Reducing Delays in Follow-up Care through Process Optimization

Primary care follow-up after an emergency department (ED) visit is an important component of comprehensive healthcare, contributing to both improved patient outcomes and reduced readmissions to emergency care. In alignment with the Clinical Nurse Leader (CNL) roles of risk anticipator and lateral integrator of care, this project aimed to support improvement in care continuity for patients at a large primary care clinic in London. At this clinic, a team of physicians, nurses, and support staff care for a diverse population of adult and pediatric patients who account for nearly 3,000 ED visits annually. Assessment of the clinical review process used to coordinate post-emergency follow-up revealed that less than 22% of patients receive timely care and the process to initiate care takes an average 15 days to complete. To address this gap in quality and efficiency, an interprofessional team utilized root-cause analyses, process optimization, and small tests of change to develop an optimized clinical review process for post- emergency department follow-up care. Implementation of the process resulted in an 81.3% decrease in clinical review time and a 34.5% increase in on-time follow-up care. Process optimization is an effective framework through which rapid improvements in care processes can be implemented to enhance care quality and efficiency

The neglected contexts and outcomes of evidence-based management:A systematic scoping review in hospital settings

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic highlighted the necessity of practicing Evidence-based Management (EBMgt) as an approach to decision-making in hospital settings. The literature, however, provides limited insight into the process of EBMgt and its contextual nuances. Such insight is critical for better leveraging EBMgt in practice. Therefore, the authors' aim was to integrate the literature on the process of EBMgt in hospital settings, identify the gaps in knowledge and delineate areas for future research. DESIGN/METHODOLOGY/APPROACH: The authors conducted a systematic scoping review using an innovative methodology that involved two systematic searches. First using EBMgt terminology and second using terminology associated with the EBMgt concept, which the authors derived from the first search. FINDINGS: The authors identified 218 relevant articles, which using content analysis, they mapped onto the grounded model of the EBMgt process; a novel model of the EBMgt process developed by Sahakian and colleagues. The authors found that the English language literature provides limited insight into the role of managers' perceptions and motives in EBMgt, the practice of EBMgt in Global South countries, and the outcomes of EBMgt. Overall, this study’s findings indicated that aspects of the decision-maker, context and outcomes have been neglected in EBMgt. ORIGINALITY/VALUE: The authors contributed to the EBMgt literature by identifying these gaps and proposing future research areas and to the systematic review literature by developing a novel scoping review method

Evidence-based management in hospital settings:Unraveling the process and the role of the person and the context

Evidence-based Management in Hospital Settings: Unraveling the Process and the Role of the Person and the Context Lay Summary Tina Sahakian The use of digital healthcare technologies, such as electronic medical records and health information systems, is increasing in hospital settings and is leading to the collection of large amounts of data about patients, employees, and hospital operations. This data, if used by managers as the basis for decisions, can help improve decision-making, and consequently enhance the quality of healthcare services. One approach to encourage managers to use this and other sources of data is evidence-based management (EBMgt). EBMgt involves gathering data from different sources, assessing the reliability and relevance of this data, and using it to make decisions. However, our current knowledge about the EBMgt approach is limited because:(1) there is little research on how managers can apply the EBMgt decision process, (2) there is little research on how factors related to the decision maker, like their competencies, and factors related to the context, like organizational politics, impact EBMgt, (3) there is confusion about what data managers should rely on. The aim of my dissertation is to develop an in-depth data-driven understanding of EBMgt in hospital settings, by unraveling how the EBMgt process can be applied, what evidence is used in this process, and how the decision-maker and the context impact this process. To fulfill this aim, I conducted three studies. In Study 1, I focused on identifying the competencies needed by managers to be able to practice EBMgt in hospital settings. I conducted interviews with managers in hospitals across Lebanon and identified 13 knowledge, skills, abilities, and other characteristics that are necessary to practice EBMgt in hospital settings. These included research knowledge, resourcefulness, relationship building, and open mindedness. In Study 2, I focused on better understanding the EBMgt decision-making process, what evidence is used in the process, and what contextual factors impact the process. I conducted interviews with managers in hospitals across Lebanon and developed the Grounded Model of the EBMgt Process. The model showed that the EBMgt decision-making process involves a series of steps starting from identifying a problem to implementing a solution. The model also showed that different sources of evidence are used in this process, including evidence in the form of experience, scientific research, data from the organization, and feedback from stakeholders. Finally, the model showed that different contextual factors impact the EBMgt process. These factors can relate to the individual, for example, managers’ competencies impact the evidence they gather. These factors can relate to the organization, for example organizational resource constraints impact the solutions managers apply. These factors can also relate to the nation, for example national capacity to gather and disseminate data impact the evidence available to managers. In Study 3, I focused on identifying the gaps in our knowledge of EBMgt in hospital settings, which can be filled with future research. I searched the literature for articles about EBMgt in hospital settings using a systematic approach. I found that there are gaps in our knowledge of how managers reasons for using evidence impact the EBMgt process, how EBMgt can be conducted in developing countries, and how applying EBMgt impacts organizational outcomes. These gaps are important areas for future research. Overall, my dissertation contributes to the literature on EBMgt in hospital settings by determining the competencies needed to practice EBMgt, providing an in-depth understanding about the process of EBMgt and the factors that influence this process, and identifying gaps in our knowledge of EBMgt in hospital settings, which future research can fill