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Pun JKH, Matthiessen CMIM, Murray KA, Slade D. Factors affecting communication in emergency departments: doctors and nurses' perceptions of communication in a trilingual ED in Hong Kong. Int J Emerg Med 2015; 8:48. [PMID: 26667242 PMCID: PMC4678128 DOI: 10.1186/s12245-015-0095-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 12/02/2015] [Indexed: 11/10/2022] Open
Abstract
Background This study investigates clinicians’ views of clinician-patient and clinician-clinician communication, including key factors that prevent clinicians from achieving successful communication in a large, high-pressured trilingual Emergency Department (ED) in Hong Kong. Methods Researchers interviewed 28 doctors and nurses in the ED. The research employed a qualitative ethnographic approach. The interviews were audio-recorded, transcribed, translated into English and coded using the Nvivo software. The researchers examined issues in both clinician-patient and clinician-clinician communication. Through thematic analyses, they identified the factors that impede communication most significantly, as well as the relationship between these factors. This research highlights the significant communication issues and patterns in Hong Kong EDs. Results The clinician interviews revealed that communication in EDs is complex, nuanced and fragile. The data revealed three types of communication issues: (1) the experiential parameter (i.e. processes and procedures), (2) the interpersonal parameter (i.e. clinicians’ engagements with patients and other clinicians) and (3) contextual factors (i.e. time pressures, etc.). Within each of these areas, the specific problems were the following: compromises in knowledge transfer at key points of transition (e.g. triage, handover), inconsistencies in medical record keeping, serious pressures on clinicians (e.g. poor clinician-patient ratio and long working hours for clinicians) and a lack of focus on interpersonal skills. Conclusions These communication problems (experiential, interpersonal and contextual) are intertwined, creating a complex yet weak communication structure that compromises patient safety, as well as patient and clinician satisfaction. The researchers argue that hospitals should develop and implement best-practice policies and educational programmes for clinicians that focus on the following: (1) understanding the primary causes of communication problems in EDs, (2) accepting the tenets and practices of patient-centred care, (3) establishing clear and consistent knowledge transfer procedures and (4) lowering the patient-to-clinician ratio in order to create the conditions that foster successful communication. The research provides a model for future research on the relationship between communication and the quality and safety of the patient safety.
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Affiliation(s)
- Jack K H Pun
- Department of English, The Hong Kong Polytechnic University, Hong Kong SAR, China. .,The International Research Centre for Communication in Healthcare (IRCCH), The Hong Kong Polytechnic University, Hong Kong; & The University of Technology Sydney, Sydney, Australia. .,Department of Education, St Antony's College, University of Oxford, Oxford, UK.
| | - Christian M I M Matthiessen
- Department of English, The Hong Kong Polytechnic University, Hong Kong SAR, China.,The International Research Centre for Communication in Healthcare (IRCCH), The Hong Kong Polytechnic University, Hong Kong; & The University of Technology Sydney, Sydney, Australia
| | - Kristen A Murray
- Department of English, The Hong Kong Polytechnic University, Hong Kong SAR, China.,The International Research Centre for Communication in Healthcare (IRCCH), The Hong Kong Polytechnic University, Hong Kong; & The University of Technology Sydney, Sydney, Australia
| | - Diana Slade
- Department of English, The Hong Kong Polytechnic University, Hong Kong SAR, China.,The International Research Centre for Communication in Healthcare (IRCCH), The Hong Kong Polytechnic University, Hong Kong; & The University of Technology Sydney, Sydney, Australia.,Faculty of Arts and Social Science, The University of Technology Sydney, Sydney, Australia
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Savage DW, Woolford DG, Weaver B, Wood D. Developing emergency department physician shift schedules optimized to meet patient demand. CAN J EMERG MED 2015; 17:3-12. [DOI: 10.2310/8000.2013.131224] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AbstractObjectives: 1) To assess temporal patterns in historical patient arrival rates in an emergency department (ED) to determine the appropriate number of shift schedules in an acute care area and a fast-track clinic and 2) to determine whether physician scheduling can be improved by aligning physician productivity with patient arrivals using an optimization planning model.Methods: Historical data were statistically analyzed to determine whether the number of patients arriving at the ED varied by weekday, weekend, or holiday weekend. Poisson-based generalized additive models were used to develop models of patient arrival rate throughout the day. A mathematical programming model was used to produce an optimal ED shift schedule for the estimated patient arrival rates. We compared the current physician schedule to three other scheduling scenarios: 1) a revised schedule produced by the planning model, 2) the revised schedule with an additional acute care physician, and 3) the revised schedule with an additional fast-track clinic physician.Results: Statistical modelling found that patient arrival rates were different for acute care versus fast-track clinics; the patterns in arrivals followed essentially the same daily pattern in the acute care area; and arrival patterns differed on weekdays versus weekends in the fast-track clinic. The planning model reduced the unmet patient demand (i.e., the average number of patients arriving at the ED beyond the average physician productivity) by 19%, 39%, and 69% for the three scenarios examined.Conclusions: The planning model improved the shift schedules by aligning physician productivity with patient arrivals at the ED.
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Robinson L, Cotton J, Sarkar S, Thompson PJ, Coomarasamy A, Rajkhowa M. A 36-month study of patient complaints at a tertiary fertility centre. HUM FERTIL 2013; 17:45-9. [DOI: 10.3109/14647273.2013.859745] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Aeenparast A, Tabibi SJ, Shahanaghi K, Aryanejhad MB. Reducing outpatient waiting time: a simulation modeling approach. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:865-9. [PMID: 24616801 PMCID: PMC3929826 DOI: 10.5812/ircmj.7908] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 01/27/2013] [Accepted: 07/15/2013] [Indexed: 11/28/2022]
Abstract
Objectives The objective of this study was to provide a model for reducing outpatient waiting time by using simulation. Materials and Methods A simulation model was constructed by using the data of arrival time, service time and flow of 357 patients referred to orthopedic clinic of a general teaching hospital in Tehran. The simulation model was validated before constructing different scenarios. Results In this study 10 scenarios were presented for reducing outpatient waiting time. Patients waiting time was divided into three levels regarding their physicians. These waiting times for all scenarios were computed by simulation model. According to the final scores the 9th scenario was selected as the best way for reducing outpatient's waiting time. Conclusions Using the simulation as a decision making tool helps us to decide how we can reduce outpatient's waiting time. Comparison of outputs of this scenario and the based- case scenario in simulation model shows that combining physician's work time changing with patient's admission time changing (scenario 9) would reduce patient waiting time about 73.09%. Due to dynamic and complex nature of healthcare systems, the application of simulation for the planning, modeling and analysis of these systems has lagged behind traditional manufacturing practices. Rapid growth in health care system expenditures, technology and competition has increased the complexity of health care systems. Simulation is a useful tool for decision making in complex and probable systems.
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Affiliation(s)
- Afsoon Aeenparast
- Department of Health Services Management, Mother and Child Health Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, IR Iran
- Clinical Research Center, Milad Hospital, Tehran, IR Iran
- Corresponding author: Afsoon Aeenparast, Department of Health Services Management, Mother and Child Health Research Center, Iranian Institute for Health Sciences Research P.O. Box: 13145-1756, Tehran, IR Iran. Tel: +98-2166480804, Fax: +98-2166480805, E-mail:
| | - Seyed Jamaleddin Tabibi
- School of Management Science and Medical Information, Tehran University of Medical Sciences and Health Services, Tehran, IR Iran
| | - Kamran Shahanaghi
- College of Industrial Engineering, Iran University of Science and Technology, Tehran, IR Iran
| | - Mir Bahador Aryanejhad
- College of Industrial Engineering, Iran University of Science and Technology, Tehran, IR Iran
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van Sambeek J, Cornelissen F, Bakker P, Krabbendam J. Models as instruments for optimizing hospital processes: a systematic review. Int J Health Care Qual Assur 2010; 23:356-77. [DOI: 10.1108/09526861011037434] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Elkhuizen SG, Limburg M, Bakker PJM, Klazinga NS. Evidence‐based re‐engineering: re‐engineering the evidence. Int J Health Care Qual Assur 2006; 19:477-99. [PMID: 17100219 DOI: 10.1108/09526860610686980] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Business process redesign (BPR) is used to implement organizational transformations towards more customer-focused and cost-effective care. Ideally, these innovations should be carefully described and evaluated so that "best practices" can be re-applied. To investigate this, available evidence was collected on patient care redesign projects. DESIGN/METHODOLOGY/APPROACH The Ebsco Business Source Premier, Embase and Medline databases were searched. Studies on innovations related to re-engineering patient care that used before-after design as minimum prerequisites were selected. General characteristics, logistic parameters and other outcome measures to determine the objectives and results and interventions used were looked at. FINDINGS A total of 86 studies that conformed to the criteria were found: a minority mentioned measurable parameters in their objectives. In the majority of studies, multiple interventions were combined within single studies, making it impossible to compare the effects of individual interventions. Only three randomized controlled trials were found. Furthermore, inconsistencies were noted between the study objectives and the reported results. Many more issues were reported in the results than were mentioned in the study aims. It would appear that publications were hard to find owing to a lack of specific MeSH headings. Nearly 7,500 abstracts were scanned and from these it was concluded that clear and univocal research methods, terms and reporting guidelines are advisable and must be developed in order to learn and benefit from BPR innovations in health care organizations. ORIGINALITY/VALUE This appears to be the first time available evidence about redesign projects in hospitals has been systematically collected and assessed.
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Affiliation(s)
- S G Elkhuizen
- Academic Medical Center, University of Amsterdam, Department of Innovation and Process Management, Amsterdam, The Netherlands.
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Hayman B, Cioffi J, Wilkes L. Redesign of the model of nursing practice in an acute care ward: Nurses' experiences. Collegian 2006; 13:31-6. [PMID: 16541831 DOI: 10.1016/s1322-7696(08)60514-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE to describe nurses' experiences of the change associated with redesign of the model of nursing practice in an acute care ward in the preparatory and implementation phases. DESIGN descriptive case study SETTING a surgical ward in an acute care hospital in Greater Western Sydney SUBJECTS fourteen registered and six enrolled nurses working on the surgical ward volunteered to be interviewed, eight in the preparatory phase and twelve six months into the implementation phase MAIN OUTCOME MEASURE descriptions of nurses' experiences in the preparatory phase and six months into the implementation phase of the redesigned nursing practice model RESULTS many nurses felt apprehensive in the preparatory phase, however, six months into implementation phase their willingness to trial the model was evident. Negativity pervaded both phases, as did their concerns for the quality of care being given. In the preparatory phase nurses described the clinical activities coordinator (CAC) role as having potential to be beneficial and this was realised to some degree six months into implementation phase. A preference for registered nurses over enrolled nurses as a dominant component of the staff was evident in both phases CONCLUSIONS the struggle with the change that nurses experienced suggests redesign needs to be a more collaborative process involving strong communication and supportive education so nurses can empower themselves within the change.
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Brown AD, Sandoval GA, Levinton C, Blackstien-Hirsch P. Developing an Efficient Model to Select Emergency Department Patient Satisfaction Improvement Strategies. Ann Emerg Med 2005; 46:3-10. [PMID: 15988417 DOI: 10.1016/j.annemergmed.2004.11.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE Patient satisfaction is an important performance measure for emergency departments (EDs), but the most efficient ways of improving satisfaction are unclear. This study uses optimization techniques to identify the best possible combination of predictors of overall patient satisfaction to help guide improvement efforts. METHODS The results of a satisfaction survey from 20,500 patients who visited 123 EDs were used to develop ordinal logistic regression models for overall quality of care, overall medical treatment, willingness to recommend the ED to others, and willingness to return to the same ED. Originally, 68,981 surveys were mailed, and 20,916 were returned, representing an overall response rate of 30.3%. We then incorporated these regressions into an optimization model to select the most efficient combination of predictors necessary to increase the 4 overall satisfaction measures by 5%. A sensitivity analysis was also conducted to explore differences across hospital peer groups and regions. RESULTS Results differ slightly for each of the 4 overall satisfaction measures. However, 4 predictors were common to all of these measures: "perceived waiting time to receive treatment," "courtesy of the nursing staff," "courtesy of the physicians," and "thoroughness of the physicians." The selected predictors were not necessarily the strongest predictors identified through regression models. The optimization model suggests that most of these predictors must be improved by 15% to increase the overall satisfaction measures by 5%. CONCLUSION This study introduces the use of optimization techniques to study ED patient satisfaction and highlights an opportunity to apply this technique to widely collected data to help inform hospitals' improvement strategies. The results suggest that hospitals should focus most of their improvement efforts on the 4 predictors mentioned above.
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Affiliation(s)
- Adalsteinn D Brown
- Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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Taylor DM, Wolfe R, Cameron PA. Complaints from emergency department patients largely result from treatment and communication problems. Emerg Med Australas 2002; 14:43-9. [PMID: 11993834 DOI: 10.1046/j.1442-2026.2002.00284.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Emergency department patient complaints are often justified and may lead to apology, remedial action or compensation. The aim of the present study was to analyse emergency department patient complaints in order to identify procedures or practices that require change and to make recommendations for intervention strategies aimed at decreasing complaint rates. METHODS We undertook a retrospective analysis of patient complaints from 36 Victorian emergency departments during a 61 month period. Data were obtained from the Health Complaint Information Program (Health Services Commissioner). RESULTS In all, 2,419 emergency department patients complained about a total of 3,418 separate issues (15.4% of all issues from all hospital departments). Of these, 1,157 complaints (47.80%) were received by telephone and 829 (34.3%) were received by letter; 1,526 (63.1 %) complaints were made by a person other than the patient. Highest complaint rates were received from patients who were female, born in non-English-speaking countries and very young or very old. One thousand one hundred and forty-one issues (33.4%) related to patient treatment, including inadequate treatment (329 issues) and inadequate diagnosis (249 issues); 1079 (31.6%) issues related to communication, including poor staff attitude, discourtesy and rudeness (444 issues); 407 (11.9%) issues related to delay in treatment. Overall, 2516 issues (73.6%) were resolved satisfactorily, usually by explanation or apology. Only 59 issues (1.7%) resulted in a procedure or policy change. Remedial action was taken in 109 issues (3.2%) and compensation was paid to eight patients. CONCLUSIONS Communication remains a significant factor in emergency department patient dissatisfaction. While patient complaints have resulted in major changes to policy and procedure, research and intervention strategies into communication problems are indicated. In the short term, focused staff training is recommended.
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Affiliation(s)
- David McD Taylor
- Emergency Department, Royal Melbourne Hospital Monash University, Victoria, Australia.
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Browne GJ. Paediatic emergency departments: old needs, new challenges and future opportunities. Emerg Med Australas 2001; 13:409-17. [PMID: 11903425 DOI: 10.1046/j.1035-6851.2001.00254.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- G J Browne
- Department of Emergency Medicine, The Children's Hospital, Westmead, New South Wales, Australia
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