Patient-centeredness in Integrated healthcare delivery systems - Needs, expectations and priorities for organized healthcare systems

Directory of Open Access Journals (Sweden)

Christin Juhnke

2013-11-01

Full Text Available Introduction: Patient-centred healthcare is becoming a more significant success factor in the design of integrated healthcare systems. The objective of this study is to structure a patient-relevant hierarchy of needs and expectations for the design of organised healthcare delivery systems.Methods: A questionnaire with 84 items was conducted with N = 254 healthcare experts and N = 670 patients. Factor analyses were performed using SPSS©18. The number of factors retained was controlled by Kaiser's criterion, validation of screeplots and interpretability of the items. Cronbach's α was used to assess the internal consistency of the subscales.Results: Exploratory factor analysis led to 24 factors in the expert sample and 20 in the patient sample. After analysing the screeplots, confirmatory factor analyses were computed for 7-factor solutions accounting for 42.963% of the total variance and Kaiser–Meyer–Olkinof 0.914 for the patients (experts: 38.427%, Kaiser–Meyer–Olkin = 0.797. Cronbach's α ranged between 0.899 and 0.756. Based on the analysis, coordinated care could be differentiated into seven dimensions: access, data and information, service and infrastructure, professional care, interpersonal care, individualised care, continuity and coordination.Conclusion and Discussion: The study provides insight into patient and experts expectations towards the organisation of integrated healthcare delivery systems. If providers and payers can take into account patient needs and expectations while implementing innovative healthcare delivery systems, greater acceptance and satisfaction will be achieved. In the best case, this will lead to better adherence resulting in better clinical outcomes.

Integration of research and practice to improve public health and healthcare delivery through a collaborative 'Health Integration Team' model - a qualitative investigation.

Science.gov (United States)

Redwood, Sabi; Brangan, Emer; Leach, Verity; Horwood, Jeremy; Donovan, Jenny L

2016-06-22

Economic considerations and the requirement to ensure the quality, safety and integration of research with health and social care provision have given rise to local developments of collaborative organisational forms and strategies to span the translational gaps. One such model - the Health Integration Team (HIT) model in Bristol in the United Kingdom (UK) - brings together National Health Service (NHS) organisations, universities, local authorities, patients and the public to facilitate the systematic application of evidence to promote integration across healthcare pathways. This study aimed to (1) provide empirical evidence documenting the evolution of the model; (2) to identify the social and organisational processes and theory of change underlying healthcare knowledge and practice; and (3) elucidate the key aspects of the HIT model for future development and translation to other localities. Contemporaneous documents were analysed, using procedures associated with Framework Analysis to produce summarised data for descriptive accounts. In-depth interviews were undertaken with key informants and analysed thematically. Comparative methods were applied to further analyse the two data sets. One hundred forty documents were analysed and 10 interviews conducted with individuals in leadership positions in the universities, NHS commissioning and provider organisations involved in the design and implementation of the HIT model. Data coalesced around four overarching themes: 'Whole system' engagement, requiring the active recruitment of all those who have a stake in the area of practice being considered, and 'collaboration' to enable coproduction were identified as 'process' themes. System-level integration and innovation were identified as potential 'outcomes' with far-reaching impacts on population health and service delivery. The HIT model emerged as a particular response to the perceived need for integration of research and practice to improve public health and

Viability of healthcare service delivery alternatives for the Australian mining sector.

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Williams, Patricia A H; Giles, Margaret

2012-01-01

The changing and demanding nature of the mining workforce in rural and remote Australia brings unique challenges to the delivery of healthcare services. In an attempt to control costs whilst delivering cost effective and quality healthcare, new models of delivery must be considered. For a workforce that is fly-in/fly-out, the provision of healthcare is problematic given the lack of consistency in location. A cost-benefit framework is analysed comparing three models of service provision using travel to a major location, locum services and remote health monitoring. Ultimately, new models of care must be considered to address the issues of increasing workforce turnover, to cater for rising healthcare costs, and to improve the health of such communities.

Environmental sustainability in European public healthcare.

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Chiarini, Andrea; Vagnoni, Emidia

2016-01-01

Purpose - The purpose of this paper is to enlarge the debate concerning the influence of leadership on environmental sustainability implementation in European public healthcare organisations. Design/methodology/approach - This paper is a viewpoint. It is based on preliminary analysis of European standards dedicated to environmental sustainability and their spread across Europe in public healthcare organisations. Viewpoints concerning leadership are then discussed and asserted. Findings - This paper found a limited implementation of standards such as Green Public Procurement criteria, Eco-Management and Audit Scheme and ISO 14001 in public healthcare. Some clues indicate that the lack of implementation is related to leadership and management commitment. Originality/value - For the first time, this paper investigates relationships between leadership and environmental sustainability in European public healthcare opening further avenues of research on the subject.

Improving Outcomes in the Nigeria Healthcare Sector through Public ...

African Journals Online (AJOL)

Nigeria's healthcare sector over the years has continued to degenerate with health indicators ... in service delivery as well as increases access to quality healthcare. ... Key words: Nigeria, Healthcare Sector, Health Outcomes, Health Indicators, ...

Components of Maternal Healthcare Delivery System Contributing to ...

African Journals Online (AJOL)

Components of Maternal Healthcare Delivery System Contributing to Maternal Deaths ... transcripts were analyzed using a directed approach to content analysis. Excerpts were categorized according to three main components of the maternal ...

Situation Analysis of Healthcare Service Delivery using ...

African Journals Online (AJOL)

ISML5

7. No. 1, AARSE 2017 Special Edition, January 2017. 75. Situation Analysis of ... then becomes a major bottleneck to proper planning and policy formulation in healthcare delivery. ... Uganda Annual Health Sector Performance Report for Financial Year 2014/15 ... government's strategy of taking services closer to the people.

Impact of managed care on healthcare delivery practices: the perception of healthcare administrators and clinical practitioners.

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Tietze, Mari F

2003-01-01

Managed care has introduced changes, such as cost effectiveness, access to care, and quality of care, to many components of the U.S. healthcare delivery system. These changes have affected how healthcare administrators and clinical practitioners perceive the impact of managed care on healthcare delivery practices. A survey was initiated to explore whether the perceptions of administrators differed from those of practitioners and to discover which organizational variables could explain the difference. A descriptive, cross-sectional survey design was used for the target population of administrators and practitioners in high, moderate, and low managed-care-penetration markets. Two investigator-developed instruments--the Managed Care Perceptions Inventory (MCPI) and the MCPI-Demographic--and an intact centralization of decision-making assessment subscale were used for data collection. Administrators had a statistically significant, more positive perception of the impact of managed care on healthcare delivery than did practitioners. When the distinction between administrator and practitioner was not used as a grouping factor, managed care market penetration, nonprofit status, and years in current employment position were factors that had statistically significant associations with a more positive perception of managed care. Based on these findings, both administrators and practitioners have a role in maintaining awareness regarding their perceptions and should work collaboratively to address issues of concern. Similarly, promoting trust and commitment at the organizational level is important. Recommendations for further research are also provided.

Influence of organizational culture on quality healthcare delivery.

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Carney, Marie

2011-01-01

The purpose of this paper is to identify if aspects of organizational culture may indicate a new terrain in the cultural influences-quality healthcare relationship. This research stems from the author's belief that viewing the role of head of department or directorate as pivotal to health care management is critical to health care planning and quality healthcare delivery. Interviews were undertaken among 50 professional clinician and non-clinician managers working in the role of head of department, in acute care hospitals in Ireland. The sample was drawn from the total population of 850 managers, utilized in a previous survey study. Organizational culture is more complex than was previously thought. Several cultural influences such as excellence in care delivery, ethical values, involvement, professionalism, value-for-money, cost of care, commitment to quality and strategic thinking were found to be key cultural determinants in quality care delivery. Health care managers perceive that in order to deliver quality focused care they need to act in a professional, committed manner and to place excellence at the forefront of care delivery, whilst at the same time being capable of managing the tensions that exist between cost effectiveness and quality of care. These tensions require further research in order to determine if quality of care is affected in a negative manner by those tensions. Originality relates to the new cultural terrain presented in this paper that recognizes the potential of health service managers to influence the organizations' culture and through this influence to take a greater part in ensuring that quality health care is delivered to their patients. It also seems to be important that value-for-money is viewed as an ethical means of delivering healthcare, and not as a conflict between quality and cost.

Comparative performance of private and public healthcare systems in low- and middle-income countries: a systematic review.

Directory of Open Access Journals (Sweden)

Sanjay Basu

Full Text Available INTRODUCTION: Private sector healthcare delivery in low- and middle-income countries is sometimes argued to be more efficient, accountable, and sustainable than public sector delivery. Conversely, the public sector is often regarded as providing more equitable and evidence-based care. We performed a systematic review of research studies investigating the performance of private and public sector delivery in low- and middle-income countries. METHODS AND FINDINGS: Peer-reviewed studies including case studies, meta-analyses, reviews, and case-control analyses, as well as reports published by non-governmental organizations and international agencies, were systematically collected through large database searches, filtered through methodological inclusion criteria, and organized into six World Health Organization health system themes: accessibility and responsiveness; quality; outcomes; accountability, transparency, and regulation; fairness and equity; and efficiency. Of 1,178 potentially relevant unique citations, data were obtained from 102 articles describing studies conducted in low- and middle-income countries. Comparative cohort and cross-sectional studies suggested that providers in the private sector more frequently violated medical standards of practice and had poorer patient outcomes, but had greater reported timeliness and hospitality to patients. Reported efficiency tended to be lower in the private than in the public sector, resulting in part from perverse incentives for unnecessary testing and treatment. Public sector services experienced more limited availability of equipment, medications, and trained healthcare workers. When the definition of "private sector" included unlicensed and uncertified providers such as drug shop owners, most patients appeared to access care in the private sector; however, when unlicensed healthcare providers were excluded from the analysis, the majority of people accessed public sector care. "Competitive

Comparative performance of private and public healthcare systems in low- and middle-income countries: a systematic review.

Science.gov (United States)

Basu, Sanjay; Andrews, Jason; Kishore, Sandeep; Panjabi, Rajesh; Stuckler, David

2012-01-01

Private sector healthcare delivery in low- and middle-income countries is sometimes argued to be more efficient, accountable, and sustainable than public sector delivery. Conversely, the public sector is often regarded as providing more equitable and evidence-based care. We performed a systematic review of research studies investigating the performance of private and public sector delivery in low- and middle-income countries. Peer-reviewed studies including case studies, meta-analyses, reviews, and case-control analyses, as well as reports published by non-governmental organizations and international agencies, were systematically collected through large database searches, filtered through methodological inclusion criteria, and organized into six World Health Organization health system themes: accessibility and responsiveness; quality; outcomes; accountability, transparency, and regulation; fairness and equity; and efficiency. Of 1,178 potentially relevant unique citations, data were obtained from 102 articles describing studies conducted in low- and middle-income countries. Comparative cohort and cross-sectional studies suggested that providers in the private sector more frequently violated medical standards of practice and had poorer patient outcomes, but had greater reported timeliness and hospitality to patients. Reported efficiency tended to be lower in the private than in the public sector, resulting in part from perverse incentives for unnecessary testing and treatment. Public sector services experienced more limited availability of equipment, medications, and trained healthcare workers. When the definition of "private sector" included unlicensed and uncertified providers such as drug shop owners, most patients appeared to access care in the private sector; however, when unlicensed healthcare providers were excluded from the analysis, the majority of people accessed public sector care. "Competitive dynamics" for funding appeared between the two sectors, such

Reinventing Emergency Department Flow via Healthcare Delivery Science.

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DeFlitch, Christopher; Geeting, Glenn; Paz, Harold L

2015-01-01

Healthcare system flow resulting in emergency departments (EDs) crowding is a quality and access problem. This case study examines an overcrowded academic health center ED with increasing patient volumes and limited physical space for expansion. ED capacity and efficiency improved via engineering principles application, addressing patient and staffing flows, and reinventing the delivery model. Using operational data and staff input, patient and staff flow models were created, identifying bottlenecks (points of inefficiency). A new flow model of emergency care delivery, physician-directed queuing, was developed. Expanding upon physicians in triage, providers passively evaluate all patients upon arrival, actively manage patients requiring fewer resources, and direct patients requiring complex resources to further evaluation in ED areas. Sustained over time, ED efficiency improved as measured by near elimination of "left without being seen" patients and waiting times with improvement in door to doctor, patient satisfaction, and total length of stay. All improvements were in the setting on increased patient volume and no increase in physician staffing. Our experience suggests that practical application of healthcare delivery science can be used to improve ED efficiency. © The Author(s) 2015.

The impact of the consumer on healthcare delivery.

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Scott, Cheryl M

2003-01-01

The authors of the lead articles are correct that the customer experience should be at the forefront of our attention and work in healthcare delivery. Expanding our current definitions of customer satisfaction and patient safety to include the important intangibles of "experience" will be key. However, a singular focus on patient or consumer experience is not enough in the long run. A solid business model and an understanding of the healthcare market dynamics are also required. The promises we make in support of our business strategy are at the core of how we interact with our patients, how we ensure their safety, and how we build their loyalty. Our work as healthcare leaders should be to keep those promises.

The Indiana University Center for Healthcare Innovation and Implementation Science: Bridging healthcare research and delivery to build a learning healthcare system.

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Azar, Jose; Adams, Nadia; Boustani, Malaz

2015-01-01

In the United States, it is estimated that 75,000 deaths every year could be averted if the healthcare system implemented high quality care more effectively and efficiently. Patient harm in the hospital occurs as a consequence of inadequate procedures, medications and other therapies, nosocomial infections, diagnostic evaluations and patient falls. Implementation science, a new emerging field in healthcare, is the development and study of methods and tools aimed at enhancing the implementation of new discoveries and evidence into daily healthcare delivery. The Indiana University Center for Healthcare Innovation and Implementation Science (IU-CHIIS) was launched in September 2013 with the mission to use implementation science and innovation to produce great-quality, patient-centered and cost-efficient healthcare delivery solutions for the United States of America. Within the first 24 months of its initiation, the IU-CHIIS successfully scaled up an evidence-based collaborative care model for people with dementia and/or depression, successfully expanded the Accountable Care Unit model positively impacting the efficiency and quality of care, created the first Certificate in Innovation and Implementation Science in the US and secured funding from National Institutes of Health to investigate innovations in dementia care. This article summarizes the establishment of the IU-CHIIS, its impact and outcomes and the lessons learned during the journey. Copyright © 2015. Published by Elsevier GmbH.

Measurement of integrated healthcare delivery: a systematic review of methods and future research directions

Directory of Open Access Journals (Sweden)

Martin Strandberg-Larsen

2009-02-01

Full Text Available Background: Integrated healthcare delivery is a policy goal of healthcare systems. There is no consensus on how to measure the concept, which makes it difficult to monitor progress. Purpose: To identify the different types of methods used to measure integrated healthcare delivery with emphasis on structural, cultural and process aspects. Methods: Medline/Pubmed, EMBASE, Web of Science, Cochrane Library, WHOLIS, and conventional internet search engines were systematically searched for methods to measure integrated healthcare delivery (published – April 2008. Results: Twenty-four published scientific papers and documents met the inclusion criteria. In the 24 references we identified 24 different measurement methods; however, 5 methods shared theoretical framework. The methods can be categorized according to type of data source: a questionnaire survey data, b automated register data, or c mixed data sources. The variety of concepts measured reflects the significant conceptual diversity within the field, and most methods lack information regarding validity and reliability. Conclusion: Several methods have been developed to measure integrated healthcare delivery; 24 methods are available and some are highly developed. The objective governs the method best used. Criteria for sound measures are suggested and further developments should be based on an explicit conceptual framework and focus on simplifying and validating existing methods.

Comparative Performance of Private and Public Healthcare Systems in Low- and Middle-Income Countries: A Systematic Review

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Basu, Sanjay; Andrews, Jason; Kishore, Sandeep; Panjabi, Rajesh; Stuckler, David

2012-01-01

Introduction Private sector healthcare delivery in low- and middle-income countries is sometimes argued to be more efficient, accountable, and sustainable than public sector delivery. Conversely, the public sector is often regarded as providing more equitable and evidence-based care. We performed a systematic review of research studies investigating the performance of private and public sector delivery in low- and middle-income countries. Methods and Findings Peer-reviewed studies including case studies, meta-analyses, reviews, and case-control analyses, as well as reports published by non-governmental organizations and international agencies, were systematically collected through large database searches, filtered through methodological inclusion criteria, and organized into six World Health Organization health system themes: accessibility and responsiveness; quality; outcomes; accountability, transparency, and regulation; fairness and equity; and efficiency. Of 1,178 potentially relevant unique citations, data were obtained from 102 articles describing studies conducted in low- and middle-income countries. Comparative cohort and cross-sectional studies suggested that providers in the private sector more frequently violated medical standards of practice and had poorer patient outcomes, but had greater reported timeliness and hospitality to patients. Reported efficiency tended to be lower in the private than in the public sector, resulting in part from perverse incentives for unnecessary testing and treatment. Public sector services experienced more limited availability of equipment, medications, and trained healthcare workers. When the definition of “private sector” included unlicensed and uncertified providers such as drug shop owners, most patients appeared to access care in the private sector; however, when unlicensed healthcare providers were excluded from the analysis, the majority of people accessed public sector care. “Competitive dynamics” for

Crowding and delivery of healthcare in emergency departments: the European perspective.

LENUS (Irish Health Repository)

Jayaprakash, Namita

2009-11-01

Emergency department (ED) crowding is a multifactorial problem, resulting in increased ED waiting times, decreased patient satisfaction and deleterious domino effects on the entire hospital. Although difficult to define and once limited to anecdotal evidence, crowding is receiving more attention as attempts are made to quantify the problem objectively. It is a worldwide phenomenon with regional influences, as exemplified when analyzing the problem in Europe compared to that of the United States. In both regions, an aging population, limited hospital resources, staff shortages and delayed ancillary services are key contributors; however, because the structure of healthcare differs from country to country, varying influences affect the issue of crowding. The approach to healthcare delivery as a right of all people, as opposed to a free market commodity, depends on governmental organization and appropriation of funds. Thus, public funding directly influences potential crowding factors, such as number of hospital beds, community care facilities, and staffing. Ultimately ED crowding is a universal problem with distinctly regional root causes; thus, any approach to address the problem must be tailored to regional influences.

Demand for private healthcare in a universal public healthcare system: empirical evidence from Sri Lanka.

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Pallegedara, Asankha; Grimm, Michael

2017-11-01

This paper examines healthcare utilization behaviour in Sri Lanka with special emphasis on the choice between costly private and free public healthcare services. We use a data set that combines nationwide household survey data and district level healthcare supply data. Our findings suggest that even with universal public healthcare policy, richer people tend to use private sector healthcare services rather than public services. We also find significant regional and ethnic discrepancies in healthcare access bearing the risk of social tensions if these are further amplified. Latent class analysis shows in addition that the choice between private and public sector healthcare significantly differs between people with and without chronic diseases. We find in particular that chronically ill people rely for their day-to-day care on the public sector, but for their inpatient care they turn more often than non-chronically ill people to the private sector, implying an additional financial burden for the chronically ill. If the observed trend continues it may not only increase further the health-income gradient in Sri Lanka but also undermine the willingness of the middle class to pay taxes to finance public healthcare. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Specialist participation in healthcare delivery transformation: influence of patient self-referral.

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Aliu, Oluseyi; Sun, Gordon; Burke, James; Chung, Kevin C; Davis, Matthew M

2014-01-01

Improving coordination of care and containing healthcare costs are prominent goals of healthcare reform. Specialist involvement in healthcare delivery transformation efforts like Accountable Care Organizations (ACOs) is necessary to achieve these goals. However, patients’ self-referrals to specialists may undermine care coordination and incur unnecessary costs if patients frequently receive care from specialists not engaged in such healthcare delivery transformation efforts. Additionally, frequent self-referrals may also diminish the incentive for specialist participation in reform endeavors like ACOs to get access to a referral base. To examine recent national trends in self-referred new visits to specialists. A descriptive cross-sectional study of new ambulatory visits to specialists from 2000 to 2009 using data from the National Ambulatory Medical Care Survey. We calculated nationally representative estimates of the proportion of new specialist visits through self-referrals among Medicare and private insurance beneficiaries. We also estimated the nationally representative absolute number of self-referred new specialist visits among both groups of beneficiaries. Among Medicare and private insurance beneficiaries, self-referred visits declined from 32.2% (95% confidence interval [CI], 24.0%-40.4%) to 19.6% (95% CI, 13.9%-23.3%) and from 32.4% (95% CI, 27.9%-36.8%) to 24.1% (95% CI,18.8%-29.4%), respectively. Hence, at least 1 in 5 and 1 in 4 new visits to specialists among Medicare and private insurance beneficiaries, respectively, are self-referred. The current considerable rate of self-referred new specialist visits among both Medicare and private insurance beneficiaries may have adverse implications for organizations attempting to transform healthcare delivery with improved care coordination.

Quality improvement in healthcare delivery utilizing the patient-centered medical home model.

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Akinci, Fevzi; Patel, Poonam M

2014-01-01

Despite the fact that the United States dedicates so much of its resources to healthcare, the current healthcare delivery system still faces significant quality challenges. The lack of effective communication and coordination of care services across the continuum of care poses disadvantages for those requiring long-term management of their chronic conditions. This is why the new transformation in healthcare known as the patient-centered medical home (PCMH) can help restore confidence in our population that the healthcare services they receive is of the utmost quality and will effectively enhance their quality of life. Healthcare using the PCMH model is delivered with the patient at the center of the transformation and by reinvigorating primary care. The PCMH model strives to deliver effective quality care while attempting to reduce costs. In order to relieve some of our healthcare system distresses, organizations can modify their delivery of care to be patient centered. Enhanced coordination of services, better provider access, self-management, and a team-based approach to care represent some of the key principles of the PCMH model. Patients that can most benefit are those that require long-term management of their conditions such as chronic disease and behavioral health patient populations. The PCMH is a feasible option for delivery reform as pilot studies have documented successful outcomes. Controversy about the lack of a medical neighborhood has created concern about the overall sustainability of the medical home. The medical home can stand independently and continuously provide enhanced care services as a movement toward higher quality care while organizations and government policy assess what types of incentives to put into place for the full collaboration and coordination of care in the healthcare system.

Public-private partnerships and new models of healthcare access

NARCIS (Netherlands)

Lange, Joep M. A.; Schellekens, Onno P.; Lindner, Marianne; van der Gaag, Jacques

2008-01-01

PURPOSE OF REVIEW: The aim of this article is to lay the ground for the engagement and support of a well managed and effectively regulated private sector in the delivery of healthcare in sub-Saharan Africa. RECENT FINDINGS: About 60% of healthcare financing in sub-Saharan Africa comes from private

PUBLIC FINANCING OF HEALTHCARE SERVICES

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Agnieszka Bem

2013-10-01

Full Text Available Healthcare in Poland is mainly financed by public sector entities, among them the National Health Fund (NFZ, state budget and local government budgets. The task of the National Health Fund, as the main payer in the system, is chiefly currently financing the services. The state budget plays a complementary role in the system, and finances selected groups of services, health insurance premiums and investments in healthcare infrastructure. The basic role of the local governments is to ensure access to the services, mostly by performing ownership functions towards healthcare institutions.

Public and private health-care financing with alternate public rationing rules.

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Cuff, Katherine; Hurley, Jeremiah; Mestelman, Stuart; Muller, Andrew; Nuscheler, Robert

2012-02-01

We develop a model to analyze parallel public and private health-care financing under two alternative public sector rationing rules: needs-based rationing and random rationing. Individuals vary in income and severity of illness. There is a limited supply of health-care resources used to treat individuals, causing some individuals to go untreated. Insurers (both public and private) must bid to obtain the necessary health-care resources to treat their beneficiaries. Given individuals' willingnesses-to-pay for private insurance are increasing in income, the introduction of private insurance diverts treatment from relatively poor to relatively rich individuals. Further, the impact of introducing parallel private insurance depends on the rationing mechanism in the public sector. We show that the private health insurance market is smaller when the public sector rations according to need than when allocation is random. Copyright © 2010 John Wiley & Sons, Ltd.

From Data to Improved Decisions: Operations Research in Healthcare Delivery.

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Capan, Muge; Khojandi, Anahita; Denton, Brian T; Williams, Kimberly D; Ayer, Turgay; Chhatwal, Jagpreet; Kurt, Murat; Lobo, Jennifer Mason; Roberts, Mark S; Zaric, Greg; Zhang, Shengfan; Schwartz, J Sanford

2017-11-01

The Operations Research Interest Group (ORIG) within the Society of Medical Decision Making (SMDM) is a multidisciplinary interest group of professionals that specializes in taking an analytical approach to medical decision making and healthcare delivery. ORIG is interested in leveraging mathematical methods associated with the field of Operations Research (OR) to obtain data-driven solutions to complex healthcare problems and encourage collaborations across disciplines. This paper introduces OR for the non-expert and draws attention to opportunities where OR can be utilized to facilitate solutions to healthcare problems. Decision making is the process of choosing between possible solutions to a problem with respect to certain metrics. OR concepts can help systematically improve decision making through efficient modeling techniques while accounting for relevant constraints. Depending on the problem, methods that are part of OR (e.g., linear programming, Markov Decision Processes) or methods that are derived from related fields (e.g., regression from statistics) can be incorporated into the solution approach. This paper highlights the characteristics of different OR methods that have been applied to healthcare decision making and provides examples of emerging research opportunities. We illustrate OR applications in healthcare using previous studies, including diagnosis and treatment of diseases, organ transplants, and patient flow decisions. Further, we provide a selection of emerging areas for utilizing OR. There is a timely need to inform practitioners and policy makers of the benefits of using OR techniques in solving healthcare problems. OR methods can support the development of sustainable long-term solutions across disease management, service delivery, and health policies by optimizing the performance of system elements and analyzing their interaction while considering relevant constraints.

Assessment of the administration of healthcare service delivery in ...

African Journals Online (AJOL)

The study examined the structure and mode of administration in Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife Nigeria; and also assessed the impact of the structure and mode of administration on the service delivery in the hospital. These were with a view to assessing the administration of healthcare ...

Healthcare in Equatorial Guinea, West Africa: obstacles and barriers to care.

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Reuter, Kim Eleanor; Geysimonyan, Aurora; Molina, Gabriela; Reuter, Peter Robert

2014-01-01

The provision of healthcare services in developing countries has received increasing attention, but inequalities persist. One nation with potential inequalities in healthcare services is Equatorial Guinea (Central-West Africa). Mitigating these inequalities is difficult, as the Equatoguinean healthcare system remains relatively understudied. In this study, we interviewed members of the healthcare community in order to: 1) learn which diseases are most common and the most common cause of death from the perspective of healthcare workers; and 2) gain an understanding of the healthcare community in Equatorial Guinea by describing how: a) healthcare workers gain their professional knowledge; b) summarizing ongoing healthcare programs aimed at the general public; c) discussing conflicts within the healthcare community and between the public and healthcare providers; d) and addressing opportunities to improve healthcare delivery. We found that some causes of death, such as serious injuries, may not be currently treatable in country, potentially due to a lack of resources and trauma care facilities. In addition, training and informational programs for both healthcare workers and the general public may not be effectively transmitting information to the intended recipients. This presents hurdles to the healthcare community, both in terms of having professional competence in healthcare delivery and in having a community that is receptive to medical care. Our data also highlight government-facility communication as an opportunity for improvement. Our research is an important first step in understanding the context of healthcare delivery in Equatorial Guinea, a country that is relatively data poor.

Healthcare delivery systems: designing quality into health information systems.

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Joyce, Phil; Green, Rosamund; Winch, Graham

2007-01-01

To ensure that quality is 'engineered in' a holistic, integrated and quality approach is required, and Total Quality Management (TQM) principles are the obvious foundations for this. This paper describes a novel approach to viewing the operations of a healthcare provider where electronic means could be used to distribute information (including electronic fund settlements), building around the Full Service Provider core. Specifically, an approach called the "triple pair flow" model is used to provide a view of healthcare delivery that is integrated, yet detailed, and that combines the strategic enterprise view with a business process view.

The Impact of General Strike on Government Healthcare Delivery in Kerala State in India

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Aasems Jacob

2016-01-01

Full Text Available General strike (also known as hartal is used as a mode of protest by organizations and political parties in India. It is generally thought that hartals negatively impact the healthcare delivery in a society. We used the Right to Information Act to obtain data from government health centers in Kerala state in India for four hartal days (H-day and two control days (A-day and B-day for each H-day, from sixteen health centers including 6 Community Health Center (CHC, 6 Secondary Health Center (SHC, and 4 Tertiary Health Center (THC. Data on emergency room visits was available for six HCs. 15 HCs had a statistically significant decrease in the number of outpatient visits on H-day. There was no difference in the number of outpatient visits between the two control days (A and B in 15 HCs, suggesting the lack of a posthartal surge in visits. Median decrease in outpatient visits in CHCs, SHCs, and THCs was 50.4%, 59.5%, and 47.4%, respectively. Hartal did not impact the number of emergency room visits in 6 out of 7 health centers assessed. Our study identified a significant harmful impact on government healthcare delivery due to hartals in Kerala. These findings have major public health implications.

Technical quality of delivery care in private- and public-sector health facilities in Enugu and Lagos States, Nigeria.

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Hirose, Atsumi; Yisa, Ibrahim O; Aminu, Amina; Afolabi, Nathanael; Olasunmbo, Makinde; Oluka, George; Muhammad, Khalilu; Hussein, Julia

2018-06-01

Private-sector providers are increasingly being recognized as important contributors to the delivery of healthcare. Countries with high disease burdens and limited public-sector resources are considering using the private sector to achieve universal health coverage. However, evidence for the technical quality of private-sector care is lacking. This study assesses the technical quality of maternal healthcare during delivery in public- and private-sector facilities in resource-limited settings, from a systems and programmatic perspective. A summary index (the skilled attendance index, SAI), was used. Two-staged cluster sampling with stratification was used to select representative samples of case records in public- and private-sector facilities in Enugu and Lagos States, Nigeria. Information to assess criteria was extracted, and the SAI calculated. Linear regression models examined the relationship between SAI and the private and public sectors, controlling for confounders. The median SAI was 54.8% in Enugu and 85.7% in Lagos. The private for-profit sector's SAI was lower than and the private not-for-profit sector's SAI was higher than the public sector in Enugu [coefficient = -3.6 (P = 0.018) and 12.6 (P private for-profit sector's SAI was higher and the private not-for-profit sector's SAI was lower than the public sector [3.71 (P = 0.005) and -3.92 (P private for-profit providers' care was poorer than public providers where the public provision of care was weak, while private for-profit facilities provided better technical quality care than public facilities where the public sector was strong and there was a relatively strong regulatory body. Our findings raise important considerations relating to the quality of maternity care, the public-private mix and needs for regulation in global efforts to achieve universal healthcare.

Public healthcare interests require strict competition enforcement.

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Loozen, Edith M H

2015-07-01

Several countries have introduced competition in their health systems in order to maintain the supply of high quality health care in a cost-effective manner. The introduction of competition triggers competition enforcement. Since healthcare is characterized by specific market failures, many favor healthcare-specific competition enforcement in order not only to account for the competition interest, but also for the healthcare interests. The question is whether healthcare systems based on competition can succeed when competition enforcement deviates from standard practice. This paper analyzes whether healthcare-specific competition enforcement is theoretically sound and practically effective. This is exemplified by the Dutch system that is based on regulated competition and thus crucially depends on getting competition enforcement right. Governments are responsible for correcting market failures. Markets are responsible for maximizing the public healthcare interests. By securing sufficient competitive pressure, competition enforcement makes sure they do. When interpreted according to welfare-economics, competition law takes into account both costs and benefits specific market behavior may have for healthcare. Competition agencies and judiciary are not legitimized to deviate from standard evidentiary requirements. Dutch case law shows that healthcare-specific enforcement favors the healthcare undertakings concerned, but to the detriment of public health care. Healthcare-specific competition enforcement is conceptually flawed and counterproductive. In order for healthcare systems based on competition to succeed, competition enforcement should be strict. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Improving the effectiveness of service delivery in the public healthcare sector: the case of ophthalmology services in Malaysia.

Science.gov (United States)

Foo, Chee Yoong; Lim, Ka Keat; Sivasampu, Sheamini; Dahian, Kamilah Binti; Goh, Pik Pin

2015-08-28

Rising demand of ophthalmology care is increasingly straining Malaysia's public healthcare sector due to its limited human and financial resources. Improving the effectiveness of ophthalmology service delivery can promote national policy goals of population health improvement and system sustainability. This study examined the performance variation of public ophthalmology service in Malaysia, estimated the potential output gain and investigated several factors that might explain the differential performance. Data for 2011 and 2012 on 36 ophthalmology centres operating in the Ministry of Health hospitals were used in this analysis. We first consulted a panel of ophthalmology service managers to understand the production of ophthalmology services and to verify the production model. We then assessed the relative performance of these centres using Data Envelopment Analysis (DEA). Efficiency scores (ES) were decomposed into technical, scale, and congestion component. Potential increase in service output was estimated. Sensitivity analysis of model changes was performed and stability of the result was assessed using bootstrap approach. Second stage Tobit regression was conducted to determine if hospital type, availability of day services and population characteristics were related to the DEA scores. In 2011, 33% of the ophthalmology centres were found to have ES > 1 (mean ES = 1.10). Potential output gains were 10% (SE ± 2.92), 7.4% (SE ± 2.06), 6.9% (SE ± 1.97) if the centres could overcome their technical, scale and congestion inefficiencies. More centres moved to the performance frontier in 2012 (mean ES = 1.07), with lower potential output gain. The model used has good stability. Robustness checks show that the DEA correctly identified low performing centres. Being in state hospital was significantly associated with better performance. Using DEA to benchmarking service performance of ophthalmology care could provide insights for policy

Benchmarking and Learning in Public Healthcare

DEFF Research Database (Denmark)

Buckmaster, Natalie; Mouritsen, Jan

2017-01-01

This research investigates the effects of learning-oriented benchmarking in public healthcare settings. Benchmarking is a widely adopted yet little explored accounting practice that is part of the paradigm of New Public Management. Extant studies are directed towards mandated coercive benchmarking...

Approaches to organizing public relations functions in healthcare.

Science.gov (United States)

Guy, Bonnie; Williams, David R; Aldridge, Alicia; Roggenkamp, Susan D

2007-01-01

This article provides health care audiences with a framework for understanding different perspectives of the role and functions of public relations in healthcare organizations and the resultant alternatives for organizing and enacting public relations functions. Using an example of a current issue receiving much attention in US healthcare (improving rates of organ donation), the article provides examples of how these different perspectives influence public relations goals and objectives, definitions of 'public', activities undertaken, who undertakes them and where they fit into the organizational hierarchy.

Building a middle-range theory of free public healthcare seeking in sub-Saharan Africa: a realist review.

Science.gov (United States)

Robert, Emilie; Samb, Oumar Mallé; Marchal, Bruno; Ridde, Valéry

2017-09-01

Realist reviews are a new form of knowledge synthesis aimed at providing middle-range theories (MRTs) that specify how interventions work, for which populations, and under what circumstances. This approach opens the 'black box' of an intervention by showing how it triggers mechanisms in specific contexts to produce outcomes. We conducted a realist review of health user fee exemption policies (UFEPs) in sub-Saharan Africa (SSA). This article presents how we developed both the intervention theory (IT) of UFEPs and a MRT of free public healthcare seeking in SSA, building on Sen's capability approach. Over the course of this iterative process, we explored theoretical writings on healthcare access, services use, and healthcare seeking behaviour. We also analysed empirical studies on UFEPs and healthcare access in free care contexts. According to the IT, free care at the point of delivery is a resource allowing users to make choices about their use of public healthcare services, choices previously not generally available to them. Users' ability to choose to seek free care is influenced by structural, local, and individual conversion factors. We tested this IT on 69 empirical studies selected on the basis of their scientific rigor and relevance to the theory. From that analysis, we formulated a MRT on seeking free public healthcare in SSA. It highlights three key mechanisms in users' choice to seek free public healthcare: trust, risk awareness and acceptability. Contextual elements that influence both users' ability and choice to seek free care include: availability of and control over resources at the individual level; characteristics of users' and providers' communities at the local level; and health system organization, governance and policies at the structural level. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Women veterans' healthcare delivery preferences and use by military service era: findings from the National Survey of Women Veterans.

Science.gov (United States)

Washington, Donna L; Bean-Mayberry, Bevanne; Hamilton, Alison B; Cordasco, Kristina M; Yano, Elizabeth M

2013-07-01

The number of women Veterans (WVs) utilizing the Veterans Health Administration (VA) has doubled over the past decade, heightening the importance of understanding their healthcare delivery preferences and utilization patterns. Other studies have identified healthcare issues and behaviors of WVs in specific military service eras (e.g., Vietnam), but delivery preferences and utilization have not been examined within and across eras on a population basis. To identify healthcare delivery preferences and healthcare use of WVs by military service era to inform program design and patient-centeredness. Cross-sectional 2008-2009 survey of a nationally representative sample of 3,611 WVs, weighted to the population. Healthcare delivery preferences measured as importance of selected healthcare features; types of healthcare services and number of visits used; use of VA or non-VA; all by military service era. Military service era differences were present in types of healthcare used, with World War II and Korea era WVs using more specialty care, and Vietnam era-to-present WVs using more women's health and mental health care. Operations Enduring Freedom, Iraqi Freedom, New Dawn (OEF/OIF/OND) WVs made more healthcare visits than WVs of earlier military eras. The greatest healthcare delivery concerns were location convenience for Vietnam and earlier WVs, and cost for Gulf War 1 and OEF/OIF/OND WVs. Co-located gynecology with general healthcare was also rated important by a sizable proportion of WVs from all military service eras. Our findings point to the importance of ensuring access to specialty services closer to home for WVs, which may require technology-supported care. Younger WVs' higher mental health care use reinforces the need for integration and coordination of primary care, reproductive health and mental health care.

Spirituality and healthcare: Towards holistic peoplecentred ...

African Journals Online (AJOL)

Healthcare in South Africa is in a crisis. Problems with infrastructure, management, human resources and the supply of essential medicines are at a critical level. This is compounded by a high burden of disease and disparity in levels of service delivery, particularly between public and private healthcare. The government ...

The 2014-2015 Ebola virus disease outbreak and primary healthcare delivery in Liberia: Time-series analyses for 2010-2016.

Science.gov (United States)

Wagenaar, Bradley H; Augusto, Orvalho; Beste, Jason; Toomay, Stephen J; Wickett, Eugene; Dunbar, Nelson; Bawo, Luke; Wesseh, Chea Sanford

2018-02-01

The aim of this study is to estimate the immediate and lasting effects of the 2014-2015 Ebola virus disease (EVD) outbreak on public-sector primary healthcare delivery in Liberia using 7 years of comprehensive routine health information system data. We analyzed 10 key primary healthcare indicators before, during, and after the EVD outbreak using 31,836 facility-month service outputs from 1 January 2010 to 31 December 2016 across a census of 379 public-sector health facilities in Liberia (excluding Montserrado County). All indicators had statistically significant decreases during the first 4 months of the EVD outbreak, with all indicators having their lowest raw mean outputs in August 2014. Decreases in outputs comparing the end of the initial EVD period (September 2014) to May 2014 (pre-EVD) ranged in magnitude from a 67.3% decrease in measles vaccinations (95% CI: -77.9%, -56.8%, p sector primary healthcare system has made strides towards recovery from the 2014-2015 EVD outbreak. All primary healthcare indicators tracked have recovered to pre-EVD levels as of November 2016. Yet, for most indicators, it took more than 1 year to recover to pre-EVD levels. During this time, large losses of essential primary healthcare services occurred compared to what would have been expected had the EVD outbreak not occurred. The disruption of malaria case management during the EVD outbreak may have resulted in increased malaria cases. Large and sustained investments in public-sector primary care health system strengthening are urgently needed for EVD-affected countries.

Ranking of healthcare programmes based on health outcome, health costs and safe delivery of care in hospital pharmacy practice.

Science.gov (United States)

Brisseau, Lionel; Bussières, Jean-François; Bois, Denis; Vallée, Marc; Racine, Marie-Claude; Bonnici, André

2013-02-01

To establish a consensual and coherent ranking of healthcare programmes that involve the presence of ward-based and clinic-based clinical pharmacists, based on health outcome, health costs and safe delivery of care. This descriptive study was derived from a structured dialogue (Delphi technique) among directors of pharmacy department. We established a quantitative profile of healthcare programmes at five sites that involved the provision of ward-based and clinic-based pharmaceutical care. A summary table of evidence established a unique quality rating per inpatient (clinic-based) or outpatient (ward-based) healthcare programme. Each director rated the perceived impact of pharmaceutical care per inpatient or outpatient healthcare programme on three fields: health outcome, health costs and safe delivery of care. They agreed by consensus on the final ranking of healthcare programmes. A ranking was assigned for each of the 18 healthcare programmes for outpatient care and the 17 healthcare programmes for inpatient care involving the presence of pharmacists, based on health outcome, health costs and safe delivery of care. There was a good correlation between ranking based on data from a 2007-2008 Canadian report on hospital pharmacy practice and the ranking proposed by directors of pharmacy department. Given the often limited human and financial resources, managers should consider the best evidence available on a profession's impact to plan healthcare services within an organization. Data are few on ranking healthcare programmes in order to prioritize which healthcare programme would mostly benefit from the delivery of pharmaceutical care by ward-based and clinic-based pharmacists. © 2012 The Authors. IJPP © 2012 Royal Pharmaceutical Society.

How can insulin initiation delivery in a dual-sector health system be optimised? A qualitative study on healthcare professionals' views.

Science.gov (United States)

Lee, Ping Yein; Lee, Yew Kong; Ng, Chirk Jenn

2012-04-30

The prevalence of type 2 diabetes is increasing at an alarming rate in developing countries. However, glycaemia control remains suboptimal and insulin use is low. One important barrier is the lack of an efficient and effective insulin initiation delivery approach. This study aimed to document the strategies used and proposed by healthcare professionals to improve insulin initiation in the Malaysian dual-sector (public-private) health system. In depth interviews and focus group discussions were conducted in Klang Valley and Seremban, Malaysia in 2010-11. Healthcare professionals consisting of general practitioners (n = 11), medical officers (n = 8), diabetes educators (n = 3), government policy makers (n = 4), family medicine specialists (n = 10) and endocrinologists (n = 2) were interviewed. We used a topic guide to facilitate the interviews, which were audio recorded, transcribed verbatim and analysed using a thematic approach. Three main themes emerged from the interviews. Firstly, there was a lack of collaboration between the private and public sectors in diabetes care. The general practitioners in the private sector proposed an integrated system for them to refer patients to the public health services for insulin initiation programmes. There could be shared care between the two sectors and this would reduce the disproportionately heavy workload at the public sector. Secondly, besides the support from the government health authority, the healthcare professionals wanted greater involvement of non-government organisations, media and pharmaceutical industry in facilitating insulin initiation in both the public and private sectors. The support included: training of healthcare professionals; developing and disseminating patient education materials; service provision by diabetes education teams; organising programmes for patients' peer group sessions; increasing awareness and demystifying insulin via public campaigns; and subsidising glucose

Age of diagnosis of congenital hearing loss: Private v. public healthcare sector.

Science.gov (United States)

Butler, I R T; Ceronio, D; Swart, T; Joubert, G

2015-11-01

The age of diagnosis of congenital hearing loss is one of the most important determinants of communication outcome. A previous study by the lead author had evaluated the performance of the public health services in Bloemfontein, South Africa (SA), in this regard. This study aimed to examine whether the private health services in the same city were any better. To determine whether the age of diagnosis of congenital hearing loss (CHL) in children seen in the private healthcare sector in Bloemfontein, Free State Province, SA, was lower than that in the public healthcare system in the same city. A comparative study design was utilised and a retrospective database review conducted. Data obtained from this study in the private healthcare sector were compared with data from a previous study in the public healthcare sector using the same study design. Forty-eight children aged private healthcare sector during the study period; 33/47 (70.2%) did not undergo hearing screening at birth. The median age of diagnosis of DHI in the private healthcare sector was 2.24 years, and this was statistically significantly lower than the median age of diagnosis of 3.71 years in the public healthcare sector (pprivate healthcare sector was 3.01 years in children who were not screened at birth, and 1.25 years in those who were screened at birth. This difference was statistically significant (pprivate healthcare sector who were not screened at birth (median 3.01 years) with that in children in the public healthcare sector (median 3.71 years). This difference was statistically significant (pprivate healthcare sector than in the public healthcare sector. With the social and economic benefits of early intervention in cases of DHI well established internationally, SA healthcare providers in both the public and private sectors need to develop screening, diagnostic and (re)habilitation services for children with hearing impairment.

The challenges of healthcare delivery to people with multiple sclerosis in Iran.

Science.gov (United States)

Yazdannik, Ahmadreza; Abolhassani, Shahla; Taleghani, Fariba; Zamani, Ahmadreza

2015-01-01

Multiple sclerosis (MS) is a chronic disease prevalent in young and middle-aged people. Patients with MS often have numerous complicated needs and, consequently, require a broad range of health services. Results of a number of studies indicate that patients' needs are only partially met. This study was conducted to explore the challenges of healthcare delivery to patients with MS in Iran. In this qualitative case study, 43 participants selected through purposeful sampling were interviewed using semi-structured method in the cities of Isfahan and Tehran in 2012-2013. Besides the interview, documentations relevant to healthcare delivery were collected from different sources, including websites of all Iranian universities of medical sciences, insurance organizations, patients' weblogs, news agencies, the MS Center forum for MS patients, and MS Payam bimonthly. The data were analyzed through the constant comparative analysis. The data were categorized into four main categories, including functional challenges (diagnosis problems, failure to pay attention to patient needs, failure to follow-up, and miscommunication), administrative challenges (resource allocation and supervision), policy-making challenges (lack of comprehensive services, bureaucracy, and problems in provision of medications), and structural challenges (difficult access to services, lack of comprehensive centers, space limit, and long wait). Despite all attempts of governmental and nongovernmental organizations for healthcare delivery to MS patients, these services cannot satisfy all needs of the patients. In this regard, service providers and administrators should pay more attention to the needs and expectations of patients and their families.

Value Chains of Public and Private Health-care Services in a Small EU Island State: A SWOT Analysis.

Science.gov (United States)

Buttigieg, Sandra C; Schuetz, Marcus; Bezzina, Frank

2016-01-01

The global financial and macroeconomic crisis of 2008/2009 and the ensuing recessions obliged policy makers to maximize use of resources and cut down on waste. Specifically, in health care, governments started to explore ways of establishing collaborations between the public and private health-care sectors. This is essential so as to ensure the best use of available resources, while securing quality of delivery of care as well as health systems sustainability and resilience. This qualitative study explores complementary and mutual attributes in the value creation process to patients by the public and private health-care systems in Malta, a small European Union island state. A workshop was conducted with 28 professionals from both sectors to generate two separate value chains, and this was followed by an analysis of strengths, weaknesses, opportunities, and threats (SWOT). The latter revealed several strengths and opportunities, which can better equip health-policy makers in the quest to maximize provision of health-care services. Moreover, the analysis also highlighted areas of weaknesses in both sectors as well as current threats of the external environment that, unless addressed, may threaten the state's health-care system sustainability and resilience to macroeconomic shocks. The study goes on to provide feasible recommendations aimed at maximizing provision of health-care services in Malta.

Healthcare reform: the role of coordinated critical care.

Science.gov (United States)

Cerra, F B

1993-03-01

To evaluate and editorialize the evolving role of the discipline of critical care as a healthcare delivery system in the process of healthcare reform. The sources included material from the Federal Office of Management and Budget, Health Care Financing Review, President Bush's Office, Association of American Medical Colleges, and publications of the Society of Critical Care Medicine. Data were selected that the author felt was relevant to the healthcare reform process and its implications for the discipline of critical care. The data were extracted by the author to illustrate the forces behind healthcare reform, the implications for the practice of critical care, and role of critical care as a coordinated (managed) care system in the process of healthcare reform. Healthcare reform has been initiated because of a number of considerations that arise in evaluating the current healthcare delivery system: access, financing, cost, dissatisfactions with the mechanisms of delivery, and political issues. The reform process will occur with or without the involvement of critical care practitioners. Reforms may greatly alter the delivery of critical care services, education, training, and research in critical care. Critical care has evolved into a healthcare delivery system that provides services to patients who need and request them and provides these services in a coordinated (managed) care model. Critical care practitioners must become involved in the healthcare reform process, and critical care services that are effective must be preserved, as must the education, training, and research programs. Critical care as a healthcare delivery system utilizing a coordinated (managed) care model has the potential to provide services to all patients who need them and to deliver them in a manner that is cost effective and recognized as providing added value.

Transforming Healthcare Delivery: Integrating Dynamic Simulation Modelling and Big Data in Health Economics and Outcomes Research.

Science.gov (United States)

Marshall, Deborah A; Burgos-Liz, Lina; Pasupathy, Kalyan S; Padula, William V; IJzerman, Maarten J; Wong, Peter K; Higashi, Mitchell K; Engbers, Jordan; Wiebe, Samuel; Crown, William; Osgood, Nathaniel D

2016-02-01

In the era of the Information Age and personalized medicine, healthcare delivery systems need to be efficient and patient-centred. The health system must be responsive to individual patient choices and preferences about their care, while considering the system consequences. While dynamic simulation modelling (DSM) and big data share characteristics, they present distinct and complementary value in healthcare. Big data and DSM are synergistic-big data offer support to enhance the application of dynamic models, but DSM also can greatly enhance the value conferred by big data. Big data can inform patient-centred care with its high velocity, volume, and variety (the three Vs) over traditional data analytics; however, big data are not sufficient to extract meaningful insights to inform approaches to improve healthcare delivery. DSM can serve as a natural bridge between the wealth of evidence offered by big data and informed decision making as a means of faster, deeper, more consistent learning from that evidence. We discuss the synergies between big data and DSM, practical considerations and challenges, and how integrating big data and DSM can be useful to decision makers to address complex, systemic health economics and outcomes questions and to transform healthcare delivery.

Perceived quality of healthcare delivery in a rural District of Ghana ...

African Journals Online (AJOL)

Objective: The study aimed at finding out clients' perceptions of the quality of healthcare delivery at the district level in rural Ghana, using the Komenda-Edina- Eguafo-Abrem District as a case study. Design: 803 patients were purposively selected and interviewed after visits to health facilities using a pretested questionnaire, ...

How can insulin initiation delivery in a dual-sector health system be optimised? A qualitative study on healthcare professionals’ views

Directory of Open Access Journals (Sweden)

Lee Ping Yein

2012-04-01

Full Text Available Abstract Background The prevalence of type 2 diabetes is increasing at an alarming rate in developing countries. However, glycaemia control remains suboptimal and insulin use is low. One important barrier is the lack of an efficient and effective insulin initiation delivery approach. This study aimed to document the strategies used and proposed by healthcare professionals to improve insulin initiation in the Malaysian dual-sector (public–private health system. Methods In depth interviews and focus group discussions were conducted in Klang Valley and Seremban, Malaysia in 2010–11. Healthcare professionals consisting of general practitioners (n = 11, medical officers (n = 8, diabetes educators (n = 3, government policy makers (n = 4, family medicine specialists (n = 10 and endocrinologists (n = 2 were interviewed. We used a topic guide to facilitate the interviews, which were audio recorded, transcribed verbatim and analysed using a thematic approach. Results Three main themes emerged from the interviews. Firstly, there was a lack of collaboration between the private and public sectors in diabetes care. The general practitioners in the private sector proposed an integrated system for them to refer patients to the public health services for insulin initiation programmes. There could be shared care between the two sectors and this would reduce the disproportionately heavy workload at the public sector. Secondly, besides the support from the government health authority, the healthcare professionals wanted greater involvement of non-government organisations, media and pharmaceutical industry in facilitating insulin initiation in both the public and private sectors. The support included: training of healthcare professionals; developing and disseminating patient education materials; service provision by diabetes education teams; organising programmes for patients’ peer group sessions; increasing awareness and demystifying

Decision-making strategies: ignored to the detriment of healthcare training and delivery?

Science.gov (United States)

Desmond, Chris; Brubaker, Kathryn A; Ellner, Andrew L

2013-01-01

Context : People do not always make health-related decisions which reflect their best interest - best interest being defined as the decision they would make if they carefully considered the options and fully understood the information available. A substantial literature has developed in behavioral economics and social psychology that seeks to elucidate the patterns in individual decision-making. While this is particularly relevant to healthcare, the insights from these fields have only been applied in a limited way. To address the health challenges of the twenty-first century, healthcare providers and healthcare systems designers need to more fully understand how individuals are making decisions. Methods : We provide an overview of the theories of behavioral economics and social psychology that relate to how individuals make health-related decisions. The concentration on health-related decisions leads to a focus on three topics: (1) mental shortcuts and motivated reasoning; (2) implications of time; and (3) implications of affect. The first topic is relevant because health-related decisions are often made in a hurry without a full appreciation of the implications and the deliberation they warrant. The second topic is included because the link between a decision and its health-related outcomes can involve a significant time lag. The final topic is included because health and affect are so often linked. Findings : The literature reviewed has implications for healthcare training and delivery. Selection for medical training must consider the skills necessary to understand and adapt to how patients make decisions. Training on the insights garnered from behavioral economics and social psychology would better prepare healthcare providers to effectively support their clients to lead healthy lives. Healthcare delivery should be structured to respond to the way in which decisions are made. Conclusions : These patterns in decision-making call into question basic assumptions

An Organizational Model for Excellence in Healthcare Delivery: Evidence From Winners of the Baldrige Quality Award.

Science.gov (United States)

Griffith, John R

Winners of the Baldrige National Quality Award in healthcare have documented top quartile clinical outcomes and patient satisfaction across a variety of American communities and a full spectrum of care. Their results also show high levels of satisfaction among physicians, nurses, and other workers, as well as effective financial performance. The managerial methods they use-collectively, the Baldrige model-are consistent with organizational theory literature and are found across all winners. The winners have sustained excellence after winning and expanded it by acquisition of other healthcare organizations.The model differs substantially from traditional management approaches in healthcare delivery. It is a comprehensive program that emphasizes a shared focus on excellence, systematically responsive management, evidence-based medicine, multidimensional measures and negotiated goals, improvement of work processes, thorough training, and extensive rewards. The model could be expanded on a much larger scale. Doing so successfully would substantially improve the quality and cost of healthcare, as well as the satisfaction and commitment of care providers and other staff. The opportunity deserves further study and trial by large healthcare delivery systems, insurers, and consulting companies.

Creating value-focused healthcare delivery systems: Part three--Core competencies.

Science.gov (United States)

Beveridge, R N

1997-01-01

Value is created through the delivery of high-quality, cost--effective healthcare services. The ability to create value from the providers' perspective is facilitated through the development and implementation of essential, customer-focused core competencies. These core competencies include customer relationship management, payer/provider relationship management, disease management, outcomes management, financial/cost management, and information management. Customer relationship management is the foundation upon which all core competencies must be built. All of the core competencies must focus on the needs of the customers, both internal and external. Structuring all processes involved in the core competencies from the perspective of the customer will ensure that value is created throughout the system. Payer/provider relationship management will become a crucial pillar for healthcare providers in the future. As more vertical integration among providers occurs, the management of the relationships among providers and with payers will become more important. Many of the integration strategies being implemented across the country involve the integration of hospitals, physicians, and payers to form accountable health plans. The relationships must be organized to form "win/win" situations, where all parties are focused on a shared vision of creating value and none of the parties benefits at the expense of the others. Disease management in creating value requires that we begin examining the disease process along the entire continuum. Not only must providers be able to provide high-quality acute and chronic care, but they must also begin to focus more heavily on programs of prevention. Value is created throughout the system through reducing the prevalence and incidence of disease. Only through managing the full continuum of health will value be created throughout the healthcare delivery system. Outcomes management ensures that the outcomes are the highest quality at a cost

Patient assessment within the context of healthcare delivery packages: A comparative analysis.

Science.gov (United States)

Rossen, Camilla Blach; Buus, Niels; Stenager, Egon; Stenager, Elsebeth

2016-01-01

Due to an increased focus on productivity and cost-effectiveness, many countries across the world have implemented a variety of tools for standardizing diagnostics and treatment. In Denmark, healthcare delivery packages are increasingly used for assessment of patients. A package is a tool for creating coordination, continuity and efficient pathways; each step is pre-booked, and the package has a well-defined content within a predefined category of diseases. The aim of this study was to investigate how assessment processes took place within the context of healthcare delivery packages. The study used a constructivist Grounded Theory approach. Ethnographic fieldwork was carried out in three specialized units: a mental health unit and two multiple sclerosis clinics in Southern Denmark, which all used assessment packages. Several types of data were sampled through theoretical sampling. Participant observation was conducted for a total of 126h. Formal and informal interviews were conducted with 12 healthcare professionals and 13 patients. Furthermore, audio recordings were made of 9 final consultations between physicians and patients; 193min of recorded consultations all in all. Lastly, the medical records of 13 patients and written information about packages were collected. The comparative, abductive analysis focused on the process of assessment and the work made by all the actors involved. In this paper, we emphasized the work of healthcare professionals. We constructed five interrelated categories: 1. "Standardized assessing", 2. "Flexibility", which has two sub-categories, 2.1. "Diagnostic options" and 2.2. "Time and organization", and, finally, 3. "Resisting the frames". The process of assessment required all participants to perform the predefined work in the specified way at the specified time. Multidisciplinary teamwork was essential for the success of the process. The local organization of the packages influenced the assessment process, most notably the pre

Value Chains of Public and Private Health-care Services in a Small EU Island State: A SWOT Analysis

Science.gov (United States)

Buttigieg, Sandra C.; Schuetz, Marcus; Bezzina, Frank

2016-01-01

The global financial and macroeconomic crisis of 2008/2009 and the ensuing recessions obliged policy makers to maximize use of resources and cut down on waste. Specifically, in health care, governments started to explore ways of establishing collaborations between the public and private health-care sectors. This is essential so as to ensure the best use of available resources, while securing quality of delivery of care as well as health systems sustainability and resilience. This qualitative study explores complementary and mutual attributes in the value creation process to patients by the public and private health-care systems in Malta, a small European Union island state. A workshop was conducted with 28 professionals from both sectors to generate two separate value chains, and this was followed by an analysis of strengths, weaknesses, opportunities, and threats (SWOT). The latter revealed several strengths and opportunities, which can better equip health-policy makers in the quest to maximize provision of health-care services. Moreover, the analysis also highlighted areas of weaknesses in both sectors as well as current threats of the external environment that, unless addressed, may threaten the state’s health-care system sustainability and resilience to macroeconomic shocks. The study goes on to provide feasible recommendations aimed at maximizing provision of health-care services in Malta. PMID:27683658

[Public health stewardship and governance regarding the Colombian healthcare system, 2012-2013].

Science.gov (United States)

Roth-Deubel, André N; Molina-Marín, Gloria

2013-01-01

Analysing decision-making concerning public health issues regarding the Colombian healthcare system from a market economy-based approach. This study involved applying Glaser and Strauss's grounded theory in six Colombian cities during 2012: Bogotá, Barranquilla, Bucaramanga, Leticia, Medellin and Pasto. 120 individual interviews were conducted with professionals involved in decision-making, running public healthcare programmes and making policy within public and private institutions. Fourteen focus groups were held with community organisation leaders. The findings suggested national and municipal health authorities' weak stewardship and ineffective governance regarding public healthcare policy and programmes, related to a lack of staff trained in public health management issues. In turn, this was related to political parties' interference and private insurers' particular interests and the structural fragmentation of functions and actors within the health system, thereby limiting public health development. A new axiology is necessary for achieving effective governance (I.e. cooperation between Colombian Healthcare Social Security System actors) to overcome current incompetence and financial self-interest predominating within the Colombian healthcare system.

Integration of social media with healthcare big data for improved service delivery

Directory of Open Access Journals (Sweden)

Sibulela Mgudlwa

2018-04-01

Full Text Available Background: In the last decade, social media users across the world have crossed 1 billion, making it one of the fastest growing sources of big data. Also, people needing healthcare continue to increase in every society. Through accessibility, communication and interaction between health practitioners and patients, this type of ever-growing, social media subscriber–based platform can be of significant use in improving healthcare delivery to society. However, users encounter serious challenges in their attempts to make use of social media and big data for health-related services. The challenges are primarily caused by factors such as integration, complexity, security and privacy. The challenges are mainly owing to the sensitive nature of the healthcare environment, as a result of personalisation and privacy of information.   Objectives: The objectives of the study were to examine and gain a better understanding of the complexities that are associated with the use of social media and healthcare big data, through influencing factors, and to develop a framework that can be used to improve health-related services to the patients.   Methods: The interpretivist approach was employed, within which qualitative data were collected. This included documents and existing literature in the areas of social media and healthcare big data. To have a good spread of both previous and current state of events within the phenomena being studied, literature published between 2006 and 2016 were gathered. The data were interpretively analysed.   Results: Based on the analysis of the data, factors of influence were found, which were used to develop a model. The model illustrates how the factors of influence can enable and at the same time constrain the use of social media for healthcare services. The factors were interpreted from which a framework was developed. The framework is intended to guide integration of social media with healthcare big data through which

The challenges of leading change in health-care delivery from the front-line.

Science.gov (United States)

Byers, Vivienne

2017-09-01

The public sector is facing turbulent times and this challenges nurses, who are expected to serve both patient interests and the efficiency drives of their organisations. In the context of implementing person-centred health policy, this paper explores the evolving role of front-line nurses as leaders and champions of change. Nurses can be seen to have some autonomy in health-care delivery. However, they are subject to systems of social control. In implementing person-centred policy, nurses can be seen to be doing the best they can within a constrained environment. A survey of nursing practice in person-centred health-policy implementation is presented. Despite much being written about managing health-professional resistance to policy implementation, there is a gap between what is being asked of nurses and the resources made available to them to deliver. In this milieu, nurses are utilising their discretion and leading from the front-line in championing change. Empowering nurses who seek to lead patient involvement could be the key to unlocking health-care improvement. Health services tend to be over-managed and under-led and there is a need to harness the potential of front-line nurses by facilitating leadership development through appropriate organisational support. © 2015 John Wiley & Sons Ltd.

Faith, Trust and the Perinatal Healthcare Maze in Urban India

Directory of Open Access Journals (Sweden)

S. Raman

2014-05-01

Full Text Available How women access and utilise health services through pregnancy, childbirth and infancy needs to be understood if we are to improve the delivery of and access to appropriate healthcare. Drawing on ethnographic observations of clinic encounters and in-depth interviews with women in Bangalore, South India, this paper reports on the complexities of negotiating healthcare throughout the perinatal continuum in urban India. Key themes identified include faith and trust in health services, confusion over right to healthcare; and the contested nature of choice for women. What is revealed is a socially restrictive framework that results in choices that seem arbitrary, irrational and self-defeating; poor women being particularly vulnerable. Given the current policy support for public-private-partnerships in reproductive healthcare delivery in India, both public and private health services need to move substantially to achieve true partnership and provide care that is respectful and valued by women and children in urban India.

Healthcare librarians and the delivery of critical appraisal training: barriers to involvement.

Science.gov (United States)

Maden-Jenkins, Michelle

2011-03-01

  Many healthcare librarians are undertaking training in critical appraisal but a significant number are not cascading the training to their end-users.   To examine the barriers to healthcare librarian involvement in delivering critical appraisal training.   A questionnaire survey of 57 library services across 48 NHS Trust Library Services in north west England followed up with 21 semi-structured interviews.   Two types of barriers were noted: extrinsic barriers (organisational, environmental, training, role expectations) and intrinsic barriers (knowledge, skills, attitude).   These barriers are not mutually exclusive and by overcoming one of them it does not necessarily follow that healthcare librarians will engage in delivering critical appraisal skills training. The challenge lies in developing strategies to deal effectively with these barriers to encourage and support healthcare librarians in the delivery of critical appraisal training at a level at which they feel confident and able. © 2010 The authors. Health Information and Libraries Journal © 2010 Health Libraries Group.

Benchmarking and Learning in Public Healthcare

DEFF Research Database (Denmark)

Buckmaster, Natalie; Mouritsen, Jan

2017-01-01

This research investigates the effects of learning-oriented benchmarking in public healthcare settings. Benchmarking is a widely adopted yet little explored accounting practice that is part of the paradigm of New Public Management. Extant studies are directed towards mandated coercive benchmarking...... applications. The present study analyses voluntary benchmarking in a public setting that is oriented towards learning. The study contributes by showing how benchmarking can be mobilised for learning and offers evidence of the effects of such benchmarking for performance outcomes. It concludes that benchmarking...... can enable learning in public settings but that this requires actors to invest in ensuring that benchmark data are directed towards improvement....

Improving the Quality and Cost of Healthcare Delivery: The Potential of Radio Frequency Identification (RFID) Technology

Science.gov (United States)

Vilamovska, Anna-Marie

2010-01-01

The study investigated whether an upcoming class of health information technology (HIT) can be used to address currently outstanding issues in the quality and cost of healthcare delivery. Expert interviews and a literature review were used to describe the 2009 universe of in- and outpatient healthcare RFID applications and to identify those…

Public perceptions of key performance indicators of healthcare in Alberta, Canada.

Science.gov (United States)

Northcott, Herbert C; Harvey, Michael D

2012-06-01

To examine the relationship between public perceptions of key performance indicators assessing various aspects of the health-care system. Cross-sequential survey research. Annual telephone surveys of random samples of adult Albertans selected by random digit dialing and stratified according to age, sex and region (n = 4000 for each survey year). The survey questionnaires included single-item measures of key performance indicators to assess public perceptions of availability, accessibility, quality, outcome and satisfaction with healthcare. Cronbach's α and factor analysis were used to assess the relationship between key performance indicators focusing on the health-care system overall and on a recent interaction with the health-care system. The province of Alberta, Canada during the years 1996-2004. Four thousand adults randomly selected each survey year. Survey questions measuring public perceptions of healthcare availability, accessibility, quality, outcome and satisfaction with healthcare. Factor analysis identified two principal components with key performance indicators focusing on the health system overall loading most strongly on the first component and key performance indicators focusing on the most recent health-care encounter loading most strongly on the second component. Assessments of the quality of care most recently received, accessibility of that care and perceived outcome of care tended to be higher than the more general assessments of overall health system quality and accessibility. Assessments of specific health-care encounters and more general assessments of the overall health-care system, while related, nevertheless comprise separate dimensions for health-care evaluation.

Can delivery systems use cost-effectiveness analysis to reduce healthcare costs and improve value?

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Savitz, Lucy A; Savitz, Samuel T

2016-01-01

Understanding costs and ensuring that we demonstrate value in healthcare is a foundational presumption as we transform the way we deliver and pay for healthcare in the U.S. With a focus on population health and payment reforms underway, there is increased pressure to examine cost-effectiveness in healthcare delivery. Cost-effectiveness analysis (CEA) is a type of economic analysis comparing the costs and effects (i.e. health outcomes) of two or more treatment options. The result is expressed as a ratio where the denominator is the gain in health from a measure (e.g. years of life or quality-adjusted years of life) and the numerator is the incremental cost associated with that health gain. For higher cost interventions, the lower the ratio of costs to effects, the higher the value. While CEA is not new, the approach continues to be refined with enhanced statistical techniques and standardized methods. This article describes the CEA approach and also contrasts it to optional approaches, in order for readers to fully appreciate caveats and concerns. CEA as an economic evaluation tool can be easily misused owing to inappropriate assumptions, over reliance, and misapplication. Twelve issues to be considered in using CEA results to drive healthcare delivery decision-making are summarized. Appropriately recognizing both the strengths and the limitations of CEA is necessary for informed resource allocation in achieving the maximum value for healthcare services provided.

Funding New Zealand's public healthcare system: time for an honest appraisal and public debate.

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Keene, Lyndon; Bagshaw, Philip; Nicholls, M Gary; Rosenberg, Bill; Frampton, Christopher M; Powell, Ian

2016-05-27

Successive New Zealand governments have claimed that the cost of funding the country's public healthcare services is excessive and unsustainable. We contest that these claims are based on a misrepresentation of healthcare spending. Using data from the New Zealand Treasury and the Organisation for Economic Cooperation and Development (OECD), we show how government spending as a whole is low compared with most other OECD countries and is falling as a proportion of GDP. New Zealand has a modest level of health spending overall, but government health spending is also falling as a proportion of GDP. Together, the data indicate the New Zealand Government can afford to spend more on healthcare. We identify compelling reasons why it should do so, including forecast growing health need, signs of increasing unmet need, and the fact that if health needs are not met the costs still have to be borne by the economy. The evidence further suggests it is economically and socially beneficial to meet health needs through a public health system. An honest appraisal and public debate is needed to determine more appropriate levels of healthcare spending.

The LIFEspan model of transitional rehabilitative care for youth with disabilities: healthcare professionals' perspectives on service delivery.

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Hamdani, Yani; Proulx, Meghann; Kingsnorth, Shauna; Lindsay, Sally; Maxwell, Joanne; Colantonio, Angela; Macarthur, Colin; Bayley, Mark

2014-01-01

LIFEspan is a service delivery model of continuous coordinated care developed and implemented by a cross-organization partnership between a pediatric and an adult rehabilitation hospital. Previous work explored enablers and barriers to establishing the partnership service. This paper examines healthcare professionals' (HCPs') experiences of 'real world' service delivery aimed at supporting transitional rehabilitative care for youth with disabilities. This qualitative study - part of an ongoing mixed method longitudinal study - elicited HCPs' perspectives on their experiences of LIFEspan service delivery through in-depth interviews. Data were categorized into themes of service delivery activities, then interpreted from the lens of a service integration/coordination framework. Five main service delivery themes were identified: 1) addressing youth's transition readiness and capacities; 2) shifting responsibility for healthcare management from parents to youth; 3) determining services based on organizational resources; 4) linking between pediatric and adult rehabilitation services; and, 5) linking with multi-sector services. LIFEspan contributed to service delivery activities that coordinated care for youth and families and integrated inter-hospital services. However, gaps in service integration with primary care, education, social, and community services limited coordinated care to the rehabilitation sector. Recommendations are made to enhance service delivery using a systems/sector-based approach.

The public healthcare sector and governance in South Africa

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Melody Brauns

2015-05-01

Full Text Available This article reviews literature on governance in order to facilitate an analysis of the governance of the South African public healthcare sector. Some of the key theoretical perspectives have been presented on how best to organise the state and its bureaucracy. Theorists have long interrogated in what way public institutions foster or impede economic growth. Evans and Rauch point out for example, that the role of bureaucratic authority structures in facilitating economic growth has been a sociological concern since Max Weber’s classic contributions almost 100 years ago. These debates and others are explored in this article with specific reference to the provision of equitable public healthcare. Weber’s theory on rational bureaucracy as well as New Public Management will be reviewed as these theories offer two distinct approaches to governance

Beyond patient care: the impact of healthcare reform on job satisfaction in the Ethiopian public healthcare sector.

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Manyazewal, Tsegahun; Matlakala, Mokgadi C

2017-02-03

While healthcare reform has been a central attention for local governments, its impact on job satisfaction is poorly understood. This study aimed to determine the impact of healthcare reform on job satisfaction in the public healthcare sector in Ethiopia. The study was designed as a facility-based cross-sectional survey of healthcare professionals and carried out in all public hospitals in central Ethiopia which have been implementing healthcare reform (n = 5). All healthcare professionals in the hospitals who were involved in the reform from the inception (n = 476) were purposively sourced to complete a self-administered questionnaire adapted from a framework proposed for measuring job satisfaction of health professionals in sub-Saharan Africa. Kaiser-Meyer-Olkin and Bartlett's tests were conducted to measure sampling adequacy and sphericity for factor analysis. Likert's transformation formula was used to numerically analyse the satisfaction level of the respondents and to determine the cut-off value of satisfaction levels. Non-parametric and multiple logistic regression analysis were conducted to determine predictors of job satisfaction. A total of 410 healthcare professionals completed the survey, representing an 88% response rate. The median and mean job satisfaction scores were 50 and 49, respectively, on a scale 1-100, which was equivalent to 'Job dissatisfied' on the Likert scale. Only 25% of respondents perceived job satisfaction due to implementation of the reform. Moral satisfaction (adjusted odds ratio (aOR), 177.65; 95% confidence interval (CI), 59.54-530.08), management style (aOR, 4.02; 95% CI, 1.49-10.83), workload (aOR, 2.42; 95% CI, 0.93-6.34), and task (aOR, 5.49; 95% CI, 2.31-13.07) were the most significant predictors. Job satisfaction results were significantly different among the study hospitals (χ 2  = 30.56, p < .001). The healthcare reform significantly and negatively influences public healthcare professionals' job

Public-Privat e Partnership in the System of Regional Healthcare Financing

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Margarita Yur’evna Molchanova

2016-05-01

Full Text Available Healthcare financing reform in the Russian Federation, besides its positive consequences, has led to the emergence of several major organizational and economic problems that hinder the expansion of financing sources for this sphere, which also involves public-private partnership (PPP. The paper highlights the regional specifics of such healthcare projects compared to similar projects of other spheres of the national economy. The author describes the problems of PPP projects implementation in healthcare; they include the insufficiency of substantiation of public-private partnership application in healthcare, and the absence of typical models for establishment of relations between PPP participants. The paper presents the healthcare priorities put forward by the author; these priorities are based on the theory of the life cycle of a service. The author presents her own model for organizing a regional concession, which is the most common form of public-private partnership in healthcare so far. The cluster brings together on a voluntary basis the legally independent organizations that are interested in improving the quality and increasing the accessibility of health services. These can include medical institutions of various forms of ownership located in the region, clinics, facilities, institutions that train healthcare workers, authorities, etc. The author shows that a favorable environment for the formation and implementation of PPP projects can be created under the cluster approach to the organization of healthcare. When establishing the medical cluster, the main task is to organize interaction between all its subjects in the interest of the overall development of healthcare in the region and the implementation of one’s own interests

Artificial Intelligence and Public Healthcare Service Innovation

DEFF Research Database (Denmark)

Sun, Tara Qian; Medaglia, Rony

Public healthcare ecosystems are complex networks of diverse actors that are subject to pressures to innovate, also a result of technological advancements. Artificial Intelligence (AI), in particular, has the potential to transform the way hospitals, doctors, patients, government agencies...

Quality of the ophthalmological service to outpatients of the public and private healthcare systems.

Science.gov (United States)

Hercos, Benigno Vicente Santos; Berezovsky, Adriana

2017-01-01

To compare perceptions of the quality of ophthalmological services offered to outpatients from the public healthcare system to those from the private healthcare system, and to determine which measures are seen as necessary and a priority for improving the quality of care. This was a prospective observational study on 200 patients, 101 and 99 of whom were from the public and private healthcare systems, respectively. All patients underwent an ophthalmological examination at an ophthalmology hospital in Belo Horizonte, Minas Gerais, Brazil. Personal interviews were conducted using two structured questionnaires adapted from the modified SERVQUAL scale. Overall, patients from the private healthcare system were significantly more dissatisfied than those from the public healthcare system. In both systems, reliability was considered to be the most important determinant of quality, and it presented the highest level of dissatisfaction. Satisfaction with the public healthcare system was significantly greater than that with the private healthcare system in terms of the tangibles, reliability, responsiveness, and assurance determinants of the SERVQUAL scale. Institutions must plan, execute, evaluate, and monitor measures that seek to improve the overall patient satisfaction with the quality of services provided, particularly in the private healthcare system, and special attention must be paid to reliability in both healthcare systems. The identification and monitoring of the quality of healthcare services through the periodic use of the SERVQUAL scale may provide healthcare managers with information so that they can identify, plan, and monitor necessary and priority measures. This could be a key strategy for improving the quality of outpatient health services in the public and private systems.

Integrated delivery systems: the cure for fragmentation.

Science.gov (United States)

Enthoven, Alain C

2009-12-01

Our healthcare system is fragmented, with a misalignment of incentives, or lack of coordination, that spawns inefficient allocation of resources. Fragmentation adversely impacts quality, cost, and outcomes. Eliminating waste from unnecessary, unsafe care is crucial for improving quality and reducing costs--and making the system financially sustainable. Many believe this can be achieved through greater integration of healthcare delivery, more specifically via integrated delivery systems (IDSs). An IDS is an organized, coordinated, and collaborative network that links various healthcare providers to provide a coordinated, vertical continuum of services to a particular patient population or community. It is also accountable, both clinically and fiscally, for the clinical outcomes and health status of the population or community served, and has systems in place to manage and improve them. The marketplace already contains numerous styles and degrees of integration, ranging from Kaiser Permanente-style full integration, to more loosely organized individual practice associations, to public-private partnerships. Evidence suggests that IDSs can improve healthcare quality, improve outcomes, and reduce costs--especially for patients with complex needs--if properly implemented and coordinated. No single approach or public policy will fix the fragmented healthcare system, but IDSs represent an important step in the right direction.

[Autonomy for financial management in public and private healthcare facilities in Brazil].

Science.gov (United States)

Santos, Maria Angelica Borges dos; Madeira, Fátima Carvalho; Passos, Sonia Regina Lambert; Bakr, Felipe; Oliveira, Klivia Brayner de; Andreazzi, Marco Antonio Ratzsch de

2014-01-01

Autonomy in financial management is an advantage in public administration. A 2009 National Healthcare Facility Survey showed that 3.9% of Brazil's 52,055 public healthcare facilities had some degree of financial autonomy. Such autonomy was more common in inpatient facilities (17.8%), those managed by State governments (26.3%), and in Southern Brazil (6.6%). Autonomy was mainly partial (for resources in specific areas, relating to small outlays, consumables and capital goods, and outsourced services or personnel). 74.3% of 2,264 public facilities with any financial autonomy were under direct government administration. Financial autonomy in public healthcare facilities appears to be linked to local political decisions and not necessarily to the facility's specific legal and administrative status. However, legal status displays distinct scopes of autonomy - those under direct government administration tend to be less autonomous, and those under private businesses more autonomous; 85.8% of the 45,394 private healthcare facilities reported that they were financially autonomous.

Healthcare is primary

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Raman Kumar

2015-01-01

Full Text Available India is undergoing a rapid transformation in terms of governance, administrative reforms, newer policy develoment, and social movements. India is also considered one of the most vibrant economies in the world. The current discourse in public space is dominated by issues such as economic development, security, corruption free governance, gender equity, and women safety. Healthcare though remains a pressing need of population; seems to have taken a backseat. In the era of decreasing subsidies and cautious investment in social sectors, the 2 nd National Conference on Family Medicine and Primary Care 2015 (FMPC brought a focus on "healthcare" in India. The theme of this conference was "Healthcare is Primary." The conference participants discussed on the theme of why healthcare should be a national priority and why strong primary care should remain at the center of healthcare delivery system. The experts recommended that India needs to strengthen the "general health system" instead of focusing on disease based vertical programs. Public health system should have capacity and skill pool to be able to deliver person centered comprehensive health services to the community. Proactive implementation of policies towards human resource in health is the need of the hour. As the draft National Health Policy 2015 is being debated, "family medicine" (academic primary care, the unfinished agenda of National Health Policy 2002, remains a priority area of implementation.

Accounting System in Croatian Public Healthcare Organizations: an Empirical Analysis

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Davor VAŠIČEK

2010-06-01

Full Text Available In considering the adequacy of adopting accruals and IPSASs, this paper tests the appropriateness of existing modified accrual accounting and financial reporting system in Croatian public healthcare sector. The paper indicates that accounting information system contains discrepancies and constraints in assuring true and fair view of organization’s financial position and performance. Our statistics confirms low level of cost and managerial accounting methods development, and external and internal financial reporting convergence.Having in mind its specificities, we argue that Croatian public healthcare sector represents a segmental accounting subsystem within the integral public sector accounting framework, where accruals implementation might prove justifiable.

Spirituality and healthcare: Towards holistic people-centred healthcare in South Africa

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Andre de la Porte

2016-07-01

Full Text Available Healthcare in South Africa is in a crisis. Problems with infrastructure, management, human resources and the supply of essential medicines are at a critical level. This is compounded by a high burden of disease and disparity in levels of service delivery, particularly between public and private healthcare. The government has put ambitious plans in place, which are part of the National Development Plan to ward 2030. In the midst of this we find the individual person and their family and community staggering under the suffering caused by disease, poverty, crime and violence. There is a more than 70% chance that this person and their family and community are trying to make sense of this within a spiritual framework and that they belong to a faith-based community. This article explores the valuable contribution of spirituality, spiritual and pastoral work, the faith-based community (FBC and faith-based organisations (FBOs to holistic people-centred healthcare in South Africa. Keywords: Healthcare; Spirituality; Clinical Spiritual Counselling

Patients’ perception of quality service delivery of public hospitals in Nigeria using analytical hierarchy process

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Emmanuel Olateju Oyatoye

2016-07-01

Full Text Available Introduction: Patients are recently more aware and conscious. This is because of the belief that a high level of quality can translate into patient satisfaction. This is critical for healthcare providers as they deal with life. This recognition by both the service provider and service receivers made the government to establish units of service commission (SERVICOM in each of the governmental agencies including hospitals in Nigeria to monitor the level of quality of service delivery. However, to what extent do patients’ perceptions about health services seem to have been largely recognized remain unclear by health care providers, despite the (SERVICOM units in public institutions in Nigeria? Method: A cross-sectional analytical study using convenient sample method, based on the fact that not every patient of the selected hospitals can be chosen, was performed on 400 patients who received health services at four different public hospitals in Ogun state Nigeria. The selection of these hospitals was based on the zones in the state (Egba, Ijebu, Remo and Yewa area of Ogun-state. The instrument was a valid and reliable analytical hierarchy process based questionnaire containing five service quality dimensions. Data were analyzed using SPSS, Expert choice and Microsoft Excel software to determine the perception of patients towards service quality delivery in pairwise comparison of judgment consistent at less than 10%. Results:The results showed the composite priorities of the patients’ perception with respect to determinants of the patients’ perception towards quality of services delivered in the public hospitals in Nigeria. The most important factor to patients was the reliability dimension with composite priority 0.24 or 24% followed by the responsiveness dimension with 0.22 assurance dimension 0.21, tangibility dimension with 0.21, and the least determinant factor was the empathy dimension with 0.1101. Conclusion: Based on the results, the

Private Sector in Indian Healthcare Delivery: Consumer Perspective and Government Policies to promote private Sector

OpenAIRE

Utkarsh Shah, Ragini Mohanty

2011-01-01

This research paper attempts to collate literature from various sources, in an attempt to answer three pertinent questions related to healthcare in India. Firstly, what is it meant by ‘private sector’ in healthcare delivery system of India, secondly how has the private sector evolved over the decades and what has been the role of the government in propelling the growth. Finally, the paper tries to highlight some of the factors that have promoted the growth of private sector in India with spec...

Assessment of the Ehlanzeni District health transport and logistics function: Enhancing rural healthcare delivery systems

CSIR Research Space (South Africa)

Mashiri, MAM

2009-07-01

Full Text Available This paper seeks to establish a baseline against which to assess the impacts of the ‘Ehlanzeni District Health Transport Function’ for the district’s healthcare service delivery output, and by extension, health and welfare outcomes. The main...

mHealth: Knowledge and use among doctors and nurses in public secondary health-care facilities of Lagos, Nigeria

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Bukola Samuel Owolabi

2018-01-01

Full Text Available Objectives: Mobile health (mHealth is gaining importance worldwide, changing and improving the way healthcare and services are provided, but its role is just emerging in Nigeria. This study aimed to assess the knowledge and use of mHealth among health workers and the provisions for its use in public secondary health-care facilities of Lagos State, Nigeria. Methods: The study was a descriptive cross-sectional study carried out among 65 doctors and 135 nurses selected using a two-staged sampling method. Data were collected with pretested self-administered questionnaires and analyzed with EpiInfo™ 7. Results: Majority (doctors 84.6%, nurses 91.1% had not heard of the term “mHealth,” but most (doctors 96.9%, nurses 87.4% were aware of the use of mobile phones in health-care delivery. Only three (27.3% (health call centers/health-care telephone helpline, appointment reminders, and mobile telemedicine out of 11 mHealth components listed were mostly known. Most doctors simply used patient monitoring/surveillance and mobile telemedicine, while nurses mainly used treatment compliance and appointment reminder services. Majority were willing to use more mHealth services if available in their hospital. All the doctors and 97% of nurses had mobile phones. However, only about one-quarter (27.5% had smartphones with applications used for mHealth purposes. Conclusions: Knowledge, awareness, and use of mHealth services were low. Doctors and nurses should be enlightened and trained on ways to use mHealth services to improve health-care delivery, mHealth services should be made available in the hospitals, and use of smartphones encouraged as they portend better adaptability for mHealth use.

Optimal healthcare delivery to care homes in the UK: a realist evaluation of what supports effective working to improve healthcare outcomes.

Science.gov (United States)

Gordon, Adam L; Goodman, Claire; Davies, Sue L; Dening, Tom; Gage, Heather; Meyer, Julienne; Schneider, Justine; Bell, Brian; Jordan, Jake; Martin, Finbarr C; Iliffe, Steve; Bowman, Clive; Gladman, John R F; Victor, Christina; Mayrhofer, Andrea; Handley, Melanie; Zubair, Maria

2018-01-05

care home residents have high healthcare needs not fully met by prevailing healthcare models. This study explored how healthcare configuration influences resource use. a realist evaluation using qualitative and quantitative data from case studies of three UK health and social care economies selected for differing patterns of healthcare delivery to care homes. Four homes per area (12 in total) were recruited. A total of 239 residents were followed for 12 months to record resource-use. Overall, 181 participants completed 116 interviews and 13 focus groups including residents, relatives, care home staff, community nurses, allied health professionals and General Practitioners. context-mechanism-outcome configurations were identified explaining what supported effective working between healthcare services and care home staff: (i) investment in care home-specific work that legitimises and values work with care homes; (ii) relational working which over time builds trust between practitioners; (iii) care which 'wraps around' care homes; and (iv) access to specialist care for older people with dementia. Resource use was similar between sites despite differing approaches to healthcare. There was greater utilisation of GP resource where this was specifically commissioned but no difference in costs between sites. activities generating opportunities and an interest in healthcare and care home staff working together are integral to optimal healthcare provision in care homes. Outcomes are likely to be better where: focus and activities legitimise ongoing contact between healthcare staff and care homes at an institutional level; link with a wider system of healthcare; and provide access to dementia-specific expertise. © The Author(s) 2018. Published by Oxford University Press on behalf of the British Geriatrics Society.

Six Sigma in healthcare delivery.

Science.gov (United States)

Liberatore, Matthew J

2013-01-01

The purpose of this paper is to conduct a comprehensive review and assessment of the extant Six Sigma healthcare literature, focusing on: application, process changes initiated and outcomes, including improvements in process metrics, cost and revenue. Data were obtained from an extensive literature search. Healthcare Six Sigma applications were categorized by functional area and department, key process metric, cost savings and revenue generation (if any) and other key implementation characteristics. Several inpatient care areas have seen most applications, including admission, discharge, medication administration, operating room (OR), cardiac and intensive care. About 42.1 percent of the applications have error rate as their driving metric, with the remainder focusing on process time (38 percent) and productivity (18.9 percent). While 67 percent had initial improvement in the key process metric, only 10 percent reported sustained improvement. Only 28 percent reported cost savings and 8 percent offered revenue enhancement. These results do not favorably assess Six Sigma's overall effectiveness and the value it offers healthcare. Results are based on reported applications. Future research can include directly surveying healthcare organizations to provide additional data for assessment. Future application should emphasize obtaining improvements that lead to significant and sustainable value. Healthcare staff can use the results to target promising areas. This article comprehensively assesses Six Sigma healthcare applications and impact.

[Beyond the horizon of health-care delivery - medical marketing].

Science.gov (United States)

Hoffmann, M; Großterlinden, L G; Rueger, J M; Ruecker, A H

2014-12-01

The progress in medical health care and demographic changes cause increasing financial expenses. The rising competitive environment on health-care delivery level calls for economisation and implementation of a professional marketing set-up in order to ensure long-term commercial success. The survey is based on a questionnaire-analysis of 100 patients admitted to a trauma department at a university hospital in Germany. Patients were admitted either for emergency treatment or planned surgical procedures. Competence and localisation represent basic criteria determing hospital choice with a varying focus in each collective. Both collectives realise a trend toward economisation, possibly influencing medical care decision-making. Patients admitted for planned surgical treatment are well informed about their disease, treatment options and specialised centres. The main source of information is the internet. Both collectives claim amenities during their in-hospital stay. Increasing economisation trends call for a sound and distinct marketing strategy. The marketing has to be focused on the stakeholders needs. Concomitant factors are patient satisfaction, the establishment of cooperation networks and maintenance/improvement of medical health-care quality. Georg Thieme Verlag KG Stuttgart · New York.

Integrating and rationalizing public healthcare services as a source of cost containment in times of economic crises.

Science.gov (United States)

Pettoello-Mantovani, Massimo; Namazova-Baranova, Leyla; Ehrich, Jochen

2016-02-24

Serious concern has been raised about the sustainability of public health care systems of European Nations and ultimately about the health of European citizens, as a result of the economic crisis that has distressed Europe since 2008. The severe economic crisis of the Euro zone, which is still afflicting Europe in 2016, has in fact threatened to equally impact public health services of nations presenting either a weak or a strong domestic growth. On behalf of the European Paediatric Association, the Union of National European Societies and Associations, the authors of the Commentary debates the relationship between the effects of economic instability and health, through the report on an article recently published in the Italian Journal of Pediatrics, which emphasized the importance of integrating existing public health care services, otherwise independently provided by public hospitals, and Primary Care Paediatric networks. The interconnections between the effects of economic instability and health are briefly commented, following the observation that these two factors are not yet fully understood, and that the definition of proper solutions to be applied in circumstances, where health is negatively impacted by periods of economic distress, is still open for discussion. Furthermore it is noted that the pressure to "deliver more for less" often seems to be the driving force forging the political strategic decisions in the area of pediatric healthcare, rather than social, cultural, and economic sensitivity and competences. Thus, the delivery of appropriate pediatric healthcare seems not to be related exclusively to motivations aimed to the benefit of children, but more often to other intervening factors, including economic, and political rationales. The conclusions emphasize that local European experiences suggest that positive and cost effective healthcare programs are possible, and they could serve as a model in the development of effective cross-border regional

Two decades of reforms. Appraisal of the financial reforms in the Russian public healthcare sector.

Science.gov (United States)

Gordeev, Vladimir S; Pavlova, Milena; Groot, Wim

2011-10-01

This paper reviews the empirical evidence on the outcomes of the financial reforms in the Russian public healthcare sector. A systematic literature review identified 37 relevant publications that presented empirical evidence on changes in quality, equity, efficiency and sustainability in public healthcare provision due to the Russian public healthcare financial reforms. Evidence suggests that there are substantial inter-regional inequalities across income groups both in terms of financing and access to public healthcare services. There are large efficiency differences between regions, along with inter-regional variations in payment and reimbursement mechanisms. Informal and quasi-formal payments deteriorate access to public healthcare services and undermine the overall financing sustainability. The public healthcare sector is still underfinanced, although the implementation of health insurance gave some premises for future increases of efficiency. Overall, the available empirical data are not sufficient for an evidence-based evaluation of the reforms. More studies on the quality, equity, efficiency and sustainability impact of the reforms are needed. Future reforms should focus on the implementation of cost-efficiency and cost-control mechanisms; provide incentives for better allocation and distribution of resources; tackle problems in equity in access and financing; implement a system of quality controls; and stimulate healthy competition between insurance companies. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Factors influencing HPV vaccine delivery by healthcare professionals at public health posts in São Paulo, Brazil.

Science.gov (United States)

Figueroa-Downing, Daniella; Baggio, Maria Luiza; Baker, Misha L; Dias De Oliveira Chiang, Ellen; Villa, Luisa L; Eluf Neto, Jose; Evans, Dabney P; Bednarczyk, Robert A

2017-01-01

To assess the association between Brazilian healthcare providers' characteristics and their knowledge, perceptions, and practices regarding the HPV vaccine. An observational cross-sectional study was conducted at five public health posts in São Paulo between July 28 and August 8, 2014. Healthcare professionals directly involved in patient care were asked to complete a written survey. Factors associated with routine verification of HPV vaccination status were evaluated using Poisson regression. Among 200 participants included, 74 (38.5%) reported never and 70 (36.5%) reported always asking about HPV immunization status. Doctors were significantly less likely to report always asking than were community health agents (5/39 [12.8%] vs 32/60 [53.3%]; adjusted prevalence ratio [aPR] 0.25 [95% confidence interval (CI) 0.07-0.91]). Knowledge about the correct dosing schedule was associated with always rather than never verifying vaccination status (aPR 2.46 [95% CI 1.06-5.70]). Knowledge and attitude played secondary roles in influencing HPV vaccine verification. Community health agents were crucial for vaccine promotion; continued education and support of this group is essential for the sustained success of HPV immunization efforts in Brazil. © 2016 International Federation of Gynecology and Obstetrics.

Using mobile technology to optimize disease surveillance and healthcare delivery at mass gatherings: a case study from India's Kumbh Mela.

Science.gov (United States)

Kazi, Dhruv S; Greenough, P Gregg; Madhok, Rishi; Heerboth, Aaron; Shaikh, Ahmed; Leaning, Jennifer; Balsari, Satchit

2017-09-01

Planning for mass gatherings often includes temporary healthcare systems to address the needs of attendees. However, paper-based record keeping has traditionally precluded the timely application of collected clinical data for epidemic surveillance or optimization of healthcare delivery. We evaluated the feasibility of harnessing ubiquitous mobile technologies for conducting disease surveillance and monitoring resource utilization at the Allahabad Kumbh Mela in India, a 55-day festival attended by over 70 million people. We developed an inexpensive, tablet-based customized disease surveillance system with real-time analytic capabilities, and piloted it at five field hospitals. The system captured 49 131 outpatient encounters over the 3-week study period. The most common presenting complaints were musculoskeletal pain (19%), fever (17%), cough (17%), coryza (16%) and diarrhoea (5%). The majority of patients received at least one prescription. The most common prescriptions were for antimicrobials, acetaminophen and non-steroidal anti-inflammatory drugs. There was great inter-site variability in caseload with the busiest hospital seeing 650% more patients than the least busy hospital, despite identical staffing. Mobile-based health information solutions developed with a focus on user-centred design can be successfully deployed at mass gatherings in resource-scarce settings to optimize care delivery by providing real-time access to field data. © The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health.

Understanding the organization of public health delivery systems: an empirical typology.

Science.gov (United States)

Mays, Glen P; Scutchfield, F Douglas; Bhandari, Michelyn W; Smith, Sharla A

2010-03-01

Policy discussions about improving the U.S. health care system increasingly recognize the need to strengthen its capacities for delivering public health services. A better understanding of how public health delivery systems are organized across the United States is critical to improvement. To facilitate the development of such evidence, this article presents an empirical method of classifying and comparing public health delivery systems based on key elements of their organizational structure. This analysis uses data collected through a national longitudinal survey of local public health agencies serving communities with at least 100,000 residents. The survey measured the availability of twenty core public health activities in local communities and the types of organizations contributing to each activity. Cluster analysis differentiated local delivery systems based on the scope of activities delivered, the range of organizations contributing, and the distribution of effort within the system. Public health delivery systems varied widely in organizational structure, but the observed patterns of variation suggested that systems adhere to one of seven distinct configurations. Systems frequently migrated from one configuration to another over time, with an overall trend toward offering a broader scope of services and engaging a wider range of organizations. Public health delivery systems exhibit important structural differences that may influence their operations and outcomes. The typology developed through this analysis can facilitate comparative studies to identify which delivery system configurations perform best in which contexts.

Social marketing in healthcare.

Science.gov (United States)

Aras, Radha

2011-01-01

Social marketing is an important tool in the delivery of healthcare services. For any healthcare programme or project to be successful, community/consumer participation is required. The four principles of social marketing can guide policymakers and healthcare providers to successfully plan and implement health programmes. To review the existing literature in order to project the benefits of social marketing in healthcare. A search of periodical literature by the author involving social marketing and marketing concepts in health was carried out. Items were identified initially through health-oriented indexing services such as Medline, Health STAR and Cinahl, using the identifiers "social marketing" and "marketing in health". An extensive search was also carried out on educational database ERIC. A literature review of various studies on social marketing indicated that the selection of the right product (according to the community need) at the right place, with the right strategy for promotion and at the right price yields good results. However, along with technical sustainability (product, price, promotion and place), financial sustainability, institutional sustainability and market sustainability are conducive factors for the success of social marketing. The purpose of this literature review was to ascertain the likely effectiveness of social marketing principles and approaches and behaviour change communication towards health promotion. It is important for all healthcare workers to understand and respond to the public's desires and needs and routinely use consumer research to determine how best to help the public to solve problems and realise aspirations. Social marketing can optimise public health by facilitating relationship-building with consumers and making their lives healthier.

[Private health insurance in Brazil: approaches to public/private patterns in healthcare].

Science.gov (United States)

Sestelo, José Antonio de Freitas; Souza, Luis Eugenio Portela Fernandes de; Bahia, Lígia

2013-05-01

This article draws on a previous review of 270 articles on private health plans published from 2000 to 2010 and selects 17 that specifically address the issue of the relationship between the public and private healthcare sectors. Content analysis considered the studies' concepts and terms, related theoretical elements, and predominant lines of argument. A reading of the argumentative strategies detected the existence of a critical view of the modus operandi in the public/private relationship based on Social Medicine and the theoretical tenets of the Brazilian Health Reform Movement. The study also identified contributions based on neoliberal business approaches that focus strictly on economic issues to discuss private health insurance. Understanding the public/private link in healthcare obviously requires the development of a solid empirical base, analyzed with adequate theoretical assumptions due to the inherent degree of complexity in the public/private healthcare interface.

Performance management of the public healthcare services in Ireland: a review.

Science.gov (United States)

Mesabbah, Mohammed; Arisha, Amr

2016-01-01

Performance Management (PM) processes have become a potent part of strategic and service quality decisions in healthcare organisations. In 2005, the management of public healthcare in Ireland was amalgamated into a single integrated management body, named the Health Service Executive (HSE). Since then, the HSE has come up with a range of strategies for healthcare developments and reforms, and has developed a PM system as part of its strategic planning. The purpose of this paper is to review the application of PM in the Irish Healthcare system, with a particular focus on Irish Hospitals and Emergency Services. An extensive review of relevant HSE's publications from 2005 to 2013 is conducted. Studies of the relevant literature related to the application of PM and of international best practices in healthcare performance systems are also presented. PM and performance measurement systems used by the HSE include many performance reports designed to monitor performance trends and strategic goals. Issues in the current PM system include inconsistency of measures and performance reporting, unclear strategy alignment, and deficiencies in reporting (e.g. feedback and corrective actions). Furthermore, PM processes have not been linked adequately into Irish public hospitals' management systems. The HSE delivers several services such as mental health, social inclusion, etc. This study focuses on the HSE's PM framework, with a particular interest in acute hospitals and emergency services. This is the first comprehensive review of Irish healthcare PM since the introduction of the HSE. A critical analysis of the HSE reports identifies the shortcomings in its current PM system.

Nurses' perceptions of mental healthcare in primary-care settings in Kenya.

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Mendenhall, Emily; Isaiah, Gitonga; Nelson, Bernadette; Musau, Abednego; Koon, Adam D; Smith, Lahra; Mutiso, Victoria; Ndetei, David

2018-04-01

Kenya maintains an extraordinary treatment gap for mental health services because the need for and availability of mental health services are extraordinarily misaligned. One way to narrow the treatment gap is task-sharing, where specialists rationally distribute tasks across the health system, with many responsibilities falling upon frontline health workers, including nurses. Yet, little is known about how nurses perceive task-sharing mental health services. This article investigates nurses' perceptions of mental healthcare delivery within primary-care settings in Kenya. We conducted a cross-sectional study of 60 nurses from a public urban (n = 20), private urban (n = 20), and public rural (n = 20) hospitals. Nurses participated in a one-hour interview about their perceptions of mental healthcare delivery. Nurses viewed mental health services as a priority and believed integrating it into a basic package of primary care would protect it from competing health priorities, financial barriers, stigma, and social problems. Many nurses believed that integrating mental healthcare into primary care was acceptable and feasible, but low levels of knowledge of healthcare providers, especially in rural areas, and few specialists, would be barriers. These data underscore the need for task-sharing mental health services into existing primary healthcare in Kenya.

Public Service Delivery in Hybrid Organisations : public management reform and horizontalisation as main challenges for public leaders

NARCIS (Netherlands)

Kuitert, L.; Volker, L.

2016-01-01

The public sector has been subject to some major movements the last 15 years. In public service delivery a trend called socialisation, leading to the displacement between public and private, is most crucial. A withdrawing government and privatization led to increased collaboration between public and

Improving the delivery of care and reducing healthcare costs with the digitization of information.

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Noffsinger, R; Chin, S

2000-01-01

In the coming years, the digitization of information and the Internet will be extremely powerful in reducing healthcare costs while assisting providers in the delivery of care. One example of healthcare inefficiency that can be managed through information digitization is the process of prescription writing. Due to the handwritten and verbal communication surrounding prescription writing, as well as the multiple tiers of authorizations, the prescription drug process causes extensive financial waste as well as medical errors, lost time, and even fatal accidents. Electronic prescription management systems are being designed to address these inefficiencies. By utilizing new electronic prescription systems, physicians not only prescribe more accurately, but also improve formulary compliance thereby reducing pharmacy utilization. These systems expand patient care by presenting proactive alternatives at the point of prescription while reducing costs and providing additional benefits for consumers and healthcare providers.

Patient Populations, Clinical Associations, and System Efficiency in Healthcare Delivery System

Science.gov (United States)

Liu, Yazhuo

The efforts to improve health care delivery usually involve studies and analysis of patient populations and healthcare systems. In this dissertation, I present the research conducted in the following areas: identifying patient groups, improving treatments for specific conditions by using statistical as well as data mining techniques, and developing new operation research models to increase system efficiency from the health institutes' perspective. The results provide better understanding of high risk patient groups, more accuracy in detecting disease' correlations and practical scheduling tools that consider uncertain operation durations and real-life constraints.

Rethinking the delivery of public services to citizens

National Research Council Canada - National Science Library

Seidle, F. Leslie

1995-01-01

... Sector Reform and Service Delivery in the Antipodes New Zealand: Transforming the State Australia: a Concerted Program of Management Reform Conclusion Notes 75 Chapter Four The Canadian Federal Government and Service Delivery Issues Perceptions of Service from the Federal Government The Mulroney Government and Public Service 2000 Special Operati...

Knowledge and attitudes of doctors towards e-health use in healthcare delivery in government and private hospitals in Northern Uganda: a cross-sectional study.

Science.gov (United States)

Olok, Geoffrey Tabo; Yagos, Walter Onen; Ovuga, Emilio

2015-11-04

E-health is an essential information sharing tool in healthcare management and delivery worldwide. However, utilization of e-health may only be possible if healthcare professionals have positive attitudes towards e-health. This study aimed to determine the relationships between healthcare professionals' attitudes towards e-health, level of ICT skills and e-Health use in healthcare delivery in government and private hospitals in northern Uganda. Cross-sectional survey design was used. Sixty-eight medical doctors in three government hospitals and four private hospitals in Northern Uganda participated in the study. A pretested self-administered questionnaire was used to collect the required data. Data was analysed using SPSS software Version 19. Out of the 68 respondents, 39 (57.4 %) reported access to computer and 29 (48.5 %) accessed Internet in the workplace. Majority of healthcare professionals had positive attitudes towards e-health attributes (mean 3.5). The level of skills was moderate (mean 3.66), and was the most important and significant predictor of ICT use among healthcare professionals (r = .522, p < .001); however, attitudes towards e-health attributes did not contribute significantly in predicting e-health use. The findings suggest need for hospitals managements to strengthen e-health services in healthcare delivery in Northern Uganda.

Transforming Healthcare Delivery: Integrating Dynamic Simulation Modelling and Big Data in Health Economics and Outcomes Research

NARCIS (Netherlands)

Marshall, Deborah A.; Burgos-Liz, Lina; Pasupathy, Kalyan S.; Padula, William V.; IJzerman, Maarten Joost; Wong, Peter K.; Higashi, Mitchell K.; Engbers, Jordan; Wiebe, Samuel; Crown, William; Osgood, Nathaniel D.

2016-01-01

In the era of the Information Age and personalized medicine, healthcare delivery systems need to be efficient and patient-centred. The health system must be responsive to individual patient choices and preferences about their care, while considering the system consequences. While dynamic simulation

Determinants of Healthcare Utilisation and Out-of-Pocket Payments in the Context of Free Public Primary Healthcare in Zambia

Directory of Open Access Journals (Sweden)

Felix Masiye

2016-12-01

Full Text Available Background Access to appropriate and affordable healthcare is needed to achieve better health outcomes in Africa. However, access to healthcare remains low, especially among the poor. In Zambia, poor access exists despite the policy by the government to remove user fees in all primary healthcare facilities in the public sector. The paper has two main objectives: (i to examine the factors associated with healthcare choices among sick people, and (ii to assess the determinants of the magnitude of out-of-pocket (OOP payments related to a visit to a health provider. Methods This paper employs a multilevel multinomial logistic regression to model the determinants of an individual’s choice of healthcare options following an illness. Further, the study analyses the drivers of the magnitude of OOP expenditure related to a visit to a health provider using a two-part generalised linear model. The analysis is based on a nationally representative healthcare utilisation and expenditure survey that was conducted in 2014. Results Household per capita consumption expenditure is significantly associated with increased odds of seeking formal care (odds ratio [OR] = 1.12, P = .000. Living in a household in which the head has a higher level of education is associated with increased odds of seeking formal healthcare (OR = 1.54, P = .000 and (OR = 1.55, P = .01, for secondary and tertiary education, respectively. Rural residence is associated with reduced odds of seeking formal care (OR = 0.706, P = .002. The magnitude of OOP expenditure during a visit is significantly dependent on household economic wellbeing, distance from a health facility, among other factors. A 10% increase in per capita consumption expenditure was associated with a 0.2% increase in OOP health expenditure while every kilometre travelled was associated with a K0.51 increase in OOP health expenditure. Conclusion Despite the removal of user fees on public primary healthcare in Zambia, access to

The Integration of Two Healthcare Systems: A Common Healthcare Problem.

Science.gov (United States)

Cassatly, Hannah; Cassatly, Michael

2015-01-01

The change in reimbursement mandated by the Affordable Care Act is causing a rapid consolidation of the marketplace as well as the delivery of clinical care in a team-based model. This case report examines the successful joining of two clinical teams concurrent with the merger of two healthcare organizations and discusses some of the difficulties encountered. A subsequent discussion focuses on the resolution: the need for physicians to embrace the team concept of healthcare delivery and for healthcare systems to facilitate this transition with team and leadership coaching.

Comparing patient and healthcare worker experiences during a dengue outbreak in Singapore: understanding the patient journey and the introduction of a point-of-care test (POCT) toward better care delivery.

Science.gov (United States)

Tan, Qinghui; Hildon, Zoe J-L; Singh, Shweta; Jing, Jin; Thein, Tun Linn; Coker, Richard; Vrijhoef, Hubertus J M; Leo, Yee Sin

2017-07-19

In the aftermath of an upsurge in the number of dengue cases in 2013 and 2014, the SD BIOLINE Dengue Duo rapid diagnostic Point-of-Care Test (POCT) kit was introduced in Tan Tock Seng Hospital, Singapore in June 2013. It is known that the success of POCT usage is contingent on its implementation within the health system. We evaluated health services delivery and the Dengue Duo rapid diagnostic test kit application in Singapore from healthcare workers' perspectives and patient experiences of dengue at surge times. Focus group discussions were conducted with dengue patients, from before and after the POCT implementation period. In-depth interviews with semi-structured components with healthcare workers were carried out. A patient centred process mapping technique was used for evaluation, which mapped the patient's journey and was mirrored from the healthcare worker's perspective. Patients and healthcare workers confirmed a wide range of symptoms in adults, making it challenging to determine diagnosis. There were multiple routes to help seeking, and no 'typical patient journey', with patients either presenting directly to the hospital emergency department, or being referred there by a primary care provider. Patients groups diagnosed before and after POCT implementation expressed some differences between speed of diagnoses and attitudes of doctors, yet shared negative feelings about waiting times and a lack of communication and poor information delivery. However, the POCT did not in its current implementation do much to help waiting times. Healthcare workers expressed that public perceptions of dengue in recent years was a major factor in changing patient management, and that the POCT kit was helpful in improving the speed and accuracy of diagnoses. Health service delivery for dengue patients in Singapore was overall perceived to be of an acceptable clinical standard, which was enhanced by the introduction of the POCT. However, improvements can be focused on Adapting

Challenges in healthcare delivery in an economic downturn, in the Republic of Ireland.

Science.gov (United States)

Carney, Marie

2010-07-01

The purpose of the present study was to discuss some of effects of the downturn in the Irish economy and to demonstrate that in the face of economic difficulties innovation in health care is still occurring. Staff that are managing and delivering healthcare need to know the challenges facing them and have an awareness of the importance of maintaining interest in innovative practice in turbulent times. Information obtained from several sources including government papers, the nursing regulatory board and quality authority documents and current best practice articles. Information was evaluated based on the study's aim. Issues emerging were that current challenges facing Irish health care delivery relate mainly to economic, clinical management, education and information technology factors and further reductions in the cost base of health care delivery remains focused on value for money. In the face of the economic downturn Ireland is achieving health targets and is now sitting in 13th place on the European health index, down from number 28 in 2008. This improvement in position has resulted from several new innovative work practices. As a result of cost reduction measures in place nurse managers will face greater challenges than ever before in meeting the objectives of the healthcare transformation programme.

Changing public service delivery: Learning in co-creation

NARCIS (Netherlands)

W.H. Voorberg (William); V.J.J.M. Bekkers (Victor); Timeus, K. (Krista); Tonurist, P. (Piret); L.G. Tummers (Lars)

2017-01-01

textabstractCo-creation – where citizens and public organizations work together to deal with societal issues – is increasingly considered as a fertile solution for various public service delivery problems. During cocreation, citizens are not mere consumers, but are actively engaged in building

Changing public service delivery: learning in co-creation

NARCIS (Netherlands)

Voorberg, William; Bekkers, Victor; Timeus, Krista; Tonurist, Piret; Tummers, L.G.

2017-01-01

Co-creation – where citizens and public organizations work together to deal with societal issues – is increasingly considered as a fertile solution for various public service delivery problems. During co-creation, citizens are not mere consumers, but are actively engaged in building resilient

Medical capability team: the clinical microsystem for combat healthcare delivery in counterinsurgency operations.

Science.gov (United States)

Clark, Susz; Van Steenvort, Jon K

2008-01-01

Today's operational environment in the support of counterinsurgency operations requires greater tactical and operational flexibility and diverse medical capabilities. The skills and organizations required for full spectrum medical operations are different from those of the past. Combat healthcare demands agility and the capacity for rapid change in clinical systems and processes to better support the counterinsurgency environment. This article proposes the Army Medical Department (AMEDD) develop and implement the medical capability team (MCT) for combat healthcare delivery. It discusses using the concept of the brigade combat team to develop medical capability teams as the unit of effectiveness to transform frontline care; provides a theoretical overview of the MCT as a "clinical microsystem"; discusses MCT leadership, training, and organizational support, and the deployment and employment of the MCT in a counterinsurgency environment. Additionally, this article proposes that the AMEDD initiate the development of an AMEDD Combat Training Center of Excellence to train and validate the MCTs. The complexity of combat healthcare demands an agile and campaign quality AMEDD with joint expeditionary capability in order to promote the best patient outcomes in a counterinsurgency environment.

Bringing Big Data to the Forefront of Healthcare Delivery: The Experience of Carolinas HealthCare System.

Science.gov (United States)

Dulin, Michael F; Lovin, Carol A; Wright, Jean A

2017-01-01

The use of big data to transform care delivery is rapidly becoming a reality. To deliver on the promise of value-based care, providers must know the key drivers of wellness at the patient and community levels, as well as understand resource constraints and opportunities to improve efficiency in the health-care system itself. Data are the linchpin. By gathering the right data and finding innovative ways to glean knowledge, we can improve clinical care, advance the health of our communities, improve the lives of our patients, and operate more efficiently. At Carolinas HealthCare System-one of the nation's largest health-care systems, with nearly 12 million patient encounters annually at more than 900 care locations-we have made substantial investments to establish a centralized data and analytics infrastructure that is transforming the way we deliver care across the continuum. Although the impetus and vision for our program have evolved over the past decade, our efforts coalesced into a strategic, centralized initiative with the launch of the Dickson Advanced Analytics (DA) group in 2012. DA has yielded significant gains in our ability to use data, not only for reporting purposes and understanding our business but also for predicting outcomes and informing action.While these efforts have been successful, the path has not been easy. Effectively harnessing big data requires navigating myriad technological, cultural, operational, and other hurdles. Building a program that is feasible, effective, and sustainable takes concerted effort and a rigorous process of continuous self-evaluation and strategic adaptation.

Bringing Big Data to the Forefront of Healthcare Delivery: The Experience of Carolinas HealthCare System.

Science.gov (United States)

Dulin, Michael F; Lovin, Carol A; Wright, Jean A

2016-01-01

The use of big data to transform care delivery is rapidly becoming a reality. To deliver on the promise of value-based care, providers must know the key drivers of wellness at the patient and community levels, as well as understand resource constraints and opportunities to improve efficiency in the healthcare system itself. Data are the linchpin. By gathering the right data and finding innovative ways to glean knowledge, we can improve clinical care, advance the health of our communities, improve the lives of our patients, and operate more efficiently. At Carolinas HealthCare System-one of the nation's largest healthcare systems, with nearly 12 million patient encounters annually at more than 900 care locations-we have made substantial investments to establish a centralized data and analytics infrastructure that is transforming the way we deliver care across the continuum. Although the impetus and vision for our program have evolved over the past decade, our efforts coalesced into a strategic, centralized initiative with the launch of the Dickson Advanced Analytics (DA2) group in 2012. DA2 has yielded significant gains in our ability to use data, not only for reporting purposes and understanding our business but also for predicting outcomes and informing action.While these efforts have been successful, the path has not been easy. Effectively harnessing big data requires navigating myriad technological, cultural, operational, and other hurdles. Building a program that is feasible, effective, and sustainable takes concerted effort and a rigorous process of continuous self-evaluation and strategic adaptation.

The role of short messaging service in supporting the delivery of healthcare: An umbrella systematic review.

Science.gov (United States)

Househ, Mowafa

2016-06-01

Short messaging service (SMS) messages may present a convenient and cost-effective method to support healthcare interventions. This work assesses the effects of short messaging service on various healthcare interventions found in systematic reviews. The search strategy was based on two key concepts: short messaging service and healthcare delivery. The initial search was conducted in December 2012 and was updated in June 2013. Of the 550 identified references, 13 systematic reviews met the inclusion criteria, of which 8 were published in peer-reviewed journals and 5 were retrieved from the Cochrane library. Data analysis shows that low to moderate research evidence exists on the benefits of short messaging service interventions for appointment reminders, promoting health in developing countries and preventive healthcare. In many interventions, however, there were a few studies that were of high quality, and most of the studies were rated from low to moderate quality or had no rating at all. Healthcare organizations, policy makers, or clinicians using short messaging service messages to support healthcare interventions should (1) implement interventions that have been found to work in healthcare settings, (2) continue evaluating short messaging service interventions that have not been adequately assessed, and (3) improve collaboration between various healthcare entities to develop studies targeted at specific populations to evaluate the long-term impact of short messaging service on healthcare outcomes. © The Author(s) 2014.

A method for defining value in healthcare using cancer care as a model.

Science.gov (United States)

Feeley, Thomas W; Fly, Helen Shafer; Albright, Heidi; Walters, Ronald; Burke, Thomas W

2010-01-01

Value-based healthcare delivery is being discussed in a variety of healthcare forums. This concept is of great importance in the reform of the US healthcare delivery system. Defining and applying the principles of value-based competition in healthcare delivery models will permit future evaluation of various delivery applications. However, there are relatively few examples of how to apply these principles to an existing care delivery system. In this article, we describe an approach for assessing the value created when treating cancer patients in a multidisciplinary care setting within a comprehensive cancer center. We describe the analysis of a multidisciplinary care center that treats head and neck cancers, and we attempt to examine how this center integrates with Porter and Teisberg's (2006) concept of value-based competition based on the results analysis. Using the relationship between outcomes and costs as the definition of value, we developed a methodology to analyze proposed outcomes for a population of patients treated using a multidisciplinary approach, and we matched those outcomes to the costs of the care provided. We present this work as a model for defining value for a subset of patients undergoing active treatment. The method can be applied not only to head and neck treatments, but to other modalities as well. Public reporting of this type of data for a variety of conditions can lead to improved competition in the healthcare marketplace and, as a result, improve outcomes and decrease health expenditures.

Transforming trauma healthcare delivery in rural areas by use of an integrated call center.

Science.gov (United States)

Agrawal, Deepak

2012-01-01

There is poor penetration of trauma healthcare delivery in rural areas. On the other hand, mobile penetration in India is now averaging 80% with most families having access to mobile phone. The aim of this study was to assess the implementation and socioeconomic impact of a call center in providing healthcare delivery for patients with head and spinal injuries. This was a prospective observational study carried out over a 6-month period at a level I trauma Center in New Delhi, India. A nine-seater call center was outsourced to a private company and the hospital's electronic medical records were integrated with the call-center operations. The call center was given responsibility of maintaining appointments and scheduling clinics for the whole hospital as well as ensuring follow-up visits. Trained call-center staff handled simple patient queries and referred the rest via email to concerned doctors. A telephonic survey was done prior to the start of call-center operations and after 3 months to assess for user satisfaction. The initial cost of outsourcing the call center was Rs 1.6 lakhs (US$ 4000), with a recurring cost of Rs 80,000 (US$ 2000) per month. A total of 484 patients were admitted in the department of Neurosurgery during the study period. Of these, 63% (n=305) were from rural areas. Patients' overall experience for clinic visits improved markedly following implementation of call center. Patient satisfaction for follow-up visits increased from a mean of 32-96%. Ninety-five percent patients reported a significant decrease in waiting time in clinics 80.4% reporting improved doctor-patient interaction. A total of 52 visits could be postponed/cancelled for patients living in far flung areas resulting in major socioeconomic benefits to these families. As shown by our case study, call centers have the potential to revolutionize delivery of trauma healthcare to rural areas in an extremely cost-effective manner.

Transforming trauma healthcare delivery in rural areas by use of an integrated call center

Directory of Open Access Journals (Sweden)

Deepak Agrawal

2012-01-01

Full Text Available Introduction: There is poor penetration of trauma healthcare delivery in rural areas. On the other hand, mobile penetration in India is now averaging 80% with most families having access to mobile phone. Aims and Objectives: The aim of this study was to assess the implementation and socioeconomic impact of a call center in providing healthcare delivery for patients with head and spinal injuries. Materials and Methods: This was a prospective observational study carried out over a 6-month period at a level I trauma Center in New Delhi, India. A nine-seater call center was outsourced to a private company and the hospital′s electronic medical records were integrated with the call-center operations. The call center was given responsibility of maintaining appointments and scheduling clinics for the whole hospital as well as ensuring follow-up visits. Trained call-center staff handled simple patient queries and referred the rest via email to concerned doctors. A telephonic survey was done prior to the start of call-center operations and after 3 months to assess for user satisfaction. Results: The initial cost of outsourcing the call center was Rs 1.6 lakhs (US$ 4000, with a recurring cost of Rs 80,000 (US$ 2000 per month. A total of 484 patients were admitted in the department of Neurosurgery during the study period. Of these, 63% (n=305 were from rural areas. Patients′ overall experience for clinic visits improved markedly following implementation of call center. Patient satisfaction for follow-up visits increased from a mean of 32-96%. Ninety-five percent patients reported a significant decrease in waiting time in clinics 80.4% reporting improved doctor-patient interaction. A total of 52 visits could be postponed/cancelled for patients living in far flung areas resulting in major socioeconomic benefits to these families. Conclusions: As shown by our case study, call centers have the potential to revolutionize delivery of trauma healthcare to

Transforming trauma healthcare delivery in rural areas by use of an integrated call center

Science.gov (United States)

Agrawal, Deepak

2012-01-01

Introduction: There is poor penetration of trauma healthcare delivery in rural areas. On the other hand, mobile penetration in India is now averaging 80% with most families having access to mobile phone. Aims and Objectives: The aim of this study was to assess the implementation and socioeconomic impact of a call center in providing healthcare delivery for patients with head and spinal injuries. Materials and Methods: This was a prospective observational study carried out over a 6-month period at a level I trauma Center in New Delhi, India. A nine-seater call center was outsourced to a private company and the hospital's electronic medical records were integrated with the call-center operations. The call center was given responsibility of maintaining appointments and scheduling clinics for the whole hospital as well as ensuring follow-up visits. Trained call-center staff handled simple patient queries and referred the rest via email to concerned doctors. A telephonic survey was done prior to the start of call-center operations and after 3 months to assess for user satisfaction. Results: The initial cost of outsourcing the call center was Rs 1.6 lakhs (US$ 4000), with a recurring cost of Rs 80,000 (US$ 2000) per month. A total of 484 patients were admitted in the department of Neurosurgery during the study period. Of these, 63% (n=305) were from rural areas. Patients’ overall experience for clinic visits improved markedly following implementation of call center. Patient satisfaction for follow-up visits increased from a mean of 32-96%. Ninety-five percent patients reported a significant decrease in waiting time in clinics 80.4% reporting improved doctor-patient interaction. A total of 52 visits could be postponed/cancelled for patients living in far flung areas resulting in major socioeconomic benefits to these families. Conclusions: As shown by our case study, call centers have the potential to revolutionize delivery of trauma healthcare to rural areas in an

Operations and quality management for public service delivery improvement.

Directory of Open Access Journals (Sweden)

Paulin Mbecke

2014-10-01

Full Text Available Public service management reforms have not yet contributed to poverty eradication and generally socio-economic development of many African countries. The reforms suggested and implemented to date still prove to be weak in addressing the many challenges faced by the public service in delivering goods and services to the population. The failure of the current public service management calls for a consideration of business-driven approaches and practices that facilitate effectiveness, efficiency, competitiveness and flexibility in goods and services provision. The critical social theory methodology and the literature review technique described and raised awareness on service delivery chaos in South Africa. A public service reform that focuses on operations and quality management is one of the ways of improving and sustaining service delivery in South Africa. Operations management is an essential tool for the planning, execution, control, monitoring and evaluation of production processes. Quality management, in the other hand, is essential to ensure best quality of goods and services produced by the public service within acceptable time and available resources to meet or exceed people’s expectations. The operations and quality management framework proposed in this article is a potential alternative to the current service delivery crisis in South Africa.

Value-Based Health Care Delivery, Preventive Medicine and the Medicalization of Public Health

OpenAIRE

Vilhelmsson, Andreas

2017-01-01

The?real paradigm shift for healthcare is often stated to include a transition from accentuating health care production and instead emphasize patient value by moving to a??value-based health care delivery?. In this transition, personalized medicine is sometimes referred to as almost a panacea in solving the current and future health challenges.?In theory, the progress of precision medicine sounds uncontroversial and most welcomed with its promise of?a better healthcare for all, with real bene...

Alternative Public Service Delivery Models in Health, Water and ...

International Development Research Centre (IDRC) Digital Library (Canada)

The literature on public service delivery alternatives has to date been highly localized, sector specific and lacking in methodological consistency. This project seeks to analyze health, water and electricity delivery models in Africa, Asia and Latin America in order to identify and document successful alternatives to ...

Commercial versus in-situ usability testing of healthcare information systems: towards "public" usability testing in healthcare organizations.

Science.gov (United States)

Kushniruk, Andre W; Borycki, Elizabeth M; Kannry, Joseph

2013-01-01

The need for improved usability in healthcare IT has been widely recognized. In addition, methods from usability engineering, including usability testing and usability inspection have received greater attention. Many vendors of healthcare software are now employing usability testing methods in the design and development of their products. However, despite this, the usability of healthcare IT is still considered to be problematic and many healthcare organizations that have purchased systems that have been tested at vendor testing sites are still reporting a range of usability and safety issues. In this paper we explore the distinction between commercial usability testing (conducted at centralized vendor usability laboratories and limited beta test sites) and usability testing that is carried out locally within healthcare organizations that have purchased vendor systems and products (i.e. public "in-situ" usability testing). In this paper it will be argued that both types of testing (i.e. commercial vendor-based testing) and in-situ testing are needed to ensure system usability and safety.

Healthcare public key infrastructure (HPKI) and non-profit organization (NPO): essentials for healthcare data exchange.

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Takeda, Hiroshi; Matsumura, Yasushi; Nakagawa, Katsuhiko; Teratani, Tadamasa; Qiyan, Zhang; Kusuoka, Hideo; Matsuoka, Masami

2004-01-01

To share healthcare information and to promote cooperation among healthcare providers and customers (patients) under computerized network environment, a non-profit organization (NPO), named as OCHIS, was established at Osaka, Japan in 2003. Since security and confidentiality issues on the Internet have been major concerns in the OCHIS, the system has been based on healthcare public key infrastructure (HPKI), and found that there remained problems to be solved technically and operationally. An experimental study was conducted to elucidate the central and the local function in terms of a registration authority and a time stamp authority by contracting with the Ministry of Economics and Trading Industries in 2003. This paper describes the experimental design with NPO and the results of the study concerning message security and HPKI. The developed system has been operated practically in Osaka urban area.

Patient assessment within the context of healthcare delivery packages

DEFF Research Database (Denmark)

Rossen, Camilla Blach; Buus, Niels; Stenager, Egon

2016-01-01

. RESULTS: We constructed five interrelated categories: 1. "Standardized assessing", 2. "Flexibility", which has two sub-categories, 2.1. "Diagnostic options" and 2.2. "Time and organization", and, finally, 3. "Resisting the frames". The process of assessment required all participants to perform...... is a tool for creating coordination, continuity and efficient pathways; each step is pre-booked, and the package has a well-defined content within a predefined category of diseases. The aim of this study was to investigate how assessment processes took place within the context of healthcare delivery...... the predefined work in the specified way at the specified time. Multidisciplinary teamwork was essential for the success of the process. The local organization of the packages influenced the assessment process, most notably the pre-defined scope of relevant diseases targeted by the package. The inflexible frames...

Workforce diversity among public healthcare workers in Nigeria: Implications on job satisfaction and organisational commitment

Directory of Open Access Journals (Sweden)

Ayodotun Stephen Ibidunni

2018-06-01

Full Text Available The aim of this research was to present a data article that identify the relationship between workforce diversity, job satisfaction and employee commitment among public healthcare workers in Nigeria. Copies of structured questionnaire were administered to 133 public healthcare workers from the Lagos state ministry of health in Nigeria. Using descriptive and structural equation modelling statistical analysis, the data revealed the relationship between workforce diversity and job satisfaction, workforce diversity and organisational commitment, and the role of job satisfaction on organisational commitment was also established. Keywords: Workforce diversity, Job satisfaction, Employee commitment, Public healthcare, Diversity management

PARTICIPATORY GOVERNANCE IN THE PUBLIC HEALTHCARE SYSTEMS OF THE SCANDINAVIAN AND BALTIC COUNTRIES

Directory of Open Access Journals (Sweden)

Stefanescu Aurelia

2011-12-01

Full Text Available The diminished trust of citizens in the public sector, the increased complexity of policy issues and the reforms in accordance with the new public management principles generate the need of focusing more extensively on participatory governance. Participatory governance can be defined as the genuine engagement of citizens and other organizations in the formulation of policies and strategies, in the decision-making process from the public sector and in the implementation of the decisions. The present paper's objectives are to define the concept of participatory governance, to argue in favor of implementing it in the public sector and to find to what extent public healthcare institutions from Scandinavian and Baltic countries publish information on participatory governance and how they perceive community engagement. The research findings are that the information on participatory governance disclosed on the websites of relevant institutions from within the Scandinavian and Baltic public healthcare systems is scarce. The countries with the greatest concern for community engagement are Denmark and Sweden. It is argued that there should be a shift in focus within the public sector in general and within the healthcare system in particular, so that citizens are genuinely involved in the relevant processes and their satisfaction is indeed at an adequate level.

Do senior management cultures affect performance? Evidence from Italian public healthcare organizations.

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Prenestini, Anna; Lega, Federico

2013-01-01

Healthcare organizations are often characterized by diffuse power, ambiguous goals, and a plurality of actors. In this complex and pluralistic context, senior healthcare managers are expected to provide strategic direction and lead their organizations toward their goals and performance targets. The present work explores the relationship between senior management team culture and performance by investigating Italian public healthcare organizations in the Tuscany region. Our assessment of senior management culture was accomplished through the use of an established framework and a corresponding tool, the competing values framework, which supports the idea that specific aspects of performance are related to a dominant management culture. Organizational performance was assessed using a wide range of measures collected by a multidimensional performance evaluation system, which was developed in Tuscany to measure the performance of its 12 local health authorities (LHAs) and four teaching hospitals (THs). Usable responses were received from 80 senior managers of 11 different healthcare organizations (two THs and nine LHAs). Our findings show that Tuscan healthcare organizations are characterized by various dominant cultures: developmental, clan, rational, and hierarchical. These variations in dominant culture were associated with performance measures. The implications for management theory, professional practice, and public policy are discussed.

Harnessing the Potential to Quantify Public Preferences for Healthcare Priorities through Citizens’ Juries

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Jennifer A. Whitty

2014-07-01

Full Text Available Despite progress towards greater public engagement, questions about the optimal approach to access public preferences remain unanswered. We review two increasingly popular methods for engaging the public in healthcare priority-setting and determining their preferences; the Citizens’ Jury (CJ and Discrete Choice Experiment (DCE. We discuss the theoretical framework from which each method is derived, its application in healthcare, and critique the information it can provide for decision-makers. We conclude that combining deliberation of an informed public via CJs and quantification of preferences using DCE methods, whilst it remains to be tested as an approach to engaging the public in priority-setting, could potentially achieve much richer information than the application of either method in isolation.

New challenges of public health: bringing the future of personalised healthcare into focus.

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Ricciardi, Walter; Boccia, Stefania

2017-10-01

The greater personalization of healthcare represents a driver of innovation for research, and for the healthcare systems and industries as a whole. Still policy-makers, healthcare professionals, citizens and private companies need to take some steps to realize the potential for such a radical shift. In this paper, we illustrate the challenges, the benefits and consequences that might accompany the implementation of personalized healthcare, and the steps that policy-makers and practitioners would need to take to realise its potential. Six main prerequisites for radical change in healthcare are presented, that include achieving better genetic literacy for professionals and for the public; engaging citizen in the discourse; improved governance, consent and trust in healthcare; feeding and harnessing the data-knowledge cycle for better health; adopting and adapting the Health Technology Assessment framework for the evaluation of the new technologies; and retaining humanity and community in health and care. Some of these concepts originate from a discussion on the future of health and healthcare, looking at least 15-20 years into the future, that we had at the end of 2016 at Ickworth with an international group of experts, under the aegis of the PHG Foundation. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Evaluation of chloroquine as a potent anti-malarial drug: issues of public health policy and healthcare delivery in post-war Liberia.

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Massaquoi, Moses B F; Kennedy, Stephen B

2003-02-01

Chloroquine-resistant plasmodium falciparum malaria is a serious public health threat that is spreading rapidly across Sub-Saharan Africa. It affects over three quarters (80%) of malarial endemic countries. Of the estimated 300-500 million cases of malaria reported annually, the vast majority of malarial-related morbidities occur among young children in Africa, especially those concentrated in the remote rural areas with inadequate access to appropriate health care services. In Liberia, in vivo studies conducted between 1993 and 2000 observed varying degrees of plasmodium falciparum malaria infections that were resistant to chloroquine, including sulfadiazine-pyrimethamine. As the country emerges from a prolonged civil war, the health care delivery system may not be adequately prepared to implement an effective nation-wide malarial control strategy. As a result, the management of uncomplicated malaria in Liberia poses a significant public health challenge for the government-financed health care delivery system. Therefore, based on extensive literature review, we report the failure of chloroquine as an effective first-line drug for the treatment of uncomplicated plasmodium falciparum malaria in Liberia and recommend that national health efforts be directed at identifying alternative drug(s) to replace it.

Interactions: Trade Policy and Healthcare Reform After Chaoulli v. Quebec: Is it time for Canada to acknowledge the fragile boundary between health and trade policies and strengthen the separation between private and public health insurance?

OpenAIRE

Crawford, Mark

2006-01-01

The insulation of Canada’s healthcare system from trade treaty obligations is crucial to the legitimacy of Canada’s trade policy. Legal analysis has suggested, however, that competitive and for-profit delivery of the kind contemplated by the Kirby Report and some provinces may make healthcare more vulnerable to challenges under NAFTA and GATS. The Government of Canada has tried to counter this interpretation by stressing the importance of public financing as the principal criterion for exempt...

US Health Care Reform and Transplantation, Part II: impact on the public sector and novel health care delivery systems.

Science.gov (United States)

Axelrod, D A; Millman, D; Abecassis, M M

2010-10-01

The Patient Protection and Affordable Care Act passed in 2010 will result in dramatic expansion of publically funded health insurance coverage for low-income individuals. It is estimated that of the 32 million newly insured, 16 million will obtain coverage through expansion of the Medicaid Program, and the remaining 16 million will purchase coverage through their employer or newly legislated insurance exchanges. While the Act contains numerous provisions to improve access to private insurance as discussed in Part I of this analysis, public sector coverage will significantly be affected. The cost of health care reform will be borne disproportionately by Medicare, which faces nearly $500 billion in cuts to be identified by a new independent board. Transplant centers should be concerned about the impact of the reform on the financial aspects of transplantation. In addition, this legislation also utilizes the Medicare Program to drive reform of the health care delivery system, by encouraging the development of integrated Accountable Care Organizations, experimentation with new 'models' of healthcare delivery, and expanded support for Comparative Effectiveness Research. Transplant providers, including transplant centers and physicians/surgeons need to lead this movement, drawing on our experience providing comprehensive multidisciplinary care under global budgets with publically reported outcomes.

The public healthcare sector and governance in South Africa

OpenAIRE

Melody Brauns

2015-01-01

This article reviews literature on governance in order to facilitate an analysis of the governance of the South African public healthcare sector. Some of the key theoretical perspectives have been presented on how best to organise the state and its bureaucracy. Theorists have long interrogated in what way public institutions foster or impede economic growth. Evans and Rauch point out for example, that the role of bureaucratic authority structures in facilitating economic growth has been a soc...

Knowledge, attitudes, and practices regarding dengue infection among public sector healthcare providers in Machala, Ecuador

OpenAIRE

Handel, Andrew S.; Ayala, Efra?n Beltr?n; Borbor-Cordova, Mercy J.; Fessler, Abigail G.; Finkelstein, Julia L.; Espinoza, Roberto Xavier Robalino; Ryan, Sadie J.; Stewart-Ibarra, Anna M.

2016-01-01

Background Dengue fever is a rapidly emerging infection throughout the tropics and subtropics with extensive public health burden. Adequate training of healthcare providers is crucial to reducing infection incidence through patient education and collaboration with public health authorities. We examined how public sector healthcare providers in a dengue-endemic region of Ecuador view and manage dengue infections, with a focus on the 2009 World Health Organization (WHO) Dengue Guidelines. Metho...

Toward a Nationwide Mobile-Based Public Healthcare Service System with Wireless Sensor Networks

Directory of Open Access Journals (Sweden)

Chien-wen Shen

2016-01-01

Full Text Available This paper describes the development of a nationwide public healthcare service system with the integration of cloud technology, wireless sensor networks, and mobile technology to provide citizens with convenient and professional healthcare services. The basic framework of the system includes the architectures for the user end of wireless physiological examinations, for the regional healthcare cloud, and for national public healthcare service system. Citizens with chronic conditions or elderly people who are living alone can use the wireless physiological sensing devices to keep track of their health conditions and get warning if the system detects abnormal signals. Through mobile devices, citizens are able to get real-time health advice, prompt warning, health information, feedback, personalized support, and intervention ubiquitously. With the long-term tracking data for physiological sensing, reliable prediction models for epidemic diseases and chronic diseases can be developed for the government to respond to and control diseases immediately. Besides, such a nationwide approach enables government to have a holistic understanding of the public health information in real time, which is helpful to establish effective policies or strategies to prevent epidemic diseases or chronic diseases.

Public Health Risks from Mismanagement of Healthcare Wastes in Shinyanga Municipality Health Facilities, Tanzania

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Kizito Kuchibanda

2015-01-01

Full Text Available The increase of healthcare facilities in Shinyanga municipality has resulted in an increase of healthcare wastes, which poses serious threats to the environment, health workers, and the general public. This research was conducted to investigate management practices of healthcare wastes in Shinyanga municipality with a view of assessing health risks to health workers and the general public. The study, which was carried out in three hospitals, involved the use of questionnaires, in-depth interview, and observation checklist. The results revealed that healthcare wastes are not quantified or segregated in all the three hospitals. Healthcare wastes at the Shinyanga Regional Referral Hospital are disposed of by on-site incineration and burning and some wastes are disposed off-site. At Kolandoto DDH only on-site burning and land disposal are practiced, while at Kambarage UHC healthcare solid wastes are incinerated, disposed of on land disposal, and burned. Waste management workers do not have formal training in waste management techniques and the hospital administrations pay very little attention to appropriate management of healthcare wastes. In light of this, it is evident that management of healthcare solid wastes is not practiced in accordance with the national and WHO’s recommended standards.

Harmony in health sector: a requirement for effective healthcare delivery in Nigeria.

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Osaro, Erhabor; Charles, Adias Teddy

2014-09-01

Harmony is defined as the pleasing combination of elements of a system to form an all-inclusive, all involving and more productive team. The aim of this present review was to investigate the factors militating against harmony among healthcare professional in the Nigerian healthcare delivery system. This review was carried out by searching through literature on the topic that bother on harmony among health professions in the health sector. Literature search and reports from previous studies indicates that harmony among health workers is pivotal to improving the health indices. However, available evidence suggests that unlike in the developed world, health care professionals do not collaborate well together in Nigeria because of the claim of superiority of a particular health professional over others. This has often resulted in inter-professional conflict which is threatening to tear the health sector apart to the detriment of the patients. The Nigeria health system should be based on team work. Health professionals from a variety of disciplines should work together to deliver the best possible healthcare services to all Nigerians. All members of the team are equally valuable and essential to the smooth running of hospitals. Hospitals should ideally be headed by health administrators or by a qualified member of any of the professions in the health sector. Copyright © 2014 Hainan Medical College. Published by Elsevier B.V. All rights reserved.

Effect of Government-Community Healthcare Co-Financing on ...

African Journals Online (AJOL)

BACKGROUND: Effective maternal and child healthcare delivery requires a proper and adequate funding of the health sector. OBJECTIVE: To determine the effect of government-community healthcare co-financing on maternal and child healthcare services' delivery. METHODS: A descriptive, cross-sectional study with an ...

Reforming primary healthcare: from public policy to organizational change.

Science.gov (United States)

Gilbert, Frédéric; Denis, Jean-Louis; Lamothe, Lise; Beaulieu, Marie-Dominique; D'amour, Danielle; Goudreau, Johanne

2015-01-01

Governments everywhere are implementing reform to improve primary care. However, the existence of a high degree of professional autonomy makes large-scale change difficult to achieve. The purpose of this paper is to elucidate the change dynamics and the involvement of professionals in a primary healthcare reform initiative carried out in the Canadian province of Quebec. An empirical approach was used to investigate change processes from the inception of a public policy to the execution of changes in professional practices. The data were analysed from a multi-level, combined contextualist-processual perspective. Results are based on a longitudinal multiple-case study of five family medicine groups, which was informed by over 100 interviews, questionnaires, and documentary analysis. The results illustrate the multiple processes observed with the introduction of planned large-scale change in primary care services. The analysis of change content revealed that similar post-change states concealed variations between groups in the scale of their respective changes. The analysis also demonstrated more precisely how change evolved through the introduction of "intermediate change" and how cycles of prescribed and emergent mechanisms distinctively drove change process and change content, from the emergence of the public policy to the change in primary care service delivery. This research was conducted among a limited number of early policy adopters. However, given the international interest in turning to the medical profession to improve primary care, the results offer avenues for both policy development and implementation. The findings offer practical insights for those studying and managing large-scale transformations. They provide a better understanding of how deliberate reforms coexist with professional autonomy through an intertwining of change content and processes. This research is one of few studies to examine a primary care reform from emergence to implementation

Web-based Service Portal in Healthcare

Science.gov (United States)

Silhavy, Petr; Silhavy, Radek; Prokopova, Zdenka

Information delivery is one the most important task in healthcare. The growing sector of electronic healthcare has an important impact on the information delivery. There are two basic approaches towards information delivering. The first is web portal and second is touch-screen terminal. The aim of this paper is to investigate the web-based service portal. The most important advantage of web-based portal in the field of healthcare is an independent access for patients. This paper deals with the conditions and frameworks for healthcare portals

The Healthcare Public System – Does Standardization Withhold the Bucket from Leaking?

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Biţoiu Teodora

2017-12-01

Full Text Available The public healthcare system is heavily influenced by the 3C trilemma - cost - coverage - choice. The paper’s argument tackles the fact that should the public decision on improving capacity be leaning towards universal coverage in would result in efficiency losses and, in an attempt to control the costs it would limit patients’ choice. Should priority be given to performance or value? The present paper deals with the compromise between the equity and efficiency, a leaky bucket that becomes more visible in the struggle to build capacity and intervene in the market by setting standards. Setting healthcare standards is a global concern, the 3rd Sustainable Development Goal is a clear proof of that the aim to emphasise and better analyse two of the most influential variables: efficiency and equity. All in all, what we argue is that the current leaky bucket is a trade-off between choice, coverage, and cost. For a complex public service like healthcare, targeting a full coverage and multiple choice would incur huge costs and, cutting costs considerably restricts both the choice and coverage. The cost is influenced by the production capacity use when the activity has large fixed costs.

Control costs, enhance quality, and increase revenue in three top general public hospitals in Beijing, China.

Science.gov (United States)

Zhao, Lue-Ping; Yu, Guo-Pei; Liu, Hui; Ma, Xie-Min; Wang, Jing; Kong, Gui-Lan; Li, Yi; Ma, Wen; Cui, Yong; Xu, Beibei; Yu, Na; Bao, Xiao-Yuan; Guo, Yu; Wang, Fei; Zhang, Jun; Li, Yan; Xie, Xue-Qin; Jiang, Bao-Guo; Ke, Yang

2013-01-01

With market-oriented economic and health-care reform, public hospitals in China have received unprecedented pressures from governmental regulations, public opinions, and financial demands. To adapt the changing environment and keep pace of modernizing healthcare delivery system, public hospitals in China are expanding clinical services and improving delivery efficiency, while controlling costs. Recent experiences are valuable lessons for guiding future healthcare reform. Here we carefully study three teaching hospitals, to exemplify their experiences during this period. We performed a systematic analysis on hospitalization costs, health-care quality and delivery efficiencies from 2006 to 2010 in three teaching hospitals in Beijing, China. The analysis measured temporal changes of inpatient cost per stay (CPS), cost per day (CPD), inpatient mortality rate (IMR), and length of stay (LOS), using a generalized additive model. There were 651,559 hospitalizations during the period analyzed. Averaged CPS was stable over time, while averaged CPD steadily increased by 41.7% (Phospitalizations with higher costs, along with an overall stable CPS, reduced IMR, and shorter LOS, appear to be the major characteristics of these three hospitals at present. These three teaching hospitals have gained some success in controlling costs, improving cares, adopting modern medical technologies, and increasing hospital revenues. Effective hospital governance and physicians' professional capacity plus government regulations and supervisions may have played a role. However, purely market-oriented health-care reform could also misguide future healthcare reform.

Saving for delivery through technology: an inquiry into an electronic commitment savings product for maternal healthcare in Kenya.

Science.gov (United States)

van Bastelaer, Thierry; Woodman, Benjamin; Chatterji, Minki; Long, David

2016-10-01

Many women in low-income countries cannot afford maternal healthcare services. Changamka, a Kenyan company, developed an electronic, stored-value card to help pregnant women save for maternal healthcare at a Nairobi hospital. This paper reports results from a mixed-methods process evaluation of the card's implementation. The study found high levels of uptake and identified several benefits of the program, such as facilitating payment for services. The evaluation also identified several challenges. Most users completed only one transaction before discontinuing card use; only 6% of women who acquired the card used it to pay for delivery, and slightly less than 1% used it as it was originally intended-to pay for several antenatal care visits and for delivery. According to respondents, the main reason for this discontinuation was a lack of understanding about how to use the card. Users were, on average, of a higher socioeconomic and educational status than non-card users. Most users obtained the card in their third trimester, and among those who used the card to save for delivery, most started to do so too late in pregnancy to accumulate sufficient savings to pay for that service. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

To serve or to leave: a question faced by public sector healthcare providers in Pakistan.

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Mir, Ali Mohammad; Shaikh, Muhammad Saleem; Rashida, Gul; Mankani, Neha

2015-11-25

The availability of properly trained and motivated providers is a prerequisite for provision of easily accessible healthcare. Pakistan has been listed by the World Health Organization in its World Health Report 2006 as one of 57 countries with a critical health workforce deficiency. This study examines the factors associated with the willingness of public sector healthcare providers to leave government service and recommends measures that can be adopted to attract and retain staff in the country's public healthcare system. A stratified, random sampling methodology was adopted to recruit a nationally representative sample of 1,296 public sector healthcare providers, including paramedics, medical doctors, and specialists. A semi-structured questionnaire was used to interview these providers. Logistic regressions measured the association with determinants of their willingness to leave the public health sector for better prospects elsewhere. A third of all healthcare providers who were interviewed were of the view that, provided the opportunity, they would leave government service. The odds of willingness to leave service were highest among providers from the region of Azad Jammu and Kashmir (adjusted odds ratio [AOR] = 4.33; 95% CI, 2.49-7.54) followed by the province of Balochistan (AOR = 4.21; 95% CI, 2.41-7.33), and the region of Gilgit Baltistan (AOR = 3.34; 95% CI, 1.67-6.67). Providers who expressed dissatisfaction in the manner their performance was evaluated and those who were dissatisfied with the current salary, each had higher odds of considering leaving government service (AOR = 1.67; 95% CI, 1.18-2.40 and AOR = 2.03; 95% CI, 1.47-2.81, respectively). Providers who reported experiencing interference in their work by influential politicians of the area were more inclined to leave (AOR = 1.44; 95% CI, 1.05-1.98). This study clearly highlights the need to implement more focused strategies in the public healthcare system in Pakistan in

Does social trust increase willingness to pay taxes to improve public healthcare? Cross-sectional cross-country instrumental variable analysis.

Science.gov (United States)

Habibov, Nazim; Cheung, Alex; Auchynnikava, Alena

2017-09-01

The purpose of this paper is to investigate the effect of social trust on the willingness to pay more taxes to improve public healthcare in post-communist countries. The well-documented association between higher levels of social trust and better health has traditionally been assumed to reflect the notion that social trust is positively associated with support for public healthcare system through its encouragement of cooperative behaviour, social cohesion, social solidarity, and collective action. Hence, in this paper, we have explicitly tested the notion that social trust contributes to an increase in willingness to financially support public healthcare. We use micro data from the 2010 Life-in-Transition survey (N = 29,526). Classic binomial probit and instrumental variables ivprobit regressions are estimated to model the relationship between social trust and paying more taxes to improve public healthcare. We found that an increase in social trust is associated with a greater willingness to pay more taxes to improve public healthcare. From the perspective of policy-making, healthcare administrators, policy-makers, and international donors should be aware that social trust is an important factor in determining the willingness of the population to provide much-needed financial resources to supporting public healthcare. From a theoretical perspective, we found that estimating the effect of trust on support for healthcare without taking confounding and measurement error problems into consideration will likely lead to an underestimation of the true effect of trust. Copyright © 2017 Elsevier Ltd. All rights reserved.

Is healthcare a 'Necessity' or 'Luxury'? an empirical evidence from public and private sector analyses of South-East Asian countries?

Science.gov (United States)

Khan, Jahangir Am; Mahumud, Rashidul Alam

2015-01-01

South-East Asian Regional (SEAR) countries range from low- to middle-income countries and have considerable differences in mix of public and private sector expenditure on health. This study intends to estimate the income-elasticities of healthcare expenditure in public and private sectors separately for investigating whether healthcare is a 'necessity' or 'luxury' for citizens of these countries. Panel data from 9 SEAR countries over 16 years (1995-2010) were employed. Fixed- and random-effect models were fitted to estimate income-elasticity of public, private and total healthcare expenditure. Results showed that one percent point increase in GDP per capita increased private expenditure on healthcare by 1.128%, while public expenditure increased by only 0.412%. Inclusion of three-year lagged variables of GDP per capita in the models did not have remarkable influence on the findings. The citizens of SEAR countries consider healthcare as a necessity while provided through public sector and a luxury when delivered by private sector. By increasing the public provisions of healthcare, more redistribution of healthcare resources can be ensured, which can accelerate the journey of SEAR countries towards universal health coverage.

Mental healthcare need and service utilization in older adults living in public housing.

Science.gov (United States)

Simning, Adam; van Wijngaarden, Edwin; Fisher, Susan G; Richardson, Thomas M; Conwell, Yeates

2012-05-01

Anxiety and depression in socioeconomically disadvantaged older adults frequently go unrecognized and untreated. This study aims to characterize mental illness and its treatment in older adult public housing residents who have many risk factors for anxiety and depression. Cross-sectional study. Public housing high-rises in Rochester, New York. One hundred ninety residents aged 60 years and older. Anxiety and depression were assessed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, GAD-7, and Patient Health Questionnaire. We obtained information on mental healthcare from medication review and self-report. Participants had a median age of 66 years, 58% were women, 80% were black, and 92% lived alone. Many participants (31%) were in need of mental healthcare: 21% had syndromal and 11% had subsyndromal anxiety or depression. Mental healthcare need was associated with younger age; intact cognitive functioning; impairments in instrumental activities of daily living (IADL); more medical illness; decreased mobility; smaller social network size; more severe life events; and increased utilization of medical, human, and informal services. Of those with mental healthcare need, most were not receiving it. Compared with residents receiving mental healthcare, residents with untreated need were more likely to be men and have less IADL impairment, medical illness, severe life events, onsite social worker use, and human services utilization. Mental illness was common and largely untreated in public housing residents. Increasing collaboration between medical, mental, and human services is needed to improve identification, treatment, and ultimately prevention of late-life mental illness in this community setting.

Healthcare service providers' and facility administrators' perspectives of the free maternal healthcare services policy in Malindi District, Kenya: a qualitative study.

Science.gov (United States)

Lang'at, Evaline; Mwanri, Lillian

2015-06-27

Globally, there are increasing efforts to improve maternal health outcomes including the reduction in maternal mortality rates. Improved access to skilled care utilisation during pregnancy and delivery has been one of the strategies employed to improve maternal health outcomes. In Kenya, more than half of the women deliver without the assistance of a skilled attendant and this has contributed to high maternal mortality rates. The free maternal healthcare services policy in all public facilities was initiated as a strategy to improve access to skilled care and reduce poor maternal health outcomes. This study aimed to explore the perspectives of the service providers and facility administrators of the free maternal health care service policy that was introduced in Kenya in 2013. A qualitative inquiry using semi-structured one-on-one interviews was conducted in Malindi District, Kenya. The participants included maternal health service providers and facility administrators recruited from five different healthcare facilities. Data were analysed using a thematic framework analysis. Free maternal healthcare service provision was perceived to boost skilled care utilisation during pregnancy and delivery. However, challenges including; delays in the reimbursement of funds by the government to the facilities, stock outs of essential commodities in the facilities to facilitate service provision, increased workload amidst staff shortage and lack of consultation and sensitisation of key stakeholders were perceived as barriers to effective implementation of this policy. Free maternal healthcare services can be one of the strategies to improve a range of maternal health outcomes. However, the implementation of this policy would be more effective if; the healthcare facilities were upgraded, equipped with adequate supplies, funds and staff; the community are continually sensitized on the importance of seeking skilled care during pregnancy and delivery; and inclusivity and

Strategies for healthcare information systems

NARCIS (Netherlands)

Stegwee, R.A.; Spil, Antonius A.M.

2001-01-01

Information technologies of the past two decades have created significant fundamental changes in the delivery of healthcare services by healthcare provider organizations. Many healthcare organizations have been in search of ways and strategies to keep up with continuously emerging information

National healthcare information system in Croatian primary care: the foundation for improvement of quality and efficiency in patient care

Directory of Open Access Journals (Sweden)

Darko Gvozdanovi_

2007-09-01

Full Text Available In order to improve the quality of patient care, while at the same time keeping up with the pace of increased needs of the population for healthcare services that directly impacts on the cost of care delivery processes, the Republic of Croatia, under the leadership of the Ministry of Health and Social Welfare, has formed a strategy and campaign for national public healthcare system reform. The strategy is very comprehensive and addresses all niches of care delivery processes; it is founded on the enterprise information systems that will aim to support end-to-end business processes in the healthcare domain. Two major requirements are in focus: (1 to provide efficient healthcare-related data management in support of decision-making processes; (2 to support a continuous process of healthcare resource spending optimisation. The first project is the Integrated Healthcare Information System (IHCIS on the primary care level; this encompasses the integration of all primary point-of-care facilities and subjects with the Croatian Institute for Health Insurance and Croatian National Institute of Public Health. In years to come, IHCIS will serve as the main integration platform for connecting all other stakeholders and levels of health care (that is, hospitals, pharmacies, laboratories into a single enterprise healthcare network. This article gives an overview of Croatian public healthcare system strategy aims and goals, and focuses on properties and characteristics of the primary care project implementation that started in 2003; it achieved a major milestone in early 2007 - the official grand opening of the project with 350 GPs already fully connected to the integrated healthcare information infrastructure based on the IHCIS solution.

Harnessing hospital purchase power to design safe care delivery.

Science.gov (United States)

Ebben, Steven F; Gieras, Izabella A; Gosbee, Laura Lin

2008-01-01

Since the Institute of Medicine's well-publicized 1999 report To Err is Human, the healthcare patient safety movement has grown at an exponential pace. However, much more can be done to advance patient safety from a care process design vantage point-improving safety through effective care processes and technology integration. While progress is being made, the chasm between technology developers and caregivers remains a profound void. Why hasn't more been done to expand our view of patient safety to include technology design? Healthcare organizations have not consolidated their purchasing power to expect improved designs. This article will (1) provide an assessment of the present state of healthcare technology management and (2) provide recommendations for collaborative design of safe healthcare delivery systems.

Healthcare for persons with intellectual disability in the community

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David Alan Ervin

2014-07-01

Full Text Available Introduction While there has been impressive progress in creating and improving community healthcare delivery systems that support people with intellectual and developmental disabilities (IDD, there is much more that can and should be done. Method This paper offers a review of healthcare delivery concepts on which new models are being developed, while also establishing an historical context. We review the need for creating fully integrated models of healthcare, and at the same time offer practical considerations that range from specific healthcare delivery system components to the need to expand our approach to training healthcare providers. The models and delivery systems, and the areas of needed focus in their development are reviewed to set a starting point for more and greater work going forward. Conclusions Today, we celebrate longer lifespans of people with IDD, increased attention to the benefits of healthcare that is responsive to their needs, and the development of important healthcare delivery systems that are customized to their needs. We also know that the growing body of research on health status offers incentive to continue developing healthcare structures for people with IDD by training healthcare providers about the needs of people with IDD, by establishing systems of care that integrate acute healthcare with long term services and support, by developing IDD medicine as a specialty, and by building health promotion and wellness resources to provide people with IDD a set of preventative health supports.

Virtualized healthcare delivery: understanding users and their usage patterns of online medical consultations.

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Jung, Changmi; Padman, Rema

2014-12-01

Virtualization of healthcare delivery via patient portals has facilitated the increasing interest in online medical consultations due to its benefits such as improved convenience and flexibility, lower cost, and time savings. Despite this growing interest, adoption by both consumers and providers has been slow, and little is known about users and their usage and adoption patterns. To learn characteristics of online healthcare consumers and understand their patterns of adoption and usage of online clinical consultation services (or eVisits delivered via the portal) such as adoption time for portal users, whether adoption hazard changes over time, and what factors influence patients to become early/late adopters. Using online medical consultation records between April 1, 2009 and May 31, 2010 from four ambulatory practices affiliated with a major healthcare provider, we conduct simple descriptive analysis to understand the users of online clinical consults and their usage patterns. Multilevel Logit regression is employed to measure the effect of patient and primary care provider characteristics on the likelihood of eVisit adoption by the patient, and survival analysis and Ordered Logit regression are applied to study eVisit adoption patterns that delineate elements describing early or late adopters. On average, eVisit adopters are younger and predominantly female. Their primary care providers participate in the eVisit service, highlighting the importance of physician's role in encouraging patients to utilize the service. Patients who are familiar with the patient portal are more likely to use the service, as are patients with more complex health issues. Younger and female patients have higher adoption hazard, but gender does not affect the decision of adopting early vs. late. These adopters also access the patient portal more frequently before adoption, indicating that they are potentially more involved in managing their health. The majority of eVisits are submitted

Innovations in health service delivery: the corporatization of public hospitals

National Research Council Canada - National Science Library

Harding, April; Preker, Alexander S

2003-01-01

... hospitals play a critical role in ensuring delivery of health services, less is known about how to improve the efficiency and quality of care provided. Much can be learned in this respect from the experiences of hospital reforms initiated during the 1990s. Innovations in Health Service Delivery: The Corporatization of Public Hospitals is an a...

Clinical engagement: improving healthcare together.

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Riches, E; Robson, B

2014-02-01

Clinical engagement can achieve lasting change in the delivery of healthcare. In October 2011, Healthcare Improvement Scotland formulated a clinical engagement strategy to ensure that a progressive and sustainable approach to engaging healthcare professionals is firmly embedded in its health improvement and public assurance activities. The strategy was developed using a 90-day process, combining an evidence base of best practice and feedback from semi-structured interviews and focus groups. The strategy aims to create a culture where clinicians view working with Healthcare Improvement Scotland as a worthwhile venture, which offers a number of positive benefits such as training, career development and research opportunities. The strategy works towards developing a respectful partnership between Healthcare Improvement Scotland, the clinical community and key stakeholders whereby clinicians' contributions are recognised in a non-financial reward system. To do this, the organisation needs a sustainable infrastructure and an efficient, cost-effective approach to clinical engagement. There are a number of obstacles to achieving successful clinical engagement and these must be addressed as key drivers in its implementation. The implementation of the strategy is supported by an action and resource plan, and its impact will be monitored by a measurement plan to ensure the organisation reviews its approaches towards clinical engagement.

Web-based integrated public healthcare information system of Korea: development and performance.

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Ryu, Seewon; Park, Minsu; Lee, Jaegook; Kim, Sung-Soo; Han, Bum Soo; Mo, Kyoung Chun; Lee, Hyung Seok

2013-12-01

The Web-based integrated public healthcare information system (PHIS) of Korea was planned and developed from 2005 to 2010, and it is being used in 3,501 regional health organizations. This paper introduces and discusses development and performance of the system. We reviewed and examined documents about the development process and performance of the newly integrated PHIS. The resources we analyzed the national plan for public healthcare, information strategy for PHIS, usage and performance reports of the system. The integrated PHIS included 19 functional business areas, 47 detailed health programs, and 48 inter-organizational tasks. The new PHIS improved the efficiency and effectiveness of the business process and inter-organizational business, and enhanced user satisfaction. Economic benefits were obtained from five categories: labor, health education and monitoring, clinical information management, administration and civil service, and system maintenance. The system was certified by a patent from the Korean Intellectual Property Office and accredited as an ISO 9001. It was also reviewed and received preliminary comments about its originality, advancement, and business applicability from the Patent Cooperation Treaty. It has been found to enhance the quality of policy decision-making about regional healthcare at the self-governing local government level. PHIS, a Web-based integrated system, has contributed to the improvement of regional healthcare services of Korea. However, when it comes to an appropriate evolution, the needs and changing environments of community-level healthcare service and IT infrastructure should be analyzed properly in advance.

Healthcare Finance in the Kingdom of Saudi Arabia: A Qualitative Study of Householders' Attitudes.

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Al-Hanawi, Mohammed Khaled; Alsharqi, Omar; Almazrou, Saja; Vaidya, Kirit

2018-02-01

The public sector healthcare system in Saudi Arabia, essentially financed by oil revenues and 'free at the point of delivery', is coming under increasing strain due to escalating expenditure and an increasingly volatile oil market and is likely to be unsustainable in the medium to long term. This study examines how satisfied the Saudi people are with their public sector healthcare services and assesses their willingness to contribute to financing the system through a national health insurance scheme. The study also examines public preferences and expectations of a future national health insurance system. A total of 36 heads of households participated in face-to-face audio-recorded semi-structured interviews. The participants were purposefully selected based on different socio-economic and socio-demographic factors from urban and rural areas to represent the geographical diversity that would presumably influence individual views, expectations, preferences and healthcare experiences. The evidence showed some dissatisfaction with the provision and quality of current public sector healthcare services, including the availability of appointments, waiting times and the availability of drugs. The households indicated a willingness to contribute to a national insurance scheme, conditional upon improvements in the quality of public sector healthcare services. The results also revealed a variety of preferences and expectations regarding the proposed national health insurance scheme. Quality improvement is a key factor that could motivate the Saudi people to contribute to financing the healthcare system. A new authority, consisting of a partnership between the public and private sectors under government supervision, could represent an acceptable option for addressing the variation in public preferences.

The Dilemma of Accountability and Good Governance for Improved Public Service Delivery in Nigeria

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Kehinde David Adejuwon

2012-12-01

Full Text Available The public sector in Nigeria is irrefutably beset with gross  incompetence and ineffective management. Perplexing difficulties endure in the Nigerian public sector in spite of a number of reform programmes that have been designed to enhance efficient and effective service delivery for almost two decades. The fact that public service has failed dismally to achieve its laudable objectives is the reason for the vote of no confidence passed on its administrators by majority of the Nigerian populace. The article examines the dilemma of accountability and good governance in Nigeria and demonstrates that the critical point in achieving meaningful developments in the country intrinsically lay with improved service delivery in the public sector. The basic reason why the public service has become the scorn of the people is because for too long, both the government and public servants have paid lip service to the crucial issue of effective and efficient service delivery. The article argues that improved service delivery will improve both the performance and the image of public service and re-awaken the citizens’ interest and trust in them to do business with public servants. It suggests that  in order to bring sanity back to the Nigerian Public Service,  all unprofessional tendencies such as ethnicity bias and nepotism in appointments and promotions, lack of security of tenure of office, and appointment of non-career public servants into key positions in the public service must stop. Also,  effective service delivery must be tailored to the circumstances of Nigeria. The study made use of secondary data obtained from various sources. It therefore concludes that without a reawakening of the culture of accountability and transparency lost over the years, the trusting relationship needed to forge between the government and the governed for the actualization of good governance will not materialize.

Last Mile Towards Efficient Healthcare Delivery in Switzerland: eHealth Enabled Applications Could Speed Up the Care Process.

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Deng, Yihan; Bürkle, Thomas; Holm, Jürgen; Zetz, Erwin; Denecke, Kerstin

2018-01-01

A precise and timely care delivery depends on an efficient triage performed by primary care providers and smooth collaboration with other medical specialities. In recent years telemedicine gained increasing importance for efficient care delivery. It's use, however, has been limited by legal issues, missing digital infrastructures, restricted support from health insurances and the digital divide in the population. A new era towards eHealth and telemedicine starts with the establishment of national eHealth regulations and laws. In Switzerland, a nation-wide digital infrastructure and electronic health record will be established. But appropriate healthcare apps to improve patient care based on this infrastructure remain rare. In this paper, we present two applications (self-anamnesis and eMedication assistant) for eHealth enabled care delivery which have the potential to speed up diagnosis and treatment.

Redesigning mental healthcare delivery: is there an effect on organizational climate?

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Joosten, T C M; Bongers, I M B; Janssen, R T J M

2014-02-01

Many studies have investigated the effect of redesign on operational performance; fewer studies have evaluated the effects on employees' perceptions of their working environment (organizational climate). Some authors state that redesign will lead to poorer organizational climate, while others state the opposite. The goal of this study was to empirically investigate this relation. Organizational climate was measured in a field experiment, before and after a redesign intervention. At one of the sites, a redesign project was conducted. At the other site, no redesign efforts took place. Two Dutch child- and adolescent-mental healthcare providers. Professionals that worked at one of the units at the start and/or the end of the intervention period. The main intervention was a redesign project aimed at improving timely delivery of services (modeled after the breakthrough series). Scores on the four models of the organizational climate measure, a validated questionnaire that measures organizational climate. Our analysis showed that climate at the intervention site changed on factors related to productivity and goal achievement (rational goal model). The intervention group scored worse than the comparison group on the part of the questionnaire that focuses on sociotechnical elements of organizational climate. However, observed differences were so small, that their practical relevance seems rather limited. Redesign efforts in healthcare, so it seems, do not influence organizational climate as much as expected.

Migration and access to maternal healthcare: determinants of adequate antenatal care and institutional delivery among socio-economically disadvantaged migrants in Delhi, India.

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Kusuma, Yadlapalli S; Kumari, Rita; Kaushal, Sonia

2013-10-01

To identify the determinants of adequate antenatal care (ANC) utilisation and institutional deliveries among socio-economically disadvantaged migrants living in Delhi, India. In a cross-sectional survey, 809 rural-urban migrant mothers with a child aged below 2 years were interviewed with a pretested questionnaire. Data on receiving antenatal, delivery and post-natal services, migration history and other social, demographic and income were collected. Recent migrants used the services significantly less than settled migrants. ANC was adequate only among 37% (35% of recent migrant women and 39% of settled migrants). Multinomial regression revealed that being a recent migrant, multiparous, illiterate and married to an unskilled worker were significant risk factors for receiving inadequate ANC. Around 53% of deliveries took place at home. ANC seeking has a strong influence on place of delivery: 70% of births to women who received inadequate ANC were at home. Women who are educated, had their first delivery after the age of 20 years and received adequate ANC were more likely to deliver their child in hospital. Post-natal care is grossly neglected among these groups. Migrant women, particularly recent migrants, are at the risk of not receiving adequate maternal healthcare. Because migration is a continuing phenomenon, measures to mitigate disadvantage due to migration need to be taken in the healthcare system. © 2013 John Wiley & Sons Ltd.

Industry Update: the latest developments in therapeutic delivery.

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Steinbach, Oliver C

2013-05-01

The present industry update covers the period 2-28 February 2013, with information sourced from company press releases, regulatory and patent agencies, as well as from scientific literature. With the US presidential inauguration in January, the inevitable 'fiscal cliff' and with the healthcare reform taking shape, there are many challenges ahead for the world's largest healthcare market. Healthcare providers are preparing for the 'accountable care organizations' paradigm shift and it has been reported that the pharmaceutical industry is low in public perception; only 'for-profit' health insurers rank lower according to a survey recently published. Although in 2012 one could still observe a decline in the overall number of drug delivery partnering deals announced, there has been a slight recovery, thus, meaning a repeat of the lows of 2011 have not been witnessed. The experts expect a reversed trend in 2013 as larger companies seek to refill pipelines with new candidates and drug-delivery solutions. There is a lot of emphasis on altered oral delivery profiles to provide patient compliance. This is indicated by the recent licensing deals, such as that between Radius Health Inc. and 3M, TissueGen and Biomedical Structures, and new financing rounds of companies, such as SKL, Catalent and BioActiva. Injectable technology, including needle-free delivery, continues to be prevalent in deals, such as those between Clearside and Kala until compelling alternatives to the delivery of biologicals are available. Alternative routes of administration, such as nasal, buccal (Kala), sublingual (Stallergenes) see growing interest; however, bioavailability and reproducible dosing will continue to be a challenge in the foreseeable future.

A decentralised model of psychiatric care: Profile, length of stay and outcome of mental healthcare users admitted to a district-level public hospital in the Western Cape

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Eileen Thomas

2015-02-01

Full Text Available Background. There is a lack of studies assessing the profile and outcome of psychiatric patients at entry-level public hospitals that are prescribed by the Mental Health Care Act to provide a decentralised model of psychiatric care. Objective. To assess the demographic and clinical profile as well as length of stay and outcomes of mental healthcare users admitted to a district-level public hospital in the Western Cape.  Method. Demographic data, clinical diagnosis, length of stay, referral profile and outcomes of patients (N=487 admitted to Helderberg Hospital during the period 1 January 2011 - 31 December 2011 were collected.  Results. Psychotic disorders were the most prevalent (n=287, 59% diagnoses, while 228 (47% of admission episodes had comorbid/secondary diagnoses. Substance use disorders were present in 184 (38% of admission episodes, 37 (57% of readmissions and 19 (61% of abscondments. Most admission episodes (n=372, 76% were discharged without referral to specialist/tertiary care.  Conclusion. Methamphetamine use places a significant burden on the provision of mental healthcare services at entry-level care. Recommendations for improving service delivery at this district-level public hospital are provided.

'Where is the public health sector?' Public and private sector healthcare provision in Madhya Pradesh, India.

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De Costa, Ayesha; Diwan, Vinod

2007-12-01

This paper aims to empirically demonstrate the size and composition of the private health care sector in one of India's largest provinces, Madhya Pradesh. It is based on a field survey of all health care providers in Madhya Pradesh (60.4 million in 52,117 villages and 394 towns). Seventy-five percent of the population is rural and 37% live below poverty line. This survey was done as part of the development of a health management information system. The distribution of health care providers in the province with regard to sector of work (public/private), rural-urban location, qualification, commercial orientation and institutional set-up are described. Of the 24,807 qualified doctors mapped in the survey, 18,757 (75.6%) work in the private sector. Fifteen thousand one hundred forty-two (80%) of these private physicians work in urban areas. The 72.1% (67793) of all qualified paramedical staff work in the private sector, mostly in rural areas. The paper empirically demonstrates the dominant heterogeneous private health sector and the overall the disparity in healthcare provision in rural and urban areas. It argues for a new role for the public health sector, one of constructive oversight over the entire health sector (public and private) balanced with direct provision of services where necessary. It emphasizes the need to build strong public private partnerships to ensure equitable access to healthcare for all.

Income, egalitarianism and attitudes towards healthcare policy: a study on public attitudes in 29 countries.

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Azar, A; Maldonado, L; Castillo, J C; Atria, J

2018-01-01

To evaluate the relationship between income and egalitarian values and attitudes towards healthcare policy. Cross-sectional and cross-national study. Data for 29 countries from the International Social Survey Programme (ISSP) 2011 were used. The dependent variables are a general attitude towards government involvement in healthcare provision and two attitudes regarding specific policies (taxes and public funding). Income and egalitarianism were also measured by using ISSP. Data were analysed using regression models that account for individual and country-level characteristics, and country-fixed effects. The effect of income is small and non-significant for attitudes towards government involvement and public funding. For willingness to pay (WTP) taxes to improve healthcare services, we find a positive association with income. Results for egalitarianism suggest a positive association with government involvement in healthcare provision and significant interactions with WTP taxes. The distinction of dimensions and mechanisms underlying policy attitudes appears as relevant. Citizens across socioeconomic groups are motivated to support state-funded healthcare, favouring the design of non-selfish policies. These findings suggest that there is space for policymakers who seek to increase healthcare spending encouraging either policies for specific groups or broader institutional changes. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Balancing influence between actors in healthcare decision making

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Babad Yair M

2011-04-01

Full Text Available Abstract Background Healthcare costs in most developed countries are not clearly linked to better patient and public health outcomes, but are rather associated with service delivery orientation. In the U.S. this has resulted in large variation in healthcare availability and use, increased cost, reduced employer participation in health insurance programs, and reduced overall population health outcomes. Recent U.S. healthcare reform legislation addresses only some of these issues. Other countries face similar healthcare issues. Discussion A major goal of healthcare is to enhance patient health outcomes. This objective is not realized in many countries because incentives and structures are currently not aligned for maximizing population health. The misalignment occurs because of the competing interests between "actors" in healthcare. In a simplified model these are individuals motivated to enhance their own health; enterprises (including a mix of nonprofit, for profit and government providers, payers, and suppliers, etc. motivated by profit, political, organizational and other forces; and government which often acts in the conflicting roles of a healthcare payer and provider in addition to its role as the representative and protector of the people. An imbalance exists between the actors, due to the resources and information control of the enterprise and government actors relative to the individual and the public. Failure to use effective preventive interventions is perhaps the best example of the misalignment of incentives. We consider the current Pareto efficient balance between the actors in relation to the Pareto frontier, and show that a significant change in the healthcare market requires major changes in the utilities of the enterprise and government actors. Summary A variety of actions are necessary for maximizing population health within the constraints of available resources and the current balance between the actors. These actions include

Balancing influence between actors in healthcare decision making.

Science.gov (United States)

Kaplan, Robert M; Babad, Yair M

2011-04-19

Healthcare costs in most developed countries are not clearly linked to better patient and public health outcomes, but are rather associated with service delivery orientation. In the U.S. this has resulted in large variation in healthcare availability and use, increased cost, reduced employer participation in health insurance programs, and reduced overall population health outcomes. Recent U.S. healthcare reform legislation addresses only some of these issues. Other countries face similar healthcare issues. A major goal of healthcare is to enhance patient health outcomes. This objective is not realized in many countries because incentives and structures are currently not aligned for maximizing population health. The misalignment occurs because of the competing interests between "actors" in healthcare. In a simplified model these are individuals motivated to enhance their own health; enterprises (including a mix of nonprofit, for profit and government providers, payers, and suppliers, etc.) motivated by profit, political, organizational and other forces; and government which often acts in the conflicting roles of a healthcare payer and provider in addition to its role as the representative and protector of the people. An imbalance exists between the actors, due to the resources and information control of the enterprise and government actors relative to the individual and the public. Failure to use effective preventive interventions is perhaps the best example of the misalignment of incentives. We consider the current Pareto efficient balance between the actors in relation to the Pareto frontier, and show that a significant change in the healthcare market requires major changes in the utilities of the enterprise and government actors. A variety of actions are necessary for maximizing population health within the constraints of available resources and the current balance between the actors. These actions include improved transparency of all aspects of medical decision

Education of healthcare professionals and the public.

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McNulty, Cliodna A M; Cookson, Barry D; Lewis, Michael A O

2012-07-01

In the winter of 2007-08 a new public-facing antimicrobial campaign was agreed by the Advisory Committee on Antimicrobial Resistance and Healthcare-Associated Infection (ARHAI) Education sub-Group (later divided into subgroups for professional and public education): it comprised posters with a positive message on how the public could help themselves when they had a cold. However, the poster campaign, used in isolation in England, did not improve antibiotic use; therefore, the Public Education sub-Group took forward educational approaches to change the behaviour of the public and health professionals. Professionals have been encouraged to give patients clear information about the likely duration of symptoms, self-care, and benefits and harms of antibiotics, reinforcing the public poster campaigns in surgeries, hospitals and pharmacies. Since 2008, campaigns have been launched in England to coincide with European Antibiotic Awareness Day (EAAD) on 18 November, using Department of Health and EAAD materials. Professional education has been facilitated by the 2008 National Institute for Health and Clinical Excellence respiratory tract infection delayed prescribing guidance for general practitioners. A toolkit of materials for medicines management teams, to facilitate good antimicrobial stewardship in primary care (ASPIC), is being taken forward by the Public Education sub-Group and professional societies. After advice from ARHAI, in 2009 the General Medical Council requested that all postgraduate deans and Royal Colleges ensure infection prevention and control and antimicrobial prescribing become standard practice implemented in all clinical settings, and that they are emphasized strongly in undergraduate and postgraduate medical training. ARHAI has also taken a keen interest in reviewing, advising and leading on a number of European Union initiatives dealing with professional education.

Workforce diversity among public healthcare workers in Nigeria: Implications on job satisfaction and organisational commitment.

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Ibidunni, Ayodotun Stephen; Falola, Hezekiah Olubusayo; Ibidunni, Oyebisi Mary; Salau, Odunayo Paul; Olokundun, Maxwell Ayodele; Borishade, Taiye Tairat; Amaihian, Augusta Bosede; Peter, Fred

2018-06-01

The aim of this research was to present a data article that identify the relationship between workforce diversity, job satisfaction and employee commitment among public healthcare workers in Nigeria. Copies of structured questionnaire were administered to 133 public healthcare workers from the Lagos state ministry of health in Nigeria. Using descriptive and structural equation modelling statistical analysis, the data revealed the relationship between workforce diversity and job satisfaction, workforce diversity and organisational commitment, and the role of job satisfaction on organisational commitment was also established.

Realist synthesis of educational interventions to improve nutrition care competencies and delivery by doctors and other healthcare professionals

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Mogre, Victor; Scherpbier, Albert J J A; Stevens, Fred; Aryee, Paul; Cherry, Mary Gemma; Dornan, Tim

2016-01-01

Objective To determine what, how, for whom, why, and in what circumstances educational interventions improve the delivery of nutrition care by doctors and other healthcare professionals work. Design Realist synthesis following a published protocol and reported following Realist and Meta-narrative Evidence Synthesis: Evolving Standards (RAMESES) guidelines. A multidisciplinary team searched MEDLINE, CINAHL, ERIC, EMBASE, PsyINFO, Sociological Abstracts, Web of Science, Google Scholar and Science Direct for published and unpublished (grey) literature. The team identified studies with varied designs; appraised their ability to answer the review question; identified relationships between contexts, mechanisms and outcomes (CMOs); and entered them into a spreadsheet configured for the purpose. The final synthesis identified commonalities across CMO configurations. Results Over half of the 46 studies from which we extracted data originated from the USA. Interventions that improved the delivery of nutrition care improved skills and attitudes rather than just knowledge; provided opportunities for superiors to model nutrition care; removed barriers to nutrition care in health systems; provided participants with local, practically relevant tools and messages; and incorporated non-traditional, innovative teaching strategies. Operating in contexts where student and qualified healthcare professionals provided nutrition care in developed and developing countries, these interventions yielded health outcomes by triggering a range of mechanisms, which included feeling competent, feeling confident and comfortable, having greater self-efficacy, being less inhibited by barriers in healthcare systems and feeling that nutrition care was accepted and recognised. Conclusions These findings show how important it is to move education for nutrition care beyond the simple acquisition of knowledge. They show how educational interventions embedded within systems of healthcare can improve

The root causes of ineffective and inefficient healthcare technology management in Benin public health sector

NARCIS (Netherlands)

Houngbo, T.; Zweekhorst, M.B.M.; Bunders- Aelen, J.G.F.; Coleman, H.L.S.; Medenou, D.; Dakpanon, L.Y.; de Cock Buning, Tjard

2017-01-01

This study aims to identify the root causes and solutions of main problems facing Healthcare Technology Management in Benin׳s public health sector. Conducted in Benin from 2008 to 2010, two surveys were used with key actors in Healthcare Technology Management. The first survey was based on 377

Emerging role of human factors and ergonomics in healthcare delivery – A new field of application and influence for the IEA

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Carayon, Pascale

2014-01-01

Recent developments of research and application of Human Factors and Ergonomics (HFE) are described, in particular the domain of healthcare delivery. HFE activities in this domain are highlighted and challenges for the discipline and the International Ergonomics Association are presented. PMID:22317500

E-commerce in healthcare: changing the traditional landscape.

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Aggarwal, A K; Travers, S

2001-01-01

The healthcare industry, with more than one trillion dollars in revenue, accounts for about one-seventh of the U.S. economy. A significant portion of this revenue is lost to escalating healthcare system costs. This article examines the shortcomings of the traditional healthcare delivery system in terms of information flow, communication standards, case collections, and IT spending. It makes the case that e-commerce has the ability to transact some healthcare business more efficiently and cost-effectively. With the Internet as a delivery platform, several models offer improvement over the status quo.

Techno-Bureaucratic Governance and Public Service Delivery: Indonesia and Nigeria in Perspectives

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Jacob Olufemi Fatile

2015-09-01

Full Text Available Techno-bureaucratic governance is fundamental to contemporary public service. This is because the roles of the bureaucrats and technocrats become more relevant in policy formulation and implementation when the government had to (reinvent its institutions to move from routine administration to that of development planning and management. Utilizing a qualitative approach, the paper notes that techno-bureaucratic ideology values technical expertise itself and its technical experts, efficiency, economic development and effective public service delivery. Adopting comparative perspective, the paper examines techno-bureaucratic governance and public service delivery in Indonesia and Nigeria. The paper takes a cursory look at the similarities and differences between the two countries. The paper notes that the technocracy nurtured by the New Order in Indonesia was cohesive and effective because of its technical expertise and has helped Indonesia to turn oil income into productive investments,whereas in Nigeria the oil income was used for prestigious projects to the detriment of productive investments. The paper therefore recommend among others that developing societies need a new strategy in delivery services in their public service, and this can be achieved through skilled professionals, technocrats and knowledge based actors. It concludes that for public service to deliver effective services, an efficient bureaucracy and technocracy remain invaluable.

Developing a conceptual model for the application of patient and public involvement in the healthcare system in Iran.

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Azmal, Mohammad; Sari, Ali Akbari; Foroushani, Abbas Rahimi; Ahmadi, Batoul

2016-06-01

Patient and public involvement is engaging patients, providers, community representatives, and the public in healthcare planning and decision-making. The purpose of this study was to develop a model for the application of patient and public involvement in decision making in the Iranian healthcare system. A mixed qualitative-quantitative approach was used to develop a conceptual model. Thirty three key informants were purposely recruited in the qualitative stage, and 420 people (patients and their companions) were included in a protocol study that was implemented in five steps: 1) Identifying antecedents, consequences, and variables associated with the patient and the publics' involvement in healthcare decision making through a comprehensive literature review; 2) Determining the main variables in the context of Iran's health system using conceptual framework analysis; 3) Prioritizing and weighting variables by Shannon entropy; 4) designing and validating a tool for patient and public involvement in healthcare decision making; and 5) Providing a conceptual model of patient and the public involvement in planning and developing healthcare using structural equation modeling. We used various software programs, including SPSS (17), Max QDA (10), EXCEL, and LISREL. Content analysis, Shannon entropy, and descriptive and analytic statistics were used to analyze the data. In this study, seven antecedents variable, five dimensions of involvement, and six consequences were identified. These variables were used to design a valid tool. A logical model was derived that explained the logical relationships between antecedent and consequent variables and the dimensions of patient and public involvement as well. Given the specific context of the political, social, and innovative environments in Iran, it was necessary to design a model that would be compatible with these features. It can improve the quality of care and promote the patient and the public satisfaction with healthcare and

Buprenorphine Maintenance for Opioid Dependence in Public Sector Healthcare: Benefits and Barriers.

Science.gov (United States)

Duncan, Laura G; Mendoza, Sonia; Hansen, Helena

Since its U.S. FDA approval in 2002, buprenorphine has been available for maintenance treatment of opiate dependence in primary care physicians' offices. Though buprenorphine was intended to facilitate access to treatment, disparities in utilization have emerged; while buprenorphine treatment is widely used in private care setting, public healthcare integration of buprenorphine lags behind. Through a review of the literature, we found that U.S. disparities are partly due to a shortage of certified prescribers, concern of patient diversion, as well as economic and institutional barriers. Disparity of buprenorphine treatment dissemination is concerning since buprenorphine treatment has specific characteristics that are especially suited for low-income patient population in public sector healthcare such as flexible dosing schedules, ease of concurrently treating co-morbidities such as HIV and hepatitis C, positive patient attitudes towards treatment, and the potential of reducing addiction treatment stigma. As the gap between buprenorphine treatment in public sector settings and private sector settings persists in the U.S., current research suggests ways to facilitate its dissemination.

Value-Based Health Care Delivery, Preventive Medicine and the Medicalization of Public Health.

Science.gov (United States)

Vilhelmsson, Andreas

2017-03-01

The real paradigm shift for healthcare is often stated to include a transition from accentuating health care production and instead emphasize patient value by moving to a 'value-based health care delivery'. In this transition, personalized medicine is sometimes referred to as almost a panacea in solving the current and future health challenges. In theory, the progress of precision medicine sounds uncontroversial and most welcomed with its promise of a better healthcare for all, with real benefits for the individual patient provided a tailored and optimized treatment plan suitable for his or her genetic makeup. And maybe, therefore, the assumptions underpinning personalized medicine have largely escaped questioning. The use of personalized medicine and the use of digital technologies is reshaping our health care system and how we think of health interventions and our individual responsibility. However, encouraging individuals to engage in preventive health activities possibly avoids one form of medicalization (clinical), but on the other hand, it takes up another form (preventive medicine and 'self-care') that moves medical and health concerns into every corner of everyday life. This ought to be of little value to the individual patient and public health. We ought to instead demand proof of these value ideas and the lacking research. Before this is in place critical appraisal and cynicism are requisite skills for the future. Otherwise, we are just listening to visionaries when we put our future health into their hands and let personalized solutions reach into people's everyday life regardless of patient safety and integrity.

Patients' appraisals of public and private healthcare: a qualitative study of physiotherapy and osteopathy.

Science.gov (United States)

Bradbury, Katherine J; Bishop, Felicity L; Yardley, Lucy; Lewith, George

2013-10-01

Patients have previously reported differences in their experiences of treatments received in the public and private sectors; it remains unclear whether such perceived differences are particular to or shared across different interventions. This study explored whether patients' appraisals of public and private treatments are similar when appraising a complementary therapy (osteopathy) compared to a mainstream therapy (physiotherapy). Thirty-five qualitative interviews were analysed thematically. Patients' appraisals varied by health-care sector and therapy type: physiotherapy was appraised more negatively in the National Health Service than the private sector but osteopathy was appraised similarly within both health-care sectors. Potential reasons for this are discussed.

45 CFR 61.9 - Reporting civil judgments related to the delivery of a health care item or service.

Science.gov (United States)

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Reporting civil judgments related to the delivery of a health care item or service. 61.9 Section 61.9 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION HEALTHCARE INTEGRITY AND PROTECTION DATA BANK FOR FINAL ADVERSE INFORMATION...

Interactions: trade policy and healthcare reform after Chaoulli v. Quebec: is it time for Canada to acknowledge the fragile boundary between health and trade policies and strengthen the separation between private and public health insurance?

Science.gov (United States)

Crawford, Mark

2006-01-01

The insulation of Canada's healthcare system from trade treaty obligations is crucial to the legitimacy of Canada's trade policy. Legal analysis has suggested, however, that competitive and for-profit delivery of the kind contemplated by the Kirby Report and some provinces may make healthcare more vulnerable to challenges under NAFTA and GATS. The Government of Canada has tried to counter this interpretation by stressing the importance of public financing as the principal criterion for exemption of healthcare from trade treaties, but now the potential for private financing of essential medical services indicated by the Supreme Court's decision in Chaoulli v. Quebec has made that line of argument look risky as well. It is apparent that Canada failed to anticipate the possible interactions of domestic, international and constitutional law when it made commitments in the area of private health insurance at the WTO in 1997. Accordingly, the time has come to acknowledge the fragility of the boundary between health and trade policies, to take the risks and costs associated with trade treaty obligations fully into account when undertaking healthcare reform and to strengthen the separation between private and public health insurance.

Healthcare waste management: current practices in selected healthcare facilities, Botswana.

Science.gov (United States)

Mbongwe, Bontle; Mmereki, Baagi T; Magashula, Andrew

2008-01-01

Healthcare waste management continues to present an array of challenges for developing countries, and Botswana is no exception. The possible impact of healthcare waste on public health and the environment has received a lot of attention such that Waste Management dedicated a special issue to the management of healthcare waste (Healthcare Wastes Management, 2005. Waste Management 25(6) 567-665). As the demand for more healthcare facilities increases, there is also an increase on waste generation from these facilities. This situation requires an organised system of healthcare waste management to curb public health risks as well as occupational hazards among healthcare workers as a result of poor waste management. This paper reviews current waste management practices at the healthcare facility level and proposes possible options for improvement in Botswana.

Improving interpretation of publically reported statistics on health and healthcare: the Figure Interpretation Assessment Tool (FIAT-Health).

Science.gov (United States)

Gerrits, Reinie G; Kringos, Dionne S; van den Berg, Michael J; Klazinga, Niek S

2018-03-07

Policy-makers, managers, scientists, patients and the general public are confronted daily with figures on health and healthcare through public reporting in newspapers, webpages and press releases. However, information on the key characteristics of these figures necessary for their correct interpretation is often not adequately communicated, which can lead to misinterpretation and misinformed decision-making. The objective of this research was to map the key characteristics relevant to the interpretation of figures on health and healthcare, and to develop a Figure Interpretation Assessment Tool-Health (FIAT-Health) through which figures on health and healthcare can be systematically assessed, allowing for a better interpretation of these figures. The abovementioned key characteristics of figures on health and healthcare were identified through systematic expert consultations in the Netherlands on four topic categories of figures, namely morbidity, healthcare expenditure, healthcare outcomes and lifestyle. The identified characteristics were used as a frame for the development of the FIAT-Health. Development of the tool and its content was supported and validated through regular review by a sounding board of potential users. Identified characteristics relevant for the interpretation of figures in the four categories relate to the figures' origin, credibility, expression, subject matter, population and geographical focus, time period, and underlying data collection methods. The characteristics were translated into a set of 13 dichotomous and 4-point Likert scale questions constituting the FIAT-Health, and two final assessment statements. Users of the FIAT-Health were provided with a summary overview of their answers to support a final assessment of the correctness of a figure and the appropriateness of its reporting. FIAT-Health can support policy-makers, managers, scientists, patients and the general public to systematically assess the quality of publicly reported

Estimating the cost of healthcare delivery in three hospitals in southern ghana.

Science.gov (United States)

Aboagye, A Q Q; Degboe, A N K; Obuobi, A A D

2010-09-01

The cost burden (called full cost) of providing health services at a referral, a district and a mission hospital in Ghana were determined. Standard cost-finding and cost analysis tools recommended by World Health Organization are used to analyse 2002 and 2003 hospital data. Full cost centre costs were computed by taking into account cash and non-cash expenses and allocating overhead costs to intermediate and final patient care centres. The full costs of running the mission hospital in 2002 and 2003 were US$600,295 and US$758,647 respectively; for the district hospital, the respective costs were US$496,240 and US$487,537; and for the referral hospital, the respective costs were US$1,160,535 and US$1,394,321. Of these, overhead costs ranged between 20% and 42%, while salaries made up between 45% and 60%. Based on healthcare utilization data, in 2003 the estimated cost per outpatient attendance was US$ 2.25 at the mission hospital, US$ 4.51 at the district hospital and US$8.5 at the referral hospital; inpatient day costs were US$ 6.05, US$ 9.95 and US$18.8 at the respective hospitals. User fees charged at service delivery points were generally below cost. However, some service delivery points have the potential to recover their costs. Salaries are the major cost component of the three hospitals. Overhead costs constitute an important part of hospital costs and must be noted in efforts to recover costs. Cost structures are different at different types of hospitals. Unit costs at service delivery points can be estimated and projected into the future.

Funding issues and the delivery of public library services in Nigeria ...

African Journals Online (AJOL)

This paper examined the impact of government public expenditure on education and the effect of special funding in enhancing the delivery of public library services in Nigeria. secondary data were collected from the websites of the Central Bank of Nigeria (CBN) and Education Trust Fund (ETF.). Results from the regression ...

How do we want to grow old? Anti-ageing-medicine and the scope of public healthcare in liberal democracies.

Science.gov (United States)

Schweda, Mark; Marckmann, Georg

2013-09-01

Healthcare counts as a morally relevant good whose distribution should neither be left to the free market nor be simply imposed by governmental decisions without further justification. This problem is particularly prevalent in the current boom of anti-ageing medicine. While the public demand for medical interventions which promise a longer, healthier and more active and attractive life has been increasing, public healthcare systems usually do not cover these products and services, thus leaving their allocation to the mechanisms of supply and demand on the free market. This situation raises the question on which basis the underlying preferences for and claims to a longer, healthier life should be evaluated. What makes anti-ageing medicine eligible for public funding? In this article, we discuss the role of anti-ageing medicine with regard to the scope and limits of public healthcare. We will first briefly sketch the basic problem of justifying a particular healthcare scheme within the framework of a modern liberal democracy, focusing on the challenge anti-ageing interventions pose in this regard. In the next section, we will present and discuss three possible solutions to the problem, essentialistic, transcendental, and procedural strategies of defining the scope of public healthcare. We will suggest a procedural solution adopting essentialistic and transcendental elements and discuss its theoretical and practical implications with regard to anti-ageing medicine. © 2012 John Wiley & Sons Ltd.

Private investment in hospitals: a comparison of three healthcare systems and possible implications for real estate strategies.

Science.gov (United States)

van der Zwart, Johan; van der Voordt, Theo; Jonge, Hans de

2010-01-01

This article explores lessons to be learned from three different healthcare systems and the possible implications for the management of healthcare real estate, in particular in connection to the Dutch system. It discusses similarities and differences among the different systems, in search of possible consequences on cost, financing, and design innovation. To keep healthcare affordable in the future, the Dutch government is currently in the process of changing legislation to move from a centrally directed system to a so-called regulated market system. The deregulation of real estate investment that accompanies the new healthcare delivery system offers healthcare organizations new opportunities, but also more responsibility and greater risk in return on investment. Consequently, healthcare organizations must find new methods of financing. Private investment is one of the options. Three healthcare systems were analyzed on the basis of a literature review and document analysis, then schematized to show similarities and dissimilarities with regard to private investment in hospitals. Observations are based on a selection of recently published articles on private-sector financing and its implications for healthcare real estate decision making in the Netherlands, the United Kingdom, and Germany. The strengths and weaknesses of three healthcare systems with differing proportions of private and public investment in hospitals were explored. Research revealed a gap between intended effects and actual effects with regard to quality and cost. Costly private finance does not necessarily lead to "value for money." Transferring real estate decisions to private investors decreases the influence of the healthcare organization on future costs and quality. The three healthcare systems show substantial differences between public and private responsibilities. Less governmental involvement affords both opportunities and risks for hospitals. Private investment may lead to innovation

Towards an oral healthcare framework and policy analysis for Swaziland

OpenAIRE

Mndzebele, Samuel

2010-01-01

Background and Rationale: A synopsis by the researcher suggested that caries was becoming a public health problem among the youth, hence there was a need for deeper investigations which would lead to possible oral health interventions. Purpose: The purpose of the study was to assess dental care practices and experiences among teenagers in the Northern region of Swaziland. Based on the outcomes and views from health professionals; develop a framework for oral healthcare delivery and ...

Healthcare Systems and Other Applications

NARCIS (Netherlands)

van Kasteren, T.L.M.; Kröse, B.J.A.

2007-01-01

This Works in Progress department discusses eight projects related to healthcare. The first project aims to aid people with mild dementia. The second project plans to simplify the delivery of healthcare services to the elderly and cognitively disabled, while the third project is developing models

Social marketing in healthcare

Directory of Open Access Journals (Sweden)

Radha Aras

2011-08-01

Full Text Available BackgroundSocial marketing is an important tool in the delivery ofhealthcare services. For any healthcare programme orproject to be successful, community/consumer participationis required. The four principles of social marketing can guidepolicymakers and healthcare providers to successfully planand implement health programmes.AimTo review the existing literature in order to project thebenefits of social marketing in healthcare.MethodA search of periodical literature by the author involvingsocial marketing and marketing concepts in health wascarried out. Items were identified initially through healthorientedindexing services such as Medline, Health STARand Cinahl, using the identifiers “social marketing“ and“marketing in health”. An extensive search was also carriedout on educational database ERIC.ResultsA literature review of various studies on social marketingindicated that the selection of the right product (accordingto the community need at the right place, with the rightstrategy for promotion and at the right price yields goodresults. However, along with technical sustainability(product, price, promotion and place, financialsustainability, institutional sustainability and marketsustainability are conducive factors for the success of socialmarketing.ConclusionThe purpose of this literature review was to ascertain thelikely effectiveness of social marketing principles andapproaches and behaviour change communication towardshealth promotion.It is important for all healthcare workers to understand andrespond to the public’s desires and needs and routinely useconsumer research to determine how best to help thepublic to solve problems and realise aspirations. Socialmarketing can optimise public health by facilitatingrelationship-building with consumers and making their liveshealthier.

Institutional delivery in India, 2004-14: unravelling the equity-enhancing contributions of the public sector.

Science.gov (United States)

Joe, William; Perkins, Jessica M; Kumar, Saroj; Rajpal, Sunil; Subramanian, S V

2018-06-01

To achieve faster and equitable improvements in maternal and child health outcomes, the government of India launched the National Rural Health Mission in 2005. This paper describes the equity-enhancing role of the public sector in increasing use of institutional delivery care services in India between 2004 and 2014. Information on 24 661 births from nationally representative survey data for 2004 and 2014 is analysed. Concentration index is computed to describe socioeconomic-rank-related relative inequalities in institutional delivery and decomposition is used to assess the contributions of public and private sectors in overall socioeconomic inequality. Multilevel logistic regression is applied to examine the changes in socioeconomic gradient between 2004 and 2014. The analysis finds that utilization of institutional delivery care in India increased from 43% in 2004 to 83% in 2014. The bulk of the increase was in public sector use (21% in 2004 to 53% in 2014) with a modest increase in private sector use (22% in 2004 to 30% in 2014). The shift from a pro-rich to pro-poor distribution of public sector use is confirmed. Decomposition analysis indicates that 51% of these reductions in socioeconomic inequality are associated with improved pro-poor distribution of public sector births. Multilevel logistic regressions confirm the disappearance of a wealth-based gradient in public sector births between 2004 and 2014. We conclude that public health investments in India have significantly contributed towards an equitable increase in the coverage of institutional delivery care. Sustained policy efforts are necessary, however, with an emphasis on education, sociocultural and geographical factors to ensure universal coverage of institutional delivery care services in India.

Coproduction of healthcare service.

Science.gov (United States)

Batalden, Maren; Batalden, Paul; Margolis, Peter; Seid, Michael; Armstrong, Gail; Opipari-Arrigan, Lisa; Hartung, Hans

2016-07-01

Efforts to ensure effective participation of patients in healthcare are called by many names-patient centredness, patient engagement, patient experience. Improvement initiatives in this domain often resemble the efforts of manufacturers to engage consumers in designing and marketing products. Services, however, are fundamentally different than products; unlike goods, services are always 'coproduced'. Failure to recognise this unique character of a service and its implications may limit our success in partnering with patients to improve health care. We trace a partial history of the coproduction concept, present a model of healthcare service coproduction and explore its application as a design principle in three healthcare service delivery innovations. We use the principle to examine the roles, relationships and aims of this interdependent work. We explore the principle's implications and challenges for health professional development, for service delivery system design and for understanding and measuring benefit in healthcare services. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

The CRACK programme: a scientific alliance for bridging healthcare research and public health policies in Italy

Directory of Open Access Journals (Sweden)

Giovanni Corrao

2013-09-01

Full Text Available Healthcare utilisation databases, and other secondary data sources, have been used with growing frequency to assess health outcomes and healthcare interventions worldwide. Their increased popularity as a research tool is due to their timely availability, the large patient populations covered, low cost, and applicability for studying real-world clinical practice. Despite the need to measure Italian National Health Service performance both at regional and national levels, the wealth of good quality electronic data and the high standards of scientific research in this field, healthcare research and public health policies seem to progress along orthogonal dimensions in Italy. The main barriers to the development of evidence-based public health include the lack of understanding of evidence-based methodologies by policy makers, and of involvement of researchers in the policy process. The CRACK programme was launched by some academics from the Lombardy Region. By extensively using electronically stored data, epidemiologists, biostatisticians, pharmacologists and clinicians applied methods and evidence to several issues of healthcare research. The CRACK programme was based on their intention to remove barriers that thwart the process of bridging methods and findings from scientific journals to public health practice. This paper briefly describes aim, articulation and management of the CRACK programme, and discusses why it might find articulated application in Italy.

The Healthcare and Public Health Sector Challenges and Strategies to Conducting Sector Wide Assessments

OpenAIRE

Meyer, Harry

2008-01-01

Our Healthcare and Public Health (HPH) sector is vast, complex and essential to virtually all other sectors of our nation’s infrastructure. Without a healthy workforce modern society quickly grinds to a halt. The often messy networks of healthcare providers, insurance companies, emergency departments, pharmaceutical manufactures and other equally important actors are bound together in fragile alliances to maintain and restore basic health. Thus the HPH sector becomes an important cog in the w...

Healthcare service delivery: a literature review

CSIR Research Space (South Africa)

Arhete, LE

2016-05-01

Full Text Available African government is in the process of implementing a multibillion rand national health insurance (NHI) programme intended to revamp the entire national health system to among others, ensure affordability and accessibility to healthcare. The purpose...

Concepts and trends in healthcare information systems

CERN Document Server

Koutsouris, Dionysios-Dimitrios

2014-01-01

​Concepts and Trends in Healthcare Information Systems covers the latest research topics in the field from leading researchers and practitioners. This book offers theory-driven research that explores the role of Information Systems in the delivery of healthcare in its diverse organizational and regulatory settings. In addition to the embedded role of Information Technology (IT) in clinical and diagnostics equipment, Information Systems are uniquely positioned to capture, store, process, and communicate timely information to decision makers for better coordination of healthcare at both the individual and population levels. For example, data mining and decision support capabilities can identify potential adverse events for an individual patient while also contributing to the population's health by providing insights into the causes of disease complications. Information systems have great potential to reduce healthcare costs and improve outcomes. The healthcare delivery systems share similar characteristics w...

Forging a Frailty-Ready Healthcare System to Meet Population Ageing.

Science.gov (United States)

Lim, Wee Shiong; Wong, Sweet Fun; Leong, Ian; Choo, Philip; Pang, Weng Sun

2017-11-24

The beginning of the 21st century has seen health systems worldwide struggling to deliver quality healthcare amidst challenges posed by ageing populations. The increasing prevalence of frailty with older age and accompanying complexities in physical, cognitive, social and psychological dimensions renders the present modus operandi of fragmented, facility-centric, doctor-based, and illness-centered care delivery as clearly unsustainable. In line with the public health framework for action in the World Health Organization's World Health and Ageing Report, meeting these challenges will require a systemic reform of healthcare delivery that is integrated, patient-centric, team-based, and health-centered. These reforms can be achieved through building partnerships and relationships that engage, empower, and activate patients and their support systems. To meet the challenges of population ageing, Singapore has reorganised its public healthcare into regional healthcare systems (RHSs) aimed at improving population health and the experience of care, and reducing costs. This paper will describe initiatives within the RHS frameworks of the National Health Group (NHG) and the Alexandra Health System (AHS) to forge a frailty-ready healthcare system across the spectrum, which includes the well healthy ("living well"), the well unhealthy ("living with illness"), the unwell unhealthy ("living with frailty"), and the end-of-life (EoL) ("dying well"). For instance, the AHS has adopted a community-centered population health management strategy in older housing estates such as Yishun to build a geographically-based care ecosystem to support the self-management of chronic disease through projects such as "wellness kampungs" and "share-a-pot". A joint initiative by the Lien Foundation and Khoo Teck Puat Hospital aims to launch dementia-friendly communities across the island by building a network comprising community partners, businesses, and members of the public. At the National

Fiscal Decentralization and Delivery of Public Services: Evidence from Education Sector in Pakistan

Directory of Open Access Journals (Sweden)

Rauf Abdur

2017-04-01

Full Text Available Fiscal Decentralization is the devolution of fiscal assignments to lower governments for high growth and better delivery of public services. The current study covering the period from 1972 to 2009 is an attempt to find out the impacts of fiscal decentralization on public services deliveries in Pakistan. Public services are proxy by Gross enrollment at primary school level while fiscal decentralization by fiscal transfer and expenditure sides of devolution. Using time series data, it is found that the individual impacts of fiscal transfer are although insignificant but still support the theoretical proposition regarding fiscal decentralization and public services relationship while delegation of expenditure responsibilities helps in improving the gross enrollment at primary school level. Furthermore the study evident that complete delegation of fiscal responsibilities to lower governments enhance enrollment ratio in Pakistan.

Contribution of Sudanese medical diaspora to the healthcare delivery system in Sudan: exploring options and barriers.

Science.gov (United States)

Abdalla, Fayrouz Mohammed; Omar, Maye Abu; Badr, Elsheikh Elsiddig

2016-06-30

Medical diaspora options, including the engagement of expatriate physicians in development efforts within their home country, are being called for to reverse the effects of brain drain from developing countries. This paper presents the results of a study exploring the potential contributions for the Sudanese Medial Diaspora Options to the healthcare delivery system (HCDS) in Sudan, focusing on the options of temporal and permanent returns and the likely obstacles faced in their implementation. This was a cross-sectional study using a mixed methods design including quantitative and qualitative approaches. For the quantitative approach, the study, which focused on the possible contribution of the diaspora to healthcare delivery in Sudan, was based on an online survey using random purposive and snowballing sampling techniques involving 153 Sudanese physicians working in Saudi Arabia and other Gulf States, the United Kingdom, the Republic of Ireland, and the United States of America. The qualitative approach involved in-depth interviews with returnee physicians and key informants in Sudan, focusing on the return experiences, the barriers for return, and the options to improve future contributions. Despite contributions of the Sudanese medical diaspora being of a small scale considering the size of the phenomenon, as well as infrequent and not appropriately organized, their inputs to academia and the links built with overseas institutions and specialist clinical services were nevertheless remarkable. The main barrier to temporal return was inappropriate organization by the local counterparts, while those for permanent return of physicians were poor work environment, insufficient financial payment, unsecured accommodation, and offspring education. The study identified short-term return as a feasible option considering the country's current conditions. Proper coordination mechanisms for short-term returns and facilitation of permanent return through stakeholders

Latest developments in innovative manufacturing to combine nanotechnology with healthcare

OpenAIRE

Parhizkar, M.; Mahalingam, S.; Homer-Vanniasinkam, S.; Edirisinghe, M.

2017-01-01

Nanotechnology has become increasingly important in advancing the frontiers of many key areas of healthcare, for example, drug delivery and tissue engineering. To fully harness the many benefits of nanotechnology in healthcare, innovative manufacturing is necessary to mass produce nanoparticles and nanofibers, the two major types of nanofeatures currently sought after and of immense utilitarian value in healthcare. For example, nanoparticles are a key drug delivery enabler, the structural and...

The future of UK healthcare: problems and potential solutions to a system in crisis.

Science.gov (United States)

Montgomery, H E; Haines, A; Marlow, N; Pearson, G; Mythen, M G; Grocott, M P W; Swanton, C

2017-08-01

The UK's Health System is in crisis, central funding no longer keeping pace with demand. Traditional responses-spending more, seeking efficiency savings or invoking market forces-are not solutions. The health of our nation demands urgent delivery of a radical new model, negotiated openly between public, policymakers and healthcare professionals. Such a model could focus on disease prevention, modifying health behaviour and implementing change in public policy in fields traditionally considered unrelated to health such as transport, food and advertising. The true cost-effectiveness of healthcare interventions must be balanced against the opportunity cost of their implementation, bolstering the central role of NICE in such decisions. Without such action, the prognosis for our healthcare system-and for the health of the individuals it serves-may be poor. Here, we explore such a new prescription for our national health. © The Author 2017. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

[Ophthalmological service quality offered to outpatients of the Public Healthcare System].

Science.gov (United States)

Santos Hercos, Benigno Vicente; Berezovsky, Adriana

2006-01-01

To identify the perception of the ophthalmic service quality provided for outpatients of the public healthcare system as well as to detect which actions should be considered necessary and priority in order to improve its quality. A quantitative descriptive study was carried out on 100 outpatients of the public healthcare system which were submitted to ophthalmic tests at Fundação Hilton Rocha--Belo Horizonte-MG, from July 1st-July 30th 2004. Individual interviews were carried out by giving the interviewees two structured questionnaires adapted from the modified SERVQUAL. This scale is in agreement with the reality of the studied institute. The adapted SERVQUAL scale was submitted to statistical validation and it showed a suitable internal consistency index. In general terms, a slight general dissatisfaction was detected regarding ophthalmological service quality. The interviewees cared more about safety and reliability. A higher degree of dissatisfaction was detected mainly concerning fulfillment of procedures at scheduled appointments related to the execution of services within due time-limits. The institute is supposed to plan as well as carry out actions which lead to a general improvement in the patient's satisfaction regarding service quality and mainly reliability. Service quality monitoring through periodic use of the SERVQUAL scale will not only make it possible to plan highly precise and effective intervention strategies in these and in other healthcare services but it will also allow monitoring the responses to these actions. All these actions will contribute to the improvement of the service in the system as a whole.

Control costs, enhance quality, and increase revenue in three top general public hospitals in Beijing, China.

Directory of Open Access Journals (Sweden)

Lue-Ping Zhao

Full Text Available BACKGROUND: With market-oriented economic and health-care reform, public hospitals in China have received unprecedented pressures from governmental regulations, public opinions, and financial demands. To adapt the changing environment and keep pace of modernizing healthcare delivery system, public hospitals in China are expanding clinical services and improving delivery efficiency, while controlling costs. Recent experiences are valuable lessons for guiding future healthcare reform. Here we carefully study three teaching hospitals, to exemplify their experiences during this period. METHODS: We performed a systematic analysis on hospitalization costs, health-care quality and delivery efficiencies from 2006 to 2010 in three teaching hospitals in Beijing, China. The analysis measured temporal changes of inpatient cost per stay (CPS, cost per day (CPD, inpatient mortality rate (IMR, and length of stay (LOS, using a generalized additive model. FINDINGS: There were 651,559 hospitalizations during the period analyzed. Averaged CPS was stable over time, while averaged CPD steadily increased by 41.7% (P<0.001, from CNY 1,531 in 2006 to CNY 2,169 in 2010. The increasing CPD seemed synchronous with the steady rising of the national annual income per capita. Surgical cost was the main contributor to the temporal change of CPD, while medicine and examination costs tended to be stable over time. From 2006 and 2010, IMR decreased by 36%, while LOS reduced by 25%. Increasing hospitalizations with higher costs, along with an overall stable CPS, reduced IMR, and shorter LOS, appear to be the major characteristics of these three hospitals at present. INTERPRETATIONS: These three teaching hospitals have gained some success in controlling costs, improving cares, adopting modern medical technologies, and increasing hospital revenues. Effective hospital governance and physicians' professional capacity plus government regulations and supervisions may have played a role

Assessment of patient safety culture in private and public hospitals in Peru.

Science.gov (United States)

Arrieta, Alejandro; Suárez, Gabriela; Hakim, Galed

2018-04-01

To assess the patient safety culture in Peruvian hospitals from the perspective of healthcare professionals, and to test for differences between the private and public healthcare sectors. Patient safety is defined as the avoidance and prevention of patient injuries or adverse events resulting from the processes of healthcare delivery. A non-random cross-sectional study conducted online. An online survey was administered from July to August 2016, in Peru. This study reports results from Lima and Callao, which are the capital and the port region of Peru. A total of 1679 healthcare professionals completed the survey. Participants were physicians, medical residents and nurses working in healthcare facilities from the private sector and public sector. Assessment of the degree of patient safety and 12 dimensions of patient safety culture in hospital units as perceived by healthcare professionals. Only 18% of healthcare professionals assess the degree of patient safety in their unit of work as excellent or very good. Significant differences are observed between the patient safety grades in the private sector (37%) compared to the public sub-sectors (13-15%). Moreover, in all patient safety culture dimensions, healthcare professionals from the private sector give more favorable responses for patient safety, than those from the public sub-systems. The most significant difference in support comes from patient safety administrators through communication and information about errors. Overall, the degree of patient safety in Peru is low, with significant gaps that exist between the private and the public sectors.

Public engagement in setting healthcare priorities: a ranking exercise in Cyprus.

Science.gov (United States)

Farmakas, Antonis; Theodorou, Mamas; Galanis, Petros; Karayiannis, Georgios; Ghobrial, Stefanos; Polyzos, Nikos; Papastavrou, Evridiki; Agapidaki, Eirini; Souliotis, Kyriakos

2017-01-01

In countries such as Cyprus the financial crisis and the recession have severely affected the funding and priority setting of the health care system. There is evidence highlighting the importance of population' preferences in designing priorities for health care settings. Although public preferences have been thorough analysed in many countries, there is a research gap in terms of simultaneously investigating the relative importance and the weight of differing and competing criteria for determining healthcare priority settings. The main objective of the study was tο investigate public preferences for the relative utility and weight of differing and competing criteria for health care priority setting in Cyprus. The 'conjoint analysis' technique was applied to develop a ranking exercise. The aim of the study was to identify the preferences of the participants for alternative options. Participants were asked to grade in a priority order 16 hypothetical case scenarios of patients with different disease and of diverse socio-economic characteristics awaiting treatment. The sample was purposive and consisted of 100 Cypriots, selected from public locations all over the country. It was revealed that the "severity of the disease" and the " age of the patient" were the key prioritization criteria. Participants assigned the smallest relative value to the criterion " healthy lifestyle" . More precisely, participants older than 35 years old assigned higher relative importance to " age" , while younger participants to the " severity of the disease". The " healthy lifestyle" criterion was assigned to the lowest relative importance to by all participants. In Cyprus, public participation in health care priority setting is almost inexistent. Nonetheless, it seems that the public's participation in this process could lead to a wider acceptance of the healthcare system especially as a result of the financial crisis and the upcoming reforms implemented such as the establishment of the

The construction of a public key infrastructure for healthcare information networks in Japan.

Science.gov (United States)

Sakamoto, N

2001-01-01

The digital signature is a key technology in the forthcoming Internet society for electronic healthcare as well as for electronic commerce. Efficient exchanges of authorized information with a digital signature in healthcare information networks require a construction of a public key infrastructure (PKI). In order to introduce a PKI to healthcare information networks in Japan, we proposed a development of a user authentication system based on a PKI for user management, user authentication and privilege management of healthcare information systems. In this paper, we describe the design of the user authentication system and its implementation. The user authentication system provides a certification authority service and a privilege management service while it is comprised of a user authentication client and user authentication serves. It is designed on a basis of an X.509 PKI and is implemented with using OpenSSL and OpenLDAP. It was incorporated into the financial information management system for the national university hospitals and has been successfully working for about one year. The hospitals plan to use it as a user authentication method for their whole healthcare information systems. One implementation of the system is free to the national university hospitals with permission of the Japanese Ministry of Education, Culture, Sports, Science and Technology. Another implementation is open to the other healthcare institutes by support of the Medical Information System Development Center (MEDIS-DC). We are moving forward to a nation-wide construction of a PKI for healthcare information networks based on it.

Depression and diabetes: Treatment and health-care delivery

DEFF Research Database (Denmark)

Petrak, Frank; Baumeister, Harald; Skinner, Timothy C.

2015-01-01

© 2015 Elsevier Ltd. Despite research efforts in the past 20 years, scientific evidence about screening and treatment for depression in diabetes remains incomplete and is mostly focused on North American and European health-care systems. Validated instruments to detect depression in diabetes......, which are often implemented through collaborative care and stepped-care approaches. The evidence for improved glycaemic control in the treatment of depression by use of selective serotonin reuptake inhibitors or psychological approaches is conflicting; only some analyses show small to moderate...... improvements in glycaemic control. More research is needed to evaluate treatment of different depression subtypes in people with diabetes, the cost-effectiveness of treatments, the use of health-care resources, the need to account for cultural differences and different health-care systems, and new treatment...

Delivery of public services in ethnic minority states: Gender equality ...

International Development Research Centre (IDRC) Digital Library (Canada)

Delivery of public services in ethnic minority states: Gender equality and decentralization in Myanmar. In 2017, to sustain Myanmar's democratic transition, IDRC and Global Affairs Canada ... and staff from the University of Toronto's Munk School of Global Affairs (Asia ... Ideas from the global climate change hotspot research.

Redefining continuing education delivery.

Science.gov (United States)

Carlton, K H

1997-01-01

Just as technology is transforming the delivery of education, the Internet and advanced telecommunication applications are changing the "face" of CE and the connotation of "lifelong learning." As late as the mid-1980s, a discussion of computer applications in nursing CE focused on the "timely" transition to microcomputers as tools for the enhancement of managerial tasks for increased productivity. Even as recently as 1990, there seemed to be "time" for those providers who were "slower to adopt innovation" to "catch up." Now, the CE provider who does not integrate the microcomputer and advanced telecommunications as an integral component of their delivery modalities may be outsourced rapidly by an educational or commercial competitive unit that is able to utilize the communication medium, mergers and partnerships, enterprise, and individual lifestyle and learning patterns that will epitomize the CE unit of the 21st century. As with the "re-engineering" of nursing education, the "re-engineered" delivery modalities of evolving CE entity might now best be conceptualized on a continuum from the traditional mode that time and place dependent to a mode of synchronous and asynchronous data and advanced telecommunication. Delivery methods will need to be selected according to the target populations, content, and situation. The health-care educational provider may discover, as in other industries, that a combination of distance and residential offerings will be the most successful medium for the delivery of CE to the progressively more "information and technologically savvy" lifelong learner of the 21st century. In addressing the dramatic effects of the information technology era on the refocused multimedia/interactive delivery method for student education, educators amply quoted Bob Dylan's phrase of the 1960s, "The times, they are a-changing." And so, we see that the times are also changing at an astronomical rate for the health-care educational provider as well as the

Measurement and evaluation of the public administration performance through delivery of electronic services

Directory of Open Access Journals (Sweden)

Mirlinda Batalli

2015-07-01

Full Text Available The purpose of this paper concerns the relation between delivery of electronic services (e-services and evaluation of public administration performance. Public sector organizations should pay attention and determine the strategies to be followed in order to increase the satisfaction of citizens and businesses in relation to delivery of electronic services. The study aims to review the demands toward progress to the competitiveness, the sustainability, efficiency and effectives in public administration that have rapidly enforced the wide reforms in the public sector, in order to modernize the initiatives to offer better electronic services for the citizens. The article aims to present that the transformation process toward providing electronic services to the citizens should be assessed continuously, in light with challenges, demands and process of globalization, in order to strengthen the capacities of public administration and make it more efficient. In this regard, the regular evaluation and measurement of the public administration performance leads toward the promotion of enhanced public services and higher level of accountability. Through receiving the e-services, citizens can save their time, can reduce the expenses and create an easier access of communication with all levels of the government.

Public and Healthcare Professionals’ Knowledge and Attitudes toward Binge Eating Disorder: A Narrative Review

Science.gov (United States)

Reas, Deborah Lynn

2017-01-01

Binge eating disorder (BED) is characterized by recurrent binge eating and marked distress in the absence of inappropriate compensatory behaviors for weight control. BED is prevalent in men and women, is associated with elevated psychosocial and functional impairment, and is associated strongly with obesity and related medical comorbidities. The aim is to provide a brief, state-of-the-art review of the major and recent findings to inform educational and awareness campaigns, stigma reduction interventions, as well as current clinical practice and future research. A narrative approach was used to synthesize emerging literature on the public and healthcare professionals’ knowledge and attitudes toward individuals with BED in comparison to other eating disorders (EDs) or mental illness. A total of 13 articles were reviewed. Nine studies investigated community samples and four studies investigated healthcare professionals. The reviewed literature suggested that BED is perceived by the public as less impairing, less severe, and “easier-to-treat” than other EDs. Attitudes and beliefs reflecting perceived blameworthiness and lack of self-discipline were ascribed to vignettes with BED. Community studies indicated a low level of public awareness that BED constitutes a discreet eating disorder. The literature on healthcare professionals’ knowledge and attitudes toward BED remains very limited. The few existing studies suggest encouraging trends in recognition and diagnostic accuracy, yet there remains a need for increased clinical awareness of BED-associated medical complications and knowledge of full BED diagnostic criteria. PMID:29160843

Public and Healthcare Professionals’ Knowledge and Attitudes toward Binge Eating Disorder: A Narrative Review

Directory of Open Access Journals (Sweden)

Deborah Lynn Reas

2017-11-01

Full Text Available Binge eating disorder (BED is characterized by recurrent binge eating and marked distress in the absence of inappropriate compensatory behaviors for weight control. BED is prevalent in men and women, is associated with elevated psychosocial and functional impairment, and is associated strongly with obesity and related medical comorbidities. The aim is to provide a brief, state-of-the-art review of the major and recent findings to inform educational and awareness campaigns, stigma reduction interventions, as well as current clinical practice and future research. A narrative approach was used to synthesize emerging literature on the public and healthcare professionals’ knowledge and attitudes toward individuals with BED in comparison to other eating disorders (EDs or mental illness. A total of 13 articles were reviewed. Nine studies investigated community samples and four studies investigated healthcare professionals. The reviewed literature suggested that BED is perceived by the public as less impairing, less severe, and “easier-to-treat” than other EDs. Attitudes and beliefs reflecting perceived blameworthiness and lack of self-discipline were ascribed to vignettes with BED. Community studies indicated a low level of public awareness that BED constitutes a discreet eating disorder. The literature on healthcare professionals’ knowledge and attitudes toward BED remains very limited. The few existing studies suggest encouraging trends in recognition and diagnostic accuracy, yet there remains a need for increased clinical awareness of BED-associated medical complications and knowledge of full BED diagnostic criteria.

Household coping strategies for delivery and related healthcare cost: findings from rural Bangladesh.

Science.gov (United States)

Hoque, Mohammad Enamul; Dasgupta, Sushil Kanta; Naznin, Eva; Al Mamun, Abdullah

2015-10-01

This study aims to measure the economic costs of maternal complication and to understand household coping strategies for financing maternal healthcare cost. A household survey of the 706 women with maternal complication, of whom 483 had normal delivery, was conducted to collect data at 6 weeks and 6 months post-partum. Data were collected on socio-economic information of the household, expenditure during delivery and post-partum, coping strategies adopted by households and other related information. Despite the high cost of health care associated with maternal complications, the majority of families were capable of protecting consumption on non-health items. Around one-third of households spent more than 20% of their annual household expenditure on maternal health care. Almost 50% were able to avoid catastrophic spending because of the coping strategies that they relied on. In general, households appeared resilient to short-term economic consequences of maternal health shocks, due to the availability of informal credit, donations from relatives and selling assets. While richer households fund a greater portion of the cost of maternal health care from income and savings, the poorer households with severe maternal complication resorted to borrowing from local moneylenders at high interest, which may leave them vulnerable to financial difficulties. Financial protection, especially for the poor, may benefit households against economic consequences of maternal complication. © 2015 John Wiley & Sons Ltd.

The Learning Healthcare System: Where are we now? A systematic review.

Science.gov (United States)

Budrionis, Andrius; Bellika, Johan Gustav

2016-12-01

The Learning Healthcare System paradigm has attracted the attention of researchers worldwide. The great potential originating from high-scale health data reuse and the inclusion of patient perspectives into care models promises personalized care, lower costs of health services and minimized consumption of resources. The aim of this review is to summarize the attempts to adopt the novel paradigm, putting emphasis on implementations and evaluating the impact on current medical practices. PRISMA methodology was followed for structuring the review process. Three major research databases (PubMed, IEEE Xplore and ACM DL) were queried with the predefined search terms "learning healthcare" and "learning health". Publications containing specific theoretical or empirical results were considered. Three hundred and fifty-eight publications were identified; however, only 32 met the inclusion criteria. Nineteen papers were characterized as theoretical contributions, while the rest presented empirical achievements. Only one paper described the initial estimates of impact and economy. Individualistic communication of studies ignoring popular frameworks for assessing and reporting research achievements prevents the systematic generation of knowledge. Evaluating the impact of the Learning Healthcare System instances where it is implemented could work as a catalyst in reaching higher acceptance and adoption of the proposed ideas by healthcare worldwide; however, it mostly remains described in theory. The review demonstrated the interest of researchers in exploring the Learning Healthcare System ideas. However, it also revealed minimal focus on evaluating the impact of the novel paradigm on both healthcare service delivery and patient outcome. Copyright © 2016 Elsevier Inc. All rights reserved.

The role of information and communication technology in the transformation of the healthcare business model: a case study of Slovenia.

Science.gov (United States)

Stanimirovic, Dalibor; Vintar, Mirko

The Slovenian healthcare business model (BM) has largely failed to integrate information and communication technologies (ICT) into its operational context, instead maintaining its rigid structure and traditional 'way of doing business'wo managers of public clinics). Findings present a roadmap for the redefinition of BM elements and the transformation of the Slovenian healthcare BM. It includes the specific reconfiguration of BM actors and their interactions, and the application of advanced ICT solutions, which could facilitate more effective utilisation of healthcare resources and promote an improved delivery of healthcare services and products. The presented development approach and derived conceptual solution could be transferable to other countries with similar socio-economic characteristics and comparable healthcare systems, subject to certain adjustments and inclusion of national specifics.

Cesarean deliveries and maternal weight retention.

Science.gov (United States)

Kapinos, Kandice A; Yakusheva, Olga; Weiss, Marianne

2017-10-04

Cesarean delivery accounts for nearly one-third of all births in the U.S. and contributes to an additional $38 billion in healthcare costs each year. Although Cesarean delivery has a long record of improving maternal and neonatal mortality and morbidity, increased utilization over time has yielded public health concerns and calls for reductions. Observational evidence suggests Cesarean delivery is associated with increased maternal postpartum weight, which may have significant implications for the obesity epidemic. Previous literature, however, typically does not address selection biases stemming from correlations of pre-pregnancy weight and reproductive health with Cesarean delivery. We used fetal malpresentation as a natural experiment as it predicts Cesarean delivery but is uncorrelated with pre-pregnancy weight or maternal health. We used hospital administrative data (including fields used in vital birth record) from the state of Wisconsin from 2006 to 2013 to create a sample of mothers with at least two births. Using propensity score methods, we compared maternal weight prior to the second pregnancy of mothers who delivered via Cesarean due to fetal malpresentation to mothers who deliver vaginally. We found no evidence that Cesarean delivery in the first pregnancy causally leads to greater maternal weight, BMI, or movement to a higher BMI classification prior to the second pregnancy. After accounting for correlations between pre-pregnancy weight, gestational weight gain, and mode of delivery, there is no evidence of a causal link between Cesarean delivery and maternal weight retention.

Preference of Chinese general public and healthcare providers for a good death.

Science.gov (United States)

Haishan, Huang; Hongjuan, Liu; Tieying, Zeng; Xuemei, Pu

2015-03-01

The aim of this study is to find and compare the current situation between common people and healthcare providers' preferences for a good death in the context of Chinese culture. A cross-sectional anonymous questionnaire survey covering 190 ordinary Chinese people and 323 healthcare providers was conducted. An inventory of the good death was translated and the subjects were surveyed about their attitude toward it. Permission to conduct the study was granted by department chiefs, nurse managers and the participants themselves. The participants were informed that they took part on a voluntary and anonymous basis, that they could withdraw at any time, that they had the right to ignore questions they did not wish to answer, and that whatever they chose to do would not jeopardize their employment conditions. The attributes that were perceived as important by major respondents for a good death were maintaining hope and pleasure, good relationship with medical staff, good relationship with family, independence, environment comfort, being respected as an individual, preparation for death, physical and psychological comfort, dying in a favorite place, and not being a burden to others. And some relatively less important characteristics were life completion, receiving enough treatment, natural death, controlling over the future, unawareness of death, pride and beauty, feeling that one's life is worth living, and religious and spiritual comfort. We also found that healthcare providers were more likely than general out-patients to perceive "physical and psychological comfort," "dying in a favorite place," "good relationship with medical staff," and "natural death" as important for a good death. This study offers healthcare providers in China a fundamental understanding of the normal expectations of the general public for a good death. It is believed that these findings in our study are valuable to improve palliative care in China. We compared the attitudes of Chinese and

Migration of women from the Philippines: implications for healthcare delivery.

Science.gov (United States)

Tejero, Lourdes Marie S; Fowler, Cathrine

2012-01-01

Filipinos have been an important part of the global workforce since the first half of the twentieth century. The initial migration of primarily men has shifted to an increasing numbers of women in recent decades. These changes are primarily attributed to a high demand for domestic workers, nurses and occupations that are female dominated. In 2005, about 70% of the international Labour migrants are women from the Philippines. Living in a foreign land, these women face challenges that affect their physical, emotional and social well being. Especially on their first year living abroad, these women experience significant stress which affects their health as they adjust to a new work environment, culture, social norms, diet, and weather. The emotional strain can be greater for those who have left their families behind in the Philippines and aggravated by the financial need to send money to them. Striking examples, such as the homicide rate of Filipino women married to Australian men being 5.6 times higher than that of Australian-born women, underscores the importance of supportive health care environments and appreciating socio-cultural factors. In the delivery of healthcare services to migrant women, it is critical to consider the unique socio-cultural background of women as well as health beliefs and practices.

Cognitive overload and communication in two healthcare settings.

Science.gov (United States)

Cicourel, Aaron V

2004-01-01

The confluence of organizational social interaction and cognitive information processing constraints create 'noisy' conditions in institutionalized settings. Attentional and memory limitations always influence the ability of participants to comprehend each other's communication. Two organizational settings (a medical specialty clinic and periodontal office) will be used to explore a few features of healthcare delivery that are often ignored in studies of such systems. Scheduling appointments, for example, creates stress for both patients and healthcare personnel but is often an unexamined aspect of healthcare delivery that has become both challenging and often irritating for all concerned. For example, when patients call, someone at a general scheduling center or the particular clinic or office of an individual physician or dentist or a group practice will answer the call with a menu of options, or the caller may be asked to leave message. When a patient leaves a clinic or surgery office after a visit, they may be allowed to make a new appointment. The term 'cognitive overload' is a ubiquitous element of all healthcare systems and refers to organizationally induced and constrained limited capacity processing inherent in the way improvised discourse practices, and annotative devices or artifacts (such as written notes or some related strategy) become an integral part of everyday healthcare delivery.

An Interoperable Security Framework for Connected Healthcare

NARCIS (Netherlands)

Asim, M.; Petkovic, M.; Qu, M.; Wang, C.

2011-01-01

Connected and interoperable healthcare system promises to reduce thecost of the healthcare delivery, increase its efficiency and enableconsumers to better engage with clinicians and manage their care. However at the same time it introduces new risks towards security andprivacy of personal health

Enhancing the nurses' role in healthcare delivery through strategic management: recognizing its importance or not?

Science.gov (United States)

Carney, Marie

2009-09-01

To determine the importance of strategy in nursing management and to establish if strategic management has entered the lexicon of nurses' vocabulary. Developing and managing strategy is a critical success factor for health care managers. It remains unclear if nurse managers view strategy development as their role. A review of scholarly International nursing and management literature, available through CINAHL and PUBMED Data Bases was undertaken. The titles of 1063 articles, published between 1997 and 2007 were examined in order to determine the profile of strategy in those titles. Documentary analysis was undertaken on a random sample of 250 of those articles and on the full text of a further 100. Less than 10% of journal titles contained the word strategy. What was presented as strategy was in the majority of cases describing policy, administration or management. Little formal strategy theory was evident. The nursing profession does not appear to have adopted the terms strategy or strategic management to any great extent. Nurse Managers could play a greater role in enhancing healthcare delivery if an understanding of, and acceptance of the importance of strategy in health care delivery was promoted.

Managing today's complex healthcare business enterprise: reflections on distinctive requirements of healthcare management education.

Science.gov (United States)

Welton, William E

2004-01-01

In early 2001, the community of educational programs offering master's-level education in healthcare management began an odyssey to modernize its approach to the organization and delivery of healthcare management education. The community recognized that cumulative long-term changes within healthcare management practice required a careful examination of healthcare management context and manpower requirements. This article suggests an evidence-based rationale for defining the distinctive elements of healthcare management, thus suggesting a basis for review and transformation of master's-level healthcare management curricula. It also suggests ways to modernize these curricula in a manner that recognizes the distinctiveness of the healthcare business enterprise as well as the changing management roles and careers within these complex organizations and systems. Through such efforts, the healthcare management master's-level education community would be better prepared to meet current and future challenges, to increase its relevance to the management practice community, and to allocate scarce faculty and program resources more effectively.

Big Data Analytics in Healthcare.

Science.gov (United States)

Belle, Ashwin; Thiagarajan, Raghuram; Soroushmehr, S M Reza; Navidi, Fatemeh; Beard, Daniel A; Najarian, Kayvan

2015-01-01

The rapidly expanding field of big data analytics has started to play a pivotal role in the evolution of healthcare practices and research. It has provided tools to accumulate, manage, analyze, and assimilate large volumes of disparate, structured, and unstructured data produced by current healthcare systems. Big data analytics has been recently applied towards aiding the process of care delivery and disease exploration. However, the adoption rate and research development in this space is still hindered by some fundamental problems inherent within the big data paradigm. In this paper, we discuss some of these major challenges with a focus on three upcoming and promising areas of medical research: image, signal, and genomics based analytics. Recent research which targets utilization of large volumes of medical data while combining multimodal data from disparate sources is discussed. Potential areas of research within this field which have the ability to provide meaningful impact on healthcare delivery are also examined.

An interoperable security framework for connected healthcare

NARCIS (Netherlands)

Asim, M.; Petkovic, M.; Qu, M.; Wang, Changjie

2011-01-01

Connected and interoperable healthcare system promises to reduce the cost of healthcare delivery, increase its efficiency and enable consumers to better engage with clinicians and manage their care. However at the same time it introduces new risks towards security and privacy of personal health

An intelligent tele-healthcare environment offering person-centric and wellness-maintenance services.

Science.gov (United States)

Abidi, S S

2001-06-01

Worldwide healthcare delivery trends are undergoing a subtle paradigm shift--patient centered services as opposed to provider centered services and wellness maintenance as opposed to illness management. In this paper we present a Tele-Healthcare project TIDE--Tele-Healthcare Information and Diagnostic Environment. TIDE manifests an 'intelligent' healthcare environment that aims to ensure lifelong coverage of person-specific health maintenance decision-support services--i.e., both wellness maintenance and illness management services--ubiquitously available via the Internet/WWW. Taking on an all-encompassing health maintenance role--spanning from wellness to illness issues--the functionality of TIDE involves the generation and delivery of (a) Personalized, Pro-active, Persistent, Perpetual, and Present wellness maintenance services, and (b) remote diagnostic services for managing noncritical illnesses. Technically, TIDE is an amalgamation of diverse computer technologies--Artificial Intelligence, Internet, Multimedia, Databases, and Medical Informatics--to implement a sophisticated healthcare delivery infostructure.

Leveraging Digital Innovation in Healthcare

DEFF Research Database (Denmark)

Brown, Carol V.; Jensen, Tina Blegind; Aanestad, Margun

2014-01-01

Harnessing digital innovations for healthcare delivery has raised high expectations as well as major concerns. Several countries across the globe have made progress in achieving three common goals of lower costs, higher quality, and increased patient access to healthcare services through...... investments in digital infrastructures. New technologies are leveraged to achieve widespread 24x7 disease management, patients’ wellbeing, home-based healthcare and other patient-centric service innovations. Yet, digital innovations in healthcare face barriers in terms of standardization, data privacy...... landscapes in selected countries. Then panelists with expertise in digital data streams, cloud, and mobile computing will present concrete examples of healthcare service innovations that have the potential to address one or more of the global goals. ECIS attendees are invited to join a debate about...

Toward a Learning Health-care System - Knowledge Delivery at the Point of Care Empowered by Big Data and NLP.

Science.gov (United States)

Kaggal, Vinod C; Elayavilli, Ravikumar Komandur; Mehrabi, Saeed; Pankratz, Joshua J; Sohn, Sunghwan; Wang, Yanshan; Li, Dingcheng; Rastegar, Majid Mojarad; Murphy, Sean P; Ross, Jason L; Chaudhry, Rajeev; Buntrock, James D; Liu, Hongfang

2016-01-01

The concept of optimizing health care by understanding and generating knowledge from previous evidence, ie, the Learning Health-care System (LHS), has gained momentum and now has national prominence. Meanwhile, the rapid adoption of electronic health records (EHRs) enables the data collection required to form the basis for facilitating LHS. A prerequisite for using EHR data within the LHS is an infrastructure that enables access to EHR data longitudinally for health-care analytics and real time for knowledge delivery. Additionally, significant clinical information is embedded in the free text, making natural language processing (NLP) an essential component in implementing an LHS. Herein, we share our institutional implementation of a big data-empowered clinical NLP infrastructure, which not only enables health-care analytics but also has real-time NLP processing capability. The infrastructure has been utilized for multiple institutional projects including the MayoExpertAdvisor, an individualized care recommendation solution for clinical care. We compared the advantages of big data over two other environments. Big data infrastructure significantly outperformed other infrastructure in terms of computing speed, demonstrating its value in making the LHS a possibility in the near future.

The Guatemala-Penn Partners: An Innovative Inter-Institutional Model for Scientific Capacity-Building, Healthcare Education, and Public Health

Science.gov (United States)

Paniagua-Avila, Maria Alejandra; Messenger, Elizabeth; Nelson, Caroline A.; Calgua, Erwin; Barg, Frances K.; Bream, Kent W.; Compher, Charlene; Dean, Anthony J.; Martinez-Siekavizza, Sergio; Puac-Polanco, Victor; Richmond, Therese S.; Roth, Rudolf R.; Branas, Charles C.

2017-01-01

Population health outcomes are directly related to robust public health programs, access to basic health services, and a well-trained health-care workforce. Effective health services need to systematically identify solutions, scientifically test these solutions, and share generated knowledge. The World Health Organization (WHO)’s Global Healthcare Workforce Alliance states that the capacity to perform research is an essential factor for well-functioning public health systems. Low- and middle-income countries have greater health-care worker shortages and lower research capacity than higher-income countries. International global health partnerships between higher-income countries and low-middle-income countries aim to directly address such inequalities through capacity building, a process by which human and institutional resources are strengthened and developed, allowing them to perform high-level functions, solve complex problems, and achieve important objectives. The Guatemala–Penn Partners (GPP) is a collaboration among academic centers in Guatemala and the University of Pennsylvania (Penn), in Philadelphia, Pennsylvania that echoes the vision of the WHO’s Global Healthcare Workforce Alliance. This article describes the historical development and present organization of the GPP according to its three guiding principles: university-to-university connections, dual autonomies with locally led capacity building, and mutually beneficial exchanges. It describes the GPP activities within the domains of science, health-care education, and public health, emphasizing implementation factors, such as sustainability and scalability, in relation to the guiding principles. Successes and limitations of this innovative model are also analyzed in the hope that the lessons learned may be applied to similar partnerships across the globe. PMID:28443274

Caring Wisely: A Program to Support Frontline Clinicians and Staff in Improving Healthcare Delivery and Reducing Costs.

Science.gov (United States)

Gonzales, Ralph; Moriates, Christopher; Lau, Catherine; Valencia, Victoria; Imershein, Sarah; Rajkomar, Alvin; Prasad, Priya; Boscardin, Christy; Grady, Deborah; Johnston, S

2017-08-01

We describe a program called "Caring Wisely"®, developed by the University of California, San Francisco's (UCSF), Center for Healthcare Value, to increase the value of services provided at UCSF Health. The overarching goal of the Caring Wisely® program is to catalyze and advance delivery system redesign and innovations that reduce costs, enhance healthcare quality, and improve health outcomes. The program is designed to engage frontline clinicians and staff-aided by experienced implementation scientists-to develop and implement interventions specifically designed to address overuse, underuse, or misuse of services. Financial savings of the program are intended to cover the program costs. The theoretical underpinnings for the design of the Caring Wisely® program emphasize the importance of stakeholder engagement, behavior change theory, market (target audience) segmentation, and process measurement and feedback. The Caring Wisely® program provides an institutional model for using crowdsourcing to identify "hot spot" areas of low-value care, inefficiency and waste, and for implementing robust interventions to address these areas. © 2017 Society of Hospital Medicine.

Pregnancy outcomes associated with Cesarean deliveries in Peruvian public health facilities

Science.gov (United States)

Gonzales, Gustavo F; Tapia, Vilma L; Fort, Alfredo L; Betran, Ana Pilar

2013-01-01

A continuous rise in the rate of cesarean deliveries has been reported in many countries over recent decades. This trend has prompted the emergence of a debate on the risks and benefits associated with cesarean section. The present study was designed to estimate cesarean section rates over time during the period between 2000 and 2010 in Peru and to present outcomes for each mode of delivery. This is a secondary analysis of a large database obtained from the Perinatal Information System, which includes 570,997 pregnant women and their babies from 43 Peruvian public health facilities in three geographical regions: coast, highlands, and jungle. Over 10 years, 558,901 women delivered 563,668 infants weighing at least 500 g. The cesarean section rate increased from 25.5% in 2000 to 29.9% in 2010 (26.9% average; P cesarean than vaginal deliveries (P cesarean section (P cesarean section group than in the vaginal delivery group. Data suggest that cesarean sections are associated with adverse pregnancy outcomes. PMID:24124393

[The use of benchmarking to manage the healthcare supply chain: effects on purchasing cost and quality].

Science.gov (United States)

Naranjo-Gil, David; Ruiz-Muñoz, David

2015-01-01

Healthcare supply expenses consume a large part of the financial resources allocated to public health. The aim of this study was to analyze the use of a benchmarking process in the management of hospital purchases, as well as its effect on product cost reduction and quality improvement. Data were collected through a survey conducted in 29 primary healthcare districts from 2010 to 2011, and through a healthcare database on the prices, quality, delivery time and supplier characteristics of 5373 products. The use of benchmarking processes reduced or eliminated products with a low quality and high price. These processes increased the quality of products by 10.57% and reduced their purchase price by 28.97%. The use of benchmarking by healthcare centers can reduce expenditure and allow more efficient management of the healthcare supply chain. It also facilitated the acquisition of products at lower prices and higher quality. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

Graduate public health training in healthcare of refugee asylum seekers and clinical human rights: evaluation of an innovative curriculum.

Science.gov (United States)

Asgary, Ramin

2016-04-01

An innovative curriculum was developed to equip public health students with appropriate attitude and skills to address healthcare of asylum seekers. Implemented in 2005 the curriculum included: (1) didactic sessions covering epidemiology and health sequelae of torture, asylum laws, and approaches to identify survivors' healthcare needs; (2) panel discussions with survivors and advocates; and (3) participating in medico-legal process of asylum seeking. Complementary mixed methods evaluations included pre- and post-curriculum questionnaires, formal curriculum evaluations, final papers and oral presentations. 125 students participated. Students showed improved knowledge regrading sequelae of abuse and survivors' healthcare needs (P health and human rights careers. As an advocacy and cultural competency training in public health practice addressing healthcare of refugees domestically, this curriculum was well received and effective, and will also help students better serve other similar populations. Population case-based domestic opportunities to teach global health and health and human rights should be effectively utilized to develop a well-equipped global health corps.

Corruption in healthcare and medicine: why should physicians and bioethicists care and what should they do?

Science.gov (United States)

Chattopadhyay, Subrata

2013-01-01

Corruption, an undeniable reality in the health sector, is arguably the most serious ethical crisis in medicine today. However, it remains poorly addressed in scholarly journals and by professional associations of physicians and bioethicists. This article provides an overview of the forms and dynamics of corruption in healthcare as well as its implications in health and medicine. Corruption traps millions of people in poverty, perpetuates the existing inequalities in income and health, drains the available resources undermines people's access to healthcare, increases the costs of patient care and, by setting up a vicious cycle, contributes to ill health and suffering. No public health programme can succeed in a setting in which scarce resources are siphoned off, depriving the disadvantaged and poor of essential healthcare. Quality care cannot be provided by a healthcare delivery system in which kickbacks and bribery are a part of life. The medical profession, historically considered a noble one, and the bioethics community cannot evade their moral responsibility in the face of this sordid reality. There is a need to engage in public discussions and take a stand - against unethical and corrupt practices in healthcare and medicine - for the sake of the individual's well-being as well as for social good.

Healthcare mergers and acquisitions: strategies for consolidation.

Science.gov (United States)

Zuckerman, Alan M

2011-01-01

The passage of federal healthcare reform legislation, in combination with other factors, makes it likely that the next few years will be a major period of consolidation for healthcare organizations. This article examines the seven key forces reshaping healthcare delivery--from insurance industry consolidation to cost inflation to the increasing gap between financially strong and struggling providers--and provides advice for organizations on both sides of an acquisition.

e-Healthcare in India: critical success factors for sustainable health systems.

Science.gov (United States)

Taneja, Udita; Sushil

2007-01-01

As healthcare enterprises seek to move towards an integrated, sustainable healthcare delivery model an IT-enabled or e-Healthcare strategy is being increasingly adopted. In this study we identified the critical success factors influencing the effectiveness of an e-Healthcare strategy in India. The performance assessment criteria used to measure effectiveness were increasing reach and reducing cost of healthcare delivery. A survey of healthcare providers was conducted. Analytic Hierarchy Process (AHP) and Interpretive Structural Modeling (ISM) were the analytical tools used to determine the relative importance of the critical success factors in influencing effectiveness of e-Healthcare and their interplay with each other. To succeed in e-Healthcare initiatives the critical success factors that need to be in place are appropriate government policies, literacy levels, and telecommunications and power infrastructure in the country. The focus should not be on the IT tools and biomedical engineering technologies as is most often the case. Instead the nontechnology factors such as healthcare provider and consumer mindsets should be addressed to increase acceptance of, and enhance the effectiveness of, sustainable e-Healthcare services.

Integrated decision making in healthcare: an operations research and management science perspective

NARCIS (Netherlands)

Hulshof, P.J.H.

2013-01-01

The pressure on healthcare systems rises as both demand for healthcare and expenditures are increasing steadily. As a result, healthcare professionals face the challenging task to design and organize the healthcare delivery process more effectively and efficiently. Designing and organizing processes

Healthscape role towards customer satisfaction in private healthcare.

Science.gov (United States)

Sahoo, Debajani; Ghosh, Tathagata

2016-07-11

Purpose - The purpose of this paper is to identify the motives that enforce consumers to find out the major determinants that frame healthscape in private healthcare service that leads to their satisfaction in a developing country like India. Design/methodology/approach - The generic motive dimensions are identified using an exploratory factor analysis. Next the reliability and validity of the factors are established followed by regression analysis using SPSS 20.0 s/w. Findings - This paper identifies six healthscape motives in the private healthcare sector named as service personnel conduct and cleanliness, service delivery and facilities, ambience, location and look, appealing decoration, and upgraded safety service, out of which only service delivery, ambience, location, and decorations contribute the most to build customer satisfaction as per their significance value. Research limitations/implications - The various dimensions of healthcare motives should be viewed as the levers of improving hospitals' service quality in the minds of its present and future customers. This finding can offer valuable insight to the forthcoming as well as existing developer who are planning to have their healthcare service presence in India. Practical implications - This study suggests some important strategic guidelines for service positioning and market segmentation of healthcare services as per customer requirements. In the recent past, availing services from hospitals were purely utilitarian in nature. Customers were more inclined to get proper and timely services and cared more about the service quality of the healthcare service provider. Originality/value - This paper is among the few works done on understanding private healthcare service delivery process in India and customer satisfaction level from those Hospitals. This study addresses the gap by identifying a set of dimensions that are relevant to customers for a unique healthcare experience.

SU-B-BRF-01: Professional Council Symposium: The Evolving US Healthcare Delivery Model, How Will the Medical Physics Profession Be Impacted and How Should We Respond?

International Nuclear Information System (INIS)

Halvorsen, P; Shine, K; White, G

2014-01-01

The United States' healthcare delivery model is undergoing significant change. Insurance and reimbursement models are rapidly evolving, federal allocations are shifting from specialty services to preventive and generalpractice services, and Accountable Care Organizations are gaining in prominence. One area of focus is on the perceived over-utilization of expensive services such as advanced imaging and, in some cases, radiation therapy. Reimbursement incentives are increasingly aimed at quality metrics, leading to an increased interest in the core concepts of High Reliability Organizations. With the shift in federal resources away from specialty services and the increasing prominence of Accountable Care Organizations, we will likely be challenged to re-assess our traditional model for delivering medical physics services. Medical physicists have a unique combination of education and training in physics principles, radiation physics applications in medicine, human anatomy, as well as safety analysis and quality control methods. An effective medical physicist recognizes that to advance the institution's mission, the medical physicist must join other professional leaders within the institution to provide clear direction and perspective for the entire team. To do that, we must first recognize the macro changes in our healthcare delivery system and candidly assess how the medical physics practice model can evolve in a prudent way to support the institution's objectives while maintaining the traditionally high level of quality and safety. This year's Professional Council Symposium will explore the many facets of the changing healthcare system and its potential impact on medical physics. Dr. Shine will provide an overview of the developing healthcare delivery and reimbursement models, with a focus on how the physician community has adapted to the changing objectives. Mr. White will describe recent changes in the reimbursement patterns for both imaging

SU-B-BRF-01: Professional Council Symposium: The Evolving US Healthcare Delivery Model, How Will the Medical Physics Profession Be Impacted and How Should We Respond?

Energy Technology Data Exchange (ETDEWEB)

Halvorsen, P [Lahey Clinic, Burlington, MA (United States); Shine, K [Austin, TX (United States); White, G [Colorado Associates in Medical Phys, Colorado Springs, CO (United States)

2014-06-15

The United States' healthcare delivery model is undergoing significant change. Insurance and reimbursement models are rapidly evolving, federal allocations are shifting from specialty services to preventive and generalpractice services, and Accountable Care Organizations are gaining in prominence. One area of focus is on the perceived over-utilization of expensive services such as advanced imaging and, in some cases, radiation therapy. Reimbursement incentives are increasingly aimed at quality metrics, leading to an increased interest in the core concepts of High Reliability Organizations. With the shift in federal resources away from specialty services and the increasing prominence of Accountable Care Organizations, we will likely be challenged to re-assess our traditional model for delivering medical physics services. Medical physicists have a unique combination of education and training in physics principles, radiation physics applications in medicine, human anatomy, as well as safety analysis and quality control methods. An effective medical physicist recognizes that to advance the institution's mission, the medical physicist must join other professional leaders within the institution to provide clear direction and perspective for the entire team. To do that, we must first recognize the macro changes in our healthcare delivery system and candidly assess how the medical physics practice model can evolve in a prudent way to support the institution's objectives while maintaining the traditionally high level of quality and safety. This year's Professional Council Symposium will explore the many facets of the changing healthcare system and its potential impact on medical physics. Dr. Shine will provide an overview of the developing healthcare delivery and reimbursement models, with a focus on how the physician community has adapted to the changing objectives. Mr. White will describe recent changes in the reimbursement patterns for both imaging

Individual responsibility for what? : A conceptual framework for exploring the suitability of private financing in a publicly funded health-care system

OpenAIRE

Tinghög, Gustav; Carlsson, Per; Lyttkens, Carl H.

2010-01-01

Policymakers in publicly funded health-care systems are frequently required to make intricate decisions on which health-care services to include or exclude from the basic health-care package. Although it seems likely that the concept of individual responsibility is an essential feature of such decisions, it is rarely explicitly articulated or evaluated in health policy. This paper presents a tentative conceptual framwork for exploring when health-care services contain characteristics that fac...

Situation Analysis of Healthcare Service Delivery using ...

African Journals Online (AJOL)

ISML5

Geography plays an important role in planning and allocation of healthcare resources for an effective and efficient ... utilization and gaps in resource allocation, and to develop propositions to support the health policy. Facility survey and .... Figure 2. Location of health centres against population density in Sironko district ...

Cultural and Linguistic Imperatives in Public Health Delivery in Developing Countries.

Science.gov (United States)

Goke-Pariola, Abiodun

Some cultural realities and linguistic considerations are discussed that public health providers can use to make preventive health care delivery more effective and acceptable in several developing countries. The case of the Yoruba people of southwestern Nigeria is used as an example. Two points are addressed: the question of the usefulness of…

A framework for preventing healthcare-associated infection in ...

African Journals Online (AJOL)

To ensure safe healthcare delivery to children, a co-ordinated HAI prevention strategy should promote development of infection prevention norms and policies, education, patient safety advocacy, healthcare infrastructure, surveillance and research. We present a framework for SA to develop and expand HAI prevention in ...

The challenges of government use of cloud services for public service delivery

NARCIS (Netherlands)

Irion, K.

2014-01-01

Cloud services hold the promise of rendering public service delivery and back-office operations more effective and efficient, by providing ubiquitous, on-demand access to computing resources. Beyond the compelling cost economies, cloud technology is also a promising platform for open government,

Public Value Creation Enabled by Healthcare IS Projects – a resource-based-view

DEFF Research Database (Denmark)

Schlichter, Bjarne Rerup; Svejvig, Per; Laursen, Markus

Creation of value from IT projects is a recurring theme that has diffused into healthcare information sys-tems (HIS). By applying a resource-based-view on findings from a study on the optimisation project of an integrated health information system (HIS) we develop a framework of capabilities needed...... in a public HIS setting to create value. The framework consists of Professional- , Organisational-, Patient Perceived- and Employee Perceived-Value dimensions. HIS is partly overlooked in the public management literature and the aspect of emergence and (personal as well as organisational) learning plays...... an important role in the creation value in HIS-projects....

The Utility of Rural and Underserved Designations in Geospatial Assessments of Distance Traveled to Healthcare Services: Implications for Public Health Research and Practice

Directory of Open Access Journals (Sweden)

Matthew Lee Smith

2013-01-01

Full Text Available Health disparities research in rural populations is based on several common taxonomies identified by geography and population density. However, little is known about the implications of different rurality definitions on public health outcomes. To help illuminate the meaning of different rural designations often used in research, service delivery, or policy reports, this study will (1 review the different definitions of rurality and their purposes; (2 identify the overlap of various rural designations in an eight-county Brazos Valley region in Central Texas; (3 describe participant characteristic profiles based on distances traveled to obtain healthcare services; and (4 examine common profile characteristics associated with each designation. Data were analyzed from a random sample from 1,958 Texas adults participating in a community assessment. K-means cluster analysis was used to identify natural groupings of individuals based on distance traveled to obtain three healthcare services: medical care, dental care, and prescription medication pick-up. Significant variation in cluster representation and resident characteristics was observed by rural designation. Given widely used taxonomies for designating areas as rural (or provider shortage in health-related research, this study highlights differences that could influence research results and subsequent program and policy development based on rural designation.

The utility of rural and underserved designations in geospatial assessments of distance traveled to healthcare services: implications for public health research and practice.

Science.gov (United States)

Smith, Matthew Lee; Dickerson, Justin B; Wendel, Monica L; Ahn, Sangnam; Pulczinski, Jairus C; Drake, Kelly N; Ory, Marcia G

2013-01-01

Health disparities research in rural populations is based on several common taxonomies identified by geography and population density. However, little is known about the implications of different rurality definitions on public health outcomes. To help illuminate the meaning of different rural designations often used in research, service delivery, or policy reports, this study will (1) review the different definitions of rurality and their purposes; (2) identify the overlap of various rural designations in an eight-county Brazos Valley region in Central Texas; (3) describe participant characteristic profiles based on distances traveled to obtain healthcare services; and (4) examine common profile characteristics associated with each designation. Data were analyzed from a random sample from 1,958 Texas adults participating in a community assessment. K-means cluster analysis was used to identify natural groupings of individuals based on distance traveled to obtain three healthcare services: medical care, dental care, and prescription medication pick-up. Significant variation in cluster representation and resident characteristics was observed by rural designation. Given widely used taxonomies for designating areas as rural (or provider shortage) in health-related research, this study highlights differences that could influence research results and subsequent program and policy development based on rural designation.

Improving healthcare using Lean processes.

Science.gov (United States)

Baker, G Ross

2014-01-01

For more than a decade, healthcare organizations across Canada have been using Lean management tools to improve care processes, reduce preventable adverse events, increase patient satisfaction and create better work environments. The largest system-wide effort in Canada, and perhaps anywhere, is currently under way in Saskatchewan. The jury is still out on whether Lean efforts in that province, or elsewhere in Canada, are robust enough to transform current delivery systems and sustain new levels of performance. This issue of Healthcare Quarterly features several articles that provide a perspective on Lean methods in healthcare. Copyright © 2014 Longwoods Publishing.

Demand for healthcare in India

Directory of Open Access Journals (Sweden)

Brijesh C. Purohit

2013-03-01

Full Text Available In a developing country like India, allocation of scarce fiscal resources has to be based on a clear understanding of how investments in the heath sector are going to affect demand. Three aspects like overall healthcare demand, consumer decisions to use public and/or private care and role of price/quality influencing poor/rich consumer’s decisions are critical to assessing the equity implications of alternative policies. Our paper addresses these aspects through examining the pattern of healthcare demand in India. Data from the National Family Health Survey are used to model the healthcare choices that individuals make. We consider what these behavioral characteristics imply for public policy. This analysis aims to study disparities between rural and urban areas from all throughout India to five Indian states representing three levels of per capita incomes (all-India average, rich and poor. Results evidence that healthcare demand both in rural and urban areas is a commodity emerging as an essential need. Choices between public or private provider are guided by income and quality variables mainly with regard to public healthcare denoting thus a situation of very limited alternatives in terms of availing private providers. These results emphasize that existing public healthcare facilities do not serve the objective of providing care to the poor in a satisfactory manner in rural areas. Thus, any financing strategy to improve health system and reduce disparities across rich-poor states and rural-urban areas should also take into account not only overcoming inadequacy but also inefficiency in allocation and utilization of healthcare inputs.

A rapid assessment of the availability and use of obstetric care in Nigerian healthcare facilities.

Directory of Open Access Journals (Sweden)

Daniel O Erim

Full Text Available BACKGROUND: As part of efforts to reduce maternal deaths in Nigeria, pregnant women are being encouraged to give birth in healthcare facilities. However, little is known about whether or not available healthcare facilities can cope with an increasing demand for obstetric care. We thus carried out this survey as a rapid and tactical assessment of facility quality. We visited 121 healthcare facilities, and used the opportunity to interview over 700 women seeking care at these facilities. FINDINGS: Most of the primary healthcare facilities we visited were unable to provide all basic Emergency Obstetric Care (bEmOC services. In general, they lack clinical staff needed to dispense maternal and neonatal care services, ambulances and uninterrupted electricity supply whenever there were obstetric emergencies. Secondary healthcare facilities fared better, but, like their primary counterparts, lack neonatal care infrastructure. Among patients, most lived within 30 minutes of the visited facilities and still reported some difficulty getting there. Of those who had had two or more childbirths, the conditional probability of a delivery occurring in a healthcare facility was 0.91 if the previous delivery occurred in a healthcare facility, and 0.24 if it occurred at home. The crude risk of an adverse neonatal outcome did not significantly vary by delivery site or birth attendant, and the occurrence of such an outcome during an in-facility delivery may influence the mother to have her next delivery outside. Such an outcome during a home delivery may not prompt a subsequent in-facility delivery. CONCLUSIONS: In conclusion, reducing maternal deaths in Nigeria will require attention to both increasing the number of facilities with high-quality EmOC capability and also assuring Nigerian women have access to these facilities regardless of where they live.

Economic incentives to promote innovation in healthcare delivery.

Science.gov (United States)

Luft, Harold S

2009-10-01

Economics influences how medical care is delivered, organized, and progresses. Fee-for-service payment encourages delivery of services. Fee-for-individual-service, however, offers no incentives for clinicians to efficiently organize the care their patients need. Global capitation provides such incentives; it works well in highly integrated practices but not for independent practitioners. The failures of utilization management in the 1990s demonstrated the need for a third alternative to better align incentives, such as bundling payment for an episode of care. Building on Medicare's approach to hospital payment, one can define expanded diagnosis-related groups that include all hospital, physician, and other costs during the stay and appropriate preadmission and postdischarge periods. Physicians and hospitals voluntarily forming a new entity (a care delivery team) would receive such bundled payments along with complete flexibility in allocating the funds. Modifications to gainsharing and antikickback rules, as well as reforms to malpractice liability laws, will facilitate the functioning of the care delivery teams. The implicit financial incentives encourage efficient care for the patient; the episode focus will facilitate measuring patient outcomes. Payment can be based on the resources used by those care delivery teams achieving superior outcomes, thereby fostering innovation improving outcomes and reducing waste.

Women's preferences and mode of delivery in public and private hospitals: a prospective cohort study.

Science.gov (United States)

Mazzoni, Agustina; Althabe, Fernando; Gutierrez, Laura; Gibbons, Luz; Liu, Nancy H; Bonotti, Ana María; Izbizky, Gustavo H; Ferrary, Marta; Viergue, Nora; Vigil, Silvia I; Zalazar Denett, Gabriela; Belizán, José M

2016-02-08

Rates of caesarean section have steadily increased in most middle- and high-income countries over the last few decades without medical justification. Maternal request is one of the frequently cited non-medical factors contributing to this trend. The objectives of this study were to assess pregnant women's preferences regarding mode of delivery and to compare actual caesarean section rates in the public and private sectors. A prospective cohort study was conducted in two public and three private hospitals in Buenos Aires, Argentina. 382 nulliparous pregnant women (183 from the private sector and 199 from the public sector) aged 18 to 35 years, with single pregnancies over 32 weeks of gestational age were enrolled during antenatal care visits between October 2010 and September 2011. We excluded women with pregnancies resulting from assisted fertility, women with known pre-existing major diseases or, with pregnancy complications, or with a medical indication of elective cesarean section. We used two different approaches to assess women's preferences: a survey using a tailored questionnaire, and a discrete choice experiment. Only 8 and 6% of the healthy nulliparous women in the public and private sectors, respectively, expressed a preference for caesarean section. Fear of pain and safety were the most frequently expressed reasons for preferring caesarean section. When reasons for delivery mode were assessed by a discrete choice experiment, women placed the most emphasis on sex after childbirth. Of women who expressed their preference for vaginal delivery, 34 and 40% ended their pregnancies by caesarean section in public and private hospitals, respectively. The preference for caesarean section is low among healthy nulliparous women in Buenos Aires. The reasons why these women had a rate of more than 35% caesarean sections are unlikely related to their preferences for mode of delivery.

Role Of E-Government In Delivery Of Public Services In Tanzania Electric Supply Company In Ruvuma Region Tanzania

Directory of Open Access Journals (Sweden)

Emmanuel Jackson Petro Gunda

2015-06-01

Full Text Available ABSTRACT E-government facilitates delivery of public services of relevant government information in electronic form to citizens in a timely manner and better service delivery to citizens. E-government is a kind of governmental administration which is based on Information Communication and Technology Services. Electronic government describes the use of technologies to facilitate the operation of government and disperse of government information and services. The scope of the work was limited to Tanzania Electric Supply Company Limited TANESCO in Ruvuma region. The population of thirty 31 were selected from a total population of 169 public servants use both purposive and stratified random sampling techniques applied. The major findings of study revealed that about 67.7 of response from respondents agree that ICT infrastructures specifically modern computer connected to internet reliable internet speed well organized organization website power availability in public operation contribute to efficient in delivery of services it also noted by respondents to faster decision making speeding up transaction processing and reduce cost. The study greatly recommends that capacity building to public servants on ICT install and strengthening ICT infrastructures to government organizational are inevitable to realise relevant role of e-government in delivery of public services.

Value-based contracting innovated Medicare advantage healthcare delivery and improved survival.

Science.gov (United States)

Mandal, Aloke K; Tagomori, Gene K; Felix, Randell V; Howell, Scott C

2017-02-01

In Medicare Advantage (MA) with its CMS Hierarchical Condition Categories (CMS-HCC) payment model, CMS reimburses private plans (Medicare Advantage Organizations [MAOs]) with prospective, monthly, health-based or risk-adjusted, capitated payments. The effect of this payment methodology on healthcare delivery remains debatable. How value-based contracting generates cost efficiencies and improves clinical outcomes in MA is studied. A difference in contracting arrangements between an MAO and 2 provider groups facilitated an intervention-control, preintervention-postintervention, difference-in-differences approach among statistically similar, elderly, community-dwelling MA enrollees within one metropolitan statistical area. Starting in 2009, for intervention-group MA enrollees, the MAO and a provider group agreed to full-risk capitation combined with a revenue gainshare. The gainshare was based on increases in the Risk Adjustment Factor (RAF), which modified the CMS-HCC payments. For the control group, the MAO continued to reimburse another provider group through fee-for-service. RAF, utilization, and survival were followed until December 31, 2012. The intervention group's mean RAF increased significantly (P based visits (P based care for these MA enrollees with multiple comorbidities, a 6% survival benefit with a 32.8% lower hazard of death (P Value-based contracting can drive utilization patterns and improve clinical outcomes among chronically ill, elderly MA members.

Healthcare financing: approaches and trends in India.

Science.gov (United States)

Bajpai, Vikas; Saraya, Anoop

2010-01-01

Despite the importance of healthcare for the well-being of society, there is little public debate in India on issues relating to it. The 'human capital approach' to finance healthcare largely relies on private investment in health, while the 'human development approach' envisages the State as the guarantorof preventive as well as curative care to achieve universalization of healthcare. The prevailing health indices of India and challenges in the field of public health require a human developmentapproach to healthcare. On the eve of independence, India adopted the human development approach, with the report of the Bhore Committee emphasizing the role of the State in the development and provision of healthcare. However, more recently, successive governments have moved towards the human capital approach. Instead of increasing state spending on health and expanding the public health infrastructure, the government has been relying more and more on the private sector. The public-private partnership has been touted as the new-age panacea for the ills of the Indian healthcare system. This approach has led to a stagnation of public health indices and a decrease in the access of the poor to healthcare.

Toward a Learning Health-care System – Knowledge Delivery at the Point of Care Empowered by Big Data and NLP

Science.gov (United States)

Kaggal, Vinod C.; Elayavilli, Ravikumar Komandur; Mehrabi, Saeed; Pankratz, Joshua J.; Sohn, Sunghwan; Wang, Yanshan; Li, Dingcheng; Rastegar, Majid Mojarad; Murphy, Sean P.; Ross, Jason L.; Chaudhry, Rajeev; Buntrock, James D.; Liu, Hongfang

2016-01-01

The concept of optimizing health care by understanding and generating knowledge from previous evidence, ie, the Learning Health-care System (LHS), has gained momentum and now has national prominence. Meanwhile, the rapid adoption of electronic health records (EHRs) enables the data collection required to form the basis for facilitating LHS. A prerequisite for using EHR data within the LHS is an infrastructure that enables access to EHR data longitudinally for health-care analytics and real time for knowledge delivery. Additionally, significant clinical information is embedded in the free text, making natural language processing (NLP) an essential component in implementing an LHS. Herein, we share our institutional implementation of a big data-empowered clinical NLP infrastructure, which not only enables health-care analytics but also has real-time NLP processing capability. The infrastructure has been utilized for multiple institutional projects including the MayoExpertAdvisor, an individualized care recommendation solution for clinical care. We compared the advantages of big data over two other environments. Big data infrastructure significantly outperformed other infrastructure in terms of computing speed, demonstrating its value in making the LHS a possibility in the near future. PMID:27385912

LEAN thinking in Finnish healthcare.

Science.gov (United States)

Jorma, Tapani; Tiirinki, Hanna; Bloigu, Risto; Turkki, Leena

2016-01-01

Purpose - The purpose of this study is to evaluate how LEAN thinking is used as a management and development tool in the Finnish public healthcare system and what kind of outcomes have been achieved or expected by using it. The main focus is in managing and developing patient and treatment processes. Design/methodology/approach - A mixed-method approach incorporating the Webropol survey was used. Findings - LEAN is quite a new concept in Finnish public healthcare. It is mainly used as a development tool to seek financial savings and to improve the efficiency of patient processes, but has not yet been deeply implemented. However, the experiences from LEAN initiatives have been positive, and the methodology is already quite well-known. It can be concluded that, because of positive experiences from LEAN, the environment in Finnish healthcare is ready for the deeper implementation of LEAN. Originality/value - This paper evaluates the usage of LEAN thinking for the first time in the public healthcare system of Finland as a development tool and a management system. It highlights the implementation and achieved results of LEAN thinking when used in the healthcare environment. It also highlights the expectations for LEAN thinking in Finnish public healthcare.

In science communication, why does the idea of a public deficit always return? How do the shifting information flows in healthcare affect the deficit model of science communication?

Science.gov (United States)

Ko, Henry

2016-05-01

The healthcare field contains a multitude of opportunities for science communication. Given the many stakeholders dancing together in a multidirectional tango of communication, we need to ask how much does the deficit model apply to the health field? History dictates that healthcare professionals are the holders of all knowledge, and the patients and other stakeholders are the ones that need the scientific information communicated to them. This essay argues otherwise, in part due to the rise of shared decision-making and patients and other stakeholders acting as partners in healthcare. The traditional deficit model in health held that: (1) doctors were experts and patients were consumers, (2) it is impossible for the public to grasp the many disciplines of knowledge in medicine, (3) if experts have trouble keeping up with medical research then the public surely can't keep up, and (4) it is safer for healthcare professionals to communicate to the public using a deficit model. However, with the rise of partnerships with patients in healthcare decision-making, the deficit model might be weakening. Examples of public participation in healthcare decision-making include: (1) crowd-sourcing public participation in systematic reviews, (2) public participation in health policy, (3) public collaboration in health research, and (4) health consumer groups acting as producers of health information. With the challenges to the deficit model in science communication in health, caution is needed with the increasing role of technology and social media, and how these may affect the legitimacy of healthcare information flows away from the healthcare professional. © The Author(s) 2016.

Public health, healthcare, health and inequality in health in the Nordic countries

DEFF Research Database (Denmark)

Christiansen, Terkel; Lauridsen, Jørgen Trankjær; Kifmann, Mathias

2018-01-01

-economic equality in health. Each of the five countries has established extensive public health programmes, although with somewhat different measures to increase health of the populations. We compare these countries to the UK and Germany by using data from the European Social Survey for 2002 and 2012 in addition......All five Nordic countries emphasize equal and easy access to healthcare, assuming that increased access to healthcare leads to increased health. It is the purpose of the present study to explore to which extent the populations of these countries have reached good health and a high degree of socio...... to OECD statistics for the same years. Health is measured by self-assessed health in five categories, which is transformed to a cardinal scale using Swedish time trade-off (TTO) weights. As socio-economic measures we use household income and length of education. Socio-economic inequality in health...

Squaring the circle of healthcare supplies.

Science.gov (United States)

Böhme, Tillmann; Williams, Sharon; Childerhouse, Paul; Deakins, Eric; Towill, Denis

2014-01-01

The purpose of this paper is to use a systems lens to assess the comparative performance of healthcare supply chains and provide guidance for their improvement. A well-established and rigorous multi-method audit methodology, based on the uncertainty circle model, yields an objective assessment of value stream performance in eight Australasian public sector hospitals. Cause-effect analysis identifies the major barriers to achieving smooth, seamless flows. Potentially high-leverage remedial actions identified using systems thinking are examined with the aid of an exemplar case. The majority of the healthcare value streams studied are underperforming compared with those in the European automotive industry. Every public hospital appears to be caught in the grip of vicious circles of system uncertainty, in large part being caused by problems of their own making. The single exception is making good progress towards seamless functional integration, which has been achieved by elevating supply chain management to a core competence; having a clearly articulated supply chain vision; adopting a systems approach; and, managing supplies with accurate information. The small number of cases limits the generalisability of the findings at this time. Hospital supply chain managers endeavouring to achieve smooth and seamless supply flows should attempt to elevate the status of supplies management within their organisation to that of a core competence, and should use accurate information to manage their value streams holistically as a set of interwoven processes. A four-level prism model is proposed as a useful framework for thus improving healthcare supply delivery systems. Material flow concepts originally developed to provide objective assessments of value stream performance in commercial settings are adapted for use in a healthcare setting. The ability to identify exemplar organisations via a context-free uncertainty measure, and to use systems thinking to identify high

Business resilience: Reframing healthcare risk management.

Science.gov (United States)

Simeone, Cynthia L

2015-09-01

The responsibility of risk management in healthcare is fractured, with multiple stakeholders. Most hospitals and healthcare systems do not have a fully integrated risk management system that spans the entire organizational and operational structure for the delivery of key services. This article provides insight toward utilizing a comprehensive Business Resilience program and associated methodology to understand and manage organizational risk leading to organizational effectiveness and operational efficiencies, with the fringe benefit of realizing sustainable operational capability during adverse conditions. © 2015 American Society for Healthcare Risk Management of the American Hospital Association.

Organisation and delivery of imaging services: The contributions of ethics and political economy

International Nuclear Information System (INIS)

Durand-Zaleski, I.

2009-01-01

The objective of this discussion is to explore how theories from other disciplines can contribute to the debate on organisation and delivery of diagnostic and therapeutic exposures. The first part explores how theories of justice suggest that health services should be provided; the second part explores how stakeholders in the field of public health and health care incorporate their own strategies in the deployment of health technologies and health-care programmes. (authors)

Applying a Total Market Lens: Increased IUD Service Delivery Through Complementary Public- and Private-Sector Interventions in 4 Countries.

Science.gov (United States)

White, Julia N; Corker, Jamaica

2016-08-11

Increasing access to the intrauterine device (IUD), as part of a comprehensive method mix, is a key strategy for reducing unintended pregnancy and maternal mortality in low-income countries. To expand access to IUDs within the framework of informed choice, Population Services International (PSI) has historically supported increased IUD service delivery through private providers. In applying a total market lens to better understand the family planning market and address major market gaps, PSI identified a lack of high-quality public provision of IUDs. In 2013, PSI started a pilot in 4 countries (Guatemala, Laos, Mali, and Uganda) to grow public-provider IUD service delivery through increased public-sector engagement while maintaining its ongoing focus on private providers. In collaboration with country governments, PSI affiliates carried out family planning market analyses in the 4 pilot countries to identify gaps in IUD service delivery and create sustainable strategies for scaling up IUD services in the public sector. Country-specific interventions to increase service delivery were implemented across all levels of the public health system, including targeted advocacy at the national level to promote government ownership and program sustainability. Mechanisms to ensure government ownership were built into the program design, including a proof-of-concept approach to convince governments of the feasibility and value of taking over and scaling up interventions. In the first 2 years of the pilot (2013-2014), 102,055 IUD services were provided to women at 417 targeted public-sector facilities. These preliminary results suggest that there is untapped demand for IUD service delivery in the public sector that can be met in part through greater participation of the public sector in family planning and IUD provision. © White et al.

Applying a Total Market Lens: Increased IUD Service Delivery Through Complementary Public- and Private-Sector Interventions in 4 Countries

Science.gov (United States)

White, Julia N; Corker, Jamaica

2016-01-01

ABSTRACT Increasing access to the intrauterine device (IUD), as part of a comprehensive method mix, is a key strategy for reducing unintended pregnancy and maternal mortality in low-income countries. To expand access to IUDs within the framework of informed choice, Population Services International (PSI) has historically supported increased IUD service delivery through private providers. In applying a total market lens to better understand the family planning market and address major market gaps, PSI identified a lack of high-quality public provision of IUDs. In 2013, PSI started a pilot in 4 countries (Guatemala, Laos, Mali, and Uganda) to grow public-provider IUD service delivery through increased public-sector engagement while maintaining its ongoing focus on private providers. In collaboration with country governments, PSI affiliates carried out family planning market analyses in the 4 pilot countries to identify gaps in IUD service delivery and create sustainable strategies for scaling up IUD services in the public sector. Country-specific interventions to increase service delivery were implemented across all levels of the public health system, including targeted advocacy at the national level to promote government ownership and program sustainability. Mechanisms to ensure government ownership were built into the program design, including a proof-of-concept approach to convince governments of the feasibility and value of taking over and scaling up interventions. In the first 2 years of the pilot (2013–2014), 102,055 IUD services were provided to women at 417 targeted public-sector facilities. These preliminary results suggest that there is untapped demand for IUD service delivery in the public sector that can be met in part through greater participation of the public sector in family planning and IUD provision. PMID:27540122

'Reframing Healthcare Services through the Lens of Co-Production' (RheLaunCh): a study protocol for a mixed methods evaluation of mechanisms by which healthcare and social services impact the health and well-being of patients with COPD and CHF in the USA and The Netherlands.

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Hesselink, Gijs; Johnson, Julie; Batalden, Paul; Carlson, Michelle; Geense, Wytske; Groenewoud, Stef; Jones, Sylvester; Roy, Brita; Sansone, Christina; Wolf, Judith R L M; Bart, Bradley; Wollersheim, Hub

2017-09-07

The USA lags behind other high-income countries in many health indicators. Outcome differences are associated with differences in the relative spending between healthcare and social services at the national level. The impact of the ratio and delivery of social and healthcare services on the individual patient's health is however unknown. ' Reframing Healthcare Services through the Lens of Co-Production ' (RheLaunCh) will be a cross-Atlantic comparative study of the mechanisms by which healthcare and social service delivery may impact patient health with chronic conditions. Insight into these mechanisms is needed to better and cost-effectively organise healthcare and social services. We designed a mixed methods study to compare the socioeconomic background, needs of and service delivery to patients with congestive heart failure and chronic obstructive pulmonary disease in the USA and the Netherlands. We will conduct: (1) a literature scan to compare national and regional healthcare and social service systems; (2) a retrospective database study to compare patient's socioeconomic and clinical characteristics and the service use and spending at the national, regional and hospital level; (3) a survey to compare patient perceived quality of life, receipt and experience of service delivery and ability of these services to meet patient needs; and (4) multiple case studies to understand what patients need to better govern their quality of life and how needs are met by services. Ethics approval was granted by the ethics committee of the Radboud University Medical Center (2016-2423) in the Netherlands and by the Human Subjects Research Committee of the Hennepin Health Care System, Inc. (HSR #16-4230) in the USA. Multiple approaches will be used for dissemination of results, including (inter)national research presentations and peer-reviewed publications. A website will be established to support the development of a community of practice. © Article author(s) (or their employer

How Can Information and Communication Technology Improve Healthcare Inequalities and Healthcare Inequity? The Concept of Context Driven Care.

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Yee, Kwang Chien; Bettiol, Silvana; Nash, Rosie; Macintyrne, Kate; Wong, Ming Chao; Nøhr, Christian

2018-01-01

Advances in medicine have improved health and healthcare for many around the world. The challenge is achieving the best outcomes of health via healthcare delivery to every individual. Healthcare inequalities exist within a country and between countries. Health information technology (HIT) has provided a mean to deliver equal access to healthcare services regardless of social context and physical location. In order to achieve better health outcomes for every individual, socio-cultural factors, such as literacy and social context need to consider. This paper argues that HIT while improves healthcare inequalities by providing access, might worsen healthcare inequity. In order to improve healthcare inequity using HIT, this paper argues that we need to consider patients and context, and hence the concept of context driven care. To improve healthcare inequity, we need to conceptually consider the patient's view and methodologically consider design methods that achieve participatory outcomes.

Using the Bologna Score to assess normal delivery healthcare

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Isaiane da Silva Carvalho

Full Text Available Abstract OBJECTIVE Describing the obstetric care provided in public maternity hospitals during normal labour using the Bologna Score in the city of Natal, Northeastern Brazil. METHOD A quantitative cross-sectional study conducted with 314 puerperal women. Data collection was carried out consecutively during the months of March to July 2014. RESULTS Prenatal care was provided to 95.9% of the mothers, beginning around the 1st trimester of pregnancy (72.3% and having seven or more consultations (51%. Spontaneous vaginal delivery was planned for 88.2% women. All laboring women were assisted by a health professional, mostly by a physician (80.6%, and none of them obtained 5 points on the Bologna Score due to the small percentage of births in non-supine position (0.3% and absence of a partogram (2.2%. A higher number of episiotomies were observed among primiparous women (75.5%. CONCLUSION The score obtained using the Bologna Index was low. Thus, it is necessary to improve and readjust the existing obstetrical model.

Queueing for healthcare.

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Palvannan, R Kannapiran; Teow, Kiok Liang

2012-04-01

Patient queues are prevalent in healthcare and wait time is one measure of access to care. We illustrate Queueing Theory-an analytical tool that has provided many insights to service providers when designing new service systems and managing existing ones. This established theory helps us to quantify the appropriate service capacity to meet the patient demand, balancing system utilization and the patient's wait time. It considers four key factors that affect the patient's wait time: average patient demand, average service rate and the variation in both. We illustrate four basic insights that will be useful for managers and doctors who manage healthcare delivery systems, at hospital or department level. Two examples from local hospitals are shown where we have used queueing models to estimate the service capacity and analyze the impact of capacity configurations, while considering the inherent variation in healthcare.

The Development of a New Master's of Science in Healthcare Quality Program

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Sears, Kim; Broderick, Briana; Stockley, Denise; Goldstien, D.; Egan, R.

2014-01-01

Working in silos or working within one discipline has not improved the delivery of healthcare. With a goal to advance the healthcare quality agenda and in response to an identified need within both the educational and healthcare sector, Queen's University has established a Master's degree in Healthcare Quality [MSc(HQ)]. The interprofessional…

A Big Data-driven Model for the Optimization of Healthcare Processes.

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Koufi, Vassiliki; Malamateniou, Flora; Vassilacopoulos, George

2015-01-01

Healthcare organizations increasingly navigate a highly volatile, complex environment in which technological advancements and new healthcare delivery business models are the only constants. In their effort to out-perform in this environment, healthcare organizations need to be agile enough in order to become responsive to these increasingly changing conditions. To act with agility, healthcare organizations need to discover new ways to optimize their operations. To this end, they focus on healthcare processes that guide healthcare delivery and on the technologies that support them. Business process management (BPM) and Service-Oriented Architecture (SOA) can provide a flexible, dynamic, cloud-ready infrastructure where business process analytics can be utilized to extract useful insights from mountains of raw data, and make them work in ways beyond the abilities of human brains, or IT systems from just a year ago. This paper presents a framework which provides healthcare professionals gain better insight within and across your business processes. In particular, it performs real-time analysis on process-related data in order reveal areas of potential process improvement.

Oral healthcare systems in the extended European union.

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Widström, Eeva; Eaton, Kenneth A

2004-01-01

This article reports a survey of the systems for the provision of oral healthcare in the 28 member and accession states of the EU/EEA in 2003. Descriptions of the systems were collected from the principal dental advisers to governments in the individual states. In many states these were the Chief Dental Officers (CDOs). In states without a CDO, descriptions were gathered from CDO equivalents or senior academics. A template (model description) was used to guide all respondents. Additional statistical information on oral healthcare costs and workforce was collected from the Council of European Chief Dental Officers, WHO and World Bank websites. The study showed that in broad terms there were six patterns (Beveridgian, Bismarkian, The Eastern European (in transition), Nordic, Southern European and Hybrid) for the administration and financing of oral healthcare in the expanding EU. The extent and nature of government involvement in planning and coordinating oral healthcare services and the numbers and pay of the oral healthcare workforce varied between the different models. The biggest recent changes in European oral healthcare were found to have occurred in Eastern Europe, where there has been wide scale privatization of the previously public dental services. However, most of the EU accession (Eastern European) states seemed to be slowly developing insurance systems to cover oral health treatment costs. In the existing EU/EEA, the public dental services such as those in the Nordic countries still have strong political support and some expansion has occurred. In Southern Europe public dental services seemed to have gained some acceptance for the treatment of children and special needs groups. In UK, which has a unique public dental service system, there are plans to make big changes in the delivery, commissioning and remuneration of dental services in the near future. Some EU member states which operate the Bismarkian system with health insurances offering wide

Mental healthcare delivery in rural Greece: A 10-year account of a mobile mental health unit

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Vaios Peritogiannis

2017-01-01

Full Text Available Introduction: Patients living in rural and remote areas may have limited access to mental healthcare due to lack of facilities and socioeconomic reasons, and this is the case of rural areas in Eastern Europe countries. In Greece, community mental health service delivery in rural areas has been implemented through the development of the Mobile Mental Health Units (MMHUs. Methods: We present a 10-year account of the operation of the MMHU of the prefectures of Ioannina and Thesprotia (MMHU I-T and report on the impact of the service on mental health delivery in the catchment area. The MMHU I-T is a multidisciplinary community mental health team which delivers services in rural and mountainous areas of Northwest Greece. Results: The MMHU I-T has become an integral part of the local primary care system and is well known to the population of the catchment area. By the end of 2016, the majority of patients (60% were self-referred or family-referred, compared to 24% in the first 2 years. Currently, the number of active patients is 293 (mean age 63 years, 49.5% are older adults, and the mean caseload for each member of the team is 36.6. A significant proportion of patients (28% receive care with regular domiciliary visits, and the provision of home-based care was correlated with the age of the patients. Within the first 2 years of operation of the MMHU I-T hospitalizations of treatment, engaged patients were reduced significantly by 30.4%, whereas the treatment engagement rates of patients with psychotic disorders were 67.2% in 5 years. Conclusions: The MMHU I-T and other similar units in Greece are a successful paradigm of a low-cost service which promotes mental health in rural, remote, and deprived areas. This model of care may be informative for clinical practice and health policy given the ongoing recession and health budget cuts. It suggests that rural mental healthcare may be effectively delivered by integrating generic community mental health

Frank Gilbreth and health care delivery method study driven learning.

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Towill, Denis R

2009-01-01

The purpose of this article is to look at method study, as devised by the Gilbreths at the beginning of the twentieth century, which found early application in hospital quality assurance and surgical "best practice". It has since become a core activity in all modern methods, as applied to healthcare delivery improvement programmes. The article traces the origin of what is now currently and variously called "business process re-engineering", "business process improvement" and "lean healthcare" etc., by different management gurus back to the century-old pioneering work of Frank Gilbreth. The outcome is a consistent framework involving "width", "length" and "depth" dimensions within which healthcare delivery systems can be analysed, designed and successfully implemented to achieve better and more consistent performance. Healthcare method (saving time plus saving motion) study is best practised as co-joint action learning activity "owned" by all "players" involved in the re-engineering process. However, although process mapping is a key step forward, in itself it is no guarantee of effective re-engineering. It is not even the beginning of the end of the change challenge, although it should be the end of the beginning. What is needed is innovative exploitation of method study within a healthcare organisational learning culture accelerated via the Gilbreth Knowledge Flywheel. It is shown that effective healthcare delivery pipeline improvement is anchored into a team approach involving all "players" in the system especially physicians. A comprehensive process study, constructive dialogue, proper and highly professional re-engineering plus managed implementation are essential components. Experience suggests "learning" is thereby achieved via "natural groups" actively involved in healthcare processes. The article provides a proven method for exploiting Gilbreths' outputs and their many successors in enabling more productive evidence-based healthcare delivery as summarised

Healthcare costs for new technologies

International Nuclear Information System (INIS)

Goyen, Mathias; Debatin, Joerg F.

2009-01-01

Continuous ageing of the population coupled with growing health consciousness and continuous technological advances have fueled the rapid rise in healthcare costs in the United States and Europe for the past several decades. The exact impact of new medical technology on long-term spending growth remains the subject of controversy. By all measures it is apparent that new medical technology is the dominant driver of increases in health-care costs and hence insurance premiums. This paper addresses the impact of medical technology on healthcare delivery systems with regard to medical practice and costs. We first explore factors affecting the growth of medical technology and then attempt to provide a means for assessing the effectiveness of medical technology. Avoidable healthcare cost drivers are identified and related policy issues are discussed. (orig.)

Healthcare costs for new technologies

Energy Technology Data Exchange (ETDEWEB)

Goyen, Mathias; Debatin, Joerg F. [University Medical Center Hamburg-Eppendorf, Hamburg (Germany)

2009-03-15

Continuous ageing of the population coupled with growing health consciousness and continuous technological advances have fueled the rapid rise in healthcare costs in the United States and Europe for the past several decades. The exact impact of new medical technology on long-term spending growth remains the subject of controversy. By all measures it is apparent that new medical technology is the dominant driver of increases in health-care costs and hence insurance premiums. This paper addresses the impact of medical technology on healthcare delivery systems with regard to medical practice and costs. We first explore factors affecting the growth of medical technology and then attempt to provide a means for assessing the effectiveness of medical technology. Avoidable healthcare cost drivers are identified and related policy issues are discussed. (orig.)

A systematic review of stated preference studies reporting public preferences for healthcare priority setting.

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Whitty, Jennifer A; Lancsar, Emily; Rixon, Kylie; Golenko, Xanthe; Ratcliffe, Julie

2014-01-01

There is current interest in incorporating weights based on public preferences for health and healthcare into priority-setting decisions. The aim of this systematic review was to explore the extent to which public preferences and trade-offs for priority-setting criteria have been quantified, and to describe the study contexts and preference elicitation methods employed. A systematic review was performed in April 2013 to identify empirical studies eliciting the stated preferences of the public for the provision of healthcare in a priority-setting context. Studies are described in terms of (i) the stated preference approaches used, (ii) the priority-setting levels and contexts, and (iii) the criteria identified as important and their relative importance. Thirty-nine studies applying 40 elicitation methods reported in 41 papers met the inclusion criteria. The discrete choice experiment method was most commonly applied (n = 18, 45.0 %), but other approaches, including contingent valuation and the person trade-off, were also used. Studies prioritised health systems (n = 4, 10.2 %), policies/programmes/services/interventions (n = 16, 41.0 %), or patient groups (n = 19, 48.7 %). Studies generally confirmed the importance of a wide range of process, non-health and patient-related characteristics in priority setting in selected contexts, alongside health outcomes. However, inconsistencies were observed for the relative importance of some prioritisation criteria, suggesting context and/or elicitation approach matter. Overall, findings suggest caution in directly incorporating public preferences as weights for priority setting unless the methods used to elicit the weights can be shown to be appropriate and robust in the priority-setting context.

[The quality of the German health-care system in an international comparison - a systematic review].

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Lauerer, M; Emmert, M; Schöffski, O

2013-08-01

Studies assessing the quality of the German health-care system in an international comparison come to different results. Therefore, this review aims to investigate how the German health-care system is evaluated in comparison to other health-care systems by reviewing international publications. Results show starting points for ways to improve the German health-care system, to maintain and expand its strengths as well as to derive strategies for solving identified problems. A systematic review searching different databases [library catalogues, WorldCat (including MEDLINE and OAIster-search), German National Library, Google Scholar and others]. Search requests were addressed to English or German language publications for the time period 2000-2010 (an informal search was conducted in October 2011 for an update). Results of the identified studies were aggregated and main statements derived. In total, 13 publications assessing the German health-care system in an international comparison were identified. These comparisons are based on 377 measures. After aggregation, 244 substantially different indicators remained, which were dedicated to 14 categories. It became apparent that the German health-care system can be characterised by a high level of expenses, a well-developed health-care infrastructure as well as a high availability of personal and material resources. Outcome measures demonstrate heterogeneous results. It can be stated that, particularly in this field, there is potential for further improvement. The utilisation of health-care services is high, the access is mostly not regulated and out of pocket payments can pose a barrier for patients. Waiting times are not regarded as a major weakness. Although civic satisfaction seems to be acceptable, a large portion of the citizens calls for elementary modifications. Especially, more patient-centred health-care delivery should be addressed as well as management of information and the adoption of meaningful electronic

Language awareness in the bilingual healthcare setting: a national survey.

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Roberts, Gwerfyl Wyn; Irvine, Fiona Elizabeth; Jones, Peter Reece; Spencer, Llinos Haf; Baker, Colin Ronald; Williams, Cen

2007-09-01

The significance of effective interpersonal communication in healthcare is well established, as is the importance of overcoming language barriers. This has a particular bearing for minority language speakers, where denying language choice can compromise the quality of healthcare provision. Nevertheless, there is limited empirical research exploring language awareness in healthcare and the factors that influence language choice for minority language speakers. This paper reports on the nurses, midwives and health visitors (NMHV) data set of the first phase of a large-scale national study, commissioned by the Welsh Assembly Government, to examine the nature and extent of Welsh language awareness amongst healthcare professionals in Wales, UK. The study involved a questionnaire survey of healthcare professionals working in the public, private and voluntary sectors of healthcare. A stratified random sample of 3358 healthcare professionals was surveyed, of which 1842 (55%) were nurses, midwives and health visitors. The researcher-designed self-administered questionnaire was distributed by post to participants between July and September 2003. A total of 1042 (57%) NMHV returned their questionnaires for analysis. A strong positive correlation is identified between the NMHV use of the Welsh language in practice and their Welsh language proficiency (planguage attitudes (planguage region (planguage attitude scores are more positive than expected, particularly amongst those with limited Welsh language proficiency and those working in regions with the lowest proportions of Welsh speakers. In view of the universal drive for culturally and linguistically appropriate healthcare practice, the findings have important implications for bilingual and multilingual healthcare settings worldwide. The evidence emerging from this survey confirms that cross-cultural communication is enhanced by NMHV language attitudes as well as their proficiency levels. Language awareness training is

The public-private partnership regulatory support of the healthcare sector in Ukraine

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N. G. Gojda

2013-10-01

Full Text Available Summary: Article is devoted to the legislation review of the public-private partnership projects of the healthcare sector inUkraine. Authors focused attention on the basic problems of public-private partnership projects inUkraine. Objective: Analysis of the legal framework provides the possibility of public-private partnerships in health care ofUkraine and confirms the relevance of the scientific concept of development of public-private partnerships in health care ofUkraine. Methods: There were used periodic data of legal, economic and medical research publications inUkraine and CIS countries on regulatory support public-private partnerships. Results: The researches in many countries have proven the established of state regulatory bodies that carefully study various aspects of the business partnership in the services of provision of health care. Developed numerical models as simple infrastructure projects implement business participation in providing non-medical services (construction, hotels and utilities, technical re-equipment etc. to complex integrated models that involve the transfer of important state functions to private partner (strategic planning, highly specialized medical care, research, medical education, etc.. Conclusion: The development of public-private partnerships in health care of Ukraine is possible only in condition of further improvement of legislation to the line with the norms and principles of international law, providing a clear and coordinated cooperation of all branches and friendly to business partnership administrative environment.

U-Form vs. M-Form: How to Understand Decision Autonomy Under Healthcare Decentralization?

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Bustamante, Arturo Vargas

2016-01-01

For more than three decades healthcare decentralization has been promoted in developing countries as a way of improving the financing and delivery of public healthcare. Decision autonomy under healthcare decentralization would determine the role and scope of responsibility of local authorities. Jalal Mohammed, Nicola North, and Toni Ashton analyze decision autonomy within decentralized services in Fiji. They conclude that the narrow decision space allowed to local entities might have limited the benefits of decentralization on users and providers. To discuss the costs and benefits of healthcare decentralization this paper uses the U-form and M-form typology to further illustrate the role of decision autonomy under healthcare decentralization. This paper argues that when evaluating healthcare decentralization, it is important to determine whether the benefits from decentralization are greater than its costs. The U-form and M-form framework is proposed as a useful typology to evaluate different types of institutional arrangements under healthcare decentralization. Under this model, the more decentralized organizational form (M-form) is superior if the benefits from flexibility exceed the costs of duplication and the more centralized organizational form (U-form) is superior if the savings from economies of scale outweigh the costly decision-making process from the center to the regions. Budgetary and financial autonomy and effective mechanisms to maintain local governments accountable for their spending behavior are key decision autonomy variables that could sway the cost-benefit analysis of healthcare decentralization. PMID:27694684

Board Governance: Transformational Approaches Under Healthcare Reform.

Science.gov (United States)

Zastocki, Deborah K

2015-01-01

Previous successes of healthcare organizations and effective governance practices in the pre-reform environment are not predictive of future success. Healthcare has been through numerous phases of growth and development using tried-and-true strategies. The challenge is that our toolbox does not contain what is needed to build the future healthcare delivery systems required in the post-reform world. Healthcare has had a parochial focus at the local level, with some broadening of horizons at the state and national levels. But healthcare delivery is now a global issue that requires a totally different perspective, and many countries are confronting similar issues. US healthcare reform initiatives have far-reaching implications. Compounding the reform dynamics are the simultaneously occurring, gamechanging accelerants such as enabling information technologies and mobile health, new providers of healthcare, increased consumer demands, and limited healthcare dollars, to name a few. Operating in this turbulent environment requires transformational board, executive, and physician leadership because traditional ways of planning for incremental change and attempting to time those adjustments can prove disastrous. Creating the legacy healthcare system for tomorrow requires governing boards and executive leadership to act today as they would in the desired future system. Boards need to create a culture that fosters.innovation with a tolerance for risk and some failure. To provide effective governance, boards must essentially develop new skills, expertise, and ways of thinking. The rapid rate of change requires board members to possess certain capabilities, including the ability to deal with ambiguity and uncertainty while demonstrating flexibility and adaptability, all with a driving commitment to metrics and results. This requires development plans for both individual members and the overall board. In short, the board needs to function differently, particularly regarding the

Healthcare waste management in Uganda: management and generation rates in public and private hospitals in Kampala

NARCIS (Netherlands)

Mugambe, R.K.; Ssempebwa, J.C.; Tumwesigye, N.M.; Vliet, van B.J.M.; Adedimeji, A.

2012-01-01

Aim The aim of this study was to assess the management, characteristics and generation of healthcare waste (HCW) in public and private hospitals in Kampala City, Uganda. Methods We employed mainly qualitative methods through the use of a waste inventory, observations, document review and key

Emerging nicotine delivery products. Implications for public health.

Science.gov (United States)

Benowitz, Neal L

2014-02-01

The idea of clean nicotine delivery systems that would satisfy nicotine craving and promote smoking cessation has been considered as a possible public health tool for many years. Nicotine medications have been useful for smoking cessation but have not found widespread popularity among smokers, perhaps because of slow nicotine delivery and other sensory characteristics that differ from cigarettes. Traditional smokeless tobacco delivers as much nicotine as cigarettes and has been advocated for harm reduction but contains carcinogenic nitrosamines and has not been proven to promote cessation. Furthermore, there is concern that dual use of smokeless tobacco and cigarettes may inhibit quitting smoking. Newer oral dissolvable tobacco products contain lower levels of toxicants than other smokeless tobacco but also deliver much less nicotine and have not been popular with consumers. Electronic cigarettes that aerosolize nicotine without generating toxic tobacco combustion products have become quite popular and hold promise as a way to attract smokers away from cigarettes, although efficacy in promoting smoking cessation has not yet been demonstrated. There are concerns about safety of long-term use, and there is evidence that youth, including nonsmokers, are taking up e-cigarette use. E-cigarettes are marketed for use when one cannot smoke conventional cigarettes, and such use might result in more persistent cigarette smoking. Although their benefits and risks are being vigorously debated, e-cigarettes or other clean nicotine delivery devices could play an important role as an adjunct to a U.S. Food and Drug Administration regulatory intervention to make cigarettes less addictive and in this context could contribute to the end of cigarette smoking and smoking-induced disease.

Critical success factors for implementing healthcare e-Learning.

Science.gov (United States)

Lee, Te-Shu; Kuo, Mu-Hsing; Borycki, Elizabeth M; Yunyong, David

2011-01-01

The use of e-Learning in educational institutes has rapidly increased along with the development of information and communication technology (ICT). In healthcare, more medical educators are using e-Learning to support their curriculum design, delivery and evaluation. However, no systematic work exists on characterizing a collective set of Critical Success Factors (CSFs) for implementing e-Learning in the healthcare education institutions. The aim of this paper is to study the CSFs of implementing healthcare e-Learning.

MEDICARE PAYMENTS AND SYSTEM-LEVEL HEALTH-CARE USE

Science.gov (United States)

ROBBINS, JACOB A.

2015-01-01

The rapid growth of Medicare managed care over the past decade has the potential to increase the efficiency of health-care delivery. Improvements in care management for some may improve efficiency system-wide, with implications for optimal payment policy in public insurance programs. These system-level effects may depend on local health-care market structure and vary based on patient characteristics. We use exogenous variation in the Medicare payment schedule to isolate the effects of market-level managed care enrollment on the quantity and quality of care delivered. We find that in areas with greater enrollment of Medicare beneficiaries in managed care, the non–managed care beneficiaries have fewer days in the hospital but more outpatient visits, consistent with a substitution of less expensive outpatient care for more expensive inpatient care, particularly at high levels of managed care. We find no evidence that care is of lower quality. Optimal payment policies for Medicare managed care enrollees that account for system-level spillovers may thus be higher than those that do not. PMID:27042687

Protecting Public Health: Plug-In Electric Vehicle Charging and the Healthcare Industry

Energy Technology Data Exchange (ETDEWEB)

Ryder, Carrie; Lommele, Stephen

2016-10-01

In 2014, the U.S. transportation sector consumed more than 13 million barrels of petroleum a day, approximately 70% of all domestic petroleum consumption. Internal combustion engine vehicles are major sources of greenhouse gases (GHGs), smog-forming compounds, particulate matter, and other air pollutants. Widespread use of alternative fuels and advanced vehicles, including plug-in electric vehicles (PEVs), can reduce our national dependence on petroleum and decrease the emissions that impact our air quality and public health. Healthcare organizations are major employers and community leaders that are committed to public well-being and are often early adopters of employer best practices. A growing number of hospitals are offering PEV charging stations for employees to help promote driving electric vehicles, reduce their carbon footprint, and improve local air quality.

How do healthcare consumers process and evaluate comparative healthcare information? A qualitive study using cognitive interviews

NARCIS (Netherlands)

Damman, O.C.; Hendriks, M.; Rademakers, J.; Delnoij, D.M.J.; Groenewegen, P.P.

2009-01-01

Background: To date, online public healthcare reports have not been effectively used by consumers. Therefore, we qualitatively examined how healthcare consumers process and evaluate comparative healthcare information on the Internet. Methods: Using semi-structured cognitive interviews, interviewees

How do healthcare consumers process and evaluate comparative healthcare information? A qualitative study using cognitive interviews.

NARCIS (Netherlands)

Damman, O.C.; Hendriks, M.; Rademakers, J.; Delnoij, D.; Groenewegen, P.

2009-01-01

Background: To date, online public healthcare reports have not been effectively used by consumers. Therefore, we qualitatively examined how healthcare consumers process and evaluate comparative healthcare information on the Internet. Methods: Using semi-structured cognitive interviews, interviewees

A web-based information system for a regional public mental healthcare service network in Brazil.

Science.gov (United States)

Yoshiura, Vinicius Tohoru; de Azevedo-Marques, João Mazzoncini; Rzewuska, Magdalena; Vinci, André Luiz Teixeira; Sasso, Ariane Morassi; Miyoshi, Newton Shydeo Brandão; Furegato, Antonia Regina Ferreira; Rijo, Rui Pedro Charters Lopes; Del-Ben, Cristina Marta; Alves, Domingos

2017-01-01

Regional networking between services that provide mental health care in Brazil's decentralized public health system is challenging, partly due to the simultaneous existence of services managed by municipal and state authorities and a lack of efficient and transparent mechanisms for continuous and updated communication between them. Since 2011, the Ribeirao Preto Medical School and the XIII Regional Health Department of the Sao Paulo state, Brazil, have been developing and implementing a web-based information system to facilitate an integrated care throughout a public regional mental health care network. After a profound on-site analysis, the structure of the network was identified and a web-based information system for psychiatric admissions and discharges was developed and implemented using a socio-technical approach. An information technology team liaised with mental health professionals, health-service managers, municipal and state health secretariats and judicial authorities. Primary care, specialized community services, general emergency and psychiatric wards services, that comprise the regional mental healthcare network, were identified and the system flow was delineated. The web-based system overcame the fragmentation of the healthcare system and addressed service specific needs, enabling: detailed patient information sharing; active coordination of the processes of psychiatric admissions and discharges; real-time monitoring; the patients' status reports; the evaluation of the performance of each service and the whole network. During a 2-year period of operation, it registered 137 services, 480 health care professionals and 4271 patients, with a mean number of 2835 accesses per month. To date the system is successfully operating and further expanding. We have successfully developed and implemented an acceptable, useful and transparent web-based information system for a regional mental healthcare service network in a medium-income country with a decentralized

Perspectives on healthcare leader and leadership development

OpenAIRE

Scott, Elaine S.

2010-01-01

Elaine S ScottCollege of Nursing, Graduate Nursing Science Department, East Carolina University, Greenville, NC USAAbstract: Healthcare delivery systems are complex entities that must merge the best of administrative and clinical practices into a new model of leadership. But, despite growing recognition that healthcare organizational leaders must partner with clinical leaders to address patient safety, evidence based practice, financial sustainability, and capacity, tensions between the group...

How front-line healthcare workers respond to stock-outs of essential medicines in the Eastern Cape Province of South Africa.

Science.gov (United States)

Hodes, R; Price, I; Bungane, N; Toska, E; Cluver, L

2017-08-25

Shortages of essential medicines are a daily occurrence in many of South Africa (SA)'s public health facilities. This study focuses on the responses of healthcare workers to stock-outs, investigating how actors at the 'front line' of public health delivery understand, experience and respond to shortages of essential medicines and equipment in their facilities. Findings are based on focus groups, observations and interviews with healthcare workers and patients at healthcare facilities in the Eastern Cape Province of SA, conducted as part of the Mzantsi Wakho study. The research revealed a discrepancy between 'informal' definitions of stock-outs and their reporting through formal stock-out management channels. Front-line healthcare workers had designed their own systems for classifying the severity of stock-outs, based on the product in question, and on their potential to access stocks from other facilities. Beyond formal systems of procurement and supply, healthcare workers had established vast networks of alternative communication and action, often using personal resources to procure medical supplies. Stock-outs were only reported when informal methods of stock-sharing did not secure top-up supplies. These findings have implications for understanding the frequency and severity of stock-outs, and for taking action to prevent and manage stock-outs effectively.

The 2014–2015 Ebola virus disease outbreak and primary healthcare delivery in Liberia: Time-series analyses for 2010–2016

Science.gov (United States)

Beste, Jason; Toomay, Stephen J.; Dunbar, Nelson; Bawo, Luke; Wesseh, Chea Sanford

2018-01-01

Background The aim of this study is to estimate the immediate and lasting effects of the 2014–2015 Ebola virus disease (EVD) outbreak on public-sector primary healthcare delivery in Liberia using 7 years of comprehensive routine health information system data. Methods and findings We analyzed 10 key primary healthcare indicators before, during, and after the EVD outbreak using 31,836 facility-month service outputs from 1 January 2010 to 31 December 2016 across a census of 379 public-sector health facilities in Liberia (excluding Montserrado County). All indicators had statistically significant decreases during the first 4 months of the EVD outbreak, with all indicators having their lowest raw mean outputs in August 2014. Decreases in outputs comparing the end of the initial EVD period (September 2014) to May 2014 (pre-EVD) ranged in magnitude from a 67.3% decrease in measles vaccinations (95% CI: −77.9%, −56.8%, p < 0.001) and a 61.4% decrease in artemisinin-based combination therapy (ACT) treatments for malaria (95% CI: −69.0%, −53.8%, p < 0.001) to a 35.2% decrease in first antenatal care (ANC) visits (95% CI: −45.8%, −24.7%, p < 0.001) and a 38.5% decrease in medroxyprogesterone acetate doses (95% CI: −47.6%, −29.5%, p < 0.001). Following the nadir of system outputs in August 2014, all indicators showed statistically significant increases from October 2014 to December 2014. All indicators had significant positive trends during the post-EVD period, with every system output exceeding pre-Ebola forecasted trends for 3 consecutive months by November 2016. Health system outputs lost during and after the EVD outbreak were large and sustained for most indicators. Prior to exceeding pre-EVD forecasted trends for 3 months, we estimate statistically significant cumulative losses of −776,110 clinic visits (95% CI: −1,480,896, −101,357, p = 0.030); −24,449 bacille Calmette–Guérin vaccinations (95% CI: −45,947, −2,020, p = 0.032); −9

Public stewardship of private for-profit healthcare providers in low- and middle-income countries

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Wiysonge, Charles S; Abdullahi, Leila H; Ndze, Valantine N; Hussey, Gregory D

2016-01-01

Background Governments use different approaches to ensure that private for-profit healthcare services meet certain quality standards. Such government guidance, referred to as public stewardship, encompasses government policies, regulatory mechanisms, and implementation strategies for ensuring accountability in the delivery of services. However, the effectiveness of these strategies in low- and middle-income countries (LMICs) have not been the subject of a systematic review. Objectives To assess the effects of public sector regulation, training, or co-ordination of the private for-profit health sector in low- and middle-income countries. Search methods For related systematic reviews, we searched the Cochrane Database of Systematic Reviews (CDSR) 2015, Issue 4; Database of Abstracts of Reviews of Effectiveness (DARE) 2015, Issue 1; Health Technology Assessment Database (HTA) 2015, Issue 1; all part of The Cochrane Library, and searched 28 April 2015. For primary studies, we searched MEDLINE, Epub Ahead of Print, In-Process & Other Non-Indexed Citations, MEDLINE Daily and MEDLINE 1946 to Present, OvidSP (searched 16 June 2016); Science Citation Index and Social Sciences Citation Index 1987 to present, and Emerging Sources Citation Index 2015 to present, ISI Web of Science (searched 3 May 2016 for papers citing included studies); Cochrane Central Register of Controlled Trials (CENTRAL), 2015, Issue 3, part of The Cochrane Library (including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register) (searched 28 April 2015); Embase 1980 to 2015 Week 17, OvidSP (searched 28 April 2015); Global Health 1973 to 2015 Week 16, OvidSP (searched 30 April 2015); WHOLIS, WHO (searched 30 April 2015); Science Citation Index and Social Sciences Citation Index 1975 to present, ISI Web of Science (searched 30 April 2015); Health Management, ProQuest (searched 22 November 2013). In addition, in April 2016, we searched the reference lists of relevant

What is preventable harm in healthcare? A systematic review of definitions

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Nabhan Mohammed

2012-05-01

Full Text Available Abstract Background Mitigating or reducing the risk of harm associated with the delivery of healthcare is a policy priority. While the risk of harm can be reduced in some instances (i.e. preventable, what constitutes preventable harm remains unclear. A standardized and clear definition of preventable harm is the first step towards safer and more efficient healthcare delivery system. We aimed to summarize the definitions of preventable harm and its conceptualization in healthcare. Methods We conducted a comprehensive electronic search of relevant databases from January 2001 to June 2011 for publications that reported a definition of preventable harm. Only English language publications were included. Definitions were coded for common concepts and themes. We included any study type, both original studies and reviews. Two reviewers screened the references for eligibility and 28% (127/460 were finally included. Data collected from studies included study type, description of the study population and setting, and data corresponding to the outcome of interest. Three reviewers extracted the data. The level of agreement between the reviewers was calculated. Results One hundred and twenty seven studies were eligible. The three most prevalent preventable harms in the included studies were: medication adverse events (33/127 studies, 26%, central line infections (7/127, 6% and venous thromboembolism (5/127, 4%. Seven themes or definitions for preventable harm were encountered. The top three were: presence of an identifiable modifiable cause (58/132 definitions, 44%, reasonable adaptation to a process will prevent future recurrence (30/132, 23%, adherence to guidelines (22/132, 16%. Data on the validity or operational characteristic (e.g., accuracy, reproducibility of definitions were limited. Conclusions There is limited empirical evidence of the validity and reliability of the available definitions of preventable harm, such that no single one is supported by

Planning of public healthcare facility using a location allocation modelling: A case study

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Shariff, S. Sarifah Radiah; Moin, Noor Hasnah; Omar, Mohd

2014-09-01

Finding the correct location of any facility and determining the demands which are to be assigned to it is very crucial in public health service. This is to ensure that the public gain maximum benefits. This article analyzes the previous location decisions of public primary healthcare (PHC) facilities in the district of Kuala Langat, Malaysia. With total population of 220214 (in 2010), the PHC in the district is currently served by 28 facilities. The percentages of total population covered (in 2007) within the maximum allowable distance of 3km and 5km are 69.7 percent and 77.8 percent respectively. This is very low compared to the Malaysian National Health Policy of Health for All or 100 percent coverage. The determination of health facility location should be planned carefully to further increase effective primary health service to the nation that is required for economic sustainability.

Service models for remote healthcare monitoring systems.

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Moorman, Bridget A

2010-01-01

These scenarios reflect where the future is heading for remote health monitoring technology and service expectations. Being able to manage a "system of systems" with timely service hand-off over seams of responsibility and system interfaces will become very important for a BMET or clinical engineer. These interfaces will include patient homes, clinician homes, commercial/civilian infrastructure, public utilities, vendor infrastructure as well as internal departmental domains. Concurrently, technology is changing rapidly resulting in newer software delivery modes and hardware appliances as well as infrastructure changes. Those who are able to de-construct the complex systems and identify infrastructure assumptions and seams of servicing responsibility will be able to better understand and communicate the expectations for service of these systems. Moreover, as identified in Case 1, prodigious use of underlying system monitoring tools (managing the "meta-data") could move servicing of these remote systems from a reactive approach to a proactive approach. A prepared healthcare organization will identify their current and proposed future service combination use cases and design service philosophies and expectations for those use cases, while understanding the infrastructure assumptions and seams of responsibility. This is the future of technical service to the healthcare clinicians and patients.

[Digital health as a motor for change towards new healthcare models and the relationship between patients and healthcare professionals. Disruption of healthcare processes].

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Garcia-Cuyàs, Francesc; de San Pedro, Marc; Martínez Roldan, Jordi

2015-11-01

We find ourselves at the end of an era of asymmetry in the domain of health information where the majority of this data is in the hands of the healthcare system. Increasingly, the public are calling for a more central role in the new paradigm that enables them to duly exercise their right of access to their health data while availing of more reliable and safer technologies which contribute to the management of their condition and promote healthy lifestyles. So far, the TIC Salud strategic plan has been developed independently from the Generalitat de Catalunya Health Department's Healthcare Plan, which sets out health policy strategy in Catalonia. However, from its initial design stage the new Healthcare Plan (2016- 2020) envisages incorporating a new strategic Information and communications technology (ICT) line called "Digital Health". Incorporating ICT into the Health Plan will allow these technologies to become integral part of all strategic healthcare processes, acting as a driving force for a shift towards a new healthcare models and an innovative relationship between the public and healthcare professionals. The Digital Health implies a disruption in itself, by way of the convergence of several technologies and their positive impact on health and healthcare procedures, by way of the public's access to information concerning their health, and by creating new opportunities for promoting health and the salutogenic paradigm which empowers people to develop their health, welfare and quality of life. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Distribution Pattern of Healthcare Facilities in Osun State, Nigeria ...

African Journals Online (AJOL)

In this paper we employed the use of locational quotient, which is a measure of spatial pattern of services, to examine the distribution pattern of healthcare facilities in the thirty local government areas in Osun State, Nigeria. Twelve indices, representing the totality of healthcare delivery by State and local governments in the ...

Healthcare Quality: A Concept Analysis.

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Allen-Duck, Angela; Robinson, Jennifer C; Stewart, Mary W

2017-10-01

Worsening quality indicators of health care shake public trust. Although safety and quality of care in hospitals can be improved, healthcare quality remains conceptually and operationally vague. Therefore, the aim of this analysis is to clarify the concept of healthcare quality. Walker and Avant's method of concept analysis, the most commonly used in nursing literature, provided the framework. We searched general and medical dictionaries, public domain websites, and 5 academic literature databases. Search terms included health care and quality, as well as healthcare and quality. Peer-reviewed articles and government publications published in English from 2004 to 2016 were included. Exclusion criteria were related concepts, discussions about the need for quality care, gray literature, and conference proceedings. Similar attributes were grouped into themes during analysis. Forty-two relevant articles were analyzed after excluding duplicates and those that did not meet eligibility. Following thematic analysis, 4 defining attributes were identified: (1) effective, (2) safe, (3) culture of excellence, and (4) desired outcomes. Based on these attributes, the definition of healthcare quality is the assessment and provision of effective and safe care, reflected in a culture of excellence, resulting in the attainment of optimal or desired health. This analysis proposes a conceptualization of healthcare quality that defines its implied foundational components and has potential to improve the provision of quality care. Theoretical and practice implications presented promote a fuller, more consistent understanding of the components that are necessary to improve the provision of healthcare and steady public trust. © 2017 Wiley Periodicals, Inc.

Social Influence on Information Technology Adoption and Sustained Use in Healthcare: A Hierarchical Bayesian Learning Method Analysis

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Hao, Haijing

2013-01-01

Information technology adoption and diffusion is currently a significant challenge in the healthcare delivery setting. This thesis includes three papers that explore social influence on information technology adoption and sustained use in the healthcare delivery environment using conventional regression models and novel hierarchical Bayesian…

Outcomes of treatment of drug-susceptible tuberculosis at public sector primary healthcare clinics in Johannesburg, South Africa: A retrospective cohort study.

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Budgell, E P; Evans, D; Schnippel, K; Ive, P; Long, L; Rosen, S

2016-09-05

Despite the large number of tuberculosis (TB) patients treated in South Africa (SA), there are few descriptions in the published literature of drug-susceptible TB patient characteristics, mode of diagnosis or treatment outcomes in routine public sector treatment programmes. To enhance the evidence base for public sector TB treatment service delivery, we reported the characteristics of and outcomes for a retrospective cohort of adult TB patients at public sector clinics in the Johannesburg Metropolitan Municipality (JHB), SA. We collected medical record data for a retrospective cohort of adult (≥18 years) TB patients registered between 1 April 2011 and 31 March 2012 at three public sector clinics in JHB. Data were abstracted from National TB Programme clinic cards and the TB case registers routinely maintained at study sites. We report patient characteristics, mode of diagnosis, mode of treatment supervision, treatment characteristics, HIV status and treatment outcomes for this cohort. A total of 544 patients were enrolled in the cohort. Most (86%) were new TB cases, 81% had pulmonary TB, 58% were smear-positive at treatment initiation and 71% were HIV co-infected. Among 495 patients with treatment outcomes reported, 80% (n=394) had successful outcomes, 11% (n=55) were lost to follow-up, 8% (n=40) died and 1% (n=6) failed treatment. Primary healthcare clinics in JHB are achieving relatively high rates of success in treating drug-susceptible TB. Missing laboratory results were common, including follow-up smears, cultures and drug susceptibility tests, making it difficult to assess adherence to guidelines and leaving scope for substantial improvements in record-keeping at the clinics involved.

The orthopaedist's role in healthcare system governance.

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Probe, Robert A

2013-06-01

Historically, physicians as participants in healthcare governance were shunned because of perceived potential for conflict of interest. This maxim is being revisited as health systems begin to appreciate the value presented by physician leaders. This overview of the orthopaedist's role in healthcare governance will be addressed in three sections: first to identify the need for change in American healthcare, second to examine the role that physicians should play in governing over this inevitable change, and third to outline strategies for effective participation for those physicians wishing to play a role in healthcare governance. The PubMed data set was queried applying the search commands "governance AND (healthcare OR hospital) AND (doctor OR physician OR surgeon)" for the time period 1969 to 2012. In addition, the bibliographies of relevant articles were reviewed. This search strategy returned 404 titles. Abstract and article review identified 19 relevant to the topic. Bibliographic review identified five more articles of relevance forming the foundation for this review. The delivery of American health care will require change to face current economic realities. Organizations that embrace this change guided by the insight of physician governors are well positioned to recognize the simultaneous improvement in value and quality. Although few physicians are formally trained for these roles, multiple paths to becoming effective governors are available. In this environment of rapid change in healthcare delivery, the medical insight of physician leadership will prove invaluable. Governing bodies should reach out to talented physicians and administratively talented physicians should rise to this challenge.

Ethical issues in healthcare financing.

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Maharaj, S R; Paul, T J

2011-07-01

The four goals of good healthcare are to relieve symptoms, cure disease, prolong life and improve quality of life. Access to healthcare has been a perpetual challenge to healthcare providers who must take into account important factors such as equity, efficiency and effectiveness in designing healthcare systems to meet the four goals of good healthcare. The underlying philosophy may designate health as being a basic human right, an investment, a commodity to be bought and sold, a political demand or an expenditure. The design, policies and operational arrangements will usually reflect which of the above philosophies underpin the healthcare system, and consequently, access. Mechanisms for funding include fee-for-service, cost sharing (insurance, either private or government sponsored) free-of-fee at point of delivery (payments being made through general taxes, health levies, etc) or cost-recovery. For each of these methods of financial access to healthcare services, there are ethical issues which can compromise the four principles of ethical practices in healthcare, viz beneficence, non-maleficence, autonomy and justice. In times of economic recession, providing adequate healthcare will require governments, with support from external agencies, to focus on poverty reduction strategies through provision of preventive services such as immunization and nutrition, delivered at primary care facilities. To maximize the effect of such policies, it will be necessary to integrate policies to fashion an intersectoral approach.

Perceptions of International Students on Service Quality Delivery in a Malaysian Public University

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Njie, Baboucarr; Asimiran, Soaib; Baki, Roselan

2012-01-01

Purpose: The purpose of this study is to explore the perceptions of international students of service quality delivery (SQD) in a Malaysian public university. Design/methodology/approach: The study was limited to the University's immediate physical environment and its associated human and systems-based services. The physical environment in this…

Public Healthcare Organizations: Leadership or Management?

Directory of Open Access Journals (Sweden)

Maite Martínez-Gonzalez

2016-11-01

Full Text Available This article studies the type of leadership that managers are currently exercising in the Catalan health system in Catalonia. A questionnaire (MQL-5X was sent to 120 people occupying management positions in healthcare centers and hospitals as well as 14 others who also hold such positions in these healthcare centers and hospitals, were interviewed. The mixed methods research design attests that the Catalan health system is managed through a structure of simultaneous transformational and transactional leadership. However, the efficacy of this system is conditioned purely by the communicative competence that a manager may or may not possess, as the system itself makes no effort to encourage transformational leadership. Transformation leadership inspires positive change, conveys a clear vision and enhances morale, motivation and job performance. It galvanizes a team into changing their expectations and perceptions and motivates them to work towards common goals.

An evaluation of the development of a marketing strategy in mental healthcare delivery

NARCIS (Netherlands)

Bierbooms, J.J.P.A.; Bongers, I.M.B.; van Oers, J.A.M.

2014-01-01

Background Budget restrictions and increasing market forces within the Dutch mental healthcare sector have been forcing mental healthcare providers to manifest the added value of their quality of care. This calls for the development of the marketing skills of a mental healthcare provider, which can

mHealth transforming healthcare

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Malvey, Donna

2014-01-01

Examines regulatory trends and their impact on mHealth innovations and applications Offers solutions for those in the health care industry that are attempting to engage consumers in reducing healthcare costs and in improving their health care encounters and personal health Explains what is necessary for long-term viability of mHealth as a health care delivery medium.

Patient engagement as an emerging challenge for healthcare services: mapping the literature.

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Barello, Serena; Graffigna, Guendalina; Vegni, Elena

2012-01-01

Patients' engagement in healthcare is at the forefront of policy and research practice and is now widely recognized as a critical ingredient for high-quality healthcare system. This study aims to analyze the current academic literature (from 2002 to 2012) about patient engagement by using bibliometric and qualitative content analyses. Extracting data from the electronic databases more likely to cover the core research publications in health issues, the number of yearly publications, the most productive countries, and the scientific discipline dealing with patient engagement were quantitatively described. Qualitative content analysis of the most cited articles was conducted to distinguish the core themes. Our data showed that patient engagement is gaining increasing attention by all the academic disciplines involved in health research with a predominance of medicine and nursing. Engaging patients is internationally recognized as a key factor in improving health service delivery and quality. Great attention is up to now paid to the clinical and organizational outcomes of engagement, whereas there is still a lack of an evidence-based theoretical foundation of the construct as well as of the organizational dimensions that foster it.

Patient Engagement as an Emerging Challenge for Healthcare Services: Mapping the Literature

Directory of Open Access Journals (Sweden)

Serena Barello

2012-01-01

Full Text Available Patients’ engagement in healthcare is at the forefront of policy and research practice and is now widely recognized as a critical ingredient for high-quality healthcare system. This study aims to analyze the current academic literature (from 2002 to 2012 about patient engagement by using bibliometric and qualitative content analyses. Extracting data from the electronic databases more likely to cover the core research publications in health issues, the number of yearly publications, the most productive countries, and the scientific discipline dealing with patient engagement were quantitatively described. Qualitative content analysis of the most cited articles was conducted to distinguish the core themes. Our data showed that patient engagement is gaining increasing attention by all the academic disciplines involved in health research with a predominance of medicine and nursing. Engaging patients is internationally recognized as a key factor in improving health service delivery and quality. Great attention is up to now paid to the clinical and organizational outcomes of engagement, whereas there is still a lack of an evidence-based theoretical foundation of the construct as well as of the organizational dimensions that foster it.

Will forensic use of medical biobanks decrease public trust in healthcare services? Some empirical observations.

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Bexelius, Christin; Hoeyer, Klaus; Lynöe, Niels

2007-01-01

The authors tested the prevalent hypothesis that forensic use of medical biobanks has a negative impact on public trust in healthcare services. A questionnaire was sent to 1,184 inhabitant in the age group 20-80 years in Stockholm County, Sweden, in November 2005. With a response rate of 68.4%, the results showed that a majority (88.1%) of the respondents thought that it would be acceptable for the police to gain access to genetic samples stored in relation to healthcare; 5.6% said no and 6.3% were uncertain. In the case of police access to medical biobanks, a minority (6.3%) indicated that this would have a negative impact on their trust, a larger proportion (37.8%) that it would influence their trust in the healthcare services positively, and 56% stated that it would not affect their trust at all. The hypothesis tested appears to be unfounded. This should cause us to reconsider prevalent assumptions and current policies on the interface of medical and forensic genetics.

Caesarean section deliveries: Experiences of mothers of midwifery care at a public hospital in Nelson Mandela Bay

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Thobeka P. Jikijela

2018-01-01

Conclusion: Experiences of mothers following a caesarean section delivery with midwifery services at a public hospital in Nelson Mandela Bay were explored and described as diverse. A need for adequate pain management as well as assistance and breastfeeding support to mothers following caesarean delivery was identified as crucial to promote a good mother-to-child relationship.

Public Private Partnerships: A possible alternative for delivery of infrastructure projects in Africa

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Salim Bwanali

2017-12-01

Full Text Available It is estimated that Africa needs $93 billion annually until 2020 in order to bridge its infrastructure deficit. It is through significant investment in infrastructure development that economic growth and poverty alleviation can be enhanced. However central to all construction projects is an effective and sustainable procurement system. There is a notable shift by some African governments to turn to the private sector to design, build, finance and operate infrastructure facilities previously provided by the public sector in the form of Public Private Partnerships (PPP’s. As an innovative financing model, PPPs present an opportunity to governments to improve service delivery. Accordingly, this paper focuses on assessing international best practices as to how some developing nations tap into the resources of the private sector in implementing their infrastructure projects. The study is a result of critical review, synthesis and contextualization of relevant academic literature, conference and journal publications. A thorough document review method was employed to assess how some developing countries have institutionalized PPP as part of their development strategy. The paper will be of significant value to senior government officials as understanding the concept and dynamics of PPP will result in accelerated and effective service delivery.

Does co-creation impact public service delivery? The importance of state and governance traditions

NARCIS (Netherlands)

Voorberg, Willem; Bekkers, Victor; Flemig, Sophie; Timeus, Krista; Tõnurist, Piret; Tummers, L.G.

2017-01-01

Co-creation in public service delivery requires partnerships between citizens and civil servants. The authors argue that whether or not these partnerships will be successful depends on state and governance traditions (for example a tradition of authority sharing or consultation). These traditions

Evaluating Business Value of IT in Healthcare: Three Clinical Practices from Australia and the US.

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Haddad, Peter; Schaffer, Jonathan L; Wickramasinghe, Nilmini

2015-01-01

Exponentially increasing costs in healthcare coupled with poor quality and limited access have motivated the healthcare industry to turn to IS/IT solutions to overcome these issues and facilitate superior healthcare delivery. In an environment of rapid development of new clinical informatics solutions claiming to provide better healthcare delivery, there is a paucity of systematic frameworks to robustly measure the actual value of these systems. The promised business value of these solutions has been elusive; hence, this study offers an approach for the evaluation of the business value of health IS/IT solutions based on a conceptual model, which has been validated using three clinical case studies.

Healthcare-associated infections: challenges to public health in Brazil.

Science.gov (United States)

Padoveze, Maria Clara; Fortaleza, Carlos Magno Castelo Branco

2014-12-01

This study presents a critical evaluation of the scientific literature related to this subject, aiming to assess the policies and administrative issues regarding the prevention and magnitude of healthcare-associated infections and discuss the challenges for their prevention in Brazil. The topics discussed included historical and administrative issues, challenges imposed by the characteristics of the healthcare system and the territorial dimension, laboratorial support limitations, costs, institutional culture, professional qualification, and patient engagement. It is urgent to hold a nationwide discussion among government representatives, institutions, and healthcare workers and users to overcome these challenges.

Public-private delivery of insecticide-treated nets: a voucher scheme in Volta Region, Ghana

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Taylor Ian

2007-02-01

Full Text Available Abstract Background Coverage of vulnerable groups with insecticide-treated nets (ITNs in Ghana, as in the majority of countries of sub-Saharan Africa is currently low. A voucher scheme was introduced in Volta Region as a possible sustainable delivery system for increasing this coverage through scale-up to other regions. Successful scale-up of public health interventions depends upon optimal delivery processes but operational research for delivery processes in large-scale implementation has been inadequate. Methods A simple tool was developed to monitor numbers of vouchers given to each health facility, numbers issued to pregnant women by the health staff, and numbers redeemed by the distributors back to the management agent. Three rounds of interviews were undertaken with health facility staff, retailers and pregnant women who had attended antenatal clinic (ANC. Results During the one year pilot 25,926 vouchers were issued to eligible women from clinics, which equates to 50.7% of the 51,658 ANC registrants during this time period. Of the vouchers issued 66.7% were redeemed by distributors back to the management agent. Initially, non-issuing of vouchers to pregnant women was mainly due to eligibility criteria imposed by the midwives; later in the year it was due to decisions of the pregnant women, and supply constraints. These in turn were heavily influenced by factors external to the programme: current household ownership of nets, competing ITN delivery strategies, and competition for the limited number of ITNs available in the country from major urban areas of other regions. Conclusion Both issuing and redemption of vouchers should be monitored as factors assumed to influence voucher redemption had an influence on issuing, and vice versa. More evidence is needed on how specific contextual factors influence the success of voucher schemes and other models of delivery of ITNs. Such an evidence base will facilitate optimal strategic decision making

Smoking and Depression among Healthcare Workers

Directory of Open Access Journals (Sweden)

Madhusudhan Ghimire

2014-06-01

Full Text Available Introduction: Healthcare workers are a special public icon for the community because people would like to adopt and implement their knowledge, skill, attitude and behaviour for improving quality of health. People respect them for their knowledge and health behavior. It is believed that the level of health status of health workers as well as community should go ahead parallel but many researchers have noted that high risk behaviours (smoking, tobacco use, alcoholism, irregular diet intake, lack of exercise etc. are prevalent among health workers. The result of this will be physical, psychological, familial and social disturbance, which might have an impact on health care delivery system of the country. The study was concerned to assess health status (body mass index, smoking and depression of healthcare workers and its impact on social adjustment in Banke district of Nepal. Methods: A cross sectional study design was applied to conduct the research. One hundred and eight respondents were selected through random sampling from the purposive group. Data wa collected through interview by using interview schedule. SPSS-16 windows process was used to analyze data. Results: Most of the respondent (81.40% were under the age group less than 30 years (M = 27.35, SD = 9.24 years. More than 57.40% of respondents were female. Most of them (68.50% were unmarried. Maximum (82.20% responders had normal Body Mass Index (18.5-24.99. Near about forty percent (38.9% healthcare worker had faced social problems in their working area. Conclusion: Age (above 20 years and male healthcare workers were more likely to smoke cigarettes. Depressed health workers were more likely to smoke cigarette. Depression could be observed as a determinant for social adjustment.

AcademyHealth's Delivery System Science Fellowship: Training Embedded Researchers to Design, Implement, and Evaluate New Models of Care.

Science.gov (United States)

Kanani, Nisha; Hahn, Erin; Gould, Michael; Brunisholz, Kimberly; Savitz, Lucy; Holve, Erin

2017-07-01

AcademyHealth's Delivery System Science Fellowship (DSSF) provides a paid postdoctoral pragmatic learning experience to build capacity within learning healthcare systems to conduct research in applied settings. The fellowship provides hands-on training and professional leadership opportunities for researchers. Since its inception in 2012, the program has grown rapidly, with 16 health systems participating in the DSSF to date. In addition to specific projects conducted within health systems (and numerous publications associated with those initiatives), the DSSF has made several broader contributions to the field, including defining delivery system science, identifying a set of training objectives for researchers working in delivery systems, and developing a national collaborative network of care delivery organizations, operational leaders, and trainees. The DSSF is one promising approach to support higher-value care by promoting continuous learning and improvement in health systems. © 2017 Society of Hospital Medicine.

State of science: human factors and ergonomics in healthcare.

Science.gov (United States)

Hignett, Sue; Carayon, Pascale; Buckle, Peter; Catchpole, Ken

2013-01-01

The past decade has seen an increase in the application of human factors and ergonomics (HFE) techniques to healthcare delivery in a broad range of contexts (domains, locations and environments). This paper provides a state of science commentary using four examples of HFE in healthcare to review and discuss analytical and implementation challenges and to identify future issues for HFE. The examples include two domain areas (occupational ergonomics and surgical safety) to illustrate a traditional application of HFE and the area that has probably received the most research attention. The other two examples show how systems and design have been addressed in healthcare with theoretical approaches for organisational and socio-technical systems and design for patient safety. Future opportunities are identified to develop and embed HFE systems thinking in healthcare including new theoretical models and long-term collaborative partnerships. HFE can contribute to systems and design initiatives for both patients and clinicians to improve everyday performance and safety, and help to reduce and control spiralling healthcare costs. There has been an increase in the application of HFE techniques to healthcare delivery in the past 10 years. This paper provides a state of science commentary using four illustrative examples (occupational ergonomics, design for patient safety, surgical safety and organisational and socio-technical systems) to review and discuss analytical and implementation challenges and identify future issues for HFE.

How do healthcare consumers process and evaluate comparative healthcare information? A qualitative study using cognitive interviews.

OpenAIRE

Damman, O.C.; Hendriks, M.; Rademakers, J.; Delnoij, D.; Groenewegen, P.

2009-01-01

Abstract Background To date, online public healthcare reports have not been effectively used by consumers. Therefore, we qualitatively examined how healthcare consumers process and evaluate comparative healthcare information on the Internet. Methods Using semi-structured cognitive interviews, interviewees (n = 20) were asked to think aloud and answer questions, as they were prompted with three Dutch web pages providing comparative healthcare information. Results We identified twelve themes fr...

Examining leadership as a strategy to enhance health care service delivery in regional hospitals in South Africa.

Science.gov (United States)

Govender, Sagaren; Gerwel Proches, Cecile N; Kader, Abdulla

2018-01-01

Four public hospitals in South Africa, which render both specialized and nonspecialized services to thousands of patients, were examined to determine the impact of leadership on health care service delivery. These hospitals were inundated by various problems that were impacting negatively on health care service delivery. This research study aimed to gain a comprehensive understanding of the challenges, complexities and constraints facing public health care in KwaZulu-Natal (KZN) and to examine leadership as a strategy to enhance healthcare service delivery with a particular focus on four regional hospitals in the KZN Province. The mixed-method research approach was utilized. Purposive sampling and stratified random sampling were employed in the research setting, and in-depth, semistructured interviews and questionnaires were used to collect data. Data were analyzed using the Nvivo computer software package for in-depth interviews and the Statistical Package for the Social Sciences (SPSS) software for the quantitative analysis. The research findings showed that the current leadership framework adopted by the health care leaders in regional hospitals in KZN is weak and is contributing to poor health care service delivery. This study, therefore, aimed to address the current challenges and weaknesses that are impacting negatively on health care service delivery in regional hospitals in the KZN Province and made recommendations for improvement.

Device Data Protection in Mobile Healthcare Applications

Science.gov (United States)

Weerasinghe, Dasun; Rajarajan, Muttukrishnan; Rakocevic, Veselin

The rapid growth in mobile technology makes the delivery of healthcare data and services on mobile phones a reality. However, the healthcare data is very sensitive and has to be protected against unauthorized access. While most of the development work on security of mobile healthcare today focuses on the data encryption and secure authentication in remote servers, protection of data on the mobile device itself has gained very little attention. This paper analyses the requirements and the architecture for a secure mobile capsule, specially designed to protect the data that is already on the device. The capsule is a downloadable software agent with additional functionalities to enable secure external communication with healthcare service providers, network operators and other relevant communication parties.

Firms’ reshaping of commercialization practices to overcome the ‘not invented here’ phenomenon in public healthcare organizations

DEFF Research Database (Denmark)

Nissen, Helle Aarøe; Evald, Majbritt Rostgaard; Clarke, Ann Højbjerg

2015-01-01

The present study is rooted in Public Private Innovation (PPI) projects where public hospitals and private firms engage in cross-sector collaboration with a view to developing new welfare solutions targeting public sector needs. Research into PPI is mainly focused on public management of innovation...... processes. Consequently, PPI is rarely examined from a private sector perspective, including how private firms seek to commercialize new innovations after co-creating these innovations in collaboration with public organizations. However, commercialization is a critical aspect of innovation because...... by elucidating how private firms commercialize co-created welfare solutions. The empirical setting is a multiple case study consisting of four PPI projects conducted in public Danish healthcare. The findings reveal that PPI firms experience the ‘not invented here’ (NIH) phenomenon across Danish hospitals...

Implementing telemonitoring in heart failure care : Barriers from the perspectives of patients, healthcare professionals and healthcare organizations

NARCIS (Netherlands)

Boyne, J.J.; Vrijhoef, H.J.M.

2013-01-01

The increasing prevalence of chronic diseases, such as heart failure, presents a substantial challenge to healthcare systems. Telemonitoring is believed to be a useful instrument in the delivery of heart failure care. However, a widespread use of telemonitoring is currently failing for various

Challenges of Data-driven Healthcare Management

DEFF Research Database (Denmark)

Bossen, Claus; Danholt, Peter; Ubbesen, Morten Bonde

This paper describes the new kind of data-work involved in developing data-driven healthcare based on two cases from Denmark: The first case concerns a governance infrastructure based on Diagnose-Related Groups (DRG), which was introduced in Denmark in the 1990s. The DRG-system links healthcare...... activity and financing and relies of extensive data entry, reporting and calculations. This has required the development of new skills, work and work roles. The second case concerns a New Governance project aimed at developing new performance indicators for healthcare delivery as an alternative to DRG....... Here, a core challenge is select indicators and actually being able to acquire data upon them. The two cases point out that data-driven healthcare requires more and new kinds of work for which new skills, functions and work roles have to be developed....

Decision making at the frontline: Exploring coping with moral conflicts during public service delivery

NARCIS (Netherlands)

Vink, E.; Tummers, L.G.; Bekkers, V.J.J.M.; Musheno, M.

2015-01-01

Moral conflicts, where a person is confronted with two or more clashing values, norms or responsibilities, are common in public service delivery. Choosing one is realized at the cost of the other(s). Frontline professionals, such as physicians and police officers, often experience clashes over the

Where to go in the near future: diverging perspectives on online public service delivery

NARCIS (Netherlands)

van Deursen, Alexander Johannes Aloysius Maria; Wimmer, Maria A.; Scholl, Jochen; Grönlund, Åke

2007-01-01

Although the electronic government is under heavy development, a clear vision doesn’t seem to exist. In this study 20 interviews among leaders in the field of e-government in the Netherlands resulted in different perspectives on the future of electronic public service delivery. The interviews

Assessment of pharmacists' delivery of public health services in rural and urban areas in Iowa and North Dakota.

Science.gov (United States)

Scott, David M; Strand, Mark; Undem, Teri; Anderson, Gabrielle; Clarens, Andrea; Liu, Xiyuan

2016-01-01

The profession of pharmacy is expanding its involvement in public health, but few studies have examined pharmacists' delivery of public health services. To assess Iowa and North Dakota pharmacists' practices, frequency of public health service delivery, level of involvement in achieving the essential services of public health, and barriers to expansion of public health services in rural and urban areas. This study implemented an on-line survey sent to all pharmacists currently practicing pharmacy in Iowa and North Dakota. Overall, 602 valid responses were analyzed, 297 in rural areas and 305 in urban areas. Three practice settings (chain stores [169, 28.2%], independent community pharmacies [162, 27.0%], and hospital pharmacies [156, 26.0%]) comprised 81.2% of the sample. Both chain and independent community pharmacists were more commonly located in rural areas than in urban areas (PDakota. These findings should be interpreted to be primarily due to differences in the role of the rural pharmacist and the quest for certain opportunities that rural pharmacists are seeking.

Health Literacy Impact on National Healthcare Utilization and Expenditure.

Science.gov (United States)

Rasu, Rafia S; Bawa, Walter Agbor; Suminski, Richard; Snella, Kathleen; Warady, Bradley

2015-08-17

Health literacy presents an enormous challenge in the delivery of effective healthcare and quality outcomes. We evaluated the impact of low health literacy (LHL) on healthcare utilization and healthcare expenditure. Database analysis used Medical Expenditure Panel Survey (MEPS) from 2005-2008 which provides nationally representative estimates of healthcare utilization and expenditure. Health literacy scores (HLSs) were calculated based on a validated, predictive model and were scored according to the National Assessment of Adult Literacy (NAAL). HLS ranged from 0-500. Health literacy level (HLL) and categorized in 2 groups: Below basic or basic (HLS Healthcare utilization expressed as a physician, nonphysician, or emergency room (ER) visits and healthcare spending. Expenditures were adjusted to 2010 rates using the Consumer Price Index (CPI). A P value of 0.05 or less was the criterion for statistical significance in all analyses. Multivariate regression models assessed the impact of the predicted HLLs on outpatient healthcare utilization and expenditures. All analyses were performed with SAS and STATA® 11.0 statistical software. The study evaluated 22 599 samples representing 503 374 648 weighted individuals nationally from 2005-2008. The cohort had an average age of 49 years and included more females (57%). Caucasian were the predominant racial ethnic group (83%) and 37% of the cohort were from the South region of the United States of America. The proportion of the cohort with basic or below basic health literacy was 22.4%. Annual predicted values of physician visits, nonphysician visits, and ER visits were 6.6, 4.8, and 0.2, respectively, for basic or below basic compared to 4.4, 2.6, and 0.1 for above basic. Predicted values of office and ER visits expenditures were $1284 and $151, respectively, for basic or below basic and $719 and $100 for above basic (P healthcare utilization and expenditure. Individuals with below basic or basic HLL have greater healthcare

Value-Based Delivery of Education: MOOCs as Messengers

Science.gov (United States)

Gilfoil, David M.; Focht, Jeffrey W.

2015-01-01

Value-based delivery of healthcare has been discussed in the literature for almost a decade. The concept focuses on the patient and defines value as the improvement of patient outcomes divided by healthcare costs. Further refinements, called the Triple Aim model, focus on improving patient outcomes, reducing treatment costs, and improving patient…

Accelerated reforms in healthcare financing: the need to scale up private sector participation in Nigeria.

Science.gov (United States)

Ejughemre, Ufuoma John

2014-01-01

The health sector, a foremost service sector in Nigeria, faces a number of challenges; primarily, the persistent under-funding of the health sector by the Nigerian government as evidence reveals low allocations to the health sector and poor health system performance which are reflected in key health indices of the country.Notwithstanding, there is evidence that the private sector could be a key player in delivering health services and impacting health outcomes, including those related to healthcare financing. This underscores the need to optimize the role of private sector in complementing the government's commitment to financing healthcare delivery and strengthening the health system in Nigeria. There are also concerns about uneven quality and affordability of private-driven health systems, which necessitates reforms aimed at regulation. Accordingly, the argument is that the benefits of leveraging the private sector in complementing the national government in healthcare financing outweigh the challenges, particularly in light of lean public resources and finite donor supports. This article, therefore, highlights the potential for the Nigerian government to scale up healthcare financing by leveraging private resources, innovations and expertise, while working to achieve the universal health coverage.

The welfare implications of public healthcare financing: a macro-micro simulation analysis of Uganda.

Science.gov (United States)

Kabajulizi, Judith; Keogh-Brown, Marcus R; Smith, Richard D

2017-12-01

Studies on global health and development suggest that there is a strong correlation between the burden of disease and a country's level of income. Poorer countries tend to suffer more deaths from preventable causes such as communicable, maternal, perinatal and nutritional conditions, compared with high-income countries. In low-income countries, the government health expenditure share in the general government budget is low and out-of-pocket payments for healthcare relatively high. They also rely heavily on external resources for health funding, yet sustainability of external resource flows is not guaranteed. This article explores increasing public healthcare funding from domestic resources mobilization, and evaluates the impact of measures to achieve this on sectoral growth and poverty reduction rates in Uganda using a dynamic computable general equilibrium model. This article shows that increasing the government health budget share, facilitates expanded healthcare services, improved population health, higher sectoral growth and reduced poverty. The agricultural sector is predicted to post the highest growth when compared with services and industry sectors under both domestic taxation and aid funding scenarios, while national poverty is predicted to decline from 31 to 12% of the population by 2020. This article demonstrates that the most effective measure is to frontload investment in healthcare and generate additional domestic funding for health from a household tax earmarked for health. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

ACEHSA accreditation safeguards the public interest.

Science.gov (United States)

Sundre, Steven M

2004-01-01

Daily, we are reminded that the public's investment in attaining quality health and medical care is among the most important priorities of our nation's citizens. Central to realizing that attainment is the level of professional competence of those charged with managing the nation's health resources. The not-for-profit Accrediting Commission on Education for Health Services Administration is the sole national organization governing the standards by which future health managers, administrators, and executives are educated and trained in accredited graduate programs. The impact of the ACEHSA is growing as health and medical leaders, government and regulatory policy-makers, insurance executives, special interest groups, and, of course, members of the public increasingly realize that top-flight healthcare delivery requires excellence in the management of health resources.

Understanding the healthcare experiences of teenaged cancer patients and survivors.

Science.gov (United States)

Farjou, G; Sinha, R; Dix, D; Shahbaz, A; Klaassen, R J; Klassen, A F

2014-09-01

Despite literature supporting a client and family-centred approach to healthcare delivery in paediatric facilities, there is little information about healthcare delivery from the perspective of teenagers in the oncology setting. The objective of this study is to describe the healthcare experiences of teenagers with cancer. As part of a larger study on teen-centred care delivery in paediatric oncology, a survey included several open-ended questions to learn about the following: (1) what teenagers liked about the cancer care they received; (2) what they disliked about the cancer care received; and (3) what they would include if they could design the perfect cancer centre for teenagers. The survey was completed by 200 teenagers (aged 12-20 years) from three paediatric hospitals in Canada. Answers to these questions were coded and developed into themes and subthemes using a thematic analysis approach. The number of patients providing answers was 89% for question 1, 63% for question 2 and 68.5% for question 3. Likes and dislikes were conceptualized in terms of four key themes as follows: (1) staff at the treatment centre; (2) the cancer care they received; (3) the treatment centre itself; and (4) social activities. The most common suggestions for the perfect cancer centre included having access to better entertainment, more social opportunities to interact with peers, and a more comfortable environment for themselves and their families. Understanding teenagers' experiences in the paediatric oncology setting provides information that could be used to shape the delivery of healthcare in a way that is tailored to their needs. Further research in this area is required in order to improve existing oncology care. © 2013 John Wiley & Sons Ltd.

An Investigation of the Amount of Emphasis Placed on Content and Delivery by Instructors of Public Speaking.

Science.gov (United States)

Siddens, Paul J., III

A study examined how much emphasis instructors of public speaking place on content and delivery when teaching and delivering oral and written critiques. The study sought to determine whether when teaching a hybrid introduction to communication course, or public speaking course, instructors are challenged with teaching their students about issues…

[Art, mental health, and public healthcare: profile of a care culture in the history of São Paulo city].

Science.gov (United States)

Galvanese, Ana Tereza Costa; D'Oliveira, Ana Flávia Pires Lucas; Lima, Elizabeth Maria Freire de Araújo; Pereira, Lygia Maria de França; Nascimento, Ana Paula; Nascimento, Andréia de Fátima

2016-01-01

By studying the inclusion of artistic and cultural activities in the care provided throughout the history of public mental healthcare in greater São Paulo, Brazil, we can better understand and characterize the practices adopted in the Psychosocial Care Centers in the city today. Experiments carried out between the 1920s and 1990s are investigated, based on bibliographic research. The contemporary data were obtained from research undertaken at 126 workshops at 21 Psychosocial Care Centers in the same city between April 2007 and April 2008. The findings indicate that the current trend in mental healthcare, whose clinical perspective spans the realms of art and mental health and has territorial ramifications, has maintained some of the features encountered in earlier mental healthcare experiments.

Patients, the public and priorities in healthcare

National Research Council Canada - National Science Library

Littlejohns, Peter; Rawlins, Michael

2009-01-01

"Sharing the costs of ill health is the mark of a civilised society. However, every society has limited healthcare resources, and must therefore make finely balanced decisions on how best to allocate...

Tracing pathways from antenatal to delivery care for women in Mumbai, India: cross-sectional study of maternity in low-income areas

Science.gov (United States)

More, Neena Shah; Alcock, Glyn; Bapat, Ujwala; Das, Sushmita; Joshi, Wasundhara; Osrin, David

2009-01-01

Summary In many cities, healthcare is available through a complex mix of private and public providers. The line between the formal and informal sectors may be blurred and movement between them uncharted. We quantified the use of private and public providers of maternity care in low-income areas of Mumbai, India. We identified births among a population of about 300 000 in 48 vulnerable slum areas and interviewed women at 6 weeks after delivery. For 10,754 births in 2005–7, levels of antenatal care (93%) and institutional delivery (90%) were high. Antenatal care was split 50:50 between public and private providers, and institutional deliveries 60:40 in favour of the public sector. Women generally stayed within the sector and institution in which care began. Home births were common if women did not register in advance. The findings were at least superficially reassuring, and there was less movement than expected between sectors and health institutions. In the short term, we suggest an emphasis on birth preparedness for pregnant women and their families, and an effort to rationalize the process of referral between institutions. In the longer term, service improvement needs to acknowledge the private-public mix and work towards practicable regulation of quality in both sectors. PMID:20119484

How Multi-Levels of Individual and Team Learning Interact in a Public Healthcare Organisation: A Conceptual Framework

Science.gov (United States)

Doyle, Louise; Kelliher, Felicity; Harrington, Denis

2016-01-01

The aim of this paper is to review the relevant literature on organisational learning and offer a preliminary conceptual framework as a basis to explore how the multi-levels of individual learning and team learning interact in a public healthcare organisation. The organisational learning literature highlights a need for further understanding of…

Integrated Delivery of Quality, Safety and Environment through Road Sector Procurement: The Case of Public Sector Agencies in Ghana

Directory of Open Access Journals (Sweden)

Abdul-Majeed Mahamadu

2015-01-01

Full Text Available Poor quality, safety and environmental (QSE performance within Ghana's road sector has been cited as a major challenge in the procurement of infrastructure. This study evaluates the applicability and level of integrated consideration of QSE in the delivery of roads through procurement by public sector agencies in Ghana. Integrated delivery is explored on the basis of theoretical and empirical evidence of an existing synergistic relationship among QSE in the management and delivery of projects. A mixed methodological design was adopted to investigate two public road agencies through a questionnaire survey and interviews of technical staff with procurement responsibilities. This was done concurrently with soliciting professional perspectives on the subject. Procurement is widely regarded as paramount to the delivery of better QSE in the Ghana road sector. However, the level of synergistic consideration is low, which is attributable to an over-reliance on traditional procurement arrangements as a result of non-supportive local procurement regulatory frameworks. It is further established that a general lack of know-how and experience in the use of modern and integrated procurement arrangements prevent effective management and realisation of QSE beyond the current focus on time and cost through procurement processes within public road sector agencies.

The scale of faith based organization participation in health service delivery in developing countries: systematic [corrected] review and meta-analysis.

Science.gov (United States)

Kagawa, Rose Calnin; Anglemyer, Andrew; Montagu, Dominic

2012-01-01

The extent of faith-based organizations' participation within the overall health systems of developing countries is unclear. Recent reports state that faith-based organizations play a substantial role in providing healthcare in developing countries, cited in some publications as up to 70% of all healthcare services. The data behind these numbers are sometimes difficult to pinpoint and seem at odds to national and regional survey data. In an effort to quantify the contribution of faith-based organizations to healthcare delivery in low- and middle-income countries, we undertook a systematic review of the literature and conducted a new analysis of relevant Demographic and Health Survey data from 47 countries. Our findings demonstrate that the magnitude of healthcare provided by faith-based organizations may be lower than previously estimated. Understanding the scale of FBO-provided medical care is important for health sector planning, and more accurate and complete estimates are needed.

The role of transformational leadership and organizational culture in service delivery within a public service organization

Directory of Open Access Journals (Sweden)

Ophillia Ledimo

2014-08-01

Full Text Available Continuous changes in the external environment deriving from legislative, economic and technological factors, puts pressure not only to corporate organizations, but also to public service organizations. These changes have increased pressure on service delivery and calls for accountability in public service organizations. With this increased pressure comes the need for public service organizations to discover how to most effectively enhance their organizational performance. Two of the most effective ways to improve performance are through the organizational leadership and culture. Although many studies were conducted on transformational leadership and organizational culture, there is still a need to investigate the link between these constructs in public service organizations. Hence the objective of this study was to explore the relationship between transformational leadership and organizational culture for service delivery practices. The Leadership Practice Inventory (LPI and Organizational Culture Inventory (OCI were administered to a random sample size of N=238, from a population of 4350 employees working within the public service organization. Descriptive statistics and Pearson’s correlation were conducted to analyse the data. The results of this study indicated a significant positive relationship between transformational leadership and the constructive dimension of organizational culture within a public service organization. In terms of contributions and practical implications, insight gained from the findings may be used in proposing leadership and organizational development interventions and future research

National Health-Care Reform

Science.gov (United States)

2009-03-24

and pre/ post partum care during delivery. America should select measures that reflect the health-care goals of the nation. As an example, the Healthy...accidents (8) More than 50% of patients with diabetes, hypertension, tobacco addiction, hyperlipidemia, congestive heart failure, asthma, depression ...reflect the cumulative efforts of different types of individual care. For example, infant mortality is a reflection of pre-natal care, post - natal care

Teaching at primary healthcare services within the Brazilian national health system (SUS in Brazilian healthcare professionals' training

Directory of Open Access Journals (Sweden)

Ramona Fernanda Ceriotti Toassi

2013-06-01

Full Text Available The aim of this study was to analyze the role of teaching at primary healthcare services within the Brazilian National Health System (SUS in dentists' training, at a public university in the south of Brazil. A qualitative methodological approach (case study was used. Interviews were conducted with 12 dentistry students, six dentists who were preceptors working in public primary healthcare services and three teachers connected with this curricular training. Our findings showed that the curricular training in SUS primary healthcare services had an impact on the dentists' education through establishment of bonds, autonomy in problem-solving and multiprofessional teamwork. It was seen that they learned about how healthcare services function, about healthcare and about development of cultural competence. There is a need to maintain constant questioning regarding these practices, and to ensure the presence of infrastructure and qualified professionals for teaching at these services.

Individual responsibility, solidarity and differentiation in healthcare

NARCIS (Netherlands)

Stegeman, I.; Willems, D. L.; Dekker, E.; Bossuyt, P. M.

2014-01-01

Access to healthcare in most western societies is based on equality. Rapidly rising costs have fuelled debates about differentiation in access to healthcare. We assessed the public's perceptions and attitudes about differentiation in healthcare according to lifestyle behaviour. A vignette study was

Healthcare Data Gateways: Found Healthcare Intelligence on Blockchain with Novel Privacy Risk Control.

Science.gov (United States)

Yue, Xiao; Wang, Huiju; Jin, Dawei; Li, Mingqiang; Jiang, Wei

2016-10-01

Healthcare data are a valuable source of healthcare intelligence. Sharing of healthcare data is one essential step to make healthcare system smarter and improve the quality of healthcare service. Healthcare data, one personal asset of patient, should be owned and controlled by patient, instead of being scattered in different healthcare systems, which prevents data sharing and puts patient privacy at risks. Blockchain is demonstrated in the financial field that trusted, auditable computing is possible using a decentralized network of peers accompanied by a public ledger. In this paper, we proposed an App (called Healthcare Data Gateway (HGD)) architecture based on blockchain to enable patient to own, control and share their own data easily and securely without violating privacy, which provides a new potential way to improve the intelligence of healthcare systems while keeping patient data private. Our proposed purpose-centric access model ensures patient own and control their healthcare data; simple unified Indicator-Centric Schema (ICS) makes it possible to organize all kinds of personal healthcare data practically and easily. We also point out that MPC (Secure Multi-Party Computing) is one promising solution to enable untrusted third-party to conduct computation over patient data without violating privacy.

Accumulation of Domain-Specific Physical Inactivity and Presence of Hypertension in Brazilian Public Healthcare System.

Science.gov (United States)

Turi, Bruna Camilo; Codogno, Jamile S; Fernandes, Romulo A; Sui, Xuemei; Lavie, Carl J; Blair, Steven N; Monteiro, Henrique Luiz

2015-11-01

Hypertension is one of the most common noncommunicable diseases worldwide, and physical inactivity is a risk factor predisposing to its occurrence and complications. However, it is still unclear the association between physical inactivity domains and hypertension, especially in public healthcare systems. Thus, this study aimed to investigate the association between physical inactivity aggregation in different domains and prevalence of hypertension among users of Brazilian public health system. 963 participants composed the sample. Subjects were divided into quartiles groups according to 3 different domains of physical activity (occupational; physical exercises; and leisure-time and transportation). Hypertension was based on physician diagnosis. Physical inactivity in occupational domain was significantly associated with higher prevalence of hypertension (OR = 1.52 [1.05 to 2.21]). The same pattern occurred for physical inactivity in leisure-time (OR = 1.63 [1.11 to 2.39]) and aggregation of physical inactivity in 3 domains (OR = 2.46 [1.14 to 5.32]). However, the multivariate-adjusted model showed significant association between hypertension and physical inactivity in 3 domains (OR = 2.57 [1.14 to 5.79]). The results suggest an unequal prevalence of hypertension according to physical inactivity across different domains and increasing the promotion of physical activity in the healthcare system is needed.

Has the Reform of the Japanese Healthcare Provision System Improved the Value in Healthcare? A Cost-Consequence Analysis of Organized Care for Hip Fracture Patients.

Science.gov (United States)

Fukuda, Haruhisa; Shimizu, Sayuri; Ishizaki, Tatsuro

2015-01-01

To assess the value of organized care by comparing the clinical outcomes and healthcare expenditure between the conventional Japanese "integrated care across specialties within one hospital" mode of providing healthcare and the prospective approach of "organized care across separate facilities within a community". Retrospective cohort study. Two groups of hospitals were categorized according to healthcare delivery approach: the first group included 3 hospitals autonomously providing integrated care across specialties, and the second group included 4 acute care hospitals and 7 rehabilitative care hospitals providing organized care across separate facilities. Patients aged 65 years and above who had undergone hip fracture surgery. Regression models adjusting for patient characteristics and clinical variables were used to investigate the impact of organized care on the improvements to the mobility capability of patients before and after hospitalization and the differences in healthcare resource utilization. The sample for analysis included 837 hip fracture surgery cases. The proportion of patients with either unchanged or improved mobility capability was not statistically associated with the healthcare delivery approaches. Total adjusted mean healthcare expenditure for integrated care and organized care were US$28,360 (95% confidence interval: 27,787-28,972) and US$21,951 (21,511-22,420), respectively, indicating an average increase of US$6,409 in organized care. Our cost-consequence analysis underscores the need to further investigate the actual contribution of organized care to the provision of efficient and high-quality healthcare.

The effect of service delivery in public ‘community service centres’: A case of an emerging economy

OpenAIRE

Ndabazinhle Ngobese; Roger B. Mason; Mandusha Maharaj

2017-01-01

This study investigated public perceptions of the service delivery provided by the Community Service Centres (CSC) of the South African Police Service (SAPS) Durban, South Africa. The study focuses on measuring service quality and service delivery. SERVQUAL was used to compare clients’ perceptions against expectations of service quality. Four hundred respondents were surveyed at three community service centres (previously known as ‘police stations’), with expectations and perceptions being as...

Information resources assessment of a healthcare integrated delivery system.

Science.gov (United States)

Gadd, C. S.; Friedman, C. P.; Douglas, G.; Miller, D. J.

1999-01-01

While clinical healthcare systems may have lagged behind computer applications in other fields in the shift from mainframes to client-server architectures, the rapid deployment of newer applications is closing that gap. Organizations considering the transition to client-server must identify and position themselves to provide the resources necessary to implement and support the infrastructure requirements of client-server architectures and to manage the accelerated complexity at the desktop, including hardware and software deployment, training, and maintenance needs. This paper describes an information resources assessment of the recently aligned Pennsylvania regional Veterans Administration Stars and Stripes Health Network (VISN4), in anticipation of the shift from a predominantly mainframe to a client-server information systems architecture in its well-established VistA clinical information system. The multimethod assessment study is described here to demonstrate this approach and its value to regional healthcare networks undergoing organizational integration and/or significant information technology transformations. PMID:10566414

Information resources assessment of a healthcare integrated delivery system.

Science.gov (United States)

Gadd, C S; Friedman, C P; Douglas, G; Miller, D J

1999-01-01

While clinical healthcare systems may have lagged behind computer applications in other fields in the shift from mainframes to client-server architectures, the rapid deployment of newer applications is closing that gap. Organizations considering the transition to client-server must identify and position themselves to provide the resources necessary to implement and support the infrastructure requirements of client-server architectures and to manage the accelerated complexity at the desktop, including hardware and software deployment, training, and maintenance needs. This paper describes an information resources assessment of the recently aligned Pennsylvania regional Veterans Administration Stars and Stripes Health Network (VISN4), in anticipation of the shift from a predominantly mainframe to a client-server information systems architecture in its well-established VistA clinical information system. The multimethod assessment study is described here to demonstrate this approach and its value to regional healthcare networks undergoing organizational integration and/or significant information technology transformations.

Survey of patient and public perceptions of electronic health records for healthcare, policy and research: Study protocol

Directory of Open Access Journals (Sweden)

Luchenski Serena

2012-05-01

Full Text Available Abstract Background Immediate access to patients’ complete health records via electronic databases could improve healthcare and facilitate health research. However, the possible benefits of a national electronic health records (EHR system must be balanced against public concerns about data security and personal privacy. Successful development of EHR requires better understanding of the views of the public and those most affected by EHR: users of the National Health Service. This study aims to explore the correlation between personal healthcare experience (including number of healthcare contacts and number and type of longer term conditions and views relating to development of EHR for healthcare, health services planning and policy and health research. Methods/design A multi-site cross-sectional self-complete questionnaire designed and piloted for use in waiting rooms was administered to patients from randomly selected outpatients’ clinics at a university teaching hospital (431 beds and general practice surgeries from the four primary care trusts within the catchment area of the hospital. All patients entering the selected outpatients clinics and general practice surgeries were invited to take part in the survey during August-September 2011. Statistical analyses will be conducted using descriptive techniques to present respondents’ overall views about electronic health records and logistic regression to explore associations between these views and participants’ personal circumstances, experiences, sociodemographics and more specific views about electronic health records. Discussion The study design and implementation were successful, resulting in unusually high response rates and overall recruitment (85.5%, 5336 responses. Rates for face-to-face recruitment in previous work are variable, but typically lower (mean 76.7%, SD 20. We discuss details of how we collected the data to provide insight into how we obtained this unusually high

Healthcare systems--an international review: an overview.

Science.gov (United States)

Lameire, N; Joffe, P; Wiedemann, M

1999-01-01

Based on the source of their funding, three main models of healthcare can be distinguished. The first is the Beveridge model, which is based on taxation and has many public providers. The second is the Bismarck 'mixed' model, funded by a premium-financed social insurance system and with a mixture of public and private providers. Finally, the 'Private Insurance model' is only in existence in the US. The present report explores the impact of these healthcare models on the access to, quality and cost of healthcare in selected European countries. Access is nearly 100% in countries with a public provider system, while in most of the 'mixed' countries, the difference from 100% is made up by supplementary private insurance. No differences are seen between public and mixed provider systems in terms of quality of care, despite the fact that the countries with the former model spend, in general, less of their Gross National Product on healthcare. The Private Insurance/private provider model of the US produces the highest costs, but is lowest in access and is close to lowest ranking in quality parameters.

Public assessment of key performance indicators of healthcare in a Canadian province: the effect of age and chronic health problems.

Science.gov (United States)

Nurullah, Abu Sadat; Northcott, Herbert C; Harvey, Michael D

2014-01-15

This study explores the effect of age and chronic conditions on public perceptions of the health system, as measured by the Key Performance Indicators (KPIs) of healthcare, in the province of Alberta in Canada. Drawing from data collected by Government of Alberta's Department of Health and Wellness, this research examines two key questions: (1) Do people in the 65+ age group rate the KPIs of healthcare (i.e., availability, accessibility, quality, outcome, and satisfaction) more favorably compared to people in younger age groups in Alberta? (2) Does the rating of KPIs of healthcare in Alberta vary with different chronic conditions (i.e., no chronic problem, chronic illnesses without pain, and chronic pain)? The findings indicate that people in the older age group tend to rate the KPIs of healthcare more favorably compared to younger age groups in Alberta, net of socio-demographic factors, self-reported health status, and knowledge and utilization of health services. However, people experiencing chronic pain are less likely to rate the KPIs of healthcare favorably compared to people with no chronic health problem in Alberta. Discussion includes implications of the findings for the healthcare system in the province.

Attitudes of oncology healthcare practitioners towards smoking cessation: A systematic review of the facilitators, barriers and recommendations for delivery of advice and support to cancer patients

International Nuclear Information System (INIS)

Conlon, K.; Pattinson, L.; Hutton, D.

2017-01-01

Objectives: A systematic review of the literature was conducted. The review was conducted using a search of the literature for all years up to October 2016. Statements that identified facilitators, barriers or recommendations surrounding smoking cessation delivery were extracted and analogous statements aggregated to enable thematic analysis. After searching multiple databases and the application of exclusion and inclusion criteria, a total of 19 acceptable studies were identified. Key findings: Delivery of cessation by oncology professionals was impacted by their own knowledge and views, their perception of the benefits to patient health and by the workplace procedures within their institution. Conclusion: Oncology practitioners worldwide face similar issues in delivering smoking cessation advice. By improving training programs that address the attitudes and beliefs which facilitate or block delivery of smoking cessation and by implementing systemic changes within cancer centres, delivery of smoking cessation should be enabled. - Highlights: • Oncology professional attitudes towards smoking cessation are relatively ubiquitous. • Lack of training is frequently reported to be a barrier to smoking interventions. • Oncology healthcare practitioners have a desire to be trained in smoking cessation. • Required improvements to training programs to facilitate delivery are addressed. • Integration of smoking assessment and advice into workplace policy is required.

The implementation of mindfulness in healthcare systems: a theoretical analysis.

Science.gov (United States)

Demarzo, M M P; Cebolla, A; Garcia-Campayo, J

2015-01-01

Evidence regarding the efficacy of mindfulness-based interventions (MBIs) is increasing exponentially; however, there are still challenges to their integration in healthcare systems. Our goal is to provide a conceptual framework that addresses these challenges in order to bring about scholarly dialog and support health managers and practitioners with the implementation of MBIs in healthcare. This is an opinative narrative review based on theoretical and empirical data that address key issues in the implementation of mindfulness in healthcare systems, such as the training of professionals, funding and costs of interventions, cost effectiveness and innovative delivery models. We show that even in the United Kingdom, where mindfulness has a high level of implementation, there is a high variability in the access to MBIs. In addition, we discuss innovative approaches based on "complex interventions," "stepped-care" and "low intensity-high volume" concepts that may prove fruitful in the development and implementation of MBIs in national healthcare systems, particularly in Primary Care. In order to better understand barriers and opportunities for mindfulness implementation in healthcare systems, it is necessary to be aware that MBIs are "complex interventions," which require innovative approaches and delivery models to implement these interventions in a cost-effective and accessible way. Copyright © 2015 Elsevier Inc. All rights reserved.

Leaving a mark on healthcare delivery with operations analysis

NARCIS (Netherlands)

Vanberkel, P.T.; Golden, B.L.; Seidmann, A.; Zonderland, Maartje Elisabeth; Boucherie, Richardus J.; Hans, Elias W.

In the Dutch context, we see similar problems as outlined in Green’s (2012) commentary and also an increased interest by healthcare providers to use operations analysis to confront them. In this commentary, we provide our take on the same problems to extend the discussion and to highlight additional

Scaling of an information system in a public healthcare market--infrastructuring from the vendor's perspective.

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Johannessen, Liv Karen; Obstfelder, Aud; Lotherington, Ann Therese

2013-05-01

The purpose of this paper is to explore the making and scaling of information infrastructures, as well as how the conditions for scaling a component may change for the vendor. The first research question is how the making and scaling of a healthcare information infrastructure can be done and by whom. The second question is what scope for manoeuvre there might be for vendors aiming to expand their market. This case study is based on an interpretive approach, whereby data is gathered through participant observation and semi-structured interviews. A case study of the making and scaling of an electronic system for general practitioners ordering laboratory services from hospitals is described as comprising two distinct phases. The first may be characterized as an evolving phase, when development, integration and implementation were achieved in small steps, and the vendor, together with end users, had considerable freedom to create the solution according to the users' needs. The second phase was characterized by a large-scale procurement process over which regional healthcare authorities exercised much more control and the needs of groups other than the end users influenced the design. The making and scaling of healthcare information infrastructures is not simply a process of evolution, in which the end users use and change the technology. It also consists of large steps, during which different actors, including vendors and healthcare authorities, may make substantial contributions. This process requires work, negotiation and strategies. The conditions for the vendor may change dramatically, from considerable freedom and close relationships with users and customers in the small-scale development, to losing control of the product and being required to engage in more formal relations with customers in the wider public healthcare market. Onerous procurement processes may be one of the reasons why large-scale implementation of information projects in healthcare is difficult

Conceptions of Patients and Their Roles in Healthcare

DEFF Research Database (Denmark)

McDermott, Aoife M.; Reff Pedersen, Anne

2016-01-01

/methodology/approach: – The paper utilises a literature synthesis and thematic analysis of the special issue submissions. These emanated from the Ninth International Organisational Behaviour in Healthcare Conference, hosted by Copenhagen Business School on behalf of the Learned Society for Studies in Organizing Healthcare...... to patients to engage, by organisations and their employees. Originality/value: – The paper explores the relationally embedded nature of patient involvement in healthcare, inherent in the interdependence between patient and providers’ roles. The typology aims to prompt discussion regarding...... the conceptualisation patients’ roles in healthcare organisations, and the individual, employee, organisational and contextual factors that may help and hinder their involvement in service delivery and improvement. The authors close by noting four areas meriting further research attention, and potentially useful...

Caesarean section deliveries: Experiences of mothers of midwifery care at a public hospital in Nelson Mandela Bay.

Science.gov (United States)

Jikijela, Thobeka P; James, Sindiwe; Sonti, Balandeli S I

2018-01-30

The rate of caesarean section deliveries has increased globally and mothers are faced with challenges of postoperative recovery and caring thereof. Midwives have a duty to assist these mothers to self-care. The objective was to explore and describe experiences of post-caesarean section delivered mothers of midwifery care at a public hospital in Nelson Mandela Bay. A qualitative, descriptive and explorative research design was used in the study. Data were collected from 11 purposively criterion-selected mothers who had a caesarean section delivery. One-on-one semi-structured interviews were conducted in the post-natal wards. Research ethics, namely autonomy, beneficence, justice and informed consent, were adopted in the study. All participants were informed of their right to withdraw from the study at any stage without penalties. Interviews were analysed using Tesch's method of data analysis. Three main themes were identified as experiences of: diverse pain, physical limitation and frustration and health care services as different. Experiences of mothers following a caesarean section delivery with midwifery services at a public hospital in Nelson Mandela Bay were explored and described as diverse. A need for adequate pain management as well as assistance and breastfeeding support to mothers following caesarean delivery was identified as crucial to promote a good mother-to-child relationship.

Assessment of pharmacists’ delivery of public health services in rural and urban areas in Iowa and North Dakota

Science.gov (United States)

Scott, David M.; Strand, Mark; Undem, Teri; Anderson, Gabrielle; Clarens, Andrea; Liu, Xiyuan

2016-01-01

Background: The profession of pharmacy is expanding its involvement in public health, but few studies have examined pharmacists’ delivery of public health services. Objective: To assess Iowa and North Dakota pharmacists’ practices, frequency of public health service delivery, level of involvement in achieving the essential services of public health, and barriers to expansion of public health services in rural and urban areas. Methods: This study implemented an on-line survey sent to all pharmacists currently practicing pharmacy in Iowa and North Dakota. Results: Overall, 602 valid responses were analyzed, 297 in rural areas and 305 in urban areas. Three practice settings (chain stores [169, 28.2%], independent community pharmacies [162, 27.0%], and hospital pharmacies [156, 26.0%]) comprised 81.2% of the sample. Both chain and independent community pharmacists were more commonly located in rural areas than in urban areas (PDakota. These findings should be interpreted to be primarily due to differences in the role of the rural pharmacist and the quest for certain opportunities that rural pharmacists are seeking. PMID:28042356

Regulation for delivery of subsidies for public relations and safety

International Nuclear Information System (INIS)

1981-01-01

This rule is established under the provisions of the law for the proper enforcement of subsidy budgets and the ordinance for the execution of this law, and to practice these provisions. It is applied to subsidies for the expenses of popularizing the knowledge of atomic power generation to inhabitants in the surrounding areas of atomic power generating facilities, investigation on the security of inhabitants in these areas, communication and coordination concerning the safety of such facilities during and after their installation and other expenses of establishing the facilities for public relations to inhabitants in the surrounding areas of these facilities. Basic terms are defined, such as atomic power generating facility, facility related to atomic power generation, and place of business. Subsidies are delivered to prefectures, cities, towns and villages where atomic power generating facilities are or are expected to be set up, prefectures including cities, towns and villages adjacent to those where such facilities are or are expected to be established, and prefectures which include the surrounding areas of those facilities. The limits of subsidies are stipulated in the lists attached. The terms of delivery vary according to the kinds of atomic power generating facilities and related facilities. Prefectures or cities, towns and villages which intend to apply for the delivery of subsidies shall file specified applications attached with the explanation of subsidy business outlines to the director of the ministry or agency concerned. Decision and conditions of delivery, reports on the situations and results of business and other concerned matters are defined, respectively. (Okada, K.)

Examining leadership as a strategy to enhance health care service delivery in regional hospitals in South Africa

Science.gov (United States)

Govender, Sagaren; Gerwel Proches, Cecile N; Kader, Abdulla

2018-01-01

Background Four public hospitals in South Africa, which render both specialized and nonspecialized services to thousands of patients, were examined to determine the impact of leadership on health care service delivery. These hospitals were inundated by various problems that were impacting negatively on health care service delivery. Purpose This research study aimed to gain a comprehensive understanding of the challenges, complexities and constraints facing public health care in KwaZulu-Natal (KZN) and to examine leadership as a strategy to enhance healthcare service delivery with a particular focus on four regional hospitals in the KZN Province. Methods The mixed-method research approach was utilized. Purposive sampling and stratified random sampling were employed in the research setting, and in-depth, semistructured interviews and questionnaires were used to collect data. Data were analyzed using the Nvivo computer software package for in-depth interviews and the Statistical Package for the Social Sciences (SPSS) software for the quantitative analysis. Results The research findings showed that the current leadership framework adopted by the health care leaders in regional hospitals in KZN is weak and is contributing to poor health care service delivery. Conclusion This study, therefore, aimed to address the current challenges and weaknesses that are impacting negatively on health care service delivery in regional hospitals in the KZN Province and made recommendations for improvement. PMID:29535529

Outpatient parenteral antimicrobial therapy for orthopedic infections – a successful public healthcare experience in Brazil

Directory of Open Access Journals (Sweden)

Priscila Rosalba Oliveira

2016-05-01

Full Text Available Treatment of orthopedic infections usually requires prolonged antimicrobial therapy, ranging from 14 days up to 6 months. Nowadays, rising levels of antimicrobial resistance demands parenteral therapy for many patients. Outpatient parenteral antimicrobial therapy (OPAT is a modality that allows treatment out of hospital in these situations. In Brazil, where a public universal healthcare system allows full coverage for all citizens, implantation and dissemination of OPAT programs would be beneficial for patients and for the system, because it would allow a better allocation of health resources. The Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da USP (IOT started, in July 2013, a partnership with municipal health authorities in Sao Paulo, Brazil, in order to initiate an OPAT program in which patients discharged from that hospital would be able to continue antimicrobial therapy at primary care facilities. When necessary, patients could also receive their therapy at the day-hospital located at IOT. Primary care nursing and physician staff were trained about antimicrobial infusion and peripherally inserted central catheter manipulation. An OPAT specific antimicrobial protocol was designed and a special reference and counter-reference organized. As a result, 450 primary healthcare professionals were trained. In the first year of this program, 116 patients were discharged for OPAT. Chronic and acute osteomyelitis were most frequent diagnosis. Teicoplanin, ertapenem and tigecycline were the most used drugs. Duration of treatment varied from 10 to 180 days (average 101, median 42. Total sum of days in OPAT regimen was 11,698. Only 3 patients presented adverse effects. Partnership between services of different levels of complexity allowed implantation of a safe and effective public healthcare OPAT program for treatment of orthopedic infections. This program can serve as a model for developing similar strategies

Strength of primary care service delivery: a comparative study of European countries, Australia, New Zealand, and Canada.

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Pavlič, Danica R; Sever, Maja; Klemenc-Ketiš, Zalika; Švab, Igor; Vainieri, Milena; Seghieri, Chiara; Maksuti, Alem

2018-05-01

AimWe sought to examine strength of primary care service delivery as measured by selected process indicators by general practitioners from 31 European countries plus Australia, Canada, and New Zealand. We explored the relation between strength of service delivery and healthcare expenditures. The strength of a country's primary care is determined by the degree of development of a combination of core primary care dimensions in the context of its healthcare system. This study analyses the strength of service delivery in primary care as measured through process indicators in 31 European countries plus Australia, New Zealand, and Canada. A comparative cross-sectional study design was applied using the QUALICOPC GP database. Data on the strength of primary healthcare were collected using a standardized GP questionnaire, which included 60 questions divided into 10 dimensions related to process, structure, and outcomes. A total of 6734 general practitioners participated. Data on healthcare expenditure were obtained from World Bank statistics. We conducted a correlation analysis to analyse the relationship between strength and healthcare expenditures.FindingsOur findings show that the strength of service delivery parameters is less than optimal in some countries, and there are substantial variations among countries. Continuity and comprehensiveness of care are significantly positively related to national healthcare expenditures; however, coordination of care is not.

A clean bill of health? The efficacy of an NHS commissioned outsourced police custody healthcare service.

Science.gov (United States)

de Viggiani, Nick

2013-08-01

Police custody healthcare services for detainees in the UK are most commonly outsourced to independent healthcare providers who employ custody nurses and forensic physicians to deliver forensic healthcare services. A pilot was introduced in 2008 by the Department of Health to explore the efficacy of commissioning custody healthcare via the NHS, in the wake of the 2005-2006 shift of prison healthcare to the NHS. The objective was to improve quality and accountability through NHS commissioning and the introduction of NHS governance to the management and delivery of custody healthcare. This article discusses key themes that arose from the project evaluation, which focused on the commissioning relationship between the police, the NHS commissioner and the private healthcare provider. The evaluation observed an evolving relationship between the police, the local NHS and the front-line nurses, which was complicated by the quite distinctive professional values and ideologies operating, with their contrasting organisational imperatives and discordant values and principles. A key challenge for commissioners is to develop synergy between operational and strategically located stakeholders so that they can work effectively towards common goals. Government policy appears to remain focused on creating safe, supportive and humane custody environments that balance criminal justice and health imperatives and support the rights and needs of detainees, victims, professionals and the public. This remains an ambitious agenda and presents a major challenge for new criminal justice health partnerships. Copyright © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Leading ladies: women in healthcare leadership.

Science.gov (United States)

Fontenot, Teri

2012-01-01

Women represent an overwhelming majority of the healthcare workforce, yet they are significantly underrepresented in leadership positions, particularly at the executive and board levels. However, women are uniquely positioned to leverage traits such as compassion, transparency, and the ability to foster teamwork to lead organizations into the next phase of contemporary healthcare delivery. In the future, the pace with which women gain access to the C-suite will accelerate as organizations embrace diversity and select the best qualified leaders in terms of both experience and leadership style that supports organizational culture. While the future for women in healthcare leadership looks bright, many women are currently struggling to reach the executive office, facing glass ceilings, competing priorities, and lack of access to support and guidance. In this article I discuss the role of women in healthcare leadership and offer practical suggestions on how women can reach the top echelon and achieve their goals and aspirations.

The Cost of Health Services Delivery in Health Houses of Alborz: A Case Study

Directory of Open Access Journals (Sweden)

Javad Ghoddousinejad

2015-07-01

Full Text Available Background and Objectives : Health houses play an active role to improve health status of rural population.Furthermore, it is important to know the costs of provided services. This research was designed to determine the costs of healthcare delivery in health houses of ALBORZ district. Material and Methods : In this cross-sectional descriptive study, Activity Based Costing (ABC was used to analyze the costs of services. Results : The average Direct Costs (DC of healthcare delivery in health houses was estimated 37033365 Rials. Direct and Indirect Costs (IC of service delivery in health houses were 65.91% and 34.09% of Total Costs (TC respectively. Conclusion : Since human resources play the most important role in determining the costs of health services delivery in healthcare, reforming payment mechanisms would be a suitable solution to reduce extra costs. Moreover, in order to decrease extra costs, it is essential to modify activities and eliminate parallel tasks.

[Involving patients, the insured and the general public in healthcare decision making].

Science.gov (United States)

Mühlbacher, Axel C; Juhnke, Christin

2016-01-01

No doubt, the public should be involved in healthcare decision making, especially when decision makers from politics and self-government agencies are faced with the difficult task of setting priorities. There is a general consensus on the need for a stronger patient centeredness, even in HTA processes, and internationally different ways of public participation are discussed and tested in decision making processes. This paper describes how the public can be involved in different decision situations, and it shows how preference measurement methods are currently being used in an international context to support decision making. It distinguishes between different levels of decision making on health technologies: approval, assessment, pricing, and finally utilization. The range of participation efforts extends from qualitative surveys of patients' needs (Citizen Councils of NICE in the UK) to science-based documentation of quantitative patient preferences, such as in the current pilot projects of the FDA in the US and the EMA at the European level. Possible approaches for the elicitation and documentation of preference structures and trade-offs in relation to alternate health technologies are decision aids, such as multi-criteria decision analysis (MCDA), that provide the necessary information for weighting and prioritizing decision criteria. Copyright © 2015. Published by Elsevier GmbH.

How Business Cycles Affect the Healthcare Sector: A Cross-country Investigation.

Science.gov (United States)

Cleeren, Kathleen; Lamey, Lien; Meyer, Jan-Hinrich; De Ruyter, Ko

2016-07-01

The long-term relationship between the general economy and healthcare expenditures has been extensively researched, to explain differences in healthcare spending between countries, but the midterm (i.e., business cycle) perspective has been overlooked. This study explores business cycle sensitivity in both public and private parts of the healthcare sector across 32 countries. Responses to the business cycle vary notably, both across spending sources and across countries. Whereas in some countries, consumers and/or governments cut back, in others, private and/or public healthcare buyers tend to spend more. We also assess long-term consequences of business cycle sensitivity and show that public cost cutting during economic downturns deflates the mortality rates, whereas private cut backs increase the long-term growth in total healthcare expenditures. Finally, multiple factors help explain variability in cyclical sensitivity. Private cost cuts during economic downturns are smaller in countries with a predominantly publicly funded healthcare system and more preventive public activities. Public cut backs during contractions are smaller in countries that rely more on tax-based resources rather than social health insurances. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

(Re Making the Procrustean Bed? Standardization and Customization as Competing Logics in Healthcare

Directory of Open Access Journals (Sweden)

Russell Mannion

2017-06-01

Full Text Available Recent years have witnessed a parallel and seemingly contradictory trend towards both the standardization and the customization of healthcare and medical treatment. Here, we explore what is meant by ‘standardization’ and ‘customization’ in healthcare settings and explore the implications of these changes for healthcare delivery. We frame the paradox of these divergent and opposing factors in terms of institutional logics – the socially constructed rules, practices and beliefs which perpetuate institutional behaviour. As the tension between standardization and customization is fast becoming a critical fault-line within many health systems, there remains an urgent need for more sustained work exploring how these competing logics are articulated, adapted, resisted and co-exist on the front line of care delivery.

The Hazards of Data Mining in Healthcare.

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Househ, Mowafa; Aldosari, Bakheet

2017-01-01

From the mid-1990s, data mining methods have been used to explore and find patterns and relationships in healthcare data. During the 1990s and early 2000's, data mining was a topic of great interest to healthcare researchers, as data mining showed some promise in the use of its predictive techniques to help model the healthcare system and improve the delivery of healthcare services. However, it was soon discovered that mining healthcare data had many challenges relating to the veracity of healthcare data and limitations around predictive modelling leading to failures of data mining projects. As the Big Data movement has gained momentum over the past few years, there has been a reemergence of interest in the use of data mining techniques and methods to analyze healthcare generated Big Data. Much has been written on the positive impacts of data mining on healthcare practice relating to issues of best practice, fraud detection, chronic disease management, and general healthcare decision making. Little has been written about the limitations and challenges of data mining use in healthcare. In this review paper, we explore some of the limitations and challenges in the use of data mining techniques in healthcare. Our results show that the limitations of data mining in healthcare include reliability of medical data, data sharing between healthcare organizations, inappropriate modelling leading to inaccurate predictions. We conclude that there are many pitfalls in the use of data mining in healthcare and more work is needed to show evidence of its utility in facilitating healthcare decision-making for healthcare providers, managers, and policy makers and more evidence is needed on data mining's overall impact on healthcare services and patient care.

Fairness in healthcare finance and delivery: what about Tunisia?

Science.gov (United States)

Abu-Zaineh, Mohammad; Arfa, Chokri; Ventelou, Bruno; Ben Romdhane, Habiba; Moatti, Jean-Paul

2014-07-01

Anecdotal evidence on hidden inequity in health care in North African countries abounds. Yet firm empirical evidence has been harder to come by. This article fills the gap. It presents the first analysis of equity in the healthcare system using the particular case of Tunisia. Analyses are based on an unusually rich source of data taken from the Tunisian HealthCare Utilization and Morbidity Survey. Payments for health care are derived from the total amount of healthcare spending which was incurred by households over the last year. Utilization of health care is measured by the number of physical units of two types of services: outpatient and inpatient. The measurement of need for health care is apprehended through a rich set of ill-health indicators and demographics. Findings are presented and compared at both the aggregate level, using the general summary index approach, and the disaggregate level, using the distribution-free stochastic dominance approach. The overall picture is that direct out-of-pocket payments, which constitute a sizeable share in the current financing mix, emerge to be a progressive means of financing health care overall. Interestingly, however, when statistical testing is applied at the disaggregate level progressivity is retained over the top half of the distribution. Further analyses of the distributions of need for--and utilization of--two types of health care--outpatient and inpatient--reveal that the observed progressivity is rather an outcome of the heavy use, but not need, for health care at the higher income levels. Several policy relevant factors are discussed, and some recommendations are advanced for future reforms of the health care in Tunisia. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

Comparative performance of public and private sector delivery of BCG vaccination: evidence from Sub-Saharan Africa.

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Wagner, Zachary; Szilagyi, Peter G; Sood, Neeraj

2014-07-31

The private sector is an important source of health care in the developing world. However, there is limited evidence on how private providers compare to public providers, particularly for preventive services such as immunizations. We used data from Sub-Saharan Africa (SSA) to assess public-private differences in Bacillus Calmette-Guérin (BCG) vaccine delivery. We used demographic and health surveys from 102,629 children aged 0-59 months from 29 countries across SSA to measure differences in BCG status for children born at private versus public health facilities (BCG is recommended at birth). We used a probit model to estimate public-private differences in BCG delivery, while controlling for key confounders. Next, we estimated how differences in BCG status evolved over time for children born at private versus public facilities. Finally, we estimated heterogeneity in public-private differences based on wealth and rural-urban residency. We found that children born at a private facility were 7.1 percentage points less likely to receive BCG vaccine in the same month as birth than children born at a public facility (95% CI 6.3-8.0; pprivate providers (as opposed to NGOs) where the BCG provision rate was 10.0 percentage points less than public providers (95% CI 9.0-11.2; pprivate for-profit facilities remained less likely to be vaccinated up to 59 months after birth. Finally, public-private differences were more pronounced for poorer children and children in rural areas. The for-profit private sector performed substantially worse than the public sector in providing BCG vaccine to newborns, resulting in a longer duration of vulnerability to tuberculosis. This disparity was greater for poorer children and children in rural areas. Copyright © 2014 Elsevier Ltd. All rights reserved.

Who Owns the Data? Open Data for Healthcare.

Science.gov (United States)

Kostkova, Patty; Brewer, Helen; de Lusignan, Simon; Fottrell, Edward; Goldacre, Ben; Hart, Graham; Koczan, Phil; Knight, Peter; Marsolier, Corinne; McKendry, Rachel A; Ross, Emma; Sasse, Angela; Sullivan, Ralph; Chaytor, Sarah; Stevenson, Olivia; Velho, Raquel; Tooke, John

2016-01-01

Research on large shared medical datasets and data-driven research are gaining fast momentum and provide major opportunities for improving health systems as well as individual care. Such open data can shed light on the causes of disease and effects of treatment, including adverse reactions side-effects of treatments, while also facilitating analyses tailored to an individual's characteristics, known as personalized or "stratified medicine." Developments, such as crowdsourcing, participatory surveillance, and individuals pledging to become "data donors" and the "quantified self" movement (where citizens share data through mobile device-connected technologies), have great potential to contribute to our knowledge of disease, improving diagnostics, and delivery of -healthcare and treatment. There is not only a great potential but also major concerns over privacy, confidentiality, and control of data about individuals once it is shared. Issues, such as user trust, data privacy, transparency over the control of data ownership, and the implications of data analytics for personal privacy with potentially intrusive inferences, are becoming increasingly scrutinized at national and international levels. This can be seen in the recent backlash over the proposed implementation of care.data, which enables individuals' NHS data to be linked, retained, and shared for other uses, such as research and, more controversially, with businesses for commercial exploitation. By way of contrast, through increasing popularity of social media, GPS-enabled mobile apps and tracking/wearable devices, the IT industry and MedTech giants are pursuing new projects without clear public and policy discussion about ownership and responsibility for user-generated data. In the absence of transparent regulation, this paper addresses the opportunities of Big Data in healthcare together with issues of responsibility and accountability. It also aims to pave the way for public policy to support a balanced

Implementing standards for the interoperability among healthcare providers in the public regionalized Healthcare Information System of the Lombardy Region.

Science.gov (United States)

Barbarito, Fulvio; Pinciroli, Francesco; Mason, John; Marceglia, Sara; Mazzola, Luca; Bonacina, Stefano

2012-08-01

Information technologies (ITs) have now entered the everyday workflow in a variety of healthcare providers with a certain degree of independence. This independence may be the cause of difficulty in interoperability between information systems and it can be overcome through the implementation and adoption of standards. Here we present the case of the Lombardy Region, in Italy, that has been able, in the last 10 years, to set up the Regional Social and Healthcare Information System, connecting all the healthcare providers within the region, and providing full access to clinical and health-related documents independently from the healthcare organization that generated the document itself. This goal, in a region with almost 10 millions citizens, was achieved through a twofold approach: first, the political and operative push towards the adoption of the Health Level 7 (HL7) standard within single hospitals and, second, providing a technological infrastructure for data sharing based on interoperability specifications recognized at the regional level for messages transmitted from healthcare providers to the central domain. The adoption of such regional interoperability specifications enabled the communication among heterogeneous systems placed in different hospitals in Lombardy. Integrating the Healthcare Enterprise (IHE) integration profiles which refer to HL7 standards are adopted within hospitals for message exchange and for the definition of integration scenarios. The IHE patient administration management (PAM) profile with its different workflows is adopted for patient management, whereas the Scheduled Workflow (SWF), the Laboratory Testing Workflow (LTW), and the Ambulatory Testing Workflow (ATW) are adopted for order management. At present, the system manages 4,700,000 pharmacological e-prescriptions, and 1,700,000 e-prescriptions for laboratory exams per month. It produces, monthly, 490,000 laboratory medical reports, 180,000 radiology medical reports, 180

The interplay between formal and informal contracting in integrated project delivery

NARCIS (Netherlands)

Bygballe, L.E.; Dewulf, Geert P.M.R.; Levitt, R.

2015-01-01

This research examines the interplay between formal and informal contracting in integrated project delivery (IPD). It investigates how the interplay enables parties in health-care construction projects to cope with uncertainty and complexities, due to, among others, changing demands. New delivery

["Integrity" in the healthcare system : Recognize and avoid risks: on dealing with the Association of Statutory Health Insurance Physicians and the public prosecutors office].

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Wohlgemuth, Martin; Heinrich, Julia

2018-05-24

This article describes the introduction of the law to combat corruption in the healthcare system. The effects of the introduced penal regulations on the delivery of medical services is critically scrutinized and the associated procedures as well as indications for the course of action are presented. Knowledge of the relevant regulations and types of procedure is decisive for the penal, social legislative and professional conduct risk minimization.

Three methods to monitor utilization of healthcare services by the poor

Directory of Open Access Journals (Sweden)

Urni Farhana

2009-08-01

Full Text Available Abstract Background Achieving equity by way of improving the condition of the economically poor or otherwise disadvantaged is among the core goals of contemporary development paradigm. This places importance on monitoring outcome indicators among the poor. National surveys allow disaggregation of outcomes by socioeconomic status at national level and do not have statistical adequacy to provide estimates for lower level administrative units. This limits the utility of these data for programme managers to know how well particular services are reaching the poor at the lowest level. Managers are thus left without a tool for monitoring results for the poor at lower levels. This paper demonstrates that with some extra efforts community and facility based data at the lower level can be used to monitor utilization of healthcare services by the poor. Methods Data used in this paper came from two sources- Chakaria Health and Demographic Surveillance System (HDSS of ICDDR,B and from a special study conducted during 2006 among patients attending the public and private health facilities in Chakaria, Bangladesh. The outcome variables included use of skilled attendants for delivery and use of facilities. Rate-ratio, rate-difference, concentration index, benefit incidence ratio, sequential sampling, and Lot Quality Assurance Sampling were used to assess how pro-poor is the use of skilled attendants for delivery and healthcare facilities. Findings Poor are using skilled attendants for delivery far less than the better offs. Government health service facilities are used more than the private facilities by the poor. Benefit incidence analysis and sequential sampling techniques could assess the situation realistically which can be used for monitoring utilization of services by poor. The visual display of the findings makes both these methods attractive. LQAS, on the other hand, requires small fixed sample and always enables decision making. Conclusion With some

Three methods to monitor utilization of healthcare services by the poor

Science.gov (United States)

Bhuiya, Abbas; Hanifi, SMA; Urni, Farhana; Mahmood, Shehrin Shaila

2009-01-01

Background Achieving equity by way of improving the condition of the economically poor or otherwise disadvantaged is among the core goals of contemporary development paradigm. This places importance on monitoring outcome indicators among the poor. National surveys allow disaggregation of outcomes by socioeconomic status at national level and do not have statistical adequacy to provide estimates for lower level administrative units. This limits the utility of these data for programme managers to know how well particular services are reaching the poor at the lowest level. Managers are thus left without a tool for monitoring results for the poor at lower levels. This paper demonstrates that with some extra efforts community and facility based data at the lower level can be used to monitor utilization of healthcare services by the poor. Methods Data used in this paper came from two sources- Chakaria Health and Demographic Surveillance System (HDSS) of ICDDR,B and from a special study conducted during 2006 among patients attending the public and private health facilities in Chakaria, Bangladesh. The outcome variables included use of skilled attendants for delivery and use of facilities. Rate-ratio, rate-difference, concentration index, benefit incidence ratio, sequential sampling, and Lot Quality Assurance Sampling were used to assess how pro-poor is the use of skilled attendants for delivery and healthcare facilities. Findings Poor are using skilled attendants for delivery far less than the better offs. Government health service facilities are used more than the private facilities by the poor. Benefit incidence analysis and sequential sampling techniques could assess the situation realistically which can be used for monitoring utilization of services by poor. The visual display of the findings makes both these methods attractive. LQAS, on the other hand, requires small fixed sample and always enables decision making. Conclusion With some extra efforts monitoring of the

Emerging technologies in healthcare: navigating risks, evaluating rewards.

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McGrady, Elizabeth; Conger, Sue; Blanke, Sandra; Landry, Brett J L

2010-01-01

The purpose of this prescriptive research is to help decision makers become better informed about three technologies emerging in the healthcare arena by providing a basic description of the technology and describing their current applications, future healthcare deployment, potential risks, and related managerial issues. Two of the technologies, radio frequency identification (RFID) and global positioning systems (GPS), are currently available to healthcare organizations and appear capable of decreasing cost but may require significant initial investment and have disruptive potential. The third technology, nanotechnology, has limited current use but may revolutionize both the delivery of medicine and hospital infrastructure management. With cautious attention to managerial issues and meticulous attention to implementation details, healthcare organizations that can successfully navigate the coming technologically driven paradigm shifts will emerge more resilient organizations.

Healthcare reforms in Cyprus 2013-2017: Does the crisis mark the end of the healthcare sector as we know it?

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Petrou, Panagiotis; Vandoros, Sotiris

2018-02-01

As part of a bailout agreement with the International Monetary Fund, the European Commission and the European Central Bank (known as the Troika), Cyprus had to achieve a fiscal surplus through budget constraints and efficiency enhancement. As a result, a number of policy changes were implemented, including a reform of the healthcare sector, and major healthcare reforms are planned for the upcoming years, mainly via the introduction of a National Health System. This paper presents the healthcare sector, provides an overview of recent reforms, assesses the recently implemented policies and proposes further interventions. Recent reforms targeting the demand and supply side included the introduction of clinical guidelines, user charges, introduction of coding for Diagnosis Related Groups (DRGs) and the revision of public healthcare coverage criteria. The latter led to a reduction in the number of people with public healthcare coverage in a time of financial crises, when this is needed the most, while co-payments must be reassessed to avoid creating barriers to access. However, DRGs and clinical guidelines can help improve performance and efficiency. The changes so far are yet to mark the end of the healthcare sector as we know it. A universal public healthcare system must remain a priority and must be introduced swiftly to address important existing coverage gaps. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

The Role of Healthcare Technology Management in Facilitating Medical Device Cybersecurity.

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Busdicker, Mike; Upendra, Priyanka

2017-09-02

This article discusses the role of healthcare technology management (HTM) in medical device cybersecurity and outlines concepts that are applicable to HTM professionals at a healthcare delivery organization or at an integrated delivery network, regardless of size. It provides direction for HTM professionals who are unfamiliar with the security aspects of managing healthcare technologies but are familiar with standards from The Joint Commission (TJC). It provides a useful set of recommendations, including relevant references for incorporating good security practices into HTM practice. Recommendations for policies, procedures, and processes referencing TJC standards are easily applicable to HTM departments with limited resources and to those with no resource concerns. The authors outline processes from their organization as well as best practices learned through information sharing at AAMI, National Health Information Sharing and Analysis Center (NH-ISAC), and Medical Device Innovation, Safety, and Security Consortium (MDISS) conferences and workshops.

Pregnancy outcomes associated with Cesarean deliveries in Peruvian public health facilities

Directory of Open Access Journals (Sweden)

Gonzales GF

2013-10-01

Full Text Available Gustavo F Gonzales,1–2 Vilma L Tapia,2 Alfredo L Fort,3 Ana Pilar Betran31Department of Biological and Physiological Sciences, Faculty of Sciences and Philosophy, 2Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima, Peru; 3Department of Reproductive Health and Research, World Health Organization, Geneva, SwitzerlandAbstract: A continuous rise in the rate of cesarean deliveries has been reported in many countries over recent decades. This trend has prompted the emergence of a debate on the risks and benefits associated with cesarean section. The present study was designed to estimate cesarean section rates over time during the period between 2000 and 2010 in Peru and to present outcomes for each mode of delivery. This is a secondary analysis of a large database obtained from the Perinatal Information System, which includes 570,997 pregnant women and their babies from 43 Peruvian public health facilities in three geographical regions: coast, highlands, and jungle. Over 10 years, 558,901 women delivered 563,668 infants weighing at least 500 g. The cesarean section rate increased from 25.5% in 2000 to 29.9% in 2010 (26.9% average; P < 0.01. The rate of stillbirths was lower with cesarean than vaginal deliveries (P < 0.01. On the other hand, and as expected, the rates for preterm births, twin pregnancies, and preeclampsia were higher in women who delivered by cesarean section (P < 0.01. More importantly, the rate of maternal mortality was 5.5 times higher in the cesarean section group than in the vaginal delivery group. Data suggest that cesarean sections are associated with adverse pregnancy outcomes.Keywords: elective cesarean, emergency cesarean, geographical regions, cesarean rates over time, adverse outcomes, developing country

A framework to expand public services to children with biomedical healthcare needs related to HIV in the Free State, South Africa.

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Reid, Marianne; Botma, Yvonne

2012-06-01

The study undertook the development of a framework for expanding the public services available to children with biomedical healthcare needs related to HIV in South Africa. The study consisted of various component projects which were depicted as phases. The first phase was a descriptive quantitative analysis of healthcare services for children exposed to or infected by HIV, as rendered by the public health sector in the Free State Province. The second stage was informed by health policy research: a nominal group technique with stakeholders was used to identify strategies for expanding the healthcare services available to these children. The third phase consisted of workshops with stakeholders in order to devise and validate a framework for the expansion. The theory of change logic model served as the theoretical underpinning of the draft framework. Triangulated data from the literature and the preceding two phases of the study provided the empirical foundation. The problem identified was that of fragmented care delivered to children exposed to or infected with HIV, due to the 'over-verticalization' of programmes. A workshop was held during which the desired results, the possible factors that could influence the results, as well as the suggested strategies to expand and integrate the public services available to HIV-affected children were confirmed. Thus the framework was finalised during the validation workshop by the researchers in collaboration with the stakeholders.

From PACS to Web-based ePR system with image distribution for enterprise-level filmless healthcare delivery.

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Huang, H K

2011-07-01

The concept of PACS (picture archiving and communication system) was initiated in 1982 during the SPIE medical imaging conference in New Port Beach, CA. Since then PACS has been matured to become an everyday clinical tool for image archiving, communication, display, and review. This paper follows the continuous development of PACS technology including Web-based PACS, PACS and ePR (electronic patient record), enterprise PACS to ePR with image distribution (ID). The concept of large-scale Web-based enterprise PACS and ePR with image distribution is presented along with its implementation, clinical deployment, and operation. The Hong Kong Hospital Authority's (HKHA) integration of its home-grown clinical management system (CMS) with PACS and ePR with image distribution is used as a case study. The current concept and design criteria of the HKHA enterprise integration of the CMS, PACS, and ePR-ID for filmless healthcare delivery are discussed, followed by its work-in-progress and current status.

Career patterns of healthcare executives.

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Fahey, D F; Myrtle, R C

2001-02-01

This research examines the job and career changes of healthcare executives and managers working in different segments of the healthcare industry in the western United States. The results suggest that the job and career patterns in the healthcare delivery sector are undergoing significant transformation. One third of the respondents reports that at least one of their last four job changes was involuntary or unplanned. One half of those attempted to make a career change. This study identifies four different executive and management career patterns. The most common was one of multiple career changes. The second pattern was that of a single career change, followed by a 'traditional' career in which one did not seek a career change. The final pattern was characterized as a movement back and forth between two different segments of the healthcare industry. Age, gender, marital status and education were not associated with any specific career pattern. The need to achieve results early in the respondent's career had a strong influence on career patterns. This study confirms the fluidity of career movement and the changing permeability between the various segments of the healthcare industry. It also suggests that career success increasingly will require broad management experience in those different segments.

The healthcare system and the provision of oral healthcare in European Union member states. Part 8: Italy.

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Bindi, M; Paganelli, C; Eaton, K A; Widström, E

2017-05-26

In Italy healthcare is provided for all Italian citizens and residents and it is delivered mainly by public providers, with some private or private-public entities. Italy's public healthcare system - the Servizio Sanitario Nazionale (SSN) - is organised by the Ministry of Health and administered on a devolved regional basis. It is financed by general taxation that provides universal coverage, largely free of charge at the point of service. The central government establishes the basic national health benefits package, which must be uniformly provided throughout the country, through services guaranteed under the NHS provision called LEA - (Livelli Essenziali di Assistenza [Essential Level of Assistance]) and allocates national funds to the regions. The regions, through their regional health departments, are responsible for organising, administering and delivering primary, secondary and tertiary healthcare services as well as preventive and health promotion services. Regions are allowed a large degree of autonomy in how they perform this role and regarding decisions about the local structure of the system. Complementary and supplementary private health insurance is also available. However, as in most other Mediterranean European countries, in Italy oral healthcare is mainly provided under private arrangements. The public healthcare system provides only 5-8% of oral healthcare services and this percentage varies from region to region. Oral healthcare is included in the Legislation on Essential levels of care (LEAs) for specific populations such as children, vulnerable people (medically compromised and those on low income) and individuals who need oral healthcare in some urgent/emergency cases. For other people, oral healthcare is generally not covered. Apart from the national benefits package, regions may also carry out their own initiatives autonomously, but must finance these themselves. The number of dentists working in Italy has grown rapidly in the last few years

Successful healthcare programs and projects: organization portfolio management essentials.

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Pickens, Scott; Solak, Jamie

2005-01-01

Many healthcare organization projects take more time and resources than planned and fail to deliver desired business outcomes. Healthcare IT is a major component of many projects and often undeservedly receives the blame for failure. Poor results are often not a result of faulty healthcare IT or poor project management or poor project execution alone. Many projects fail because of poor portfolio management--poor planning and management of the portfolio of initiatives designed to meet an organization's strategic goals. Because resources are limited, portfolio management enables organizations to more strategically allocate and manage their resources so care delivery, service delivery, and initiatives that advance organizations toward their strategic goals, including healthcare IT initiatives, can be accomplished at the levels of quality and service desired by an organization. Proper portfolio management is the essential foundation for program and project success and supports overall organization success. Without portfolio management, even programs and projects that execute flawlessly may not meet desired objectives. This article discusses the essential requirements for porfolio management. These include opportunity identification, return on investment (ROI) forecast, project prioritization, capacity planning (inclusive of human, financial, capital, and facilities resources), work scheduling, program and project management and execution, and project performance and value assessment. Portfolio management is essential to successful healthcare project execution. Theories are drawn from the Organizational Project Management Maturity Model (OPM3) work of the Project Management Institute and other leading strategy, planning, and organization change management research institutes.

Healthcare 2025 : buildings for the future

NARCIS (Netherlands)

2008-01-01

Healthcare in Europe is changing. Many countries are introducing reforms, and creating more competition and an open healthcare market. Product pricing is becoming normal; in some cases, such as the Netherlands, capital costs are becoming a component of charges. Experiments with public/private

Profiling health-care accreditation organizations: an international survey.

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Shaw, Charles D; Braithwaite, Jeffrey; Moldovan, Max; Nicklin, Wendy; Grgic, Ileana; Fortune, Triona; Whittaker, Stuart

2013-07-01

To describe global patterns among health-care accreditation organizations (AOs) and to identify determinants of sustainability and opportunities for improvement. Web-based questionnaire survey. Organizations offering accreditation services nationally or internationally to health-care provider institutions or networks at primary, secondary or tertiary level in 2010. s) External relationships, scope and activity public information. Forty-four AOs submitted data, compared with 33 in a survey 10 years earlier. Of the 30 AOs that reported survey activity in 2000 and 2010, 16 are still active and stable or growing. New and old programmes are increasingly linked to public funding and regulation. While the number of health-care AOs continues to grow, many fail to thrive. Successful organizations tend to complement mechanisms of regulation, health-care funding or governmental commitment to quality and health-care improvement that offer a supportive environment. Principal challenges include unstable business (e.g. limited market, low uptake) and unstable politics. Many organizations make only limited information available to patients and the public about standards, procedures or results.

Use of quality measurement across US dental delivery systems: a qualitative analysis.

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Alrqiq, Hosam M; Edelstein, Burton L

2016-03-01

Dentistry is increasingly challenged by payers and the public to demonstrate quality measurement (QM) activities that substantiate value. Unknown is how various components of the US oral health-care financing and delivery systems have adopted QM. The objective of this study is to explore QM activities by US dental delivery, management, financing, and related organizations. Using a structured interview guide based on a novel conceptual framework that incorporates factors influencing QM intention, adoption, and implementation, 19 key informant interviews were conducted. Informants represented safety net delivery programs (health center, nonprofit mobile, hospital-based, Veterans Administration, and tribal dental programs), private delivery organizations (private practice, closed panel HMO, and for-profit mobile dental programs), training programs that deliver care (dental and dental therapy programs), management organizations (private and Medicaid group practice management companies), care financing organizations (Medicaid managed care plan, state Medicaid program, dental benefits companies), and dental quality organizations (institute and dental professional organization). Interviews were transcribed and analyzed qualitatively. Informants report wide variation in the intensity of QM efforts with organizational leadership cited as most influential. Motivation to adopt QM efforts is more often internal than imposed. Data management and information technology both facilitate and limit QM activities. QM activities are associated with operational improvements including use of guidelines and refinements of mission. Organizational type and size appear to influence QM programs. The current status of QM is highly variable across dental organizations because organizational leadership, needs, and requirements vary according to mission and structure. © 2015 American Association of Public Health Dentistry.

Factors associated with the impact of quality improvement collaboratives in mental healthcare: an exploratory study.

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Versteeg, M.H.; Laurant, M.G.H.; Franx, G.C.; Jacobs, A.J.M; Wensing, M.J.P.

2012-01-01

BACKGROUND: Quality improvement collaboratives (QICs) bring together groups of healthcare professionals to work in a structured manner to improve the quality of healthcare delivery within particular domains. We explored which characteristics of the composition, participation, functioning, and

Unemployment, public-sector health-care spending and breast cancer mortality in the European Union: 1990-2009.

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Maruthappu, Mahiben; Watkins, Johnathan A; Waqar, Mueez; Williams, Callum; Ali, Raghib; Atun, Rifat; Faiz, Omar; Zeltner, Thomas

2015-04-01

The global economic crisis has been associated with increased unemployment, reduced health-care spending and adverse health outcomes. Insights into the impact of economic variations on cancer mortality, however, remain limited. We used multivariate regression analysis to assess how changes in unemployment and public-sector expenditure on health care (PSEH) varied with female breast cancer mortality in the 27 European Union member states from 1990 to 2009. We then determined how the association with unemployment was modified by PSEH. Country-specific differences in infrastructure and demographic structure were controlled for, and 1-, 3-, 5- and 10-year lag analyses were conducted. Several robustness checks were also implemented. Unemployment was associated with an increase in breast cancer mortality [P unemployment rises (P unemployment and breast cancer mortality remained in all robustness checks. Rises in unemployment are associated with significant short- and long-term increases in breast cancer mortality, while increases in PSEH are associated with reductions in breast cancer mortality. Initiatives that bolster employment and maintain total health-care expenditure may help minimize increases in breast cancer mortality during economic crises. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

A new generation of healthcare buildings in South Africa: complexities and opportunities for greening

CSIR Research Space (South Africa)

De Jager, Peta

2012-07-01

Full Text Available , efficient, healing environment desirable for healthcare delivery. In South Africa there has been a commitment to transform the healthcare sector through the introduction of the national health insurance system which is to be unfolded over a 14 year period...

[Production chain supply management for public hospitals: a logistical approach to healthcare].

Science.gov (United States)

Infante, Maria; dos Santos, Maria Angélica Borges

2007-01-01

Despite their importance for hospital operations, discussions of healthcare organization logistics and supply and materials management are notably lacking in Brazilian literature. This paper describes a methodology for organizing the supply of medical materials in public hospitals, based on an action-research approach. Interventions were based on the assumption that a significant portion of problems in Brazil's National Health System (SUS) facilities derive from the fact that their clinical and administrative departments do not see themselves as belonging to the same production chain - neither the hospital nor the supply department is aware of what the other produces. The development of the methodology and its main steps are presented and discussed, against a background of recent literature and total quality and supply chain management concepts.

Electronic Health Delivery using Open Source Software and ...

International Development Research Centre (IDRC) Digital Library (Canada)

This project aims to strengthen primary healthcare delivery to vulnerable ... and communication technology (ICT), specifically, personal digital assistants (PDAs) ... de Argentina through its centre for interdisciplinary studies and management ...

PKI security in large-scale healthcare networks

OpenAIRE

Mantas, G.; Lymberopoulos, D.; Komninos, N.

2012-01-01

During the past few years a lot of PKI (Public Key Infrastructures) infrastructures have been proposed for healthcare networks in order to ensure secure communication services and exchange of data among healthcare professionals. However, there is a plethora of challenges in these healthcare PKI infrastructures. Especially, there are a lot of challenges for PKI infrastructures deployed over large-scale healthcare networks. In this paper, we propose a PKI infrastructure to ensure security in a ...

Incorporating financial protection into decision rules for publicly financed healthcare treatments.

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Smith, Peter C

2013-02-01

Almost all health systems seek to offer some form of publicly financed healthcare insurance, and governments must therefore choose the size of the benefit package and the types of treatments to cover. Conventionally, the usual approach of economists has been to recommend choices on the basis of cost effectiveness of treatments, using metrics such as the 'cost per quality adjusted life year'. However, this approach is based on the assumption of health maximization subject to a budget constraint and ignores the potential impact of any additional concern with protecting individuals from the financial consequences of a health shock. Furthermore, it does not take account of the possible availability of complementary privately funded health care. This paper develops a model in which risk-averse individuals care about health but also place a value on protection from the financial consequences of rare but costly events. The paper shows how conventional cost-effectiveness analysis can readily be augmented to take account of financial protection objectives. The results depend on whether or not there exists a market in complementary privately funded health care. They have important implications for the methodology adopted by health technology assessment agencies and for the broader design of publicly funded health systems. Copyright © 2012 John Wiley & Sons, Ltd.

Relation of people-centered public health and person-centered healthcare management: a case study to reduce burn-out.

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Stoyanov, Drozdstoj S; Cloninger, C Robert

2012-01-01

Healthcare management is one practical tool for mediation and implementation of public health into clinical healthcare outcomes and is taken in our case study as an exemplar arena to demonstrate the vital importance of the person-centered approach. Healthcare personnel are frequently at risk for the 'burn-out' syndrome. However, modern measures of burn-out recognize burn-out only at a late stage when it is fully developed. There are no available methods to assess the risk for vulnerability to burnout in healthcare systems. Our aim was therefore to design a complex person-centered model for detection of high risk for burn-out at an early stage, that has been termed 'flame-out'. We accept the observation that decreased personal performance is one crucial expression of burn-out. Low personal performance and negative emotions are strongly related to low self-directedness as measured by the Temperament and Character Inventory (TCI). At the same time, burn-out is characterized by decreased interest and positive emotions from work. Decreased positive emotion is directly related to low self-transcendence as measured by the TCI. Burn-out is also frequently associated with feelings of social alienation or inadequacy of support, which is in turn related to low TCI Cooperativeness. However, high Persistence and Harm Avoidance are predisposing traits for burn-out in healthcare professionals who are often overly perfectionistic and compulsive, predisposing them to anxiety, depression, suicide and burn-out. Hence, people at risk for future burn-out are often highly conscientious over-achievers with intense mixtures of positive and negative emotions. The high demand for perfection comes from both intrinsic characteristics and from features of the social milieu in their psychological climate. Letting go of the unfulfillable desire to be perfect by increasing self-transcendence allows acceptance of the imperfection of the human condition, thereby preventing burn-out and other

American Heart Association's Call to Action for Payment and Delivery System Reform.

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Bufalino, Vincent J; Berkowitz, Scott A; Gardner, Timothy J; Piña, Ileana L; Konig, Madeleine

2017-08-15

The healthcare system is undergoing a transition from paying for volume to paying for value. Clinicians, as well as public and private payers, are beginning to implement alternative delivery and payment models, such as the patient-centered medical home, accountable care organizations, and bundled payment arrangements. Implementation of these new models will necessitate delivery system transformation and will actively involve all fields of medical care, in particular medicine and surgery. This call to action, on behalf of the American Heart Association's Expert Panel on Payment and Delivery System Reform, serves to offer support and direction for further involvement by the American Heart Association. In doing so, it (1) provides baseline review and definition of the present models and some of the early results of these delivery models, including outcomes; (2) initiates a conversation within the American Heart Association on the impact of payment and delivery system reform, as well as how the American Heart Association should engage in the interest of patients; (3) issues a call to action to our organization and to cardiovascular and stroke health professionals across the country to become educated about these models so to as to understand their impact on patient care; and (4) asks the government and other funding agencies, including the American Heart Association, to begin supporting and prioritizing meaningful research endeavors to further evaluate these models. © 2017 American Heart Association, Inc.

Accessing Safe Deliveries in Tanzania (IMCHA) | IDRC ...

International Development Research Centre (IDRC) Digital Library (Canada)

Few healthcare workers are trained to offer emergency obstetrical care, so timely ... With better access to skilled care and emergency services, the project aims to ... training program as it relates to health service delivery and health outcomes.

The Relationship of Repeated Technical Assistance Support Visits to the Delivery of Positive Health, Dignity, and Prevention (PHDP) Messages by Healthcare Providers in Mozambique: A Longitudinal Multilevel Analysis.

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Gutin, Sarah A; Amico, K Rivet; Hunguana, Elsa; Munguambe, António Orlando; Rose, Carol Dawson

Positive health, dignity, and prevention (PHDP) is Mozambique's strategy to engage clinicians in the delivery of prevention messages to their HIV-positive clients. This national implementation strategy uses provider trainings on offering key messages and focuses on intervening on 9 evidence-based risk reduction areas. We investigated the impact of longitudinal technical assistance (TA) as an addition to this basic training. We followed 153 healthcare providers in 5 Mozambican provinces over 6 months to evaluate the impact of on-site, observation-based TA on PHDP implementation. Longitudinal multilevel models were estimated to model change in PHDP message delivery over time among individual providers. With each additional TA visit, providers delivered about 1 additional PHDP message ( P < .001); clinicians and nonclinicians started at about the same baseline level, but clinicians improved more quickly ( P = .004). Message delivery varied by practice sector; maternal and child health sectors outperformed other sectors. Longitudinal TA helped reach the programmatic goals of the PHDP program in Mozambique.

Identifying Critical Factors Influencing the Rents of Public Rental Housing Delivery by PPPs: The Case of Nanjing

Directory of Open Access Journals (Sweden)

Jingfeng Yuan

2017-02-01

Full Text Available The occupancy rate of Public Rental Housing (PRH in China is relatively low due to the unreasonable rents. At the same time, the development of PRH using Public Private Partnerships (PPPs increases the complexity of the rents. Therefore, the critical factors influencing the rents of PRH delivery by PPPs should be identified. Based on the comprehensive literature, this article identified a conceptual model for the factors influencing the rents of PRH delivery by PPPs in China, composed of 14 factors grouped in three factor packages, and discussed the relationships among three factor packages. A survey based on Nanjing was conducted to assess the relative significance of 14 factors. According to the results, six critical factors were identified: construction costs, household income, floor area and structure, transportation, market rents in the same district and public facilities. In addition, the proposed conceptual model had a good fit. The results also supported two hypothetical relationships among three factor packages: (1 the increase of the affordability of the target tenants had a positive effect on the increase of profits of private sectors; and (2 the increase of the affordability of the target tenants had a positive effect on the increase of level of the characteristics of PRH units. For future research, six critical factors and the relationships among three factor packages can be used to determine the reasonable rents for PRH delivery by PPPs in China.

Mobile Phones: The Next Step towards Healthcare Delivery in Rural India?

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DeSouza, Sherwin I.; Rashmi, M. R.; Vasanthi, Agalya P.; Joseph, Suchitha Maria; Rodrigues, Rashmi

2014-01-01

Background Given the ubiquity of mobile phones, their use to support healthcare in the Indian context is inevitable. It is however necessary to assess end-user perceptions regarding mobile health interventions especially in the rural Indian context prior to its use in healthcare. This would contextualize the use of mobile phone communication for health to 70% of the country's population that resides in rural India. Objectives To explore the acceptability of delivering healthcare interventions through mobile phones among users in a village in rural Bangalore. Methods This was an exploratory study of 488 mobile phone users, residing in a village, near Bangalore city, Karnataka, South India. A pretested, translated, interviewer-administered questionnaire was used to obtain data on mobile phone usage patterns and acceptability of the mobile phone, as a tool for health-related communication. The data is described using basic statistical measures. Results The primary use of mobile phones was to make or receive phone calls (100%). Text messaging (SMS) was used by only 70 (14%) of the respondents. Most of the respondents, 484 (99%), were willing to receive health-related information on their mobile phones and did not consider receiving such information, an intrusion into their personal life. While receiving reminders for drug adherence was acceptable to most 479 (98%) of our respondents, 424 (89%) preferred voice calls alone to other forms of communication. Nearly all were willing to use their mobile phones to communicate with health personnel in emergencies and 367 (75%) were willing to consult a doctor via the phone in an acute illness. Factors such as sex, English literacy, employment status, and presence of chronic disease affected preferences regarding mode and content of communication. Conclusion The mobile phone, as a tool for receiving health information and supporting healthcare through mHealth interventions was acceptable in the rural Indian context. PMID

Mobile phones: the next step towards healthcare delivery in rural India?

Science.gov (United States)