Do we need one science of production in healthcare?

The question addressed is: Is there need, in health care, for one consolidated science of production? For responding to this question, the classical science of production is reviewed and the current approaches to production and service in healthcare are analysed as for their evolution and current status. It is found that these current movements are not self-aware of the restrictions deriving from their backgrounds, and of the resultant partiality in their approaches. It is concluded that improvement of healthcare is slowed down by the fragmentation of the related disciplines; thus one consolidated science of production (of healthcare) is needed

Development and Evaluation of an Internet-Based Airway Evaluation Tutorial

Airway evaluation and basic management are essential skills for all physicians. Identifying patients for whom mask ventilation or endotracheal intubation will be difficult to impossible is vital for patient safety. Despite this, training in airway evaluation is minimal in the curricula of most medical schools. To ensure a thorough understanding of airway anatomy and evaluation, as well as exposure to various abnormal findings, we developed an Internet-based module including interactive components, graphics, animation, video, and a self-assessment tool. The site received more than 1800 visits in its first nine months of operation, with uniformly laudatory comments. Eighty subjects over a six-month period completed a pre- and post-test quiz structured to evaluate the utility of the site. Of those completing the on-line survey, more than 76% rated the site very useful. Most felt their knowledge of airway examination improved after completion of the site (p<0.00004). The median amount of time spent on the site was 29.5 minutes. Judging from the overwhelming response to this site from around the world and across disciplines, such interactive training tools that exploit the technological capabilities of the Internet provide useful adjuncts to traditional teaching methods

Medical errors : Healthcare professionals’ perspective at a tertiary hospital in Kuwait

Medical errors are of economic importance and can contribute to serious adverse events for patients. Medical errors refer to preventable events resulting from healthcare interactions, whether these events harm the patient or not. In Kuwait, there is a paucity literature detailing the causes, forms, and risks of medical errors in their state-funded healthcare facilities. This study aimed to explore medical errors, their causes and preventive strategies in a Kuwait tertiary hospital based on the perceptions and experience of a cross-section of healthcare professionals using a questionnaire with 27 open (n = 10) and closed (n = 17) questions. The recruited healthcare professionals in this study included pharmacists, nurses, physicians, dentists, radiographers, hospital administrators, surgeons, nutritionists, and physiotherapists. The collected data were analysed quantitatively using descriptive statistics. A total of 203 participants filled and completed the survey questionnaire. The frequency of medical errors in Kuwait was found to be high at 60.3% ranging from incidences of prolonged hospital stays (32.9%), adverse events and life-threatening complications (32.3%), and fatalities (20.9%). The common medical errors result from incomplete instructions, incorrect dosage, and incorrect route of administration, diagnosis errors, and labelling errors. The perceived causes of these medical errors include high workload, lack of support systems, stress, medical negligence, inadequate training, miscommunication, poor collaboration, and non-adherence to safety guidelines among the healthcare professionals.Peer reviewe

Equity in the Digital Age: How Health Information Technology Can Reduce Disparities

While enormous medical and technological advancements have been made over the last century, it is only very recently that there have been similar rates of development in the field of health information technology (HIT).This report examines some of the advancements in HIT and its potential to shape the future health care experiences of consumers. Combined with better data collection, HIT offers signi?cant opportunities to improve access to care, enhance health care quality, and create targeted strategies that help promote health equity. We must also keep in mind that technology gaps exist, particularly among communities of color, immigrants, and people who do not speak English well. HIT implementation must be done in a manner that responds to the needs of all populations to make sure that it enhances access, facilitates enrollment, and improves quality in a way that does not exacerbate existing health disparities for the most marginalized and underserved

Spectrum, Winter 1992

Spectrum was a newsletter for students, faculty, staff and alumni of the Henry M. Goldman School of Dental Medicine, published from 1983-1992

Surveillance of emerging drugs of abuse in Hong Kong: Validation of an analytical tool

© 2015, Hong Kong Academy of Medicine Press. All rights reserved. Objective: To validate a locally developed chromatography-based method to monitor emerging drugs of abuse whilst performing regular drug testing in abusers. Design: Cross-sectional study. Setting: Eleven regional hospitals, seven social service units, and a tertiary level clinical toxicology laboratory in Hong Kong. Participants: A total of 972 drug abusers and high-risk individuals were recruited from acute, rehabilitation, and high-risk settings between 1 November 2011 and 31 July 2013. A subset of the participants was of South Asian ethnicity. In total, 2000 urine or hair specimens were collected. Main outcome measures: Proof of concept that surveillance of emerging drugs of abuse can be performed whilst conducting routine drug of abuse testing in patients. Results: The method was successfully applied to 2000 samples with three emerging drugs of abuse detected in five samples: PMMA (paramethoxymethamphetamine), TFMPP [1-(3-trifluoromethylphenyl)piperazine], and methcathinone. The method also detected conventional drugs of abuse, with codeine, methadone, heroin, methamphetamine, and ketamine being the most frequently detected drugs. Other findings included the observation that South Asians had significantly higher rates of using opiates such as heroin, methadone, and codeine; and that ketamine and cocaine had significantly higher detection rates in acute subjects compared with the rehabilitation population. Conclusions: This locally developed analytical method is a valid tool for simultaneous surveillance of emerging drugs of abuse and routine drug monitoring of patients at minimal additional cost and effort. Continued, proactive surveillance and early identification of emerging drugs will facilitate prompt clinical, social, and legislative management.Link_to_subscribed_fulltex

Telesonography In Emergency Medicine : A Systematic Review

Funding: No specific funding was received for this work; however LE’s salary was paid from funding for the SatCare trial into remotely supported prehospital ultrasound, provided by the European Space Agency in collaboration with ViaSat (contract SC16005). The specific roles of this author are articulated in the ‘author contributions’ section. These funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD

Centerscope

Centerscope, formerly Scope, was published by the Boston University Medical Center "to communicate the concern of the Medical Center for the development and maintenance of improved health care in contemporary society.

POLICY DEPLOYMENT FOR CONTINUOUS IMPROVEMENT IN PUBLIC HOSPITALS. From Kaizen Initiatives to a Kaizen Initiative Program: an action research

Purpose. Although kaizen methodology is increasingly applied and investigated in healthcare, most of the current literature describes successful kaizen initiatives and report their technical outcomes (e.g. Dickson et al., 2009; Laganga, 2011). Aspects related to the deployment of the kaizen approach across healthcare organizations are often neglected by the scholars. Thus, this thesis aims at filling this gap by developing and testing a theoretical framework to understand how the continuous improvement approach could be adopted and adapted to a public hospital and what features should be considered as key drivers of a successful implementation. In particular, this study uses a policy deployment perspective to investigate the linkage between decisions at the strategic level within healthcare organizations and those regarding the implementation of a set of kaizen initiatives over time (Kaizen Initiative Program \u2013 KIP). Design/Methodology/Approach. This study uses the action research methodology to develop theoretical and practical insights from a complex endeavour as kaizen implementation in public hospitals. The research is divided in four main cycles: Design; Training; Kaizen (Implementation and Monitoring) and Evaluation. Each cycle includes: a pre-step for understanding context and purpose; a six main-step stage (to gather, feedback and analyse data, to plan, implement and evaluate actions) and a meta-step (to monitor) (Coughlan and Coghlan, 2002). The researcher played an active role and adopted the process consultation model to support the healthcare professionals engaged. Thus, the researcher could investigate in real time what characterized a continuous improvement program and how it has been deployed across the hospitals involved. Findings. By investigating how the continuous improvement approach is implemented in public hospitals this study describes and discusses the practical problems addressed and difficulties emerging over time at both strategical and operational level, and at team and organisational level during the action research. In particular, this study provides: 1) a tested framework for applying a KI Program at both organisational and system level (e.g., regional/healthcare district); 2) the key features/practices of the KI Program (what) and their sequence for a successful implementation (when); 3) the successful deployment modalities of the KI Program (how) to properly select the kaizen teams and initiatives (e.g., the periodic briefings between the managers from the strategic level and the kaizen teams). Practical implications. Results provide a structured framework for healthcare practitioners and managers who are interested in successfully launching and sustaining a KI Program. This framework could help hospital managers to link the strategic level decisions with continuous improvement actions at the operational level, avoiding the only use of bottom-up and pop-corn initiatives. Originality. The research proposes a tested framework emerging from the action research for successfully selecting kaizen initiatives that are linked to the strategic objectives of healthcare organizations. Differently from the existing kaizen literature, this research engaged seven different and independent hospitals that have been performing their first kaizen experience simultaneously and which belong to the same regional healthcare system and are led by a unique regional administration office. Keywords: continuous improvement, kaizen, hospital, kaizen programPurpose. Although kaizen methodology is increasingly applied and investigated in healthcare, most of the current literature describes successful kaizen initiatives and report their technical outcomes (e.g. Dickson et al., 2009; Laganga, 2011). Aspects related to the deployment of the kaizen approach across healthcare organizations are often neglected by the scholars. Thus, this thesis aims at filling this gap by developing and testing a theoretical framework to understand how the continuous improvement approach could be adopted and adapted to a public hospital and what features should be considered as key drivers of a successful implementation. In particular, this study uses a policy deployment perspective to investigate the linkage between decisions at the strategic level within healthcare organizations and those regarding the implementation of a set of kaizen initiatives over time (Kaizen Initiative Program \u2013 KIP). Design/Methodology/Approach. This study uses the action research methodology to develop theoretical and practical insights from a complex endeavour as kaizen implementation in public hospitals. The research is divided in four main cycles: Design; Training; Kaizen (Implementation and Monitoring) and Evaluation. Each cycle includes: a pre-step for understanding context and purpose; a six main-step stage (to gather, feedback and analyse data, to plan, implement and evaluate actions) and a meta-step (to monitor) (Coughlan and Coghlan, 2002). The researcher played an active role and adopted the process consultation model to support the healthcare professionals engaged. Thus, the researcher could investigate in real time what characterized a continuous improvement program and how it has been deployed across the hospitals involved. Findings. By investigating how the continuous improvement approach is implemented in public hospitals this study describes and discusses the practical problems addressed and difficulties emerging over time at both strategical and operational level, and at team and organisational level during the action research. In particular, this study provides: 1) a tested framework for applying a KI Program at both organisational and system level (e.g., regional/healthcare district); 2) the key features/practices of the KI Program (what) and their sequence for a successful implementation (when); 3) the successful deployment modalities of the KI Program (how) to properly select the kaizen teams and initiatives (e.g., the periodic briefings between the managers from the strategic level and the kaizen teams). Practical implications. Results provide a structured framework for healthcare practitioners and managers who are interested in successfully launching and sustaining a KI Program. This framework could help hospital managers to link the strategic level decisions with continuous improvement actions at the operational level, avoiding the only use of bottom-up and pop-corn initiatives. Originality. The research proposes a tested framework emerging from the action research for successfully selecting kaizen initiatives that are linked to the strategic objectives of healthcare organizations. Differently from the existing kaizen literature, this research engaged seven different and independent hospitals that have been performing their first kaizen experience simultaneously and which belong to the same regional healthcare system and are led by a unique regional administration office. Keywords: continuous improvement, kaizen, hospital, kaizen progra