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Broughton TC, Weggelaar-Jansen AM, de Graaff B. The development of Dutch COVID-19 ICU triage guidelines from an institutional work perspective. PLoS One 2023; 18:e0291075. [PMID: 37708167 PMCID: PMC10501561 DOI: 10.1371/journal.pone.0291075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 08/22/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Throughout the COVID-19 pandemic, two ICU triage guidelines were developed in the Netherlands-the Pandemic Guideline and the Guideline Code Black-ostensibly to tackle the threat of absolute care scarcity. Healthcare guidelines are generally based on evidence and prescribe what healthcare professionals should do in certain situations. We used the institutional work perspective, focusing on the human agency to create, maintain, and/or disrupt institutional structures, to study the development of these guidelines and observed that they did a lot more than just offering guidance to healthcare professionals. By including the Actor Network Theory (ANT) perspective on materiality's agency in our theoretical lens, we show how guidelines, as a materiality-a non-human artefact-interact with human actors and as such shape and are shaped by the social context. METHODS 17 online documents were analyzed. This analysis resulted in a timeline of events, which was used to identify key actors in the guideline development process. We included 12 purposely sampled respondents for semi-structured interviews. Interview transcripts were thematically coded. RESULTS During their development, the guidelines played a role in diverse forms of institutional work performed by a variety of stakeholders to: 1) strengthen the medical profession of intensivists; 2) control the medical profession; 3) gain support for the actions needed; and 4) protect the medical profession. In turn, institutional work performed by these stakeholders also shaped the guidelines, indicating the two-sidedness of the interaction between human actors and materiality in the healthcare context. CONCLUSIONS This case study shows how guidelines as a materiality and human actors interact and influence each other in multiple ways, resulting in institutional work and thus shaping two institutions: the guidelines and healthcare professions. We found that a materiality does not stand on its own but influences and shapes institutional work in relation to human actors. By studying the development, implementation, and use of the guidelines, we gained more empirical insights into the impact materiality can have on the social context of healthcare and how this can influence existing institutional environments.
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Affiliation(s)
- Tamara Christina Broughton
- Tranzo, Tilburg University, Tilburg, The Netherlands
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
| | - Anne Marie Weggelaar-Jansen
- Tranzo, Tilburg University, Tilburg, The Netherlands
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
| | - Bert de Graaff
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
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Hulter P, Langendoen W, Pluut B, Schoonman GG, Luijten R, van Wetten F, Ahaus K, Weggelaar-Jansen AM. Patients' choices regarding online access to laboratory, radiology and pathology test results on a hospital patient portal. PLoS One 2023; 18:e0280768. [PMID: 36735739 PMCID: PMC9897579 DOI: 10.1371/journal.pone.0280768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/08/2023] [Indexed: 02/04/2023] Open
Abstract
The disclosure of online test results (i.e., laboratory, radiology and pathology results) on patient portals can vary from immediate disclosure (in real-time) via a delay of up to 28 days to non-disclosure. Although a few studies explored patient opinions regarding test results release, we have no insight into actual patients' preferences. To address this, we allowed patients to register their choices on a hospital patient portal. Our research question was: When do patients want their test results to be disclosed on the patient portal and what are the reasons for these choices? We used a mixed methods sequential explanatory design that included 1) patient choices on preferred time delay to test result disclosure on the patient portal for different medical specialties (N = 4592) and 2) semi-structured interviews with patients who changed their mind on their initial choice (N = 7). For laboratory (blood and urine) results, 3530 (76.9%) patients chose a delay of 1 day and 912 (19.9%) patients chose a delay of 7 days. For radiology and pathology results 4352 (94.8%) patients chose a delay of 7 days. 43 patients changed their mind about when they wanted to receive their results. By interviewing seven patients (16%) from this group we learned that some participants did not remember why they made changes. Four participants wanted a shorter delay to achieve transparency in health-related information and communication; to have time to process bad results; for reassurance; to prepare for a medical consultation; monitoring and acting on deviating results to prevent worsening of their disease; and to share results with their general practitioner. Three participants extended their chosen delay to avoid the disappointment about the content and anxiety of receiving incomprehensible information. Our study indicates that most patients prefer transparency in health-related information and want their test results to be disclosed as soon as possible.
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Affiliation(s)
- Pauline Hulter
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
- * E-mail:
| | - Wesley Langendoen
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
| | - Bettine Pluut
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
| | - Guus G. Schoonman
- Department of Neurology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
- Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands
| | - Remco Luijten
- Department of Rheumatology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
- ETZ Digital, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Femke van Wetten
- ETZ Digital, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
- D&A Medical Group B.V., Waardenburg, The Netherlands
| | - Kees Ahaus
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
| | - Anne Marie Weggelaar-Jansen
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
- Clinical Informatics, Eindhoven University of Technology, Eindhoven, The Netherlands
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van Rijt AM, Hulter P, Weggelaar-Jansen AM, Ahaus K, Pluut B. Mental Health Care Professionals' Appraisal of Patients' Use of Web-Based Access to Their Electronic Health Record: Qualitative Study. J Med Internet Res 2021; 23:e28045. [PMID: 34448705 PMCID: PMC8433850 DOI: 10.2196/28045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/16/2021] [Accepted: 07/05/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Patients in a range of health care sectors can access their medical health records using a patient portal. In mental health care, the use of patient portals among mental health care professionals remains low. Mental health care professionals are concerned that patient access to electronic health records (EHRs) will negatively affect the patient's well-being and privacy as well as the professional's own workload. OBJECTIVE This study aims to provide insights into the appraisal work of mental health care professionals to assess and understand patient access to their EHRs through a patient portal. METHODS We conducted a qualitative study that included 10 semistructured interviews (n=11) and a focus group (n=10). Participants in both the interviews and the focus group were mental health care professionals from different professional backgrounds and staff employees (eg, team leaders and communication advisors). We collected data on their opinions and experiences with the recently implemented patient portal and their attempts to modify work practices. RESULTS Our study provides insights into mental health care professionals' appraisal work to assess and understand patient access to the EHR through a patient portal. A total of four topics emerged from our data analysis: appraising the effect on the patient-professional relationship, appraising the challenge of sharing and registering delicate information, appraising patient vulnerability, and redefining consultation routines and registration practices. CONCLUSIONS Mental health care professionals struggle with the effects of web-based patient access and are searching for the best ways to modify their registration and consultation practices. Our participants seem to appraise the effects of web-based patient access individually. Our study signals the lack of systematization and communal appraisal. It also suggests various solutions to the challenges faced by mental health care professionals. To optimize the effects of web-based patient access to EHRs, mental health care professionals need to be involved in the process of developing, implementing, and embedding patient portals.
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Affiliation(s)
| | - Pauline Hulter
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Anne Marie Weggelaar-Jansen
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands.,Eindhoven University of Technology, Eindhoven, Netherlands
| | - Kees Ahaus
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Bettine Pluut
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
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Sülz S, van Elten HJ, Askari M, Weggelaar-Jansen AM, Huijsman R. eHealth Applications to Support Independent Living of Older Persons: Scoping Review of Costs and Benefits Identified in Economic Evaluations. J Med Internet Res 2021; 23:e24363. [PMID: 33687335 PMCID: PMC7988395 DOI: 10.2196/24363] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/04/2020] [Accepted: 01/13/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND eHealth applications are constantly increasing and are frequently considered to constitute a promising strategy for cost containment in health care, particularly if the applications aim to support older persons. Older persons are, however, not the only major eHealth stakeholder. eHealth suppliers, caregivers, funding bodies, and health authorities are also likely to attribute value to eHealth applications, but they can differ in their value attribution because they are affected differently by eHealth costs and benefits. Therefore, any assessment of the value of eHealth applications requires the consideration of multiple stakeholders in a holistic and integrated manner. Such a holistic and reliable value assessment requires a profound understanding of the application's costs and benefits. The first step in measuring costs and benefits is identifying the relevant costs and benefit categories that the eHealth application affects. OBJECTIVE The aim of this study is to support the conceptual phase of an economic evaluation by providing an overview of the relevant direct and indirect costs and benefits incorporated in economic evaluations so far. METHODS We conducted a systematic literature search covering papers published until December 2019 by using the Embase, Medline Ovid, Web of Science, and CINAHL EBSCOhost databases. We included papers on eHealth applications with web-based contact possibilities between clients and health care providers (mobile health apps) and applications for self-management, telehomecare, telemedicine, telemonitoring, telerehabilitation, and active healthy aging technologies for older persons. We included studies that focused on any type of economic evaluation, including costs and benefit measures. RESULTS We identified 55 papers with economic evaluations. These studies considered a range of different types of costs and benefits. Costs pertained to implementation activities and operational activities related to eHealth applications. Benefits (or consequences) could be categorized according to stakeholder groups, that is, older persons, caregivers, and health care providers. These benefits can further be divided into stakeholder-specific outcomes and resource usage. Some cost and benefit types have received more attention than others. For instance, patient outcomes have been predominantly captured via quality-of-life considerations and various types of physical health status indicators. From the perspective of resource usage, a strong emphasis has been placed on home care visits and hospital usage. CONCLUSIONS Economic evaluations of eHealth applications are gaining momentum, and studies have shown considerable variation regarding the costs and benefits that they include. We contribute to the body of literature by providing a detailed and up-to-date framework of cost and benefit categories that any interested stakeholder can use as a starting point to conduct an economic evaluation in the context of independent living of older persons.
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Affiliation(s)
- Sandra Sülz
- Erasmus School of Health Policy & Management, Rotterdam, Netherlands
| | - Hilco J van Elten
- Erasmus School of Health Policy & Management, Rotterdam, Netherlands
| | - Marjan Askari
- Erasmus School of Health Policy & Management, Rotterdam, Netherlands
| | - Anne Marie Weggelaar-Jansen
- Erasmus School of Health Policy & Management, Rotterdam, Netherlands
- Clinical Informatics, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Robbert Huijsman
- Erasmus School of Health Policy & Management, Rotterdam, Netherlands
- Geriant, Heerhugowaard, Netherlands
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Wehrens R, Sihag V, Sülz S, van Elten H, van Raaij E, de Bont A, Weggelaar-Jansen AM. Understanding the Uptake of Big Data in Health Care: Protocol for a Multinational Mixed-Methods Study. JMIR Res Protoc 2020; 9:e16779. [PMID: 33090113 PMCID: PMC7644380 DOI: 10.2196/16779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 11/25/2022] Open
Abstract
Background Despite the high potential of big data, their applications in health care face many organizational, social, financial, and regulatory challenges. The societal dimensions of big data are underrepresented in much medical research. Little is known about integrating big data applications in the corporate routines of hospitals and other care providers. Equally little is understood about embedding big data applications in daily work practices and how they lead to actual improvements for health care actors, such as patients, care professionals, care providers, information technology companies, payers, and the society. Objective This planned study aims to provide an integrated analysis of big data applications, focusing on the interrelations among concrete big data experiments, organizational routines, and relevant systemic and societal dimensions. To understand the similarities and differences between interactions in various contexts, the study covers 12 big data pilot projects in eight European countries, each with its own health care system. Workshops will be held with stakeholders to discuss the findings, our recommendations, and the implementation. Dissemination is supported by visual representations developed to share the knowledge gained. Methods This study will utilize a mixed-methods approach that combines performance measurements, interviews, document analysis, and cocreation workshops. Analysis will be structured around the following four key dimensions: performance, embedding, legitimation, and value creation. Data and their interrelations across the dimensions will be synthesized per application and per country. Results The study was funded in August 2017. Data collection started in April 2018 and will continue until September 2021. The multidisciplinary focus of this study enables us to combine insights from several social sciences (health policy analysis, business administration, innovation studies, organization studies, ethics, and health services research) to advance a holistic understanding of big data value realization. The multinational character enables comparative analysis across the following eight European countries: Austria, France, Germany, Ireland, the Netherlands, Spain, Sweden, and the United Kingdom. Given that national and organizational contexts change over time, it will not be possible to isolate the factors and actors that explain the implementation of big data applications. The visual representations developed for dissemination purposes will help to reduce complexity and clarify the relations between the various dimensions. Conclusions This study will develop an integrated approach to big data applications that considers the interrelations among concrete big data experiments, organizational routines, and relevant systemic and societal dimensions. International Registered Report Identifier (IRRID) DERR1-10.2196/16779
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Affiliation(s)
- Rik Wehrens
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Vikrant Sihag
- Rotterdam School of Management, Erasmus University Rotterdam, Rotterdam, Netherlands.,Department of Industrial Engineering & Innovation Sciences, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Sandra Sülz
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Hilco van Elten
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Erik van Raaij
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands.,Rotterdam School of Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Antoinette de Bont
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Anne Marie Weggelaar-Jansen
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands.,School of Medical Physics and Engineering, University of Technology Eindhoven, Eindhoven, Netherlands
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Nunes FG, Robert G, Weggelaar-Jansen AM, Wiig S, Aase K, Karltun A, Fulop NJ. Enacting quality improvement in ten European hospitals: a dualities approach. BMC Health Serv Res 2020; 20:658. [PMID: 32678008 PMCID: PMC7364540 DOI: 10.1186/s12913-020-05488-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/01/2020] [Indexed: 11/30/2022] Open
Abstract
Background Hospitals undertake numerous initiatives searching to improve the quality of care they provide, but these efforts are often disappointing. Current models guiding improvement tend to undervalue the tensional nature of hospitals. Applying a dualities approach that is sensitive to tensions inherent to hospitals’ quest for improved quality, this article aims to identify which organizational dualities managers should particularly pay attention to. Methods A set of cross-national, multi-level case studies was conducted involving 383 semi-structured interviews and 803 h of non-participant observation of key meetings and shadowing of staff in ten purposively sampled hospitals in five European countries (England, the Netherlands, Portugal, Sweden, and Norway). Results Six dualities that describe the quest for improved quality, each embracing a seemingly contradictory feature were identified: plural consensus, distributed connectedness, orchestrated emergence, formalized fluidity, patient coreness, and cautious generativeness. Conclusions We advocate for a move from the usual sequential and project-based and systemic thinking about quality improvement to the development of meta-capabilities to balance the simultaneous operation of opposing ideas or concepts. Doing so will help hospital managers to deal with major challenges of change inherent to quality improvement initiatives.
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Affiliation(s)
- Francisco G Nunes
- ISCTE-IUL, Lisbon University Institute, BRU-IUL, Avenida das Forças Armadas, 1649-026, Lisbon, Portugal.
| | - Glenn Robert
- King's College London, Strand, London, WC2R 2LS, UK
| | | | - Siri Wiig
- SHARE-Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway
| | - Karina Aase
- SHARE-Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway
| | - Anette Karltun
- The Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare and Department of Supply Chain and Operations Management, School of Engineering, Jönköping University, PO Box 1026, SE-551 11, Jönköping, Sweden
| | - Naomi J Fulop
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
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Hulter P, Pluut B, Leenen-Brinkhuis C, de Mul M, Ahaus K, Weggelaar-Jansen AM. Adopting Patient Portals in Hospitals: Qualitative Study. J Med Internet Res 2020; 22:e16921. [PMID: 32427110 PMCID: PMC7268003 DOI: 10.2196/16921] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/02/2020] [Accepted: 03/05/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Theoretical models help to explain or predict the adoption of electronic health (eHealth) technology and illustrate the complexity of the adoption process. These models provide insights into general factors that influence the use of eHealth technology. However, they do not give hospitals much actionable knowledge on how to facilitate the adoption process. OBJECTIVE Our study aims to provide insights into patient portal adoption processes among patients and hospital staff, including health care professionals (HCPs), managers, and administrative clerks. Studying the experiences and views of stakeholders answers the following question: How can hospitals encourage patients and HCPs to adopt a patient portal? METHODS We conducted 22 semistructured individual and group interviews (n=69) in 12 hospitals and four focus groups with members of national and seminational organizations and patient portal suppliers (n=53). RESULTS The effort hospitals put into adopting patient portals can be split into three themes. First, inform patients and HCPs about the portal. This communication strategy has four objectives: users should (1) know about the portal, (2) know how the portal works, (3) know that action on the portal is required, and (4) know where to find help with the portal. Second, embed the patient portal in the daily routine of HCPs and management. This involves three forms of support: (1) hospital policy, (2) management by monitoring the numbers, and (3) a structured implementation strategy that includes all staff of one department. Third, try to adjust the portal to meet patients' needs to optimize user-friendliness in two ways: (1) use patients' feedback and (2) focus on optimizing for patients with special needs (eg, low literacy and low digital skills). CONCLUSIONS Asking stakeholders what they have learned from their efforts to stimulate patient portal use in hospitals elicited rich insights into the adoption process. These insights are missing in the theoretical models. Therefore, our findings help to translate the relatively abstract factors one finds in theoretical models to the everyday pragmatics of eHealth projects in hospitals.
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Affiliation(s)
- Pauline Hulter
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Bettine Pluut
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | | | - Marleen de Mul
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Kees Ahaus
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Anne Marie Weggelaar-Jansen
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands.,Eindhoven University of Technology, Eindhoven, Netherlands
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Weggelaar-Jansen AM, van Wijngaarden J. Transferring skills in quality collaboratives focused on improving patient logistics. BMC Health Serv Res 2018; 18:224. [PMID: 29606124 PMCID: PMC5879809 DOI: 10.1186/s12913-018-3051-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/21/2018] [Indexed: 12/24/2022] Open
Abstract
Background A quality improvement collaborative, often used by the Institute for Healthcare Improvement, is used to educate healthcare professionals and improve healthcare at the same time. However, no prior research has been done on the knowledge and skills healthcare professionals need to achieve improvements or the extent to which quality improvement collaboratives help enhance both knowledge and skills. Our research focused on quality improvement collaboratives aiming to improve patient logistics and tried to identify which knowledge and skills are required and to what extent these were enhanced during the QIC. Methods We defined skills important for logistic improvements in a three-phase Delphi study. Based on the Delphi results we made a questionnaire. We surveyed participants in a national quality improvement collaborative to assess the skills rated as 1) important, 2) available and 3) improved during the collaborative. At two sense-making meetings, experts reflected on our findings and hypothesized on how to improve (logistics) collaboratives. Results The Delphi study found 18 skills relevant for reducing patient access time and 21 for reducing throughput time. All skills retrieved from the Delphi study were scored as ‘important’ in the survey. Teams especially lacked soft skills connected to project and change management. Analytical skills increased the most, while more reflexive skills needed for the primary goal of the collaborative (reduce access and throughput times) increased modestly. At two sense-making meetings, attendees suggested four improvements for a quality improvement collaborative: 1) shift the focus to project- and change management skills; 2) focus more on knowledge transfer to colleagues; 3) teach participants to adapt the taught principles to their own situations; and 4) foster intra-project reflexive learning to translate gained insights to other projects (inter-project learning). Conclusions Our findings seem to suggest that Quality collaboratives could benefit if more attention is paid to the transfer of ‘soft skills’ (e.g. change, project management and communication skills) and reflexive skills (e.g. adjusting logistics principles to specific situations and inter-project translation of experiences). Electronic supplementary material The online version of this article (10.1186/s12913-018-3051-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne Marie Weggelaar-Jansen
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Campus Woudestein, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands.
| | - Jeroen van Wijngaarden
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Campus Woudestein, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
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Weggelaar-Jansen AM, van Buren-Jansen E, van 't Schip S, Pel JJ, Nieboer AP, Helder OK. Design study to develop screen savers aimed at improving hand hygiene behavior. Am J Infect Control 2016; 44:860-7. [PMID: 27040563 DOI: 10.1016/j.ajic.2016.01.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 01/06/2016] [Accepted: 01/12/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Displaying screen savers with gain-framed messages are effective to improve hand hygiene, but the design of screen savers has not been studied yet. METHODS Based on the literature, scientific propositions were developed for the design of screen savers, exploring 2 strategies to subconsciously influence hand hygiene behavior; the first was to gain attention, and the second was to exert peer pressure. The designed screen savers were tested for attention with an eye-tracking study (N = 27) and for the influence of peer pressure with a questionnaire (N = 25). RESULTS Twenty-five propositions for gaining attention concerned the format and color of the screen saver itself and color, position, and style of visual and text elements. Seven propositions for peer pressure concerned the influence of peers, role models, and feelings of being watched. Eye-tracking measurements showed that text on the 4 screen savers based on propositions gained more, earlier, and longer attention and the visual elements gained earlier and longer attention than the control screen savers. The questionnaire results showed that feelings of peer pressure were evoked by 3 screen savers; of these, one was not based on propositions. CONCLUSIONS Screen savers designed according to scientific propositions for visual attention and peer pressure have the potential to alter hand hygiene behavior.
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Weggelaar-Jansen AM, van Wijngaarden J, Slaghuis SS. Do quality improvement collaboratives' educational components match the dominant learning style preferences of the participants? BMC Health Serv Res 2015; 15:239. [PMID: 26087653 PMCID: PMC4473844 DOI: 10.1186/s12913-015-0915-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 06/08/2015] [Indexed: 01/17/2023] Open
Abstract
Background Quality improvement collaboratives are used to improve healthcare by various organizations. Despite their popularity literature shows mixed results on their effectiveness. A quality improvement collaborative can be seen as a temporary learning organization in which knowledge about improvement themes and methods is exchanged. In this research we studied: Does the learning approach of a quality improvement collaborative match the learning styles preferences of the individual participants and how does that affect the learning process of participants? Methods This research used a mixed methods design combining a validated learning style questionnaire with data collected in the tradition of action research methodology to study two Dutch quality improvement collaboratives. The questionnaire is based on the learning style model of Ruijters and Simons, distinguishing five learning style preferences: Acquisition of knowledge, Apperception from others, Discovery of new insights, Exercising in fictitious situations and Participation with others. Results The most preferred learning styles of the participants were Discovery and Participation. The learning style Acquisition was moderately preferred and Apperception and Exercising were least preferred. The educational components of the quality improvement collaboratives studied (national conferences, half-day learning sessions, faculty site visits and use of an online tool) were predominantly associated with the learning styles Acquisition and Apperception. We observed a decrease in attendance to the learning activities and non-conformance with the standardized set goals and approaches. Conclusions We conclude that the participants’ satisfaction with the offered learning approach changed over time. The lacking match between these learning style preferences and the learning approach in the educational components of the quality improvement collaboratives studied might be the reason why the participants felt they did not gain new insights and therefore ceased their participation in the collaborative. This study provides guidance for future organisers and participants of quality improvement collaboratives about which learning approaches will best suit the participants and enhance improvement work. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0915-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne Marie Weggelaar-Jansen
- Department of Health Policy and Management, Erasmus University, Campus Woudestein, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands.
| | - Jeroen van Wijngaarden
- Department of Health Policy and Management, Erasmus University, Campus Woudestein, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands.
| | - Sarah-Sue Slaghuis
- Department of Health Policy and Management, Erasmus University, Campus Woudestein, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands.
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