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Skuban-Eiseler T, Orzechowski M, Denkinger M, Kocar TD, Leinert C, Steger F. Artificial Intelligence-Based Clinical Decision Support Systems in Geriatrics: An Ethical Analysis. J Am Med Dir Assoc 2023; 24:1271-1276.e4. [PMID: 37453451 DOI: 10.1016/j.jamda.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES To provide an ethical analysis of the implications of the usage of artificial intelligence-supported clinical decision support systems (AI-CDSS) in geriatrics. DESIGN Ethical analysis based on the normative arguments regarding the use of AI-CDSS in geriatrics using a principle-based ethical framework. SETTING AND PARTICIPANTS Normative arguments identified in 29 articles on AI-CDSS in geriatrics. METHODS Our analysis is based on a literature search that was done to determine ethical arguments that are currently discussed regarding AI-CDSS. The relevant articles were subjected to a detailed qualitative analysis regarding the ethical considerations Supplementary Datamentioned therein. We then discussed the identified arguments within the frame of the 4 principles of medical ethics according to Beauchamp and Childress and with respect to the needs of frail older adults. RESULTS We found a total of 5089 articles; 29 articles met the inclusion criteria and were subsequently subjected to a detailed qualitative analysis. We could not identify any systematic analysis of the ethical implications of AI-CDSS in geriatrics. The ethical considerations are very unsystematic and scattered, and the existing literature has a predominantly technical focus emphasizing the technology's utility. In an extensive ethical analysis, we systematically discuss the ethical implications of the usage of AI-CDSS in geriatrics. CONCLUSIONS AND IMPLICATIONS AI-CDSS in geriatrics can be a great asset, especially when dealing with patients with cognitive disorders; however, from an ethical perspective, we see the need for further research. By using AI-CDSS, older patients' values and beliefs might be overlooked, and the quality of the doctor-patient relationship might be altered, endangering compliance to the 4 ethical principles of Beauchamp and Childress.
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Affiliation(s)
- Tobias Skuban-Eiseler
- Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, Ulm University, Ulm, Germany; kbo-Isar-Amper-Klinikum Region München, München-Haar, Germany.
| | - Marcin Orzechowski
- Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, Ulm University, Ulm, Germany
| | - Michael Denkinger
- Institute of Geriatric Research, Ulm University Medical Center, Ulm, Germany; AGAPLESION Bethesda Clinic Ulm, Ulm, Germany
| | - Thomas Derya Kocar
- Institute of Geriatric Research, Ulm University Medical Center, Ulm, Germany; AGAPLESION Bethesda Clinic Ulm, Ulm, Germany
| | - Christoph Leinert
- Institute of Geriatric Research, Ulm University Medical Center, Ulm, Germany; AGAPLESION Bethesda Clinic Ulm, Ulm, Germany
| | - Florian Steger
- Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, Ulm University, Ulm, Germany
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Reddy B, Thomas S, Karachiwala B, Sadhu R, Iyer A, Sen G, Mehrtash H, Tunçalp Ö. A scoping review of the impact of organisational factors on providers and related interventions in LMICs: Implications for respectful maternity care. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001134. [PMID: 36962616 PMCID: PMC10021694 DOI: 10.1371/journal.pgph.0001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/14/2022] [Indexed: 11/05/2022]
Abstract
We have limited understanding of the organisational issues at the health facility-level that impact providers and care as it relates to mistreatment in childbirth, especially in low- and middle-income countries (LMICs). By extension, it is not clear what types of facility-level organisational changes or changes in working environments in LMICs could support and enable respectful maternity care (RMC). While there has been relatively more attention to health system pressures related to shortages of staff and other resources as key barriers, other organisational challenges may be less explored in the context of RMC. This scoping review aims to consolidate evidence to address these gaps. We searched literature published in English between 2000-2021 within Scopus, PubMed, Google Scholar and ScienceDirect databases. Study selection was two-fold. Maternal health articles articulating an organisational issue at the facility- level and impact on providers and/or care in an LMIC setting were included. We also searched for literature on interventions but due to the limited number of related intervention studies in maternity care specifically, we expanded intervention study criteria to include all medical disciplines. Organisational issues captured from the non-intervention, maternal health studies, and solutions offered by intervention studies across disciplines were organised thematically and to establish linkages between problems and solutions. Of 5677 hits, 54 articles were included: 41 non-intervention maternal healthcare studies and 13 intervention studies across all medical disciplines. Key organisational challenges relate to high workload, unbalanced division of work, lack of professional autonomy, low pay, inadequate training, poor feedback and supervision, and workplace violence, and these were differentially influenced by resource shortages. Interventions that respond to these challenges focus on leadership, supportive supervision, peer support, mitigating workplace violence, and planning for shortages. While many of these issues were worsened by resource shortages, medical and professional hierarchies also strongly underpinned a number of organisational problems. Frontline providers, particularly midwives and nurses, suffer disproportionately and need greater attention. Transforming institutional leadership and approaches to supervision may be particularly useful to tackle existing power hierarchies that could in turn support a culture of respectful care.
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Affiliation(s)
- Bhavya Reddy
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Sophia Thomas
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | - Baneen Karachiwala
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | - Ravi Sadhu
- T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Aditi Iyer
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | - Gita Sen
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | - Hedieh Mehrtash
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Özge Tunçalp
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Oyegoke S, Gigli KH. Evaluation of the Culture of Safety and Quality in Pediatric Primary Care Practices. J Patient Saf 2022; 18:e753-e759. [PMID: 35617600 DOI: 10.1097/pts.0000000000000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purposes of this article were to describe the perceptions of the culture of safety in pediatric primary care and evaluate whether organizational factors and staff roles are associated with perceptions of the culture of safety. METHODS We conducted a secondary data analysis using 2020 Agency for Healthcare Research and Quality Medical Office Survey on Patient Safety Culture to examine the culture of safety and quality in pediatric primary care practices. We used descriptive statistics and calculated differences in perceptions of patient safety and quality based on practice size, ownership, and staff roles using bivariate and logistic regressions. RESULTS The sample included 99 pediatric primary care practices and 1228 staff (physicians n = 169, advanced practice providers n = 70, nurses n = 338, and administration/management n = 651). The "teamwork" domain had the highest positive ratings (≥81.6% positive responses), whereas the "work pressure and pace" domain had the lowest positive ratings (≤28.6% positive response). There were no differences in perceptions of safety or quality based on practice size or ownership. However, there were differences based on staff roles, specifically between administration/management and direct care staff. CONCLUSIONS Overall, perceptions of the culture of safety and quality in pediatric primary care practices were positive. Differences in perceptions existed based on staff role. Future studies are needed to determine whether differences are clinically meaningful and how to narrow differences in perceptions among staff and improve of the culture of safety as a mechanism to improve the safety and quality of pediatric primary care.
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Affiliation(s)
| | - Kristin Hittle Gigli
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas
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Ellis LA, Tran Y, Pomare C, Long JC, Churruca K, Mahmoud Z, Liauw W, Braithwaite J. "Time is of the essence": relationship between hospital staff perceptions of time, safety attitudes and staff wellbeing. BMC Health Serv Res 2021; 21:1256. [PMID: 34801004 PMCID: PMC8605531 DOI: 10.1186/s12913-021-07275-6] [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: 07/01/2021] [Accepted: 11/08/2021] [Indexed: 12/03/2022] Open
Abstract
Background Hospitals are perceived as fast-paced and complex environments in which a missed or incorrect diagnosis or misread chart has the potential to lead to patient harm. However, to date, limited attention has been paid to studying how hospital sociotemporal norms may be associated with staff wellbeing or patient safety. The aim of this study was to use novel network analysis, in conjunction with well-established statistical methods, to investigate and untangle the complex interplay of relationships between hospital staff perceived sociotemporal structures, staff safety attitudes and work-related well-being. Method Cross-sectional survey data of hospital staff (n = 314) was collected from four major hospitals in Australia. The survey included subscales from the Organizational Temporality Scale (OTS), two previously established scales of safety attitudes (teamwork climate and safety climate) and measures of staff-related wellbeing (job satisfaction, emotional exhaustion, depersonalisation). Results Using confirmatory factor analysis, we first tested a 19-item version of the OTS for use in future studies of hospital temporality (the OTS-H). Novel psychological network analysis techniques were then employed, which identified that “pace” (the tempo or rate of hospital activity) occupies the central position in understanding the complex relationship between temporality, safety attitudes and staff wellbeing. Using a path analysis approach, serial mediation further identified that pace has an indirect relationship with safety attitudes through wellbeing factors, that is, pace impacts on staff wellbeing, which in turn affects hospital safety attitudes. Conclusions The findings of this study are important in revealing that staff wellbeing and safety attitudes can be significantly improved by placing more focus on temporal norms, and in particular hospital pace. There are implications for increasing levels of trust and providing staff with opportunities to exercise greater levels of control over their work. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07275-6.
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Affiliation(s)
- Louise A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW, Sydney, Australia.
| | - Yvonne Tran
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW, Sydney, Australia
| | - Chiara Pomare
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW, Sydney, Australia
| | - Janet C Long
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW, Sydney, Australia
| | - Kate Churruca
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW, Sydney, Australia
| | - Zeyad Mahmoud
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW, Sydney, Australia.,Université de Nantes, LEMNA, F-44000, Nantes, France
| | - Winston Liauw
- South Eastern Sydney Local Health District, Sydney, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW, Sydney, Australia
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Long JC, Pomare C, Ellis LA, Churruca K, Braithwaite J. The pace of hospital life: A mixed methods study. PLoS One 2021; 16:e0255775. [PMID: 34407092 PMCID: PMC8372908 DOI: 10.1371/journal.pone.0255775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 07/26/2021] [Indexed: 11/18/2022] Open
Abstract
The pace-of-life hypothesis is a socio-psychological theory postulating that citizens of different cities transact the business of life at varying paces, and this pace is associated with a number of population level variables. Here we apply the pace-of-life hypothesis to a hospital context to empirically test the association between pace and patient and staff outcomes. As pressure on hospitals grow and pace increases to keep up with demand, is there empirical evidence of a trade-off between a rapid pace and poorer outcomes? We collected data from four large Australian hospitals, inviting all staff (clinical and non-clinical) to complete a survey, and conducted a series of observations of hospital staff's walking pace and transactional pace. From these data we constructed three measures of pace: staff perception of pace, transactional pace, and walking pace. Outcome measures included: hospital culture, perceived patient safety, and staff well-being outcomes of job satisfaction and burnout. Overall, participants reported experiencing a "fast-paced" "hurried" and "rapid" pace-of-life working in the Australian hospital sector. We found a significant difference in perceived pace across four hospital sites, similar to trends observed for transactional pace. This provides support that the pace-of-life hypothesis may apply to the hospital context. We tested associations between faster perceived pace, hospital culture, staff well-being and patient safety. Results revealed perceived faster pace significantly predicted negative perceptions of organizational culture, greater burnout and lower job satisfaction. However, perceived pace did not predict perceptions of patient safety. Different perceptions of hospital pace-of-life were found between different clinical settings and the type of care delivered; staff working in emergency departments reported significantly "faster-paced" work environments than staff working in palliative, aged care, or rehabilitation wards.
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Affiliation(s)
- Janet C. Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Chiara Pomare
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Louise A. Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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Davies C, Lyons C, Whyte R. Optimizing nursing time in a day care unit: Quality improvement using Lean Six Sigma methodology. Int J Qual Health Care 2020; 31:22-28. [PMID: 31665293 DOI: 10.1093/intqhc/mzz087] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/20/2019] [Accepted: 09/07/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE This study applies Lean Six Sigma (LSS) to improve the efficiency of a private hospital day care unit and generate a positive impact on optimizing nursing time and improving personalized patient care and staff satisfaction. DESIGN A prospective interventional study using pre- and post-evaluation. SETTING A day care unit at a private hospital. PARTICIPANTS Nurses and patients from the day unit. INTERVENTION(S) Define, Measure, Analyze, Improve and Control was used as an overarching problem-solving framework. All front line staff, clinical leaders and managers were supported as active change agents in the quality improvement (QI) initiative. Multiple interventions were adopted across the service that aimed to de-implement non-value added activities and enhance processes with activities that added value. MAIN OUTCOME MEASURES Patient turnaround times (PTTs), nursing time, nurse-patient ratio, nurse and patient survey. RESULTS A post-implementation evaluation highlighted significant improvements in service performance and patient and staff satisfaction. Significant added value includes a reduction in PTTs, an increase in nursing care time and improvement in the nurse-patient ratio. CONCLUSION This project identified that utilizing LSS that relies on collaborative team effort is effective in creating a positive organizational culture for improvement and change. The Six Sigma tools and techniques provide evidence-based approaches that support QI in practice.
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Affiliation(s)
- Carmel Davies
- School of Nursing,Midwifery and Health Systems,University College Dublin, Belfield, Dublin 4, Ireland. D04 V1W8
| | - Caroline Lyons
- Bon Secours Health System,Renmore,Co. Galway, Ireland. H91 KC7H
| | - Regina Whyte
- Bon Secours Health System,Renmore,Co. Galway, Ireland. H91 KC7H
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