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van Klaveren LM, Geukers V, de Vos R. Care complexity, perceptions of complexity and preferences for interprofessional collaboration: an analysis of relationships and social networks in paediatrics. BMC MEDICAL EDUCATION 2024; 24:334. [PMID: 38528513 DOI: 10.1186/s12909-024-05304-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/13/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND In the context of increasingly intricate healthcare systems, professionals are compelled to collaborate within dynamically changing interprofessional teams. Moreover, they must adapt these collaborative processes to effectively and efficiently manage the evolving complexity of care needs. It remains unclear how professionals determine care complexity and relate this complexity to their preferences for interprofessional collaboration (IPC). This study investigated the relationships between care complexity, professionals' perceived complexity and IPC preferences, and examined the variation in individual and team characteristics of IPC-practices across different levels of complexity in paediatric care. METHODS In an online questionnaire, 123 healthcare professionals working at an academic tertiary children's hospital scored their perceptions of complexity and preferences for IPC. They also selected family and various professions as members of the interprofessional (IP-) team based on thirteen patient cases. We employed conjoint analysis to systematically model the complexity of case descriptions across the five domains of the International Classification of Functioning, Disability and Health (ICF). Additionally, we applied social network analysis to identify important professions, crucial connectors and influential professions in the IP-team, and to describe the cohesiveness of IP-teams. RESULTS Modelled case complexity, professionals' perceived complexity and IPC preferences were positively associated. We found large inter-individual variations in the degree of these associations. Social network analysis revealed that the importance and influence of professions was more equally distributed when case complexity increased. Depending on the context and complexity of the case, different professions (e.g. medical doctors, social professionals, extramural professionals) were considered to be more crucial connectors within the IP-team. Furthermore, team cohesion was positively associated with modelled and perceived care complexity. CONCLUSIONS In conclusion, our study contributes to the existing knowledge by integrating task-specific insights and broadening the use of conjoint and social network analysis in the context of IPC. The findings substantiate the contingency theory that relates characteristics of IPC to care complexity, offering quantified insights into how IP-teams adapt to situational needs. This understanding of relationships and variations within IPC holds crucial implications for designing targeted interventions in both clinical and health profession education contexts. Consequently, it contributes to advancements in healthcare systems.
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Affiliation(s)
- Lisa-Maria van Klaveren
- Institute for Education and Training, Amsterdam Universities Medical Centres location University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands.
| | - Vincent Geukers
- Emma Children's Hospital, Amsterdam Universities Medical Centres location University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands
| | - Rien de Vos
- Institute for Education and Training, Amsterdam Universities Medical Centres location University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands
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Implementing structured follow-up of neonatal and paediatric patients: an evaluation of three university hospital case studies using the functional resonance analysis method. BMC Health Serv Res 2022; 22:191. [PMID: 35152890 PMCID: PMC8842913 DOI: 10.1186/s12913-022-07537-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 01/24/2022] [Indexed: 12/02/2022] Open
Abstract
Background In complex critical neonatal and paediatric clinical practice, little is known about long-term patient outcomes and what follow-up care is most valuable for patients. Emma Children’s Hospital, Amsterdam UMC (Netherlands), implemented a follow-up programme called Follow Me for neonatal and paediatric patient groups, to gain more insight into long-term outcomes and to use such outcomes to implement a learning cycle for clinical practice, improve follow-up care and facilitate research. Three departments initiated re-engineering and change processes. Each introduced multidisciplinary approaches to long-term follow-up, including regular standardised check-ups for defined age groups, based on medical indicators, developmental progress, and psychosocial outcomes in patients and their families. This research evaluates the implementation of the three follow-up programmes, comparing predefined procedures (work-as-imagined) with how the programmes were implemented in practice (work-as-done). Methods This study was conducted in 2019–2020 in the outpatient settings of the neonatal intensive care, paediatric intensive care and paediatric surgery departments of Emma Children’s Hospital. It focused on the organisational structure of the follow-up care. The functional resonance analysis method (FRAM) was applied, using documentary analysis, semi-structured interviews, observations and feedback sessions. Results One work-as-imagined model and four work-as-done models were described. The results showed vast data collection on medical, developmental and psychosocial indicators in all work-as-done models; however, process indicators for programme effectiveness and performance were missing. In practice there was a diverse allocation of roles and responsibilities and their interrelations to create a multidisciplinary team; there was no one-size-fits-all across the different departments. Although control and feedback loops for long-term outcomes were specified with respect to the follow-up groups within the programmes, they were found to overlap and misalign with other internal and external long-term outcome monitoring practices. Conclusion Implementing structured long-term follow-up may provide insights for improving daily practice and follow-up care, with the precondition of standardised measurements. Lessons learned from practice are (1) to address fragmentation in data collection and storage, (2) to incorporate the diverse ways to create a multidisciplinary team in practice, and (3) to include timely actionable indicators on programme effectiveness and performance, alongside medical, developmental and psychosocial indicators. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07537-x.
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Liu Y, Li X, Ma L, Wang Y. Mapping theme trends and knowledge structures of dignity in nursing: A quantitative and co-word biclustering analysis. J Adv Nurs 2021; 78:1980-1989. [PMID: 34812513 DOI: 10.1111/jan.15097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 09/21/2021] [Accepted: 11/04/2021] [Indexed: 01/31/2023]
Abstract
AIM The present study aims to explore the research hot spots, development trends and knowledge structure of dignity in the nursing field. DESIGN Quantitative and co-word biclustering analysis were used. METHODS Articles on dignity care published from 01 Jan 2011 to 31 Dec 2020, were retrieved from PubMed. The extracted Medical Subject Headings (MeSH) terms were quantitatively analysed using Bibliographic Item Co-occurrence Matrix Builder software. To determine the hot spots, a biclustering analysis was completed using gCluto1.0 software. A strategic diagram and a social network analysis (SNA) were used to reveal trends in the theme and knowledge structure. RESULTS In the parameters of the retrieval strategy, a total of 1977 papers were included in the present study. Amongst all the extracted MeSH terms, 27 high-frequency MeSH terms were identified, and the hot spots were grouped into five categories. These were namely dignity in: (1) dementia care, (2) palliative care, (3) older people care, (4) healthcare and (5) clinical nursing. In the strategic diagram, the study of dignity in clinical nursing was active and should become an emerging field of research in the near future. CONCLUSIONS Based on the co-word biclustering of dignity care over the past 10 years, five hot spots were identified, and it was predicted that research on dignity in clinical nursing would be the main trend in future studies. Amongst the five themes it was interesting to note that dignity in dementia and palliative care are core priorities to which scholars should pay more attention. IMPACT In recent years, dignity-conserving care has been highly valued, however, there are few relevant bibliometric articles that can be referenced on this topic. The present study was considered to offer novel insights into research on dignity in nursing and could be a reliable reference point for researchers when launching new projects.
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Affiliation(s)
- Yujia Liu
- School of Nursing, China Medical University, Shenyang, Liaoning Province, PR China
| | - Xiaohan Li
- School of Nursing, China Medical University, Shenyang, Liaoning Province, PR China
| | - Li Ma
- School of Nursing, China Medical University, Shenyang, Liaoning Province, PR China
| | - Yanjie Wang
- School of Nursing, Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning Province, PR China
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The Key Role of Strategically and People-Oriented HRM in Hospitals in Slovakia in the Context of Their Organizational Performance. Healthcare (Basel) 2021; 9:healthcare9030255. [PMID: 33804383 PMCID: PMC7999855 DOI: 10.3390/healthcare9030255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/07/2021] [Accepted: 02/16/2021] [Indexed: 12/20/2022] Open
Abstract
The main objective and purpose of our paper is to verify the positive congruence between the synergistic effect of the mixed roles of human resources management departments in healthcare facilities and their organizational performance. Such congruence is mediated by means of a transformational leadership style and information sharing. The research was carried out on a sample of 44 hospitals in the Slovak Republic, which are included in the ranking according to a comprehensive indicator of their performance (medical and non-medical). Data were obtained using a questionnaire for 44 top managers from these hospitals. Mediation was used as a tool to examine the relevant variables relationship mechanism. All data was analyzed using the SPSS 24.0 software package with the help of selected analytical tools. A series of regression analysis were used to identify the proposed hypotheses. ANOVA was used to analyze the multiple dependence. We worked at a significance level of 5%. The main conclusion of our study is the significant impact of the implementation of the new-mixed role of human resources management departments on organizational performance. Another finding is that the direct effect between the two variables examined is more significant than the mediated effect. This means that if management unambiguously declares and implements the policy of mixed roles of human resources management departments, less influence from the mediator-transformational leadership is sufficient to transmit the effect of this variable onto organizational performance. Completed specialization studies in the field of management play a significant role in the studied relationships.
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Rocks S, Berntson D, Gil-Salmerón A, Kadu M, Ehrenberg N, Stein V, Tsiachristas A. Cost and effects of integrated care: a systematic literature review and meta-analysis. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:1211-1221. [PMID: 32632820 PMCID: PMC7561551 DOI: 10.1007/s10198-020-01217-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 06/30/2020] [Indexed: 05/26/2023]
Abstract
BACKGROUND Health and care services are becoming increasingly strained and healthcare authorities worldwide are investing in integrated care in the hope of delivering higher-quality services while containing costs. The cost-effectiveness of integrated care, however, remains unclear. This systematic review and meta-analysis aims to appraise current economic evaluations of integrated care and assesses the impact on outcomes and costs. METHODS CINAHL, DARE, EMBASE, Medline/PubMed, NHS EED, OECD Library, Scopus, Web of Science, and WHOLIS databases from inception to 31 December 2019 were searched to identify studies assessing the cost-effectiveness of integrated care. Study quality was assessed using an adapted CHEERS checklist and used as weight in a random-effects meta-analysis to estimate mean cost and mean outcomes of integrated care. RESULTS Selected studies achieved a relatively low average quality score of 65.0% (± 18.7%). Overall meta-analyses from 34 studies showed a significant decrease in costs (0.94; CI 0.90-0.99) and a statistically significant improvement in outcomes (1.06; CI 1.05-1.08) associated with integrated care compared to the control. There is substantial heterogeneity in both costs and outcomes across subgroups. Results were significant in studies lasting over 12 months (12 studies), with both a decrease in cost (0.87; CI 0.80-0.94) and improvement in outcomes (1.15; 95% CI 1.11-1.18) for integrated care interventions; whereas, these associations were not significant in studies with follow-up less than a year. CONCLUSION Our findings suggest that integrated care is likely to reduce cost and improve outcome. However, existing evidence varies largely and is of moderate quality. Future economic evaluation should target methodological issues to aid policy decisions with more robust evidence on the cost-effectiveness of integrated care.
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Affiliation(s)
- Stephen Rocks
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Daniela Berntson
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Mudathira Kadu
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Viktoria Stein
- International Foundation for Integrated Care, Oxford, UK
| | - Apostolos Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
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Khan N, Rudoler D, McDiarmid M, Peckham S. A pay for performance scheme in primary care: Meta-synthesis of qualitative studies on the provider experiences of the quality and outcomes framework in the UK. BMC FAMILY PRACTICE 2020; 21:142. [PMID: 32660427 PMCID: PMC7359468 DOI: 10.1186/s12875-020-01208-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 06/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Quality and Outcomes Framework (QOF) is an incentive scheme for general practice, which was introduced across the UK in 2004. The Quality and Outcomes Framework is one of the biggest pay for performance (P4P) scheme in the world, worth £691 million in 2016/17. We now know that P4P is good at driving some kinds of improvement but not others. In some areas, it also generated moral controversy, which in turn created conflicts of interest for providers. We aimed to undertake a meta-synthesis of 18 qualitative studies of the QOF to identify themes on the impact of the QOF on individual practitioners and other staff. METHODS We searched 5 electronic databases, Medline, Embase, Healthstar, CINAHL and Web of Science, for qualitative studies of the QOF from the providers' perspective in primary care, published in UK between 2004 and 2018. Data was analysed using the Schwartz Value Theory as a theoretical framework to analyse the published papers through the conceptual lens of Professionalism. A line of argument synthesis was undertaken to express the synthesis. RESULTS We included 18 qualitative studies that where on the providers' perspective. Four themes were identified; 1) Loss of autonomy, control and ownership; 2) Incentivised conformity; 3) Continuity of care, holism and the caring role of practitioners' in primary care; and 4) Structural and organisational changes. Our synthesis found, the Values that were enhanced by the QOF were power, achievement, conformity, security, and tradition. The findings indicated that P4P schemes should aim to support Values such as benevolence, self-direction, stimulation, hedonism and universalism, which professionals ranked highly and have shown to have positive implications for Professionalism and efficiency of health systems. CONCLUSIONS Understanding how practitioners experience the complexities of P4P is crucial to designing and delivering schemes to enhance and not compromise the values of professionals. Future P4P schemes should aim to permit professionals with competing high priority values to be part of P4P or other quality improvement initiatives and for them to take on an 'influencer role' rather than being 'responsive agents'. Through understanding the underlying Values and not just explicit concerns of professionals, may ensure higher levels of acceptance and enduring success for P4P schemes.
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Affiliation(s)
| | - David Rudoler
- Faculty of Health Sciences, University of Ontario Institute of Technology, 2000 Simcoe Street North, Unit UA3000, Oshawa, ON, L1H 7K4, Canada
| | - Mary McDiarmid
- Ontario Shores Centre for Mental Health Sciences, 700 Gordon Street, Whitby, ON, L1N 5S9, Canada
| | - Stephen Peckham
- Centre for Health Services Studies, University of Kent, Kent, Canterbury, CT2 7NF, UK
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Brunn M, Diefenbacher A, Volpe-Gillot L. Psychiatrists and neurologists in dementia care: Professionalism, practice, and perspectives. Gen Hosp Psychiatry 2020; 64:105-107. [PMID: 32067822 DOI: 10.1016/j.genhosppsych.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Matthias Brunn
- Université de Montpellier, Université de Montpellier, CEPEL, CNRS, 39 rue de l'Université, 34060 Montpellier, France.
| | - Albert Diefenbacher
- Evangelisches Krankenhaus Königin Elisabeth Herzberge, Abteilung für Psychiatrie, Psychotherapie und Psychosomatik, Herzbergstraße 79, 10365 Berlin, Germany.
| | - Lisette Volpe-Gillot
- Hôpital Leopold Bellan, Service de Neuro-Psycho-Gériatrie, 185 C, rue Raymond-Losserand, 75014 Paris, France.
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Schot E, Tummers L, Noordegraaf M. Working on working together. A systematic review on how healthcare professionals contribute to interprofessional collaboration. J Interprof Care 2019; 34:332-342. [DOI: 10.1080/13561820.2019.1636007] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Evert Schot
- School of Governance, Utrecht University, Utrecht, Netherlands
| | - Lars Tummers
- School of Governance, Utrecht University, Utrecht, Netherlands
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Vodopivec V, Vrijhoef HJM. Integrated healthcare models for rheumatoid arthritis: A descriptive systematic review. INTERNATIONAL JOURNAL OF CARE COORDINATION 2019. [DOI: 10.1177/2053434519836425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Integrated people-centred care is a modern approach for addressing healthcare issues related to demographic changes, increasing prevalence of chronic diseases, and restricted resources. By providing an overview of integrated care models for patients with rheumatoid arthritis, we aimed to offer insight into the strategies and interventions that are being used for designing and implementing integrated models of care for this patient group, and their outcomes. Methods We conducted a systematic literature search of peer-reviewed literature available in English and published between 2013 and 2018, using three databases: Cochrane, PubMed and EMBASE. We analysed the publications based on the Framework on integrated people-centred health services and the Triple/Quadruple Aim framework. Results We identified 1271 records. After screening, 50 articles met the criteria for inclusion in the review. Approaches for improving patient empowerment, engagement and experience of care were most prevalent in the identified care profiles. Similarly, frequently reported outcomes were related to improvements in patients’ experience of care and their health status. Most of the studies we reviewed did not demonstrate notable improvements from the perspective of cost-effectiveness or benefits for the healthcare workforce. Conclusions Our findings suggest that for rheumatoid arthritis, integrated care is in the early stages of development. Strategies focusing on patient outcomes and patient satisfaction were found to be prioritised. Future initiatives aiming to redesign rheumatology care should adopt systems thinking perspective to better address all of the building blocks of people-centred integrated care.
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Affiliation(s)
| | - Hubertus JM Vrijhoef
- Panaxea B.V., The Netherlands
- Maastricht University Medical Center, The Netherlands
- Vrije Universiteit Brussel, Belgium
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Reis DDO, Cecílio LCDO, Andreazza R, Araújo EC, Correia T. Nem herói, nem vilão: elementos da prática médica na atenção básica em saúde. CIENCIA & SAUDE COLETIVA 2018; 23:2651-2660. [DOI: 10.1590/1413-81232018238.16672016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 08/25/2016] [Indexed: 11/22/2022] Open
Abstract
Resumo O artigo sistematiza e discute elementos presentes na prática médica que contribuam para uma melhor compreensão da sua reconhecida baixa adesão às diretrizes da Política Nacional de Atenção Básica (PNAB). Para tanto, fez uso de material empírico produzido em duas investigações de caráter qualitativo conduzidas pelo mesmo grupo de pesquisa. Na primeira, entrevistas feitas com dirigentes gestores e controle social de dois municípios paulistas, os médicos são apontados como explicação importante para as dificuldades de se construir uma atenção básica qualificada e resolutiva: um “médico vilão”. Na segunda, utilizou-se observação direta do cotidiano em sete unidades básicas de saúde em três municípios paulistas, com registros de cenas do médico em ação e/ou quando reflete sobre seu trabalho ou quando observado pela equipe. Emerge assim um médico mais complexo, fragilizado, com instrumental reduzido para atuar perante o “social” que invade seu consultório, ameaçado em sua autonomia profissional, com dificuldade de integrar-se ao trabalho em equipe, expropriado das funções regulatórias e nem sempre com clareza do lugar reservado para a clínica na atenção básica: um médico humano, demasiado humano, nem herói, nem vilão.
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Kuhlmann E, Batenburg R, Wismar M, Dussault G, Maier CB, Glinos IA, Azzopardi-Muscat N, Bond C, Burau V, Correia T, Groenewegen PP, Hansen J, Hunter DJ, Khan U, Kluge HH, Kroezen M, Leone C, Santric-Milicevic M, Sermeus W, Ungureanu M. A call for action to establish a research agenda for building a future health workforce in Europe. Health Res Policy Syst 2018; 16:52. [PMID: 29925432 PMCID: PMC6011393 DOI: 10.1186/s12961-018-0333-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 06/05/2018] [Indexed: 11/30/2022] Open
Abstract
The importance of a sustainable health workforce is increasingly recognised. However, the building of a future health workforce that is responsive to diverse population needs and demographic and economic change remains insufficiently understood. There is a compelling argument to be made for a comprehensive research agenda to address the questions. With a focus on Europe and taking a health systems approach, we introduce an agenda linked to the 'Health Workforce Research' section of the European Public Health Association. Six major objectives for health workforce policy were identified: (1) to develop frameworks that align health systems/governance and health workforce policy/planning, (2) to explore the effects of changing skill mixes and competencies across sectors and occupational groups, (3) to map how education and health workforce governance can be better integrated, (4) to analyse the impact of health workforce mobility on health systems, (5) to optimise the use of international/EU, national and regional health workforce data and monitoring and (6) to build capacity for policy implementation. This article highlights critical knowledge gaps that currently hamper the opportunities of effectively responding to these challenges and advising policy-makers in different health systems. Closing these knowledge gaps is therefore an important step towards future health workforce governance and policy implementation. There is an urgent need for building health workforce research as an independent, interdisciplinary and multi-professional field. This requires dedicated research funding, new academic education programmes, comparative methodology and knowledge transfer and leadership that can help countries to build a people-centred health workforce.
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Affiliation(s)
- Ellen Kuhlmann
- Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover, OE 5410, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
- Karolinska Institutet, Medical Management Centre, LIME, Tomtebodavagen 18a, 171 77 Stockholm, Sweden
| | - Ronald Batenburg
- Netherlands Institute for Health Services Research, Otterstraat 118-124, 3513 Utrecht, The Netherlands
| | - Matthias Wismar
- European Observatory on Health Systems and Policies, Place Victor Horta/Victor Hortaplein, 40/10, 1060 Brussels, Brussels Belgium
| | - Gilles Dussault
- Global Health and Tropical Medicine & WHO Collaborating Center on Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine-NOVA University of Lisbon, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
| | - Claudia B. Maier
- Department of Healthcare Management, Technische Universität Berlin, Strasse des 17. Juni 135, 10623 Berlin, Germany
| | - Irene A. Glinos
- European Observatory on Health Systems and Policies, Place Victor Horta/Victor Hortaplein, 40/10, 1060 Brussels, Brussels Belgium
| | - Natasha Azzopardi-Muscat
- Department of Health Services Management, Faculty of Health Science & WHO Collaborating Centre for Health Systems and Policy in Small States at the Islands and Small States Institute, University of Malta, Msida, MSD 2080 Malta
- European Public Health Association (EUPHA), Utrecht, Netherlands
| | - Christine Bond
- Christine Bond, Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 ZD United Kingdom
| | - Viola Burau
- Department of Public Health, University of Aarhus, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Tiago Correia
- ISCTE-Instituto Universitário de Lisboa, School of Sociology and Public Policies, Avenida das Forcas Armadas, 1649-026 Lisbon, Portugal
| | - Peter P. Groenewegen
- Netherlands Institute for Health Services Research, Otterstraat 118-124, 3513 Utrecht, The Netherlands
- Department of Sociology, Utrecht University, Heidelberglaan 2, 3584 CS Utrecht, The Netherlands
- Department of Human Geography, Utrecht University, Heidelberglaan 2, 3584 CS Utrecht, The Netherlands
| | - Johan Hansen
- Netherlands Institute for Health Services Research, Otterstraat 118-124, 3513 Utrecht, The Netherlands
| | - David J. Hunter
- Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
| | - Usman Khan
- European Health Management Association (EHMA), Rue Belliard 15-17, 1040 Brussels, Belgium
| | - Hans H. Kluge
- Division of Health Systems and Public Health, WHO Regional Office for Europe, Marmorvej 51, 2100 Copenhagen, Denmark
| | - Marieke Kroezen
- Department of General Practice, Erasmus University Medical Center Rotterdam, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Claudia Leone
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, 57 Waterloo Road, SE1 8WA London, United Kingdom
| | - Milena Santric-Milicevic
- Institute of Social Medicine, Faculty of Medicine University of Belgrade, Dr Subotica, Belgrade, 15 11000 Serbia
| | - Walter Sermeus
- KU Leuven Institute for Healthcare Policy, Kapucijnenvoer 35 blok d – box 7001, 3000 Leuven, Belgium
| | - Marius Ungureanu
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University, 7 Pandurilor Street, 400376 Cluj-Napoca, Romania
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Loh HP, de Korne DF, Chee SP, Mathur R. Reducing wrong intraocular lens implants in cataract surgery. Int J Health Care Qual Assur 2018; 30:492-505. [PMID: 28714828 DOI: 10.1108/ijhcqa-06-2016-0095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Wrong lens implants have been associated with the highest frequency of medical errors in cataract surgery. The purpose of this paper is to explore the use of the Systems Engineering Initiative for Patient Safety (SEIPS) framework to sustainably reduce wrong intraocular lens (IOL) implants in cataract surgery. Design/methodology/approach In this mixed-methods study, the SEIPS framework was used to analyse a series of (near) misses of IOL implants in a national tertiary specialty hospital in Singapore. A series of interventions was developed and applied in the case hospital. Risk assessment audits were done before the interventions (2012; n=6,111 surgeries), during its implementation ( n=7,475) and in the two years post-interventions (2013-2015; n=39,390) to compare the wrong IOL-rates. Findings Although the absolute number of incidents was low, the incident rate decreased from 4.91 before to 2.54 per 10,000 cases after. Near miss IOL error decreased from 5.89 before to 3.55 per 1,000 cases after. The number of days between two IOL incidents increased from 35 to an initial peak of 385 before stabilizing on 56. The large variety of available IOL types and vendors was found as the main root cause of wrong implants that required reoperation. Practical implications The SEIPS framework seems to be helpful to assess components involved and develop sustainable quality and safety interventions that intervene at different levels of the system. Originality/value The SEIPS model is supportive to address differences between person and system root causes comprehensively and thereby foster quality and patient safety culture.
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Liu Z, Zhang Y, Tian L, Sun B, Chang Q, Zhao Y. Application of latent class analysis in assessing the competency of physicians in China. BMC MEDICAL EDUCATION 2017; 17:208. [PMID: 29132410 PMCID: PMC5683211 DOI: 10.1186/s12909-017-1039-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 11/02/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The physicians' competency is an important public health issue around the world. Several international organizations have taken the lead in examining the competencies required to be a physician. The purpose of this study is to identify subgroups of physicians' competency based upon the importance results of competency evaluation and provide a scientific basis for the qualitative research of the competency of physicians. METHODS A cross-sectional study was conducted on a large population-based sample in 31 provinces, autonomous regions and municipalities directly under the central government in China. The latent class analysis was performed to identify patterns of physicians' competency using M-plus software. RESULTS In this study, the latent class analysis was adopted to identify the appropriate number of distinct latent classes of physicians' competency based on eight competency dimensions, and a four-class model best fit the data, which are excellent competency group, lack of professionalism competency group, individual competency driven group, and lack of competency cognitive group. Therefore, 6247 physicians can be divided into four latent classes based on the importance results of competency evaluation, and the number of each class is 5684, 284, 215 and 64, respectively. CONCLUSION These findings suggested that latent class analysis can be used to study the competency of physicians, and four distinct subgroups were identified. Therefore, we can effectively understand the patterns of physicians' competency, and the health administrative departments could utilize more specific measures according to their different competency subgroups, and providing individualized training schemes in the future training and management of physicians.
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Affiliation(s)
- Zhuang Liu
- School of Public Health, China Medical University, Shenyang, Liaoning China
| | - Yue Zhang
- School of Public Health, China Medical University, Shenyang, Liaoning China
| | - Lei Tian
- Research Center for Medical Education, China Medical University, Shenyang, Liaoning China
| | - Baozhi Sun
- Research Center for Medical Education, China Medical University, Shenyang, Liaoning China
| | - Qing Chang
- Department of Clinical Epidemiology, Shengjing Hospital, China Medical University, No.36, Sanhao Street, Heping District, Shenyang, Liaoning Province 110004 People’s Republic of China
| | - Yuhong Zhao
- Department of Clinical Epidemiology, Shengjing Hospital, China Medical University, No.36, Sanhao Street, Heping District, Shenyang, Liaoning Province 110004 People’s Republic of China
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Borgermans L, Marchal Y, Busetto L, Kalseth J, Kasteng F, Suija K, Oona M, Tigova O, Rösenmuller M, Devroey D. How to Improve Integrated Care for People with Chronic Conditions: Key Findings from EU FP-7 Project INTEGRATE and Beyond. Int J Integr Care 2017; 17:7. [PMID: 29588630 PMCID: PMC5854097 DOI: 10.5334/ijic.3096] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 05/17/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Political and public health leaders increasingly recognize the need to take urgent action to address the problem of chronic diseases and multi-morbidity. European countries are facing unprecedented demand to find new ways to deliver care to improve patient-centredness and personalization, and to avoid unnecessary time in hospitals. People-centred and integrated care has become a central part of policy initiatives to improve the access, quality, continuity, effectiveness and sustainability of healthcare systems and are thus preconditions for the economic sustainability of the EU health and social care systems. PURPOSE This study presents an overview of lessons learned and critical success factors to policy making on integrated care based on findings from the EU FP-7 Project Integrate, a literature review, other EU projects with relevance to this study, a number of best practices on integrated care and our own experiences with research and policy making in integrated care at the national and international level. RESULTS Seven lessons learned and critical success factors to policy making on integrated care were identified. CONCLUSION The lessons learned and critical success factors to policy making on integrated care show that a comprehensive systems perspective should guide the development of integrated care towards better health practices, education, research and policy.
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Affiliation(s)
- Liesbeth Borgermans
- Faculty of Medicine and Pharmacy, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, BE
| | - Yannick Marchal
- Faculty of Medicine and Pharmacy, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, BE
| | - Loraine Busetto
- Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, NL
| | - Jorid Kalseth
- SINTEF Technology and Society, Health Services Research, Trondheim, NO
| | - Frida Kasteng
- SINTEF Technology and Society, Health Services Research, Trondheim, NO
| | - Kadri Suija
- Department of Family Medicine, Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Tartu, EE
| | - Marje Oona
- Department of Family Medicine, Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Tartu, EE
| | - Olena Tigova
- Center for Research in Healthcare Innovation Management, IESE Business School, ES
| | - Magda Rösenmuller
- Center for Research in Healthcare Innovation Management, IESE Business School, ES
| | - Dirk Devroey
- Faculty of Medicine and Pharmacy, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, BE
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Burau V, Carstensen K, Lou S, Kuhlmann E. Professional groups driving change toward patient-centred care: interprofessional working in stroke rehabilitation in Denmark. BMC Health Serv Res 2017; 17:662. [PMID: 28915837 PMCID: PMC5602838 DOI: 10.1186/s12913-017-2603-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 09/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient-centred care based on needs has been gaining momentum in health policy and the workforce. This creates new demand for interprofessional teams and redefining roles and tasks of professionals, yet little is known on how to implement new health policies more effectively. Our aim was to analyse the role and capacity of health professions in driving organisational change in interprofessional working and patient-centred care. METHODS A case study of the introduction of interprofessional, early discharge teams in stroke rehabilitation in Denmark was conducted with focus on day-to-day coordination of care tasks and the professional groups' interests and strategies. The study included 5 stroke teams and 17 interviews with different health professionals conducted in 2015. RESULTS Professional groups expressed highly positive professional interest in reorganised stroke rehabilitation concerning patients, professional practice and intersectoral relations; individual professional and collective interprofessional interests strongly coincided. The corresponding strategies were driven by a shared goal of providing needs-based care for patients. Individual professionals worked independently and on behalf of the team. There was also a degree of skills transfer as individual team members screened patients on behalf of other professional groups. CONCLUSIONS The study identified supportive factors and contexts of patient-centred care. This highlights capacity to improve health workforce governance through professional participation, which should be explored more systematically in a wider range of healthcare services.
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Affiliation(s)
- Viola Burau
- DEFACTUM – Public Health & Health Services Research, Aarhus, Central Denmark Region Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Kathrine Carstensen
- DEFACTUM – Public Health & Health Services Research, Aarhus, Central Denmark Region Denmark
| | - Stina Lou
- DEFACTUM – Public Health & Health Services Research, Aarhus, Central Denmark Region Denmark
| | - Ellen Kuhlmann
- Institute for Economics, Labour and Culture (IWAK), Goethe-University Frankfurt, Frankfurt, Germany
- Medical Management Centre, LIME, |Karolinska Institutet, Stockholm, Sweden
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Bidabadi FS, Yazdannik A, Zargham-Boroujeni A. Patient's dignity in intensive care unit: A critical ethnography. Nurs Ethics 2017; 26:738-752. [PMID: 28835156 DOI: 10.1177/0969733017720826] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Maintaining patient's dignity in intensive care units is difficult because of the unique conditions of both critically-ill patients and intensive care units. OBJECTIVES The aim of this study was to uncover the cultural factors that impeded maintaining patients' dignity in the cardiac surgery intensive care unit. RESEARCH DESIGN The study was conducted using a critical ethnographic method proposed by Carspecken. PARTICIPANTS AND RESEARCH CONTEXT Participants included all physicians, nurses and staffs working in the study setting (two cardiac surgery intensive care units). Data collection methods included participant observations, formal and informal interviews, and documents assessment. In total, 200 hours of observation and 30 interviews were performed. Data were analyzed to uncover tacit cultural knowledge and to help healthcare providers to reconstruct the culture of their workplace. ETHICAL CONSIDERATION Ethical approval for the study from Ethics committee of Isfahan University of Medical Sciences was obtained. FINDINGS The findings of the study fell into the following main themes: "Presence: the guarantee for giving enough attention to patients' self-esteem", "Instrumental and objectified attitudes", "Adherence to the human equality principle: value-action gap", "Paternalistic conduct", "Improper language", and "Non-interactive communication". The final assertion was "Reductionism as a major barrier to the maintaining of patient's dignity". DISCUSSION The prevailing atmosphere in subculture of the CSICU was reductionism and paternalism. This key finding is part of the biomedical discourse. As a matter of fact, it is in contrast with dignified care because the latter necessitate holistic attitudes and approaches. CONCLUSION Changing an ICU culture is not easy; but through increasing awareness and critical self-reflections, the nurses, physicians and other healthcare providers, may be able to reaffirm dignified care and cure in their therapeutic relationships.
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Affiliation(s)
- Farimah Shirani Bidabadi
- Student Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Ali Zargham-Boroujeni
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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17
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Youngerman BE, Zacharia BE, Hickman ZL, Bruce JN, Solomon RA, Benzil DL. Making Milestones. Neurosurgery 2016; 79:492-8. [DOI: 10.1227/neu.0000000000001126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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18
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Valentijn PP, Biermann C, Bruijnzeels MA. Value-based integrated (renal) care: setting a development agenda for research and implementation strategies. BMC Health Serv Res 2016; 16:330. [PMID: 27481044 PMCID: PMC4970292 DOI: 10.1186/s12913-016-1586-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 07/27/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Integrated care services are considered a vital strategy for improving the Triple Aim values for people with chronic kidney disease. However, a solid scholarly explanation of how to develop, implement and evaluate such value-based integrated renal care services is limited. The aim of this study was to develop a framework to identify the strategies and outcomes for the implementation of value-based integrated renal care. METHODS First, the theoretical foundations of the Rainbow Model of Integrated Care and the Triple Aim were united into one overarching framework through an iterative process of key-informant consultations. Second, a rapid review approach was conducted to identify the published research on integrated renal care, and the Cochrane Library, Medline, Scopus, and Business Source Premier databases were searched for pertinent articles published between 2000 and 2015. Based on the framework, a coding schema was developed to synthesis the included articles. RESULTS The overarching framework distinguishes the integrated care domains: 1) type of integration, 2) enablers of integration and the interrelated outcome domains, 3) experience of care, 4) population health and 5) costs. The literature synthesis indicated that integrated renal care implementation strategies have particularly focused on micro clinical processes and physical outcomes, while little emphasis has been placed on meso organisational as well as macro system integration processes. In addition, evidence regarding patients' perceived outcomes and economic outcomes has been weak. CONCLUSION These results underscore that the future challenge for researchers is to explore which integrated care implementation strategies achieve better health and improved experience of care at a lower cost within a specific context. For this purpose, this study's framework and evidence synthesis have set a developmental agenda for both integrated renal care practice and research. Accordingly, we plan further work to develop an implementation model for value-based integrated renal services.
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Affiliation(s)
- Pim P Valentijn
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands. .,Department Integrated Care University, Essenburgh, Hierden, The Netherlands.
| | - Claus Biermann
- Faculty of Social Science, Ruhr University Bochum, Bochum, Germany
| | - Marc A Bruijnzeels
- Jan van Es Institute, Netherlands Expert Centre Integrated Primary Care, Almere, The Netherlands
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Kerasidou A, Kingori P, Legido-Quigley H. "You have to keep fighting": maintaining healthcare services and professionalism on the frontline of austerity in Greece. Int J Equity Health 2016; 15:118. [PMID: 27457098 PMCID: PMC4960903 DOI: 10.1186/s12939-016-0407-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 07/17/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Greece has been severely affected by the 2008 global economic crisis and its health system was, and still is, among the national institutions most shaped by its effects. METHODS In 2014, this qualitative study examined these changes through in-depth interviews with 22 frontline healthcare professionals in five different locations in mainland Greece. These interviews with nurses, doctors and pharmacists explored perceptions of austerity and how ideas of professionalism were challenged and revised by these measures. RESULTS Participants reported working conditions characterised by dramatic increases in public hospital admissions alongside decreases in personnel, consumables, materials, and also many hospital closures. Many drew on analogies of war and fighting to describe the effects of healthcare reforms on their working lives and professional conduct. Despite accounts of deteriorating conditions and numerous challenges, healthcare professionals presented themselves as making every effort to meet patients' needs, while battling to resist guidelines which they perceived diminished their roles to production-line operatives. CONCLUSIONS Participants considered it their duty to defend their professional ethos and serve patients without compromising standards, even if this meant liberal interpretation and implementation of regulations. These professionals regarded themselves on the frontline of healthcare provision but also the frontline defence in a war on their professional standards from austerity.
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Affiliation(s)
- Angeliki Kerasidou
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Patricia Kingori
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- London School of Hygiene and Tropical Medicine, London, UK
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Kringos DS, van den Broeke JR, van der Lee APM, Plochg T, Stronks K. How does an integrated primary care approach for patients in deprived neighbourhoods impact utilization patterns? An explorative study. BMC Public Health 2016; 16:545. [PMID: 27402143 PMCID: PMC4940836 DOI: 10.1186/s12889-016-3246-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 06/29/2016] [Indexed: 11/25/2022] Open
Abstract
Background To explore changes in utilization patterns for general practice (GP) and hospital care of people living in deprived neighbourhoods when primary care providers work in a more coherent and coordinated manner by applying an integrated approach. Methods We compared expected (based on consumption patterns of a health insurers’ total population) and actual utilization patterns in a deprived Dutch intervention district in the city of Utrecht (Overvecht) with control districts 1 (Noordwest) and 2 (Kanaleneiland) over the period 2006–2011, when an integrated care approach was increasingly provided in the intervention district. Standardized insurance claims data were used to indicate use of GP care and hospital care. Results Our findings revealed that the utilization of total GP care increased more in the intervention district than in the control districts. And that the intervention district showed a more pronounced decreasing trend in total hospital use as compared to what was expected, in particular from 2008 onwards. In addition, we observed a change in type of GP care use in the intervention district in particular: the number of regular consultations, long consultations, GP home visits and evening, night and weekend consultations were increasingly higher than expected. The intervention district also showed the largest decrease between actual and expected use of ambulatory care, clinical care and 1-day hospitalizations. Conclusions Utilization patterns for general practice and hospital care of people living in deprived districts may change when primary care professionals work in a more coherent and coordinated manner by applying a more ‘comprehensive’ integrated care approach. Results support the expectation that a comprehensive integrated care approach might eventually contribute to the future sustainability of healthcare systems. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3246-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dionne S Kringos
- Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, PO-box 22660, Amsterdam, 1100 DD, The Netherlands.
| | - Jennifer R van den Broeke
- Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, PO-box 22660, Amsterdam, 1100 DD, The Netherlands
| | | | - Thomas Plochg
- Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, PO-box 22660, Amsterdam, 1100 DD, The Netherlands
| | - Karien Stronks
- Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, PO-box 22660, Amsterdam, 1100 DD, The Netherlands
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Hybrid management, organizational configuration, and medical professionalism: evidence from the establishment of a clinical directorate in Portugal. BMC Health Serv Res 2016; 16 Suppl 2:161. [PMID: 27229146 PMCID: PMC4896258 DOI: 10.1186/s12913-016-1398-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The need of improving the governance of healthcare services has brought health professionals into management positions. However, both the processes and outcomes of this policy change highlight differences among the European countries. This article provides in-depth evidence that neither quantitative data nor cross-country comparisons have been able to provide regarding the influence of hybrids in the functioning of hospital organizations and impact on clinicians' autonomy and exposure to hybridization. METHODS The study was designed to witness the process of institutional change from the inside and while that process was underway. It reports a case study carried out in a public hospital in Portugal when the establishment of a clinical directorate was being negotiated. Data collection comprises semi-structured interviews with general managers and surgeons complemented with observations. RESULTS The clinical directorate under study illustrates a divisionalized professional bureaucracy model that combines features of professional bureaucracies and divisionalized forms. The hybrid manager is key to understand the extent to which practising clinicians are more accountable and to whom given that managerial tools of control have not been strengthened, and trust-based relations allow them to keep professional autonomy untouched. In sum, clinicians are allowed to profit from their activity and to perform autonomously from the hospital's board of directors. The advantageous conditions enjoyed by the clinical directorate intensify internal re-stratification in medicine, thus suggesting forms of divisionalized medical professionalism grounded in organizational dynamics. CONCLUSION It is discussed the extent to which policy change to the governance of health organizations regarding the relationship between medicine and management is subject to specific constraints at the workplace level, thus conditioning the expected outcomes of policy setting. The study also highlights the role of hybrid managers in determining the extent to which practising professionals are more accountable to managerial criteria. The overall conclusion is that although medical and managerial values link to each other, clinicians reconfigure managerial criteria according to specific interests. Ultimately, medical autonomy and authority may be reinforced in organizational settings subject to NPM-driven reforms.
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Kuhlmann E, Rangnitt Y, von Knorring M. Medicine and management: looking inside the box of changing hospital governance. BMC Health Serv Res 2016; 16 Suppl 2:159. [PMID: 27230654 PMCID: PMC4896265 DOI: 10.1186/s12913-016-1393-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Health policy has strengthened the demand for coordination between clinicians and managers and introduced new medical manager roles in hospitals to better connect medicine and management. These developments have created a scholarly debate of concepts and an increasing ‘hybridization’ of tasks and roles, yet the organizational effects are not well researched. This research introduces a multi-level governance approach and aims to explore the organizational needs of doctors using Sweden as a case study. Methods We apply an assessment framework focusing on macro-meso levels and managerial-professional modes of hospital governance (using document analysis, secondary sources, and expert information) and expand the analysis towards the micro-level. Qualitative explorative empirical material gathered in two different studies in Swedish hospitals serves to pilot research into actor-centred perceptions of clinical management from the viewpoint of the ‘managed’ and the ‘managing’ doctors in an organization. Results Sweden has developed a model of integrated hospital governance with complex structural coordination between medicine and management on the level of the organization. In terms of formal requirements, the professional background is less relevant for many management positions but in everyday work, medical managers are perceived primarily as colleagues and not as experts advising on managerial problems. The managers themselves seem to rely more on personal strength and medical knowledge than on management tools. Bringing doctors into management may hybridize formal roles and concepts, but it does not necessarily change the perceptions of doctors and improve managerial–professional coordination at the micro-level of the organization. Conclusion This study brings gaps in hospital governance into view that may create organizational weaknesses and unmet management needs, thereby constraining more coordinated and integrated medical management.
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Affiliation(s)
- Ellen Kuhlmann
- Medical Management Centre, LIME, Karolinska Institutet, Stockholm, Sweden. .,Institute of Economics, Labour and Culture, Goethe-University Frankfurt, Frankfurt, Germany.
| | - Ylva Rangnitt
- Medical Management Centre, LIME, Karolinska Institutet, Stockholm, Sweden
| | - Mia von Knorring
- Medical Management Centre, LIME, Karolinska Institutet, Stockholm, Sweden.,Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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How Does Sex Influence Multimorbidity? Secondary Analysis of a Large Nationally Representative Dataset. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:391. [PMID: 27043599 PMCID: PMC4847053 DOI: 10.3390/ijerph13040391] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/11/2016] [Accepted: 03/23/2016] [Indexed: 11/24/2022]
Abstract
Multimorbidity increases with age and is generally more common in women, but little is known about sex effects on the “typology” of multimorbidity. We have characterized multimorbidity in a large nationally representative primary care dataset in terms of sex in ten year age groups from 25 years to 75 years and over, in a cross-sectional analysis of multimorbidity type (physical-only, mental-only, mixed physical and mental; and commonest conditions) for 1,272,685 adults in Scotland. Our results show that women had more multimorbidity overall in every age group, which was most pronounced in the 45–54 years age group (women 26.5% vs. men 19.6%; difference 6.9 (95% CI 6.5 to 7.2). From the age of 45, physical-only multimorbidity was consistently more common in men, and physical-mental multimorbidity more common in women. The biggest difference in physical-mental multimorbidity was found in the 75 years and over group (women 30.9% vs. men 21.2%; difference 9.7 (95% CI 9.1 to 10.2). The commonest condition in women was depression until the age of 55 years, thereafter hypertension. In men, drugs misuse had the highest prevalence in those aged 25–34 years, depression for those aged 35–44 years, and hypertension for 45 years and over. Depression, pain, irritable bowel syndrome and thyroid disorders were more common in women than men across all age groups. We conclude that the higher overall prevalence of multimorbidity in women is mainly due to more mixed physical and mental health problems. The marked difference between the sexes over 75 years especially warrants further investigation.
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van der Aa MJ, van den Broeke JR, Stronks K, Busschers WB, Plochg T. Measuring renewed expertise for integrated care among health- and social-care professionals: Development and preliminary validation of the ICE-Q questionnaire. J Interprof Care 2016; 30:56-64. [PMID: 26789936 DOI: 10.3109/13561820.2015.1057271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Accumulations of health and social problems challenge current health systems. It is hypothesized that professionals should renew their expertise by adapting generalist, coaching, and population health orientation capacities to address these challenges. This study aimed to develop and validate an instrument for evaluating this renewal of professional expertise. The (Dutch) Integrated Care Expertise Questionnaire (ICE-Q) was developed and piloted. Psychometric analysis evaluated item, criterion, construct, and content validity. Theory and an iterative process of expert consultation constructed the ICE-Q, which was sent to 616 professionals, of whom 294 participated in the pilot (47.7%). Factor analysis (FA) identified six areas of expertise: holistic attitude towards patients (Cronbach's alpha [CA] = 0.61) and considering their social context (CA = 0.77), both related to generalism; coaching to support patient empowerment (CA = 0.66); preventive action (CA = 0.48); valuing local health knowledge (CA = 0.81); and valuing local facility knowledge (CA = 0.67) point at population health orientation. Inter-scale correlations ranged between 0.01 and 0.34. Item-response theory (IRT) indicated some items were less informative. The resulting 26-item questionnaire is a first tool for measuring integrated care expertise. The study process led to a developed understanding of the concept. Further research is warranted to improve the questionnaire.
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Affiliation(s)
- Maartje J van der Aa
- a Department of Health Services Research, Maastricht University , Maastricht , The Netherlands
| | | | - Karien Stronks
- b Department of Public Health , Academic Medical Center Amsterdam , Amsterdam , The Netherlands
| | - Wim B Busschers
- b Department of Public Health , Academic Medical Center Amsterdam , Amsterdam , The Netherlands
| | - Thomas Plochg
- b Department of Public Health , Academic Medical Center Amsterdam , Amsterdam , The Netherlands
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Jambroes M, Nederland T, Kaljouw M, van Vliet K, Essink-Bot ML, Ruwaard D. Implications of health as 'the ability to adapt and self-manage' for public health policy: a qualitative study. Eur J Public Health 2015; 26:412-6. [PMID: 26705568 DOI: 10.1093/eurpub/ckv206] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To explore the implications for public health policy of a new conceptualisation of health as 'The ability to adapt and to self-manage, in the face of social, physical and emotional challenges'. METHODS Secondary qualitative data analysis of 28 focus group interviews, with 277 participants involved in public health and healthcare, on the future of the Dutch healthcare system. WHO's essential public health operations (EPHOs) were used as a framework for analysis. RESULTS Starting from the new concept of health, participants perceived health as an individual asset, requiring an active approach in the Dutch population towards health promotion and adaptation to a healthy lifestyle. Sectors outside healthcare and public health were considered as resources to support individual lifestyle improvement. Integrating prevention and health promotion in healthcare is also expected to stimulate individuals to comply with a healthy lifestyle. Attention should be paid to persons less skilled to self-manage their own health, as this group may require a healthcare safety net. The relationship between individual and population health was not addressed, resulting in little focus on collective prevention to achieve health. CONCLUSIONS The new concept of health as a basis for changes in the healthcare system offers opportunities to create a health-promoting societal context. However, inequalities in health within the general population may increase when using the new concept as an operationalisation of health. For public health, the main challenge is to maintain focus on the collective socioeconomic and environmental determinants of health and disease and, thereby, preserve collective prevention.
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Affiliation(s)
- Marielle Jambroes
- Department of Public Health, Academic Medical Centre/University of Amsterdam, PO box 22660 1100 DD Amsterdam, The Netherlands
| | - Trudi Nederland
- Verwey-Jonker Institute, Kromme Nieuwegracht 6, 3512 HG Utrecht, The Netherlands
| | - Marian Kaljouw
- The Dutch Healthcare Authority, PO box 3017, 3502 GA Utrecht, the Netherlands
| | - Katja van Vliet
- National Health Care Institute, dept. Healthcare professions and Health education, PO box 320 1110 AH Diemen, The Netherlands
| | - Marie-Louise Essink-Bot
- Department of Public Health, Academic Medical Centre/University of Amsterdam, PO box 22660 1100 DD Amsterdam, The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. box 616 6200 MD Maastricht, The Netherlands
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Calciolari S, Ilinca S. Unraveling care integration: Assessing its dimensions and antecedents in the Italian Health System. Health Policy 2015; 120:129-38. [PMID: 26725643 DOI: 10.1016/j.healthpol.2015.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 09/24/2015] [Accepted: 12/02/2015] [Indexed: 11/29/2022]
Abstract
In recent decades, consensus has grown on the need to organize health systems around the concept of care integration to better confront the challenges associated with demographic trends and financial sustainability. However, care integration remains an imprecise umbrella term in both the academic and policy arenas. In addition, little substantive knowledge exists on the success factors for integration initiatives. We propose a composite measure of care integration and a conceptual framework suggesting its relationships with three types of antecedents: contextual, cultural, and organizational factors. Our framework was tested using data from the Italian National Health System (NHS). We administered an ad-hoc questionnaire to all Italian local health units (LHUs), with a 60.4% response rate, and used structural equation modeling to assess the relationships between the relevant latent constructs. The results validated our measure of care integration and supported the hypothesized relationships. In particular, integration was found to be fostered by results-oriented institutional settings, a professional culture conducive to inclusiveness and shared goals, and organizational arrangements promoting clear expectations among providers. Thus, integration improves care and mediates the effects of specific operating means on care enhancement.
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Affiliation(s)
- Stefano Calciolari
- Università della Svizzera Italiana, IdEP Institute, Lugano, Switzerland.
| | - Stefania Ilinca
- European Centre for Social Welfare Policy and Research, Vienna, Austria
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Batenburg R. Health workforce planning in Europe: Creating learning country clusters. Health Policy 2015; 119:1537-44. [DOI: 10.1016/j.healthpol.2015.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 10/01/2015] [Accepted: 10/03/2015] [Indexed: 11/26/2022]
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Care coordination of multimorbidity: a scoping study. JOURNAL OF COMORBIDITY 2015; 5:15-28. [PMID: 29090157 PMCID: PMC5636034 DOI: 10.15256/joc.2015.5.39] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 03/05/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND A key challenge in healthcare systems worldwide is the large number of patients who suffer from multimorbidity; despite this, most systems are organized within a single-disease framework. OBJECTIVE The present study addresses two issues: the characteristics and preconditions of care coordination for patients with multimorbidity; and the factors that promote or inhibit care coordination at the levels of provider organizations and healthcare professionals. DESIGN The analysis is based on a scoping study, which combines a systematic literature search with a qualitative thematic analysis. The search was conducted in November 2013 and included the PubMed, CINAHL, and Web of Science databases, as well as the Cochrane Library, websites of relevant organizations and a hand-search of reference lists. The analysis included studies with a wide range of designs, from industrialized countries, in English, German and the Scandinavian languages, which focused on both multimorbidity/comorbidity and coordination of integrated care. RESULTS The analysis included 47 of the 226 identified studies. The central theme emerging was complexity. This related to both specific medical conditions of patients with multimorbidity (case complexity) and the organization of care delivery at the levels of provider organizations and healthcare professionals (care complexity). CONCLUSIONS In terms of how to approach care coordination, one approach is to reduce complexity and the other is to embrace complexity. Either way, future research must take a more explicit stance on complexity and also gain a better understanding of the role of professionals as a prerequisite for the development of new care coordination interventions.
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Micoulaud-Franchi JA, Fond G, Allilaire JF. Le psychiatre doit-il être un sur-spécialiste ? ANNALES MEDICO-PSYCHOLOGIQUES 2014. [DOI: 10.1016/j.amp.2014.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Öcek ZA, Çiçeklioğlu M, Yücel U, Özdemir R. Family medicine model in Turkey: a qualitative assessment from the perspectives of primary care workers. BMC FAMILY PRACTICE 2014; 15:38. [PMID: 24571275 PMCID: PMC3942270 DOI: 10.1186/1471-2296-15-38] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 02/21/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND A person-list-based family medicine model was introduced in Turkey during health care reforms. This study aimed to explore from primary care workers' perspectives whether this model could achieve the cardinal functions of primary care and have an integrative position in the health care system. METHODS Four groups of primary care workers were included in this exploratory-descriptive study. The first two groups were family physicians (FP) (n = 51) and their ancillary personnel (n = 22). The other two groups were physicians (n = 44) and midwives/nurses (n = 11) working in community health centres. Participants were selected for maximum variation and 102 in-depth interviews and six focus groups were conducted using a semi-structured form. RESULTS Data analysis yielded five themes: accessibility, first-contact care, longitudinality, comprehensiveness, and coordination. Most participants stated that many people are not registered with any FP and that the majority of these belong to the most disadvantaged groups in society. FPs reported that 40-60% of patients on their lists have never received a service from them and the majority of those who use their services do not use FPs as the first point of contact. According to most participants, the list-based system improved the longitudinality of the relationship between FPs and patients. However, based on other statements, this improvement only applies to one quarter of the population. Whereas there was an improvement limited to a quantitative increase in services (immunisation, monitoring of pregnant women and infants) included in the performance-based contracting system, participants stated that services not among the performance targets, such as family planning, postpartum follow-ups, and chronic disease management, could be neglected. FPs admitted not being able to keep informed of services their patients had received at other health institutions. Half of the participants stated that the list-based system removed the possibility of evaluating the community as a whole. CONCLUSIONS According to our findings, FPs have a limited role as the first point of contact and in giving longitudinal, comprehensive, and coordinated care. The family medicine model in Turkey is unable to provide a suitable structure to integrate health care services.
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Affiliation(s)
- Zeliha Asli Öcek
- Ege University Faculty of Medicine, Department of Public Health, 35100 Izmir, Turkey
| | - Meltem Çiçeklioğlu
- Ege University Faculty of Medicine, Department of Public Health, 35100 Izmir, Turkey
| | - Ummahan Yücel
- Ege University Izmir Atatürk School of Health, Department of Midwifery, Izmir, Turkey
| | - Raziye Özdemir
- Karabuk University School of Health, Department of Midwifery, Karabuk, Turkey
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Kuhlmann E, von Knorring M. Management and medicine: why we need a new approach to the relationship. J Health Serv Res Policy 2014; 19:189-191. [DOI: 10.1177/1355819614524946] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
New Public Management has affected the relationship between corporate managerialism and professional modes of governing hospitals. While doctors’ increasing involvement in management may have positive effects on health care, hospital governance, health care policies and medical education have largely failed to support this change. There is a need for new policies and approaches to support the changing connections between medicine and management that abandons both the military discourse of ‘wars’ and ‘battlefields’ and the new rhetoric of ‘clinical leadership’.
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Affiliation(s)
- Ellen Kuhlmann
- Senior Researcher, Institute of Economics, Labour and Culture, Goethe-University Frankfurt, Germany
| | - Mia von Knorring
- Researcher and Lecturer in Medical Management, Medical Management Centre, Karolinska Institutet, Sweden
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Wat is de werkwijze van zorg- en welzijnsorganisaties in Utrecht en Amsterdam om de hoge zorgconsumptie in achterstandswijken te verlagen? ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s12508-014-0016-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Medical professionalism and professional organizations. J Taibah Univ Med Sci 2013. [DOI: 10.1016/j.jtumed.2013.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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van Wijngaarden JDH, Botje D, Ilinca S, van der Waa N, Mendes RV, Hamer S, Plochg T. How doctor involvement in management affects innovation. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2013. [DOI: 10.1179/2047971912y.0000000021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Kuhlmann E, Burau V, Correia T, Lewandowski R, Lionis C, Noordegraaf M, Repullo J. "A manager in the minds of doctors:" a comparison of new modes of control in European hospitals. BMC Health Serv Res 2013; 13:246. [PMID: 23819578 PMCID: PMC3702431 DOI: 10.1186/1472-6963-13-246] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 06/28/2013] [Indexed: 11/26/2022] Open
Abstract
Background Hospital governance increasingly combines management and professional self-governance. This article maps the new emergent modes of control in a comparative perspective and aims to better understand the relationship between medicine and management as hybrid and context-dependent. Theoretically, we critically review approaches into the managerialism-professionalism relationship; methodologically, we expand cross-country comparison towards the meso-level of organisations; and empirically, the focus is on processes and actors in a range of European hospitals. Methods The research is explorative and was carried out as part of the FP7 COST action IS0903 Medicine and Management, Working Group 2. Comprising seven European countries, the focus is on doctors and public hospitals. We use a comparative case study design that primarily draws on expert information and document analysis as well as other secondary sources. Results The findings reveal that managerial control is not simply an external force but increasingly integrated in medical professionalism. These processes of change are relevant in all countries but shaped by organisational settings, and therefore create different patterns of control: (1) ‘integrated’ control with high levels of coordination and coherent patterns for cost and quality controls; (2) ‘partly integrated’ control with diversity of coordination on hospital and department level and between cost and quality controls; and (3) ‘fragmented’ control with limited coordination and gaps between quality control more strongly dominated by medicine, and cost control by management. Conclusions Our comparison highlights how organisations matter and brings the crucial relevance of ‘coordination’ of medicine and management across the levels (hospital/department) and the substance (cost/quality-safety) of control into perspective. Consequently, coordination may serve as a taxonomy of emergent modes of control, thus bringing new directions for cost-efficient and quality-effective hospital governance into perspective.
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Affiliation(s)
- Ellen Kuhlmann
- Institute of Economics, Labour and Culture, Goethe-University Frankfurt, Frankfurt, Germany.
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Valentijn PP, Schepman SM, Opheij W, Bruijnzeels MA. Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care. Int J Integr Care 2013; 13:e010. [PMID: 23687482 PMCID: PMC3653278 DOI: 10.5334/ijic.886] [Citation(s) in RCA: 474] [Impact Index Per Article: 43.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 02/19/2013] [Accepted: 02/20/2013] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Primary care has a central role in integrating care within a health system. However, conceptual ambiguity regarding integrated care hampers a systematic understanding. This paper proposes a conceptual framework that combines the concepts of primary care and integrated care, in order to understand the complexity of integrated care. METHODS The search method involved a combination of electronic database searches, hand searches of reference lists (snowball method) and contacting researchers in the field. The process of synthesizing the literature was iterative, to relate the concepts of primary care and integrated care. First, we identified the general principles of primary care and integrated care. Second, we connected the dimensions of integrated care and the principles of primary care. Finally, to improve content validity we held several meetings with researchers in the field to develop and refine our conceptual framework. RESULTS The conceptual framework combines the functions of primary care with the dimensions of integrated care. Person-focused and population-based care serve as guiding principles for achieving integration across the care continuum. Integration plays complementary roles on the micro (clinical integration), meso (professional and organisational integration) and macro (system integration) level. Functional and normative integration ensure connectivity between the levels. DISCUSSION The presented conceptual framework is a first step to achieve a better understanding of the inter-relationships among the dimensions of integrated care from a primary care perspective.
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Affiliation(s)
- Pim P Valentijn
- Jan van Es Institute, Netherlands Expert Centre Integrated Primary Care, The Netherlands
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Two innovative solutions for fragmented care to multi-problem patients in deprived neighbourhoods: 2 case studies. Int J Integr Care 2012. [PMCID: PMC3617769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] Open
Abstract
Theory Purpose Methods Results and conclusions
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Hudson JN, Knight PJ, Weston KM. Patient perceptions of innovative longitudinal integrated clerkships based in regional, rural and remote primary care: a qualitative study. BMC FAMILY PRACTICE 2012; 13:72. [PMID: 22839433 PMCID: PMC3503733 DOI: 10.1186/1471-2296-13-72] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 07/11/2012] [Indexed: 11/23/2022]
Abstract
Background Medical students at the University of Wollongong experience continuity of patient care and clinical supervision during an innovative year-long integrated (community and hospital) clinical clerkship. In this model of clinical education, students are based in a general practice ‘teaching microsystem’ and participate in patient care as part of this community of practice (CoP). This study evaluates patients’ perceptions of the clerkship initiative, and their perspectives on this approach to training ‘much-needed’ doctors in their community. Methods Semi-structured, face-to-face, interviews with patients provided data on the clerkship model in three contexts: regional, rural and remote health care settings in Australia. Two researchers independently thematically analysed transcribed data and organised emergent categories into themes. Results The twelve categories that emerged from the analysis of transcribed data were clustered into four themes: learning as doing; learning as shared experience; learning as belonging to a community; and learning as ‘becoming’. Patients viewed the clerkship learning environment as patient- and student-centred, emphasising that the patient-student-doctor relationship triad was important in facilitating active participation by patients as well as students. Patients believed that students became central, rather than peripheral, members of the CoP during an extended placement, value-adding and improving access to patient care. Conclusions Regional, rural and remote patients valued the long-term engagement of senior medical students in their health care team(s). A supportive CoP such as the general practice ‘teaching microsystem’ allowed student and patient to experience increasing participation and identity transformation over time. The extended student-patient-doctor relationship was seen as influential in this progression. Patients revealed unique insights into the longitudinal clerkship model, and believed they have an important contribution to make to medical education and new strategies addressing mal-distribution in the medical workforce.
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Affiliation(s)
- Judith N Hudson
- School of Rural Medicine, University of New England, Armidale, NSW 2351, Australia.
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30th George Swift Lecture: generalism in undergraduate medical education - what's next? Br J Gen Pract 2012; 62:323-5. [PMID: 22687227 DOI: 10.3399/bjgp12x649296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Affiliation(s)
- Thomas J Nasca
- Accreditation Council for Graduate Medical Education, Chicago, USA
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Sturmberg JP, O'Halloran DM, Martin CM. Understanding health system reform - a complex adaptive systems perspective. J Eval Clin Pract 2012; 18:202-8. [PMID: 22221420 DOI: 10.1111/j.1365-2753.2011.01792.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Everyone wants a sustainable well-functioning health system. However, this notion has different meaning to policy makers and funders compared to clinicians and patients. The former perceive public policy and economic constraints, the latter clinical or patient-centred strategies as the means to achieving a desired outcome. DESIGN Theoretical development and critical analysis of a complex health system model. RESULTS AND CONCLUSIONS We introduce the concept of the health care vortex as a metaphor by which to understand the complex adaptive nature of health systems, and the degree to which their behaviour is predetermined by their 'shared values' or attractors. We contrast the likely functions and outcomes of a health system with a people-centred attractor and one with a financial attractor. This analysis suggests a shift in the system's attractor is fundamental to progress health reform thinking.
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Cui W, Yuan H. Analysis of the components of Chinese medical professionalism. Eur J Intern Med 2012; 23:e30-1. [PMID: 22153545 DOI: 10.1016/j.ejim.2011.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 10/03/2011] [Accepted: 10/19/2011] [Indexed: 11/22/2022]
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Ifanti AA, Argyriou AA, Kalofonos HP. Promises and hurdles of undergraduate medical development in Greece. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2011; 2:201-208. [PMID: 23745091 PMCID: PMC3661258 DOI: 10.2147/amep.s25200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM In this paper we sought to explore undergraduate medical students' views about their professional development during their studies that are considered to be related to medical professionalism. METHOD A descriptive cross-sectional study using interpretative analysis of anonymous 10-item questionnaires was conducted at the University of Patras Medical School (UPMS), Greece. The study sample consisted of 134 undergraduate students in their fifth and sixth year of study at UPMS. RESULTS Undergraduate students emphasized the great significance of daily clinically-oriented practice in the wards in the group of behaviors consistent with medical professionalism. The integrated curriculum and informal discussions with members of the academic staff in the form of role models were also regarded as valuable approaches strongly enhancing professionalism. Students' personal statements contained attributes regarding premium professional skills, including constancy and perfectionism throughout a lifelong learning process, so as to be able to provide high quality medical care to patients. CONCLUSION According to our undergraduate medical students themselves, the last 2 years of their studies are important to understand the essence of professionalism and develop their professional medical attitudes. Clinically-oriented teaching activities together with the informal curriculum of enhanced role modeling promote medical professional behaviors and increase standards of health care provided to patients.
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Affiliation(s)
- Amalia A Ifanti
- Department of Educational Sciences and Early Childhood Education, University of Patras, Rio, Patras, Greece
| | - Andreas A Argyriou
- Department of Medicine, Division of Oncology, University Hospital of Patras, Rio, Patras, Greece
| | - Haralabos P Kalofonos
- Department of Medicine, Division of Oncology, University Hospital of Patras, Rio, Patras, Greece
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Kuhlmann E, Burau V, Larsen C, Lewandowski R, Lionis C, Repullo J. Medicine and management in European healthcare systems: how do they matter in the control of clinical practice? Int J Clin Pract 2011; 65:722-4. [PMID: 21518159 DOI: 10.1111/j.1742-1241.2011.02665.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- E Kuhlmann
- Department of Social and Policy Sciences, University of Bath, Bath, UK.
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Cleveland AD. Miles to go before we sleep: education, technology, and the changing paradigms in health information. J Med Libr Assoc 2011; 99:61-9. [PMID: 21243057 DOI: 10.3163/1536-5050.99.1.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
PURPOSE This lecture discusses a philosophy of educating health information professionals in a rapidly changing health care and information environment. DISCUSSION Education for health information professionals must be based upon a solid foundation of the changing paradigms and trends in health care and health information, as well as technological advances, to produce a well-prepared information workforce to meet the demands of health-related environments. Educational programs should begin with the core principles of library and information sciences and expand in interdisciplinary collaborations. A model of the health care environment is presented to serve as a framework for developing educational programs for health information professionals. CONCLUSION Interdisciplinary and collaborative relationships-which merge health care, library and information sciences, and other information-related disciplines-should form the basis of education for health information professionals.
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Affiliation(s)
- Ana D Cleveland
- College of Information, University of North Texas, Denton, TX 76203, USA.
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