Evaluating Performance in the Tuscan Health Care System.

The Tuscan health care system strives to foster cooperation among the various organizations that provide services. Government authorities therefore believe it is important to plan and develop a transparent system capable of monitoring the economic results of the region’s 16 public health authorities and their ability to pursue and accomplish the aims of the regional health care plan. The principal aim of the Tuscan performance evaluation system is to give a general outline of the management of the region’s health care authorities. This outline is intended to be useful both for evaluating performance and for enhancing and promoting the results of the healthcare system.Performance evaluation system, benchmarking in healthcare.

Can equity be included in a performance evaluation system? Some evidences from the tuscan health care system

Objectives. Can Equity be included in a performance evaluation system? In Italy, the Tuscan Region has tested and now is adopting an integrated model for performance measurement to which the regional administration, the local health authorities, and other stakeholders may refer either in terms of indicators and shared responsibilities. Thoughout this performance evaluation system it is now possible to measure also the capacity to persue equity at a regional and local level. Methods. In 2005 aspects as equity and access to services, that, in a public system, are very relevant and characterize the political strategy, were included in the performance evaluation system to evaluate the action carried out by the local health authorities, i.e. the operative actors of the system. This was achieved identifing equity measures and including them in an essential number of indicators, classified in six dimensions and represented in diagram targets. Results. This comprehensive performance evaluation system helped managers and the regional healthcare system as a whole to learn and to consider equity not only as a political issue but as a management goal. Conclusions. This system, used continuously and systematically at a regional level, is now a public policy tool and supports the Local Health Authorities in keeping equity in their management goals.Performance, Evaluation, Balanced Scorecard, Equity, Health Service Access, Health Targets.

A system dynamics-based simulation study for managing clinical governance and pathways in a hospital

This paper examines the development of clinical pathways in a hospital in Australia based on empirical clinical data of patient episodes. A system dynamics (SD)-based decision support system (DSS) is developed and analyzed for this purpose. System dynamics was used as the simulation modeling tool because of its rigorous approach in capturing interrelationships among variables and in handling dynamic aspects of the system behavior in managing healthcare. The study highlights the scenarios that will help hospital administrators to redistribute caseloads amongst admitting clinicians with a focus on multiple Diagnostic Related Groups (DRG’s) as the means to improve the patient turnaround and hospital throughput without compromising quality patient care. DRG’s are the best known classification system used in a casemix funding model. The classification system groups inpatient stays into clinically meaningful categories of similar levels of complexity that consume similar amounts of resources. Policy explorations reveal various combinations of the dominant policies that hospital management can adopt. The analyses act as a scratch pad for the executives as they understand what can be feasibly achieved by the implementation of clinical pathways given a number of constraints. With the use of visual interfaces, executives can manipulate the DSS to test various scenarios. Experimental evidence based on focus groups demonstrated that the DSS can enhance group learning processes and improve decision making. The simulation model findings support recent studies of CP implementation on various DRG’s published in the medical literature. These studies showed substantial reductions in length of stay, costs and resource utilization

The Placement Pathway Project : a report for Yorkshire and the Humber Strategic Health Authority

Executive Summary This report represents the findings from an evaluation of current service provision within placements used by nursing and allied health professional students in the Yorkshire and Humber geographical area. The aim of the evaluation was to capture the thoughts and feelings of a variety of related professionals and students who have experience of working and operating within the current system of placement pathways and so to discover the extent and nature of these pathways. The study was designed around three phases. In each of these data were generated and interpreted by the research team via interviews, questionnaires and this was in turn considered against a reading of the relevant current literature. In conducting the evaluation we found that : Placement pathways add value to the student learning experience and simultaneously contribute to the development of the existing workforce. Pathways contribute to the debate on quality and employability by offering a change of focus to meeting the needs of learners in the workplace. Pathways are now a necessity for students in order that they are able to gain sufficient skills and knowledge to meet the requirements of the professional registration bodies. We therefore recommend that: All placements develop their own placement pathways in line with findings. Good communication systems be set up between the placement, the student and the link lecturer university/HEI. The placement should produce a document that outlines the placement learning opportunities for the specific pathway. Student progress on the pathway must be incorporated into overall placement assessment. We have produced a tool by which personnel connected to student learning on placement can store and record all relevant data and access materials associated with achieving successful outcomes. This is on a DVD and is included in a separate pocket at the back of this report

Building Effective Responses: An Independent Review of Violence against Women, Domestic Abuse and Sexual Violence Services in Wales

Independent researchers from the Connect Centre for International Research on Interpersonal Violence based in the School of Social Work at the University of Central Lancashire were commissioned by the Welsh Government in 2013 to conduct research into violence against women, domestic abuse and sexual violence services in Wales. The research aimed to inform the forthcoming Ending Violence Against Women and Domestic Abuse (Wales) Bill, implementation of the legislation and future policy more generally, as well as informing future funding decisions. The remit of the review covers: Domestic abuse, including that experienced in Lesbian, Gay, Bisexual and Transgender (LGBT) relationships and elder abuse. Violence against women, including female genital mutilation (FGM), forced marriage and honour-based violence. Sexual violence including rape, sexual assault and harassment Sexual exploitation including prostitution and trafficking1 for sexual purposes. Services for women and men who are victims or perpetrators of violence against women, domestic abuse or sexual violence. The review does not encompass criminal justice services or housing services and, with the exception of prevention work, services for children and young people in Wales were also excluded from this study

Evaluating telemedicine: A focus on patient pathways

Evaluations of telemedicine have sought to assess various measures of effectiveness (e.g., diagnostic accuracy), efficiency (e.g., cost), and engagement (e.g., patient satisfaction) to determine its success. Few studies, however, have looked at evaluating the organizational impact of telemedicine, which involves technology and process changes that affect the way that it is used and accepted by patients and clinicians alike. This study reviews and discusses the conceptual issues in telemedicine research and proposes a fresh approach for evaluating telemedicine. First, we advance a patient pathway perspective, as most of the existing studies view telemedicine as a support to a singular rather than multiple aspects of a health care process. Second, to conceptualize patient pathways and understand how telemedicine impacts upon them, we propose simulation as a tool to enhance understanding of the traditional and telemedicine patient pathway

Alcohol, assault and licensed premises in inner-city areas

This report contains eight linked feasibility studies conducted in Cairns during 2010. These exploratory studies examine the complex challenges of compiling and sharing information about incidents of person-to-person violence in a late night entertainment precinct (LNEP). The challenges were methodological as well as logistical and ethical. The studies look at how information can be usefully shared, while preserving the confidentiality of those involved. They also examine how information can be compiled from routinely collected sources with little or no additional resources, and then shared by the agencies that are providing and using the information.Although the studies are linked, they are also stand-alone and so can be published in peer-reviewed literature. Some have already been published, or are ‘in press’ or have been submitted for review. Others require the NDLERF board’s permission to be published as they include data related more directly to policing, or they include information provided by police.The studies are incorporated into the document under section headings. In each section, they are introduced and then presented in their final draft form. The final published form of each paper, however, is likely to be different from the draft because of journal and reviewer requirements. The content, results and implications of each study are discussed in summaries included in each section.Funded by the National Drug Law Enforcement Research Fund, an initiative of the National Drug StrategyAlan R Clough (PhD) School of Public Health, Tropical Medicine and Rehabilitation Sciences James Cook UniversityCharmaine S Hayes-Jonkers (BPsy, BSocSci (Hon1)) James Cook University, Cairns.Edward S Pointing (BPsych) James Cook University, Cairns