Journal of Health Services Research & Policy最新文献

{"title":"Understanding the factors influencing implementation of a new national patient safety policy in England: Lessons from 'learning from deaths'.","authors":"Mirza Lalani,&nbsp;Sarah Morgan,&nbsp;Anamika Basu,&nbsp;Helen Hogan","doi":"10.1177/13558196221096921","DOIUrl":"https://doi.org/10.1177/13558196221096921","url":null,"abstract":"<p><strong>Objective: </strong>A new patient safety policy, 'Learning from Deaths' (LfD), was implemented in 2017 in National Health Service (NHS) organisations in England. This study examined how contextual factors influenced the implementation of LfD policy and the ability of the programme to achieve its goals.</p><p><strong>Methods: </strong>Semi-structured interviews were undertaken with key policymakers involved in the development of the policy, along with interviews with managers and senior clinicians in five NHS organisations responsible for implementing the policy at the local level. We also undertook non-participant observation of relevant meetings and documentary reviews of key organisation procedures and policies pertaining to LfD.</p><p><strong>Results: </strong>The study findings suggest several factors that hinder or support patient safety policy implementation at a local level. These include: (a) an organisation's capacity and capability to support data collation, analysis and synthesis, (b) the dissemination of the resulting information, (c) the learning culture and hence perceptions of the purpose of LfD within an organisation, and (d) the extent of engagement in cross-organisational approaches to learning.</p><p><strong>Conclusions: </strong>Extra and intra-organisational contextual factors influence all stages of the policy implementation process from preparation and tracking to implementation support and review affecting its chances of success or failure. Successful adoption of a national patient safety policy within health care organisations can be informed by taking into consideration those factors.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"28 1","pages":"50-57"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9850371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10627141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Village health worker motivation for better performance in a maternal and child health programme in Nigeria: A realist evaluation.","authors":"Chinyere Mbachu,&nbsp;Enyi Etiaba,&nbsp;Bassey Ebenso,&nbsp;Udochukwu Ogu,&nbsp;Obinna Onwujekwe,&nbsp;Benjamin Uzochukwu,&nbsp;Ana Manzano,&nbsp;Tolib Mirzoev","doi":"10.1177/13558196211055323","DOIUrl":"https://doi.org/10.1177/13558196211055323","url":null,"abstract":"<p><strong>Background: </strong>Community health workers play an important role in linking communities with formal health service providers, thereby improving access to and utilization of health care. A novel cadre of community health workers known as village health workers (VHWs) were recruited to create demand for maternal health services in the Nigerian Subsidy Reinvestment Programme (SURE-P/MCH). In this study, we investigated the role of contextual factors and underlying mechanisms motivating VHWs.</p><p><strong>Methods: </strong>We used realist evaluation to understand the impact of a multi-intervention maternal and child health programme on VHW motivation using Anambra State as a case study. Initial working theories and logic maps were developed through literature review and stakeholder engagement; programme theories were developed and tested using focus group discussions and in-depth interviews with various stakeholder groups. Interview transcripts were analysed through an integrated approach of Context, Mechanism and Outcomes (CMO) categorisation and connecting, and matching of patterns of CMO configurations. Motivation theories were used to explain factors that influence VHW motivation. Explanatory configurations are reported in line with RAMESES reporting standards.</p><p><strong>Results: </strong>The performance of VHWs in the SURE-P maternal and child health programme was linked to four main mechanisms of motivation: feelings of confidence, sense of identity or feeling of acceptance, feeling of happiness and hopefulness/expectation of valued outcome. These mechanisms were triggered by interactions of programme-specific contexts and resources such as training and supervision of VHWs by skilled health workers, provision of first aid kits and uniforms, and payments of a monthly stipend. The monthly payment was considered to be the most important motivational factor by VHWs. VHWs used a combination of innovative approaches to create demand for maternity services among pregnant women, and their performance was influenced by health system factors such as organisational capacity and culture, and societal factors such as relationship with the community and community support.</p><p><strong>Conclusion: </strong>This paper highlights important contextual factors and mechanisms for VHW motivation that can be applied to other interventions that seek to strengthen community engagement and demand creation in primary health care. Future research on how to sustain VHW motivation is also required.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"27 3","pages":"222-231"},"PeriodicalIF":2.4,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9277337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39729262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unseen patterns of preventable emergency care: Emergency department visits for ambulatory care sensitive conditions.","authors":"Beth Parkinson,&nbsp;Rachel Meacock,&nbsp;Katherine Checkland,&nbsp;Matt Sutton","doi":"10.1177/13558196211059128","DOIUrl":"https://doi.org/10.1177/13558196211059128","url":null,"abstract":"<p><strong>Objective: </strong>Admissions for ambulatory care sensitive conditions (ACSCs) are often used to measure potentially preventable emergency care. Visits to emergency departments with ACSCs may also be preventable care but are excluded from such measures if patients are not admitted. We established the extent and composition of this preventable emergency care.</p><p><strong>Methods: </strong>We analysed 1,505,979 emergency department visits (5% of the national total) between 1 April 2015 and 31 March 2017 at six hospital Trusts in England, using International Classification of Diseases diagnostic coding. We calculated the number of visits for each ACSC and examined the proportions of these visits that did not result in admission by condition and patient characteristics.</p><p><strong>Results: </strong>11.1% of emergency department visits were for ACSCs. 55.0% of these visits did not result in hospital admission. Whilst the majority of ACSC visits were for acute rather than chronic conditions (59.4% versus 38.4%), acute visits were much more likely to conclude without admission (70.3% versus 33.4%). Younger, more deprived and ethnic minority patients were less likely to be admitted when they visited the emergency department with an ACSC.</p><p><strong>Conclusions: </strong>Over half of preventable emergency care is not captured by measures of admissions. The probability of admission at a preventable visit varies substantially between conditions and patient groups. Focussing only on admissions for ACSCs provides an incomplete and skewed picture of the types of conditions and patients receiving preventable care. Measures of preventable emergency care should include visits in addition to admissions.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"27 3","pages":"232-241"},"PeriodicalIF":2.4,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9277334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39892843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inter-organisational collaboration enabling care delivery in a specialist cancer surgery provider network: A qualitative study.","authors":"Cecilia Vindrola-Padros,&nbsp;Angus Ig Ramsay,&nbsp;Georgia Black,&nbsp;Ravi Barod,&nbsp;John Hines,&nbsp;Muntzer Mughal,&nbsp;David Shackley,&nbsp;Naomi J Fulop","doi":"10.1177/13558196211053954","DOIUrl":"https://doi.org/10.1177/13558196211053954","url":null,"abstract":"<p><strong>Objective: </strong>To explore the processes, challenges and strategies used to govern and maintain inter-organisational collaboration between professionals in a provider network in London, United Kingdom, which implemented major system change focused on the centralisation of specialist cancer surgery.</p><p><strong>Methods: </strong>We used a qualitative design involving interviews with stakeholders (<i>n</i> = 117), non-participant observations (<i>n</i> = 163) and documentary analysis (<i>n</i> = 100). We drew on an existing model of collaboration in healthcare organisations and expanded this framework by applying it to the analysis of collaboration in the context of major system change.</p><p><strong>Results: </strong>Network provider organisations established shared goals, maintained central figures who could create and sustain collaboration, and promoted distributed forms of leadership. Still, organisations continued to encounter barriers or challenges in relation to developing opportunities for mutual acquaintanceship across all professional groups; the active sharing of knowledge, expertise and good practice across the network; the fostering of trust; and creation of information exchange infrastructures fit for collaborative purposes.</p><p><strong>Conclusion: </strong>Collaborative relationships changed over time, becoming stronger post-implementation in some areas, but continued to be negotiated where resistance to the centralisation remained. Future research should explore the sustainability of these relationships and further unpack how hierarchies and power relationships shape inter-organisational collaboration.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"27 3","pages":"211-221"},"PeriodicalIF":2.4,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9277336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39759002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Operating room waste management: A case study of primary hip operations at a leading National Health Service hospital in the United Kingdom","authors":"Melissa Pegg, R. Rawson, Uchechukwu Okere","doi":"10.1177/13558196221094488","DOIUrl":"https://doi.org/10.1177/13558196221094488","url":null,"abstract":"Objective This research examines current waste management within an operating room at a large United Kingdom National Health Service (NHS) hospital. The study measured the volume and type of waste produced for primary hip operations (PHOs) and estimated the total waste produced across the United Kingdom by the procedure. Methods Three PHOs were audited to measure and compare the waste volumes generated. Results The average volume of waste per surgical procedure was 10.9 kg, consisting of clinical (84.4%), recyclable (12.8%) and bio-bin (2.8%) waste. This research also found that single-use devices contribute significantly to operating room waste. In addition, it was estimated that there is a missed opportunity to reduce clinical waste volume in each procedure, where approximately 15% of clinical waste disposal consisted of visibly clean recyclable waste material, including cardboard and plastics. Conclusions It was estimated that in the NHS approximately 1043 tonnes of waste is produced annually by PHOs alone. A significant volume of this waste could be prevented through improved recycling and reduced use of single-use devices.","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"1 1","pages":"255 - 260"},"PeriodicalIF":2.4,"publicationDate":"2022-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91280313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing joint training sessions of general practitioners and specialists aimed at improving clinical coordination in Colombia: Contributions from participatory action research","authors":"H. G. León-Arce, Josefina Chávez Chávez, A. Mogollón-Pérez, I. Vargas, M. Vázquez","doi":"10.1177/13558196221094676","DOIUrl":"https://doi.org/10.1177/13558196221094676","url":null,"abstract":"Objective To analyse the contribution of participatory action research (PAR) in designing and implementing joint training sessions as a means to improve clinical coordination in a public health care network in Bogotá, Colombia. Methods A qualitative, descriptive-interpretative study using semi-structured individual interviews and focus groups with 40 professionals (GPs, specialists, members of the local steering committee (LSC) and network middle managers) involved in designing and implementing joint training sessions to improve cross-level clinical coordination. The intervention consisted of two forms of joint training sessions for GPs and specialists, implemented through two PAR cycles. Results The PAR approach in designing and implementing joint training sessions led to greater awareness of clinical coordination problems and helped adapting sessions to the local health care context. Study participants highlighted the role of LSC leadership during the PAR process and the importance of ensuring the necessary resources for adopting the intervention. Limited institutional support and differences between joint training sessions affected doctors’ participation and reduced the time available to conduct the sessions. The use of a reflexive method was essential in enhancing doctors’ participation, along with session duration, the facilitator’s role and session content. Conclusions The study provides evidence regarding the contribution of a PAR process to designing and implementing joint training sessions for improving clinical coordination. The findings can inform similar approaches in other health systems.","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"193 1","pages":"261 - 268"},"PeriodicalIF":2.4,"publicationDate":"2022-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72731594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing patient navigator programmes within a hospital setting in Toronto, Canada: A qualitative interview study","authors":"K. Kokorelias, Sarah Gould, Tracey Das Gupta, Naomi Ziegler, D. Cass, S. Hitzig","doi":"10.1177/13558196221103662","DOIUrl":"https://doi.org/10.1177/13558196221103662","url":null,"abstract":"Objectives: This study sought to identify the organisation and system level barriers and facilitators influencing the implementation of patient navigator programmes in one acute care hospital system in Toronto, Canada. Methods: A qualitative descriptive approach informed by the Consolidated Framework for Implementation Research. Data were collected using in-depth interviews and analysed thematically. Results: Thirty-eight individuals participated in interviews (17 community, 21 acute care hospital), including 24 frontline clinicians and 14 programme directors, health care leaders and managers. Implementation of patient navigator programmes was dependent on: (1) a clear consensus on the unique need for patient navigators; (2) champions to promote patient navigation; (3) programme ownership and accountability; (4) external system and organisational landscape and (5) implementation climate. Appropriate mechanisms of communication were found to have impacted each factor as a barrier or facilitator to programme implementation. Conclusion: Strategies for implementing patient navigator programmes into hospital clinical practice should include incorporating evidence to support the programme, considering mechanisms to enable collaborative communication, and the integration of frameworks to facilitate programme integration into the current practices within the organisation.","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"124 1","pages":"313 - 320"},"PeriodicalIF":2.4,"publicationDate":"2022-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88029084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The experience of informal caregivers in providing patient care in hospitals in low- and middle-income countries: A qualitative meta-synthesis","authors":"U. Hogan, A. Bingley, H. Morbey, C. Walshe","doi":"10.1177/13558196221101968","DOIUrl":"https://doi.org/10.1177/13558196221101968","url":null,"abstract":"Objective In low- and middle-income countries, informal caregivers frequently stay in hospitals and perform patient care tasks typically performed by nurses in other contexts. This article reviews qualitative research on these informal caregivers, to gain insight and understanding of their experiences. Methods We undertook a qualitative meta-synthesis. Relevant literature was identified through searches of electronic databases in 2021. Thematic analysis was conducted to facilitate the identification of conceptual relationships to formulate synthesised findings. Results Twenty-four studies met the inclusion criteria – 13 from Sub-Saharan Africa, five from Bangladesh, two from India, two from Iran, one from Brazil and one from Peru. Three themes were generated from the meta-synthesis: (1) The unwelcome but tolerated guest, (2) Enduring personal sacrifice and (3) Fulfilling familial obligations. These themes emphasised the significant burden associated with the hospital caregiving experience and highlighted the implicit reliance on informal caregivers in low- and middle-income countries. Conclusions Informal caregivers perform an essential caregiving role, yet occupy a peripheral and voluntary space in hospitals. There is a clear need to support informal caregivers so that they can safely perform their tasks.","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"73 1","pages":"321 - 329"},"PeriodicalIF":2.4,"publicationDate":"2022-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72945056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Staff perspectives on barriers to and facilitators of quality of life, health, wellbeing, recovery and reduced risk for older forensic mental-health patients: A qualitative interview study","authors":"K. Walker, J. Yates, T. Dening, B. Völlm, Jack Tomlin, Chris Griffiths","doi":"10.1177/13558196221094512","DOIUrl":"https://doi.org/10.1177/13558196221094512","url":null,"abstract":"Objectives There is a lack of research informing service delivery for older forensic mental health patients. This study explored service provision in forensic mental health inpatient and community services in England, investigating what is required for progress in terms of quality of life, health, wellbeing, recovery and reduced risk, and the barriers and facilitators associated with this. Methods Semi-structured interviews were undertaken with 48 members of staff working with older forensic mental health patients in secure inpatient units or the community in England. Data were analysed using thematic analysis. Results Two global themes ‘What works’ and ‘What doesn’t work’ were identified comprising themes representing environmental, interpersonal and individual factors. ‘What works’ included: positive social support and relationships; individualised holistic patient-centred care; hub and spoke approach to patient care; and suitable environments. ‘What doesn’t work’ included: absence of/or maladaptive relationships with family and friends; gaps in service provision; and unsuitable environments. Conclusions For older patients to progress to improved quality of life, health, wellbeing and reduced risk, multilevel and comprehensive support is required, comprising a range of services, interventions, and multidisciplinary input, and individualised to each patient’s needs. The physical environment needs to be adapted for older patients and provide a social environment that seeks to include supportive families, friends and expert professional input. A clear patient progression pathway is required; this must be reflected in policy and provision.","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"9 1","pages":"287 - 300"},"PeriodicalIF":2.4,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75428214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variations in policies for accessing elective musculoskeletal procedures in the English National Health Service: A documentary analysis","authors":"L. Rooshenas, S. Ijaz, A. Richards, A. Realpe, J. Savović, Tim Jones, W. Hollingworth, Jenny L Donovan","doi":"10.1177/13558196221091518","DOIUrl":"https://doi.org/10.1177/13558196221091518","url":null,"abstract":"Objective The overall aim of this study was to investigate how commissioning policies for accessing clinical procedures compare in the context of the English National Health Service. Our primary objective was to compare policy wording and categorise any variations identified. Our secondary objective was to explore how any points of variation relate to national guidance. Methods This study entailed documentary analysis of commissioning policies that stipulated criteria for accessing eight elective musculoskeletal procedures. For each procedure, we retrieved policies held by regions with higher and lower rates of clinical activity relative to the national average. Policies were subjected to content and thematic analysis, using constant comparison techniques. Matrices and descriptive reports were used to compare themes across policies for each procedure and derive categories of variation that arose across two or more procedures. National guidance relating to each procedure were identified and scrutinised, to explore whether these provided context for explaining the policy variations. Results Thirty-five policy documents held by 14 geographic regions were included in the analysis. Policies either focused on a single procedure/treatment or covered several procedures/treatments in an all-encompassing document. All policies stipulated criteria that needed to be fulfilled prior to accessing treatment, but there were inconsistences in the evidence cited. Policies varied in recurring ways, with respect to specification of non-surgical treatments and management, requirements around time spent using non-surgical approaches, diagnostic requirements, requirements around symptom severity and disease progression, and use of language, in the form of terms and phrases (‘threshold modifiers’) which could open up or restrict access to care. National guidance was identified for seven of the procedures, but this guidance did not specify criteria for accessing the procedures in question, making direct comparisons with regional policies difficult. Conclusions This, to our knowledge, is the first study to identify recurring ways in which policies for accessing treatment can vary within a single-payer system with universal coverage. The findings raise questions around whether formulation of commissioning policies should receive more central support to promote greater consistency – especially where evidence is uncertain, variable or lacking.","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"1 1","pages":"190 - 202"},"PeriodicalIF":2.4,"publicationDate":"2022-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87179797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}