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Akter K, Shawar YR, Tesfa A, Howell CD, Seruwagi G, Kyamulabi A, Dube A, Gonfa G, Mwaba K, Kinney M, English M, Shiffman J, Djellouli N, Colbourn T. Influences on policy-formulation, decision-making, organisation and management for maternal, newborn and child health in Bangladesh, Ethiopia, Malawi and Uganda: The roles and legitimacy of a multi-country network. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001742. [PMID: 37988328 PMCID: PMC10662733 DOI: 10.1371/journal.pgph.0001742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 10/12/2023] [Indexed: 11/23/2023]
Abstract
The Network for Improving Quality of Care for Maternal, Newborn and Child Health (QCN) is intended to facilitate learning, action, leadership and accountability for improving quality of care in member countries. This requires legitimacy-a network's right to exert power within national contexts. This is reflected, for example, in a government's buy-in and perceived ownership of the work of the network. During 2019-2022 we conducted iterative rounds of stakeholder interviews, observations of meetings, document review, and hospital observations in Bangladesh, Ethiopia, Malawi, Uganda and at the global level. We developed a framework drawing on three models: Tallberg and Zurn which conceptualizes legitimacy of international organisations dependent on their features, the legitimation process and beliefs of audiences; Nasiritousi and Faber, which looks at legitimacy in terms of problem, purpose, procedure, and performance of institutions; Sanderink and Nasiritousi, to characterize networks in terms of political, normative and cognitive interactions. We used thematic analysis to characterize, compare and contrast institutional interactions in a cross-case synthesis to determine salient features. Political and normative interactions were favourable within and between countries and at global level since collective decisions, collaborative efforts, and commitment to QCN goals were observed at all levels. Sharing resources and common principles were not common between network countries, indicating limits of the network. Cognitive interactions-those related to information sharing and transfer of ideas-were more challenging, with the bi-directional transfer, synthesis and harmonization of concepts and methods, being largely absent among and within countries. These may be required for increasing government ownership of QCN work, the embeddedness of the network, and its legitimacy. While we find evidence supporting the legitimacy of QCN from the perspective of country governments, further work and time are required for governments to own and embed the work of QCN in routine care.
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Affiliation(s)
- Kohenour Akter
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Yusra Ribhi Shawar
- Bloomberg School of Public Health, John Hopkins University, Baltimore, United States of America
- Paul H. Nitze School of Advanced International Studies, John Hopkins University, Washington, D.C., United States of America
| | - Anene Tesfa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Gloria Seruwagi
- School of Public Health, Makerere University, Kampala, Uganda
| | - Agnes Kyamulabi
- School of Public Health, Makerere University, Kampala, Uganda
| | - Albert Dube
- Parent And Child Health Initiative PACHI, Lilongwe, Malawi
| | - Geremew Gonfa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Kasonde Mwaba
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Mary Kinney
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Mike English
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Jeremy Shiffman
- Bloomberg School of Public Health, John Hopkins University, Baltimore, United States of America
- Paul H. Nitze School of Advanced International Studies, John Hopkins University, Washington, D.C., United States of America
| | - Nehla Djellouli
- Institute for Global Health, University College London, London, United Kingdom
| | - Tim Colbourn
- Institute for Global Health, University College London, London, United Kingdom
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English M, Aluvaala J, Maina M, Duke T, Irimu G. Quality of inpatient paediatric and newborn care in district hospitals: WHO indicators, measurement, and improvement. Lancet Glob Health 2023; 11:e1114-e1119. [PMID: 37236212 DOI: 10.1016/s2214-109x(23)00190-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/02/2023] [Accepted: 04/03/2023] [Indexed: 05/28/2023]
Abstract
Poor-quality paediatric and neonatal care in district hospitals in low-income and middle-income countries (LMICs) was first highlighted more than 20 years ago. WHO recently developed more than 1000 paediatric and neonatal quality indicators for hospitals. Prioritising these indicators should account for the challenges in producing reliable process and outcome data in these settings, and their measurement should not unduly narrow the focus of global and national actors to reports of measured indicators. A three-tier, long-term strategy for the improvement of paedicatric and neonatal care in LMIC district hospitals is needed, comprising quality measurement, governance, and front-line support. Measurement should be better supported by integrating data from routine information systems to reduce the future cost of surveys. Governance and quality management processes need to address system-wide issues and develop supportive institutional norms and organisational culture. This strategy requires governments, regulators, professions, training institutions, and others to engage beyond the initial consultation on indicator selection, and to tackle the pervasive constraints that undermine the quality of district hospital care. Institutional development must be combined with direct support to hospitals. Too often the focus of indicator measurement as an improvement strategy is on reporting up to regional or national managers, but not on providing support down to hospitals to attain quality care.
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Affiliation(s)
- Mike English
- Kenya Medical Research Institute-Wellcome Programme, Nairobi, Kenya; Health Systems Collaborative, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Jalemba Aluvaala
- Kenya Medical Research Institute-Wellcome Programme, Nairobi, Kenya; Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Michuki Maina
- Kenya Medical Research Institute-Wellcome Programme, Nairobi, Kenya
| | - Trevor Duke
- Intensive Care Unit, Royal Melbourne Children's Hospital, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - Grace Irimu
- Kenya Medical Research Institute-Wellcome Programme, Nairobi, Kenya; Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
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Liu L, Curry LA, Nadew K, Desai MM, Linnander E. Measuring Organizational Culture in Ethiopia's Primary Care System: Validation of a Practical Survey Tool for Managers. Int J Health Policy Manag 2022; 11:3071-3078. [PMID: 35942973 PMCID: PMC10105185 DOI: 10.34172/ijhpm.2022.6646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 06/18/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Organizational culture has been widely recognized as predictive of health system performance and improved outcomes across various healthcare settings. Research on organizational culture in healthcare has been largely conducted in high-income settings, and validated scales to measure this concept in primary healthcare systems in low- and middle-income country (LMIC) settings are lacking. Our study aimed to validate a tool to measure organizational culture in the context of the Ethiopian Primary Healthcare Transformation Initiative (PTI), a collaborative of the Federal Ministry of Health (FMoH) and the Yale Global Health Leadership Initiative to strengthen primary healthcare system performance in Ethiopia. METHODS Following established survey development and adaptation guidelines, we adapted a 31-item US-based organizational culture scale using (1) cognitive interviewing, (2) testing with 1176 district and zonal health officials from four regions in Ethiopia, and (3) exploratory factor analysis (EFA). RESULTS Based on the results of cognitive interviewing, an adapted 30-item survey was piloted. The factor analyses of 1034 complete surveys (88% complete responses) identified five constructs of the scale which demonstrated strong validity and internal consistency: learning and problem solving, psychological safety, resistance to change, time for improvement, and commitment to the organization. Of the 30 a priori items, 26 items loaded well on the five constructs (loading values 0.40-0.86), and 4 items failed to load. Cronbach alpha coefficients were 0.86 for the scale as a whole and ranged from 0.65 to 0.90 for the subscales. The five-factor solution accounted for 62% of total variance in culture scores across respondents. CONCLUSION Through validation and factor analyses, we generated a 26-item scale for measuring organizational culture in public primary healthcare systems in LMIC settings. This validated tool can be useful for managers, implementers, policy-makers, and researchers to assess and improve organizational culture in support of improved primary healthcare system performance.
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Affiliation(s)
- Lingrui Liu
- Global Health Leadership Initiative, Yale University, New Haven, CT, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Leslie A. Curry
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Kidest Nadew
- Global Health Leadership Initiative, Yale University, New Haven, CT, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Mayur M. Desai
- Global Health Leadership Initiative, Yale University, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Erika Linnander
- Global Health Leadership Initiative, Yale University, New Haven, CT, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
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Argaw MD, Desta BF. Examining Governing Board Functions and Health Center Performances During Health System Reform: A Cross-sectional Study in 4 Regional States of Ethiopia. Int J Health Policy Manag 2022; 11:928-936. [PMID: 33300761 PMCID: PMC9808206 DOI: 10.34172/ijhpm.2020.235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 11/14/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Since 1995, the Ethiopian health system has been managed through decentralizing functions, resources, and authorities to local levels. As a result, health centers are led and managed by governing boards. In addition, the national health system strives to transform the performance of health centers through the implementation of reforms. Therefore, this study aims to examine the relationship between governing board functions and health center performances within a health reform context in 4 agrarian regions of Ethiopia. METHODS A cross-sectional survey was conducted from August 28, 2018 to September 30, 2018. Primary data were collected from governing board chairpersons or their designees using interviewer-administered structured questionnaires. The performance of each health center was rated out of 100 percentage points against the Ethiopian Health Center Reform Guideline (EHCRIG) standards. Secondary data were abstracted from a routine health information database using customized tools to capture achievements on 69 EHCRIG standards and its 174 validation criteria. Since the data violate the assumptions of the parametric test, the Spearman's rank (rho) correlation test, (a non-parametric test) was employed to see if any correlation exists among 4 parameters; namely: structure, roles and responsibilities, training and development of governing boards, and performance of health centers against EHCRIGs standards. A statistically significant relationship was claimed at P<.050. RESULTS All 83 health center governing boards or designees who were approached for this study, participated. The mean health center governing board function score with standard deviation was 56.0% (SD ± 14.5%). The overall performance of health centers against EHCRIGs was 70.4% (SD ± 15.0%). There was a statistically significant and strong correlation (Spearman rho correlation coefficient) between health center performance scores measured against reform standards with governing board scores of (rho=0.866, P<.001) and overall governance scores (rho=0.828, P<.001). CONCLUSION Based on the results of this study, we can conclude that well-functioning health center governing boards can improve the performance of health centers against clinical, and management reform standards. Therefore, continuous strengthening of the capacity of governing boards, focusing on improving implementation of their roles and responsibilities, and continuing training on business management is recommended.
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Affiliation(s)
- Mesele Damte Argaw
- USAID Transform: Primary Health Care, JSI Research & Training Institute Inc., Addis Ababa, Ethiopia
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Peng X, Tang X, Chen Y, Zhang J. Ranking the Healthcare Resource Factors for Public Satisfaction with Health System in China-Based on the Grey Relational Analysis Models. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030995. [PMID: 33498645 PMCID: PMC7908117 DOI: 10.3390/ijerph18030995] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: Public satisfaction with the health system is a very important comprehensive indicator. Given the limited healthcare resources in a society, it is always important for policymakers to have full information about the priority and the ranking order of the factors of healthcare resources for improving public satisfaction. (2) Methods: Grey Relational Analysis (GRA) is advantageous for satisfaction analysis because satisfaction is a “grey concept” of “having a clear boundary but vague connotation”. The data were from the CGSS and the China Health Statistics Yearbook (2013 and 2015), with a total of 15,969 samples (average satisfaction score = 68.5, age = 51.9, female = 49.4%). (3) Results: The government’s percentage of total expenditure on healthcare was ranked as the most important factor for public satisfaction with the health system in China in both 2013 and 2015. The second most important factor changed from “Out-of-pocket percentage of individuals” in 2013 to “Hospital beds per thousand populations” in 2015. Meanwhile, “Healthcare workforce per thousand populations” increased from the least important factor in 2013 to the 3rd in 2015. Disparities in the ranking orders of the factors among regions of China were identified too. (4) Conclusions: The analysis results suggest that during recent years the priority of Chinese residents’ healthcare satisfaction for healthcare resources has shifted on the national level from economic affordability to more intensive “people-centered” services, while the regional disparities and gaps need to receive more attention and be further improved in the healthcare reform of next round.
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Affiliation(s)
- Xinxin Peng
- School of Business, Macau University of Science and Technology, Macao 999078, China; (X.P.); (X.T.); (Y.C.)
- School of Business, Jiangsu University of Technology, Changzhou 213000, China
| | - Xiaolei Tang
- School of Business, Macau University of Science and Technology, Macao 999078, China; (X.P.); (X.T.); (Y.C.)
| | - Yijun Chen
- School of Business, Macau University of Science and Technology, Macao 999078, China; (X.P.); (X.T.); (Y.C.)
| | - Jinghua Zhang
- School of Business, Macau University of Science and Technology, Macao 999078, China; (X.P.); (X.T.); (Y.C.)
- Correspondence: ; Tel.: +853-8897-2986; Fax: +853-2882-7666
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Webster PD, Deka S, Ismail A, Stern AF, Barker PM. Using a Multicountry Learning Network to Harvest and Rapidly Spread Implementation Knowledge across Programs Aimed to Reduce Mother-to-Child Transmission of HIV and Improve Nutrition: Perspectives and Lessons Learned for Similar Large-Scale Initiatives. J Int Assoc Provid AIDS Care 2020; 18:2325958219847452. [PMID: 31185792 PMCID: PMC6748464 DOI: 10.1177/2325958219847452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
As countries pursue UNAIDS’s 90-90-90 target for ending the AIDS epidemic, success is dependent on learning how to deliver effective care. We describe a learning network and mechanisms used to foster communication and sharing of ideas and results across 6 countries in the Partnership for HIV-Free Survival. The network used 2 forms of peer exchange, in-person and virtual, and a variety of knowledge management mechanisms to harvest and spread key learning. Key learning included valuable insights on how to design and convene a multicountry learning network, including top enablers of success and practical insights on the network’s value. The network was instrumental in accelerating learning about improving care. Our experience shows the value of creating a quality improvement–driven, multicountry learning network to accelerate the pace of improving care systems. Government ownership and adaptation of collaborative learning efforts to the country context must be considered when designing future networks.
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Affiliation(s)
| | - Sidhartha Deka
- 2 USAID ASSIST Project, Johns Hopkins Center for Communication Programs, Chevy Chase, MD, USA
| | - Anisa Ismail
- 3 USAID ASSIST Project, University Research Co, LLC, Chevy Chase, MD, USA
| | - Amy F Stern
- 3 USAID ASSIST Project, University Research Co, LLC, Chevy Chase, MD, USA
| | - Pierre M Barker
- 1 Institute for Healthcare Improvement, Boston, MA, USA.,4 Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Zamboni K, Baker U, Tyagi M, Schellenberg J, Hill Z, Hanson C. How and under what circumstances do quality improvement collaboratives lead to better outcomes? A systematic review. Implement Sci 2020; 15:27. [PMID: 32366269 PMCID: PMC7199331 DOI: 10.1186/s13012-020-0978-z] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 03/02/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Quality improvement collaboratives are widely used to improve health care in both high-income and low and middle-income settings. Teams from multiple health facilities share learning on a given topic and apply a structured cycle of change testing. Previous systematic reviews reported positive effects on target outcomes, but the role of context and mechanism of change is underexplored. This realist-inspired systematic review aims to analyse contextual factors influencing intended outcomes and to identify how quality improvement collaboratives may result in improved adherence to evidence-based practices. METHODS We built an initial conceptual framework to drive our enquiry, focusing on three context domains: health facility setting; project-specific factors; wider organisational and external factors; and two further domains pertaining to mechanisms: intra-organisational and inter-organisational changes. We systematically searched five databases and grey literature for publications relating to quality improvement collaboratives in a healthcare setting and containing data on context or mechanisms. We analysed and reported findings thematically and refined the programme theory. RESULTS We screened 962 abstracts of which 88 met the inclusion criteria, and we retained 32 for analysis. Adequacy and appropriateness of external support, functionality of quality improvement teams, leadership characteristics and alignment with national systems and priorities may influence outcomes of quality improvement collaboratives, but the strength and quality of the evidence is weak. Participation in quality improvement collaborative activities may improve health professionals' knowledge, problem-solving skills and attitude; teamwork; shared leadership and habits for improvement. Interaction across quality improvement teams may generate normative pressure and opportunities for capacity building and peer recognition. CONCLUSION Our review offers a novel programme theory to unpack the complexity of quality improvement collaboratives by exploring the relationship between context, mechanisms and outcomes. There remains a need for greater use of behaviour change and organisational psychology theory to improve design, adaptation and evaluation of the collaborative quality improvement approach and to test its effectiveness. Further research is needed to determine whether certain contextual factors related to capacity should be a precondition to the quality improvement collaborative approach and to test the emerging programme theory using rigorous research designs.
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Affiliation(s)
- Karen Zamboni
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Ulrika Baker
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Department of Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Mukta Tyagi
- Public Health Foundation, Kavuri Hills, Madhapur, Hyderabad, India
| | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Zelee Hill
- Institute for Global Health, University College London, London, UK
| | - Claudia Hanson
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Perceived Patient Satisfaction and Associated Factors among Psychiatric Patients Who Attend Their Treatment at Outpatient Psychiatry Clinic, Jimma University Medical Center, Southwest Ethiopia, Jimma, 2019. PSYCHIATRY JOURNAL 2020; 2020:6153234. [PMID: 32206668 PMCID: PMC7077051 DOI: 10.1155/2020/6153234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/12/2020] [Indexed: 11/17/2022]
Abstract
Background In health care, patient satisfaction is an attitudinal response and a pillar for quality assurance, but there is reluctance to measure it among mentally ill patients. Satisfied patients become more compliant. However, no study was done in this study area before. Therefore, this study was conducted to determine the magnitude of perceived patient satisfaction and associated factor at Jimma University Medical Center, outpatient psychiatry clinic. Methods Cross-sectional study design was conducted, and systematic random sampling technique was used to get study participants. The 24-item Mental Health Service Satisfaction Scale (a validated tool in Ethiopia) was used to assess patient satisfaction. Data was entered using Epi-data 3.1 and exported to the Statistical Package for the Social Sciences 22.0 for analysis. Linear regression analysis (P < 0.05) was used to identify the association between the outcome and independent variable. Result 414 respondents participated in the study with response rate of 98%. The overall percentage of patient satisfaction was 50.3% (95% CI 48.4%-51.2%). Being male (β = -0.651, 95% CI (-0.969, -0.332)), having secondary and above educational status (β = -0.651, 95% CI (-0.969, -0.332)), having secondary and above educational status (β = -0.651, 95% CI (-0.969, -0.332)), having secondary and above educational status (β = -0.651, 95% CI (-0.969, -0.332)), having secondary and above educational status (β = -0.651, 95% CI (-0.969, -0.332)), having secondary and above educational status (β = -0.651, 95% CI (-0.969, -0.332)), having secondary and above educational status (β = -0.651, 95% CI (-0.969, -0.332)), having secondary and above educational status (β = -0.651, 95% CI (-0.969, -0.332)), having secondary and above educational status (β = -0.651, 95% CI (-0.969, -0.332)), having secondary and above educational status (Conclusion and Recommendation. This study found that half of the study participants are satisfied with the service. Distance from the hospital, current substance use, waiting time, and having good social support were identified as modifiable factors that can be improved through working with stakeholders to increase patient satisfaction.
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Boehmer KR, Holland DE, Vanderboom CE. Identifying and addressing gaps in the implementation of a community care team for care of Patients with multiple chronic conditions. BMC Health Serv Res 2019; 19:843. [PMID: 31730457 PMCID: PMC6858771 DOI: 10.1186/s12913-019-4709-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 11/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with multiple chronic conditions represent a growing segment for healthcare. The Chronic Care Model (CCM) supports leveraging community programs to support patients and their caregivers overwhelmed by their treatment plans, but this component has lagged behind the adoption of other model elements. Community Care Teams (CCTs) leverage partnerships between healthcare delivery systems and existing community programs to address this deficiency. There remains a gap in moving CCTs from pilot phase to sustainable full-scale programs. Therefore, the purpose of this study was to identify the cognitive and structural needs of clinicians, social workers, and nurse care coordinators to effectively refer appropriate patients to the CCT and the value these stakeholders derived from referring to and receiving feedback from the CCT. We then sought to translate this knowledge into an implementation toolkit to bridge implementation gaps. METHODS Our research process was guided by the Assess, Innovate, Develop, Engage, and Devolve (AIDED) implementation science framework. During the Assess process we conducted chart reviews, interviews, and observations and in Innovate and Develop phases, we worked with stakeholders to develop an implementation toolkit. The Engage and Devolve phases disseminate the toolkit through social networks of clinical champions and are ongoing. RESULTS We completed 14 chart reviews, 11 interviews, and 2 observations. From these, facilitators and barriers to CCT referrals and patient re-integration into primary care were identified. These insights informed the development of a toolkit with seven components to address implementation gaps identified by the researchers and stakeholders. CONCLUSION We identified implementation gaps to sustaining the CCT program, a community-healthcare partnership, and used this information to build an implementation toolkit. We established liaisons with clinical champions to diffuse this information. The AIDED Model, not previously used in high-income countries' primary care settings, proved adaptable and useful.
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Affiliation(s)
- Kasey R Boehmer
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Diane E Holland
- Nursing Research Division, Department of Nursing, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Catherine E Vanderboom
- Nursing Research Division, Department of Nursing, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Hossain MS, Kiumarsi S, Yahya S, Hashemi S. The effect of healthcare management and physicians’ loyalty. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2019. [DOI: 10.1080/20479700.2019.1620479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Md Shamim Hossain
- Graduate School of Business, Universiti Sains Malaysia, USM Penang, Malaysia
- Management Studies Department, Faculty of Business Studies, University of Rajshahi, Rajshahi, Bangladesh
| | - Shaian Kiumarsi
- Graduate School of Business, Universiti Sains Malaysia, USM Penang, Malaysia
| | - Sofri Yahya
- Graduate School of Business, Universiti Sains Malaysia, USM Penang, Malaysia
| | - Shiva Hashemi
- School of Housing, Building and Planning (HBP), (USM), Penang, Malaysia
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11
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Linnander EL, Mantopoulos JM, Allen N, Nembhard IM, Bradley EH. Professionalizing Healthcare Management: A Descriptive Case Study. Int J Health Policy Manag 2017; 6:555-560. [PMID: 28949471 PMCID: PMC5627783 DOI: 10.15171/ijhpm.2017.40] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/18/2017] [Indexed: 11/29/2022] Open
Abstract
Despite international recognition of the importance of healthcare management in the development of high-performing systems, the path by which countries may develop and sustain a professional healthcare management workforce has not been articulated. Accordingly, we sought to identify a set of common themes in the establishment of a professional workforce of healthcare managers in low- and middle-income country (LMIC) settings using a descriptive case study approach. We draw on a historical analysis of the development of this profession in the United States and Ethiopia to identify five common themes in the professionalization of healthcare management: (1) a country context in which healthcare management is demanded; (2) a national framework that elevates a professional management role; (3) standards for healthcare management, and a monitoring function to promote adherence to standards; (4) a graduatelevel educational path to ensure a pipeline of well-prepared healthcare managers; and (5) professional associations to sustain and advance the field. These five components can to inform the creation of a long-term national strategy for the development of a professional cadre of heathcare managers in LMIC settings.
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Affiliation(s)
- Erika L Linnander
- Yale School of Public Health, Yale University, New Haven, CT, USA.,Yale Global Health Leadership Institute, Yale University, New Haven, CT, USA
| | - Jeannie M Mantopoulos
- Yale School of Public Health, Yale University, New Haven, CT, USA.,Yale Global Health Leadership Institute, Yale University, New Haven, CT, USA
| | - Nikole Allen
- Yale School of Public Health, Yale University, New Haven, CT, USA.,Yale Global Health Leadership Institute, Yale University, New Haven, CT, USA
| | - Ingrid M Nembhard
- Yale School of Public Health, Yale University, New Haven, CT, USA.,Yale Global Health Leadership Institute, Yale University, New Haven, CT, USA
| | - Elizabeth H Bradley
- Yale School of Public Health, Yale University, New Haven, CT, USA.,Yale Global Health Leadership Institute, Yale University, New Haven, CT, USA
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Abstract
Each year, approximately 2.7 million babies die during the neonatal period; more than 90% of these deaths occur in developing countries, largely from preventable causes. The known, evidence-based, simple, low-cost interventions that may improve neonatal survival often have low or unknown baseline coverage rates. Gaps in coverage of essential interventions and in quality of care may be amenable to improvement strategies. However, often these gaps are not easily identified. A variety of international organizations have recommended key indicators of quality and established roadmaps for improving neonatal outcomes. Quality improvement at the facility level is an area for future investment.
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Affiliation(s)
- Danielle Yerdon Ehret
- Department of Pediatrics, Robert Larner M.D. College of Medicine at the University of Vermont, 89 Beaumont Avenue, Burlington, VT 05405, USA; Vermont Oxford Network, 33 Kilburn Street, Burlington, VT 05401, USA.
| | - Jacquelyn Knupp Patterson
- Department of Pediatrics, University of North Carolina School of Medicine, 321 S. Columbia Street, Chapel Hill, NC 27516, USA
| | - Carl Lewis Bose
- Department of Pediatrics, University of North Carolina School of Medicine, 321 S. Columbia Street, Chapel Hill, NC 27516, USA
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Canavan ME, Brault MA, Tatek D, Burssa D, Teshome A, Linnander E, Bradley EH. Maternal and neonatal services in Ethiopia: measuring and improving quality. Bull World Health Organ 2017; 95:473-477. [PMID: 28603314 PMCID: PMC5463811 DOI: 10.2471/blt.16.178806] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 12/06/2016] [Accepted: 01/30/2017] [Indexed: 11/29/2022] Open
Abstract
Problem Maternal and neonatal mortality remains high in low- and middle-income countries, with poor quality of intrapartum care as a barrier to further progress. Approach We developed and tested a method of measuring the quality of maternal and neonatal care that could be embedded in a larger national performance management initiative. The tool used direct observations and medical record reviews to score quality in nine domains of intrapartum care. We piloted and evaluated the tool in visits to the 18 lead hospitals that have responsibility to promote and coordinate quality improvement efforts within a hospital cluster in Ethiopia. Between baseline and follow-up assessments, staff from a national quality collaborative alliance provided hospital-based training on labour and delivery services. Local setting Ethiopia has invested in hospital quality improvement for more than a decade and this tool was integrated into existing quality improvement mechanisms within lead hospitals, with the potential for scale-up to all government hospitals. Relevant changes Significant improvements in quality of intrapartum care were detected from baseline (June–July 2015) to follow-up (February–March 2016) in targeted hospitals. The overall mean quality score rose from 65.6 (standard deviation, SD: 10.5) to 91.2 (SD: 12.4) out of 110 items (P < 0.001). Lessons learnt The method was feasible, requiring a total of 3 days and two to three trained data collectors per hospital visit. It produced data that detected substantial changes made during 8 months of national hospital quality improvement efforts. With additional replication studies, this tool may be useful in other low- and middle-income countries.
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Affiliation(s)
- Maureen E Canavan
- Global Health Leadership Institute, Yale University School of Public Health, 2 Church Street South, New Haven, Connecticut, 06519, United States of America
| | - Marie A Brault
- Global Health Leadership Institute, Yale University School of Public Health, 2 Church Street South, New Haven, Connecticut, 06519, United States of America
| | - Dawit Tatek
- Global Health Leadership Institute, Yale University School of Public Health, 2 Church Street South, New Haven, Connecticut, 06519, United States of America
| | | | | | - Erika Linnander
- Global Health Leadership Institute, Yale University School of Public Health, 2 Church Street South, New Haven, Connecticut, 06519, United States of America
| | - Elizabeth H Bradley
- Global Health Leadership Institute, Yale University School of Public Health, 2 Church Street South, New Haven, Connecticut, 06519, United States of America
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