Innovative capability development process: A Singapore IT healtcare case study

How do emotions affect telemedicine adoption and usage for critical-care episodes? We report on early findings from a grounded theory approach in a multiple-case study of critical care telepediatrics (research in progress). Thus far our findings suggest that specialists believe that generalist clinicians at remote “spoke” hospitals are anxious and fearful when performing in a high stress crisis situation involving an acutely ill or gravely injured child, leading to tunneling of attention (overlooking important clinical details). The specialists at tertiary care “hub” hospitals feel they are able to keep an emotional distance from the situation and they also report feeling less anxious because they have had extensive training for these acute care situations. Both emotional distance and higher skill level seem to help the specialists to take in more clinically-relevant information and use this to guide the generalists. The generalists’ fear of negative evaluation by the specialists, or embarrassment in front of other clinicians, may have some impact on their decision to use tele-pediatrics, but does not seem to be a salient concern during critical care episodes. These findings suggest that emotions do play a role in telemedicine use and possibly also in other forms of technology-mediated interorganizational collaboration

Investigating the Emotional Context of Pediatric Critical Care Telemedicine Consultations

Patient-present physician-to-physician telemedicine consultations have been shown to be effective, yet diffusion is not widespread. While much prior research has investigated how computer anxiety affects acceptance and usage of telemedicine and other systems, few prior studies have addressed the impact of situational anxiety (e.g., anxiety caused by the stress of treating a critically-ill child under time pressure) or other emotions on telemedicine acceptance and ongoing use. We report on findings from an embedded-cases study of four hospitals that participate in a telemedicine consultation service provided by a rural tertiary-care hospital. Interviews revealed that telemedicine can help clinicians cope with emotions such as anxiety, grief, and anger that arise from the high-stakes pediatric critical care context. Study findings point to design principles for telemedicine and for collaborative systems in other domains, in and beyond health care

Exploring the effects of telehealth on medical human resources supply: a qualitative case study in remote regions

BACKGROUND: The availability of medical human resource supply is a growing concern for rural and remote communities in many countries. In the last decade, various telehealth experiences in Canada have highlighted the potential impact of this technology on professional practice. The purpose of this study was to explore physicians' and managers' perceptions regarding the potential of telehealth to support recruitment and retention of physicians in remote and rural regions. METHODS: A case study in Eastern Quebec was performed to explore this complex phenomenon. The analytical framework was based on two literature reviews and a Delphi study. Data were collected from semi-structured interviews with 41 physicians and 22 managers. Transcripts were produced and interview content was coded independently by two judges and validated by an expert panel. RESULTS: Interviews have highlighted the potential impact of telehealth on several factors influencing the recruitment and retention of physicians in rural and remote regions. The potential effects of telehealth on physicians' choice of practice location could be seen at the professional, organizational, educational and individual levels. For instance, telehealth could improve work satisfaction by allowing a regional on-call duty system and a better follow-up of patients. However, there are also certain limits related to telehealth, such as the fear that it would eventually replace all continuing medical education activities and onsite specialists in remoteregions. CONCLUSION: Telehealth is likely to have an impact on several factors related to medical workforce supply in remote and rural regions. However, the expected benefits will materialize if and only if this technology is properly integrated into organizations as a support to professional practice

Clinicians’ Emotions and TeleStroke Use

Telemedicine has been available and in use for over fifty years yet by most accounts it has fallen short of its promised impact on healthcare. While legal and reimbursement issues continue to plague the spread of telemedicine use, the technology has continued to improve. We feel there are additional dimensions that play a key role in the use of telemedicine; in particular, we believe that doctors’ and nurses’’ emotional state during use of a telemedicine system has a significant impact on how telemedicine is used. What are the main drivers that give rise to these emotions? How do they impact the use of telemedicine? What changes in the business process can mitigate the negative impact of these emotions? We investigate these research questions by conducting an embedded case study utilizing interview data and archival documents to gain insight into the emotional components at play during TeleStroke consultations

Telepediatric assistance in Iran: Specialist and subspecialty challenges

INTRODUCTION: Having justice for easy access to health services may probably be a standard feature and indisputable right of all health policies. The health policy of Iran enunciates this right. Unfortunately, as may happen in many countries, the execution of this policy depends on different factors. Among these parameters should be quoted as the suitable distribution of professionals, hospitals, and medical facilities. On the other hand, in Iran, there are many other problems linked to accessing areas with natural hindrances. OBJECTIVE: In this study, we analyzed the primary studies that report specialty and subspecialty challenges that had been faced by Iran to improve pediatric assistance. METHODS: Conduction of literature search in PubMed and CINAHL libraries was done, especially studies from 2010 to 2019. A Boolean operated ‘MeSH’ term was used for search. Newcastle–Ottawa Scale (NOS) scoring was adopted to assess the quality of each study. RESULTS: A total of 118 studies were displayed, and among them, 102 were excluded due to duplication and study relevance. Study selection was made based on its content were classified into two groups (1) shortage and unsuitable distribution of specialist and sub-specialist physicians in Iran, and (2) studies that explain the status of degradation in different areas of Iran. Outcomes demonstrated that Iran is generally suffering the shortage and unsuitable distribution of specialists and sub-specialists. This lack is particularly crucial in deprived and far-away areas from the cities. CONCLUSION: The present study analyzed in detail the current data regarding pediatric health services (specialist and subspecialty) and health-specific facilities distribution in the country

Evaluating the feasibility and impact of a synchronous health technology innovation in the provision of pediatric health care in a University Hospital.

La prestation de soins critiques et d'orthophonie en milieu pédiatrique nécessite beaucoup de travail pour atteindre le niveau de soins souhaité. Plusieurs facteurs contribuent à ce problème, parmi lesquels la pénurie de ressources, les besoins pressants et l’augmentation du nombre d’enfants malades. Parmi les solutions proposées, beaucoup pensent que la télémédecine synchrone peut être utile en donnant un accès virtuel immédiat aux compétences à distance. Ainsi, l'expertise pourrait être instantanément disponible via une plateforme permettant une communication efficace et capable de soutenir les soins pédiatriques. La télémédecine s’est beaucoup développée dans la prestation des soins critiques et de réadaptation pédiatriques, et ce aux plans diagnostique et thérapeutique. Pourtant, peu d’études ont examiné la faisabilité et évalué l’impact de la télémédecine sur la qualité des soins critiques et de réadaptation pédiatrique. L'objectif principal de cette thèse était d'évaluer la faisabilité de la télémédecine synchrone dans deux contextes pédiatriques, critique et réadaptation, et d'évaluer son influence sur le processus de prestation de soins pédiatriques. Le premier article présente les résultats d'une revue systématique qui synthétisait des études évaluant l'impact des modèles de télémédecine synchrone sur les résultats cliniques dans les établissements de soins de courte durée en pédiatrie. Les résultats ont révélé que l’utilisation de la télémédecine synchrone avait pour effet d’améliorer la qualité des soins, de diminuer le taux de transfert, de réduire de la durée du séjour, de modifier ou renforcer le plan de soins médicaux, de réduire les complications et la gravité de la maladie, et de diminuer le taux de mortalité hospitalière et standardisé. Cependant, la revue de l’état de connaissances a révélé que la qualité des études incluses était faible et que des preuves de haute qualité étaient nécessaires. Le deuxième article, fondé sur un devis pré/post, évalue la faisabilité de la télémédecine à domicile en orthophonie et son impact sur la satisfaction des enfants et orthophonistes, le coût économique, et les performances vocales. Cette étude a montré que la télémédecine en orthophonie était faisable et que les enfants et les orthophonistes étaient satisfaits du service. En outre, l'utilisation de la télémédecine en orthophonie a permis d'améliorer la voix et de faire économiser de l'argent aux parents. Le troisième article évalue la faisabilité de la mise en place d’une plate-forme de télémédecine synchrone dans l’unité des soins intensifs pédiatriques (USIP). Pour qu'une solution de télémédecine synchrone à l’USIP soit faisable, elle nécessite une bonne préparation préalable à la mise en œuvre de la plate-forme de télémédecine synchrone pour être réellement utile. Avec des médecins résidents compétents et autonomes, l’utilité d’une plate-forme de télémédecine synchrone reliant les intensivistes pédiatriques hors site et les médecins résidents sur site à l’USIP est faible. Cette étude a ajouté qu'un tel service pourrait être plus bénéfique que le modèle traditionnel des soins (face à face) pour les communications avec d'autres établissements de soins de santé éloignés, où le besoin d'expertise d'un intensiviste en soins intensifs pédiatriques est plus important. Ces trois études permettent de conclure que la télémédecine synchrone est réalisable et peut avoir un impact sur la qualité des soins intensifs et de réadaptation pédiatrique. On peut déduire de cette thèse qu'il est important de prendre en compte le contexte dans lequel la technologie sera mise en œuvre. Traiter le contexte de l’USIP et celui de réadaptation de la même manière n'aboutit pas aux mêmes résultats et une innovation technologique pourrait réussir dans un contexte et échouer dans un autre.Delivering critical and speech-language pathology care in pediatric settings requires much hard work to reach the desired level of care for children. Several factors contribute to this problem, including resources shortage, pressing needs, and the growing number of ill children. Among the proposed solutions, many believe that synchronous telemedicine can play a role by providing virtual and immediate access to remote skills, with expertise could be made instantly available through a platform that allows efficient communication and is able to support pediatric care. Telemedicine has developed significantly in the provision of critical care and pediatric rehabilitation in terms of diagnosis and therapy. Yet, few studies have examined the feasibility and evaluated the impact of telemedicine on the quality of pediatric critical care and rehabilitation. The main objective of this dissertation was to assess the feasibility of synchronous telemedicine in two pediatric settings—critical care and rehabilitation—and to evaluate its influence on the process of providing pediatric care. The first article presented the results of a systematic review that synthesized studies evaluating the impacts of synchronous telemedicine models on clinical outcomes in pediatric acute care settings. The findings revealed that the use of synchronous telemedicine improved quality of care and resulted in a lower transfer rate, a shorter length of stay, a change in or reinforcement of the medical care plan, a reduction in complications and illness severity, and a low hospital standardized mortality rate. However, the review of the state of knowledge revealed that the quality of the included studies was weak, so more high-quality evidences is needed. The second article, which used a pre/post design, assesses the feasibility assessed the feasibility of home-based telepractice in speech-language pathology (TSLP) and its impact on satisfaction among the children and speech-language pathologists, economic cost, and voice performance. This study showed that TSLP is feasible and that both the children and the speech-language pathologists were satisfied with the service. In addition, the use of TSLP demonstrated more voice improvement at less cost to the parents. The third article evaluated the feasibility of implementing a synchronous telemedicine platform in a pediatric intensive care unit (STEP-PICU). For a STEP-PICU to be feasible and truly helpful, it needs good preparation for the implementation of the telemedicine solution. With competent and autonomous fellows (a fellow is a physician who has completed their residency and elects to complete further training in a subspecialty), the usefulness of an synchronous telemedicine (STM) platform linking off-site pediatric intensivists and on-site fellows in a PICU is limited. This study added that such a service could be more beneficial than the traditional model of care (face to face) for communications with other remote healthcare facilities, where there is a greater need for the expertise of a pediatric critical care intensivist. These three studies allow us to conclude that STM is feasible and can have an impact on the quality of pediatric intensive care and rehabilitation. This thesis underscores the importance of taking into consideration the context in which the technology will be implemented. Treating the PICU and the rehabilitation contexts in the same way does not lead to the same results, and a technological innovation that succeeds in one setting may fail in another

A Tele-Coaching Intervention to Support Families in the NPP+: An Experimental Mixed Method Design

Poverty is the single greatest threat to a child’s well-being. Poverty has been shown to exacerbate child maltreatment (CM) and minimize nurturing parenting. CM is a leading cause of death among children under the age of five in the United States. Both poverty and CM are major public health concerns worldwide with important implications for the family. For over three decades great focus has been placed on developing evidence-based (EB) parenting and family interventions to promote the well-being of high-risk families. Using a conceptual framework guided by elements of the social cognitive theory, attachment theory and family systems theory, this pilot study examined if adding personalized tele-coaching to the delivery of the 16-week, evidence-based parenting program (EBPP) Nurturing Parenting Program (NPP) plus case management (NPP+) would offer better results for high-risk, low SES parents. Parents attending the NPP+ in community sites were randomly selected to receive 30-60 minutes of tele-coaching. Key treatment variables (i.e., stress-management, parental self-efficacy, child attachment and self-regulation of emotions) were examined for increases in self-reported parenting competencies scores in the intervention versus the control groups. Pre and post test survey results suggest that while the overall NPP+ is highly effective, adding a telecoaching intervention to individually review key topics to support parenting and related variables seems to not significantly add to the NPP+’s effectiveness. Nevertheless, in our process evaluation most parents stated that they really appreciated the flexibilty and additonal support that the individualized tel-coaching sessions offered. Thus, tele-coaching was well received. Tele-coaching as a content solidifying intervention should be explored adding it alone to NPP vs. NPP with case management as this may benefit some high need parents if resources are limited and a decision has to be made to offer case management or tele-coaching

Factors Affecting Emergency Medical Technicians’ On-Scene Decision-Making in Emergency Situations: A Qualitative Study

Introduction: To save lives and reduce the disability and death of the patients, emergency medical technicians (EMTs) must make timely decisions in complex and, sometimes, life-threatening situations. Since the pre-hospital decision-making is a continuous and important process. Objective: The present study aims to identify the factors affecting EMTs’ on-scene decision-making in emergency situations. Methods: A qualitative approach using in-depth semi-structured interviews and field observations was employed to explore the factors influencing EMTs’ on-scene decision-making in emergency situations. Purposeful sampling was performed with 19 participants including 12 EMTs, 3 dispatchers, 3 medical directions physicians and one EMS manager as a policy maker. Interviews were conducted from October 2018 to March 2018 and the data were analyzed using Graneheim and Lundman’s content analysis approach. Results: Eight categories and 18 sub-categories emerged to describe the factors effective in emergency medical technicians’ on-scene decision-making. they  were cultural context (community’s culture and organizational culture), interactions (malingering, threat and violence and considerations), competencies (acquisitive and intrinsic); personal feeling (positive feeling and negative feeling), authority (structural and in processing),  education (public and professional), special conditions (patient’s clinical situation, weather conditions, mission’s time and mission’s location), and organizational resource (facility and equipment, and human resources). Conclusions: To facilitate EMTs’ on-scene decision-making, it is recommended to clarify the EMTs’ responsibilities, promote the community’s culture, modify people’s expectations, police monitoring and control and value the star of logo on EMTs' uniform. The EMTs’ on-scene decision-making process should also be explored

Evaluation of the psychometric properties of a modified version of the Social Phobia Screening Questionnaire for use in adolescents

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