Ability Of Health Care Organizations Research Articles

Making the Business Case for Value-Based Dementia Care

Summary Alzheimer disease and related dementias (ADRDs) are growing exponentially, making it critical to expand dementia/memory assessment and care. Insufficient funding, poor access to care, and low ROIs are some of the barriers that limit the ability of health care organizations to build comprehensive dementia care programs. This article aims to make a business case for developing and maintaining programs for patients with dementia and their caregivers. Concrete guidance on tactics and steps that can help transform dementia care in a health care institution is provided. The authors argue that transitioning from a traditional fee-for-service payment model to a value-based care model is key to expanding and improving dementia care across the board. Dementia care models, financial metrics, and sources of financial value are discussed, and financial data from the Ochsner Center for Brain Health are presented.

An Overview of Patient Safety Culture with the AHRQ

Safety has become a global issue, especially for hospitals. Patient safety culture is a product of values, attitudes, competencies, and behavioral patterns of individuals and groups that determine the commitment, style, and ability of health care organizations to patient safety. The purpose of this study was to determine the description of patient safety culture with the AHRQ model. Quantitative research method with cross sectional. The population of all officers in the inpatient installation of RSUD Dr. R. M Djoelham 156 samples found 61 respondents with simple random sampling technique. The results of the study describe the expectations and actions of managers promoting patient safety by 77.04%, organizational learning by 91.8%, cooperation in units of 93.85% (good or strong culture), open communication by 71.04%, feedback on errors 77.05% (good or strong culture), non-punitive response dimension to errors is 61.20% staffing is 59.01% management support for patient safety efforts is 85.8% cooperation between units is 71.32%, Handsoff work and patient transitions are 59.02% (good enough or moderately cultured), the overall perception of hospital staff about patient safety is 68.86% (good enough or moderately cultured), reporting frequency is 73.22% (good enough or moderately cultured). moderate culture). With the results of this study, it is hoped that RSUD Dr. R.M. Djoelham Kota Binjai is expected to continue, maintain, and develop ongoing patient safety programs and maintain the existing patient safety culture.

Predictive Monitoring-Impact in Acute Care Cardiology Trial (PM-IMPACCT): Protocol for a Randomized Controlled Trial.

BackgroundPatients in acute care wards who deteriorate and are emergently transferred to intensive care units (ICUs) have poor outcomes. Early identification of patients who are decompensating might allow for earlier clinical intervention and reduced morbidity and mortality. Advances in bedside continuous predictive analytics monitoring (ie, artificial intelligence [AI]–based risk prediction) have made complex data easily available to health care providers and have provided early warning of potentially catastrophic clinical events. We present a dynamic, visual, predictive analytics monitoring tool that integrates real-time bedside telemetric physiologic data into robust clinical models to estimate and communicate risk of imminent events. This tool, Continuous Monitoring of Event Trajectories (CoMET), has been shown in retrospective observational studies to predict clinical decompensation on the acute care ward. There is a need to more definitively study this advanced predictive analytics or AI monitoring system in a prospective, randomized controlled, clinical trial.ObjectiveThe goal of this trial is to determine the impact of an AI-based visual risk analytic, CoMET, on improving patient outcomes related to clinical deterioration, response time to proactive clinical action, and costs to the health care system.MethodsWe propose a cluster randomized controlled trial to test the impact of using the CoMET display in an acute care cardiology and cardiothoracic surgery hospital floor. The number of admissions to a room undergoing cluster randomization was estimated to be 10,424 over the 20-month study period. Cluster randomization based on bed number will occur every 2 months. The intervention cluster will have the CoMET score displayed (along with standard of care), while the usual care group will receive standard of care only.ResultsThe primary outcome will be hours free from events of clinical deterioration. Hours of acute clinical events are defined as time when one or more of the following occur: emergent ICU transfer, emergent surgery prior to ICU transfer, cardiac arrest prior to ICU transfer, emergent intubation, or death. The clinical trial began randomization in January 2021.ConclusionsVery few AI-based health analytics have been translated from algorithm to real-world use. This study will use robust, prospective, randomized controlled, clinical trial methodology to assess the effectiveness of an advanced AI predictive analytics monitoring system in incorporating real-time telemetric data for identifying clinical deterioration on acute care wards. This analysis will strengthen the ability of health care organizations to evolve as learning health systems, in which bioinformatics data are applied to improve patient outcomes by incorporating AI into knowledge tools that are successfully integrated into clinical practice by health care providers.Trial RegistrationClinicalTrials.gov NCT04359641; https://clinicaltrials.gov/ct2/show/NCT04359641International Registered Report Identifier (IRRID)DERR1-10.2196/29631

Health Care Sustainability Metrics: Building A Safer, Low-Carbon Health System.

As understanding grows of the scale of health care's environmental impacts, so too does interest in measuring and reporting on sustainability as a facet of health care system performance. This article examines important lessons from health care's long experience with performance and quality measurement and reporting that can be applied to the creation of health care sustainability metrics. Although some large health systems such as Kaiser Permanente have invested heavily in environmental stewardship, in the US the focus of health care sustainability measurement and reporting has typically been on corporate social responsibility and climate risk disclosure. The ability of health care organizations to generate data on and control environmental impacts can be limited by legacy infrastructure and complex supply chains. However, just as in other domains of performance, health care sustainability measurement and reporting must proceed from a clear conceptual framework and statement of purpose. Measurement must reflect strategic goals, instead of letting goals become dictated by ease of measurement. Health system leaders now need to set clear and compelling sustainability goals, invest in internationally comparable metrics by which to measure their success, and embed them in their core business.

Remote monitoring of cardiac implantable devices during COVID-19 outbreak: “keep people safe” and “focus only on health care needs”

Background The COVID-19 pandemic has challenged the ability of health care organisations to provide adequate care. We report the experience of a national tertiary electrophysiology centre in the management of patients with cardiac implantable electronic devices (CIEDs) through the use of a fully remote follow-up model. Methods We daily and prospectively collected remote monitoring (RM) relevant findings and following clinical actions performed from March 10th to April 3rd 2020, a period of suspension of routine ambulatory activity due to the national lockdown. Results During the study period (25 days), we received 2,215 transmissions from 2,955 devices. Among them, 129 patients reported potential clinically actionable RM observations (event rate: 12.0/1000 patient-week). In 77 patients (60%), RM events triggered a clinical action, but only 5 patients needed an urgent in-hospital access (4 urgent procedures and 1 device reprogramming). Conclusions In the unprecedented COVID-19 pandemic, RM became an essential tool in healthcare delivery for CIED patients. We observed that RM was effective in “keep people safe” and “focus only on individuals with health care needs”.

Increasing affordance potency through process improvement: case study of a healthcare system

ABSTRACTWhile the adoption of electronic health records (EHR) has greatly increased in recent years, the ability of healthcare organizations to leverage their EHRs to improve clinical outcomes has not been clearly evidenced. One reason is that most healthcare organizations implement commercial information systems that are designed to support a pre-defined set of clinical work processes. These systems rarely support every clinical work process in the most effective way and must therefore be modified post-implementation to improve operational alignment in order to better meet the needs of the healthcare organization. This paper investigates that process in the context of a clinical process improvement project. We found that EHR adaptations are most effectively enabled when the goals of the organization and the affordances of system features are known to those using the system. This is because the actualization of the affordances, which result in process improvement, arises from the potency of affordances of the system’s features. In this paper we present the case of a healthcare organization that has successfully modified and leveraged its EHR to improve the clinical process that supports the entire spectrum of care for the identification and treatment of alcohol withdrawal patients. We use the post-implementation adaptation of EHRs to extend the theoretical concept of affordance potency for process improvement from a temporal perspective.

Framing the Shades of Sustainability in Health Care: Pitfalls and Perspectives from Western EU Countries

Sustainability is momentous for the appropriate functioning of health care systems. In fact, health and sustainability are two strictly related values, which could not be separately sought. While studies discussing the contextualization of this issue with respect to the distinguishing attributes of health care systems are rapidly blooming, there is still little agreement about what is ultimately meant by sustainability in the health care arena. On the one hand, attention is primarily focused on the proper use of available financial resources; on the other hand, people engagement and empowerment are gradually arising as a crucial step to enhance the viability of the health care system. This paper tries to identify, from a conceptual point of view inspired by the European integrative movement, the different shades of sustainability in health care and proposes a recipe to strengthen the long-term viability of health care organizations. The balanced mix of financial, economic, political, and social sustainability is compelling to increase the ability of health care organizations to create meaningful value for the population served. However, the focus on a single dimension of sustainability is thought to engender several side effects, which compromise the capability of health care organizations to guarantee health gains at the individual and collective levels. From this standpoint, further conceptual and practical developments are envisioned, paving the way for a full-fledged understanding of sustainability in the health care environment.

Who empowers whom? The role of organizational health literacy in empowering patients

Purpose of the paper: This paper aims to explore the organizational health literacy of pharmacies, which are believed to perform as critical patient navigators in the health care arena. Organizational health literacy is understood as the ability of health care organizations to establish clear and comfortable relationships with their patients, involving them in a co-creating partnership. Methodology: A comparative research design was arranged. Two convenience samples of pharmacies operating in two regional sub-systems of the Italian National Health Service (INHS) were built. Sixty units of analysis were included in the study; their organizational health literacy was examined in absolute and comparative terms. Results: The units of analysis were aware of their role in enabling patients, but they did not conceive organizational health literacy as being either a strategic or a managerial tool to enhance their ability to empower patients and engage them in value co-creation. Research limitations: Since the research concerned two convenience, non-representative samples, it is not possible to claim the findings’ generalizability. Practical implications: Organizational health literacy should be conceived as a core idea inspiring pharmacies’ activities. In particular, health literacy should be dealt with as a driver to raise the awareness of the pharmacy’s role in enhancing the effectiveness and the appropriateness of care. Originality of the paper: The scientific literature has focused most of its attention on the process of patient enablement; in contrast, the role of health care organizations in empowering patients has been overlooked. This is one of the first attempts to examine the organizational health literacy of pharmacies, investigating their ability to perform as patients’ navigators.

The new frontier of strategic alliances in health care: New partnerships under accountable care organizations

Accountable care organizations (ACOs) and similar reforms aim to improve coordination between health care providers; however, due to the fragmented nature of the US health care system, successful coordination will hinge in large part on the ability of health care organizations to successfully partner across organizational boundaries. Little is known about new partnerships formed under the ACO model. We use mixed methods data from the National Survey of ACOs, Medicare ACO performance data and interviews with executive leaders across 31 ACOs to examine the prevalence, characteristics, and capabilities of partnership ACOs and why and how ACO partnerships form. We find that a striking percentage of ACOs – 81% – involve new partnerships between independent health care organizations. These “partnership ACOs” generally report lower capabilities on care management, care coordination, and health information technology. Additionally, under Medicare ACO programs partnership ACO achieved somewhat lower quality performance. Qualitative interviews revealed that providers are motivated to partner for resource complementarity, risk reduction, and legislative requirements, and are using a variety of formal and informal accountability mechanisms. Most partnership ACOs were formed out of existing, positive relationships, but a minority of ACOs formed out of previously competitive or conflictual relationships. Our findings suggests that the success of the ACO model will hinge in large part upon the success of new partnerships, with important implications for understanding ACO readiness and capabilities, the relatively small savings achieved to date by ACO programs, and the path to providers bearing more risk for population health management. In addition, ACO partnerships may provide an important window to monitor a potential wave of health care consolidation or, in contrast, a new model of independent providers successfully coordinating patient care.

Empowering organizations to empower patients: An organizational health literacy approach

Background: Health literacy has been usually discussed as an individual trait, concerning the patient ability to navigate the health care service system. Alternatively, the organizational side of health literacy, or the ability of health care organizations to establish comfortable relationships with patients, has been widely overlooked. This manuscript is one of the first attempts to empirically examine organizational health literacy as a key attribute of health care organizations.Method: A convenience sample of municipal pharmacies operating within the Italian National Health Services was built. Their awareness of organizational health literacy issues and their ability to establish a co-creating relationship with their users were assessed through the Italian version of the Health Literacy Assessment Tool. Three domains were included in the assessment tool: (1) the accessibility of print informative materials used in the pharmacy; (2) the interpersonal communication between the pharmacy staff and the patients; and (3) the sensitivity of the pharmacy staff to health literacy issues.Results: The units of analysis were aware of the impacts of inadequate organizational health literacy on the ability of patients to understand and use health information; however, the organizational commitment to address the needs and the expectations of low health literate patients was limited among the units of analysis.Conclusions: Organizational health literacy is a crucial, but neglected issue among health care practitioners. There is a desperate need for an improvement of health care organizations’ friendliness, which is an essential ingredient in the recipe for patient empowerment.

Examining the Meaningfulness of Healthcare Organizations in the Light of Patient Empowerment

The role played by patient empowerment in health reform has been widely discussed by the scientific literature. In fact, patient empowerment has been variously presented as a new paradigm emerging in the healthcare service system, which involves a reconceptualization of the patient from a mere consumer of health services to a value co-creator. However, to the authors’ knowledge, until now most of the attention has been paid to the process of patient enablement, that is to say to the activation and the enhancement of the patients’ functional, interactive, and critical skills to navigate the healthcare service system. Alternatively, the meaningfulness of healthcare organizations, that is to say the ability of healthcare organizations to effectively communicate with patients and to establish with them a comfortable and co-creating relationship has been neglected. Drawing from the organizational health literacy construct, this paper is aimed at discussing the facilitators and the impediments to the meaningful...

014 Can health care networks develop autonomy over development and implementation of guidance within an environment shaped by accreditation standards?

BackgroundStandards for clinical practice enacted by external accreditation organisations can limit the ability of health care organisations to develop and implement evidence-based guidance to improve clinical practice and health system...

Practice-Based Knowledge Discovery for Comparative Effectiveness Research: An Organizing Framework.

Electronic health information systems can increase the ability of health-care organizations to investigate the effects of clinical interventions. The authors present an organizing framework that integrates outcomes and informatics research paradigms to guide knowledge discovery in electronic clinical databases. They illustrate its application using the example of hospital acquired pressure ulcers (HAPU). The Knowledge Discovery through Informatics for Comparative Effectiveness Research (KDI-CER) framework was conceived as a heuristic to conceptualize study designs and address potential methodological limitations imposed by using a single research perspective. Advances in informatics research can play a complementary role in advancing the field of outcomes research including CER. The KDI-CER framework can be used to facilitate knowledge discovery from routinely collected electronic clinical data.

Strengthening organizations to implement evidence-based clinical practices

Despite recognition that implementation of evidence-based clinical practices (EBPs) usually depends on the structure and processes of the larger health care organizational context, the dynamics of implementation are not well understood. This project's aim was to deepen that understanding by implementing and evaluating an organizational model hypothesized to strengthen the ability of health care organizations to facilitate EBPs. CONCEPTUAL MODEL: The model posits that implementation of EBPs will be enhanced through the presence of three interacting components: active leadership commitment to quality, robust clinical process redesign incorporating EBPs into routine operations, and use of management structures and processes to support and align redesign. In a mixed-methods longitudinal comparative case study design, seven medical centers in one network in the Department of Veterans Affairs participated in an intervention to implement the organizational model over 3 years. The network was selected randomly from three interested in using the model. The target EBP was hand-hygiene compliance. Measures included ratings of implementation fidelity, observed hand-hygiene compliance, and factors affecting model implementation drawn from interviews. Analyses support the hypothesis that greater fidelity to the organizational model was associated with higher compliance with hand-hygiene guidelines. High-fidelity sites showed larger effect sizes for improvement in hand-hygiene compliance than lower-fidelity sites. Adherence to the organizational model was in turn affected by factors in three categories: urgency to improve, organizational environment, and improvement climate. Implementation of EBPs, particularly those that cut across multiple processes of care, is a complex process with many possibilities for failure. The results provide the basis for a refined understanding of relationships among components of the organizational model and factors in the organizational context affecting them. This understanding suggests practical lessons for future implementation efforts and contributes to theoretical understanding of the dynamics of the implementation of EBPs.

Improving the effectiveness of health care and public health: a multiscale complex systems analysis.

The US health care system is struggling with a mismatch between the large, simple (low-information) financial flow and the complex (high-information) treatment of individual patients. Efforts to implement cost controls and industrial efficiency that are appropriate for repetitive tasks but not high-complexity tasks lead to poor quality of care. Multiscale complex systems analysis suggests that an important step toward relieving this structural problem is a separation of responsibility for 2 distinct types of tasks: medical care of individual patients and prevention/population health. These distinct tasks require qualitatively different organizational structures. The current use of care providers and organizations for both purposes leads to compromises in organizational process that adversely affect the ability of health care organizations to provide either individual or prevention/population services. Thus, the overall system can be dramatically improved by establishing 2 separate but linked systems with distinct organizational forms: (a) a high-efficiency system performing large-scale repetitive tasks such as screening tests, inoculations, and generic health care, and (b) a high-complexity system treating complex medical problems of individual patients.

The CLAS Challenge: Promoting Culturally and Linguistically Appropriate Services in Health Care

Vista Community Clinic's Cultural Awareness Program (CAP), funded by the US Office of Minority Health, aims to institutionalize culturally and linguistically appropriate services as outlined in the federal Culturally and Linguistically Appropriate Services (CLAS) Standards for the diverse San Diego County population through the promotion of organizational change at all levels of health care. The CAP program hopes to contribute to this end through offering educational sessions, aiding health care organizations in making changes to their structure in the areas of culture and language, as well as through the development of a website and a resource manual. Facilitating systems change in culturally and linguistically appropriate service delivery has proven to be the most challenging component of the CAP program. Based on seven years of experience in this area, CAP program staff proposes that the success of culturally and linguistically appropriate services depends on the degree to which organizational “buy-in” is achieved, the enforcement of the standards and the ability of health care organizations to work in collaboration with the community in which they serve.