International Journal of Health Planning and Management最新文献

In the quest for healthcare systems enhancement, the improvement of patient experience plays a central role. The challenge lies in converting patient-reported experience data into actionable knowledge for quality improvement. This study aims to investigate the use of patient-reported data as knowledge base for actions and to identify and map actions derived from the use of patient-experience data within two Italian regional healthcare systems. Patient Experience Data are systematically collected in both systems, providing real-time updates accessible by professionals and managers through web-based reporting systems and including a collaborative network among practitioners. A sequential exploratory mixed-method study was carried out in several qualitative and quantitative phases. In the first phase, a qualitative method was conducted to discuss the actionability of patient-reported data and to design a tool for collecting the improvement actions based on these data. In the second phase, a quali-quantitative survey was performed to explore the professionals' use of patient-reported information and the types of actions implemented. Finally, a workshop was held to discuss, interpret and validate the results. The initial workshop identified key dimensions for improvement initiatives. After design and distribution of survey, a total of 189 responses was collected, respectively 96 from Region A and 93 from Region B. Both regions ensured widespread use of patient-reported data (89%). The establishment of a collaborative network seemed to reduce the learning curve in using patient-reported data and fostered a culture of using patient feedback effectively. The results reveal a difference between the two regions, with a more extensive patient-reported data use in Region A, attributed to its systematic joining the PREMs Observatory, prior experiences with patient-feedback collection and use, and patient-experience indicators integrated into the performance evaluation system. Regarding practices of data use, four themes emerged, namely, internal actions addressed to hospital staff (35.9%), external actions addressed to users (18.6%), comfort and hospitality aspects (34.7%) and review of processes and procedures (10.8%). The study highlights the importance of effectively using patient-reported data to achieve organisational goals, by combining different managerial strategies. It demonstrates how professionals use such data for improvement actions and underscores the significance of various forms of knowledge dissemination and sharing. It advocates for fostering a culture of continuous learning and improvement within and across healthcare organisations.

Background: Formal networks are increasingly being used as a strategy to address complex health system issues. This study aimed to understand the organisational performance of a novel network, the Rural Surgical and Obstetrical Networks (RSON) in the Canadian province of British Columbia, as it developed and grew over four years.

Methods: Between 2019 and 2022, we administrated an annual 37-item survey on network organisational aspects with RSON leaders. We calculated the percentage of favourable ratings (four or five rating out of five) for each survey item and used a two-tailed Wilcoxon Mann-Whitney rank sum test to compare ratings over time. Key themes in respondent comments were described narratively.

Results: Over four years, we distributed 114 survey invitations to RSON leaders and received 77 responses. From 2019 to 2022, 24 out of 37 survey items (65%) had a statistically significant increase in ratings. Ratings and comments indicated that RSON could have improved its function by (a) including more peripheral network members in decision-making and (b) formalising structures and processes for some network areas. Findings also indicate the presence of three network tensions within RSON: inclusiveness versus efficiency, stability versus flexibility, and network operations versus health system operations.

Conclusion: Study findings validate and build on existing network theories and provide practical learnings for other jurisdictions interested in implementing a network like RSON. Among the tensions identified within RSON, the network operations versus health system operations tension, specific to a healthcare delivery setting, has not been well described previously.

To improve healthcare quality there has been a growing interest in collecting and analysing patient feedback. Patient Reported Experience Measures (PREMs) are instruments through which the feedback can be collected and used for improvement purposes. However, the collection process is often associated with an administrative burden for healthcare professionals who collect and register surveys manually. Additionally, the manual procedure limits the data collection efforts to fewer patients, thus resulting in a less representative sample. A digital and automated procedure for collecting and visualising patient experience data can relieve healthcare staff and allow more patients to share their experiences. At Karolinska University Hospital, a multi-disciplinary project to develop the automated PREM process-from data collection to visualisation-has been undertaken. As a result, there are about 25,000 digital questionnaires distributed per month with the response rate of approximately 35%-40%. This is an equivalent of about 9000 completed questionnaires per month to be compared to less than 1000 responses per month received during the manual process used before 2021. The large amount of patient experience data is analysed and made accessible to the hospital management and staff. To increase the transparency, part of the collected data is visualised at Karolinska's external website. Furthermore, hospital staff is relieved from all survey administration. Remaining challenges concern survey language and the analysis of textual responses that are not yet done at hospital level. Overall, this initiative has led to several quality improvement activities and contributed to strengthening Karolinska's internal learning health system.

This paper addresses regional disparities in the allocation of medical professionals within the Portuguese National Health Service (NHS) and its policy implications, drawing recommendations to address these inequalities. In a country with a universal and comprehensive healthcare system, ensuring equitable geographical distribution of healthcare professionals is crucial for the effectiveness and equity of the health system. The analysis uses data from the NHS payroll system (RHV), covering the period from 2017 to 2023, and focuses on active medical workers, including those on duty and retired but still in service, distributed among the five Regional Health Administrations that then existed. The analysis is based on Full-Time Equivalents to provide a more realistic picture of the healthcare workforce. Population data comes from the official source. The Dissimilarity Index is used to measure regional disparities, focusing on the medical workforce (specialist doctors). The study aims to identify disparities in the distribution of these healthcare professionals throughout the five regions within the NHS and inform evidence-based policies to address such inequalities in resource allocation of the healthcare workforce. The findings reveal that while the overall density of NHS healthcare workers per 1000 inhabitants grew, and global disparities in the allocation of NHS workers slightly diminished, some regional disparities have worsened, as it was the case of the distribution of specialist doctors among the territory. The Dissimilarity Index indicates increasing inequality among the allocation of the medical workforce in the national territory, with statistically significant growth in disparity over time. The study underscores the urgent need for targeted policies to address these growing inequalities in allocating specialist doctors within the NHS.

Introduction: Prevention of suicidal behaviour is complex, and a host of effective interventions have now been recognised in addressing this concern. However, adoption, delivery, and sustainment of these interventions within real-life settings is challenging; and the translation process, often overlooked. Examining the impact of context is necessary to explain how implementation outcomes are achieved and aid generalisability of findings. This study aims to explore factors influencing implementation outcomes (contextual determinants) across the implementation lifecycle of complex suicide prevention interventions.

Methods: A qualitative design was adopted. Semi structured interviews were conducted with 16 stakeholders (leaders, project managers/implementors, lived experience advocates) involved in implementation of complex suicide prevention interventions across the world. A purposive and snowball sampling approach was used to identify participants with requisite experiences. An understanding of determinants was deduced from participant narratives. These were mapped using the Exploration, Preparation, Implementation and Sustainment (EPIS) framework.

Results: Across different phases of implementation, outer context barriers were predominantly reported and pertained to service environmental factors, pre-existing dynamics, and engaging leadership. Several inner context barriers including individual characteristics, staffing and resources, and challenges in maintaining fidelity were reported during the implementation phase. Bridging factors (such as interrelationships and partnerships) were identified as important facilitators throughout different phases of implementation and levels of context. Implementation strategies related to stakeholder relationship building were prioritised across different phases of implementation.

Conclusion: This study helps expand the notion of an evidence-base for complex suicide prevention interventions. Determinants salient across different levels of the social-ecology and phases of implementation address questions related to what works and under what circumstances.

This study examined the relationship of social support, happiness, state anxiety, and passion at work (PAW) among medical staff members during armed conflict in Israel. Using snowball sampling, this research investigated how these factors interact in healthcare settings during crisis periods. Findings revealed a significant positive correlation between happiness and harmonious PAW, whereas no relationship was found with obsessive PAW. State anxiety showed a negative correlation with harmonious passion. Social support patterns indicate that healthcare workers relied primarily on immediate supervisors and colleagues rather than formal organizational services, with high support levels reported from significant others and family compared to moderate organizational support. These findings extend previous research by outlining how psychological factors influence different forms of PAW during specific crisis events. The current research has important implications for healthcare organisations in developing effective support mechanisms and crisis management strategies.

This integrative review aimed to explore the impact of the spread of coronavirus disease 2019 (COVID-19) on fertility to establish foundational knowledge and guide future epidemiological studies. The PubMed and Central Journal of Medicine databases were searched, yielding 80 relevant articles published between 2019 and 2021. Of these, 14 were published in Japanese and 66 in English. None of the Japanese studies met the inclusion criteria. Fourteen English-language studies, all of which were retrieved from PubMed, were included in the final analysis. No relevant literature was found in the Central Journal of Medicine. The keywords used were COVID-19, fertility, and demographics. COVID-19 led to an increase in unplanned pregnancies and abortions in developing countries. Fever associated with the infection was suggested to have reduced sperm concentration and motility, and the spread of the infection caused young couples to delay childbearing, potentially decreasing fertility. Conversely, relatively older couples showed fewer changes in their childbearing plans, indicating that COVID-19 had both positive and negative effects on fertility. Physical, psychological, and economic factors as well as sex, age, and cultural background exerted complex effects on fertility. Herein, the impact of social crises on fertility rates has been discussed in the context of the recent COVID-19 pandemic. Analysing the effects of this pandemic on fertility rates is crucial for understanding future demographic trends and national strengths. This study provides valuable data for future research in this field.

Objective: Long-term care insurance (LTCI) is a widely adopted approach to address the growing long-term care (LTC) needs associated with ageing. Little is known about its effect on unmet LTC needs among different LTC populations in China. This study explored the effect of LTCI pilot programs on unmet LTC needs and their pathways among different LTC need populations in China.

Methods: Data were derived from the China Health and Retirement Longitudinal Study 2013, 2015, and 2018. Difference-in-Difference methods were used to estimate the impact of LTCI on unmet LTC needs and informal LTC services. According to the degree of ADL or IADL needs, participants were categorised into broad, intermediate, and narrow LTC need populations.

Results: The unmet LTC needs increased in both broad, intermediate, and narrow LTC need populations, while informal LTC hours received decreased for the intermediate and narrow LTC need populations. Informal LTC was identified as a mediator, contributing to increased unmet LTC needs. With LTCI coverage, heterogeneity analysis showed a direct effect, resulting in a 72.1% reduction in informal LTC hours without an increase in unmet LTC needs. Additionally, a spillover effect led to a 35.7% reduction in informal LTC hours and an average increase of 0.133 unmet needs.

Conclusions: With the inadequate formal LTC services, the LTCI implementation decreased the informal LTC provision and further increased the unmet LTC needs in almost all LTC need populations. Only for individuals with severe disabilities LTCI effectively substituted the informal LTC provided by families. The government needs to improve the quality of formal LTC services to avoid increasing unmet LTC needs.