Evolving Health Care Delivery Research Articles

A review of consent policies in Dermatological Surgery in the United Kingdom and the impact of leaner pathways and teledermatology on consent.

Obtaining valid consent is an ethical and legal requirement in clinical practice, ensuring patients are adequately informed about their treatments. Recent updates in consent policies, including GMC guidance, the Patterson inquiry report, and key legal rulings like Montgomery, emphasise a shift towards patient-centred care and the importance of a comprehensive patient-clinician dialogue. Budget constraints and increasing NHS demand have led to the adoption of digital solutions and streamlined pathways, such as teledermatology and direct booking to surgery, potentially compromising the consent process. This review examines the current state of informed consent in UK dermatology, particularly in light of the Montgomery ruling, which requires clinicians to ensure patients are aware of all material risks and alternatives associated with their treatments. The two-stage consent process, involving consent at two distinct points, is advocated to allow patients adequate time for reflection and decision-making. However, challenges remain in pathways like one-stop clinics and direct booking for surgery, where limited face-to-face interaction and time constraints can undermine the quality of informed consent. To mitigate these issues, integrating multimedia tools and standardised procedure-specific consent forms can enhance patient comprehension and satisfaction. These tools ensure consistent and clear communication of risks, benefits, and alternatives, maintaining robust informed consent amidst evolving healthcare delivery models. Sustaining a thorough and individualised dialogue throughout the patient care journey is essential for upholding patient autonomy and shared decision-making in dermatological surgery.

Envisioning the sustainable and climate resilient hospital of the future

ObjectivesThis study aims to create a vision of the future hospital to help healthcare leaders understand how changes in society and the healthcare system, compounded by climate change, could affect future hospital estate. Study designThe study is part of a larger project based on participatory backcasting aimed at providing integrated strategies for transitioning to a zero-carbon future and adapting to existing climate change through improved asset management. MethodsThe data presented in this paper were collected during a full-day workshop to construct the vision of the future hospital in 2050. A multidisciplinary team of 19 participants participated in the discussions. A six-phase thematic analysis was applied to the data to develop the narrative vision and graphic recording. ResultsThe healthcare system is undergoing transformative changes due to evolving healthcare delivery, patient expectations, emerging technologies, climate change, and sustainability. However, current hospital strategies often fail to consider the interrelationship between the hospital estate and its socio-environmental context. Policymakers, healthcare system leaders, and hospital leaders need a clear vision of the hospital of the future to implement transformational strategies. ConclusionsHealthcare transformations require shifting from traditional centralised hospitals to a more flexible, distributed model. Healthcare leaders need to proactively assess how hospitals respond to current and future hazards and consider the impacts within the context of integrated and dispersed healthcare delivery. To address this, a systematic approach to modelling hazards and evaluating design or upgrading options is essential to mitigate the transfer of climate-related risks within healthcare systems.

Analyzing the Public Health Impact of Adopting Telehealth after a Pandemic: A Business Model

Abstract: In response to the global shift in healthcare delivery due to the COVID-19 pandemic, this study investigates the adoption of telehealth technologies and assesses their long-term sustainability within new public health paradigms. Telehealth, accelerated by the pandemic's demands, offers a unique perspective on evolving healthcare delivery methods that emphasize accessibility and efficiency. By employing a mixed-methods approach, which synthesizes quantitative data with qualitative insights from various stakeholders, this research evaluates how telehealth has enhanced the delivery of medical services, especially in remote and underserved communities. Despite challenges related to technological infrastructure and regulatory constraints, our analysis of revenue models and cost-benefit evaluations suggests that telehealth is economically feasible and possesses significant market potential. The findings advocate for robust policy support and technological investment to enhance global telehealth accessibility and implementation. Additionally, the study highlights the necessity of expanding educational training for healthcare professionals to effectively adapt to telehealth systems. These strategic measures are pivotal for promoting the widespread application and sustainable development of telehealth, positioning it as a cornerstone in the future landscape of global healthcare. Continued research is recommended to further refine telehealth models and develop comprehensive frameworks that address emerging healthcare challenges and disparities.

Transition of Clinical Pharmacy from Theory to Practice

Since the 1960s, the world has witnessed a significant development in the role of clinical pharmacists, as the pharmacy profession has shifted toward improving drug treatment, promoting health, and preventing diseases. Clinical pharmacists are in high demand around the world and are now recognized as indispensable members of health care teams. Key competencies required in a clinical pharmacist include patient care, medical knowledge, collaboration with health care teams, professionalism, delivery of exceptional care, and ensuring the safe use of medications. Modern competency-based pharmacy education focuses on specific outcomes that graduates are expected to achieve, in alignment with professional standards. This curriculum prepares students to excel in changing and evolving health care delivery, ultimately leading to improved patient outcomes and more efficient health care delivery. Therefore, the future of clinical pharmacy looks bright as pharmacists play vital roles in patient care using advanced technology and personalized medicine. Collaboration with other health care professionals is also key to improving outcomes. Therefore, pharmacy education must be changed by focusing on clinical skills, combined professional training, and career development. Challenges such as regulations, differences in practices, and lack of recognition must be addressed through collaboration between health stakeholders, educators, and policy makers. This review article aims to explore the evolving role of clinical pharmacists in the health care system, highlighting their key competencies, the impact of competency-based education, and future prospects for the clinical pharmacy profession in the context of advancing technology and personalized medicine.

Software Engineering in Health Care

Software engineering has emerged as a cornerstone in the evolution of healthcare delivery, serving as a key player in improving patient care and maximizing systemic efficiency. This paper delves into the integration of software engineering principles, methodologies, and technologies within the healthcare sector, highlighting key applications such as Electronic Health Records (EHR), telemedicine platforms, clinical decision support systems, and medical imaging software. Through an exploration of challenges, opportunities, future trends, and case studies illustrating successful implementations, this study underscores the critical importance of software engineering in shaping the future of providing healthcare and enhancing patient results. By tackling current issues, seizing opportunities, and embracing future trends, Software engineering's revolutionary potential can be used by the healthcare industry to improve patient care and operational efficiency.

A Re-evaluation of Global Financial Outlooks and Prospects in the Telehealth Industry Amidst the Transition to a Post-Pandemic Era

The onset of the COVID-19 pandemic propelled the telehealth sector into a period of rapid expansion, with web-based care emerging as a crucial tool for ensuring the safety of patients and healthcare providers alike. However, with the introduction of vaccines, the perceived need for telehealth services appeared to diminish, leading to a decline in value for telehealth companies. This shift prompted both existing players and newcomers in the telehealth space to innovate and redefine their value propositions in order to regain investor and customer confidence and stand out amidst increasing competition. The struggle to reshape the perception of telehealth from a pandemic-era necessity to a valuable complement to traditional in-person care has been reflected in the volatility of stock prices and declining valuations. This dynamic has underscored the need for telehealth companies to differentiate themselves through technological advancements and the convenience they offer. Analyzing the market through qualitative secondary research, incorporating insights from contemporary sources, financial data from platforms like Yahoo! Finance, and peer-reviewed literature, it becomes evident that the telehealth market experienced a surge in 2020, reaching $17.9 billion in the US alone, and is projected to grow to $140.7 billion by 2030. This growth was accompanied by a nearly twofold increase in digital health venture funding, reaching $14.1 billion in total funding. However, this rapid expansion led to an oversaturation of the market, with supply outpacing demand, resulting in a significant drop in valuations as vaccination rates rose in 2021. In response to this rebalancing, telehealth companies must chart a course for the post-pandemic era. The current role of suppliers in the telehealth space, whether they are established healthcare industry incumbents or innovative "telehealth-first" challengers, will influence the growth strategies they pursue. Moreover, identifying medical specialties and patient demographics that are best suited for web-based care will be critical for long-term success in the evolving healthcare delivery system. Looking ahead, investors should anticipate a bullish market characterized by growing share prices. Success in the telehealth industry is likely to hinge on fundamentally transforming care delivery models rather than simply transitioning traditional care to a web-based format. As the market consolidates, established telehealth giants capable of adapting to the changing landscape are expected to thrive, albeit amidst continued growth at a slower pace.

Analyzing the barriers and enablers to internet hospital implementation: a qualitative study of a tertiary hospital using TDF and COM-B framework.

Internet hospitals have become an important way to improve the accessibility of medical services and promote medical equity in China. However, there is still lack of research on the behavior of medical personnel during the process of using Internet medical services, and the elements of behavior that motivate doctors to actively use or resist the use of Internet hospitals are still not fully analyzed. The study applied the Theoretical Domains Framework to examine the factors affecting the engagement of medical personnel in Internet hospitals, with the aim of guiding the design of intervention to enhance Internet hospital participation. This study utilized qualitative analysis. Semi-structured questionnaires based on the Theoretical Domains Framework (TDF) and Capability-Opportunity-Motivation-Behavior (COM-B) model was developed and administered to 40 doctors and nurses at a Grade A tertiary hospital in Guangdong Province. Data was coded and analyzed using qualitative methods including Nvivo software. The research displayed 19 barriers and 7 enablers for the implementation of Internet hospitals, all 14 TDF domains impacted participation with motivation cited most frequently. Despite challenges, medical personnel exhibited a generally optimistic stance towards utilization of the Internet hospital. Major barriers include the higher requirement of diagnostic ability, objective difficulties brought by online consultation to the decision-making process, limitation of time and other resources, not ideal technological and institutional environment, lack of self-efficacy and negative expectation of results in online consultation. Key enablers include patient needs and the positive impact of online care on the medical process and patient experience. This qualitative study identified a range of barriers and enablers to Internet hospital participation according to medical personnel, providing an conceptual framework to guide further research evaluating implementation strategies. Expanded research and targeted interventions design can help optimize participation in this evolving healthcare delivery model.

Mission Alliance Community Engagement Project: Exploring the Impact of COVID-19 on Social Isolation, Loneliness, Mental Health and Wellbeing in Veterans

During the Coronavirus disease pandemic, many U.S. veterans with posttraumatic stress disorder (PTSD) experienced increased symptomology and worsened mental health and well-being due in part to social isolation and loneliness. The Mission Alliance project explored these ramifications and prioritized critical issues expressed by U.S. veterans and stakeholders (N = 182) during virtual regional meetings (N = 32). Field notes created specifically for this project were recorded and thematically analyzed. Emerging themes included: (1) social isolation: missed opportunities, collapsed social circles, work-life balance, fostering relationships, and evolving health care delivery; (2) loneliness: deteriorated mental health, suffered with PTSD together but alone, looked out for each other, ambivalence toward technology, and strained and broken systems; (3) mental health: sense of chaos, increased demand and decreased access, aggravation, implementation of tools, innovative solutions, fear and loss, and availability of resources; (4) wellbeing: sense of purpose, holistic perspective on well-being, recognition of balance, persisting stigma, redefined pressures, freedom to direct treatment, and reconnection and disconnection. A PTSD-related patient centered outcomes research (PCOR)/comparative effectiveness research (CER) agenda was developed from these themes. Establishment of a veteran and stakeholder network is suggested to support, facilitate, and promote the PTSD-related PCOR/CER agenda. Furthermore, enhancement of opportunities for veterans with PTSD and stakeholders to partner in PCOR/CER is required to develop and conduct projects that lead to PTSD-related comprehensive care of veterans affected by traumatic events with the potential to translate findings to other populations.

Developing a feedback-rich culture in academic medicine: the effect of coaching and 360-feedback on physician leadership

BackgroundThis is a time of unprecedented change in healthcare. More physicians are being tasked with stepping into a variety of leadership roles without having received the training needed to be an effective leader. Previous data have demonstrated the effectiveness of both leadership coaching and 360-feedback tools to foster physician well-being and leadership growth. In this proof of concept study, we explore the combined effect of these two tools. The objective of this study was to examine the effect of a brief physician 360 leadership coaching intervention on perception of professional dynamics and acquired leadership skills.MethodsParticipants completed a tailored 360-feedback tool to gather input on their leadership skills, then engaged in five bi-weekly leadership coaching sessions. We conducted a post-intervention semi-structured qualitative interview. Qualitative data were coded using an inductive thematic analysis approach.ResultsTwenty-three primary care physicians at an academic medical center engaged in the 360 leadership coaching study. Participants reported that the intervention yielded valuable benefits in five coaching sessions. Two overarching themes emerged: a Shift in leadership awareness and Navigating their environment. Leadership awareness included increased clarity of purpose and role, and recognition that routine feedback is critical to leadership development. Navigating their environment included gaining relationship-building communication, organizational awareness and navigation strategies.ConclusionsCombining a tailored 360-feedback tool with a five-session leadership coaching intervention provided physicians with valued support infrastructure for becoming more effective leaders. Physicians described a nuanced understanding of the leadership challenges physicians face, and identified the leadership tools needed to navigate the evolving healthcare delivery landscape. Curricula for physician leadership learning could consider this combination of a customized 360 plus targeted leadership coaching for training physician leaders.

Expecting the Unexpected: How Regulators Can Prepare for Serious Events

Expecting the Unexpected: How Regulators Can Prepare for Serious Events

Aftermath as Disaster: An Evaluation of Disaster Capitalism and The Evolution of Healthcare Delivery in New Orleans 15 Years After Katrina

While Hurricane Katrina’s impact on the city of New Orleans has been discussed at length, what remains under discussed is how Hurricane Katrina’s initial destruction was only one part of a protracted disaster that unfolded. The closure of Charity Hospital, described herein through the lens of disaster capitalism, resulted in a concentration of ill-fated consequences for marginalized communities in New Orleans, the effects of which are longstanding. The various sociopolitical maneuvers state officials used to keep Charity Hospital closed— in favor of building a new hospital—should serve as a cautionary tale for communities under the ever-increasing threat of natural disasters secondary to climate change; safety net hospitals like Charity are subject to predatory disaster capitalism that puts the health and safety of the communities they serve at risk. The first iteration of what would become Charity Hospital— L'Hospital des Pauvres de la Charite—was founded in the French colony of New Orleans with funds bequeathed by Jean Louis for treatment of the colony’s indigent in 17361;(2) fires, hurricanes, and the need for more space forced a series of several moves and rebuilds over the hospital’s history until a sixth and final iteration in 1939 resulted in a twenty story, Art Deco-styled hospital located at 1532 Tulane Ave housing over 2,680 beds.(1-4) The hospital came under public control after the Louisiana Department of Health assumed control from the Sisters of Charity in 1970.(4) Eventually, Charity’s operation was turned over to the Louisiana Health Care Authority (LHCA) in 1991, the state’s network of public safety-net hospitals described as a “holdover remnant of Keynesian New Deal-era policies”5 before ownership of this system was transferred to the Louisiana State University (LSU) system in 1997. While its position as one of the nation’s oldest hospitals alone is noteworthy, it is also Charity Hospital’s sustained function as a hospital of last resort for the region’s poor and underserved amidst a variety of operational changes that makes Charity Hospital’s history unique. The landfall of Hurricane Katrina brought an end to this legacy and irreversibly changed healthcare delivery for the entirety of New Orleans.

Advanced Practice Provider Onboarding Support Model Comparison: Is there a Superior Choice?

Health care practices and institutions are providing variable onboarding models to prepare physician assistants (PAs) and nurse practitioners (NPs) for transition into new practice settings. With the evolution of healthcare delivery and increased opportunities for PAs and NPs to specialize in advanced practice environments, there has been a growing demand for an evidenced-based strategy, structure, and appraisal of content within existing onboarding models. The aim of this paper is to compare two onboarding models for Advanced Practice Providers (APPs): postgraduate training programs and traditional institutional transition to practice programs. With expanding numbers of postgraduate training programs offered nationally and increasing numbers of PA and NP graduates seeking out these opportunities calls into question the differences offered through each model. Postgraduate training programs appear to provide a consistent structure of comprehensive curriculum design, interprofessional learning, meaningful institutional engagement, leadership exposure, and support a superior onboarding support model for PAs and NPs.

Evolving Healthcare Delivery in Neurology During the Coronavirus Disease 2019 (COVID-19) Pandemic.

Evolving Healthcare Delivery in Neurology During the Coronavirus Disease 2019 (COVID-19) Pandemic.

Opportunities for, and implications of, skill mix changes in health care pathways: Pay, productivity and practice variations in a needs-based planning framework.

Health workforce planning is traditionally based on demographically-driven 'silo-based' models in which future requirements for particular health professions are determined by applying estimates of the future population to the existing population-based level of workforce supply. Estimates of future workforce requirements are focused on, and constrained by population size and requirements increase monotonically. Key failures of existing models include (1) lack of integration between planning the health care workforce, health care services and health care funding and (2) lack of integration between planning different health care inputs and the potential for substitution between inputs. Hence planning models fail to incorporate emerging developments in healthcare delivery and workforce change. We present an integrated needs-based framework for health workforce planning and apply the framework using data from nine European countries to explore the workforce and financial implications of re-configuring the delivery of care through changes in the allocation of treatment tasks between health care professions (skill mix). We show that cost consequences depend not only on pay differences. Instead, workforce planning in rapidly changing workforce environments must consider and incorporate between-provider group differences in productivity (the number of patients that are served per fixed period of time) and practice style (the number and mix of tasks used in providing care to the same type of patient).

The role of oral health in an evolving health care delivery system: An interview with Bruce Donoff, D.M.D., M.D.

This interview is focused on the role that dentistry, and oral health more broadly, can play in improving the quality, accessibility, and value of health care delivered in the United States. The interview touches on the importance of oral health, transitioning from interprofessional education to interprofessional practice, and the opportunity for dental professionals to participate in value-based reimbursement models, among other related topics.

ICT Influence on the healthcare sector in the Niger Delta region: ICT policy at an organizational level

ABSTRACTOrganizational inefficiency, infrastructural decay and the challenge of untrained ICT personnel in the health sector have all contributed to the erratic development in healthcare delivery in the Niger Delta region. The region generates the nation's crude-oil, yet is marginalized, resulting in the neglect of infrastructural development and the collapse of functional health systems. Humans now suffer from various kinds of diseases resulting from the effects of oil exploitation and exploration, and gas flaring. This study is focused on growth within the health sector, identifying the extent of ICT application, the application of appropriate ICT policy in the sector, and the influence of related policy. Critical data were obtained from key-players by way of interviews and questionnaires. A quantitative analysis was carried out on the data obtained at an organizational level. Several tests were performed on the parameters; descriptive statistics, and where necessary, the Pearson correlation coefficient were introduced to check relationships between variables. Results obtained indicated low-level adoption rates of ICT application in healthcare delivery and a need for an enabling policy. This study confirmed the low levels of healthcare delivery in the region and the importance of an ICT policy in the healthcare sector to improve efficiency.

Graduate Medical Education Past, Present, and Future: Sponsoring Institutions in Transition.

Graduate Medical Education Past, Present, and Future: Sponsoring Institutions in Transition.

Let's Get Real About Health Care Reform.

In light of the ongoing debate about health care policy in the United States, including efforts to repeal and replace the Affordable Care Act, it will be critically important for the academic community to engage in the dialogue. Developing a viable approach to health care reform requires an understanding of the interaction and interdependence between choice, cost, and coverage in a competitive and functional market-based system. Some institutions have implemented models that indicate the feasibility of providing high-quality, efficient patient care while working within fixed budgets. The academic community must stay engaged in these conversations because of its moral commitment to equitable access to health care for all. Academic medical centers will also have to define and protect their roles in an evolving health care delivery system in the United States.

Collaborative Care in an Evolving Health Care Delivery Landscape

Collaborative Care in an Evolving Health Care Delivery Landscape

Diffusion of Mobile Health Apps Among Smartphone Users : Role of Neighborhood Effects, Informational Network Effects, and Social Ties in Health 3.0

The convergence of mobile technology with an evolving healthcare delivery system has ushered a wave of disruptive innovations that has bought a paradigm shift in healthcare delivery services; known as Health 3.0. If Health 1.0 was about content (portals, sites like WebMD), and Health 2.0 was focused around communities that capitalize on the knowledge gained by specific patients and their physicians (a diabetes message board), then Health 3.0 is about coherence of health information and active participation from users itself. Digital natives (DNs) are users born after 1980, grown up with digital devices and who are developing N-fluence networks (Topscott, 2008) via the Internet, especially through social media. This study proposed a conceptual model that deals with the diffusion of mobile health apps (mHealth apps) among digital natives (consumer reviews) and the role played by neighborhood effects, social network effects, and opinion leadership in such diffusion.