Toward Customized Care Comment on “(Re) Making the Procrustean Bed? Standardization and Customization as Competing Logics in Healthcare”

Abstract Patients want their personal needs to be taken into account. Accordingly, the management of care has long involved some degree of personalization. In recent times, patients’ wishes have become more pressing in a moving context. As the population ages, the number of patients requiring sophisticated combinations of longterm care is rising. Moreover, we are witnessing previously unvoiced demands, preferences and expectations (eg, demand for information about treatment, for care complying with religious practices, or for choice of appointment dates). In view of the escalating costs and the concerns about quality of care, the time has now come to rethink healthcare delivery. Part of this reorganization can be related to customization: what is needed is a customized business model that is effective and sustainable. Such business model exists in different service sectors, the customization being defined as the development of tailored services to meet consumers’ diverse and changing needs at near mass production prices. Therefore, its application to the healthcare sector needs to be seriously considered

E-health and the performativity of the health democracy

Since at least the 1990s, a movement quoted as the “health democracy,” has set out to establish new rights for patients, and changes current professional practices. Its dynamic can be analyzed through the lens of performativity, a whole wave of research with the aim to understand how a theory or doctrine can feasibly make real what it theorizes and encourages. “Health democracy” intends to reduce the disproportionate distribution of power in doctor/patient relationships. In parallel, different innovations related to the ir- ruption of E-health (social networks, web applications, and other devices) are currently modifying the practices, and thereby reconstructing the relationships between patients and professionals. Based on a corpus analysis, using a scoping review method, this article ex- plores the ways E-health modifies the process of performativity in the “health democracy”. Two effects are identified: a co-production introduced in the classic relationship between patients and healthcare professionals thanks to a better follow-up at distance, and a new form of expertise based on the information circulating on the internet. Each effect develops its own benefits and risks. In order to optimize this new added-value offered by E-health on patient engagement, many managerial consequences must be taken into account. Em- ploying a narrative approach to the dynamics currently at play, it establishes that E-health represents a process of performativity of health democracy by “overflowing”. It also high- lights a risk of counter-performativity: in that if the traditional patient/doctor relationship is less asymmetric, answering to the “health democracy”’s demand may pose another risk related to the use of internet-based information that threats this equilibrium

E-health and the performativity of the health democracy

Since at least the 1990s, a movement quoted as the “health democracy,” has set out to establish new rights for patients, and changes current professional practices. Its dynamic can be analyzed through the lens of performativity, a whole wave of research with the aim to understand how a theory or doctrine can feasibly make real what it theorizes and encourages. “Health democracy” intends to reduce the disproportionate distribution of power in doctor/patient relationships. In parallel, different innovations related to the ir- ruption of E-health (social networks, web applications, and other devices) are currently modifying the practices, and thereby reconstructing the relationships between patients and professionals. Based on a corpus analysis, using a scoping review method, this article ex- plores the ways E-health modifies the process of performativity in the “health democracy”. Two effects are identified: a co-production introduced in the classic relationship between patients and healthcare professionals thanks to a better follow-up at distance, and a new form of expertise based on the information circulating on the internet. Each effect develops its own benefits and risks. In order to optimize this new added-value offered by E-health on patient engagement, many managerial consequences must be taken into account. Em- ploying a narrative approach to the dynamics currently at play, it establishes that E-health represents a process of performativity of health democracy by “overflowing”. It also high- lights a risk of counter-performativity: in that if the traditional patient/doctor relationship is less asymmetric, answering to the “health democracy”’s demand may pose another risk related to the use of internet-based information that threats this equilibrium

Managing Customization in Health Care: A Framework Derived from the Services Sector Literature

Organizations that provide health services are increasingly in need of systems and approaches that will enable them to be more responsive to the needs and wishes of their clients. Two recent trends, namely, patient-centered care (PCC) and personalized medicine, are first steps in the customization of care. PCC shifts the focus away from the disease to the patient. Personalized medicine, which relies heavily on genetics, promises significant improvements in the quality of healthcare through the development of tailored and targeted drugs. We need to understand how these two trends can be related to customization in healthcare delivery and, because customization often entails extra costs, to define new business models. This article analyze how customization of the care process can be developed and managed in healthcare. Drawing on relevant literature from various services sectors, we have developed a framework for the implementation of customization by the hospital managers and caregivers involved in care pathways

Suitability of three indicators measuring the quality of coordination within hospitals

<p>Abstract</p> <p>Background</p> <p>Coordination within hospitals is a major attribute of medical care and influences quality of care. This study tested the validity of 3 indicators covering two key aspects of coordination: the transfer of written information between professionals (medical record content, radiology exam order) and the holding of multidisciplinary team meetings during treatment planning.</p> <p>Methods</p> <p>The study was supervised by the French health authorities (COMPAQH project). Data for the three indicators were collected in a panel of 30 to 60 volunteer hospitals by 6 Clinical Research Assistants. The metrological qualities of the indicators were assessed: (i) Feasibility was assessed using a grid of 19 potential problems, (ii) Inter-observer reliability was given by the kappa coefficient () and internal consistency by Cronbach's alpha test, (iii) Discriminatory power was given by an analysis of inter-hospital variability using the Gini coefficient as a measure of dispersion.</p> <p>Results</p> <p>Overall, 19281 data items were collected and analyzed. All three indicators presented acceptable feasibility and reliability (, 0.59 to 0.97) and showed wide differences among hospitals (Gini, 0.08 to 0.11), indicating that they are suitable for making comparisons among hospitals.</p> <p>Conclusion</p> <p>This set of 3 indicators provides a proxy measurement of coordination. Further research on the indicators is needed to find out how they can generate a learning process. The medical record indicator has been included in the French national accreditation procedure for healthcare organisations. The two other indicators are currently being assessed for inclusion.</p

Barriers to staff adoption of a surgical safety checklist

International audienceObjective: Implementation of a surgical checklist depends on many organisational factors and on socio-cultural patterns. The objective of this study was to identify barriers to effective implementation of a surgical checklist and to develop a best use strategy.Setting: 18 cancer centres in France.Design: The authors first assessed use compliance and completeness rates of the surgical checklist on a random sample of 80 surgical procedures performed under general or loco-regional anaesthesia in each of the 18 centres. They then developed a typology of the organisational and cultural barriers to effective checklist implementation and defined each barrier's contents using data from collective and semi-structured individual interviews of key staff, the results of an email questionnaire sent to the 18 centres, and direct observations over 20 h in two centres.Results: The study consisted of 1440 surgical procedures, 1299 checklists, and 28 578 items. The mean compliance rate was 90.2% (0, 100). The mean completion rate was 61% (0, 84). 11 barriers to effective checklist implementation were identified. Their incidence varied widely across centres. The main barriers were duplication of items within existing checklists (16/18 centres), poor communication between surgeon and anaesthetist (10/18), time spent completing the checklist for no perceived benefit, and lack of understanding and timing of item checks (9/18), ambiguity (8/18), unaccounted risks (7/18) and a time-honoured hierarchy (6/18).Conclusions: Several of the barriers to the successful implementation of the surgical checklist depended on organisational and cultural factors within each centre. The authors propose a strategy for change for checklist design, use and assessment, which could be used to construct a feedback loop for local team organisation and national initiatives

Keys to successful implementation of a French national quality indicator in health care organizations: a qualitative study

International audienceBackground: Several countries have launched public reporting systems based on quality indicators (QIs) to increase transparency and improve quality in health care organizations (HCOs). However, a prerequisite to quality improvement is successful local QI implementation. The aim of this study was to explore the pathway through which a mandatory QI of the French national public reporting system, namely the quality of the anesthesia file (QAF), was put into practice

Jusqu’où la santé numérique va-t-elle transformer l’organisation des soins ?

International audienceDigital health, understood as all new information technologies (including artificial intelligence) applied to health, seems to impose the idea of a revolution. This general review studies their added value by taking the emblematic case of the contribution of telehealth in the organization of patient care. Based in particular on research conducted in oncology, the CAPRI program, analysis shows that effectiveness in terms of quality of care, patient experience and cost control depends on the use made of technology. The expected uses, the best coordination and the implementation of effective patient monitoring depend on three factors: the implementation of the technology, but also the way of organizing the activity of the coordinating nurses to treat the information, and uptake by patients and physicians. In particular, the adoption by doctors is improved when the activity of nurses makes it possible to select the relevant clinical information and to ensure a delegation of tasks. It is an assessment of organizational transformation through the prism of its uses that digital innovation requires. Strategies must be designed at this level of use to enable the promises of digital health to be realized.La santé numérique, comprise comme l’ensemble des nouvelles technologies de l’information (dont l’intelligence artificielle) appliquée à la santé, semble imposer l’idée d’une révolution. Cette revue générale étudie leur valeur ajoutée en prenant le cas emblématique de l’apport de la télésurveillance dans l’organisation de la prise en charge des malades. En s’appuyant notamment sur une recherche menée en oncologie, le programme CAPRI, l’analyse montre que l’efficacité en matière de qualité des soins, d’expérience patient, et de contrôle des coûts dépend de l’usage qui est fait de la technologie. Les usages attendus, la meilleure coordination et la mise en œuvre d’un suivi efficace des patients, dépendent de trois facteurs : l’implantation de la technologie, mais aussi la manière d’organiser l’activité des infirmières de coordination pour traiter l’information, et l’adoption par les patients et les médecins. En particulier, l’adoption par les médecins est améliorée lorsque l’activité des infirmières permet de sélectionner les informations cliniques pertinentes, et d’assurer une délégation de tâches. C’est une évaluation de la transformation organisationnelle au prisme de ses usages que requiert l’innovation numérique. Des stratégies doivent être conçues à ce niveau des usages pour permettre de concrétiser les promesses de la santé numérique

: The patient and the system

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