Development of a minimization instrument for allocation of a hospital-level performance improvement intervention to reduce waiting times in Ontario emergency departments

<p>Abstract</p> <p>Background</p> <p>Rigorous evaluation of an intervention requires that its allocation be unbiased with respect to confounders; this is especially difficult in complex, system-wide healthcare interventions. We developed a short survey instrument to identify factors for a minimization algorithm for the allocation of a hospital-level intervention to reduce emergency department (ED) waiting times in Ontario, Canada.</p> <p>Methods</p> <p>Potential confounders influencing the intervention's success were identified by literature review, and grouped by healthcare setting specific change stages. An international multi-disciplinary (clinical, administrative, decision maker, management) panel evaluated these factors in a two-stage modified-delphi and nominal group process based on four domains: change readiness, evidence base, face validity, and clarity of definition.</p> <p>Results</p> <p>An original set of 33 factors were identified from the literature. The panel reduced the list to 12 in the first round survey. In the second survey, experts scored each factor according to the four domains; summary scores and consensus discussion resulted in the final selection and measurement of four hospital-level factors to be used in the minimization algorithm: improved patient flow as a hospital's leadership priority; physicians' receptiveness to organizational change; efficiency of bed management; and physician incentives supporting the change goal.</p> <p>Conclusion</p> <p>We developed a simple tool designed to gather data from senior hospital administrators on factors likely to affect the success of a hospital patient flow improvement intervention. A minimization algorithm will ensure balanced allocation of the intervention with respect to these factors in study hospitals.</p

The use of smartphones in general and internal medicine units : a boon or a bane to the promotion of interprofessional collaboration?

Effective communication and coordination are critical components for improving collaborative care delivery among different healthcare providers who work in mobile and time-pressured environments. Increasingly, healthcare providers are exploring alternative communication technologies to help bridge the temporal and spatial issues that are often inherent in the clinical communication conundrum. Our study examined perceptions of General Internal Medicine (GIM) staff on the usage of Smartphone devices and a Webpaging system, which were implemented on the inpatient GIM units at two teaching hospitals in North America. An exploratory case study approach was employed and in-depth interviews with 31 clinicians were conducted. This data-set serves as a subset and prelude to a larger research study that examined and compared the impacts of different types of communication technologies used in five teaching hospitals. Findings from our study indicate that the use of Smartphone technology was well received among clinicians. Specifically, healthcare professionals valued the use of emails when communicating nonurgent issues and the availability of the phone function that enabled access to clinicians especially in urgent situations. Dissatisfaction, however, was expressed over the suitability of these smartphone features in different communication contexts as well as discrepancies between clinicians over the appropriate use of the communication modes. Future interventions in communication technology should take into considerations how communication mediums and situational contexts (e.g. urgent and nonurgent patient issues) impact interprofessional interactions

The challenges in making electronic health records accessible to patients

It is becoming increasingly apparent that there is a tension between growing consumer demands for access to information and a healthcare system that may not be prepared to meet these demands. Designing an effective solution for this problem will require a thorough understanding of the barriers that now stand in the way of giving patients electronic access to their health data. This paper reviews the following challenges related to the sharing of electronic health records: cost and security concerns, problems in assigning responsibilities and rights among the various players, liability issues and tensions between flexible access to data and flexible access to physicians

The Patient Empowerment Program: Using Novel Mediums to Communicate the Patient Experience to Providers and Medical Students

Purpose of Presentation: Understanding the patient experience is critical for patients themselves, healthcare providers and students training for various healthcare professions. Although strong communication is paramount for everything from patient safety to patient-centered care, patients and providers often struggle with communicating and understanding each other\u27s perspectives, thereby potentially limiting care. This presentation explores our journey with the Patient Empowerment Program, which aims to use novel methods to aide communication between patients, providers, and students. Background/Significance: Patients\u27 emotional and spiritual perspectives are integral to the healing process, yet often not addressed within the healthcare system. Providing. patients with a voice that allows them to express their journey, concerns, hopes and fears to their healthcare providers is key in delivering patient-centered care. Some patients already use novel strategies like poetry to make sense of their illnesses and to communicate with other patients and providers. When Robert Hawke, an award winning actor and comedian, was diagnosed with cancer, he struggled to make sense of his illness and communicate with his healthcare providers. Turning to his natural coping mechanism - comedy - Robert co-created and starred in a play called Norm Vs Cancer: A Terminally Funny One-Man Show . Initially, Rob performed this play outside the clinical environment. There is huge potential for new communication mediums within the clinical environment, as they could provide healthcare professionals with a unique lens into the patient experience. We have begun piloting the utility of this play for multiple communication and education strategies in healthcare by: 1. Inviting interprofessional groups (including patients) to watch the play within the healthcare environment and immediately following, participate in a facilitated discussion about patient-centered care. 2. Developing the play for medical school curriculum. In addition to learning about patient centered care from a renowned thought leader in nursing, these medical students also participated in an exercise to understand the personal impact of illness from the patient perspective. Next Steps: Our goal is to formally evaluate: 1. The impact of this performance on providers\u27 understanding and application of patient centered care principles. 2. The impact of this performance and developed curriculum on medical students\u27 training

Improving hospital care and collaborative communications for the 21st century : key recommendations for general internal medicine

BACKGROUND: Communication and collaboration failures can have negative impacts on the efficiency of both individual clinicians and health care system delivery as well as on the quality of patient care. Recognizing the problems associated with clinical and collaboration communication, health care professionals and organizations alike have begun to look at alternative communication technologies to address some of these inefficiencies and to improve interprofessional collaboration. OBJECTIVE: To develop recommendations that assist health care organizations in improving communication and collaboration in order to develop effective methods for evaluation. METHODS: An interprofessional meeting was held in a large urban city in Canada with 19 nationally and internationally renowned experts to discuss suitable recommendations for an ideal communication and collaboration system as well as a research framework for general internal medicine (GIM) environments. RESULTS: In designing an ideal GIM communication and collaboration system, attendees believed that the new system should possess attributes that aim to: a) improve workflow through prioritization of information and detection of individuals' contextual situations; b) promote stronger interprofessional relationships with adequate exchange of information; c) enhance patient-centered care by allowing greater patient autonomy over their health care information; d) enable interoperability and scalability between and within institutions; and e) function across different platforms. In terms of evaluating the effects of technology in GIM settings, participants championed the use of rigorous scientific methods that span multiple perspectives and disciplines. Specifically, participants recommended that consistent measures and definitions need to be established so that these impacts can be examined across individual, group, and organizational levels. CONCLUSIONS: Discussions from our meeting demonstrated the complexities of technological implementations in GIM settings. Recommendations on the design principles and research paradigms for an improved communication system are described