IT-supported skill-mix change and standardisation in integrated eyecare: lessons from two screening projects in The Netherlands

<b>Introduction:</b> Information Technology (IT) has the potential to significantly support skill-mix change and, thereby, to improve the efficiency and effectiveness of integrated care.<br><br> <b>Theory and methods:</b> IT and skill-mix change share an important precondition: the standardisation of work processes. Standardisation plays a crucial role in IT-supported skill-mix change. It is not a matter of more or less standardisation than in the ‘old’ situation, but about creating an optimal fit. We used qualitative data from our evaluation of two integrated-care projects in Dutch eyecare to identify domains where this fit is important.<br><br> <b>Results:</b> While standardisation was needed to delegate screening tasks from physicians to non-physicians, and to assure the quality of the integrated-care process as a whole, tensions arose in three domains: the performance of clinical tasks, the documentation, and the communication between professionals. Unfunctional standardisation led to dissatisfaction and distrust between the professionals involved in screening.<br><br> <b>Discussion and conclusion:</b> Although the integration seems promising, much work is needed to ensure a synergistic relationship between skill-mix change and IT. Developing IT-supported skill-mix change by means of standardisation is a matter of tailoring standardisation to fit the situation at hand, while dealing with the local constraints of available technology and organisational context

Managing Quality in Health Care: Involving Patient Care Information Systems and Healthcare Professionals in Quality Monitoring and Improvement

It is no longer possible to ignore the issue of quality in health care. Care institutions strive to provide all patients with effective, efficient, safe, timely, patient-centered care. Increased attention for quality is also found in discussions regarding use of information and communication technologies (ICTs) in health care processes. In these discussions, ICT is almost always brought into a direct relationship with improving the quality of care, especially ICTs that professionals use directly in patient care, which are also known as patient care information systems (PCIS) [1-4]. Well-known quality reports from the US Institute of Medicine, such as To Err is Human [5] and Crossing the Quality Chasm [6], identify the lack of and delay in ICT development and implementation as a partial explanation for quality problems in existing healthcare systems. Both reports call for wider-scale imple

Integrating Users in an Interactive Video Education Project: Reframing the Patient-Centered Strategy of a Cystic Fibrosis Centre

This article reports on the formative evaluation of WebPEP (“Web-Based Patient Education Program”), an interactive video education project at ErasmusMC–Sophia Children’s Hospital (SCH) in Rotterdam, the Netherlands. Through monthly live webcasts, doctors, nurses, psychologists, and other healthcare professionals affiliated to SCH’s Cystic Fibrosis Team gave presentations on medical and psychosocial aspects related to cystic fibrosis (CF). These webcasts were first intended to educate and be educational to children between the ages of twelve and eighteen, but during the first year of the project they failed to attract this specific group. Instead, they generated unexpected enthusiasm among parents of young patients. The central question in this article is: How were patients “integrated” in the development of the WebPEP application? We show how the project’s initiator reacted to the lacking participation by prospective users: informed by the evaluation, he gradually shifted his attention from live interaction to the expansion of the video library, where the webcasts were stored for on demand viewing. Based on interviews and participant observations, we describe how the initiator reconfigured the WebPEP application and its users, and therewith reframed the CF Centre’s online patient education strategy. We discuss the importance of investigating the prospective and actual use of patient-centered e-health (PCEH) applications, and argue that a single technological artefact can be involved in different, coexisting practices of patient-centeredness. We conclude with a reflection on how formative research methods can contribute to the development of PCEH