Thinking In Healthcare Research Articles

Mental health, subjective experiences and environmental change

This article responds to Coope’s call for the medical humanities to address the climate crisis as a health issue. Coope proposes three areas for progress towards ecological thinking in healthcare,...

Is a unified model for patient empowerment possible or desirable?

Background: Patient empowerment has a history going back to the 1960’s ( Kayser et al. BMC Health Services Research (2019) 19:242) and originates in the movement for greater citizen participation in societal decision-making (e.g. ‘power to the people’). In the decade of the 1970’s there was a related shift in some healthcare thinking.
 While there has been a proliferation of terms, such as citizen engagement, patient participation, patient empowerment, patient activation and so forth, the fundamental underlying principle is the shift from the patient/citizen as a passive recipient of services to the patient /citizen as active, informed participant in their own health and healthcare.
 These shifts have been reflected in health care policy- person/patient centred care, personalised care and integrated care all put forward models of working that are designed to enhance patient empowerment and a shift from a bio-medical model of health care t a more holistic bio- psychosocial model of care
 Although there had been active proponents of this change, especially in parts of Northern Europe it remains a fragile part of health care
 Method: Unlike some health topics, although patient empowerment is often cited, for example in relation to current work on health technology including mHealth, there appears to be no overarching consensus on a strategy for local implementation, nor even how patient empowerment is defined for strategic purposes. This survey aimed to gather information which would, when collated, help to address these issues. To explore the current standing of patient empowerment at the beginning of 2021 a survey of experts including people expert in lived experience was carried out in a number of European countries (the final total was 25 responses from 14 countries) 
 This was followed up in 2022 by a international round table event of people of lived experience, researchers, policy makers and leading experts to explore this issue and to record the discussion as a marker for future thinking about the concept.
 Results and conclusions: Despite significant activity it was clear it was very siloed and y the concept was diversely defined or interpreted in practice.
 We concluded it seems that the majority of respondents from the 14 countries only use aspects of the concept with no common understanding.
 . If there is such a disparate use of terminology, is it meaningful to refer to ‘empowerment’ as a definition of anything? Is there a better term to use for an umbrella concept?
 These findings confirm that concepts such as person centred care, personalised care and patient empowerment have considerable variations in how they are understood.
 This has significant implication for their implementation when there is such diverse understandings at all levels - Macro, Miso and Micro leading to fragmentation and a lack of a unified approach to evaluation.

In-depth Historical Analysis of Healthcare Screening Systems

Purpose: The management facilitated by Triage Systems raises numerous inquiries for both healthcare professionals and users, rendering it an increasingly pertinent concern. In Portugal, emergency services cater to millions of individuals annually. The dynamic shifts in care are abundant and contingent on the specific nature of the healthcare required. Change, therefore, stands as a perpetual element in the realm of medicine, with alterations unfolding at an accelerating pace and growing complexity. Within the realm of emergency services, Triage serves as the inaugural stage in the healthcare delivery process. It necessitates a meticulous and rigorous approach, a task reserved for adept professionals who are adequately prepared for responsibility. The intricate nature of Triage underscores its pivotal role, setting the tone for the subsequent stages of healthcare provision. As the landscape of healthcare continues to evolve, the effectiveness and precision of Triage become even more crucial, emphasizing the need for ongoing training and adaptability among healthcare professionals.
 Design/Method/Approach: The methodology of the research consists of a thorough literature review to compare different screening systems in healthcare, to better understand the current situation.
 Findings: The findings indicate that the Screening System is both valid and beneficial. Nevertheless, ongoing adjustments in service management are required to enhance its effectiveness and alignment.
 Theoretical Implications: This paper explores how healthcare screening systems have evolved over time, tracing their roots from historical practices to modern technologies. It identifies paradigm shifts in healthcare thinking, policy and technology that have influenced the development of screening systems.
 Practical Implications: The screening system is a vital process mandated for all individuals seeking assistance in the emergency department, serving to ascertain the severity of their clinical condition. The primary goal of this assessment is to delve into the historical evolution of Screening Systems in Healthcare. Presently, in Portugal, the Manchester Sorting System stands out as the predominant and widely utilized approach.
 Originality/Value: The study provides a comprehensive comparative analysis of healthcare screening systems.
 Research Limitations/Future Research: Future studies could perform other types of analyses. Namely, qualitative ones in which health professionals gave opinions.
 Paper Type: Conceptual
 JEL Classification: I1, M1

A framework for lean implementation in preoperative assessment: Evidence from a high complexity hospital in Italy.

Purpose: A routine preoperative assessment is considered both ineffective and inefficient. Despite the widespread application of lean thinking in healthcare, there is little evidence of successful experiences in preoperative admissions in order to reduce "No value added" activities. A conceptual framework reporting the drivers (clinic, tools, innovation, organization, and governance) and impacts (patient, efficiency, sustainability, time, learning and growth) was developed. Methodology: Drawing on the experience of an Italian high complexity hospital, this paper analyzes the case study by reporting evidence on how to implement lean in preoperative assessment and how to evaluate the positive results obtained. Results: Applying lean principles, the identification of value improved the appropriateness of care by creating 40 personalized pathways; the value stream resulted in a reduction of "No Value Added Time" from 37% to 28%, chest X-rays from 41% to 14% and cardiac visits from 49% to 37%; the pursuit of continuous flow through innovation contributed to increase the use of digitalization; the new pull organization helped to reduce the average time spent per year by 1.5h; the continuous improvement was ensured through the governance of results. Conclusion: The proposed framework should be used to improve the quality of care in preoperative admissions by adopting the lean drivers for successful implementation and reporting the impacts.

Quality and Safety in Healthcare, Part XCI: Lean Thinking in Healthcare.

Lean thinking refers to the thought processes utilizing the main characteristics of Lean to improve processes, reduce waste, and increase value to the customer. Lean thinking can be used to improve health care organizations using such tools as the A3 form, root-cause analysis, value stream maps, Gemba walks, kaizen events, and defining standard work. Examples are given about how Lean thinking improved scheduling and productivity, as well as better compliance regarding core measures and adherence to best practices. Lean thinking examples are also given which resulted in less need for space, inventory, and personnel, and a decrease in hospital-acquired infections.

Design Thinking for Healthcare: Transliterating the Creative Problem-Solving Method Into Architectural Practice.

The purpose of this article is to define design thinking, provide insights into how it may be integrated into the healthcare design process, and provide a checklist for future implementation. Design thinking is a collaborative method of inquiry that fosters innovative, team-generated solutions to complex scenarios, known as "wicked problems," that are extraordinarily difficult to solve. It is a practical tool in the toolbox of the codesign team, which includes the client and design professionals as primary stakeholders. It is powered by team-based creativity that adaptively responds to a need for new approaches and products in an innovative and practically applicable way. The need for design thinking in healthcare is steadily increasing as the healthcare system and its care environments continue to grow in complexity. Although major medical breakthroughs have undeniably expanded the average human life span, the current healthcare system is inefficient. Now, more than ever, design thinking and the innovative, human-centered solutions it enables are needed within healthcare design. Although the use of design thinking as a method within the field of architecture is not new, many design teams struggle integrating it fully within the design process, particularly in healthcare. The knowledge, design method, checklists, and direction provided in this article can benefit healthcare design teams to successfully integrate the method into practice. If design thinking is integrated into the healthcare architectural design process with the creative problem-solving method, opportunities will arise for innovative solutions and deeper insights into problems to benefit healthcare delivery.

The tourism knowledge translation framework: bridging the canyon between theory and practice

ABSTRACT The purpose of this conceptual paper was to develop the Tourism Knowledge Translation (TKT) framework, which is positioned as a possible solution to the critical disconnect that has for some time plagued tourism theory and practice. It is adapted from state-of-the-art thinking in healthcare, and acts as a roadmap for managing a sizeable base of knowledge from academic studies; massaging this knowledge into a format that policymakers and practitioners can understand; developing specific methods and tools for use that are held in a knowledge repository; choosing the best studies for inclusion in the system; and making sure this knowledge gets into the hands of industry people quickly. The two principal domains of the TKT framework, Knowledge Creation and the Action Cycle, are applied to the current over-tourism situation in Corsica, and the effects the tourism industry is having on the breeding success of osprey.

Six-Sigma And Lean Thinking in Healthcare: A Comprehensive Literature Review And Critical Assessment

Six-Sigma And Lean Thinking in Healthcare: A Comprehensive Literature Review And Critical Assessment Eisenhower C. Etienne, Ph.D; Mineke E. Etienne, MD, FACFP Abstract Purpose: This paper undertakes a comprehensive review of the literature on six-sigma and lean thinking in healthcare as the basis for critically evaluating current success in their deployment in the healthcare industry. Design/methodology/approach: A reasonably exhaustive search of the literature was undertaken. This search targeted both research on six-sigma and lean thinking and specific research on six-sigma and lean thinking in healthcare. Findings: Five conclusions emerge from the review. First, the measurable impact of six-sigma and lean thinking on the quality, cost, responsiveness and efficiency of healthcare organizations as evidenced by the results reported for improvement projects is modest, at best. Second, six-sigma and lean thinking improvement projects have targeted a very limited range of areas. There is no evidence of attempt to evaluate the extent to which these improvement were long lasting or permanent. Third, the improvement projects uncovered by our literature review generally leave untouched the core technologies, practices and methods of medical practice and delivery of healthcare. This means that none of the cases reported targeted or achieved the deep and permanent culture change that is the sine qua non of six-sigma and lean thinking implementation. Fourth, we uncovered no case of a healthcare organization that can be said to be prototypical six-sigma or lean thinking one of the calibre of Toyota Production System (TPS) or GE Capital. Finally, our research found no systematic attempt to build a theory of healthcare service delivery processes/operations. Such a theory is a pre-requisite to the systematic adaptation of six-sigma and lean thinking in these organizations. Originality/value: First, this research has documented the state-of-the-art on the deployment of six-sigma and lean thinking in healthcare. Such documentation is the first step in any systematic effort to identify areas where progress has been made as well as avenues for further research. The review demonstrates that very little systematic deployment of six-sigma and lean thinking in healthcare has been achieved and that the field of research is fundamentally wide open. Second, the review provides rather conclusive evidence that pronouncements to the contrary, the broad applicability of six-sigma and lean thinking, as these paradigms were originally conceived of and as they are currently used to guide research in healthcare, is far from established. Third, the very weak results of research undertaken thus far speak rather forcefully to the need to make radical change in the six-sigma and lean thinking paradigms to make them applicable to healthcare organizations. Fourth, the identification of a need for a theory of healthcare organizations may prove to be significant for the deployment of six-sigma and lean thinking in healthcare. Full Text: PDF DOI: 10.15640/rcbr.v9n1-2a2

Scientific thinking in health care

Scientific thinking in health care

OM Forum—Supply Chain Thinking in Healthcare: Lessons and Outlooks

Problem definition: The lessons learned over decades of supply chain management provide an opportunity for stakeholders in complex systems, such as healthcare, to understand, evaluate, and improve their complicated and often inefficient ecosystems. Academic/practical relevance: The complexity in managing healthcare supply chains offers opportunities for important and impactful research avenues in key supply chain management areas such as coordination and integration (e.g., new care models), mass customization (e.g., the rise in precision medicine), and incentives (e.g., emerging reimbursement schemes), which might, in turn, provide insights relevant to traditional supply chains. We also put forward new perspectives for practice and possible research directions for the supply chain management community. Methodology: We provide a primer on supply chain thinking in healthcare, with a focus on healthcare delivery, by following a framework that is customer focused, systems based, and strategically orientated and that simultaneously considers clinical, operational, and financial dimensions. Our goal is to offer an understanding of how concepts and strategies in supply chain management can be applied and tailored to healthcare by considering the sector’s unique challenges and opportunities. Results: After identifying key healthcare stakeholders and their interactions, we discuss the main challenges facing healthcare services from a supply chain perspective and provide examples of how various supply chain strategies are being and can be used in healthcare. Managerial implications: By using supply chain thinking, healthcare organizations can decrease costs and improve the quality of care by uncovering, quantifying, and addressing inefficiencies.

Applying Design Thinking in Health Care: Reflections of Nursing Honors Program Students.

Nursing faculty at the University of Alabama at Birmingham (UAB) incorporated design thinking (DT) into the curriculum of the UAB School of Nursing Honors Program as a framework for undergraduate students' immersion into research experiences. This article describes the experiences of students who participated in the first honors class that used DT and discusses how to incorporate DT into nursing research and quality improvement projects. Active learning strategies provided students various opportunities to conceptualize and apply the five-step DT process by identifying possible solutions to problems in clinical settings. Three major themes emerged from these reflections: trusting the process, cultivating empathy, and applying DT in the future. Students found that trusting the process of learning about DT facilitated their understanding of empathy's role in health care as they recognized DT's far-reaching applications beyond the honors program. A pragmatic, intuitive, and innovative approach to identifying problems and solutions, DT empowers nurses to creatively and confidently address issues they encounter to improve outcomes for their patients, health-care systems, and communities.

Caregivers' failure to thrive: A case for health and continuing care systems transformation.

Excluding family caregivers and their goals from healthcare thinking and system design has contributed to their "failure to thrive." Family caregivers are diverse, with dynamic, enduring, and variable life course care trajectories that are largely ignored. Using a co-design approach, caregivers prioritized their goals across seven life domains in an on-line survey. Physical, mental, and emotional health goals were top priorities across all ages. However, care-related goals were not caregivers' highest priority. Goals related to financial well-being, social connections, employment, education, and care were variable across ages. Our findings suggest that transforming health and continuing care systems begins with recognizing variability of caregivers' goals across their life courses. Adopting a co-design approach with family caregivers may serve as a model to develop a collaborative health and continuing care system. One that recognizes and supports family caregivers to achieve their goals, so that they not only survive but thrive.

Circumnavigating the world of quality and patient safety: a compendium of highlights and perspectives.

Background In the UK, estimates suggest that approximately 10% of hospital admissions and 1–2% of primary care consultations result in some sort of adverse event. Globally, medication errors cost approximately US$42 billion annually, and 15% of total health spending in Organisation for Economic Cooperation and Development countries is used to deal with adverse events. Method Stemming from the Glasgow 2019 British Medical Journal and Institute for Healthcare Improvement International Forum on Quality and Safety in Healthcare (‘People Make Change’), a review of workforce characteristics, the psychology of change and design thinking in healthcare is presented. The concept of personalised care is also discussed. Conclusion In the last decade, the National Health Service in Scotland has undergone major reform around the integration of health and social care. In tandem with this, there have been a range of national initiatives to support patient safety and quality improvement. Moving forward, there is an increasing realisation of how service design, digital technologies and a national digitised infrastructure can improve services. Implications highlight the role of workforce development and in embedding design thinking in service organisation. This review article therefore presents an anthology of highlights and perspectives in improving healthcare quality and patient safety.

The ethics of positive thinking in healthcare.

In continuation with the New Thought movement that arose in the United States in the 19th Century, there is now a massive self-help industry that markets books and seminars. This industry has also extended to healthcare in the form of positive thinking, i.e., the idea that happy thoughts are essential for health. While some of these claims may seem reasonable and commonsensical, they are not free of problems. This article posits that positive thinking has some ethical underpinnings. Extreme positive thinking may promote alternative forms of medicine that ultimately substitute effective treatment, and this is unethical. The emphasis on positive thinking for cancer patients may be too burdensome for them. Likewise, unrestricted positive thinking is not necessarily good for mental health. After considering the ethics of positive thinking, this article proposes a more realistic approach.

Resilient Health Care as the basis for teaching patient safety – A Safety-II critique of the World Health Organisation patient safety curriculum

Resilient Health Care (RHC) is predicated on the idea that health care systems constantly adjust to changing circumstances. RHC has become increasingly popular as a new way to improve patient safety, but to date there is no agreed way of using RHC as the basis for teaching patient safety. A key resource for patient safety educators is the World Health Organisation (WHO) patient safety curriculum, released ten years ago. However, it is well established that patient safety thinking in healthcare has been driven largely by Safety-I principles, and this is reflected in the WHO curriculum. The aim of this paper is to review and to provide a critique of the WHO patient safety curriculum from a Safety-II perspective, in order to assess to what extent RHC principles are already incorporated, and to identify areas where RHC might make contributions to the WHO curriculum. Based on this analysis, we argue that RHC thinking could be added in modular fashion to the WHO curriculum, but that in the future a broader curriculum should be developed that integrates RHC thinking throughout.

Lean business models in healthcare: a systematic review

This paper includes the systematic literature review on lean business models used in the healthcare industry to aid in reducing waste, costs, and improving overall patient care and satisfaction. A systematic literature review was conducted to analyze lean business models used in the healthcare industry regarding lean thinking in healthcare, object technology, Six Sigma and quality models, organisational culture and lean implementation, healthcare delivery method study, clinical services redesign program, process improvement cost model, vendor managed inventory, supply chain innovation, strategic customer service orientation, and the model of care in the healthcare industry. The systematic review of the literature on lean business models suggests that the models such as several process improvement cost models, lean thinking models, managerial process improvement, and models of care can be used in the healthcare industry to reduce waste and costs and improve patient satisfaction. Sustaining competitive advantage for accountable care organisations was also found to help in accomplishing the value demands required by customers and competitors. This paper can be used as a guide for implementing lean business models and lean practices and the review can be used to help organisations see the benefits in using lean practices in the healthcare industry.

Design Thinking in Health Care

IntroductionApplying Design Thinking to health care could enhance innovation, efficiency, and effectiveness by increasing focus on patient and provider needs. The objective of this review is to determine how Design Thinking has been used in health care and whether it is effective.MethodsWe searched online databases (PubMed, Medline, Web of Science, CINAHL, and PyscINFO) for articles published through March 31, 2017, using the terms “health,” “health care,” or “healthcare”; and “Design Thinking,” “design science,” “design approach,” “user centered design,” or “human centered design.” Studies were included if they were written in English, were published in a peer-reviewed journal, provided outcome data on a health-related intervention, and used Design Thinking in intervention development, implementation, or both. Data were collected on target users, health conditions, intervention, Design Thinking approach, study design or sample, and health outcomes. Studies were categorized as being successful (all outcomes improved), having mixed success (at least one outcome improved), or being not successful (no outcomes improved).ResultsTwenty-four studies using Design Thinking were included across 19 physical health conditions, 2 mental health conditions, and 3 systems processes. Twelve were successful, 11 reported mixed success, and one was not successful. All 4 studies comparing Design Thinking interventions to traditional interventions showed greater satisfaction, usability, and effectiveness.ConclusionDesign Thinking is being used in varied health care settings and conditions, although application varies. Design Thinking may result in usable, acceptable, and effective interventions, although there are methodological and quality limitations. More research is needed, including studies to isolate critical components of Design Thinking and compare Design Thinking–based interventions with traditionally developed interventions.

A Qualitative, Systems Thinking Approach to Study Self-Management in Women With Migraine.

A dearth of effective and affordable treatment options has rendered nonpharmacological self-management a crucial part of living with migraine-a debilitating neurobiological condition without cure that disproportionately disables vulnerable women. The aim of the study was to describe the development and use of a systems thinking, problem-structuring data collection approach that was applied to the study of migraine self-management with women in diverse social locations. Two systems mapping activities were developed for use in focus groups: one to unpack a migraine episode (system support map) and the other (connection circle [CC]) to construct a mental model of self-management. Later in the process, a strengths-based problem-solving tool was developed to replace the CC. The CCs-often enlightening for affluent participants-left marginalized women feeling overwhelmed and defeated, as a solution to one challenge became the cause of another. Through constant comparison analysis, we recalibrated the approach using a theory, clinical experience, and participant feedback and replaced the CC with a strengths-based problem-solving activity highlighting relationships and trade-offs in a more agential, actionable way. Bringing a critical lens and strengths-based approaches to work with vulnerable populations can replace traditional deficit thinking in healthcare, developing options for leveraging resources and understanding complex health behaviors without losing sight of systemic, distributional justice issues. These systems thinking tools can provide a way to extrapolate the complexities of actual self-management behaviors and challenges faced by vulnerable women with migraine versus what they may be instructed to do by a medical model that does not always account for the social and structural determinants of equity and health.

New Approaches and Trends in Health Care

Background: Over the years a variety of process improvement methodologies have been proposed for health care delivery and Lean healthcare is one such method. The aim of this paper is to provide a review of the existing literature on Lean health care. It seeks to describe how this concept has being applied and to assess how trends and methods of approach in Lean health care have evolved over the years. The objective is to demonstrate the scientific knowledge developed on Lean thinking in health care. Design/methodology/approach: Health care systems have begun to employ Lean methods, with reports of improvements appeared in the literature. The paper surveys the applications of Lean health care in the current literature by presenting the success stories and limitations of Lean production in various health care organizations. We start from the key concepts of Lean thinking and how these concepts can be applied in the health care environment.Findings: Lean health care is a novel approach to deliver improved care services to patients, and we believe that some branches like emergency medicine, drug dispensing process in the health care sector can achieve high level of success by using this approach. It appears that there is an agreement about the potential of lean health care, but before large-scale implementation it is necessary to evaluate the true ability of Lean interventions to improve healthcare delivery. It still remains a challenge for specialists in the field to evaluate lean health care under a critical perspective.

Reading and writing for healers

Aims, background and objectives: A growing body of research demonstrates that teaching close-reading and reflective writing to clinicians improves their ability to provide patient- and person-centered care. Through narrative medicine workshops, providers gain skills that can improve relationships with patients, increase empathy among clinicians and enhance clinical care. The goal of the event series (book discussion and reflective writing sessions) offered at the University of Pittsburgh School of Dental Medicine, USA was to provide participants an interactive opportunity to practise and reflect upon the basic tenets of narrative medicine. Methods: The objectives were to recognize how a written text can inform and enhance empathetic and humanistic thinking and to develop an increased appreciation for the importance of humanistic thinking in healthcare. The goal of this article was to share the outcomes of a unique program, which was offered in an interprofessional setting and organized by collaborators across disciplines within and outside of the healthcare professions. To evaluate the overall effectiveness of the introductory presentation, book discussion and reflective writing sessions, anonymous surveys were employed to study participants’ perception about the role of literature in healthcare, the role of reflection in the provision of care and insights gained in the sessions. Results: The study revealed overwhelmingly positive responses by the participants to the programming. Qualitative data analysis revealed multiple areas of learning. Discussion and Conclusion: Due to the success of the workshop series, the School of Dental Medicine will offer the event again and expects it to become a sustained yearly event that fosters collaborations across different schools of the University.