scholarly journals Incident investigations by the regulatory authority of Swedish healthcare – a 20-year perspective

2015 ◽  
Vol 4 (6) ◽  
pp. 68 ◽  
Author(s):  
Jonas Wrigstad ◽  
Johan Bergström ◽  
Pelle Gustafson
Keyword(s):  
Healthcare System ◽  
Regulatory Authority ◽  
Qualitative Interviews ◽  
Healthcare Providers ◽  
University Hospital ◽  
Office Work ◽  
Structured Interviews ◽  
Incident Investigation ◽  
Micro Level

Objective: The purpose of this study was to describe procedural changes in hospital incident investigations and show the consequences of these changes over time.Methods: A two-stage method was used. First component of the study was a content analysis of 87 incident investigation sconducted 1995-2014 by the regulatory authority after adverse events in a Swedish university hospital. Second component was conducting semi-structured interviews with 11 investigators from all regulatory authority regional offices in Sweden.Results: In a minority of incident investigations, where further demands for action were required by the regulatory authority, a major portion of these were aimed at the micro-level. A plan for follow-up was expressed in only one tenth of the investigations. All investigators had a background from the healthcare system and saw this as advantageous. Their personal memory was claimed to be the only tool when referring to previous cases. Less fieldwork, more office work and more uniformity of language were recognised changes in comparison over time. The role of doing “auditing” was the most common description by the investigators themselves.Conclusions: The micro-level focus of the investigations reflected an organisational structure within the regulatory authority. We saw signs of parallel system weaknesses within the Swedish healthcare system with a clear absence of formalised organisational memory and a malfunctioning follow-up system of incident investigations. This can be seen both regarding the healthcare providers and the regulatory authority. The reports from the qualitative interviews data indicated that “auditing at the office” was considered the main occupation in incident investigations conducted by the regulatory authority.

Space for intuition – the ‘Surprise’-Question in haemato-oncology: Qualitative analysis of experiences and perceptions of haemato-oncologists

2019 ◽  
Vol 33 (5) ◽  
pp. 531-540 ◽  
Author(s):  
Christina Gerlach ◽  
Swantje Goebel ◽  
Sascha Weber ◽  
Martin Weber ◽  
Katherine E Sleeman
Keyword(s):  
Palliative Care ◽  
Communication Skills ◽  
Outpatient Clinic ◽  
Qualitative Interviews ◽  
Daily Practice ◽  
University Hospital ◽  
Structured Interviews ◽  
Early Integration ◽  
Willingness To Use ◽  
Surprise Question

Background: Early integration of palliative care can improve outcomes for people with cancer and non-cancer diagnoses. However, prediction of survival for individuals is challenging, in particular in patients with haematological malignancies who are known to have limited access to palliative care. The ‘Surprise’-Question can be used to facilitate referral to palliative care. Aim: To explore experiences, views and perceptions of haemato-oncologists on the use of the ‘Surprise’-Question in the haemato-oncology outpatients clinics of a university hospital in Germany. Design: A qualitative study using individual semi-structured interviews transcribed verbatim and analysed thematically based on the framework approach. Setting/participants: The study took place at the haemato-oncology outpatient clinic and the bone marrow transplantation outpatient clinic of a university hospital. Nine haemato-oncologists participated in qualitative interviews. Results: Thematic analysis identified 4 themes and 11 subthemes: (1) meaning and relevance of the ‘Surprise’-Question; (2) feasibility; (3) the concept of ‘surprise’ and (4) personal aspects of prognostication. A key function of the ‘Surprise’-Question was to stimulate intuition and promote patient-centred goals of care by initiating a process of pause → reflection → change of perspective. It was easy and quick to use, but required time and communication skills to act on. Participants’ training in palliative care enhanced their willingness to use the ‘Surprise’-Question. Conclusion: Irrespective of its use in prognostication, the ‘Surprise’-Question is a valuable tool to facilitate consideration of patient-centred goals and promote holistic care in haemato-oncology. However, prognostic uncertainty, lack of time and communication skills are barriers for integration into daily practice. Further research should involve haematology patients to integrate their needs and preferences.

scholarly journals Paradox of life among survivors of bladder cancer and treatments

2016 ◽  
Vol 50 (2) ◽  
pp. 224-231 ◽  
Author(s):  
Miriam Lopes ◽  
Lucila Castanheira Nascimento ◽  
Márcia Maria Fontão Zago
Keyword(s):  
Bladder Cancer ◽  
Methodological Approach ◽  
University Hospital ◽  
Social Dimensions ◽  
Structured Interviews ◽  
Hospital Data ◽  
Narrative Methodology ◽  
Journal Entries ◽  
Inductive Thematic Analysis

Abstract OBJECTIVE: To interpret the meanings attributed to the experience of bladder cancer among survivors in therapeutic follow-up. METHOD: Qualitative methodological approach, based on medical anthropology and narrative methodology. After approval by the research ethics committee of a public university hospital, data were collected from January 2014 to February 2015, by means of recorded semi-structured interviews, direct observation and field journal entries on daily immersion with a group of six men and six women, aged between 57 and 82 years, in therapeutic follow-up. Narratives were analyzed by means of inductive thematic analysis. RESULTS: The meanings revealed difficulties with the processes of disease and treatment, such as breakdown of normal life, uncertainty about the future due to possible recurrence of the disease, difficulty with continuity of care and emotional control, relating it to conflicting ways of understanding the present life. Thus, the meaning of this narrative synthesis is paradox. CONCLUSION: Interpretation of the meaning of experience with bladder cancer among patients provides nurses with a comprehensive view of care, which encompasses biological, psychological and social dimensions, and thereby systematizes humanized care.

scholarly journals Living with heritable retinoblastoma and the perceived role of regular follow-up at a retinoblastoma survivorship clinic: ‘That is exactly what I have been missing’

2021 ◽  
Vol 6 (1) ◽  
pp. e000760
Author(s):  
Pernille Axel Gregersen ◽  
Mikkel Funding ◽  
Jan Alsner ◽  
Maja H Olsen ◽  
Jens Overgaard ◽  
...  
Keyword(s):  
Cancer Risk ◽  
Healthcare System ◽  
Social Life ◽  
Daily Living ◽  
Psychosocial Support ◽  
Adult Survivors ◽  
University Hospital ◽  
Normal Life

ObjectiveTo explore living with heritable retinoblastoma, specifically survivors’ perceived role of regular follow-up at a retinoblastoma survivorship clinic.Methods and analysisAdult survivors of heritable retinoblastoma were recruited from the Retinoblastoma Survivorship Clinic, Aarhus University Hospital. Ten survivors participated in individual explorative, semistructured interviews. Thematic data analysis was conducted.ResultsFive key themes relating to vision, social life, family, second cancer risk and the healthcare system were identified. Subthemes relating to the Retinoblastoma Survivorship Clinic included the retinoblastoma coordinator, cancer risk, psychosocial support and genetic knowledge. The retinoblastoma-related physical and psychosocial issues influenced survivors’ everyday living; however, the opportunity to live a normal life varied considerably, with the majority experiencing no major limitations. The need for specialised management and a coordinator was emphasised to be the main value of the Retinoblastoma Survivorship Clinic.ConclusionDespite reporting an overall normal life and no major limitations in daily living activities, our data confirm that heritable retinoblastoma impacts several aspects of daily living. Uniquely, this study demonstrates that the main value of the Retinoblastoma Survivorship Clinic was a specialised contact person and coordinator in the healthcare system, providing continuous and necessary management and guidance after retinoblastoma treatment, and for all aspects of health related to heritable retinoblastoma. The needs of heritable retinoblastoma survivors are complex and extensive, and the specific role of the healthcare system to support survivorship should be prioritised, specialised and multidisciplinary.

scholarly journals Lived Experiences of Palestinian Patients With COVID-19: A Multi-center Phenomenological Study of Recovery Journey

2021 ◽  
Author(s):  
Aidah Alkaissi ◽  
Fadi AlZiben ◽  
Mohammad Abu Rajab ◽  
Mahdia Alkony
Keyword(s):  
Mental Health ◽  
Lived Experiences ◽  
Phenomenological Study ◽  
Qualitative Interviews ◽  
Healthcare Providers ◽  
Mental Healthcare ◽  
Sampling Technique ◽  
Care Plan ◽  
Structured Interviews ◽  
Study Participants

Abstract Background: Exploring lived experiences of recovered COVID-19 patients might have scientific, social, and policy relevance that apply to the healthcare infrastructure. This multi-center phenomenological study was conducted to explore lived experiences of Palestinian patients who recovered from COVID-19.  Methods: In this qualitative study, a phenomenological descriptive approach was used. A purposive sampling technique was employed to select the study participants. Semi-structured qualitative interviews were conducted with patients who recovered from COVID-19 (n = 20). The transcripts of the audio recorded interviews were analyzed by using Giorgio’s phenomenological analysis method. Results: Semi-structured interviews were conducted with 14 male and 6 female participants. The age of the participants ranged from 25-50 years. Nine themes and multiple subthemes emerged from the qualitative data. The themes were relevant to patient’s feelings about the experience, mental issues, social discriminations/stigma, symptoms, life in isolation, using supportive treatment, personal preventive measures, social support, and life after recovery.Conclusion: Survivors who were interviewed in this study recounted devastating experiences with regard to their mental health, social stigmatization, feeling guilt, shame, and hesitant to regain contact with others. Mental health issues should be addressed as a part of the care plan for patients with COVID-19. More studies are still needed to investigate if introducing mental healthcare providers to the care team of patients with COVID-19 can improve the experiences of the patients.

Exploring the Barriers Related to the Healthcare System and Healthcare Professionals in Implementing Quality Intravenous Chemotherapy: A Qualitative Study

2021 ◽  
Author(s):  
shahin salarvand ◽  
Masoumeh Sadat Mousavi ◽  
Mohammad Almasian
Keyword(s):  
Cancer Patients ◽  
Family Caregivers ◽  
Healthcare System ◽  
Healthcare Professionals ◽  
Qualitative Content Analysis ◽  
Healthcare Providers ◽  
Routine Care ◽  
Structured Interviews ◽  
Intravenous Chemotherapy ◽  
Individualized Care

Abstract Purpose: This study aimed to explore barriers related to the healthcare system (HCS) and healthcare providers (HCPs) in implementing quality intravenous (IV) chemotherapy (CT) from the perspectives of cancer patients, family caregivers, and healthcare professionals.Methods: Using an explanatory descriptive qualitative method, this study was conducted in 2019. Forty-one participants (6 patients, 5 family caregivers, 12 oncologists, and 18 nurses) were selected through purposive sampling. In-depth semi-structured interviews were conducted to collect the data, which were analyzed using qualitative content analysis. Lincoln and Guba’s criteria of rigor were employed to ensure the trustworthiness of the study.Results: Data analysis showed two categories, each with three subcategories: Barriers related to HCPs that contains “educational and communication barriers”, “failure to establish trust” and “unskilled healthcare professionals”; Barriers related to the HCS, which consists of “inadequate physical and care infrastructures to provide services”, “lack of support in the disease trajectory from diagnosis to rehabilitation” and “mismanagement of CT wards/procedures”.Conclusion: The identification and removal of the barriers related to HCPs and HCS from routine care are crucial. Education of and communication with cancer patients and their family caregivers are two important pillars in the quality of intravenous chemotherapy (IV CT) and this education and communication should be based on individualized care and tailored to the unique needs of each patient.

Attending school after treatment for a brain tumor: Experiences of children and key figures

2017 ◽  
Vol 24 (10) ◽  
pp. 1436-1447 ◽  
Author(s):  
Stephanie Vanclooster ◽  
Johan Bilsen ◽  
Lieve Peremans ◽  
Jutte Van der Werff Ten Bosch ◽  
Geneviève Laureys ◽  
...  
Keyword(s):  
Brain Tumor ◽  
School Performance ◽  
Personal Development ◽  
Healthcare Providers ◽  
Well Being ◽  
Adverse Outcomes ◽  
Return To School ◽  
Structured Interviews ◽  
Close Collaboration

Reintegration into school is a milestone for childhood brain tumor survivors, as well as for their parents, teachers, and healthcare providers. We explored their experiences following the school re-entry by conducting semi-structured interviews. Thematic analysis resulted in four main themes: “school performance,” “psychosocial well-being,” “support and approach,” and “communication and collaboration.” Children were pleased to return to school despite confrontation with adverse outcomes. Parents, teachers, and healthcare providers identified current and future concerns and challenges, as well as opportunities for academic and personal development. Their experiences highlight the importance of coordinated and systematic follow-up in close collaboration with healthcare providers.

scholarly journals Fraud and Abuse in the Saudi Healthcare System: A Triangulation Analysis

2020 ◽  
Vol 57 ◽  
pp. 004695802095462
Author(s):  
Wadi B. Alonazi
Keyword(s):  
Health Insurance ◽  
Healthcare System ◽  
Insurance Industry ◽  
Rejection Rate ◽  
Healthcare Services ◽  
Macro Level ◽  
Insurance Companies ◽  
Structured Interviews ◽  
Health Insurance Companies ◽  
Micro Level

In the insurance industry, the majority of fraud and abuse cases fall into a limited number of patterns, yet false claims normally lead to negative national, local, and organizational effects. Through monitoring the exploitative and abusive behavior commonly found in healthcare services, this paper aims to analyze initiatives implemented by governmental and related healthcare insurance agencies in Saudi Arabia to reduce moral offenses. To accomplish this objective, major governmental health insurance policy documents were analyzed at the macro-level. At the meso-level, semi-structured interviews were conducted with five health insurance professionals on measures undertaken to prevent such incidents. At the micro-level, the critical factors of fraudulent behaviors were analyzed using a retrospective analysis. Data were retrieved from anti-fraud records of ten leading health insurance companies and the focus was mainly on individuals involved in unethical practices between 2014 and 2019. After a full audit was completed, the results concluded that the Saudi healthcare system is composed of twenty-six cooperative health insurance agencies and over 5,202 health services providers. The official documents contain the details of various moral hazard measures. On annual average, more than 196 fraudulent cases were reported with a claim rejection rate of approximately 15%. The majority of fraud cases were reported in dental services with invalid card usage, followed by obstetrics-gynecology services (47 and 113 cases, respectively). Females tended to make up most deceit cases in obstetrics-gynecology with a high level of abuse (95% confidence interval: −83.398 to −24.202; P < .003 and −28 > 638 to −7.362; P < .005, respectively). This study ultimately identifies basic measures employed at the macro-level to reduce moral hazards. However, such measures are not intended to be coherently implemented at the micro-level, especially by health insurance companies and healthcare providers.

scholarly journals Cardiac donation after circulatory determination of death: protocol for a mixed-methods study of healthcare provider and public perceptions in Canada

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e033932
Author(s):  
Kimia Honarmand ◽  
Ian Ball ◽  
Matthew Weiss ◽  
Marat Slessarev ◽  
Robert Sibbald ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Healthcare Providers ◽  
Determination Of Death ◽  
Transplant Recipients ◽  
Structured Interviews ◽  
The Public ◽  
Number Of Patients ◽  
End Stage

IntroductionCardiac transplantation remains the best treatment for patients with end-stage heart disease that is refractory to medical or device therapies, however, a major challenge for heart transplantation is the persistent discrepancy between the number of patients on waiting lists and the number of available hearts. While other countries (eg, UK, Australia and Belgium) have explored and implemented alternative models of transplantation, such as cardiac donation after circulatory determination of death (DCDD) to alleviate transplantation wait times, ethical concerns have hindered implementation in some countries. This study aims to explore the attitudes and opinions of healthcare providers and the public about cardiac DCDD in order to identify and describe opportunities and challenges in ensuring that proposed cardiac DCDD procedures in Canada are consistent with Canadian values and ethical norms.Methods and analysisThis study will include two parts that will be conducted concurrently. Part 1 is a qualitative study consisting of semi-structured interviews with Canadian healthcare providers who routinely care for organ donors and/or transplant recipients to describe their perceptions about cardiac DCDD. Part 2 is a convergent parallel mixed-methods design consisting of a series of focus groups and follow-up surveys with members of the Canadian general public to describe their perceptions about cardiac DCDD.Ethics and disseminationThis study has been approved by the Research Ethics Board at Western University. The findings will be presented at regional and national conferences and reported in peer-reviewed publications.

scholarly journals Involving Patients with Multimorbidity in Service Planning: Perspectives on Continuity and Care Coordination

2016 ◽  
Vol 6 (2) ◽  
pp. 95-102 ◽  
Author(s):  
Michaela L. Schiøtz ◽  
Dorte Høst ◽  
Anne Frølich
Keyword(s):  
Care Coordination ◽  
Patient Preferences ◽  
Planning Process ◽  
Care Delivery ◽  
Healthcare Providers ◽  
Development Project ◽  
Service Planning ◽  
University Hospital ◽  
Structured Interviews ◽  
Care Coordinator

Background The prevalence of multiple comorbid chronic conditions, or multimorbidity, is increasing. Care provided to people with multimorbidity is often fragmented, incomplete, inefficient, and ineffective. As part of a research and development project focusing on improving care, we sought to involve patients with multimorbidity in the planning process. Objective To identify opportunities for improving care by understanding how patients from a Danish University Hospital experience care coordination. Design Qualitative semi-structured interviews with 14 patients with multimorbidity. Results Patients with multimorbidity described important concerns about care that included: (1) disease-centered, rather than patient-centered, care; (2) lack of attention to comorbidities and patient preferences and needs; and (3) involvement of numerous healthcare providers with limited care coordination. Poor continuity of care resulted in lack of treatment for complex problems, such as pain and mental health issues, medication errors, adverse events, and a feeling of being lost in the system. Receiving care from generalists (e.g. general practitioners and healthcare professionals at prevention centers) and having a care coordinator seemed to improve patients’ experience of continuity and coordination of care. Suggestions for service improvements when providing care for people with multimorbidity included using care coordinators, longer consultation times, consultations specifically addressing follow-up on prescribed medications, and shifting the focus of care from disease states to patients’ overall health status. Conclusions A need exists for a reorganization of care delivery for people with multimorbidity that focuses on improved care coordination and puts patient preferences at the center of care.

scholarly journals Knowledge, Attitudes, Perception and Reported Practices of Healthcare Providers on Antibiotic Use and Resistance in Pregnancy, Childbirth and Children under Two in Lao PDR: A Mixed Methods Study

Antibiotics ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1462
Author(s):  
Vanphanom Sychareun ◽  
Amphoy Sihavong ◽  
Anna Machowska ◽  
Xanded Onthongdee ◽  
Kongmany Chaleunvong ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Qualitative Interviews ◽  
Healthcare Providers ◽  
Lao Pdr ◽  
Antibiotic Use ◽  
Mixed Methods Study ◽  
Medical Doctors ◽  
Structured Interviews ◽  
Urban District ◽  
Drug Sellers

Background: Overuse and misuse of antibiotics contribute unnecessarily to antibiotic resistance (ABR), and are thereby global health threats. Inappropriate prescriptions of antibiotics during pregnancy, delivery and early childhood are widespread across the world. This study aimed to assess knowledge, attitudes, and reported practices of healthcare providers (HCPs) and to explore their perceptions regarding antibiotic use and ABR related to pregnancy, childbirth, and children under two in Lao PDR. Methods: This is a mixed methods study with data collection in 2019 via structured interviews among 217 HCPs (medical doctors/assistant doctors, midwives/nurses, pharmacists/assistant pharmacists and drug sellers), who prescribed/dispensed antibiotics in one rural and one urban district in Vientiane province and individual qualitative interviews with 30 HCPs and stakeholders. Results: Of the HCPs, 36% had below average knowledge regarding antibiotic use and ABR, and 67% reported prescribing antibiotics for uncomplicated vaginal delivery. Half of the HCPs did not believe that their prescribing contributed to ABR, and only 9% had participated in antibiotic education. Conclusion: A substantial number of HCPs had suboptimal knowledge and prescribed antibiotics unnecessarily, thereby contributing to ABR. Continuous education and regular supervision of HCPs is recommended to improve the use of antibiotics related to pregnancy, childbirth, and young children.

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