Cultural Transformation in Health Care

Describes the role of organizational culture in healthcare organizations. Recommends strategies for innovative approaches to improve the overall performance of the U.S. healthcare system

Integrating a System Approach to Identify and Manage Aggressive Behaviors in Adult Males with Severe Mental Illness in a Psychiatric Hospital

Aggressive behaviors exhibited by patients with a serious mental illness (SMI) hospitalized in inpatient psychiatric hospitals are a challenging safety problem. Early identification of aggressive behaviors is vital to helping nursing staff develop proactive interventions that focus on prevention. Structured risk assessments identify the level of risk and allow for early interventions. The purpose of the doctoral capstone project was to: (a) provide education to nursing staff on implementing a structured risk assessment tool in order to identify risk for imminent aggression, manage risk for imminent aggression, and record aggressive behaviors among adult males with severe mental illness (SMI); (b) implement the structured risk assessment tool; (c) determine by retrospective chart review if the structured risk assessment tool is used by nursing staff to identify and manage patients with moderate or high risk for aggression; and (d) evaluate nursing staff’s perspective of the usefulness of the structured DASA-IV tool in a psychiatric hospital. Nursing staff conducted a continual assessment over a four-week period in which the DASA-IV risk scores were documented, prevention plans were implemented, and aggressive behaviors were recorded for seven days on all newly admitted patients with a diagnosis of SMI. A retrospective chart review was conducted to determine if the DASA-IV was completed correctly, and an evaluation survey was administered to determine the nursing staff’s perspective of the usefulness of the tool. The nursing staff found the DASA-IV tool useful in practice and information on the tool to be useful in identifying risk for imminent aggression and recording aggressive behaviors. Of the twenty risk assessments conducted, all were completed correctly by the nursing staff documenting the risk score and rating, implementing a crisis intervention or risk management plan based on the risk rating, and recording aggression. The results of this project demonstrate that through an evidence-based system approach, the addition of a structured risk assessment instrument for appraising risk for imminent aggression in a psychiatric hospital may assist nursing staff in the initiation of preventive interventions to manage aggressive behaviors

Invisible Wounds: The Impact of Six Years of War on the Mental Health of Syria's Children

The TDR Results Report illustrates progress made against the 23 key performance indicators that are part of the monitoring and evaluation matrix, in line with the current Performance Assessment Framework.The report shows progress made on various performance indicators related to three overarching categories related to not only on what is done (technical expected results), but also on how it is done (application of organizational core values and managerial performance).The report notes a high implementation rate, numerous new health tools that are being used in critical areas, and an expanded education and training programme, particularly focused on researchers in disease endemic countries. It provides summaries of activities to increase equity, such as increasing opportunities for women. The report includes a series of lessons learnt that have further improved the Programme's managerial effectiveness

Pediatrics wards: healing environment assessment / Roslinda Ghazali and Mohamed Yusoff Abbas.

Malaysian paediatric wards were assessed on their quality status and design trends towards the creation of the healing environment. The objective was to promote best practices in design. PostOccupancy Evaluation (POE) studies were conducted upon paediatric wards in eight hospitals in the Klang Valley. The methodology adopted was the use of UK‟s NHS AEDET and ASPECT Evaluation toolkits, which evaluated the physical qualities and staffs & patients satisfaction levels respectively upon 215 nurses and 217 patients. Results seemed to show the disparity between the positivity of the physical design in relation to users‟ satisfaction. Implications of the findings are discussed

Birthing practices of traditional birth attendants in South Asia in the context of training programmes

Traditional Birth Attendants (TBA) training has been an important component of public health policy interventions to improve maternal and child health in developing countries since the 1970s. More recently, since the 1990s, the TBA training strategy has been increasingly seen as irrelevant, ineffective or, on the whole, a failure due to evidence that the maternal mortality rate (MMR) in developing countries had not reduced. Although, worldwide data show that, by choice or out of necessity, 47 percent of births in the developing world are assisted by TBAs and/or family members, funding for TBA training has been reduced and moved to providing skilled birth attendants for all births. Any shift in policy needs to be supported by appropriate evidence on TBA roles in providing maternal and infant health care service and effectiveness of the training programmes. This article reviews literature on the characteristics and role of TBAs in South Asia with an emphasis on India. The aim was to assess the contribution of TBAs in providing maternal and infant health care service at different stages of pregnancy and after-delivery and birthing practices adopted in home births. The review of role revealed that apart from TBAs, there are various other people in the community also involved in making decisions about the welfare and health of the birthing mother and new born baby. However, TBAs have changing, localised but nonetheless significant roles in delivery, postnatal and infant care in India. Certain traditional birthing practices such as bathing babies immediately after birth, not weighing babies after birth and not feeding with colostrum are adopted in home births as well as health institutions in India. There is therefore a thin precarious balance between the application of biomedical and traditional knowledge. Customary rituals and perceptions essentially affect practices in home and institutional births and hence training of TBAs need to be implemented in conjunction with community awareness programmes

Healthcare Performance Improvement and High Reliability: A Best Practice Methodology

Healthcare Performance Improvement (HPI) improves reliability in healthcare by helping organizations achieve and sustain high performance outcomes in safety, quality, and satisfaction. Safety is the core value of the healthcare organization. Yet safety – protection from harm – doesn’t just happen. HPI provides a method for reducing the Serious Safety Event Rate through translating safety from a core value to specific behavior expectations of leaders, staff, and physicians. The HPI method and techniques are based on the best practices of high-reliability organizations (such as nuclear power and aviation) that get it right in safety. While healthcare has focused on traditional process improvement as a means to better outcomes, high-reliability organizations recognize that optimizing outcomes requires a concurrent focus on human behavior accountability. Our method focuses on preventing human errors and detecting and correcting system weaknesses that can lead to events of harm and unwanted outcomes

Healing Architecture: Engagement, Nature, Community

My thesis focused on exploring death as a part of life rather than looking at death as a separate entity. I reframed a Cancer Center that engaged life as part of a community with nature rather than a hospice center that embraced death. In today’s society, healthcare institutions are very isolated and disconnected from the public like gated communities. Most people I know do not like to go to hospitals if they can prevent it. I felt there needed to be a place where people with cancer could go that offered some respite from the conventional healthcare institutions. A place that put the interests of the patient first, a place where patients could get the practical, emotional and social support they needed. I envisioned a creative architectural design that focused on three concepts of engagement, nature and community that would transform healthcare settings into healing environments that improved patient outcomes and staff effectiveness

Therapeutic Landscapes of Home: Exploring Women’s Perceptions and Experiences of Home as a Place of Birth in London, Ontario

Home birth is a very controversial issue in today’s research literature. Using a therapeutic landscapes approach, this thesis focuses on the perception and experiences of home as a place of birth in London, Ontario, Canada. Thirty interviews were conducted during the summer of 2014 with women who lived in the London area and either planned a home birth in the previous two years or were currently pregnant and planning a home birth. Results demonstrated that women chose home birth, and did not choose hospital birth, due to the need for comfort, control, and support. Key themes around barriers included overwhelming criticism, a lack of information, not enough midwives, and the absence of an alternate choice in birth location. Findings from this study contribute to the literature by providing a unique geographical perspective to women’s health. Policy applications range from the local to federal level and involve such elements as providing a more relaxing and welcoming hospital environment for women; knowledge mobilization within the health care community; and, further acceptance of alternative locations of birth within the Ontario and Canada contexts. Future research should seek to grow the breadth of understanding of the perceptions of home as a place of birth. Similar studies at municipal levels or longitudinal studies of women’s experience pre- and post-birth could fill certain gaps in the literature and give further credence to women’s voices as key elements in shaping the health care system