Health SystemsPub Date : 2019-12-02eCollection Date: 2019-01-01DOI: 10.1080/20476965.2019.1687264
Sue S Feldman, Ferhat D Zengul, Bunyamin Ozaydin, Victoria Brazil, Leslie Hayes, Benjamin Schooley
{"title":"Introduction to \"health informatics, healthcare quality and safety, and healthcare simulation: the new triad to advance healthcare operations\".","authors":"Sue S Feldman, Ferhat D Zengul, Bunyamin Ozaydin, Victoria Brazil, Leslie Hayes, Benjamin Schooley","doi":"10.1080/20476965.2019.1687264","DOIUrl":"https://doi.org/10.1080/20476965.2019.1687264","url":null,"abstract":"<p><p>This special themed international issue explores the multiple facets of health informatics, healthcare quality and safety, and healthcare simulation from different parts of the world. The papers in this issue fall into two broad themes. The first theme uses the intersection to address better management of care including physical design layout. The second theme examines innovative uses of the triad to prevent critical and non-critical safety events. The collection of papers culminates with a position paper reporting on the interdependence that is emerging as an important triad for research and practice within medical education, system development and testing, and teamwork and communication and concludes with reducing imprecision and factual errors in handoffs. Findings from the special collection of papers can inform managers and leaders on advancing operations in healthcare settings.</p>","PeriodicalId":44699,"journal":{"name":"Health Systems","volume":"8 3","pages":"153-154"},"PeriodicalIF":1.8,"publicationDate":"2019-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20476965.2019.1687264","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37460006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Health SystemsPub Date : 2019-11-11eCollection Date: 2019-01-01DOI: 10.1080/20476965.2019.1687263
Shikha Modi, Bunyamin Ozaydin, Ferhat Zengul, Sue S Feldman
{"title":"The emerging literature for the triad of health informatics, healthcare quality and safety, and healthcare simulation.","authors":"Shikha Modi, Bunyamin Ozaydin, Ferhat Zengul, Sue S Feldman","doi":"10.1080/20476965.2019.1687263","DOIUrl":"https://doi.org/10.1080/20476965.2019.1687263","url":null,"abstract":"<p><p>The areas of health informatics, healthcare quality and safety, and healthcare simulation are often thought of as separate domains. The purpose of this position paper is to report on the interdependence that is emerging as an important triad across the healthcare/health system continuum. A qualitative review of 24 studies suggests the interdependence of health informatics, healthcare quality and safety, and healthcare simulation reaches much broader than traditional utilisation of simulation. We suggest ways that organisations can take advantage of the interdependence of this triad across a broader variety of healthcare environments, including teamwork, communication, and complex system relationships. In conclusion, the reviewed 24 studies suggest that the research in the triad focuses on simulation education and computerised simulation, and when coupled with health informatics, bears greater strength on quality improvement or patient safety.</p>","PeriodicalId":44699,"journal":{"name":"Health Systems","volume":"8 3","pages":"215-227"},"PeriodicalIF":1.8,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20476965.2019.1687263","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37459954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Health SystemsPub Date : 2019-11-03eCollection Date: 2020-01-01DOI: 10.1080/20476965.2019.1680260
Daniel Bouzon Nagem Assad, Thaís Spiegel
{"title":"Improving emergency department resource planning: a multiple case study.","authors":"Daniel Bouzon Nagem Assad, Thaís Spiegel","doi":"10.1080/20476965.2019.1680260","DOIUrl":"https://doi.org/10.1080/20476965.2019.1680260","url":null,"abstract":"<p><p>Sizing and allocating health-care professionals are a critical problem in the management of emergency departments (EDs) managed by a public company in Rio de Janeiro (Brazil). An efficient ED configuration that is cost and time effective must be developed by this company for hospital managers. In this paper, the problem of health-care professional configurations in EDs is modelled to minimise the total labour cost while satisfying patient queues and waiting times as defined by the actual ED capacity and current clinical protocols. To solve this issue, mixed integer linear programming (MILP) that allocates health-care professionals and specifies the amount of professionals who must be hired is proposed. To consider the uncertainties in this environment and evaluate their impacts, a discrete-event simulation model is developed to reflect patient flow. An optimisation and simulation approach is used to search for efficiency leads for different ED configurations. These configurations change depending on the shift and the day of the week.</p>","PeriodicalId":44699,"journal":{"name":"Health Systems","volume":"9 1","pages":"2-30"},"PeriodicalIF":1.8,"publicationDate":"2019-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20476965.2019.1680260","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37828837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Health SystemsPub Date : 2019-09-24DOI: 10.1080/20476965.2019.1664941
Mark T Mackay, Leonid Churilov, Anna Moon, Ian McKenzie, Geoffrey A Donnan, Paul Monagle, Qi Li, Franz E Babl
{"title":"Identification of barriers and enablers to rapid diagnosis along the paediatric stroke chain of recovery using Value-Focused Process Engineering.","authors":"Mark T Mackay, Leonid Churilov, Anna Moon, Ian McKenzie, Geoffrey A Donnan, Paul Monagle, Qi Li, Franz E Babl","doi":"10.1080/20476965.2019.1664941","DOIUrl":"https://doi.org/10.1080/20476965.2019.1664941","url":null,"abstract":"<p><p>Coordinated systems of care are required to improve access to reperfusion therapies in paediatric stroke. A conceptual model was developed to map the process-of-care from symptom onset to confirmation of diagnosis. Value-Focused Process Engineering with event-driven process modelling was used to identify barriers and enablers to timely and accurate paediatric stroke diagnosis. Stakeholder interviews were conducted to inform model design, development, demonstration and validation. Barriers included: (i) ambulance dispatcher failure to allocate high-priority response, (ii) childrens' exclusion from paramedic clinical practice guidelines, (ii) non-allocation of high triage category on hospital arrival, (iii) absence of emergency department guidelines for focal neurological deficits, and (iv) computed tomography as the first imaging investigation. Enablers included: (i) public awareness programs, (ii) childrens' inclusion in prehospital emergency stroke algorithms, (iii) re-organisation of health services, with primary paediatric stroke centres, (iv) implementation of triage and neuroimaging decision support tools, and (iv) rapid stroke MRI imaging protocols.</p>","PeriodicalId":44699,"journal":{"name":"Health Systems","volume":"10 1","pages":"73-88"},"PeriodicalIF":1.8,"publicationDate":"2019-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20476965.2019.1664941","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25510464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Productivity-driven physician scheduling in emergency departments.","authors":"Fanny Camiat, Marìa I Restrepo, Jean-Marc Chauny, Nadia Lahrichi, Louis-Martin Rousseau","doi":"10.1080/20476965.2019.1666036","DOIUrl":"https://doi.org/10.1080/20476965.2019.1666036","url":null,"abstract":"<p><p>The objective of this study is two-fold: to propose an alternative approach for computing the productivity of physicians in emergency departments (EDs); and, to allocate productivity-driven schedules to ED physicians so as to align physician productivity with demand (patient arrivals), without decreasing fairness between physicians, in order to improve patient wait times. Historical data between 2008 and 2017 from the Sacré-Coeur Montreal Hospital ED is analysed and used to predict the demand and to estimate the productivity of each physician. These estimates are incorporated into a mathematical programming model that identifies feasible schedules to physicians that minimise the difference between patients' demand and physicians' productivity, along with the violation of physicians' preferences and fairness in the distribution of shifts. Results on real-world-based data show that when physician productivity is included in the allocation of schedules, demand under-covering is reduced by 10.85% and the fairness between physicians is maintained. However, physicians' preferences (e.g., sum of the differences between the number of wanted shifts and the number of allocated shifts) deteriorates by 7.61%. By incorporating the productivity of physicians in the scheduling process, we see a reduction in EDs overcrowding and an improvement in the overall quality of health-care services.</p>","PeriodicalId":44699,"journal":{"name":"Health Systems","volume":"10 2","pages":"104-117"},"PeriodicalIF":1.8,"publicationDate":"2019-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20476965.2019.1666036","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39076455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Health SystemsPub Date : 2019-09-12DOI: 10.1080/20476965.2019.1663974
Benjamin Schooley, Tonia San Nicolas-Rocca, Richard Burkhard
{"title":"Cloud-based multi-media systems for patient education and adherence: a pilot study to explore patient compliance with colonoscopy procedure preparation.","authors":"Benjamin Schooley, Tonia San Nicolas-Rocca, Richard Burkhard","doi":"10.1080/20476965.2019.1663974","DOIUrl":"https://doi.org/10.1080/20476965.2019.1663974","url":null,"abstract":"<p><p>Technology based patient education and adherence approaches are increasingly utilized to instruct and remind patients to prepare correctly for medical procedures. This study examines the interaction between two primary factors: patterns of patient adherence to challenging medical preparation procedures; and the demonstrated, measurable potential for cloud-based multi-media information technology (IT) interventions to improve patient adherence. An IT artifact was developed through prior design science research to serve information, reminders, and online video instruction modules to patients. The application was tested with 297 patients who were assessed clinically by physicians. Results indicate modest potential (43.4% relative improvement) for the IT-based approach for improving patient adherence to endoscopy preparations. Purposively designed cloud-based applications hold promise for aiding patients with complex medical procedure preparation. Health care provider involvement in the design and evaluation of a patient application may be an effective strategy to produce medical evidence and encourage the adoption of adherence apps.</p>","PeriodicalId":44699,"journal":{"name":"Health Systems","volume":"10 2","pages":"89-103"},"PeriodicalIF":1.8,"publicationDate":"2019-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20476965.2019.1663974","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39076454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Health SystemsPub Date : 2019-09-11DOI: 10.1080/20476965.2019.1652547
Emma Aspland, Daniel Gartner, Paul Harper
{"title":"Clinical pathway modelling: a literature review.","authors":"Emma Aspland, Daniel Gartner, Paul Harper","doi":"10.1080/20476965.2019.1652547","DOIUrl":"10.1080/20476965.2019.1652547","url":null,"abstract":"<p><p>Hospital information systems are increasingly used as part of decision support tools for planning at strategic, tactical and operational decision levels. Clinical pathways are an effective and efficient approach in standardising the progression of treatment, to support patient care and facilitate clinical decision making. This literature review proposes a taxonomy of problems related to clinical pathways and explores the intersection between Information Systems (IS), Operational Research (OR) and industrial engineering. A structured search identified 175 papers included in the taxonomy and analysed in this review. The findings suggest that future work should consider industrial engineering integrated with OR techniques, with an aim to improving the handling of multiple scopes within one model, while encouraging interaction between the disjoint care levels and with a more direct focus on patient outcomes. Achieving this would continue to bridge the gap between OR, IS and industrial engineering, for clinical pathways to aid decision support.</p>","PeriodicalId":44699,"journal":{"name":"Health Systems","volume":"10 1","pages":"1-23"},"PeriodicalIF":1.8,"publicationDate":"2019-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7946019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25510462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Health SystemsPub Date : 2019-09-01DOI: 10.1080/20476965.2019.1646105
James F Cox
{"title":"Using the theory of constraints' processes of ongoing improvement to address the provider appointment scheduling system execution problem.","authors":"James F Cox","doi":"10.1080/20476965.2019.1646105","DOIUrl":"https://doi.org/10.1080/20476965.2019.1646105","url":null,"abstract":"<p><p>Many primary care clinics suffer from chaos. In scheduling, providers are continually trying unsuccessfully to balance supply and demand, and in execution, to manage disruptions to provider focus and patient flow. In this research the theory of constraints' (TOC) three processes of ongoing improvement (POOGI) provide a direction for the solution to achieving more, cheaper, better, and faster healthcare. This research is the second of a two-part study examining the appointment scheduling literature, identifying the core problem (using a case study for validation) and providing a generic process for developing effective provider appointment scheduling systems (PASS). In the first part, PASS design was studied and in this second part PASS execution is studied. A strawman process is developed to apply across outpatient medical practices. With this generic process implemented across outpatient scheduling systems cost could be reduced significantly while the quality and timeliness could be increased significantly.</p>","PeriodicalId":44699,"journal":{"name":"Health Systems","volume":"10 1","pages":"41-72"},"PeriodicalIF":1.8,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20476965.2019.1646105","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25510463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Health SystemsPub Date : 2019-05-28eCollection Date: 2019-01-01DOI: 10.1080/20476965.2019.1620637
Danny T Y Wu, Smruti Deoghare, Zhe Shan, Karthikeyan Meganathan, Katherine Blondon
{"title":"The potential role of dashboard use and navigation in reducing medical errors of an electronic health record system: a mixed-method simulation handoff study.","authors":"Danny T Y Wu, Smruti Deoghare, Zhe Shan, Karthikeyan Meganathan, Katherine Blondon","doi":"10.1080/20476965.2019.1620637","DOIUrl":"https://doi.org/10.1080/20476965.2019.1620637","url":null,"abstract":"<p><p>The dashboards of electronic health record (EHR) systems could potentially support the chart biopsy that occurs before or after physician handoffs. In this study, we conducted a simulation handoff study and recorded the participants' navigation patterns in an EHR system mock-up. We analyzed the navigation patterns of dashboard use in terms of duration, frequency, and sequence, and we examined the relationship between dashboard use in chart biopsy and the errors identified after handoffs. The results show that the participants frequently used the dashboard as an information hub and as an information resource to help them navigate the EHR system and answer the questions in a nursing call. Moreover, using the dashboard as an information hub can help reduce imprecision and factual errors in handoffs. Our findings suggest the need for a \"context-aware\" dashboard to accommodate dynamic navigation patterns and to support clinical work as well as to reduce medical errors.</p>","PeriodicalId":44699,"journal":{"name":"Health Systems","volume":"8 3","pages":"203-214"},"PeriodicalIF":1.8,"publicationDate":"2019-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20476965.2019.1620637","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37459953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Health SystemsPub Date : 2019-05-28eCollection Date: 2019-01-01DOI: 10.1080/20476965.2019.1620638
Lauren Shivers, Sue S Feldman, Leslie W Hayes
{"title":"Development of a computerized paediatric intensive care unit septic shock pathway: improving user experience.","authors":"Lauren Shivers, Sue S Feldman, Leslie W Hayes","doi":"10.1080/20476965.2019.1620638","DOIUrl":"https://doi.org/10.1080/20476965.2019.1620638","url":null,"abstract":"<p><p>The purpose of this study was to understand the user experience with a computerized septic shock protocol relative to the workflow of Paediatric Intensive Care Unit clinicians. The need for data-driven, condition-specific, computerized protocols in the intensive care unit helps improve decision-making at the bedside. PICU clinicians were interviewed and given pre-and post-implementation surveys asking their opinions on the current PICU septic shock protocol, as well as the current electronic health record being used at [Paediatric Academic Medical Center]. User preferences guided adjustments toward improved usability of the septic shock protocol. Computerized Physician Order Entry, a critical component of the septic shock protocol, allows for more streamlined processes, more complete records, and more time to care for patients. This study revealed that although clinicians had an unfavorable view of the EHR in general, the computerized septic shock protocol was very well-received with an overall usability score of 82.</p>","PeriodicalId":44699,"journal":{"name":"Health Systems","volume":"8 3","pages":"155-161"},"PeriodicalIF":1.8,"publicationDate":"2019-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20476965.2019.1620638","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37460007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}