SSM - Health Systems最新文献

{"title":"Developing an understanding of networks with a focus on LMIC health systems: How and why clinical and programmatic networks form and function to be able to change practices: A realist review","authors":"Katherine Kalaris ,&nbsp;Mike English ,&nbsp;Geoff Wong","doi":"10.1016/j.ssmhs.2023.100001","DOIUrl":"https://doi.org/10.1016/j.ssmhs.2023.100001","url":null,"abstract":"<div><p>Networks are an increasingly employed approach to improve quality of care, service delivery, and health systems performance, particularly in low-and-middle income country (LMIC) health systems. The literature shows that networks can improve the provision and quality of services and health system functioning but there is limited evidence explaining how and why networks are established and work to achieve their reported results. We undertook a realist review to explore this. The objective of this realist review was to develop a programme theory outlining the underlying mechanisms and interactions of contexts that explain how and why a network’s set-up and function enable high-quality care and services and improved clinical outcomes in LMIC health systems. We followed Pawson’s five steps for realist reviews. The search strategy was based on a previously published scoping review with additional searches. Literature was selected based on its relevance to the programme theory and rigour. Context-mechanism-outcome configurations were developed from the extracted data to refine the initial programme theory with causal explanations. Theories on social movements and organisations supported the identification of mechanism and brought additional explanatory power to the programme theory. The programme theory explains how networks are initiated, formed, and function in a way that sets them up for network leadership and committed, engaged, and motivated network members to emerge and to change practices, which may lead to improved quality of care, service delivery, and clinical outcomes through the following phases: identify a problem, developing a collective vision, taking action to solve the problem, forming purposeful relationships, linkages, and partnerships, building a network identity and culture, and the creation of a psychological safe space. This deeper understanding of networks formation and functioning can lead to a more considered planning and implementation of networks, thereby improving health system functioning and performance.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"1 ","pages":"Article 100001"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49765024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"‘There’s a lot less time on small talk’: Rural patient perspectives on shifting to technology-enabled healthcare in Canada during COVID-19","authors":"Nicole Hawe ,&nbsp;Cherisse L. Seaton ,&nbsp;Kendra Corman ,&nbsp;Lindsay Burton ,&nbsp;Kathy L. Rush","doi":"10.1016/j.ssmhs.2023.100002","DOIUrl":"https://doi.org/10.1016/j.ssmhs.2023.100002","url":null,"abstract":"<div><p>The objective of this qualitative research study was to explore system, provider, and patient level factors from the perspective of rural-living citizens in Canada and how these factors influenced their telehealth experiences. Participants were recruited in follow-up to an online survey which asked for interest in participation in focus groups to talk about telehealth experiences. Twenty-two rural citizens participated in one of five focus groups. The qualitative data from the focus groups were thematically analyzed. The overarching theme that described rural participants’ experiences of telehealth during the pandemic was navigating the shifting care model. Two main themes were constructed from the data: shifts in the patient-provider relationship and mismatch between the telehealth requirements and provider and system support. Relational shifts involved a transactional or business-like relationship with their providers, that was reflected in changes in etiquette practices, personalization of care, and communication dynamics. Mismatch in telehealth system requirements and support was reflected in shifting personal and infrastructure technology requirements, blurred boundaries of health data access and privacy, and shifting appointment logistics. Continued use and expansion of technology-enabled healthcare must consider patient perspectives.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"1 ","pages":"Article 100002"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49765025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}