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de Beijer AE, Hansen TB, Stilling M, Jakobsen F. Staff perception of interprofessional working relationships after a work redesign intervention in a Danish orthopaedic hand unit outpatient clinic. J Interprof Care 2017; 30:149-55. [PMID: 27026187 DOI: 10.3109/13561820.2015.1120714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
There is evidence that clinical pathways improve quality of care; however, knowledge is limited concerning the influence on and the benefits experienced by the interprofessional teams working with these pathways. Our working methods in a hand unit in an orthopaedic outpatient clinic in Denmark were redesigned to include, among other changes, the introduction of clinical pathways. Changes included standardising treatment and communication methods, delegating tasks from medical specialists to nurses, and providing nurses with their own consultation room. Using focus group interviews before and after the implementation of the new working methods, we investigated staff-perceived experiences of the effects on working relationships and the utilisation of professional skills and attitudes, resulting from the mentioned change in working methods. The results were changes in daily communication methods among healthcare staff and improvements in the actual communication and collaborative problem solving skills concerning standard patients with simple hand pathology; however, there are still challenges for patients with more complex hand pathology. Though this new interprofessional arrangement improves the use of nurse and medical specialist professional competencies, it also requires a high degree of trust among the team members.
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Affiliation(s)
- Anke Elisabeth de Beijer
- a Orthopaedic Research Unit, University Clinic for Hand, Hip and Knee Surgery, Regional Hospital Holstebro , Holstebro , Denmark
| | - Torben Bæk Hansen
- a Orthopaedic Research Unit, University Clinic for Hand, Hip and Knee Surgery, Regional Hospital Holstebro , Holstebro , Denmark.,b Department of Clinical Medicine , University of Aarhus , Aarhus , Denmark
| | - Maiken Stilling
- a Orthopaedic Research Unit, University Clinic for Hand, Hip and Knee Surgery, Regional Hospital Holstebro , Holstebro , Denmark.,b Department of Clinical Medicine , University of Aarhus , Aarhus , Denmark
| | - Flemming Jakobsen
- a Orthopaedic Research Unit, University Clinic for Hand, Hip and Knee Surgery, Regional Hospital Holstebro , Holstebro , Denmark
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Seys D, Deneckere S, Sermeus W, Van Gerven E, Panella M, Bruyneel L, Mutsvari T, Bejarano RC, Kul S, Vanhaecht K. The Care Process Self-Evaluation Tool: a valid and reliable instrument for measuring care process organization of health care teams. BMC Health Serv Res 2013; 13:325. [PMID: 23958206 PMCID: PMC3751913 DOI: 10.1186/1472-6963-13-325] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 08/15/2013] [Indexed: 11/10/2022] Open
Abstract
Background Patient safety can be increased by improving the organization of care. A tool that evaluates the actual organization of care, as perceived by multidisciplinary teams, is the Care Process Self-Evaluation Tool (CPSET). CPSET was developed in 2007 and includes 29 items in five subscales: (a) patient-focused organization, (b) coordination of the care process, (c) collaboration with primary care, (d) communication with patients and family, and (e) follow-up of the care process. The goal of the present study was to further evaluate the psychometric properties of the CPSET at the team and hospital levels and to compile a cutoff score table. Methods The psychometric properties of the CPSET were assessed in a multicenter study in Belgium and the Netherlands. In total, 3139 team members from 114 hospitals participated. Psychometric properties were evaluated by using confirmatory factor analysis (CFA), Cronbach’s alpha, interclass correlation coefficients (ICCs), Kruskall-Wallis test, and Mann–Whitney test. For the cutoff score table, percentiles were used. Demographic variables were also evaluated. Results CFA showed a good model fit: a normed fit index of 0.93, a comparative fit index of 0.94, an adjusted goodness-of-fit index of 0.87, and a root mean square error of approximation of 0.06. Cronbach’s alpha values were between 0.869 and 0.950. The team-level ICCs varied between 0.127 and 0.232 and were higher than those at the hospital level (0.071-0.151). Male team members scored significantly higher than females on 2 of the 5 subscales and on the overall CPSET. There were also significant differences among age groups. Medical doctors scored significantly higher on 4 of the 5 subscales and on the overall CPSET. Coordinators of care processes scored significantly lower on 2 of the 5 subscales and on the overall CPSET. Cutoff scores for all subscales and the overall CPSET were calculated. Conclusions The CPSET is a valid and reliable instrument for health care teams to measure the extent care processes are organized. The cutoff table permits teams to compare how they perceive the organization of their care process relative to other teams.
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Affiliation(s)
- Deborah Seys
- Department of Public Health, Center for Health Services and Nursing Research, University of Leuven, Kapucijnenvoer 35 4th Floor, Leuven B-3000, Belgium
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Better Interprofessional Teamwork, Higher Level of Organized Care, and Lower Risk of Burnout in Acute Health Care Teams Using Care Pathways. Med Care 2013; 51:99-107. [DOI: 10.1097/mlr.0b013e3182763312] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Deneckere S, Euwema M, Van Herck P, Lodewijckx C, Panella M, Sermeus W, Vanhaecht K. Care pathways lead to better teamwork: results of a systematic review. Soc Sci Med 2012; 75:264-8. [PMID: 22560883 DOI: 10.1016/j.socscimed.2012.02.060] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 09/06/2011] [Accepted: 02/23/2012] [Indexed: 11/25/2022]
Abstract
Care pathways are often said to promote interprofessional teamwork. As no systematic review on pathway effectiveness has ever focused on how care pathways promote teamwork, the objective of this review was to study this relationship. We performed an extensive search of electronic databases and identified 26 relevant studies. In our analysis of these studies we identified 20 team indicators and found that care pathways positively affected 17 of these indicators. Most frequently positive effects were found on staff knowledge, interprofessional documentation, team communication and team relations. However, the level of evidence was rather low. We found Level II evidence for improved interprofessional documentation. We also found Level II evidence for increased workload; improved actual versus planned team size; and improved continuity of care. The studies most frequently mentioned the need for a multidisciplinary approach and educational training sessions in order for pathways to be successful. The systematic review revealed that care pathways have the potential to support interprofessional teams in enhancing teamwork. Necessary conditions are a context that supports teamwork and including appropriate active pathway components that can mediate an effect on team processes. To achieve this, each care pathway requires a clearly defined team approach customized to the individual teams' needs.
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Affiliation(s)
- Svin Deneckere
- Public Health School, Faculty of Medicine, KU Leuven, Belgium.
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Chilingerian JA, Sherman HD. Health-Care Applications: From Hospitals to Physicians, from Productive Efficiency to Quality Frontiers. INTERNATIONAL SERIES IN OPERATIONS RESEARCH & MANAGEMENT SCIENCE 2011. [DOI: 10.1007/978-1-4419-6151-8_16] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Deneckere S, Robyns N, Vanhaecht K, Euwema M, Panella M, Lodewijckx C, Leigheb F, Sermeus W. Indicators for Follow-Up of Multidisciplinary Teamwork in Care Processes. Eval Health Prof 2010; 34:258-77. [DOI: 10.1177/0163278710393736] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In order to study the impact of interventions on multidisciplinary teamwork in care processes, relevant indicators need to be defined. In the present study, the authors performed a Delphi survey of a purposively selected expert panel consisting of scientific researchers and hospital managers. Thirty-six experts from 13 countries participated. Each participant rated a list of team indicators on a scale of 1–6. Consensus was sought in two consecutive rounds. The content validity index (CVI) varied from 8% to 92%. A final list of 19 indicators was generated: 5 on team context/structure, 8 on team process, and 6 on team outcomes. Most relevant team indicators were as follows: “team relations,” “quality of team leadership,” “culture/climate for teamwork,” “team perceived coordination of the care process,” and “team vision.” Scientific researchers and hospital managers that want to study and improve multidisciplinary teamwork in care processes should primarily focus on these team indicators.
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Affiliation(s)
- Svin Deneckere
- Faculty of Medicine, Catholic University Leuven, Belgium
| | | | - Kris Vanhaecht
- Faculty of Medicine, Catholic University Leuven, Belgium
- European Pathway Association, Catholic University of Leuven, Belgium
| | - Martin Euwema
- Center for Organization and Personnel Psychology, Catholic University Leuven, Belgium
| | - Massimiliano Panella
- European Pathway Association, Catholic University of Leuven, Belgium
- Faculty of Medicine, Amedeo Avogadro University of Eastern Piedmont, Italy
| | | | - Fabrizio Leigheb
- Faculty of Medicine, Amedeo Avogadro University of Eastern Piedmont, Italy
| | - Walter Sermeus
- Faculty of Medicine, Catholic University Leuven, Belgium
- European Pathway Association, Catholic University of Leuven, Belgium
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Vanhaecht K, Panella M, van Zelm R, Sermeus W. An overview on the history and concept of care pathways as complex interventions. ACTA ACUST UNITED AC 2010. [DOI: 10.1258/jicp.2010.010019] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Care pathways, also known as clinical pathways, critical pathways or integrated care pathways, are used all over the world. Although they are used internationally, there are still a large number of misunderstandings. The goal of this paper is to provide an overview on the history of pathways and how pathways are actually perceived and defined. Pathways are more than just a document in the patient record. They are a concept for making patient-focused care operational and supporting the modelling of patient groups with different levels of predictability. Pathways are a method within the field of continuous quality improvement and are used in daily practice as a product in the patient record. This paper explains these different issues and provides an extensive list of references that should support pathway facilitators, clinicians, managers and policy-makers in their search for excellence.
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Wallack SS, Thomas CP, Martin TC, Chilingerian J, Reif S. Substance abuse treatment organizations as mediators of social policy: slowing the adoption of a congressionally approved medication. J Behav Health Serv Res 2008; 37:64-78. [PMID: 18668369 DOI: 10.1007/s11414-008-9132-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Accepted: 05/21/2008] [Indexed: 11/29/2022]
Abstract
Most substance abuse treatment occurs in outpatient treatment centers, necessitating an understanding of what motivates organizations to adopt new treatment modalities. Tichy's framework of organizations as being comprised of three intertwined internal systems (technical, cultural, and political) was used to explain treatment organizations' slow adoption of buprenorphine, a new medication for opiate dependence. Primary data were collected from substance abuse treatment organizations in four of the ten metropolitan areas with the largest number of heroin users. Only about one fifth offered buprenorphine. All three internal systems were important determinants of buprenorphine adoption in our multivariate model. However, the cultural system, measured by attitude toward medications, was a necessary condition for adoption. Health policies designed to encourage adoption of evidence-based performance measures typically focus on the technical system of organizations. These findings suggest that such policies would be more effective if they incorporate an understanding of all three internal systems.
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Affiliation(s)
- Stanley S Wallack
- Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454, USA.
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Pai CW, Ozcan YA, Jiang HJ. Regional variation in physician practice pattern: an examination of technical and cost efficiency for treating sinusitis. J Med Syst 2000; 24:103-17. [PMID: 10895424 DOI: 10.1023/a:1005568814163] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE An examination of the physician efficiency and resulting cost patterns by region. DATA SOURCES Virginia Medicaid sinusitis related claims for 1993 were aggregated to physician level (n = 178), and Area Resources File for 1993 was used to identify regions for evaluation. STUDY DESIGN The best practice performance in the usage of five resources (i.e., primary care physician visits, referral services, emergency room visits, prescriptions, laboratory tests) was identified using Data Envelopment Analysis (DEA). Five regions in Virginia were identified according to regional planning to evaluate the variation in efficiency across these regions. PRINCIPAL FINDINGS Inefficient physicians consumed significantly more resources and were 48% more costly than efficient physicians. Substantial regional variation was found and mainly attributed to the differences in use of prescriptions and laboratory procedures. Urban-rural discrepancy may explain part of the variation. CONCLUSIONS As this study reveals the existence of substantial variation in physician efficiency, actions should be taken to minimize the variation that is more affected by personal and structural factors. For example, information on efficient use of resources and corresponding patient outcomes can be disseminated to the attending physicians. Educational workshops can be conducted to allow sharing of experience between efficient and inefficient physicians. Efforts should also be directed to help inefficient physicians to adhere to practice guidelines.
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Affiliation(s)
- C W Pai
- Department of Health Administration, Virginia Commonwealth University, Richmond 23298-0203, USA
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