Problems In Care Delivery Research Articles

A review of deaths in surgery using the structured judgement case note review process

Introduction In December 2016, the Care Quality Commission published a review of how National Health Service trusts investigate patient deaths. Provider organisations and commissioners must work together to review and improve their local approach following the death of people receiving care from their services. Methods The Royal College of Physicians led the National Mortality Case Record Review programme based on the qualitative approach developed by Professor Hutchinson and colleagues at the Yorkshire and Humber Academic Health Science Network. The structured case note review (SCNR) is divided into six phases followed by an overall judgement of the quality of care and of the medical records. We have modified the SCNR to include a section for returns to theatre. The process also includes an assessment of whether any shortcomings in the quality of care contributed to death. Results This paper reports the results of the first 172 SCNRs undertaken in surgery at the Royal United Hospital in Bath. The vast majority (97%) of patients were admitted as emergencies. Overall care was graded as poor in four cases, with problems identified in three cases that were likely to have contributed to death. Two of the recurring themes for learning were failure to escalate a deterioration in the National Early Warning Score and delays in recognising deterioration due to acute surgical problems on medical wards. Conclusions Learning from mistakes is fundamental. The SCNR offers a process to identify both good and poor practice as well as bringing to light previously unrecognised care delivery problems.

Precision Palliative Care as a Pragmatic Solution for a Care Delivery Problem.

Precision Palliative Care as a Pragmatic Solution for a Care Delivery Problem.

Considering the role of medical radiation technologists to mitigate the care delivery problems associated with nasogastric tube verification and improve patient care

IntroductionMisplaced nasogastric (NG) tubes can have deleterious consequences for patients, including death. Medical radiation technologists (MRTs) may be well-positioned to improve the NG tube verification process. The objective of this study was to identify the care delivery problems (CDPs) associated with verifying NG tube placement and to consider where MRTs may mitigate current challenges. MethodsThis study involved three sources of data; a data audit of NG tube chest x-rays (CXRs), a review of related incident reports, and a staff survey, all conducted in the general radiography departments at two large, affiliated teaching hospitals in Toronto, Ontario. ResultsOver a 36-month period, 9,655 NG tube examinations were performed. Just over half of all exams (55.5%) required a single image for verification, while 10.1% required four or more images. The median time an MRT spent for an NG tube examination was 13.5 minutes, with 45.4% of exams completed in 10 minutes or less, while 4.5% required over 30 minutes. 118 incident reports and 57 survey submissions suggested five key CDPs; delayed verification, lack of verification, incorrect verification, increased radiation exposure, and inefficient workflow. ConclusionsCDPs associated with verifying NG tube placement can lead to poor patient care and inefficient workflows. The results of this study suggest that there may be value in future exploration of additional responsibility for MRTs as a potential solution for improving the NG tube process and thus patient care.

To Effectively Address Complex Healthcare Problems, Continuing Professional Development Must Evolve.

Continuing professional development aims to provide health professionals with the knowledge, skills, and competencies needed to improve care. Physicians and other clinicians increasingly practice within complex health care delivery organizations aiming to improve the care of populations of patients with multiple problems and differing needs. These organizations are composed of local units in different departments and venues; these teams and the patients they care for change over time. Improving outcomes within constantly changing complex organizations delivering population care takes time and persistence. It takes time to equip critical masses of clinicians and other personnel with knowledge and skills to effect change. Although some changes might be simple, those involving new workflows require implementation support. Not all change will be smooth; individuals need opportunities to learn from and adjust their early intervention efforts, measure effectiveness of change, and sustain successful practices. Longitudinal support is necessary to affect change over complex organizations. This essay proposes that to be more supportive and valuable to health care delivery organizations, continuing professional development needs to intentionally participate in longitudinal, collaborative, context-specific, team-based interventions. An expanded menu of evaluation approaches will better describe the role of continuing professional development in helping health care professionals and organizations address increasingly complex health care delivery problems and improve patient and population outcomes. Selected concepts to achieve these ends are introduced at a high level in this article. Readers are invited to explore concepts that resonate with their current situation in further detail.

Dental caries and access to oral health services among children and adolescents

There are many social, economic, political and cultural factors that affect the ability of developing and resource poor countries to provide adequate oral health care for its people, including children and adolescents. Untreated carious teeth are common findings in African children, and Restorative index and Met Need Index among children and adolescents are very low. This could be as a result of limited access to oral health services in terms of cost, accessibility, awareness, acceptability and availability. Access tooral health care service among children for preventive, restorative, rehabilitative and curative purpose is important for optimal oral health and wellbeing of a child. Access to oral health services is limited in African countries, and carious teeth are often left untreated. The challenges associated with access to oral health care are common in African countries. They are faced with continuous oral health care delivery and access problems with variation in the availability of dentists between countries and poor funding for oral health. Most of the dentists that practice in African region are mostly delivering oral health services to children and adolescents in urban areas than rural areas. This can contribute to oral health inequalities among children and adolescents in slum areas, riverine areas, rural and remote areas. After searching articles from electronic databases, the aim of this article is to review the burden of dental caries, the dentist to patient ratio, Restorative index and Met need index of children and adolescents.

Root Cause Analysis (RCA) of Adverse Events in One of the Biggest Western Iranian General Hospitals: Short Communication

Background: In developing and underdeveloped countries, medical error is often either not reported or reported improperly for various reasons. Root cause analysis (RCA) is a systematic method to determine how various factors contribute to the occurrence of medical errors. Objectives: The current study analyzed the root cause of one of western Iran’s biggest general hospitals. Methods: This retrospective RCA was conducted through a qualitative approach in 2019 following the National Patient Safety Agency (NPSA) protocol in seven steps: Initialization of the process, collecting and mapping information, identifying issues related to care delivery problems (CDP) or service delivery problems (SDP), event analysis, identifying the involved factors in the event - root causes, providing solutions, implementing solutions, and submission of reports. Results: According to the results of this study, 61 cases were examined, and committees accepted the errors in 11 cases. Here, 49 CDP and 13 SDP factors were identified. Care delivery problems factors were selected for all events based on the team’s viewpoints. Overall, task-related causes (20 cases), individual causes (17 cases), management-related causes (14 cases), training-related causes (8 cases), and causes related to work environment and conditions (7 cases) were specified. Conclusions: Accepting mistakes is the first step in the hope of improvement. In this hospital, only 11 cases of mistakes had been accepted by the authorities. In most cases, the proposed solutions to this issue included personnel training, monitoring system strengthening, and developing and standardizing processes. Overall, this study and other similar studies showed errors during service delivery and through service providers.

Application of systems analysis to safety incident investigations in a single centre using anaesthesia as an example.

Systems analysis is widely recommended for patient safety investigations in medicine, but the method is poorly described in the veterinary literature. Anaesthetic safety incidents were discussed in debriefs and then reported on standardised forms. Investigators performed informal interviews with team members involved in case management and interrogated clinical records. Finally, incidents were discussed during morbidity and mortality conferences. Systems analysis involved developing a timeline for the case, identifying any care delivery problems (CDPs) that occurred and contributing factors associated with them, and developing control measures to reduce system weaknesses. From 15 incidents, 32 CDPs were identified. These were categorised into 11 thematic groups. Misdiagnosis (n = 8), human resource allocation (n = 8), failure in planning (n = 6) and technical error (n = 5) were most frequent. Individual factors were identified in 15 (100%), team factors in 12 (80.0%), animal and owner factors in 11 (73.3%), organisation factors in 10 (66.7%), work environmental factors in 10 (66.7%) and task and technology factors in four (26.7%) investigations. Numerous immediate and longer term recommendations were made regarding how to manage systems weaknesses. Investigations were limited to pre-procedural anaesthetic safety incidents. Systems analysis applied to incident investigations can highlight areas for improvement within veterinary healthcare systems.

Patient safety in community-based mental healthcare: A systematic scoping review

IntroductionThere is limited existing research about patient safety issues in mental healthcare. A lack of evidence is particularly pronounced in relation to safety in community-based mental health services, where the majority of care is provided. To date, reviews of mental health patient safety literature have focused primarily on inpatient care settings.ObjectivesThis systematic scoping review will aim to identify and synthesise literature about the types of patient safety problems in adult community-based mental health settings, the causes of these problems, and evaluated safety interventions in this care context.MethodsA systematic search was conducted on 19th June 2020 and refreshed on 23rd October 2021, across five databases: Medline, Embase, PsycINFO, Health Management Information Consortium, and Cumulative Index to Nursing and Allied Health Literature. The search strategy focused on three key elements: ‘mental health’, ‘patient safety’ and ‘community-based mental health services’. Retrieved articles were screened at title, abstract and subject heading level, followed by full-text screen of longlisted articles.ResultsIn this presentation, the findings of this systematic scoping review will be described, based on synthesised literature about safety incidents, broader care delivery problems, their causes, and evaluated patient safety interventions to address these issues.ConclusionsThis study will offer learning opportunities about the safety problems, contributory factors, and safety interventions in adult community-based mental health services, as described in the evidence base. Review findings will also help to ascertain gaps in existing research, which should be addressed in future studies.Disclosure NS is the director of London Safety and Training Solutions Ltd, which offers training in patient safety, implementation solutions and human factors to healthcare organisations and the pharmaceutical industry. The other authors have no competing interests.

Commentary on “Integrating network theory into the study of integrated healthcare”

As medicine continues to advance, fragmentation problems in care delivery – and the promise of care integration to solve them – will remain central. But focused research over the past thirty years has yet to uncover the key factors that enable integrated care. In their paper, Burns and colleagues offer a path to new discovery in this well-trodden area: drawing on network theory to better understand the social processes through which integrated care is produced. Social processes are a vital and understudied aspect of integration, and applying network theory may help to refocus integration in a more comprehensive way. However, to transform our understanding of integrated care – and to enable impact in practice – will require expansion beyond the usual network approaches to also capture the communication and work processes that occur among entities. This is no small endeavor. It will take considerable humility, open-mindedness, and focus.

Healthcare-related infections within nursing homes (NHS): A qualitative study of care practices based on a systemic approach

Background Infectious events, often related to healthcare practice, occur frequently within Nursing Homes (NHs), representing one of the main causes for morbidity, hospital admissions and mortality. The aims of this study are the analysis of care delivery problems and contributory factors of healthcare-related infections in a sample of NHs. This research could help identify organizational, technological and behavioural aspects, to implement improvement actions and reduce the impact of infections in long-term care. Methods The study is a qualitative research with a systemic approach, based on the analysis of interactions in real practice between human factors, technologies and organizational structure and processes in 7 NHs in Tuscany (Italy), through extensive and structured observations of daily practices. The collected data were analyzed by applying clinical and ergonomic competences, comparing the data collected with established safe practices. The study was conducted by a nurse and a psychologist Results From the data several problems related to infection control emerge. Buildings are often not suitable for confined spaces, room ventilation, natural light and rapid emergency response. Hand washing is not sufficient, use of antibiotics is usually not adequate. The microclimate is often not adequate, hygienic procedures are not always flawless. Staff members are in small numbers. Discussions This study highlights high risk of contracting infections related to NHs. The study shows that dedicated infection prevention guidance are needed, to develop a local plan integrated with hospital setting, customized to needs of guests and characteristics of long-term care facilities, supported by a deep understanding of daily practices.

Process optimization in breast imaging: Exploring advanced roles for medical radiation technologists

IntroductionMedical imaging (MI) is a critical service that underpins the care journey for many who enter the healthcare system. The subspecialty of Breast Imaging (BI) represents a complex and multi-modality MI setting with a well-defined role in the healthcare system. BI holds great potential as a setting to consider opportunities for a medical radiation technologist's (MRT) current role to be modified and leveraged to fulfill novel and advanced roles to optimize patient-centered service. MethodsThis study was conducted in three interrelated BI clinics, all at large urban academic hospitals with a common operational infrastructure. It involved three phases; (i) mapping processes and workflows in BI (ii) identification and characterization of care delivery problems (CDPs) within these process maps, and prioritization of opportunities where task shifting might leverage enhanced knowledge, skills, and judgement of MRTs to optimize care. The PEPPA framework - a systematic planning tool for the development and implementation of advanced practice nursing (APN) roles5 - was used, with the first five of nine steps considered in scope for this pilot project. ResultsTwelve distinct BI processes were identified and mapped as swimlane charts; a single clerical workflow leading up to patient check-in to the BI department, and 11 subsequent clinical processes. Each map included swimlanes for MRTs, radiologists, and clerical staff, as relevant, and included processes ranging from routine mammogram and ultrasound orders to stereotactic-guided core biopsies and rapid diagnostic workflows. Across the maps, 9 CDPs were identified; scheduling, radiologist availability, incorrect orders, and coordination of externally-acquired imaging and consults. The inpatient process map had the most instances of CDP identified, and the radiologist availability CDP was flagged most frequently across processes. Characterization of the root causes of each CDP led to common reflections on team and task factors, including inefficiencies in communication or division of responsibilities, or availability of resources or team members to support workflows.Consultations based on the resultant maps and CDPs led to identification of the following potential advanced roles for MRTs; review and decision-making relating to imaging acquired externally prior to patient appointments, exam ordering and protocoling in defined scenarios, and task-shifting of certain clinical procedures such as breast screening ultrasounds and contrast-enhanced mammography. ConclusionAdvanced practice for MRTs holds great potential to address system inefficiencies in breast imaging, if approached systematically and with the primary objective to optimize care. Future work will consider trial and evaluation of pilot roles that incorporate advanced opportunities identified in this project.

Improving Column Generation for Vehicle Routing Problems via Random Coloring and Parallelization

We consider a variant of the vehicle routing problem (VRP) where each customer has a unit demand and the goal is to minimize the total cost of routing a fleet of capacitated vehicles from one or multiple depots to visit all customers. We propose two parallel algorithms to efficiently solve the column-generation-based linear-programming relaxation for this VRP. Specifically, we focus on algorithms for the “pricing problem,” which corresponds to the resource-constrained elementary shortest path problem. The first algorithm extends the pulse algorithm for which we derive a new bounding scheme on the maximum load of any route. The second algorithm is based on random coloring from parameterized complexity which can be also combined with other techniques in the literature for improving VRPs, including cutting planes and column enumeration. We conduct numerical studies using VRP benchmarks (with 50–957 nodes) and instances of a medical home care delivery problem using census data in Wayne County, Michigan. Using parallel computing, both pulse and random coloring can significantly improve column generation for solving the linear programming relaxations and we can obtain heuristic integer solutions with small optimality gaps. Combining random coloring with column enumeration, we can obtain improved integer solutions having less than 2% optimality gaps for most VRP benchmark instances and less than 1% optimality gaps for the medical home care delivery instances, both under a 30-minute computational time limit. The use of cutting planes (e.g., robust cuts) can further reduce optimality gaps on some hard instances, without much increase in the run time. Summary of Contribution: The vehicle routing problem (VRP) is a fundamental combinatorial problem, and its variants have been studied extensively in the literature of operations research and computer science. In this paper, we consider general-purpose algorithms for solving VRPs, including the column-generation approach for the linear programming relaxations of the integer programs of VRPs and the column-enumeration approach for seeking improved integer solutions. We revise the pulse algorithm and also propose a random-coloring algorithm that can be used for solving the elementary shortest path problem that formulates the pricing problem in the column-generation approach. We show that the parallel implementation of both algorithms can significantly improve the performance of column generation and the random coloring algorithm can improve the solution time and quality of the VRP integer solutions produced by the column-enumeration approach. We focus on algorithmic design for VRPs and conduct extensive computational tests to demonstrate the performance of various approaches.

Simple Mobile technology health management tool for people with severe mental illness: a randomised controlled feasibility trial

BackgroundSevere mental illness (SMI) is associated with care delivery problems because of the high levels of clinical resources needed to address patient’s psychosocial impairment and to support inclusion in society. Current routine appointment systems do not adequately foster recovery care and are not systematically capturing information suggestive of urgent care needs. This study aimed to assess the feasibility, acceptability, and potential clinical benefits of a mobile technology health management tool to enhance community care for people with severe mental illness.MethodsThis randomised-controlled feasibility pilot study utilised mixed quantitative (measure on subjective quality of life as primary outcome; questionnaires on self-management skills, medication adherence scale as secondary outcomes) and qualitative (thematic analysis) methodologies. The intervention was a simple interactive technology (Short Message Service - SMS) communication system called ‘Florence’, and had three components: medication and appointment reminders, daily individually defined wellbeing scores and optionally coded request for additional support. Eligible participants (diagnosed with schizophrenia, schizoaffective disorder or bipolar disorder ≥1 year) were randomised (1:1) to either treatment as usual (TAU, N = 29) or TAU and the technology-assisted intervention (N = 36).ResultsPreliminary results suggest that the health technology tool appeared to offer a practicable and acceptable intervention for patients with SMI in managing their condition. Recruitment and retention data indicated feasibility, the qualitative analysis identified suggestions for further improvement of the intervention. Patients engaged well and benefited from SMS reminders and from monitoring their individual wellbeing scores; recommendations were made to further personalise the intervention. The care coordinators did not utilise aspects of the intervention per protocol due to a variety of organisational barriers. Quantitative analysis of outcomes (including a patient-reported outcome measure on subjective quality of life, self-efficacy/competence and medication adherence measures) did not identify significant changes between groups over time in favour of the Florence intervention, given high baseline scores. The wellbeing scores, however, were positively correlated with all outcome measures.ConclusionIt is feasible to conduct an adequately powered full trial to evaluate this intervention. Inclusion criteria should be revised to include patients with a higher level of need and clinicians should receive more in-depth assistance in managing the tools effectively. The preliminary data suggests that this intervention can aid recovery care and individually defined wellbeing scores are highly predictive of a range of recovery outcomes; they could, therefore, guide the allocation of routine care resources.Trial registrationISRCTN34124141; retrospectively registered, date of registration 05/11/2019.

ПРОБЛЕМЫ НОРМАТИВНОГО И КАДРОВОГО ОБЕСПЕЧЕНИЯ УРОЛОГИЧЕСКОЙ ПОМОЩИ, ОКАЗЫВАЕМОЙ В АМБУЛАТОРНЫХ УСЛОВИЯХ ВЗРОСЛОМУ И ДЕТСКОМУ НАСЕЛЕНИЮ

Significance. The regulatory and staffing problems in urological care delivery to adults and children in outpatient settings, combined with the high social significance of diseases of the genitourinary system for the population of different age, potentially threaten successful implementation of the priorities of the state demographic policy. Purpose: to identify problems in regulation and staffing in urological care delivery to adults and children on the outpatient basis in the Russian Federation in 2015-2019. Material and methods. The study used data of the Fedral statistical observation Form No. 30 "Information about a medical organization" for the period 2015-2019. Statistical processing of the study materials was carried out by methods of descriptive statistics. Results. The analysis has identified contradictions in the orders of the Ministry of Health of the Russian Federation, which currently regulate staffing in urological care. The number of full-time and occupied positions of urologists in 2015-2019 decreased, which, coupled with the increased number of individuals, resulted in the increased number of urologists (+3.1%), increased level of staffing of individuals up to 62.9%. At the same time, the part-time coefficient among urologists remained high adding up to to 1.3. In 2015-2019, the number of full-time and occupied positions and individual pediatric urologists-andrologists increased, against the background of extremely low staffing level of individuals equalling to 26.7% in 2019 without any significant dynamics over a 5-year period. The function of the urologist position remained unchanged (4072 appointments per position in 20194 and 4181.3 in 2015), while the function of the pediatric urologist-andrologist position increased from 4215 appointments per position in 2015 to 5342 in 2019 (+ 26,7%). The integral staffing coefficient had a negative trend especially in relation to pediatric urologists-andrologists. Conclusions. The growth in the number of individual urologists and pediatric urologists-andrologists in 2015-2019 did not result in any significant changes in the staffing levels in the urological care delivery to adults and children on the outpatient basis. It is necessary to update the staffing standards, objectify statistical reporting and take urgent measures to bridge the shortage of doctors in outpatient settings. Scope of application. The study results can be used for timely updates of regulatory legal acts, staffing schedules of medical organizations in planning and implementing human resource programs aimed at eliminating personnel shortages and imbalances.

COVID-19: Mobilizing Quickly for a Rapid Response.

COVID-19: Mobilizing Quickly for a Rapid Response.

Geisinger Commonwealth School of Medicine.

Geisinger Commonwealth School of Medicine.

Critical Care Delivery Solutions in the Emergency Department: Evolving Models in Caring for ICU Boarders

The National Academy of Medicine has identified emergency department (ED) crowding as a health care delivery problem. Because the ED is a portal of entry to the hospital, 25% of all ED encounters are related to critical illness. Crowding at both an ED and hospital level can thus lead to boarding of a number of critically ill patients in the ED. EDs are required to not only deliver immediate resuscitative and stabilizing care to critically ill patients on presentation but also provide longitudinal care while boarding for the ICU. Crowding and boarding are multifactorial and complex issues, for which different models for delivery of critical care in the ED have been described. Herein, we provide a narrative review of different models of delivery of critical care reported in the literature and highlight aspects for consideration for successful local implementation.

4375 Developing team science for practical applications of artificial intelligence in health systems to improve value and outcomes: A case study in reducing avoidable emergency department use

OBJECTIVES/GOALS: Health care systems are complex, dynamic, and varied. Advances in artificial intelligence (AI) are enabling healthcare systems to use their own data to elicit patterns and design suitable interventions. To realize this potential, computer scientists and clinicians need an effective, practical, and replicable approach to collaboration METHODS/STUDY POPULATION: In this study, computer scientists partnered with clinicians to investigate predictors of avoidable emergency department use. The team sought an approach to computational medicine that could increase the relevance and impact of prediction to solve pressing problems in the health system. The team adopted an emergent architecture that engaged system leaders, computer scientists, data scientists, health services researchers, and practicing clinicians with deep ambulatory and inpatient knowledge to form the initial questions that shaped the prediction model; to understand nuances of coding and recording in source data and the implications for models; and to generate insights for promising points of intervention. The team recorded decisions and challenges as it progressed to analyze its function. RESULTS/ANTICIPATED RESULTS: Most avoidance models focus on a narrow time period around target events, or on high cost patients and events. This interdisciplinary team used their insights into the health system’s workflows and patient population to adopt a longitudinal approach to their prediction models. They used AI to build models of behavior in the system and consider prevention points across clinical units, time, and place. The holistic, systemwide focus enabled the team to generate insights that the system leaders and subsequently specific clinical units could apply to improve value and outcomes. A facilitated team process using learning system and cooperative network principles allowed a large and modular interdisciplinary team to build a transparent AI modeling process that yielded actionable insights into hypercomplex workflows. DISCUSSION/SIGNIFICANCE OF IMPACT: An architecture for involving diverse stakeholders in computational medicine projects can increase the relevance and impact of AI for solving care delivery problems in complex health systems. Translational science and computational medicine programs can foster this type of engagement and encourage a whole system perspective.

Innovating Cancer Care Delivery: the Example of the 4R Oncology Model for Colorectal Cancer Patients.

Care delivery innovation is necessary to address the growing complexity of cancer care across specialties and integrate new diagnostics, treatments, and services into care delivery. Informed by Cancer Care Delivery Research (CCDR), multilevel intervention research, and other disciplines, this article describes the 4-step cancer care delivery innovation cycle. The cycle guides collaborative efforts of cancer clinicians, researchers, patients, and other stakeholders to systematically define care delivery problems and formulate, test, and implement care innovations to effectively address problems. We illustrate the 4 steps of the innovation cycle with the example of developing the 4R Oncology Model for colorectal cancer (4R is Right Information and Right Care for the Right Patient at the Right Time). The 4R is a multilevel intervention informed by CCDR, the team science, and lessons learned from other models, such as survivorship care planning. We offer additional considerations for balancing the need to innovate with concerns about constrained resources and overextended workforce. We suggest to focus on care delivery models which are synergistic with other efforts and do not require extensive information systems support in earlier cycles of development.

Emerging Health Care Model in India: Road-Map for Universal Healthcare

Background India with 1.34 billion population is facing unique health care delivery problems particularly regarding the poor spending on health, access, quality, safety, lack of accountability, corruption, etc. Inequalities and health-related expenses resulting in impoverishment further marginalises the poor, underprivileged and outreach. The government of India has come up with a highly ambitious initiative Ayushman Bharat - National Health Protection Mission (AB-NHPM) as a shift from traditional health planning approaches towards a comprehensive healthcare vision. Methods Literature available, government publications, documents, press releases and other related material has been consulted to critically analyse the NHPM initiative. Results AB-NHPS was officially announced by Prime Minister Narendra Modi on 15 August 2018, in his Independence Day speech. This flagship project will be launched on September 25. The objective of ambitious AB-NHPSis to provide coverage of INR 500,00 per family annually, benefiting more than 10 crore poor families. The scheme will target poor, deprived rural families and identified occupational category of urban workers' families, 8.03 crore in rural and 2.33 crore in urban areas, as per the latest Socio-economic Caste Census (SECC) data. The eligibility criteria include: 10 crore families belonging to poor and vulnerable population based on SECC database, will take care of almost all secondary care and most of tertiary care procedures, the entitlement will be decided on the basis of deprivation criteria in the SECC database, automatically included families in rural areas having any one of the following: households without shelter, destitute, living on alms, manual scavenger families, primitive tribal groups, legally released bonded labour, will also come under this scheme. For urban areas, 11 defined occupational categories will be entitled under the scheme, the treatment in case of hospitalization will be free of cost for the family, all pre-existing conditions will be covered from day one of the policy. The benefit cover will include pre and post hospitalization and the beneficiary will be able to go to public or empanelled private hospitals across the country and get free treatment. Conclusion The NHPS enjoys a guaranteed potential to improve the lives of millions of Indians. The scheme is prominent against the backdrop that several Central Ministries and State/UT Governments have launched health insurance/ protection schemes for their own specific set of beneficiaries. To improve their efficiency, reach and coverage, a critical need has been recognized to converge these schemes, such as the Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS). This article presents the critical analysis of policy initiative, philosophy, key features, implications, impact, concerns, constraints and paving the way for future healthcare solutions. Funding: Not Applicable Declaration of Interest: None Ethical Approval: Not Applicable/Not Required