What does it take to make integrated care work? A ‘cookbook’ for large-scale deployment of coordinated care and telehealth

The Advancing Care Coordination & Telehealth Deployment (ACT) Programme is the first to explore the organisational and structural processes needed to successfully implement care coordination and telehealth (CC&TH) services on a large scale. A number of insights and conclusions were identified by the ACT programme. These will prove useful and valuable in supporting the large-scale deployment of CC&TH. Targeted at populations of chronic patients and elderly people, these insights and conclusions are a useful benchmark for implementing and exchanging best practices across the EU. Examples are: Perceptions between managers, frontline staff and patients do not always match; Organisational structure does influence the views and experiences of patients: a dedicated contact person is considered both important and helpful; Successful patient adherence happens when staff are engaged; There is a willingness by patients to participate in healthcare programmes; Patients overestimate their level of knowledge and adherence behaviour; The responsibility for adherence must be shared between patients and health care providers; Awareness of the adherence concept is an important factor for adherence promotion; The ability to track the use of resources is a useful feature of a stratification strategy, however, current regional case finding tools are difficult to benchmark and evaluate; Data availability and homogeneity are the biggest challenges when evaluating the performance of the programmes

Bioengineered Textiles and Nonwovens – the convergence of bio-miniaturisation and electroactive conductive polymers for assistive healthcare, portable power and design-led wearable technology

Today, there is an opportunity to bring together creative design activities to exploit the responsive and adaptive ‘smart’ materials that are a result of rapid development in electro, photo active polymers or OFEDs (organic thin film electronic devices), bio-responsive hydrogels, integrated into MEMS/NEMS devices and systems respectively. Some of these integrated systems are summarised in this paper, highlighting their use to create enhanced functionality in textiles, fabrics and non-woven large area thin films. By understanding the characteristics and properties of OFEDs and bio polymers and how they can be transformed into implementable physical forms, innovative products and services can be developed, with wide implications. The paper outlines some of these opportunities and applications, in particular, an ambient living platform, dealing with human centred needs, of people at work, people at home and people at play. The innovative design affords the accelerated development of intelligent materials (interactive, responsive and adaptive) for a new product & service design landscape, encompassing assistive healthcare (smart bandages and digital theranostics), ambient living, renewable energy (organic PV and solar textiles), interactive consumer products, interactive personal & beauty care (e-Scent) and a more intelligent built environment

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The gaps between healthcare service and building design : a state of the art review

Healthcare buildings are designed to achieve diverse objectives, ranging from providing appropriate environments where care can be delivered to communities to increasing operational efficiency and improving patient flows and the patient experience. Improvements in operational efficiency should result from state-of-the-art buildings, more appropriate layouts, departmental adjacencies, efficient clinical and business processes and enhanced information systems. However, complexities around requirements and stakeholders management may prevent the achievement of such objectives. The aim of this article is to identify and understand how healthcare services (re)design and building design can be integrated to facilitate increased performance both in terms of service delivery and future changes. Findings indicate that current approaches and innovation are restricted due to functional barriers in the design process, and that there is a need to support the development of operations driven design through time (e.g. flexible and durable) that satisfies diverse needs

Integrating Research and Quality Improvement Using TeamSTEPPS: A Health Team Communication Project to Improve Hospital Discharge

Purpose/Objectives: The purpose of this article is to describe an innovative approach to the integration of quality improvement and research processes. A project with the objective of improving health team communication about hospital discharge provides an exemplar case. Description of the Project/Program: The TeamSTEPPS 10-step action planning guide provided the structure for planning, developing, and evaluating a redesign of interprofessional health team communication to improve hospital discharge led by 2 clinical nurse specialists. The redesign involved development of processes for team bedside rounding, registered nurse bedside shift reports, and briefing tools to support the rounding processes. Outcome: Using the TeamSTEPPS process, a 4-phase combined quality improvement and research project was designed and implemented. Implementation is ongoing, supported by process evaluation for continuing process improvement. Longitudinal analysis of research outcomes will follow in the future. Conclusions: Led by unit-based clinical nurse specialists, use of an integrated process of quality improvement and research creates evidence-based innovation to solve interprofessional practice problems. Incorporating research within the project design allows for data-based decisions to inform the clinical process improvement, as well as documentation of both the processes and outcomes of the local improvements that can inform replications in other sites

Improving health and public safety through knowledge management

This paper reports on KM in public healthcare and public safety. It reflects the experiences of the author as a CIO (Chief Information Officer) in both industries in Australia and New Zealand. There are commonalities in goals and challenges in KM in both industries. In the case of public safety a goal of modern policing theory is to move more towards intelligence-driven practice. That means interventions based upon research and analysis of information. In healthcare the goals include investment in capacity based upon knowledge of healthcare needs, evidence-based service planning and care delivery, capture of information and provision of knowledge at the point-of-care and evaluation of outcomes. The issue of knowledge management is explored from the perspectives of the user of information and from the discipline of Information Technology and its application to healthcare and public safety. Case studies are discussed to illustrate knowledge management and limiting or enabling factors. These factors include strategy, architecture, standards, feed-back loops, training, quality processes, and social factors such as expectations, ownership of systems and politics

Planning ahead with children with life-limiting conditions and their families : development, implementation and evaluation of ‘My Choices’

Background: The United Kingdom has led the world in the development of children’s palliative care. Over the past two decades, the illness trajectories of children with life-limiting conditions have extended with new treatments and better home-based care. Future planning is a critically under-researched aspect of children’s palliative care globally. This paper describes the development, implementation and evaluation of innovative child and parent-held palliative care planning resources. The resources were designed to facilitate parent and child thinking and engagement in future planning, and to determine care preferences and preferred locations of care for children with life-limiting conditions from diagnosis onwards. These resources fill a significant gap in palliative care planning before the end-of-life phase. Methods: Drawing on contemporaneous research on producing evidence-based children’s health information, we collaborated with leading children’s not-for-profit organisations, parents, children, and professionals. A set of resources (My Choices booklets) were developed for parents and children and evaluated using interviews (parents, children, professionals) and questionnaires (professionals) and an open web-based consultation. Results: Parents and children responded in three ways: Some used the booklets to produce detailed written plans with clear outcomes and ideas about how best to achieve desired outcomes. Others preferred to use the booklet to help them think about potential options. Remaining parents found it difficult to think about the future and felt there was no point because they perceived there to be no suitable local services. Professionals varied in confidence in their ability to engage with families to plan ahead and identified many challenges that prevented them from doing so. Few families shared their plans with professionals. Parents and children have far stronger preferences for home-care than professionals. Conclusion: The My Choices booklets were revised in light of findings, have been endorsed by Together for Short Lives, and are free to download in English and Welsh for use by parents and young people globally. More work needs to be done to support families who are not yet receptive to planning ahead. Professionals would benefit from more training in person-centred approaches to future planning and additional communications skills to increase confidence and ability to engage with families to deliver sensitive palliative care planning