Search

Purpose: This study investigated the effects of healthcare service quality dimensions on service delivery improvement and patient satisfaction in the South African public healthcare sector. Theoretical framework: The quality of service delivery in the healthcare sector and its influence on patient satisfaction have gained attention globally, including in South Africa. Factors that affect service delivery, such as empathy, efficiency, tangibility, safety, reliability, responsiveness, assurance, communication, and discipline, have attracted the attention of both academics and healthcare practitioners, particularly in public healthcare facilities. Design/methodology/approach: A quantitative research design was followed. A data set of 500 was collected from Mpumalanga Province, South Africa, and a structural equation modelling approach was used to test ten hypotheses using Smart PLS statistical software. Findings: The research findings supported all the proposed hypotheses, with four hypotheses being insignificant. The study contributes to the literature on the effects of health service quality dimensions on service delivery improvement and patient satisfaction in an often-neglected context, namely Africa. Research, Practical & Social implications: The study provides recommendations for healthcare policies and strategies to improve service delivery in the public healthcare sector based on the research findings. Originality/value: The results indicate that the Healthcare sector needs to focus on quality service to be provided to the public. It also contributed to the body of knowledge on this topic in South Africa.

The article analyzes the commissioning and production of expert reports about Swedish health care management and governance. We show that these reports are rarely solitary stand-alone products, but tend to form clusters in an evolving discourse centered around specific policy solutions. We also show that the most important producers of such reports tend to come from a small circle of informally recruited academics and policy experts representing a narrow segment of academic disciplines. We point to some of the risks involved in this structure of knowledge production and argue that reports: (a) may form their own environment rather than address real problems; (b) may reproduce certain taken-for-granted assumptions and critical lacunae; (c) may have their impact decided by their network connections rather than by their intellectual content; and (d) represent a structure that provides opportunities for special interests to enter the process.

[Resumen] Introducción y objetivos. La insuficiencia cardiaca (IC) supone un reto para los sistemas sanitarios que se puede responder a través del desarrollo de modelos integrales de atención. Un grupo multidisciplinar de expertos reflexionó sobre los factores clave para avanzar en el desarrollo de este tipo de modelos, planteando una hoja de ruta dirigida a todos los agentes (administraciones, gestores y profesionales sanitarios). Métodos. Se conformó un panel Delphi multidisciplinar integrado por un comité asesor de 15 expertos y un panel adicional de 31 expertos. A través de una revisión bibliográfica sistemática y entrevistas individuales semiestructuradas se realizó un diagnóstico e identificación de retos y áreas de mejora a lo largo del proceso asistencial. El panel Delphi consensuó y priorizó los factores clave con la metodología Delphi Rand/UCLA, valorando su adecuación y necesidad. Resultados. Tras 2 rondas de valoración Delphi se consensuó una propuesta de 7 retos y 75 factores clave para el desarrollo de modelos integrados para la IC. Los 25 factores clave considerados altamente prioritarios se relacionan con la necesidad de una mayor coordinación y planificación a nivel de gestión sanitaria, el abordaje integral durante la hospitalización y la implantación de medidas de continuidad y coordinación asistencial, garantizando que se cubren las necesidades específicas de diferentes perfiles de pacientes. Conclusiones. La propuesta y priorización de acciones para avanzar en modelos de atención integral a la IC debe surgir de reflexiones multidisciplinares y multinivel que incluyan la visión de los pacientes y cuidadores. [Abstract] Introduction and objectives. Heart failure (HF) is a challenge for health systems that can be responded through the development of comprehensive care models. A multidisciplinary group of experts reflected on the key factors that could facilitate the development of this type of models, proposing a roadmap aimed at all agents (politicians, managers, administrators, and health professional). Methods. A multidisciplinary Delphi panel was formed, made up of an advisory committee of 15 experts and an additional panel of 31 experts. After a systematic bibliographic review and semi-structured individual interviews, a diagnosis and identification of challenges and areas for improvement were made throughout the healthcare process. The Delphi panel agreed and prioritized the key factors applying Delphi Rand/UCLA methodology, assessing their appropriateness and need. Results. After 2 rounds of Delphi assessment, a proposal of 7 challenges and 75 key factors was agreed upon for the development of integrated models for HF. The 25 key factors considered high priority are related to the need for greater coordination and planning at the health management level, the comprehensive approach during hospitalization and the implementation of measures of continuity and care coordination, ensuring that the specific needs of different patient profiles. Conclusions. The proposal and prioritization of actions to advance in models of comprehensive care for HF must arise from multidisciplinary and multilevel reflections that include the vision of patients and caregivers. El proyecto MAIC ha sido financiado por Boehringer Ingelheim España

Innovation fuels American business. Commonly, innovation is judged as good. Yet, many of the new medical devices that come on the U.S. market every year are later deemed unsafe. Regulation is distorted in that 98% of medical devices are never evaluated in human trials before being introduced to the marketplace. Instead, the U.S. Food and Drug Administration (FDA) approves a new medical device through a designated 501(k) process, based upon the identification of a predicate or substantially equivalent (SE) device. This is an investigation of the tension between product innovation, government regulation, and public safety in the American healthcare industry. It is a research project in two parts. The first draws upon established methodologies and utilizes the FDA’s 501(k) database to provide an illustrated example of the sequence and dependency between generations of implanted surgical mesh devices. The analysis reveals that the 501(k) approval process reliance on predicate devices facilitates medical device innovation that is problematic in several aspects, including patient safety. To further examine medical device innovation and patient safety, the second study develops a proof-of-concept exercise to evaluate data on recorded adverse events (AEs) found in the FDA’s Total Product Lifecyle (TPLC) database for surgical mesh products. The adverse events were mapped to the Association for the Advancement of Automotive Medicine’s (AAAM’s) Abbreviate Injury Scale (AIS), following precedents found in the medico-legal literature and military injury biomechanics standards. This approach forges a path forward to determine the relative frequency and severity of adverse events of a specific medical device, compared to that of the overall FDA product category. These two research projects combine to contribute to the understanding of safety of the FDA’s approval process and by extension the medical device industry’s innovation practices.

This thesis is centered around Black maternal health disparities and the impact of Roe v Wade being overturned on the future of Black maternal health. I start off by first looking at the facts of maternal health disparities and how Black women are dying at a higher rate than their White counterparts. Then I draw on social determinants of health and how systemic racism plays a role in the health disparities we see today. I bring in literature that discusses different frameworks created to reduce the maternal health disparities gap. I use the literature to argue that more initiatives need to be done since the gap is still increasing. My intention for this thesis is to bring light to some solutions that may help decrease the maternal health disparities and highlight how Roe v Wade being overturned can cause a larger harm in Black maternal health.

There is widespread perception that bureaucracy is omnipresent in Portuguese health care management. This is despite bureaucracy being heavily deprecated. This paper addresses this dissonance by studying the Portuguese Public Enterprise Entity Hospitals context. It seeks to understand how a bureaucratic approach prevails. The study is based on document analysis and extends the Institutional Logics Perspective to the health care context. Three institutional logics were observed: State, community, and profession. The need to resolve conflicts between the different logics induces a neo-bureaucratic approach to management. This paper contributes by identifying the institutional drivers of bureaucratic logic in health care settings.

Σκοπός της παρούσας διπλωματικής εργασίας είναι η μελέτη των επικοινωνιακών δεξιοτήτων του μάνατζμεντ υγείας. Ειδικότερα, μελετάται το μάνατζμεντ υγείας, δίνοντας έμφαση μεταξύ άλλων και στην έννοια της κοινωνικής φροντίδας. Ακόμη, εξετάζεται η έννοια της ηγεσίας, τα στυλ αυτής, αλλά και ο τρόπος που επιδρά η ηγεσία στη λειτουργία των οργανισμών υγείας. Όσον αφορά την επικοινωνία, μελετώνται τα είδη της επικοινωνίας, καθώς και η σύνδεση της οργανωσιακής κουλτούρας με την επικοινωνία, όπως και η σχέση της επικοινωνίας με την ηγεσία και τη συναισθηματική νοημοσύνη. Στα πλαίσια της μελέτης των επικοινωνιακών δεξιοτήτων στο μάνατζμεντ της υγείας, η εργασία επικεντρώνεται στις επικοινωνιακές προκλήσεις που δημιουργούνται στον χώρο της υγείας, καθώς επίσης και στην αποτελεσματική διαχείριση των συγκρούσεων, αλλά και στη διαχείριση της ιδιαιτερότητας και πολυμορφίας στους εργασιακούς χώρους. Όσον αφορά τη μεθοδολογία που χρησιμοποιείται είναι εκτενής βιβλιογραφική αναζήτηση σε επιστημονικά περιοδικά και αντίστοιχα συγγράμματα τα οποία αναφέρονται σε ζητήματα μάνατζμεντ υγείας και μονάδων φροντίδας υγείας. Ακόμη, χρησιμοποιείται υλικό από το διαδίκτυο, έτσι ώστε η προσέγγιση του ζητήματος να είναι όσο το δυνατόν πιο επικαιροποιημένη., The purpose of this master thesis is to study the communication skills of health management. In particular, health management is studied, with emphasis on the concept of social care, among others. Furthermore, the concept of leadership, its styles, and the way leadership affects the functioning of health organizations are examined. In terms of communication, the types of communication are studied, as well as the link between organizational culture and communication, and the relationship between communication and leadership and emotional intelligence. In the context of the study of communication skills in health management, the paper focuses on the communication challenges that arise in the health sector, as well as on the effective management of conflict, and on managing the specificity and diversity in workplaces. Regarding the methodology used is an extensive literature search in scientific journals and relevant writings that address issues of health management and health care facilities. Furthermore, material from the internet is used so that the approach to the issue is as up-to-date as possible.

Physicians are known to learn prescribing behavior from peers, although the extent and magnitude of peer influence on opioid prescribing is not well understood. Identifying the role peer networks play on influencing opioid prescribing, or opioid-related behavior, could elicit new understandings on how information in healthcare is spread and, in turn, lead to policy solutions and interventions to modify physician behavior in the direction of evidence-based medicine. The goal of this dissertation was to evaluate physicians prescribing opioids to patients in Medicare, or physicians receiving opioid industry payments, in order to determine if network-level characteristics are associated with patterns in opioid prescribing. This dissertation has three aims: (1) to determine whether patterns in opioid prescribing exist across physician networks and association with specialties, (2) to empirically demonstrate influence industry can have on clinical decision-making via targeted marketing within provider networks, and (3) to attempt to parse whether certain physicians with greater peer influence result in similar opioid prescribing among network peers. There are several findings and important implications related to this work. First, I find that primary care physicians who have more peer connections and more peers within a pain management specialty or surgery are more likely to have a higher median opioid prescribing rate across patient-sharing, hospital, and shared group clinic networks. Second, I find physicians who have any opioid payments are associated with three times the likelihood of at least one peer also having an opioid payment compared to physicians who did not have a similar payment. These physicians are more likely to belong to smaller and more interconnected patient-sharing networks. Finally, I perform a novel identification analysis of potential peer influencers to find certain provider-level characteristics that may shape peer prescribing behavior. The implications of this dissertation reveal that peer influence may serve as a potential mechanism for altering prescribing behavior and may be a lower-cost and efficacious way to increase adherence to evidence-based medicine.

Background Consumer demand, combined with industry interest, highlights the need to develop foods that have health promoting characteristics beyond basic nutrition. In this regard, Tinospora cordifolia (giloy) (TC), has paved the way in the food industry because of multi-purpose utilization for health care management. Being reservoir of bioactive components, TC has been exploited since ages for its therapeutic properties. Its’ consumption by people in the crude form has limited its utility for disease treatment and management. The greatest approach to avoid any disease is to prevent it thus, application of TC preparations in the development of functional foods would definitely address this issue and broaden the horizon of food market. However, this is relatively a nascent area and there is an urgent need to investigate the mechanisms and interactions between diverse food matrices and TC bioactive components. Scope and approach This review provides comprehensive information on TC and its health-related properties, elucidating the physiological role in human body and focusing its utilization in food industry. Literature is based on the findings of several researches on its protective role against various patho-physiological diseases. The potential of this medicinal plant as a therapeutic agent against SARS-COV-2 virus has also been reviewed. Research needs of food scientists dealing with development of functional foods using TC has also been catered under this review. Key findings and conclusion About 45 active constituents have been isolated from TC and include alkaloids, glycosides, terpenoids, steroids, polysaccharides, and are mainly responsible for its biological roles. These components provide the defense against diseases by several mechanisms viz., modulation of host immune responses via TLR4 dependent pathway, macrophage activation, inhibiting VEGF expression, activating enzyme system generating cyclic AMP, translocation of nuclear transcription factor etc. TC has also been explored in development of functional foods and edible packaging films as antioxidant, antimicrobial, lipase inhibitor and bioactive ingredient. Extensive research is required to investigate the suitable techniques for the stability of TC preparations in food matrix.

Professional service work (e.g., health care, law, accounting, management consulting) is knowledge-intensive and client-dependent for the quantity and quality of available information. Knowledge er...

The article examines modern approaches to personnel management in healthcare institutions. The main priority of using these hr-technologies is the formation of highly qualified medical personnel who ensure the effective provision of medical services to the population of Ukraine. Investments in medical personnel as the human capital of this industry today acquire a special strategic importance in the realities of modern Ukraine. Therefore, they are considered by the author as the main stimulating mechanism of hr-management for the sustainable development of the health care sector of Ukraine., У статті досліджено сучасні підходи до управління персоналом у закладах охорони здоров’я. Головним пріоритетом використання цих hr-технологій є формування висококваліфікованих медичних кадрів, які забезпечують ефективне надання медичних послуг населенню України. Інвестиції в медичні кадри як людський капітал цієї галузі сьогодні набувають особливого стратегічного значення в реаліях сучасної України. Тому саме вони розглядаються автором як основний стимулюючий механізм hr-управління для сталого розвитку сфери охорони здоров’я України. &nbsp

Background: Hereditary diseases are family diseases transmitted through a biological lineage. In psycho-social terms, these diseases are lived as transgenerational processes. Therefore, it is relevant to use an intergenerational perspective to access the family experience with the disease. Older family members have been dealing with the disease for a longer time and accumulating experience about it. Research on the effective roles performed by of the older family members is, however, scarce. Further, from an aging point of view, intergenerational roles may generate meaning for older persons. Aims: This study examined the roles of older relatives towards younger ones, in Portuguese families with hereditary diseases (using Huntington disease, HD as a model); and analyses of generativity in older affected individuals with transthyretin-related familial amyloid polyneuropathy, TTR-FAP). Methods: A mixed methodology was adopted and developed in two main stages. (i.) Qualitative methods (the Critical Incidents Technique, through semi-structured interviews) were used to assess older family-members’ health-related roles in families with HD. (ii.) Quantitative descriptive-comparative, were chosen to examine generative concerns (Loyola Generative Scale, Portuguese version); satisfaction with life (Satisfaction with Life Scale, Portuguese version); and self-rated health (single item of self-perceived health) in older individuals affected with TTR-FAP; and to compare those with individuals with no known family history of a hereditary disease. Main findings: Older family members in HD played influential roles in the health management of younger generations, namely shaping awareness about and influencing the management of HD. Older affected individuals with FAP had similar generativity scores as non-FAP ones, what was positively correlated with satisfaction with life and self-rated health. Implications: Findings support the relevancy of addressing hereditary diseases from an intergenerational perspective, where older family members perform health-related roles with influence in the health-management of younger generations. Additionally, older affected family members with TTR-FAP are attaining generativity, which seems to be meaningful to them. These results are relevant for the provision of genetic counselling and other healthcare services of these diseases. Our findings may also have implications for other hereditary diseases, particularly those with similar clinical characteristics and inheritance mode. Finally, they provide new contributions to developmental (particularly for older stages of life) and gerontological sciences, where the experiences of older persons in affected families remained unexplored. Introdução: As doenças hereditárias são doenças familiares, transmitidas por linhagem biológica (parental). Em termos psicossociais, a experiência destas doenças é transgeracional. Torna-se por isso relevante usar uma perspetiva intergeracional para aceder à experiência familiar da doença. Os familiares mais velhos convivem há mais tempo com a doença e por isso encontram-se numa posição privilegiada em termos da sua experiência com a doença. São, no entanto, escassos os estudos sobre os papéis intergeracionais que os membros mais velhos da família podem desempenhar. Além disso, do ponto de vista do envelhecimento, esses papéis podem gerar significado e serem relevantes para os próprios elementos mais velhos da família. Objetivos: Este estudo analisou os papéis dos familiares mais velhos em relação aos mais novos, em famílias portuguesas afetadas por doenças hereditárias (usando a doença de Huntington, DH, como modelo). E analisa a generatividade nos mais velhos da família com a doença (em famílias com transthyretin-related familial amyloid polyneuropathy, TTR-FAP). Métodos: Adotou-se uma metodologia mista, que foi desenvolvida em duas etapas principais: (1). Qualitativa (Técnica de Incidentes Críticos através de entrevistas semiestruturadas), para identificar os papéis dos mais velhos de famílias com DH em termos de gestão da saúde dos mais novos; (2). Quantitativa, descritiva-comparativa, para examinar a preocupação generativa (Loyola Generative Scale, versão portuguesa), satisfação com a vida (Escala de Satisfação com a Vida, versão em portuguesa) e perceção do estado de saúde (item único de auto-perceção de estado de saúde) dos mais velhos de famílias com TTR-FAP, e comparar com indivíduos sem história familiar conhecida de doença hereditária. Resultados Principais: Os membros mais velhos de famílias com DH desempenhavam papéis relevantes na gestão da saúde das gerações mais novas, nomeadamente influenciando a tomada de consciência sobre a DH e a sua gestão. Os mais velhos com TTR-FAP apresentavam scores de generatividade semelhantes aos não-afetados com FAP, correlacionando-se positivamente com a satisfação com a vida e perceção do seu estado de saúde. Implicações: Os resultados apoiam a relevância de abordar as doenças hereditárias de um ponto de vista intergeracional, onde os mais velhos da família desempenham papéis com influência na gestão da saúde das gerações mais jovens. Adicionalmente, os familiares mais velhos afetados com TTR-FAP revelaram preocupações generativas, o que parecia ser significativo para eles próprios. Esses resultados são relevantes para a prestação de aconselhamento genético e outros serviços de saúde. Os resultados desta pesquisa podem ter implicações para outras doenças hereditárias com características semelhantes. Finalmente, eles contribuem para o estudo do desenvolvimento psicossocial, nomeadamente de adultos mais velhos e para a gerontologia onde as experiências dos mais velhos das famílias permaneceram por explorar. Programa Doutoral em Gerontologia e Geriatria

Objective Large reductions in inpatient length of stay and inpatient bed supply have occurred across health systems in recent years. However, the direction of causation between length of stay and bed supply is often overlooked. This study examines the impact of changes to inpatient bed supply, as a result of recession-induced healthcare expenditure changes, on emergency inpatient length of stay in Ireland between 2010 and 2015. Study design We analyse all public hospital emergency inpatient discharges in Ireland from 2010 to 2015 using the administrative Hospital In-Patient Enquiry dataset. We use changes to inpatient bed supply across hospitals over time to examine the impact of bed supply on length of stay. Linear, negative binomial, and hospital–month-level fixed effects models are estimated. Results U-shaped trends are observed for both average length of stay and inpatient bed supply between 2010 and 2015. A consistently large positive relationship is found between bed supply and length of stay across all regression analyses. Between 2010 and 2012 while length of stay fell by 6.4%, our analyses estimate that approximately 42% (2.7% points) of this reduction was associated with declines in bed supply. Conclusion Changes in emergency inpatient length of stay in Ireland between 2010 and 2015 were closely related to changes in bed supply during those years. The use of length of stay as an efficiency measure should be understood in the contextual basis of other health system changes. Lower length of stay may be indicative of the lack of resources or available bed supply as opposed to reduced demand for care or the shifting of care to other settings.

Aims To examine the distributed characteristics and explore the research themes of Doctor of Nursing Practice (DNP) dissertations during the past two decades. Design A descriptive statistical and visualization bibliometric analysis was conducted. Methods Doctor of Nursing Practice dissertations submitted between January 2005 and June 2021 were collected from the ProQuest Dissertations and Theses database. A descriptive statistical analysis was conducted to calculate the distribution of the DNP dissertations by granting institution and the published year of publications. The VOSviewer 1.6.13 was used to explore the bibliometric networks and research priorities of the DNP dissertations. Results A total of 4989 DNP dissertations from 90 universities were included in this study, all from the United States. The number of DNP dissertations showed an upward trend, with steady growth from 2005 to 2014 and rapid growth after 2015. The DNP studies focused on five areas: health care management in clinical nursing, advanced practice in nursing education and health education, public health problems, mental health care for adolescents and nurses and the older people care and long-term care. Conclusion Parallel to the numerical increase in DNP dissertations is a steady expansion in the range of research topics and scopes, which is aligned with specific specializations of the DNP. Many are interdisciplinary and employ techniques imported from the fields of public health, psychology and social sciences, resulting in nursing educators and practitioners continually broaden their subject perspectives. Impact Knowing where, when and why DNP research trends developed will help nursing educators to further develop DNP education and optimize DNP programs in the future, such as paying more attention to the nursing practice. Moreover, this study will inspire DNP students and researchers to expand their subject perspectives and broaden the research scope to solve nursing practice problems based on interdisciplinary theories and methods.

The article examines managerial approaches to the modern reorganization of the health care sector through systemic restructuring and improvement of its state regulation mechanisms. According to international experience, the main priority of transformational processes in the field of health care is that investments in people and their potential acquire strategic importance. The models for the implementation of the European model of public policy in the field of health care are compared. The importance of clinical research of social significance in the conditions of global challenges and the Covid-19 coronavirus pandemic is noted. A comparative conceptual model of health care management was developed and proposed, which is based on human-centered, inclusive, innovative approaches to achieve sustainable development of medicine and health care. Emphasis is placed on the fact that the success and pace of health care reform depend on reasonableness, balance and adaptability to national realities, implementation strategies, coherence of actions of authorities at all levels, as well as the motivation of managers and employees of health care bodies and institutions., У статті досліджено управлінські підходи щодо сучасної реорганізації галузі охорони здоров’я шляхом системної перебудови та вдосконалення механізмів її державного регулювання. Головним пріоритетом трансформаційних процесів галузі охорони здоров’я зазначено згідно міжнародного досвіду, що інвестиції в людину, її потенціал набувають стратегічного значення. Зіставлено моделі щодо реалізації європейської моделі публічної політики в сфері охорони здоров’я. Зазначена важливість клінічних досліджень соціального значення в умовах глобальних викликів та пандемії коронавірусу Covid-19. Розроблена та запропонована порівнювальна концептуальна модель управління охороною здоров’я , в основу якої покладено людиноцентричний, інклюзивний, інноваційний підходи для досягнення сталого розвитку медицини та охорони здоров’я. Акцентується увага, що успіх і темпи реформування охорони здоров’я залежать від обґрунтованості, виваженості й адаптованості до національних реалій, стратегій здійснення, узгодженості дій органів влади усіх рівнів, а також мотивації керівників та співробітників органів і закладів охорони здоров’я.

A pandemia COVID-19 constituiu o mais recente e significativo evento de crise nas organizações de saúde, acarretando impacto sistémico, rompendo com as estruturas tradicionais da gestão e do trabalho e exigindo a superação de inúmeros desafios para a sobrevivência: desde quebras nas cadeias de abastecimento, severas limitações no contacto físico e elevadas taxas de hospitalização, a acentuado e progressivo desgaste físico e emocional das equipas. Sob a premissa de que eventos críticos tipicamente originam soluções criativas e inovadoras, o presente estudo pretendeu compreender de que forma a Unidade de Cuidados Continuados Integrados de Santo António, inserida na Santa Casa da Misericórdia de Barcelos, se adaptou ao contexto de crise, que aprendizagens realizou e como as integrou durante esse processo. Intersetando as teorias das Organizações Altamente Fiáveis, Coordenação Relacional e Aprendizagem Organizacional como enquadramento teórico, a recolha de dados foi realizada com recurso a entrevistas semiestruturadas, observação, onde se insere registo fotográfico, e análise documental. Os resultados evidenciam dez dimensões da sua atividade que comprovam que a unidade, com o apoio da instituição, se comportou de forma altamente fiável, com elevada coordenação relacional e empregando estratégias precursoras de aprendizagem organizacional, resultando em reduzidos incidentes, melhor trabalho em equipa e aumento do desempenho. Através do exemplo estudado, a investigação providencia uma referência elucidativa para a gestão e aprendizagem organizacional em contextos adversos, competitivos e em rápida mudança, no que concerne a melhorar o desempenho organizacional e gerir crises futuras. The COVID-19 pandemic constituted the most recent and significant crisis event in health care organizations, harboring systemic impact, disrupting traditional management and work structures and demanding countless challenges to be overcome: from supply chain failure, severe physical contact limitations and high hospitalization rates, to heightened and progressive emotional and physical fatigue. On the premise that critical events typically produce innovative and creative solutions, this study aimed to understand how Santo Antonio’s Community Care Unit, part of Barcelos’ Holy House of Mercy, adapted to the crisis context, what it learned and what was integrated during such process. Intersecting High Reliability Organizations, Relational Coordination and Organizational Learning theories as theoretical framework, data collection derived from semi-structured interviews, document analysis and observation, with photographic registration included. Results highlight ten dimensions from its activity that demonstrate that the care unit, with the institution’s support, behaved in a highly reliable manner, with high relational coordination, and while inducing organizational learning through specific strategies, resulting in low incidents, better teamwork and increased performance. Through studying such an example, the investigation provides an illuminating reference for management and organization learning in adverse, competitive, ever-changing contexts, in what pertains to increasing organizational performance and managing future crisis.

Objective: The current waiting times for intermediate care in the Netherlands prohibit timely access, leading to unwanted and costly hospital admissions. We propose alternative policies for improvement of intermediate care and estimate the effects on the waiting times, hospitalization, and the number of patient replacements. Design: Simulation study. Setting and Participants: For our case study, data were used of older adults who received intermediate care in Amsterdam, the Netherlands, in 2019. For this target group, in- and outflows and patient characteristics were identified. Methods: A process map of the main pathways into and out of the intermediate care was obtained and a discrete event simulation (DES) was built. We demonstrate the use of our DES for intermediate care by evaluating possible policy changes for a real-life case study in Amsterdam. Results: By means of a sensitivity analysis with the DES, we show that in Amsterdam the waiting times are not a result of a lack in bed capacity but are due to an inefficient triage and application process. Older adults have to wait a median of 1.8 days for admission, leading to hospitalization. If the application process becomes more efficient and evening and weekend admissions are allowed, we find that unwanted hospitalization can be decreased substantially. Conclusion and Implications: In this study, a simulation model is developed for intermediate care that can serve as a basis for policy decisions. Our case study shows that the waiting times for health care facilities are not always solved by increasing bed capacity. This underlines the necessity for a data-driven approach to identify logistic bottlenecks and find the best ways to solve them.

Introdução: A prática da gestão do cuidado em saúde vem sendo utilizada como uma estratégia para melhor organização dos serviços na perspectiva das redes de atenção à saúde com o intuito de garantir o cuidado integral aos usuários. Objetivo: Identificar na literatura atual quais as competências interprofissionais para a gestão do cuidado às condições crônicas na Atenção Primária à Saúde (APS). Metodologia: Trata-se de uma pesquisa descritiva de abordagem qualitativa do tipo revisão integrativa de literatura. A Coleta de dados foi realizada no período de Outubro a Dezembro de 2020 na qual buscou-se publicações brasileiras na base de dados Literatura Latino-Americano e do Caribe em Ciências da Saúde (LILACS) disponíveis na Biblioteca Virtual em Saúde (BVS). A amostra contou com a análise na íntegra de 12 artigos. Resultados: Dentre as competências interprofissionais observadas com relação à condição crônica pode-se citar a referência para os demais níveis de atenção garantindo a continuidade do cuidado, gestão dos casos, estímulo à autogestão e à autonomia, construção de um plano de cuidado integral, comunicação efetiva, capacitações para utilização de um modelo de atenção próprio às condições crônicas, informações sobre as condições do paciente, desenvolvimento de saberes compartilhados através da partilha de experiências, adoção de uma postura ética, de um bom vínculo entre profissional-usuário, operação competente do seu saber profissional, qualificação do sistema de apoio e criação de vínculo com a comunidade. Conclusões: As competências interprofissionais visualizam de uma maneira mais precisa a dimensão profissional da gestão do cuidado e pressupõem o compartilhamento de saberes para articulação da rede de atenção à saúde. Verifica-se que os profissionais da APS possuem maiores responsabilidades tendo em vista a sua posição de coordenadora do cuidado.

Purpose Hospitals have become competitive organizations striving to serve the needs of empowered consumers seeking positive experiences. As a result, the patient experience turns into a critical driver of performance for hospitals. Accordingly, the question “what are the critical dimensions for creating a well-designed patient experience?” has been drawing increasing attention from the industry and academia alike. This paper aims to contribute to the understanding of patient experience by using multiple source data obtained from experts and patients. Design/methodology/approach This study uses a qualitative research approach to examine the perspectives of both health-care experts and patients about the experience. A semi-structured interview series is conducted with health-care professionals, academicians, researchers, physicians and patients. Findings The results suggest a novel framework for the patient experience including five critical dimensions as follows: provider, physician, patient, personnel and periphery. This framework, 5Ps of patient experience, provides a holistic picture, which integrates the perspectives of patients, health-care providers and experts including scholars and researchers. Practical implications The 5P framework can be used by health-care professionals to better understand the driving factors of patient experience and to create a strategy to improve patient satisfaction. Originality/value To the best of the authors’ knowledge, the present study is the first qualitative study, which provides a holistic approach to patient experience independent from the branch and considers the perspectives of both health-care experts and patients.

Objectives Medical devices are potentially good candidates for coverage with evidence development (CED) schemes, as clinical data at market entry are often sparse and (cost-)effectiveness depends on real-world use. The objective of this research was to explore the diffusion of CED schemes for devices in Europe, and the factors that favour or hamper their utilization. Methods We conducted structured interviews with 25 decision-makers from 22 European countries to explore the characteristics of existing CED programmes for devices, and how decision makers perceived 13 pre-identified challenges associated with initiating and operating CED schemes for devices. We also collected data on individual schemes that were either initiated or still ongoing in the last 5 years. Results We identified seven countries with CED programmes for devices and 78 ongoing schemes. The characteristics of CED programmes varied across countries, including eligibility criteria, roles and responsibilities of stakeholders, funding arrangements, and type of decisions being contemplated at the outset of each scheme. We observed a high variability in how decision makers perceived CED-related challenges possibly reflecting country-specific arrangements and different experiences with CED. One general finding across all countries was that relatively little attention was paid to the evaluation of schemes, both during and at their completion. Conclusions CED programmes for devices with different characteristics exist in Europe. Decision-makers’ perceptions differ on the challenges associated with these schemes. More exchange of knowledge and experience will help decision makers anticipate the likely challenges in CED schemes for devices, and to learn from good practices existing elsewhere.

Background Ukraine is reforming its health care system to improve quality of health care. Insight into how primary health care managers perceive quality is important for the ongoing reform as well as for the improvement of medical services. Methods An online survey was conducted as part of the Ukrainian-Swiss project “Medical Educational Development” in April–May 2019 based on the contact list of USAID project “Health Reform Support”, and additionally on the database of the National Health Service of Ukraine and other channels. Data were analyzed using descriptive statistics and qualitative data analysis. Results In total, 302 health care managers took part in the study. The majority of primary health care managers perceive quality in health care as process quality. They associate quality mostly with compliance to standards. At the same time, primary health care managers prefer to assess outcome quality via a system of indicators and feedback. There appears to be a lack of consensus about health care quality. This may be due to a lack of awareness of the national strategy for better quality of health care service. Conclusions Our study provides new insights into primary care managers' perceptions of health care quality in Ukraine. The absence of a clear consensus about quality complicates the discussion about quality and how to measure quality in health care. This appears to be one of the obstacles to system-wide quality improvement.