scholarly journals Two visions of clinical integration: perspectives from health system leaders

2014 ◽  
Vol 4 (1) ◽  
pp. 36 ◽  
Author(s):  
Wenke Hwang ◽  
Joseph Andrie ◽  
Michelle LaClair ◽  
Harold Paz
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Systems ◽  
Health Care Professionals ◽  
Success Factors ◽  
Leadership Roles ◽  
Health Care Environment ◽  
Clinical Integration ◽  
System Leaders ◽  
Patient Centric

Objective: Clinical Integration has been implicated as the key to achieving higher quality of care at a lower cost. However,ambiguity regarding the meaning of clinical integration poses challenges as health care professionals strive to adapt to the rapidlyevolving health care environment. This study aims to solicit insights from health system executives about what it means to beclinically integrated.Methods: The authors interviewed 13 health system executives from 11 different institutions in Pennsylvania ranging fromsmall community hospitals to large academic medical centers.Results: Two major viewpoints of clinical integration were identified from the interviews: patient-centric, which emphasized theimportance of the patient’s experience and strengthening patient involvement in their own healthcare, and provider-centric, whichfocused on leadership roles, organizational structure, and physician alignment. Participants with provider-centric viewpointswere associated with larger medical centers and were more likely to describe their health systems as highly clinically integrated.Conversely, patient-centric perspectives were affiliated with smaller health systems/hospitals and were more likely to describetheir health systems as less integrated. Participants also identified five key success factors of clinical integration: physicianalignment, shared data and analytics, culture, patient engagement, and an emphasis on primary care.Conclusions: Despite the central role of clinical integration in emerging health systems, there is not a shared understanding ofits definition. A better understanding of the varied perspectives regarding clinical integration can help current and future healthcare professionals to better communicate with one another about clinical integration and the practical steps necessary to achieveit.

Improving Communication Skills in Health Care

2013 ◽  
Vol 20 (3) ◽  
pp. 109-117
Author(s):  
Lynda Katz Wilner ◽  
Marjorie Feinstein-Whittaker
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Communication Skills ◽  
Health Care Professionals ◽  
Skills Training ◽  
International Medical Graduate ◽  
Medical Graduate ◽  
Health Care Environment ◽  
Medical Interpreters ◽  
Accent Modification

Hospital reimbursements are linked to patient satisfaction surveys, which are directly related to interpersonal communication between provider and patient. In today’s health care environment, interactions are challenged by diversity — Limited English proficient (LEP) patients, medical interpreters, International Medical Graduate (IMG) physicians, nurses, and support staff. Accent modification training for health care professionals can improve patient satisfaction and reduce adverse events. Surveys were conducted with medical interpreters and trainers of medical interpreting programs to determine the existence and support for communication skills training, particularly accent modification, for interpreters and non-native English speaking medical professionals. Results of preliminary surveys suggest the need for these comprehensive services. 60.8% believed a heavy accent, poor diction, or a different dialect contributed to medical errors or miscommunication by a moderate to significant degree. Communication programs should also include cultural competency training to optimize patient care outcomes. Examples of strategies for training are included.

scholarly journals How Public Trust in Health Care Can Shape Patient Overconsumption in Health Systems? The Missing Links

2021 ◽  
Vol 18 (8) ◽  
pp. 3860
Author(s):  
Katarzyna Krot ◽  
Iga Rudawska
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Health System ◽  
Health Systems ◽  
Quantitative Research ◽  
Public Trust ◽  
Complex Problem ◽  
Health Care Consumption ◽  
Mediating Role ◽  
Countries In Transition

Overconsumption of health care is an ever-present and complex problem in health systems. It is especially significant in countries in transition that assign relatively small budgets to health care. In these circumstances, trust in the health system and its institutions is of utmost importance. Many researchers have studied interpersonal trust. Relatively less attention, however, has been paid to public trust in health systems and its impact on overconsumption. Therefore, this paper seeks to identify and examine the link between public trust and the moral hazard experienced by the patient with regard to health care consumption. Moreover, it explores the mediating role of patient satisfaction and patient non-adherence. For these purposes, quantitative research was conducted based on a representative sample of patients in Poland. Interesting findings were made on the issues examined. Patients were shown not to overconsume health care if they trusted the system and were satisfied with their doctor-patient relationship. On the other hand, nonadherence to medical recommendations was shown to increase overuse of medical services. The present study contributes to the existing knowledge by identifying phenomena on the macro (public trust in health care) and micro (patient satisfaction and non-adherence) scales that modify patient behavior with regard to health care consumption. Our results also provide valuable knowledge for health system policymakers. They can be of benefit in developing communication plans at different levels of local government.

scholarly journals Health care network for chronic conditions: an intervention and evaluation in the health system

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C S Cardoso ◽  
N R Baldoni ◽  
C F Melo ◽  
L O Rezende ◽  
K Noronha ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Care Professionals ◽  
Chronic Conditions ◽  
Panel Study ◽  
Health Indicators ◽  
Institutional Capacity ◽  
Local Health ◽  
Care Network ◽  
Health Care Network

Abstract Background Health assessments are necessary for the (re) formulation of effective public policies and to guarantee the quality of care offered. This study aim to evaluate the perception of health professionals concerning the institutional capacity of the health system to care for Chronic Conditions (CC) after intervention in a medium-sized municipality in Minas Gerais, Brazil. Methods It is a panel study with evaluation before, during and after an intervention in the health system with a focus on three CC, i.e., i) diabetes; ii) hypertension; and iii) pregnant women. Health care professionals from primary and specialized care units were interviewed using the Assessment of Chronic Illness Care (ACIC) scale, which was applied in nine focal groups organized by health care unit. Results A total of 240 professionals participated of this evaluation, being 94, 63 and 82 participants in 2013, 2015 and 2018 respectively. The ACIC scores showed an positive evolution in the capacity of the health system to care for CC over the years. In the first wave the global score was 5.40 (basic capacity), while in the third wave the score was 9.38 (optimal capacity), with a significant increase in the scores (p < 0.01). Conclusions An important gain in the institutional capacity of the municipality was evidenced for the care of chronic conditions after intervention in the health system. Such an enhancement of the health system to operate in the CC might be sustainable over the time. Furthermore, its impact may directly reflect on the health indicators of the population. Key messages The results showed a strengthening of the local health system. These findings can subsidize other municipalities with a similar reality in the organization of the health care network and, consequently improve the care provided to chronic conditions.

The regulation of health care in Scandinavia: professionals, the public interest and trust

2018 ◽  
pp. 61-76
Author(s):  
Karsten Vrangbæk
Keyword(s):  
Health Care ◽  
Public Policy ◽  
Health Insurance ◽  
Health System ◽  
Health Systems ◽  
Public Interest ◽  
State Level ◽  
Professional Regulation ◽  
The Public ◽  
Voluntary Health Insurance

Scandinavian health systems have traditionally been portrayed as relatively similar examples of decentralised, public integrated health systems. However, recent decades have seen significant public policy developments in the region that should lead us to modify our understanding. Several dimensions are important for understanding such developments. First, several of the countries have undergone structural reforms creating larger governance units and strengthening the state level capacity to regulate professionals and steer developments at the regional and municipal levels. Secondly, the three Nordic countries studied experienced an increase in the purchase of voluntary health insurance and the use of private providers. This introduces several issues for the equality of users and the efficiency of the system. This paper will investigate such trends and address the question: Is the Nordic health system model changing, and what are the consequences for trust, professional regulation and the public interest?

scholarly journals Emerging challenges in the health systems of Kerala, India: qualitative analysis of literature reviews

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Manesh Muraleedharan ◽  
Alaka Omprakash Chandak
Keyword(s):  
Health Care ◽  
Health Economic ◽  
Health System ◽  
Health Systems ◽  
Significant Proportion ◽  
Vital Statistics ◽  
The State ◽  
Future Research ◽  
Health Seeking ◽  
Content Type

PurposeThe substantial increase in non-communicable diseases (NCDs) is considered a major threat to developing countries. According to various international organizations and researchers, Kerala is reputed to have the best health system in India. However, many economists and health-care experts have discussed the risks embedded in the asymmetrical developmental pattern of the state, considering its high health-care and human development index and low economic growth. This study, a scoping review, aims to explore four major health economic issues related to the Kerala health system.Design/methodology/approachA systematic review of the literature was performed using PRISMA to facilitate selection, sampling and analysis. Qualitative data were collected for thematic content analysis.FindingsChronic diseases in a significant proportion of the population, low compliance with emergency medical systems, high health-care costs and poor health insurance coverage were observed in the Kerala community.Research limitations/implicationsThe present study was undertaken to determine the scope for future research on Kerala's health system. Based on the study findings, a structured health economic survey is being conducted and is scheduled to be completed by 2021. In addition, the scope for future research on Kerala's health system includes: (1) research on pathways to address root causes of NCDs in the state, (2) determine socio-economic and health system factors that shape health-seeking behavior of the Kerala community, (3) evaluation of regional differences in health system performance within the state, (4) causes of high out-of-pocket expenditure within the state.Originality/valueGiven the internationally recognized standard of Kerala's vital statistics and health system, this review paper highlights some of the challenges encountered to elicit future research that contributes to the continuous development of health systems in Kerala.

scholarly journals Re-imagining Research: A Bold Call, but Bold Enough? Comment on "Experience of Health Leadership in Partnering with University-Based Researchers in Canada: A Call to ‘Re-Imagine’ Research"

2019 ◽  
Author(s):  
Bev J. Holmes
Keyword(s):  
Health System ◽  
Health Systems ◽  
Research Area ◽  
Evidence Use ◽  
Health System Change ◽  
Health Leadership ◽  
System Leaders ◽  
Change Projects ◽  
High Level ◽  
Partnership Models

Many articles over the last two decades have enumerated barriers to and facilitators for evidence use in health systems. Bowen et al’s article "Response to Experience of Health Leadership in Partnering with University-Based Researchers: A Call to ‘Re-imagine Research’" furthers the debate by focusing on an under-explored research area (health system design and health service organization) with an under-studied stakeholder group (health system leaders), by undertaking a broad program of research on partnerships, and, based on participant responses, by calling for re-imagining of research itself. In response to the claim that the research community is not providing expertise to this pressing issue in the health system, I provide four high level reasons: partnerships mean different things to different people, our language does not reflect the reality we want, our health systems have yet to fully embrace evidence use, and complexity is easier to talk about than act within. Bowen et al’s study, and their broader program of research, is well-placed to explore these issues further, helping identify appropriate researcher-health system leader partnership models for various health system change projects. Given the positive shifts identified in this study, and the knowledge that participants demonstrate about what needs to change, the time is right for bold action, re-imagining not only research, but healthcare, such that the production and use of evidence for better health is embraced and supported.

scholarly journals A MOOC to disseminate key concepts related to the future challenges of the French health system

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
C You ◽  
V Lissillour ◽  
A Lefébure
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health System ◽  
Health Care Professionals ◽  
Decision Makers ◽  
Teaching Staff ◽  
New Public Health ◽  
New Public ◽  
Wide Range ◽  
Public Health Challenges

Abstract Background The increase of life expectancy creates critical health needs that developed countries health systems have to deal with. They are also confronted to persistent health inequalities. A common vision of these issues may not be shared by the health care professionals, decision-makers and citizens. In the context of the launch of new public health laws in France, the French School of Public Health (EHESP) decided to offer a MOOC entitled “Public Health and Health System: transition and transformation” (2019). Objectives The MOOC intends to raise awareness and increase understanding of public health challenges. It is designed for a wide audience of professionals, decision-makers and citizens in the French speaking world. The content was designed by a multidisciplinary team of academics from the EHESP (N = 50) and a network of health professionals (N = 21). The 6 modules address major themes of the recent health policies, e.g. social and territorial inequalities in health, health care security, health pathways, innovation or health democracy. Results Over the course of 6 consecutive weeks, almost 7800 people have enrolled in this e-learning. They are provided with short teaching videos (109 capsules of 4-5’) and webinars, have access to a number of supplementary reading material and a variety of self-assessment. Active learning is enhanced via forum involving peers and teaching staff. The full course represents around 20 hours of teaching. So far, completion rate has attained 13% which compares well with usual rate for MOOCs. Participants include a wide range of professionals, students and citizens from 87 different countries (72% from France) and 50% had a master or higher degree. The overall satisfaction rate is 98%. Conclusions This MOOC attracted the attention of a wide and diverse audience regarding the major public health issues. Some public health agencies have expressed interest in implementing the MOOC into their professional development program of their staff. Key messages Health system reforms are constantly implemented to face new public health challenges. A multidisciplinary MOOC can help raise awareness and understanding of the issue being addressed by new policies.

scholarly journals Exploring health system readiness for adopting interventions to address intimate partner violence: a case study from the occupied Palestinian Territory

2019 ◽  
Vol 35 (3) ◽  
pp. 245-256 ◽  
Author(s):  
Manuela Colombini ◽  
Abdulsalam Alkaiyat ◽  
Amira Shaheen ◽  
Claudia Garcia Moreno ◽  
Gene Feder ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Systems ◽  
Partner Violence ◽  
Scale Up ◽  
Successful Implementation ◽  
Occupied Palestinian Territory ◽  
System Readiness ◽  
Palestinian Territory

Abstract Domestic violence (DV) against women is a widespread violation of human rights. Adoption of effective interventions to address DV by health systems may fail if there is no readiness among organizations, institutions, providers and communities. There is, however, a research gap in our understanding of health systems’ readiness to respond to DV. This article describes the use of a health system’s readiness assessment to identify system obstacles to enable successful implementation of a primary health-care (PHC) intervention to address DV in the occupied Palestinian Territory (oPT). This article describes a case study where qualitative methods were used, namely 23 interviews with PHC providers and key informants, one stakeholder meeting with 19 stakeholders, two health facility observations and a document review of legal and policy materials on DV in oPT. We present data on seven dimensions of health systems. Our findings highlight the partial readiness of health systems and services to adopt a new DV intervention. Gaps were identified in: governance (no DV legislation), financial resources (no public funding and limited staff and infrastructure) and information systems (no uniform system), co-ordination (disjointed referral network) and to some extent around the values system (tension between patriarchal views on DV and more gender equal norms). Additional service-level barriers included unclear leadership structure at district level, uncertain roles for front-line staff, limited staff protection and the lack of a private space for identification and counselling. Findings also pointed to concrete actions in each system dimension that were important for effective delivery. This is the first study to use an adapted framework to assess health system readiness (HSR) for implementing an intervention to address DV in low- and middle-income countries. More research is needed on HSR to inform effective implementation and scale up of health-care-based DV interventions.

scholarly journals Use of EHR-Based Pediatric Quality Measures: Views of Health System Leaders and Parents

2019 ◽  
Vol 35 (2) ◽  
pp. 177-185
Author(s):  
David M. Hartley ◽  
Susannah Jonas ◽  
Daniel Grossoehme ◽  
Amy Kelly ◽  
Cassandra Dodds ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Health System ◽  
Health Care Quality ◽  
Quality Measures ◽  
Care Quality ◽  
Quality Data ◽  
High Confidence ◽  
System Leaders ◽  
Using Data

Measures of health care quality are produced from a variety of data sources, but often, physicians do not believe these measures reflect the quality of provided care. The aim was to assess the value to health system leaders (HSLs) and parents of benchmarking on health care quality measures using data mined from the electronic health record (EHR). Using in-context interviews with HSLs and parents, the authors investigated what new decisions and actions benchmarking using data mined from the EHR may enable and how benchmarking information should be presented to be most informative. Results demonstrate that although parents may have little experience using data on health care quality for decision making, they affirmed its potential value. HSLs expressed the need for high-confidence, validated metrics. They also perceived barriers to achieving meaningful metrics but recognized that mining data directly from the EHR could overcome those barriers. Parents and HSLs need high-confidence health care quality data to support decision making.

scholarly journals The Experience of Providing Physical Therapy in a Changing Health Care Environment

2002 ◽  
Vol 82 (7) ◽  
pp. 648-657 ◽  
Author(s):  
Rosemary Blau ◽  
Sarah Bolus ◽  
Terrence Carolan ◽  
Daniel Kramer ◽  
Elizabeth Mahoney ◽  
...  
Keyword(s):  
Health Care ◽  
Work Environment ◽  
Health Care Professionals ◽  
Phenomenological Study ◽  
Physical Therapists ◽  
Medical Center ◽  
Systemic Change ◽  
Academic Medical Center ◽  
Health Care Environment ◽  
Care Environment

Abstract Background and Purpose. The changes in the health care environment during the last decade have had an impact on the roles and responsibilities of all health care professionals. The purpose of this phenomenological study was to describe the experience of staff physical therapists during a time of systemic change within a large urban academic medical center. Subjects and Methods. Participants were 5 physical therapists working in various clinical settings within the medical center. The participants were interviewed and asked the question “Over the past 4 years, there have been major changes in your work environment. What has it been like for you working as a clinician during this time of change?” Interviews were recorded, transcribed, and analyzed to find thematic patterns of responses. Results. Four common themes emerged in which participants described experiencing loss of control, stress, discontent, and disheartenment. A fifth theme showed that despite these negative feelings, participants were able to “find the silver lining” in their daily work lives (ie, they were able to find positive aspects of their professional lives despite the perceived unpleasant changes with which they had to cope). Discussion and Conclusion. This study provides insight into the experiences of a group of staff physical therapists during a time of systemic change in their work environment. Although the themes reflect largely unsettling and negative experiences, there seems to be an underlying ability to find affirmative aspects of work.

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