Patient-focused Service Research Articles

Cardiac rehabilitation: goals, interventions and action plans

Cardiac rehabilitation services are now well established in the UK. There is a growing evidence base for cardiac rehabilitation interventions but, despite this, there remains much variation in service models and delivery. The 'National Service Framework for Coronary Heart Disease' sets out goals for cardiac rehabilitation interventions based on lifestyle change; however, many people do not have access to cardiac rehabilitation towards menu-driven approaches, which may suit individual need more than a standardized approach. Nurses play a crucial role in the delivery of cardiac rehabilitation services and hold the necessary skills and expertise so to do. Future challenges to cardiac rehabilitation include developing increasingly patient-focused services across the boundaries of primary, secondary and social care, and increasing patient and public involvement in services.

Using patient stories to inspire quality improvement within the NHS Modernization Agency collaborative programmes.

The importance of obtaining the opinions of service users has long been recognized and, traditionally, most contact has focused on measuring their satisfaction with the services they receive. However, there is little evidence that this has had much impact on improving care. The Discovery Interview Process, a technique for listening to patients and carers and using their narratives to improve care, is discussed in this article. This approach has been used in the pilot phases of the UK Coronary Heart Disease Collaborative and Critical Care Collaborative. These narratives develop understanding grounded in experience. Those delivering care can interpret the narratives using their own clinical and professional knowledge and experience to create better or new ways of meeting patients' and carers' needs. Using their own expert knowledge they can identify needs within the narratives, including those that patients and carers did not know they had. The principal techniques for gathering these narratives are outlined, and ways of using such data to inform patient-focused service improvements are discussed. Various locally sensitive methods for presenting the narratives to expert interprofessional teams are also described along with emerging experience of this feedback. We consider the Discovery Interview technique for gathering patient and carer narratives to be a potentially powerful method for informing quality improvements, discovering what really matters to patients and their carers. This pragmatic approach could prove manageable within local quality improvement projects.

Great, I've been let off the hook (the impact of advanced practice within the breast screening department)

The role of advanced practitioner enables the radiologist to work more efficiently. Wire localisations are essential procedures but by using a radiographer who has been trained to undertake them, this leaves the radiologist time to film read without interruption most mornings. As the advanced practitioner can perform stereocores, the assessment and symptomatic clinics are able to run more efficiently. The outcome is to minimise stress, streamline the service and promote a patient-focused quality service (i.e. shorter waiting times for results, minimise repeat attendance). Audit of these procedures for radiologists and radiographers indicate that the results are very similar. A radiologist commented, It's great, I've been let off the hook! Peace to read most mornings.

Business process re-engineering: lost hope or learning opportunity?

In the 1990s, business process re-engineering (BPR) sparkled for a while as a means of transforming health service performance. While many of the implementation projects report more modest gains, there remains much to learn from the approach. The recent emphasis on developing patient-focused services has seen a re-emergence of some of the key ideas of BPR. This article argues that we should reflect on the learning experience offered by BPR experiments in the NHS to inform current modernisation reforms.

Volunteers, Communication, and Relationships: Synergistic Possibilities

This article describes how community volunteers and stroke survivors can be involved in an inpatient/outpatient neuroscience and trauma program. We investigate the unique contribution and perceptions of volunteers within a patient-focused service delivery system. Volunteers include students, community members, friends, family members, and survivors. This article is divided into two parts. The first briefly describes a unique approach to training volunteers that incorporates conversational partnerships and professional mentoring to ensure quality learning experiences and to enhance volunteer effectiveness. The second portion of the article investigates the perceptions of various volunteers and provides some insights into the synergy that is created between volunteer and survivor.

Redesigning ambulatory care business processes supporting clinical care delivery.

The first step in redesigning the health care delivery process for ambulatory care begins with the patient and the business processes that support the patient. Patient-related business processes include patient access, service documentation, billing, follow-up, collection, and payment. Access is the portal to the clinical delivery and care management process. Service documentation, charge capture, and payment and collection are supporting processes to care delivery. Realigned provider networks now demand realigned patient business services to provide their members/customers/patients with improved service delivery at less cost. Purchaser mandates for cost containment, health maintenance, and enhanced quality of care have created an environment where every aspect of the delivery system, especially ambulatory care, is being judged. Business processes supporting the outpatient are therefore being reexamined for better efficiency and customer satisfaction. Many health care systems have made major investments in their ambulatory care environment, but have pursued traditional supporting business practices--such as multiple access points, lack of integrated patient appointment scheduling and registration, and multiple patient bills. These are areas that are appropriate for redesign efforts--all with the customer's needs and convenience in mind. Similarly, setting unrealistic expectations, underestimating the effort required, and ignoring the human elements of a patient-focused business service redesign effort can sabotage the very sound reasons for executing such an endeavor. Pitfalls can be avoided if a structured methodology, coupled with a change management process, are employed. Deloitte & Touche Consulting Group has been involved in several major efforts, all with ambulatory care settings to assist with the redesign of their business practices to consider the patient as the driver, instead of the institution providing the care.

Nursing Case Management

A multidisciplinary team was formed to develop and maintain a patient-focused service for patients receiving total joint replacement. Inpatient days, delays, surgery cancellations, and duplications in testing and supplies decreased while patient education improved. Through case management and collaboration, within one rural hospital, quality care was enhanced, patient outcomes improved and costs were contained.

A 12-Step Method for Developing New Pharmacy Programs

Clinical pharmacy service managers are usually responsible for establishing new programs. Many different methods have been used successfully to implement new clinical pharmacy services. These methods vary greatly when services are forced into development during a crisis situation as opposed to having time to employ strategic planning. The 12-step method is ideal for pharmacy leaders who have time to plan the best process for service development. However, individual hospital demographics may dictate the most effective plan for new program development. Teaching versus community hospitals and for-profit versus not-for-profit hospitals have very diverse philosophies. Clinical coordinators must assume a selling role when writing program proposals. The future of pharmacy will depend on the ability of the pharmacy leaders to establish patient-focused services that are also cost-effective.

Design and implementation of a patient-focused food service

A multi-disciplinary TQM team was established to design and implement a food service system with its primary goal to be totally patient-focused. The newly designed patient-focused food service system includes the following: (1) Food service delivers and picks up all meals, nourishments, and special requests. Appropriate charting is completed for appetite and amount consumed. (2) Meals are set up at the bedside table on a placemat (no tray). Only china, glassware and silverware are used; no plastic or disposable dishware is used. (3) No printed menu is given to the patient. Meal selections are obtained prior to that particular meal and all order taking is done verbally. (4) The patient menu follows the American Heart Association guidelines and adjustments were made to eliminate much of the modified diet food preparation. (5) Food service representatives work a 10-hour shift so all 3 meals are served by the same food service representative. (6) The food service representatives wear black slacks, a white shirt, vest and apron to distinguish them from the nursing staff.

Patient-focused Care Service Models and Nursing

Patient-focused Care Service Models and Nursing

Alkaline phosphatase activity in cultured skin fibroblasts from fibrodysplasia ossificans progressiva.

Alkaline phosphatase activity in four strains of cultured skin fibroblasts obtained from a patient with fibrodysplasia ossificans progressiva was at the low normal range. The enzyme activity in normal fibroblasts...

New Statement designed to help in organizing, operating, and evaluating effective, patient-focused services

New Statement designed to help in organizing, operating, and evaluating effective, patient-focused services