Safer Health Care System Research Articles

Enhanced Safe and Secure Distributed Healthcare System Through Efficient Duplication Detection Approach

Enhanced Safe and Secure Distributed Healthcare System Through Efficient Duplication Detection Approach

Human resource management: new approach to nurse scheduling by considering human error

Human error is a critical concern in healthcare systems from primary care clinics to operating rooms in hospitals. Prevention or reduction of the chance of occurrence of such errors through increasing human reliabilities is tremendously important and deserves to be focused within personnel scheduling problems in healthcare systems. The present study is to develop a new multi-objective integer mathematical model which includes human errors of nurses to determine optimal shift scheduling of nurses. In addition to medical errors, several constraints in real-world problem including “minimum number of available nurses in each shift”, “restrictions on shift rotation for each nurse”, and “Minimum and maximum working hours in a week” are also taken into account. Nurses’ preference score, allocation costs, penalty cost of violating soft constraints, and human errors are all considered as objectives to be optimized. The multi-objective model, developed in this study, is solved by employing the weighted-sum method. To verify and validate the proposed model, a test problem is also solved. Sensitivity analysis on the model indicates that the solution method can reach acceptable solutions within an acceptable time. The present study is to help decision-makers to achieve optimal scheduling for decreasing costs and improving safety in healthcare systems. Based on this approach, decision makers can totally minimize the number of errors by considering the number of nurses required in each grade as well as proper allocation of them to different work shifts.

Improve Healthcare Quality Through Mortality Committee: Retrospective Analysis of Bambino Gesù Children Hospital's Ten Years' Experience 2008-2017.

Healthcare quality improvements are one of the most important goals to reach a better and safer healthcare system. Reviewing in-hospital mortality data is useful to identify areas for improvement, and to monitor the impact of actions taken to avoid preventable cases, such as those related to healthcare associated infections (HAI). In this paper, we present the experience of the Mortality Committee of Bambino Gesù Children Hospital (OPBG). OPBG has instituted a process of systematic revision of all in-hospital deaths conducted by a multidisciplinary team. The goal is to identify system-wide issues that could be improved to reduce in-hospital preventable deaths. In this way, the mortality review goes alongside all the other risk management activities for the continuous quality improvement and patient safety. In years 2008-2017, we performed a systematic analysis of 1148 inpatient deaths. In this time period, the overall mortality rate was 0.4%. Forty-seven deaths were caused due to infections, 10 of which involved patients with HAI transferred to OPBG from other facilities or patients with community- acquired infections. Six deaths related to HAI were followed by claims compensations. All these cases were not followed by compensation because the onset of HAI was considered an inevitable consequence of the underlying disease. Introduction of the mortality review committee has proved to be a valid instrument to improve the quality of the care provided in a hospital, allowing early identification of care gaps that could lead to an increase in mortality rates. Article Highlights Box: Reduction of preventable deaths is one of the most important goals to be achieved for any health-care system and to improve the quality of care. • Several studies have shown that analysis of morbidity and mortality rate helps to detect any factors that can lead to an increase in in-hospital mortality rates. • The review of in-hospital deaths allows to learn how to improve the quality and safety of care through identification of critical issues that lead to an increase in mortality ratio. • In some medical areas, such as intensive care units or surgery, the implementation of the conference on mortality and morbidity is more useful for assessing procedures at high risk of errors. • The implementation of existing databases with data deriving from the systematic review of medical records and in-hospital deaths appears to be desirable. • Mortality Review Committees can represent a very useful tool for all the health facilities for the reduction of preventable deaths, such as those related to HAI.

Generating a Health Information Technology Event Database from FDA MAUDE Reports.

Patient safety events (PSEs), or medical errors, are major impediments to healthcare system safety. Health information technology (HIT) is expected to promote quality of care. Nonetheless, HIT also creates unintended consequences that concern patient safety consolidating a high-quality database of HIT events is essential to understanding their nature. Previous studies demonstrated the potential to use FDA Manufacturer and User Facility Device Experience (MAUDE) database to extract HIT events. In this study, we utilized classic and CNN models to extract HIT events from MAUDE. Both individual and combined models were evaluated on the test set, where the best model identified HIT events with ~90% accuracy and achieved a ~.87 f1 score. This model was capable of identifying HIT events in an HIT-exclusive database and serving as a quality and error check tool during event reporting. Moreover, the strategy of HIT event identification may scale in developing other PSE subtype-specific databases.

Cultural Safety in health services

The western New South Wales NSW region in Australia is one of 31 Primary Health Network PHN regions. Its land area is 441,609 km2 and with a resident population of approximately 310,000 people. Of the 28 Local Government Areas comprising western NSW, 64% are classified as socially and economically disadvantaged while 39% are classified as remote or very remote Health Intelligence Unit, WNSW: Health of the Population, December 2017. In western NSW, 12% of the population identifies as Aboriginal, compared to only 3% for all NSW. Access to health services is a key regional focus particularly for Aboriginal people Western NSW PHN: Needs Assessment, 2017. In their submission to the Australian Government Department of Health in early 2015 to operate the new Western New South Wales Primary Health Network WNSW PHN, the consortium for operating the new PHN highlighted their commitment to building and driving culturally appropriate services for Aboriginal people across the region, including with existing and prospective mainstream and other primary healthcare providers Debble Institute Canberra: ‘What works’ in partnering to deliver effective Aboriginal health services: The Western New South Wales Primary Health Network experience, 2017. Much has been written on the approaches to date by health services and related organisations to fulfil this important need. Programs are described in the literature and have included mandatory cultural awareness and sensitivity training, appointment of Aboriginal health workers, increasing the proportion of the workforce who identify as Aboriginal, and involvement of Aboriginal Elders and community leaders in service development, among other strategies. However, programs described are often occurring in isolation, predominantly in hospital settings, and with a considerable focus on antenatal care/midwifery and cardiovascular conditions. There is also limited evidence of evaluations of these initiatives to indicate their success or applicability across a range of health care settings. In 2016, WNSW PHN’s Aboriginal Health Council recommended that the PHN develop its own comprehensive Cultural Safety Framework. The Framework could then guide all service providers funded by WNSW PHN Aboriginal and other, as well as the PHN’s commissioning framework and the PHN itself in building a culturally safe primary healthcare system in Western NSW. Cultural safety in healthcare means designing and providing services that meet the needs of patients through a process of self-reflection, awareness of cultural biases and processes to actively respond in a way that will benefit the patient’s health and wellbeing. WNSW PHN is playing a leadership role in the development of culturally safe models of care to ensure access to quality health care and wellbeing programmes for Aboriginal and Torres Strait Islander people. The WNSW PHN Cultural Safety Framework sets out a continuum for primary healthcare service providers in the transformation to cultural safety, involving three major steps: Cultural Awareness; Cultural Sensitivity; and Cultural Safety. Embedding a cultural safety process in WNSW PHN’s commissioning of health services will play an important role in Closing the Gap between the health outcomes for Aboriginal and Non-Aboriginal People in western NSW.

Patient safety and medication errors: a literature review

Only in the last decades has patient safety and human errors been discussed, this is due to the publication of the book: To err is human: building a safer health care system, published In 1999 by the Institute of Medicine of the United States. Many errors occur because the practitioner does not have knowledge about the subject, so health care institutions should promote ways to keep their staff current while maintaining patient safety. It was aimed at the present study analyze through a systematized review in the literature the subject of patient safety and medication errors. The present work deals with a bibliographic research with an exploratory and descriptive character. With regard to patient safety, 12 scenarios were found regarding medication errors: Prescription error; Dispensing error; Error of omission; Time error; Error of unauthorized medication; Dose error; Presentation error; Preparation error; Administration error; Error for use of impaired medications; Monitoring error; Error by not adhering to the patient and his family. And the inducing factors to the error: Failures in the health care system; Lack of notification culture; Lack of analysis of events; Lack of adequate material resources; Professional overload; Lack of operational protocols and routines implemented; Rapid deployment of processes; Non adherence by the patient to the proposed treatments. There are still some factors that are considered as protectors to the error, that is, they make difficult the event of the error, they are: Continued education; Certainty of procedures; Technical knowledge and ability. It was observed that health institutions and managers should conduct an investigation into how much error-inducing factors are interfering with the performance of their staff's activities and carrying out the necessary interventions, since the human factor is often considered the main reason for Error, but the error does not occur in isolation, so it is not enough to punish the professional and not perform a detailed analysis of the facts that favored the error.

Patient Safety and the Significance of Human Factors Engineering Modality: A Review

The issue of patient safety and medical human error has been arousing growing concern around the world. Attempts to reduce the rate of human error present a great challenge, and there is an increased understanding that the issue of patient safety in healthcare systems is a complex one that requires in-depth analysis and understanding. Despite the many programs and interventions designed to reduce the rate of human medical errors, various publications that expose the extent of this phenomenon point to a high percentage of human errors that causes injury, and to the difficulties in improving patient safety. The understanding that the focus must be on prevention and the growing need for practical solutions have led to the involvement of disciplines such as human-factors engineering in an attempt to understand the root causes of safety problems and find ways to prevent them. Human-factors engineering is a proactive approach that may contribute to the planning of safe medical systems by taking into account the diverse needs, capabilities, and limitations of the human beings involved in these systems. This article reviews the benefits and challenges in applying the principles of human-factors engineering to promote patient safety, as well as the implications for policy in the field

Nursess Use and Understanding of the Letter 'A' in the S.A.F.E. Error Prevention Tool

In 1999 the Institute of Medicine (IOM) published its landmark report named “To Err is Human: Building a Safer Health Care System.” The report called for an extensive improvement in order to reduce medical errors which have resulted in permanent injury, even deaths. There are approximately 268 preventable deaths each day in hospitals across this country. On March 1, 2017, the Joint Commission issues a Sentinel Event Alert highlighting the industries and its leader’s failure to implement a culture of safety designed to reduces preventable error. Since the IOM report, some facilities have adopted Safety Science, High-Reliability, and behavior modifying error prevention tools to help change traditional practices. The problem: to date, there is no formal study or tool to measure nurses’ use and understanding of high-reliability Error Prevention Tools (EPT). The purpose of the quasi-experimental, quantitative, comparative study is to measure and compare (ED Nurses and ICU nurses) use and understanding of the S.A.F.E. EPT adopted by the clinical site three years prior to the study. The significance of the study is to inform the healthcare industry and the clinical site of nurses’ use and understanding of the EPT. The study was conducted using a 51 question M-HSOPSC. The nature, scope and limitations of the project focused on the letter “A” of the S.A.F.E. EPT. Of the respondents who participated in the study, the majority indicated they used and understood the (EPT). Using SPSS, Pearson correlation was used to determine directional relationship, Mann-Whitney was used as a non-parametric statistical analysis to compare ED & ICU nurses use of the Error Prevention Tool. Due to confounding variables, the sample effect size to detect a power of .80 was not met. The analysis did produce statistically significant results using a Sig .05.

Nurses' experiences of care for patients with Middle East respiratory syndrome-coronavirus in South Korea

BackgroundThis study aimed to identify nurses' experiences of care for patients with Middle East respiratory syndrome-coronavirus (MERS-CoV). Their experiences can be useful to establish a safer healthcare system in preparation for infectious disease outbreaks.MethodsData were collected through in-depth individual interviews and analyzed using Colaizzi's phenomenological method. Participants were 12 nurses.ResultsNurses' experiences of care for patients with MERS-CoV were categorized as follows: “Going into a dangerous field,” “Strong pressure because of MERS-CoV,” “The strength that make me endure,” “Growth as a nurse,” and “Remaining task.”ConclusionsIt is necessary to examine the difficulties and demands of healthcare providers for establishing a safe healthcare system to respond effectively when national disasters occur. In addition, it is necessary to develop strategies to protect healthcare providers from severe physical and psychological stress.

Period prevalence and reporting rate of medication errors among nurses in Iran: A systematic review and meta-analysis.

To estimate the 1-year period prevalence of medication errors and the reporting rate to nurse managers among nurses working in hospitals in Iran. Medication errors are one of the main factors affecting the quality of hospital services and reducing patient safety in health care systems. A literature search from Iranian and international scientific databases was developed to find relevant studies. Meta-regression was used to identify which characteristics may have a confounding effect on the pooled prevalence estimates. Based on the final 22 studies with 3556 samples, the overall estimated 1-year period prevalence of medication errors and its reporting rate to nurse managers among nurses were 53% (95% confidence interval, 41%-60%) and 36% (95% confidence interval, 23%-50%), respectively. The meta-regression analyses indicated that the sex (female/male) ratio was a statistically significant predictor of the prevalence of medication errors (p<.05), but not of the prevalence of reporting medication errors to nurse managers. The period prevalence of medication errors among nurses working in hospitals was high in Iran, whereas its reporting rate to nurse managers was low. Continuous training programmes are required to reduce and prevent medication errors among nursing staff and to improve the reporting rate to nurse managers in in Iran.

Appraisal of Soft Computing Methods in Collaboration With Smart City Applications and Wireless Network

Applications of soft computing methods are spread in fields that deal with intelligent analysis. As the human intelligence can survey the likelihood of some occasions in possibilities, comparatively soft computing systems additionally utilize some smart-based strategies to evaluate ongoing issues with diagnostic models. Fundamental segments of soft computing incorporate machine learning, probabilistic thinking, swarm intelligence, and ANN algorithms. In this research article, there is a broad analysis of these intelligence-based soft computing strategies connected as different operational parts of a wireless network and there is a scheme of a soft computing-based method for smart and safe health care systems.

Mentoring: Positively Influencing Job Satisfaction and Retention of New Hire Nurse Practitioners.

The purpose of study was to determine whether mentoring based on Watson's Caring Model positively influences nurse practitioner (NP) job satisfaction. This nonexperimental mixed-methods study utilized an online survey, administered through Qualtrics containing demographic and mentoring variables. Job satisfaction results were obtained from the Misener Nurse Practitioner Job Satisfaction Scale (MNPJSS). Also, open-ended questions regarding mentoring were reported. There was a 54% response rate in which 37 of the 69 participants responded (n = 37), with statistical significance set at p < .05. All or 100% of participants reported that the mentor experience/relationship positively influenced job satisfaction. Scores from the MNPJSS ranged from 141 to 246, with a mean of 195.26 (SD = 28.29) corresponding to "minimally satisfied" or a mean of 4.44 on the 6-point scale. These results are similar to the MNPJSS score with a mean of 4.39. A mentoring experience can provide a positive environment, which can lead to increased job satisfaction. In turn, a higher level of satisfaction in the work environment can be associated with reduced turnover and improved retention and patient outcomes. Ultimately, a safer health care system will evolve and improve patient care and outcomes. Through Watson's Caring Model, a reciprocal relationship between the mentor and the mentee can provide a new NP hire a sense of community and direct availability. By experiencing a mentor relationship, job satisfaction can improve, which is a key factor in retaining NPs. As E-mentoring is a newer topic in nursing literature, further research is needed. Further studies could also review and develop one-on-one mentoring programs.

The Age-Friendly Health System Imperative.

The unprecedented changes happening in the American healthcare system have many on high alert as they try to anticipate legislative actions. Significant efforts to move from volume to value, along with changing incentives and alternative payment models, will affect practice and the health system budget. In tandem, growth in the population aged 65 and older is celebratory and daunting. The John A. Hartford Foundation is partnering with the Institute for Healthcare Improvement to envision an age-friendly health system of the future. Our current prototyping for new ways of addressing the complex and interrelated needs of older adults provides great promise for a more-effective, patient-directed, safer healthcare system. Proactive models that address potential health needs, prevent avoidable harms, and improve care of people with complex needs are essential. The robust engagement of family caregivers, along with an appreciation for the value of excellent communication across care settings, is at the heart of our work. Five early-adopter health systems are testing the prototypes with continuous improvement efforts that will streamline and enhance our approach to geriatric care.

Self-determination: what do people who experience severe mental illness want from public mental health services?

Introduction : If people who experience severe and enduring mental illness are to experience recovery, the health care context in which they engage needs to foster human rights, self-determination and social inclusion. This qualitative research aims to advance understanding about processes that influence self-determination by engaging and involving people who experience mental illness in meaningful conversations about how health care systems impact recovery. Theory / Methods : People over age 18 who experience severe mental illness and who were living in South East Queensland were recruited through community-based mental illness support organisations. 42 people participated in five semi-structured group interviews. Digitally recorded interviews were transcribed verbatim. In conjunction with the theoretical lens of self-determination theory, principles of thematic analysis were used to code and categorise data. Emergent themes were constantly compared until the most parsimonious themes that accounted for all data were identified. Approval to conduct the study was obtained from relevant Human Research Ethics Committees. Results : People indicated that being engaged in their care was central to the experience that they desired from a safe health care system, yet actual experiences differed. People also emphasised the need for accurate, empathic communication; the importance of building and maintaining trust-based relationships; integration and continuity of care between providers and sectors within the health care system; and gaining access to care when and as needed. Discussion : People who experience severe mental illness understood that achieving autonomy in high-risk mental illness situations was tricky; that in some circumstances there were valid reasons for autonomy and self-determination to be thwarted. However, unreflective use of blanket restrictive practices without providing reasonable alternative activities disabled them. People wanted to be engaged in their care; with health professionals in autonomy supportive ways; and with health and social support networks that assisted in recovery. Conclusion : Overall, people who experience severe mental illness want individual health professionals and the collective health care system to engage them in their care. However, they often found that restricted access to adequate, timely and well-integrated support left them feeling disempowered. Lessons learned : Responsive health professionals in integrated health care systems that engage people in a person-centred manner are fundamental for recovery and to the fulfilment of their basic psychological needs: autonomy, connectedness and competence. Limitations : A small number of participants for a single geographic area limit the generalizability of this study. Additionally, participants may have engaged in the research because they had a high level of interest in sharing their experiences, and the opinions of other people who were less invested in their care is unknown. In a group interview situation, they may not have felt comfortable to express to express their full range of experience. Future research : Self-determination theory is primarily a theory of motivation. Further study needs to be undertaken to understand the motivational influences that impact how health professionals engage people who experience severe mental illness.

Recommendations for Promoting Quality and Safety in Health Care Systems.

Are you a nurse leader or professional development practitioner in a health care facility? This article provides recommendations to promote quality and safety education with a focus on systems thinking awareness among direct care nurses. A key point is error prevention, which requires a shared effort among all nurses. J Contin Educ Nurs. 2017;48(7):295-297.

Diverging views on health information exchange organizations.

IntroductionHealth information exchange (HIE) capabilities meet the demands for a more effective, efficient, and safer health care system. However, organizations and individual providers have pursued different strategies to meet their respective needs for HIE capabilities. Because effective information sharing is necessary to a learning health system, this study sought to explore the perceptions of different approaches' effect on key features of an effective health care system.MethodsAn anonymous web‐based survey was sent to a convenience sample of the membership of the Healthcare Information and Management Systems Society and the Strategic Health Information Exchange Collaborative with knowledge of HIE (n=68). A series of 7‐point Likert‐type items measured perceptions of enterprise health information exchanges (eHIEs) and community health information organizations (cHIOs) in the areas of effect on exchange participation, effect on market dynamics, relationship to DIRECT Secure Messaging and vendor‐mediated exchange, and effect on quality. Also, respondents were asked to rate 13 qualities and services as “more about eHIE” or “more about cHIO.”ResultsRespondents tended to agree on the importance of cHIO and eHIE. Community benefits and support for public health agencies were concepts more often applied to cHIOs.DiscussionThis study affirmed much of the conventional wisdom and anecdotal comments about perceptions of cHIOs and eHIEs. Although the respondents viewed cHIOs and eHIEs differently in terms of broader societal benefit and strategic advantage, nonetheless consistent agreement appeared in areas of importance in relationship to other information sharing strategies and overall effect on the quality of care.

A work systems analysis approach to understanding fatigue in hospital nurses

Occupational fatigue is an important challenge in improving health and safety in health care systems. A secondary analysis of cross-sectional data from a survey sample comprised 340 hospital nurses was conducted to explore the relationships between components of the nursing work system (person, tasks, tools and technology, environment, organisation) and nurse fatigue and recovery levels. All components of the work system were significantly associated with changes in fatigue and recovery. Results of a tree-based classification method indicated significant interactions between multiple work system components and fatigue and recovery. For example, the relationship between a task variable of ‘excessive work’ and acute fatigue varied based on an organisation variable related to ‘time to communicate with managers/supervisors’. A work systems analysis contributes to increased understanding of fatigue, allowing for a more accurate representation of the complexity in health care systems to guide future research and practice to achieve increased nurse health and safety.Practitioner Summary: This paper explored the relationships between nursing work system components and nurse fatigue. Findings revealed significant interactions between work system components and nurses’ fatigue and recovery. A systems approach allows for a more accurate representation of complexity in work systems and can guide interventions to improve nurse health and safety.

Mentoring: Positively Influencing Job Satisfaction and Retention of New Hire Nurse Practitioners.

The purpose of study was to determine whether mentoring based on Watson's Caring Model positively influences nurse practitioner (NP) job satisfaction. This nonexperimental mixed-methods study utilized an online survey, administered through Qualtrics containing demographic and mentoring variables. Job satisfaction results were obtained from the Misener Nurse Practitioner Job Satisfaction Scale (MNPJSS). Also, open-ended questions regarding mentoring were reported. There was a 54% response rate in which 37 of the 69 participants responded (n = 37), with statistical significance set at p < .05. All or 100% of participants reported that the mentor experience/relationship positively influenced job satisfaction. Scores from the MNPJSS ranged from 141 to 246, with a mean of 195.26 (SD = 28.29) corresponding to "minimally satisfied" or a mean of 4.44 on the 6-point scale. These results are similar to the MNPJSS score with a mean of 4.39. A mentoring experience can provide a positive environment, which can lead to increased job satisfaction. In turn, a higher level of satisfaction in the work environment can be associated with reduced turnover and improved retention and patient outcomes. Ultimately, a safer health care system will evolve and improve patient care and outcomes. Through Watson's Caring Model, a reciprocal relationship between the mentor and the mentee can provide a new NP hire a sense of community and direct availability. By experiencing a mentor relationship, job satisfaction can improve, which is a key factor in retaining NPs. As E-mentoring is a newer topic in nursing literature, further research is needed. Further studies could also review and develop one-on-one mentoring programs.

Organizational solutions to improve timeliness and effectiveness of the stroke care

Saving time means saving neurons in stroke care process. Managerial and organizational solutions that lean the processes should be considered in order to overcome the effects of stroke, which is the second worldwide cause of death. The purpose of the paper is to understand how Health Lean Management (HLM) can be adopted to achieve a more efficient stroke care process. In this peculiar context, efficiency enhancement leads to safety and effectiveness results. For this reason, the investigated projects have been recognized as Lean & Safety (L&S) projects, being HLM projects reporting patient safety improvements. Due to the peculiarity of the project to investigate, a holistic case study has been conducted in a university hospital of Tuscany region. Thanks to the research framework developed in the literature for L&S projects, data regarding motivations, objectives, organizational and managerial aspects, outcomes, enablers and obstacles of the project have been collected and analysed. A multidisciplinary team, already trained on HLM and supported by the top management, was created and the step-by-step Six Sigma approach was adopted. After a mapping phase, a value stream map was created, Key Performance Indicators were defined and, finally, the Door To Needle (DTN) times and the modified Rankin Scales (mRS) were measured. Thanks to root cause analysis, the identified wastes were analyzed and intervention actions were defined and implemented. They regarded mainly different organizational interventions and they led to a decrease of both DTN times and mRS. The analysed project has demonstrated how it is possible to obtain relevant operational and clinical outcomes through organizational solutions. The analysis of this project, in which pursuing efficiency has led to safety and effectiveness results, has demonstrated how these different performances are linked each other in some peculiar care processes, in which shorter time means more effective and safer care, as in the stroke case. The implementation of L&S projects can improve care processes, providing a contribution to realize a more efficient, effective and safer healthcare system.

Engaging patients and consumers in research evidence: Applying the conceptual model of patient and family engagement

ObjectiveThis essay discusses applying the Conceptual Framework for Patient and Family Engagement to partnerships with patients and consumers to increase their use of research evidence in healthcare decisions. The framework’s foundational principles hold that engagement occurs on a continuum across all levels of healthcare—from direct care to policymaking—with patients and healthcare professionals working in full partnership and sharing responsibility for achieving a safe, high-quality, efficient, and patient-centered healthcare system. DiscussionResearch evidence can serve as a critical decision-making tool in partnerships between patients and health professionals. However, as the framework suggests, without patient and consumer engagement in the design, planning, interpretation, and dissemination of research findings, it is unlikely that the broader consumer population will find research evidence useful, much less use it, to guide their healthcare decisions. Understanding what factors influence patient and consumer engagement can lead to effective strategies that enable meaningful partnerships between patients and researchers. ConclusionUnderstanding patient and consumer perspectives of research evidence is critical to engaging them in meaningful partnerships that produce actionable research findings that they can in turn use in partnership with health professionals to improve their own health and the healthcare system as a whole.