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Pavlova A, Paine SJ, Tuato'o A, Consedine NS. Healthcare compassion interventions co-design and feasibility inquiry with clinicians and healthcare leaders in Aotearoa/New Zealand. Soc Sci Med 2024; 360:117327. [PMID: 39299155 DOI: 10.1016/j.socscimed.2024.117327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/24/2024] [Accepted: 09/09/2024] [Indexed: 09/22/2024]
Abstract
Compassion in healthcare is valued by patients, healthcare professionals (HCPs), and leads to improved outcomes. Notwithstanding reports of systemic failings in the provision of compassionate care, research regarding ways to intervene remains limited. The aim of this study is to clarify compassion intervention needs in a diverse HCP workforce in public secondary healthcare in Aotearoa New Zealand (NZ) by utilising a co-design process. The co-design process involved a series of workshops with clinicians followed by in-depth interviews with healthcare leaders to derive input regarding feasibility and implementation. Reflexive thematic analysis was used to analyze the data. There was a great deal of interest in compassion interventions from healthcare professionals and leaders. However, for compassion interventions to be acceptable, feasible, and effective, compassion interventions design should be reimagined and reflected at each step of interventional design and implementation and span across organizational levels. Namely, the results of the study showed the preference for non-individual focused multi-level interventions to build bridges and connections. The desired compassion intervention components included practising connecting with others' humanity, improving compassion knowledge and relational and reflective skills, and cultural safety and anti-racism training. Experiential training embedded in models of cultural dialogue was the preferred interventional modality. Prioritising leadership as an intervention site was suggested to improve leadership's buy-in of compassion interventions and possibly serve as a starting point for transforming the broader culture, reviving interconnectedness in a healthcare system described as fragmented, disconnected, and alienating with compassion also acting as an equalizer of power.
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Affiliation(s)
- Alina Pavlova
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand.
| | - Sarah-Jane Paine
- Te Kupenga Hauora Maori, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Amelie Tuato'o
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand; Te Kupenga Hauora Maori, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Nathan S Consedine
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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Thusini S, Milenova M, Nahabedian N, Grey B, Soukup T, Chua KC, Henderson C. The development of the concept of return-on-investment from large-scale quality improvement programmes in healthcare: an integrative systematic literature review. BMC Health Serv Res 2022; 22:1492. [PMID: 36476622 PMCID: PMC9728007 DOI: 10.1186/s12913-022-08832-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Return on Investment (ROI) is increasingly being used to evaluate financial benefits from healthcare Quality Improvement (QI). ROI is traditionally used to evaluate investment performance in the commercial field. Little is known about ROI in healthcare. The aim of this systematic review was to analyse and develop ROI as a concept and develop a ROI conceptual framework for large-scale healthcare QI programmes. METHODS We searched Medline, Embase, Global health, PsycInfo, EconLit, NHS EED, Web of Science, Google Scholar using ROI or returns-on-investment concepts (e.g., cost-benefit, cost-effectiveness, value). We combined this terms with healthcare and QI. Included articles discussed at least three organisational QI benefits, including financial or patient benefits. We synthesised the different ways in which ROI or return-on-investment concepts were used and discussed by the QI literature; first the economically focused, then the non-economically focused QI literature. We then integrated these literatures to summarise their combined views. RESULTS We retrieved 10 428 articles. One hundred and two (102) articles were selected for full text screening. Of these 34 were excluded and 68 included. The included articles were QI economic, effectiveness, process, and impact evaluations as well as reports and conceptual literature. Fifteen of 68 articles were directly focused on QI programme economic outcomes. Of these, only four focused on ROI. ROI related concepts in this group included cost-effectiveness, cost-benefit, ROI, cost-saving, cost-reduction, and cost-avoidance. The remaining articles mainly mentioned efficiency, productivity, value, or benefits. Financial outcomes were not the main goal of QI programmes. We found that the ROI concept in healthcare QI aligned with the concepts of value and benefit, both monetary and non-monetary. CONCLUSION Our analysis of the reviewed literature indicates that ROI in QI is conceptualised as value or benefit as demonstrated through a combination of significant outcomes for one or more stakeholders in healthcare organisations. As such, organisations at different developmental stages can deduce benefits that are relevant and legitimate as per their contextual needs. TRIAL REGISTRATION Review registration: PROSPERO; CRD42021236948.
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Affiliation(s)
| | | | | | - Barbara Grey
- South London and Maudsley NHS Foundation Trust, London, UK
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Thusini S, Milenova M, Nahabedian N, Grey B, Soukup T, Henderson C. Identifying and understanding benefits associated with return-on-investment from large-scale healthcare Quality Improvement programmes: an integrative systematic literature review. BMC Health Serv Res 2022; 22:1083. [PMID: 36002852 PMCID: PMC9404657 DOI: 10.1186/s12913-022-08171-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/08/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND We previously developed a Quality Improvement (QI) Return-on-Investment (ROI) conceptual framework for large-scale healthcare QI programmes. We defined ROI as any monetary or non-monetary value or benefit derived from QI. We called the framework the QI-ROI conceptual framework. The current study describes the different categories of benefits covered by this framework and explores the relationships between these benefits. METHODS We searched Medline, Embase, Global health, PsycInfo, EconLit, NHS EED, Web of Science, Google Scholar, organisational journals, and citations, using ROI or returns-on-investment concepts (e.g., cost-benefit, cost-effectiveness, value) combined with healthcare and QI. Our analysis was informed by Complexity Theory in view of the complexity of large QI programmes. We used Framework analysis to analyse the data using a preliminary ROI conceptual framework that was based on organisational obligations towards its stakeholders. Included articles discussed at least three organisational benefits towards these obligations, with at least one financial or patient benefit. We synthesized the different QI benefits discussed. RESULTS We retrieved 10 428 articles. One hundred and two (102) articles were selected for full text screening. Of these 34 were excluded and 68 included. Included articles were QI economic, effectiveness, process, and impact evaluations as well as conceptual literature. Based on these literatures, we reviewed and updated our QI-ROI conceptual framework from our first study. Our QI-ROI conceptual framework consists of four categories: 1) organisational performance, 2) organisational development, 3) external outcomes, and 4) unintended outcomes (positive and negative). We found that QI benefits are interlinked, and that ROI in large-scale QI is not merely an end-outcome; there are earlier benefits that matter to organisations that contribute to overall ROI. Organisations also found positive aspects of negative unintended consequences, such as learning from failed QI. DISCUSSION AND CONCLUSION Our analysis indicated that the QI-ROI conceptual framework is made-up of multi-faceted and interconnected benefits from large-scale QI programmes. One or more of these may be desirable depending on each organisation's goals and objectives, as well as stage of development. As such, it is possible for organisations to deduce incremental benefits or returns-on-investments throughout a programme lifecycle that are relevant and legitimate.
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Affiliation(s)
| | | | | | - Barbara Grey
- South London and Maudsley NHS Foundation Trust, London, UK
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Cannaby AM, Carter V, Hoe T, Strobel S, Tafti EA, Baker R, Nash C, Whatley V, Gray R. The feasibility and validity of using a real time location system (RTLS) to measure bedside contact time. J Res Nurs 2022; 27:421-433. [PMID: 36131691 PMCID: PMC9483226 DOI: 10.1177/17449871211016169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
Background The association between the nurse-to-patient ratio and patient outcomes has been extensively investigated. Real time location systems have the potential capability of measuring the actual amount of bedside contact patients receive. Aims This study aimed to determine the feasibility and accuracy of real time location systems as a measure of the amount of contact time that nurses spent in the patients' bed space. Methods An exploratory, observational, feasibility study was designed to compare the accuracy of data collection between manual observation performed by a researcher and real time location systems data capture capability. Four nurses participated in the study, which took place in 2019 on two hospital wards. They were observed by a researcher while carrying out their work activities for a total of 230 minutes. The amount of time the nurses spent in the patients' bed space was recorded in 10-minute blocks of time and the real time location systems data were extracted for the same nurse at the time of observation. Data were then analysed for the level of agreement between the observed and the real time location systems measured data, descriptively and graphically using a kernel density and a scatter plot. Results The difference (in minutes) between researcher observed and real time location systems measured data for the 23, 10-minute observation blocks ranged from zero (complete agreement) to 5 minutes. The mean difference between the researcher observed and real time location systems time in the patients' bed space was one minute (10% of the time). On average, real time location systems measured time in the bed space was longer than the researcher observed time. Conclusions There were good levels of agreement between researcher observation and real time location systems data of the time nurses spend at the bedside. This study confirms that it is feasible to use real time location systems as an accurate measure of the amount of time nurses spend at the patients' bedside.
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Affiliation(s)
- Ann-Marie Cannaby
- Chief Nurse, The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, UK
| | - Vanda Carter
- Vanda Carter, Nursing Research and Quality Team, Holly Bush House, New Cross Hospital, Wolverhampton, West Midlands WV10 0QP, UK.
| | - Thomas Hoe
- Economist Researcher/ Consultant, The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, UK
| | - Stephenson Strobel
- Economics Candidate, Cornell University Department of Policy Analysis and Management, Ithaca, NY
| | - Elena Ashtari Tafti
- PhD in Economics Candidate, University College London, London, UK; The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, UK
| | - Rephna Baker
- Associate Chief Nurse,The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, UK
| | - Clare Nash
- Senior Procurement Nurse, The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, UK
| | - Vanessa Whatley
- Deputy CNO, The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, UK
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Hildebrandt MG, Kidholm K, Pedersen JE, Naghavi-Behzad M, Knudsen T, Krag A, Ryg J, Gerke O, Lassen AT, Ellingsen T, Ditzel HJ, Andersen V, Langhoff A, Nielsen G, Masud T, Münster AMB, Kyvik K, Brixen K. How to increase value and reduce waste in research: initial experiences of applying Lean thinking and visual management in research leadership. BMJ Open 2022; 12:e058179. [PMID: 36691235 PMCID: PMC9171225 DOI: 10.1136/bmjopen-2021-058179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 04/04/2022] [Indexed: 01/27/2023] Open
Abstract
Waste in research has been well documented, but initiatives to reduce it are scarce. Here, we share our initial experiences of implementing Lean thinking and visual management into hospital research units in the Region of Southern Denmark. A Transformation Guiding Team (TGT) anchored in the top management was established with participation from leaders, researchers and patient representatives. The role of the TGT was to implement Lean methods, considering patients as primary end-users of the research results. This is in line with an explicit decision on setting patient values first in clinical settings at participating hospitals. The leaders of the research units were instructed in Lean thinking and Lean methods during a five-module course focusing on increasing value and reducing waste in research production. Initial experiences were that Lean tools could create a patient-centred vision that through visual management could identify waste in work processes. Concerns were lack of evidence for using Lean methods in research leadership and that the model itself could be a time consumer. Some lessons learnt were that adding Lean tools in research leadership should not just provide increased research productivity, but also improve other important key performance indicators such as quality of research and patient-relevant results. We intend to evaluate the value of the initiative by follow-up research and publish the outcome of key behavioural and key performance indicators.
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Affiliation(s)
| | - Kristian Kidholm
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Jørgen Ejler Pedersen
- Department of Quality and Patient Collaboration, Odense University Hospital, Odense, Denmark
| | | | - Torben Knudsen
- Department of Gastroenterology, Southwest Jutland Hospital, Esbjerg, Denmark
| | - Aleksander Krag
- Department of Gastroenterology, Odense University Hospital, Odense, Denmark
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | | | - Torkell Ellingsen
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Henrik J Ditzel
- Oncology Research Unit, Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Vibeke Andersen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Annette Langhoff
- The Research Committee, Odense University Hospital, Odense, Denmark
| | - Gert Nielsen
- The Research Committee, Odense University Hospital, Odense, Denmark
| | - Tahir Masud
- Department of Geriatric, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Kirsten Kyvik
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Kim Brixen
- Board of Direction, Odense University Hospital, Odense, Denmark
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