Navigating in large hospitals

Navigating around large hospitals can be a stressful and time-consuming experience for all users of the hospital infrastructure. Navigation difficulties encountered by patients and visitors can result in missed appointments or simply create a poor impression of the hospital organisation. When staff encounter navigation difficulties this can lead to cost and efficiency issues and potentially put patient safety at risk. Despite the provision of an array of in-hospital navigational aids, ‘getting lost’ continues to be an everyday problem in these large complex environments. This study aims to to identify factors which affect navigation in hospitals. We do not seek to evaluate the effectiveness of a single navigation aid, instead the objective of this study was to understand the environment in which a new system must operate and the gaps in provision left by existing navigation aids. This study is intended to be used to inform the development of new in hospital navigational aids, be they technological or otherwise. Eleven participants, all users of a large hospital site, were asked to describe specific first hand experiences of navigating in a hospital. The ‘Critical Incidence Technique’ was applied in a series of semi-structured interviews to elicit information about a participants navigation experience. This work presents the results of these interviews, with concepts identified and organised into five themes: The ‘Impact’ of poor navigation, ‘Barriers’ to effective navigation, ‘Enhancers’ for effective navigation, ‘Types of Navigation Aids’ and user groups with ‘Specific Navigational Needs’. The number of navigation aids available to participants was identified as an issue in itself, we found examples of thirty seven distinct sources of information available to a hospital user. We begin by introducing previous work on in-hospital navigation before describing the study design employed in this research. The themes and categories identified from the interview data are enumerated and described, with examples given from the interview transcripts. Finally we go on to give a discussion of some potential navigation solutions in light of the identified factors. This study highlights that a candidate navigation aid must be carefully designed and implemented if it is to compliment the thirty seven other sources of navigation information available to the hospital user

Navigating Independent Double Checks for Safer Care: A Nursing Perspective

Abstract The purpose of this study was to explore registered nurses’ understanding and practice of “independent double-checks” prior to administration of high-alert medications. The study used a qualitative descriptive design for data collection and data analysis. It included thirteen participants from a hospital located in southern New Hampshire. Results of the study revealed a core theme of navigating independent double checks (IDC) for safer care. Two major themes stemming from the core theme were also uncovered. Navigating IDC through knowing and navigating IDC through nurse partnership both focused on the perception and practice on IDC prior to administration of high alert medications. IDC was accepted and promoted as best practice, but the definition and process is still unclear. Having a universal definition will assist in clarity of the process and in turn, promote ensuring safe administration of high alert medications to patients. Keywords: independent double check, safer care, knowing, nurse partnershi

Virtual reality microscope versus conventional microscope regarding time to diagnosis: an experimental study.

Aims:  To create and evaluate a virtual reality (VR) microscope that is as efficient as the conventional microscope, seeking to support the introduction of digital slides into routine practice. Methods and results:  A VR microscope was designed and implemented by combining ultra-high-resolution displays with VR technology, techniques for fast interaction, and high usability. It was evaluated using a mixed factorial experimental design with technology and task as within-participant variables and grade of histopathologist as a between-participant variable. Time to diagnosis was similar for the conventional and VR microscopes. However, there was a significant difference in the mean magnification used between the two technologies, with participants working at a higher level of magnification on the VR microscope. Conclusions:  The results suggest that, with the right technology, efficient use of digital pathology for routine practice is a realistic possibility. Further work is required to explore what magnification is required on the VR microscope for histopathologists to identify diagnostic features, and the effect on this of the digital slide production process

The impacts of corporatisation of healthcare on medical practice and professionals in Maharashtra, India

A heterogeneous private sector dominates healthcare provision in many middle-income countries. In India the contemporary period has seen this sector undergo corporatisation processes characterised by emergence of large private hospitals and the takeover of medium-sized and charitable hospitals by corporate entities. Little is known about the operations of these private providers and the effects on healthcare professions as employment shifts from practitioner-owned small and medium hospitals to larger corporate settings. This article uses data from a mixed-methods study in two large cities in Maharashtra, India, to consider the implications of these contemporary changes for the medical profession. Data were collected from semi-structured interviews with 43 respondents who have detailed knowledge of healthcare in Maharashtra, and from a witness seminar on the topic of transformation in Maharashtra’s healthcare system. Transcripts from the interviews and witness seminar were analysed thematically through a combination of deductive and inductive approaches. Our findings point to a restructuring of medical practice in Maharashtra as training shifts towards private education and employment to those corporate hospitals. The latter is fuelled by substantial personal indebtedness, dwindling appeal of government employment, reduced opportunities to work in smaller private facilities, and the perceived benefits of work in larger providers. We describe a ‘re-professionalisation’ of medicine encompassing changes in employment relations, performance targets and constraints placed on professional autonomy within the private healthcare sector, that is accompanied by trends in cost inflation, medical malpractice, and distrust in doctor-patient relationships. The accompanying ‘re-stratification’ within this part of the profession affords prestige and influence to ‘star doctors’ while eroding the status and opportunity for young and early career doctors. The research raises important questions about the role that government and medical professionals’ bodies can, and should, play in contemporary transformation of private healthcare, and the implications of these trends for health systems more broadly

Closing the Disparities Gap in Healthcare Quality With Performance Measurement and Public Reporting

Provides an overview of widening disparities in healthcare quality by race/ethnicity, socioeconomic status, and insurance. Discusses efforts to close the gap, including reporting quality measures and pay-for-performance, as well as challenges in data col

Improving Quality and Achieving Equity: A Guide for Hospital Leaders

Outlines the need to address racial/ethnic disparities in health care, highlights model practices, and makes step-by-step recommendations on creating a committee, collecting data, setting quality measures, evaluating, and implementing new strategies

Earning the Rank of Respect: One Woman\u27s Passage from Victorian Propriety to Battlefront Responsibility

Like Civil War soldiers, nurses in the Northern forces found it difficult to sustain the conflicting duties to home, nation, and army. It was especially difficult for women to assume responsibilities in battlefield hospitals. Women struggled with their new roles, which challenged and extended notions of nineteenth century womanhood. Furthermore, navigating a military establishment of male power, while also trying to maintain connections to home, forced women to use gender assumptions to their advantage when trying to gain agency in the hospitals, respect from their patients, and independence from their superiors. Women brought their Victorian manners, morals and duties into the public sphere out of necessity for the war effort and proved themselves worthy of respect by skill and strength when the government’s medical care was insufficient. Women of the North and their male allies were what the Civil War demanded and were therefore more valuable than skill in military strategy or even medical technique

A feasibility study for the provision of electronic healthcare tools and services in areas of Greece, Cyprus and Italy

Background: Through this paper, we present the initial steps for the creation of an integrated platform for the provision of a series of eHealth tools and services to both citizens and travelers in isolated areas of thesoutheast Mediterranean, and on board ships travelling across it. The platform was created through an INTERREG IIIB ARCHIMED project called INTERMED. Methods: The support of primary healthcare, home care and the continuous education of physicians are the three major issues that the proposed platform is trying to facilitate. The proposed system is based on state-of-the-art telemedicine systems and is able to provide the following healthcare services: i) Telecollaboration and teleconsultation services between remotely located healthcare providers, ii) telemedicine services in emergencies, iii) home telecare services for "at risk" citizens such as the elderly and patients with chronic diseases, and iv) eLearning services for the continuous training through seminars of both healthcare personnel (physicians, nurses etc) and persons supporting "at risk" citizens. These systems support data transmission over simple phone lines, internet connections, integrated services digital network/digital subscriber lines, satellite links, mobile networks (GPRS/3G), and wireless local area networks. The data corresponds, among others, to voice, vital biosignals, still medical images, video, and data used by eLearning applications. The proposed platform comprises several systems, each supporting different services. These were integrated using a common data storage and exchange scheme in order to achieve system interoperability in terms of software, language and national characteristics. Results: The platform has been installed and evaluated in different rural and urban sites in Greece, Cyprus and Italy. The evaluation was mainly related to technical issues and user satisfaction. The selected sites are, among others, rural health centers, ambulances, homes of "at-risk" citizens, and a ferry. Conclusions: The results proved the functionality and utilization of the platform in various rural places in Greece, Cyprus and Italy. However, further actions are needed to enable the local healthcare systems and the different population groups to be familiarized with, and use in their everyday lives, mature technological solutions for the provision of healthcare services

Working Together Toward Better Health Outcomes

Healthcare organizations and community-based organizations (CBOs) that provide human services are partnering in shared pursuit of better health outcomes. The Partnership for Healthy Outcomes – Nonprofit Finance Fund (NFF), the Center for Health Care Strategies (CHCS), and the Alliance for Strong Families and Communities (Alliance), with support from the Robert Wood Johnson Foundation (RWJF) – set out to capture and analyze the lessons emerging in this dynamic space. Information from more than 200 partnerships serving all 50 US states provide important lessons from, and for, partnerships that hope to improve access to care, address health inequities, and make progress on social issues like food, education, and housing