Differentiating innovation priorities among stakeholder in hospital care

Background Decisions to adopt a particular innovation may vary between stakeholders because individual stakeholders may disagree on the costs and benefits involved. This may translate to disagreement between stakeholders on priorities in the implementation process, possibly explaining the slow diffusion of innovations in health care. In this study, we explore the differences in stakeholder preferences for innovations, and quantify the difference in stakeholder priorities regarding costs and benefits. Methods The decision support technique called the analytic hierarchy process was used to quantify the preferences of stakeholders for nine information technology (IT) innovations in hospital care. The selection of the innovations was based on a literature review and expert judgments. Decision criteria related to the costs and benefits of the innovations were defined. These criteria were improvement in efficiency, health gains, satisfaction with care process, and investments required. Stakeholders judged the importance of the decision criteria and subsequently prioritized the selected IT innovations according to their expectations of how well the innovations would perform for these decision criteria. Results The stakeholder groups (patients, nurses, physicians, managers, health care insurers, and policy makers) had different preference structures for the innovations selected. For instance, self-tests were one of the innovations most preferred by health care insurers and managers, owing to their expected positive impacts on efficiency and health gains. However, physicians, nurses and patients strongly doubted the health gains of self-tests, and accordingly ranked self-tests as the least-preferred innovation. Conclusions The various stakeholder groups had different expectations of the value of the nine IT innovations. The differences are likely due to perceived stakeholder benefits of each innovation, and less to the costs to individual stakeholder groups. This study provides a first exploratory quantitative insight into stakeholder positions concerning innovation in health care, and presents a novel way to study differences in stakeholder preferences. The results may be taken into account by decision makers involved in the implementation of innovation

Will the Affordable Care Act Move Patient-Centeredness to Center Stage?

Outlines the evolution of ethical, economic, and clinical concepts of the patient's role in health care; efforts to develop a measurement infrastructure; and provisions in the healthcare reform law aimed at integrating and aligning measures

Application of Big Data to Support Evidence-Based Public Health Policy Decision-Making for Hearing

Ideally, public health policies are formulated from scientific data; however, policy-specific data are often unavailable. Big data can generate ecologically-valid, high-quality scientific evidence, and therefore has the potential to change how public health policies are formulated. Here, we discuss the use of big data for developing evidence-based hearing health policies, using data collected and analyzed with a research prototype of a data repository known as EVOTION (EVidence-based management of hearing impairments: public health pOlicy-making based on fusing big data analytics and simulaTION), to illustrate our points. Data in the repository consist of audiometric clinical data, prospective real-world data collected from hearing aids and an app, and responses to questionnaires collected for research purposes. To date, we have used the platform and a synthetic dataset to model the estimated risk of noise-induced hearing loss and have shown novel evidence of ways in which external factors influence hearing aid usage patterns. We contend that this research prototype data repository illustrates the value of using big data for policy-making by providing high-quality evidence that could be used to formulate and evaluate the impact of hearing health care policies

Systems mapping workshops and their role in understanding medication errors in healthcare

In this paper for Applied Ergonomics, one of the two leading journals for ergonomics/human factors, Buckle et al. discuss the role of mapping workshops in understanding medication errors in healthcare. They draw upon research that used mapping workshops as a method that systems designers, including human factors/ergonomics specialists, can use to help generate a knowledge base for better design requirements. Buckle et al. applied systems mapping workshops for the first time to the problem of medication errors in healthcare. The workshops were designed using experiential group work principles. They involved a range of stakeholders from within the health service as well as those who supply the health sector, including designers who may be able to enhance the safety of products and systems used in healthcare. The opportunity for using these methods to study patient safety issues arose as a result of a scoping study undertaken on behalf of the UK Department of Health and The Design Council. As the scope of patient safety issues within the healthcare system and the range of stakeholder groups is large (National Patient Safety Agency 2005), it was believed that mapping workshops might enhance system design in health. The results were rich from a design perspective, giving specific details of actual incidences, contexts and practices, with further depth of information emerging in the group working sessions. A wealth of detail on aspects of medication error, especially in the community, emerged from creative, primary, secondary and patient-support group sessions. As a process, similar stakeholder workshops could help designers understand better the complexity and range of factors to be taken into account. The methods are now being used in many areas of healthcare and social care design, for example by the Technology Strategy Board funded research into Telecare (see http://www.aktive.org.uk/)

Inviting a Hospital Healthcare Team to Change : A Framework for Building Capacity to Provide Intersectional, Trauma-Informed Care

This Organizational Improvement Plan is designed for Open Doors (a pseudonym), a Canadian hospital invested in providing stigma-free, social, and structural determinants-based care to patients who are marginalized from healthcare vis-à-vis previous experiences of exclusion and institutional trauma at healthcare settings. In the context of deepening scrutiny on healthcare institutions for their role in perpetuating systemic oppression and for failure to mitigate inequitable health outcomes for marginalized populations, Open Doors’ commitment to justice-centered care offers a compelling case study in hospital-based strategies for addressing health inequity. The specific Problem of Practice (PoP) addressed is the hospital’s care team’s limited capacity for providing trauma-informed care for patients from diverse communities who face complex, intersecting, and systemic barriers to hospital-based care. Broader systemic failures and contextual factors shaping this PoP are discussed and situated using organizational theory and the recent groundswell in literature on socially conscious caregiving. The need to instigate transformative, adaptive third order change to address the PoP is highlighted using transformative and adaptive leadership theories. Critical appreciative inquiry and dialogic change models are blended to propose a change framework that can mobilize such change within Open Doors’ context. Guided by the change framework and an evaluation-driven design process, a specific solution is detailed, namely, a patient-centered design and learning hub. A detailed change plan is presented, whereby patients, staff, community representatives and leaders are invited into a knowledge-based, dialogic process of co-creating intersectional, trauma informed practices to address a high-priority intersectional area of need for Open Doors. Keywords: healthcare change management; transformative leadership; health professions education; critical reflexivity; critical appreciation; evaluative thinkin

Citizen Voices on Pandemic Flu Choices: A Report of the Public Engagement Pilot Project on Pandemic Influenza

In the spring of 2005, gaps existed in the first Health and Human Services (HHS) Influenza Pandemic Plan and more guidance was considered desirable on how best to allocate the relatively meager supplies of vaccine likely to be available in the first months of a pandemic. To whom should it be given? To achieve what objectives? This report describes the convening of a representative group of stakeholders and citizens-at-large, the structure and process of stakeholder and citizen dialogues and deliberations, and the decisions made and recommendations that were developed. This Public Engagement Pilot Project on Pandemic Influenza (PEPPPI) was initiated in July 2005 to discuss and rank goals for a pandemic influenza vaccination program and to pilot test a new model for engaging citizens on vaccine related policy decisions (The Vaccine Policy Analysis CollaborativE, VPACE). The Pilot Project was sponsored by a network of interested organizations listed on the cover of this report. To conduct this public consultation, the sponsors engaged stakeholders from various organizations with an interest in pandemic influenza (the National Stakeholder Group), and individual citizens-at-large from the four principal regions of the United States. The anticipated major benefits from this public consultation were the development of an improved plan to combat pandemic influenza and one more likely to gain public support, and a demonstration that citizens can be productively engaged in informing vaccine related policy decisions. This Pilot Project provides “proof of principle” to the vaccine community that a diverse group of stakeholders and citizens-at-large can be recruited to learn about a technical subject, interact respectfully, and reach a productive outcome on an important policy question. Preliminary results from the independent evaluation of all the sessions conducted by the University of Nebraska reaffirmed this conclusion. Furthermore, the corroboration of the results of the deliberations from the four sessions involving the general public in disparate regions of the country, as well as with the National Stakeholder Group meeting in Washington D.C., gives additional weight to the recommendations. Recognition of the importance and utility of these findings was made evident in the HHS Pandemic Influenza Plan released in early November 2005 which described the agency’s consideration of the priorities that emerged from the PEPPPI project. More public discussion of a similar type was called for in the HHS plan. Participating Organizations: Atlanta Journal Constitution; Institute of Medicine; Georgia Department of Human Resources, Division of Public Health; Massachusetts Health and Human Services; National Immunization Program at the Centers for Disease Control and Prevention; National Vaccine Program Office in the Department of Health and Human Services; Nebraska Health and Human Services; Oregon Department of Human Services; Practicum Limited; Richard Lounsbery Foundation; Study Circles Resource Center; The Keystone Center; University of Georgia; and University of Nebraska Public Policy Cente

Innovation and knowledge flows in healthcare ecosystems: the portuguese case

Innovation has come a long way since the times it was defined just as a new idea. Nowadays, innovation activities comprise a lot more, from new products and/or services to improvements in organisational business models. The healthcare sector is no exception. This leads public authorities to increase their investment in innovation, research and development in the healthcare sector. The rising of internal and external collaborations between hospitals and other parties calls for a specific analysis on how the healthcare innovation environments behave and how knowledge flows within them are managed. This study, through the lens of the ecosystem theory, aims to study how a healthcare innovation ecosystem can be activated and knowledge flows are managed to ensure that all the parties are benefited. For that purpose, it presents a case study based on a set of three meetings of Portuguese stakeholders inserted in innovation healthcare ecosystems. With this work it was possible to observe that the healthcare innovation ecosystem can be analysed from different perspectives. The interaction with the different stakeholders allowed to identify possible partners to be involved in innovation activities (e.g.: hospitals, universities, research centres, start-ups). This paper suggests possible roles for the different parties along the innovation funnel as well as what they can do in each phase. Using a case study approach, it is possible to compare different contexts and identify best practices on the management of healthcare innovation ecosystems. Also, it becomes evident the need for more effective knowledge management to ensure that hospitals and the other parties meet their goals and play a relevant role in the ecosystem. Although this paper provides guidelines for action, it lacks implementation of the suggestions in a specific context. As such, this paper aims to serve as a basis for future research on the study of hospitals’ innovation ecosystems and underlying knowledge flows, in different contexts to achieve best practices for its effective management.publishe

Institutions, Governance and Economic Growth in the EU: is there a role for the Lisbon Strategy

In order to ensure that the internal market delivers (growth, jobs) in the face of a changing market and technological environment (internal market liberalisation, globalisation, the knowledge-based economy) and to take advantage of the opportunities that it presents, the European Union (EU) needs to create an adequate institutional framework that promotes its efficiency potential and adaptive capacity. In the reality of European mixed economies, its capacity to solve the structural problems that impair productivity and economic growth in Europe hinges very much on governance, in particular when reforms to realise international synergies and complementarities or policy-learning with a view to common goals involve not only the EU but as well the Member State level. The Lisbon Agenda can be considered an exercise of policy coordination that needs to ensure that Member States’ over-regulated economies comply both with liberalisation in the Single Market and with an adequate European-wide institutional environment for sustainable growth without coordination mismatches, protectionism and market segmentation. This ultimately raises the question, central to this paper, of the adequate governance level and of the regulatory model to adopt (systems competition and/or European regulation).Economic Integration; Governance; European Union; Single Market; Lisbon Agenda; Open method of coordination; Liberalisation; Regulatory model; Growth and competitiveness.