Challenges In Health Care Delivery Research Articles

Lessons from psychiatry and psychiatric education for medical learners and teachers

Medical learners, teachers, and institutions face significant challenges in health care delivery and in training the next generation of clinicians. We propose that psychiatry offers lessons which may help improve how we take care of patients and how we teach others to care for patients. Our objective is to discuss what learners and teachers can learn from psychiatry, organized around (1) how we make decisions, (2) how we learn, and (3) how we reflect on our practice. Information from clinical care, education, neuroscience and other aspects of life (e.g. business, creativity, and research) help us on these processes. We make ‘good’ decisions in concert with patients and learners, by listening to their experiences, asking questions and exploring subjective and objective information. Our learning has a neurobiological basis, and is effectively furthered by personalization, reinforcement, acquisition of critical thinking skills, and assessment of our limitations and errors. Our ability to reflect is determined by attitude, skill, tolerating ambiguity or dissonance, and planning for the unexpected. These processes – in addition to knowledge and other skills – will help physicians be successful in practice, learning and teaching, research and leadership.

Human resource challenges in healthcare delivery in African communities

This edition showcases work from South Africa, but having relevance to the African continent as a whole. The papers concerned serendipitously all have the same theme - that of addressing the human resource challenges in healthcare delivery in African communities

Enhancing Learning Through an Interprofessional Project Competition

This article describes the process of using an interprofessional team project to address one of the most commonly occurring challenges in health care delivery--medication reconciliation. We describe the planning and execution of the process and the lessons learned from the experience. The intent of this article is to document the significance of each process and the importance of each member involved in the process, and to act as a guideline for institutions planning similar interprofessional team project experiences for students.

Evaluation of HIV Postexposure Prophylaxis for Occupational and Nonoccupational Exposures at a Deployed U.S. Military Trauma Hospital

Postexposure prophylaxis (PEP) is an important strategy to prevent human immunodeficiency virus acquisition after occupational and nonoccupational exposures. Since exposures to blood and other body fluids commonly occur in a combat setting, it is important to evaluate PEP utilization in the deployed environment. This is a retrospective review of Public Health, pharmacy, and medical records for PEP cases at a U.S. military trauma hospital in Afghanistan from February 1, 2007 through June 30, 2012. The decision to initiate PEP and the antiretroviral regimens selected were also evaluated for concordance with published Centers for Disease Control (CDC) guidelines. At total of 31 cases were prescribed PEP over the 65-month study period, including 27 occupational and 4 nonoccupational exposures. Of the 23 cases with sufficient data for evaluation, 18 (78.2%) initiated PEP in concordance with CDC guidelines and the discordant cases were prescribed PEP secondary to patient request. Antiretroviral regimens were in concordance with CDC guidelines in 27 of 31 (87.1%) cases, with most discordant cases prescribed differing durations of PEP. Despite the challenges of health care delivery in a deployed environment, the decisions to initiate human immunodeficiency virus PEP and the selection of antiretroviral regimens were typically concordant with CDC guidelines.

MobiSys 2012 Keynote: Paul Jones on Mobile Health Challenges

Paul Jones, Chief Technology Officer of the UK's National Health Service (NHS), gave the keynote address at this year's 10th International Conference on Mobile Systems, Applications and Services. In a wide-ranging, unscripted talk, Jones covered healthcare systems and the NHS, IT as part of the answer to the problems of healthcare, and the challenges of healthcare delivery.

Shaping End-of-Life Care: Behavioral Economics and Advance Directives

A central but unmet challenge in health care delivery is to increase the probability that the care patients receive near the end of their life is consistent with their goals, values, and preferences. Providing patient-centered care at the end of life is challenging. In their final days, nearly a third of older Americans need critical decisions made regarding the use or nonuse of life-sustaining interventions, but the patients themselves cannot participate in those decisions. Although this observation highlights the promise of advance directives (ADs), to date ADs have not delivered on this promise. This article provides a new framework, based in behavioral economic theory, that may explain the current failures of ADs and point to potential solutions. Specifically, it discusses how five well-described cognitive biases that pervade human decision making (affective forecasting errors, optimism bias, present-biased preferences, focusing effects, and default options) may account for deficiencies in the uptake, efficacy, and patient-centeredness of ADs. The text suggests potential solutions in need of evaluation, discusses metrics for assessing these interventions' benefits, and considers alternatives to the approaches advocated.

Nonverbal Communication Behaviors of Internationally Educated Nurses and Patient Care

Because of language barriers and cultural differences, internationally educated nurses (IENs) face documented communication challenges in health care delivery. Yet, it is unknown how and to what extent nonverbal behaviors affect patient care because of research gap in the existing nursing literature. This is an exploratory study evaluating nonverbal communication behaviors of IENs interacting with standardized patients (SPs) in a controlled clinical setting through videotape analysis. Participants included 52 IENs from two community hospitals in the same hospital system in a southwestern metropolitan area in the United States. Twelve nonverbal behaviors were rated using a 4-point Likert scale with 4 indicating the best performance by the research team after watching videos of SP-IEN interactions. The global communication performance was also ranked in four areas: genuineness, spontaneity, appropriateness, and effectiveness. The relationships between these four areas and the nonverbal behaviors were explored. Finally, a qualitative analysis of two extreme cases was conducted and supplemented the quantitative findings. The IENs received average scores under 2 in 5 out of the 12 nonverbal behaviors. They were "hugging" (1.06), "lowering body position to patient's level" (1.07), "leaning forward" (1.26), "shaking hands" (1.64), and "therapeutic touch" (1.66). The top three scores were for "no distractive movement," "eye contact," and "smile" (3.80, 3.73, and 3.57, respectively). The average overall global impression score was 2.98. The average score for spontaneity was 2.80, which was significantly lower than the scores for genuineness (3.15), appropriateness (3.11), but comparable to the average score for effectiveness (2.85). Finally, therapeutic touch, interpersonal space, eye contact, smiling, and hugging were all significantly correlated with one or more of the global impression scores, with therapeutic touch showing moderate correlations with all of the scores as well as the overall global impression score. The IENs' nonverbal behaviors in areas such as hugging, lowering body position to patient's level, leaning forward, shaking hands, and therapeutic touch have room for improvement. Targeted interventions focusing on norms and expectations of nonverbal behaviors in the U.S. health care setting are called for to improve quality of care.

After the Treatment Phase of Colorectal Cancer Care: Survivorship and Follow-Up

The number of long-term colorectal cancer (CRC) survivors has increased substantially over the past three decades due to both ongoing advances in early detection and improvements in cancer therapies. Adult survivors of CRC experience chronic health conditions due to normal issues associated with aging, which is further compounded by the long-term adverse effects of having had cancer and anti-cancer therapies. In addition, they are at a higher risk for CRC recurrences, new primary cancers, and other co-morbidities. This article will provide an overview of the clinical care of adult survivors of CRC. Epidemiologic data will be presented followed by a discussion of the approach to the care of long-term adult survivors of CRC, including surveillance of recurrences and new primary cancers, interventions to manage both physical and psychological consequences of cancer and its treatments, and strategies to address concerns related to unemployment and disability. Finally, we will explore the challenges of healthcare delivery, especially with respect to the coordination of follow-up between cancer specialists and primary care physicians, so as to ensure that all of the survivor’s health needs are met promptly and appropriately.

Transitioning Hospital-Based Nurse Leaders to Professional Doctorates

The collaboration for the project Transitioning Hospital-Based Nurse Leaders to the Practice Doctorate (Doctor of Nursing Practice [DNP] degree program) was initiated by Case Western Reserve University. Participating hospitals included Greenwich (CT) Hospital, Mt. Sinai Hospital (NYC), Carilion Health Care System (Roanoke, VA), Exeter Hospital (Exeter, NH), Shore Memorial Hospital (Atlantic City, NJ), and the North Shore Long Island Jewish Health System (Long Island, NY). The partnership is focused on collaboration that enhances both nursing education and practice. This DNP program for hospital-based nurse administrators and advanced practice nurses (APNs) has been offered onsite in these hospitals to strengthen evidence-based practice, thus improving the quality of healthcare delivered in the partner hospitals. The benefit to the educational institution is the enrichment of the teaching learning experience through inclusion and integration into the curriculum of content regarding current issues and challenges in healthcare delivery. The collaboration for the project Transitioning Hospital-Based Nurse Leaders to the Practice Doctorate (Doctor of Nursing Practice [DNP] degree program) was initiated by Case Western Reserve University. Participating hospitals included Greenwich (CT) Hospital, Mt. Sinai Hospital (NYC), Carilion Health Care System (Roanoke, VA), Exeter Hospital (Exeter, NH), Shore Memorial Hospital (Atlantic City, NJ), and the North Shore Long Island Jewish Health System (Long Island, NY). The partnership is focused on collaboration that enhances both nursing education and practice. This DNP program for hospital-based nurse administrators and advanced practice nurses (APNs) has been offered onsite in these hospitals to strengthen evidence-based practice, thus improving the quality of healthcare delivered in the partner hospitals. The benefit to the educational institution is the enrichment of the teaching learning experience through inclusion and integration into the curriculum of content regarding current issues and challenges in healthcare delivery.

Health care delivery in Malaysia: changes, challenges and champions.

Since 1957, there has been major reorganization of health care services in Malaysia. This article assesses the changes and challenges in health care delivery in Malaysia and how the management in health care processes has evolved over the years including equitable health care and health care financing. The health care service in Malaysia is changing towards wellness service as opposed to illness service. The Malaysian Ministry of Health (MOH), being the main provider of health services, may need to manage and mobilize better health care services by providing better health care financing mechanisms. It is recommended that partnership between public and private sectors with the extension of traditional medicine complementing western medicine in medical therapy continues in the delivery of health care.

Virtual Valley Forge: A Revolutionary Hospital Concept

Health care delivery in the military, as in the civilian sector, is on the verge of a necessary revolution. The current system was designed for a level of technology long surpassed—an era of rudimentary communication capabilities when concentrating on very expensive equipment in a few select hospitals was necessary; health care was centered around hardware, not people. Centralized care has meant duplication of expensive resources, bottlenecks in care delivery, and a monolithic incapacity to adapt to rapidly changing demands on the system. A shift from centralized care to distributed, networked care is essential to establish a system that is timely, effi cient, responsive, and economically sustainable. Nowhere is that need more critical than in the care of combat wounded. Military medicine needs realignment not a radical departure from current practice. It will continue to operate some of the best medical centers in the western world, provide the best combat casualty care on the planet, provide support for the toughest humanitarian missions, and excel at surgical innovation and the prevention of infectious diseases. It must, however, consider 2 major issues that are shifting the “center of gravity” in military health care: an all-volunteer military whose members expect choices and information technology, which holds the key to meet the challenges in health care delivery. Components of this new military health care system must include the following: 1. Recognition that a fully volunteer military force demands choices.

Application Virtualization for Teaching Hospitals in Nigeria

Information technology has improved operations management globally. The health sector has benefited from this revolution through the introduction of eHealth solutions. The cost-effective utilization of Information Technology and flexibility in adapting and adopting organizational changes has posed some challenges to health institutions in developing countries. In the case of Nigeria, the implementation of the National Health Policy entails the delivery of a full-packaged health care system; this package includes health education, maternal, newborn and child healthcare, nutrition and immunization. All these, require record keeping and data storage. The management of massive data storage and its availability on-demand has been sources of concern to health institutions in the country. This has brought about a slow rate in hospital-tohospital collaboration, insecure information exchange between and across institutions and lack of proper accountability in the health sector amongst other challenges. In this paper we propose a Cloud computing infrastructure which will adopt application virtualization to address the challenges in health care delivery in the country. This is an emerging technology that will provide eHealth solutions as services to tenants; a process known as Software-as-a- Service (SaaS). The infrastructure should deliver a single application through the browser to thousands of clients or stakeholders using scalable multitenant architecture. This will help to minimize cost, manage healthcare resources effectively, and help with the realization of the Millennium Development Goals (MDGs) on healthcare.

Medical and health care professional education in the 21st century: institutional, national and global perspectives

Medical and health care professional education in the 21st century: institutional, national and global perspectives

The Care Coordination Home Telehealth (CCHT) rural demonstration project: a symptom-based approach for serving older veterans in remote geographical settings

Innovative healthcare delivery strategies are needed to address the healthcare needs of the 3.5 million older veterans living in US rural areas who face unique healthcare delivery challenges, including transportation barriers, poverty, and limited access to health professions and community-based programs. The care coordination home telehealth (CCHT) rural demonstration project was developed to address the mismatch between the timely identification of patient needs and the care delivered by the traditional disease-oriented institutionally-based healthcare delivery system for older rural veterans. The specific objectives were to: (1) serve as a facilitator of primary care; and (2) provide a portfolio of geriatric care management options to increase early detection of symptoms and to encourage adherence to care plans. Participants were recruited based on patterns of high outpatient, inpatient, and emergency care visits; 132 rural older veterans were enrolled. The CCHT applied care management principles to the delivery of healthcare services and used health informatics to facilitate access to evidence-based care. The CCHT's essential components, which were tailored to optimize remote access, included a face-to-face orientation, telephone contact with a designated care coordinator, and daily monitoring sessions using an in-home telehealth device to assess participants' medication usage, compliance, and symptoms, and to provide patient education. One hundred eleven participants successfully installed and connected the telehealth monitoring device in their homes without hands-on assistance, monitored complex medical and psychiatric symptoms, and reported medication compliance remotely. Of the 93 participants who used the device for more than 10 sessions, 88 reported they did not have any difficulty using the device, 86 reported they were satisfied or very satisfied with the device, 73 reported they were likely to continue using the device, and 46 reported improved communication between themselves and their primary healthcare provider. Initial utilization and satisfaction evaluation data from this project supports the feasibility of employing a CCHT approach to serve medically-complicated older veterans in rural settings. This approach could also serve as a template for addressing a greater range of healthcare needs among other populations in hard-to-reach settings.

Challenges in healthcare delivery in an economic downturn, in the Republic of Ireland

The purpose of the present study was to discuss some of effects of the downturn in the Irish economy and to demonstrate that in the face of economic difficulties innovation in health care is still occurring. Staff that are managing and delivering healthcare need to know the challenges facing them and have an awareness of the importance of maintaining interest in innovative practice in turbulent times. Information obtained from several sources including government papers, the nursing regulatory board and quality authority documents and current best practice articles. Information was evaluated based on the study's aim. Issues emerging were that current challenges facing Irish health care delivery relate mainly to economic, clinical management, education and information technology factors and further reductions in the cost base of health care delivery remains focused on value for money. In the face of the economic downturn Ireland is achieving health targets and is now sitting in 13th place on the European health index, down from number 28 in 2008. This improvement in position has resulted from several new innovative work practices. As a result of cost reduction measures in place nurse managers will face greater challenges than ever before in meeting the objectives of the healthcare transformation programme.

Health system reform

PurposeThe purpose of this paper is to describe Health Reform proposals in Australia.Design/methodology/approachThe approach to this subect is observational.FindingsA total of 123 recommendations amounting to significant reform are proposed. It remains to be seen how many of these recommendations survive an extensive consultation process.Originality/valueThe paper describes one nation's attempt to address universal challenges in healthcare delivery and gives an update of health reform proposals.

Operational research applied to health services 2007 special issue

The EURO Working Group on Operational Research Applied to Health Services was formed in 1975 as part of a programme for developing special interest groups within the European branch, EURO of the International Federation of Operational research Societies, IFORS. The group meets every year, each summer, for one week in a different host country, usually in Europe. Meetings are open to anyone with a quantitative background and an interest in the subject area. The objectives of the group are communication of ideas, knowledge and experience concerning the application of Operational Research (OR) approaches and methods to problems in the area of health services, mutual assistance among members, co-operation on joint projects as well as inspiration with regard to approaches and attitudes in this field. ORAHS came back to France 27 years after ORAHS’80 in Paris. Since then, French health systems have changed drastically and health care delivery engineering has attracted the interests of many academics. Many French hospitals have engaged in major re-engineering projects. The French speaking working group GISEH (Gestion et Ingenierie des SystEmes Hospitaliers) attracts over 192 members in management and engineering of healthcare systems. Since 2000, the region of Rhone-Alps has funded several major research programmes on health services engineering (HRP (2000–2003), HRP2 (2004–2006), HRP3 (2006–2009)). In Saint Etienne, the Ecole des Mines de Saint Etienne (ENSM.SE, one of the top engineering schools in France), the University of Jean Monnet (UJM) and the university hospital complex CHU-SE have created a joint research institute in health and health care. ORAHS’2007 was sponsored by EURO, ROADEF, GDR-RO, and GDR-MACS. ORAHS’2007 was supported by the following French organisations, institutions and companies: ILOG, Cluster GOSPI, Region Rhone-Aples, Conseil General de la Loire, Saint Etienne Metropole, Ville de Saint Etienne, Ministere de la recherche. ORAHS’2007 offered a scientific program including six tutorial lectures, 8 invited plenary talks, and 102 technical presentations covering various aspects of health care delivery engineering. ORAHS’2007 introduced some innovations that, we hope, contribute to make ORAHS an international conference in a domain of increasing demands. Feature sessions were organized by several national/regional working groups on management and engineering of health care systems. A “Project Ideas” section included 10 min presentations highlighting challenges of health care delivery that would benefit from joint European and international research efforts. Tutorial talks of 2 h each by six experts were organized to give young researchers and health professionals a comprehensive view of healthcare delivery engineering. This special issue contains eight papers selected from 20 submissions. The review process was handled by the three Health Care Manag Sci (2009) 12:117–118 DOI 10.1007/s10729-009-9102-2

Screening and Treatment for Women With Mood Disorders Associated With Reproductive Events

Article AbstractBecause this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text.Federal legislation is currently under consideration in the United States to make screening for postpartum mood disorders mandatory and increase funding for research and treatment of postpartum women with mental illness. The passage of this legislation would represent an excellent investment in the health of women and families. Its implementation would also introduce important health care delivery challenges, such as the development of large screening programs and allocation of resources.†‹

Special Issue: CSCW and Dependable Healthcare Systems

The starting point for this special issue on CSCW and Dependable Healthcare systems is the recognition of ‘dependability as an essential and under-researched, CSCW problem. Self-evidently, societys dependence on computer-based systems continues to increase, while the systems themselves – embracing humans, computers and engineered systems – become ever more complex. These trends coincide with pressure for systems to be brought to market faster and at lower (and more predictable) cost. Achieving sufficient dependability in these systems, and demonstrating this achievement in a rigorous and convincing manner, is of crucial importance to the fabric of the modern Information Society. Much progress has been made in achieving high dependability in computer hardware and software but wider systems involving computers, people and organisations are often disastrously unsuccessful and the cause of huge financial losses or worse. It is evident that satisfactory resolution of this dangerous situation demands major breakthroughs in understanding the fundamental problems that arise in attempts to build systems involving complex interactions amongst numbers of computers and human beings. Our interest in this special issue is in the issues of developing improved means of specifying, designing, assessing, deploying and maintaining complex computer-based systems in those contexts where high dependability is crucial – in this case health care systems. The enormous growth in the use of communications and information technology in all aspects of healthcare provision including electronic patient records, data warehouses, integrated clinical, biomedical and administrative computer systems, telemedicine applications, computerized workflow and order entry, presents healthcare professionals with a wide range of opportunities and challenges in healthcare delivery.

Telemedicine Complements Effective Health-Care Delivery but Is Not a Panacea

Like most health researchers in India, I share Sanjit Bagchi's enthusiasm and optimism about the potential of telemedicine in improving health-care delivery in our diverse country [1]. However, it is important to maintain a balanced perspective and debunk overstatements such as those used by Bagchi in his conclusion “This potential was well summed up by Dr. Devi Shetty: ‘In terms of disease management, there is [a] 99% possibility that the person who is unwell does not require [an] operation. If you don't operate you don't need to touch the patient. And if you don't need to touch the patient, you don't need to be there. You can be anywhere, since the decision on healthcare management is based on history and interpretation of images and chemistry … so technically speaking, 99% of health-care problems can be managed by the doctors staying at a remote place—linked by telemedicine.’” Maybe Devi Shetty, well known in telemedicine circles, has been quoted out of context, but it is not evident as such. In the wider context of the story, such conclusions as “If you don't operate you don't need to touch the patient”; “And if you don't need to touch the patient, you don't need to be there”; and “so technically speaking, 99% of health-care problems can be managed by the doctors staying at a remote place” are misleading. In the near future, online physicians or health professionals cannot replace the onsite ones for even 30% of all health problems, let alone 99% as pointed out by Shetty. Even for providing essential and readily accessible health services, we need to augment the number of onsite physicians and other health professionals with improved skill-mix, more pragmatic public health policies, and enabling of telemedicine. Though India has been a pioneer in evaluating telemedicine for improving health-care delivery [2,3], its rightful place can be established only through major coordinated research efforts [4]. Free-access medical journals are a forum for debate on emerging health issues and have the responsibility to implement rigorous peer review and editorial control to prevent wide dissemination of any misleading statements or misquotes, as the case may be. Sweeping concluding statements from opinion leaders appearing in respectable journals may unduly influence those lacking insight in the challenges of health-care delivery in underserved regions and allow further propagation by medical journalists living in virtual reality. To realize its full potential, we need to identify more innovative applications of telemedicine and generate robust data on its cost-effectiveness in different health-care settings [4]. But first we need changes in skill-mix [5], which includes enhancement of skills among various staff groups, role substitution between different groups, delegation up and down a uni-disciplinary ladder, and innovation in roles. Until we have telemedicine models that are universally implementable, with proven cost-effectiveness and user satisfaction [6], we need a stance of cautious optimism.