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Hexley P, Smith V, Wall S. Operational Changes in a Shared Resource Laboratory with the Use of a Product Lifecycle Management Approach: A Case Study. J Biomol Tech 2015; 27:18-24. [PMID: 26681929 DOI: 10.7171/jbt.16-2701-002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Shared Resource Laboratories (SRLs) provide investigators access to necessary scientific and resource expertise to leverage complex technologies fully for advancing high-quality biomedical research in a cost-effective manner. At the University of Nebraska Medical Center, the Flow Cytometry Research Facility (FCRF) offered access to exceptional technology, but the methods of operation were outdated and unsustainable. Whereas technology has advanced and the institute has expanded, the operations at the facility remained unchanged for 35 yr. To rectify this, at the end of 2013, we took a product lifecycle management approach to affect large operational changes and align the services offered with the SRL goal of education, as well as to provide service to researchers. These disruptive operational changes took over 10 mo to complete and allowed for independent end-user acquisition of flow cytometry data. The results have been monitored for the past 12 mo. The operational changes have had a positive impact on the quality of research, increased investigator-facility interaction, reduced stress of facility staff, and increased overall use of the resources. This product lifecycle management approach to facility operations allowed us to conceive of, design, implement, and monitor effectively the changes at the FCRF. This approach should be considered by SRL management when faced with the need for operationally disruptive measures.
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Affiliation(s)
- Philip Hexley
- Office of the Vice Chancellor for Research, University of Nebraska Medical Center, Omaha, Nebraska 68198-5816, USA
| | - Victoria Smith
- Office of the Vice Chancellor for Research, University of Nebraska Medical Center, Omaha, Nebraska 68198-5816, USA
| | - Samantha Wall
- Office of the Vice Chancellor for Research, University of Nebraska Medical Center, Omaha, Nebraska 68198-5816, USA
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252
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MacLure K, Stewart D. Self-Reported Digital Literacy of the Pharmacy Workforce in North East Scotland. Pharmacy (Basel) 2015; 3:182-196. [PMID: 28975912 PMCID: PMC5597103 DOI: 10.3390/pharmacy3040182] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 09/17/2015] [Accepted: 09/30/2015] [Indexed: 11/18/2022] Open
Abstract
In their day-to-day practice, pharmacists, graduate (pre-registration) pharmacists, pharmacy technicians, dispensing assistants and medicines counter assistants use widely available office, retail and management information systems alongside dedicated pharmacy management and electronic health (ehealth) applications. The ability of pharmacy staff to use these applications at home and at work, also known as digital literacy or digital competence or e-skills, depends on personal experience and related education and training. The aim of this research was to gain insight into the self-reported digital literacy of the pharmacy workforce in the North East of Scotland. A purposive case sample survey was conducted across NHS Grampian in the NE of Scotland. Data collection was based on five items: sex, age band, role, pharmacy experience plus a final question about self-reported digital literacy. The study was conducted between August 2012 and March 2013 in 17 community and two hospital pharmacies. With few exceptions, pharmacy staff perceived their own digital literacy to be at a basic level. Secondary outcome measures of role, age, gender and work experience were not found to be clear determinants of digital literacy. Pharmacy staff need to be more digitally literate to harness technologies in pharmacy practice more effectively and efficiently.
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Affiliation(s)
- Katie MacLure
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen AB10 7GJ, UK.
| | - Derek Stewart
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen AB10 7GJ, UK.
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253
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Rangachari P, Mehta R, Rethemeyer RK, Ferrang C, Dennis C, Redd V. Short or Long End of the Lever? Associations between Provider Communication of the "Asthma-Action Plan" and Outpatient Revisits for Pediatric Asthma. J Hosp Adm 2015; 4:26-39. [PMID: 29201264 PMCID: PMC5706774 DOI: 10.5430/jha.v4n5p26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND At the Children's Hospital of Georgia (CHOG), we found that outpatient revisits for pediatric asthma were significantly above national norms. According to the NIH, costly hospital revisits for asthma can be prevented through guidelines-based self-management of asthma, central to which, is the use of a written Asthma-Action Plan (AAP). PURPOSE The asthma services literature has emphasized the role of the healthcare provider in promoting asthma self-management using the AAP, to prevent hospital revisits. On the other hand, the asthma policy literature has emphasized the need for community-based interventions to promote asthma self-management. A gap remains in understanding the extent of leverage that healthcare providers may have in preventing hospital revisits for asthma, through effective communication of AAP in the outpatient setting. Our study sought to address this gap. METHODS We conducted a 6-month intervention to implement "patient-and-family-centered communication of the AAP" in CHOG outpatient clinics, based on the "change-management" theoretical framework. Provider communication of AAP was assessed through a survey of "Parent Understanding of the Child's AAP." A quasi-experimental approach was used to measure outpatient revisits for pediatric asthma, pre- and post-intervention. RESULTS Survey results showed that provider communication of the AAP was unanimously perceived highly positively by parents of pediatric asthma patients, across various metrics of patient-centered care. However, there were no statistically significant differences in outpatient "revisit behavior" for pediatric asthma between pre- and post-intervention periods after controlling for several demographic variables. Additionally, revisits remained significantly above national norms. CONCLUSIONS Results suggest limited potential of "effective provider communication of AAP," in reducing outpatient revisits for pediatric asthma; and indicate need for broader community-based interventions to address patient life variables impacting self-management and hospital revisits for pediatric asthma. Findings suggest need for a revised "socio-ecological" theoretical framework, and also provide insight into various policy, research, and practice implications for asthma management and control.
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Affiliation(s)
- Pavani Rangachari
- Department of Health Management & Informatics, Georgia Regents University, Augusta, Georgia, United States
| | - Renuka Mehta
- Department of Pediatrics, Georgia Regents University, Augusta, Georgia, United States
| | - R Karl Rethemeyer
- Department of Public Administration & Policy, University at Albany, State University of New York, United States
| | - Carole Ferrang
- Children's Hospital of Georgia, Georgia Regents Medical Center, Augusta, Georgia, United States
| | - Clifton Dennis
- CSRA Asthma Coalition, Georgia Regents University, Augusta, Georgia, United States
| | - Vickie Redd
- Children's Hospital of Georgia, Georgia Regents Medical Center, Augusta, Georgia, United States
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254
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Taylor DL 3rd. Perioperative leadership: managing change with insights, priorities, and tools. AORN J 2014; 100:8-26, 27-9. [PMID: 24973182 DOI: 10.1016/j.aorn.2013.06.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 06/13/2013] [Accepted: 06/21/2013] [Indexed: 11/21/2022]
Abstract
The personal leadership of the perioperative director is a critical factor in the success of any change management initiative. This article presents an approach to perioperative nursing leadership that addresses obstacles that prevent surgical departments from achieving high performance in clinical and financial outcomes. This leadership approach consists of specific insights, priorities, and tools: key insights include self-understanding of personal barriers to leadership and accuracy at understanding economic and strategic considerations related to the OR environment; key priorities include creating a customer-centered organization, focusing on process improvement, and concentrating on culture change; and key tools include using techniques (e.g., direct engagement, collaborative leadership) to align surgical organizations with leadership priorities and mitigate specific perioperative management risks. Included in this article is a leadership development plan for perioperative directors.
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255
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Abstract
OBJECTIVES To explore how advanced practice nurses implement practice change in academic medical centers to support optimal patient and staff outcomes. DATA SOURCES Published peer reviewed literature, web-based resources, and professional society materials. CONCLUSION Cancer care is rapidly evolving and advanced practice nurses can shape the future of how care is delivered as well as the setting it is delivered in. IMPLICATIONS FOR NURSING PRACTICE Advanced practice oncology nurses (Nurse Practitioners and Clinical Nurse Specialists) have an opportunity to significantly shape the patient experience by implementing programmatic changes across the continuum of care by engaging stakeholders in project design. Knowledge of change management and implementation science is critical to success.
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256
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Steele Gray C, Wilkinson A, Alvaro C, Wilkinson K, Harvey M. Building Resilience and Organizational Readiness During Healthcare Facility Redevelopment Transitions: Is It Possible to Thrive? HERD 2015. [PMID: 26205401 DOI: 10.1177/1937586715593552] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Hospital redevelopment constitutes a revolutionary change that can face strong resistance from employees. Few studies have examined how employee readiness for change relates to adjustment outcomes typically captured in post-occupancy evaluation (POE). The relationship between organizational readiness and employee adjustment is examined in the context of a POE conducted during a hospital redevelopment. BACKGROUND Our study focuses on the redevelopment of a complex continuing care and rehabilitation hospital that underwent complete physical redevelopment and major shifts in operational and organizational processes. METHODS Using a pretest-posttest quasi-experimental research design, staff organizational readiness was assessed using surveys at four time periods: 6 months prior to the move (n = 125), 2 months prior to the move (n = 84), 3 months after the move (n = 187), and 6 months after the move (n = 194). Measures included organizational readiness, workplace satisfaction, psychological factors (well-being and optimism), and sociodemographic information. RESULTS Findings suggest readiness changes from pre- to post-move, with notable drops just prior (2 months) and just post (3 months) hospital move. Employees demonstrated significant increases in workplace satisfaction and interprofessional relationships from 6 months prior to the move to 6 months after. Results suggest that higher readiness is related to improved employee adjustment. CONCLUSIONS A supportive change environment was found to encourage positive employee outcomes in the face of revolutionary change. It is recommended that change management activities be tailored not only to employee need but also to the timing of the change process.
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Affiliation(s)
- Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Wilkinson
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Celeste Alvaro
- Department of Architectural Science, Ryerson University, Toronto, Ontario, Canada CARE Consultancy, Toronto, Ontario, Canada
| | | | - Martha Harvey
- West Park Healthcare Centre, Toronto, Ontario, Canada
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257
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Guérin A, Lebel D, Hall K, Bussières JF. Change management in pharmacy: a simulation game and pharmacy leaders' rating of 35 barriers to change. Int J Pharm Pract 2015; 23:439-46. [PMID: 26156222 DOI: 10.1111/ijpp.12199] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 05/25/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The primary objective was to rank barriers to change in pharmacy practice. Our secondary objective was to create a simulation game to stimulate reflection and discussion on the topic of change management. METHODS The game was created by the authors and used during a symposium attended by 43 hospital pharmacy leaders from all regions of Canada (Millcroft Conference, Alton, Ontario, June 2013). The main theme of the conference was 'managing change'. KEY FINDINGS The simulation game, the rating of 35 barriers to change and the discussion that followed provided an opportunity for hospital pharmacy leaders to reflect on potential barriers to change, and how change might be facilitated through the use of an organized approach to change, such as that described in Kotter's eight-step model. CONCLUSIONS This simulation game, and the associated rating of barriers to change, provided an opportunity for a group of hospital pharmacy leaders in Canada to reflect on the challenges associated with managing change in the healthcare setting. This simulation game can be modified and used by pharmacy practitioners in other countries to help identify and rank barriers to change in their particular pharmacy practice setting.
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Affiliation(s)
- Aurélie Guérin
- Pharmacy Department, CHU Sainte-Justine, Montreal, QC, Canada
| | - Denis Lebel
- Pharmacy Department, CHU Sainte-Justine, Montreal, QC, Canada
| | - Kevin Hall
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
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258
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Abstract
Nurses are at the forefront of implementing and managing change, given constantly changing healthcare services and the increase in demand for health care. Therefore, it is important to identify the best style of leadership to engage nurses in implementing service-led improvements. This article explores the effects of transformational leadership in bringing about service-led improvements in health care, using the example of setting up a nurse-led acupuncture clinic to optimise the care of patients with chronic pain. Transformational leadership was used throughout the project - from the initial local planning, training and development, through to liaising with the appropriate staff and deciding on an evaluation strategy. Transformational leadership proved to be an effective way to engage and empower nurses and other members of the chronic pain team to enable them to achieve the project aims.
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Affiliation(s)
- Mamood Gousy
- Adult Nursing and Paramedic Science, University of Greenwich, London, England
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259
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Ead H. Change Fatigue in Health Care Professionals--An Issue of Workload or Human Factors Engineering? J Perianesth Nurs 2014; 30:504-515. [PMID: 26596386 DOI: 10.1016/j.jopan.2014.02.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 11/24/2013] [Accepted: 02/10/2014] [Indexed: 10/24/2022]
Abstract
In the demanding and fast-paced world of health care, it is not uncommon for nurses and other health care professionals to have days where they are pushed to their limits. Despite these pressures, each year, new initiatives and practice recommendations are shared within organizations that the nurses must learn, embrace, and include in their practice. Each new initiative can be additive to the nurse's workload; most changes are not time neutral but require staff to expend an allotment of time from their day to complete. In our efforts to adopt new recommendations, is it realistic or possible to add on to workload and stretched resources in an ongoing manner? The following article provides an overview of how issues such as change fatigue and increased workload need to be addressed. Through use of workload measurement tools and guidance by the principles of human factors engineering, we can better support the provision of optimal patient care in a demanding environment.
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260
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Knechtges P, Decker MC. Application of kaizen methodology to foster departmental engagement in quality improvement. J Am Coll Radiol 2014; 11:1126-30. [PMID: 25444067 DOI: 10.1016/j.jacr.2014.08.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 08/28/2014] [Indexed: 11/18/2022]
Abstract
The Toyota Production System, also known as Lean, is a structured approach to continuous quality improvement that has been developed over the past 50 years to transform the automotive manufacturing process. In recent years, these techniques have been successfully applied to quality and safety improvement in the medical field. One of these techniques is kaizen, which is the Japanese word for "good change." The central tenant of kaizen is the quick analysis of the small, manageable components of a problem and the rapid implementation of a solution with ongoing, real-time reassessment. Kaizen adds an additional "human element" that all stakeholders, not just management, must be involved in such change. Because of the small size of the changes involved in a kaizen event and the inherent focus on human factors and change management, a kaizen event can serve as good introduction to continuous quality improvement for a radiology department.
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Affiliation(s)
- Paul Knechtges
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin.
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261
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McAlearney AS, Hefner JL, Sieck CJ, Huerta TR. The journey through grief: insights from a qualitative study of electronic health record implementation. Health Serv Res 2014; 50:462-88. [PMID: 25219627 DOI: 10.1111/1475-6773.12227] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To improve understanding of facilitators of EHR system implementation, paying particular attention to opportunities to maximize physician adoption and effective deployment. DATA SOURCES/STUDY SETTING Primary data collected from 47 physician and 35 administrative key informants from six U.S. health care organizations identified because of purported success with EHR implementation. STUDY DESIGN We conducted interviews and focus groups in an extensive qualitative study. DATA COLLECTION/EXTRACTION METHODS Verbatim transcripts were analyzed both deductively and inductively using the constant comparative method. PRINCIPAL FINDINGS Conceptualizing EHR adoption as loss through the lens of Kübler-Ross's five stages of grief model may help individuals and organizations more effectively orient to the challenge of change. Coupled with Kotter's eight-step change management framework, we offer a structure to facilitate organizations' movement through the EHR implementation journey. Combining insights from these frameworks, we identify 10 EHR strategies that can help address EHR implementation barriers. CONCLUSIONS Loss is one part of change often overlooked. Addressing it directly and compassionately can potentially facilitate the EHR implementation journey. We offer a summarized list of deployment strategies that are sensitive to these issues to support physician transition to new technologies that will bring value to clinical practice.
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Affiliation(s)
- Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH
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262
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PAHKIN K, NIELSEN K, VÄÄNÄNEN A, MATTILA-HOLAPPA P, LEPPÄNEN A, KOSKINEN A. Importance of change appraisal for employee well-being during organizational restructuring: findings from the Finnish paper industry's extensive transition. Ind Health 2014; 52:445-455. [PMID: 24975107 PMCID: PMC4246533 DOI: 10.2486/indhealth.2014-0044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 05/22/2014] [Indexed: 06/03/2023]
Abstract
The global recession has forced the Finnish forest industry to carry out major restructuring activities. Employees have faced different kinds of restructuring, mainly aimed at reducing staff and production. Many studies have shown the negative consequences of restructuring on employee well-being by using negative, ill-health indicators. Our aim is to examine the extent to which change appraisal influences both the negative and positive aspects of work-related well-being among employees who continue working in the organization after the restructuring process. We also examine the role of different actors (top management, immediate supervisor, employees themselves) in how the change is appraised. The study investigated blue-collar employees working in the Finnish forest industry during a period of extensive transition (2008-2009). All six participating factories underwent restructuring between baseline and the follow-up survey (n=369). After adjustment for gender, age and baseline well-being, negative change appraisal increased the risk of experiencing more stress and less work enjoyment. Negative change appraisals thus also damaged the positive, motivational aspects of employee well-being. The results showed the importance of offering employees the opportunity to participate in the planning of changes related to their work as regards positive change appraisal.
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Affiliation(s)
| | - Karina NIELSEN
- University of East Anglia, Norwich Business School, Norwich
Research Park, UK
| | - Ari VÄÄNÄNEN
- Finnish Institute of Occupational Health, Finland
| | | | | | - Aki KOSKINEN
- Finnish Institute of Occupational Health, Finland
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263
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Evans JM, Baker GR, Berta W, Barnsley J. A cognitive perspective on health systems integration: results of a Canadian Delphi study. BMC Health Serv Res 2014; 14:222. [PMID: 24885659 PMCID: PMC4066828 DOI: 10.1186/1472-6963-14-222] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 04/30/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ongoing challenges to healthcare integration point toward the need to move beyond structural and process issues. While we know what needs to be done to achieve integrated care, there is little that informs us as to how. We need to understand how diverse organizations and professionals develop shared knowledge and beliefs - that is, we need to generate knowledge about normative integration. We present a cognitive perspective on integration, based on shared mental model theory, that may enhance our understanding and ability to measure and influence normative integration. The aim of this paper is to validate and improve the Mental Models of Integrated Care (MMIC) Framework, which outlines important knowledge and beliefs whose convergence or divergence across stakeholder groups may influence inter-professional and inter-organizational relations. METHODS We used a two-stage web-based modified Delphi process to test the MMIC Framework against expert opinion using a random sample of participants from Canada's National Symposium on Integrated Care. Respondents were asked to rate the framework's clarity, comprehensiveness, usefulness, and importance using seven-point ordinal scales. Spaces for open comments were provided. Descriptive statistics were used to describe the structured responses, while open comments were coded and categorized using thematic analysis. The Kruskall-Wallis test was used to examine cross-group agreement by level of integration experience, current workplace, and current role. RESULTS In the first round, 90 individuals responded (52% response rate), representing a wide range of professional roles and organization types from across the continuum of care. In the second round, 68 individuals responded (75.6% response rate). The quantitative and qualitative feedback from experts was used to revise the framework. The re-named "Integration Mindsets Framework" consists of a Strategy Mental Model and a Relationships Mental Model, comprising a total of nineteen content areas. CONCLUSIONS The Integration Mindsets Framework draws the attention of researchers and practitioners to how various stakeholders think about and conceptualize integration. A cognitive approach to understanding and measuring normative integration complements dominant cultural approaches and allows for more fine-grained analyses. The framework can be used by managers and leaders to facilitate the interpretation, planning, implementation, management and evaluation of integration initiatives.
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Affiliation(s)
- Jenna M Evans
- Institute of Health Policy, Management & Evaluation, Faculty of Medicine, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T3M6, Canada
| | - G Ross Baker
- Institute of Health Policy, Management & Evaluation, Faculty of Medicine, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T3M6, Canada
| | - Whitney Berta
- Institute of Health Policy, Management & Evaluation, Faculty of Medicine, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T3M6, Canada
| | - Jan Barnsley
- Institute of Health Policy, Management & Evaluation, Faculty of Medicine, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T3M6, Canada
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264
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Abstract
Poor practice associated with pro re nata (PRN) prescriptions in mental health is known to be common and can increase the risk of serious and potentially fatal side effects. A contributing factor to poor practice is the lack of a clear chain of accountability between the decision to prescribe and administer PRN prescriptions. To address this problem, a patient group direction (PGD) for acute behavioural disturbance (lorazepam 0.5-2 mg) and staff training materials were developed. The intention was to replace PRN prescriptions with the PGD in two mental health trusts. One of the potential benefits of this would be the removal of the contribution of PRN to high and combined dose antipsychotic prescriptions. This proposal, however, was met with significant resistance in both trusts and did not replace PRN as a result. A series of interviews and focus groups were conducted with 16 RMNs working in the two trusts, to explore the reasons why the PGD was met with resistance. Senior nurses perceived resistance to be associated with anxieties over increased responsibility for decision making. Junior nurses reported concerns regarding the medicalization of the nursing role, the paperwork associated with the PGD and the training approach used. Future efforts to implement PGDs in mental health settings must carefully consider the methods for engaging effectively with participating organizations, in terms of managing change and completing the necessary groundwork for successful implementation.
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Affiliation(s)
- O Price
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
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265
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Slipicevic O, Masic I. Management knowledge and skills required in the health care system of the Federation bosnia and herzegovina. Mater Sociomed 2013; 24:106-11. [PMID: 23922519 PMCID: PMC3732371 DOI: 10.5455/msm.2012.24.106-111] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 05/15/2012] [Indexed: 11/12/2022] Open
Abstract
Extremely complex health care organizations, by their structure and organization, operate in a constantly changing business environment, and such situation implies and requires complex and demanding health management. Therefore, in order to manage health organizations in a competent manner, health managers must possess various managerial skills and be familiar with problems in health care. Research, identification, analysis, and assessment of health management education and training needs are basic preconditions for the development and implementation of adequate programs to meet those needs. Along with other specific activities, this research helped to determine the nature, profile, and level of top-priority needs for education. The need for knowledge of certain areas in health management, as well as the need for mastering concrete managerial competencies has been recognized as top-priorities requiring additional improvement and upgrading.
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Affiliation(s)
- Osman Slipicevic
- Institute for Health Insurance and Reinsurance of the Federation of Bosnia and Herzegovina, Sarajevo, B&H
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266
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Teo STT, Pick D, Newton CJ, Yeung ME, Chang E. Organisational change stressors and nursing job satisfaction: the mediating effect of coping strategies. J Nurs Manag 2013; 21:878-87. [PMID: 23890099 DOI: 10.1111/jonm.12120] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2013] [Indexed: 11/29/2022]
Abstract
AIM To examine the mediating effect of coping strategies on the consequences of nursing and non-nursing (administrative) stressors on the job satisfaction of nurses during change management. BACKGROUND Organisational change can result in an increase in nursing and non-nursing-related stressors, which can have a negative impact on the job satisfaction of nurses employed in health-care organisations. METHOD Matched data were collected in 2009 via an online survey at two time-points (six months apart). RESULTS Partial least squares path analysis revealed a significant causal relationship between Time 1 administrative and role stressors and an increase in nursing-specific stressors in Time 2. A significant relationship was also identified between job-specific nursing stressors and the adoption of effective coping strategies to deal with increased levels of change-induced stress and strain and the likelihood of reporting higher levels of job satisfaction in Time 2. CONCLUSIONS The effectiveness of coping strategies is critical in helping nurses to deal with the negative consequences of organisational change. IMPLICATIONS FOR NURSING MANAGEMENT This study shows that there is a causal relationship between change, non-nursing stressors and job satisfaction. Senior management should implement strategies aimed at reducing nursing and non-nursing stress during change in order to enhance the job satisfaction of nurses.
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Affiliation(s)
- Stephen T T Teo
- New Zealand Work Research Institute, AUT Business School, AUT University, Auckland, New Zealand
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267
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Etheridge F, Couturier Y, Denis JL, Tremblay L, Tannenbaum C. Explaining the success or failure of quality improvement initiatives in long-term care organizations from a dynamic perspective. J Appl Gerontol 2013; 33:672-89. [PMID: 24652889 DOI: 10.1177/0733464813492582] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The purpose of this study was to better understand why change initiatives succeed or fail in long-term care organizations. Four case studies from Québec, Canada were contrasted retrospectively. A constipation and restraints program succeeded, while an incontinence and falls program failed. Successful programs were distinguished by the use of a change strategy that combined "let-it happen," "help-it happen," and "make-it happen" interventions to create senses of urgency, solidarity, intensity, and accumulation. These four active ingredients of the successful change strategies propelled their respective change processes forward to completion. This paper provides concrete examples of successful and unsuccessful combinations of "let-it happen," "help-it happen," and "make-it happen" change management interventions. Change managers (CM) can draw upon these examples to best tailor and energize change management strategies in their own organizations.
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Affiliation(s)
| | | | | | - Lucie Tremblay
- Donald Berman Maimonides Geriatric Centre and Jewish Eldercare, Montréal, QC Canada
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268
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Affiliation(s)
- Robert J. McNellis
- CORRESPONDING AUTHOR: Robert J. McNellis, MPH, PA, Center for Primary Care, Prevention and Clinical Partnerships, Agency for Healthcare Research and Quality, 540 Gaither Rd, Rockville, MD 20850,
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Reid RJ, Johnson EA, Hsu C, Ehrlich K, Coleman K, Trescott C, Erikson M, Ross TR, Liss DT, Cromp D, Fishman PA. Spreading a medical home redesign: effects on emergency department use and hospital admissions. Ann Fam Med 2013; 11 Suppl 1:S19-26. [PMID: 23690382 PMCID: PMC3707243 DOI: 10.1370/afm.1476] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The patient-centered medical home (PCMH) is being rapidly deployed in many settings to strengthen US primary care, improve quality, and control costs; however, evidence supporting this transformation is still lacking. We describe the Group Health experience in attempting to replicate the effects on health care use seen in a PCMH prototype clinic via a systemwide spread using Lean as the change strategy. METHODS We used an interrupted time series analysis with a patient-month unit of analysis over a 4-year period that included baseline, implementation, and stabilization periods for 412,943 patients. To account for secular trends across these periods, we compared changes in use of face-to-face primary care visits, emergency department visits, and inpatient admissions with those of a nonequivalent comparison group of patients served by community network practices. RESULTS After accounting for secular trends among network patients, patients empaneled to the PCMH clinics had 5.1% and 6.7% declines in primary care office visits in early and later stabilization years, respectively, after the implementation year. This trend was accompanied by a 123% increase in the use of secure electronic message threads and a 20% increase in telephone encounters. Declines were also seen in emergency department visits at 1 and 2 years (13.7% and 18.5%) compared with what would be expected based on secular trends in network practices. No statistically significant changes were found for hospital admissions. CONCLUSIONS The Group Health experience shows it is possible to reduce emergency department use with PCMH transformation across a diverse set of clinics using a clear change strategy (Lean) and sufficient resources and supports.
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Affiliation(s)
- Robert J Reid
- Group Health Physicians, Seattle, Washington 98101, USA.
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270
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Scholle SH, Asche SE, Morton S, Solberg LI, Tirodkar MA, Jaén CR. Support and strategies for change among small patient-centered medical home practices. Ann Fam Med 2013; 11 Suppl 1:S6-13. [PMID: 23690387 PMCID: PMC3707241 DOI: 10.1370/afm.1487] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We aimed to determine the motivations and barriers facing small practices that seek to adopt the patient-centered medical home (PCMH) model, as well as the type of help and strategies they use. METHODS We surveyed lead physicians at practices with fewer than 5 physicians, stratified by state and level of National Committee for Quality Assurance PCMH recognition, using a Web-based survey with telephone, fax, and mail follow-up. The response rate was 59%, yielding a total sample of 249 practices from 23 states. RESULTS Improving quality and patient experience were the strongest motivations for PCMH implementation; time and resources were the biggest barriers. Most practices participated in demonstration projects or received financial rewards for PCMH, and most received training or other kinds of help. Practices found training and help related to completing the PCMH application to be the most useful. Training for patients was both less common and less valued. The most commonly used strategies for practice transformation were staff training, systematizing processes of care, and quality measurement/goal setting. The least commonly endorsed strategy was involving patients in quality improvement. Practices with a higher level of PCMH recognition were more likely to have electronic health records, to report barriers, and to use measurement-based quality improvement strategies. CONCLUSIONS To spread the adoption of the PCMH model among small practices, financial support, practical training, and other help are likely to continue to be important. Few practices involved patients in their implementation, so it would be helpful to test the impact of greater patient involvement in the PCMH.
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271
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Asangansi I. Understanding HMIS Implementation in a Developing Country Ministry of Health Context - an Institutional Logics Perspective. Online J Public Health Inform 2012; 4:ojphi. [PMID: 23569646 DOI: 10.5210/ojphi.v4i3.4302] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Globally, health management information systems (HMIS) have been hailed as important tools for health reform (1). However, their implementation has become a major challenge for researchers and practitioners because of the significant proportion of failure of implementation efforts (2; 3). Researchers have attributed this significant failure of HMIS implementation, in part, to the complexity of meeting with and satisfying multiple (poorly understood) logics in the implementation process. This paper focuses on exploring the multiple logics, including how they may conflict and affect the HMIS implementation process. Particularly, I draw on an institutional logics perspective to analyze empirical findings from an action research project, which involved HMIS implementation in a state government Ministry of Health in (Northern) Nigeria. The analysis highlights the important HMIS institutional logics, where they conflict and how they are resolved. I argue for an expanded understanding of HMIS implementation that recognizes various institutional logics that participants bring to the implementation process, and how these are inscribed in the decision making process in ways that may be conflicting, and increasing the risk of failure. Furthermore, I propose that the resolution of conflicting logics can be conceptualized as involving deinstitutionalization, changeover resolution or dialectical resolution mechanisms. I conclude by suggesting that HMIS implementation can be improved by implementation strategies that are made based on an understanding of these conflicting logics.
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272
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Abstract
RATIONALE Electronic health systems are commonly included in health care reform discussions. However, their embrace by the health care community has been slow. METHODS At Addiction Research and Treatment Corporation, a methadone maintenance programme that also provides primary medical care, HIV medical care and case management, substance abuse counselling and vocational services, we describe our experience in implementing an electronic health information system that encompasses all of these areas. RESULTS We describe the challenges and opportunities of this process in terms of change management, hierarchy of corporate objectives, process mastering, training issues, information technology governance, electronic security, and communication and collaboration. CONCLUSION This description may provide practical insights to other institutions seeking to pursue this technology.
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Affiliation(s)
- Ben Louie
- Division of Medical Services, Research and Information Technology, Addiction Research and Treatment Corporation, Brooklyn, NY 11201, USA
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273
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Ali SK, Baig LA. Problems and issues in implementing innovative curriculum in the developing countries: the Pakistani experience. BMC Med Educ 2012; 12:31. [PMID: 22591729 PMCID: PMC3395573 DOI: 10.1186/1472-6920-12-31] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 05/16/2012] [Indexed: 05/26/2023]
Abstract
BACKGROUND The Government of Pakistan identified 4 medical Colleges for introduction of COME, one from each province. Curriculum was prepared by the faculty of these colleges and launched in 2001 and despite concerted efforts could not be implemented. The purpose of this research was to identify the reasons for delay in implementation of the COME curriculum and to assess the understanding of the stakeholders about COME. METHODS Mixed methods study design was used for data collection. In-depth interviews, mail-in survey questionnaire, and focus group discussions were held with the representatives of federal and provincial governments, Principals of medical colleges, faculty and students of the designated colleges. Rigor was ensured through independent coding and triangulation of data. RESULTS The reasons for delay in implementation differed amongst the policy makers and faculty and included thematic issues at the institutional, programmatic and curricular level. Majority (92% of the faculty) felt that COME curriculum couldn't be implemented without adequate infrastructure. The administrators were willing to provide financial assistance, political support and better coordination and felt that COME could improve the overall health system of the country whereas the faculty did not agree to it. CONCLUSION The paper discusses the reasons of delay based on findings and identifies the strategies for curriculum change in established institutions. The key issues identified in our study included frequent transfer of faculty of the designated colleges and perceived lack of: Continuation at the policy making level. Communication between the stakeholders. Effective leadership.
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Affiliation(s)
- Syeda Kauser Ali
- Department for Educational Development, Aga Khan University, Karachi, Pakistan
| | - Lubna A Baig
- Medical Education, King Saud Bin Abdulaziz University of Health Sciences, Riyadh and Medical Education and Research Unit, University of Calgary, Calgary, Canada
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274
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Scheele F. The art of medical education. Facts Views Vis Obgyn 2012; 4:266-9. [PMID: 24753919 PMCID: PMC3987478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Is the art of medical education just making sure to provide sufficient up to date medical knowledge and a lot of clinical experience? It is much more. The art of medical education is about a teaching program that is designed to serve the community of the near future. The program is the result of a thorough evaluation of societal needs and is capable of influencing the properties of future care. New care professionals who are trained in the program will -become instrumental in solving complex problems in health systems. The art of medical education is about the change of traditional ideas of how to cope with these health systems. This change will raise anger and resistance. Effective change management is essential to survive attacks from laggards and to maintain enthusiasm to invest in the health care of the future. Educationalist science provides several important insights that help us find the optimal shape of the program. Good role models and a learning environment that is an example of the intended professional and organisational behaviour, learning by doing, simulation programs, educational tools like e-learning systems, a good assessment and feedback system, and a portfolio to prove and discuss professional progress are all pivotal components of the ideal program. To achieve mastery within the art of medical education, a quality improvement program will be the crown of the process. Medical education is a multifaceted process and so the quality improvement should be. The art of medical education is a great challenge. The health care of your future deserves it.
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Affiliation(s)
- F. Scheele
- Professor Medical Education, VU University Medical Centre, Amsterdam, the Netherlands
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275
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Ceusters W. SNOMED CT's RF2: Is the future bright? Stud Health Technol Inform 2011; 169:829-33. [PMID: 21893863 PMCID: PMC3379709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
SNOMED CT's new RF2 format is said to come with features for better configuration management of the SNOMED vocabulary, thereby accommodating evolving requirements without the need for further fundamental change in the foreseeable future. Although the available documentation is not yet convincing enough to support this claim, the newly introduced Model Component hierarchy and associated reference set mechanism seem to hold real promise of being able to deal successfully with a number of ontological issues that have been discussed in the recent literature. Backed up by a study of the old and new format and of the relevant literature and documentation, three recommendations are presented that would free SNOMED CT from use-mention confusions, unclear referencing of real-world entities and uninformative reasons for change in a way that does not force SNOMED CT to take a specific philosophical or ontological position.
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Affiliation(s)
- Werner Ceusters
- New York State Center of Excellence in Bioinformatics & Life Sciences, Buffalo, NY 14204, USA.
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276
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Wijkel D, Mur I. The implementation of diabetic care in The Netherlands: implementation of guidelines. Workshop. Int J Integr Care 2010. [PMCID: PMC3031849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Profound ideas do not always end in profound results. Is the design wrong, or are major issues forgotten during the implementation? The evidence of a diabetics case in NL is used to show that the implementation of a sound protocol is more than barely medical. Integrating an organizational change perspective increases understanding and will improve results.
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Affiliation(s)
- Dirk Wijkel
- Medical Coordinator Stichting THEMA, The Netherlands
| | - Ingrid Mur
- Associate Professor Maastricht University, The Netherlands
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Etheridge F, Couturier Y, Trouvé H, Saint-Jean O, Somme D. Is the PRISMA-France glass half-full or half-empty? The emergence and management of polarized views regarding an integrative change process. Int J Integr Care 2009; 9:e99. [PMID: 20087426 DOI: 10.5334/ijic.510] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 11/24/2009] [Accepted: 11/29/2009] [Indexed: 11/20/2022] Open
Abstract
AIM The PRISMA-France pilot project is aimed at implementing an innovative case management type integration model in the 20th district of Paris. This paper apprehends the emergence of two polarized views regarding the progression of the model's spread in order to analyze the change management enacted during the process and its effects. METHOD A qualitative analysis was conducted based on an institutional change model. RESULTS Our results suggest that, according to one view, the path followed to reach the study's current level of progress was efficient and necessary to lay the foundation of a new health and social services system while according to the other, change management shortcomings were responsible for the lack of progress. DISCUSSION While neither of these two views appears entirely justified, analyzing the factors underlying their differences pinpoints some of the challenges involved in managing the spread of an integrated service delivery network. Meticulous preparation for the change management role and communication of the time and effort required for a wholesale institutional change process may be significant factors for a successful integrative endeavor.
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278
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Wilkins MA. Factors influencing acceptance of electronic health records in hospitals. Perspect Health Inf Manag 2009; 6:1f. [PMID: 20169018 PMCID: PMC2804461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The study's aim was to examine factors that may influence health information managers in the adoption of electronic health records. The Technology Acceptance Model (TAM) served as theoretical foundation for this quantitative study. Hospital health information managers in Arkansas were queried as to the constructs of perceived usefulness, perceived ease of use, and behavior intention. The study population comprised 94 health information managers with a return rate of 74.5 percent. One manager was identified to represent each hospital. In each of the construct areas, the results showed a difference between health information managers that had adopted components of EHRs versus those that had not. This study may serve to guide the educational process of both health information managers that have yet to implement EHRs as well as the EHR vendor community.
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Abstract
BACKGROUND National reporting of adverse incidents has resulted in a number of clinical alerts being issued. Despite a lack of evidence, these alerts are often accompanied by a mandatory requirement to alter practice. There is likely to be clinician resistance to such a method of change management, particularly where evidence of safety is missing. AIM To determine the level of implementation within neonatal units of an alert requiring the change from litmus to pH paper to test nasogastric tube position. METHOD A questionnaire sent to all neonatal units in the United Kingdom with more than 12 cots. RESULTS From the 207 questionnaires sent, there were 165 (80%) responses. Fifty five percent of units were still using litmus. All continued to use supplementary tests not recommended in best practice statements issued at the time of the alert. There was considerable variation in the pH value at which it was considered safe to feed. CONCLUSIONS Nine months after the alert, more than half the units had not changed to pH paper, and supplementary methods of testing were still being used. The wide range of pH values highlights the uncertainty about the "normal" gastric pH in the newborn. The evidence that, in neonatal units, changing to pH paper is safer than the long established use of litmus is lacking. Recommendations for change in practice must be based on good information and not seen just as a "knee jerk" response to adverse incidents.
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Affiliation(s)
- Y Freer
- Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4SA, Scotland, UK
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280
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DePalma RG. Surgical therapy for venous stasis: results of a modified Linton operation. Am J Surg 1979; 137:810-3. [PMID: 378013 PMCID: PMC10589830 DOI: 10.1016/0002-9610(79)90101-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 07/13/2023] [Accepted: 08/12/2023] [Indexed: 12/14/2022]
Abstract
Bipedicled flaps in the natural skin lines permit ligation of offending perforating and communicating veins of the postphlebitic leg with stasis change. This technic affords safer immediate postoperative healing and durable long-term results. The indications for operation have been extended to include more elderly patients as well as selected patients with ulcerations due to combined venous stasis and arterial insufficiency.
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