Understanding and measuring quality of care: dealing with complexity.

Existing definitions and measurement approaches of quality of health care often fail to address the complexities involved in understanding quality of care. It is perceptions of quality, rather than clinical indicators of quality, that drive service utilization and are essential to increasing demand. Here we reflect on the nature of quality, how perceptions of quality influence health systems and what such perceptions indicate about measurement of quality within health systems. We discuss six specific challenges related to the conceptualization and measurement of the quality of care: perceived quality as a driver of service utilization; quality as a concept shaped over time through experience; responsiveness as a key attribute of quality; the role of management and other so-called upstream factors; quality as a social construct co-produced by families, individuals, networks and providers; and the implications of our observations for measurement. Within the communities and societies where care is provided, quality of care cannot be understood outside social norms, relationships, trust and values. We need to improve not only technical quality but also acceptability, responsiveness and levels of patient-provider trust. Measurement approaches need to be reconsidered. An improved understanding of all the attributes of quality in health systems and their interrelationships could support the expansion of access to essential health interventions

Antimicrobial resistance as a global health threat:the need to learn lessons from the COVID-19 pandemic

The global COVID‐19 pandemic has exacerbated existing health, social, and economic challenges and threatened progress towards achieving the UN sustainable development goals. We discuss lessons learned from the COVID‐19 pandemic for global policymaking for health security governance, with a particular focus on antimicrobial resistance. We identify One Health as the primary foundation of public health risk management owing to the collaborative, multidisciplinary, and multisectoral efforts that underpin the One Health approach and that enhance understanding of the complex interactions at the human–animal–environment interface. We discuss the narrow human‐centric focus of the One Health approach, highlight the underrepresentation of the environmental sector in One Health networks, and encourage greater representation from the environmental sector. Furthermore, we highlight the importance of the social sciences for health security research and the need for effective communication and trust. Finally, we underscore the importance of strengthened and collaborative health, social care, and disaster management systems. The application of these lessons will facilitate holistic, multisectoral, collaborative, and ethical actions on antimicrobial resistance

A qualitative study exploring the influence of a talent management initiative on registered nurses' retention intentions

AimThe aim of this study is to explore the influence of a talent management scheme in an English National Health Service (NHS) Trust on registered nurses' retention intentions.BackgroundThe retention of nurses is a global challenge, and talent management initiatives can play a role in improving retention. Talent management in its broadest sense is a way in which an organization recruits and retains the workforce that it needs to optimize the services it delivers.MethodsIn this qualitative study, eight in-depth semi-structured interviews were conducted with registered nurses who had participated in a talent management initiative, at an English acute NHS Trust. Data were collected in July 2019.ResultsThe talent management initiative influenced positive retention intentions. Retention of nurses was facilitated by the creation of networks and networking.ConclusionNetworks and networking can be viewed as a form of social capital, which was a facilitating factor for positive retention intentions for nurses.Implications for Nursing ManagementTalent management initiatives for nurses should be developed and directed to include the building of networks and networking to enable development of social capital. Although this talent management scheme is within the NHS, the issue of nursing retention is global. Application of learning from this paper to other health care systems is possible

Introducing Care 4.0: An Integrated Care Paradigm Built on Industry 4.0 Capabilities

Western developed health and care policy is shifting from a patriarchal medical model to a co-managed and integrated approach. Meanwhile, the fourth industrial revolution (Industry 4.0) is transforming manufacturing in line with the digital consumer revolution. Digital health and care initiatives are beginning to use some of the same capabilities to optimize healthcare provision. However, this is usually limited to self-management as part of an organization-centric delivery model. True co-management and integration with other organizations and people is difficult because it requires formal care organizations to share control and extend trust. Through a co-design lens, this paper discusses a more person-centered application of Industry 4.0 capabilities for care. It introduces ‘Care 4.0’, a new paradigm that could change the way people develop digital health and care services, focusing on trusted, integrated networks of organizations, people and technologies.These networks and tools would help people co-manage and use their own assets, in the context of their own care circle and community. It would enable personalized services that are more responsive to care needs and aspirations, offering preventative approaches that ultimately create a more flexible and sustainable set of integrated health and social care services that support meaningful engagement and interactions

Penggunaan Sepeda Motor sebagai Ambulan Komunitas dalam Rujukan Pelayanan: Studi Kasus di Lombok Utara

Background: Community participation can be based on a spiritof mutual trust and mutual assistance. Health services in ruraland remote areas may survive if they are based on socialnetworks and become part of community life. Conversely, pooraccess to services happen if he only relies on the efforts ofthe parties in reaching out to community health facilities. Cooperationbetween the public and management of health facilitiescould build a community that is the key to the success ofcommunity based health services. Motorcycle can also serveas an alternative income. Although the fund concerned, thepractice is voluntary and not burdensome. An important factorof community health services is openness between primaryhealth care facilities with community organizations.This studyaims to assess the referral on a motorcycle as a social networkingcommunity in the health services.Method: This study is a case study that tries to show apattern of social networks in community based health services.The subjects of this study is the Nipah Pustu officers,officials of polindes Setangi and Malaka, motorcycles and thepeople who use taxi services in the referral. The collection ofdata were carried out with in-depth interviews and observation.Result: This study shows that informal motorbike ambulancewhich grows in the community can help increase visits to healthfacilities. Acceptance of the motorcycle by the public andhealth professionals make an impact on the economic conditionsof transportation service providers. Wide availabilitythroughout the hamlet, 24-hour service, low cost, helps intaking care of patients health card are the unique features forwhich many people use motorcycle service. Also importantis that motorcycles are also used by the clinic staff for deliveryof examination materials and referral of patients.Conclusion: Motorcycle ambulance is an important community-based resources that facilitate access to health care facilityin villages in remote areas.Keywords: two-wheeled bicycle ambulance, community participation,community based health services in remote

Integration and Continuity of Primary Care: Polyclinics and Alternatives, a Patient-Centred Analysis of How Organisation Constrains Care Coordination

Background An ageing population, increasingly specialised of clinical services and diverse healthcare provider ownership make the coordination and continuity of complex care increasingly problematic. The way in which the provision of complex healthcare is coordinated produces – or fails to – six forms of continuity of care (cross-sectional, longitudinal, flexible, access, informational, relational). Care coordination is accomplished by a combination of activities by: patients themselves; provider organisations; care networks coordinating the separate provider organisations; and overall health system governance. This research examines how far organisational integration might promote care coordination at the clinical level. Objectives To examine: 1. What differences the organisational integration of primary care makes, compared with network governance, to horizontal and vertical coordination of care. 2. What difference provider ownership (corporate, partnership, public) makes. 3. How much scope either structure allows for managerial discretion and ‘performance’. 4. Differences between networked and hierarchical governance regarding the continuity and integration of primary care. 5. The implications of the above for managerial practice in primary care. Methods Multiple-methods design combining: 1. Assembly of an analytic framework by non-systematic review. 2. Framework analysis of patients’ experiences of the continuities of care. 3. Systematic comparison of organisational case studies made in the same study sites. 4. A cross-country comparison of care coordination mechanisms found in our NHS study sites with those in publicly owned and managed Swedish polyclinics. 5. Analysis and synthesis of data using an ‘inside-out’ analytic strategy. Study sites included professional partnership, corporate and publicly owned and managed primary care providers, and different configurations of organisational integration or separation of community health services, mental health services, social services and acute in-patient care. Results Starting from data about patients' experiences of the coordination or under-coordination of care we identified: 1. Five care coordination mechanisms present in both the integrated organisations and the care networks. 2. Four main obstacles to care coordination within the integrated organisations, of which two were also present in the care networks. 3. Seven main obstacles to care coordination that were specific to the care networks. 4. Nine care coordination mechanisms present in the integrated organisations. Taking everything into consideration, integrated organisations appeared more favourable to producing continuities of care than were care networks. Network structures demonstrated more flexibility in adding services for small care groups temporarily, but the expansion of integrated organisations had advantages when adding new services on a longer term and larger scale. Ownership differences affected the range of services to which patients had direct access; primary care doctors’ managerial responsibilities (relevant to care coordination because of its impact on GP workload); and the scope for doctors to develop special interests. We found little difference between integrated organisations and care networks in terms of managerial discretion and performance. Conclusions On balance, an integrated organisation seems more likely to favour the development of care coordination, and therefore continuities of care, than a system of care networks. At least four different variants of ownership and management of organisationally integrated primary care providers are practicable in NHS-like settings

Integration and continuity of primary care: polyclinics and alternatives - a patient-centred analysis of how organisation constrains care co-ordination

Background An ageing population, the increasing specialisation of clinical services and diverse health-care provider ownership make the co-ordination and continuity of complex care increasingly problematic. The way in which the provision of complex health care is co-ordinated produces – or fails to produce – six forms of continuity of care (cross-sectional, longitudinal, flexible, access, informational and relational). Care co-ordination is accomplished by a combination of activities by patients themselves; provider organisations; care networks co-ordinating the separate provider organisations; and overall health-system governance. This research examines how far organisational integration might promote care co-ordination at the clinical level. Objectives To examine (1) what differences the organisational integration of primary care makes, compared with network governance, to horizontal and vertical co-ordination of care; (2) what difference provider ownership (corporate, partnership, public) makes; (3) how much scope either structure allows for managerial discretion and ‘performance’; (4) differences between networked and hierarchical governance regarding the continuity and integration of primary care; and (5) the implications of the above for managerial practice in primary care. Methods Multiple-methods design combining (1) the assembly of an analytic framework by non-systematic review; (2) a framework analysis of patients’ experiences of the continuities of care; (3) a systematic comparison of organisational case studies made in the same study sites; (4) a cross-country comparison of care co-ordination mechanisms found in our NHS study sites with those in publicly owned and managed Swedish polyclinics; and (5) the analysis and synthesis of data using an ‘inside-out’ analytic strategy. Study sites included professional partnership, corporate and publicly owned and managed primary care providers, and different configurations of organisational integration or separation of community health services, mental health services, social services and acute inpatient care. Results Starting from data about patients’ experiences of the co-ordination or under-co-ordination of care, we identified five care co-ordination mechanisms present in both the integrated organisations and the care networks; four main obstacles to care co-ordination within the integrated organisations, of which two were also present in the care networks; seven main obstacles to care co-ordination that were specific to the care networks; and nine care co-ordination mechanisms present in the integrated organisations. Taking everything into consideration, integrated organisations appeared more favourable to producing continuities of care than did care networks. Network structures demonstrated more flexibility in adding services for small care groups temporarily, but the expansion of integrated organisations had advantages when adding new services on a longer term and a larger scale. Ownership differences affected the range of services to which patients had direct access; primary care doctors’ managerial responsibilities (relevant to care co-ordination because of their impact on general practitioner workload); and the scope for doctors to develop special interests. We found little difference between integrated organisations and care networks in terms of managerial discretion and performance. Conclusions On balance, an integrated organisation seems more likely to favour the development of care co-ordination and, therefore, continuities of care than a system of care networks. At least four different variants of ownership and management of organisationally integrated primary care providers are practicable in NHS-like settings. Future research is therefore required, above all to evaluate comparatively the different techniques for coordinating patient discharge across the triple interface between hospitals, general practices and community health services; and to discover what effects increasing the scale and scope of general practice activities will have on continuity of care

The impact of central government steering and local network dynamics on the performance of mandated service delivery networks: the case of the Primary Health Care networks in Flanders

This paper focuses on the impact of central – local relations on the performance of local service delivery networks set up by central government. Analyzing network literature leaves us with some questions about the impact of coordination strategies of central government as a possible determinant of network-level effectiveness for this type of network and the possible interaction between central government coordination (as part of the network context) and internal network dynamics and the combined effects hereof on the effectiveness of mandated service delivery networks in particular. Our analysis shows that both levels are important to explain the outcomes of the Primary Health Care networks in Flanders. Our study also leads to some important observations about the meaning of ‘central government coordination’ in this context

Framework of Social Customer Relationship Management in E-Health Services

Healthcare organization is implementing Customer Relationship Management (CRM) as a strategy for managing interactions with patients involving technology to organize, automate, and coordinate business processes. Web-based CRM provides healthcare organization with the ability to broaden service beyond its usual practices in achieving a complex patient care goal, and this paper discusses and demonstrates how a new approach in CRM based on Web 2.0 or Social CRM helps healthcare organizations to improve their customer support, and at the same time avoiding possible conflicts, and promoting better healthcare to patients. A conceptual framework of the new approach will be proposed and highlighted. The framework includes some important features of Social CRM such as customer's empowerment, social interactivity between healthcare organization-patients, and patients-patients. The framework offers new perspective in building relationships between healthcare organizations and customers and among customers in e-health scenario. It is developed based on the latest development of CRM literatures and case studies analysis. In addition, customer service paradigm in social network's era, the important of online health education, and empowerment in healthcare organization will be taken into consideration.Comment: 15 pages. arXiv admin note: substantial text overlap with arXiv:1204.3689, arXiv:1203.3919, arXiv:1204.3685, arXiv:1203.4309, arXiv:1204.3691, arXiv:1203.392