Change Management and Digital Innovations in Hospitals of Five European Countries

'A Necessary Idea Given Our Current Climate': A Qualitative Study of Stakeholder Perspectives and Actions Required to Increase the Proportion of Plant to Animal Protein in Hospital Patient Menus

INTRODUCTION

Replacing dietary animal protein with plant protein reduces greenhouse gas emissions and improves human health. Hospital foodservices can support change, but require buy-in and collaboration between people across the system.

METHODS

A qualitative descriptive study aimed to explore hospital patient menu content expert perspectives regarding increasing the proportion of plant to animal protein in hospital patient menus and outline actions required to do this. Semi-structured interviews were completed with hospital or foodservice contractor employees and data were analysed using a general inductive approach.

RESULTS

Twenty-five of the 35 content experts interviewed supported increasing the proportion of plant to animal protein foods. All voiced concerns, including patients not eating meals, jeopardising protein intake and increasing malnutrition rates, and the prohibitive cost of plant-based protein foods. Participants described steps to change patient menus, including a cyclical design process. This entailed consultation with stakeholders, setting a target, choosing a strategy, developing a menu and recipes, finding food product, planning the system and operations, and checking it works. Most felt the best ways to increase the proportion of plant to animal protein were to swap ingredients in familiar recipes or replace entire menu items (n = 21), add plant-based options to the menu (n = 25), and move the position of plant-based meals on the menu (n = 22).

CONCLUSION

This study conceptualised a process for increasing the proportion of plant to animal protein in hospital patient menus for use by hospitals or policymakers. Future studies should test these suggested menu changes, assessing impacts on greenhouse gas emissions, plate waste, malnutrition indicators, cost and patient satisfaction.

Using process model to define the legislative framework of electronic prescription in the Czech Republic

Defining legislation for electronic prescription systems (EPS) is inherently challenging due to conflicting interests and requirements. The study aimed to develop a comprehensive EPS within the Czech healthcare framework, integrating legislative, process, and technical aspects to ensure security, user acceptability, and compliance with health regulations. A process modeling tool based on hierarchical state machines was employed to create a detailed process architecture for the EPS. Key participants, scenarios, and state transitions were identified and incorporated into a process model using the Craft.CASE based on the BORM methodology. The final process architecture model facilitated interdisciplinary communication and consensus-building among stakeholders, including healthcare professionals, IT specialists, and legislators. The model served as a foundation for the legislative framework and was included in the explanatory memorandum for the draft amendment to the Pharmaceuticals Act. The use of hierarchical state machines and process modeling tools in developing healthcare legislation effectively reduced misunderstandings and ensured precise implementation. This method can be applied to other complex legislative and system design projects, enhancing stakeholder communication and project success.

Long-Term Adoption of Televisits in Nursing Homes During the COVID-19 Crisis and Following Up Into the Postpandemic Setting: Mixed Methods Study

BACKGROUND

There is growing evidence that telemedicine can improve the access to and quality of health care for nursing home residents. However, it is still unclear how to best manage and guide the implementation process to ensure long-term adoption, especially in the context of a decline in telemedicine use after the COVID-19 crisis.

OBJECTIVE

This study aims to identify and address major challenges for the implementation of televisits among residents in a nursing home, their caring nurses, and their treating general practitioners (GPs). It also evaluated the impact of televisits on the nurses' workload and their nursing practice.

METHODS

A telemedical system with integrated medical devices was introduced in 2 nursing homes and their cooperating GP offices in rural Germany. The implementation process was closely monitored from the initial decision to introduce telemedicine in November 2019 to its long-term routine use until March 2023. Regular evaluation was based on a mixed methods approach combining rigorous qualitative approaches with quantitative measurements.

RESULTS

In the first phase during the COVID-19 pandemic, both nursing homes achieved short-term adoption. In the postpandemic phase, an action-oriented approach made it possible to identify barriers and take control actions for long-term adoption. The implementation of asynchronous visits, strong leadership, and sustained training of the nurses were critical elements in achieving long-term implementation in 1 nursing home. The implementation led to enhanced clinical skills, higher professional recognition, and less psychological distress among the nursing staff. Televisits resulted in a modest increase in time demands for the nursing staff compared to organizing in-person home visits with the GPs.

CONCLUSIONS

Focusing on health care workflow and change management aspects depending on the individual setting is of utmost importance to achieve successful long-term implementation of telemedicine.

Measuring the impact of digitisation on NHS nurses' time and morale: A time and motion study

Objective

Despite the benefits of digital transformation, many healthcare organisations still rely on manual, traditional processes to transfer clinical images and videos to electronic patient records (EPRs), consuming valuable nurse-patient-facing time. Our study aimed to outline tasks performed by nurses to traditionally transfer clinical images and videos to EPRs, assess the impact on nurses' time and efficiency cost, and report on nurse experiences when transitioning to a digitised process.

Methods

Observations spanned two one-week periods in the ENT outpatient department of Royal Devon University Healthcare NHS Foundation Trust, using direct observational time and predetermined motion time system analysis to map nurses' tasks pre-and post-implementation of a Medical Video Recorder and Centralised Medical Content Management. Two staff experience surveys were conducted, and data was aggregated to evaluate the impact of digitisation.

Results

Nurses traditionally followed two processes to transfer clinical images and video to EPRs. Digitisation saved 43 seconds per endoscopy (a 10% efficiency gain) compared to Process 1, in which nurses print, attach, scan, and digitise images off-site to EPRs, and 3 minutes and 8 seconds (a 33% efficiency gain) compared to Process 2, where urgent content is recorded on an iPad and transferred to EPRs. Digitising could save nurses 26 working days annually by reducing non-patient-facing tasks in the ENT department, leading to an annual time efficiency cost-saving of £6780. Furthermore, 75% of nurses reported significantly improved morale, 63% strongly agreed that digitisation improved confidence in the accuracy of patient details, and all paper processes were eliminated.

Conclusion

Our findings highlight the inefficiency of traditional methods in transferring images and videos to EPRs. Digital transformation could enhance nursing efficiency and morale, improving care quality. Future studies should evaluate the effectiveness of Medical Video Recorders and Centralised Medical Content Management in other departments.

The Constrained-Disorder Principle Assists in Overcoming Significant Challenges in Digital Health: Moving from "Nice to Have" to Mandatory Systems

The success of artificial intelligence depends on whether it can penetrate the boundaries of evidence-based medicine, the lack of policies, and the resistance of medical professionals to its use. The failure of digital health to meet expectations requires rethinking some of the challenges faced. We discuss some of the most significant challenges faced by patients, physicians, payers, pharmaceutical companies, and health systems in the digital world. The goal of healthcare systems is to improve outcomes. Assisting in diagnosing, collecting data, and simplifying processes is a "nice to have" tool, but it is not essential. Many of these systems have yet to be shown to improve outcomes. Current outcome-based expectations and economic constraints make "nice to have," "assists," and "ease processes" insufficient. Complex biological systems are defined by their inherent disorder, bounded by dynamic boundaries, as described by the constrained disorder principle (CDP). It provides a platform for correcting systems' malfunctions by regulating their degree of variability. A CDP-based second-generation artificial intelligence system provides solutions to some challenges digital health faces. Therapeutic interventions are held to improve outcomes with these systems. In addition to improving clinically meaningful endpoints, CDP-based second-generation algorithms ensure patient and physician engagement and reduce the health system's costs.

"It depends on the people!" - A qualitative analysis of contextual factors, prior to the implementation of digital health innovations for chronic condition management, in a German integrated care network

Objective

Integrated care and digital health technology interventions are promising approaches to coordinate services for people living with chronic conditions, across different care settings and providers. The EU-funded ADLIFE project intends to provide digitally integrated personalized care to improve and maintain patients' health with advanced chronic conditions. This study conducted a qualitative assessment of contextual factors prior to the implementation of the ADLIFE digital health platforms at the German pilot site. The results of the assessment are then used to derive recommendations for action for the subsequent implementation, and for evaluation of the other pilot sites.

Methods

Qualitative interviews with healthcare professionals and IT experts were conducted at the German pilot site. The interviews followed a semi-structured interview guideline, based on the HOT-fit framework, focusing on organizational, technological, and human factors. All interviews were audio recorded, transcribed, and subsequently analysed following qualitative content analysis.

Results

The results of the 18 interviews show the interviewees' high openness and motivation to use new innovative digital solutions, as well as an apparent willingness of cooperation between different healthcare professionals. Challenges include limited technical infrastructure and large variability of software to record health data, lacking standards and interfaces.

Conclusions

Considering contextual factors on different levels is critical for the success of implementing innovations in healthcare and the transfer into other settings. In our study, the HOT-fit framework proved suitable for assessing contextual factors, when implementing IT innovations in healthcare. In a next step, the methodological approach will be transferred to the six other European pilot sites, participating in the project, for a cross-national assessment of contextual factors.

Experiences and perceptions of final-year nursing students of using a chatbot in a simulated emergency situation: A qualitative study

AIM

The aim of this study is to explore the experiences and perceptions of final-year nursing students on the acceptability and feasibility of using a chatbot for clinical decision-making and patient safety.

BACKGROUND

The effective and inclusive use of new technologies such as conversational agents or chatbots could support nurses in increasing evidence-based care and decreasing low-quality services.

METHODS

A descriptive qualitative study was used through focus group interviews. The data analysis was conducted using a thematic analysis.

RESULTS

This study included 114 participants. After our data analysis, two main themes emerged: (i) experiences in the use of a chatbot service for clinical decision-making and and (ii) integrating conversational agents into the organizational safety culture.

CONCLUSIONS

The findings of our study provide preliminary support for the acceptability and feasibility of adopting SafeBot, a chatbot for clinical decision-making and patient safety. Our results revealed substantial recommendations for refining navigation, layout and content, as well as useful insights to support its acceptance in real nursing practice.

IMPLICATIONS FOR NURSING MANAGEMENT

Leaders and managers may well see artificial intelligence-based conversational agents like SafeBot as a potential solution in modern nursing practice for effective problem-solving resolution, innovative staffing and nursing care delivery models at the bedside and criteria for measuring and ensure quality and patient safety.

Incorporating value-based healthcare projects in residency training: a mixed-methods study on the impact of participation on understanding and competency development

OBJECTIVES

Stimulating the active participation of residents in projects with societally relevant healthcare themes, such as value-based healthcare (VBHC), can be a strategy to enhance competency development. Canadian Medical Education Directions for Specialists (CanMEDS) competencies such as leader and scholar are important skills for all doctors. In this study, we hypothesise that when residents conduct a VBHC project, CanMEDS competencies are developed. There is the added value of gaining knowledge about VBHC.

DESIGN

An explorative mixed-methods study assessing residents' self-perceived learning effects of conducting VBHC projects according to three main components: (1) CanMEDS competency development, (2) recognition of VBHC dilemmas in clinical practice, and (3) potential facilitators for and barriers to implementing a VBHC project. We triangulated data resulting from qualitative analyses of: (a) text-based summaries of VBHC projects by residents and (b) semistructured interviews with residents who conducted these projects.

SETTING

Academic and non-academic hospitals in the Netherlands.

PARTICIPANTS

Out of 63 text-based summaries from residents, 56 were selected; and out of 19 eligible residents, 11 were selected for semistructured interviews and were included in the final analysis.

RESULTS

Regarding CanMEDS competency development, the competencies 'leader', 'communicator' and 'collaborator' scored the highest. Opportunities to recognise VBHC dilemmas in practice were mainly stimulated by analysing healthcare practices from different perspectives, and by learning how to define costs and relate them to outcomes. Finally, implementation of VBHC projects is facilitated by a thorough investigation of a VBHC dilemma combined with an in-depth stakeholder analysis.

CONCLUSION

In medical residency training programmes, competency development through active participation in projects with societally relevant healthcare themes-such as VBHC-was found to be a promising strategy. From a resident's perspective, combining a thorough investigation of the VBHC dilemma with an in-depth stakeholder analysis is key to the successful implementation of a VBHC project.