Healthcare Redesign Research Articles

Limited RSV Vaccine Administration: A Case for Redesigning the Preventive Care Model

In this commentary, the authors describe existing barriers to vaccination access linked to the restriction of pharmacists’ prescribing authority, rationalize the need for more innovative care models to enhance the role of the pharmacist, and outline the framework required for health care redesign to enable nonphysicians to close gaps in preventive care. Regulatory and legal issues challenge care redesign at scale. To illustrate this scalability issue and its downstream impact on public health, real-world data from a large national pharmacy chain in the United States, CVS Pharmacy, were leveraged to examine the influence of state-by-state immunization policies on respiratory syncytial virus vaccination administration during the national rollout for adults. As a result of these policies, preventive care (e.g., vaccination administration) was limited in a vulnerable population.

Re-designing health care: transitioning thoracoscopic pleural biopsies from the operating room to the outpatient setting using simulation for training and testing

Re-designing health care: transitioning thoracoscopic pleural biopsies from the operating room to the outpatient setting using simulation for training and testing

Mapping the way: functional modelling for community-based integrated care for older people

BackgroundHealthcare system sustainability is challenged by several critical issues; one of the most pressing is the ageing population. Traditional, episodic care delivery models are not designed for older people who are medically complex and frail. These individuals would benefit from health and social care that is more comprehensive, coordinated, person-centred and accessible in the communities in which they live. Delivering this is a challenging endeavour. Community-based health and social care professionals are siloed, dispersed across various locations and sectors, each with their own mental models, electronic health information systems, and means of communication. To move away from fragmented care delivery models and towards a more integrated approach to care, an analysis of the process of community-based comprehensive geriatric assessment was conducted in an urban location in Atlantic Canada. The purpose of the study was to identify where in the community-based comprehensive geriatric assessment process challenges and opportunities existed for moving towards a more integrated model of care delivery.MethodThe functional resonance analysis method (FRAM) and dynamic FRAM (DynaFRAM) modelling were used to model the community-based health and social care system and create a hypothetical patient journey scenario. Data collected to inform modelling consisted of document review, focus groups, and semi-structured interviews with health and social care professionals providing care and service to older people in the community setting.Findings.Challenges and opportunities for implementing integrated care in the local context were identified. Findings from the FRAM and DynaFRAM analysis informed the co-design of multi-level process improvement recommendations that aim to move the local community-based comprehensive geriatric assessment process towards a more integrated model of care.ConclusionsA transformative redesign of community-based health and social care in the local context is necessary but cannot be accomplished without an understanding of how health and social care professionals conduct their work and how older people may receive care under the dynamic conditions. The FRAM and DynaFRAM modelling provided an enhanced understanding of system operations and functionality and demonstrated a critical step that should not be overlooked for decision-makers in their efforts to implement a more integrated model of care.

Enhanced Comprehensive Care Programme: a retrospective study of patient empanelment by generalist-led multidisciplinary teams to reduce acute care utilisation.

Singapore faces an increasingly aged population with complex multimorbidity and psychosocial impairment. This change in demographic is challenging for existing healthcare systems. Breaks in care coordination and continuity result in poor health outcomes, increased acute care utilisation and higher healthcare costs. We proposed a patient empanelment approach adapted for the Singapore context based on the University of Chicago Comprehensive Care Physician model. This retrospective quasi-experimental, matched-controlled observational study sought to assess the effectiveness of the Enhanced Comprehensive Care Programme (ECCP) in reducing acute care utilisation at National University Hospital, Singapore. The primary outcomes were the number of hospitalisations and emergency department (ED) visits 6 months pre- and post-enrolment in ECCP. We used propensity score matching to balance prior healthcare utilisation between the intervention and control groups. Fifty-seven participants were recruited in the programme between October 2019 and April 2020. There was a reduction in the mean number of hospitalisations after intervention compared to before intervention (0.58 ± 1.03 vs. 1.90 ± 1.07, P < 0.001). There was also a reduction in the mean number of ED visits (0.77 ± 1.05 vs. 1.96 ± 1.14, P < 0.001). In the propensity-matched cohort, the mean number of hospitalisations was reduced in the intervention group (from 1.92 ± 1.07 to 0.58 ± 1.03, P < 0.001) compared to the control group (from 1.85 ± 0.99 to 1.06 ± 1.17, P = 0.04). This observational study shows the potential benefits of ECCP healthcare redesign to reduce acute care utilisation.

Reflections on 3 Years of Innovation: Recognizing the Need for Innovation Beyond the Clinical Care Pathway.

The Susan and Richard Levy Healthcare Delivery Incubator is designed to bring about rapid, sustainable, scalable, and transformational health care redesign. All 10 projects in the initial 3 cohorts of teams embraced the Incubator process-forming diverse teams and following a design-thinking informed curriculum-and each successfully implemented improvements or innovations by the end of their project. The purpose of this article is to identify the key features of teams' work that may help account for projects' success. For the 10 projects completed, findings from debrief interviews and staff observations were examined to identify processes key to project's success. Analysis highlighted cross-project learnings that indicate nonclinical aspects of care delivery that play a critical role in project innovation success. Innovating health care delivery requires considering social and political determinants of health. The Incubator's process and structures enable teams to identify and respond to a broad range of health determinants.

“I always felt like I wasn't supposed to be there”. An international qualitative study of fathers’ engagement in family healthcare during transition to fatherhood

ObjectiveEngagement of fathers in family health services confers benefits for the health and wellbeing of the whole family. The childbirth continuum is traditionally considered a feminine event, however, commensurate with the changing paradigm of gender equity in family healthcare worldwide, the role of fathers is in transformation. The aim of the study is to explore father's perceptions and experiences of healthcare engagement during pregnancy and early infant care. DesignQualitative free-text questions were embedded in a large multi-country, cross-sectional survey, to explored fathers’ attendance, participation, and experience of health care during appointments with their pregnant partner and/or baby. Setting and participantsExpectant and new fathers were recruited through Prolific®, an international paid online survey platform. FindingsQualitative responses (n=889) were provided by fathers from 28 countries, with experiences of a range of contexts and models of care; 46.8% of whose partners were pregnant and 53.2% had given birth since 2020. The findings suggest that although most fathers wanted to attend and participate in maternity and early parenting-related healthcare, multiple barriers were identified at the individual father, organisational context, and societal levels. Fathers reported negative social factors such as gender bias and restrictive gender norms as barriers to their healthcare engagement. In contrast, factors that enabled fathers to overcome barriers included the fathers’ feelings of confidence in their partner's autonomy and decision-making skills, trusted professional relationships with clinicians, and clinicians with good interpersonal skills. Key conclusionsMultiple barriers restrict the participation of fathers in healthcare for childbearing and early parenting. Knowledge of these barriers can inform healthcare redesign to include more successful engagement strategies for fathers, to benefit fathers, mothers, and infants alike. Implications for practiceHealth professionals consulting with the mother, father and infant triad are ideally placed to address the healthcare needs of both parents. Early engagement of fathers in family health care by use of inclusive interpersonal skills and the development of a trusted relationship has potential to improve paternal mental health, and may be associated with benefits for the health, wellbeing and safety of the whole family.

Engaging Everyone: Co-building diverse and inclusive patient partnerships to promote health equity.

Background: To address the challenge of engaging diverse people, discover a novel model of engagement where diverse members of community bring a health equity lens to healthcare projects, policies and research.&#x0D; Workshop description: This workshop is designed to introduce participants to challenges and opportunities in diverse patient engagement. Participants will learn about the Equity-Mobilizing Partnerships in Community (EMPaCT) model. Through group discussions, participants will explore how they can adapt the EMPaCT approach to their own settings. Through tools and resources developed by EMPaCT, participants will learn how to co-design sustainable and scalable models of patient engagement to promote health equity. In particular, participants will learn about:&#x0D; 1.Conceptual frameworks that make explicit the relationships between social, political and economic inequities and health outcomes;&#x0D; 2.Strategies to involve communities experiencing the most inequities in policy and decision-making; and&#x0D; 3.Methods to design programs that are scalable. &#x0D; Intended audience: Anyone who is:&#x0D; 1.interested in learning how to engage in patient partnerships that promote health equity; &#x0D; 2.interested in engaging with diverse and seldom-heard communities for practice, research or policy development;&#x0D; 3.involved in system-level healthcare redesign and resourcing.&#x0D; &#x0D; &#x0D; Workshop overview &amp; agenda (90 mins workshop)&#x0D; 1.Introductions (10 mins) – Alies, Ambreen, Emily&#x0D; 2.Section: Getting to know the audience (10 mins ) – Emily &#x0D; Approach: Interactive polls. Responses reviewed in real-time.&#x0D; Outcome: Understand which stakeholder category participants identify with and their experiences in patient engagement including engagement with diverse voices as well as level of decision-making authority.&#x0D; 3.Section: Introduction to the challenges and opportunities in diverse patient engagement and the need for scalable equity-oriented patient partnerships (10 mins) – Ambreen &#x0D; Approach: Presentation by workshop facilitators. &#x0D; Outcome: Participants will have foundational knowledge needed to engage in interactive workshop.&#x0D; 4.Section: Identifying and using conceptual frameworks that recognize how health inequities drive health outcomes (15 mins) – Emily &#x0D; Approach: Overview of frameworks and interactive discussion using Padlet-based questions.&#x0D; Outcome: Participants will engage in learning and discussion about health and social inequities.&#x0D; 5.Section: Involving communities experiencing the most inequities in policy and decision-making (15 mins) – Alies &#x0D; Approach: Facilitators will share how EMPaCT was co-designed using an equity-oriented lens to patient engagement. Participants will learn how to apply the same lens to their setting using interactive group discussion through Padlet. &#x0D; Outcome: Participants will learn about different ways to involve communities experiencing the most inequities in policy and decision-making.&#x0D; 6.Section: Designing programs that are scalable and sustainable (15 mins) – Ambreen &#x0D; Approach: Facilitators will share how EMPaCT was co-developed as a scalable unit. Participants will engage in interactive discussions through Padlet to identify the resources available to them to co-create a scalable unit in their setting. &#x0D; Outcome: Participants will learn about different ways to scale and sustain patient engagement activities that promote health equity. &#x0D; 7.Closing summary (15 mins) – Alies &#x0D;

Optimizing care delivery in expanding health systems: Views from clinical leaders

IntroductionIn response to intense market pressures, many hospitals have consolidated into systems. However, evidence suggests that consolidation has not led to the improvements in clinical quality promised by proponents of mergers. The challenges to delivering care within expanding health systems and the opportunities posed to surgical leaders remains largely unexplored. MethodsSemistructured interviews with 30 surgical leaders at teaching hospitals affiliated with health systems from August–December 2019. Interviews were transcribed verbatim and coded in an iterative process using MaxQDA software. Attitudes and strategies toward redesigning health care delivery across expanding systems were analyzed using thematic analysis. ResultsLeaders reported challenges to redesigning care delivery across the system ranging from resource constraints (e.g. hospital beds and operating rooms) to evolving market demands (e.g., patient preferences to receive care close to home). However, participants also highlighted that system expansion provided multiple opportunities to increase access (e.g. decant low-complexity care to affiliated centers) and improve quality of care (e.g. standardize best practices) for diverse populations including the potential to leverage their health system to expand access and improve quality. ConclusionsThough evidence suggests that hospital consolidation has not led to redesigned care delivery or improved clinical quality at a national level, leaders are pursuing varying sets of strategies aimed at leveraging system expansion in order to improve access and quality of care.

Call to Action: Academic Nursing's Role in Redesigning Health Care to Reduce the Human and Financial Cost of Health Inequities.

Health equity is an aspirational goal for health outcomes that can be achieved when systemic inequalities are addressed. The human cost of health inequities is without number; we can and must ameliorate health inequities. This essay summarizes the impact of continued health disparities and inequities in the United States and outlines the ways in which increasing diversity in the nursing workforce and graduating equity-minded nurses can promote innovation and problem-solving to address these disparities and inequities. We then present multiple pathways for nurses in academia to advance health equity.

Coproduction of Low-Barrier Hepatitis C Virus and HIV Care for People Who Use Drugs in a Rural Community: Brief Qualitative Report.

People who inject drugs are experiencing syndemic conditions with increasing risk of infection with hepatitis C (HCV) and HIV. However, rates of accessing HCV and HIV testing and treatment among people who inject drugs are low for various reasons, including the criminalization of drug use, which leads to a focus on treating drug use rather than caring for drug users. For many people who inject drugs, health care becomes a form of structural violence, resulting in traumatic experiences, fear of police violence, unmet needs, and avoidance of medical care. There is a clear need for novel approaches to health care delivery for people who inject drugs. This study aimed to analyze the process of a multidisciplinary team-encompassing health care professionals, community representatives, researchers, and people with lived experience using drugs-that was formed to develop a deep understanding of the experiences of people who inject drugs and local ecosystem opportunities and constraints to inform the cocreation of low-barrier, innovative HCV or HIV care in a rural community. Given the need for innovative approaches to redesigning health care, we sought to identify challenges and tensions encountered in this process and strategies for overcoming these challenges. Analysis was based on an in-depth review of meeting notes from the project year, followed by member-checking with the project team to revise and expand upon the challenges encountered and strategies identified to navigate these challenges. Challenges and tensions included: scoping the project, setting the pace and urgency of the work, adapting to web-based work, navigating ethics and practice of payment, defining success, and situating the project for sustainability. Strategies to navigate these challenges included: dedicated effort to building personal and meaningful connections, fostering mutual respect, identifying common ground to make shared decisions, and redefining successes. While cocreated care presents challenges, the resulting program is strengthened by challenging assumptions and carefully considering various perspectives to think creatively and productively about solutions.

Examining the Real-Life Journey of Individuals and Families Affected by Single-Ventricle Congenital Heart Disease.

Background The lifetime journey of patients with single-ventricle congenital heart disease is characterized by long-term challenges that are incompletely understood and still unfolding. Health care redesign requires a thorough understanding of this journey to create and implement solutions that improve outcomes. This study maps the lifetime journey of individuals with single-ventricle congenital heart disease and their families, identifies the most meaningful outcomes to them, and defines significant challenges in the journey. Methods and Results This qualitative research study involved experience group sessions and 1:1 interviews of patients, parents, siblings, partners, and stakeholders. Journey maps were created. The most meaningful outcomes to patients and parents and significant gaps in care were identified across the life journey. A total of 142 participants from 79 families and 28 stakeholders were included. Lifelong and life-stage specific journey maps were created. The most meaningful outcomes to patients and parents were identified and categorized using a "capability (doing the things in life you want to), comfort (experience of physical/emotional pain/distress), and calm (experiencing health care with the least impact on daily life)" framework. Gaps in care were identified and classified into areas of ineffective communication, lack of seamless transitions, lack of comprehensive support, structural deficiencies, and insufficient education. Conclusions There are significant gaps in care during the lifelong journey of individuals with single-ventricle congenital heart disease and their families. A thorough understanding of this journey is a critical first step in developing initiatives to redesign care around their needs and priorities. This approach can be used for people with other forms of congenital heart disease and other chronic conditions. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04613934.

Redesigning Rural Acute Stroke Care: A Person-Centered Approach.

Stroke service delivery in rural areas in Australia lacks evidence-based, best practice care protocols as a result of limited resources and opportunity. Healthcare redesign is an approach to improving health services by understanding barriers and enablers to service provision and work with users to develop solutions for improvement. This research aimed to qualitatively evaluate stroke care in rural Tasmania using a person-centered approach, as part of a larger healthcare redesign initiative to improve acute stroke care. Semi-structured interviews, aimed at gaining insight into experiences of healthcare staff and users, were conducted. Thematic analysis revealed three global themes (communication, holistic care, and resourcing) that demonstrated some consistency between healthcare staff and user experience, highlighting that some needs and expectations were not being met. Results of this experiential study provide important perspectives for delivering needs-based improvements in service provision for acute stroke care. Overall, this study showed that systems of stroke care in rural areas could be improved by utilizing a redesign approach including healthcare staff and users in the development of solutions for health service improvement.

Burnout and Commitment After 18 Months of the COVID-19 Pandemic: A Follow-Up Qualitative Study with Primary Care Teams.

Primary care practice teams continue to grapple with the demands of the COVID-19 pandemic. Early in the pandemic, despite the increased demands and low levels of control, in practices where protective equipment were available and practice-level support was high, few team members reported burnout, and many described a greater sense of purpose. However, since those early days, burnout levels have increased and high rates of turnover have been reported across the health care system, and further qualitative studies are needed. OBJECTIVE: The present study is a follow-up to a qualitative study on the workplace stress during the pandemic. DESIGN, PARTICIPANTS, APPROACH: Fourteen primary care providers and staff completed 1-year follow-up semistructured interviews (approximately 1.5 years into the pandemic) about their workplace demands, control, social support, burnout, and commitment to primary care. Primary care practice was characterized as high demand before the pandemic but the additional demands of the pandemic were leading participants to consider early retirement, quitting primary care or health care, and expressing a profound need for health care redesign. Short staffing extended medical leaves for COVID-19 and non-COVID-19 needs, increased management of patient mental health and aggressive behaviors, and frustration that practices were being held to prepandemic metrics all contributed to ever higher rates of burnout. Troublingly, while many described high-quality relationships at the practice level, the majority of participants described their organization-level support as largely unresponsive to their input and as offering little support or resources, though a few acknowledged that this could reflect that leadership is also under immense strain. Despite challenges, a number of participants expressed continued commitment to primary care. Fundamental redesign of primary care is required to prevent further loss of health care personnel and to provide opportunities for these staff to recover during the grueling, ongoing crisis.

Spotlighting Disability in a Major Electronic Health Record: Michigan Medicine's Disability and Accommodations Tab.

People with disabilities represent the largest minority group in the United States and a priority population for health services research. Despite federal civil rights law, people with disabilities face inaccessible health care environments that fail to accommodate their disability. We present Michigan Medicine's Disability and Accommodations Tab. This patient-facing questionnaire and shared data field in the electronic health record enables the collection and reporting of patient disability-related accommodations. The Disability Tab seeks to address provider- and clinic staff-reported barriers to providing accommodations and fosters an opportunity to redesign health care to meet the needs of people with disabilities.

Development and Evaluation of a Massive Open Online Course on Healthcare Redesign: A Novel Method for Engaging Healthcare Workers in Quality Improvement.

Healthcare workers are under increasing pressure to use limited resources more efficiently and improve patient outcomes. Healthcare redesign, a quality improvement methodology derived from the automotive industry, is a proven means of achieving these goals. Continuing Professional Development (CPD) opportunities for nurses seeking to build their capacity for healthcare redesign often come in the form of university courses, which can be costly and prohibitively time-consuming. We developed a Massive Open Online Course (MOOC) with a view to increasing the number of healthcare workers undertaking CPD in healthcare redesign and subsequently using these principles in their workplaces. The aim of the current study is to describe the development of our MOOC and its initial feedback from users. Materials and Methods: The theoretical and practical components of an existing postgraduate award course unit were made fit for purpose by being arranged into six weekly modules, before being transposed to an established learning management platform for MOOCs. Related quizzes, videos and interactive activities were then developed and included in each of these modules. Peer review of this content was completed by subject matter and teaching and learning experts prior to the MOOC being launched. Results: After running for nine months, 578 participants had enrolled in the MOOC, of whom 118 (20%) had followed through to completion. Participants were overwhelmingly from Australia (89%) and identified as female (78%). Preliminary feedback obtained from participants was positive, with 81% of respondents agreeing that they were satisfied with their experience, and 82% intending to apply their knowledge in practice. Conclusions: The MOOC has addressed a learning need by providing a brief and free form of education; learning from its development will help others seeking similar educational solutions. Initial feedback suggests the MOOC has been well-received and is likely to be translated into practice.

Hurdles of innovation-insights from a new healthcare delivery innovation program.

Healthcare systems are actively working to innovate their care delivery models, seeking to improve service quality, improve patient and provider satisfaction, and reduce cost. By critically evaluating our experiences to date, this article highlights challenges systems may face in the process of trying to redesign healthcare and offers insights on how to navigate hurdles. We identify barriers to-and ultimately approaches to promote-rapid, scalable, sustainable, and transformative care redesign. Dedicated electronic health record IT and analytic support, and ongoing leadership engagement and communication, play a valuable role in enabling redesign efforts. Flexible, but guided, innovation support helps teams stay accountable and motivated, while accommodating new project needs and directions. Understanding the change ecosystem and evaluating and sharing outcomes on an ongoing basis, enables teams to adapt as needed. Facilitation and support help realize the value of diverse, engaged teams; novel approaches and techniques draw out innovative perspectives and promote creative thinking. Although not an exhaustive list of challenges or strategies to overcome them, we hope these insights will contribute to a culture of innovation and support other institutions in their healthcare redesign initiatives.

Stakeholder experiential knowledge as evidence in redesigning health-care facilities for improved usability

PurposeEvidence-based design (EBD) is traditionally limited to using empirical research findings based on randomized controlled trials. The purpose of this study is to explore stakeholder experiential knowledge as alternate credible evidence in redesigning health-care facilities for improved usability.Design/methodology/approachThis research, based on critical participatory action research, involved a case study of redesign and post-occupancy evaluation (POE) of an emergency department (ED) at Holy Family Hospital, Techiman, Ghana. Observation, interviews and document analysis were used to collect data in the redesign and POE. The data was analyzed through directed content analysis.FindingsFindings indicate that the redesign interventions, generated from stakeholder experiential knowledge, led to improved effectiveness, efficiency and satisfaction in the ED. This presents stakeholder experiential knowledge as alternate credible evidence in EBD. Furthermore, the POE revealed that open and flexible spatial arrangement, zoning care areas according to severity, and providing staff-support amenities are some redesign interventions for improving ED usability.Practical implicationsCompared to the hard and controlled nature of experimental research knowledge, the soft and fluid experiential knowledge of stakeholders could be more useful for health-care redesign process, especially in iteratively structuring design thinking and making choices.Originality/valueThis paper contributes to theory by validating and illustrating stakeholder experiential knowledge as credible evidence for EBD. Practically, it provides strategies, based on POE findings, for designing EDs to improve usability.

O16 - Engagement in health services among expectant and new fathers: Qualitative findings from a cross sectional study

Although the continuum of pregnancy, childbirth, and the puerperium is commonly considered a feminine event, the role of fatherhood and fathers’ participation in this context is in transformation. Studies suggest that engagement of fathers in family health services may confer benefits for both the father and the whole family. However, fathers commonly feel excluded from family health, and attempts made to implement father engagement strategies in these services have had limited success. The aim of this aspect of the study was to explore perceptions and experiences of healthcare engagement in the pregnancy and postnatal context. Expectant and new fathers were recruited through Prolific, an international paid online survey platform. The survey included free text questions to explore fathers’ attendance, participation and experience of health care during appointments with their pregnant partner and/or baby. The survey was completed by a culturally diverse population (n=889), 46.8% of whose partners were pregnant and 53.2% had given birth since 2020. Experiences were reported from a range of contexts and models of care across the 28 countries represented in the sample. Although most fathers wanted to attend and participate in maternity and early parenting-related healthcare, multiple barriers were identified at the individual provider, contextual and organisational levels. Fathers reported negative social factors such as gender bias and restrictive gender norms as barriers to their healthcare engagement. In contrast, fathers’ experiences of confidence in the woman’s autonomy and decision-making skills, trusted professional relationships with clinicians, and good clinician interpersonal skills enabled transcendence from some of the barriers experienced. Internationally, social, contextual and organisational barriers currently restrict the participation of fathers in healthcare for childbearing and early parenting. Knowledge of these barriers can inform healthcare redesign to include more successful engagement strategies for fathers, to benefit fathers, partners and infants.

Designing a Health Care Delivery Innovation Lab: Reflections From The First Year.

This article shares initial experiences designing and operating a new health care delivery innovation program at a rural academic medical center. The program was designed with the belief that dedicated team member time, senior leadership engagement, deliberate project/team selection, and robust, tailored project support would enable rapid and transformative health care redesign. Three teams were supported in the initial 1-year funding cycle; all 3 teams successfully designed, implemented, and tested new care models for different serious illness populations. Results demonstrated improved satisfaction, decreased length of stay, and a positive return on investment. Critical evaluation of current structures and processes will help identify refined strategies to support diverse teams that will challenge the norms of health care delivery and explore novel partnerships, approaches, and settings for care delivery. This article helps advance the conversation on how to think strategically and critically about current and future health care innovation efforts.

Thoughts on Redesigning Health Care: Aligning Incentives to Drive Innovation

Thoughts on Redesigning Health Care: Aligning Incentives to Drive Innovation