for the programme’s principles of individual adaption and patient involvement at the one hand, and responsibilities of safety and economy from a health systems perspective on the other hand.ConclusionIndividual tailoring is observed to be a comprehensive practice which includes verbal, practical and emotional involvement with the patient’s life world. This extends the notion and practice of individual tailoring as selecting among predefined, generalised knowledge based on an initial mapping of the patients’ knowledge. While the adaptions to individual tailoring could have been seen as inaccurate implementation, in-depth analyses discloses that the extended approach to individual tailoring is in fact what retains the programme’s core principles in the implementation context.

scholarly journals Lessons learned on the experienced facilitators and barriers of implementing a tailored VBHC model in a Dutch university hospital from a perspective of physicians and nurses

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e051764
Author(s):  
Dane Lansdaal ◽  
Femke van Nassau ◽  
Marije van der Steen ◽  
Martine de Bruijne ◽  
Marian Smeulers
Keyword(s):  
Patient Involvement ◽  
Implementation Process ◽  
Lessons Learned ◽  
University Hospital ◽  
Care Process ◽  
External Information ◽  
Health Records ◽  
Facilitators And Barriers ◽  
Implementation Methodology ◽  
Insight Into

ObjectiveThis study aims to obtain insight into experienced facilitators and barriers of implementing a tailored value-based healthcare (VBHC) model in a Dutch university hospital from a perspective of physicians and nurses.MethodA descriptive qualitative study with 12 physicians, nurses and managers of seven different care pathways who were involved in the implementation of a tailored VBHC methodology was conducted. Thematic content analysis was used to analyse the data guided by all factors of the Consolidated Framework for Implementation Research (CFIR).FindingsThe method designed for the implementation of a tailored VBHC methodology was appointed as a structured guide for the process. Throughout the implementation process, leadership and team dynamics were considered as important for the implementation to succeed. Also, sharing experiences with other value teams and the cooperation with external Information Technology (IT) teams in the hospital was mentioned as desirable. The involvement of patients, that is part of the VBHC methodology, was considered useful in the decision-making and improvement of the care process because it gave better insights in topics that are important for patients. The time-consuming nature of the implementation process was named as barrier to the VBHC methodology. On top of that, the shaping of the involvement of patients and the ongoing changes in departments were established as difficult. Finally, working with the Electronic Health Records and acquiring the necessary digital skills were considered to be often forgotten and, thus, hindering implementation.ConclusionClinical Healthcare organisations implementing a tailored VBHC methodology will benefit from the use of a structured implementation methodology, a well-led strong team and cooperation with (external) teams and patients. However, shaping patient involvement, alignment with other departments and attention to digitisation were seen as a most important concerns in implementation and require further attention.

scholarly journals Public and patient involvement in health data governance (DATAGov): protocol of a people-centred, mixed-methods study on data use and sharing for rare diseases care and research

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044289
Author(s):  
Cláudia de Freitas ◽  
Mariana Amorim ◽  
Helena Machado ◽  
Elisa Leão Teles ◽  
Maria João Baptista ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Rare Diseases ◽  
Patient Involvement ◽  
Healthcare Services ◽  
Health Data ◽  
Mixed Methods Study ◽  
University Hospital ◽  
Data Governance ◽  
The Public ◽  
Public And Patient Involvement

IntroductionInternational policy imperatives for the public and patient involvement in the governance of health data coexist with conflicting cross-border policies on data sharing. This can challenge the planning and implementation of participatory data governance in healthcare services locally. Engaging with local stakeholders and understanding how their needs, values and preferences for governing health data can be articulated with policies made at the supranational level is crucial. This paper describes a protocol for a project that aims to coproduce a people-centred model for involving patients and the public in decision-making processes about the use and sharing of health data for rare diseases care and research.Methods and analysisThis multidisciplinary project draws on an explanatory sequential mixed-methods study. A hospital-based survey with patients, informal carers, health professionals and technical staff recruited at two reference centres for rare diseases in Portugal will be conducted first. The qualitative study will follow consisting of semi-structured interviews and scenario-based workshops with a subsample of the participant groups recruited at baseline. Quantitative data will be analysed using descriptive and inferential statistics. Inductive and deductive approaches will be combined to analyse the qualitative interviews. Data from scenario-based workshops will be iteratively compared using the constant comparison method to identify cross-cutting themes and categories.Ethics and disseminationThe Ethics Committee for Health from the University Hospital Centre São João/Faculty of Medicine of University of Porto approved the study protocol (Ref. 99/19). Research findings will be disseminated at academic conferences and science promotion events, and through public meetings involving patient representatives, practitioners, policy-makers and students, a project website and peer-reviewed journal publications.

An Ultrastructural Study of the Proliferation Patterns of the Reserve Cells of the Human Cervix Uteri

1972 ◽  
Vol 30 ◽  
pp. 80-81
Author(s):  
Takanori Sohda ◽  
Hiroshi Saito ◽  
Goro Asano ◽  
Katsunari Fukushi ◽  
Katsuya Suzuki ◽  
...  
Keyword(s):  
Ultrastructural Study ◽  
Age Groups ◽  
Point Of View ◽  
University Hospital ◽  
Cervix Uteri ◽  
Morphological Aspect ◽  
Functional Aspect ◽  
Pathological Conditions ◽  
Human Cervix ◽  
Morphological Patterns

Recently, the functional aspect as well as morphological aspect of the reserve cells in the cervix uteri drew much attention in view of the carcinogenesis in squamocolumunar junction. In this communication, the authors elucidate the ultrastructural features of the reserve cells in patients of various age groups visiting our university hospital and affiliated hospital.From conventional light microscopic point of view, the reserve cells tend to be pronounced in various pathological conditions, such as the persisting inflammation, proliferative disorders and irritation of hormones. The morphological patterns of the reserve cells from various stage and degree of irritation were observed.

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